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The occupational therapy role in delivering social care in the next five years
College of Occupational Therapists– 5th June 2014
Glen Mason Director of People, Communities and Local GovernmentDepartment of Health
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Care and Support affect a large number of peopleMany 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…
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…
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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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• 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.
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Drivers for Change in the English Care System
• Demographic pressure
• Unprecedented financial challenges
• Raising expectations
• Technological Change
• Systems failure eg: Mid Staffs Hospital and Winterbourne View
• A drive to integrate services
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We will change care and support in two fundamental ways:
The Care and Support Act – 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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“For adult care and support in England to respond to challenges it must help people to stay well and independent”
The Care Act and other reforms will:•Promote people’s wellbeing•Enable people to prevent and postpone the need for care and support•Put people in control of their lives so they can pursue opportunities to realise their potential•People have greater certainty and peace of mind over the costs of meeting care and support needs
| Implementing the Care BillDH – Leading the nation’s health and care
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A shift in the care and support system
From To
RepairFocusing only on response after a crisis
PreventionActing earlier to prevent or delay needs
FragmentationIsolated services focused internally
IntegrationJoined-up services working as partners
PaternalState knows best
PersonalPerson knows best
Exclusive“Doing to”
Inclusive“Doing with”
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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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The Care Act is built around people
• People’s well-being will be at the heart of every decision
• Carers rights on the same footing as those they care for• Freedom and flexibility to encourage innovation and
integration• Preventing and delaying needs for care and support• Personal budgets giving people greater control over
their care• Information and advice about the care and support
system• New guarantees to ensure continuity of care
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The Care Act is built around people
• Promoting the diversity and quality of the local care market, shaping care and support around what people want
• Ensure that no one goes without care if their providers fails
• Puts adult safeguarding on a statutory footing for the first time
• Young adults receive care and support during transition
• Reforms what and how people pay for their care and support
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What does the Occupational Therapy Workforce in Social Care look like now?• 1.5 million people working in adult social care in total
• Of these, 3,800 are occupational therapists
• 2,800 occupational therapists work in a statutory setting and 1,000 work in an independent setting
• Occupational therapists have been working in social care since 1970
• The workforce is mainly female (93%)
• Occupational therapists deal with between 35-45% of local authority referrals and yet make up only 2% of the workforce
• ? turnover rates (21%)
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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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Pioneers Programme and Better Care fund
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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
Local 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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Role of Occupational Therapists in adult social care• Helping people to remain in their own homes and carry out
activities safely
• Promote and support personalisation
• A key to the delivery of re-ablement services
• Assess need for technology to support people to live independently in their own home
• Home safety checks
• Review care packages
• Assess and problem solve manual handling issues
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The contribution of Occupational Therapists to social care
A significant contribution is made by a small workforce:
•Provision of equipment reduces care package costs
•Housing adaptations can reduce or remove the need for daily care visits
•Prevention of falls at home leads to significant savings to health sector
•Postponing entry into residential care through adapting people’s homes results in significant cost savings
•Telecare can save costs where it replaces traditional care
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Care Act 2014 – implications for Occupational Therapy• Many Acts you have been familiar with have been
repealed• Introduction of the well being principle – this is
fundamental to OT philosophy• Duty of candour now enshrined in law• Introduction of prevention where OTs have a key role to
play• Integration is in the act • Please get involved in the consultation response on the
guidance note. Julia Skelton is leading response from COT
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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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