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The 2002 Healthcare Conference

abcd. The 2002 Healthcare Conference. 29 September-1 October 2002 Scarman House, The University of Warwick, Coventry. Long Term Care - Where is the new Government Regime leading us?. Richard M Thomas FCII Managing Director, RED ARC Assured Ltd.

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The 2002 Healthcare Conference

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  1. abcd The 2002 Healthcare Conference 29 September-1 October 2002 Scarman House, The University of Warwick, Coventry

  2. Long Term Care - Where is the new Government Regime leading us? Richard M Thomas FCII Managing Director, RED ARC Assured Ltd

  3. 1990-1998 : Managing Director, Hambro Assured Care plc - Specialist Long Term Care distribution company Chairman of the ABI’s Long Term Care sub-committee for 3 years Gave evidence on LTC to: Health Select Committee Royal Commission 1998 to present : Managing Director, RED ARC Assured Ltd - Independent Care Advisory Service Credentials

  4. Context Where is the Government going? Legislation, Reform and Guidance Importance of Assessment Single Assessment Process Registered Nursing Care Contribution Intermediate Care and Rehabilitation Early Intervention and Prevention Equipment and Assistive Devices Early Signs and Premature Conclusions Discussion and Questions Agenda

  5. We will focus on England Devolution has allowed each country to develop its own policies Scotland all care in nursing homes is free no distinction between nursing and personal care Wales flat £100 allowance towards the cost of nursing care in nursing homes N Ireland still to decide Legislation and reform envisage major change timeframes typically run from 2001-2006 it will be some time before we can make judgements about outcomes Context

  6. Big changes in commissioning and delivery of care NHS and Social Services more closely aligned multi-disciplinary teams pooling of budgets More appropriate use of available resources Single Assessment Process (SAP) care pathways Intermediate Care avoidance of bed blocking More prescriptive standards and audits More user choice Where is the Government going?

  7. National Service Framework for Older People, 2001 basis on which care decisions are reached Single Assessment Process (SAP) person centred professionals working together rounded picture of care needs taking account of user preferences standardised through an agreed evidence base sharing information across disciplines builds and supports good practice produces standardised assessment information outcome centred appropriate and effective care plan promoting healthy independence and quality of life Quality and Consistence in Assessment

  8. Single Assessment Process - April 2002 • Nature of the problem? • NHS • GP/PCT • Social Services • Condition measured against set headings eg • clinical background • mental health • personal care and wellbeing • environment and resources • Focus on specific issues using relevant specialist resources • eg geriatric depression • Complex, multiple needs assessed Contact Assessment Overview Assessment In-depth Assessment Comprehensive Old-age Assessment NB: No determination of Registered Nursing Care Contribution can be made until SAP is completed.

  9. Single Assessment and Care Pathways Assessment Completed Care at home or in a residential home Rehabilitation CARE PLAN NHS Continuing Care Intermediate Care Care in a Nursing Home Referral to designated NHS Nurse. Checks all options have been considered. Evaluation of care needs in CARE PLAN Allocation to RNCC Banding

  10. Low Band - Minimal Nursing Requirement £35 pw - Care needs can be met in other settings Medium Band - Multiple care needs £70 pw - Daily access to nursing - Physical/mental state STABLE AND PREDICTABLE High Band - Complex needs £110 pw - Frequent nursing interventions over 24 hours - Physical/mental state UNSTABLE AND UNPREDICTABLE Registered Nursing Care Contribution

  11. NHS and Social Services MUST “provide high quality pre-admission and rehabilitation care to older people to help them live as independently as possible by reducing preventable hospitalisation and ensuring year-on-year reductions in delays in moving people over 75 on from hospital. NHS Plan Guidelines Care to last no more than 6 weeks pneumonia 1-2 weeks hip fracture 2-3 weeks stroke 6 weeks Intermediate Care

  12. Models include 2003/4 Targets Rapid Resource 24 hour access to A&E, GPs NHS Direct 70,000 Hospital at Home people pa intensive support at home beyond that normally provided in primary care Residential Rehabilitation 5,000 new to regain function and confidence to return beds home Supported Discharge home care and equipment to support earlier return home 1,700 places Day Rehabilitation short term therapeutic support in a Day Centre Intermediate Care Models

