joint commissioning strategy - nhs grampian for older people final 20... · 8.3 consultation on the...
TRANSCRIPT
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CONTENTS
Executive Summary 51. Introduction and Objectives of Strategy 111.1 OurVision12 121.2 Definitionofcommissioningandcitizeninput 121.3 JointPlanningArrangements 121.4 EqualitiesIntentions 131.5 Facts&Figures 132. National Policy Drivers 142.1 ReshapingCareforOlderPeople 142.2 ManagingLongtermConditionsandSelfcare 152.3 UnscheduledCare 152.4 Personalisation,ChoiceandControl 162.5 OutcomeFocusedCare 172.6 EarlyInterventionandPrevention 172.7 PlanningandDeliveringIntegratedHealthandCare 182.8 RehabilitationandEnablement 182.9 Dementia 192.10 AdultSupportandProtection 192.11 FreePersonalCare 202.12 SupportingUnpaidCarers 20
3. Environmental Scan 213.1 Demography 213.2 StrategicHealthNeedsAssessment 243.3 IncreasingLifeExpectancy 283.4 FinancialSecurityinOlderAge 293.5 PopulationDependencyRatio 29
4. Delivering Better Outcomes: Recent Comparative Data 304.1 ShiftingtheBalanceofCare2008-12 304.2 FreePersonalCare 314.3 HousingandLivingAccommodationforOlderPeople 334.4 CareatHome 354.5 CareHomes 374.6 Hospitals 384.7 PrimaryCare 404.8 LivingWellwithDementia 404.9 DayServices 414.10 SupportingCarers 424.11 TelehealthCare 424.12 ChangeFund2011-13 43
5. Finance and Investment Patterns 465.1 Overview 465.2 IntegratedResourceFramework 475.3 NHSExpenditure 475.4 SocialWorkExpenditure 485.5 FundingCarerSupport 495.6 CapitalFunding 495.7 ChangeFund 50
6. Strategic Commissioning Intentions: Key Changes 2013 – 2023 An Overview 516.1 IntegrationofHealthandSocialCare 516.2 ReducingInequalities 516.3 ASenseofPlace 526.4 BetterOutcomes 52
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6.5 Publicexpectations,chargingforcareandthemutualcaredebate 536.6 ImprovingPersonalisation,ChoiceandControl 536.7 CreatingASustainableLocalMarketforCare 53
A Early Intervention and Prevention 54A.1 StrategicOutcomes 54A.2 LivingWellinLaterLife–buildingindividualandcommunitycapacity 54A.3 HousingwithSupport 55A.4 SupportingInformalCarers 56A.5 CareManagementandPersonalSupportPlanning 56A.6 DiagnosisandTreatment 56A.7 SelfCareandManagingLongTermConditions 57A.8 FallsPrevention 57
B Rehabilitation and Enablement 58B.1 StrategicOutcomes 58B.2 MovingfromMaintenancetoRecoveryandRehabilitation 58B.3 CareatHome 58B.4 Telehealthcare 59B.5 DaySupportActivitiesforFrailOlderPeopleandPeoplewithDementia 59
C Improving Long Term Care 60C.1 StrategicOutcomes 60C.2 SpecialistDementiaCare 60C.3 LongtermCare 60C.4 AcuteandIntermediateHealthCare 62C.5 PalliativeandEndofLifeCare 62
7 Workforce 637.1 Overview 637.2 CommunityHealthPartnership 647.3 AberdeenshireCouncil 657.4 Independentsector 667.5 Challenges 67
8 Involving and Engaging People 688.1 CapturingViewsofOlderPeopleandtheirCarers 688.2 “YourVoice”–NetworkofOlderPeoplesForums 698.3 ConsultationontheJointCommissioningStrategy 708.4 CitizenPanel 708.5 TakingAction 71
9. Conclusions 72
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APPENDICES
A. JointResourceFramework2012-14 75
B. IntegratedResourceFramework2010-11 79
C. ConsultationResults 82
D. CitizensPanelOnlineSurveyResults 84
E. CitizensPanelInterimReport–Viewpoint31 87
F. AberdeenshireChangePlanProgressReportJanuary2013 93
G. EqualityImpactAssessment 96
H. HousingContributionStatement 105
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Executive SummaryAgeing Well In Aberdeenshire
AgeingWellinAberdeenshireisAberdeenshire’sJointCommissioningStrategyforOlderPeople2013-23.Thestrategyproposeshowlocalcareandhealthserviceswilldevelopoverthenexttenyears,alwaysaimingtoprovidethebestpossibleoutcomes,asdefinedbyolderpeoplethemselves,collectivelyandindividually.
ThedocumentexaminesthecurrentsystemandlooksatthechallengesfacingtheNHS,AberdeenshireCouncil,thevoluntaryandindependentsectors,aswellasolderpeoplethemselves.
Itoutlinesthegovernment’spolicy,whichincludespersoncentredsupportwithlessbureaucracy;movinghealthcareclosertowherepeoplelive;andensuringtheycanaccesstherightsupportwhentheyneedit.
Thestrategyisdesignedtogiveolderpeopleconfidencethatthroughoutlaterlifetheycanexercisechoiceandcontrolovertheircareaswellashowtheylive.
Attheheartofthisstrategyisthebeliefthat:
Oldageshouldbecelebrated,notstigmatisedbysociety.Olderpeoplemustberespectedfortheexperience,wisdomandvaluesthattheybringtocommunity,civicandfamilylifethroughoutlaterlife.Olderpeopleshouldexpecttobetreatedwithdignityasindividualswithinthehealthandsocialcaresystemswhichshouldbeaccessibleandasclosetohomeaspossible.
BACKGROUND
Reshaping care for older peopleIn2011,theScottishGovernmentoutlinedanationalvisionforreshapingcareandsupportforolderpeoplein“ReshapingCareforOlderPeople:AProgrammeforChange2011-2021”
Thisistobeachievedagainstthebackgroundofasteepriseintheproportionofthepopulationwhoareolder,areducinghealthandsocialcareworkforce,andlongtermpublicsectorfundingrestraint.
Evidenceshowsthatolderpeopleformthesignificantmajorityofpatientsinbothprimaryandacutehealthservices.Similarly,almosthalfoflocalauthoritytotalsocialworkexpenditureisattributedtocareforolderpeople(approx.44%).
Ourkeyaimistopromotewellbeing,self-care,personalisationandcommunityresilience,whileimprovingaccesstoaspectrumoflocally-basedhealth,socialcare,housingandsupporttohelppeoplemaintainasmuchindependenceaspossiblethroughoutlaterlife.
Thegovernment’sstrategyischaracterisedbyimprovingaccesstoarangeofclinicalinterventionsandmanagementoflongtermconditionswithinprimarycaresettings,includinglocalout-patientclinicsanddaysurgery.
Acutehospitalswouldfocusonspecialistclinicalinterventionsonly.Simultaneously,concertedeffortacrossScotlandisgraduallyshiftinginvestmentfrominstitutionalmodelsoflongtermcaresuchascontinuingNHScarewardsandcarehomestowardscareathomeorinhomelysettings,suchasveryshelteredorextracarehousing.
What has been achieved in Aberdeenshire to date?Sincethesepolicieswerelaunchedthereisnowevidenceofgreateremphasisonrapidresponseandsupportedearlydischargearrangements,whichpreventunnecessaryhospitaladmissionsandreduceaperson’slengthofstayinhospitalbyprovidingadditionalsupporttohelppeoplereturnhomeasearlyasissafetodoso.
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Aberdeenshirehasalreadyseenasignificantreductionoverthelast5yearsintheemergencybeddaysrateforpeopleover65andover75andwehavelowerthanaveragenumbersofpatientsinNHScontinuingcarebeds.
Theratioofpatientstreatedinlocalcommunityhospitals,comparedtothoseadmittedtoAberdeenRoyalInfirmary(ARI),isincreasing,reflectingeffortstoshiftclinicaldiagnosisandtreatmenttocommunitysettings,asclosetohomewherepractical.
Duringthesameperiod,therehasbeenasustainedincreaseinnumbersofolderpeoplereceivingthecaretheyneedathomeandanincreaseof30%intheproportionofover65sreceivingintensivecareathome.
Wearesupportingmorepeopletomaintaintheirownhomeortenancyuntiltheendoftheirlife,ifthisistheirchoice.Wecanevidencethat,particularlyinshelteredandveryshelteredhousingsettings,veryfewtenantsmoveontocarehomes.
Theseadvanceshavebeenachievedthrough:
• bettercommunicationandjointwaysofworkingbyhealthandsocialcareprofessionalsatalllevels;• increasinginvestmentinnewmodelsofcommunitycare,bothwithintheNHSandlocalauthorities,and• promotingconceptsofselfcareandselfmanagementamongstpatients,familiesandcommunities.
Aims of Aberdeenshire’s Strategy
• Improvethewaylocalhealthandcaresystemsworksothattheexperiencepeoplehavewhentheyneed careisseamless,effectiveandaccessible.
• Aspiretoasinglepointofentrytohealthandcaresystemsforolderpeoplewithintegratedcaredelivered bytherightteamattherighttime,intherightplace.
• Helpfuturegenerationsofolderpeopletoremainfit,healthyandactivewithinformalsupportfrom familiesandcommunities,postponingandpreventingdependencyonformalhealthandsocialcare.
• Shiftpublicattitudesandchallengestereotypesofolderpeople,ageingandselfcare.
• Improvechoiceforolderpeopleandhelpthemhavemorecontrolovertheirownlives.
• EngageallAberdeenshirecitizensinshapingandprioritisingthefutureofhealthandsocialcare.
Challenges
DemographicsThedemographicprofileofAberdeenshirechallengesthecurrentmodelofhealthandsocialcare.Lifeexpectancyis79.7years,comparedtoaScottishaverageof77.8yrs.By2020,thenumberofover85yrsoldsispredictedtoriseby42.6%from2010figures,comparedwithariseinScotlandof39.6%.
HousingAspeoplecontinuetolivelongerandbesupportedintheirownhomes,weexpecttofacelocalchallengeslinkedtodiversityinnew-buildhousingandtheneedtomaximisetheuseofexistinghousingthroughtelehealthcare,equipmentandadaptations.Weanticipatethatdemandwillrisefromsinglehouseholdsforlivingoptionsthatofferflexiblecombinationsofcareandsupport.
Theextentofhousingunder-occupancywillbedeterminedbytheextenttowhichfuturegenerationsofolderpeoplechoose,orhaveopportunity,todownsize.
LocationAberdeenshireisalargelyruralarea.Localpeoplefaceparticularchallengesaccessingservicesasaconsequence.Localpublictransportisparticularlyinadequatetomeettheneedsofanageingpopulation.
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HealthAberdeenshirehasahigherthanaverageprevalenceofpeoplewithspecificlongtermconditions,namelydementia,obesity,hypothyroidismandchronickidneydisease.
Thereisalowerthanaverageprevalenceofdiabetes,COPD,chronicheartdiseaseandstrokecomparedwiththerestofScotland,buttheincidenceofcardiovasculardiseaseisstillpoorcomparedwithmanyEuropeancountries.
WorkforceThereisarealchallengetorecruitandretainallgradesofstaffandthissituationisexacerbatedbyavibrantemploymentmarketinAberdeenshire.IncommonwithotherpartsofScotland,ourcareworkforceisolderandmanywillberetiringinthenexttenyears.Newrolesandskillswillberequiredtodeliverourvision.
How We Will Meet These Challenges To Achieve Our AimsThereisagrowingunderstandingthattheimpactofasignificantlyageingpopulationcannotbemetbythecurrentmodelofpublicserviceor,indeedbythecurrentlevelofresourceavailableinstatutoryhealthandsocialcareservices.
Someofthefinancialimpactofthisdemographicpressurewillbedefrayedbyimaginativeapproachestosupportingfuturegenerationsofolderpeople.However,thereremainsamajorfundinggapthatwillrequiretobemetfromincreasedgeneraltaxationorfromamutualcareapproach,whereindividualsandtheirfamilies,meetthecostsoftheircareinoldage.Inthenextthreeyearswewillrefineourapproachtomeasuringoutcomesforpeoplewhouseourservicesandtheircarers.Surveysin2011/12ofolderpeopleatmediumriskofunplannedhospitaladmissionandtheircarershaveevidencedgeneralsatisfactionwithservicesandinvolvementinthedesignoftheircare.However,theseconfirmmoreneedstobedonetosupportpeopletofeelsafeathome,andtosupportinformalcarerstocontinueintheircaringrole.
Manyfrailorvulnerableolderpeoplearesupportedtomanagetheirhealthandindependencebyfamily,friendsandcommunities.Wewillendeavourtoensuretheircontributionisvaluedandrecognisedthroughcarerrespite,trainingandguidance.
Asanintegratedpartnershipweintendtouseallmeansofcommunicationtoensurepeopleunderstandhowtheycanlivehealthierlivesandaccesssupportwhentheyneedit.
Commissioning Intentions
Aberdeenshire’sstrategyforlongtermchangefocusesonthreethemes:
Early Intervention and Prevention
• Living well in later lifeBypromotingandsustainingco-productionactivitieslinkedtohealthyeating,lifelonglearning,regularexercisewellintooldage,reductioninalcoholconsumptionandsmokingcessationwebelieveolderpeoplewillbeabletolivefullerandhealthierlives.Usingaco-productionfocuswebelieverelativelysmallamountsoffundingcanstimulatediverseactivityandgoodoutcomesforpeople.Arangeofpublichealthprogrammesarebeingprogressedwhichwillincludeolderpeopleinthetargetgroup.Encouragingandenablingolderpeople,throughanasset-basedapproach,tomaintaingoodsocialrelationshipsthroughoutlaterlife,supportedbyinter-generationalparticipation,willbeanimportantelementofourstrategy.
• Housing with SupportOverthenextthreeyearswewillincreasethenumberofveryshelteredorextracarehousingunitsbyremodellingsomeshelteredhousingcomplexes.
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• Supporting Informal Carers Wearecommittedtoincreasingtherange,flexibilityandquantityofsupportforcarersinpartnershipwiththethirdsector.Increasingly,carerserviceswillbejudgedandmeasuredonhowwelltheyenablecarerstocontinueintheircaringrole.Thisoutcome willbecomefundamentaltoourcommissioningapproach.
• Personal Support Planning Wehavemadegoodearlyprogresstoestablishnewandsimplerwaysforpeopletomanagetheirownbudgetforcaresothatindividualsachievebetterpersonaloutcomesintermsoftheirpersonaldevelopment,recoveryorqualityoflife.
• Diagnosis and Treatment Wewillcontinuetodevelopcapacityforclinicianstoinvestigate,diagnoseandtreat acuteandchronichealthconditionsrapidlyandlocally.Intheshorttermweaimtoimprovethecapacityofprimarycareteamstodiagnose,treatandmanagepatientswithdementiaclosetohome.DevelopmentsofthiskindhavealreadyallowedustomanagemorepatientswithinGeneralPracticeoronanout-patientbasis,avoidingunnecessaryhospitaladmissions.Thiswillbeanincreasingfeature.
Accesstotimelydiagnosisofdementiathroughincreasingthecapacityofprimarycareservicestodiagnoseandmanagepatientswithdementiaisourshorttermpriority,givingmorepeopleearlyopportunitiestoaccessadvice,support,treatment,and,withtheirfriendsandfamily,planforthefuture.Localcapacityisbeingenhancedbynewperipateticoutreachteams,incorporatingAlzheimersScotlandlinkworkers,supportinglocalassessment,postdiagnosticsupportandcommunityengagement.
• Self Care and Managing Long Term Conditions Inrecentyears,wehavesuccessfullyapplieddifferentapproachestomanaginglongtermconditionswithinprimarycaresuchasdiabetes,coronaryheartdiseaseandCOPD.TherateofdeathfromheartdiseaseinGrampianisdecreasingandweaimtomaintainthistrendoverthenexttenyearssothatasmallerproportionofthepopulationarelivingordyingwithheartdisease.Duringthenextthreeyears,wewilldevelopourcapacitytosupportpeopletoselfcareandselfmanagetheirconditioneffectively.
• Falls Prevention Aquartertoonethirdoffallsbypeopleover80yearsoldcouldbeprevented.Muchwork hasbeendoneinAberdeenshiretoidentifyandreducerisksamongstolderpeopleatriskofinjuryfromfallsthroughbetterselfmanagement.OursuccesstodatehasbeenachievedinpartnershipwithawiderangeofpartnerssuchastheFire&RescueService,CareandRepaircommunitygroupsandvoluntaryorganisations.Overthenextthreeyearswewillcontinuetodevelopourapproachandreachmoreolderpeopleearlyinordertohelpthemreducetheirriskofinjuryfromfalls.
Rehabilitation and Enablement
• Moving from Maintenance to Recovery and RehabilitationTheAberdeenshirePartnershipendorsesamodelofhome-basedrecoveryandconsidersthatcommunityrehabilitationandenablementisthesame(orbetter)thanintermediatecareinaninstitutionalsetting.Withinthenextfiveyears,allprimaryandcommunitycarepractitionersi.e.districtnurses,homecarers,voluntaryorsupportworkers,daycarestaff,caremanagers,will,throughtrainingandpracticedevelopment,re-orientatethemselvesfromamaintenancemindsettooneofrecoveryandrehabilitation.
• Care at Home AberdeenshireCouncilcurrentlyprovidesandcommissionsinexcessof15,000hoursperweekofcareathomeservices.Increasinglyourservicesoperate24hoursadaydeliveringbothplannedandunscheduledcare.Weacknowledgethismaymeanunavoidablecostpressuresoverthenextfiveyearsinordertogrowtheserviceandmeetdemandforskilledpersonalsocialcareacrossourlargeremoteandruralarea.TheCouncil’spolicyistoremainasasignificantproviderofcareathomeserviceswhilecreatingandsustainingaviableindependentcaremarketacrossAberdeenshirebygraduallyandcontinuallyincreasingtheprocurementofhighqualityindependentcareathomeservices.
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• Telehealthcare Ourinvestmentintelehealthcarehasgrownannuallythroughjointinvestment.Creativeandinnovativetechnologicalsolutionsthatgivefasteraccesstodiagnosis,treatmentandsupport,reduceriskandimprovepersonaloutcomesforolderpeoplewillbeasignificantareaofdevelopmentfortheAberdeenshirePartnershipoverthenextthreetofiveyears.
AllAberdeenshirecommunityhospitalshaveaccesstotelemedicineandoverthenextthreeyearsweplantoexploittelemedicineopportunitiestosupportout-patientactivityandout-of-hoursnursingcare.
• Day Support Activities Werecognisethevalueandpotentialofourexistingtraditionaldaycareresourcestore-focustheircontributioninlinewiththeneeds,aspirationsandlifestylechoicesoffuturegenerationsoffrailolderpeopleandthosewithdementia.By2014wewill,withcommunityplanningpartnersandolderpeoplethemselves,re-designdaysupportwithanemphasisonrecovery,keepingwellandnewintegratedmodelsofdelivery.
Improving Long Term Care
• Specialist Dementia Care Increasingthecapacityofprimarycaretodiagnoseandmanagepatientswithdementiawillfreespecialistandsecondarycareservicestoworkwithmorecomplexcasesandofferrapiddecisionmakingsupporttoprimarycareclinicians.Wewillcontinuetodriveupstandardsofcareforpeoplewithdementiainacutehospitalsettingsandacrossallsectorsthroughtraininginadvanceddementiapracticefornursingandsocialcarestaff.
Apsychosocialtrainingmanualforinformalcarers,ofpeoplewithdementia,willbecascadedtocarersupportorganisationstoguideandsupportcarers.
DuringthelifeofthisstrategycareandtreatmentofpeoplewithdementiawillincreasinglybecommissionedandmanagedlocallywithintheAberdeenshirePartnership.Secondarycarewillbetargetedonthoseindividualswithcomplexbehaviouralproblemsorotherhighneeds.Theuseofspecialisthospitalbedsincommunityhospitalsoverseenbyconsultantsassupporttocarehomeswillprovideaccesstothefullspectrumofdementiacareforpeoplethroughouttheirillness.
• Long Term Care ReshapingcareforolderpeoplewillhaveasignificantimpactonthecarehomemarketinAberdeenshire.Overa20yearperiodprogrammethelocalcarehomemarkethasbeenshapedlargelybyspeculativeratherthanplanneddevelopmentandweaspire,throughtheimplementationofthisstrategy,toshifttheemphasistowardsacarehomemarketthatisfitfor21stcenturyliving,targetedandtailoredtomeetthedemandsandexpectationsoffutureoldergenerationsandoflocalcommunities.Overthenextthreeyearswewillrefineourapproachtocommissioningandcontractingtosupportandpromotecarehomeproviderswhocanconsistentlyevidencepositiveoutcomesforresidentsandhighqualitystandards.
Weanticipatethattheaverageage,levelofdependencyanddegreeofmentalorphysicalfrailtyofpeoplemovingintoacarehomewillcontinuetoriseinthefuture,aswesupportmanymoreolderpeoplewithcomplexhealthandcareneedstoliveathomewithsupport,orincarehousing,iftheychoosetodoso.
By2018,thecouncil’smodernisationstrategywillcreateandsustainthehighestqualityofaccommodationandcare.AswellasactingasanexemplarforthecarehomemarkettheCouncil’scarehomeswillensurethatolderpeoplehaveaccesstopubliclyownedprovisioninornearallmainsettlementsofAberdeenshire.
By2018weaspiretooffer,inpartnershipwithregisteredsociallandlordsandprivatedevelopers,134flatsaspartofveryshelteredorextracarehousingfacilities,wherethereiscurrentlynoneorinsufficientcapacityembeddedaspartofcommunities.Thiswilldeliverouraspirations,subjecttoavailablerevenue,duringthisperiod.
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Extracarehousingthatcanmeettheparticularneedsofolderadultswithalearningdisabilityfeatureinourcommissioningplansoverthenext10years.Weanticipatethatsomeoftheplannednew134veryshelteredflatsinsixcomplexeswillbeallocatedtoolderadultswithalearningdisability.
