Prevention Personalisation A Health Social Care Agenda Jan

Prevention & Personalisation A Health & Social Care Agenda Jan Clark East Midlands Programme Director for Personalisation

The National Policy Agenda “…authentic partnership working with the local NHS, other statutory agencies, third and private sector providers, users and carers and the wider local community to create a new, high quality care system which is fair, accessible and responsive to the individual needs of those who use services and their carers. ” Putting People First – The Concordat (2007)

“An integrated approach to health and wellbeing will require a step change in the relationship between local NHS organisations, local government, other relevant statutory services, employers, third sector and independent sector providers…to ensure synergy between vibrant primary and community care services and the ‘Putting People First’ transformation programme led by local government. ” Next Stage Review, Darzi, 2008

Universal Services • Leisure • Information and advice • Health & wellbeing • Quality housing • Transport • Community Safety • Employment services • Education • Libraries

Universal Services • Leisure • Information and advice • Health & wellbeing • Quality housing • Transport • Community Safety • Employment services • Education • Libraries Social Capital • Support networks • Volunteering • Neighbours/friends • Voluntary sector services • Carers • Community work • Faith communities • Supporting People

Choice and Control • Self-Directed Support • Personal Budgets & Personal Health Budgets • User-Led Organisations • Advocacy • Brokerage

Choice and Control • Self-Directed Support • Personal Budgets & Personal Health Budgets • User-Led Organisations • Advocacy • Co-production • Brokerage Prevention & Early Intervention • Falls prevention • Intermediate Care & Reablement • Early intervention • Extra Care • Telecare & assistive technology • Community equipment • ‘At Risk’ Case identification

Putting People First Milestones

Number of individuals aged 75+ with 2+ emergency admissions per 1000 High: 100 Average: 66 Low: 24

Occupied bed days of those aged 75+ associated with 2+ emergency admissions per 1000 High: 3, 879 Average: 1, 984 Low: 496

People choose less dependent options: this is typically more cost effective TRANSFORMING SOCIAL CARE General Population “Low Level” Advice & Support At Home Institutional Care Information Crisis Response Re-ablement/ POPPs Transforming Community Equipment Support Related Housing & Assistive Technology Commissioning and Brokerage Models of Support Planning Acute Care

How well are Health & Social Care doing? • In 2005, 2. 5% (241, 200) people over 65 in care homes, supported by their council. In 2009, this had fallen to 2. 1% (208, 530). • In 2009, 148, 000 people received support services that helped avoid emergency admission to hospital, compared to 80, 000 five years ago. • 157, 000 people received support services that helped them return home quickly from hospital, compared to 112, 000 five years ago. • The number of people experiencing delayed discharges fell from 3, 600 per week in 2003/04 to 2, 200 per week in 2008/09. • Non-residential intermediate care supported 122, 000 people (40% increase since 2004) with 34, 000 in residential intermediate care. 78% of people using rehabilitation and reablement continued to live at home.

Challenges • A three-fold variation in the extent to which councils place older people into care homes. • Up to a thirty-fold variation in the proportion of people experiencing delayed discharges. • Variation in the development of joint preventative services that reduce emergency admissions. • Variation in the effectiveness of intermediate care. • 53% of GPs report receiving discharge summaries in time for them to be useful. Hospital to Community services interface. • Continuing financial pressures.

Prevention and Personalisation: What does good look like? • Joint falls prevention and fractures pathway • Joint comprehensive intermediate care and crisis response • Mainstreamed assistive technology • Self-directed support Ø Personal Budgets/Personal Health Budgets Ø Direct Payments Ø Service users/carers active in decision making • Primary care case identification of individuals at high risk • Health actively engaged locally in TASC/PPF delivery and governance arrangements

East Midlands Personalisation Website www. dhcarenetworks. org. uk/Personalisation/Regions/East. Midlands