prevention and promotion john bolton director of community services coventry city council
TRANSCRIPT
Approaches to delivery of social care
Social Justice Model
User Led Services
Navigators of system
Preventative Model
Universal Services
Low Level Services
Social Inclusion ModelEnablementChallenge to keep people away from social careStronger CommunitiesCE NOT DASSSocial Model of Disability
What might happen in 2010
Current Policy• User Led Services
– Person Centred Planning– Direct Payments– Individual Budgets
• Council as a Commissioner • Social Worker as
Navigator/ Broker• Same policy approach to all
service users• Low level preventative
services
Alternative Viewpoint• Council as an enabler –
creating the right markets• Challenging service users
to reach their potential• Focus on enablement not
dependency• Different approaches for
different customer groups• Focus on OUTCOMES• Stronger community
services
Dependency Models
• In what way might we have developed services in a way that encourages people to be dependent on social care?
Who needs help from whom?
• Those people who have long-term enduring conditions which lead them to be dependent for daily living on some form of care support
• Those people who have conditions, which though long-term, with the right type of enablement/ rehabilitation the amount of long-term support required can change and reduce over time.
• Those people who have shorter-term conditions, which with the right type of enablement/rehabilitation will need little or no care support.
• Those people who have minimum care needs that may be helped by sign posting to community based services.
Approaches to outcome focussed work in Coventry
Older People– Enablement OT Services – focus on helping older people
regain confidence / strength– Rehabilitation Services for Visually Impaired– Intermediate Care Services – Residential/Day Care/
Community Support Teams– Extra Care Housing – life style promotes independence– Assistive technology – Community based services can contribute– Engagement of Older People through Partnership Board
“Shape”
• High use of extra care housing (low use of residential at a higher unit cost)
• High level of support to people in their own homes after enablement (some higher costs)
• Investment in Intermediate Care
• Commitment to NOT keeping people in hospital (where their care needs increase)
Putting these factors in a wider context
• Using models of intermediate care/ enablement to reduce dependency on long term care– De Montford University Finding –
• 62% did not need a service after enablement programme
• 28% needed less service
• Ensuring that there are wider community services that older people can access – social and fitness.
Good News for Coventry
• 570 Extra Care tenancies @ £85 per week• 87 fewer people in residential care (from low
base – total 736 and falling) @ £397• 3000 people helped to live at home but
reducing with enablement and with less intensive packages
• TOTAL SAVING in Coventry about £1 million with positive outcomes!
Low admissions to residential care2004/05 Comparative Performance and Coventry 2005/06 projected performance
C26 Admissions of Supported Residents aged 65+ to Res/Nur Care
NN Comparator Average 105.2 80Metropolitan Average 100.8 803 Star Average 95.7 80England Average 90.5 801 Star Average 90.1 802 Star Average 89.7 80Top Quartile 80.0 80Coventry 04/05 58.2 80Coventry 05/06 Projected 41.7 80
Very Good Performance is between 70 and 99.99
* 05/06 Q3 performance is 35.3
105.2100.8
95.790.5 90.1 89.7
58.2
41.7
0
20
40
60
80
100
120
Low admissions to residential care (2)
Coventry Trend Analysis
PAF C26Admissions of Supported Residents aged 65 or over to Residential / Nursing Care
00/01 01/02 02/03 03/04 04/05 05/06 ProjectedC26 110.5 107.9 93.6 73.2 58.2 41.7
0
20
40
60
80
100
120
00/01 01/02 02/03 03/04 04/05 05/06
Year
Per
10,
000
Getting intensive home care right 2004/05 Comparative Performance and Coventry 2005/06 actual performance
C28 Intensive Home Care
England Average 11.5 15.41 Star Average 12.7 15.42 Star Average 12.8 15.4NN Comparator Average 13.4 15.4Metropolitan Average 14.8 15.43 Star Average 15.3 15.4Top Quartile 15.4 15.4Coventry 05/06 18.7 15.4Coventry 04/05 20.3 15.4
Very Good Performance is between 16 and 45
11.512.7 12.8
13.4
14.815.3
18.7
20.3
0
5
10
15
20
25
Role of Social Care Staff
Soc Worker/Occupational Therapists
• To challenge the person with care needs to raise their ambitions
• To help carers deal with their emotions in taking risks
• To offer a supportive environment in which outcomes can be achieved
Care Workers• To do things with the
person not for them• To contribute to the
challenge• To provide the supportive
environment where risks can be taken
• To keep focussed on the outcome