• Acute and Intermediate Health Care AcuteinpatientcarewillcontinuetobedeliveredinAberdeenshire’scommunityhospitalsforthosepatientswhoseillnesscanbediagnosed,treatedandrehabilitatedwithouttheneedforspecialistfacilitiesofamajoracutehospital,althoughthenumberandconfigurationofourcommunityhospitalswillbesubjecttofurtherreviewduringthelifeofthisplan.Overthenextfiveyears,wewillexploreopportunitiestocommissionsomeGPacutebedsincarehomes,particularlyinremoteandruralareas.
• Palliative and End of Life Care OuraiminAberdeenshireistoofferaccesstocohesiveandequitablecareforpatientsandfamilieslivingwithanddyingfromanyadvanced,progressiveorincurableconditionwhereverpeoplechoosetoreceiveit.
Wehavealreadyevidencedimprovementsinchoicethroughsuccessfulintegratedapproachestopalliativeandendoflifecare.In2012theproportionofpeoplefromAberdeenshiredyinginacutehospitalsreducedfrom35%to29.9%,whilstthosedyingincarehomesandcommunityhospitalshadrisenby3.8%and1.8%respectively.
Ourforwardplan,overthenextthreeyearsistobuildontheskills,confidenceandexpertiseofcarestaffandtostrengthenexistingout-of-hoursnursingcareinapartnershiparrangement,sothatmorepeoplewithterminalillnessescandiewithdignityinaplaceoftheirchoice.
Consultation
Thistenyearstrategyhasbeendevelopedbyhealthandsocialcareagenciessupportedbycommunityplanningpartners,thirdandindependentcareproviders,carersandthecitizensofAberdeenshire.
Wehaveadoptedadiverseapproachtocapturingtheviewsofolderpeopleandtheircarersthroughindividualassessmentofneed,careplanningandreviewprocesses;throughsurveys,consultationeventsandbycommissioningindependentresearch.
InOctoberandNovember2012weundertookaconsultationprocesswiththegeneralpublic,includingolderpeople,carersandcarers’forums,CouncilandNHSstaffandwithcareprovidersfromwhomwecommissionservices.Over200peopleprovidedwritttenresponses.ResultsaredetailedinAppendixC.CitizenPanelswerealsoconsultedandtheirresultsaretobefoundinAppendicesD&E.
Therewasastrongconsensusamongtheresponsesreceivedwithbroadsupportforourstrategicdirectionandastrongendorsementforafocusonearly intervention and prevention.
Conclusion
Ourtenyearstrategy,developedwiththecitizensandcommunityplanningpartnersofAberdeenshire,analysescurrentandpredictedtrends,reviewsourcurrentstateofeffectivenessinmeetingtheneedsoffrailolderpeopleandthosewithdementiaandoutlinesourfuturecommissioningintentionsandinbuiltreviewmechanisms.
Underpinningourthreestrategicthemesisaclearphilosophy:wewantpeopletolivewellinlaterlifebyen-couragingthemtokeephealthy,remainindependentforaslongaspossible,assumetheirrightfulplaceasvaluedmembersofthecommunityandhaveaccesstoreliable,highqualityhealthandsocialcare,whentheyneedit.
Eachyearanactionplan,incorporatingourjointperformanceframework,willbedrawnuptoensurewedowhatwesaywewill.ThiswillbeoverseenbyTheJointOlderPeoplesStrategicOutcomeGroupreportingtoAberdeenshire’sHealthandCommunityCarePartnershipandtotheCommunityPlanningPartnership.
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Chapter 1: Introduction and Objectives of Strategy
InAberdeenshiretherehasbeensignificantpopulationgrowthoverthepast30years.In2009totalpopulationwasestimatedas243,810,ofwhom39,194(16%)wereover65yrs,17,558(7.2%)wereover75yrs.Lifeexpectancyis79.7years,comparedtoaScottishaverageof77.8yrs.By2020,thenumberofover85yrsoldsispredictedtoriseby42.6%from2010figures,comparedwithariseinScotlandof39.6%.Aberdeenshireisalargelyruralareawithlowunemploymentandpocketsofdeprivation.Localpeoplefaceparticularchallengesaccessingservicesasaconsequenceofrurality.
Aberdeenshirehasahigherthanaverageprevalenceofpeoplewithspecificlongtermconditions,namelydementia,obesity,hypothyroidismandchronickidneydisease. Thereisalowerthanaverageprevalenceofdiabetes,COPD,chronicheartdiseaseandstrokecomparedwithScotland,buttheincidenceofcardiovasculardiseaseisstillpoorcomparedwithmanyEuropeancountries.
Againstthisbackdrop,theAberdeenshirePartnershipcanevidenceamarkedshiftinthebalanceofcare.Wehaveachievedasignificantreductioninemergencybeddayrateforpeopleover65and75overthelastfiveyearsandwehavelowerthanaveragenumbersofpatientsinNHScontinuingcare.Theratioofpatientstreatedinlocalcommunityhospitals,comparedtonumbersadmittedtoAberdeenRoyalInfirmary(ARI)isincreasing,reflectingeffortstoshiftclinicaldiagnosisandtreatmenttocommunitysettings,closetohomewherepractical.
Duringthesameperiod,weevidencedasustainedincreaseinnumbersofolderpeoplereceivingthecaretheyneedathomeandanincreaseof30%intheproportionofover65sreceivingintensivecareathome(i.e.over10hoursperweek).Thishasbeenmatchedbyareductioninpeoplemovingintocarehomes.Wearesupportingmorepeopletomaintaintheirownhomeortenancyuntiltheendoftheirlife,ifthisistheirchoice,particularlyinshelteredandveryshelteredhousingsettings,whereveryfewtenantsmoveontocarehomes.
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1.1 Our Vision Ourvision,tooptimisetheindependenceandwellbeingofeveryolderpersoninAberdeenshire,echoestheScottishGovernment’sReshapingCarepolicy.
1.2 Definition of commissioning and citizen inputStrategiccommissioningisthetermusedfortheactivitiesinvolvedinassessingandforecastingpopulationneeds,linkinginvestmenttoagreedoutcomes,consideringoptions,planningthenature,rangeandqualityoffutureservicesandworkinginpartnershiptoputtheseinplace.Jointcommissioningiswheretheseactionsareundertakenbytwoormoreagenciesworkingtogether,typicallyhealthandlocalgovernment,andoftenusingapooledoralignedbudget.
Tobeeffective,strategiccommissioningneedstoinvolveandengagecitizenssothattheirinfluenceandparticipationhelpstoshapethefuturejointstrategicplan.Aberdeenshire’sJointCommissioningStrategyforOlderPeople2013-23proposeshowlocalcareandhealthserviceswillevolveanddevelopoverthenexttenyears,alwaysaimingtoprovidethebestpossibleoutcomes,asdefinedbyolderpeoplethemselves,collectivelyandindividually.
Ourforwardstrategydrawsonevidenceofapproachesandsystemsthathaveagreaterimpactthanothersonavoidableadmissionstohospitalofolderpeople.Wewillfocusonimprovingintegratedpathwaysofcareandprofessionalpracticetosupportasustainedreductioninemergencyadmissionstohospitalandimprovepeople’sjourneyandwellbeingthrougholdageandattheendoftheirlife.Asapartnership,wearefocusingourchangeagendaacrossthreekeydimensions:
• early intervention/prevention
• integrated rehabilitation and enablement
• quality, choice and control in long term care
Eachthemewillcontributetoachievingourstrategicoutcomes.
1.3 Joint Planning ArrangementsAberdeenshirehasastronghistoryofjointworkingbetweenstatutoryagenciesandthevoluntaryandindependentsectors.ThistenyearJointCommissioningStrategyisdevelopedbyhealthandsocialcareagenciessupportedbycommunityplanningpartners,thevoluntaryandindependentcaresectors,carersandthecitizensofAberdeenshire.
In2013/14anintegratedHealthandCarePartnershipCommitteewillbeestablishedtoshadowtheNHSCHPCommittee.Therevisedjointplanningstructurelinkedtothesepolicy-makingcommitteeswillcontinuetooverseetheworkofthejointOlderPeople’sStrategicOutcomeGroup(OPSOG)andtheDementiaStrategyGroup,bothofwhichhaveclinicalandmanagerialrepresentationfromallsectorsandfulfilaleadroleinplanning,reviewing,developingandre-designingthelocalhealthandsocialcaresystemusingpooledandalignedbudgets,aswellasimprovingquality,performanceandefficiency.
Ineachlocalitywehavewell-establishedmulti-disciplinaryteams,manyofwhicharealreadyco-located.Wewill,throughtheseandothersinglepointsofaccess,continuetoimprovethequalityofintegratedprofessionalpracticeandoutcomefocusedworking.
TheAberdeenshirepartnershiprecognisesthegreatestimpactisachievedthroughstrongleadership,constructiverelationshipsandeffectivemulti-disciplinaryworkingwithinandbetweenprimaryandsocialcareteamsatthepatient/serviceuserinterface.ToenhancepracticeweestablishedAberdeenshirehealthandcarelearningnetworkin2011,creatingopportunitiesforGPs,localmanagersandpractitionerstocometogethertoconstructivelychallengeandimprovepractice,behavioursandpathwaysofcare,towardsasharedgoalofreshapingcareforolderpeople.Thesharedlearningfromthisinitiativehasbeensignificantandwillhelptoshapeourjourneyofintegrationoverthenextfiveyears.
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1.4 Equalities IntentionsTheJointCommissioningStrategyprovidestheHealthandSocialCarepartnershipwithanimportantopportunitytoputintopracticetheprinciplesofthepublicsectorequalityduty.Themaintenetsofthestrategyare:
• topromotehealthyageing,
• topromoteindependentlifestyles,
• toprovideaccesstohighqualityhealthandsocialcarewhenrequired,and
• tosupportolderpeopletomaintaintheirrightfulplaceasvaluedmembersofthecommunity.
Theseprinciplesdemonstrateveryclearlyourambitiontoeliminatediscrimination,tocreateopportunitieswhereolderpeoplecanrealisetheirfullpotential,andtopromotetheirgreaterrespectandinclusion.
Informationcollectedduringtheequalityimpactassessmentprocesswillberevisitedwhenthestrategyisreviewed.Weintendtomainstreamequalitiesmonitoringarrangementsintothepartnership’sroutinedatacollectionduringthenextthreeyears.
1.5 Facts & FiguresWehaveusedthelatestdataavailabletousthroughoutthestrategy.Insomecasesithasnotbeenpossibletopresentdirectcomparisonswithotherareas,orovertime.Toreducethecomplexityofthedocumentwehavenotquotedallsourcesbuttheyareavailableonrequest.MostdataoriginatesfromtheScottishGovernment,GeneralRegisterOfficeforScotland,NHSGrampian,ScottishHouseholdSurveys,AberdeenCityandShireHousingNeedsandDemandAssessmentandAberdeenshireCouncil.
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Chapter 2: National Policy Drivers
2.1 Reshaping Care for Older PeopleShiftingthebalanceofcareandreshapingcareforolderpeopleareScottishpolicyinitiativeswhichhaveevolvedinvariouswayssincethelaunchin1998ofModernisingCommunityCare.Thesereshapingcarepoliciesformpartofacontinuumoflongtermchangeinthewaysocietyingeneral,andhealthandcareagenciesinparticular,viewandaddressoldage.
Evidenceshowsthatolderpeopleformthesignificantmajorityofpatientsinbothprimaryandacutehealthservices.Similarly,almosthalfoflocalauthoritytotalsocialworkexpenditureisattributedtocareforolderpeople(approx.44%).Thekeydriverhasbeentoincreaseaccesstoaspectrumoflocally-basedhealth,socialcare,housingandsupporttohelppeoplemaintainasmuchindependenceaspossiblethroughoutlaterlifeandtopromotewellbeing,self-care,personalisationandcommunityresilience.
TheGovernment’sstrategyischaracterisedbyimprovingaccesstoarangeofclinicalinterventionsandmanagementoflongtermconditionswithinprimarycaresettings,includinglocalout-patientclinicsanddaysurgery.Acutehospitalswouldfocusonspecialistclinicalinterventionsonly.Simultaneously,concertedeffortacrossScotlandisgraduallyshiftinginvestmentfrominstitutionalmodelsoflongtermcaresuchascontinuingNHScarewardsandcarehomestowardscareathomeorinhomelysettings,suchasveryshelteredorextracarehousing.
Sincethesepolicieswerelaunchedthereisnowevidenceofgreateremphasisonpreventinganyunnecessaryhospitaladmissionsthroughrapidresponseorreducingaperson’slengthofstayinhospitalbyprovidingadditionalsupporttohelpthemreturnhomeasearlyasissafetodoso.InAberdeenshiretheseadvanceshavebeenachievedthrough:
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• bettercommunicationandjointwaysofworkingbyhealth,socialcareandhousingprofessionalsatall levels;
• increasinginvestmentinnewmodelsofcommunitycare,bothwithintheNHSandlocalauthorities,and
• bypromotingconceptsofself careandselfmanagementamongstpatients,familiesandcommunities.
Theanticipatedgrowthinpopulationofolderpeople,andparticularlyveryoldpeople(over85years)overthenexttenyears,alongwithadifficulteconomicclimateandchangingpublicexpectations,challengethesustainabilityofanyconfigurationofinvestmentandservicesthatwemightputinplace.Inotherwords,ourfuturecommissioningstrategieswillrecognisethatthestatusquoisnotanoption.Flexible,dynamic,efficientjointcommissioningalongsidesignificantadditionalfinancialinvestmentisrequiredtohelpagrowingpopulationofolderpeopletoagewellandendtheirlifewithdignityintheirplaceofchoice.
2.2 Managing Long Term Conditions and Self Care Amajorpolicydriverforthehealthsystemistosupportmorepatientswithlongtermconditionstoincreasinglycareforthemselveswithguidance,supportandaccesstohealthprofessionalswhenrequired.
Theprevalenceofsomelongtermconditions,suchasdementia,diabetes,andobesityislikelytoriseinthefuture.Thosewhodevelopalongtermhealthconditionneedtofeelequippedwiththeinformationandskillstoselfmanagetheirsymptomsandmaintainstablehealthasfaraspossible,withaccesstoprofessionalinterventionwhentheyneedit.
In2009theAberdeenshirepartnershiplaunchedanticipatorycareplans(ACPs)asatooltohelpindividualsandprofessionalsmanagelongtermconditions,maintainwellbeingandreduceunscheduledepisodesofcareinhospital.ACPsweretestedby3practiceswithinAberdeenshire,targetedonindividualswhowereathighriskofemergencyadmissiontohospital,basedontheirrecenthistory.DatafortheperiodJanuarytoJuly2011showedthat,inthosepracticesthatusedACPs,thenumberandrateofemergencyadmissionshadslowlyandconsistentlydecreased.GPpracticesthathadnotyetimplementedanticipatorycareplanningrecordedvariableemergencyadmissionrates,includingsomewithincreasingrates.
BetweenJanuary2010andFebruary2012thoseGPpracticesusingACPsrecordedasignificantlyhigheraveragereductioninoccupiedhospitalbeddaysthanGPpracticeswhichdidnotuseACPs.Thisimprovingperformancehasbeenachievedagainstabackgroundofincreasingnumbersoffrailolderpeopleinthecommunity.ACPshavebeendeliveredthroughLocalEnhancedServiceAgreements(LES),anarrangementwherebyGPscontracttoundertakeadditionalservices,andwhilst61%ofAberdeenshireGPpracticesarenowsigneduptousingACPsthroughthismechanism,allpracticeshavestartedtousethem.In2013allpracticeswillbeadoptingACPsaspartofthenewScottishGPcontractandtheQualityOutcomesFramework(QOF)linkedtoit.
ByreducingthenumberofemergencyadmissionstheAberdeenshirepartnershipcouldcreateopportunitiestoshiftresourcestowardspreventionandearlyinterventionandequipindividualstotakegreatercontrol,inordertolivewellwithlife-limitingconditions.Throughourstrategicjointplanninggroups,likeOPSOG,weareclearlyarticulatingthetypesandproportionofadmissionstohospitalwebelieveareavoidableandweareinvestigatingandapplyingevidence-basedapproachesthatmayimprovelocalperformanceoverthenextthreetofiveyears.Indoingsoweendorsetheappropriatenessofadmissiontohospitalformanyolderpeople,particularlytheveryoldandthosewithcomplexconditions,wheretheseverityoftheexacerbationortheirunderlyinghealthconditionsmeanthatahospitalsettingistheoptimalenvironmentforfurtherassessment,diagnosisortreatment.
2.3 Unscheduled Care Sincethe1990s,theNHSandlocalpartnershavebeenimplementingtheGovernment’spolicytoreduceinappropriateadmissionstohospitalandfacilitatetimeousdischargehomefromhospital.Aswellasmakingsub-optimaluseofscarceresources,inappropriatehospitaladmissionsanddelayeddischargescanbeharmfultothewellbeingoffrailolderpeople.
Unscheduledoremergencycareiscarethatisrequiredinresponsetoacrisisinaperson’shealth.Somecrisesareclearlynotpreventable,suchasappendicitis.Otherunscheduledhospitaladmissionscanbeprevented,forexample,followingafallorfailuretomonitororaddresschronichealthconditions(e.g.COPD).Recent
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indicationsacrossScotlandarethattherecenttrendofreducingemergencyadmissionandlengthofstaymaybeunsustainableinthelongerterm.OurperformanceindeliveringthesenationalpoliciesisdetailedinChapter3.Overthenextthreeyears,Aberdeenshire’shealthandsocialcarepartnershipwillincreaseitsattentiontothisareaofwork.
Aperson’sdischargefromhospitalisconsideredtobedelayedwhenmedicaltreatmenthasbeencompletedbuttheindividualcannotbedischargedtoamoreappropriatesettingforavarietyofreasonse.g.thecaretheyneedisnotavailableatthatparticulartime,oraperson’smentalcapacitytomakeinformeddecisionsabouttheirfuturehasdiminished.In2008theScottishGovernmentdeterminedthattheprocessofplanningandarrangingcareforpeoplefollowingdischargefromhospitalshouldtakenolongerthan6weeksfromthetimeapersonisdeclaredmedicallyfitfordischarge.InAberdeenshiresince2008wehavetypicallyrecordednodelayeddischargesover6weeks.Thisstrongandsustainedperformancehasbeenachievedthrougheffectivecollaboration,communicationandsharedresponsibilityforresolvingproblemsbetweenhealthandcareteams.SinceOctober2012,however,somedelayeddischargeshavebeenrecorded,causedbyamultiplicityoffactors.ByApril2013theScottishGovernment’stargetisthatnopatientshouldbedelayedinhospitalforlongerthanfourweeksandbyApril2015thistargetwillreducetoamaximumoftwoweeks.Whilethiswillbeaverychallengingtargettomeet,wearecommittedtocontinuallyimprovingourperformancewhenthisisclearlylinkedtobetteroutcomesforolderpeople.
2.4 Personalisation, Choice and ControlThepre-eminenceofuserandcarers’voicesinshapingaccesstogoodqualitycarehasbeenagrowingfeatureofthewayweplan,deliverandmeasuresuccess.Inamodernsociety,publicexpectationsareofrapidaccesstosupport,whichanindividualfeelstheyneed,whentheyneeditandinaformwhichreflectstheirparticularcircumstancesandpreferences.Thepostwar“babyboom”generationandotherswhofollowdonotaspiretoalimitedtariffofpre-ordainedservicesinoldagetohelpthemlivelongandfulfillinglives.Duringthelifeofthisplantheirexpectationsanddemandforindividuallytailoredsolutionstomeettheconditionsofageingwillcomeintosharpreliefagainstabackdropofsignificantincreasesinthenumbersofpeoplelivinglonger.
InAugust2012,205peoplewithcommunitycareneedswerereceivingdirectpaymentsfromAberdeenshireCounciltomeetthecostsoftheircare.16oftheseindividualsarepurchasingcarefromanindependentagencyand178areusingadirectpaymenttoemploypersonalassistantstohelpthemmanagetheirlifestyleandcareneeds.ThenumberofpeoplereceivingdirectpaymentsinAberdeenshireishigherthanaverage(2011/12data)comparedtootherScottishLocalAuthorities.In2010,inresponsetofeedbackfromserviceusersandcarers,AberdeenshireCouncilreviseditsdirectpaymentguidanceandprocedurestomakethemeasiertouse.Sincethentherehasbeenanincreasedtake-upofdirectpaymentsandwecontinuetopromotethisroute,asonewaybywhichindividualscanexercisegreaterchoiceandcontrolovertheirlives.Notwithstandingtheimprovedflexibilityoftheseoptions,mostserviceuserscontinuetooptforservicesthatarearrangedordeliveredbyAberdeenshireCouncil.Overthenextfiveyearsweexpectthistochangemarkedlyinfavourofanincreasingnumberofpeopleoptingforself-directedsupport.
InSeptember2010AberdeenshireCouncillaunchedapilotprojectcalled“InControl”.ThisoffersamoreflexibleoptionthanDirectPaymentsforindividualswhowishtoarrangetheirownsupportusinganagreedindividualbudgettoachievetheirpersonaloutcomesandgoals.66peopleareusing“InControl”toshapeandmanagetheirowncare.Theseinclude13olderpeople,somewithdementia,andtheircarers,aswellaschildrenandadultswithphysicalorlearningdisabilitiesandpeoplewithmentalhealthproblems.Therelativelysmallnumberofolderpeoplewhohavechosentobe“InControl”islinkedtofinancialdisincentivescomparedtofreepersonalcare.
“InControl”wasevaluatedin2012andtheresultswillinfluenceourcommissioningandservicedeliverymodelsoverthenextfiveyears.Forthcominglegislationinrelationtoselfdirectedsupportwillstrengthenpeople’srightstoselfdirecttheirowncareusingapersonalbudgetfromthelocalauthority.ForthefirsttimeitislikelythatserviceuserswillbeabletousetheirbudgettopurchaseCouncilservices,iftheychoose.
