Practical Delivery of the Accommodation Strategy

KHG OP Day 22 October 2014

Christy Holden – Head of Commissioning (Accommodation) Kent County Council

Why we need an Accommodation Strategy

• KCC spends £180m on residential and nursing care

• The right type of accommodation in the right place

• Stimulate the market or directly intervene

• Inform planning applications

• Secure better outcomes and make savings

• Quality and safeguarding

Development of the Strategy

• Joint KCC, NHS and KHG document supported by KPOG and the DH Housing LIN

• Analysis of KCC case load, placement patterns, availability of services

• Engaged with local teams, CCG’s, District Councils in its development

• Formal approval and launch in July 2014

The Accommodation Strategy

www.kent.gov.ukAbout the Council

Strategies and Policies

Adult Social Care Policies

Accommodation Strategy

www.kent.gov.uk/accommodationstrategy

• Dynamic strategy• On-line with links• Evidence Base• Case studies• Maps• Design Principles• District Profiles• Key findings by user group• Financial Impact• District aligned with

CCG Consideration

Accommodation Strategy Overview

Accommodation for Older People Analysis

Service Type National Ratio Kent Ratio Future need?

Sheltered 125 units per 1000 pop 75+ 144

Extra Care 45 units per 1000 pop 75+ 1.51

Residential Care 65 units per 1000 pop 75+ 65.7

Nursing Care 45 units per 1000 pop 75+ 30

Intermediate Care 26.3 units per 100,000 pop 29.7

• National Ratios • Population forecast• Impact of enhanced

community provision• Placement patterns• Market appraisal• Workshops with

KCC,CCGs and DistrictsNumbers are indicative and will be used to target priority areas. Numbers will need to be periodically reviewed and adjusted in line with the performance of enhanced community services

District Profiles

Older People Summary

OP +/-R -133N +52EC +120SH 0

OP +/-R -48N +108EC +161SH 0

OP +/-R -128N +18EC +166SH 0

OP +/-R +5 N +150 EC +112 SH 0

OP +/-R -94 N +270 EC +416 SH -36

OP +/-R -439 N +264 EC +183 SH -96

OP +/-R +43 N -111 EC +197 SH 0

OP +/-R -318 N +297 EC +331 SH -25

OP +/-R -96 N +90 EC +114 SH 0

OP +/-R -360 N +195 EC +234 SH 0

OP +/-R -281 N +254 EC +230 SH -87

OP +/-R -621 N +344 EC +278 SH 0

R = Residential incl. DementiaN – Nursing incl. DementiaEC = Extra CareSH = Sheltered Housing

Vacancy Rate:National = 7%Kent = 3%

Average Size:New build = 57 bedsKent = 35 bedsWest Kent = 40 bedsEast Kent = 32 beds

Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021

OP EXISTING 2021 +/- Known

R 8200 5730 -2470 70N 3730 5661 +1931 170EC 490 3032 +2542 946SH 17950 17706 -244 0

30370 32129 +1759 1186

Positive impact on Kent Economy

Fit for Purpose Modern Accommodation

More Nursing Care

KCC fund:37% of placements

% increase by 2021:Accommodation units = 6%Older People 85+ = 30% 334 care homes

The number of services users receiving long term

residential care as a result of the short term

pathway could be reduced by 13%

Acute Demand

Opportunity to support more individuals at home

Actions:

• Data capture in place to review decision making process in acute hospitals

• Development of menu of service in one hospital

• Data capture in place to review performance of STB outcomes

• Review assessment process for STB assessments

• Plan for roll out across all hospitals

£4.1M - £7.6M through improved short term pathways

116138

158

6552 368

87

33

4789

68

18 88

15

0%

10%

20%

30%

40%

50%

60%

1-4 5-9 10-19 20-49 50-99 100-399 400+

Annual Provisions

Resi Nursing Dom Enablement Other None/Pre-Existing

Variation by STB Type

© Newton Europe Limited. All Rights Reserved

Page 2018/08/2014

Outcomes appear to be better for clients attending homes with higher throughput

Opportunity Areas – Acute

© N

ewto

n Eu

rope

Lim

ited.

All

Rig

hts

Rese

rved

Incorrect Decision Pressure from family/ friend

Meet Housing Need

Residential was appropriate

Risk Adverse No clear goals0%

5%

10%

15%

20%

25%

30%

35%

40%

Review1 Review2

Incorrect Decision Pressure from family/ friend

Meet Housing Need

Residential was appropriate

Risk Adverse No clear goals0%

5%

10%

15%

20%

25%

30%

35%

40%

Review1 Review2

© N e w t o n E u r o p e L i m i t e d . A l l R i g h t s R e s e r v e d

Source: BICA Study

In 11% of cases residential was deemed appropriate

Pathway resulted in residential placement (Unintended/Incorrect

decisions)

Was Residential Appropriate?

STB RequiredYes –61%

No – 39%

STB not

requ

ired

OT Hom

e Ax.

