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1. Introduction and Strategic Context
a. What is the Market Position Statement and who is it for?
b. Forecast Demographic Pressures
c. Population Profile of Wirral
d. Forecast Health Pressures
i) Strokes
ii) Dementia
2. Early Intervention
3. Current Market Supply
a. Overall Demand Analysis
b. Early Intervention
i) Equipment & Adaptations
ii) Assistive Technology
c) Hospital Discharge & Re-Ablement
i) Re-Ablement
ii) Rapid Access
iii) Intermediate Care
iv) Short Term & Respite Care
c) Ongoing Community Based Support
i) Day Services
ii) Direct Payments
iii) Home Care
iv) Shared Lives & Home Share
v) Supported Living
d) Long Term Care (Non-Community Based)
i) Extra Care Housing
ii) Nursing and Residential Care
3. Financial Context & Future Resources
4. The Changing Market for Care and Support Services
Summary re Traditional Service route
Focus on Outcomes
Commissioning Timetable
Contract renewal dates, etc.
5. References
1. Introduction and Strategic Context
a. What is the Market Position Statement and who is it for?
The Market Position Statement (MPS) is the first step in a renewed dialogue on market capacity and capability between the Council and adult social providers, identifying together where pressure points exist and deciding on how innovation and best value can be achieved and if need be incentivised. The Council is committed to working with providers to facilitate the development of a diverse and active market where innovation is encouraged and rewarded and where poor quality is actively discouraged.
This MPS is designed to be a document containing intelligence, information and analysis of benefit to adult social care providers within Wirral. It aims to describe current and potential future demand and supply and outlines the model of care the Council wishes to encourage.
The MPS aims to provide intelligence in relation to markets of care commissioned directly by the Council (Care Homes, Day Services, Personal Support, Shared Lives Schemes) and also those not directly commissioned by the Council whether they are funded by self funders or personal budget holders.
As a strategic commissioner the role of the Council is to:
- Understand the local population and their need
- Recognise how people and communities want to live their lives
- Facilitate individuals and communities to meet needs in a manner that best suits them
- Enable self help and community resilience
- Understand local social care markets, monitoring the quality of care provision
- Have a clear view of which services should be provided by the local market to meet the needs of the local population
- Work effectively with all stakeholders to ensure that the right services are available, in the right place and at the right time.
The MPS will be reviewed annually and should be considered in conjunction with other publicly available documents such as the Joint Strategic Needs Assessment1and Commissioning?
b. Forecast Demographic Pressures
In the UK, the number of people aged over 65 is projected to rise from 10.1 million to 16.7 million over the next 25 years2. In 2008, there were 1.3 million people in the UK aged 85 and over. This is projected to more than double to 3.3 million by 20333.
When considering the resources needed to meet forecast population demands it is estimated by the Department of Health that the average cost of providing hospital and community health services for a person aged 85 years or more is three times greater than for a person aged 65 to 74 years. Overall, there is a general growth in admissions to hospital but for older people this is at nearly double the rate of the rest of the population; 66% for those aged 75 and over as compared to 38% for the whole population 4.
Based on 2011 census data 19% of the population of Wirral is currently aged 65 or over compared to the national average of 16%. The population pyramids overleaf detail both current and projected population profiles by age.
