1. North East Regional HOUSING LEARNING & IMPROVEMENT NETWORK Monday 27th April 2006, Your Homes Newcastle. Our Health, Our Care, Our Say: a new direction for health and social care

2. Note “Social care” refers to the wider social care arena of social services, the wider the local authority services, housing, voluntary services, independent sector both non profit and for profit sectors, and mainstream community services.

3. People recognise improvements have happened but people want further improvements. We need to face future demographic challenges New opportunities from new technologies  Personalised services meeting individual needs  Support for healthier, independent lives  Promotion of well-being  Better support for those with high level needs  Services shifted to local communities What people want Recall why new direction

4. Therefore… we see some strategic shifts –From acute responses to a prevention focus, –From illness to health and from welfare to rights based approaches –From client groups to long term conditions –From hospitals to communities and care closer to home –From Inputs and services to outcomes for people and communities so shifting from separate performance and commissioning frameworks to more joined up approaches –From Whitehall to local communities of interest –From doing “to”, “for” and “with” people to being “led by” people

5. So the new direction Change the way services are offered in the community around 3 themes. –Putting people more in control of their own health and care –Enabling and supporting health, independence and well-being –Rapid and convenient access to high-quality cost- effective care

6. What will happen(1) Help people to make choices and take control by understanding their own health and lifestyle better, with more support on prevention and promoting their independence –Pilot new NHS Life Check –More emphasis on mental illness and support to deal with isolation and depression: –Direct Payments –Individual Budgets: –Improve information: –Grasp the opportunities of the 2012 Olympics through a “Fitter Britain”

7. What will happen (2) Offer people easy access to help when they need it, in a way that fits their lives New initiatives to support carers. Give patients a guarantee of registration onto a GP practice list in their locality Make it easier for people to get the information they need to choose a GP practice and know what health and local authority services are available in their area Provide incentives for GPs to work in areas that are under provided for at present – this might include introducing new providers Improve access to GP practices: more flexible opening hours; easier to make appointments

8. What will happen (3) Meet the whole of people’s needs and support their well-being and health, not just focusing on sickness or an immediate crisis Support self care: treble investment in the Expert Patient Programme Strengthen role of a Director of Adult Social Services; widen role of Director of Public Health; more joint appointments Health and social care jointly responsible for understanding the needs of their communities and providing the right services to prevent ill health and support independent living Develop a common assessment framework to ensure less duplication across different agencies and allow people to self-assess where possible Establish end of life care networks, building on the pilots being undertaken with Marie Curie and other innovations

9. Provide care closer to where people live, provided these services are also safe and cost-effective A fundamental long term shift from hospitals to community facilities, and from institutional to home-based care. Pilot outpatient appointments for common conditions such as dermatology in the community Encourage existing community service providers to take on more practitioners with a special interest A new generation of community hospitals to provide a wide array of non-urgent services in a community setting What will happen (4)

10. Underpinning reforms: –Develop outcomes which apply to both NHS and social care, implemented through Local Area Agreements –Align performance measures, assessments and inspection –Align planning and budget frameworks between health and local authorities –Strengthen local commissioning, shifting towards prevention and early support: PCTs and LAs; Practice based commissioning and Individual Budgets –Unbundle the tariff –Encourage practices to expand by helping with expansion costs and making more money follow the patient –Clarify roles of social enterprise, not for profit and independent sector providers To facilitate change you will see system reforms

11. Asking people is the system changing / working? Control – have you a major say in shaping your service or do you take only what is offered? How flexible is the shape of your service? Access- How easy is it to access services? If you have a long term condition how has your service helped you to manage your condition better and are you healthier and more independent as a result? Where is your service? Does it start in your own living room or close to your home? Is your service open to continuous improvement shaped by feedback from you? Are you able to say that the outcomes you wanted are being delivered?

12. Housing and Independence and Health in the White Paper (Chap 3) case studies in this chapter is Westbury Fields extra care village in Bristol for older people which has150 flats and a 60 bed care home all on one site (There is further information on Westbury Fields on the Housing LIN website under case studies). reference to Supporting People consultation, Creating Sustainable Communities: Supporting Independence, and the need to achieve better programme coordination (paragraph 2.25). There is also emphasis on stronger local commissioning and achieving improved health and social care outcomes for people in communities (paragraph 2.76). (The Housing LIN has a produced a useful strategic commissioning workbook, Strategic Moves, and accompanying CD- rom available from housinglin@cat.csip.org.uk)housinglin@cat.csip.org.uk The work of the POPP pilots highlights the need to reduce hospital admissions and residential care stays and later there is reference to sheltered housing (paragraph 2.88).

13. Housing and The White Paper (Chap.4.) Policy drivers for housing include: – giving people more choice through the development of Direct Payments (paragraph 4.21) and Individual Budgets (paragraph 4.29). –There is recognition of the needs of vulnerable groups such as the homeless who find it difficult to access health and social care services. –DH and ODPM are encouraging housing and health services to work together to improve well-being and prevent homelessness (paragraphs 4.66 and 4.70); –the needs of people with learning disabilities in particular being supported to live in ordinary housing (paragraph 4.90); –the complex needs of offenders who may also have drug alcohol and mental health problems (paragraph 4.92). –In addition, there is reference to meeting the needs of people with dementia and the recent service development guide, Everybody’s Business – Integrated mental health services for older adults (paragraph 4.100).

14. Housing and Wider Community Needs (Chapter 7- putting people in control) This chapter makes reference to better needs assessment arrangements to help inform decision- making, commissioning and investment decision. It highlights the links with Supporting People (paragraph 7.48). It also refers to Neighbourhood Renewal and wider health impact assessments to tackle health inequalities in deprived areas (paragraphs 7.49 and 7.50). The Housing LIN has produced a toolkit, Assessing the Health Risks and Health Inequalities in Housing, available on Housing LIN website.

15. Housing seen as: Part of wider public services that contribute to health, well-being and social inclusion Provider of services to vulnerable people such as the homeless, those at risk of domestic violence, people with learning disabilities and older people Part of local service infrastructure and part of local ‘One Stop Shops’ as advocated in the Social Exclusion Report A sure Start to Later Life Directors of Adult Social Services having responsibility for co-ordinating agencies such as health, housing and transport to promote social inclusion Recognition that ill-health is often a symptom of poor or inappropriate housing, often making it more difficult for people to access health care Sheltered housing and community buildings as infrastructure for the delivery of health living services Housing estates and communities as a locus for the promotion of fitness and improved lifestyles Multi-disciplinary networks and teams, co-located with a common assessment involving all key players – social services, housing, NHS and the voluntary sector Supporting people to remain in their own home or in new models of provision such as extra care, as an alternative to institutional care Impact of new housing development on health and social care infrastructure and the need for joint planning

16. For Social Care and PCT to Consider Joint evaluation of population needs - LAA Joint LTC Approach and joint teams Joint Commissioning approaches Focus on outcomes for people Shift to prevention and promotion of health Shift care closer to homes/communities Joined

17. Seamus Breen National Programme Manager for White Paper Support Social Team Care Services Improvement Partnership Tel : 020 797 24375 (PA Jasmine Chadha) e-mail: seamus.breen@dh.gsi.gov.uk