Commissioning for Independence: Shaping Future Health and Social Care

1. Integrated Care Conference 15th April, 2016 Commissioning For Independence and Shaping the Future Doug Sheperdigian Atlantic Customer Solutions

2. Introduction • This document contains the slides presented at the ICC conference on 15th April, 2016, by Doug Sheperdigian of Atlantic Customer Solutions. • In a few cases, slides representing proprietary material have been taken out. • In the event that you would like to discuss the full text or have follow up questions, please contact Doug at: • Doug.sheperdigian@atl-cs.com • 07880 521224

3. Agenda • Who are we? • Is the System Working? • What are relevant Outcomes? • Can Independence improve? • Integrating Social Care and Health in the Home • Our Vision for the Future of Long Term Care • Co-Production • Questions

4. Who Are We? • Local government – commissioner, operations, etc • Health authority • Provider • Other • Work with the Elderly • Work with Learning Disabilities • Other Service • Have Participated in an Atlantic workshop • Anyone’s birthday today? ?

5. Who is Atlantic? Commercial Background… 10 years in UK Public sector – Local Government, Health & Social care Championing Outcome Based Services

6. Our Scope today - Health and Social Care in the Home • Older People • Home Care • Supporting activities of daily life • Dementia support • Community equipment and Telecare • Continuing Health care • District Nursing • Community Matrons • General Practitioners

7. Commissioning for Independence (Outcome Based Services) • Most of our health and social care is delivered on a “time and task” basis • We specify a particular task • We pay for a unit of input Outcome Based commissioning means commissioning to: • Improve outcomes for individuals which promote personal independence and resilience. • Improve outcomes at a population level • Social care recipients • health care recipients • Specifying a desired, measurable outcome • Paying for the achievement of the outcome

8. Models of Care • Working in a Time and Task world? • Working in new models of care (eg, an outcome based model) • Working with a payment by results model?

9. Question 1– Current Sustainability In Twos and Threes: Quick Questionnaire • How sustainable is the current time and task system for home care and community health services? • Do you believe that the current system tends to create a culture of dependency? (or independence?) • What are the issues? Choose one to share.

10. Gathering Thoughts

11. Some we Prepared Earlier • Workforce not available • Budgets cannot cope with Living wage • Budgets cannot cope with demographic pressure • Providers cannot be sufficiently profitable • Difficulties in integrating Health and Social Care

12. A County Council How would you rank the state of home care in your Council? Unsustainable Neutral Sustainable Very Unsustainable Very Sustainable

13. A London Borough How would you rank the state of home care in your Council?

14. This is what providers said In your opinion, how sustainable is the current system for commissioning home care services? • 1= very unsustainable • 2 = unsustainable • 3= neutral or don’t know • 4 = sustainable • 5= very sustainable Make legend clear Source: RBWM Provider event, 2014

15. Outcomes

16. Three Types of Outcomes • Personal outcomes (eg, “Outcomes that matter to the individual”) • Independence and Wellbeing Outcomes (eg, able to dress, feed and transfer, social inclusion) • Population Level outcomes (eg, number of falls, emergency hospital visits, overall cost or cost per head)

17. A Number of Frameworks have been published Population Level Independence Outcomes Personal Outcomes Personal Outcomes

18. Care Act Guidance uses Personal Outcome Language and a standard for wellbeing Section 1.1 “…the outcomes that matter to them …” Section 1.11 “their desired outcomes” “flexible approach” Section 1.15 (and 4.12) “The focus should be on supporting people to live as independently as possible for as long as possible.” Section 1.19 outcomes that truly matter to people, rather than using the relatively abstract term “independent living”. Section 1.6 “The individual aspects of wellbeing or outcomes”

19. Wiltshire focusses on Activities of Daily Life (ADL’s) • Keep in mind that the programme includes Re-ablement – so Initial Support plan was about recovery from hospital

20. Some Evidence – for Independence From Peter Gore, Professor of Practice at Newcastle University, Centre for Ageing

21. Quick Quiz on Functional Decline According to Newcastle Centre on Ageing Research: What is the first capability to be lost of these three? • Cutting Toenails • Cook a hot meal • Transfer from toilet What is the last to be lost? • Transfer from bed • Walk 400 yards • Feeding oneself

22. The Concept in a Nutshell • Functional decline can be measured in terms of Activities of Daily Life • These Generally occur in a predictable order as people age • Specific, Timely interventions can delay specific loss of function • Life expectancy is not affected • Quality of life is affected!

23. Integrating Health and Social Care

24. Health Outcomes Desired • Fewer (non-elective) hospital admissions • Quicker Discharge • Shorter stays • Lower cost for Continuing Health Care (CHC) • Fewer home visits • Deflection from Nursing/Residential care These are generally measured on a population level rather than individual clinical outcomes

25. In

26. Integrating with Health presents a big Prize, but requires much time and co-operation Safeguarding is paramount Training is the Foundation The Atlantic “staircase” was presented. As this concept is still in development, the detail has been taken out of this version. If you are interested in learning more or discussing in detail, please contact doug.sheperdigian@atl-cs.com In conjunction with self-medication, self-treatment schemes

27. What Have you Seen? In groups of 4 and 5… • Where have you seen successful, or promising examples of health and social care activities joined up at the local level • Pick one to relate back • Fewer (non-elective) hospital admissions • Quicker Discharge • Shorter stays • Lower cost for Continuing Health Care (CHC) • Deflection from Nursing/Residential care

28. The Business Case for Independence

29. The Commissioner’s Headache • How to deliver the letter and spirit of the Care Act and the NHS Act… • …Without the budget going bust?

30. What are the Benefits of an Independence Service • Increased Independence means less work in the system. • Frees up NHS resources • Better lives for our patients/clients • Removing culture of dependence • Better sustainability and profitability for Providers

31. A Closer look at the Economics of Independence

32. Status Quo – Three kinds of People Some People will stay the same for quite a while Standard Support Package Level of Support Needed Time

33. Some service users will decline over time Their support plans will increase Standard Support Package Level of Support Needed Time

34. Some service users will improve under the status quo Standard Support Package Level of Support Needed Time

35. The Case for Independence Rests on the Assumption that People can Regain what is temporarily lost Standard Support Package Level of Support Needed If Outcomes are Met Time

36. Some will be able to halt a decline Standard Support Package Level of Support Needed If Outcomes are Met Time

37. Some will improve even more than expected Standard Support Package Level of Support Needed If Outcomes are Met Time

38. And for some it will make no difference Outcomes Attempted, but not met Standard Support Package Level of Support Needed Time

39. The Business Case – orders of magnitude • Fewer hours of community-based care for a given population • Less time in Residential/Nursing Care • Less time in Hospital £200m to £1Billion £2 Billion £ Very Large!

40. An Idea for the future was presented, however this concept remains in development and is not yet authorised for publication.

41. Atlantic has convened a national dialogue on outcome based commissioning

42. The Next Event will be 27 May, in Cambridge

43. Thank you for your attention!

44. Questions and Discussion