Figure 1 – Structure of the mid-year 2010 population in Wirral
Source:
Figure 2 – Forecast structure of the population of Wirral in 2030
Source:
c. Population Profile of Wirral
Table 1 – Predicted population in Wirral of people aged 65+, 2012-2030
People aged 65+ with a limiting long term illness / 30,984 / 32,760
(5.7%) / 35,049
(7.0%) / 38,108
(8.7%) / 41,507
(8.9%)
People aged 65+ with dementia / 4,446 / 4,685
(5.4%) / 5,167
(10.3%) / 5,871
(13.6%) / 6,672
(13.6%)
People aged 65+ unable to manage at least one domestic care task / 25,522 / 26,859
(5.2%) / 29,092
(8.3%) / 32,208
(10.7%) / 35,439
(10.0%)
People aged 65+ unable to manage at least one personal care task / 20,951 / 22,080
(5.4%) / 23,827
(7.9%) / 26,306
(10.4%) / 28,964
(10.1%)
People aged 65+ providing unpaid care / 7,562 / 8,051
(6.5%) / 8,521
(5.8%) / 8,921
(4.7%) / 9,629
(7.9%)
Source:
Table 2 – Predicted Services provided to people aged 65+, 2012-2030
2012 / 2015 with % Change / 2020 with % Change / 2025 with % Change / 2030 with % ChangeTotal number of people aged 65 and over in residential and nursing care during the year, purchased or provided by the Council / 2,058 / 2,182
(6.0%) / 2,329
(6.7%) / 2,506
(7.6%) / 2,727
(8.8%)
Total population aged 65+ unable to manage at least one domestic task on their own / 25,522 / 26,859
(5.2%) / 29,092
(8.3%) / 32,208
(10.7%) / 35,439
(10.0%)
Number of households receiving intensive homecare (10+ hours per week) for people aged 18 and over / 903 / 909
(0.7%) / 917
(0.9%) / 928
(1.2%) / 945
(1.8%)
Number of people aged 65 and over receiving community-based services purchased by the Council / 5,780 / 6,127
(6.0%) / 6,540
(6.7%) / 7,038
(7.6%) / 7,657
(8.8%)
Number of Carers aged 65 and over receiving services / 1,052 / 1,116
(6.1%) / 1,191
(6.7%) / 1,281
(7.6%) / 1,394
(8.8%)
Number of people aged 65 and over in receipt of direct payments and/or individual budgets / 1,812 / 1,921
(6.0%) / 2,050
(6.7%) / 2,206
(7.6%) / 2,400
(8.8%)
Source:
Table 3 – Predicted population in Wirral of people aged 18-64 with a disability or Mental Health problem, 2012-2030
2012 / 2015 with % Change / 2020 with % Change / 2025 with % Change / 2030 with % ChangePeople with a moderate or severe learning disability / 992 / 983
(-0.9%) / 979
(-0.4%) / 984
(0.5%) / 990
(0.6%)
People with a moderate or severe physical disability / 19,420 / 19,170
(-1.3%) / 19,164
(0.0%) / 18,880
(-1.5%) / 18,253
(-3.3%)
People with a mental health problem / 13,168 / 13,016
(-1.2%) / 12,841
(-1.3%) / 12,686
(-1.2%) / 12,545
(-1.1%)
Source:
d. Forecast Health Pressures
i) Strokes
Stroke is a manifestation of cardiovascular disease (CVD) and is the third largest cause of mortality in England. Between 2008 and 2010 rates of premature mortality due to stroke in Wirral were higher than both the North-West and National averages.
Those who survive a stroke are often left with a disability. In the UK, on average, two-thirds of people survive stroke, but half of those are left with a disability.
Source:
ii) Dementia
Nationally there are approximately 750,000 people in the UK who have dementia with this number expected to double in the next thirty years. Dementia is therefore recognised as a national issue, with only around 45% of the estimated number of people with Dementia on a GP register, obtaining the care needed.
The national picture is mirrored within Wirral with the number of people forecast to have dementia set to increase by 55% by 2030. There will be a steady increase of 19% by 2020 with a steeper increase between 2020 and 2030.
Source:
Whilst traditionally dementia has been associated with people aged 65 and over there are an increasing number of people aged between 30-64 who have a diagnosis of dementia. Due to younger people with dementia being physically fitter than their older counterparts this presents particular issues for carers.
2012 / 2015 / 2020 / 2025 / 2030Males aged 30-64 predicated to have early onset dementia / 48 / 47 / 48 / 48 / 45
Females aged 30-64 predicated to have early onset dementia / 36 / 36 / 37 / 36 / 34
Total aged 30-64 predicted to have early onset dementia / 84 / 83 / 85 / 84 / 79
Source:
The drive to improve dementia services in Wirral can be traced back to before the National Dementia Strategy. There has been a recognition within Wirral of the over dependence in the local care economy on care home admissions. Currently 33% of all placements for adults aged over 65 are made to EMI beds.
2. Early Intervention
Whilst a greater proportion of people are being supported to live at home the greatest proportion of resources have been targeted at those with the greatest need; with crisis incidences often acting as trigger crisis points.
More people across all age groups are being supported to live at home, but at the same time resources are increasingly targeted at those with the greatest need. This is despite the evidence from the Partnership for Older Peoples Projects (POPP) which indicated that earlier intervention and prevention, before people reach high levels of need, may be more cost effective for health and social care systems as well as providing better outcomes for individuals.
Definitions of early intervention and prevention vary enormously, and these differences affect the scale and effectiveness of strategies employed by health and social care systems. Improving care and saving money -learning the lessons on prevention and early intervention for older people (DH, Jan 2010) identified four important elements of prevention:
- Delay or reverse older people’s deterioration (or, to put it more positively, promote their independence and wellbeing).
- Reduce the risk of crisis and the harm arising from them.
