The Future Direction of Adult Services

Welcome

Samih Kalakeche – Director of Adult Services

Welcome from the Director

The Future Direction of Adult Services

Natalie Markham Divisional Manager – Governance, Quality, Safeguarding and

commissioning

Session 1: Demand and Supply

•To present the latest policy requirements & commissioning priorities•To set out the budgetary position and implications•To set out the long term supply and demand trends•To explore what is required to support organisations to develop and transform service models•To launch the Innovation Network

Key outcome: Market position statement

Purpose of the sessions

Session 2 (September): Supporting innovation in service delivery•Complex needs intelligence, trends and analysis•A chance to explore new approaches and enabling programmes:- Asset based community development- Social enterprises and mutuals- Workforce development- Personalisation- Early feedback from Innovation Network

Key outcome: Market Facilitation Approaches

Purpose of the sessions

Purpose of the sessions

Session 3 (December): Review and Next Steps

Financial Challenges

Andrew BuckHead of Finance

Childrens, Adult Social Care & Health

Britain faces spending cuts “almost without historical or international precedent” over

the next few years and, painful as the squeeze has been so far, it amounts to less

than a 10th of what is planned by the 2016/17 fiscal year.

(Institute for Fiscal Studies, February 2012)

Savings proposals for 2012-13

2012-13 Resolving the Revenue budget gap

£'000's £'000'sTarget to find 50,000

Full Council 12th December agreed savings -30,716New - Budget pressures/growth 4,767New - Additional Savings -9,859New - Further options to be agreed -6,248New - Council Tax Freeze Grant/CT increase -4,068Total by January 6th -46,124

Still to find 3,876

The Budget Gap

2011-12 £91.4m (delivered) 2012-13 £50.0m2013-14 £20.0m 2014-15 £30.0m 2015-17 £30.0m

TOTAL £221.4m

£0

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illion)

Net Expenditure Income

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n)Social Care - Children Social Care - AdultsEnvironment (inc Waste) Money available for all other services

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n)Social Care - Children Social Care - AdultsEnvironment (inc Waste) Money Available for all other services

2013-17 Mayoral Budget Strategy

• Open & transparent process• Priority led• A longer term view• Take decisions early• Challenge the financial assumptions• Consider all budgets and all spending and income• Consult on the difficult decisions• Ensure equality • Look to do things differently• Recognise growth/ demand pressures• Consider cost v performance

TimescalesDevelop budget savings options - July 2012 to September 2012

Stakeholder Consultation - October 2012 to January 2013

Mayoral Select Committee - February 2013

Cabinet - February 2013

City Council - March 2013

Demand Challenges

Jonny Keville- Performance Improvement Manager

Population by age (Liverpool)

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

2012 2013 2014 2015 2016 2020 2025 2030

Popu

latio

n

Total population aged 18-64 Total population aged 65+

POPPI / PANSI Population Projections

Average Age Entering Service Against Average Service Duration

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

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2019

2020

2021

2022

2023

Age

(Yea

rs)

0.02.04.06.08.010.012.014.016.018.0

Average Age (Projection)Average AgeAverage Service Duration (Projection)Average Service Duration

SU age at point of entry in ASC compared to the projected length of service requirement

Average Age Entering Service

0.010.020.030.040.050.060.070.080.090.0

Community Base

d

Residenti

al Care

Nursing

Home Care

Teleca

re

Grand To

tal

Age

(Yea

rs)

2007 2008 2009 2010 2011 2012

Average Age Entering Service

0.010.020.030.040.050.060.070.080.090.0

PhysicalDisability

LearningDisability

MentalHealth

Dementia SubstanceMisuse

OtherVulnerable

People

Grand Total

Age

(Yea

rs)

2007 2008 2009 2010 2011 2012

SU age at point of entry in ASC trend by year (2007 – 2012)

Average Service Duration

0.0

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4.0

6.0

8.0

10.0

12.0

PhysicalDisability

LearningDisability

MentalHealth

Dementia SubstanceMisuse

OtherVulnerable

People

Grand Total

Age

(Yea

rs)

2007 2008 2009 2010 2011 2012

Average Duration of Service

0.01.02.03.04.05.06.07.08.0

Community Base

d

Residenti

al Care

Nursing

Home Care

Teleca

re

Grand To

tal

Year

s

2007 2008 2009 2010 2011 2012

SU service duration in ASC trend by year (2007 – 2012)

SU Population July 2007

Age as of July 2007 Age as point of entry

Service User Age Breakdown

400 300 200 100 0 100 200

106104102100

9896949290888684828078767472706866646260585654525048464442403836343230282624222018