Aberdeenshireembracesthisnewapproachwhichplaceschoice,controlandpersonalisationfirmlyinthehandsoftheindividual.Weareatanadvancedstageofdevelopingarevisedpolicyandpracticeframeworktodeliverthelocalauthority’snewstatutorydutiesfrom2014inrelationtoselfdirectedsupport.
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2.5 Outcome Focused CareInlinewithgovernmentpolicy,Aberdeenshirecouncilisdevelopingcapacitytoplan,deliver,measureandcommissionmodelsofcarethatdeliverpositiveoutcomesforindividualswithhealthorcommunitycareneeds.Since2010oursocialcarecommissioningandcontractsprocesseshavebeenbasedonoutcomes.WeusenationalandlocaloutcomesdrawnfromtheSingleOutcomeAgreementandserviceprioritiespublishedinourthreeyearHousingandSocialWorkServicePlantodemonstratethestrategicrelevanceofserviceswecommission.Theseareexpressedinourcarecontractsasoutcomestobeachievedbytheserviceprovider.Contractmonitoringisusedtodeterminewhetheracontractorismeetingtheexpectedoutcomes.IndividualServiceAgreementsspecifytheoutcomesthatindividualswanttoachievefromaservice.Careprovidersareexpectedtomonitorandassesstheirownperformanceagainsttheseindividualserviceagreements,incollaborationwithsocialworkcaremanagers.Wecontinuetorefineourmethodsofmeasuringandevidencingthatachievementofindividualoutcomesisdirectlyrelatedtocarethatwecommission.Overthenextthreeyearswewillcontinuetorefineandextendoutcomefocusedcommissioningarrangements.
Aberdeenshireoffersaprogrammeofintensivemandatorytrainingtodeveloptheskillsofsocialworkersandcaremanagersonoutcomesfocusedassessmentandcaremanagement.Wewillcontinuetoevolvethisprogrammeoverthenextthreeyearstoreflectchangingpolicyandpracticeandensurethathealthandsocialworkprofessionalsareskilledindeliveringoutcome-focusedassessment.
Inrespectofwideroutcomes,ourperformanceonfourofthenationalcommunitycareoutcomemeasureswerereportedin2012usingtheresultsofresearchwithasampleofolderpeopleatmedianriskofre-admissiontohospital.Theseshowthat89%ofthosewhorespondedweresatisfiedwiththeirinvolvementinthedesignoftheircarepackage;87%ofpeoplefeltsafe;92%weresatisfiedwithopportunitiesforspendingtimewithothers;and86%ofcarersfeltabletocontinueintheirrole.Itisimportanttonotethesamplesizewassmallandresponserateswererelativelylow.However,thisprovidesuswithabasistobuildimprovementoverthenextyear.
2.6 Early Intervention and PreventionThecornerstoneofAberdeenshire’slongtermcommissioningstrategyisanemphasisonencouragingpeopleandcommunitiestoactearlytomaintainandprolongahealthylifestyle.Wewillcontinuetofocusonhelpingpeopletoaddhealthyyearstolife.
Since2011thePartnershiphassoughttoharnesstheconceptofco-production,wherebynaturalcommunitiesandcommunitiesofinterestworktogethertoidentifyanddeliversolutionstosharedchallenges.Manylocalgroupsarealreadyrisingtothechallenge.Otherswelcomesupportintheformofcommunitycapacitybuilding.Supportingoldergenerationsofthepopulationcannotbemetbystatutoryservicesaloneandco-productionwillcontinuetobeapowerfulpolicydriverinAberdeenshire’scommissioningstrategy.
Olderpeoplehaveacriticalroletoplayinsupportingeachothertostaywell,keepactiveandinvolvedinthelivesoftheirfamiliesandcommunities.Growingandsustainingthiscapacityisessentialinthenext10yearsaswefaceanunprecedentedincreaseintheproportionofourpopulationwhoareover75yearsold,combinedwithalengthyperiodoffinancialconstraintinthepublicsector.
LaterinthestrategywedescribeingreaterdetailwhythisissocrucialtoAberdeenshire’sfutureasagoodplacetolive.ItisworthnotingthatmostolderpeoplereceivenoformalservicesfromtheNHSorsocialcareonanongoingbasisandalthoughtheproportionofolderpeoplerequiringcareisincreasing,65%ofthoseaged85andoverdonotrequireformalsupportandcare.
CommunityPlanningpartnerships(CPPs)arenowrenewingSingleOutcomeAgreementswhichincreasethefocusonpreventionandsecurecontinuousimprovementinpublicservicedelivery.
“OutcomesforOlderPeople”isoneofsixkeyprioritiesforCPPssetbytheScottishGovernment.Preventativeandearlyinterventionapproachesinthecareofolderpeoplehavethepotentialtodeliversignificantgainsoverthemediumtolongtermandreduceinequalities.Thedriveistowards“actionswhichpreventproblemsandeasefuturedemandonservicesbyinterveningearly,therebydeliveringbetteroutcomesandvalueformoney”.
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CommunityPlanningPartnershipsarerequiredtodevelopaclearplandetailingspendonpreventionacrossallactivity,prioritiesandactionstoimproveoutcomes.Aspartofthenationalprioritytosupportolderpeople,Aberdeenshire’sCommunityPlanningPartnershipaimstodemonstrateashiftinphilosophyfromservicesdonetopeopletowardssupportwithpeople,usingco-productionapproaches.
2.7 Planning and Delivering Integrated Health and Care SincetheScottishGovernment’spolicyonJointFutureinthelate1990s,considerableprogresshasbeenmadetoimproveintegratedapproachestohealthandcaredelivery,particularlyinrespectofolderpeople’scare.In2011,theScottishGovernmentindicatedanintentiontolegislateinordertoachievecloser,formalintegrationofhealthandsocialcare.Thepreciseimpactonlocalitiesofthislegislationstillrequirestobedetermined.Withinabroadlyprescribedframework,itisanticipatedlocalpartnershipswillbeabletodesigndeliverymechanismsandstructuresthatbestsuitlocalneedsandpriorities.Partnershipsmaychoosetodelegatefunctions,budgetsandresponsibilityforsomeaspectsofservicedeliveryifthereislocalagreementtodoso,asinthetypeofleadagencyarrangementimplementedinHighlandin2012.
Thesereformsoccurwithinthecontextofwiderpublicservicereformandintandemwiththecentralroleofcommunityplanningindeliveringtherightconfigurationoflocalservicestoreflecttheneedsandaspirationsofcommunities.Housingandtransport,forexample,areparticularlyimportantfeaturesinsustainingtheindependenceandwellbeingofolderpeople.
Athreeyearjointfinancialframeworktotalling£86,627m,comprisingallsocialworkandprimarycareresourcesforolderpeopleisinplaceinAberdeenshire.Acomprehensivejointperformanceframeworkwhichincludeschallengingtargetsforthepartnershiptoevidencehowitisshiftingthebalanceofcareyearonyear,isoverseenbytheOlderPeople’sStrategicOutcomeGroup(OPSOG).
AssessmentandcaremanagementactivityforolderpeopleinAberdeenshireisdeliveredfrom24healthandcommunitycareteams(HCCT),allofwhichcompriseprimarycareandsocialcarepractitioners.Someoftheseteamsareco-located.HCCTsarealignedtoGPpracticesandcomprisedistrictnurses,physiotherapists,communityhospitalwardmanagers,caremanagers,localareaco-ordinatorsandhealthandlocalauthorityoccupationaltherapists.ThesealignedteamsremainaccountabletotheirrespectiveNHSorlocalauthorityagencymanagementarrangementsforpractice,budgetallocationandworkload.Professionalsintheseteamsprovidein-reachservicesto11localcommunityhospitals,whichincludeGPacute,rehabilitation,strokeandoldagepsychiatryassessmentbeds.Caremanagershaveindividualpurchasingbudgetstosupporttheircaremanagementpractice.Therewillbeopportunitiestobuildfromthiswell-establishedmodelofjointworkingoverthenext3years.
2.8 Rehabilitation and EnablementTheAberdeenshirepartnershipisatanearlystageofre-positioninglocalcareandhealthservicestowardsarehabilitationandenablementapproach.Bythiswemeanadjustingourassessment,careplanning,treatmentandreviewactivitiestohelpolderpeoplewhorequirecaretorecoveroptimumcognitiveandphysicalabilityintheperiodimmediatelyfollowinganepisodeofacuteillnessordegenerationintheircondition.OurmodelisinformedbytheresultsofEdinburghCityCouncil’sre-ablementserviceandsubsequentbestpracticeevidence.
Enablementrepresentsaseachangeinthewayweworkwithpeopleandintheattitudesandcontributionsofserviceusers,theirfamiliesandcommunitiestorecoveryandself-care.ItformsamajorstrandofourworktoshiftthebalanceofcareandaddressthedemographicprofileofAberdeenshireoverthenext10years.Ourinitialpathfinderprojectscompriseintegratedhomecare,occupationaltherapy,physiotherapy,nursingandtelehealthcarewithinasinglehealthandcareteam.Wehaveintroducedawarenesstrainingforaround700staffanddesignedanintegratedrehabilitationandenablementcarepathwaywhichwearetestinginthreelocalities(Turriff,PeterheadandInverurie).Tobeeffective,webelieveitisessentialthatourrehabilitationandenablementsystemisfullyembeddedinmainstreamservicesandthatwehavecapacityinplacetoidentifyindividualswhocanbenefitfromsuchanapproach:withcleargoal-setting,andtime-limited,intensive,integratedteamworkingaroundtheolderpersonandhis/herfamily.Earlyimplementersiteswillbeindependentlyevaluatedin2013toprovidelearningthatwillshapeourfuturemainstreamapproachoverthenextthreetofiveyears.Rehabilitationandenablementwillsignificantlychangethewayweprioritiseandallocateresourcesandthewaywedesignandreviewcareinthefuture.
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2.9 Dementia Dementiais“atermusedtorefertoavarietyofillnessesandconditionswhichresultinaglobalimpairmentofbrainfunctionandadeclineinintellectualfunctioning,personalitychangesandbehaviouralproblemswhichdisruptindependentlivingskillsandsocialrelationships”.
Scotland’sDementiaStrategy,alongwiththeStandardsofCareforDementiainScotland,providestheframeworkforourcommissioningplansforpeoplewithdementia,theirfamiliesandcarers.Aberdeenshire’sdementiastrategy2013-16willbeinfluencedbytheScottishGovernment’snewdementiastrategyandwillsetoutavisionandcommitmenttoanetworkofcareandsupportthatpeoplewithdementiainAberdeenshire,andtheircarers,canaccesstoimprovetheirexperienceoflivingwithdementia.Thestrategywillalsosetouttheresultsofalocaljointneedsassessmentexercisewhichincludedthosewithearlyonsetdementia.Theseareinformedbywhatpeoplewithdementiaandtheircarershavetoldustheyneedaswellasbestpractice.Theyinclude:
• raisingawarenessandunderstandingofdementia
• earlydiagnosis
• supporttohelppeoplelivewellwithdementia
Weplantodevelopourcommissioningapproachduringthenextthreeyearsinpartnershipwithpeoplewhohavedementia,throughAlzheimersScotlandlinkworkers,localusersgroup,PositiveAboutDementiaGroups,andthroughDementiaCafesanddayservicesoperatingthroughoutAberdeenshire.Furtherreferencestodementiaaretobefoundlaterinthestrategy.
2.10 Adult Support and ProtectionMostolderpeoplemanagetolivecomfortablyandsecurely,eitherindependentlyorwithassistancefromcaringrelatives,friends,neighbours,professionalsorvolunteers.However,forasmallnumberofpeople,dependenceonsomeonecanleadtothembeingexploited,harmedorabused.
ProtectingadultsfromharmisahighpriorityfortheAberdeenshirePartnership.Wedothisbyseekingtoempowerindividualsandtheircarerswithknowledgeofwhattheyshouldexpect,anunderstandingoftheirrightsandaccesstoresponsivecomplaintsandadvocacyservices.
Bothvulnerablemenandwomenareatriskofbeingharmedindifferentways:thefivemostcommontypesofharmbeingphysical,psychological,financial,sexualandneglect.In2007,researchbyActionforElderAbuseindicatedthat4%ofolderpeopleexperiencedabuseintheirownhomes.
GrampianInteragencyPolicyandProcedureswereinitiallyproducedinresponsetothegrowingawarenessoftherangeandfrequencyofharmtowardsadults.Theseprovideaframeworkbywhichagenciescanapplyaconsistentandclearresponsetosituationswhereadultsmaybeatriskofharm.
Aberdeenshire’sAdultProtection(ASP)Committeeisaccountabletothepublic.Itmonitorsandadvisesonadultprotectionprocedures,ensuringappropriatecooperationbetweenagenciesandimprovingtheskillsandknowledgeofthosewitharesponsibilityfortheprotectionofadultsatrisk.Overthelastreportingperiodolderpeopleaccountedfor41%ofadultprotectionconcernsreportedinAberdeenshire.TheAdultProtectionCommitteehasaclearactionplanwhichisreviewedandupdatedregularly.TheCommitteewillcontinue,intheperiodahead,togivepriorityto:
• raisingpublicawarenessofadultprotectionandhowtoapplyit
• raisingtheskills,knowledgeandexperienceofprofessionalsindealingwithadultprotection
• strengtheninter-agencyworkingtoprotectadultsatrisk.
• consultwithpeoplewhousetheserviceandthepublicaboutinter-agencyservicesfortheprotectionof adultsatrisk.
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2.11 Free Personal Care SinceJuly2002,freepersonalandnursingcare(FPNC)hasbeenofferedasauniversalbenefitforolderpeopleinScotland,foreveryoneaged65andoverwhoneedspersonalcareservicestohelpthemliveindependentlyintheirownhome.Personalcareisdefinedasassistancewithwashing,dressingandeating,includingfoodpreparation.
TheimpactofthisnationalpolicyinAberdeenshireisdiscussedinmoredetailinChapter3.
2.12 Supporting Unpaid CarersInAberdeenshiremanyolderpeoplearesupportedbyunpaidcarers,includingaspouse,siblings,sons,daughters,otherrelatives,friends,neighboursandcommunityvolunteers.Manyofthesesupportersarethemselvesolder.Researchindicatesthatcaring,inmanycases,givesolderpeopleanimportantrolewhichsustainstheirphysicalandmentalhealthforlonger.However,ithasbeenidentifiedthat75%ofunpaidcarersinScotlanddonothavealifeoutsidetheircaringresponsibilities.Therefore,caringhastobebalancedwithopportunitiesforbreakstoensurecarershavealifeoftheirown,alongsidetrainingandsupporttohelpthemmanagetheirresponsibilities.Thereisalsoaneedformoreflexibleworkingopportunitiestoenablecarerstochoosetomaintainemployment.RecognisingandsupportingunpaidcarershasbeenahighpriorityforAberdeenshireCouncilandtheCommunityHealthPartnershipandthiswillremainanimportantareaforinvestmentinthefuture.AberdeenshireCarersCharter,endorsedbytheCommunityPlanningPartnershipin2012andallvoluntaryprovidersofcarerservices,makesafundamentalcommitmenttocarersinlinewiththenationalpolicydirection.
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Chapter3: Environmental Scan
3.1 Demography In2011,thepopulationofAberdeenshirewasestimatedtobe247,600.16.6%(41,095)wereaged65oroverand2.1%(5,143)wereaged85orolder.Aberdeenshirehastraditionallyhadarelativelyyoungpopulation,primarilyasaresultofinwardmigration.TheproportionofolderpeopleinAberdeenshireisslightlylowerthanthenationalaverage(19.1%)buttheproportionofover85yroldsiscomparable(2.1%).54.1%ofthoseagedover65inAberdeenshirearewomen,comparedwith57.1%inScotland.
Thelocalpopulationhasbeenincreasinginrecentyearsandthistrendwillcontinue.Growthintheproportionofolderpeopleisthemostsignificantchangewefaceinourpopulationduetoincreasesinlifeexpectancy(seeTable1andFigure1).Thebiggestincreasebyfarisexpectedinthe75+agegroup(by130.7%in2035ascomparedto2010).Theproportionof50-64yearoldswilldecreaseby5.1%.Overall,therewillbea96.3%increaseinthepopulationagedover65by2035.
ThepatternofgrowthisconsistentacrossthesixadministrativeareasofAberdeenshire.
Womenhaveahigherlifeexpectancythanmen.Olderwomenhavespecifichealthneedsthatdifferfrommen,andservicedesignanddeliverywillneedtoreflectthisfact.
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Table 1: Projected populations by age Aberdeenshire
Age Groups
Population in 000s (% change from 2010)
2010 2015 2020 2025 2035
50-64 53.0 55.9(5.5) 59.2(11.7) 58.7(10.8) 50.3(-5.1
65-74 22.1 27.4(24.0) 30.9(39.8) 32.1(45.2) 37.2(68.3)
75+ 17.9 20.8(16.2) 24.5(36.9) 30.9(72.6) 41.3(130.7)
Figure 1: Population projections by age, Aberdeenshire
Aberdeenshire Population Projections
0.0
10.0
20.0
30.0
40.0
50.0
60.0
2010 2015 2020 2025 2030 2035
50-64
65-74
75+
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Population Projections by GP Practices
In2012thepracticepopulationsofpeopleaged65andoverwere:
Table 2: GP Practice Population projected on July 2012 figures
Age 2012 2017 2022 2027 2032
BANFF & BUCHAN
65-74 3799 4518 4874 5190 5661
75-84 2237 2573 3164 3808 4158
85+ 806 956 1187 1479 1946
TOTAL 6842 8047 9225 10477 11765
BUCHAN
65-74 4293 5106 5508 5865 6397
75-84 2314 2662 3273 3939 4301
85+ 748 888 1103 1375 1809
TOTAL 7355 8656 9884 11179 12507
FORMARTINE
65-74 3519 4185 4515 4807 5243
75-84 1923 2212 2720 3274 3574
85+ 733 870 1080 1346 1771
TOTAL 6175 7267 8315 9427 10588
GARIOCH
65-74 3988 4743 5117 5448 5942
75-84 2218 2552 3138 3777 4124
85+ 757 898 1115 1390 1829
TOTAL 6963 8193 9370 10615 11895
KINCARDINE & MEARNS
65-74 3523 4190 4520 4813 5249
75-84 1754 2018 2482 2987 3261
85+ 693 822 1021 1273 1675
TOTAL 5970 7030 8023 9073 10185
MARR
65-74 4061 4830 5211 5549 6052
75-84 2589 2978 3662 4408 4813
85+ 1091 1295 1608 2004 2637
TOTAL 7741 9103 10481 11961 13502
(Source: GROS 2010)
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3.2 Strategic Health Needs Assessment
DeprivationOnbothincomeandemploymentdeprivationindicators,AberdeenshireperformsbetterthanScotlandasawhole.AberdeenshireisoneoftheleastdeprivedareasinScotland.TheleastdepriveddatazoneinScotlandisBanchoryinAberdeenshire(ScottishIndexofMultipleDeprivation,SIMD).However,smallareas/pocketsofdeprivationareafeatureinAberdeenshire,wheredeprivationdataisamongsttheworst20%inScotland.ThesetendtobeconcentratedinpartsofFraserburghandPeterhead.Educational,skillsandtrainingdeprivationhaveworsenedovertime,especiallyintheseareas.AnalysisoftheincomedeprivationdomainofSIMD(2009)indicatesthatthereisincomedeprivationacrossAberdeenshirebutthatapproximately50%isinthetwonorthareas(BuchanandBanff&Buchan)withtherestalmostevenlyspreadacrosstheotherfourareas.ThisdataisnotrestrictedtotheolderpopulationbutweassumethatincomedeprivationamongstolderpeopleisevidentinallareasofAberdeenshire.
AlthoughthestatisticsshowAberdeenshireisoneoftheleastdeprivedareasinScotland,individualanddisperseddeprivationismasked.Thenumberofincomedeprivedindividuals(40-64yrs)issimilarinAberdeenshireandAberdeenCityindicatingalevelofhiddendeprivationacrossAberdeenshire.
AhighnumberofdatazonesacrossAberdeenshirerankinthemostdeprived5%ofScotlandintermsofgeographicalaccesstoservices,reflectingtheremoteandruralnatureofAberdeenshire.ThereisdispersedruraldeprivationandisolationacrossAberdeenshirewhereaccessissues,lackofpublictransport,highdependencyoncarsandfuelpovertyparticularlyaffecttheolderpopulation.Highdependencyoncarsplacesanextraburdenonthosewithlowincomes.
Accommodation&EnvironmentThetypeofaccommodationandenvironmentinwhichpeoplelivecontributessignificantlytotheirstateofhealth,socialwellbeing,qualityoflifeandtheircapacitytoliveindependentlywithminimumformalsupports.ThehighrateofowneroccupiedhousingandalsoprivaterentedhousinginAberdeenshireisaconcerninanareawithasignificantlyageingpopulation.TheconditionandconcernaboutdisrepairofhousingstockaswellasaneedforbetterinsulationisanissueinAberdeenshire.Houseswithpoorenergy-efficiencyandthermalconditionscanincreaseaperson’sriskofflu,heartdisease,strokeandrespiratoryillness.Housesindisrepairmayincreasetheriskoffallsandaccidents.InstallationofenergyefficiencymeasureshasbeenidentifiedasastrategicpriorityintheAberdeenshireFuelPovertyStrategy(2010)andtherevisedAberdeenshireLocalHousingStrategy(2012–2017).
In2010Aberdeenshirerecorded103,770separatehouseholds,anincreaseof6.5%since2005.ThisrateofincreaseishigherthaninotherpartsofGrampianandhigherthantheScottishaverageandweexpectthistrendtocontinueasthepopulationgrows.Weanticipateanincreaseddemandforsmallerproperties,asthenumberofolderpersonhouseholdsincreases.
