WELCOME North Ayrshire Health & Social Care Providers Forum - PowerPoint PPT Presentation

WELCOME North Ayrshire Health & Social Care Providers Forum Add Title Here Friday, 25 th October 2019 Add name of presenter here Greenwood Conference Centre WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care

Care Home Commissioning Strategy N ORTH A YRSHIRE Heal alth a and S d Socia cial C Care Par Partne nership ip Caroline Whyte WORKING TOGETHER IN PARTNERSHIP

Introduction • Progress so far – Reference group • Care home / evidence base • Future Requirements • Financial implications • Next Steps N ORTH A YRSHIRE Health & Social Care Partnership

Current Context • In North Ayrshire, we have identified: • Fragility in the Care Home Market • Changing population • Financial pressures on IJB • Current care home use • Limited success of tests of change (palliative/end of life and step up/down beds • Lack of future ‘shared’ vision about the role and expectations of care home provision Shared Ambition – An effective, responsive and sustainable care home market in North Ayrshire

Future challenge • Predicted increase in older people population • Offset by a decreasing working age population • In 2017 the Older People Dependency Ratio was 35% • By 2027, this is expected to rise to 48%

Current Situation • Care Home Data • Use of historic information – quality issues with information dating back to 1980’s • Use of more recent placements and capacity – split pre and post IJB • Future capacity requirements – demographic projections, length of stay, community supports, HSCP strategic ambition • Locality information – occupancy, capacity, placements • Caveats • Only for clients North Ayrshire HSCP financially support • Unknown capacity used by other areas • Further test assumptions from data, next steps

Impact of National Care Home Contract North Ayrshire Care Home: Capacity and Occupancy Capacity Occupancy Contract 50 160 140 120 100 80 60 40 20 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Arran Garnock Valley Irvine Kilwinning North Coast Three Towns • Green line illustrates assumed capacity in the National Contract Costing model • In North Ayrshire, most Care Homes fall below this line

Current Residents Current Care Home Residents • 805 care home residents, care managed by North OOA, 156, HSCP 19% • 81% cared for in an NA Care Home. • 19% in an out of area care NAC, 649, 81% home. Placement based on client choice • • Indicates sufficient capacity in North Ayrshire, gap info capacity other areas using

Residents by care type Breakdown by Care Type Residents by Care Type Op Nursing Care Op Residential Care 150 138 Op 121 Residential Care, 258, 83 32% 61 56 43 Op Nursing 30 29 28 Care, 547, 26 16 14 10 68% Arran Garnock Irvine Kilwinning North Coast Three Towns OOA Valley • Most areas have higher levels of Nursing care than Residential • Out of area (OOA) – established this is through personal choice/preference • Analysis of eligibility criteria suggests people are placed appropriately by need (Substantial or Critical)

Care Home Residents Age of Care Home Residents (Current) Gender of Care Home Residents (Current) Op Nursing Care Op Residential Care Op Nursing Care Op Residential Care 281 389, 66% 198, 34% 132 131 173, 73% 113 108 64, 27% 36 18 5 65 - 69 70 - 79 80 - 89 90 plus Female Male • While greater number of women overall, there is a slightly greater proportion of men in Nursing Care

Care Home Capacity by Locality Care homes per locality Capacity by Locality and current occupancy 379 Three Towns 5 North Coast 5 233 219 Kilwinning 1 162 152 121 Irvine 4 103 70 60 46 45 36 Garnock Valley 2 Arran Garnock Valley Irvine Kilwinning North Coast Three Towns Arran 2 Residents Capacity • Indicates adequate capacity in localities • Gap – capacity used by other Partnership’s / people from out-with NA

Care home residents by home locality • Most Care Home residents remain in their home locality (except Kilwinning)

Care Home Turnover CARE HOME ADMISSIONS CARE HOME DISCHARGES Nursing Residential Total Nursing Residential Total 409 398 397 394 391 383 382 370 366 355 344 335 316 296 273 321 311 311 241 297 293 293 283 283 269 264 263 259 238 231 193 180 105 101 102 100 99 88 86 86 81 80 80 78 76 73 65 61 1 1 / 1 2 1 2 / 1 3 1 3 / 1 4 14 / 1 5 15 / 1 6 16 / 1 7 17/ 18 18/ 19 11/ 12 12/ 13 13/ 14 14/ 15 15/ 16 16/ 17 17/ 18 18/ 19 • Historically greater level of admissions to Nursing provision • Trends show pattern of reducing admissions since 2015.

