Appendix 1
Demonstrator for Older People’s Housing, Support, Health and Care
Detailed Request for Demonstrator Area Status
Section 1 Partnership Details Q1 Name of partnership
Inverclyde Joint Care
Organisations and/or services party to this application
Inverclyde Council, Riverclyde Homes, Trust Housing Association, NHS Greater Glasgow and Clyde, Inverclyde CHP.and Communities Scotland.
What level of support exists between the partners (e.g. including elected members, non-exec members of CHPs/HBs, users and carers) for this proposal? (Please note the requirements set out in para 23 of the specification for the demonstrators.)
High level commitment Partnership commitment is derived through the Joint Care Board in Inverclyde where the proposed application was discussed and approved at a meeting on 30th January 2008.
This is the high level strategic joint board developed to support the joint future agenda. Membership includes the Director of the CHP, Director of Education and Social Care, CHP Clinical Director, Chief Social Work Officer, Trade Unions, Inverclyde Community Care Forum and Elected Members, with the Chair being the Health and Social Care convenor and also vice-chair of the CHP.
A multi agency Housing and Accommodation Group forms part of the joint structures in Inverclyde and is the forum for ensuring health, social care and housing matters link together across the care groups and agencies and also into the local Housing Association Forum.
There is also a well developed providers forum that includes all private and voluntary sector providers (National and local), including care home providers, housing providers, housing support providers and care at home providers.
NHS Non-acute Service redesign The partnership is currently progressing a whole system redesign of older people’s services and mental health services as part of the closure of Ravenscraig Hospital.
Detailed plans for the redesign/re-provisioning of services for Older People with Mental Illness services have been developed and discussion to agree a financial envelope around these plans is underway.
Detailed Application for Demonstrator 1 Joint Improvement Team: January 2008 Appendix 1
Background work to begin to redesign Older People’s services has been ongoing for a period of time, with final requirements currently being updated based on hospital useage and throughput over the past year and also the present hospital population.
The aforementioned plans are being developed through joint structures and encompass a whole system approach, both in terms of being multi-disciplinary but also multi-agency, ranging from redesign of NHS continuing care provision, through intermediate tiers of care to intensive community care in a range of housing provision, to maintenance and preventative work.
Sheltered Housing A comprehensive review of sheltered housing has taken place, with the final stage being wider consultation with key stakeholders including the community and service providers. This work will take place at the end of March 2008. Reports outlining preliminary findings from the review have been submitted to and approved by appropriate committees within the local authority including the Corporate Management Team. Consultation with the wider community will be led by the Inverclyde Community Care Forum who have access to and involvement with, over 900 local stakeholders including individuals and community groups across Inverclyde.
The review process has included an audit of the condition and standard of current sheltered housing provision and a minimum standard has been drawn up with relevant costings for implementation. This would allow for joint working with the community occupational therapy service to link adaptation requirements into upgrading programmes across sheltered housing.
Work is underway to change a sheltered housing unit to housing with care. This is a partnership development with Trust Housing Association and the local authority. The supporting people budget plays a key role in the funding of this initiative. This project has involved the transfer of care coordination and provision of care services from the local authority to the housing provider.
Telecare The telecare work in Inverclyde makes clear links between community alarm services and sheltered housing, and this is an area that continues to develop with RSLs and the council.
Care at Home services A Best Value review of older people’s services in the local authority was undertaken in 2003 and implementation is ongoing. This has included the development of services that are better able to adapt and respond to the changing requirements of service users as other services redesign. These services include care at home in its widest sense: – Homecare – both internal and external provision – Day services – Respite services – Community Alarm services – Meals on Wheels
Detailed Application for Demonstrator 2 Joint Improvement Team: January 2008 Appendix 1
The review was undertaken jointly with Community Nursing services to ensure that the support was available as patients/clients became more dependent but chose to be cared for in their own homes. The joint working developed at this time has continued to progress with community nurses and homecare staff working comfortably together to provide intensive support in the community.
A recent joint efficiency review has been requested for homecare services by the corporate management team and this piece of work is nearing completion. One of the requirements of the review is to develop a joint commissioning strategy for homecare provision.
Balance of Care and delayed discharges The delayed discharge agenda is managed and monitored through the Older Person’s Development Group, with a single manager being responsible for a pooled budget of approx £2m to support this work. Attached is a list of the range of services covered through this budget. (See Appendix 1)
Use of the care home budget and allocation of care home places links into the delayed discharge process and care home places allocated are monitored carefully to ensure that the balance of care does not tip in the wrong direction.
A new care home is being built in the area at present with completion date being due for August 2008. Discussions have already begun with the care home provider to link their facilities into the Ravenscraig Hospital closure, looking at specialist services for older people with mental illness and also as a possible alternative to long stay NHS continuing care.
The number of older people being supported in the community has not increased dramatically, but the intensity of care packages has changed significantly.
The delayed discharge work in Inverclyde has ensured that people are being delayed for shorter periods and are able to access a range of services both on discharge and to prevent admission. Bed days occupied have reduced by 56% from April 2006 to January 2008.
Joint store and adaptations A singly managed joint equipment store has been developed in Inverclyde with full commitment from local authority and NHS attracting additional funding for equipment.