- Maximising people’s functioning (i.e. re-ablement).
- Provide ‘care closer to home’ (i.e. arrange for the least institutional or intensive intervention that is able to appropriately meet people’s needs).
However as a direct consequence of the spectrum of needs for which adult social care services are designed, it is difficult to define prevention solely in social care terms. Social care services described as prevention range from intermediate care services to ‘low-level’ interventions and community services supporting social inclusion.
Early Intervention and Preventative services need to be rooted within the community so they can appropriately support vulnerable adults with less complex needs that do not need the intervention of health or social care professionals. Vulnerable adults include people with learning disabilities, mental health needs, older people, people with physical impairments and their carers.
The voluntary, community and faith sector (VCF) is a key provider of preventative services and we will work more closely with the sector as a partner in delivering early intervention and preventative services. We acknowledge that the VCF often:
- Have more established links with the wider community and better reach of all communities including the more disadvantaged and ‘hard to reach’.
- Having specialist knowledge and experience that statutory services may not, as well as being better placed to fill gaps in provision.
- More freedom from institutional pressures so quicker to respond and more flexible in approach.
- Able to access additional resources for innovation.
- Able to be more responsive to local needs and respond quicker than statutory services.
- Able to provide economies of scale and fulfil niche markets which often provide the greatest challenges for public sector providers.
3. Current Market Supply
a. Overall Demand Analysis
Client Type / Total Service Users 2011/12 / % of Overall Packages / 5 Year MovementOlder People / 8,500 / 70% / ↑ 2%
Physical Disabilities / Other / 1,400 / 12% / ↓ 11%
Mental Health / 1,300 / 11% / ↑ 17%
Learning Disabilities / 900 / 7% / ↑ 13%
Total / 12,100 / 100% / ↑ 3%
During 2011/12 approximately 12,000 people received a package of care with between 9,000 and 10,000 in receipt of a service at any one point in time.
Source:
The greatest proportion of people supported during 2011/12 received equipment and/or adaptations to enable them to remain supported in their own home.
This is representative of the growth of assistive technology as a means to enable independence.
The majority of people supported with commissioned packages received support at home in the form of personal care.
Only 10% of people were supported within a nursing or residential care setting.
b. Early Intervention
i) Equipment & Adaptations
Adaptations – Role of Wirral Home Improvement Agency (Pete Gosling)
ICES & Joint Loan Store (Pete Gosling)
Client Group / Equipment & AdaptationsLearning Disabilities / 51
Mental Health / 33
Older Persons / 1,273
Physical Disabilities / 453
Total / 1,810
ii) Assistive Technology
Assistive Technology is a general term used for devices and related systems that can support individuals to live independently at home, whilst also providing reassurance and support to those around them. This can include monitoring of well being and safety and enabling individuals to carry out tasks independently. It includes standalone devices and interactive systems such as telecare and telehealth, as well as other forms of technology which are rapidly being developed.
The principles of Assistive Technologies are that it is part of a joined up response to providing personalised outcomes for individuals. It should not be seen or developed as an extra discrete service to other support offered/provided. It is focused on person centred outcomes and is not equipment led. Technology solutions should meet individual’s needs, not individuals meeting the requirements of the technology. It is not a substitute for face- to- face contact. Assistive Technology can increase the options that individuals have in meeting their needs in their own personalised way; it does not make those choices for them.
The number of people supported with Assistive Technology in Wirral is illustrated in the table below.
Client Group / Supported Living / Home Care / Residential / Nursing Care / No Commissioned PackageLearning Disabilities / 93 / 6 / 17 / 53
Mental Health / 5 / 7 / 1 / 44
Older Persons / 15 / 487 / 48 / 2,905
Physical Disabilities / 15 / 58 / 2 / 341
Total / 128 / 558 / 68 / 3,343
c) Hospital Discharge & Re-Ablement
i) Re-Ablement
Overview of Re-Ablement service (Anne Bailey)
Client Group / Number of People with a Care Package / Average Package Length (Weeks) / Average Hours Per WeekOlder Persons / 141 / 3.36 / 8.82
Physical Disabilities / Other / 10 / 3.82 / 7.94
Total / 151 / 3.38 / 8.75
Source: Local Intelligence
ii) Rapid Access
Overview of service (What does it do/Who does it support)
Volume currently delivered/Admissions prevented as a result
iii) Intermediate Care
Client Group / Total Placements / Average Length of Stay (Weeks)Older Persons / 198 / 5.2
Physical Disabilities / Other / 17 / 8.8
Total / 215 / 5.5
Source: Local Intelligence
iv) Short Term & Respite Care
Over reliance on short term beds as a step down from hospital
Shortfall in domiciliary care market to offer responsive service
Providers need to be flexible due to the growth in personal budgets and individuals commissioning their own respite.
