CfWI produces quality intelligence to inform better workforce planning, that improves people’s lives Key Ingredients: Integrated planning across the older people pathway 18 th October 2010

The Institute of Public Care For well led, evidence-informed public care. Oxford Brookes University. Health, social care and education. Analysis, implementation and development. A partner in the Centre for Workforce Intelligence.

Workshop context Capacity and workforce challenges facing health and social care services for older people. Changes in economy, demography and expectations mean old models of delivery will not be viable or acceptable.

Workshop aim To explore emerging approaches to workforce development based on meeting needs across the full care pathway. To consider what local health and social care communities need to do to develop cost effective integrated workforce provision.

1. Introduction - demographic change Nationally 56% increase in our over 80 year old population over the next fifteen years. Not much change in terms of incapacity in the final years of life. However change is not uniform. Brighton is projected to have a 20% increase in over 85 year olds whilst the increase is 93% in Wokingham.

Shire in 1911

Shire 2001

2. Implications: health care expenditure Expenditure in for each age group, expressed as a cost per head of the population

Social care expenditure In , gross current expenditure in England on adult PSS was £14 billion. The largest items of expenditure were for residential care (50.6 per cent) and day care and domiciliary provision (36.7 per cent). If expenditure remained constant on the same items Wanless estimated this would need to rise to at least £24 billion by The government estimates a gap of £6 billion in social care funding.

3. Pathway redesign – the agenda Workforce design Commissioning and Brokerage SYSTEM OPTIMISATION General Population Support At Home “Low Level” Advice & Support Institutional Care Acute Care Information, Choice and Control Crisis Response Welfare Support Re-ablement Support Related Housing Transformation of the pathway

Pathway redesign - the approach

Pathway redesign – the challenge Not just about efficiencies in the process. Basically about balance of resources between parts of the pathway. Fundamentally about a different balance of workforce capacity and skills across the whole health and social care pathway. Also about a shift in control from agencies to the individual including personal budgets.

A shift in control The Service User Identifying own needs Specifying and securing services from the provider Sharing intelligence The Service Provider Contracting with the user Co-ordinating workforce Delivering outcomes The Commissioner Allocating resources Shaping services and workforce Sharing intelligence

4. Commissioning the workforce 15

Challenges to effective workforce commissioning Boundary and resource disputes? Provider diversification? Professional barriers? Personalisation, choice and unpredictability of demand? Risk reluctance?

5. Discussion What are the practical challenges that local health and social care agencies need to address to deliver more integrated services and complementary workforces? How would you like to see the DH and CfWI support this agenda over the next few years?

References Poppi and Pansi projection systems ( DH North-West JIP: How to Commission the Social Care Workforce (May 2010) National Market Development Forum (