Supporting older adults to maintain their independence through a new offer, promoting; stronger communities, self-care, and integrated care teams.
The population of West Cheshire is ageing; people are living longer, and although this is something to celebrate it also places additional pressure on health, social care and housing.
Over the past five years, an 18% rise the number of people over the age of 85 has resulted in a 40% increase in the number of unplanned hospital admissions, and a 30% rise in unplanned hospital bed days. Using current demographic forecasts it is estimated that to maintain existing service standards would require an additional £19.1 million.
Against this backdrop, a business case for Ageing Well was submitted to Government in October 2012 outlining a new approach to enable older adults maintain their independence through radical changes to service delivery which involve supporting stronger communities, self care and integrated care teams. As well as enhancing the quality of life for older adults the proposals charted a course for whole-system reform which, through joint investment and reinvestment, will reduce non-elective hospital admissions.
What are we trying to achieve?
Historical models of care for older people within health and social care in Cheshire West are unsustainable, particularly within times of austerity and increasing demand. Partners know that, without change, we will require more hospital beds and more complex packages for longer term care and, of most importance, quality of service and citizen experience will worsen.
Locally, £133.6m (2011/12) is spent on NHS acute and community care and social care on the over 65s and, at the same time, Local Government is making budget reductions of 25+% and the NHS is on ‘flat cash’ at a time when demand for acute care for older people is continuing to increase. The local leadership, consisting of Chief Executive Officers from main commissioners and providers, recognise a local analysis that demonstrates at least 25% of older people in an emergency hospital bed do not need to be there and that there could be 15% fewer placements to long-term care if adequate alternative provision and a ‘whole system’ approach was in place.
Through the Ageing Well Business Case, Partners have agreed to focus on people aged 65+ who live in Cheshire West who need care and support or who are at risk. Specifically, the intention is to reduce non-elective bed day use by those aged over 65 by 25-30%, accompanied by a 15% reduction of placements into long term care with an initial focus on people aged 85+.
Our approach in the short term has focused on scaling-up and extending existing good practice and trialing new and innovative solutions to develop and deliver more sustainable provision. Over the medium and longer term, whole-system approaches will be addressed through a new funding and contracting model, through which payment will be driven by outcomes rather than activity.
What have we achieved so far?
All our work so far has involved a wide range of Partners under the banner of reducing demand for more costly services, giving people greater control and personal choice over services and reducing duplication across the agencies involved. Some of our notable achievements include:
- Creating a stronger role for communities and valuing older adults; supporting people to help themselves where possible. Initiatives such as the ‘Keep Well Campaign’ (and extension of an existing ‘Snow Angels’ project) are doing just this.
- Extension of the Single Point of Access for health services with detailed plans developed for creating a common assessment for health and social care (by aligning the Single Point of Access for Health and the Gateway service for Social Care). This will provide better access to the right services, treat people in a holistic way and share information more effectively.
- A better approach to self-care, maximising the potential of personalisation, shifting power and responsibility to citizens and aligning organisational budgets in order to do so.
- Rolling out the initial phase of integrated neighbourhood teams; aligned to GP surgeries this model of working brings together health, social care, the voluntary and community sector, and other professionals in ensuring a more joined-up approach to case management.
- Introduction of more effective and less costly early local interventions such as the extension of reablement, telecare, Hospital at Home, end of life care, and extra care housing provision.