Post Diagnostic Support HEAT Measurement Workshop

Workforce Planning and Costings

6th February 2013Welcome

Mental Health Division

QuESTQuality and Efficiency Support Team

Glasgow City Community Health Partnership

North West Sector

• Identify the additional costs attached to delivering the commitment...

• …and in our spare time deliver world peace

What we set out to do

• Range of services and staff involved in delivering post diagnosis support

• Difficulty in separating out 1st year support from ongoing support

• Difficulties in quantifying service redesign opportunities

But we had difficulties in working out additional costs

So, instead we looked at the costs of just the link-worker role.

• Estimate how many people will get diagnosed each year

• Estimate total number of link-workers needed to provide 1 year post diagnostic support to everyone newly diagnosed

• Plan a proposed split of link-worker role across different types of staff

• Estimate how much of the link-worker role was already happening and funded

So not world peace, but not a walk in the park either. To do this we needed to:

South Sector Glasgow City CHP

• Pop. 126,194 (Over 30) and 27,023 (Over 65). NRS – GRO Figures 2010.

• Approximately 25% of the population live in income deprivation.

• 16% live in income deprivation in Scotland as a whole.

• Relatively higher mortality, poorer physical and mental health.

• Dementia incidence using Eurocode - 327.

Challenge One and Two

Estimating how many people will be diagnosed with dementia each year in your area

Estimating total number of link-workers needed to provide 1 year post diagnostic support to

everyone newly diagnosed

No of individuals newly diagnosed with dementia by mental health servicesSouth Glasgow 2003/4 to 2011/12

0

50

100

150

200

250

300

350

400

450

500

2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 20010/11 2011/12

No of people newly diagnosed with dementia Mean

But only info on who diagnosed in specialist

services…

…Glasgow unusual – most areas don’t even have this

We can predict new diagnosis using population estimates but its complicated

and there will be margins of error

Number of people actually diagnosed at a given moment in time

Estimated prevalence = total predicted number of people in your area with dementia at a given moment in time

Estimated annual incidence = predicted number of new people per year developing

dementia

HEAT Standard is that at least

50% of the total predicted

population with dementia

should have a diagnosis. As the population

is aging the actual number

needed to meet 50% increases

each year

South Glasgow

2013 = 2,646

1414 (53%)

South Glasgow 2013 = 327

1232

South Glasgow

2013 = 320

Estimated annual mortality but don’t know how many of those are

diagnosed.

Number of people with dementia but

not diagnosed

So if maintaining their current performance

against the HEAT standard, South

Glasgow will expect to diagnose between

175 -324 people a year

Step 1Estimated number of people newly diagnosed

with dementiaWorkforce Planning and Costing Model for Dementia Post Diagnostic Support - HEAT Target 2013

Linkworker Staffing Calculation

40Date 31/01/2013

2,646Area Glasgow City - South

327Population Year 2013NRS - GRO Scotland Population Projection (based 2010)

53%

1403

173 - 324

WTE required to maintain the current % diagnosed 4.4 - 8.3

55%

1455

201 - 351

6. - 9.8

How many WTE would you like to model costs for? 8

What % of the total predicted population with dementia are you currently diagnosing (suggest you enter your current performance against the HEAT standard here )

Assuming linkworker only does 1 Year PDS, how many newly diagnosed individuals can 1 WTE take onto caseload each year

To achieve your desired levels of diagnosis this year, we predict you will need to diagnose the following numbers of individuals

Are you expecting to increase the percentage of the estimated population you diagnose? If so please enter the percentage here:

To maintain your current levels of diagnosis (as a % of the total predicted population with dementia), you will need to diagnose the following number of people in this year:

To achieve this expected level of diagnosis (as a % of the total predicted population), you will need to have the following number of people diagnosed by the end of year you are modelling.

Prevalence:Research data (EuroCoDe) estimates that the total number of people with dementia in your area in the year you are modelling is/will be:

WTE required to reach the new % diagnosed

Incidence: Research data (EuroCoDe) estimates that the following number of people will develop dementia in your area in the year you are modelling

To continue with you current levels of diagnosis (as a % of the total predicted population), you will need to have the following number of people diagnosed by the end of the year you are modelling.

Challenge Three

Estimating how the link-worker role will be split across different

profession

Step 3Planning your staff profile for linkworker role

• Moving most of early intervention input to non-health providers, but keeping strong links to OPCMHT and consultant referrers.– Alz Scot Link worker. 70%

– C.P.N. 20%

– O.T. 10%

• Linking clients with appropriate support skill level.

• Reducing cost/releasing specialist health resources for moderate or severe.

Planning staffing profile cnt/d

• Based on local model/local circumstances. • Change Fund money to employ 2 WTE

Alzheimer Scotland Link Workers in Sept 2012.• OT in self management.• Strong links to other services• Social Work – Carers Support Service. Must be

strong links with Social Work.• Dementia Advisor.• MacMillan Partnership – Financial/legal.

