Long, healthy, active and happy lives in Argyll & Bute

1. Long, healthy, active and happy lives in Argyll & Bute Tiree 16th July 2014

2. Scottish Government’s ‘20-20’ Vision By 2020 everyone is able to live longer healthier lives at home, or in a homely setting where we have: • Integrated health and social care • Prevention, anticipation & supported self management • If hospital treatment is required, and cannot be provided in a community setting, day case treatment is the norm • Highest standards of quality and safety, with the person at the centre of all decisions • People back into their home or community environment as soon as appropriate, with minimal risk of re-admission Tiree 16th July 2014

3. Reshaping Care for Older People: A Programme for Change 2011 - 2021 “Older people are valued as an asset, their voices are heard and they are supported to enjoy full and positive lives in their own home or in a homely setting." Scottish Government's vision for older people A Report on the Future Delivery of Public Services published in 2011 suggested we need to: • Prioritise preventative spending more money to help people live healthier and safer lives. This will mean less spending is required on hospital or specialist care later on. • Empower individuals and communities involving them in service design and delivery. This should result in services that match what people need and want. • Have organisations work closely together to deliver Services • Improve efficiency Tiree 16th July 2014

4. The Case for Change in Argyll & Bute • We are living longer. By 2032, the population aged 65 years and over is expected to increase by almost half (49%) across Scotland. • In Argyll & Bute the population of older people is projected to increase by 122% between 2011 and 2023. The largest projected increase (153%) is projected in the oldest age group (85+). • Between now and 2035: • An increase of 73.6% in the population aged 75 and over • Number of working age people will decrease by 14.4% • To continue to provide current services would need an extra £1.1 billion nationally • To meet demands in Scotland we would need: • a 600-bed hospital every 3 years for 20 years • a 50 bed care home every 2 weeks for 20 years • Need to act now to meet this increased demand… Tiree 16th July 2014

5. Reshaping Care for Older People: A Programme for Change 2011 - 2021 • 90% of older people do not receive ‘formal care’ in NHS continuing care, a care home or a home care service • Even though the proportion of older people receiving formal care rises with age it is still under half of those aged 85 years and over • 3000 people over 65 years receive more than 20 hours of paid care per week but 40000 people over 65 provide more than 20 hours unpaid care per week • 60% of health and social care funding is spent on providing institutional care in hospitals and care homes but only 7% on home care Tiree 16th July 2014

6. Reshaping Care for Older People: A Programme for Change 2011 - 2021 • Some messages from consultation • -people want to stay in their own homes for as long as possible • -people want personalised services, involved in planning their own care and be better informed about their options and choices • - people want more joined up working between health and social care • -people viewed prolonged hospital stays as not a good thing and should be avoided if there were better community services Tiree 16th July 2014

7. Model of Care PrinciplesExamples • Person centred joint anticipatory care planning • Prevention of unnecessary admissions to hospital • Prompt discharge home from hospital • Shift in culture towards enablement / reablement • High quality end of life care delivered in place of choice • Supporting people to manage their own illness • Developing services with third and independent sectors Tiree 16th July 2014

8. Reshaping Care for Older People: A Programme for Change 2011 - 2021 The agreed joint aims of the local and national Re-Shaping Care for Older People framework: • Caring for people in their own home wherever possible and for as long as possible; • Developing a range of suitable extra care housing that provides an alternative to low and potentially high dependency care home placements; • For service users in permanent residential care, the care will be delivered in a fit for purpose single care home providing high dependency nursing care and/or specialist dementia or end of life care. Tiree 16th July 2014

9. Reshaping Care for Older People: A Programme for Change 2011 - 2021 The agreed model of care is consistent with: • Outcome of consultation by Argyll & Bute Council with service users, carers and the community during 2009/10 and thereafter. • Outcome of joint consultation by Argyll & Bute Council and Argyll & Bute CHP via the Re-Shaping Care Framework during 2012/13. • The national Reshaping Care for Older People, A programme for Change 2011-21 Tiree 16th July 2014

10. Reshaping Care for Older People: A Programme for Change 2011 - 2021 The model of care is influenced by a number of factors: • A professional view within social and health care. Institutional care should be the last rather than the first choice of care provision. • Service user choice. A consistent message from the majority of service users is that given the opportunity they wish to live and die in their own home. • Demographics: 83% increase in the over 75’s between 2006-31 • Finance: Care in the community is invariably more cost effective than institutional care Tiree 16th July 2014

11. Reshaping Care for Older People: A Programme for Change 2011 - 2021 • Where are we now? • Joint Strategic Plan for Older People- Argyll and Bute • Engagement Programme with local communities September 2014 onwards • Shortened easy read version Tiree 16th July 2014

12. Some examples of change Dementia • Establishment of Dementia teams ~ partnership of NHS, Argyll and Bute Council, Alzheimer Scotland. • Multi disciplinary locality based teams who work closely with local communities and existing hospital and community services: Nurse, Occupational Therapist, Social Work involvement and Dementia link worker supported by a Consultant for Old Age Psychiatry. • Their work is demonstrating benefits to individuals, carers and families and include: - increased confidence in ability to do tasks and challenges - increased well-being through increased activity - increased use of skills via volunteering opportunities - Reduced isolation via increased social contact - increased participation in range of peer and activity groups Tiree 16th July 2014

