A Strategic Commissioning Framework for

Day Opportunities for Older People

John Jackson

Director for Social & Community Services 29th September 2010

Welcome & Domestics

• Welcome & Introductions• Domestic Arrangements• Health & Safety

– No-Smoking– Fire & Alarms

• Phones

Purpose of this Presentation

• We last met in May (Banbury and Drayton)• Now want to

– Update you on feedback received from stakeholders– Explain our proposals to you– Share the details of the emerging model– Highlight likely issues that we will face– Advise you of the next steps– Hear your views on my proposals

Recap - We Asked

1. How much of the budget for day services should be in included in the Resource Allocation System (RAS)?

2. Should we continue to provide day services for older people in some form?

3. Should we have Resource and Well Being Centres in our larger towns run by the County Council or other providers?

4. What should happen in other areas/communities?

5. What should happen to transport to day services?

Consultation with Stakeholders

• Day Service Providers (2 meetings in May)

• Internal Briefing Note to Staff (June)

• Age UK Health & Social Care Panel (June & July)

• Annual Commissioning Conference (June)

• Individual provider meetings (x 4) (August)

Feedback from Stakeholders (1)

• General support for our proposed strategy

• Stakeholders wish to see more of the details

• We have been asked to take the following issues into consideration

– More service user involvement in developing the model

– Future organisational sustainability, if providers are unable to attract sufficient business/income

Feedback from Stakeholders (2)

– Ensure that locality determination takes into account issues of deprivation and diversity

– Involve Members in locality distribution and decision making

– Robust governance arrangements must be in place for local determination

– Concerns raised about opening up County Council services for market testing

– Ensure adequate transport arrangements

Key Message – 1

We will invest 30% of the budget in the Resource Allocation System (RAS) to

fund Self Directed Support

Stakeholders have generally agreed with this approach

Key Message – 2

We will continue to invest in

this service area

Stakeholders have generally agreed with this approach

Key Message - 3

Our service model will move

from ‘Day Services’ to ‘Day Opportunities’

Day Opportunities

• Broader spectrum of opportunities for older people that promote flexible and personalised support

• May be cultural, learning or leisure or a mixture of both

• May be traditional buildings based or within the wider community

• Options at different times during the day, evening or even at the weekend

• The things people want and choose to do during the day

The Emerging Model

• Emphasises independence, choice and well-being

• Promotes a vision that

– Supports flexible and personalised support

– Moves from day services to wider day opportunities

– Increases community engagement

– Devolves determination of services to localities

– Supports the changing business model & funding streams brought about through Self Directed Support

Proposed 3-Tier Model Tier 1: Community Initiatives / Universal services, leisure, cultural, vocational and

educational / one off bids / community self referral / open access services

Tier 2: Community &Low level support Voluntary / independent and community

activities / self referral—some assessment of need

Tier 3: Health and Well Being resource centres / highest level of dependency / Specialist Day Opportunities / Specialist Health Based Services / Day Hospitals

Key Messages - 4

We will increase our investment in Community Engagement

Community engagement

• We want to promote a sense of health and well being

• We want people to remain valued members of the community

• To support the above we will

– Consolidate, review and extend existing Volunteer Schemes and Good Neighbour Schemes

– Establish a Community Fund - for creative and innovative one-off bids that promote a sense of well being (no more than £750 )

Examples of Support

• We have successfully piloted 9 Good Neighbour Schemes across the county – Transport for GP Appointments, Hospital Visits or to

Day Centres– Errands, shopping or collecting prescriptions– Minor household tasks, repairs or gardening– Visiting or befriending– Letter writing or simple form-filling– Reading to blind or partially sighted people– Signposting

Key Messages - 5

We will continue to invest in

Community and Low Level Support

Community and low level support

• Based in community centres/village halls

• Outcome-based focus for each individual

• Enablers for access to H & WB Centres

• Provide health promotion activities

• Facilitate access to relevant sources of financial, health, social care information

• Address the needs of socially excluded groups

Community and low level support

• Contributes to the wider prevention agenda

• Forms a key building block for reduced social isolation

• Enables people to be a valued member of the community

• Funding of services to be locally determined

• Organised around 14 ‘Closer to Communities’ areas

Key Message - 6

We will devolve

determination of investment options

to local representatives

Locality Determination Key Governance Requirements

• Devolved commissioning responsibilities and budgets

• Effective engagement of local communities

• Clear processes for decision making

• Equitable bidding process

• Investment recommendations within a best value framework

• Dispute Resolution & Appeals Panel led by Senior Manager

• Effective central support throughout

Locality Determination Suggested Area Board Membership

• Local County and District Elected Members

• Relevant County & District Council Officers

• Local Involvement Network / Health Watch members

• GP Consortia representatives

• Public Health input

• Older People representatives

Allocating The Locality Budget

• Based on 14 ‘Closer to Communities’ boundary areas.