FuelPovertyAhouseholdspendingover20%ofitsincomeonallhouseholdfuelisdefinedasbeinginextremefuelpoverty.Fuelpovertyislinkedtoincreasedriskofillhealth,particularlyduetoexacerbationfromdiseasessuchasinfluenza,heartdiseaseandotherrespiratorydiseases.SurveydatashowsthatAberdeenshirehasahigherproportionoffuelpoorhouseholdsthanAberdeenCitybutaslightlylowerproportionthantheScottishaverage.ArecentsurveyindicatedthatfuelpoorhouseholdscouldmakeupmorethanonethirdofAberdeenshire’shouseholds.Since2008-10theproportionoffuelpoorhouseholdsinallareashasincreased,butthebiggestincreaseinGrampianappearstobeinAberdeenshire.
Householdswitholderadultsaremorelikelytobefuelpoorandextremelyfuelpoor.Forexample55%ofsinglepensionerhouseholdsinScotlandarefuelpoorcomparedtojust6%ofsmallfamilyhouseholds.Fuelpovertyalsohasadisproportionateeffectontheolderpopulationbecausetheyarelikelytohavelessincomethanpeopleofworkingage,spendmoretimeathomeandrequireawarmertemperaturetostayhealthyandsafe.
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RuralitySincethe1980stherehasbeenrecordedmovementofyoungpeoplefromruralareasofAberdeenshiretowardsthetownsandalsoasignificantdeclineinkeyruralamenities.ThelargestdeclinehasbeenrecordedinKincardine&MearnsandBanff&Buchanareas.
HealthProfileInthoseagedover70,AberdeenshirehasthehighestproportionofpopulationinGrampianwithalong-standingillnessordisability.ThismayreflectthelongerlifeexpectancyofAberdeenshirecitizens.Thispopulationofpeopleagedover80andover90aremorelikelytohavedisablingage-relatedconditionssuchasdementiaandstroke.In2011,thethreemostcommondiagnosesonemergencyadmissionforpeopleregisteredwithAberdeenshireGPswereurinarytractinfections,unspecifiedacutelowerrespiratoryinfectionsandChronicObstructivePulmonaryDisease(COPD).
Inthissectionweidentifythosehealthconditionsthathaveastronglinktoageing,highmorbidityand/ormortality,arepreventableandwhichwillpresentasignificantburdenuponhealth,socialcare,andunpaidcarersunlesswechangecurrentlifestylepatternsandthewaywedesignanddeliverpublicservicesforolderpeople.WehavethereforefocusedontheprevalenceinAberdeenshireofmental ill health (dementia, depression and wellbeing), stroke, coronary heart disease, COPD, diabetes and cancer.Baseduponagealone,theseconditionsarepredictedtoincreasebythesameproportioni.e.96%by2035.
Thisdoesnottakeintoaccountotheradverseorunfavourableinfluences,suchastheimpactofincreasedalcoholconsumptionandobesityonhealthylifeexpectancyofAberdeenshire’spopulation.Inotherwords,ifpeoplecontinuetodisplaysimilarpatternsoffoodandalcoholconsumptionintooldageastheycurrentlydoinyoungerage,theirlikelihoodoflivingwithchronichealthconditionsinlaterlifeisgreater.Thisisasignificantpublichealthconcernandtoaddressit,preventionrepresentsamajorpriorityinourlongtermcommissioningstrategy.
TheWHOlistsIschaemicHeartDiseaseastheleadingcauseofdeathandsecondhighestcauseofburdenofdiseaseinhighincomecountries.
Cerebrovasculardisease(whichincludesstrokeandTIA)isthesecondhighestcauseofdeathandthethirdhighestcauseofburdenofdiseaseinhighincomecountries.Strokeislinkedtoincreasingageandtheriskfactorsaresimilartothoseforcoronaryheartdisease,e.g.lackofexercise,obesity,smoking,alcoholandDiabetesMellitus.Itispossibletopreventmanystrokesthroughtargetingmodifiableriskfactors.Ourcommissioningintentionswillreflecttheimportanceofreducingtheserisksandimprovingoutcomesforfuturegenerationsofolderpeople.
Atransientischaemicattack(TIA)hasthesamecausesandsymptomsasstroke.Theonlydifferenceisthatsymptomsresolvewithin24hours.TheoccurrenceofaTIAisastrongpredictiveriskfactorforafuturestroke.
EstimatesofprevalenceofstrokearedrawnfromtheQualityOutcomeFrameworkdata.
Table 3: Estimated number of people in Aberdeenshire with stroke
Year 2010 2015 2020 2025 2035
Population 245,780 258,629 269,625 280,383 299,404
Estimatednumberwithstroke 4522 4759 4961 5159 5509
EstimatedratesofconsultationswithaGPorPracticeNurseforstrokeincreasewithage.Ifconsultationratesincreaseinthesamemannerasthenumberofstrokes,therecouldbebetween1,749and2,825GPorPracticeNurseconsultationsinAberdeenshireforstrokeperyearby2035.Ifthenumbersincreasewiththeprojectedincreaseinstrokecasestherecouldbebetween37and59electivedischargesduetostrokein2035utilisingbetween6,523and10,534beddays.
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DeathsfromcerebrovasculardiseaseinGrampianhavedecreasedoverrecentyears.Thisisanationaltrendthoughttobeduetoimproveddiagnosisandmanagement.Whilstthisispositiveitmaymeanincreasingcareneedsinsurvivorsofstroke.
Coronaryheartdisease(CHD)describesarangeofconditionswhichariseduetoanarrowingofthebloodsupplytotheheart.TheimportanceofCHDliesinthefactthatitispreventable(manyofthelistedriskfactorsaremodifiable)andthatitisamajorcauseofdeathinScotland.Riskfactorsinclude:smoking,highbloodpressure,highcholesterol,beingphysicallyinactive,beingoverweight/obese,havingafamilyhistoryofheartdisease,certainethnicbackgrounds(e.g.SouthAsiancommunities)andolderage.MenaremorelikelytodevelopCHDatayoungeragethanwomen.OurjointcommissioningintentionswillreflectthepriorityofencouragingandinformingtheolderpopulationandpeopleapproachingoldageofhowtomaintainahealthylifestyleandreducetheirriskofCHD.
Table 4: Estimated population with CHD in Aberdeenshire, based on Scottish Health survey data
Year 2010 2015 2020 2025 2035
Populationaged65+(000s) 40 48.2 55.4 63 78.5
EstimatednumberwithIHD(000s) 8 9.6 11.1 12.6 15.7
ThecrudeCHDQOFprevalencehasremainedbroadlystablesince2008/09
Aswithstroke,theincreasingprevalenceofriskfactorssuchaspoordiet,lackofexercise,obesityandalcoholconsumptionmeanthatthesefiguresarelikelytounderestimatethenumbersofpeopleinAberdeenshirewithCHD.ThedeathratefromheartdiseaseinGrampianisdecreasing.Thisispositivebutalsosuggestsmorepeoplearelivingwithheartdiseaseandcouldsuggestincreasedhealthandsocialcarerequirementsinthefuture.
Theprevalenceofsmokingislessinolderpeopleduetothehighrateofprematuredeathinsmokers.Oldersmokersareatahigherriskthanthosewhodonotsmokeofdevelopingtheconditionsdescribedabove.Smokingisalsostronglyassociatedwithdeprivation.ThemostrecentSHSfiguresin2009/10suggestsmokingprevalenceinAberdeenshireislowerthantheScottishaverageandotherpartsofGrampianandthismayleadtoacorrespondingdecreaseinratesofCOPDandlungcancerinAberdeenshireinthefuture.
Increasingage,initself,isnotsignificantlyassociatedwithpoorermentalwellbeingbutgoodmentalwellbeingisimportanttoindividualsinitselfandalsoactsasadeterminantofhealth.Mentalwellbeingcanallowindividualstocopebetterwithadversity,makehealthierbehaviouralchoicesandrecoverfromillness.Thequalityoflongtermrelationshipsisaparticularlyimportantfactoramongstolderpeopleintheiroverallwellbeing.
Theprevalenceofdepressioninolderadultsisoftenunder-recognisedorunreportedbyolderpeoplethemselvesandisthereforenottreatedadequately.Depressionisthemostcommonmentalhealthprobleminlaterlife.Riskfactorsfordepressionwhicharemorecommonamongstolderpeopleincludelosingaspousethroughdeathordivorce,loneliness,achangeinrole,lossofsocialstatus(e.g.retirementanddecreaseinincome),andbeingininstitutionalcare.Beingfemale,havingchronicdisease,pain,ororganicbraindiseasesuchasdementiaandstrokearealsolikelytoincreasethechanceofanolderpersonexperiencingdepression.Theprevalenceofdepressionisincreasedmarkedlyinbraindisorderssuchasdementiaandmaybearound30%inAlzheimer’spatients.Theprevalenceofdepressioninolderadultsrangesfrom4.6%to9.3%ofthepopulation.Olderpeoplewithdepressionhavehigherdisabilityandpooreroutcomesfromillness.Ifrecognized,olderpeoplewithdepressioncanrespondwelltotreatment.Ourcommissioningintentionswillraiseawarenessofpreventingandtreatingdepressionamongstolderpeopleasakeywayofimprovingqualityoflifeoutcomesforolderpeople.
Olderpeoplehavelesstolerancetoalcoholandtherecommendedsafelevelsforadultsmaybeexcessiveforolderpeople.Theeffectofalcoholcanbegreaterduetophysiologicalchangesmeaningbloodalcohollevels
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arehigherwiththesameintake.Adverseinteractionswithmedicationandahigherriskofinjuryfromfallsmayalsobeafeatureamongstolderdrinkers.ThenumberofolderpeoplewhoareharmfulandhazardousdrinkersinAberdeenshireishigherthanintherestofGrampian.Alcoholmisuseamongstolderpeoplemaybearesponsetothelossofaspouse,isolationorchronicillness.
Table 5: Number of older hazardous and harmful drinkers in Aberdeenshire
Hazardous drinkers Harmful drinkers
65-74yrs >75yrs 65-74yrs >75yrs
Male 2582 964 413 69
Female 1291 412 215 103
Ahazardousdrinkerisapersonwhoisdrinkingabovetherecommendedmaximumalcohollevelbutnotcurrentlyexperiencingsocial,physicalorpsychologicalharm.Aharmful(highrisk)drinkerisdrinkingabovetherecommendedmaximumalcohollevelandisexperiencingsocial,physicalorpsychologicalharm.
ItislikelythatasignificantnumberofolderpeopleattendingA&Edepartmentsareaffectedtosomedegreebyalcohol.However,numbersarenotregularlyrecordedbyageandalcoholmaynotbeidentifiedasacause.
Ourcommissioningplans,includingthoseofAberdeenshireDrugandAlcoholPartnership,overthemediumterm,willincludeincreasedattentiontodrinkinghabitsinolderage,improvedassessment,screeningandaccesstobriefinterventions.
Beingoverweightorobeseincreasestheriskofdiseaseandmortality.Type2Diabetes,highbloodcholesterolandhighbloodpressurearemorelikely.Thesefactorsalsoincreasetheriskofvasculardiseasesuchasischaemicheartdiseaseandstroke.Musculoskeletaldisorderssuchasosteoarthritisinthejointsandrespiratoryproblemslikeobstructivesleepapnoeaaremorecommon.Thereisanincreasedriskofcertaincancerssuchascolorectal,breastandendometrialcancer.Theprevalenceofobesityisincreasingatanationallevel.TheprevalenceofobesityintheScottishHealthSurveyincreasesbyageuntillatemiddle-age.Itis13.3%inthoseaged16-24and38.3%inthoseaged55-64.Theprevalenceinthetwooldestagegroupsissequentiallylower.
Alzheimer’sandotherdementiasarecollectivelythesixthhighestcauseofdeathandfourthhighestcauseofburdenofdiseaseinhighincomecountriesaccordingtotheWorldHealthOrganisation(WHO).Thecostofcaringforpeoplewithdementia(intermsofhealthcare,socialcareandfriendsandrelatives)aswellastheprojecteddrasticincreaseinthenumberofaffectedindividualsduetoanageingpopulationmeansdementiapresentsallofsocietywithoneofthemostsignificantchallengesofthe21stcentury.Alzheimer’sdiseaseandvasculardementiamakeuparound75%ofalldiagnosesofdementia.Increasingageisthepredominantriskfactor,sowithanincreasingpopulationofolderpeopletherewillbeacorrespondingincreaseinthosepeoplewithdementia.Themainsymptomofdementiaisprogressivememoryloss.Peoplemayincreasinglystruggletoreasonandmakedecisionsandcanhavepersonalitychangeswhich,asthediseaseprogresses,limitaperson’sabilitytoself-care.Thiscanbecomeincreasinglychallengingifindividualsstoprecognisingfamilyandcarersandrequirehelpwithactivitiesofdailylivingsuchasdressingandeating.
Itisnotpossibletopreventthemajorityofcasesofdementia.However,stepscanbetakentoreducetheriskofvasculardementiaandAlcoholRelatedBrainDamage,inparticular,bytargetingthekeyriskfactors.Thereissomeevidencethattheriskofallformsofdementiacanbereducedbybeingmentallyandphysicallyactive,followingahealthydiet,notsmokingordrinkingharmfullevelsofalcohol.
Thereissignificantliteratureevidencewhichsuggeststheunder-diagnosisofdementiaissubstantialandasystematicreviewestimatedaround50%ofpeopleagedover65livingwiththeconditionwerenotdiagnosedashavingdementiabytheirGP.Estimatesofthenumberofpeoplewithdementiain2012arebaseduponEuropeanleveldata.InEurope,theprevalenceofdementiainthoseaged65-69is1.6%.
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Thisriseswithageto26.2%inthoseaged85-89and46.3%inthoseaged95andover.InScotland,itisestimatedthatin2012over81,000peopleaged65yearsandoverhaddementia.BymodellingprevalenceforAberdeenshirebasedonthelatestnationalpopulationdataavailable,weestimatethatabout3,191peopleaged65yearsandoverinAberdeenshirehaddementiain2010.Thisisaprevalencerateof8%.Theseprojectionsarelikelytounderestimatethetruepositionduetotherateofincreaseintheover75yrspopulationrelativetotheincreaseintheyoungerpopulation(i.e.65to75yrs).
Table 6: Estimated number of people with dementia, Aberdeenshire 2010-35
Year 2010 2015 2020 2025 2035
Populationaged65+(000s) 40 48.2 55.4 63 78.5
Estimatedno.aged65+withdementia(000s) 3.2 3.9 4.4 5.0 6.3
(Base:EuropeanPrevalenceEstimates)
DiabetesMellitus(DM)isaconditionwhichariseswhenthebodyhasalackofendogenousinsulin.Upuntiltheageof80theriskofDMincreasesandthenstartstodecline.Itisasignificanthealthissuenotonlybecauseofitsdirecthealtheffectsbutbecauseitincreasesaperson’sriskofotherhealthconditions,suchascardiovasculardiseaseandstroke.Itispreventable.Usingsurveydatathereareanestimated4,400peopleaged65andoverwithDMinAberdeenshireandthiscouldriseto8,600peopleby2035.Theincreasingprevalenceofobesitymeansthatthesefiguresmaywellunderestimatethefuturescaleofthisproblem.
Cancercontinuestobeofgrowingsignificancetous.TheInformationServicesDivisionofNHSScotland(ISD)predictsthatnewcancercaseswillincreasebyapproximately8%everyfiveyearsupto2020dueprimarilytoanageingpopulation.ThemostcommoncancersinScotlandin2010inmenwereprostate,trachea,bronchusandlungcancerandforwomenwerebreast,trachea,bronchus,lungandcolorectalcancer.Trachea,bronchusandlungcancerwerethemostcommoncauseofdeathfromcancer,followedbyprostatecancerinmenandbreastcancerinwomen.TheincidenceoflungandcolorectalcancerislowerinGrampianthaninScotlandasawhole.CancermortalityratesinGrampiantendtobeslightlylowerthanScotlandasawhole.TheleadingfourcausesofemergencyadmissionsduetocancerinGrampianintheover65populationweremalignantneoplasmsofthebronchusandlung,colon,prostateandrectum;theleadingfourcausesofelectiveadmissionsweremalignantneoplasmsofthebronchusandlung,breast,colonandprostate.
Malnutritionhasbeenidentifiedasamajorpublichealthproblemonadmissiontohospital,theriskofmalnutritionis34%forthoseaged80yearsandolder.Itisworstforthoselivingalone.Additionallyolderpeoplehavebeenfoundtobemorelikelytobeundernourishedwhenadmittedtohospitalandremainundernourishedduringtheirstaythere.
3.3. Increasing Life ExpectancyIn2008-10maleandfemalelifeexpectancyinAberdeenshirewasthehighestinGrampianandhigherthantheScottishaverage.However,ScotlandhasoneoftheworstlevelsoflifeexpectancyinWesternEurope.TheestimatedaveragelifeexpectancyformalesandfemalesvariessignificantlyacrossAberdeenshirefrommoreaffluenttodepriveddatazonesindicatingsignificantinequalityinhealthoutcomes.Whiletheaveragelifeexpectancy(79.9yrs)ishigherthantheaverageforScotland(74.5yrs),theworstlifeexpectancyinAberdeenshireissignificantlybelowtheScottishaverage.ForexamplemalelifeexpectancyinAberdeenshirevariesfrom88.9years(BanchoryDevenick)to66.3yrs(FraserburghharbourandBroadsea).
Lifeexpectancyisincreasingwitheachgenerationasishealthylifeexpectancy(HLE)butnotatthesamerate.HLEisanestimateofhowmanyyearsanindividualmayliveina‘healthy’state.Thisisanimportantmeasureasthehealthofaperson,notsolelylongerlifeexpectancy,impactsuponthedegreetowhichtheyareabletocontributetosociety(economicallyandsocially)asopposedtotheextenttowhichtheyrequirehealthandcareresources.Italsohasalowerexpectedperiodinwhichindividualsexperiencebeingunhealthy.ThisplacesusinamoreadvantageouspositionthanmanyotherpartsofScotlandandmayreducetheimpactonpublicservicesofthehigherincreasesthatwefaceintheolderpopulation.
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Figure 2: Healthy Life Expectancy
3.4 Financial Security In Older AgeThepercentageofthepopulationuptopensionableageseekingbenefitsislowerinAberdeenshirethaninGrampianandScotlandasawhole.Theguaranteedpensioncreditprovidesfinancialhelptothoseaged60oroverwhoseincomeisbelowacertainlevelanditisausefulindicatorofthefinancialhealthofolderpeople.In201011.1%ofthepopulationofAberdeenshireaged60oroverclaimedguaranteedpensioncreditscomparedto12.4%inGrampianand17.7%inScotlandasawhole.
However,thereisconsiderablevariationwithinAberdeenshireandtherearesomemoredeprivedpopulationsespeciallyintheBanffandBuchanandBuchanadministrativeareas.
3.5 Population Dependency RatioThepopulationdependencyratioistheratioofthepopulationagedunder16andover65(“dependents”)tothepopulationaged16-64years(“workingage”).TheprojecteddependencyratioforAberdeenshireinallyearsishigherthanScotlandasawhole.Thisincreaseindependencyratiocouldpotentiallyresultinfewerpeoplebeingavailabletoinformallycareforthoseintheolderpopulation.Theremayberesourceimplicationsduetoapotentialdecreaseintaxrevenuescombinedwithanincreaseinuseofstatutorypublicservicesbyolderpeople.
Theoretically,thiscouldbeoffsettosomedegreebyolderpeoplechoosingtoworklongerorbyareducingrequirementforotherservices,suchaseducation,duetoasmallerchildpopulation.InAberdeenshire,thehigherhealthylifeexpectancycouldalsomitigatesomeoftheimpactofthistrend.Therefore,althoughagreaterproportionofourpopulationwillbeeconomicallydependentthanotherpartsofScotland,therearemitigatingfactorsthatwecanassumewillmeanpublicservicesarenomoreadverselyaffectedintermsofdemand,thanotherareas.
Acleardemographicchallengeawaitsusinplanninghealthandcareprovisionforolderpeople.However,whiletheweightofnumbersislikelytoplaceagreaterburdenonpublicservices,wearefortunatetohavearelativelyhealthyandwealthyolderpopulationwhosedependencyonstatutoryhealthandcareislikelytobefocusedonthelastfewyearsoflife.Overthelifeofthisstrategywecaninfluencethistrendbyensuringthatwefocusattentionandresourcesonearlyintervention,preventionandpromotingawarenessofthebenefitsofadoptinghealthylifestyles.
Thedatafromourenvironmentalscanhasbeenusedtoinformourcommissioningintentionsoutlinedinalaterchapter.
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Chapter 4: Delivering Better Outcomes 2008-12
Arangeoflocalandnationalstrategiesandinitiativestoshiftthebalanceofcareandpromotejointdeliveryofhealthandsocialcarehavebecomefirmlyestablishedduringthedecadeprecedingthisstrategy/plan.Thechallengeofanageingpopulationanditsimpactonourcapacitytodeliverhealthandsocialcareserviceswasrecognisedattheturnofthenewcentury.
“LivingLifeToTheFull”,Aberdeenshire’sJointStrategyforOlderPeople(published2000)predicteda50%increaseinthe60-75populationby2016,andcurrentdatawouldsuggestthispredictionisbeingexceeded.SincethenthenationalreportoftheJointFutureGroup,BetterOutcomesforOlderPeople,andAllOurFutures(2007),amongotherpolicies,havereinforcedthisagenda.
Locally,theJointStrategyforOlderPeopleinGrampian(AgeingWithConfidence,2002),andannualJointCommunityCarePlans,helpedtoshapeanewrealityofjointworkingandservicedeliveryandtoshiftthebalanceofcare.Progressoverthelasttenyearsformsthebedrockofthisstrategyaswemoveforwardtoaddressgreaterchallengesinthenextdecade.
4.1 Shifting the Balance of Care 2008-2012Continuingtoreshapecareforolderpeoplefrominstitutionalsettingstohomerepresentssomethingofachallengeforthenexttenyearsinthecontextofasignificantlychangingdemographicanddiminishingpublicsectorresources.
