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

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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. Developing localities

10. 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

11. 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

12. FOP Case Management Pathway1 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

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

14. …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

15. 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

16. 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

17. And finally
Questions?