The Future Direction of Adult Services Welcome Samih Kalakeche – Director of Adult Services
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Transcript of The Future Direction of Adult Services Welcome Samih Kalakeche – Director of Adult Services
The Future Direction of Adult Services
Welcome
Samih Kalakeche – Director of Adult Services
Welcome from the Director
The Future Direction of Adult Services
Natalie Markham Divisional Manager – Governance, Quality, Safeguarding and
commissioning
Session 1: Demand and Supply
•To present the latest policy requirements & commissioning priorities•To set out the budgetary position and implications•To set out the long term supply and demand trends•To explore what is required to support organisations to develop and transform service models•To launch the Innovation Network
Key outcome: Market position statement
Purpose of the sessions
Session 2 (September): Supporting innovation in service delivery•Complex needs intelligence, trends and analysis•A chance to explore new approaches and enabling programmes:- Asset based community development- Social enterprises and mutuals- Workforce development- Personalisation- Early feedback from Innovation Network
Key outcome: Market Facilitation Approaches
Purpose of the sessions
Purpose of the sessions
Session 3 (December): Review and Next Steps
Financial Challenges
Andrew BuckHead of Finance
Childrens, Adult Social Care & Health
Britain faces spending cuts “almost without historical or international precedent” over
the next few years and, painful as the squeeze has been so far, it amounts to less
than a 10th of what is planned by the 2016/17 fiscal year.
(Institute for Fiscal Studies, February 2012)
Savings proposals for 2012-13
2012-13 Resolving the Revenue budget gap
£'000's £'000'sTarget to find 50,000
Full Council 12th December agreed savings -30,716New - Budget pressures/growth 4,767New - Additional Savings -9,859New - Further options to be agreed -6,248New - Council Tax Freeze Grant/CT increase -4,068Total by January 6th -46,124
Still to find 3,876
The Budget Gap
2011-12 £91.4m (delivered) 2012-13 £50.0m2013-14 £20.0m 2014-15 £30.0m 2015-17 £30.0m
TOTAL £221.4m
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illion)
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n)Social Care - Children Social Care - AdultsEnvironment (inc Waste) Money Available for all other services
2013-17 Mayoral Budget Strategy
• Open & transparent process• Priority led• A longer term view• Take decisions early• Challenge the financial assumptions• Consider all budgets and all spending and income• Consult on the difficult decisions• Ensure equality • Look to do things differently• Recognise growth/ demand pressures• Consider cost v performance
TimescalesDevelop budget savings options - July 2012 to September 2012
Stakeholder Consultation - October 2012 to January 2013
Mayoral Select Committee - February 2013
Cabinet - February 2013
City Council - March 2013
Demand Challenges
Jonny Keville- Performance Improvement Manager
Population by age (Liverpool)
0
50,000
100,000
150,000
200,000
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300,000
350,000
400,000
2012 2013 2014 2015 2016 2020 2025 2030
Popu
latio
n
Total population aged 18-64 Total population aged 65+
POPPI / PANSI Population Projections
Average Age Entering Service Against Average Service Duration
0.0
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Age
(Yea
rs)
0.02.04.06.08.010.012.014.016.018.0
Average Age (Projection)Average AgeAverage Service Duration (Projection)Average Service Duration
SU age at point of entry in ASC compared to the projected length of service requirement
Average Age Entering Service
0.010.020.030.040.050.060.070.080.090.0
Community Base
d
Residenti
al Care
Nursing
Home Care
Teleca
re
Grand To
tal
Age
(Yea
rs)
2007 2008 2009 2010 2011 2012
Average Age Entering Service
0.010.020.030.040.050.060.070.080.090.0
PhysicalDisability
LearningDisability
MentalHealth
Dementia SubstanceMisuse
OtherVulnerable
People
Grand Total
Age
(Yea
rs)
2007 2008 2009 2010 2011 2012
SU age at point of entry in ASC trend by year (2007 – 2012)
Average Service Duration
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4.0
6.0
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PhysicalDisability
LearningDisability
MentalHealth
Dementia SubstanceMisuse
OtherVulnerable
People
Grand Total
Age
(Yea
rs)
2007 2008 2009 2010 2011 2012
Average Duration of Service
0.01.02.03.04.05.06.07.08.0
Community Base
d
Residenti
al Care
Nursing
Home Care
Teleca
re
Grand To
tal
Year
s
2007 2008 2009 2010 2011 2012
SU service duration in ASC trend by year (2007 – 2012)
SU Population July 2007
Age as of July 2007 Age as point of entry
Service User Age Breakdown
