Prevention & Personalisation
A Health & Social Care Agenda
Jan Clark
East Midlands Programme Director
for Personalisation
The National Policy Agenda
“…authentic partnership working with the local
NHS, other statutory agencies, third and
private sector providers, users and carers
and the wider local community to create a
new, high quality care system which is fair,
accessible and responsive to the individual
needs of those who use services and their
carers.”
Putting People First – The Concordat (2007)
“An integrated approach to health and
wellbeing will require a step change in the
relationship between local NHS
organisations, local government, other
relevant statutory services, employers, third
sector and independent sector providers…to
ensure synergy between vibrant primary and
community care services and the ‘Putting
People First’ transformation programme led
by local government.”
Next Stage Review, Darzi, 2008
Universal Services
• Leisure
• Information and advice
• Health & wellbeing
• Quality housing
• Transport
• Community Safety
• Employment services
• Education
• Libraries
Universal Services
• Leisure
• Information and advice
• Health & wellbeing
• Quality housing
• Transport
• Community Safety
• Employment services
• Education
• Libraries
Social Capital
• Support networks
• Volunteering
• Neighbours/friends
• Voluntary sector
services
• Carers
• Community work
• Faith communities
• Supporting People
Choice and Control
• Self-Directed Support
• Personal Budgets &
Personal Health
Budgets
• User-Led Organisations
• Advocacy
• Brokerage
Choice and Control
• Self-Directed Support
• Personal Budgets &
Personal Health
Budgets
• User-Led Organisations
• Advocacy
• Co-production
• Brokerage
Prevention & Early
Intervention
• Falls prevention
• Intermediate Care &
Reablement
• Early intervention
• Extra Care
• Telecare & assistive
technology
• Community equipment
• ‘At Risk’ Case
identification
Putting People First Milestones
Effective
partnerships
with People
using services,
carers and other
local citizens
April 2010
October 2010
April 2011
That a communication has been made to the public including all
current service users and to all local stakeholders about the
transformation agenda and its benefits for them.
That local service users understand the
changes to personal budgets and that many
are contributing to the development of local
practice.
That every council area has at least one user-led
organisation who are directly contributing to the
transformation to personal budgets. (By December
2010)
That all new service users / carers (with
assessed need for ongoing support) are offered
a personal budget.
That at least 30% of eligible service users/carers have
a personal budget.
That the move to personal budgets is well understood and that
local service users are contributing to the development of local
practice. [By Dec 2009]
That users and carers are involved with and regularly consulted
about the councils plans for transformation of adult social care.
Self-directed
support and
personal
budgets
Prevention and
cost effective
services
That every council has introduced personal budgets, which are
being used by existing or new service users/ carers. *
That every council has a clear strategy, jointly with health, for
how it will shift some investment from reactive provision towards
preventative and enabling/ rehabilitative interventions for
2010/11. Agreements should be in place with health to share the
risks and benefits to the ‘whole system’.
That all service users whose care plans are
subject to review are offered a personal budget.
**
That processes are in place to monitor across
the whole system the impact of this shift in
investment towards preventative and enabling
services. This will enable efficiency gains to be
captured and factored into joint investment
planning, especially with health.
That there is evidence that cashable savings have
been released as a result of the preventative
strategies and that overall social care has delivered a
minimum of 3% cashable savings.
There should also be evidence that joint planning has
been able to apportion costs and benefits across the
‘whole system’.
Information and
advice
That every council has a strategy in place to create universal
information and advice services.
That the council has put in place arrangements
for universal access to information and advice.
That the public are informed about where they can go
to get the best information and advice about their care
and support needs.
Local
commissioning
That councils and PCTs have commissioning strategies that
address the future needs of their local population and have been
subject to development with all stakeholders especially service
users and carers; providers and third sector organisations in their
areas.
That providers and third sector organisations
are clear on how they can respond to the needs
of people using personal budgets.
That stakeholders are clear on the impact that
purchasing by individuals, both publicly (personal
budgets) and privately funded, will have on the
procurement of councils and PCTs in such a way that
will guarantee the right kind of supply of services to
meet local care and support needs.
These commissioning strategies take account of the priorities
identified through their JSNAs.
An increase in the range of service choice is
evident.
That councils have clear plans regarding the
required balance of investment to deliver the
transformation agenda.
High: 100
Average: 66
0
Low: 24
Rutland 51
Lincolnshire 53
Northamptonshire 58
20
Nottinghamshire 62
Leicestershire 62
40
Derbyshire 62
Nottingham 77
60
Derby 67
80
Leicester 92
Number of individuals aged 75+ with 2+ emergency admissions
per 1000
120
100
Occupied bed days of those aged 75+ associated with 2+
emergency admissions per 1000
4,500
4,000
3,500
High: 3,879
Average: 1,984
Rutland 1,353
Lincolnshire 1,560
Nottinghamshire 1,620
0
Northamptonshire 1,690
500
Derbyshire 1,771
1,000
Leicestershire 1,819
1,500
Derby 1,973
2,000
Nottingham 2,224
2,500
Leicester 2,963
3,000
Low: 496
People choose less dependent options: this is typically more cost effective
TRANSFORMING SOCIAL CARE
General
Population
“Low Level”
Advice & Support
Support
At Home
Institutional
Care
Information
Crisis Response
Re-ablement/ POPPs
Transforming Community Equipment
Support Related Housing & Assistive Technology
Commissioning and Brokerage
Models of Support Planning
Acute
Care
How well are Health & Social Care doing?
• In 2005, 2.5% (241,200) people over 65 in care homes,
supported by their council. In 2009, this had fallen to
2.1% (208,530).
• In 2009, 148,000 people received support services that
helped avoid emergency admission to hospital,
compared to 80,000 five years ago.
• 157,000 people received support services that helped
them return home quickly from hospital, compared to
112,000 five years ago.
• The number of people experiencing delayed discharges
fell from 3,600 per week in 2003/04 to 2,200 per week in
2008/09.
• Non-residential intermediate care supported 122,000
people (40% increase since 2004) with 34,000 in
residential intermediate care. 78% of people using
rehabilitation and reablement continued to live at home.
Challenges
• A three-fold variation in the extent to which councils
place older people into care homes.
• Up to a thirty-fold variation in the proportion of people
experiencing delayed discharges.
• Variation in the development of joint preventative
services that reduce emergency admissions.
• Variation in the effectiveness of intermediate care.
• 53% of GPs report receiving discharge summaries in
time for them to be useful. Hospital to Community
services interface.
• Continuing financial pressures.
Prevention and Personalisation:
What does good look like?
• Joint falls prevention and fractures pathway
• Joint comprehensive intermediate care and crisis
response
• Mainstreamed assistive technology
• Self-directed support
 Personal Budgets/Personal Health Budgets
 Direct Payments
 Service users/carers active in decision making
• Primary care case identification of individuals at high risk
• Health actively engaged locally in TASC/PPF delivery
and governance arrangements
East Midlands Personalisation Website
www.dhcarenetworks.org.uk/Personalisation/Regions/EastMidlands