  13. Multi-disciplinary team Occupational Therapy Physiotherapy Social Workers 138 admissions, mostly over 75 with mobility problems 88% returned home 7% still under treatment 4% hospitalised 1% nursing or residential home Follow-up on those returned home 76% still at home after 3 months 54% still at home after 6 months Source : Broom Hayes, Rotherham Health Authority 2001-2002 Intermediate Care - Residential Rehabilitation

  14. “We believe the Government’s aims to be principled, but it remains to be seen whether the money is spread too thinly across these key areas. In particular, more funding is needed to provide preventative support for older people early on, rather than waiting until they need intensive community or nursing care.” Source : Help The Aged (Response to the Secretary of State’s proposals for older people’s services) July 2002 Early Intervention and Prevention

  15. Home adaptations ‘transform lives’ reduce the need for hospital and residential care Minor adaptations 62% of survey felt ‘safer’ 77% felt that their health had improved Major adaptations before: ‘prisoners’, ‘degraded’, ‘afraid’ after: ‘independent’, ‘confident’ Psychological aspects as important as physiological Source : Joseph Rowntree Foundation 2001 Early Intervention Can Work

  16. Secretary of State’s announcement 23rd July 2002 included: Faster assessment by end 2004 Social Services contact within 48 hours assessment within 1 month equipment in place within 1 week Removal of all charges for equipment from April 2003 (subject to legislation) 500,000 extra pieces of equipment hand rails, ramps, hoists etc Extension of direct payments to older people choice of receiving a service OR cash payments Carers’ grants doubled to £185m by 2006 Equipment and Assistive Devices

  17. Views from the coal face Nursing home co-ordinator Nursing home group Charities Premature conclusions A personal view As at February 2002 Low £35 - 19% Medium £70 - 58% High £110 - 22% Source : HANSARD Early Signs and Premature Conclusions

  18. Bedding in OK after initial disorganisation Each Authority establishing its own models for elder-care and intermediate care within framework and guidance highly dependent on existing resources Most determinations falling into middle RNCC band Workload issues reassessments at 3 and 12 months April 2003 DSS case load GPs and Consultants need to ‘buy in’ to changes SSDs defensive especially on budgetary issues Source : RED ARC Interviews, August 2002 An NHS View

  19. ‘Free nursing care’ allowances inadequate most assessments fall into £70 band average difference between nursing home and residential home costs £113* Payments made to care homes direct payments would offer more choice Bureaucracy costly use of scare NHS nursing resources single rate preferable (as in Wales) variations in Local Authority interpretation Ill-prepared start date 1.10.2001 20% assessments outstanding 1.1.2002 Source : RED ARC Interviews, August 2002 *DSS Rates 2001/2002 A Nursing Home View

  20. Government should meet full cost of Long Term Care no distinction between nursing and personal care Allocation to bandings largely reflect pre 1.10.2001 ‘self-payers’ placed themselves in care disposition will change over time fewer in the lowest banding Complaints about big increases in Nursing Home Fees some homes not passing on the ‘savings’ shrinking supply of beds reducing 5 to 6% per annum Source : Age concern England A Charity View

  21. The approach in England is well-thought through, comprehensive and ‘joined up’ There is growing acceptance of the need to intervene earlier and apply the right level of care There is an intent to give users more choice Methodologies for standards monitoring, consistency of application and audit are in place BUT Conclusions

  22. It’s early days DoH review only just starting results not expected until early 2003 There must be concerns about availability of trained resources to implement the changes ability to manage a large multi-disciplinary, multi-agency programme SOUND POLICIES … SIGNIFICANT ADDITIONAL FUNDING … … DELIVERY ? Conclusions (2)

  23. Some issues for Insurers Will free nursing care improve LTCI sales? care homes passing on the savings general trends in nursing home costs anticipating actual costs Other opportunities. Where are they? product development affordable options early intervention and prevention controlling access to the customer Observations and questions Discussion and Questions

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