long, healthy, active and happy lives in argyll & bute tiree 16th july 2014

Long, healthy, active and happy lives in Argyll & Bute

Tiree 16th July 2014

Scottish Government’s ‘20-20’ VisionScottish Government’s ‘20-20’ Vision

By 2020 everyone is able to live longer healthier lives at home, or in a homely setting where we have:

• Integrated health and social care

• Prevention, anticipation & supported self management

• If hospital treatment is required, and cannot be provided in a community setting, day case treatment is the norm

• Highest standards of quality and safety, with the person at the centre of all decisions

• People back into their home or community environment

as soon as appropriate, with minimal risk of re-admission Tiree 16th July 2014

Reshaping Care for Older People: Reshaping Care for Older People: A Programme for Change 2011 - 2021A Programme for Change 2011 - 2021

“Older people are valued as an asset, their voices are heard and they are supported to enjoy full and positive lives in their own home or in a homely setting." Scottish Government's vision for older people

A Report on the Future Delivery of Public Services published in 2011 suggested we need to:

• Prioritise preventative spendingmore money to help people live healthier and safer lives. This will mean less spending is required on hospital or specialist care later on.

• Empower individuals and communitiesinvolving them in service design and delivery. This should result in services that match what people need and want.

• Have organisations work closely together to deliver Services

• Improve efficiency


The Case for Change in Argyll & ButeThe Case for Change in Argyll & Bute We are living longer. By 2032, the population aged 65 years and over is expected to increase by almost half (49%) across Scotland.

In Argyll & Bute the population of older people is projected to increase by 122% between 2011 and 2023. The largest projected increase (153%) is projected in the oldest age group (85+).

Between now and 2035:– An increaseincrease of 73.6% in the population aged 75 and over– Number of working age people will decreasedecrease by 14.4%

To continue to provide current services would need an extra £1.1 billion nationally

To meet demands in Scotland we would need: – a 600-bed hospital every 3 years for 20 years – a 50 bed care home every 2 weeks for 20 years

Need to act now to meet this increased demand…



• 90% of older people do not receive ‘formal care’ in NHS continuing care, a care home or a home care service

• Even though the proportion of older people receiving formal care rises with age it is still under half of those aged 85 years and over

• 3000 people over 65 years receive more than 20 hours of paid care per week but 40000 people over 65 provide more than 20 hours unpaid care per week

• 60% of health and social care funding is spent on providing institutional care in hospitals and care homes but only 7% on home care



• Some messages from consultation• -people want to stay in their own homes for as long as

possible• -people want personalised services, involved in planning

their own care and be better informed about their options and choices

• - people want more joined up working between health and social care

• -people viewed prolonged hospital stays as not a good thing and should be avoided if there were better community services


Model of Care PrinciplesModel of Care PrinciplesExamplesExamples

• Person centred joint anticipatory care planning • Prevention of unnecessary admissions to hospital• Prompt discharge home from hospital• Shift in culture towards enablement / reablement • High quality end of life care delivered in place of choice• Supporting people to manage their own illness • Developing services with third and independent sectors



The agreed joint aims of the local and national Re-Shaping Care for Older People framework: •Caring for people in their own home wherever possible and for as long as possible;•Developing a range of suitable extra care housing that provides an alternative to low and potentially high dependency care home placements; •For service users in permanent residential care, the care will be delivered in a fit for purpose single care home providing high dependency nursing care and/or specialist dementia or end of life care.



The agreed model of care is consistent with:•Outcome of consultation by Argyll & Bute Council with service users, carers and the community during 2009/10 and thereafter.•Outcome of joint consultation by Argyll & Bute Council and Argyll & Bute CHP via the Re-Shaping Care Framework during 2012/13. •The national Reshaping Care for Older People, A programme for Change 2011-21



The model of care is influenced by a number of factors:•A professional view within social and health care. Institutional care should be the last rather than the first choice of care provision.•Service user choice. A consistent message from the majority of service users is that given the opportunity they wish to live and die in their own home.•Demographics: 83% increase in the over 75’s between 2006-31•Finance: Care in the community is invariably more cost effective than institutional care



• Where are we now?• Joint Strategic Plan for Older People- Argyll and

Bute• Engagement Programme with local communities

September 2014 onwards• Shortened easy read version


Some examples of change Some examples of change

Dementia

• Establishment of Dementia teams ~ partnership of NHS, Argyll and Bute Council, Alzheimer Scotland.

• Multi disciplinary locality based teams who work closely with local

communities and existing hospital and community services: Nurse, Occupational Therapist, Social Work involvement and Dementia link worker supported by a Consultant for Old Age Psychiatry.

• Their work is demonstrating benefits to individuals, carers and families and include:

- increased confidence in ability to do tasks and challenges

- increased well-being through increased activity- increased use of skills via volunteering opportunities

- Reduced isolation via increased social contact- increased participation in range of peer and activity

groupsTiree 16th July 2014

Some examples of change Some examples of change

Management & Prevention of Falls

• Development of evidence based training resources to reduce falls risk.

• An extensive training programme for staff, carers and wider public groups is now being delivered in all localities. It includes raising general awareness of the risk factors that lead to falls and how to reduce these for individuals and in the environment.

• Falls champions in each locality are training staff from all partners to identify and act on modifiable falls risks.

• Implementing pathways to help support older people at home after a fall and to reduce future falls.


