kent in a national context. where might it all go wrong and how do we prevent that? june 2012
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Kent in a national context. Where might it all go wrong and how do we prevent that? June 2012. About IPC. We work for well run evidence based public care We are part of Oxford Brookes University We work with national and local government, the NHS and private, community and voluntary sectors - PowerPoint PPT PresentationTRANSCRIPT
Kent in a national context.Where might it all go wrong and how do we prevent that?
June 2012
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About IPC
We work for well run evidence based public care We are part of Oxford Brookes University We work with national and local government, the
NHS and private, community and voluntary sectors We work across the United Kingdom We were formed in 1987, and have a team of 40 staff
and Fellows, based in Oxford and Bath
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The good news – we are living longer
UK (England, Wales Scotland and Northern Ireland) 1971 2011 2031
Total population aged 65 and over
7,408,000 10,508,000 15,837,000
Total population aged 80 and over
1,287,000 2,970,000 5,415,000
Number of centenarians in 1981, 2,500. By 2011 12,640
The good news – we are wealthier!
Currently in England over 75% of people aged 68-74 live in property that they own. In 1945 fewer than 40% of all people were owner occupiers. Half of all housing equity is held by people aged 65 and over.
In 2008/09 pensioner couples received an average income of $564 per week, compared with £304 per week for single men and £264 per week for single women , pensioners.
Average gross pensioner incomes have increased by 44% in real terms between 1994/5 and 2008/09, well ahead of the growth in average earnings.
59% of older people now receive an occupational pensions as compared to just 13% prior to 1945
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The bad news
We live longer but the period of morbidity or ill health prior to death has not been compressed.
Public expenditure is in decline for at least the next three years, but probably longer and greater than we originally thought.
The state (and possibly younger people) will increasingly expect baby boomers to pick up more of the health and social care costs.
Key old age conditions are all areas of poor performance by the health service.
At times of financial hardship protectionism tends to trump partnership and sharing of resources.
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About Kent
1.5 million people of whom over a quarter of a million are aged 65 and over.
By 2030 that population of 65’s and over will have grown to 400,000.
Of that OP population, 97% white, predominantly home owning (80%) and around 20,000 people with dementia.
The oldest old population will increase disproportionately , those aged 80 and over will grow from 77J to 143K.
Around five and a half thousand adults with a moderate to severe learning disability.
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Government
Les ring fencing of money, more localism. Social care not likely to get the same protection as
health and education. The social care white paper mainly about rights and
responsibilities from the Law Commission report and eventually about the future funding of care.
‘Innovation’, ‘prevention’ and ‘individual choice’ much mentioned but not a great focus on how demand can be reduced.
Increasing challenge in the courts from consumers and from providers.
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So what will happen if nothing changes
Demand for care amongst older people will rise, although not in proportion to the demographic rise and with an increasing proportion of care being in the private and voluntary sector.
Demand for acute sector health care will rise, of which an increased proportion will get displaced into large hospital type residential care.
Local authorities will provide a diminishing amount of funding, with people increasingly needing to make their own care arrangements or have voluntary organisations make arrangements for them.
Government will be about to consider new proposals over the future funding of care.
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Impact of current economic situation on the social care market
Cheaper to borrow money now but harder to obtain due to banks caution.
Low interest rates mean people eat into their capital quicker.
Harder for older people to sell their property now which may make it harder for people to move.
An upturn in economic growth may; disproportionately disadvantage the care sector. May lead to a number of single home care
owners leaving the market.
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So what do we need to do
1. Proceed thoughtfully with personalisation.2. Change relationships with the market.3. Improve health sector performance.4. Focus on outcomes.5. Stimulate the specialist housing market.6. Build community involvement and create
communities that work for older people.
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Personalisation
Good idea, works better and is more welcomed by some groups more than others.
Need to be sharper on what we mean by choice. Local authorities need to stop seeing this as a way
of abdicating responsibility for the future. Need to monitor spend and outcomes. Need to make sure its impact on the market is not to
lose the very providers we most cherish.
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Caricatures of the market- from the LA
“Private sector just about making money, not really welcome in the sector.
Members would still like all our services to be in- house.
Voluntary sector useful but not really able to run with big contracts”.
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Caricatures of the market – from providers
“Local authorities enforce pernicious terms in contracts.
Don’t really understand how businesses are run .
They are not even handed and protect their in house services from price competition.
They pretend to consult but actually only tell you after decisions have been made”.
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Caricatures of the market – from older people
“They only think of us in stereotypes and their approach is always patronising.
Local authorities are just focussed on cuts – they don’t really understand the impact on individuals.
They pretend to consult but actually only tell you after decisions have been made.
They don’t care about those who fund their own care”.
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The common ground
Running a quality service Efficiency Desire to innovate Giving greater choice to users.
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The uncommon ground
LA’s need to: Recognise we are all in this together. Seek solutions from the sector and be more open
about long term strategic commissioning directions and intentions.
Be clearer abut what constitutes good practice and work with the sector so that it can be achieved and kite marked to the public.
