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

Add Title Here

Add name of presenter here

WELCOME

North Ayrshire Health & Social Care Providers Forum

Friday, 25th October 2019 Greenwood Conference Centre

WORKING TOGETHER IN PARTNERSHIP

North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care

NORTH AYRSHIRE Heal alth a and S d Socia cial C Care Par Partne nership ip

Caroline Whyte

Care Home Commissioning Strategy

WORKING TOGETHER IN PARTNERSHIP

• Progress so far – Reference group
• Care home / evidence base
• Future Requirements
• Financial implications
• Next Steps

Introduction

NORTH AYRSHIRE Health & Social Care Partnership

• 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

Current Context

Future challenge

• Predicted increase in
• lder 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%

• 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
• f 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

Current Situation

Impact of National Care Home Contract

North Ayrshire Care Home: Capacity and Occupancy

• Green line illustrates assumed capacity in the National Contract Costing model
• In North Ayrshire, most Care Homes fall below this line

Current Residents

• 805 care home residents,

care managed by North HSCP

• 81% cared for in an NA

Care Home.

• 19% in an out of area care

home.

NAC, 649, 81% OOA, 156, 19% Current Care Home Residents

• Placement based on client choice
• Indicates sufficient capacity in North Ayrshire, gap info capacity other areas using

Residents by care type

Op Nursing Care, 547, 68% Op Residential Care, 258, 32%

Breakdown by Care Type

Residents by Care Type

• 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

65 - 69 70 - 79 80 - 89 90 plus

Age of Care Home Residents (Current)

• While greater number of women overall, there is a slightly greater proportion of

men in Nursing Care

389, 66% 173, 73% 198, 34% 64, 27%

Female Male

Gender of Care Home Residents (Current)

Care Home Capacity by Locality

2 2 4 1 5 5 Arran Garnock Valley Irvine Kilwinning North Coast Three Towns

Care homes per locality

36 45 162 70 103 233 46 60 219 121 152 379

Capacity by Locality and current occupancy

• 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

• Historically greater level of admissions to Nursing provision
• Trends show pattern of reducing admissions since 2015.

Length of Stay

Average length of Stay - years (discharged)

Length of stay for Care Home Residents (Current)

Op Nursing Care Op Residential Care

• Reduction in overall length of stay
• Historical admissions distort figures
• 14% of current residents have been in a

care home for more than 4 years

Age and Gender Trends

2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Average age on Admission to Care Homes

Op Nursing Care Op Residential Care All Care

Admissions to Care Homes by Gender and Provision

Care Home Respite

CANCELLED, 4279, 8% EMERGENCY, 30261, 58% PLANNED, 17829, 34%

Respite Provision Type (2015-19)

Care Home Respite Provision

• 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

∗ A number of very small care homes in NA – greater risk

• perational 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

Data Conclusions

Predict based on:

• Growth in older people, frailty and complexity
• Reduced working age population
• Requirements at the locality level
• HSCP strategic direction – people supported at home for longer:
• Community and familial supports
• Alternative models – including care at home, respite, step up step

down, end of life care

• Specific intervention/investment in community services
• Frailty impact on nursing/residential care beds
• Shorter stay in care homes
• By 2021, predicted 672 sheltered housing units across NA (additional

130 units)

Future Requirements

Population projection

• 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

Next Steps

2019/20 Budget & Transformation Update

North Ayrshire Health and Social Care Partnership

WORKING TOGETHER IN PARTNERSHIP

Purpose

NORTH AYRSHIRE Health & Social Care Partnership

• Update on the 19/20 budgetary position
• Outline the recovery plan
• Transformation Programme
• Medium Term Financial Plan

2019-20 Budget

Where we are: IJB approved the budget on 21st March 2019 including:

• Pressures (and noting unfunded pressures)
• Savings programme
• Financial risks
• Planned debt repayment

Budget Gap

Social Care (NAC) £m Health (NHS A&A) £m Total £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)

Council NHS

Description 19/20 £000's Description 19/20 £000's Deliver the Strategic Plan objectives for Older People's Residential Services 130 Trindlemoss 250 Adult Community Support - Commissioning

• f Services

388 Payroll Turnover Target - Mental Health * 300 Mental Health - Tarryholme / Trindlemoss 328 Review

• f

Elderly Mental Health Inpatients* 727 Children's residential placements 355 UnPACs - 7% reduction* 200 Care at Home - Reablement Investment 500 Payroll Turnover Target - Other Services 365 LD - Reduction to Sleepover Provision 215 Packages of Care 150 LD Day Service 111 Assessment and Self Directed Support 150 * denotes a Mental Health saving Charging Policy 200 Payroll Turnover Target 500

Savings – Key Areas

∗ Following a review of the assumptions behind the projections a projected overspend of £2m was reported to the IJB in period 4. ∗ The main areas of overspend were LD Care Packages, Children’s residential placements, Care Homes, Care at Home and Adult Inpatients ∗ Overspend has improved but not to a level where there is confidence that financial balance can be delivered. ∗ Development of a recovery plan which was approved by the IJB on 26th September.