In-House beds/usage – LD Wirral Autistic Society
Respite budget option
Opportunity re savings option for short term commissioning
c) Ongoing Community Based Support
i) Day Services
The Council currently operates as in-house services six day centres for people with physical and learning disabilities, three day centres for people with mental health needs and six day services offering “work type” placements for people with a disability. These have close links with their communities, operate increasingly personalized services and carry out a range of trading activities including catering and sale of plants and produce.
The model of operation needs to evolve further to meet national expectations and changing needs.The policy of offering people Personal Budgets has changed the profile of service provision. It is increasing demand for flexible support packages, which has in turn reduced demand for traditional long term day care.There is evidence that service users often attend more than one day centre and “mix and match” provision. Young people who are making the transition from children’s to adult services are not choosing to attend day centres. Council run day centres have sometimes been seen as less flexible and innovative than alternative types of provision.
There is evidence of an increasing demand for the “work type” placements delivered in six of the council’s day services. These currently offer the equivalent of around 130 full time places a day to service users.
There are also continuing changes in the population of people requiring support in the community, with a steady rise in the number of people with the highest support needs who will continue to require specialist centres which can offer skilled therapeutic support and appropriate equipment and facilities. In addition the population of people who attend day centres is aging and are likely to require a different range of services into the future.
Day services provided by vol.sector (summary of type)
Cross reference table with above figures
Client Group / Number of People Accessing Day Services Per Week / Total Days Attended Per Week / Local Authority Day Centres / Independent/Not For Profit Day CentresLearning Disabilities / 463 / 1,728 / 8 / 3
Mental Health / 209 / 224 / 4 / 3
Older Persons / 319 / 616 / - / 19
Physical Disabilities / 86 / 204 / 2 / 7
Total / 1,077 / 2,772 / 14 / 32
ii) Direct Payments
Personal Assistants - Supply
Client Group / Total Clients with a Direct Payment / Average Weekly ValueOlder Persons / 146 / £185.92
Physical Disabilities / Other / 220 / £233.48
Mental Health / 20 / £117.49
Learning Disabilities / 158 / £272.67
Total / 544 / £227.83
iii) Home Care
Home care, also known as domiciliary care, is the support and help with personal care and household tasks for the frail or those with long term care needs.
Domiciliary care makes it possible for individuals to remain in their own home, enabling them to maintain comfort and personal independence within their local community.
In Wirral, these services are commissioned ……….. (Julie to add current contract arrangements).
The number of people in receipt of these services and the average number of hours commissioned each week is illustrated in the tables below.
Client Group / Number of People with a Care Package / Total Hours Per Week Commissioned / Average Hours Per Week CommissionedOlder Persons / 1,117 / 16,300 / 14.50
Physical Disabilities / Other / 170 / 3,800 / 22.50
Mental Health / 40 / 480 / 12.00
Learning Disabilities / 81 / 1,550 / 19.00
Total / 1,408 / 22,130 / 15.50
Source: Local intelligence
Care Package Per Week / Older Persons / Physical Disabilities / Other / Mental Health / Learning Disabilities / TotalLess than 5 Hours / 220 / 42 / 12 / 25 / 299
Between 5 hours and 10 hours / 359 / 45 / 13 / 13 / 430
Between 10 hours and 15 hours / 190 / 21 / 6 / 11 / 228
Between 15 hours and 20 hours / 101 / 13 / 2 / 6 / 122
Between 20 hours and 25 hours / 72 / 9 / 2 / 7 / 90
Between 25 hours and 30 hours / 47 / 7 / 1 / 5 / 60
More than 30 hours / 128 / 33 / 4 / 14 / 179
Source: Local intelligence
The Council is reviewing its existing contract arrangements (Julie to add future commissioning intentions).
Development of a night service (Mike Houghton-Evans)
Somerset Project – Double Handlers (Jayne Marshall)
iv) Shared Lives & Home Share
Shared lives is a little known alternative to home care and care homes for disabled adults and older people. There are estimated to be approximately 10,000 shared lives carers in the UK. They share their family and community life with someone who needs some support to live independently.
A shared lives carer and someone who needs support get to know each other and, if they both feel that they will be able to form a long-term bond, they share family and community life. This may mean that the individual becomes a regular daytime or overnight visitor to the carer’s home or they may even move in permanently.