Home Care Review

25th March 2009

Care of Older People

The Purpose

Background

• 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%

Past trend in Emergency Admission Bed Days for people aged 65 and over

2,400,000

2,500,000

2,600,000

2,700,000

2,800,000

2,900,000

1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07

Financial year

no.o

f bed

days

HEAT

Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031

0

2000

4000

6000

8000

10000

12000

14000

16000

Y/E Mar 2007 Projected2011

Projected2016

Projected2021

Projected2026

Projected2031

Year

Be

ds

9%24%

41%

61%

84%

Calendar year ’07 estimate

P Knight Scottish Government

General Practice

Contact rates in general practice

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

4 & under 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 & over All ages

(B) Females - age categories (years)

Co

nta

ct r

ate

per

1,0

00 p

op

ula

tio

n

GP Practice nurse

FEMALE

GP Practicenurse

Longer term care of older people by Health and in Social Care Services

Current service provision by service type

People aged 65 and over

hospital est

care home

home care

all others

Current service provision by age group

75-84

85+

65-74

97%

88%

60%

Preparing for the growingolder population

Ministerial Strategic Group for Health andCommunity Care• Chaired by Minister for Public Health and Sport• Members - 4 NHS Board Chairs and 4 Local Authority Councillors • Support provided by Scottish Govt, COSLA, Tim Davison (NHS

Lanarkshire) and Sue Brace (ADSW)

Delivery Group for Health and Community Care• Chaired by Tim Davison• Membership covers NHS, ADSW, COSLA, local government, Scottish

Government , Care Commission

1. H1 Home Care Survey – overview

2. Uses of survey – Scotland Performs, SOAs

3. The way forward

History

1976 – First home care survey?1998 - Current survey began2003 - reviewed (added FPNC, supporting people

and person level data for SNS)

• Survey takes place last week March each year• Provides information on all services provided

during survey week• Home Care services provided or purchased by

LAs• Published around November each year

Home Care Clients (1976 - 2008)

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Year

Chart 1: Home care clients and hours provided, 1998-2008

Chart 4: Proportion of Home Care Clients by Provider, 1998 - 2008

Chart 7: Ratio of people aged 65 and over to people aged under 65 by level of service, 2008

Chart : Clients receiving home care / personal care services

Home Care clients aged 65+

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2003-04 2004-05 2005-06 2006-07 2007-08

Home Care Clients aged65+

Home Care Clientsreceiving personal care

What currently goes well?

• All 32 LAs return completed survey

• Comparability within LAs – time series data is good

• Survey largely unchanged for 10 years – so good time series

• Comparisons with Audit Scotland SPI

Are there any issues with current data collection?

• Not all LAs can provide data on purchased services (data is estimated)

• ‘Planned’ hours vs ‘actual’ hours

• Morning/afternoon/evening/weekend services – difficult to complete

• Comparability between LAs

• Limited analysis

Outcomes & Indicators

Overview

• National Performance Framework

• Scotland Performs

• Concordat

• Single Outcome Agreements

• Resources for SOAs

National Performance Framework (1)

• The 2007 Spending Review introduced a new National Performance Framework with an overarching national purpose, five strategic objectives, fifteen national outcomes, and forty-five national indicators.

• Moving to an outcomes-focused approach to performance.

• Delivery partners - including local government

National Performance Framework (2)

Our PurposeTo focus government and public services on creating a more

successful country, with opportunities for all of Scotland to flourish, through increasing economic sustainable growth

Scotland Performs

• Scotland Performs tell us how Scotland is doing in our pursuit of our aims. It describes the outcomes we want to achieve and how well Scotland is progressing in key areas: health and wellbeing; justice and communities;

the environment; the economy; and education and skills. • Scotland Performs follows the National Performance

Framework• http://www.scotland.gov.uk/About/scotPerforms

National Indicator

• Increase the percentage of people aged 65 and over with high levels of care needs who are cared for at home

• Clients receiving 10 hours+ home care / (Clients receiving 10 hours+ home care + LA supported long stay care home residents + geriatric long stay hospital patients)

Concordat

• Spending Review agreement

• Partnership working with Local Government

• Statistical collections will remain

• http://www.scotland.gov.uk/Resource/Doc/923/0054147.pdf

Single Outcome Agreements (SOAs)

• Single Outcome Agreement (SOA) for every LA (Community Planning Partnership 2009-)

• SOAs set out local priorities/outcomes, aligned to the fifteen national outcomes.

• The SOA sets out how the Community Planning

Partnership intend to measure progress towards their local outcomes.

Resources for SOAs (1)• In developing SOAs a range of indicator were used from a range of

sources:

– the 45 indicators contained in the National Performance Framework

– Menu of local outcome indicators http://www.improvementservice.org.uk/core-programmes/single-outcome-agreements-/

– Statutory Performance Indicators

– Community Care Outcomes Framework http://www.scotland.gov.uk/Topics/Health/care/JointFuture/CommunityCareOutcomesF

http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/Data/CommunityCareOutcomes

– Indicators taken from existing local Community Planning Partnership plans and local authority strategic documents

– council developed local indicators

Resources for SOAs (2)

• Data Sources and Suitability Websections on the SG website www.scotland.gov.uk/statistics

• ScotStat Network of Analysts from LG and Public Bodies local workshops and short-lived working groups http://www.scotland.gov.uk/Topics/Statistics/scotstat/analystsnet

work Analysts.Network@scotland.gsi.gov.uk

Current data collections

Home CareServices

Care Homes

Day Care

Housing Support

Free Personal

Care

Self-directed Support

Registered Blind & Partially Sighted

FPNC

Meals / Shopping

Equipment &

adaptations

Telecare

What don’t we collect?

Intermediate Care

Alarms

Day opportunities

Respite

Others?

Needs (IoRN)

Rehab / Enablement

Future

Home CareServices

Meals / Shopping

Telecare

Day Care

Housing Support

Equipment &

adaptationsCare Homes

Self-directed Support

Alarms

Needs (IoRN)

Respite

Priorities

• Better overview of number of people getting services at home and their needs

• 10+ hours – not good proxy – what should replace this?• Only collecting information on home helps at the moment

– lots of other services that ‘make a difference’• Analysis is limited to the tables we currently collect.

Don’t know overall number of people known to Social Work, etc

• The world is changing – data collection needs to adapt.

How can we do this?

1. Move to person-based data collection.– Would allow for more flexible analysis– Would allow us to look at needs as well as variety of services– Could provide us with longitudinal data– Start small and build up each year

2. Set up working group to take forward– Small group– Representation from variety of stakeholders– Make use of IT expertise (Scottish Government and IT suppliers to LAs)– Volunteers?

Contact Details

Julie Rintoul – 0131 244 5366

Ellen Lynch – 0131 244 4093

Email: Swstat@scotland.gsi.gov.uk

Address: Health Analytical Services Division,

Basement Rear,

St Andrews House

Edinburgh

EH1 3DG