Shaun Fitzpatrick Supporting People Manager North Somerset Council The whole systems approach

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Shaun FitzpatrickSupporting People ManagerNorth
Somerset CouncilThe whole systems approach
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Presentation to coverWhere is North
Somerset?DemographyAccommodation
situationDemandsOlder Peoples
aspirationsResource issuesService shapingMenu
approachLocal servicesSome slides have
background which will not be discussed in the
presentation
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Where is North Somerset?
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• Population 202,000 - doubled since 1950s
  continued massive development
• 8319 Social housing units 8 12k private
  lettings. Must build 26k units by 2026.
• Increasingly older population and inward
  migration
• Large number of visitors which doubles
  population in Summer
• PCT co-terminus but in deficit many services
  Bristol based
• Generally prosperous...10th richest
  parliamentary constituency But pockets of
  deprivation in WsM

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Future Demography

• Substantial increase in people over 50 and
  exponential increase in over 85s by 2029
• More older people every where, but some regions
  and cities more affected
• Higher proportion of men than now
• More people with disabilities and health, care
  and support needs
• More wealthy older people
• Significant group of impoverished older people
• Mismatch of supply and demand
• Lack of care and SP budget to meet needs
  rationing issues

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Accommodation situation

• More older owner occupiers, particularly in the
  SW
• More older people living in poor standard homes
  need for repair, adaptation and improvement
• Low void rates in social housing for older people
  2 to 1applicants
• Un-sustainable repair/improvement reinvestment
  needed in sheltered housing - 4 to 8M for NSC,
  1.4B nationally?
• More older people live in general needs social
  and private housing than sheltered
• Large proportion of owner occupiers live in
  former council housing
• Most sheltered housing units too small
• Population/society change have isolated some
  communities and sheltered schemes

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Demands

• Continued demand for social housing options
• Increased need for social care at home
• Increased adaptation
• Seamless services to people rather than people
  into services
• More specialist services as minority needs
  increase
• Services which were focused on younger groups
  will migrate through natural progression to older
  people
• Demand for accessible information by most but
  some not in IT loop
• More privately financed options capital,
  revenue and individual
• More older person focused new accommodation
• Increase in informal care needs less couples
  and caring attitude?

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Aspirations

• Greater choice, where and when demanded the
  rights brigade
• To stay in own home for as long as possible
• Affordable housing options more down sizing to
  release capital
• Living in mixed community options the young
  old
• More older people only community options -
  village development
• Improved transport links
• More activity services for increased numbers of
  fitter older people
• More control over individualised care and support
  services
• Flexible finance arrangements to realise capital
  with honest John providers
• Improved coordination of services by those
  responsible

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Resource issues

• Sheltered stock nationally 800K units, revenue
  cost 399M
• Sheltered stock regionally 67K, revenue cost
  38M
• Sheltered stock NSC 1.8K units, revenue cost
  1.4M move to 75 floating
• Pressure on SP budgets 10 cut over 3 years
  nationally and 24 regionally not reflected for
  North Somerset
• SP in LAA budgets loss to other sectors?
• Social care budget pressures, continuing 4 gap
  of cost over grant SP to deliver more care?
• Social care focus on crisis avoidance/intervention
  and re-enablement
• Social housing capital controlled by RHA and
  focused on general stock, affordable purchase and
  homelessness currently 5M pa (3 of total
  capital) on extra care
• Increased informal care cost which is currently
  estimated at 57B, twice the formal budget

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How to re-shape services in the ideal world!

• Consult local population, providers and service
  users
• Develop an Older Persons Strategy
• Develop an Older Persons Housing Strategy
• Link to Sustainable Community Strategy and LAA
• Based on resources available - create a menu of
  services
• Deal with crisis intervention more effectively
• Provide services based on need
• Promote purchase of services
• Publicise services and make access to information
  easy

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Crisis service delivery

• Hospital discharge Discharge Manger for FACs
  cases
• Option of Intermediate Care beds where return
  home not possible in short term
• At home Rapid Response Nursing for limited
  period
• At Home Intermediate Care team for limited
  period integrated services
• At Home Re-enablement Home Care for limited
  period
• At Home better Home Care purchase and
  management
• Linking to other secondary services and advice
  SP, dispersed alarms, adaptation, assistive
  technology and trips coordination and community
  development services.

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Service information the single gateway

• Careconnect
• http//www.n-somerset.gov.uk/Socialcare/Advicea
  ndsupport/CareConnect/
• Our Care Connect service is the first point of
  contact for all social care inquiries within
  North Somerset
• Community Café regularly over 7 locations 30
  info providers
• Free information and advice
• Food by LD Community Enterprise
• Social time

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Care Connect

• Contact centre offers impartial advice on social
  care issues and helped thousands of people and
  since its launch in 2004.
• It can guide towards the social care services we
  offer or put people in touch with voluntary,
  statutory or private sector organisations for
  help
• Basic housing help and advice
• Benefits advice integrated team
• Carelink dispersed alarms
• Charging enquiries
• Home care and day care advice
• Home energy conservation advice
• Local transport scheme information
• Recording incidents of general, racial and
  homophobic abuse
• Referrals to organisations within the Supporting
  People initiative
• Residential and nursing home searches
• Security issues for older people

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Housing Links Partnership working

