Shaun Fitzpatrick Supporting People Manager North Somerset Council ‘The whole systems approach’

1. Shaun FitzpatrickSupporting People ManagerNorth Somerset Council‘The whole systems approach’

2. Presentation to cover:Where is North Somerset?DemographyAccommodation situationDemandsOlder Peoples aspirationsResource issuesService shapingMenu approachLocal servicesSome slides have background which will not be discussed in the presentation

3. Where is North Somerset?

4. Population 202,000 - doubled since 1950s – continued massive development • 8319 Social housing units & 8 – 12k private lettings. Must build 26k units by 2026. • Increasingly older population and inward migration • Large number of visitors which doubles population in Summer • PCT co-terminus but in deficit – many services Bristol based • Generally prosperous...10th richest parliamentary constituency But pockets of deprivation in WsM

5. Future Demography • Substantial increase in people over 50 and exponential increase in over 85’s by 2029 • More older people every where, but some regions and cities more affected • Higher proportion of men than now • More people with disabilities and health, care and support needs • More wealthy older people • Significant group of impoverished older people • Mismatch of supply and demand • Lack of care and SP budget to meet needs – rationing issues

6. Accommodation situation • More older owner occupiers, particularly in the SW • More older people living in poor standard homes need for repair, adaptation and improvement • Low void rates in social housing for older people – 2 to 1applicants • Un-sustainable repair/improvement reinvestment needed in sheltered housing - £4 to £8M for NSC, £1.4B nationally? • More older people live in general needs social and private housing than sheltered • Large proportion of owner occupiers live in former council housing • Most sheltered housing units too small • Population/society change have isolated some communities and sheltered schemes

7. Demands • Continued demand for social housing options • Increased need for social care at home • Increased adaptation • Seamless services to people rather than people into services • More specialist services as minority needs increase • Services which were focused on younger groups will migrate through natural progression to older people • Demand for accessible information by most but some not in IT loop • More privately financed options – capital, revenue and individual • More older person focused new accommodation • Increase in informal care needs – less couples and caring attitude?

8. Aspirations • Greater choice, where and when demanded – the ‘rights’ brigade • To stay in own home for as long as possible • Affordable housing options – more down sizing to release capital • Living in mixed community options – the ‘young old’ • More ‘older people only’ community options - village development • Improved transport links • More activity services for increased numbers of fitter older people • More control over individualised care and support services • Flexible finance arrangements to realise capital with ‘honest John’ providers • Improved coordination of services by those responsible

9. Resource issues • Sheltered stock nationally – 800K units, revenue cost £399M • Sheltered stock regionally – 67K, revenue cost £38M • Sheltered stock NSC – 1.8K units, revenue cost £1.4M – move to 75% floating • Pressure on SP budgets – 10% cut over 3 years nationally and 24% regionally – not reflected for North Somerset • SP in LAA budgets – loss to other sectors? • Social care budget pressures, continuing 4% gap of cost over grant – SP to deliver more care? • Social care focus on crisis avoidance/intervention and re-enablement • Social housing capital controlled by RHA and focused on general stock, affordable purchase and homelessness – currently £5M pa (3% of total capital) on extra care • Increased informal care cost which is currently estimated at £57B, twice the formal budget

10. How to re-shape services in the ideal world! • Consult local population, providers and service users • Develop an Older Persons Strategy • Develop an Older Persons Housing Strategy • Link to Sustainable Community Strategy and LAA • Based on resources available - create a menu of services • Deal with crisis intervention more effectively • Provide services based on need • Promote purchase of services • Publicise services and make access to information easy

11. Crisis service delivery • Hospital discharge – Discharge Manger for FACs cases • Option of Intermediate Care beds where return home not possible in short term • At home – Rapid Response Nursing for limited period • At Home – Intermediate Care team for limited period – integrated services • At Home – Re-enablement Home Care for limited period • At Home – better Home Care purchase and management • Linking to other secondary services and advice – SP, dispersed alarms, adaptation, assistive technology and trips coordination and community development services.

12. Service information – the single gateway • Careconnect http://www.n-somerset.gov.uk/Social+care/Advice+and+support/Care+Connect/ Our Care Connect service is the first point of contact for all social care inquiries within North Somerset Community Café – regularly over 7 locations – 30 info providers Free information and advice Food – by LD Community Enterprise Social time

13. Care Connect • Contact centre offers impartial advice on social care issues and helped thousands of people and since its launch in 2004. • It can guide towards the social care services we offer or put people in touch with voluntary, statutory or private sector organisation’s for help: • Basic housing help and advice • Benefits advice – integrated team • Carelink – dispersed alarms • Charging enquiries • Home care and day care advice • Home energy conservation advice • Local transport scheme information • Recording incidents of general, racial and homophobic abuse • Referrals to organisations within the Supporting People initiative • Residential and nursing home searches • Security issues for older people