Length of Stay Average length of Stay - years Length of stay for Care Home (discharged) Residents (Current) Op Nursing Care Op Residential Care Op Nursing Care Op Residential Care 3.7 3.6 288 3.0 2.7 2.6 2.6 2.5 2.5 2.9 2.1 2.3 2.4 2.3 2.1 148 2.0 1.8 108 85 65 45 33 24 16 12 2011 2012 2013 2014 2015 2016 2017 2018 0-6 m 6-12 m 1-3 y 4-6 y 7 yrs + • Reduction in overall length of stay • 14% of current residents have been in a care home for more than 4 years • Historical admissions distort figures

Age and Gender Trends Average age on Admission to Care Homes Admissions to Care Homes by Gender and Provision Op Nursing Care Op Residential Care All Care Female Male 86.8 86.5 86.2 85.8 85.7 85.4 84.8 84.7 84.5 84.5 84.3 84.1 84.1 84.6 83.7 84.4 83.5 83.8 83.8 83.7 83.0 83.0 82.9 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 Op Nursing Care Op Residential Care

Care Home Respite Care Home Respite Provision Respite Provision Type (2015-19) CANCELLED, PLANNED CANCELLED EMERGENCY 4279, 8% 9685 PLANNED, 9631 17829, 34% 6545 5453 4563 4281 3532 4400 1325 1069 1032 853 EMERGENCY, 30261, 58% 2015/16 2016/17 2017/18 2018/19 • Have seen a steady growth in the volume of emergency respite provided in Care Homes • Better use of planned respite can ease pressures on Care Homes and provide better support to elderly carers • Anecdotal evidence suggests respite provision is not used appropriately • Move towards greater levels of planned respite

Data Conclusions ∗ A number of very small care homes in NA – greater risk operational and financial sustainability ∗ Capacity aligned across localities- risk of sustainability ∗ Seeing more admissions with reduced length of stay ∗ 14% of current residents length of stay more than 4 years (117 beds) – no need for more placements ∗ Emergency respite provision in care homes greatly exceeds planned

Future Requirements Predict based on: o Growth in older people, frailty and complexity o Reduced working age population o Requirements at the locality level o HSCP strategic direction – people supported at home for longer: o Community and familial supports o Alternative models – including care at home, respite, step up step down, end of life care o Specific intervention/investment in community services o Frailty impact on nursing/residential care beds o Shorter stay in care homes o By 2021, predicted 672 sheltered housing units across NA (additional 130 units)

Population projection

Next Steps • Reference Group – further work: • Benchmarking good practice • Respite provision • Projecting future demand • Investment requirement in community services • Agree future position • Financial position • Draft commissioning strategy to Strategic Planning Group • Approval IJB • Timescales – budget 2021

North Ayrshire Health and Social Care Partnership 2019/20 Budget & Transformation Update WORKING TOGETHER IN PARTNERSHIP

Purpose • Update on the 19/20 budgetary position • Outline the recovery plan • Transformation Programme • Medium Term Financial Plan N ORTH A YRSHIRE Health & Social Care Partnership

2019-20 Budget Where we are: IJB approved the budget on 21 st March 2019 including: • Pressures (and noting unfunded pressures) • Savings programme • Financial risks • Planned debt repayment

Budget Gap Social Health Care (NAC) (NHS A&A) Total £m £m £m Funding Increase 1.389 2.319 3.708 Funded Pressures (5.093) (2.561) (7.654) Budget Gap (3.704) (0.242) (3.946) Add historic CRES - (2.188) (2.188) TOTAL Savings Required (3.704) (2.430) (6.134)

Savings – Key Areas Council NHS Description Description 19/20 19/20 £000's £000's 130 Trindlemoss 250 Deliver the Strategic Plan objectives for Older People's Residential Services 388 Payroll Turnover Target - Mental Health * 300 Adult Community Support - Commissioning of Services 328 Review of Elderly Mental Health 727 Inpatients* Mental Health - Tarryholme / Trindlemoss 355 UnPACs - 7% reduction* 200 Children's residential placements 500 Payroll Turnover Target - Other Services 365 Care at Home - Reablement Investment 215 Packages of Care 150 LD - Reduction to Sleepover Provision 111 LD Day Service 150 * denotes a Mental Health saving Assessment and Self Directed Support 200 Charging Policy 500 Payroll Turnover Target