Age

(Yea

rs)

Volume of Service Users

Female

Male

Service User Age Breakdown

400 300 200 100 0 100 200

103101

9997959391898785838179777573716967656361595755535149474543413937353331292725232119Un

Age

(Yea

rs)

Volume of Service Users

Female

Male

SU Population July 2012

Age as of July 2012 Age as point of entry

Service User Age Breakdown

400 300 200 100 0 100 200

106104102100

9896949290888684828078767472706866646260585654525048464442403836343230282624222018

Age

(Yea

rs)

Volume of Service Users

Female

Male

Service User Age Breakdown

450 350 250 150 50 50 150

103101

9997959391898785838179777573716967656361595755535149474543413937353331292725232119Un

Age

(Yea

rs)

Volume of Service Users

Female

Male

Commissioning

Natalie Markham Divisional Manager – Governance, Quality, Safeguarding and

commissioning

• Core vision: promoting people’s well being and independence to avoid crisis

• Improving information • Eligibility and assessment• Commissioning for outcomes• Supporting carers• Quality of care and support/safeguarding• Care audits – dementia care• Healthwatch

Policy Priorities – Care & Support White Paper/Bill

Commissioning Implications• Stimulate development of time banking schemes• New ways of investing in services (social impact bonds)• Development of specialised housing for older and disabled

people• Dignity and respect• Improve joined up working between NHS and care and

support• Testing scope of extending direct payments into residential

care• Developing user led organisations• Social action in deprived neighbourhoods

3 Key Shifts• Managing demand – shift resources to

prevention & community based solutions• Personalisation & Outcomes• Reablement/short term interventions to

maximise independence

Managing DemandWe want a shift this way

We

wa n

t a s

h ift

this

way

Rigid and agencyled

Innovative and userled e.g. Social

Enterprise

Universal

Reablement

Long term

Shifting Priorities - Prevention

Family, Friends, Natural Support

Building Community

Crisis Response, Resettlement / Outreach Equipment, Re-ablement,

Intermediate Care

Short Term Interventions

Long Term Care and Support

Access, Pathways, Assessment, Support Planning and Review

Universal, Information

Early Intervention & Prevention

Embedding Personalisation• Culture shift – consumer as purchaser

• Adapting systems and processes to deal with personal budgets and direct payments

• Workforce development and leadership are key

• Know your unique selling points and strengths to give you market edge

•Develop whole family services

•Focus on outcomes

•Supporting community capacity

•Flexible integrated care and support service models

Shift resources to short term interventions

•Innovative approaches to reablement and post discharge care and support

•Develop crisis and rapid response services

•LA working in partnership with independent sector to maximise value of community hubs

•Effective resettlement and rough sleeper services

Care & support•Increasing shift away from residential care to community support, housing & care solutions

•Dementia services – day & community support, joint working to improve pathways

•Increased use of assistive technology to maximise independence and resources

•Complex needs – short term step up and step down residential services, short breaks

Context Vision

*Develop extracare/innovative housing & care models

*Dignity in care dementia audit

*Develop partnership working to support Sedgemoor Dementia Hub

*Commission complex needs (homeless) service

*Integration of drug and alcohol services/pathways

*Development of homeless gateway

Connectivity: Health & Well Being Strategy, Mayoral Priorities, Clinical Commissioning Strategy

Improvement Programmes

Building social capital

No £ Growth Expected

Emergency admissions Th

ink

Fam

ily

Stra

tegi

c In

telli

genc

e an

d D

ata

Shar

ing

Nei

ghbo

urho

od/In

tegr

ated

Wor

king

Prevention & Early

Intervention

*Reducing A&E attendances*Reduce emergency admissions for ACS*Commission specialiat residential for complex needs*Increase access to self contained accommodation

*Develop pathways for early identification and support *Enable carers to pursue education & employment *Develop personalised support *Support to remain physically and mentally well*Support young carers

Del

ayin

g an

d re

duci

ng th

e ne

ed fo

r car

e an

d su

ppor

t

Wor

kfor

ce D

evel

opm

ent

Mental Health

Mar

ket i

nnov

atio

n an

d en

hanc

ing

soci

al v

alue

Ensu

ring

peop

le h

ave

a po

sitiv

e ex

perie

nce

of c

are

& s

uppo

rt

Long Term Care & Support

Health Inequalities

Com

mun

ity S

ervi

ces

Inte

grat

ed C

are

Path

way

s

Personalisation

Reducing Health Inequalities

Impr

oved

Out

com

esR

educ

e H

ealth

Ineq

ualit

ies

Incr

ease

d Li

fe E

xpec

tanc

y, B

ette

r Qua

lity

of L

ife

Hig

h Q

ualit

y So

cial

Car

e Se

rvic

esS

afe

& E

ffect

ive

Car

e, C

usto

mer

Exp

erie

nce

Gre

ater

Cho

ice,

Impr

oved

Acc

ess

More people achieving independent living

Growing Elderly Population

High Deprivation

Reduction in permanent admissions into residential care

Complex Needs/Alcohol

Increase number of working age adults receiving social care in paid

employment

*Transform LCC MH day services into a reablement/recovery model*Programmes to reduce mental health delays*Improve routes into work and employment*Single point of access with clear care pathways

