The Bournemouth and Poole Joint Commissioning Strategy for Older People - Appendix

OLDER PEOPLES JOINT COMMISSIONING STRATEGY

Table of Contents

1 Executive summary

3

2 Background and context

National

Regional

Local

What older people say they want for their later years

The embedded principles of services for older people

The current services, resources available and who pays for what

Our vision for services for older people

The model for services for older people

Where the gaps are in services for older people

Top 10 priorities for transforming services

Work programme for the top 10 priorities

Commissioning plan

1.EXECUTIVE SUMMARY

This joint commissioning strategy sets out the commitment of the Borough of Poole, Bournemouth Borough Council and NHS Bournemouth and Poole to the development and delivery of health and social care services for older people for the next 5 years. It outlines how the organisations will commission services in line with the priorities set out in this document. Services which do not meet the criteria set out in this strategy will be decommissionedto ensure best use of the £122,000,000 that is currently spent on services for older people locally.

The strategy is a snapshot, representing our joint thinking at this time, on the future direction for older people’s services. It has been developed in the light of the previous government’s policies, which are listed in section 2. The new coalition government has set out the headlines on how it will be changing health and social care, but few details are available yet. This strategy will therefore need to be refined as those policies become clearer.However we believe it is still worthwhile to set out the direction of travel which we intend to take, in the light of our analysis of local needs (section 2) and the views of local people (section 3) which has informed the development of the vision described in section 5.

The core of this vision involves working with the local community to ensure that older people can access information and informal support to remain fit and active in their homes for as long as possible, avoiding the preventable causes of ill health and dependence. When they do require health and social care they can be confident that it will be easily accessible, tailored to meet their individual requirements and effective. It will make the best use of available resources and above all be delivered with kindness, dignity and respect.

We have reviewed the current use of our shared resources (section 6) in the light of this vision and identified a model for the future delivery of services. This model must be developed over time and section 9 presents the top ten priorities for transforming services. Section 10 sets out the broad work programme that will be required to implement this strategy.

The diagram on the next page demonstrates how we have linked the messages from older people to our top ten priorities for action, and reflecting the embedded principles which inform the way we expect services to be delivered.

2.background and cONTEXT

National context

2.1Key national strategies which have set the context for this strategy are:

The Putting People First Concordat (December 2007) which set out the principles underpinning Transforming Social Care and initiated the personalisation agenda

Transforming Community Services (January 2009) which sets the framework for the further shift of health care from hospital to community settings

National Carers’ Strategy (June 2008) which sets the framework for improving the care and support offered to carers

National End of Life Strategy (July 2008)which aims to provide people approaching the end of life, with more choice about where they would like to live and die.

Living well with Dementia: A National Dementia Strategy (February 2009) which sets a framework for improving dementia services, particularly improving awareness and early diagnosis and intervention

The Quality, Innovation, Prevention and Productivity agenda (2009) which is requiring the NHS to review the way it currently delivers services to maximise the effective use of resources within a much tighter financial climate

2.2The new coalition government has published the headlines on its proposed policy changes in Our Programme for Government (May 2010). Many of the actions in this programme continue the changes already initiated by the previous government, such as the development of community care. Those changes which are likely to have an impact on this strategy include:

Helping older people live at home for longer through solutions such as home adaptations and community support programmes

Providing much more control to individuals by extending the roll-out of personal budgets and direct payments to carers

Breaking down the barriers between health and social care funding to incentivise preventive action

Greater involvement of independent and voluntary providers in providing services

Taking action to support and encourage social responsibility, volunteering and philanthropy

Establishing an independent commission on the funding of long-term care, to report within a year

Strengthening the commissioning role of GPs

Prioritising dementia research within the health research and development budget

Reducing the budget deficit, mainly through reduced public spending. However health spending will increase in real terms year on year, even though this will have an impact on other sectors

Regional context

2.3This strategy takes into account the ambitions set out in the Strategic Framework for Improving Health in the South West, 2008/09 to 2010/11. These include:

All people with long term conditions to have a self care plan which supports self-management

Having aco-ordinated multi-disciplinary approach for long-term conditions in each locality with a single point of access

Reducing emergency bed days for people with long-term conditions

Agreeing an initial care plan for people with dementia within four weeks of their diagnosis

Reducing the number of deaths in acute hospitals

Improving access to IT systems for community based health and social care professionals

Expanding the use of telemedicine, telecare and assistive technology

Local context

2.4In 2009, 20.5% of the population in the two boroughs of Bournemouth and Poole were aged 65 and over. This is significantly higher than the national average of 16.3%. The differential is even greater for the very elderly with 3.7% of the local population aged 85 and over, compared with the national average of 2.2%. This has a marked effect on the demand for health and social care services. In Bournemouth and Poole, 39% of the population aged 65+ live alone and this percentage rises to 50.5% for people aged 75 and over. In most cases, the level of support and care required for someone living alone is likely to be more intense than someone who is living with a carer.

