Building sustainable social care –
reducing demand and lowering costs
Professor John Bolton Consultant
JRFB Ltd
Ways to save money in Adult
Social Care – England and Wales
Reducing demand for services
Reducing demand for domiciliary
care
Reablement
Reviews
Reducing demand for residential
care
Intermediate Care and Health
based solutions
Driving down costs
The Resource Allocation Process
Direct Payments
Lean Processes
Mobile and remote working
Electronic Care Records
IT solutions
Models of care delivery
Housing based solution
including Extra Care Housing
and solutions for Younger
Adults
Commissioning for better
outcomes
Telecare and Telehealth
Children’s Transitions
Externalising services
Procurement
Adult Placement Schemes
Further ways to save money in
England and Wales
Raising monies
Citizens Contributions
Continuing Health Care
Partnership working
Health
Shared costs
Falls prevention
Diverting people away from social
care
Screening
Other partnerships
Stricter eligibility
Day Care future
Employment and Training
Customer Contact
Better management
Reviewing staffing numbers and
structures
Skills mix and Job Carving
Tackling sickness levels
Admissions to residential care from hospital
NHS nursing/group/residential care home
Non-NHS (not local auth) Res Care Home
Episodes ending between 1/1/2009 and 31/12/2009 by Welsh Local Health Boards to
Local Authority Areas
170
480
500
360
30
150
60
110
20
400
50
250
50
20
50
0
90
190
150
60
90
20
90
10
120
20
120
130
20
70
120
270
130
140
20
160
20
20
30
130
50
0
30
30
Vale of Glamorgan – improved
discharges
At a cost to the PCT – increased
nursing home admissions
Telecare and telehealth
Positive noises from whole system
demonstrator sites
Hard to identify “savings” because intrinsic to
approach to lowering demand – but business
case can be made – North Yorkshire
Investments and Partnerships – Birmingham
Could be part of the joint solution with NHS
For more help……….




Professor John Bolton
Independent Consultant
07789748166
john.bolton@jrfb.co.uk
Derek Law. MBE
Corporate Director,
North Yorkshire County Council
Telecare – Part of our Care Market Solution
Our Basic Budget Strategy.
Downward
Extra
Care
pressure on
Residential Care
Admissions
Increase
Support
More
People
Reablement
Domiciliary
Care Hours
More early
Intervention
via
3rd
Sector
Increase use
of
Assistive
Technology
We have over 12,000 using lifelines, 3346
have had access to telecare and each team
has a monthly target to increase usage.
Cumulative total of Telecare Services Started April 10 - February 2011
(new people w ho did not have a Telecare service prior to 010410)
300
250
HC Started
200
HR Started
Selby Started
150
SWR Started
Average
100
Target
50
0
April
May
June
July
August
September
October
November
December
January
February
HC Started
13
23
31
54
73
97
126
173
190
203
220
HR Started
14
35
65
96
113
129
146
188
211
230
239
Selby Started
9
18
25
38
60
73
86
104
119
133
142
SWR Started
17
30
47
64
76
89
111
140
157
164
175
Average
13.25
26.5
42
63
80.5
97
117.25
151.25
169.25
182.5
194
Target
16.67
33.34
50.01
66.68
83.35
100.02
116.69
133.36
150.03
166.7
183.37
We set ourselves a 10% increase at the beginning of the year. We are
achieving on average a 14% increase !
Outcomes and achievements
• Between April 09 – Now
– some 5000 multi-agency attendees at awareness, PR and installation training
sessions.
– The approach is assisting staff to manage risks when providing customised
services.
– People speak of how the service has helped them to carry on living at home
give more confidence/peace of mind, feel safer.
– All staff in social care have received awareness training, with new staff
targeted soon after arrival. It is embedded as part of our reablement
programme.
– The County has created a training pack and guidelines for fitting equipment
and developed Long Term Conditions pathways for a range of conditions with
PCT.
– LD providers now beginning to embed personalised technology as part of
support.
– Short stay residents to EPH’s offered Telecare to use in EPH and take home.
– Telecare tested and piloted in home for people with dementia and
demonstrated improved outcomes for residents and staff. ( St Celia’s)
The Finance Case
• We have an ongoing process of evaluation:
– Care managers identify what people’s traditional care package would have
been if Telecare had not available, and what the actual Telecare enhanced
packages of care were.
– 46% traditional packages would have been residential, EMI or nursing.
– 54% traditional packages would have been care at home.
– If existing homecare is >10 hrs, the trends indicated homecare reduced,
but still an element of care.
– If the traditional package was <7 hours, the trend was home care hrs
reduced or not have to be provided at all.
– Analysis indicated a net average efficiency/person on annual basis at
£3,654
– – a 38% reduction in care package costs.
• The DH and CSED have now taken NYCC model and expanded it
as a national evaluation tool. See the SCED website.
Case Studies
• Numerous!
• Tell the story ..we have numerous case
studies … they capture minds and hearts.
• How people are in control
• Personalisation.
• This is both a finance story and more
importantly one of people being more in
control of their own lives.
Thank You
A Range of videos, case studies,
reports and other resources are freely
available at:
http://www.northyorks.gov.uk/telecare
Derek Law MBE Corporate Director
Making Telecare Happen
Fast!!
Linda Sanders
Director of Social Care, Health & Housing
London Borough of Hillingdon
Change of scene
• Previously Director in Dudley
– Developed an effective Telecare service in the Borough over a number
of years
– Recently accelerated this development with Tunstall’s assistance
• Moved to new job in Hillingdon
– Telecare under-developed
– “Marginal” service
– OPPORTUNITY!!! Better outcomes, save money!!!
Making it Happen
• Plan has 4 key elements:– Business Case
– Leadership approach
– Ensuring local services are “Fit for purpose”
– “Winning over” the front line staff
Making it Happen
• Business Plan
–
–
–
–
Developed by Finance team
Foresees a net £4m+ saving over 4 years, (£805k first year)
Need to save 80 residential care weeks to breakeven, (year 1)
Delivers 3,000 Telecare users
• Leadership
–
–
–
–
Council and SMT on board
Clear, strong message about the vision
Appropriate Performance Management put in
“Partner Plan” put in place to ensure third sector, independent sector
and citizen voice organisations are also on board
Making it Happen
• Local services “fit for purpose”?
– Good basis in place with existing service
– Made sure that capacity to meet demand was properly planned
• “Winning over the Front Line”
– Training, training, training!!!
– Win over “hearts and minds”, NOT about the technology
– A little bit of “stick”!!
• Team targets for referrals
• You need a reason WHY NOT to include Telecare
Making it Happen
• A couple of other key things:– Assigned clear delivery responsibility to Assistant Director in order to
ensure that the work is done
– Hired a project manager to drive implementation, (part time)
– Work closely with the Telecare supplier
Thank you very much for
listening!!