400 300 200 100 0 100 200
106104102100
9896949290888684828078767472706866646260585654525048464442403836343230282624222018
Age
(Yea
rs)
Volume of Service Users
Female
Male
Service User Age Breakdown
400 300 200 100 0 100 200
103101
9997959391898785838179777573716967656361595755535149474543413937353331292725232119Un
Age
(Yea
rs)
Volume of Service Users
Female
Male
SU Population July 2012
Age as of July 2012 Age as point of entry
Service User Age Breakdown
400 300 200 100 0 100 200
106104102100
9896949290888684828078767472706866646260585654525048464442403836343230282624222018
Age
(Yea
rs)
Volume of Service Users
Female
Male
Service User Age Breakdown
450 350 250 150 50 50 150
103101
9997959391898785838179777573716967656361595755535149474543413937353331292725232119Un
Age
(Yea
rs)
Volume of Service Users
Female
Male
Commissioning
Natalie Markham Divisional Manager – Governance, Quality, Safeguarding and
commissioning
• Core vision: promoting people’s well being and independence to avoid crisis
• Improving information • Eligibility and assessment• Commissioning for outcomes• Supporting carers• Quality of care and support/safeguarding• Care audits – dementia care• Healthwatch
Policy Priorities – Care & Support White Paper/Bill
Commissioning Implications• Stimulate development of time banking schemes• New ways of investing in services (social impact bonds)• Development of specialised housing for older and disabled
people• Dignity and respect• Improve joined up working between NHS and care and
support• Testing scope of extending direct payments into residential
care• Developing user led organisations• Social action in deprived neighbourhoods
3 Key Shifts• Managing demand – shift resources to
prevention & community based solutions• Personalisation & Outcomes• Reablement/short term interventions to
maximise independence
Managing DemandWe want a shift this way
We
wa n
t a s
h ift
this
way
Rigid and agencyled
Innovative and userled e.g. Social
Enterprise
Universal
Reablement
Long term
Shifting Priorities - Prevention
Family, Friends, Natural Support
Building Community
Crisis Response, Resettlement / Outreach Equipment, Re-ablement,
Intermediate Care
Short Term Interventions
Long Term Care and Support
Access, Pathways, Assessment, Support Planning and Review
Universal, Information
Early Intervention & Prevention
Embedding Personalisation• Culture shift – consumer as purchaser
• Adapting systems and processes to deal with personal budgets and direct payments
• Workforce development and leadership are key
• Know your unique selling points and strengths to give you market edge
•Develop whole family services
•Focus on outcomes
•Supporting community capacity
•Flexible integrated care and support service models
Shift resources to short term interventions
•Innovative approaches to reablement and post discharge care and support
•Develop crisis and rapid response services
•LA working in partnership with independent sector to maximise value of community hubs
•Effective resettlement and rough sleeper services
Care & support•Increasing shift away from residential care to community support, housing & care solutions
•Dementia services – day & community support, joint working to improve pathways
•Increased use of assistive technology to maximise independence and resources
•Complex needs – short term step up and step down residential services, short breaks
Context Vision
*Develop extracare/innovative housing & care models
*Dignity in care dementia audit
*Develop partnership working to support Sedgemoor Dementia Hub
*Commission complex needs (homeless) service
*Integration of drug and alcohol services/pathways
*Development of homeless gateway
Connectivity: Health & Well Being Strategy, Mayoral Priorities, Clinical Commissioning Strategy
Improvement Programmes
Building social capital
No £ Growth Expected
Emergency admissions Th
ink
Fam
ily
Stra
tegi
c In
telli
genc
e an
d D
ata
Shar
ing
Nei
ghbo
urho
od/In
tegr
ated
Wor
king
Prevention & Early
Intervention
*Reducing A&E attendances*Reduce emergency admissions for ACS*Commission specialiat residential for complex needs*Increase access to self contained accommodation
*Develop pathways for early identification and support *Enable carers to pursue education & employment *Develop personalised support *Support to remain physically and mentally well*Support young carers
Del
ayin
g an
d re
duci
ng th
e ne
ed fo
r car
e an
d su
ppor
t
Wor
kfor
ce D
evel
opm
ent
Mental Health
Mar
ket i
nnov
atio
n an
d en
hanc
ing
soci
al v
alue
Ensu
ring
peop
le h
ave
a po
sitiv
e ex
perie
nce
of c
are
& s
uppo
rt
Long Term Care & Support
Health Inequalities
Com
mun
ity S
ervi
ces
Inte
grat
ed C
are
Path
way
s
Personalisation
Reducing Health Inequalities
Impr