19/20 Budgetary Position

The Recovery Plan (1)

Ref Service Area Action Planned Impact £ 000's 1 Care at Home Reduction in care at home provision 200 2 Care Homes - Respite Placements Policy and criteria in relation to emergency respite in commissioned care home settings

• 3 Equipment &

Adaptations Temporary reduction (2019-20 only) in the equipment and adaptations budget 200 4 Learning Disabilities Prioritised Review of Adult Community Packages 750 5 Learning Disabilities Trindlemoss development finalise the financial impact

• f the new service (LD day service, complex care unit

and supported accommodation) tbc 6 Learning Disabilities Sleepovers - develop policy in relation to 24 hour care for Adults in the Commnunity 128 7 Learning Disabilities Transition Cases (Adults aged 65+) 134 Health and Community Care: Mental Health and Learning Disabilities:

The Recovery Plan (2)

Ref Service Area Action Planned Impact £ 000's

8 Adult Community Packages Adult Resource Group no overall increase in care package provision

• 9

All Self Directed Support

• 10 Looked After and

Accomodated Children Children's External Residential Placements bring forward planned discharge dates 200 11 All Recruitment freeze non-front line posts 200 12 All Moratorium non-essential expenditure 185 13 All Systems improvements re care packages

• 1,997

Children and Families: Other: TOTAL

∗ There are a number of ongoing financial risk areas that may impact

• n the 2019-20 budget, these include:

∗ High risk areas of low volume / high cost services areas e.g. Learning Disability care packages and children’s residential placements. ∗ Delivery of approved savings inc sleepovers and Trindlemoss ∗ Progress with the work to develop set aside arrangements and the pan Ayrshire approach to risk sharing arrangements agreed as part

• f this

∗ Mitigating the costs and impact of the outlined unfunded pressures ∗ Lead / hosted service arrangements, including managing pressures and reporting this across the 3 IJBs ∗ The impact on Lead partnership and acute services from decisions taken by other Ayrshire areas. E.g. Elderly Mental Health beds and Ward 2 at Woodland View

Budget Risks

Transformation Main Areas/Projects

∗ Care Home Commissioning Strategy ∗ Care at Home reablement approach ∗ Older people day service review ∗ Pan Ayrshire rehabilitation and Enablement review ∗ Pan Ayrshire end of life and Palliative Care ∗ Arran Integrated Island Services ∗ Cumbrae Integrated Island Services ∗ Complex Care Packages

Health and Community Care

∗ New GP Practice Team – GP Contract ∗ Wider MDT Team – Kilwinning and Garnock Valley Cluster ∗ Wider MDT Team – frailty and end of life collaborative model in Arran and Largs practice ∗ Community Link Workers in place and Mental Health Practitioners being explored ∗ Primary Care Review of Premises

Primary Care

∗ Alcohol and Drugs – Participatory Budget approach ∗ New community mental health model ∗ Mental Health Action 15 – re-design of prison, psychology, primary care and first psychosis approaches ∗ National adolescent mental health build ∗ CAMHs wellness model ∗ Warrix Avenue supported accommodation ∗ Elderly Mental Health bed review

Mental Health

∗ Trindlemoss supported accommodation and complex care unit development including new Day service model ∗ Sleepover review ∗ Arrol Park review ∗ Autism Strategy ∗ Community based Learning disability approach

Learning disabilities

∗ Delivery of residential and external placements ∗ ASN Residential and respite model ∗ School based model for localities ∗ Review of fostering and adoption ∗ Family nurse review ∗ Children with disabilities review with acute teams ∗ Locality working

Children and Families

Next Steps Medium Term Financial Plan

#NAHSCP

• 3 year Medium Term Financial Plan for the partnership

– delayed due to the uncertainty over funding assumptions

• Projections – funding and pressures
• Support the delivery of the strategic plan and setting
• ut our plans to start to deliver transformational

change

• Review of Integration - £ loses it’s identity
• Sustainable services to the local community over the

medium term.

• Financial Sustainability inc a reserves policy

Questions?

NORTH AYRSHIRE Heal alth a and S d Socia cial C Care Par Partne nership ip

Scott Bryan

Locality Planning in North Ayrshire

WORKING TOGETHER IN PARTNERSHIP

• HSCP Strategic Plan
• Localities overview
• Key information by locality
• Population
• Deprivation
• Health data
• Children’s Social Work
• Locality Planning Forums
• Structure and purpose

Locality Planning

Our vision is that:

"All people who live in North Ayrshire are able to have a safe, healthy and active life."

HSCP Strategic Plan

HSCP Five Strategic Priorities

• 1. Tackling Inequalities
• 2. Engaging Communities
• 3. Prevention and Early

Intervention

• 4. Improving Mental Health

& Wellbeing

• 5. Bringing Services

Together

Working with communities

“Working with you” (Strategic Plan pp35)

States our commitment to working “together” with local people and communities, recognising the:

• Assets in local communities
• The value in community input to

services

• Legislation
• Public Bodies (Joint Working) (Scotland) Act 2014 places an onus
• n Partnerships to establish localities
• Prior to the Act their was a lack of opportunity for communities

and community based professionals, to provide leadership for planning and local service provision

Why localities?

