Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009 Mike Martin Partnership Improvement and Outcomes Division.

Shifting the Balance of Care (SBC)Enabling Independent Living

15 September 2009

Mike MartinPartnership Improvement and Outcomes Division

The changing shape of Scotland’s population

Some headline projections

Scotland’s 65+ population projected to rise by 21% between 2006 - 2016

By 2031 it will have risen by 62%For the 85+ age group specifically, a 38% rise is

projected for 2016And, for 2031, the increase is 144%

Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031

0

2000

4000

6000

8000

10000

12000

14000

16000

Y/E Mar 2007 Projected2011

Projected2016

Projected2021

Projected2026

Projected2031

Year

Be

ds

9%24%

41%

61%

84%

Calendar year ’07 estimate

P Knight Scottish Government

Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031

0

40000

80000

120000

160000

200000

Actual2007

2011 2016 2021 2026 2031

N of

peo

ple

1-9 hrsHome care

10+ hrsHome care

Care Home

Cont h/care (hosp)

Projection

26%

94%

P Knight Scottish Government

Community Care - Impact

Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)

Other Social Work

Care Homes

Home Care

FHS

PrescribingCommunity

Other Hospital care

Emergency admissions

£1.4bn

£0.8bn£0.4bn

£0.4bn

£0.4bn

£0.3bn

£0.6bn£0.2bn

Projected Health and Social care expenditure for Scottish populatiion aged 65+

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2007/08 Actual 2011 2016 2021 2026 2031

£m

NHS Social Work

22%

74%

What this all means for Scotland …

A new 600 bed hospital every 3 years for 20 years

A new 50 bed care home every 2 weeks for 20 years

£2.8 billion investment in sheltered housing to “stand still”

Virtually all school leavers into the care sector by 2030

all this will require by 2016

22% increase in health and social care expenditure [extra £1 billion!]

while

8% reduction in public expenditure*

[* Institute of Fiscal Studies estimate]

it just doesn’t add up!

Facing the Challenges

- An Outcomes Focus…………..

An outcomes focus – what it means

Frail and vulnerable people supported to live at home Control and decisions with the individual Strong, caring, supportive communities Fairness and equity High quality environment Contributing to local economy

Growing old -

Not an illness; a state of beingShould we shift our focus?

Current service provision by service type

People aged 65 and over

hospital est

care home

home care

all others

Current service provision by age group

75-84

85+

65-74

97%

88%

60%

Some further considerations

Tenure implications – an equity stake ‘Young until your dead’ – self image Economically active Politically active and influential Best healthy life expectancy prospects Pension provision Older people provide far more care than they receive

Home Care – some observations

Huge variations across Scotland 45% local authority home care staff 50+ years old 40,000 of 65+ provide 20+ hours care per week 3,000 65+ receive more than 20 hours per week paid

care 1:2 ratio of 10 hours and home care to care home

Reshaping Care for older people …..

Into the Spotlight Conference (Dec 08)Lord Sutherland Review of Free Personal and Nursing Care (Dec 08)Ministerial Strategic Group (Dec 08-March 09)Joint Leadership Summit (May 09)Engagement from NowEmerging proposals to MSG Dec 09Wider engagement Jan 10

Reshaping Care for Older People … 8 workstreams

Vision and engagement Care at home – a mutual care approach Care homes Care pathways Planning for ageing communities Workforce Healthy life expectancy Demographics and funding

It has to be … outcomes

How well do our services help achieve our policy goals?

How can we help people stay out of the formal care system?

How can we support self care?Is it a change of philosophy and approach –

support not services?We are doing it now – in pockets – what’s

stopping the spread?

Care at Home – some emerging ideas …… Better integrated approaches

- across health, housing and social care- across paid, unpaid and volunteer care

More anticipatory and preventative care- support to unpaid carers/volunteers- telehealthcare- “contact and connect” support

Better crisis care - appropriate rapid response- 24/7 cover- telehealthcare

Develop and support volunteer and unpaid care- older people as carers- “back-up” for unpaid carers- ? Fiscal incentives (reserved matters)

More complex care at home- integrated approaches across acute, primary and social care- telehealthcare

Focus on re-ablement/outcomes/goals- rehabilitation- support to do not services done to- more personal budgets/Self Directed Support

Other emerging ideas ……Remodelling care homes to provide more specialist careImproved ‘care pathways’ – especially in/out hospitalNew models of sheltered housing – very sheltered and ‘hub and spoke’Promoting healthy lives

– self management of long term conditions– active ageing

Building the workforce– integration across health and social care– integration across paid and unpaid and volunteers

and finally –

Need to model the costs and the funding options for the size and scope of care services we will need over the next 20 years