oved
Out
com
esR
educ
e H
ealth
Ineq
ualit
ies
Incr
ease
d Li
fe E
xpec
tanc
y, B
ette
r Qua
lity
of L
ife
Hig
h Q
ualit
y So
cial
Car
e Se
rvic
esS
afe
& E
ffect
ive
Car
e, C
usto
mer
Exp
erie
nce
Gre
ater
Cho
ice,
Impr
oved
Acc
ess
More people achieving independent living
Growing Elderly Population
High Deprivation
Reduction in permanent admissions into residential care
Complex Needs/Alcohol
Increase number of working age adults receiving social care in paid
employment
*Transform LCC MH day services into a reablement/recovery model*Programmes to reduce mental health delays*Improve routes into work and employment*Single point of access with clear care pathways
Qua
lity
& S
afeg
uard
ing
Reduced Incidence of Avoidable Harm in Social Care Services
Increase in number of adults, older people and carers receiving self
directed support
Join
t Com
mis
sion
ing
for I
nteg
rate
d D
eliv
ery
Older People Dementia
Prev
entio
n &
R
eabl
emen
t
Enabling Programmes
Part
ners
hip
wor
king
to m
axim
ise
Valu
e of
Com
mis
sion
ing
Spen
dH
igh
Qua
lity
Soc
ial C
are
Ser
vice
s Le
adin
g to
Impr
oved
Out
com
es a
t Low
Cos
t
Building Community
Capital
Long Term Conditions
*Develop infrastructure for self directed support*Increase take up of personal budgets/direct payments*Undertake leadership role re community development*Build capacity of User Led Organisations*Develop peer support initiatives
*Pathways development, implementation & adherence*Co-ordinated approaches to complex needs*Support implementation of integrated model of care*Identify opportunities to support lifestyle change*End of life care
*Develop crisis and rapid response services*Further development of reablement pathway*Complex Care*Develop transition processes and pathways
Short Term Interventions
*Commission information, advice & advocacy servicees*Engage with universal services to promote inclusion*Improve access to training & employment support*Floating support for older people and those at risk of social exclusion
Carers
Whole System Approach
Safe
guar
ding
vul
nera
ble
adul
ts a
nd p
rote
ctin
g th
em fr
om a
void
able
har
m
Improved Social Care Related Quality of Life
Outcome Aspirations
Enha
ncin
g Q
ualit
y of
life
for p
eopl
e w
ith c
are
and
supp
ort n
eeds
Increase number of carers achieving outcomes
Improved service user experience of social care services
More adult service users feel safe and secure
Reduction in acute unplanned admissions and length of stay
Reduction in emergency readmissions within 30 Days of
discharge from hospital
Procurement Timetable
2011 2012 2013 2014 2015 2016 2017 2018
Homecare
Residential and Nursing
Specialist Residential Homes
Extra Care
SE ACC Based
Community BasedContract 1102
Floating Support
Cont
ract
Start of ContractPre Tender ProcessStart of Tender ProcessEnd of Contract
Key messagesThe Council:• needs your innovation and creativity to find more effective solutions for
local people• wants to work with organisations that can show the outcomes they
deliver for people• needs organisations that can maximise resources outside of the public
purse – including volunteers• wants partnership approaches to connect up the various systems –
Health, Welfare, Benefits, Housing, Community• wants services that actively engage with citizens and communities
The iNnovation Network (iN):
‘no old roads to new directions’
Phil RigbyTransformation Manager
iNnovation Network (iN)‘Innovation is anything, but business as usual…’1. iNnovation Roundtables [monthly]2. Adult Services Hack Days [one off sessions] 3. a) Collaboration Forum (Matching)
[quarterly]3. b) Collaboration Forum (Hatching) [by
project]4. Alternative Assets [ongoing]
iNnovation Matrix
Priorities for innovation Cost Efficiency Improved Outcomes Improved Convenience
Innovation through Improved Interface
Innovation through Better Monitoring
Innovation through Collaborative Infrastructure
Inno
vatio
n A
rea
Innovation Type
iNnovation Toolkit
Next Steps
• Circulate iN Matrix with guidance• Submissions should be mindful of the analysis
identified today, commissioning intentions etc.
• Expressions of interest by noon, Weds August 15th
Phil [email protected]
0151 233 4199
Group Workshop
Workshop
Purpose:
• To explore the information and intelligence that will enable your organisation to make intelligent decisions about investment and development
Discussion Questions• What opportunities do you see to respond to the
changing requirements for meeting future care needs?
• What factors can help or hinder your ability to transform your services to meet the challenges?
• How can we as an authority help create the right conditions for innovation and sustainability?
• How can you as a sector better inform our commissioning intelligence?