Some examples of change Some examples of change Community Resilience / Capacity

Building Social Networks

• Community resilience staff are a core support to older people.

• Demand from older people ~ development of over 27 initiatives provided with and inclusive of the local communities, e.g. community cafes, craft clubs, music and lunch groups, book clubs, social activities.

• Volunteers provide transport, help with shopping, and a range of other services amounting to an average 1300 volunteer hours each month.

• Time banking is growing and is a form of community volunteering where people support each other and where everyone’s time is valued equally.

- For example, Fred may offer to tidy Doris’ garden and bank those hours; Doris may teach a young mother to knit and bank those hours; the young mum may help Paul with using facebook or basic IT and Paul may offer transport to take Fred to hospital appointments.

- Everyone can both give and receive and community networks are built.

- In Argyll there are now over 1,000 time bankers many supporting older people and making us the largest Timebank network in the UK.


Reshaping Care for Older People

Key

RCOP workstream where there is Change Fund investment and/or a specific working group other priority areas for RCOP and Joint commissioning

Active & Included

Healthy & Achieving

Anticipatory Care

Dementia

Management & Prevention of Falls

Reablement

Respected & Responsible

Safe & Nurtured

Person Centred Health & Social Care (incl Self Directed Support)

Community Resilience

Housing

Equipment, Aids, Adaptions & Telehealthcare

Discharge Planning & Length of Stay in Hospitals and Care Homes

Carer Support

Care at Home and Care Management

Rural General Hospitals & Community Hospitals

Day Care

Care Home Provision

Standards for Older People in Care (OPAC)

Reducing Emergency Admissions to Hospital

Medicines Management

Intermediate Care

End of Life Care

Self Management

Healthy Aging

Co production

Commissioning

Organisational Development

Workforce Development

Information TechnologyCommunication &

Engagement


Reshaping Care for Older PeopleReshaping Care for Older People

So overall, we want to help older people stay safe and well outside the care system by:

• Promoting healthy ageing • Supporting Self Care • Supporting communities and unpaid carers • Focusing on more preventative and anticipatory care • Using more telehealthcare / equipment / adaptations

Key to this is partnership working of the NHS, Council, independent & third sectors, users and carers and

communities


Tiree Initial Engagement

• Purpose

-to begin a partnership journey with community of Tiree and Coll

-to start engagement that is meaningful and ongoing

-to lay out some initial thoughts/ ideas

-to listen to what you are saying today to these

-to take on board your comments

-to seek your ongoing involvement and engagement

-to move together, to grapple with the issues and , to commit to ongoing engagement and information giving and hopefully agree a way ahead

-not to set anxiety racingTiree 16th July 2014


• So what is the detail• i) Tigh a Rhuda is not the long term solution-model

of care is 60s/70s thinking, ongoing investment in it, questionable from public £ perspective. Low

occupancy rate/ high cost• ii) The solution cannot be in like for like-reflect on

what big messages people are telling us around Reshaping Care-individualised care/ in control/ at home

• Iii) A couple of meetings with NHS Argyll and Bute/ Argyll and Bute Council/ACHA and CuN ram Thiriodh



• v) Both sites would negate need for land purchase• vi) Proposal would be to provide 8 (?) one bedroom

housing units for affordable rent on secure tenancies plus 1 respite plus 1 medical bed with associated service hub area for day activities/health and social care staff base/ chapel of rest

• vii) Proposal is to explore and include an appraisal of each option with refurbishment, remodelling, demolition, new build or a hybrid proposal for the first site and new build for the latter.

• viii) Option appraisal to look at the detailed cost of each option and a split of the costs for the housing and non-housing elements.



• ix) This will allow ACHA to test the viability of the proposal against the current SG funding benchmarks and inform the NHS and Council who would have to look to capital funding (with CuN ram Thiriodh ? ) to meet the non-housing element of the

proposal.



iv) Concept of Progressive Care/ Extra Care Housing-what is it ? Mull and Jura are examples

Care providers working together to ensure the older person maintains as much independence as is

possible

May include provision for in-patients,.May be 8 (? )individual supported living flats

managed by ACHA.

Residents care will be a tailored care package which will meet their needs during the day and night. Other features day provision, operational base for health and social care staff working across the community




Current Status of Proposal-Strong argument that Tigh A Rudha is no longer fit for purpose due to its design against current standards-Partners share common philosophy consistent with Reshaping Care and Strategic Plan that

- We aspire to support islanders in their own home and on their own island for as long as is possible

- We recognise that integration , partnership and professional flexibility will improve the probability of local solutions


• - We have signed up to Initial Scoping and Outline Agreement to undertake option appraisal

• -We recognise that early and detailed consultation and engagement requires to be undertaken on the potential service development to seek broad support for the direction of travel, to inform where we should be going and to potentially extend and inform options

• - We will look to develop a detailed service specification by the end of July/ early August to inform the current options

• - no political approval to the above



• - need to learn the lessons of communication, and engagement from our experience with other progressive care centres

• Need to build a plan of engagement with Tiree community to ensure clear understanding of what is to be planned for example clarity around progressive care, update on progress and timescales

• Need to set up series of future engagement and planning meetings including with service users and families



• Comments and Questions


long, healthy, active and happy lives in argyll & bute tiree 16th july 2014

Documents

community setting

hospital treatment

happy lives

healthier lives

community environment

homely setting

day case treatment

argyll bute tiree