Post Diagnostic Support HEAT Measurement Workshop Workforce Planning and Costings

1. QuESTQuality and Efficiency Support Team Post Diagnostic Support HEAT Measurement Workshop Workforce Planning and Costings 6th February 2013 Welcome Glasgow City Community Health Partnership North West Sector Mental Health Division

2. What we set out to do • Identify the additional costs attached to delivering the commitment... • …and in our spare time deliver world peace

3. But we had difficulties in working out additional costs • Range of services and staff involved in delivering post diagnosis support • Difficulty in separating out 1st year support from ongoing support • Difficulties in quantifying service redesign opportunities

4. So, instead we looked at the costs of just the link-worker role.

5. So not world peace, but not a walk in the park either. To do this we needed to: • Estimate how many people will get diagnosed each year • Estimate total number of link-workers needed to provide 1 year post diagnostic support to everyone newly diagnosed • Plan a proposed split of link-worker role across different types of staff • Estimate how much of the link-worker role was already happening and funded

6. South Sector Glasgow City CHP • Pop. 126,194 (Over 30) and 27,023 (Over 65). NRS – GRO Figures 2010. • Approximately 25% of the population live in income deprivation. • 16% live in income deprivation in Scotland as a whole. • Relatively higher mortality, poorer physical and mental health. • Dementia incidence using Eurocode - 327.

7. Challenge One and TwoEstimating how many people will be diagnosed with dementia each year in your areaEstimating total number oflink-workers needed to provide 1 year post diagnostic support to everyone newly diagnosed

8. But only info on who diagnosed in specialist services… …Glasgow unusual – most areas don’t even have this

9. We can predict new diagnosis using population estimates but its complicated and there will be margins of error So if maintaining their current performance against the HEAT standard, South Glasgow will expect to diagnose between 175 -324 people a year Estimated annual incidence = predicted number of new people per year developing dementia South Glasgow 2013 = 327 1232 Number of people with dementia but not diagnosed Estimated prevalence = total predicted number of people in your area with dementia at a given moment in time HEAT Standard is that at least 50% of the total predicted population with dementia should have a diagnosis. As the population is aging the actual number needed to meet 50% increases each year South Glasgow 2013 = 2,646 Number of people actually diagnosed at a given moment in time 1414 (53%) South Glasgow 2013 = 320 Estimated annual mortalitybut don’t know how many of those are diagnosed.

10. Step 1Estimated number of people newly diagnosed with dementia

11. Challenge ThreeEstimating how the link-worker role will be split across different profession

12. Step 3Planning your staff profile for linkworker role • Moving most of early intervention input to non-health providers, but keeping strong links to OPCMHT and consultant referrers. • Alz Scot Link worker. 70% • C.P.N. 20% • O.T. 10% • Linking clients with appropriate support skill level. • Reducing cost/releasing specialist health resources for moderate or severe.

13. Planning staffing profile cnt/d • Based on local model/local circumstances. • Change Fund money to employ 2 WTE Alzheimer Scotland Link Workers in Sept 2012. • OT in self management. • Strong links to other services • Social Work – Carers Support Service. Must be strong links with Social Work. • Dementia Advisor. • MacMillan Partnership – Financial/legal.

14. Step 4Costing proposed staff profile for linkworker role

15. Challenge FourEstimating how much of the link worker role is already happening and funded

16. Step 5Who is currently doing the role? This is difficult to collect and self estimates not likely to be accurate

17. Step 5Who is currently doing the role? • South Glasgow now piloting an activity tracker to audit over a 2 week period how staff actually spend their time.

18. Step 6Working out the difference • You’ve estimated the total numbers and costs of staff you need to deliver the target • You’ve estimated the total amount of time by different staff currently spent on PDS in the 1st year post diagnosis • So the additional staffing/funding you need is simply 1-2 • But not quite that simple….

19. The tool then automatically works out marginal staffing costs for the linkworker role

20. Step 7 Additional costs associated with link-worker role

21. The tool then automatically gives you a summary of overall total and marginal costs

22. Key lessons learnt - costing • Not possible to fully cost impact of target too many uncertainties • Variation in current fundingRanging from 58% – 100% of projected linkworker costs • 3 sites currently using change fund to part fund linkworker costs(fixed term 2014/15)

23. South Glasgow lessons learnt using the tool • Emphasis on non health providers but with strong links to local mental health team and referral pathways. • Strong links with social work/social care providers. • Balance between ideal and what is practical/affordable • Tool is a useful planning resource for HEAT target.

24. Questions/Discussion • Utility of Tool: Would you use this tool to facilitate PDS planning? What are your thoughts/comments? • Who: From your own area – can you identify the core professionals who you think will undertake the one year link worker role? • From this group, how would you see the professional mix? Why? • How: What would your local model look like? How and where would your PDS link workers operate in your area? (For example, where would they be based? Would they be part of a discrete team or linked to other teams?) • What would the patient’s journey look like in your model? Could you draw a diagram? • Change: What would you need to do/change to make this happen?

25. QuESTQuality and Efficiency Support Team Thank you for attending Glasgow City Community Health Partnership North West Sector Mental Health Division