Inverclyde has many topographic challenges that impact both on the ability of some adaptations to be made and in the costs of the adaptations. It is therefore essential that housing plans take into account not only the needs of older people who can and want to move house, but also making best use of existing property that could come back into the housing stock to benefit other tenants, maximising the value of any investment made.
Community Occupational Therapy staff work closely with Care and Repair colleagues who administer the grants for Owner Occupiers on behalf of Inverclyde Council.
Detailed Application for Demonstrator 3 Joint Improvement Team: January 2008 Appendix 1
Additional funding has been obtained for 2007/2008 which has resulted in £370,000 being spent to date on Adaptations for disabled people, £54,000 being spent on repair grants and £24,000 being spent on lead pipe replacements. The small repairs service is also widely used and advice is also given to people regarding contractors, other sources of funding etc.
Community Occupational Therapy staff also carry out assessments for other Housing Providers. Following the assessment of need the Housing Provider will carry out the required work.
Invest also have a large role in providing advice/guidance on insulation and safety aspects for older people.
The Joint Equipment Store is part of the service operated at The Centre for Independent Living. As part of the display area Telecare equipment can be viewed and tried in addition to a stairlift/level access shower/clos-o-mat toilet.
Such demonstration sites in Inverclyde have been of significant interest to service users, family carers and professionals to allow them to see what assistive techmology can really do to support people in their own homes. Early evidence suggests that admissions into care are now being avoided as a result.
Q2 Contact Details Name of Main Contact
Gillian McCready Position/Designation
Service Manager, Older People and Physical Disability Services Address
Inverclyde Council, Education and Social Care Services, 195 Dalrymple Street Greenock PA15 1UN Telephone Number
01475 714079 Email address
Detailed Application for Demonstrator 4 Joint Improvement Team: January 2008 Appendix 1
Section 2 Your Proposal Q3 Demonstrator Area What geographical area do you propose to use as the demonstrator?
The partnership acknowledges the suggestion in the demonstrator guidance for an area population of 20,000 to 50,000.
Inverclyde however is a small authority, with the work that under-pins this submission covering the whole local authority administrative area. If the area were to be split for the demonstrator purposes, it would remove the diversity from the population base, and also remove the majority of private sector provision from the work. Progress would be in danger of becoming “pilot” based as opposed to making a longer term strategic shift in provision.
It is proposed that the whole area is included – this being a population of 81,539.
What are the main socio-economic characteristics of the area you are proposing for the demonstrator? Please include information on housing tenure in the area.
Over the past ten years there has been a year on year decrease in the population of Inverclyde and it is projected that, if trends were to remain unchecked, by 2024 the depopulation rate would be 14%, reducing Inverclyde’s population to around 71,000. The significant regeneration of the area, including new housing developments, is aimed at arresting this projected decline and producing an inflow of population to Inverclyde.
Inverclyde is one of the most socially deprived Local Authority areas in Scotland. • The number of people unemployed in Inverclyde in November 2007 was 2,600 (a rate of 6.7%); higher than the Scottish average unemployment rate of 5.2 • 23.6% of Inverclyde’s working age population are claiming benefit , which equates to almost 12,500 people • 4% of these are claiming Job seekers allowance compared to national average of 2.4% • 13.3% (1,655 people) are claiming incapacity benefit (IB) compared to a Scottish average of 9.4%. • 44% of incapacity benefit claims are related to disorders of a mental and behavioural nature, • 14% of IB claims are related to diseases of the musculoskeletal system. Ref: 1st Draft CHP Development Plan 2008-2010.
There are major variations in life expectancy across Inverclyde. In fact in one community (Greenock East) just over half of 15 year old boys are not expected to live beyond 65. This compares to communities in Kilmacolm and Inverkip where almost 88% of young males are expected to reach old age (respective).
Detailed Application for Demonstrator 5 Joint Improvement Team: January 2008 Appendix 1
Many communities in Inverclyde have a substantially higher percentage of adults unable to work due to illness. In some cases this is more than 100% higher than the Scottish average.
As the graph below shows, the percentage of adults not in employment due to ill health is over 20% in Greenock Central (28.3), Greenock Rankin (22.0), Greenock South East and Port Glasgow (20.2 respectively). In complete contrast, less than 10% of households in Gourock, Greenock Finnart, Kilmacolm and Weymss Bay cannot work due to ill health.
% Adults who Cannot Work due to Illness
Greenock Central 28.3 Greenock Rankin 22 Greenock E 21.7 e d
y Greenock SE 20.2 l c
r Port Glasgow E 20.2 e v
n Greenock Esplanade 18.3 I
n Port Glasgow W 17.4 i
s Inverkip Greenock SW 15.6 e i t i Inverclyde 15.3 n
u Loch Thom 13 m
m Gourock 8.9 o
C Greenock Finnart 7.5 Kilmacolm 5.1 Wemyss Bay 4.5
0 5 10 15 20 25 30
% of Adults
Graph : % Adults in Inverclyde who cannot Work Due to Illness (Source: A Community Health and Well-being Profile: Inverclyde, 2004)
As economically inactive people grow older there will be an increased pressure on services for older people to maintain independent living.