Insightsfromnationaldatademonstratethehugeprogresswehavemadeinaddressingthebalanceofcareoverthepast10years.Between2003and2011thenumberofpeoplelivinginresidentialcareinScotlandreducedby17%.ThecarehomepopulationinAberdeenshireshowsasimilarbutmoregradualtrendsince2008(11%).
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InthesameperiodthenumberofpeoplereceivinghomecareinScotlandreducedby19%.Fewerpeoplereceivedlowerlevelsofhomecare(i.e.under10hpw)thaninpreviousyearsassocialcarebecamemorefocusedonpeoplewithcomplexcareneeds.However,inAberdeenshirethenumberofpeoplereceivinghomecarecontinuedtorisebetween2003and2009,sincewhenithasgraduallydeclinedbutremainsaround4%higherthanthenumberin2003.
Theproportionofpeopleaged65andoverinAberdeenshirewhoreceive10ormorehoursofhomecareperweekcomparedwiththosereceivinglowerlevelsofhomecarehasstartedtorisein2012andisexpectedtocontinuetodoso.
Bycomparinglocaltrenddatafrom2004-2011(figure3),thereisaconsistentpictureofagradualshiftinthebalanceofcare,butamoresignificantonewhenmappedagainstthegrowthinpeopleaged65andolderasshowninFigures11and12.Progressisintherightdirectionbutneedstoincreaseinpacesothatmoreolderpeoplecanchoosetoremainathomewithaccesstotherightcarewhentheyneedit,ratherthanmovingtohospitalortocarehomes.
Figure 3: People aged 65+ in receipt of home care v people aged 65+ in care homes in Aberdeenshire 2004-2011
4.2 Free Personal Care Approximately12peopleper1000populationaged65yearsandoverreceivefreepersonalandnursingcare(FPNC)incarehomesinAberdeenshire.ThenumberofolderpeoplelivingincarehomesinAberdeenshirehasfallenby11%since2001(from1,821-1,614)andconsequentlythecostofprovidingFPNCincarehomeshasalsoreducedbyaround£1.3mperannum.(Source:ScottishCareHomeCensus,March2012).Thenumberofpeoplereceivingfreepersonalcareathomehasrisenby52%,between2002and2012.(From1,210-1,840).
Since2003,thevolumeoffreepersonalcareathomehasgrownby97%(from6,200to12,200hoursperweek)andnowcostsAberdeenshireCouncil£12mperannum,overthreetimesthecostofdeliveringthepolicywhenitwasfirstintroduced.Basedonpopulationgrowthpredictionsandthegrowthtrends,afurther£25mwillberequiredtopayforFPNCinAberdeenshireby2023.
TherateatwhichuptakeoffreepersonalcarehasgrowninAberdeenshireislowerthanitisacrossScotland(150%growthnationallysince2003).Thismayreflectahealthierpopulationofolderpeople,ormorefamilysupport,thanisprevalentinotherpartsofScotland.Byfocusingourcommissioningintentionsonearlyintervention,prevention,recovery,enablementandcommunitycapacity-buildingweaimtoreducethefinancialburdenoffreepersonalcareonthepublicsector.
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Figure 4: Number of people 65+ in receipt of FPC/FNC in Care Homes in Aberdeenshire (per 1,000 65+ Population)
Figure 5: Number of people 65+ in receipt of FPC at home in Aberdeenshire (Per 1,000 65+ Pop.)
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Figure 6: 2005-2010 Comparisons in Aberdeenshire No. of people aged 65+ in receipt of Free Personal Care/Free Nursing Care
4.3 Housing and Living Accommodation for Older PeopleCurrentlythereareintheregionof2000shelteredhousingflatsavailableinAberdeenshire.TheseareownedandoperatedbytheCouncilandRegisteredHousingLandlords(RSLs).Themajorityofshelteredhousingtenantsareagedbetween76and90.
Despitetheincreasingolderpopulation,therehasbeennosignificantincreaseinthenumberofapplicationsforshelteredhousingsince2008andthisisconsistentwiththepositionacrossScotland.Applicationsfromthoseaged65-84tomoveintoshelteredhousinghavedeclined,butapplicationsfrompeopleover85haveincreased(AberdeenshireLocalHousingStrategy).
Table 7: Number of applicants for SH between 2008-2012 by Age Groups
Age Groups 2008 2009 2010 2011 2012
65-74 232 229 193 175 174
75-84 344 338 342 331 308
85+ 112 116 127 152 148
Total 688 683 662 658 630
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Figure 7: All Sheltered Housing Tenants by Age Group 31.3.2012
Since2008,inlinewithnationaltrends,therehasbeenasteadydeclineintherateofnewtenantsmovingintoshelteredhousing.Weconcludethisarisesfromacombinationoffactors:
• morepeoplearechoosingnottomovehouseastheygetolderastheyareabletoreceivethecareand supporttheyneedinmainstreamhousing,includingaccesstocommunityalarmandtelehealthcare systems;and
• moreshelteredhousingtenantsarechoosingtostayintheirtenancyforlongerwithincreasedsupport, ratherthanmovingintoresidentialcareastheircareneedsincrease.
Thisimpliesthattheprojectedincreaseinolderhouseholdswill,overtime,leadtomoreolderpeoplelivinginmainstreamhousingratherthaninspecialistcareaccommodation,particularlyshelteredhousing.Thisisalreadyevidentintherapidlygrowingdemandforaids,adaptations,communityandprimaryhealthcareservices,whichallowpeopletomodifytheirhomeenvironmenttomeettheirincreasingdependencyandreducingfunctionalabilities.Thiswillbeaconsistentlygrowingtrendandreflectswhatwealreadyknow,i.e.thatmostolderpeoplewanttoremainintheirownhomeandcommunityforaslongaspossible,withsupportwhentheyneedit.
Table 8: New tenants – Aberdeenshire Council Sheltered Housing
2008-2009 2009-2010 2010-2011 2011-2012
NewTenants 195 151 185 173
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Figure 8: New tenants – Aberdeenshire Council Sheltered Housing
Verysheltered,sometimesdescribedasextracare,housingoffersarealalternativetoresidentialcareforpeoplewhochoosetolivemoreindependentlyintheirowntenancy.Increasingtherangeofaccommodationoptionswithcareforolderpeopleislikelytohavethegreatestimpactuponthepartnership’sabilitytodeliverkeynationalhealthandcommunitycarepolicies.Aberdeenshire’sLocalHousingStrategysupportsthedevelopmentofatleast40extracarehousingunitasawayofimprovingaccesstoaffordablehousingforpeoplewithhighercareandsupportneedsandfreeinguplargerpropertiesforfamilylivingwhichmayotherwisebeunder-used.
Currentlytherearefiveveryshelteredhousing(VSH)complexes,comprising135flats,inAberdeenshire;oneiscouncilownedandfourareownedbyRegisteredSocialLandlords(RSLs).OneofourprioritiesfordevelopmentistoincreaseaccesstoVSHoptionsformoreolderpeopleandourcommissioningintentionsaredescribedinChapter6.
Small(1and2bedroom)mainstreamhousingcontinuestooffervaluableoptionsforolderpeople.TheLocalHousingStrategyprioritisesmaximisingtheuseofthesepropertieswithappropriateaidsandadaptations,whererequired,allowingpeopletolivelongerathome.Chapter6alsodiscussesthisinmoredetail.
4.4 Care at Home ComparedwithotherareasinScotland,AberdeenshireCouncilprovidesanaveragenumberofhomecarehoursperheadofpopulation.Intermsofthenumberofolderpeoplewithcomplexneeds(i.e.thoseinreceiptofmorethan10hoursperweekofhomecare)Aberdeenshireisagainclosetotheaverage.
ThedatainFigure10maybeanindicationthatourpolicyintentofsupportingpeopletorecover,whenpossible,andresumeselfcare,appearstobeworking,exertingadownwardpressureonlowerlevelsofneed.Whilsttheproportionofover65sneedingalowerlevelofhomecareisdeclining,theproportionofpeoplerequiringandbeingprovidedwith10ormorehoursofhomecarehasremainedfairlyconstant.Asthenumberofolderpeoplegrows,weanticipatetheneedtoreallocateresourcestosupportpeoplewiththemostcomplexcareneedstoliveathome.
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Figure 9: Number of people per 1000 65+ population in receipt of home care in Aberdeenshire 2004-11
Figure 10: Number of people per 1000 of 65 +population in receipt of 10 hrs or more per week home care in Aberdeenshire 2004-12
Figure 11 Number of people per 1000 of 65 +population in receipt of home care and number of people per 1000 of 65+ population in receipt of 10 hrs or more hours per week in Aberdeenshire 2004-12
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4.5 Care HomesInlinewithourpolicygoal,therehasbeenasteadydeclineinthenumberofolderpeoplemovingintocarehomessince2006,exceptforaslightrisein2008-9(figure12).Asimilardownwardtrendisevidentwhencomparedwiththepopulationaged65andover.(figure13).
Figure 12: Number of People Aged 65+ placed by Aberdeenshire Council in a Care Home 2004-12 (Per 1,000 of 65+ Pop.)
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Figure 13: Mean Aberdeenshire Council Commissioned Care Home Placements per month per 1000 65+ Population 2004-12
InMarch2012,3.3%ofthepopulationinAberdeenshireagedover65werelivinginacarehome,comparedtothenationalrateinScotlandof3.4%,with15%ofthosewhoare85oroverlivinginacarehome.
However,Aberdeenshirehadtheseventhhighestnumberofover65slivinginacarehomeoutof32Scottishlocalauthorities.Asaconsequenceofimprovingchoicebyexpandingtherangeofcareandaccommodationoptions,weanticipateacontinuingdownwardtrend,intheshorttomediumterm,ofpeoplemovingintocarehomes,inspiteofthegrowthintheover85yearoldpopulation.
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In2011,55.4%ofolderpeoplelivingincarehomesinAberdeenshirehaddementia(45.7%medicallydiagnosed).Althoughweanticipatefewerpeoplewillchoosetomoveintoresidentialcareinfuture,themajorityofhomecareresidentswilldisplaysymptomsofdementia.Themodelofcareandstafftrainingwillbeadaptedtoaddressthistrendinordertosupportresidentstomanagedailyroutinessafelyandwell.
4.6 HospitalsSince2008theAberdeenshirePartnershiphastakenanumberofconcertedactionswhichhavereducedtheaveragelengthofstayinhospitalforpeopleaged75andoverfollowinganunplannedadmission.Thisisasignificantlymorepositivetrendthanthenationalposition.Between2008and2010thenumberofemergencyinpatientbeddaysattributedtopeopleover65decreased:in2011/12therewasa7.8%reductionintheemergencybeddayrateforpeopleagedover75.Againstthesignificantriseintheolderpopulation,theactualreductioninemergencyinpatientbeddaysforpeopleover65in2011was11%lowerthanwouldhavebeenexpectediftherehadbeennochangesinhealthandcarepractice.
However,during2012adversetrendswererecordedinrelationtounscheduledcareandtheuseofhospitalbeds.Thenumberofpeopleagedover65experiencingtwoormoreemergencyhospitaladmissionsincreasedduringthisyear,asdidthenumberofpeopleadmittedtoA&Efollowingafall.Thenumberofhospitalbeddayslosttodelayeddischargealsoincreasedslightly.ThePartnershipacknowledgesthatitwillbechallengingtosustainthestrongperformancewehaveachievedoverrecentyears,duetothesignificantriseinthepopulationofolderpeoplelivinglongerwithalongtermcondition.
Figure 14: Emergency Occupied Bed Days 2010 - 2012
Therateper1,000populationofolderpeopleadmittedtwiceormoretoanacutehospitalshowsafluctuatingtrendsince2008.NeverthelesstheAberdeenshiretrendissignificantlybetterthanthenationalposition.
Nationallythereisconcernabouttheyearonyearincreaseinthenumberofemergencyadmissionsforthose65+anditisrisingfasterthanexpected.In2010/11therateroseby7%.
DataisnotavailableforAberdeenshirebutacrosstheNHSGrampianarea(i.e.AberdeenCity,AberdeenshireandMoray),thereisarealdecreaseinemergencyadmissionsagainstarisingnumberofolderpeopleasthefollowingfiguresdemonstrate.
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Figure 15: NHS Grampian Emergency Admissions Actual 2011-2012
Figure 16: NHS Grampian Emergency Admissions rate per 1000 2011-2012
Thisholdstrueeventhoughtheoverallproportionofhospitalbedsareincreasinglyusedbyolderpeople.
Figure 17: NHS Grampian Emergency Admissions by Age Group 2011-2012
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Theeffectivenessofintegratedpathwaysisimprovingbetweenprimaryandsecondaryhealthcareandpatientflowthroughoutthewholesystemisimproving.Thiscoupledwiththedesiretomanage‘interim’patientsoutofthesystem,shouldensureintermediatecareisavitalbutflexiblepartofholisticcare.
Communityhospitalshavetraditionallyprovidedawideandvariedrangeofservices.AlthoughthereisnostandarddefinitionofacommunityhospitaloritsroleinScotland,themostcommonlyusedis:
“A community hospital is a local hospital, unit or centre providing an appropriate range and format of accessible health care facilities and resources. Medical care is normally led by GPs, in liaison with consultant, nursing and allied health professional colleagues as necessary and may also incorporate consultant long stay beds, primary care nurse-led and midwife services”
Thereare11communityhospitalsmanagedbyAberdeenshireCommunityHealthPartnershipprovidingamixofin-patientfacilitiesincludingGPacutebeds,rehabilitationbedsandoldagepsychiatryassessmentbeds.FraserburghHospitalhassixslowstreamstrokerehabilitationbeds.80%ofcommunityhospitalpatientsareaged65andover.ArangeofdiagnosticandtreatmentsarenowroutinelyavailableincommunityhospitalsinAberdeenshire,suchasdermatology,minorsurgery,orthopaedics,diabetescare,INRtesting,ENT,Endoscopy,Ultrasound,CardiacAssessment,dialysisandplainX-ray.Thisaccordswithourvisiontoprovidelocalaccesstohealthcare,reducingtheneedforpeopletotraveltoAberdeenasfarasispracticable.
Standardisedpracticeshavebeenestablishedincommunityhospitals,includingsettingexpecteddateofdischargeforeachpatientonadmission,co-ordinateddischargeplanningandmovingonpolicieswhichhavehelpedtoreducelengthsofstayanddelaysinthedischargeofpatientswhoaremedicallyfit.Therehasbeenanincreasingfocusonrehabilitationbycommunityhospitalstaff.
4.7 Primary CareAberdeenshire’sprimarycaresectorcomprisesfourindependenthealthcontractorservices,GeneralPractice,Optometry,DentistryandPharmacy.Itisestimatedthatpeople,aged65yrsandover,representatleast60%ofthosewhoregularlyuseprimarycareservices.Thereare36GPpracticesprovidinggeneralmedicalserviceswithalignedDistrictNurses,HealthVisitors,CommunityPsychiatricNurses(CPNs)andAlliedHealthProfessionals(AHPs).AHPsincludecommunitydieticians,speechandlanguagetherapists,physiotherapistsandoccupationaltherapists.37independentoptometrypracticesofferfreeNHSeyeexaminationstoall.SomepracticesofferanextendedservicethroughanenhancedservicecontractasmembersoftheEyeHealthNetwork.
Thereare35dentalpracticesinAberdeenshiremostofwhichareindependent.NotallofferdentistrytoNHSpatients.TheNHScommunityandsalariedservicespecificallytargetsvulnerablegroups.TheNHSprovidesdentistrytotheprisonersinPeterheadprisonand,fromDec2013withtheopeningofHMPrisonGrampian,thisservicewillexpandtomeettheneedsoftheincreaseintheprisonpopulationfrom120to550.
Thereare53pharmaciesinAberdeenshirethataremostlyindependentcontractors,withasmallnumberofdispensarieswithinafewGeneralPractices.ManypharmaciesofferadditionalservicessuchasChronicMedicationService(CMS),MinorAilmentService(MAS)andsmokingcessation.
4.8 Living Well with Dementia
Since2010/11thenumberofolderpeoplewithdementiawhoreceiveeitherrespitecare,careathome,orarelivinginacarehomehasincreasedslightly.AkeypriorityofourcommissioningstrategyistoextendandimprovesupportforpeoplewithdementiainaccordancewiththeScottishGovernment’snationaldementiastrategy,ensuringthatpeoplehaveatimelydiagnosisandreadyaccesstoadvice,information,treatmentandcarewhentheyneedittohelpthemtolivewellwithdementia.
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Figure 18: People aged 65 and over with Dementia by Service Received 2010-12
65+ with dementia by service received
Figure19demonstratestheincreasingproportionofpeopleincarehomeswithadiagnosisofdementia.Thisunderstatesthetrueposition,sincemanycarehomeresidentsexhibitingthesymptomsofdementiahavenoformaldiagnosis.Inordertoensurecarehomesareequippedtodeliverthehigheststandardsofcaretopeoplewithchangingneeds,wewillensureallcarehomestaffintheprivate,thirdandlocalauthoritysectorshaveaccesstorelevanttrainingindementiacare.
Figure 19: % of Aberdeenshire Care Home Residents with Dementia 2004 -2012
04 05 06 07 08 09 10 11 12 0405 060708 09 10 1112
%ofAberdeenshireCareHomeresidentswithdementia
4.9 Day ServicesAberdeenshireCouncilspendsover£1mperyeardeliveringorcommissioningdayservicesforolderpeople.Itcontinuestofulfilanimportantelementinthespectrumofcareandsupportforolderpeopleandtheircarers,enablingpeopletomaintainand/orrestoretheirdailylivingskills,improvetheirindependenceathomeandwithintheirowncommunity.InJune2012,476peopleovertheageof65(1.2%ofthe65+population)wereusingourdayservices.
In2011,usingasimplemodifieddependencytool(BarthelIndex),30%ofolderpeopleusingdayservicesinAberdeenshirewereassessedashavinghighorveryhighdependencylevels.Themajorityofpeopleusingdayserviceareover75yrsofage,withover50%agedover80andsignificantnumbersover90.Thisrepresentsamarkedchangeoveraperiodoffiveyearswithnewserviceusersjoiningatanolderagethanwastraditionallythecase.
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Aberdeenshire’s28daycentresoffersocialactivities,physicalandmentalstimulationaswellasrespiteforinformalcarersanddedicatedtransporttoaccessthis.Dayserviceshelpmanyolderpeopletomaintaintheirwellbeingandexpandsocialnetworks.Lunchisakeyelementofdayservicesenablingolderpeopletoremainindependent,sociallyengagedandwell-nourished.Thenumberofdaycarefacilitiesandsessionshasremainedrelativelyconstantformanyyears.Eachfacilityisconfiguredaccordingtolocalcircumstances(i.e.transport,sizeofbuilding,demandetc).Althoughdayservicesremainapopularchoiceformanyolderpeople,themodelofcarehasbroadlyremainedthesameforseveralyears.Inanticipationofchangingdemandsandexpectationsoffuturegenerationsofolderpeople,significantre-designanddevelopmentisplannedoverthenextthreeyears.Detailsareoutlinedlaterinthestrategy.
VolunteersplayavitalroleinAberdeenshire’sdayservices.ThelevelofvolunteerinvolvementisunusuallyhighcomparedtootherpartsofScotland.Volunteersarehighlyvaluedaspartofthecoreteam,supportingpaidstaffsotheyhavemoretimetofocusoncareplanningandco-ordinationofvariedactivityprogrammes.TheCouncilalsosupportseightdayservicesoperatedbyvolunteergroupswithformallyconstitutedcommittees.Supportisprovidedintheformoffunding,accommodation,transportandinsomecases,paidstaff.
FivespecialistdementiadayservicesinAberdeenshireareoperatedbytheCouncilandvoluntaryorganisationsinadditiontoAlzheimersScotlanddayservicesinfivelocationsacrossAberdeenshire.Theseservicesaretargetedonthosewithadiagnosisofdementiaatanadvancedstageofillness.Theyofferhigherstaffratios,complementaryservicessuchashomesupportandcarersgroupsandhavestronglinkswiththespecialistoldagepsychiatryservice.
4.10 Supporting CarersTraditionallycarershavebeensupportedtocarryouttheircaringresponsibilitiesbyofferingshortbreaksorrespiteforthepersontheycarefor,usuallyinaresidentialsetting.Thenumberofweeksofrespitecareprovidedtopeopleover65inresidentialsettingshasrisenfrom3470in2009to3876in2012.CarerswhowanttoholidaywiththepersontheycareforcannowreceivedirectfundingfromAberdeenshireCounciltoallowthemtoarrangeshortbreakswhichbestsuittheirlifestyle.Manycarersvalueopportunitiestoattendappointmentsalone,joinaclassorparticipateinaleisurepursuit,withaccesstospecialconcessionaryratesforAberdeenshireCouncilfacilities.IncreasinglyAberdeenshirecarersarechoosingtoaccesscommunityrespite,allowingthecarertohavesomepersonaltimeawayfromhomewhilethepersontheycareforremainsathomewithapaidorvolunteercarer.
ArangeofoptionssuchasTimetoLiveandSelfDirectedSupportallowcarerstopurchaseinnovativeshortbreaksforthingslikedrivinglessonsorrelaxationclassesthatprovideaboostforthecarerandeasetheircaringresponsibilities.Anumberofthirdsectororganisationsofferlocalinformation,advice,trainingandsupporttocarers,withfundingfromAberdeenshireCouncilandNHSGrampian.ThechangingpatternofrespitedemandinAberdeenshiredemonstratestheneedforustobetterunderstandwhathelpscarerstocontinuetocare.ThisisfurtheraddressedinChapter6.
4.11 Telehealth CareTelehealthcareisarapidlydevelopingconceptinhealthandsocialcareandhastremendouspotentialtogiveolderpeoplemorechoiceandcontrolovertheirlifestyles,tolivemoreindependentlyandsafelythaneverbefore,andtobettermanagetheirownhealthandcare.In2011-12,11%(2002people)ofthepopulationaged75yearsandoverusedtelehealthcareinAberdeenshire.ThisisbroadlycomparablewithotherpartsofScotland.
