Older People’s Provision and Self Directed Support

Geoff Mark

Joint Planning & Commissioning Manager

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Overview

• Why have so few older people taken up SDS?

• What impact will the SDS Bill have?

• How would we use SDS to address the key challenges facing older people ?

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Why have so few older people taken up SDS?

Commonly Cited Reasons

• Not what older people want?• Attitudes and expectations • Limited Resources (especially beyond

Personal Care)• Time

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Why have so few older people taken up SDS?

Or are these just excuses? Do we just need to try harder and believe a little more?

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Why have so few older people taken up SDS?

Research suggests• Not what older people want?

• YES - but also that this depends on the information they have and crucially the support they have to manage an SDS budget

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Why have so few older people taken up SDS?

Research suggests• Attitudes and expectations

• YES – attitudes of older people, their families and professionals but attitudes do not exist in isolation. Different experiences and expectation can lead to fundamental attitude change

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Why have so few older people taken up SDS?

Research suggests• Limited Resources (especially beyond

Personal Care)• YES – but we don’t give people a chance

to make choices about this and there is also the question of whether a small amount of preventative resource could deliver a better outcome?

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Why have so few older people taken up SDS?

Research suggests

• Time

• YES – but the key point is that people need to be able to change things when their needs change or their experience develops – we need to deliver SDS in a way which reflects the experiences of older people e.g. discharge from hospital

• The current system is struggling too.

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What impact will the SDS Bill have?

• Answer - I’m not really sure

• Certainty: Existing Models are unsustainable

• If SDS can assist with maintaining outcomes in the context of decreasing workforce, increasing demand and limited public finance the impact will be huge.

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What impact will the SDS Bill have?

Options

• Option 1 direct payment• Option 2 the person directs the available

support (arranged by the local authority)• Option 3 the local authority arranges the

support• Option 4 a mix of the above.

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What impact will the SDS Bill have?

Option 3 – What we do already

• Choice = choice of provider• Control = choice of visit time (one of in the

specification of the care plan)• Reality as things get stretched – provider

= whoever has capacity and visit times = when they can be fitted in.

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GIS Examples

Traditional Approaches to Efficiency (Option 3) – Geographical Zones

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Traditional Approaches to Efficiency (Option 3) – Geographical Zones

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• Probably couldn’t force people to change providers under SDS Bill – has to be a good thing?

• But if there is no change and traditional approaches are unsustainable – then what?

What impact will the SDS Bill have?

• Option 1 – Will work very well for some

• Perhaps not many?

• Will it address workforce and financial issues?

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So that leaves Option 2

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Individual Service Funds

• Developed to give individuals more choice and control by disaggregating the resources in block contracts.

• This is not required within older people’s services where there are no block contracts.

• For older people – they could allow greater by:

• Greater flexibility and co-ordination - negotiation directly between the service user and the provider.

• Ability to aggregate resources with others

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Example – A sheltered Housing Development in Dumfries

• 28 residents • 8 receiving care from 8 different providers• Residents and Sheltered Co-ordinator very

frustrated

“surely we can organise things better than this”

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Key elements of Extra Care Housing

• On site care team • Coordination – not just of care but of wider

aspects of wellbeing in both the community and for individuals e.g. Social activities, participation of the wider community etc

• Also flexibility to maintain a community with a range of dependency levels.

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Example – A sheltered Housing Development in Dumfries

• Traditional Extra Care Housing Solution

• Tender for one provider

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Example – A sheltered Housing Development in Dumfries

• Personalised Approach – tender for a provider to work with the residents and the Housing providers to achieve better outcomes:

• Could centralise care – but under ISFs• Could start by centralising communal activities

e.g. laundry, meals, social activity• Anyone wishing to retain current provision can

do so

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What the residents said

• Residents said they were “up for change” if it would work?

• We are just developing the specification and tender process.

• It won’t be the traditional tender because we can’t be sure ahead of time what we want.

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Lessons for the wider care at home services

• “Virtual Extra Care Housing”

• Would like to try to replicate some of the positives of Extra Care Housing in the care at home market

• This will need to have a geographical component as we will not have the resources to simply increase prices so different models will have to be viable in the current resource envelope?

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GIS Examples

Possible components

• Geographical clusters of 20 – 30 people

• Change care at home specification to include wider coordination, including a focus on wellbeing and connections with the wider community

• The big question – Will geographical efficiencies release resource and will the balance between flexibility and constraints on choice be attractive?

• Can there be incentives for service users, families and providers to find alternative ways of meeting need?

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Final points

• Small achievements may be very significant in the context of older people’s care e.g. one hour per month for social activity is better than nothing at all.

• People will opt in if there outcomes are better!

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