• Numbers of people aged over 75

• Numbers of people in receipt of attendance allowance

• Levels of deprivation

• The impact of living in rural Oxfordshire

• Adjusted for existence of Health & Well-Being Centre

Key Message - 7

We will commission Health & Well-Being Centres in the major market towns and in the City.

These will be supported by Mobile Services

Tier 3 - Health & Well-Being Centres

• 7 specialist building based centres in major market towns and the City

• Meet the highest levels of dependency

• Extended day and seven days per week opening

• Range of health and social care services

• Respite opportunities for carers

• Universal support available

• Complemented by a vehicular Mobile Service

Mobile Service

• For vulnerable, isolated older people in rural and urban areas

• Provide a range of Health information, general advice and services

• Access to assessment and low level equipment• Improved outcomes - people better informed to make

choices• An opportunity for isolated older people to meet with

others in their community

Key Message - 8

We will market-test our Health and

Well-Being Centres to establish who is

best placed to deliver service

Health & Well-Being Centres (Tier 3)

Market-testing based on –

– Innovation to achieve specified outcomes for older people

– Demonstration of financial sustainability

– Best use of building based resources.

– Use of volunteers to deliver services.

– Empowerment of older people

Key Message - 9

We will expect people to make their own transport arrangements to their service of

choice

We will make information accessible so that people can have choices about the

transport options available to them

Future Transport Arrangements

• Transport is a key issue for older people

• Existing transport arrangements have served us well

• Do not see transport as S&CS’ core business

• We will make further investments in community transport schemes

• Transport Advisor pilot scheme proving successful

• People will have choices about transport options

Key Message - 10

We will support providers to respond

to the changing business model

New business model for Health & Well Being Centres

• Funding from 3 main income streams

– Personal Budgets– Income generation - those not eligible for County

Council support.  – Funding from County Council for universal services to

promote health and wellbeing

• Future sustainability requires more income generation at realistic unit costs

A Financial Overview

Service Type From To

  £000 £000

Community Engagement & Innovative Bids £0 £200

Good Neighbour Schemes & Volunteers £80 £150

Community & Low level Support £1,320 £1,209

Health & Well-Being Centre £1,814 £350

Mobile Adult Service Centre £0 £159

Resource Allocation System £0 £964

Future Developments £0 £182

Day Opportunities (excluding Transport) £3,214 £3,214

Transport £1,596 £250

Efficiencies   £1,346

Total £4,810 £4,810

Key Message - 11

We want to create a 6 months transition period

We want to implement our strategy from October 2011

Taking Our Proposals Forward

• ‘Preparing the Providers’ - Workshop 20th September 2010

• Meet Day Services providers - 29th September 2010

• Formal consultation during October/November

• Final decisions in late November

• Full implementation by 1st October 2011

Taking Our Proposals Forward

• Generates a 12 months transition ‘window’ to

– Develop and confirm locality arrangements

– Market test Health & Well-Being Centres

– Support providers throughout this transition

– Help providers to plan their response

– Help providers to prepare for the proposed changes

Consultation Process

• 6 weeks consultation period • Runs through to 12th November 2010• Would like to encourage you to comment early • Comments will be recorded centrally • Paper available for viewing from 1st October 2010• View online at -

www.oxfordshire.gov.uk» About your council» Have your say» Consultation

SUMMARY

• Ambitious agenda for future day opportunities for older people of Oxfordshire

• Supports our ‘Ageing Successfully’ strategy

• Delivers services fit for the 21st Century

• Wide range of day opportunities will be available

• Locality based to ensure that people do not travel long distances to access opportunities

• People enabled to be a valued member of the community

• Supports the Directorate’s Efficiencies Strategy