Ourcapacitytoharnessitspotentialiscentraltoourplanstoreshapecareforolderpeopleoverthenextdecadeandbeyond.Aberdeenshire’scurrentinvestmentintelehealthcaresystemsisaround£132,000perannumor0.2%ofthepartnership’sjointfinancialframework.ThePartnershipwillcommitfurtherinvestmenttoexpandtherangeandaccessoftelehealthcareovertheshortandmediumterm.ThisisaddressedinChapter6.
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TelehealthcareinAberdeenshireutilisesalarmandsensoractivatedalertsystems,dailyactivitymonitoring,assistivedevicestooptimisephysical,sensoryandcognitiveabilities,environmentalcontrols,anddevicestoenableclinicianstoremotelymonitorvitalsignsandconduct‘virtual’consultationswithapatientoverawidegeographicaldistance.Telehealthcarefunctionseffectivelyaspartofanetworkofcareandsupportaroundanindividual.Ithasakeyroleinstrengtheningpersonalsupportnetworksandcommunities.
InAberdeenshirewebelieveacomprehensive24hourcareathomeandresponderserviceiscriticaltotheeffectivenessoftelehealthcare.Itreliesonafast,skilledandpersonalisedresponsetoalarmsandalertsfromserviceusersandprofessionalsutilisinglocalknowledgebackedupwithtimeousdatareportingfacilitiesthatallowustomeasuretrends,risksandareasforimprovement.
ThroughAberdeenshire’sjointequipmentservice,healthandsocialcareprofessionalscanrapidlyprocureandinstalltelehealthcareequipmentaspartofapersonalisedcareandsupportplan.Staffareencouragedtosupportclientstofindcreativeandinnovativesolutionsusingtechnologyandwepromotetheuseofprofessional“champions”whostayabreastofinnovationanddevelopmentinpractice.Wehavepilotedtheuseoftelehealthcaretechnologytosupportstrokepatientsandtofacilitateconsultationsbycliniciansinruralareas,reducingtraveltimeandcostforpatients.
In2009-10,telehealthcareprevented39unplannedhospitaladmissionsinAberdeenshire,equivalentto337acutehospitalbeddays,asavingof£192,090.Since2010,theimpactoftelehealthcareonuseofhospitalsandhomecareserviceshasbeenevident(i.e.reducespressureonmainstreamservices).However,wenolongercollectorreportdataontelehealthcareinthesamewayaswedidduringthepilotphase.
Table 9: Number and percentage of over 75 population using telehealthcare 2011-12
Area No. clients aged 75+ Population aged 75+ % 75+ population
Grampian 4,647 41,439 11.21%
AberdeenCity 1,503 15,888 9.46%
Aberdeenshire 2,002 17,925 11.17%
Moray 1,142 7,626 14.98%
4.12 Change Fund 2011-14Since2011/12theScottishGovernment’s‘ReshapingCare:AProgrammeforfundingChange’(RCOP)ChangeFundhasprovidedPartnershipswithadditionalshorttermcapacitytoprogressthepolicygoalsandoutcomesoutlinedintheintroductiontoourjointcommissioningstrategy,andactasacatalysttodrivesustainableimprovementsthroughgreatercollaborationandintegratedworkingwithinandacrosssectors.Ourpartnershiphasusedthefundingtomakefasterprogresstomoveawayfromreactive,institutionalcareandtowardsmorepreventativeandanticipatorycarethatenablesolderpeopletoremainsafeandwellintheirownhomes:seekingtotransformthecultureandphilosophyofcarefrommaintenanceservicesprovidedtopeopletowardspreventative,anticipatoryandcoordinatedcareandsupportdeliveredwithpeopleincommunities.
Aberdeenshire’sjointperformanceframeworktracksthePartnership’sprogressinachievingtheaimsoftheChangeFund.Itcomprises30performanceindicatorswithannualtargetsalongwiththeresultsofregularsurveysofolderpeoplewhoaremostatriskofemergencyadmissiontohospital,andtheircarers.ThesearereportedinmoredetailinChapter7.ActivitydataacrossthelocalhealthandcaresystemisreportedquarterlytotheOlderPeople’sStrategicOutcomesGroupandactionsareagreedtoaddressadversetrendsinreshapingcareduringthefouryearlifeoftheChangeFund.
In2011/12,thefirstyearoftheChangeFund,slowbutpositiveprogresswasevidencedinreshapingcaretowardsagreateremphasisonselfcare,careathomeandinlocalcommunitiesforthosewithcomplexcareneeds.Thisreflectedearliertrendsbutgaveimpetustoourstrategicplansandacceleratesourdirectionoftravel.
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Considerableattentionhasbeenpaid,usingtheChangeFund,toco-productionapproaches.TheOPSOGrecognisedthereisaplethoraofactivitiesandopportunitiesforengagementofolderpeopleinAberdeenshirebutitisnotalwayseasyforolderpeopletonavigatesuchdiverseandvariednetworks.ThroughtheChangeFund,AberdeenshireSignpostingProjecthasbeensuccessfulin linkingmanyolderpeoplewithcommunitygroups,activitiesorservices thatmatchtheirneedsandinterests.BasedinGPsurgeries,communityhospitalsandacceptingselfreferrals,theSignpostingProjectworkswith olderpeople tofindtailoredsolutionstonon-medicalissuesaffectingtheirlifestyle,moodandwellbeingwiththeaimofenhancingtheirqualityoflifeandpromotingpositivementalhealth.Theprojectisinitsinfancybutisalreadyreportinggreatsuccesses,withsomeindividualsneedingareducedlevelofmedicationandmedicalcontactsaswellasimprovedwellbeing.
AReshapingCareCo-ProductionSteeringGroupwasformedin2011toco-ordinateandstimulateactivitiesthatsupportearlyinterventionandpreventionintheoldergeneration.Interestfromgroupswantingtodevelopoptionshasbeenhigh.Enablingolderpeopletomaintaingoodsocialrelationshipsiscriticalandaconnectivityprojecthasbeenfundedtoconnectpeoplewithsharedinterests,particularlyculturalpursuits.BeingcuriousishelpedbystimulationandwearedelightedtosupportnewgroupssuchasPhilosopheranddementiacafes,whicharegrowinginpopularity.ArtsdevelopmentworkerswithasmallgrantareprovidingtastersessionstodiversegroupsofolderpeopleandarenowfacilitatingCreate:Connect,anAberdeenshirewideartstrainingprojectthataimstobuildcapacityacrossallsectorstoworkwithvulnerablegroupsandcarersandtherearegrowingnumbersofdrama,artgroups,teadancesandchoirsestablishingthemselves,sometimesasadjunctstocarehomesordementiacafesbutopentoall.AberdeenshireisfortunatetohaveavibrantCommunityPlanningPartnershipwhereofficersandcouncilsforvoluntaryserviceareworkingwithlocalcommunitiestoestablishco-productionventuressuchasWesthillMensShed,communityallotmentsandkitchens.Weareawarethatcertaingroupssuchasoldermen,ethnicminoritiesandlesbiangay,bisexualandtransgenderindividualscanbeparticularlyvulnerable.Wewishtosupportalleffortstoengagethem.AlocalartsprojectaimstoincreaseaccesstohealthchecksforGypsyTravellers,includingtheiroldermembers.
Usingacommunitydevelopmentapproachwearefacilitatinginter-generationalengagementinanareathathasexperiencedrecentrapidpopulationgrowthandhelpingshelteredhousingtenantsbuildsustainableandmutuallybeneficialconnectionswiththeirlocalcommunities.
UsingtheChangeFundwearetestinganintegratedmodelofcommunityrehabilitationandenablementinthreeareasofAberdeenshire(Turrif,Peterhead,Inverurie).REACHdeliversintensivesupporttoolderpeopleatriskofdependencytoenablethemtoregainindependencewithina6-8weekperiod.
Thethreetestsitesproviderapidinterventiontoassistpeopletoregainfunctionalcompetence(i.e.theabilitytocareforoneselfandmanageone’sownaffairs(Willis,1996),whichmayhavebeencompromisedduetoillness,hospitalisationordisability.KnownasREACH(RehabilitationandEnablementinAberdeenshireforCareatHome)theservicecomprisesofmultidisciplinaryteamsofNHSandlocalauthorityoccupationaltherapists,homecarers,districtandwardnurses,caremanagersandphysiotherapists.TheREACHinitiativehasactivelyencouragedcarerandfamilyinvolvementinsettingandachievinganolderperson’sagreedgoals.Thecontextforsuchinterventionsisalwaystheindividual’shomeoranappropriatecommunitysetting.
Althoughnumbersofpeoplereferredtotheteamsarelow,somepositiveoutcomeshavebeenrecordedaswellasvaluablelearningpointsthatwillshapeourapproachtomainstreamingreablementoverthenext3to5years.
AnindependentevaluationofREACHbyRobertGordon’sUniversityin2012/13willinformourfuturemodelofintegratedrehabilitationandenablementbymeasuringandanalysingusersatisfactionandeffectiveness;theburdenofcareoninformalcarers;andtheexperienceofagenciesinvolvedinthedesignanddeliveryofREACH.
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TheChangeFundisalsocontributingtodemonstrableimprovementsinsupportingolderpeoplewithcomplexneedsathome:
• morepeoplemanagetheircarethroughananticipatorycareplan;
• levelsofcareathomedeliveredatweekendsandovernighthavesignificantlyincreased;
• numberofpeoplereceivingmorethan10hoursofhomecareperweekhasincreased;
• morepeopleover75andmorepeoplewithdementiausetelehealthcaretohelpthemremain independentathome;
• shortbreaksforcarersofolderpeopleisrisingandremainsabovetheScottishaverage;
• morepeoplereceivedanearlydiagnosisofdementia,inaccordancewithnationalpolicyandtargets
Ofthosepeople,aged65andoverneedingcare,theproportionofpeopleover65livingathomewithsupportincreasedandthenumberofpeoplemovingintocarehomesreduced.ThissupportsourpolicygoalofshiftingthebalanceofcareandplacesusinastrongpositiontomakesignificantchangestoAberdeenshire’smodelofcareandinvestment.
Asstatedintheprevioussectionthreeearlyimplementerteamsapplyinganintegratedrehabilitationandenablementmodelwillshapeourapproachtomainstreamingreablementoverthenext3to5years.
In2011-12fundingtoexpandtheoutofhoursresponderservicewasapproved.Atpresentaround2,500peopleinAberdeenshirehaveacommunityalarmandhavenamedcontactsofpeoplewhocanbecalledontorespondorprovidenecessaryassistance.Thenew24hourresponderservicewillbenefitsignificantlymoreolderpeoplewhohavenoclosefamilyorfriendstoassistthem.Thenewextendedservice,calledARCH,willbefullyoperationalin2013andhasthepotentialtoexpanditsroleasdemandgrows.Whilstitwillnothandleemergenciesrequiringmedical,policeorfireservicesresponses,ARCHwillbecapableofprovidingarapidresponseavoidinginappropriatehospitaladmissionsbyofferingsocialcareandsupportuntilotherservicescanbearrangedorbyavertingsocialcarecrises.ARCHwillformakeyelementofAberdeenshire’scomprehensive24/7careathomeservice.
UsingtheChangeFund,wehaveinvestedinthedevelopmentofourworkforcesinthestatutory,independentandthirdsectorstoimproveknowledge,skillsandpracticeinpalliativeandendoflifecareandworkingwithpeoplewhohavedementia.
AppendixFgivesfulldetailsofChangeFundprojectsanddevelopmentsdesignedtoreshapecareforolderpeopleusingtheChangeFundbetween2010and2012.Chapter5providesfinancialdetailsoftheChangeFund.
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Chapter 5: Finance and Investment Patterns
5.1 Overview
AberdeenshireCouncilandCommunityHealthPartnershiphavebeenworkingtogetherforsometimetoproduceanintegratedbudgetforolderpeopleandthefirstiterationwasachievedin2011-12.Wecallthisourjointfinancialframework.Thetotalalignednetbudgetis£120,540mfor2013/14.ThisincludesresourcetransferfundingpassedfromtheNHStothelocalauthoritytofundcareforolderpeoplewhowouldtraditionallyhaveremainedaspatientsoftheNHS.Figure20belowshowsthecategoriesanddetailsofexpenditurefor2012-13.Thesebudgetscontinuetoberefinedandmayincreaseasbudgetsettingprogresses,henceAppendixAholdslatestrevisedbudgetsavailable.
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Figure 20; Joint Resource Framework 2012-13
Ouraimistodevelopthejointfinancialframeworkasathreeyearrollingbudgetcomprisingallsocialworkandprimarycarefundingforthecareofolderpeople.Itwouldbeaccuratetosaythat,despitelongandformallyestablishedjointplanningarrangements,itisonlynowthatworkisbeingundertakentoensurethatlocalauthoritiesandtheNHSundertakemediumtermfinancialplanningandmonitoringactivitiestogether.Budgetsettingprocessesandtimescalesarenotalignedandplansandgovernancearoundefficiencytargetsarenotyetjoinedup.Inaddition,responsibilityforfinancialmanagementisnotdevolvedbytheGrampianHealthBoardtotheCHPforallprimaryandcommunityhealthservicessuchasGeneralMedicalServicesandcommunitymentalhealthservices.Forthesereasonsithasbeendifficulttocapturetheshort,mediumandlongtermconfigurationofhealthandsocialcareexpenditureonacomparativebasis.LocallydevelopedIRF(IntegratedResourceFramework)dataprovidessomeofthisbutnotintermsofcurrentorrecentexpenditure.ThisremainsanareafordevelopmentbetweenNHSGrampianandAberdeenshireCounciloverthenextthreeyears.
AberdeenshireCouncilhasapprovedindicativebudgetsforthenextfouryears.AlthoughbudgetsaremanagedandaccountedforbytheNHSandAberdeenshireCouncilrespectively,thePartnershiphasagreed,inprinciple,thatplansforinvesting,disinvestingorchangingtheallocationpatternofthesebudgetsshouldbeplannedandapprovedjointlythroughAberdeenshireOlderPeople’sStrategicOutcomeGroupandtheJointCommunityCarePartnershipgroup.
5.2 Integrated Resource FrameworkIn2010anexercisewascompletedtocomparepatternsofactivityandspendingonhealthandcareservicesbyareaacrossGrampianandperheadofpopulation.ThisiscalledtheIntegratedResourceFramework(IRF)anddatafor2008-11aredetailedinAppendixB.Datafor2011-12willbeavailableinthesummerof2013.
5.3 NHS ExpenditureTwosignificantareasofexpenditurenotcurrentlyunderthecontroloftheCHPbuttraditionallyregardedascorecommunityhealthservicesforolderpeoplearegeneralmedicalservicesprovidedbyGPsandtheirprimarycareteams(£9.27min2013-14),andGPprescribingbudget(£14.79m).
In2010-11NHSGrampianspent£87mperannumonacutehospitalcareofolderpatientsoriginatingfromAberdeenshire.PredominantlythesearepatientsreceivingassessmentortreatmentatAberdeenRoyalInfirmary,WoodendHospitalorDrGray’sinElgin,butincludesexpenditureforolderpatientsusingtheAberdeenshirecommunityhospitals.ItisnotpossiblefromtheIRFtoextractthecostsofAberdeenshirecommunityhospitalsmanagedbytheCHPbutestimatessuggestitisaround£11.547mperannum.MonitoringandinvestmentdecisionsaroundmostofhealthcarespendingareoutwiththescopeofAberdeenshire’sjointfinancialframework.
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In2010-1170%ofexpenditureonolderpatientsfromAberdeenshirewasattributabletoin-patienthealthcare,30%tocommunitybasedhealthservices.GPprescribingaccountsforthebiggestelementofcommunityhealthspendandcommunitynursingcomprisesthesmallestareaofexpenditure.Specialistmentalhealthservicesforolderpeople,primarilydementiaservices,accountsfor3%ofNHStotalexpenditureinAberdeenshire.Figure21belowshowsthebroadcategoriesofhealthexpenditurefor2010-11.
Figure 21: NHS Expenditure on Older People in Aberdeenshire 2010-11
5.4 Social Work ExpenditureIn2010-2011,Aberdeenshireranked24thoutof32localauthoritiesintermsofthelevelofsocialworkspendonolderpeople’sservicesperheadofpopulationover65yrsold.
In2012-13theproportionofcommunityorhomebasedtoinstitutionalcarespendingwas46%to54%respectively.
Figure 22: Social Work Community: Institutional Spend in Aberdeenshire 2012-13
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AberdeenshireCouncilhasacknowledgedthatsocialworkservicesfaceunprecedenteddemographicandsignificantinflationarypressuresandarecommittedtoprotectingorincreasingresourcesasfaraspossible.Intheshortterm,theCouncilhasinjected£1.5monanon-recurringbasisin2012/13toimprovefasteraccesstocareathomeandin2013isre-tenderingcareathomeservices.Inthecontextofmediumtolongtermeconomicforecasts,partnersarecommittedtoadequatelyfundthelocalhealthandcaresystemsbutacknowledgethiswillbecomeincreasinglydifficult.
35%ofsocialworkexpenditurefundsthecostsofolderpeoplelivingincarehomesandapproximately27%fundscareathomeservices.Thesecomprisethetwobiggestsingleareasofsocialworkexpenditure.Overthelifeofthisplan,theAberdeenshirePartnershipaimstoshiftthebalanceofexpendituretowardsawiderangeofsupportwhichfacilitatesgreaterindependentliving,choiceandcontrolforfrailolderpeopleandpeoplewithdementiaathomeandintheircommunity(e.g.homecare,daysupport,respitecareetc).Toassistustomeasureprogress,weproposetosetshort,mediumandlongtermexpenditureandresourcetransfertargets.
InAberdeenshire,residentialcareandcareathomeservicesareprovidedbytheCouncilandbyprivateandthirdsectorcareproviders.AberdeenshireCouncilhasexplicitlydecidedtoremainasaproviderofcarewithinamixedeconomyofcareathome.TheCouncilcommissionsapproximately30%ofcareservices.Theremaining70%isprovidedbystaffunderthedirectcontrolofAberdeenshireCouncil.Untilnow,thenumberofcareathomeprovidershasbeenrelativelylow,geographicalspreadhasbeenpatchyandahigherthanaveragenumberofprovidershaveterminatedtheirbusinessintheareaatshortnotice.In2012ajointplanninggroupwasestablishedbetweentheCouncilandprivatehomecareproviderstoexploreanddevelopnewapproachestocommissioningandcontractingforcarewhichwillimprovetheconsistency,sustainabilityandgrowthofthelocalmarketforcareathome.ThisinitiativehasledtoamanagedtransferofhomecarebusinessfromtheCounciltoprivatecareprovidersduring2012andincentivisedpaymentsforproviderswhoarewillingtomoveintoareasofhighdemand,e.g.Banchory,Stonehaven,Westhill.
AberdeenshireCouncilcommissions77%ofcarehomeplacesfromtheindependentsectorandprovides23%inCouncilcarehomes.ThisbalanceislikelytoremainasAberdeenshireCouncilplanstoretainaround200carehomeplacesin-houseinreconfiguredfacilities.
5.5 Funding Carers SupportInaccordancewiththeScottishGovernment’srequirementtodedicateatleast20%oftheChangeFundtocarersupport,theAberdeenshirePartnershipiscommitting£1.05mfromtheChangeFundin2012-13tosupportinformalcarers.InadditiontheScottishGovernmenthasprovidedfundingdirectlytosomelocalthirdsectorcarerorganisations.
AberdeenshireCouncilalsocommissionsdirectsupportforcarersfromthirdsectororganisationssuchasVSA,MentalHealthAberdeen,AlzheimersScotlandandCairScotland,withfundingof£517,224perannum.
CarersinAberdeenshirealsobenefitfromfundinglinkedtotheNHSCarers’InformationStrategy,suchasaccesstoonlinetrainingforhealthstafftoimprovetheirknowledgeandawarenessofcarers’needsandrights.Fundinghasalsobeenusedtodevelopacarers’advocacyservice.
5.6 Capital FundingBetweenMarch2010andMarch2013AberdeenshireCouncilspent£17.2mre-providingCouncilCareHomes,and£0.9mconvertingshelteredtoveryshelteredhousing.
ByApril2016theCouncilplanstoinvestafurther£10.872monbuildingasecondcarehomeandupgradingshelteredtoveryshelteredhousinginareasofhighdemand.
AberdeenshireCHPrecentlyupgradedBanffCommunityHospitalandHealthCentreatacostof£12.3mandadentalpracticeinFraserburgh(£1.5m).Whilsttheseareuniversalservicesahighproportionofusersareolderpeople.
AberdeenshireCHPiscurrentlydevelopinganoptionsappraisalfortheredevelopmentofprimaryandcommunityservicesinInverurie.
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5.7 Change Fund 2010-14
AberdeenshirePartnershipreceivedaround£3mperannumofChangeFundingfromtheScottishGovernment.WehavefocusedourChangePlanonthreethemesandcommittedthefollowingsums: 2012/13• EarlyIntervention £1.058m
• RehabilitationandEnablement £0.871m
• ImprovingLongTermCare £0.994m
Preventionwillremainakeyaimofthisjointcommissioningstrategy,fundinghasbeenusedfornon-recurringdevelopmentssuchasx-rayequipment,andcommunitycapacitybuildingtosupportcommunitiestostartactivities,whichwillbecomeselfsustaining,sotheoverallresourcesrequiredfromtheCouncildonotgrowsignificantly.Asourreshapingcareprogrammemovesmoreactivityfromacutetocommunityhospitalsandhome,weanticipatefundingwillbereleasedfromtheacutesectororprovidedbytheScottishGovernmenttomatchchangingpatternsofresourceuse.
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Chapter 6: Strategic Commissioning Intentions 2012-22
An Overview
6.1 Integration of Health and Social CareWearecommittedtoimprovingthewaylocalhealthandcaresystemsworksothattheexperiencepeoplehavewhentheyneedcareisseamless,effectiveandaccessible.Weaspiretoasinglepointofentrytooutcome-focusedhealthandcareforolderpeoplewithintegratedcarepathwaysdeliveredbytherightteam,attherighttime,intherightplace.
