The occupational therapy role in delivering social care in the next five years College of Occupational Therapists– 5th June 2014 Glen Mason Director of People, Communities and Local Government Department of Health 1 DH – Leading the nation’s health and care Care and Support affect a large number of people Many people need some extra care and support during their adult years to lead an active and independent life. Three-quarters of people aged 65 will need care and support in their later years… Who needs care? At age 65, what are your chances of needing different types of care within your lifetime? 19 per cent of men and 34 per cent of women will need residential care 48 per cent of men and 51 per cent of women will need domiciliary care only 33 per cent of men and 15 per cent of women will never need formal care 2 DH – Leading the nation’s health and care Care and support affects a large number of people … are In England there Supported Supported …around 310,000 people in residential care, 60% of whom are state-supported …around 680,000 people in domiciliary care, 60% of whom are state-supported …and around 5 million people caring for a friend or family member. …1.8 million people working as care professionals • There are 800,000 people living with dementia and it is forecast that 1 in 3 people currently over 65 will develop dementia • 178,000 people receiving direct payments • More and more people are living with one or more long term conditions e.g. heart disease, hypertension, diabetes, etc. 3 DH – Leading the nation’s health and care Drivers for Change in the English Care System • Demographic pressure • Unprecedented financial challenges • Raising expectations • Technological Change • Systems failure eg: Mid Staffs Hospital and Winterbourne View • A drive to integrate services 4 DH – Leading the nation’s health and care The Care and Support Act – our vision We will change care and support in two fundamental ways: 1. The focus of care and support will be to promote people’s independence, connections and wellbeing by enabling them to prevent and postpone the need for care and support. 2. We will transform people’s experience of care and support, putting them in control and ensuring that services respond to what they want. 5 DH – Leading the nation’s health and care “For adult care and support in England to respond to challenges it must help people to stay well and independent” The Care Act and other reforms will: • Promote people’s wellbeing • Enable people to prevent and postpone the need for care and support • Put people in control of their lives so they can pursue opportunities to realise their potential • People have greater certainty and peace of mind over the costs of meeting care and support needs 6 DH |–Implementing Leading the nation’s the Carehealth Bill and care A shift in the care and support system 7 From To Repair Prevention Focusing only on response after a crisis Acting earlier to prevent or delay needs Fragmentation Integration Isolated services focused internally Joined-up services working as partners Paternal Personal State knows best Person knows best Exclusive Inclusive “Doing to” “Doing with” DH – Leading the nation’s health and care Shifting the focus – from crisis to wellbeing The new system will promote wellbeing and independence at all stages to reduce risk of people reaching a crisis point, and so improve their lives Living well People will be given better information and advice to plan ahead to prevent care needs, and will be better connected to those around them. Low-level needs More support within communities, better housing options and improved support for carers will help people maintain their independence and avoid a crisis. Crisis Need for intensive care and support 8 DH – Leading the nation’s health and care Re-ablement services and crisis response will help people regain their independence at home after a crisis. Choice, control and quality In the new, person-centred system... People can choose between a range of high quality options, or create their own People have clear information to make good choices about care i People develop their own care and support plan 9 DH – Leading the nation’s health and care People’s views are heard and help improve services People are in control of their own budget The Care Act is built around people • • • • • • • 10 People’s well-being will be at the heart of every decision Carers rights on the same footing as those they care for Freedom and flexibility to encourage innovation and integration Preventing and delaying needs for care and support Personal budgets giving people greater control over their care Information and advice about the care and support system New guarantees to ensure continuity of care DH – Leading the nation’s health and care The Care Act is built around people • • • • • 11 Promoting the diversity and quality of the local care market, shaping care and support around what people want Ensure that no one goes without care if their providers fails Puts adult safeguarding on a statutory footing for the first time Young adults receive care and support during transition Reforms what and how people pay for their care and support DH – Leading the nation’s health and care What does the Occupational Therapy Workforce in Social Care look like now? • 1.5 million people working in adult social care in total • Of these, 3,800 are occupational therapists • 2,800 occupational therapists work in a statutory setting and 1,000 work in an independent setting • Occupational therapists have been working in social care since 1970 • The workforce is mainly female (93%) • Occupational therapists deal with between 35-45% of local authority referrals and yet make up only 2% of the workforce 12 DH – Leading the nation’s health and care Pioneers Programme and Better Care fund Benefits of integration Co-ordinated approach to health and social care Better use of existing resources for health and care services Putting users at the heart of the service Better outcomes for users Bring together a greater range of skills and expertise Access to care and support 7 days a week Reduction in demand on acute services 13 DH – Leading the nation’s health and care Examples of where it’s happening Pioneers In November 2013 the Department of Health announced the 14 pioneers which will lead the way in co-ordinated care. These pioneers are driving the integrated care agenda forward by taking innovative new approaches in transforming the way health and care services are Delivered. • In Greenwich 2,000 patient admissions have already been avoided thanks to interventions by the Joint Emergency Team. The team responds to alerts within care homes, A & E departments and GP surgeries. • At South Devon and Torbay they have found that by bringing professionals closer together it has cut waiting times. Patients used to have to wait 8 weeks for physiotherapy service, now they wait only 48 hours. • The Tri-borough calculated that 20% of the local population account for 77% of health and social care costs. It’s new model designed to help people manage chronic conditions more effectively and reduce hospital admissions, is estimated to deliver £38m net savings per year. • In Greater Manchester the 10 authorities and 12 Clinical Commissioning Groups have joined forces to support the largest reconfiguration of hospital services in the National Health Service. Projected to save £270 million over 5 years. 14 DH – Leading the nation’s health and care What is Government doing to support this? The Better Care Fund June 2013 announcement: £3.8bn to be deployed locally in 2015/2016 on health and social care through pooled budget arrangements 15 Part of the £3.8bn allocated to local authorities includes a payment for performance element to incentivise ambition and real change DH – Leading the nation’s health and care Local authorities and NHS Clinical Commissioning Groups must agree a joint plan to deliver better, person-centred care before receiving funding Autumn Statement December 2013: Pooled budgets will be an enduring part of framework in future years 16 DH – Leading the nation’s health and care Role of Occupational Therapists in adult social care • Helping people to remain in their own homes and carry out activities safely • Promote and support personalisation • A key to the delivery of re-ablement services • Assess need for technology to support people to live independently in their own home • Home safety checks • Review care packages • Assess and problem solve manual handling issues 17 DH – Leading the nation’s health and care The contribution of Occupational Therapists to social care A significant contribution is made by a small workforce: • Provision of equipment reduces care package costs • Housing adaptations can reduce or remove the need for daily care visits • Prevention of falls at home leads to significant savings to health sector • Postponing entry into residential care through adapting people’s homes results in significant cost savings • Telecare can save costs where it replaces traditional care 18 DH – Leading the nation’s health and care Care Act 2014 – implications for Occupational Therapy • Many Acts you have been familiar with have been repealed • Introduction of the well being principle – this is fundamental to OT philosophy • Duty of candour now enshrined in law • Introduction of prevention where OTs have a key role to play • Integration is in the act • Please get involved in the consultation response on the guidance note. Julia Skelton is leading response from COT 19 DH – Leading the nation’s health and care Thank you and any questions? Glen Mason Director of People Communities and local Government Department of Health 20 DH – Leading the nation’s health and care