Practical Delivery of the Accommodation Strategy KHG OP Day 22 October 2014 Christy Holden – Head of Commissioning (Accommodation) Kent County Council

Why we need an Accommodation Strategy KCC spends £180m on residential and nursing care The right type of accommodation in the right place Stimulate the market or directly intervene Inform planning applications Secure better outcomes and make savings Quality and safeguarding

Development of the Strategy Joint KCC, NHS and KHG document supported by KPOG and the DH Housing LIN Analysis of KCC case load, placement patterns, availability of services Engaged with local teams, CCG’s, District Councils in its development Formal approval and launch in July 2014

The Accommodation Strategy About the Council Strategies and Policies Adult Social Care Policies Accommodation Strategy

Dynamic strategy On-line with links Evidence Base Case studies Maps Design Principles District Profiles Key findings by user group Financial Impact District aligned with CCG Consideration Accommodation Strategy Overview

Accommodation for Older People Analysis Service TypeNational RatioKent RatioFuture need? Sheltered 125 units per 1000 pop Extra Care 45 units per 1000 pop Residential Care 65 units per 1000 pop Nursing Care 45 units per 1000 pop Intermediate Care 26.3 units per 100,000 pop 29.7 National Ratios Population forecast Impact of enhanced community provision Placement patterns Market appraisal Workshops with KCC,CCGs and Districts Numbers are indicative and will be used to target priority areas. Numbers will need to be periodically reviewed and adjusted in line with the performance of enhanced community services

District Profiles

Older People Summary OP+/- R-133 N+52 EC+120 SH0 OP+/- R-48 N+108 EC+161 SH0 OP+/- R-128 N+18 EC+166 SH0 OP+/- R+5 N+150 EC+112 SH0 OP+/- R-94 N+270 EC+416 SH-36 OP+/- R-439 N+264 EC+183 SH-96 OP+/- R+43 N-111 EC+197 SH0 OP+/- R-318 N+297 EC+331 SH-25 OP+/- R-96 N+90 EC+114 SH0 OP+/- R-360 N+195 EC+234 SH0 OP+/- R-281 N+254 EC+230 SH-87 OP+/- R-621 N+344 EC+278 SH0 R = Residential incl. Dementia N – Nursing incl. Dementia EC = Extra Care SH = Sheltered Housing Vacancy Rate: National = 7% Kent = 3% Vacancy Rate: National = 7% Kent = 3% Average Size: New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds Average Size: New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021 OPEXISTING2021+/-Known R N EC SH Positive impact on Kent Economy Positive impact on Kent Economy Fit for Purpose Modern Accommodation More Nursing Care KCC fund: 37% of placements KCC fund: 37% of placements % increase by 2021: Accommodation units = 6% Older People 85+ = 30% % increase by 2021: Accommodation units = 6% Older People 85+ = 30% 334 care homes

The number of services users receiving long term residential care as a result of the short term pathway could be reduced by 13% Acute Demand Opportunity to support more individuals at home Actions: Data capture in place to review decision making process in acute hospitals Development of menu of service in one hospital Data capture in place to review performance of STB outcomes Review assessment process for STB assessments Plan for roll out across all hospitals £4.1M - £7.6M through improved short term pathways Opportunity Areas – Acute © Newton Europe Limited. All Rights Reserved

Source: BICA Study In 11% of cases residential was deemed appropriate Pathway resulted in residential placement (Unintended/Incorrect decisions) Was Residential Appropriate?

STB Required Yes –61% No – 39% © Newton Europe Limited. All Rights Reserved Short Term Bed Usage - Review Outcomes

User Preferred Outcome Family/Friends Preferred Outcome Family & friends request residential or STB 77% vs 9% service user requests. What factors lead to this decision being made by the family? Source: BICA Study Comparison of Preference for Long Term Care © Newton Europe Limited. All Rights Reserved

Family are concerned about [NAME] discharge home and her ability to manage at home Family feel he will be unsafe living at home alone [NAME] is at great risk if she is to return to home Concerns regarding safety Concerns regarding carer’s ability to cope Family have stated that they are struggling to support [NAME] recently Wife feels unable to cope any longer at home. Son who states that he feels he cannot manage his fathers needs, and that 24hr care is needed Alternatives to STB : Enablement / Increase care packages / telecare Alternatives to STB : Carer support / respite care / carer assessments Concerns influence outcome with no evidence of alternatives being discussed © Newton Europe Limited. All Rights Reserved Comments from Friends / Family

Results based on initial study 43 residential placement cases reviewed by Panel Jan-May 2014 match PSSRU study results Informal care breakdown, psycho-social vulnerability & cognitive / behavioural needs consistently top 3 reasons given for placement Source: Panel Jan-May 2014 and PSSRU How could we work with the voluntary sector and others to prevent these causes? What Causes Lead to Residential Placement? © Newton Europe Limited. All Rights Reserved

Older People Summary OP+/- R-133 N+52 EC+120 SH0 OP+/- R-48 N+108 EC+161 SH0 OP+/- R-128 N+18 EC+166 SH0 OP+/- R+5 N+150 EC+112 SH0 OP+/- R-94 N+270 EC+416 SH-36 OP+/- R-439 N+264 EC+183 SH-96 OP+/- R+43 N-111 EC+197 SH0 OP+/- R-318 N+297 EC+331 SH-25 OP+/- R-96 N+90 EC+114 SH0 OP+/- R-360 N+195 EC+234 SH0 OP+/- R-281 N+254 EC+230 SH-87 OP+/- R-621 N+344 EC+278 SH0 R = Residential incl. Dementia N – Nursing incl. Dementia EC = Extra Care SH = Sheltered Housing Reduce 2470 residential beds across the County All tenure considered; keep people in their own home OPEXISTING2021+/-Known R N EC SH Who are we targeting for extra care housing? Investment in Enablement, Short term interventions and 24/7 home care Are housing providers supported in the care needs of their tenants? 334 care homes CCG’s investing in enhanced community provision – varied across the County

Delivery Step One: Establish Priority list based on Need, Opportunity and Stakeholder desire Step Two: Agree Priority list through KCC’s Transformation Board Step Three: Prepare Market Position Statements and publish on the Kent Business Portal Step Four: Meet with providers or developers that wish to develop services in that area, scope all opportunities Step Five: Undertake business cases where investment is required Step Six: Issue any formal procurement opportunities and develop legal agreements where required

Timetable Project and Resource planning by December 2014 Market Position Statements/Locality Focus Schedules to be issued from October 2014 Undertake full analysis for people with learning disabilities, people with physical disabilities and people with mental health needs – underway for LD, to start in the new year for PD and MH

Questions Christy Holden, Head of Commissioning – Accommodation – King Edward Court,Herne Bay