The level of elderly Attendance Allowance claimants suggests that in a number of communities there are many older people who need care. In some Inverclyde communities, such as: Greenock Central and Greenock East, the level of such provision is more than 40% above the national average.
The table below illustrates that at the other end of the spectrum in Loch Thom and Wemyss Bay, 20% fewer elderly households are claiming Attendance Allowance than is the case nationally.
Detailed Application for Demonstrator 6 Joint Improvement Team: January 2008 Appendix 1
ATTENDANCE ALLOWANCE – ELDERLY CLAIMANTS No. of Elderly % of Elderly Above/Below Area Households Households Scottish Av. Inverclyde 2,332 16.6 8% Kilmacolm 82 9.9 -36% Port Glasgow West 293 20.8 35% Port Glasgow East 164 14.4 -7% Greenock Central 183 22.1 43% Greenock East 161 22.2 44% Greenock South East 64 18.2 18% Greenock Rankin 342 20.8 34% Inverkip Greenock South West 162 15 -3% Greenock Esplanade 254 16.2 5% Greenock Finnart 179 15.6 1% Loch Thom 114 11.9 -23% Wemyss Bay 23 11.7 -24% Gourock 311 14.6 -6% Table : Attendance Allowance: Elderly Claimants (Source: Inverclyde: A Community Health and Well Being Profile 2004)
The number of people with dementia living in Inverclyde as estimated to rise by 12% by 2015.
The number of older people who are single and living alone is very substantial and in many areas is significantly above the national average. In Inverclyde as a whole this is 9% above the national average, though in one community (Greenock Central) the number of single person elderly households is over 140% greater than the national average. 21% of all households will be pensioner households by 2024.
HOUSING TENURE ACROSS INVERCLYDE HOUSING TENURE Owner occupation 19,438 RSLs 10,367 Private rented sector 1,944 Other 648
The figures presented indicate that the socio-economic characteristics of Inverclyde reflecting an area of great contrast where there are concentrated areas of acute socio-economic disadvantage where the health and well being of residents is significantly below the Scottish average e.g. Greenock and Port Glasgow, while at the other end of the spectrum communities are thriving both in socio-economic and health terms in Kilmacolm and Wemyss Bay.
Detailed Application for Demonstrator 7 Joint Improvement Team: January 2008 Appendix 1
Sheltered Housing There are 686 sheltered housing units within Inverclyde, provided within 23 separate complexes.
Very sheltered housing/extra care housing currently represents 6% of all sheltered housing available in Inverclyde.
The provision of sheltered housing is predominately within the social rented sector which provides 83% of sheltered housing units within Inverclyde. Sheltered housing provision within the owner occupied sector represents 17% of sheltered housing supply. There are three owner occupied sheltered housing complexes.
River Clyde Homes is the single largest provider of sheltered housing in Inverclyde. Providing 38 % of supply (258 units), across 7 complexes
Just over one half of all sheltered housing units are located within the Greenock settlement, with considerably lower levels of provision in other localities within Inverclyde.
When rented only units are considered sheltered housing in Greenock makes up 63 % of rented sheltered housing units in Inverclyde. However, 54% of the population of Inverclyde reside in Greenock with 20% of the people living in Greenock being pensionable age or over (2001 census):
There is no sheltered housing provision to the west of Inverclyde within the settlements of Inverkip, or Wemyss Bay.
Port Glasgow, Gourock and Kilmacolm have relatively similar shares of the distribution of sheltered housing units across Inverclyde at around 16% of total units within each settlement.
Only Gourock and Kilmacolm have owner occupied sheltered housing provision with 80% of sheltered housing units located in Kilmacolm being owned by residents.
What is the estimated number of older people in this area? What information do you have, if any, on the needs profile of the older people in this area? Please include details below, or attach.
Age bracket Total Number %age of total Projections %age of total (June 2006) population 2024 population (June 2006) Total Number (2024) 0 – 16 15492 19% 11000 15% 17 – 59 47293 58% 36374 51% 60 + 18754 23% 23817 33% Total 81539 71191
Population projections suggest that the number of 0 - 16 years olds will decrease by 29% by 2024 and the number of people aged 65 years and older is predicted to increase by 27%. There is a notable increases in age bands 75-80 (35%) and 80+
Detailed Application for Demonstrator 8 Joint Improvement Team: January 2008 Appendix 1
age bands (35%)
The population of Inverclyde is therefore not only decreasing, but is also aging and support available from informal carers will also reduce as younger people leave the area in search of employment. The out-migration of younger people is also expected to put pressure on the future availability for recruitment of care staff and also on the statutory services to provide responsive front line preventative services.
Attached is a future need profile for older people in Inverclyde commissioned by the partnership to inform the baseline for the review of Sheltered Housing. This document details the population profile for older people in detail. (See Appendix 2). Overall the demand for specialist housing is expected increase to accommodate the changing population. It is therefore seen as essential that the partnership is clear about requirements especially at a time when opportunities for investment in housing are available.
Intensive homecare packages have increased considerably in recent years, with the increase being noticeable within mainstream housing as opposed to sheltered housing units.
The pattern of homecare packages is detailed below, showing a shift in the balance of care from domestic care to personal care.
