Older People’s Well Being: Making the Shift Towards Prevention 9 th March 2006

1. Older People’s Well Being: Making the Shift Towards Prevention 9th March 2006

2. Public Health and the Preventative Agenda Carl Petrokofsky - Snr PH Mgr South East Public Health Group Older People – Opportunities for Public Health Action Dr Mike Gill - Regional Director of Public Health- South East South East Public Health Group Health Promotion in Extra Care Settings Michael Bridges - Principal Health Promotion Adviser Eastern Cheshire PCT

3. Policy Context Social Exclusion Unit Reports – March 2005/Jan 2006 House of Lords committee report – July 2005 Rowntree Report on long term care – August 2005 NAO report on stroke services - Autumn 2005 Opportunity Age – DWP - Spring 2005 NICE: Improving Health in Mid Life – 2005 Everybody’s Business: MH Services for Older Adults -2005 Elder Abuse - Sept 2004 Choosing Health – Nov 2005 NSFs – Older People, Long Term Conditions (Diabetes, Ca, CHD) POPPs projects Our Health, Our Choice, Our Say – Feb 2006

4. Choosing Health aims to: • Increase quality of life and life expectancy • Reduce inequalities in health • Improve the chances people have, to engage in healthy choices • Encourage healthy lifestyles

5. A Sure Start to Later Life… Ending Inequalities for Older People • Key themes: • Independence, Dignity, Choice • Use the approach of Sure Start for Older People • Achieve Basic Stds of Health and Wealth… and Housing • Quality of Life: participation; continue having meaningful relationships and roles • Building Inclusive Communities: contribution plus safety, access to services, transport • Strong leadership/citizenship: equality and discrimination

6. Early intervention and low level services 1 - Early intervention and low-level services • The current provision of services for excluded older people is focused on providing intensive, costly services once problems arise. • Shifting the emphasis to providing lower level services, earlier - before people develop intensive needs - means there will be less need for intensive services in the future. This is better for individuals and less costly. Relatively small numbers of people with high levels of need receiving care. Larger numbers of people who fall outside eligibility criteria for services but may benefit from lower level services. Improved access to “universal” services. Better “joined up” rehabilitation services. Lower levels of high cost intensive care services. Adapted from ADSS/LGA All our tomorrows

7. Big Wins from ‘Choosing Health’

8. Heating/insulation, Home safety/security, Cleaning, Shopping, Gardening, Equipment, Adaptations, Home Improvement Agencies, Community Alarms, Use of Technology, Handyperson/repairs, Lifetime Housing, Specialist Housing, benefit Take-up, Equity Release Befriending, Bathing, Meals service, Hairdressing, Carers support, Range of personal care including nursing, intensive home support, resettlement into sheltered housing, floating support, rapid response, rehabilitation, advocacy Transport, Personal safety, street lighting, built environment (pavements, dropped kerbs, disabled access), traffic management, community centres, advice centres and one stop shops, accessible shops with affordable products. Leisure, Primary Health care, Chiropody, Lifelong learning, libraries, employment, volunteering, day care, luncheon clubs, rehabilitation, step-up schemes, step-down schemes, engagement in priority setting, community development, healthy living schemes, peer support Home External Environment Early intervention and low level services The right bit of help, for the right person… ...the same services will affect people differently... Physical and Practical Personal and Social

9. Joined up and co-ordinated services What future services might look like for an excluded older person? • A ‘SURE START ‘model would enable a person entering at any place in the system to receive a seamless service. • Key features: • As access to services is critical for excluded older people - this could be via an outreach service, or via the voluntary sector. • The services available would not be limited to core statutory services. The voluntary and community sector would be fully involved and ‘low level’ would be part of the provision. • There would be local involvement in the ‘direction’ of the service. Finance & benefits Safety & environment Advocacy & specialist advice Housing Excluded older person Transport Social care Social activities Health

11. LOCAL AREA AGREEMENT • 3 year agreement that sets out the priorities for a local area agreed between central government and a local area (represented by the LA, LSP, and other key partners) • It will be refreshed annually • LAAs are outcome based and enable LAs and their partners to deliver national outcomes in a way that reflects local priorities, particularly those in Community Strategies, • A new way of managing relations between LAs and Govt • Brings together many different funding streams and priorities • Set out in 4 Blocks: Healthy Communities & OP Block

12. Social Exclusion…… it isn’t just a black and white issue

13. Key Questions for the Workshop: • Your team has £50k over 3 years to spend as a LAA Pump Priming Grant: • What are the public health ‘big wins? • What are the key obstacles to developing the Single Accessible Gateway to services? • Is the Single Assessment Framework the route to achieve this? • What’s stopping this? • How can we use the LAA process to support this? • How can we provide both the high intensive levels of support required awa the low level preventive services which reduce the demand in the high intensive end. (Is it possible to ‘invert the triangle’?) • How can we rapidly spread adoption of good (world class) practice: esp. within an increasingly pluralistic set of providers: e.g. poly-pharmacy; falls practice; nutrition; smoking; etc