Making Birmingham a Great Place to Grow Old: The Early Intervention Programme

1. Making Birmingham a great place to grow old in. TheEarly Intervention Programme. Part of the Birmingham Older Peoples Programme.

2. Why we need to change • Fragmented services, inconsistent capacity and an overreliance on beds • Phyllis production – true stories of working that isn’t joined up • Sticking plasters as tactical responses to pressures • Financial situation – must inject pace The people of Birmingham have been let down (CQC)

3. END 2017 ASSESSMENT SUMMARY COLOURPALETTE Improving how we support people in their home could result in… Improving how we make decisions about supporting older people could result in… Improving the services we provide to people in temporary bedded environments could result in… 28,000 - 40,000 fewer days spent in beds per year, 2,300 - 4,000 people living more independently, 3,500 - 4,500 people living more independently,

4. How we will manage change Solihull Health and Wellbeing Board BSol Ageing Well & Later Life Portfolio Ageing Well Strategy JSNA & H&W Strategy End of Life Group Birmingham Older Peoples Programme Framework & Locality Model Black Country & West Birmingham STP Board Integrated pathways Integrated Commissioning Integrated Provision Prevention Workstream Early Intervention Workstream Ongoing Personalised Support Workstream Communication, engagement and co-production Organisational Development and Workforce Planning ICT and Digital Estates

5. Our joint vision for the future A universal wellbeing offer enabling older people to manage their own health & wellbeing, based in local communities and utilising local resources. It will address the issues that lead to older people entering into formal health & care systems, such as social isolation, falls and carer breakdown. Access to good quality information & advice will be the cornerstone of our wellbeing offer, enabling people to identify and access the support that they need in order to maintain living fulfilled lives. A range of targeted interventions to promote faster recovery from illness or injury, prevent unnecessary hospital admission and premature admission to long-term residential care, support timely discharge from hospital and maximise independent living. We will respond quickly, minimise delays and not make decisions about long term care in a hospital setting. The right care at the right time in the right place Some older people will need ongoing support to remain living in their own homes and communities. These services aim to maintain individual wellbeing and self-sufficiency, keep older people safe and enable them to be treated with dignity, stay connected to their communities and avoid unnecessary admissions to hospitals or care homes. We will change the way our services are commissioned and delivered to be more focused on achieving better outcomes for older people.

6. COMPONENT TESTING TEAMS Component testing is a true partnership effort: team members, sponsors and practitioners have come together from across Birmingham

8. DECEMBER 2018: Prototype approach PROTOTYPE PHASE Designing and testing prior to roll-out. December ‘18 - May ‘19 INPUTS TOPROTOTYPE Deliverables:a. Model & Principlesb. Outcomes for people c. Financial benefits Constraints:a. Timelineb. Resources ITERATEagainst the model until clearly defined enough to move forward. ITERATEindividual components of the model until working effectively. ITERATEthe combined components together until working effectively. COMPONENTSDEFINITION COMPONENTS TESTING LOCALITY TESTING STAGE #1 STAGE #2 STAGE #3 ROLL-OUT PHASE Defining components of the model that will enable us to deliver the outcomes and financial benefits.People: 28 Duration: 4 weeks Evidencing that each component delivers the expected outcomes and financial benefits using multiple tests in the most appropriate environment. People: 10-20 per component Duration: 6-12 weeks Testing that the components work in combination as expected and understand how best to roll them out more widely. People: Scaling up to whole locality. Duration: 10-20 weeks

9. ROLL-OUT: GAP ANALYSIS CITY-WIDE EXISTING PROVISION TESTING SITES CITY-WIDE REQUIREMENT SOUTH LOCALITY 5 LOCALITIES 5 LOCALITIES QUANTIFY THE GAP DEMAND SCALING ITERATE FEB-JUN ITERATE FEB-JUN ITERATE FEB-JUN KEY: INITIAL AREAS FOR INVESTIGATION CATEGORIES FOR INVESTIGATION • COMMISSIONING • COMMUNICATION & ENGAGEMENT • GOVERNANCE • WORKFORCE & ORGANISATIONAL DEVELOPMENT • INFRASTRUCTURE (ESTATES, CONNECTIVITY, EQUIPMENT) • INFORMATION, DATA & TECHNOLOGY • LEADERSHIP

10. What’s been observed or happenedin the first few weeks of testing? TEST SITE 1: New Community Team There are about 15 staff from BCHC, UHB and BCC now a joint integrated health and social care, with ANPs, RNs, SWs and Therapists Patient feedback has so far been 100% very positive. Initial results are positive. Referrals coming from wards to support discharge from the QEHB. Not a service available before. Likewise from non acute beds. TEST SITE 4: Juniper Centre for acute mental health beds Results indicate that the overall length of stay has dropped by 16% (equivalent to over 10 days) The proportion of people we were getting home directly from Norman Power was 28%, it’s now over 40%. 25% of people leaving previous EAB beds previously got readmitted straight back to hospital – that’s been zero at Norman Power for the last 5 weeks. TEST SITE 2: QE front door/OPAL TEST SITE 5: Temporary beds not in an acute hospital Evidence gathered in testing indicates 4 times more people would benefit from an OPAL intervention, compared to how many are receiving one now The team is seeing more people every week through staffing and process changes. TEST SITE 3: QE back door/Complex Discharge Hub. • We’ve created a hub Edgbaston team of nurses, therapists and social workers and they have discharged everyone back to where they came from, rather than a long term care placement, in the last 5 weeks with a reduction to the length of stay of 4 days

11. From January 2019 Staff at the following locations will start to get involved in testing some of the new ways of working on a small scale and feeding back what works and what doesn’t: MAJOR MILESTONES. • Juniper Centre > Norman Power Centre > Older Person’s Assessment and Liaison (OPAL) at Queen Elizabeth Hospital Birmingham > QEHB Discharge Hub > Community setting (Edgbaston) From May 2019 Across the South of the city, staff working with older people will become increasingly involved in testing the new ways of working, making sure things work well for them and the people they look after. From June 2019 More and more areas and staff across Birmingham will begin to hear about the workstream and the benefits it will bring to them and the people they help. An increasing number of staff will find themselves more actively involved, making changes to what they do and how they work. This will probably involve working differently and receiving training where appropriate. September 2019 In the Autumn, most staff that work with older people will know about the programme and how it impacts on what they do. By this time, some staff will be very familiar with the changes and they will probably help other teams get familiar with it too, helping one another bring the changes in systematically. From November 2019 All the changes should be more or less in place towards the end of the year, and the conversation should be turning away from one of uncertainty and a feeling of everything is different and more towards business as usual.