ThedemographicprofileofAberdeenshireoutlinedearlierinthisplanchallengesthecurrentmodelofhealthandsocialcare.Thisjointcommissioningstrategyaimstoaddressthesechallengesthroughreshapingthewayweenvision,designanddeliverhealthandsocialcareforolderpeople.SomeofthesechallengeshavebeenreportedinourChangePlanperformanceframeworkin2011-13.
6.2 Reducing InequalitiesGoodtransportlinksareofvitalimportanceinruralcommunitiestoenablepeopletoparticipate,remainactiveandprovidesupporttoeachother.Creatingandestablishingsustainabletransportsolutionscontinuallyfeaturesasapriorityinallourconsultationswitholderpeopleandcommunities.AberdeenshirehealthandcarepartnershipiscommittedtoworkingasanactivememberoftheCommunityPlanningPartnershiptodeliverthiswithinthelifeofthisjointcommissioningplan.
Throughoutthelifeofthisplan,wewillgiveprioritytoimprovingequityofaccesstoessentialsocialandhealthcareprovisionacrossAberdeenshirebyidentifyingandreversingthewideninghealthinequalitiesbetweenthoselivinginareasofdeprivationandolderpeopleinmoreaffluentpartsofAberdeenshire.Overthenext3-5years,wewillsystematicallyimproveidentificationofhealthinequalities,andincreasinglytarget
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resourcestowardscommunitiesandindividualswithgreatestneeds.Deprivationwillpositivelyinfluenceourdecisionsandrecommendationsforinvestment.
AberdeenshireCounciluseseligibilitycriteriatotargetresourcesfairlyandtransparently.Oureligibilitycriteria,whicharebasedonScottishGovernmentguidance,addressboththeseverityofriskandtheurgencyofinterventionrequiredtoaddressrisks.Oureligibilityframeworkprioritisesrisksintocategoriesofcritical,substantial,mediumandlow.
6.3 A Sense of PlaceAsmoreandmoreolderpeoplearesupportedtoliveintheirownhomethroughoutlaterlife,weanticipatelocalchallengesassociatedwithdiversityandscaleofnewhousingandtheneedtomaximisetheuseofexistinghousingthroughtelehealthcare,equipmentandadaptations.Theextentofunder-occupancywillbedeterminedbytheextenttowhichfuturegenerationsofolderpeoplechoose,orhaveopportunity,todownsize.Weanticipaterisingdemandfromsinglehouseholdsforlivingoptionsthatofferflexiblecombinationsofcareandsupport.
Inordertomeetthesechallenges,wewilldevelopcapacitytoforgeeffectivelinkswiththewiderpublicsectorfamily,buildingonexistingeffectiveCommunityPlanningnetworks,engagingwithcommunitiesandbusinessandthirdsectors.
6.4 Better Outcomes During2012/13weareexperiencingincreasesintherateofpeopleovertheageof65admittedtohospitaltwiceormorewithinayearasanemergency.Thenumbersofpeopleover65attendingAccidentandEmergencyunitsfollowingafallhavealsoincreased.Simultaneously,NHSGrampianisreducingthenumberofacutemedicaladmissionbeds.
WhilethezerotargetfordischargesdelayedbysixweeksormorehasmostlybeenachievedbytheAberdeenshirePartnershipsince2008,thenumberofbeddayslosttodelayeddischargeshasbeenincreasing.Weareworkingtoovercomechallengestoachievezerodischargesdelayedbyfourandtwoweeksoverthecomingyear.
Overthenext3–5yearstheAberdeenshirePartnershipwillmaintainitsfocusonbettermanagementofchronicconditions,fallspreventionandanticipatorycareplanningthroughincreasedpublicknowledgeandawarenessofhealthconditionsandhowtoself-managethese.Inthesameperiod,plannedcarewillbeanincreasingfeatureofthelocalhealthsystemevidencedbyclearpathwayswhichincludere-directionanddecisionsaboutsupportstrategies,andearlydischargefollowedbycommunityrehabilitationandre-ablement.Weanticipateoursustainedapproachtomanagingunscheduledcarewillbringfurtherreductionsinthenumberofoccupiedbeddaysarisingthrougholderpeoplebeinginappropriatelyadmittedtoorremaininginhospital.
Buildingonwell-establishedlinkswithlocalcommunities,localauthorityandothercommunityplanningpartners,NHSGrampian’svisionforcommunityhospitalsistoprovideaccesstolocal,safeandsustainablediagnosticservices,includingcasualty/minorinjury;clinicalandtherapytreatment,GPledin-patientcare,daycaseactivityandbothnurse/therapistandspecialistledoutpatientservices.AlthoughCommunityHospitalsarealreadycentresforthedeliveryoftelemedicinethereispotentialtodeveloptheseassatellitecentresfortelemedicinelinkingintospecialistandsecondaryhealthcare.TherespectiveroleandcontributionsofARIandAberdeenshire’scommunityhospitalswillberefinedtoimproverapidaccesstoout-patientassessment,diagnosisandtreatmentandappropriateplannedtransfersbetweenacuteandcommunityhealthandcarefacilities.
Duringthenextthreeyearswewillrefineourapproachtomeasuringoutcomestoensurethattheyaremetforpeoplewhouseourservicesandtheircarers.Surveysin2011/12ofolderpeopleatmediumriskofunplannedhospitaladmissionandtheircarershaveevidencedgeneralsatisfactionwithservicesandinvolvementinthedesignoftheircare.However,thesealsoconfirmthatmoreneedstobedonetosupportpeopletofeelsafeathome,andtosupportcarerstocontinueintheircaringrole.
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6.5 Public Expectations, charging for care and the mutual care debateWerecogniseandembracethebroaderstrategicchallengeofchangingpublicattitudesamongstnorth-eastrural,agricultural,andfishingcommunities.ManyAberdeenshirecommunitieshaveastrongsenseofcivilsocietyandatraditionofself-sufficiency.‘Grassroots’initiativeshavegrownacrossAberdeenshireoverthepastdecadethatprovidesocialandpracticalsupporttooldercitizensincommunities.Some(suchastheSilverCircleinStrathdon)areregularlycitedasexemplarsofwhatcommunitiescanachievetodirectlyadvancehealthandwellbeinginaholisticandinclusivefashion.WeaspiretoseethewholeofAberdeenshireservedbyacomprehensivenetworkoflocalinitiatives,sothatolderpeopleareincludedinthelifeoftheirlocalcommunity,wherevertheyhappentolive.Inmanyinstances,thecreation,andcontinuedexistence,ofsuccessfulcommunityinitiativesinaparticularvillageorneighbourhoodcanbeattributedtotheexistencewithinthatcommunityofafewdedicatedcommunityactivistsand‘socialentrepreneurs’-peoplewiththemotivation,confidence,resourcefulnessandcommitmentto‘getthingsdone’withintheirownlocality.Aspartofourcommissioningintentions,wewillseektodevelopcapacitywithinallofAberdeenshire’sdiversecommunities,sothatallcommunitiesareenabledtolookaftertheneedsoftheiroldergeneration,eitherthough‘importing’andadaptingideasthathavebeentestedelsewhere,orbycraftinginitiativesspecificallytailoredtotheneedsandresourcesoftheirparticularcommunity.
Thereisgrowingunderstandingoftheimpactofasignificantlyageingpopulation.Thiscannotbemetbythecurrentmodelofpublicserviceor,indeedbythecurrentlevelofresourceavailableinthestatutoryhealthandsocialcaresector.Eventhoughsomeofthefinancialimpactofthisdemographicpressurewillbedefrayedbyimaginativeapproachestosupportingtheoldergeneration,thereremainsamajorfundinggapthatwillrequiretobemetfromincreasedgeneraltaxationorfromamutualcareapproachwhereindividualsandtheirfamiliesmeetthecostsoftheircareinoldage.In2012manyfrailorvulnerableolderpeoplearewhollyorpartlysupportedtomanagetheirhealthandindependencebyfamily,friendsandcommunitiesandwewillendeavourtoensurethesepeoplearerecognised,offeredsupport,respite,trainingandguidancetoallowthemtocontinuetocare.
Finallyourrolewillbetochangesociety’sviewaboutwhatpeoplecandoforthemselvestoimproveandmaintaingoodhealthand,tomaximisetheirqualityoflifethroughselfmanagementofillnessorchronicconditions.Asweoutlinelaterinthischapterweintendtouseallmeansofcommunicationtoensurepeopleunderstandhowtheycanlivehealthierlivesandengageallpartnersinsupportingpeopletodoso.
6.6 Improving Personalisation, Choice & ControlPatientcentredcareandselfdirectedsupportwillhaveanincreasinginfluenceonourcommissioningintentionsoverthenext3-5years.Increasingly,individualswillmanagetheirownpersonalcarebudgetsandwillbecommissionersintheirownright.Thesocialworkrolewillre-focusonstimulatingthemarketandfacilitatingaccesstoinformationandadvicesothatpeoplecansourcesupporttomeettheiroutcomes.Weanticipatethat,withinfiveyears,internalandexternalcaremarketswillevolvetoreflectcitizendemandforgreaterchoiceandcontrolovertheircarearrangements.
6.7 Creating A Sustainable Local Market for CareWearesucceedinginouraimtoreducetheproportionofolderpeoplemovingintocarehomes(seefigure13inChapter4).Withinthenext3years,thiswillpresentachallengeforprivatecarehomeproviders,whowillrequiretotailorfuturecapacityinlinewiththesetrends,anddiversifybusinessplanstomeettheaspirationsandexpectationsofanewgenerationofolderpeople.
TheAberdeenshirePartnershipwillhaveagrowingandimportantroleinmanagingthelocalmarketforcaretoensureadequatecapacityanddiversityexistsineachofthesixareasofAberdeenshire,offeringchoiceandhighqualityresidentialcare,careathomeandcommunitysupportservices.Intheshortterm(1-3years),theCouncilplanstostrengthenthelocalindependentcaremarketbyattractingnewprovidersandofferingmutuallyattractivecontracttermswhichwillsustainastrong,healthyprivatecaremarketofferingolderpeoplechoice,responsivenessandhighstandardsofquality.
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Thelocalauthoritywillcontinuetohaveanimportantroleinmonitoringcommissionedcareservicestoensuretheyaresafe,reliable,responsibleandmeetingtheexpectationsandneedsofourcitizens.Onlythoseserviceswhichcanclearlydemonstratethattheyaredeliveringoutcomeswillcontinuetobecommissioned.
A. Early Intervention and Prevention
A.1 Strategic OutcomesWewilldeliverthefollowingStrategicOutcomessothatOlderPeoplecan;• remainindependentandintheirownhomeforaslongaspossible• livelifetothefull,maximisingtheirhealthandwellbeing• feelsafeandsecurewithintheirhomeandcommunity• accessarangeofhousingoptions• havegreaterchoiceandcontrolovertheirlives• feelpartoftheircommunityandsociallyengaged• haveunpaidcarerswhoaresupportedtocontinueintheircaringrole
A.2 Living Well in Later Life – Building Individual and Community CapacityInAberdeenshire,werecognisethatthesocial,environmentalandeconomicdeterminantsofhealthandwellbeing,inotherwordsthecircumstancesinwhichpeoplelive,workandretire,willcontinuetochangedramaticallyfromthoseofpreviousgenerations.ThemajorityofolderpeoplereceivenoformalservicesfromtheNHSorsocialworkonanongoingbasisandalthoughtheproportionofolderpeoplerequiringcareisincreasing,65%ofthoseaged85andoverreceivenoformalsupportorcare.Farfrombeinga“burden”onsocietyolderpeoplearethemselvesvolunteersinmanysettings,withsomevolunteersbeingolderthanthosetheysupport.Manyarecarers.
In2008theNationalEconomicFoundationreviewedtheinterdisciplinaryevidenceofover400scientistsfromaroundtheworld.Theyidentifiedasetofevidencedbasedactionstoimprovementalandphysicalwellbeingwhichindividualscanbuildintotheirdailylives.Wewillpromotetheseactionsasakeyelementofourapproachtoearlyinterventionandprevention:• connectwiththepeoplearoundyou,• beactive,• takenotice,• keeplearning,and• give.
Intheshorttomediumterm,adedicatedcommunicationsofficer,fundedfromtheChangeFund,isusingarangeofmediatodisseminatemessages,challengestereotypesandpromoteeventsandactivitieswhichinvolveandengagewholecommunitiesaroundsupportforolderpeople.
WewillworkcloselywiththosetakingforwardtheFuelPovertyActionplan,ensureallstaffworkingwitholderpeopleareequippedtoidentifyfuelpoverty,andhelppeopleaccesssupporttomaintainandrepairtheirhomes.
Apreviouslystatedpoordiet,lackofexerciseandobesityareassociatedwithanincreasedriskofstroke,coronaryheartdisease,Type2Diabetesandcertaincancers.Physicalactivitycanalsoimprovementalwellbeing.Physicalactivitylevelsappeartodecreasewithageandobesitycurrentlyincreaseswithageuntilapeakisreachedinthoseaged55-64andthendeclines.Publichealthprogrammesarebeingcommissionedwhich,thoughnotdirectlyaimedatolderpeople,willincludetheminthetargetgroup.Ourstrategicintentistoco-ordinateandlinkolderpeople’sservicesanduniversalprogrammes.Examplesincludecommunitytrainingkitchensofferingfoodskills,healthyeating,nutritionandcommunityallotments;healthpromotingNHSwithanincreasedemphasisinthehospitalsettingtoensurethat“everyhealthcarecontactisahealthimprovementopportunity,”payingparticularattentiontosmokingcessation,physicalactivity,foodandhealthandactivetravel;socialprescribingbyAberdeenshireprimarycareteamsandleisureservices;developinga
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genericexercisepathwayandphysicalactivitybriefinterventionsinaccordancewithnationalguidelines;anddevelopingaHealthyEatingActiveLivingStrategywithassociatedactivitysuchashealthyweightprogrammesdeliveredthroughGPpractices,alcoholbriefinterventionsdeliveredbyGPsandotherhealthorthirdsectorprofessionals.Preventionprogrammestargetingyoungeradultswillbedesignedtochangethehealthoutcomesoffuturegenerationsofolderpeople.
NHSGrampianwillcontinueaproactiveapproachincommunities,hospitalsandcarehomestoensuredietaryandfluidintakeandoutputisrecordedandmonitored.
WewillcontinuetoworkwithCommunityPlanningPartnerstoco-ordinateandstimulateactivitiesthatsupportearlyinterventionandpreventionintheoldergeneration.
Itisimportantthatlifelonglearningfullyembracesthespecificneedsandpreferencesofolderpeopleandthatopportunitiesaremaximisedtocreateawiderangeofopportunitiesforolderpeopletoparticipateinlearning.
TheAberdeenshirePartnershipanticipatesthatoverthenext3–5years,allthesemeasureswillcollectivelyandindividuallyhaveapositiveandcontinuingimpactonthementalandphysicalhealthandwellbeingofouroldergenerations,preventingordelayingtheirneedforformalcare.
Byadoptingaco-productionfocus,webelievearelativelysmallamountoffundingcanstimulatewidespreadanddiverseactivityandgoodoutcomesforindividualsandcommunities.TheAberdeenshirePartnershipiscommittedtogrowinganetworkofearlyinterventionandprevention,inclosecollaborationwiththeCommunityPlanningPartnership,firmlyfocusedonthefiveimportantactions.Werecognisetheimportanceoforganicandopportunisticapproachesandwewillnotspecifyexactlywhatwillbecommissionedinfuture.Weplantodevelopmechanismstoscaleupinitiativeswhichdemonstrateparticularlygoodoutcomes,whereappropriate.
Inplanningforthemajorpopulationchangesthatfaceus,AberdeenshireCouncilcommissionedLowlandResearch,anindependentresearchcompany,togaugetheviews,aspirationsandintentionsofarepresentativegroupofAberdeenshire“babyboomers”abouttheircareandlivingarrangementsinolderage.Thefindingsin2010reinforcedtheaimsofourpolicydirectionintermsofpeople’saspirationtoliveindependentlivesforaslongaspossibleintheirexistingcommunities,withaccesstoatariffofcareandsupporttailoredtomeetindividualneedsinavarietyofaccommodationtypesincludingbungalows,sheltered,veryshelteredhousingandcarehomes.Acitizenspanelsurveyin2011expressedthesamepreferencesregardlessofageofrespondents.
TheAberdeenshirepartnershiprecognisesthefundamentalimportancetoindividualsastheyage,ofmaintainingnaturalcirclesofsupportandopportunitiestocontinuelivingintheirexistingcommunitieswithaugmentedcarewhentheyneedit.Weaspiretoreflecttheseviewsinthewayweplananddelivercare,healthandaccommodationacrossAberdeenshireforfuturegenerationsofolderpeople.
A.3 Housing with SupportTheAberdeenshireassetmanagementstrategyforolderpeopleaddressesawidervisionforAberdeenshire’scitizens:creatingchoicethroughamixedprovisionofcarehome,supportedlivingandaugmentedhousingforolderpeopleacrossthecouncilarea.ThisapproachisreflectedintheLocalHousingStrategyandtheCouncil’sStrategicLocalPlan(SLP),whichincludesplanneddevelopmentof1and2bedroombungalowsoverthenext3years.
Between2012and2015someoftheCouncil’sexisting63shelteredhousingcomplexeswillbere-modelledtocreateveryshelteredhousingoptionsinlocalitieswherenoneexistatpresentandwhereneedisidentifiedforthistypeofaccommodationwithcareandsupport.Inadditionopportunitiestoconsiderre-designingCouncilandRSLownedandoperatedshelteredhousinginthemediumterminlinewithpopulationneeds,willalsobeconsideredaspartofourstrategy.
MaximisingexistingstockacrossalltenuresforolderpeopleisalsoakeyactionintheLocalHousingStrategyandcorrespondswiththeaimofthisstrategytomaximiseindependentlivingopportunities.Adaptations,
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anddementiadesignprinciplesandtelecareworkwelltoprovideoftensimpleandeffectivewaysofassistingpeopletoremainintheirownhomeforlonger.Itiswellknownthattheseareimportantfactorsthatcanenhanceindependentlivingopportunities.
A.4 Supporting Informal Carers In2009/10about11%ofadultsofallagesinAberdeenshireprovidedunpaidcare(source:ScottishHouseholdSurvey).ThisisbroadlycomparablewiththeScottishaverage.Althoughthereisnolocaldataavailable,nationaldatademonstratesthatolderadultsbetween45and64(i.e.ofworkingage)aremorelikelytobecarersandolderpeopleagedabove64aremorelikelytorequirecare.Carersagedover65self-assessedashavingbetterhealththannon-carersofthesameage.Thissuggeststhatoldercarersderivesomebenefitfromcaringbutthismaydependonfactorssuchastheavailabilityoflocalsupportandhowfinanciallysecuretheyare.
Wearecommittedtoincreasingtherangeandfrequencyofsupportavailabletocarersoverthenextthreeyears.Wewillcontinuetofundthirdsectororganisationstodeliversupport,advice,informationandtrainingforcarers.Wewillendeavourtomakeiteasierforcarerstopursuealifeoutsidetheircaringrole;evidencehasshownthatsmallamountsoffundingallowcarerstoaccesspersonaldevelopmentorleisurefacilities,andwewillseektomainstreamtheseapproaches.Awiderangeofflexibleshortbreakoptionswillbeavailable,inadditiontoresidentialandcommunitysupportmodels.Individualbudgetswillcreateopportunitiesforcarersthemselvestodesignflexible,tailor-madeshortbreaks,whichmayincludefriendsandfamiliesofferingsupportandcareforserviceuserstoaccompanytheircarertoachosenholidaydestination.
Increasingly,carerserviceswillbejudgedandmeasuredonhowwelltheyenablecarerstocontinueintheircaringrole.Thisoutcomewillbecomefundamentaltoourcommissioningapproach.
A.5 Care Management and Personal Support Planning Duringthenextthreeyears,newself-directedsupportarrangementswillmeanmorepeople,includingolderpeople,willbemanagingtheirownbudgetforcare,usingarelativelysimplesupportedself-assessment.Anolderpersonchoosingtomanageapersonalbudgetwillworkwithacaremanagertodecidetheoutcomeshe/shewantstoachieve,intermsoftheirpersonaldevelopment,recoveryorimprovedqualityoflife.Services,activitiesorproducts,designedtodeliverdesiredoutcomes,maythenbepurchasedbytheindividualusinghis/herindividualservicefundorpurchasedforthembyanominatedproviderorganisationorarrangedbyacaremanager.Thisnewapproachtodesigninganddeliveringcareandsupport,aimstoincreasethechoiceandcontrolthatpeoplehaveovertheirlivesandtheircareandsupportarrangements.Itavoidspeoplebeingfittedintoatariffofavailableservices,whichareoftencostlyandmaynotdelivertheoutcomesthepersonwantsorneedstoimprovetheirwellbeingandqualityoflife.
A.6 Diagnosis and Treatment AkeystrandofourapproachinAberdeenshiretoearlyinterventionandpreventioninolderageistodevelopcapacitytoinvestigateandtreatproblemsmorespeedily,eitherlocallyorinacutehospitals.Toachievethis,wewillimproveaccesstoearlydiagnosisofdementiaandincreasethecapacityofprimarycareteamstotreatandmanagepatientswithdementiaclosetohome.Wewillcontinuetogrowtherangeoflocally-basedservicesthatfacilitaterapiddiagnosisandpromptaccesstotreatmentofacuteandchronichealthconditionsasclosetohomeaspossible.ThisincludeslocalaccesstoplainX-ray,ultrasound,endoscopy,cystoscopy,exerciseECG,echocardiography,Holtermonitoring,minorsurgery,cancerfollowup,dermatology,orthopaedics,diabetes,pointofcaretestingforINR(teststhataGPcandototestforheartfailure,DVD(deepveinthrombosis)orwhetherpeoplearehavingaheartattack)andcardiacmarkers,whichtakenwithaclinicalassessmentand ECGcaneliminate60%ofpatientspresentingtoA&Eunnecessarilywithchestpain.
