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Shifting the Balance of Care (SBC) Enabling Independent Living 15 September 2009. Mike Martin Partnership Improvement and Outcomes Division. The changing shape of Scotland’s population. Some headline projections. Scotland’s 65+ population projected to rise by 21% between 2006 - 2016

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shifting the balance of care sbc enabling independent living 15 september 2009

Shifting the Balance of Care (SBC)Enabling Independent Living15 September 2009

Mike Martin

Partnership Improvement and Outcomes Division

some headline projections
Some headline projections
  • Scotland’s 65+ population projected to rise by 21% between 2006 - 2016
  • By 2031 it will have risen by 62%
  • For the 85+ age group specifically, a 38% rise is projected for 2016
  • And, for 2031, the increase is 144%
slide4

84%

61%

41%

24%

9%

Calendar year ’07 estimate

P Knight Scottish Government

slide5

Community Care - Impact

Demographic change for population aged 65+ Scotland Potential impact on specialist care services 2007-2031

94%

1-9 hrs

Home care

26%

10+ hrs

Home care

Care Home

Cont h/care (hosp)

Projection

P Knight Scottish Government

what this all means for scotland
What this all means for Scotland …
  • A new 600 bed hospital every 3 years for 20 years
  • A new 50 bed care home every 2 weeks for 20 years
  • £2.8 billion investment in sheltered housing to “stand still”
  • Virtually all school leavers into the care sector by 2030
slide9
all this will require by 2016

22% increase in health and social care expenditure [extra £1 billion!]

while

8% reduction in public expenditure*

[* Institute of Fiscal Studies estimate]

it just doesn’t add up!

slide10

Facing the Challenges

- An Outcomes Focus…………..

an outcomes focus what it means
An outcomes focus – what it means
  • Frail and vulnerable people supported to live at home
  • Control and decisions with the individual
  • Strong, caring, supportive communities
  • Fairness and equity
  • High quality environment
  • Contributing to local economy
growing old
Growing old -
  • Not an illness; a state of being
  • Should we shift our focus?
some further considerations
Some further considerations
  • Tenure implications – an equity stake
  • ‘Young until your dead’ – self image
  • Economically active
  • Politically active and influential
  • Best healthy life expectancy prospects
  • Pension provision
  • Older people provide far more care than they receive
home care some observations
Home Care – some observations
  • Huge variations across Scotland
  • 45% local authority home care staff 50+ years old
  • 40,000 of 65+ provide 20+ hours care per week
  • 3,000 65+ receive more than 20 hours per week paid care
  • 1:2 ratio of 10 hours and home care to care home
reshaping care for older people
Reshaping Care for older people …..
  • Into the Spotlight Conference (Dec 08)
  • Lord Sutherland Review of Free
  • Personal and Nursing Care (Dec 08)
  • Ministerial Strategic Group (Dec 08-March 09)
  • Joint Leadership Summit (May 09)
  • Engagement from Now
  • Emerging proposals to MSG Dec 09
  • Wider engagement Jan 10
reshaping care for older people 8 workstreams
Reshaping Care for Older People … 8 workstreams
  • Vision and engagement
  • Care at home – a mutual care approach
  • Care homes
  • Care pathways
  • Planning for ageing communities
  • Workforce
  • Healthy life expectancy
  • Demographics and funding
it has to be outcomes
It has to be … outcomes
  • How well do our services help achieve our policy goals?
  • How can we help people stay out of the formal care system?
  • How can we support self care?
  • Is it a change of philosophy and approach – support not services?
  • We are doing it now – in pockets – what’s stopping the spread?
care at home some emerging ideas
Care at Home – some emerging ideas ……
  • Better integrated approaches

- across health, housing and social care

- across paid, unpaid and volunteer care

  • More anticipatory and preventative care

- support to unpaid carers/volunteers

- telehealthcare

- “contact and connect” support

  • Better crisis care

- appropriate rapid response

- 24/7 cover

- telehealthcare

slide21
Develop and support volunteer and unpaid care

- older people as carers

- “back-up” for unpaid carers

- ? Fiscal incentives (reserved matters)

  • More complex care at home

- integrated approaches across acute, primary and social care

- telehealthcare

  • Focus on re-ablement/outcomes/goals

- rehabilitation

- support to do not services done to

- more personal budgets/Self Directed Support

other emerging ideas
Other emerging ideas ……
  • Remodelling care homes to provide more specialist care
  • Improved ‘care pathways’ – especially in/out hospital
  • New models of sheltered housing – very sheltered and ‘hub and spoke’
  • Promoting healthy lives

– self management of long term conditions

– active ageing

  • Building the workforce

– integration across health and social care

– integration across paid and unpaid and volunteers

and finally –

Need to model the costs and the funding options for the size and scope of care services we will need over the next 20 years