Redesigning Services for Frail Older People – and Housing implications Mick Sanders Head of Locality Commissioning for Norwich

Overview Norfolk Profile Structure and Role of Integrated Commissioning in Norfolk Frail and Older People Work Housing Contribution Concluding Remarks

Norfolk Profile Two tier local government 7 district councils (housing authorities) 1.5 PCT’s Under ‘clustering’ to be .9 PCT ! 5.5 Clinical Commissioning Groups (CCG’s) 3 acute hospitals

New Integrated Commissioning Team 1 June 2011 start at PCT offices 5 localities in CCG boundaries Change Implementation Team Learning Difficulties, Mental Health and Drug and Alcohol not included Acute commissioning not included

housing related services: As was… NHS Out of hospital Services: Inc Frail elderly Long term conditions Community health services Community beds Carers End of life PHBs Social Care Services: Inc Domiciliary care Residential care Community care services Carers End of life PBs Supporting People housing related services: Inc Supported housing Floating support Socially excluded groups Employment

Integrated commissioning COSTS Person at the centre NHS Social care Community around them PERFORMANCE SP

Our priorities Managing the money – Quality, Innovation, Productivity and Prevention (QIPP) Managing the money – Comprehensive Spending Review (CSR) Moving to locality commissioning The added value of integration

What we offer A ‘one stop shop for community commissioning’ Expertise in commissioning across health, care and housing New thinking to old problems Networks to resolve issues A focused and evidence-based approach A resource to deliver to local priorities Added value of integration

Developing localities

Frail Older People’s Pilot McKinsey deep-dive work early in 2010 on unnecessary admissions 12 week intensive project Major tranche of Norfolk QIPP programme Priority, given Norfolk demographics ‘1 for 2’ investment for savings

Components of Frail and Older pathway include: Identifying those at high risk Case management function Navigator / advocacy (PHA role) Telecare & telehealth Community ‘sub-acute’ bed based provision Medicine for the elderly / mental health Links to integrated care sites Links to ‘Care Closer to Home’ Project

FOP Case Management Pathway 1 2 3 4 9 Identification of high-risk patients Allocation of high-risk patients to Case Managers Cases taken up by Case Manager and visits are made Patient is removed from list and referral arranged Case Manager reviews cases and makes referrals 5 Case Manager reviews case with Integrated Care Team Services are delivered to patient 8 Case Manager follows up regularly with patient Case Manager is updated by services 6 7

The New Landscape Clinician led commissioning Localism Putting patients first Closer integration Financial austerity

…and Housing Commissioning: evidenced based approach through the SP programme; Localism: local focus of many housing providers Putting patients first: tenant participation and service user engagement well developed Closer integration: already multi-disciplinary Financial austerity: long experience at belt-tightening and redesign

More specific added value Housing a significant determinant of ill health Think ‘prospective Frail Older People’ Strategic and enabling work Democratic mandate Sheltered housing and floating support Home Improvement Agencies: adaptations, falls prevention, affordable warmth, housing options etc. The Swedish approach

Concluding Remarks Cultural and language barriers Common commissioning skills Demonstrating added value Solutions to health increasingly outside medical and clinical interventions Health professionals need help to understand housing solutions Significant change needs to be within 12 months

And finally Questions?