The English Elderly Care and Support System

British-Poland Panel Discussion on Healthy Aging – 28th January 2014

Glen Mason Director of People, Communities and Local GovernmentDepartment of Health

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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…

And even if we don’t need care ourselves, we will all know someone – a family member or friend – who needs care and support. 5 million people in England currently care for a friend or relative.

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

19 per cent of men and 34 per cent of women will need residential care

Who needs care? At age 65, what are your chances of needing different types of care within your lifetime?

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…and around 5 million people caring for a friend or family member.

…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

…1.8 million people working as care professionals

In England there are…Su

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…and around 5 million people caring for a friend or family member.

…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

…1.8 million people working as care professionals

…

Care and support affects a large number of people

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Older Persons Population

• In 2012 just over nine million people in England (15% of the population) were over the age of 65 and over 1 million people were over the age of 85

• 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.

• On 31st March 2012 there were 651,130 older people being supported by adult social services (councils) in England

– Of these 480, 575 were living in the community– With 170,555 living in residential or nursing care

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The Social Care Workforce

• Size of the workforce 1.85 million jobs with 1.63 million people doing them

• 22,000 employers (most private sector)

• 18,500 employers employ less than 50 staff (12,000 employ less than 10)

• Percentage of jobs – 655 private sector, 23% individuals, 9% local government, 4% NHS

• About 60% of care staff are qualified

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Right Capacity

GPs 40,265

Consultants 40,394

Registrars 39,404

GP practice nurses 23,458

Support to doctors & nursing staff 269,714

Support to ambulance staff 13,451

Central functions 106,696

Hotel, property and estates 71, 242

Manager and senior manager 37,314

Qualified ambulance staff

18,645

Allied health professionals 74,902

Healthcare scientists 31,173

Other scientific, therapeutic

& technical staff 47,490

GP providers 26,886

Estimated number of NHS hospital & community health service and general practice

workforce as at 30 September 2012:

1.36 million

Professionally qualified clinical staff

687,810

Other doctors in training and equivalents 13,952Other medical and

dental staff 12,302

Other GPs 8,898

GP registrars 4,426

Qualified nursing, midwifery & health

visiting staff 346,410

Support to clinical staff

343,927

Infrastructure support 215,071

Nursing369,868

Doctors146,075

Scientific, therapeutic & technical 153,472

Support to scientific, therapeutic & technical staff 61,345

Residential 675,000

Domiciliary 831,000

Estimated number of adult social care jobs by employer type in England, 2011:

1.85 millionDay 96,000

Community 251,000

Other GP practice staff 113,832

Direct care 776,200

Managerial/supervisory 31,700

Other 18,400

Professional 4,300

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English Care System

• Assessment of need by 152 local Councils

• Eligible for services – 4 eligibility thresholds (low 1%, moderate 13%, substantial 83% and critical 2%) and a financial assessment

• 60/40 split state funded/self funded

• Direct payments must be offered

• 70% Community Services designed to keep people living at home as long as possible. 30% services residential and nursing

• Growing importance of rehabilitation services

• Interrelationship with health – preventing unnecessary hospital admissions, reducing length of hospital stay and preventing ‘blocked beds’

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Drivers for Change in the English Care System

• Demographic pressure– As a country we are living longer and almost all of us will need care– Medical improvements also mean more people with disabilities are living longer in

adulthood. – Most of us will need care and support at some point in our lives

• Unprecedented financial challenges– Need £10bn in more savings– Public spending – reduction of £80bn in four years– Economy will be 10-15% smaller than we thought it would be

• Raising expectations

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We will change care and support in two fundamental ways:

The Care and Support Bill – our vision

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.

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“I” Statements

1. “I am supported to maintain my independence for as long as possible” 1. “I am supported to maintain my independence for as long as possible”

2. “I understand how care and support works, and what my entitlements are”2. “I understand how care and support works, and what my entitlements are”

3. “I am happy with the quality of my care and support”3. “I am happy with the quality of my care and support”

4. “I know that the person giving me care and support will treat me with dignity and respect”

4. “I know that the person giving me care and support will treat me with dignity and respect”

5. “I am in control of my care and support”5. “I am in control of my care and support”

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Priorities

Shifting the system from a focus on crisis

to prevention

Making choice and control a reality

Drive improvement in the quality of care

throughout the system

Integration between Health and Social

Care

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Shifting the focus – from crisis to wellbeing

Need for intensive care and support

Living well

Low-level needs

Crisis

People will be given better information and advice to plan ahead to prevent care needs,

and will be better connected to those around them.

More support within communities, better housing

options and improved support for carers will help people

maintain their independence and avoid a crisis.

Re-ablement services and crisis response will help people regain

their independence at home after a crisis.

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

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Choice, control and quality

People can choose between a range of high quality options, or create their own

People develop their own care and support plan

People have clear

information to make good

choices about care

People are in control of their own

budget

People’s views are heard and

help improve services

In the new, person-centred system...

i

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Benefits of integration

Better use of existing resources for health and care services

Co-ordinated approach to health and social care

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

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Examples of where it’s happening

• 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.

PioneersIn November 2013 the Department of Health announced the 14 pioneers which will lead theway 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 interventionsby 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 andsocial 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 savingsper year.

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What is Government doing to support this?

The Better Care FundThe Better Care Fund

June 2013 announcement:

£3.8bn to be deployed locally in

2015/2016 on health and social care through pooled

budget arrangements

June 2013 announcement:

£3.8bn to be deployed locally in

2015/2016 on health and social care through pooled

budget arrangements

To assist areas in preparing for the

Better Care Fund, an additional £200m will be

provided in 2014/2015

To assist areas in preparing for the

Better Care Fund, an additional £200m will be

provided in 2014/2015

Draft plans to be submitted in February

with finalised plans to be agreed in

April

Draft plans to be submitted in February

with finalised plans to be agreed in

AprilLocal authorities and NHS Clinical Commissioning Groups must

agree a joint plan to deliver better, person-centred

care before receiving funding

Local authorities and NHS Clinical Commissioning Groups must

agree a joint plan to deliver better, person-centred

care before receiving funding

Part of the £3.8bn allocated to local

authorities includes a payment for performance element to

incentivise ambition and real change

Part of the £3.8bn allocated to local

authorities includes a payment for performance element to

incentivise ambition and real change

Autumn Statement

December 2013:Pooled budgets

will be an enduring part of

framework in future years

Autumn Statement

December 2013:Pooled budgets

will be an enduring part of

framework in future years

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Thank you and any questions?

Glen Mason

Director of People Communities and local Government

Department of Health

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