Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009 Mike Martin Partnership Improvement and Outcomes Division

The changing shape of Scotland’s population

Some headline projections  Scotland’s 65+ population projected to rise by 21% between  By 2031 it will have risen by 62%  For the 85+ age group specifically, a 38% rise is projected for 2016  And, for 2031, the increase is 144%

9% 24% 41% 61% 84% Calendar year ’07 estimate P Knight Scottish Government

Demographic change for population aged 65+ Scotland Potential impact on specialist care services hrs Home care 10+ hrs Home care Care Home Cont h/care (hosp) Projection 26% 94% P Knight Scottish Government Community Care - Impact

Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)

What this all means for Scotland …  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 to “stand still”  Virtually all school leavers into the care sector by 2030

all this will require by % increase in health and social care expenditure [extra £1 billion!] while 8% reduction in public expenditure* [* Institute of Fiscal Studies estimate] it just doesn’t add up!

Facing the Challenges - An Outcomes Focus…………..

An outcomes focus – what it means  Frail and vulnerable people supported to live at home  Control and decisions with the individual  Strong, caring, supportive communities  Fairness and equity  High quality environment  Contributing to local economy

Growing old -  Not an illness; a state of being  Should we shift our focus?

Current service provision by service type

Current service provision by age group % 88% 60%

Some further considerations  Tenure implications – an equity stake  ‘Young until your dead’ – self image  Economically active  Politically active and influential  Best healthy life expectancy prospects  Pension provision  Older people provide far more care than they receive

Home Care – some observations  Huge variations across Scotland  45% local authority home care staff 50+ years old  40,000 of 65+ provide 20+ hours care per week  3, receive more than 20 hours per week paid care  1:2 ratio of 10 hours and home care to care home

Reshaping Care for older people …..  Into the Spotlight Conference (Dec 08)  Lord Sutherland Review of Free  Personal and Nursing Care(Dec 08)  Ministerial Strategic Group(Dec 08-March 09)  Joint Leadership Summit(May 09)  Engagementfrom Now  Emerging proposals to MSGDec 09  Wider engagementJan 10

Reshaping Care for Older People … 8 workstreams  Vision and engagement  Care at home – a mutual care approach  Care homes  Care pathways  Planning for ageing communities  Workforce  Healthy life expectancy  Demographics and funding

It has to be … outcomes  How well do our services help achieve our policy goals?  How can we help people stay out of the formal care system?  How can we support self care?  Is it a change of philosophy and approach – support not services?  We are doing it now – in pockets – what’s stopping the spread?

Care at Home – some emerging ideas ……  Better integrated approaches -across health, housing and social care -across paid, unpaid and volunteer care  More anticipatory and preventative care -support to unpaid carers/volunteers - telehealthcare -“contact and connect” support  Better crisis care - appropriate rapid response -24/7 cover - telehealthcare

 Develop and support volunteer and unpaid care -older people as carers -“back-up” for unpaid carers -? Fiscal incentives (reserved matters)  More complex care at home - integrated approaches across acute, primary and social care -telehealthcare  Focus on re-ablement/outcomes/goals -rehabilitation -support to do not services done to -more personal budgets/Self Directed Support

Other emerging ideas ……  Remodelling care homes to provide more specialist care  Improved ‘care pathways’ – especially in/out hospital  New models of sheltered housing – very sheltered and ‘hub and spoke’  Promoting healthy lives – self management of long term conditions – active ageing  Building the workforce – integration across health and social care – integration across paid and unpaid and volunteers and finally – Need to model the costs and the funding options for the size and scope of care services we will need over the next 20 years