Step 4Costing proposed staff profile for linkworker

roleCosting Calculation

Linked worker bandingCost at mid point and 21% on costs

What % of individuals newly diagnosed with

dementia do you expect the following workers to provide the

linkworker role for WTE Needed Cost (£)

Band 4 24,724 0.00 £0Band 5 29,127 20.0% 0.98 £28,565Band 6 35,651 0.00 £0Band 7 42,573 0.00 £0Band 8a 51,522 0.00 £0Alzheimer Scotland Linkworker 30,540 70.0% 3.43 £104,828

0.00 £0Occ Therapist - band 6 35,651 10.0% 0.49 £17,482

0.00 £00.00 £00.00 £00.00 £0

Total 100.0% 4.90 £150,874

WHAT YOU NEED TO MEET THE PDS COMMITMENT

Glasgow City2013South

Challenge Four

Estimating how much of the link worker role is already happening

and funded

Step 5Who is currently doing the role?

Linked worker bandingCost at mid point and 21% on costs

Please enter total WTE of

any professions

who provide PDS

What % of their current time is spent fulling link worker role

for 1 year post diagnostic

support

Current WTE allocated to PDS in 1st year after diagnosis

Please identify if any WTE funded

by change fund or other fixed term

funding

Costs of current PDS provided in 1st year

after diagnosisBand 4 24,724 0.00 0 £0Band 5 29,127 13.00 15.0% 1.95 £56,797Band 6 35,651 4.00 20.0% 0.8 £28,521Band 7 42,573 1.00 5.0% 0.05 £2,129Band 8a 51,522 0.00 0 £0Alzheimer Scotland Linkworker 30,540 2.00 100.0% 2 2 £61,080

0 £0Occ Therapist - band 6 35,651 1.80 30.0% 0.54 £19,252

0 £00 £00 £00 £0

Total 21.80 5.34 £167,778

WHAT YOU CURRENTLY HAVE IN POST

This is difficult to collect and self estimates not likely to be accurate

Step 5Who is currently doing the role?

• South Glasgow now piloting an activity tracker to audit over a 2 week period how staff actually spend their time.

Step 6Working out the difference

1. You’ve estimated the total numbers and costs of staff you need to deliver the target

2. You’ve estimated the total amount of time by different staff currently spent on PDS in the 1st year post diagnosis

3. So the additional staffing/funding you need is simply 1-2

4. But not quite that simple….

Linked worker banding

WTE (red figures

indicate a reduction, ie

you have more staff than need)

Marginal Costs (Red figures indicate a projected

saving. This may not be cash releasing)

Financial risk associated with fixed term posts

Band 4 0.00 £0 £0.00Band 5 -0.97 -£28,232 £0.00Band 6 -0.80 -£28,521 £0.00Band 7 -0.05 -£2,129 £0.00Band 8a 0.00 £0 £0.00Alzheimer Scotland Linkworker 1.43 £43,748 £61,080.00

0.00 £0 £0.00Occ Therapist - band 6 -0.05 -£1,770 £0.00

0.00 £0 £0.000.00 £0 £0.000.00 £0 £0.000.00 £0 £0.00

Total -0.44 £61,080.00

THE DIFFERENCE

These calculations assume any reduction in current staff time spent on PDS are not cash releasing

Marginal costs of meeting target £43,748

Value of staff time released for other work £60,652

Total hours of staff time released per week for other work (assumes 37.5 per WTE) 70

These calculations assume any reduction in costs through redesign are cash releasing and hence available for reinvestment in PDS. This is less likely to be the case than the above scenario.

Net Marginal Costs         -£16,904

The tool then automatically works out marginal staffing costs for the linkworker role

Step 7 Additional costs associated with link-worker role

Additional costs over and above link worker role Cost

If funding is already

attached to this please enter how

much Marginal CostAlz Scot Fees/Admin etc £6,100 £6,100 £0Dementia Advisor £30,540 £30,540 £0OT/Alz Scot Grp included £0 £0

£0£0£0£0£0£0£0

Total £36,640 £36,640 £0

If any of the existing funding comes from the change fund -

please state how much

Additional costs associated with linkworker role

£6,100.00

£6,100.00

The tool then automatically gives you a summary of overall total and marginal costs

Summary CostsTotal Costs

Linkworker Staffing £150,874Linkworker Associated £36,640

Total £187,514

Marginal Costs£43,748

£0

£43,748

Key lessons learnt - costing

• Not possible to fully cost impact of target too many uncertainties

• Variation in current fundingRanging from 58% – 100% of projected linkworker costs

• 3 sites currently using change fund to part fund linkworker costs(fixed term 2014/15)

South Glasgow lessons learnt using the tool

• Emphasis on non health providers but with strong links to local mental health team and referral pathways.

• Strong links with social work/social care providers.

• Balance between ideal and what is practical/affordable

• Tool is a useful planning resource for HEAT target.

Questions/Discussion

• Utility of Tool: Would you use this tool to facilitate PDS planning? What are your thoughts/comments?

• Who: From your own area – can you identify the core professionals who you think will undertake the one year link worker role?

• From this group, how would you see the professional mix? Why?

• How: What would your local model look like? How and where would your PDS link workers operate in your area? (For example, where would they be based? Would they be part of a discrete team or linked to other teams?)

• What would the patient’s journey look like in your model? Could you draw a diagram?

• Change: What would you need to do/change to make this happen?

Thank you for attending

Mental Health Division

QuESTQuality and Efficiency Support Team

Glasgow City Community Health Partnership

North West Sector