Adult Care Update since JSNA 2008

1. Adult Care Update since JSNA 2008

2. Changes Since Last Year • The increase in the overall population of Derbyshire is well publicised with trend data on age profiles etc. available to download from within the demography page of the Derbyshire JSNA website; http://www.derbyshire.gov.uk/Social_health/inspection_of_services/joint_needs_assessment/default.asp • The latest population estimates released by ONS for 2008, show that the population of Derbyshire aged over 65 is estimated to be 134,600 - this is made up of 59,800 males over 65, and 74,800 females over 65 • By 2028, the number of people aged over 65 is estimated to increase to 204,700 people overall.

3. Services for Older People • The increase in the number of people of 65 and over will inevitably lead to increased pressure on social care services within Derbyshire • The “Baby Boomers” (post-second world war births), who will add to the population of 65+ from 2010, also have increased life expectancy and will live to older ages • With the increase in the size of the population needing care, this will inevitably increase the burden on social care; The Department of Health green paper on the future funding of adult social care (14 July 2009) http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102338 These changes imply that ’ future services will be provided to people who need support in their own homes rather than by providing residential care services,’ and will result in; • a need for more labour-intensive services to a widely spread countywide population • logistical difficulties and issues in the provision of home based social care services • a need for services to be more flexible to meet the needs of the user, and reliance on carers to provide more support to people who remain in their own homes.

4. Figure 1: Percentage of Derbyshire Adult Care Expenditure on Services for Older People (2007/08) • Derbyshire’s proportion of expenditure on services for older people is 9th highest among its CIPFA “Family” of 16 authorities • Its rate is slightly higher than the average for England, but only average compared with the East Midlands Region • The time-series chart shows an increase across all authorities between 2006/07 and 2007/08. Source Dr Foster - KIGS Data

5. Figure 2: Helping Older People in Derbyshire to Live at Home (2007/08) • Derbyshire is 2nd out of 16 only to Durham in the rate of older people it helps to stay living at home • Derbyshire has consistently performed higher than the England and Regional average on this indicator for the last 6 year period. Source Dr Foster - KIGS Data

6. Adult Care Initiatives Derbyshire Adult Care is investing in a number of initiatives during 2009/10 as part of the Older Persons’ Strategy these are: • To increase the range of specialist housing and related support for people with dementia and complex needs. • To develop specialist services for older people with dementia and complex needs • To develop a co-ordinated programme of information, advice and advocacy services across the County • The needs of carers will be addressed through the Carers’ Joint Commissioning Strategy’ • To review Intermediate Care services across the County and commission according to need • To develop high quality, consistent falls prevention services across Derbyshire

7. Adult Care Initiatives cont. • To commission high quality, integrated Stroke Services in Derbyshire, • We will work with partners to reduce health inequalities and improve life expectancy in specified districts • To maximise choice and control in terms of adult social care provision, by setting up systems and services to ensure that all new service users accessing social care services will receive a personal budget by 2010.

8. Home Care Between 01.04.08 and 31.03.09, 11,335 people aged 65 or over (8.4%) received home care provided either: • directly by Adult Care domiciliary home care services; • commissioned through an independent or private service; or • via direct payments to clients. Of these some 4,530 are aged 85 or over (25.6% of all people of this age). Given the projected changes to the working age population available to provide care services, such changes are likely to result in a significant shift to the current pattern of provision, with the development of new forms of provision including social care enterprises and more use of the “Telecare” assistive technology to support people to remain independent.

9. Disabled People (working age) • There will be an additional 711 people with a “moderate” or “serious” physical disability requiring support from Adult Care by 2015 (1.4% rise between 2008 and 2015). • Whilst the increased number of people with physical disabilities is not as large as the increase in older person’s population, what is significant is the growth in young people with complex and multiple disabilities in transition to adult life. • We are providing services to more people with complex, long-term/lifelong conditions as well as people with traumatic brain injury or early-onset dementia who require high-cost placements and intensive packages to support them in the community.

10. People with Learning Disabilities • The number of people aged 18-24 with a moderate/severe learning disability is projected to increase from 363 in 2008 to 379 by 2015 (4.4% increase) = high cost support packages • The number of people aged 18-64 with moderate/severe learning disabilities will increase from 2,596 to 2,655 by 2015 (an increase of 59 people or just over 1%) • A growth in the number of older people (i.e. aged 50 to 80 years) with learning disabilities which will rise from 1,126 to 1,265 by 2015. • Increase in the number of younger people with autistic spectrum disorder and cases requiring support where learning disability is not present • Family carers of people with learning disabilities are an ageing group who need increased levels of support in order to enable them to continue to cope with their caring responsibilities.

11. People with Mental Health Problems (working age) • The number of people affected by mental health problems will increase by 1,240 (1%) between 2008 and 2010 and by 2,526 (2%) between 2008 and 2015 • By 2015 there will be over 115,000 people living in Derbyshire who are affected by a mental health problem • An increase in the number of people with drug and alcohol dependency problems • Rates of mental ill health and people misusing drugs and alcohol will be further exacerbated by the impact of the recession • Derbyshire compares poorly in comparison to its “family group” of local authorities for ‘Percentage expenditure on mental health’ (14th out of the comparison family of 16).

12. Improving Support for Carers • Improving Support for Carers is a key priority within the JSNA for 2009 and one of our Local Area Agreement (LAA) targets. • To help us strengthen our performance we are changing the criteria for deciding who is providing regular and substantial care/ support to people and therefore providing improvements in the number of assessments and the delivery of services to carers. The Challenge: To improve the way we collect management information and obtain robust data in this area (by improvements in the way data is recorded and maintained) • We are currently reviewing the support we provide to all carers across all the client groups within Adult care with a view to re-commissioning services particularly to provide improvements in respite services for all carers.

13. Making Care Personal: Your Choice, Your Life Programme The emphasis is now on; • the individual’s dignity • the right to choice • control and power over the services they receive • a focus on providing services at an early stage, to help prevent people requiring high levels of care over a longer term. Changes we propose will; • enable people to have better access to information • to have greater control over assessment • more choice as to the services that suit them and their personal requirements. • A transformation programme, headed by a programme board, has been set up to implement the changes in Derbyshire - ‘Making Care Personal: Your Choice, Your Life’ and it is expected to continue through to 2011.

14. Outcome Based commissioning Outcome based commissioning is being introduced as part of the “Making Care Personal” Programme which will focus on providing services that meet the needs of individuals and will be measured by: • effectiveness • timeliness • what outcome the user gave and how they felt about the way in which is was delivered. The way in which these outcomes will be measured is under development but will include: • Performance measures e.g. National Indicators; • Results e.g. improved ability to undertake activities of daily living; • Experience of users and carers e.g. survey results Other client groups will focus on: • Maintaining a high level of performance on helping people to live at home • extending access to Direct Payments • the development of person-centred planning • reducing admissions to residential and nursing care.