Transcript National Care Homes Conference and Exhibition

“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
How did you get here today?
1.
2.
3.
4.
5.
6.
7.
Bus
Train
Speedboat
Helicopter
Spaceship
Bike
All of the above!
35%
24%
13%
12%
8%
5%
3%
1
2
3
4
5
6
7
What would make the conference
better?
1. New Chairperson
2. Have the bar open
3. Collaborative team
working
4. New AV Company
5. Consistency of care
6. Safe and effective care
55%
16%
12%
9%
9%
1%
1
2
3
4
5
6
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Quality or
Compromise
The reality of delivering Care at Home
You decide…..
Shadowing our conference carer Mel
in real time
• with a live broadcast through out
the morning conference
Care
09.30
Times
minutes
Session 1
Client
A
Client
B
Client
C
Client
D
60
15
15
30
07.00 08.00
08.00 08.15
08.15 08.30
08.30 09.00
Actual
arrival
times
Planned Care
6.45
An older wheelchair user with osteoporosis, provide
all aspects of Personal Care, support with multiple
medications, help to prepare breakfast and support
to enjoy meals, tidy bedroom, kitchen.
7.51
Support with medications time specific
(Diabetic)and support to prepare breakfast
8.13
Support with medications and support to prepare
breakfast
8.30
Older client of 82 with a history of frequent falls,
limited mobility, requires support and variable
assistance to get in and out of bed, wash dress etc.
This support package has over time been
successfully reduced through an enablement
approach. This client is also the main carer for her
60 year daughter with enduring Mental Health
Care
Actual
10.15 X Times arrival
Min
times
Planned Care
Client
09.00 45
E
09.45
2 Carers required to meet at same time to support a young
adult wheelchair user with multiple LCT's. The support is fo
9.06 all aspects of personal care, support and nutrition and to
assist the individual to meet daily transport schedules to
attend college
Client
09.45 30
F
10.15
Personal Care for an older gentleman with moderate
dementia, living with his wife, who has a LTC and has
9.57 recently also been added to the package for support with
medications. Their daughter who is the main carer for both
parents is currently recovering from a serious illness.
Older gentleman known to the care service for 5 years, a
stroke survivor, with reduced mobility and a history of falls
Client
10.15 with a recent # neck of femur. Staff have been integral to h
60
10.29
G
11.15
return home and to his on-going rehabilitation. Following
surgery the package of care has been slowly reduced in
response to increasing independence.
Care
12.15
x
Mins
Times
Actual
arrival
times
Planned Care
Unpaid
break
15
Client in
hospital
Carer used own unpaid break to make up time and
to avoid running late
Client
H
30
11.30 12.00
11.34
Meal preparation for lunch, assist with continence
management
Client
A
30
12.00 12.30
12.10 12.40
Meal preparation for lunch, assist with continence
management
Quality or Compromise
• Mel has been out from 06.30 to arrive at her
first call at 06.45
• Starting early and working through unpaid
breaks ensures she just makes all her visits on
time – today was a good day
• During her lunch she will now – drop off a
sample to GP surgery, and pick up a
prescription
• No additional payment for travel /fuel of 16
miles during the morning
• and for 5.25 hrs. direct contact time, Mel has
been out for 6.5 hours her gross pay before
deductions is £33. 80
Question
Should all care staff regardless of sector/
employer be paid the living wage of £7.45
then we can address time to care, time to
travel/fuel payments
1. Yes
2. No
3. Don’t Know
0%
1
0%
2
0%
3
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Health & Social Care Integration
Professor Jim McGoldrick
Chair, Joint Improvement Partnership Board
JOINT IMPROVEMENT
PARTNERSHIP BOARD
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Angela Leitch, Chief Executive, East Lothian Council;
Angiolina Foster, Director, Health & Social Care Integration, Scottish Government;
Annie Gunner-Logan, Director, Coalition of Care Providers Scotland (CCPS);
Cathie Cowan, Chief Executive, NHS Orkney;
Colin Mackenzie, Chief Executive, Aberdeenshire Council;
Fiona Mackenzie, Chief Executive, NHS Forth Valley;
Ian Welsh, Chief Executive, Health & Social Care Alliance Scotland;
Kenneth Hogg, Director, Local Government & Communities, Scottish Government;
Martin Sime, Chief Executive, Scottish Council for Voluntary Organisations (SCVO);
Mary Taylor, Chief Executive, Scottish Federation of Housing Associations (SFHA);
Ranald Mair, Chief Executive, Scottish Care; and
Rory Mair, Chief Executive, CoSLA.
JIT’s STRATEGIC PRIORITIES
Person
centred
outcomes
ROUTE MAP TO THE 20:20 VISION
20:20 Vision / Quality Ambitions
20:20 Vision
Person Centred, Safe and Effective Care which supports people to live as
long as possible at home or in a homely setting.
Triple Aim
Quality of Care
Health of the
Population
Quality
Outcomes
Independent living
Services are safe
Engaged workforce
Positive experiences
Healthier living
12 Priority Areas for Action
Value &
Financial
Sustainability
Effective resource use
Health & Social Care Integration
Underpinned by Legislation:
• nationally agreed outcomes;
1.Healthier
2.Independent Living
3.Positive experiences and outcomes
4.Carers are supported
5.Services are safe
6.Engaged workforce
7.Effective resource use
Health & Social Care Integration
Policy Context SG Consultation
• Improve Outcomes
• Focus on Population
• Address funding and demographic challenges
• Variability in care by geography
• The Accountability/Responsibility Paradox
Health & Social Care Integration
Key themes in the Consultation (the Bill)
• Consistency of approach
• Statutory underpinning
• Integrated budget
• Clear Accountability
• Professional Leadership
• Simplified structures and minimal disruption
Health & Social Care Integration
Workforce development issues
• Definition of Workforce – not just the paid
employees of Health Boards and Councils
• “Professional leadership”
• Definition of leadership – not a function of
hierarchy or job title. Leadership happens at
all levels.
Health & Social Care Integration
Workforce development – strategic context
• Ministerial Strategic Group
• RCOP workforce work stream 2010- 2012
• Change Plans and Change Fund
• Position paper in response to SG Consultation
on what work has already been done
• Development of a strategic narrative
Health & Social Care Integration
Strategic Narrative on workforce development
• Not about workforce planning
• Not about terms and conditions
• Not in isolation
Health & Social Care Integration
Workforce Development Strategic Group –
WDSG
• “[SG] will work with NES and SSSC and other
stakeholders to define priority training
requirements within an integrated context;
articulate what these mean for frontline staff
and mobilise support through an education
and training infrastructure”
• (Consultation doc p44)
Health & Social Care Integration
WDSG
• Who are we and how do we work together?
• Shared meaning and understanding for
“collaborative leadership
• “Reference Groups” approach (not “Expert”
Group
• WDSG as a portal to frontline staff
Health & Social Care Integration
Workforce Reference Groups – emerging themes
• Don’t re-invent the wheel, use existing joint
working to observe the process of integration
• Skills and training environment, better IT
support
• Leadership and Clarity of communication
Health & Social Care Integration
Workforce Reference Groups – emerging themes
• Understand what is already happening –
mapping existing work
• Issues of Professional Identity
• Need to define what’s national and what’s
local
Health & Social Care Integration
Workforce position paper – Scottish Care
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Follow-up to the reference group session
Strategic narrative
Well – defined priorities
Challenges and opportunity
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Integrated Resource Framework:
Supporting Health and Social
Care Integration through
Strategic Planning
Christine McGregor, Economic Adviser, Scottish
Government, Health Analytical Services Division.
Scottish Care Annual Care at Home and Housing
Support Conference.
Glasgow Marriot Hotel, Friday 31st May 2013.
Outline
Integration and Strategic Commissioning
 What is the Integrated Resource
Framework?
 Two main aspects – “IRF mapping” and
“Patient (client) level analysis”
 Extensive examples of where IRF has been
used.
 Highlight where Scottish Care and partners
could input and benefit from IRF mapping.

