Use of Resources Summit14 December 2009

Workshop C: Partnership with Health – the East Sussex POPP programme

Beverly Hone

Assistant Director – Strategy & Commissioning

&

Jessie McArthur

Head of Policy & Service Development

Local ‘enablers’

• Joint Commissioning Strategy for Older People and Partnership Board

• All Plans aligned to ‘direction of travel’• Good use of JSNA• Mechanisms for ‘Whole Systems’

developments• Accountability to older people (3500 forum

members)

Local barriers?

• History of difficult relationships eg high DTCs

• Complex picture re preventative developments – causal links and benefits accrual

• Securing resources for community investment (resisting the ‘pull’ into hospitals)

• National policy context

Partnerships for Older People Projects (POPP)

A £60m national fund from the DH, awarded to 19 sites in 2006 (and 10 more in 2007) to test and evaluate, innovative approaches that sustain prevention work for older people

“Innovation, the prevention & well-being agenda, and partnership”

“Independence First”The East Sussex programme

• £3.2 million 2 year partnership between older people, local health, social services and community services.

• Grant funding ended in June 2008, and services now fully integrated

• Why this programme?Local issues – large older people population and

known gaps esp. Mental Health Targeted prevention Long-Term Conditions

Independence First aims

• Improve the care, quality of life & wellbeing of older people

• Help older people maintain their independence • Support sustainable shifts in resources from

acute to community care• Increase support for people with long term

conditions• Maximise effective partnership with the voluntary

sector• Test service innovation

Independence First services

12 services improving the health & wellbeing of older people most at risk of going into hospital or a care home – Specialist & Community-based

Specialist Services•Enhanced response (ASC) – rapid access home care•Duty & Assessment - extended hours•Falls prevention•Medicines management•Rapid response (health)•Memory assessment•Extended hours community mental health•Paramedic practitioners

Community services

• ICES Direct – rapid access simple equipment• County Connect – simple inter-agency referral• Bathing advice & information• Navigator service – info + practical support

handyperson services wellbeing, carer and transport grants

(prototype personal budgets) aids and equipment

Measuring success

• Service use data• Case studies• Quality of life surveys• Staff, public and stakeholder surveys• Service user interviews• Economic impact• Whole System indicators

Outcomes

Over 12,350 people accessed services funded by Independence First (July 06 – March 09)

Economic appraisal suggests by avoiding more expensive care options, the POPP specialist services have returned £3 for ever £2 spent for reinvestment in health and social care.

Even after formal closure, performance sustained or improved!

Quality of life

Quality of life survey suggests that while peoples’ health status remains stable they:

• Feel more confident• Knowledgeable about their condition and where to

get information• Able to manage their condition• Modest improvement in perceived quality of life• Self reported decrease in use of emergency care

0 10 20 30 40 50 60 70 80 90

stayed in hospital overnight

gone to the hospital for an appointment

gone to hospital for an emergency

visited a GP / family doctor

had a home visit from a GP

seen a nurse at the health centre

%

Example of Outcome reporting6 month Before & After Navigator service user survey results

Sample of 70 in March 2008

Before After

ASC performance improvements

Older people helped to live at home 62

Households receiving intensive homecare 22%

Carers who receive services 12%

Waiting time for social care services 90%

Health service indicators

Reduce Emergency bed days -16%

Reduce admissions via A&E -10%

Reduce falls related ambulance attendances

-3%

Reduce falls related ambulance conveyances to A&E

9%

Reduce emergency fractured hip admissions

-2%

Improving equity

Improving equity

Older people’s involvement

• Commissioning services• POPP Reference Group • Service Champions• Service user interviews • Facilitating focus groups – Anchor staying put

Charter Mark

Tools to share

• End of POPP programme report

• Monitoring and evaluation toolkit

• Older people involvement toolkit

• Just released: National POPP evaluation, incl. 4 generic business cases for preventative interventions

Learnings to sharere Partnership work

• Directly engage with older people (co-production)

• Use evidence base/good practice for design• Clearly define and resource projects• Use partners effectively - Health and VCS (and

beyond)• Good performance tools

Learnings to sharere Partnership work cont.

• Agree your approach to joint investment/sustainability: Close alignment to commissioning plans –

cautious exposure to non-core business Proven reductions in emergency care usage

but not released spend from acute provision ie be realistic

Use an Investment/Disinvestment tool

Does this approach scale-up to support further integration?

Yes (we think!)

Our next step – Integration Plan for Health, Social Care & Wellbeing

‘Big Ticket’ items – Intermediate Care/re-ablement, Dementia, LTC, etc

‘Add Value’ items – Quality of Life and personalisation

‘Efficiency’ items – commissioning resource and back office

Contacts

beverly.hone@eastsussex.gov.uk01273 482586

jessie.mcarthur@eastsussex.gov.uk01273 481141