2.5The population of NHS Bournemouth and Poole is larger than the sum of the population of the two boroughs. Just under 7,000 people aged 65 and over are registered with GPs practising on the borders of the PCT and are therefore counted in the PCT population but live outside Bournemouth or Poole Local Authorities. This particularly affects the western and northern edges of Poole. This is a challenge for joint commissioning and will need to be addressed by formal agreements with NHS Dorset and Dorset County Council.

2.6Data from the Quality and Outcomes Framework for 2008/09 identified that there are 149,237 people on long term condition registers in GP practices. It is recognised that a number of individuals will have more than one condition and will therefore have been counted more than once. The Joint Strategic Needs Assessment 2010 concluded that currently in Bournemouth and Poole:

26,600 patients are living with a long term condition, with a predicted increase of 10% by 2015 approximately 2,600 additional patients;

21,000 patients (80%) require supported self care;

 3,900 patients (15%) require complex disease management;

1,300 patients (5%) require complex case management.

2.7There will be an 8.3% growth in the number of people aged 65+ in the boroughs of Bournemouth and Poole over the next five years, and an 11.1% increase in the numbers aged 85 and over. This is about half the increase expected nationally but it still has significant implications for the levels of need that local services will have to meet. It has been forecast that these population changes will have the following impact on particular diseases among people aged 65:

6.8% increase to 5,400 in people with dementia;

7.9% increase to 1,800 in people with a long standing health condition caused by a stroke;

11.4% increase to 1,500 in people with a long standing respiratory condition.

In addition, it has been forecast that over the next five years there will be an 8.5% increase to 16,100 in number of people who are obese and this brings additional health risks;

2.8Map 1 shows the distribution of people over retirement age by super output area in the boroughs of Bournemouth and Poole. It can be seen that there are certain neighbourhoods which have a much higher density of older people than others. These include the Southbourne/Tuckton area, Eastcliff and Boscombe West, Bournemouth Central Westbourne, Redhill and Northbourne and Kinson North in Bournemouth,

2.9 Map 1.

2.10It should also be noted that there is considerable local variation in the affluence and health status of older people across the two boroughs and this affects the demand for services, particularly social care services which are means tested. In November 2009, there were 15,820 people claiming pension credits – 9,375 in Bournemouth and 6445 in Poole. Eight wards had more than 600 pension credit claimants: Kinson North (770); Kinson South (690); East Cliff and Springbourne (680); Boscombe West ( 655) and StroudenPark (620) in Bournemouth; and Newtown (755); Alderney (710) and PooleTown (645) in Poole.

2.11The numbers of people claiming pension credits have remained fairly static over the past three years but the numbers of people claiming carers’ allowance has increased by 18% over this period to 2,060 in November 2009.

2.12Whilst there are areas of deprivation, it should also be recognised that the majority of older people in Bourenmouth and Poole will fund their own social care and sometimes private healthcare also.

2.13There is a heavy reliance on hospital care for older people in Bournemouth and Poole. Locally, in 2008, 41.7% of all elective hospital admissions are people aged 69 and over, compared with the national average of 29%. For non-elective admissions, 54.2% of local patient bed days were patients aged 75 and over, compared with 40.5% nationally. Partners are working closely together to reduce this reliance on hospital care and provide more community care and this strategy sits in the centre of this agenda.

2.14The 5-year NHS Bournemouth and Poole Strategic Plan aims to ensure that local residents of all ages will:

have more opportunities and support to keep physically and mentally healthy;

receive consistent and individually tailored health and social care at or close to home from integrated locality teams, if they have a complex long-term condition;

be able to access a greater range of diagnostic and treatment services in their locality;

receive integrated care at home, if clinically appropriate, when they are acutely ill and rehabilitation services to help them recuperate;

only attend or be admitted to hospital when there is no other effective way of providing the treatment they need;

still be able to access any service they require swiftly, confident of the high quality of those services;

be able to access an integrated information and advice helpline 24 hours a day, seven days a week which links to and supports practitioners in their delivery of care.

