1. MS BERNADETTE MCNALLY DIRECTOR OF SOCIAL WORK BELFAST HEALTH AND SOCIAL CARE TRUST UNITED KINGDOM Health and long-term care for older people: access, financing, providers: Experience from a service provider

2. Welfare state established 1945 NHS free to all citizens a the point of use Social care services to those most in need charges based on ability to pay (means tested )

3. National assistance act (1948) “to provide residential accomodation for persons who by reason of age, infirmity, or any other circumstances are in need of care and attention which is not otherwise available to them”

4. Growth in institutional care Hospital long stay geriatric wards Psychiatric hospitals Childrens homes Learning disability institutions Prisons

5. asylum

7. Concerns about quality of care

8. Development of community care Child care: foster care preferred to institutions for children(experience of family life) Older people: increasingly supported in own homes Poor quality of life in institutions(Townsend report 1964) Hospital plan(1962) major programme of hospital closure White paper (1976) redistribution of resources away from acute hospitals to community services

9. ” Community care reforms Community Care Act (1990) “people first” Comprehensive individual assessment Focus on those with complex needs Mixed economy of care People remaining at home Reducing hospital provision

10. Focus on the individual

11. Comprehensive assessment Individual multidisciplinary assessment of complex needs Individual care plan Devolved budgets to social worker to purchase packages of care Systematic review process

12. Mixed economy of care Huge growth in independent sector in market conditions Private providers coming into the market alongside statutory and NGO providers Providing residential, respite, domicillary and day care services Emphasis on improving quality standards Emphasis on value for money

13. Nursing home

14. Residential home

15. Statutory v Private Residential Nursing Domiciliary Total Care Managed (complex needs) 768 (12%) 1697 (26%) 3980 (62%) 6445 Non Care Managed (low level care) - - 2987 (100%) 2987 Direct Payments (Complex) - - 43 43 Direct Payments (low level) - - 60 60 TOTAL768 (8%)1697 (18%)7070 (74%)9535

16. Expansion of domicillary care

17. People staying at home Closing large institutions Domicillary and day care free of charge Residential and nursing homes means tested Support for carers Direct payments Increased use of tecnology

18. People staying at home

19. Reducing hospital provision De institutionalisation of older people from long stay wards Resettlement of mental health and learning disability clients into community settings Timely acute hospital discharges Acute hospital admission avoidance

21. Key components of social care in the 90s Flexible and responsive services Choice of a range of options Foster independence Concentrate on those in greatest need Purchasing power of care manager (sw)

22. Rising demand Aging population Demographic changes Medical innovation Rising public expectations Breakdown in extended family supports Breakdown in community infrastructure

23. UK RISING COSTS Spending doubled in a decade £7billion to £14 billion 1.2 million older people receiving publicly funded home based social care 20,000 care homes 450,000 care home places

24. Current thinking Prevention, rehabilitation, re ablement Target low level support not just complex needs User empowerment Recovery model What people can do rather than cant do Partnership with users

26. Reablement

27. Current thinking Focus on interface between acute hospitals and community services Timely discharge of old and frail Hospital avoidance (intermediate care, step down, home based treatment) Short term focused rehabilitation Purchasing power of client (direct payments)

28. Current thinking More choice Louder voice for users Tackle inequalities Improve access to low level support services Supporting long term needs Chronic disease management Fostering independence Recovery model

29. USER EMPOWERMENT Real choice To be listened to To be respected To be treated as equals To stay healthy To go to work To have a safe place to live Valuing human rights

30. Interagency partnerships Housing: social housing with floating support Police: Community safety initiatives Leisure services: actively aging Transport: free transport for over 60s Community: neighbourhood renewal Employment: Education:

31. Mullen mews

34. POSITIVE LIFESTYLES Walking groups Line Dancing Chair Based Activity Tai Chi __ Gym Pool – steam / sauna Dancing Aerobics / Spin Badminton

35. The future Personalised budgets (pooling all state services) Expert patient (self help condition management) Promotion of positive health and wellbeing Enabling rather than disabling Medicines management Stroke management Falls prevention

36. Actively aging well