Building sustainable social care

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Building sustainable social care reducing
demand and lowering costs

• Professor John Bolton - Consultant
• JRFB Ltd

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Ways to save money in Adult Social Care England
and Wales

• Reducing demand for services
• Reducing demand for domiciliary care
• Reablement
• Reviews
• Reducing demand for residential care
• Intermediate Care and Health based solutions
• Housing based solution including Extra Care
  Housing and solutions for Younger Adults
• Telecare and Telehealth

• Driving down costs
• The Resource Allocation Process
• Direct Payments
• Lean Processes
• Mobile and remote working
• Electronic Care Records
• IT solutions
• Models of care delivery
• Commissioning for better outcomes
• Externalising services
• Procurement
• Childrens Transitions
• Adult Placement Schemes
•  

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Further ways to save money in England and Wales

• Raising monies
• Citizens Contributions
• Continuing Health Care
•  
• Diverting people away from social care
• Stricter eligibility
• Day Care future
• Employment and Training
• Customer Contact

• Partnership working
• Health
• Shared costs
• Falls prevention
• Screening
• Other partnerships
•  
• Better management
• Reviewing staffing numbers and structures
• Skills mix and Job Carving
• Tackling sickness levels

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Admissions to residential care from hospital
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Vale of Glamorgan improved discharges
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At a cost to the PCT increased nursing home
admissions
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Telecare and telehealth

• Positive noises from whole system demonstrator
  sites
• Hard to identify savings because intrinsic to
  approach to lowering demand but business case
  can be made North Yorkshire
• Investments and Partnerships Birmingham
• Could be part of the joint solution with NHS

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For more help.

• Professor John Bolton
• Independent Consultant
• 07789748166
• john.bolton_at_jrfb.co.uk

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• Derek Law. MBE
• Corporate Director,
• North Yorkshire County Council

Telecare Part of our Care Market Solution
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Our Basic Budget Strategy.
Extra Care
Reablement
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We have over 12,000 using lifelines, 3346 have
had access to telecare and each team has a
monthly target to increase usage.
We set ourselves a 10 increase at the beginning
of the year. We are achieving on average a 14
increase !
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Outcomes and achievements

• Between April 09 Now
• some 5000 multi-agency attendees at awareness, PR
  and installation training sessions.
• The approach is assisting staff to manage risks
  when providing customised services.
• People speak of how the service has helped them
  to carry on living at home give more
  confidence/peace of mind, feel safer.
• All staff in social care have received awareness
  training, with new staff targeted soon after
  arrival. It is embedded as part of our reablement
  programme.
• The County has created a training pack and
  guidelines for fitting equipment and developed
  Long Term Conditions pathways for a range of
  conditions with PCT.
• LD providers now beginning to embed personalised
  technology as part of support.
• Short stay residents to EPHs offered Telecare to
  use in EPH and take home.
• Telecare tested and piloted in home for people
  with dementia and demonstrated improved outcomes
  for residents and staff. ( St Celias)

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The Finance Case

• We have an ongoing process of evaluation
• Care managers identify what peoples traditional
  care package would have been if Telecare had not
  available, and what the actual Telecare enhanced
  packages of care were.
• 46 traditional packages would have been
  residential, EMI or nursing.
• 54 traditional packages would have been care at
  home.
• If existing homecare is gt10 hrs, the trends
  indicated homecare reduced, but still an element
  of care.
• If the traditional package was lt7 hours, the
  trend was home care hrs reduced or not have to be
  provided at all.
• Analysis indicated a net average
  efficiency/person on annual basis at 3,654
• a 38 reduction in care package costs.
• The DH and CSED have now taken NYCC model and
  expanded it as a national evaluation tool. See
  the SCED website.

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Case Studies

• Numerous!
• Tell the story ..we have numerous case studies
  they capture minds and hearts.
• How people are in control
• Personalisation.
• This is both a finance story and more importantly
  one of people being more in control of their own
  lives.

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Thank You

• A Range of videos, case studies, reports and
  other resources are freely available at
  http//www.northyorks.gov.uk/telecare

Derek Law MBE Corporate Director
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Making Telecare Happen Fast!!

• Linda Sanders
• Director of Social Care, Health Housing
• London Borough of Hillingdon

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Change of scene

• Previously Director in Dudley
• Developed an effective Telecare service in the
  Borough over a number of years
• Recently accelerated this development with
  Tunstalls assistance
• Moved to new job in Hillingdon
• Telecare under-developed
• Marginal service
• OPPORTUNITY!!! Better outcomes, save money!!!

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Making it Happen

• Plan has 4 key elements-
• Business Case
• Leadership approach
• Ensuring local services are Fit for purpose
• Winning over the front line staff

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Making it Happen

• Business Plan
• Developed by Finance team
• Foresees a net 4m saving over 4 years, (805k
  first year)
• Need to save 80 residential care weeks to
  breakeven, (year 1)
• Delivers 3,000 Telecare users
• Leadership
• Council and SMT on board
• Clear, strong message about the vision
• Appropriate Performance Management put in
• Partner Plan put in place to ensure third
  sector, independent sector and citizen voice
  organisations are also on board

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Making it Happen

• Local services fit for purpose?
• Good basis in place with existing service
• Made sure that capacity to meet demand was
  properly planned
• Winning over the Front Line
• Training, training, training!!!
• Win over hearts and minds, NOT about the
  technology
• A little bit of stick!!
• Team targets for referrals
• You need a reason WHY NOT to include Telecare

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Making it Happen

• A couple of other key things-
• Assigned clear delivery responsibility to
  Assistant Director in order to ensure that the
  work is done
• Hired a project manager to drive implementation,
  (part time)
• Work closely with the Telecare supplier

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Thank you very much for listening!!