June 06 March 07 September January 07 08 Number of people >65 with 10 270 302 316 335 hours or more Number of people >65 with 20 62 67 65 65 hours or more Total Personal care hours n/a n/a 10687 11198 Free personal care hours 8257 8707 (65+) Total Domestic Care hours 494 260 Total Housing support hours 3068 3289 Number of people requiring 2 56 61 home helps per visit
The figures below reflect the fact that the number of people being inappropriately delayed and also the number of bed days occupied has reduced steadily over the past year.
Detailed Application for Demonstrator 9 Joint Improvement Team: January 2008 Appendix 1
Patients ready for discharge 2007
18
16 16
14 14 13 13 13 12 12 12 s t 10 10 10 n Within 6 w eeks e i t Outw ith 6 w eeks a 8 P 6 5 5 5 4 4 4 3 3 3 2 2
0 April May June July Aug Sept Oct Nov Dec
Bed days delayed
3500
3000
2500
2000 2006-07
1500 2007-08
1000
500
0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar NB Adults with Incapacity account for 607 days of December 2007, therefore actual waiting days = 531
Although many older people are out right home owners (see Appendix 2), the equity available from the sale of their homes is lower than in some more affluent areas therefore the ability to purchase private sheltered housing is limited, so there is a need for tenure choice/diversification to allow ‘downsizing’ and private ownership options with care/support.
All new build housing by RSLs will be to ‘‘lifetime homes/barrier-free” standards.
Detailed Application for Demonstrator 10 Joint Improvement Team: January 2008 Appendix 1
What is the current provision in this area of continuing care (if any), care homes, very sheltered/extra care housing and sheltered housing?
Inverclyde Council has no directly managed care homes or housing stock.
Stock transfer of local authority housing to River Clyde Homes in December 2007 has provided an opportunity to revisit local housing plans with a view to appropriate investment in the whole range of housing including options that will meet the needs and deliver better outcomes for all older people.
The work to ascertain the needs of this care group has developed through the joint future partnership and links closely to work jointly managing the delayed discharge agenda thereby ensuring a whole system approach to the process.
Sheltered and Very Sheltered Housing Units Housing Associations: ° River Clyde Homes 258 (Including Bagatelle Court (28)) ° Bield Housing Association 180 (including 39 very sheltered) ° Cloch Housing Association 22 ° Margaret Blackwood Housing Association 20 ° Trust Housing Association 57 Total 537 Other Charitable Organisations: ° Abbeyfield Society 13 ° Little Sisters of the Poor 20 Total 33 Private Sector ° Elphinstone Court 49 ° Woodrow Court 43 ° Ashton Court 24 Total 116
Care Homes
661 care home places provided by the independent sector including 60 beds for Older People with Mental Health needs.
A new build development is planned to open in August with 90 places.
Regular communication takes place with care home providers and RSLs through the well established Providers Forum. This forum addresses communication in terms of policy changes, contract issues, joint working and commissioning intentions.
NHS beds Medicine for the elderly Continuing care beds – current – 51. Planned for future – 20. Assessment and rehabilitation beds – current and planned - 74 plus 16 stroke.
Detailed Application for Demonstrator 11 Joint Improvement Team: January 2008 Appendix 1
Psycho-geriatric Continuing care beds – current – 80. Planned for future –33 Assessment and rehabilitation beds – current – 20. Planned for future – 20
Q4 Objectives and Outcomes What changes do you want to make to the current balance of accommodation options available to older people?
The partnership has worked hard to maintain the current balance of care through very difficult times both in terms of changes in organisational structures across key partners, with pressures on budgets and also in terms of an opportunistic developer bringing a new care home on stream while there was pressure to reduce delayed discharges.
The focus for the delayed discharge agenda in Inverclyde has been on establishing a robust and sustainable community infrastructure as opposed to “quick wins” through care home admissions.
The natural progression is to take this a step further by developing a comprehensive intermediate tier of care where people can be supported either to prevent admission or to ensure a successful, sustainable discharge.
A key component of this progression would be the application and implementation of an allocation policy across a range of provision for older people, based on need through a single shared assessment process. The underlying development work has started in order to provide the complete range of available options for older people. This includes development of housing criteria and a community care checklist to support the SSA process. The difficult part is the identification of availability to match identified individual need. Work is underway to consider the implementation of a common application process across providers with associated ICT solutions to support this process.
Telecare developments locally have already supported a number of people in their own homes where previously they would have been placed in a care home. Most of these cases have proved to both family, carers and assessors that it can be safe for someone to be supported without 24 hour waking cover, thereby promoting independence and accommodating the client’s choice.
The planned closure of Ravenscraig hospital offers a number of opportunities in terms of the release of funding from institutional investment into community services. The partnership has tackled this in a whole system way, identifying the population base and gaps in provision throughout the spectrum of services, ensuring interdependencies and streamlining of services takes place through the redesign.
This application could also provide expertise and a focus on areas that have been seen as “grey areas” and that depend on availability of the range of available
Detailed Application for Demonstrator 12 Joint Improvement Team: January 2008 Appendix 1
housing stock to develop further, such as palliative/end of life care, intermediate care and real alternatives to care home placements. New guidance on NHS Continuing care will also support this work.
