Redesigning Services for Frail Older People – and Housing implications Mick Sanders

1. Redesigning Services for Frail Older People – and Housing implications Mick Sanders Head of Locality Commissioning for Norwich

2. Overview • Norfolk Profile • Structure and Role of Integrated Commissioning in Norfolk • Frail and Older People Work • Housing Contribution • Concluding Remarks

3. Norfolk Profile • Two tier local government • 7 district councils (housing authorities) • 1.5 PCT’s • Under ‘clustering’ to be .9 PCT ! • 5.5 Clinical Commissioning Groups (CCG’s) • 3 acute hospitals

4. New Integrated Commissioning Team • 1 June 2011 start at PCT offices • 5 localities in CCG boundaries • Change Implementation Team • Learning Difficulties, Mental Health and Drug and Alcohol not included • Acute commissioning not included

5. As was… NHS Out of hospital Services: Inc Frail elderly Long term conditions Community health services Community beds Carers End of life PHBs Social Care Services: Inc Domiciliary care Residential care Community care services Carers End of life PBs Supporting People housing related services: Inc Supported housing Floating support Socially excluded groups Employment

6. Integrated commissioning COSTS Person at the centre Social care NHS Community around them PERFORMANCE SP

7. Our priorities • Managing the money – Quality, Innovation, Productivity and Prevention (QIPP) • Managing the money – Comprehensive Spending Review (CSR) • Moving to locality commissioning • The added value of integration

8. What we offer • A ‘one stop shop for community commissioning’ • Expertise in commissioning across health, care and housing • New thinking to old problems • Networks to resolve issues • A focused and evidence-based approach • A resource to deliver to local priorities • Added value of integration

9. Developing localities

10. Frail Older People’s Pilot • McKinsey deep-dive work early in 2010 on unnecessary admissions • 12 week intensive project • Major tranche of Norfolk QIPP programme • Priority, given Norfolk demographics • ‘1 for 2’ investment for savings

11. Components of Frail and Older pathway include: • Identifying those at high risk • Case management function • Navigator / advocacy (PHA role) • Telecare & telehealth • Community ‘sub-acute’ bed based provision • Medicine for the elderly / mental health • Links to integrated care sites • Links to ‘Care Closer to Home’ Project

12. 8 6 5 9 4 3 2 1 7 FOP Case Management Pathway Identification of high-risk patients Allocation of high-risk patients to Case Managers Cases taken up by Case Manager and visits are made Patient is removed from list and referral arranged Case Manager reviews cases and makes referrals Case Manager reviews case with Integrated Care Team Services are delivered to patient Case Manager follows up regularly with patient Case Manager is updated by services

13. The New Landscape • Clinician led commissioning • Localism • Putting patients first • Closer integration • Financial austerity

14. …and Housing • Commissioning: evidenced based approach through the SP programme; • Localism: local focus of many housing providers • Putting patients first: tenant participation and service user engagement well developed • Closer integration: already multi-disciplinary • Financial austerity: long experience at belt-tightening and redesign

15. More specific added value • Housing a significant determinant of ill health • Think ‘prospective Frail Older People’ • Strategic and enabling work • Democratic mandate • Sheltered housing and floating support • Home Improvement Agencies: adaptations, falls prevention, affordable warmth, housing options etc. • The Swedish approach

16. Concluding Remarks • Cultural and language barriers • Common commissioning skills • Demonstrating added value • Solutions to health increasingly outside medical and clinical interventions • Health professionals need help to understand housing solutions • Significant change needs to be within 12 months

17. And finally Questions? Questions? Questions?