Qua

lity

& S

afeg

uard

ing

Reduced Incidence of Avoidable Harm in Social Care Services

Increase in number of adults, older people and carers receiving self

directed support

Join

t Com

mis

sion

ing

for I

nteg

rate

d D

eliv

ery

Older People Dementia

Prev

entio

n &

R

eabl

emen

t

Enabling Programmes

Part

ners

hip

wor

king

to m

axim

ise

Valu

e of

Com

mis

sion

ing

Spen

dH

igh

Qua

lity

Soc

ial C

are

Ser

vice

s Le

adin

g to

Impr

oved

Out

com

es a

t Low

Cos

t

Building Community

Capital

Long Term Conditions

*Develop infrastructure for self directed support*Increase take up of personal budgets/direct payments*Undertake leadership role re community development*Build capacity of User Led Organisations*Develop peer support initiatives

*Pathways development, implementation & adherence*Co-ordinated approaches to complex needs*Support implementation of integrated model of care*Identify opportunities to support lifestyle change*End of life care

*Develop crisis and rapid response services*Further development of reablement pathway*Complex Care*Develop transition processes and pathways

Short Term Interventions

*Commission information, advice & advocacy servicees*Engage with universal services to promote inclusion*Improve access to training & employment support*Floating support for older people and those at risk of social exclusion

Carers

Whole System Approach

Safe

guar

ding

vul

nera

ble

adul

ts a

nd p

rote

ctin

g th

em fr

om a

void

able

har

m

Improved Social Care Related Quality of Life

Outcome Aspirations

Enha

ncin

g Q

ualit

y of

life

for p

eopl

e w

ith c

are

and

supp

ort n

eeds

Increase number of carers achieving outcomes

Improved service user experience of social care services

More adult service users feel safe and secure

Reduction in acute unplanned admissions and length of stay

Reduction in emergency readmissions within 30 Days of

discharge from hospital

Procurement Timetable

2011 2012 2013 2014 2015 2016 2017 2018

Homecare

Residential and Nursing

Specialist Residential Homes

Extra Care

SE ACC Based

Community BasedContract 1102

Floating Support

Cont

ract

Start of ContractPre Tender ProcessStart of Tender ProcessEnd of Contract

Key messagesThe Council:• needs your innovation and creativity to find more effective solutions for

local people• wants to work with organisations that can show the outcomes they

deliver for people• needs organisations that can maximise resources outside of the public

purse – including volunteers• wants partnership approaches to connect up the various systems –

Health, Welfare, Benefits, Housing, Community• wants services that actively engage with citizens and communities

The iNnovation Network (iN):

‘no old roads to new directions’

Phil RigbyTransformation Manager

iNnovation Network (iN)‘Innovation is anything, but business as usual…’1. iNnovation Roundtables [monthly]2. Adult Services Hack Days [one off sessions] 3. a) Collaboration Forum (Matching)

[quarterly]3. b) Collaboration Forum (Hatching) [by

project]4. Alternative Assets [ongoing]

iNnovation Matrix

Priorities for innovation Cost Efficiency Improved Outcomes Improved Convenience

Innovation through Improved Interface

Innovation through Better Monitoring

Innovation through Collaborative Infrastructure

Inno

vatio

n A

rea

Innovation Type

iNnovation Toolkit

Next Steps

• Circulate iN Matrix with guidance• Submissions should be mindful of the analysis

identified today, commissioning intentions etc.

• Expressions of interest by noon, Weds August 15th

Phil Rigbyphil.rigby@liverpool.gov.uk

Ray Dixonray.dixon@liverpool.gov.uk

0151 233 4199

Group Workshop

Workshop

Purpose:

• To explore the information and intelligence that will enable your organisation to make intelligent decisions about investment and development

Discussion Questions• What opportunities do you see to respond to the

changing requirements for meeting future care needs?

• What factors can help or hinder your ability to transform your services to meet the challenges?

• How can we as an authority help create the right conditions for innovation and sustainability?

• How can you as a sector better inform our commissioning intelligence?