2.15This strategy should be considered in conjunction with A Time of our lives’, Borough of Poole’s Older People’s strategy, 2008-2013, Age Friendly Bournemouth, Bournemouth Borough Council Older Persons Strategy, 2008-2011, Transforming Community Services Strategic Commissioning Plan, NHS Bournemouth and Poole, 2009 and the except at 2.14, above, from the PCT Strategic Plan

3.WHAT OLDER PEOPLE SAY THEY WANT FOR THEIR LATER YEARS

3.1There has been widespread consultation with older people in, Bournemouth and Pooleand this has contributed to the development of this joint commissioning strategy. There are three related strategies: ‘A Time of our lives’, Borough of Poole’s Older People’s strategy, 2008-2013, Age Friendly Bournemouth, Bournemouth Borough Council Older Persons Strategy, 2008-2011 and Transforming Community Services Plan, NHS Bournemouth and Poole, 2009. were all subject to extensive consultation with public forums, clinicians, voluntary and statutory organisations.

3.2The following extracts illustrate opinions expressed by older people at different public consultation events:

‘I want to be able to get access to any information that I need about health and health services when I want – the PALS service is brilliant for this’ (Littledown Event, Older People’s Day – October 2009)
‘I want to be treated with dignity and respect – it is the small things that make a difference such as when staff treat you as an individual and ask how you feel and what you want’ (Older People’s Strategy Group - Feb 2009)
‘I don’t want to be pushed from pillar to post – I want staff to help me with choices and options and when I ask and get me the help I need’ (Public Involvement Network Launch – August 2009)
‘Staff would benefit from more customer care training to make sure we are always treated as individuals and feel listened to’ (Older people’s Strategy Group – September 2009)
‘I am a carer and I want to feel a valued member of the team – for services to support me in order that I can help my family’ (Working Carers Forum – July 2009)

3.3The views of older people were also taken into account in the consultation for Total Place, for the Bournemouth, Poole and Dorset Health and Social Care communities. The Total Place report focused on the following areas:

Having housing suitable for their needs
Being socially integrated
Making a positive, fulfilling contribution
Feeling safe and secure
Feeling free from discrimination
Feeling financially secure
Being in good health in mind and body
Having dignity, choice and control

3.4From these consultations, we have summarised the wishes of older people:

3.5The success of this strategy will be measured by the extent to which it meets these requirements which older people have expressed.

4.THE EMBEDDED PRINCIPLES OF SERVICES FOR OLDER PEOPLE

4.1The following embedded principles are shared by all three commissioning partners and underpin the strategy and its delivery:

4.2These principles will underpin the commissioning of servicesand are central to all work programmes in health and social care.

4.3Table 1 overpage relates the expressed wishes of older people to the embedded principles and the redesign programmes which flow from these

Statement / Embedded Principles and Work programmes
1 / I want to be able to live the way I want to live. I want to wake up in the morning feeling positive. I want services to recognise the contribution I make to my family and friends and community /

Embedding Personalisation
Improved community engagement
Promoting Privacy, Dignity and Respect
Promote healthy and sustainable communities
Total Place

2 / As I get older, I want services to recognise my fears of the unknown and give me good information and allow me to discuss those fears /

Signposting services with good Information and Advice
Following up people who have asked for information to see if it assists or if they need something else
Well skilled workforce with good listening skills
Ensure people with Long Term conditions have access to case management

3 / I want services to work with me and do what’s important for me /

Promote Choice and Control
Embedding Personalisation

4 / I want to be treated with dignity and respect. Do not make assumptions about what I can do simply because I have lived longer /

Promoting Privacy, Dignity and Respect
Ensuring equality of access

5 / I want information about choices and options to be easily available /

Promote Choice and Control
Signposting services with good Information and Advice

6 / Please be honest with me, when giving advice or support /

Good listening to Older people ??
Well skilled workforce with good listening skills

7 / I want to be confident that when I need health or social care I can get it quickly /

Integrated Health and Social care locality teams
Acute Care Close to Home Teams for crisis

8 / I want the staff who care for me to be well-trained and competent /

Having a well trained workforce in all sectors who communicate with each other
Ensure up to date skills competencies

9 / I want to know that the money spent on my care is being spent wisely. /

Best use of public money and services that have been tested for value for money

10 / I don’t want to stay in hospital longer than I need to /

Reduce planned and unplanned admissions to acute and specialist hospitals
Redirect resources from secondary to primary and community care

11 / I want my death to be a good death /

Gold Standard Framework and End of Life Strategy implemented throughout
Increasing numbers of older people being able to die in the place of their choice

12 / As a carer, I want to know that the services recognise my contribution and will support me /

Carers Strategy
Carers consultation Groups to listen to feedback

Table 1