Integration and Strategic
Commissioning
The Bill to integrate adult health and social
care places a duty on Health and Social Care
Partnerships to produce Strategic
Commissioning Plans .
 A multi-sectorial co-production approach to
be used to develop the Strategic Plan.
 Knowledge and expertise of independent and
third sector will be critical for successful joint
commissioning.
 Build on change fund experience.
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Strategic Commissioning Cycle
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“Analysis is one of the most important activities
in the commissioning cycle. Poor analysis of
post or future trends will result in flawed
commissioning decisions and wasted resources”
SWIA Guide to Strategic Commissioning
Critical for partnerships to understand current
service provision, quality, costs of in house and
procured services, and transparency of
information for all partners.
 Only then will decisions be based on robust
evidence and result in positive outcomes for
individuals.

Question 1
Do you think we have sufficient information
to develop commissioning plans?
1. Yes
2. No
78%
22%
1
2
National Support and Improvement
Programme Analysis
We will give you sufficient information!
 Quality of “analysis” in plans varied.
 Programme to support development of
commissioning abilities by extending what
is already offered from IRF team.
 Target for all partnerships to have patient
(client level) data by April 2015 to inform
decision making.
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What is IRF - 1

Development by SG, COSLA and NHS in 2008/09,
with objective being to begin to understand joint
resources (NHS and LA) across population they
serve.

As it developed use by all sectors.

Focus on joint resources rather then more
traditional budget lines such as acute budget,
community budget, social work budget.

Provide a evidence base for shifts within and across
health and social care.
IRF mapping -1

Every community health partnership in
Scotland is given mapped data for all ages 65
and 75 plus.