13. Some examples of change Management & Prevention of Falls • Development of evidence based training resources to reduce falls risk. • An extensive training programme for staff, carers and wider public groups is now being delivered in all localities. It includes raising general awareness of the risk factors that lead to falls and how to reduce these for individuals and in the environment. • Falls champions in each locality are training staff from all partners to identify and act on modifiable falls risks. • Implementing pathways to help support older people at home after a fall and to reduce future falls. Tiree 16th July 2014

14. Some examples of change Community Resilience / Capacity Building Social Networks • Community resilience staff are a core support to older people. • Demand from older people ~ development of over 27 initiatives provided with and inclusive of the local communities, e.g. community cafes, craft clubs, music and lunch groups, book clubs, social activities. • Volunteers provide transport, help with shopping, and a range of other services amounting to an average 1300 volunteer hours each month. • Time banking is growing and is a form of community volunteering where people support each other and where everyone’s time is valued equally. - For example, Fred may offer to tidy Doris’ garden and bank those hours; Doris may teach a young mother to knit and bank those hours; the young mum may help Paul with using facebook or basic IT and Paul may offer transport to take Fred to hospital appointments. - Everyone can both give and receive and community networks are built. - In Argyll there are now over 1,000 time bankers many supporting older people and making us the largest Timebank network in the UK. Tiree 16th July 2014

15. Reshaping Care for Older People Key RCOP workstream where there is Change Fund investment and/or a specific working group other priority areas for RCOP and Joint commissioning Tiree 16th July 2014

16. Reshaping Care for Older People So overall, we want to help older people stay safe and well outside the care system by: • Promoting healthy ageing • Supporting Self Care • Supporting communities and unpaid carers • Focusing on more preventative and anticipatory care • Using more telehealthcare / equipment / adaptations Key to this is partnership working of the NHS, Council, independent & third sectors, users and carers and communities Tiree 16th July 2014

17. Tiree Initial Engagement • Purpose -to begin a partnership journey with community of Tiree and Coll -to start engagement that is meaningful and ongoing -to lay out some initial thoughts/ ideas -to listen to what you are saying today to these -to take on board your comments -to seek your ongoing involvement and engagement -to move together, to grapple with the issues and , to commit to ongoing engagement and information giving and hopefully agree a way ahead -not to set anxiety racing Tiree 16th July 2014

18. Tiree Initial Engagement • So what is the detail • i) Tigh a Rhuda is not the long term solution-model of care is 60s/70s thinking, ongoing investment in it, questionable from public £ perspective. Low occupancy rate/ high cost • ii) The solution cannot be in like for like-reflect on what big messages people are telling us around Reshaping Care-individualised care/ in control/ at home • Iii) A couple of meetings with NHS Argyll and Bute/ Argyll and Bute Council/ACHA and Cu᷅ram Thiriodh Tiree 16th July 2014

19. Tiree Initial Engagement • iv) Integrated Health , Council, and Community approach to Tiree • v) proposal for the development of a progressive care centre with some initial modelling based on the Mull and Jura centres • vi) A 2 site option -existing site at Tigha A Rudha with the 6 ACHA cottages • Site adjoining the Tiree GP’s surgery Tiree 16th July 2014

20. Tiree Initial Engagement • v) Both sites would negate need for land purchase • vi) Proposal would be to provide 8 (?) one bedroom housing units for affordable rent on secure tenancies plus 1 respite plus 1 medical bed with associated service hub area for day activities/health and social care staff base/ chapel of rest • vii) Proposal is to explore and include an appraisal of each option with refurbishment, remodelling, demolition, new build or a hybrid proposal for the first site and new build for the latter. • viii) Option appraisal to look at the detailed cost of each option and a split of the costs for the housing and non-housing elements. Tiree 16th July 2014

21. Tiree Initial Engagement • ix) This will allow ACHA to test the viability of the proposal against the current SG funding benchmarks and inform the NHS and Council who would have to look to capital funding (with Cu᷅ram Thiriodh ? ) to meet the non-housing element of the proposal. Tiree 16th July 2014

22. Tiree Initial Engagement • Concept of Progressive Care/ Extra Care Housing-what is it ? Mull and Jura are examples Care providers working together to ensure the older person maintains as much independence as is possible May include provision for in-patients,. May be 8 (? )individual supported living flats managed by ACHA. Residents care will be a tailored care package which will meet their needs during the day and night. Other features day provision, operational base for health and social care staff working across the community Tiree 16th July 2014

23. Tiree Initial Engagement Current Status of Proposal • Strong argument that Tigh A Rudha is no longer fit for purpose due to its design against current standards • Partners share common philosophy consistent with Reshaping Care and Strategic Plan that • We aspire to support islanders in their own home and on their own island for as long as is possible • We recognise that integration , partnership and professional flexibility will improve the probability of local solutions Tiree 16th July 2014

24. Tiree Initial Engagement • - We have signed up to Initial Scoping and Outline Agreement to undertake option appraisal • -We recognise that early and detailed consultation and engagement requires to be undertaken on the potential service development to seek broad support for the direction of travel, to inform where we should be going and to potentially extend and inform options • - We will look to develop a detailed service specification by the end of July/ early August to inform the current options • - no political approval to the above Tiree 16th July 2014

25. Tiree Initial Engagement • - need to learn the lessons of communication, and engagement from our experience with other progressive care centres • Need to build a plan of engagement with Tiree community to ensure clear understanding of what is to be planned for example clarity around progressive care, update on progress and timescales • Need to set up series of future engagement and planning meetings including with service users and families Tiree 16th July 2014

26. Tiree Initial Engagement • Comments and Questions Tiree 16th July 2014