Reshaping Care for Older People

1. Reshaping Care for Older People Improvement Network WebEx 08/06/2011

2. Agenda

3. Reshaping Care Change Plans 2011/15 Improvement measures (work in progress) putting outcomes at the heart of community care

4. “Find out what matters to your customers and turn the same into operational measures – the measures against which you will work and improve. The result is always better service and lower costs.” John Seddon

5. We will double the proportion of the total health and social care budget for older people that is spent on care at home over the life of this plan. We will build the capacity of third sector partners to help them do more to support the experience, assets and capabilities of older people. We will shift resources to unpaid carers, as part of a wider shift from institutional care to care at home. We will improve quality and productivity through reducing waste and unnecessary variation in practice and performance with regard to emergency admissions and bed days across Scotland. 10 year Programme for Change

6. We will aim to reduce rates of emergency bed days used by those aged 75+ by a minimum of 20% by 2021 and at least 10% by 2014/15. We will ensure older people are not admitted directly to long term institutional care from an acute hospital. All older people over 75 years will be offered a telecare package in accordance with their assessed needs. 10 year Programme for Change

7. Reduction in unplanned acute bed-days in the over 75 population; Reduction in bed-days lost to delayed discharge; Remodelled care home use; Increase in proportion of older people living at home; Improved support for unpaid carers; Increased personalisation/SDS care; and Increases in housing-related support” “Key measures of success or outputs from use of the Change Fund might include:

8. 7 suggested areas for measurement I counted 182 different measures Fall into 12 themes Proposed measures in 32 Change Plans

9. Shifting the balance of care – 19 plans Emergency admissions – 32 plans Delayed discharge – 31 plans Changes to use of hospital or care homes – 27 plans Self Directed Support and care – 20 More support at home – 24 plans Support for carers – 17 plans Improvement measures in 32 Change Plans

10. “Extra” themes: Better management of care – 17 plans Reablement – 10 plans Dementia – 7 plans Preventative and low-level services/ Community capacity building – 8 plans Measures of personal experience – 18 Improvement measures in 32 Change Plans

11. Measuring improvement in personal outcomes Outcome - Seeing people East Renfrewshire – Shared assessment review outcomes – (7 of them) met (M), partially met (P), unmet (U) Quarter ending 31 December 2010

12. So far we have consultation responses from 21 partnerships, 6 individuals and round table discussions at the Community Care Benchmarking Network quarterly meeting COSLA Health & Wellbeing Executive approved principle of Core Suite Health & Care Delivery Group supportive NHS Chief Execs 22nd June Consultation process

13. General support for the approach Please can we measure outcomes and quality – using Talking Points Yes, “A” are measurable without undue effort Will help test improvement alongside our other measures There are gaps - full set of 12 themes have support – but there is not always a “ready made” measure Consultation messages

14. Statutory perspective – unavoidable? All measures should be collected/analysed at local partnership level (or below) and for age groups 65 – 74, 75 – 84, 85 plus Low level of awareness of new end of life measure from Quality Measurement Framework Consultation messages

15. A1. Emergency inpatient bed day rates for people aged 75+ A2. Patients whose discharge from hospital is delayed (monthly) and accumulated days delayed for those on a census (quarterly) A3. Prevalence rates for diagnosis of Dementia lots of respondents don’t like this measure, but is there anything else for dementia? A4. Percentage of people aged 65 and over with high levels of care needs who are cared for at home Or A4. Rates per 1000 of people aged 65+ who live in housing, rather than a care home or a hospital setting A: Nationally available outcome measures and indicators

16. A5. Respite care for older people per 1000 population – propose to move respite to section B and develop a better improvement measure A7. Percentage of time in the last 6 months of life spent at home or in a community setting We also recommend that partnerships continue to develop their use of A6. Experience measures and support for carers (CCOF) A: Nationally available outcome measures and indicators (continued)

