Older People’s Provision and Self Directed Support

1. Older People’s Provision and Self Directed Support Geoff Mark Joint Planning & Commissioning Manager

2. Overview • Why have so few older people taken up SDS? • What impact will the SDS Bill have? • How would we use SDS to address the key challenges facing older people ?

3. Why have so few older people taken up SDS? Commonly Cited Reasons • Not what older people want? • Attitudes and expectations • Limited Resources (especially beyond Personal Care) • Time

4. Why have so few older people taken up SDS? Or are these just excuses? Do we just need to try harder and believe a little more?

5. Why have so few older people taken up SDS? Research suggests • Not what older people want? • YES - but also that this depends on the information they have and crucially the support they have to manage an SDS budget

6. Why have so few older people taken up SDS? Research suggests • Attitudes and expectations • YES – attitudes of older people, their families and professionals but attitudes do not exist in isolation. Different experiences and expectation can lead to fundamental attitude change

7. Why have so few older people taken up SDS? Research suggests • Limited Resources (especially beyond Personal Care) • YES – but we don’t give people a chance to make choices about this and there is also the question of whether a small amount of preventative resource could deliver a better outcome?

8. Why have so few older people taken up SDS? Research suggests • Time • YES – but the key point is that people need to be able to change things when their needs change or their experience develops – we need to deliver SDS in a way which reflects the experiences of older people e.g. discharge from hospital • The current system is struggling too.

9. What impact will the SDS Bill have? • Answer - I’m not really sure • Certainty: Existing Models are unsustainable • If SDS can assist with maintaining outcomes in the context of decreasing workforce, increasing demand and limited public finance the impact will be huge.

10. What impact will the SDS Bill have? Options • Option 1 direct payment • Option 2 the person directs the available support (arranged by the local authority) • Option 3 the local authority arranges the support • Option 4 a mix of the above.

11. What impact will the SDS Bill have? Option 3 – What we do already • Choice = choice of provider • Control = choice of visit time (one of in the specification of the care plan) • Reality as things get stretched – provider = whoever has capacity and visit times = when they can be fitted in.

12. GIS Examples

13. Traditional Approaches to Efficiency (Option 3) – Geographical Zones

14. Traditional Approaches to Efficiency (Option 3) – Geographical Zones • Probably couldn’t force people to change providers under SDS Bill – has to be a good thing? • But if there is no change and traditional approaches are unsustainable – then what?

15. What impact will the SDS Bill have? • Option 1 – Will work very well for some • Perhaps not many? • Will it address workforce and financial issues?

16. So that leaves Option 2

17. Individual Service Funds • Developed to give individuals more choice and control by disaggregating the resources in block contracts. • This is not required within older people’s services where there are no block contracts. • For older people – they could allow greater by: • Greater flexibility and co-ordination - negotiation directly between the service user and the provider. • Ability to aggregate resources with others

18. Example – A sheltered Housing Development in Dumfries • 28 residents • 8 receiving care from 8 different providers • Residents and Sheltered Co-ordinator very frustrated “surely we can organise things better than this”

19. Key elements of Extra Care Housing • On site care team • Coordination – not just of care but of wider aspects of wellbeing in both the community and for individuals e.g. Social activities, participation of the wider community etc • Also flexibility to maintain a community with a range of dependency levels.

20. Example – A sheltered Housing Development in Dumfries • Traditional Extra Care Housing Solution • Tender for one provider

21. Example – A sheltered Housing Development in Dumfries • Personalised Approach – tender for a provider to work with the residents and the Housing providers to achieve better outcomes: • Could centralise care – but under ISFs • Could start by centralising communal activities e.g. laundry, meals, social activity • Anyone wishing to retain current provision can do so

22. What the residents said • Residents said they were “up for change” if it would work? • We are just developing the specification and tender process. • It won’t be the traditional tender because we can’t be sure ahead of time what we want.

23. Lessons for the wider care at home services • “Virtual Extra Care Housing” • Would like to try to replicate some of the positives of Extra Care Housing in the care at home market • This will need to have a geographical component as we will not have the resources to simply increase prices so different models will have to be viable in the current resource envelope?

24. GIS Examples

25. Possible components • Geographical clusters of 20 – 30 people • Change care at home specification to include wider coordination, including a focus on wellbeing and connections with the wider community • The big question – Will geographical efficiencies release resource and will the balance between flexibility and constraints on choice be attractive? • Can there be incentives for service users, families and providers to find alternative ways of meeting need?

26. Final points • Small achievements may be very significant in the context of older people’s care e.g. one hour per month for social activity is better than nothing at all. • People will opt in if there outcomes are better!