Promoting Independence: changing the model for social care in NorfolkNorfolk Older People’s Strategic Partnership BoardSeptember 2015

The drivers for change:

• Outcomes and expectations are changing

• Patterns of ageing are changing

• The Care Act is changing entitlements and responsibilities

• The pressure on public funding and very real cuts in local authority budgets mean we need to refocus LA funding.

In comparison with our ‘family’ of shire counties, Norfolk’s pattern of services shows:

• A very high number of people contact the Council about social services

• We formally assess twice as many people as our comparator authorities

• A high level of older people admitted permanently to residential care homes

• There is a good track record of enabling people to stay independent after discharge from hospital through reablement

• A very low number of discharges from hospital are delayed because of social care

• A very high number of admissions to residential care are made from hospital

• A relatively low number of carers use self-directed support

• People using care services in Norfolk generally feel safe and well supported: they generally feel very satisfied with their care.

How does Norfolk compare with elsewhere?

Contacts to social services

Norfolk has lots of contacts

Assessments

And turns a greater proportion

of these into assessments and then into service

users

Numbers of people admitted to permanent residential or nursing care for people 65+ What this measures:

• The number of people aged 65+ being permanently admitted to residential or nursing care per 100,000 population aged 65+

• 2014/15 data

Notes and comments:

• Similar position to last year – towards the upper end of the family group, though not as significant an outlier as the 18-64 rates

What this is telling us:

• Norfolk’s rate still seem a little high, particularly given lower levels of short term, and even overall long term, support

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1400.0

Number of people aged 65+ permanently admitted to residential care per 100,000 population aged 65+

All councilsFamilyNorfolkShropshire

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/150

100

200

300

400

500

600

700

800

900

Permanent admissions to residential and nursing care for people aged 65+ per 100,000 population, over time

NorfolkFamily Group

Percentage of residential and nursing care placements referred from hospital for people 65+What this measures:

• The % of residential and nursing care placements that were referred directly from hospitals for people 65+

• 2014/15 data

Notes and comments:

• Included here because a developing hypothesis is that Norfolk receives excessive referrals from hospitals

• Follows on from last slide re: high overall hospital referrals into short term social care

What this is telling us:

• Norfolk is highest in its family group, and very high overall

• Significant lead for further investigation – people are obviously going into residential care following a crisis, via hospitals. What is driving this? The John Bolton delayed discharges hypothesis? Market failure in other (homecare) settings?

0

20

40

60

80

100

120

Percentage of residential and nursing care placements referred from hospital for people aged 65+

All councils

Family group

Norfolk

Shropshire

Adult social care budget for 14/15: £242m

Current predicted overspend: £5.5m

Anticipated gap in NCC funding over next three years: £110m

Translates into over £50m reduction of ‘addressable spend’ in adult social services over the next 3 years.

The financial position:

Involvement in your

community

Getting better after

being ill

Getting early help when you need it

Getting support for

your complex health needs

Running your own life – making choices and decisions

Looking after yourself Keeping well & recovering your health

Living with complex health conditions

Getting information and advice

Managing your long

term health condition

Promoting Independence

Living independently at home

Excellence in education Real jobs

Quality of life for vulnerable

people

Making the difference: early focus

• Work with District Councils on local information, community development

• Consider a locally based ‘clinic’ approach to assessment to strengthen community links (Staffordshire model)

• Ensure reablement is working to best effect – increase access

• Rework assessment and review processes to strengthen independence, link to community assets, review Personal Budget allocation process

• Build on integration to ensure smart working with NHS

• Progressing development of housing with care.

Making the difference: wider changes?

• What really makes a difference for older people and their families?

• How do we make the most of what communities have to offer?

• How do we change culture and assumptions?