• One stop shop for all advice on housing and link
  to services and Choice Based Lettings
• Co-location with Deposit Bond Scheme plus link to
  Credit Union
• Close working relations with Private Landlord
  Forum
• West of England Private Landlords guide
• Close working with RSL Housing Management Forum
• Management team cross over with Adult Care,
  Strategic Housing and Supporting People
• Link between Local Strategic Partnership,
  Strategic Housing Partnership and SP
  Commissioning Body
• SP Provider Forum and Sector Groups

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SP services Choice and menu approach

• Some traditional Sheltered due to nature, size
  and location, but close links with floating
  services
• Move to retirement housing rather than
  sheltered
• Extra care some new build and some part
  conversion
• Some modified Abbeyfield schemes link to care
  homes
• Large provision of floating support for Older
  People, some providers also provide care
• Cross authority commissioned Dementia floating
  support service
• Largest sheltered provider moved to low level
  support menu creating own intensive service and
  Home from Hospital Service for non FACs cases
• Care and Repair service with Private Rented
  Sector team
• Future development of volunteers service

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Typical Sheltered service

• Aim is to prolong independence and stay, avoid
  crisis and jointly work with
• Adult care services and hospitals hospital
  discharge, care planning and delivery
• OTs, Doctors and day services regaining
  physical activity and avoiding trips
• Alarm provider and response
• Benefits service debt and money management
• Supermarkets and volunteers - shopping
• Community transport social orientation
• Sourcing grants for equipment and holidays
• Referrals to Care Connect and Care Homes
• Other residents over IT learning and social and
  fitness activity
• Relatives and other Sheltered providers over
  support and activity
• Floating support services to top up support
  needs
• Self purchasing care and support providers or
  in house

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Typical Extra Care service

• Aim is to prolong independence and stay, avoid
  crisis and jointly work with
• Adult care services and hospitals hospital
  discharge, care planning and delivery including
  co-location
• OTs, Doctors and day services regaining and
  maintaining physical activity and avoiding trips
• Alarm response and daily contact
• Benefits service debt, money management and
  maximising disability benefits
• Supermarkets and volunteers - shopping
• Community transport social orientation
• Referrals to Care Connect and Care Homes
• Other residents over IT learning and social and
  fitness activity
• Relatives and other Sheltered providers over
  support and activity
• Self purchasing care and support providers or
  in house
• Re-housing services for remaining partners who
  do not need service

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Floating services

• Aim is to prolong independence and stay, avoid
  crisis and jointly work with
• Adult care services and hospitals hospital
  discharge, care planning and delivery
• Benefits service debt and money management
• Supermarkets and volunteers - shopping
• Community transport social orientation
• Sourcing grants for equipment
• Referrals to Care Connect and Care Homes
• Care Repair for adaptation and improvement
• Bobby van for security
• Joint planning and delivery of all care and
  support services
• Self purchasing care and support providers or
  in house

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Retirement housing rather than sheltered

• Aim is to prolong independence and stay with
  minimum support options
• The right accommodation option
• The right tenure options rent/purchase
• Alarm and assistive technology link only where
  needed
• In house support telecon/Net service
• Ability to adapt home for future frailty
• Self generated community activity
• Referrals to Care Connect and Care Homes
• Floating support services to top up support
  needs
• Self purchasing care and support providers

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Care Repair

• Jointly funded and managed service
• As with a number of services a Home Safety Action
  Form completed on each visit and referrals made
  and form returned to council for collation
• Security
• Fire Safety
• Utility Safety check
• Keeping warm
• Falls
• Accident Prevention

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Care Repair Typical case

• Hospital discharge delay or re-admission avoided
  by
• Urgent visit, with permission to assess home
• Key safe fitted
• Adaptations undertaken
• Disability equipment organised free or
  purchased
• Carelink alarm fitted
• DFG accessed for ramp, rails and shower work
  executed by use of digital camera specification
• Benefits advice given and Attendance Allowance
  sourced
• Grant for new boiler organised with PRS team
• Agreed with client to pay directly for approved
  provider to renew some flooring and make some
  general repairs
• Charity sourced for some extra income
• British Legion agreed to visit and set up visits
  to social events
• Bobby Van referral and security fitted
• Fire Brigade referral and alarms fitted

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Menu Sheltered Services

• Residents consulted on own need and preferences
  resulting in menu of
• Low alarm response and 6 monthly physical
  check
• 30 of residents - 4 pw
• Medium One to three intercom checks per week
  and one physical check per week
• 50 of residents - 10 pw
• High Up to two intercom calls per week and up
  to three physical visits per week
• 20 of residents - 20 pw

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Menu cont

• Support delivered by
• Support Coordinators (200 units each)
  responsible for a number of schemes and carry out
  assessments of need, risk assessments and support
  planning
• Support Advisors carry out visits and support
  tasks
• Development workers to promote self help
  activity, visit schemes and increase social
  activity
• Teams split geographically
• Sheltered Service Manager to coordinate and
  manage teams
• Additional links to current general needs
  floating service

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Menu cont..

• Additional Floating services
• Long term for those with additional needs,
  plus linking out to nearby community
• Short term hospital discharge for non FACs
  cases in the community and where need be in
  sheltered. Will provide cross over of current
  floating and care and repair services , but can
  and will work jointly with them. Covers about 30
  people per week.
• Contract costs
• Block gross chargeable
• Value 615k covering about 1000 service users
• Total service worth 755k including self payers
• Some redundant stock to be re-used for other
  purposes

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Questions ?