Health and Social Care Integration -Anticipatory Care Training Day Hospital and Community Geriatric Provision 30th August 2012 Health and Social Care Integration -Anticipatory Care Ranald Mair (Chief Executive, Scottish Care)

Services for Older People now have higher political priority

As an example of working that is not joined up - Each of these fire fighters is putting their training in to practice but because they are not joined up then the overall outcome is clearly affected.

Demand on Services 2010…….90,000 receive care services 2016……..113,000 [+23,000] Increase = +25% over next 6 years! To meet demands 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 Most school leavers going into the care sector to sustain current staffing levels

Scottish Block Finance & Demand 2010/11 – 2013/14 (% real terms) The Emerging Care Gap Scottish Block Finance & Demand 2010/11 – 2013/14 (% real terms)

Health and Social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn) Slide 4 By far the biggest area of expenditure, almost 50% of the Older People’s budget, is within the acute sector: This would be perfectly acceptable and right to maintain if it were necessary for meeting need, but it is not. Indeed, in many instances people could have their needs met more effectively through non-acute sector services. Unnecessary hospital admission for non-specialist assessment, intervention and care that could just as readily be provided in community settings Unnecessary lengths of stay for continuing care and rehabilitation, with the added risks of Hospital Acquired Infection and a reduced capacity for independence, could be avoided Unnecessary admission for palliative and end of life care that could be provided at home or in a more appropriate care setting These are all areas where we feel real gains could be made very quickly through shifting the locus of care away from the acute sector, providing there is a willingness to shift resource at the same time.   Ending all continuing care in hospital settings would free the acute sector to concentrate on its primary function of specialist assessment and intervention. At weekly rates of £1400+ pw for general hospital beds and £2800+ for acute provision, even enhanced packages of care in Care Homes or Care at Home would be a huge saving to the public purse. Building on existing step-down and re-ablement models, it would also make sense to locate rehabilitation teams in the community and move the locus of care away from the hospital setting. Similarly, developing step-up and step-down capacity in community settings to provide assessment and rehabilitation as an alternative to hospital admission has to be the way forward. 7

Care Home Statistics Currently in Scotland around 86% of care home places are located in the independent sector; of which 72%; over 31,000 care home beds are located in the private sector and 14% or 6,300 in the voluntary sector.

The social services workforce (data from December 2008) Service type Headcount % of sector Care Homes for Adults 53,970 27.4% Housing Support / Care at Home 63,140 32.1% Nurse Agency 3,280 1.7% Total Social care workforce now at 196,970 100% 38% located in the private sector 36% public sector 26% voluntary sector

Strands of Development Reshaping Care for Older People / The Change Fund Health and Social Care Integration Self-Directed Support Intermediate Care Living and Dying Well National Dementia Strategy Anticipatory Care Planning/Advance Care Planning/DNACPR Health Prevention and Protection New models of care delivery

Care Hub Respite Residential & Nursing Care Tele Health Tele Care GP Care at Home Reablement Extra Care Housing Support Meals Laundry Care & Repair GP Community Health Tele Health Tele Care

Developing Inclusive Partnerships Local Authorities Health Boards (Primary and Secondary Health Care) Service Users and Carers Third and Independent Sector Providers – (Care Homes, Care at Home, Housing Support, Housing Associations)

How joined-up are we?

And make sure services are well signposted!

Scottish Care: the voice of the independent care sector 54a Holmston Road Ayr KA7 3BE, Telephone: 01292 270240:Email: ranald.mair@scottishcare.org