14. Housing Links – Partnership working • One stop shop for all advice on housing and link to services and Choice Based Lettings • Co-location with Deposit Bond Scheme plus link to Credit Union • Close working relations with Private Landlord Forum • West of England Private Landlords guide • Close working with RSL Housing Management Forum • Management team cross over with Adult Care, Strategic Housing and Supporting People • Link between Local Strategic Partnership, Strategic Housing Partnership and SP Commissioning Body • SP Provider Forum and Sector Groups

15. SP services – Choice and menu approach • Some traditional Sheltered due to nature, size and location, but close links with floating services • Move to ‘retirement housing’ rather than sheltered • Extra care – some new build and some part conversion • Some modified Abbeyfield schemes – link to care homes • Large provision of floating support for Older People, some providers also provide care • Cross authority commissioned Dementiafloating support service • Largest sheltered provider moved to low level support menu creating own intensive service and Home from Hospital Service for non FACs cases • Care and Repair service with Private Rented Sector team • Future development of ‘volunteers’ service

16. Typical Sheltered service • Aim is to prolong independence and stay, avoid crisis and jointly work with: Adult care services and hospitals – hospital discharge, care planning and delivery OTs, Doctors and day services – regaining physical activity and avoiding trips Alarm provider and response Benefits service – debt and money management Supermarkets and volunteers - shopping Community transport – social orientation Sourcing grants for equipment and holidays Referrals to Care Connect and Care Homes Other residents over IT learning and social and fitness activity Relatives and other Sheltered providers over support and activity Floating support services to top up support needs Self purchasing care and support providers or ‘in house’

17. Typical Extra Care service • Aim is to prolong independence and stay, avoid crisis and jointly work with: Adult care services and hospitals – hospital discharge, care planning and delivery including co-location OTs, Doctors and day services – regaining and maintaining physical activity and avoiding trips Alarm response and daily contact Benefits service – debt, money management and maximising disability benefits Supermarkets and volunteers - shopping Community transport – social orientation Referrals to Care Connect and Care Homes Other residents over IT learning and social and fitness activity Relatives and other Sheltered providers over support and activity Self purchasing care and support providers or ‘in house’ Re-housing services for remaining partners who do not need service

18. Floating services • Aim is to prolong independence and stay, avoid crisis and jointly work with: Adult care services and hospitals – hospital discharge, care planning and delivery Benefits service – debt and money management Supermarkets and volunteers - shopping Community transport – social orientation Sourcing grants for equipment Referrals to Care Connect and Care Homes Care & Repair for adaptation and improvement Bobby van for security Joint planning and delivery of all care and support services Self purchasing care and support providers or ‘in house’

19. Retirement housing – rather than sheltered • Aim is to prolong independence and stay with minimum support options: The right accommodation option The right tenure options – rent/purchase Alarm and assistive technology link only where needed In house ‘support telecon/Net’ service Ability to adapt home for future frailty Self generated community activity Referrals to Care Connect and Care Homes Floating support services to top up support needs Self purchasing care and support providers

20. Care & Repair • Jointly funded and managed service • As with a number of services a Home Safety Action Form completed on each visit and referrals made and form returned to council for collation: Security Fire Safety Utility Safety check Keeping warm Falls Accident Prevention

21. Care & Repair – Typical case • Hospital discharge delay or re-admission avoided by: • Urgent visit, with permission to assess home • Key safe fitted • Adaptations undertaken • Disability equipment organised – free or purchased • Carelink alarm fitted • DFG accessed for ramp, rails and shower – work executed by use of digital camera specification • Benefits advice given and Attendance Allowance sourced • Grant for new boiler organised with PRS team • Agreed with client to pay directly for approved provider to renew some flooring and make some general repairs • Charity sourced for some extra income • British Legion agreed to visit and set up visits to social events • Bobby Van referral and security fitted • Fire Brigade referral and alarms fitted

22. Menu Sheltered Services • Residents consulted on own need and preferences resulting in menu of: Low – alarm response and 6 monthly physical check 30% of residents - £4 pw Medium – One to three intercom checks per week and one physical check per week 50% of residents - £10 pw High – Up to two intercom calls per week and up to three physical visits per week 20% of residents - £20 pw

23. Menu cont… • Support delivered by: Support Coordinators (200 units each) – responsible for a number of schemes and carry out assessments of need, risk assessments and support planning Support Advisors – carry out visits and support tasks Development workers – to promote self help activity, visit schemes and increase social activity Teams split geographically Sheltered Service Manager to coordinate and manage teams Additional links to current general needs floating service

24. Menu cont….. • Additional Floating services Long term – for those with additional needs, plus linking out to nearby community Short term – hospital discharge for non FACs cases in the community and where need be in sheltered. Will provide cross over of current floating and care and repair services , but can and will work jointly with them. Covers about 30 people per week. • Contract costs Block gross chargeable Value £615k covering about 1000 service users Total service worth £755k including self payers Some redundant stock to be re-used for other purposes

25. Questions ?