Promoting Independence:
changing the model for
social care in Norfolk
Norfolk Older People’s Strategic Partnership Board
September 2015
The drivers for change:
• Outcomes and expectations are changing
• Patterns of ageing are changing
• The Care Act is changing entitlements and responsibilities
• The pressure on public funding and very real cuts in local
authority budgets mean we need to refocus LA funding.
How does Norfolk compare with elsewhere?
In comparison with our ‘family’ of shire counties, Norfolk’s pattern of services shows:
• A very high number of people contact the Council about social services
• We formally assess twice as many people as our comparator authorities
• A high level of older people admitted permanently to residential care homes
• There is a good track record of enabling people to stay independent after
discharge from hospital through reablement
• A very low number of discharges from hospital are delayed because of social care
• A very high number of admissions to residential care are made from hospital
• A relatively low number of carers use self-directed support
• People using care services in Norfolk generally feel safe and well supported: they
generally feel very satisfied with their care.
Contacts to social services
Norfolk has lots
of contacts
Assessments
And turns a
greater proportion
of these into
assessments and
then into service
users
Numbers of people admitted to permanent residential or nursing care for
people 65+
What this measures:
• The number of people aged 65+ being
permanently admitted to residential or nursing
care per 100,000 population aged 65+
• 2014/15 data
Number of people aged 65+ permanently admitted to
residential care per 100,000 population aged 65+
1400.0
All councils
Family
Norfolk
Shropshire
1200.0
1000.0
800.0
600.0
Notes and comments:
• Similar position to last year – towards the
upper end of the family group, though not as
significant an outlier as the 18-64 rates
400.0
200.0
0.0
Permanent admissions to residential and nursing care for people aged
65+ per 100,000 population, over time
What this is telling us:
• Norfolk’s rate still seem a little high,
particularly given lower levels of short term,
and even overall long term, support
900
800
700
600
500
Norfolk
400
Family Group
300
200
100
0
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
Percentage of residential and nursing care placements referred from hospital
for people 65+
What this measures:
120
• The % of residential and nursing care
placements that were referred directly from
hospitals for people 65+
100
• 2014/15 data
Percentage of residential and nursing care placements
referred from hospital for people aged 65+
All councils
Family group
80
Norfolk
Shropshire
60
Notes and comments:
• Included here because a developing
hypothesis is that Norfolk receives excessive
referrals from hospitals
• Follows on from last slide re: high overall
hospital referrals into short term social care
40
20
0
What this is telling us:
• Norfolk is highest in its family group, and very high overall
• Significant lead for further investigation – people are obviously going into residential care following a crisis, via hospitals.
What is driving this? The John Bolton delayed discharges hypothesis? Market failure in other (homecare) settings?
The financial position:
Adult social care budget for 14/15: £242m
Current predicted overspend: £5.5m
Anticipated gap in NCC funding over next three years: £110m
Translates into over £50m reduction of ‘addressable spend’ in adult
social services over the next 3 years.
Excellence in
education
Quality of life for
vulnerable
people
Real jobs
Promoting Independence
Living independently at home
Keeping well & recovering your
health
Looking after yourself
Involvement
in your
community
Getting
information
and advice
Getting early
help when
you need it
Getting
better after
being ill
Living with complex health
conditions
Managing
your long
term health
condition
Running your own life – making choices and decisions
Getting
support for
your complex
health needs
Making the difference: early focus
• Work with District Councils on local information, community development
• Consider a locally based ‘clinic’ approach to assessment to strengthen
community links (Staffordshire model)
• Ensure reablement is working to best effect – increase access
• Rework assessment and review processes to strengthen independence, link to
community assets, review Personal Budget allocation process
• Build on integration to ensure smart working with NHS
• Progressing development of housing with care.
Making the difference: wider changes?
• What really makes a difference for older people and
their families?
• How do we make the most of what communities have
to offer?
• How do we change culture and assumptions?