One mainstream sheltered housing unit has been developed to provide a housing with care model as an alternative to care home admission. This has included the provision of meals and also the transfer of care provision from the local authority to the RSL with the warden’s duties changing to take on the care coordination role. This development is being used as a pilot for development of an allocation policy that will form the basis of the wider allocation process based on needs as opposed to wants.
This work will also link to a range of an Intermediate tier of care solutions being developed to support early discharge or as an alternative to care home admission on discharge from hospital. Telecare, community alarms, a range of Allied Health Professional services and community nursing will also be key to the support of these developments.
This tier of care will feed in to the hospital closure programme and will further develop as the closure is implemented.
Recently a number of people have been delayed in hospital due to housing related issues. The solution has been to admit them on a temporary basis to a residential care home until the situation has been resolved, and while this has been successful so far it is not seen as best practice and the use of suitable housing in the community would be more appropriate.
Following direction from Better Outcomes for Older People in supporting older people to meet their aspirations to remain within their own homes, the partnership is keen to continue to promote a culture which supports independence while at the same time minimising risk through the use of new technologies and whole system working.
There is a need for greater choice to enable older people to move, if they wish to, or to remain in their own home/community environment with appropriate care and support services. A key element to this is the introduction of assistive technology for greater security/reassurance, supported by robust response mechanisms. This is an expanding area of work that must be taken as only part of the package. Over and above the response services it is essential that we do not isolate people in their homes, but provide a range of social interaction which is accessible by older people.
Historically sheltered housing provision in Inverclyde was allocated predominantly on an age factor as opposed to identified need for housing support services. The review of sheltered housing provision will lead to needs-based allocations, moving away from the current self-referral system.
Providing homes capable of meeting changing circumstances and expanding tenure choice for older people in terms of accommodation size and location will begin to be addressed through refurbishment of River Clyde Homes stock to meet with National Housing Standards. There is an opportunity to work towards ensuring that any
Detailed Application for Demonstrator 13 Joint Improvement Team: January 2008 Appendix 1
investment within this refurbishment programme will take account of the housing requirements of people with particular needs. Through a partnership approach it will be possible to support the longer term possibility of people being able to remain in their own home with appropriate adaptations as part of the renewal process. What changes do you want to achieve in terms of housing related services (such as adaptations, small repairs, handyperson repairs etc)?
– Programmed adaptations (needs-based) to make best use of two-year budgets and to address demand issues.
– Expansion of small repairs service to allow older people to remain in their own, well maintained, safe homes.
Inverclyde Council works in partnership with Inverclyde Care & Repair based within Cloch Housing Association offices to provide an adaptations service for people whose housing needs have changed and who now require their home to be adapted to allow them to continue to live in it.
Inverclyde Care & Repair is jointly revenue funded by Inverclyde Council, Communities Scotland and NHS Greater Glasgow & Clyde, with a management service delivered by Cloch Housing Association.
Inverclyde Care & Repair works closely with the Centre for Independent Living to identify an individual's needs and following assessment by an Occupational Therapist, Inverclyde Care & Repair will be advised of the adaptation required and, where possible, will organise for the works to be carried out.
– Expansion of handyperson services to support older people without carers, relatives, etc, in the local area.
Muirshiel home Maintenance service was developed in response to public consultation associated with the Best Value Review of care at home services.
The community expressed a need for services which did not fit with housing support criteria and were too small for commercial companies to take on. Often these services involve minor repairs and maintenance and contribute to supporting people to live independently.
This service is jointly funded through Local authority and NHS Greater Glasgow & Clyde.
The service also promotes safety (prevention of falls and security) and support older people to maintain their quality of life.
This is three year funded project which is supported in partnership by the local authority and Help the Aged.
– Development of a common housing register to support the roll out of the Single Shared Assessment process and link this to available housing stock.
Detailed Application for Demonstrator 14 Joint Improvement Team: January 2008 Appendix 1
– Provision of care coordination by sheltered housing wardens based on the outcome of the work currently being undertaken with Trust Housing Association.
Training of staff within RSLs on the range of adaptations/assistive technology which is regularly provided by staff from the Centre for Independent Living.
– Expansion of the role of Community Occupational Therapy Staff in carrying out specialist assessments in areas designated for re-furbishment would reduce duplication and increase efficiency and effectiveness in the use of resources, for example, where new baths are installed in housing used by people who in the near future require a shower to be installed. Current work involves kitchens and bathrooms. This enables resources to be targeted appropriately and enables older people to be maintained within their homes.
– Development of a range of information sources for potential service users and cares relating to housing and adaptations.
The hospital discharge protocol ensures that full information is provided to patients and carers on discharge for care home provision and care at home and community health services. This area of work continues to develop, with the most recent development being information around medication being expanded.
What associated changes do you expect to make in terms of other related services (health, social care, support, transport etc) to support the delivery of these changes?
Imminent planned closure of NHS continuing care wards will offer the opportunity to address those intended moves from institutional care to community care. It is therefore essential that the partnership agrees a joint commissioning strategy for the provision of accommodation for older people now and for the future. This will not only give clear direction to the partnership but also to prospective providers within the area and to older people and their family carers too.
