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Into the Spotlight. Agreeing and achieving the vision Re-investing to change Commissioning new services from existing resources. Conference 2 December 2008. Balances – Strategic Issues – Political Direction. Professional Control -- Personalisation. Managed Services – Family Carers.

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Into the Spotlight

Agreeing and achieving the vision

Re-investing to change

Commissioning new services from existing resources


2 December 2008


Balances – Strategic Issues – Political Direction

Professional Control -- Personalisation

Managed Services – Family Carers

Statutory Agencies – Independent Providers

Demography – Children’s Services – Older People

Hospitals – Community Health

Care Homes – Care at Home – Extra Care Housing


Agreeing the Vision



Better Outcomes

Whole System Integration

Variations in Practice and ExpenditurePer Capita Costs For People>75yrs In Four Scottish Localities

Community = Community Nursing

no change in practice increase with population
No change in practice – Increase with population

The need for services increases significantly with age, long-term conditions and proximity to death.

By far the greatest amount of care and support for older people at home is provided by family carers.

Maintaining the 2005 care home resident level would require an additional 560 fifty bedded care homes.

Across Scotland, there is a relatively low level of intensive home care and extra care housing.

NHS emergency and readmission rates vary – account for 25% of the health budget in one CHP.

no change system future in one partnership
No change -- System Future in One Partnership

Total Additional £46 million -- £3 million per annum




£29 m





Aged 84, his sight has deteriorated as has his physical condition. He now needs greater assistance with daily living tasks, and his care package has grown to a high level of service.

Social Care: Home Care £277.50; Day Care £36

Health: Community Nurse £24; OT £22; GP £6.90

Total Care Package £368.4

Gerry is 81years old.

He suffers from Heart Disease; Arthritis; and has poor sight. He needs help with various daily living activities, as well as bathing, and getting out.

He lives alone, but receives regular family visits.

He receives a low level of service (Total Care Package £86 pw: 4hrs homecare + DN and GP)

Gerry becomes unwell, and the attending GP identifies that he has a Urinary Tract infection. This could be treated at home with antibiotics, but the illness is causing some confusion and has increased the likelihood of a fall. To enable Mr McG to remain at home, he will require additional services for the next 72 hours.




Equivalent to 6.5 Weeks in a Care Home

Reduced length of stay in care home at initial saving of £100 per week?


Admit to DGH where, due to his age and underlying conditions, his episode of care and treatment will cost an average of £2577

Gerry is supported at home with a 72 hour care package for the crisis period; reducing to 20 hours per week for the next four weeks, before returning to the previous level.

(Additional Services: Social Care 72 hours Crisis Home; Increase Home Care For 4 Weeks -- Health Community Nurse £72 One visit per day for three days)

Whilst the Acute episode alone would represent an additional cost to the system of £1136 (above the cost of the community package), Gerry also spends seven Bed Days in the Community Hosp @ £276 per day costing £1932 for the total stay.

Total Additions To Social Care Package £1441 (+£144 CN)

Bringing the cost to the system to £4,509, representing an additional cost of £3,068 above the community option.

commissioning new services from existing resources
Commissioning New Services From Existing Resources
  • We invest a lot of £s on older people… and will be investing a lot more in future. Do we need and want to do things differently? Are we able to move money around the system to make it work as people want; or do we offer fixed choices based around existing services? If so:
        • How can we ensure that we are getting the best outcomes from the total health/care/housing/other resources available?
        • How can we disinvest from existing services and save to spend on the commissioning choices of patients/carers, clinicians, care and housing professionals?
        • How can we change the current operational/governance models from fragmented and provider led approaches to establish a transparent, integrated, flexible, personalised whole system?

Agreeing and achieving the vision

Re-investing to change

Commissioning new services from existing resources

Carer Support

Community Health

Care at Home

Extra Care Housing


Care Homes