Mapping consists of:
 Hospital based services (£5.1bn, £2.2bn, £1.4bn)
 Health community based services (£1.4bn, £439m,
£245m)
 GP and GP Prescribing (£1.7bn, £577m, £297m)
 Local authority services (18 plus £2bn, Older
people £1.3bn)
Question 2
What percentage of hospital based
resource is accounted for by
emergency (non elective) admissions?
1. 25%
2. 50%
3. 60%
68%
21%
12%
1
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3
Scotland - 65 plus hospital based resource use
2011/12
Total £2.2bn
Outpatients,
£322,161,325,
14%
Acute Elective and
Day Case,
£560,082,824,
25%
Acute Non Elective,
£1,362,206,225,
61%
Scotland - 65 plus health and social care 2011/12
Total £4.4bn
LA - Daycare,
£56,786,000, 1%
LA - Other,
£51,936,000, 1%
LA - Home care,
£404,533,000, 9%
Acute Non Elective,
£1,362,206,225, 31%
LA -Accommodation ,
£643,933,000, 15%
GP/Prescribing,
£577,776,254, 13%
Health
Community,
£439,294,832
, 10%
Acute Elective and
Day Case,
£560,082,824, 13%
Outpatients,
£322,161,325, 7%
How has IRF mapping being used?
Joint Commissioning – baseline for
current resource adult/older people
across sectors.
 Key to the analysis part of cycle.
 Support change fund projects.
 Variation analysis emergency
admissions/prescribing by GP.
 Routine briefing/health and social care bill.
 Basis of joint budgets.

Patient (client) level analysis - 1
IRF mapping examines resource and
activity to various geographical levels.
 Doesn’t say WHO is using services, for
example emergency admissions rates and
costs may fall/rise but for certain cohorts
they may be rising continually.
 Patient (client) level health and social care
allows various questions to be answered.

Patient (client) level analysis - 2
Is it the same people who use both health
and social care services?
 Is it the same people that are always
facing a delayed discharge?
 Does level of home care make a
difference to level of admissions?
 Does prescribing have an effect on
admissions?

Patient (client) level analysis - 3
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ISD linked at patient level, hospital,
prescribing, social care activity and costs for
all residents across Tayside.
Social care include care home, day care
home care, meals, alarms, rehabilitation.
Other partnerships’ linked health only.
Unit costing of social care will hopefully
simplify LFR return for social work.
Area where we would welcome input from
independent and third sector providers.
Patient (client) level analysis - 4
Once data set linked at patient (client
level) it can be used for multiply needs.
 What IRF team would like to offer each
partnership.

Dementia - 1
Define dementia cohort - from GP LTC
register.
 What health and social resources do
dementia patients use?

◦ Compared to non dementia population
Forecast future demand as a result of
demographic pressure
 Assist with planning and evaluating services
redesign

◦ Key cohort for joint commissioning of services.
Cost Attributable to Dementia
-£15,610 per person, compared to £2,880 per person for non
dementia. Total health and social care for dementia cohort was
£12m (25% of total budget) despite only accounting for just over
5% of population.
Substance Misuse
•Define
substance misuse cohort.
•Use data from criminal justice and ADP services
to augment data
•Prevalence and population characteristics
•Size
and distribution of spend.
•Comparative
•Follow
to non substance misuse population.
as service is redesigned.
Breakdown of costs
Nonsubstance
misuse:
Social Care
25%
Other health
6%
Prescribing
16%
Other health
4%
Prescribing
7%
Substance
misuse:
Planned
admissions
12%
Emergency
admissions
36%
Planned
admissions
17%
Social Care
5%
Emergency
admissions
72%
Other examples of patient (client
level analysis

Anticipatory Care Plans.

Delayed Discharge.

High resource patient (clients).

Acute flow and capacity.
Question 3
Do you think having heard a quick overview
of IRF data and analysis it could help with
commissioning and planning of services?
1. Yes
2. No
91%
9%
1
2
Conclusions
Demonstrated the benefits of both IRF
mapping and patient level analysis for
integration and planning services for future.
 Happy to share IRF mapping data and
patient level analysis.
 Happy to answer questions/discuss how
you could use analysis.
 [email protected]
0131-244-3394

“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Care
Actual
10.15 X Times arrival
Min
times
Planned Care
Client
09.00 45
E
09.45
2 Carers required to meet at same time to support a young
adult wheelchair user with multiple LCT's. The support is fo
9.06 all aspects of personal care, support and nutrition and to
assist the individual to meet daily transport schedules to
attend college
Client
09.45 30
F
10.15
Personal Care for an older gentleman with moderate
dementia, living with his wife, who has a LTC and has
9.57 recently also been added to the package for support with
medications. Their daughter who is the main carer for both
parents is currently recovering from a serious illness.
Older gentleman known to the care service for 5 years, a
stroke survivor, with reduced mobility and a history of falls
Client
10.15 with a recent # neck of femur. Staff have been integral to h
60
10.29
G
11.15
return home and to his on-going rehabilitation. Following
surgery the package of care has been slowly reduced in
response to increasing independence.
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Alex Neil MSP
Cabinet Secretary for Health and Wellbeing
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013