The redesign work will be seen as an extension to the original delayed discharge commissioning plan, ensuring there is investment in services that complement and support each other e.g. – CPN service provision in GP surgeries, – Activity programmes in the community linking to falls prevention programmes and falls clinics giving a full spectrum of support – Community Nursing and homecare – A range of homecare and care home facilities – Links between local authority day services and day hospitals – Ambulance services to support same day referrals – Continued expansion of the joint equipment store – Linking the Single Shared Assessment process to housing allocation process
Detailed Application for Demonstrator 15 Joint Improvement Team: January 2008 Appendix 1
The partnership has been actively progressing work with an independent sector provider to change a model of sheltered housing to a housing with care model as an alternative to care home admission. Through this process we will pilot: • a new allocation process, • provision of care and support services by the housing provider • changes to the wardens duties to that of care coordinator • availability of the use of facilities by the wider community including meals provision The outcome from this pilot will inform the wider needs and possibilities for accommodation for older people.
Continued expansion of the use of telecare/telemedicine with the redistribution of resources from identified savings – e.g. funding from care home budgets and NHS Continuing Care beds being redirected to response teams.
Are there specific innovations which you would like to develop and test? Why?
Evaluation of the Trust Housing development with the warden acting as care coordinator for the unit and also having the housing provider as care provider. This work would inform the commissioning process for care at home services, identifying whether or not it leads to a more flexible service able to responding to daily changing needs and also become a real home for life and alternative to care home admission.
Development of a common housing register with availability linking into the single shared assessment process. Riverclyde Homes and Inverclyde Council Social work both use the Anite system, but the two systems have not been developed together, therefore do not yet have capacity to “speak” to each other. While it is recognised that there are also other RSLs in Inverclyde, Riverclyde Homes is by far the biggest provider and it would make sense to progress this work with them initially.
To scope the feasibility and appropriateness of telemedicine and eConsultations, to increase access options for older people.
Remote consultations could potentially offer rapid reassurance or early intervention as appropriate, thereby improving health outcomes. Scoping would consider resource implications in terms of technological infrastructure, primary care staffing and staff training, against anticipated benefits. There may also be potential for linking remotely with specialist medical services beyond Inverclyde, thereby reducing the need for frail older people to undertake long journeys to Glasgow (or beyond).
At this point one aspect of interest would be the development of practical tools to support analysis, strategic planning, commissioning and delivery of change to the housing and housing related services in other areas of the local partnership. This would facilitate the transition of the sheltered housing review to its implementation stage.
The partnership is currently developing and testing new models of housing with
Detailed Application for Demonstrator 16 Joint Improvement Team: January 2008 Appendix 1
support and new approaches to housing related services, including demonstrating the potential of telecare, which support a positive and managed shift in the balance of care. This work will inform the wider housing needs for older people at a point in time where opportunities for development across the housing sector are available due to a hospital reprovision programme and area regeneration developments.
How do you anticipate that telecare would fit within the local demonstrator?
The local telecare development is targeted towards maintaining people within their own homes and a robust evaluation process has been established to inform the balance between minimising risk and supporting independence. A key outcome from this work will be the evidence to support a shift in the balance from care home/hospital admission to enabling people to remain at home.
It would allow for possible changes in service delivery, especially in sheltered housing, and would allow greater freedom of choice by providing an element of ‘security’ and peace of mind for vulnerable older people living alone and for their family and carers.
Already there is a positive return in relation to people using telecare as an alternative to care home admission, with both service users and carers having their initial fears allayed when they see the response provided when it is required and also the actual activity (as opposed to the assumed activity) and amount of assistance required to support the individual.
It is also anticipate that this model will support people with mild to moderate dementia, provided that they can be settled into the programme at early onset.
There has been a focus on people with dementia being supported to maintain their independence at home by services provided within the Telecare Development Project (TDP). This has involved telecare being use within assessment processes and as part of longer term packages of care. In most of the cases where the recipient has dementia telecare services have been put in place which have prevented admission to a care home.
People with dementia who are recipients of telecare services through the TDP have more complex packages of telecare to support their independence than those without dementia. This includes the number of telecare appliances and type of equipment installed.
The partnership has identified support to carers and respite as a key area for development of telecare, increasing the number of carers who feel able to continue in their role. This links into the preventative element of telecare where initial work has been around support to hospital discharge and alternative to admission to care homes. If this area of work were to progress, safe and suitable accommodation would play a key role in making this a longer term reality.
As part of the telecare development the partnership are looking at rationalising the use of community alarms within sheltered housing.
Detailed Application for Demonstrator 17 Joint Improvement Team: January 2008 Appendix 1
The partnership has been working with all RSLs and Supporting People team in order to ensure best use of housing support functions in the role of maintaining older people in the community. This includes proposed changes to warden practice due to both the introduction of the European Working Time Directive (EWTD) and also the changing needs of sheltered housing tenants.
Over what timescale do you anticipate that these changes could be made?
A lead in time to late 2008/09 and implementation from 2009/10 onwards.
The Sheltered Housing review is going out for public consultation in MarchApril 2008, with a final report expected in the summer of 2008.
Work to link this and other developments into the Riverclyde Homes business plan has already begun, the business plan being a sub-set of the Local Housing Strategy which in turn is linked to the Strategic Housing Investment Plan .
How do the changes you propose to make help achieve national outcomes?