17. Anticipatory and preventative care B1. Proportion of care home residents who have an Anticipatory Care Plan shared or B2. Proportion of 75+ living at home who have a completed Anticipatory Care Planor B2. Waiting times between request for a housing adaptation, assessment of need, and delivery of any required adaptation and B2. Proportion of people aged 75+ with a community alarm / a telecare package Responsive / flexible home care B3. Proportion of home care provision at weekend and evening / overnightor B4. Proportion of home care clients in receipt of Reablement service or proportion of new home care clients who receive reablement or reduction in hours required after reablement service provided Support for carers Respite care for older people per 1000 population (old A5) B: Local Improvement Measures - options in italics

18. Demand for acute care B5. Rates of 65+ conveyed to Accident & Emergency with principal diagnosis of a fall – from Scottish Ambulance Service Effective flow in acute care B6. Numbers of 65+ inpatients boarded to another specialty or B7. proportion of frail emergency admissions who access specialty unit within 24 hours Use of long term residential care B8. Rate and proportion of new entrants admitted from home; acute hospital specialty; following intermediate care; graduate from emergency respite B: Local Improvement Measures - continued

19. Partnerships should attempt to measure the following: C1 Per capita weighted cost of accumulated bed days lost to delayed discharge C2 cost of emergency inpatient bed days for people over 75 per 1000 population over 75 C3 A measure of the balance of care (e.g. split between spend on institutional and community-based care) C: Partnership resource use; suggested measures

20. C: Partnership resource use; suggested measures C1 Per capita weighted cost of accumulated bed days lost to delayed discharge This is calculated by linking the Chi number and date ready for discharge of all Delayed patients with hospital PAS data. This allows the data of actual discharge to be subtracted from the date ready for discharge for each patient. This is the total number of days lost to delays. These can then be valued by applying a bed day cost (note: there are options for which costs to use).The total cost is then divided by the NRAC weighted population for 65+ (Partners have just received a NRAC file form ISD with weighted pops for 75+ and 65+). Partners should be able to calculate this individually but we're working with ISD to test whether they can do it centrally.

21. C: Partnership resource use; suggested measures C2 cost of emergency inpatient bed days for people over 75 per 1000 population over 75 Partners can use their IRF hospital data to obtain the cost of unplanned admissions for people aged 75+. This is then divided by the NRAC weighted population for people aged 75+.

22. C: Partnership resource use; suggested measures C3 A measure of the balance of care (e.g. split between spend on institutional and community-based care) Partners can subtotal their IRF spend analysis to produce totals for the cost of institutional and non institutional services. This can then be expressed as a percentage. E.g. 33% non institutional, 67% institutional.

23. Working through current review of Community Care Outcomes Framework to ensure maximum overlap – but that Framework is for all ages of community care users How will Core Suite fit with National Performance Framework – suggest promoting the balance of care measure “living at home” Joint Information Network to (finally) agree definitions of any new measures? How or where should progress be reported? Considerations

24. Nothing (yet) on Self Directed Support Community Capacity Building Better Management of Care Happy to go with proposed choices of initial improvement measures? Happy with IRF-based development of resource use measures? Considerations

25. Request for further updates on data compiled in January 2011 to support preparation of Change Plans An iterative process of developing better measures – how to take that forward in a more inclusive way? Is it the Joint Information Network? Further work

26. Contact details Chris Bruce Lead on Outcomes – Community Care Chris.bruce@scotland.gsi.gov.uk 0131 244 5654

27. Agenda

28. Agenda

29. Co-production and community capacity building • Grow societal support for the philosophy of a mutual care approach • A shift in expectation away from institutional care settings, towards community and home-based care; • Nurture a philosophy of care that embraces self management, supported self care and re-ablement; • Adopt an asset approach that value and empowers older people and their communities; • Promote the development of third sector organisations which harness the energy of local communities

30. Creating the right care services and settings • Housing • Housing adaptations services • Housing with care and support • Low level, preventative services • Equity release and shared ownership models • Building standards - • Care homes • Equipment and adaptations • Telecare and telehealth • Transport

31. Creating effective care pathways

32. Planning, implementation and support • Workforce development • Change Fund • Strategic joint commissioning strategies • Engagement with partners • Support to partnerships

33. Supports? • JIT/Scottish Government • Each Other • WebEx • E-Bulletin • Events • Web Site