Recognise there is ore we could do to support providers at little or no cost
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Improve health sector performance
Clear link between health conditions and peoples propensity for residential care and repeat hospital admissions.
60% of all hospital beds are occupied by people aged 65 and over, 40% of whom have a dementia.
The growth in inpatient episodes in hospital for the 75 and over group is greater than the growth in all hospital episodes put together (66% growth from 1999-00 to 2009-10 in this age group as comarped to 38% growth overall).
The key conditions that older people suffer from are all areas of poor performance, falls strokes, continence, dementia.
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Health
Falls – 4.6 million hospital bed days used in 2006/07 in England for fractures in over 60 year olds and frailty related falls in over 75 year olds. The number of admissions for falls increased by 36% between 2003/04 and 2008/09. the most common serious consequence of a fall is a hip fracture.
Dementia – Total incidence about 1:100 of UK population. Aged 80+ about 1:6. About a third of those aged 65+ will develop a dementia at some point in their old age.
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Health
Cold – cold snaps are worse than protracted cold weather. We have more excess winter deaths than most other colder European countries. At low temperatures a 1% fall in temperature is associated with a 1.35% increase in deaths.
Stroke – 56% of all strokes occur in the 75 and over population. People aged 75 years and over have a 9 fold higher risk of suffering from a first ever stroke and a 14 fold higher risk of suffering a recurrent stroke when compared to people aged 45-64 years. Stroke patients occupy around 20% of all acute hospital beds.
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Falls- as an example of health problems
Only 52% of fallers who attend ED or MIU are screened for future risk of falling and a mere 15% for osteoporosis. Less than half of all falls admissions are screened for osteoporosis risk.
Performance on falls has not improved over the last two audits.
Royal College of Physicians report on Falls March 2011 and Nice guidelines on Falls
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Falls- as an example of health problems
Many of the exercise programmes being provided are not evidence based.
Despite 94% of sites stating they use a tool or proforma that includes standardised gait, balance and mobility assessment only 34% of non hip fracture patients and 72% of hip fracture patients received an assessment.
86% of services report that they provide supervised strength and balance exercise training however only 19% of non-hip fracture patients had participated in any form of exercise for falls prevention within 12 weeks of the fracture.
Royal College of Physicians report on Falls March 2011
Falls- as an example of health problems
Joint commissioning between health and social care of community based programmes to ensure the provision of therapeutic (Otago and FaME) exercise programmes.
Stop funding non-evidence based, poor outcome delivering programmes and transfer the money to community services.
Use the cheapest, most successful means of programme delivery.
Ensure nobody leaves hospital with additionally acquired avoidable conditions.
Target care homes with a cash back scheme.
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Outcomes
Need to start measuring success in terms of the outcome it achieves not in the volume or cost at which it is delivered.
Need to be able to measure overall impact, eg, fifteen minute visits, reablement programmes.
The sector needs to get better at providing the evidence that if we do x at y intensity for q people, then we believe z will be the result and here is the evidence to support that hypothesis.
Focus attention on those areas where good outcomes are easiest to deliver at most financial gain.
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Stimulate the specialist housing market
Much of our sheltered housing is out of date and is inaccessible. We have low build rates of private sector housing suitable for older people.
Little government impetus behind the lifetime homes agenda or stimulating development.
Yet the majority of people are home owners. A recent Shelter report ….Over a third of older
people are interested in the idea of retirement housing or would be in the future. This equates to over 6 million people. Suggest there is much latent demand for retirement housing.
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Stimulate the specialist housing sector
A whole range of studies have shown that good accessible housing in older age produces a positive health gain.
A recent study by Frontier Economics for the HCA, identified that the overall benefit per older person per annum to health and social care of better retirement housing would equal £444 per year.
We would crudely estimate that applying the FE model would deliver for Kent between £1-2 million per annum now for very little expenditure.
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Stimulate the specialist housing sector
Ensure that in any role the LA plays in offering older people better information, that buying and selling housing and moving into retirement housing heavily features.
Encourage the delivery of new retirement housing through the planning system.
Examine what additional, practical assistance could be offered to older people to make a housing move much easier.
Support developers through sharing financial risk, eg, interest free loans, spread land purchase costs over time and make land available.
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Build community involvement and communities that work
Challenge the assumption that more care is automatically good. Need to reduce the number of services going into people.
Promote a voluntary sector that encourages independence rather than creates dependency.
Assess the voluntary sector for funding by outcomes, by deflection, by value added.
Use the sector and its leaders to drive positive change. Where people have ability make sure they rise to the top. Do discriminate.
Work with the sector to explore how we encourage and make the best use of volunteerism.
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Build community involvement and communities that work
Are our communities welcoming of older people? Do they work well and encourage people to stay put?
Do planners recognise the demographic make up of future communities and plan accordingly?
Is the right infrastructure in place for older people? To stay put older people need; shops, services, drop curbs, good street lighting, safe neighbourhoods, security and an active social life.
We not only need housing that is fuel efficient and safe, but housing that inspires and stimulates.
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