Single Outcome Agreement – National indicator - increase the percentage of people aged 65 and over with high levels of care needs who are cared for at home.
– Avoiding unplanned hospital admissions and care home placements by caring for and supporting people in their own homes. – Giving older people greater freedom of choice over their accommodation, care and support needs and how they are delivered. – Meeting particular needs by providing ‘barrier-free’ housing and by continued support through RSL funding (Communities Scotland) and through PSHG linked to Care and Repair services.
Performance reporting for Community Care for 2007/08 – National Outcomes
– Increasing the number of people with intensive needs receiving care at home – Increasing the % of community care service users feeling safe – Increasing the % of people receiving personal care at home – % of carers who feel able to continue their role. – Shifting the balance of care from institutional care to “home based” care
No one indicator should be considered in isolation, but as part of a wider whole system working, acknowledging the impact of one part of the system on the other.
Detailed Application for Demonstrator 18 Joint Improvement Team: January 2008 Appendix 1
Section 3 Context Q6 Local context What work has already been undertaken in support of the objectives and outcomes you set out in section 2? Please attach copies of reports (any additional material only).
Sheltered Housing Review – need analysis by Arneil Johnston – August 2007 copy attached (Appendix 2) Sheltered Housing review ––Report to Leadership Forum - copy attached (Appendix 3) Sheltered Housing review – presentation to Elected Members and Corporate Management Team – copy attached (Appendix 4) Delayed discharge action plan update – copy attached (Appendix 5) SSA process and Housing Allocation – copy attached (Appendix 6) Housing with care committee report – copy attached (Appendix 7) Evaluation of Early Intervention Teams – copy attached (Appendix 8)
Are these proposals included in your local strategies and plans for health, housing and social care? Please provide supporting evidence.
Older people’s service redesign – diagram attached (Appendix 9)
Service redesign for Older People with Mental Health needs (Appendix 10)
Annual update of LHS (2007) and review of progress against objectives. – copy attached (Appendix 11)
LHS – older people and households with particular needs are identified as priorities for new housing provision and for funding of equipment and adaptations.
LHS objectives include widening of housing choice (size, type, location, tenure) and of increasing ‘barrier-free’ housing stock.
SHIP includes confirmation of ongoing RSL and council support for equipment and adaptations, Care & Repair services, grants to owners, etc.
Riverclyde Homes business plan – copy available if required.
Inverclyde Draft CHP Development Plan 2008-2010 – copy available if required
The partnership is at an early stage in relation to combining local plans in the formal sense i.e. production of strategic joint planning documents. The above information does however include a range of care group specific redesign plans which have been produced jointly as a matter of course, ensuring that all links and inter-dependencies are made at an operational level and supported by funding from all sources.
Detailed Application for Demonstrator 19 Joint Improvement Team: January 2008 Appendix 1
What do you anticipate will be the particular challenges in the local area, which would have to be overcome in order to deliver what you set out?
Working in an environment of diminishing budgets.
Reaching final agreement on the financial envelope for the closure of Ravenscraig Hospital.
Capacity building for service providers and housing providers, general ‘gearing up’ to provide wider range of services and expanded choices/options. As part of the Sheltered Housing review, the partnership is currently exploring the possible use of the Joint Improvement Team’s financial modelling work with the intention of applying that where appropriate and developing the model to suit local circumstances. This may assist in addressing the financial challenges and may prove to be of wider benefit.
Section 4 Resourcing Q7 Local resources What housing resources have already been secured, or are likely to be available, for the changes you are seeking to make in the demonstrator area?
The partnership are keen to include mainstream housing in the demonstrator work both in terms of best use of adaptations across the housing stock and in terms of including designated properties for frail and mobility impaired in the new allocation process. This has been agreed with Riverclyde Homes.
The Strategic Housing Investment Plan (SHIP) will support the implementation of the Local Housing Strategy (LHS). The local authority is currently drafting its first LHS as a non-provider. The SHIP identifies investment priorities across the housing sector and links into the funding source – this being Communities Scotland. This process is in its infancy in Inverclyde, but the work of the Housing and Accommodation Group will help to inform the priorities for older people’s housing.
Private Sector Housing Grant (PSHG) funding available and RSL commitment through SHIP for continued provision of equipment and adaptations for private and social rented housing.
Recent budget approvals for Inverclyde Council identified an additional £100,000 in 08/09 for aids to enable people to live independently at home.
Additional housing support funding has been allocated to support the housing with support model with Trust Housing Association.
In 2009-2010 there will be 175 new housing units provided through Riverclyde Homes and a further 50 units by other RSLs in the Inverclyde area.
Detailed Application for Demonstrator 20 Joint Improvement Team: January 2008 Appendix 1
LHS and SHIP commitments by RSLs to providing ‘barrier-free’ housing, some currently being delivered on site.
Outcomes of review of sheltered housing will be incorporated into the annual review of the LHS (July 2008) and future SHIPs (from November 2008 onward).
Broad support from all providers for expansion of housing and tenure options for older people and continuing commitment to addressing particular needs.
Commitment from RSLs to revise the housing allocation policy and make the transition to allocation based on the single shared assessment process and identified housing need.
What health resources have already been secured, or are likely to be available, for the changes you are seeking to make in the demonstrator area?