‘...effective services must be designed with and for people and communities – not delivered ‘top down’ for administrative convenience’

The Christie Commission Report

Our Localities

ARRAN GARNOCK VALLEY KILWINNING IRVINE NORTH COAST THREE TOWNS

SIMD In North Ayrshire

• Almost 53,000 people in

North Ayrshire reside within the 20% most deprived data zones.

• Accounts for 39% of the

population

• 10% reside in data zones that

are among the least deprived in Scotland

Most deprived (20%) datazones by locality

Locality Planning Forums

Locality Planning Forums are sub-groups of the HSCP Strategic Planning Group

“LPFs established in 2015/16 where developed to ensure a mechanism in which to inform the future planning, redesign and improvement of local health and social care services”

LPF ToR August 2018

SPG Governance Structure

STRATEGIC PLANNING GROUP

JOINT FORUM (LPF & CPP) COMMUNITY PLANNING PARTNERSHIP

Communities of North Ayrshire

LPF Core Group

Chair (IJB Member)

Primary Care Representative (Local GP)

Locality Lead (HSCP Senior Manager)

LPF Members

• The chair agrees the

membership of the larger forum

• LPF members may

include the following:

• Service users
• Carers
• HSCP Staff representatives
• TSI representative
• Independent sector

representatives

• Community Link workers
• CPP locality worker

∗ LPFs are strategic groups, they can:

∗ Review local information and identify service gaps and local need ∗ Engage with local communities to better understand local concerns and ideas ∗ Raise concerns and make recommendations for action

∗ They cannot:

∗ Make operational decisions ∗ Allocate financial resources

LPF Powers

First tasks

• Establish membership
• Review understanding of

locality

• Local knowledge
• Data profiles
• Identify key priorities for the

locality…

LPF Locality Priorities

• 1. Develop transport

• 2. Reduce social isolation
• 3. Improve support to those

• 1. Improving young people's mental health

• 2. Address low level mental health (all ages)
• 3. Reduce social isolation across all age

• 4. Address impact of musculo- skeletal issues
• 1. Raise awarenss of HSCP
• 2. Addressing poor mental

• 3. Promote Physical activity
• 4. Support continuation of

• 1. Reduce social isolation
• 2. Improve low level mental

• 3. Provide access to

• 1. Improve mental health

• 2. Reduce social isolation
• 3. Improve support to those

• 4. Promote financial inclusion
• 1. Reduce Social

• 2. Improve support for

• 3. Promote physical

• 4. Promote financial

Arran Garnock Valley North Coast Three Towns Kilwinning Irvine

Reviewing Priorities

Priorities are not set in stone

• Locality priorities are identified and agreed by each LPF
• They are identified through a variety of means:
• Statistical data
• Professional experience
• Community engagement
• They can be revised or changed
• LPFs can also identify an area for action out with their

identified priorities

LPFs can escalate locality based concerns to the Strategic Planning Group (SPG) who may refer on to Integration Joint Board (IJB) for action. The SPG Terms of Reference stated it will: “Bring forward key issues of concern expressed in North Ayrshire’s locality planning arrangements from communities through robust and engaged membership”

Progressing actions

• Lead by HSCP Engagement Officer
• Engaging with schools as part of Wellness Model – improving MH
• f young people
• Engaging with locality Chit/Chats (working with CPP localities)
• Attending tenants association meetings
• Attending parents forums
• Looking at new models of engagement following WMTY?
• Supporting development of Locality Based Social Enterprises

(new and existing)

LPF Engagement

• Planning not a ‘doing’ arrangement is harder to manage as

seems ‘conceptual’,

• Financial and service level activity has been slow to be

identified at Locality Level,

• Capacity of core members in addition to the ‘day job’ –

GP’s in particular,

• Limited community level capacity /HSCP ‘Community

Champions’ and dialogue or SINGLE issue representation ,

• Links between LPF, SPG and IJB have been slow to develop

and turn-over has an impact on IJB/SPG membership,

• We also have CPP Locality arrangements with Scottish

Govt guidance too – piloting an integrated approach on Arran.

Challenges

• Continue engagement activity

in each locality

• Enhance community

membership and youth voice

• Review findings from ‘What

Matters To You?’ 2019

• Consider if priorities are still

relevant

• Develop locality plans

Next steps for LPFs

Thank You

How Can or Do We Promote Social Care as a Career Choice?

WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care

Ged, PRO Gamblers Anonymous Scotland

CONTACT US

Address The Wellness Centre, 45 Montrose Avenue, Intake, Doncaster, DN2 6PL Email info@gamblersanonymous.org.uk

Closed Session

WORKING TOGETHER IN PARTNERSHIP North Ayrshire Council NHS Ayrshire & Arran TSI North Ayrshire Scottish Care