Reside

ntial

was

app

ropr

iate

MCA

Night t

ime

Needs

Carer

's Ax.

Declut

ter h

ome

Falls

Ax.

Mob

ility

PT Ax.

0

2

4

6

8

10

12

14

16

18

20

Use

rs

39%

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ited.

All

Rig

hts

Rese

rved

Short Term Bed Usage - Review Outcomes

User Preferred Outcome Family/Friends Preferred Outcome

Family & friends request residential or STB 77% vs 9% service user requests. What factors lead to this decision being made by the family?

Resid

entia

l

STB

None

Supp

orte

d liv

ing

Unsa

fe a

t Hom

e

Idea

l out

com

e

Hom

e

Reha

b0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

%ag

e of

case

s

Hom

e

Non

e

STB

Agre

e to

STB

Una

ble

to s

ay

Supp

orte

d liv

ing

MCA

(bla

nk)

Incr

ease

inde

pend

ence

Uns

afe

at H

ome

With

Fam

ily (R

esi)

Resi

Hous

ing

Enab

lem

ent

Enab

lem

ent/

mea

ls

Relu

ctan

t Agr

ee to

STB

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

%ag

e of

cas

esSource: BICA StudyComparison of Preference for Long Term Care

© N

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ited.

All

Rig

hts

Rese

rved

Family are concerned about [NAME] discharge home and her

ability to manage at home

Family feel he will be unsafe living at home alone

[NAME] is at great risk if she is to return to home

Concerns regarding safety

Concerns regarding carer’s ability to cope

Family have stated that they are struggling to support [NAME]

recently

Wife feels unable to cope any longer at home.

Son who states that he feels he cannot manage his fathers needs,

and that 24hr care is needed

Alternatives to STB : Enablement / Increase care packages / telecare

Alternatives to STB : Carer support / respite care / carer assessments

Concerns influence outcome with no evidence of alternatives being discussed

© N

ewto

n Eu

rope

Lim

ited.

All

Rig

hts

Rese

rved

Comments from Friends / Family

Results based on initial study 43 residential placement cases reviewed by Panel Jan-May 2014 match PSSRU study results

Informal care breakdown, psycho-social vulnerability & cognitive / behavioural needs consistently top 3 reasons given for placement

Source: Panel Jan-May 2014 and PSSRU

How could we work with the voluntary sector and others to prevent these causes?

Info

rmal

care

bre

akdo

wn

Psych

o-so

cial v

ulner

abilit

y

Cognit

ive /

beha

viour

al ne

eds

Falls

risk

Nursin

g / m

edica

l nee

ds

Mob

ility

need

s

Uniden

tified

0%

5%

10%

15%

20%

25%

30%

35%

% o

f S

amp

le C

ases

What Causes Lead to Residential Placement?

© N

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rope

Lim

ited.

All

Rig

hts

Rese

rved

Older People Summary

OP +/-R -133N +52EC +120SH 0

OP +/-R -48N +108EC +161SH 0

OP +/-R -128N +18EC +166SH 0

OP +/-R +5 N +150 EC +112 SH 0

OP +/-R -94 N +270 EC +416 SH -36

OP +/-R -439 N +264 EC +183 SH -96

OP +/-R +43 N -111 EC +197 SH 0

OP +/-R -318 N +297 EC +331 SH -25

OP +/-R -96 N +90 EC +114 SH 0

OP +/-R -360 N +195 EC +234 SH 0

OP +/-R -281 N +254 EC +230 SH -87

OP +/-R -621 N +344 EC +278 SH 0

R = Residential incl. DementiaN – Nursing incl. DementiaEC = Extra CareSH = Sheltered Housing

Reduce 2470 residential beds across the County

All tenure considered; keep people in their own home

OP EXISTING 2021 +/- Known

R 8200 5730 -2470 70N 3730 5661 +1931 170EC 490 3032 +2542 946SH 17950 17706 -244 0

30370 32129 +1759 1186

Who are we targeting for extra care housing?

Investment in Enablement, Short term interventions and 24/7 home care

Are housing providers supported in the care needs of their tenants? 334 care homes

CCG’s investing in enhanced community provision – varied across the County

Delivery

• Step One: Establish Priority list based on Need, Opportunity and Stakeholder desire

• Step Two: Agree Priority list through KCC’s Transformation Board

• Step Three: Prepare Market Position Statements and publish on the Kent Business Portal

• Step Four: Meet with providers or developers that wish to develop services in that area, scope all opportunities

• Step Five: Undertake business cases where investment is required

• Step Six: Issue any formal procurement opportunities and develop legal agreements where required

Timetable

• Project and Resource planning by December 2014

• Market Position Statements/Locality Focus Schedules to be issued from October 2014

• Undertake full analysis for people with learning disabilities, people with physical disabilities and people with mental health needs – underway for LD, to start in the new year for PD and MH

QuestionsChristy Holden, Head of Commissioning – AccommodationChristy.holden@kent.gov.uk – 07920 780623

King Edward Court ,Herne Bay