Health have been fully involved in the development of the intermediate tier of care, providing a range of nursing, day hospital, assessment and AHP provision to support care in the community and reducing delayed discharges.
A current review of community nursing provision is underway and will identify the key priorities for the service locally, taking into account the inpatient service redesign.
Community nursing have been partners in the single shared assessment process from the outset and training involving nursing and social work staff will begin in March 2008 to introduce the care management framework.
Over the past year an additional £37,000 has been committed by the NHS to the Joint equipment store.
Inpatient service redesign will provide a further opportunity to move resources from hospital based provision to care at home. This process will replicate previous work around ward closures where a whole system approach will lead to pooled budgets supporting a commissioning plan.
A recent audit of people aged over 75 years who were emergency admissions to hospital will provide information about reasons for admission, allowing the partnership to examine closely the gaps in preventative services. The sample size was approximately 650 people over a three month period.
A consultation document tying the National Framework for Adult Rehabilitation and NHS Greater Glasgow and Clyde “Towards a Community Based Rehabilitation and Enablement Service for Older People, Older People with Mental Health Problems and Adults with Physical Impairment” is providing a baseline for community rehabilitation services in Inverclyde, with a mapping exercise identifying the full range of services across the agencies. The outcome of this work will identify spending priorities from redesign monies, focussing on maintaining people at home and preventative support.
Detailed Application for Demonstrator 21 Joint Improvement Team: January 2008 Appendix 1
What care and support resources have already been secured, or are likely to be available, for the changes you are seeking to make in the demonstrator area?
Funding of £50,000 has been made available for the joint equipment store through the delayed discharge budget to ensure that any specialist equipment is made available to support carers and/or patients in order to promote independent living.
Recent budget announcements for Inverclyde Council included the abolition of the Community Alarm Charge, thereby ensuring that cost does not influence the decision by someone who need the service.
The funding for the housing with care model is a combination of supporting people funding and a direct shift of local authority homecare funding to the independent sector.
Annually there is a review of funding for homecare services to ensure that priority areas of prevention of admission to hospital and support on discharge are funded. The current efficiency review includes meals on wheels, community alarms and telecare. This links any sheltered housing development/redesign into the community alarm and telecare programme developments and also is beginning to identify best use of all available meals provision including that in sheltered housing to the wider surrounding community.
As identified in earlier information, homecare services are accommodating the shift of very intensive packages of care from care homes into the community.
Relevant moves in funding have been possible through the delayed discharge budget which includes care home and care at home budgets. This also forms the base from which inpatient redesign will progress.
The community alarm response team currently provide the response service to telecare equipment, and link into the wider out of hours service provision. This will continue to grow, with response capacity being closely monitored. Discussions are ongoing with housing providers and the supporting people team to provide cover for a reduction in warden cover.
A strategy for telecare has to be developed by May 2008 and this will consider areas where savings have been made through telecare provision, with continued funding being released from eg. Care home budgets, NHS continuing care budgets etc., where reduction in service has been identified.
The most recent annual JPIAF evaluation for Inverclyde demonstrated that the partnership has achieved good progress based on the evidence of the number of assessors who can directly access /directly refer to specific services. There was evidence of substantial ability to directly access / refer to services across agency boundaries. This is an area of work the partnership is proud of and keen to progress further including access to appropriate and good quality housing for older people.
Detailed Application for Demonstrator 22 Joint Improvement Team: January 2008 Appendix 1
Q8 JIT Support For what aspects of the proposal would you be particularly keen to have assistance from the JIT?
Developing the most efficient use of telecare, community alarm service and care provision within sheltered housing.
Developing a review framework to ascertain the effectiveness in maintaining people in their own homes rather than care homes, using a performance framework linked to the National Outcomes agenda.
Translating the sheltered housing review into its implementation stage, learning from examples of good practice elsewhere, and sharing our experience with others.
Making the transition of the allocation policy from housing waiting list to single shared assessment and access to housing.
Information sharing (IT) and information sharing protocols between housing and social care providers.
Financial modelling and redistribution of funding to support people at home. Reviewing cost/benefits of accommodation and tenure options (particularly for extra care housing provided by social landlords and for owner/occupation with care and support, such as ‘private’ sheltered housing)
Streamlining funding opportunities for moving resources from one source to another – e.g. savings in care home provision to provision of adaptations by RSLs.
Section 5 Local Project Arrangements Q9 What project management arrangements do you propose to put in place to ensure successful delivery of the demonstrator?
In line with other similar partnership working a detailed action plan would be developed and form the basis for progressing and monitoring the work.
The Strategic Joint Management Team would be the reporting mechanism through which the outcomes and timelines would be monitored, and changes be agreed as required.
A senior manager will be identified to lead the work and support will be provided through local authority social work, the strategic housing team, CHP and Riverclyde Homes senior managers.
Detailed Application for Demonstrator 23 Joint Improvement Team: January 2008 Appendix 1
Section 6 Declaration
Q10 I can confirm that the partnership making this application has considered and approved it and is committed to providing active support to deliver it.
Signed: Councillor J. McIlwee
Designation: Chairperson of Inverclyde Joint Care Board
Date: 22nd February 2008.
Detailed Application for Demonstrator 24 Joint Improvement Team: January 2008