Transcript Community Care in Dumfries & Galloway

Older People’s Provision and
Self Directed Support
Geoff Mark
Joint Planning & Commissioning Manager
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Overview
• Why have so few older people taken up
SDS?
• What impact will the SDS Bill have?
• How would we use SDS to address the key
challenges facing older people ?
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Why have so few older people taken up
SDS?
Commonly Cited Reasons
• Not what older people want?
• Attitudes and expectations
• Limited Resources (especially beyond
Personal Care)
• Time
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Why have so few older people taken up
SDS?
Or are these just excuses? Do we just need
to try harder and believe a little more?
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Why have so few older people taken up
SDS?
Research suggests
• Not what older people want?
• YES - but also that this depends on the
information they have and crucially the
support they have to manage an SDS
budget
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Why have so few older people taken up
SDS?
Research suggests
• Attitudes and expectations
• YES – attitudes of older people, their
families and professionals but attitudes do
not exist in isolation. Different
experiences and expectation can lead to
fundamental attitude change
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Why have so few older people taken up
SDS?
Research suggests
• Limited Resources (especially beyond
Personal Care)
• YES – but we don’t give people a chance
to make choices about this and there is
also the question of whether a small
amount of preventative resource could
deliver a better outcome?
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Why have so few older people taken up
SDS?
Research suggests
• Time
• YES – but the key point is that people need to
be able to change things when their needs
change or their experience develops – we
need to deliver SDS in a way which reflects
the experiences of older people e.g.
discharge from hospital
• The current system is struggling too.
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What impact will the SDS Bill have?
• Answer - I’m not really sure
• Certainty: Existing Models are unsustainable
• If SDS can assist with maintaining outcomes
in the context of decreasing workforce,
increasing demand and limited public finance
the impact will be huge.
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What impact will the SDS Bill have?
Options
• Option 1 direct payment
• Option 2 the person directs the available
support (arranged by the local authority)
• Option 3 the local authority arranges the
support
• Option 4 a mix of the above.
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What impact will the SDS Bill have?
Option 3 – What we do already
• Choice = choice of provider
• Control = choice of visit time (one of in the
specification of the care plan)
• Reality as things get stretched – provider
= whoever has capacity and visit times =
when they can be fitted in.
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GIS Examples
Traditional Approaches to Efficiency
(Option 3) – Geographical Zones
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Traditional Approaches to Efficiency
(Option 3) – Geographical Zones
• Probably couldn’t force people to change
providers under SDS Bill – has to be a
good thing?
• But if there is no change and traditional
approaches are unsustainable – then
what?
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What impact will the SDS Bill have?
• Option 1 – Will work very well for some
• Perhaps not many?
• Will it address workforce and financial
issues?
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So that leaves Option 2
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Individual Service Funds
• Developed to give individuals more choice and
control by disaggregating the resources in block
contracts.
• This is not required within older people’s services
where there are no block contracts.
• For older people – they could allow greater by:
• Greater flexibility and co-ordination - negotiation
directly between the service user and the provider.
• Ability to aggregate resources with others
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Example – A sheltered Housing
Development in Dumfries
• 28 residents
• 8 receiving care from 8 different providers
• Residents and Sheltered Co-ordinator very
frustrated
“surely we can organise things better than
this”
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Key elements of Extra Care Housing
• On site care team
• Coordination – not just of care but of wider
aspects of wellbeing in both the community and
for individuals e.g. Social activities, participation
of the wider community etc
• Also flexibility to maintain a community with a
range of dependency levels.
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Example – A sheltered Housing
Development in Dumfries
• Traditional Extra Care Housing Solution
• Tender for one provider
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Example – A sheltered Housing
Development in Dumfries
• Personalised Approach – tender for a provider to
work with the residents and the Housing
providers to achieve better outcomes:
• Could centralise care – but under ISFs
• Could start by centralising communal activities
e.g. laundry, meals, social activity
• Anyone wishing to retain current provision can
do so
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What the residents said
• Residents said they were “up for change”
if it would work?
• We are just developing the specification
and tender process.
• It won’t be the traditional tender because
we can’t be sure ahead of time what we
want.
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Lessons for the wider care at home services
• “Virtual Extra Care Housing”
• Would like to try to replicate some of the
positives of Extra Care Housing in the care at
home market
• This will need to have a geographical
component as we will not have the resources
to simply increase prices so different models
will have to be viable in the current resource
envelope?
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GIS Examples
Possible components
• Geographical clusters of 20 – 30 people
• Change care at home specification to include wider
coordination, including a focus on wellbeing and
connections with the wider community
• The big question – Will geographical efficiencies
release resource and will the balance between
flexibility and constraints on choice be attractive?
• Can there be incentives for service users, families and
providers to find alternative ways of meeting need?
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Final points
• Small achievements may be very
significant in the context of older people’s
care e.g. one hour per month for social
activity is better than nothing at all.
• People will opt in if there outcomes are
better!
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