Duringthenext3-5yearswehaveambitionstoaddDEXA(amachinewhichmeasuresbonedensityandchecksforosteoporosis),MRI(MagneticResonanceImagingusedtodiagnosehealthproblemsaffectingorgans,tissuesorbone)andCT(ComputerisedTomographyaspecialkindofX-raymachine,whichallowsmoredetailedimagestobeconstructedthanordinaryX-rays)scanningandchemotherapytotherangeoflocally-availablefacilities.
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Wewillbasetheseserviceswithinnaturalcommunitieswhereitissafeandaffordabletodoso;wewillimproveaccesstodiagnosticandtreatmentfacilitiesatAberdeenRoyalInfirmarywhenitisnotandweplantoharnessthepotentialoftelemedicinetoroutinelydiagnose,treatandmanagearangeofconditions.
DevelopmentsofthiskindhavealreadyallowedustomanagemorepatientswithinGeneralPracticeoronanout-patientbasis,avoidingunnecessaryhospitaladmissions.Thiswillbeanincreasingfeatureaswedeveloptherangeoflocallyaccessiblediagnosticandtreatmentservices.
AccesstotimelydiagnosisforpeoplewhohaveconcernsabouttheircognitivefunctionwillcontinuetobeapriorityfortheAberdeenshirepartnership.Overthenext3yearsweintendtoincreasecapacityinprimarycareservicestodiagnoseandmanagepatientswithdementia.ThiswillincludedirectaccessbyGPstoCTheadscans.Throughtimelydiagnosis,morepeoplehaveopportunitiestoaccessadvice,support,treatment,and,withtheirfriendsandfamily,planforthefuturewhiletheyremainwell.AberdeenshireGPsbelievethatlocalcapacitywouldbeenhancedbyrecentlyestablishedperipateticoutreachteams,incorporatingAlzheimersScotlandlinkworkers,whosupportassessment,postdiagnosticsupport,andengagementincommunityactivities.
Overthenextthreetofiveyearswewillcontinuetopromoteandcommissionopportunitiesforpeoplewithdementiatobesupportedintheirlocalcommunitiessuchasdementiacafes,localprojects,groupsandspecialistdayservices.
A.7 Self Care and Managing Long Term Conditions OurcommissioningintentionsreflecttheimportanceofreducingriskandimprovingoutcomesforfuturegenerationsofolderpeopleinAberdeenshire,asoutlinedintheenvironmentalscanchapter.Wewilldothisbypromoting,encouragingandreinforcingwaysthatpeoplecanaddressfactorssuchasexercise,diet,smokingoralcoholconsumptionthataffecttheirriskofdevelopingdebilitatinghealthconditionsinlaterlife.Wewillfacilitateearlydiagnosisandself-managementofhighbloodpressureandhighcholesterol.Selfcareisavitalpartofdevelopingpersonalautonomy,butisalsoakeyenablerforthePartnershiptomanagechangingdemographyandrisingdemand.
Inrecentyears,wehavesuccessfullyappliedarangeofapproachestomanaginglongtermconditionswithinprimarycaresuchasdiabetes,coronaryheartdiseaseandCOPD.TherateofdeathsfromheartdiseaseinGrampianisdecreasingandweaimtomaintainthistrendoverthenexttenyearssothatasmallerproportionofthepopulationarelivingwithheartdiseaseand,inturn,placinglessdemandonstatutoryhealthandcareservicesinthefuture.
Self-managementprogrammesforpatientswithestablishedchronicconditionsareevolvingincrementallyandweplantoacceleratethepaceofchangeinthenextfiveyearssothatmorepeoplearesafelyself-managingtheirhealthconditions.Duringthenextthreeyears,wewilldevelopourcapacitytosupportpeopletoselfcarewhentheyexperienceminorailmentsorconditions,e.gthroughre-directiontointernetadvice,localpharmaciesetc.
A.8 Falls Prevention Oneinthreepeopleover65andhalfofthoseaged80andover,falleachyear.Aquartertoonethirdofthesefallscouldbeprevented.AroundhalfofattendancesatA&Eforpeople65yrs+canresultfromfallsandevi-denceshowsthat50%ofthosewhofallwillhaveanotherfallwithin12months.MuchworkhasbeendoneinrecentyearsinAberdeenshiretoidentifyolderpeopleatriskofinjuryfromfallsandhelpthemtoreducetheirrisk.Thishasbeenachieved,inlinewithnationalfallsstrategies,byco-ordinatingtheeffortsofawiderangeofprofessionalssuchastheFire&Rescueservice,CareandRepairServicesandthirdsectororganisationsandgroupssupportedbyDietetics,OccupationalTherapy,Pharmacy,PhysiotherapyandPodiatryspecialties.
Ourforwardstrategyemphasisestheimportanceofindividualstakingresponsibilityfortheirownsafetyandhavingacentralroleinplanninghowtoreducetheirriskoffalls,e.g.bytakingopportunitiestoimprovetheirstrengthandbalanceandaddressothercausativefactorsinfalls.Wearealreadymakingprogressintheselfmanagementoffallsbydeliveringanationallyevidence-basedhomeexerciseprogramme(OTAGO).Wewillexplorehowbesttodevelopcommunitypathwaysforthosewhofallandhowtosupportindividualswhofallintheirownhome,ratherthanadmittohospital.
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Thereisalinkbetweenincreasedriskoffallsamongstolderpeopleandalcoholmisuse,poormemoryandharmfulinteractionwithmedication.Thisisanemergingareaofconcernandweaimtoimproveself-awarenessoftheserisksandinfluenceachangeinculture.Wewillencouragethosewhoroutinelycomeintocontactwithfrailolderpeopletoconsiderfallsrisksandsignpostindividualstoappropriatehelptoreducetheirriskofinjury.
B. Rehabilitation and Enablement
B.1 Strategic OutcomesHealthandcareactivitywillbedesignedanddeliveredtohelpOlderPeopleto:
• besupportedtoregainandretaindailylivingskillsandabilitiesandremainindependentathomeforas longaspossible
• livelifetothefull,maximisingtheirhealthandwellbeing
• feelsafeandsecurewithintheirhomeandcommunity
• increasechoiceandcontrolovertheirlives
• feelsociallyengagedandpartoftheircommunity
B.2 Moving from Maintenance to Recovery and RehabilitationWithinthenextfiveyears,allprimaryandcommunitycarepractitionerswill,throughtrainingandpracticedevelopment,re-orientatethemselvesfromamaintenancemindsettooneofrecoveryandrehabilitation.
Ouraspirationisthatolderpeopleexperiencingacuteillnessorexacerbationsreceivetreatmentinthemostappropriateplace,withasfewmovesaspossible.Webelievetreatmentshouldbedeliveredathomeifatallpossibleorinahospitalifanolderpersonrequiresclosemedicalsupervision.Werecognisetheimportanceofrapidandintensiverehabilitationandenablementwithincommunityhospitalsandinprimarycare.Inpursuitofourvision,wehaveusedChangeFundingin2012/13toimproveaccesstocorephysiotherapyandoccupationaltherapyprovisioninlocalhospitals.Whereitisnolongerconsideredappropriateforolderpeopletocompletetheirrecoveryortreatmentinhospitalwesupportamodelofintermediatecareathome.Thereisgoodevidencethatbed-basedintermediatecaremodelsleadtobedsbeinginappropriatelyusedinaplaceotherthanahospital,andthatmanypeopledonotreceivetheintensivetherapeuticinterventionspromisedbysuchanintermediatemove.
TheAberdeenshirePartnershipconsidersthatthefunctionofcommunityrehabilitationandenablementisthesame(orbetter)thanintermediatecareinaninstitutionalsetting.Thefactthatithappensathomeleadstobetteroutcomesfortheindividualthanashortstayintermediateplacement.Anindependentevaluationofourpilotrehabilitationandre-ablementprojectswillinformourfuturemodelofintegratedrehabilitationandenablement.
B.3 Care at Home
20%ofthepopulationaged85andoverreceivecareathome.Ourstrategiccommissioningintentionistoprovideaseamlesscareathomeservice24houraday7daysaweek,whichprovidesacombinationofplannedandunscheduledcare,respondingtounplannedneedthrougharesponderservice,describedinChapter4,whichmustbecapableofdeliveringaflexible,tailored,reliableresponsetomeetthefullrangeofspecialisedandgeneralpersonalcareneedsofpeoplewithdementia,terminalillness,physicalfrailtyaswellasrecoveryandrehabilitationdescribedabove.Itislikelythatrecoverywillbeembeddedinourdeliverymodelandintimeoccupationaltherapistswillsupportthatagenda.
In2012/13AberdeenshireCouncilprovidesandcommissionsinexcessof15,000hoursperweekofcareathomeservices.Around70%isdeliveredbythein-househomecareserviceand30%iscommissionedfromthirdandindependentsectorcareproviders.
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TheCouncil’spolicyistoremainasasignificantproviderofcareathomeserviceswhilecreatingandsustainingaviableindependentcaremarketacrossAberdeenshirebygraduallyandcontinuallyincreasingtheprocurementofhighqualityindependentcareathomeservicesoverthelifeofthisplan.Theexpansionofselfdirectedsupportislikelytohaveanimpactonthecareathomemarketbutweanticipatethatpeoplewillchoosehighqualityserviceswhichcandelivergoodoutcomesforthebestprice.
Werecognisethefuturechallengesfacedbyallcareprovidersofstaffrecruitmentandretentioninanareaoflowunemploymentcombinedwiththeimpactofruralityoncostsandavailabilityofservices.WeacknowledgethismightmeananaddedunavoidablecostpressureoverthenextfiveyearsinordertomeetdemandacrossthelargeremoteandruralareathatisAberdeenshire.
Furtherattentionisbeingpaidtotheroleandremitofcareathomeworkers,withimplicationsforanincreasedleveloftrainingastheyareincreasinglyexpectedtoproviderehabilitationandenablement,dementiacare,supportgoodnutritionand,undercommunitynursesandpharmacist’sguidance,medicinemanagement.
B.4 Telehealthcare Creativeandinnovativetechnologicalsolutionsthatgivefasteraccesstodiagnosis,treatmentandsupport,reduceriskandimprovepersonaloutcomesforolderpeoplewillbeasignificantareaofdevelopmentfortheAberdeenshirePartnershipoverthenextthreetofiveyears.Professional“champions”withinthehealthandsocialcareworkforcewillhelpusstepupthepaceofinnovationandchangeinthewayweharnessandsupplyemergingtechnologiesinoureverydayworkwithfrailandvulnerablepeople.
OurinvestmentintelehealthcarehasgrownannuallythroughjointinvestmentbyboththelocalauthorityandtheNHS,augmentedinrecentyearsbytheChangeFund.LongtermfinancialsustainabilitywillbeachievedthroughincomegeneratedfromchargesandsavingsgeneratedthroughreductionsincarehomeandhospitaladmissionsOurtargetbetween2011-13hasbeentoincreasethenumberofpeopleover75whoaresupportedwithtelehealthcarebyaminimumof1%peryearandthishasbeenconsiderablyexceeded.Inthelasteighteenmonthswehaveincreasedtheproportionofpeopleaged75andoverwithatelehealthcarepackage(excludingcommunityalarms)from3.9per1000to6.8.Wewillreviewourtargetin2013withaviewtoincreasingtherateoftake-up.
AllEmergencyDepartmentsinAberdeenshirecommunityhospitalscurrentlyhaveaccesstotelemedicine,mainlytosupportfracturemanagement.Overthenextthreeyearsitisintendedtodevelopopportunitiestosupportout-patientactivitiesandout-of-hoursnursingsupportbyembracingtheiruseoftelehealthcareintheircareprocesses.
B.5 Day Activities for Frail Older People & People with Dementia Werecognisethevalueofourexistingdaycareservicesaswellastheirpotentialtore-focustheireffortsinlinewiththeneeds,aspirationsandlifestylechoicesoffuturegenerationsofolderpeople.By2014wewill,withcommunityplanningpartnersandolderpeoplethemselves,re-designdaysupportforolderpeoplewithanemphasisonrecovery,communityinvolvementandflexibility,takinganintegratedapproach.
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C. Improving Long Term Care
C.1 Strategic OutcomesHealthandCareactivitywillbedesignedanddeliveredsothatOlderPeoplecan:
• beassuredofhighqualityofhealthandcarecommissionedorprovidedbyAberdeenshireCouncilor CHP
• livelifetothefull,maximisingtheirhealthandwellbeing
• feelsafeandsecurewherevertheyreceivetheirhealthandcareservice
• haveaccesstoarangeofaccommodationwithcareoptions
• exercisegreaterchoiceandcontrolovertheirlifestyleandhealth&care
• feelsociallyengagedandpartoftheircommunity
• maintainmutuallypositiverelationshipswithinformalcarers,friendsandrelatives.
C.2 Specialist Dementia Care Increasingthecapacityofprimarycaretodiagnoseandtreatpeoplewithdementiawillfreespecialistandsecondarycareservicestoworkwithcomplexcasesandproviderapidresponsetoprimarycareclinicians.
InlinewiththeNationalDementiaStrategyforScotland,AberdeenshirepatientshaveaccesstoaDementiaNurseConsultantintheacutehospitalsector,supportingtheworkofdementiachampionsandcommunitynursestrainedinbestpracticeindementiacare.Animportantelementoftheirworkistoimprovethequalityofcareandexperienceforolderpeopleinacutehospitalsettings.In2012/13theChangeFundhasbeenusedtodriveupstandardsacrossallsectorsthroughtrainingfornursingandsocialcarestaffinadvanceddementiapractice.Feedbackonthismultiagencyandsectorapproachhasbeenextremelypositive.
During2012,atrainingmanualinpsychosocialcarehasbeendevelopedforcarersofpeoplewithdementia,byRGUandaconsultantneuropsychologist.Followingevaluationoftheproject(fundedbytheChangeFund)itisintendedthattraininganduseofthemanualwillbecascadedtocarersupportproviderstocontinuetheinitiativeroutinelyoncefundingceases.
WeenvisionthatcareforpeoplewithdementiawillincreasinglybecommissionedandmanagedlocallywithintheAberdeenshirePartnership.Overthenextthreeyears,moreGPswillundertakeadditionaltrainingtoincreasethecapacitytodiagnoseandtreatmorepeoplelocally.Secondarycareserviceswillbetargetedonthoseindividualswithcomplexbehaviouralproblemsorotherexceptionalneeds.Byplanningtousespecialisthospitalbedsoverseenbyconsultantsincommunityhospitalsandinreachsupporttocarehomes,wewillprovideaccesswithinlocalitiestothefullspectrumofdementiacareforolderpeopleandtheircarersthroughouttheirillness.
C.3 Long term Care WerecognisethatreshapingcareforolderpeoplewillhaveadirectandsignificantimpactonthecarehomemarketinAberdeenshireintermsofthesizeofthesector,physicalenvironmentandphilosophyofcareforfuturegenerationsofolderpeople.Traditionally,Aberdeenshirehashadasizeableprivatecarehomemarketwithalmost1500bedsavailable.Approximately60%ofallcarehomeresidentsarefullyfundedbyAber-deenshireCouncil.ThequalityofcareincarehomesinAberdeenshireisgenerallyassessedasgoodbutweaspiretocontinuouslydriveupstandardsacrossthearea.Thegeographicallocationsandqualityofcareforindividualsisnotequitable.Thereisanimbalancebetweendemandandavailabilityofspecialistdemen-tiacarehomeplacesandanover-provisionofunitsforfrailolderpeople.Inrecentyears,confidenceinthequalityandsustainabilityoftheprivatecarehomemarkethasbeenadverselyaffectedbybusinessfailures,closuresandpoorinspectionreportsfromtheregulator.Thelocalcarehomemarkethaslargelybeenshapedbyspeculativeratherthanplanneddevelopmentandweaspire,throughtheimplementationofthisjointcommissioningstrategy,toshifttheemphasistowardsacarehomemarketthatisfitfor21stcenturylivingandtailoredtomeetthedemandsandexpectationsoffutureoldergenerations.
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AberdeenshireCouncil’scarehomemodernisationstrategyforitsowncarehomesembodiesthepolicyaimsofimprovingchoiceandquality,creatinghomelyaccommodationandmodernsustainablecareenviron-mentsforolderpeoplewithcomplexcareneeds.Weanticipatethattheaverageage,levelofdependencyandmentalandphysicalfrailtyofpeoplemovingintoacarehomewillcontinuetoriseinfuture,aswesupportmanymoreolderpeoplewithcomplexhealthandcareneedstoliveathomewithsupport,orinshelteredorveryshelteredhousing,iftheychoosetodoso.
TheCouncilintendstoremainaminorityproviderinamixedeconomyofcareaccountingforapproximately14%ofcarehomeplacesinAberdeenshire.By2018,thecouncil’smodernisationstrategywillcreateandsus-tainthehighestqualityofaccommodationandcarethatareexemplarsforthecarehomemarkettoensurethatolderpeoplehaveaccesstopublicprovisioninornearallmainsettlementsofAberdeenshire.Eachlocalauthoritycarehomewillincorporatespecialistdementiaprovisionandon-sitenursingcaredeliveredinapartnershipwiththeNHS.Carehomeswillofferahomeforlifetopeoplewhomovein,withcapacitytodeliverpalliativecare,respiteforcarersandshorttermrehabilitation.Themodernisationstrategypromotesacarevillageconceptcombiningcarehomeprovisionlocatedalongsideaffordablerentedhousingforolderpeople,linkedbytelehealthcare,whereolderpeoplecanliveindependently,semi-independentlyorinfullysupportedcarehomeaccommodationthroughoutlaterlifewhileremaininginandclosetotheirestablishedcommunitynetworks.Thepartnershipiscurrentlyexploringthepotentialtoincorporateacuteassessmentin-patientservicesinoneormorecarehomesinfuture,acknowledgingthebenefitsofco-locatinghealthandsocialcareprovision.
In2012/13therewere41independentcarehomesforolderpeopleinAberdeenshire.Occupancylevelsaregenerallydeclininginmanyhomesandweanticipatethisislikelytoincreaseinthenextfiveyearsasourreshapingcareplansbecomeembeddedandolderpeoplehavegreaterpersonalchoiceandcontrolovertheircareandaccommodationarrangements.Tosomeextent,thesechoiceswilldrivechangeinthecarehomemarket.EquallytheAberdeenshirehealthandsocialcarepartnershipwillseektomanagethedecom-missioningprocessinaplannedandtransparentwaythatminimisesdisruptiontoexistingandpotentialresidents.Withinthenextthreeyearswewillberefiningourapproachtocontractingandcommissioningtosupportandpromotecarehomeproviderswhoconsistentlyrecordpositiveoutcomesforresidentsandhighinspectiongradesforquality.Wewillbringforwardacoherentplan,involvingcareproviderslocallyandnationally,theregulators,communityplanningpartners,localauthorityelectedmembersandplanners.
Amentoringofficer,fundedbytheChangeFund,isengagingthecarehomesectorinapproacheswhichwillsharebestpracticeandsupportproviderstoaddressdeficits.
Inpolicyterms,veryshelteredorextracarehousingcouldpotentiallyhavethegreatestimpactonthepartnership’sabilitytoachievekeynationalhealthandcarepolicytargetsonreshapingthebalanceofcare,personalisationandself-managementoflongtermconditions.Aberdeenshire’shousingforparticularneedsstrategyaimstosupportaccesstoaffordablehousingforpeoplewithhigherlevelsofneed.WewilldothismainlybyincreasingthenumberofveryshelteredhousingcomplexesacrossofAberdeenshire.Someofour63shelteredhousingcomplexesofferpotentialforremodellingand,usingtheChangeFund,planshaveal-readybeenapprovedtoremodelthreeshelteredtoveryshelteredhousingcomplexesinlocalitieswherethegrowthintheolderpopulationispredictedtocreatethegreatestpressureonlivingaccommodation.Theseshorttermactionswillincreasethenumberofveryshelteredhousingunitsfrom135to243by2016.
Ourcommissioningintentionsextendbeyondthis,however,andby2018weaspiretooffer,inpartnershipwithregisteredsociallandlordsandprivatedevelopers,veryshelteredorextracarehousingfacilitiesembed-dedincommunitieswherethereiscurrentlynoneorinsufficientcapacity,i.e.Marr,BanffandBuchanandKincardineandMearns,subjecttoavailablerevenue.Threenewcouncilcarehomesarebeingdevelopedwithinacarevillageconceptwhichincorporateaffordablehousingforrentbyolderpeopleonthesamecampusasour24hourcarefacilities.
Agrowingnumberofadultswithlearningdisabilitiesarelivinglongerandfacingthechallengesofageingalongsidetheirpre-existingconditionsanddisabilities.Extracarehousingthatcanmeettheparticularneedsofolderadultswithalearningdisabilitywillbeafeatureofourcommissioningplansoverthenext10yearsandweanticipatethatover100veryshelteredflatsinsixcomplexeswillbeallocatedtoolderadultswithalearningdisability.
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C.4 Acute and Intermediate Health Care AcutemedicalinpatientcarewillcontinuetobedeliveredinAberdeenshire’scommunityhospitalsforthosepatientswhoseillnesscanbediagnosedandtreatedwithoutthespecialistexpertiseorfacilitiesthatareafeatureofamajoracutehospital.Overthenextfiveyears,wewillexploreopportunitiestocommissionGPacutebedsincarehomes,particularlyinremoteandruralareas.Communityhospitalswillalsocontinuetooperatein-patientrehabilitationfacilitiesalthoughthenumberandconfigurationofthesefacilitieswillbesubjecttofurtherreviewinthenextfivetotenyearsaswedevelopmodelsofcarewhichreducerelianceonin-patientcare,shortenlengthsofstayinhospitalandincreasetherangeofclinicalinterventionsthatcantakeplaceonanout-patientbasisorinthepatient’sownhome.
C.5 Palliative and End of Life Care OurvisioninAberdeenshireistoofferaccesstocohesiveandequitablecareforpeopleandfamilieslivingwithanddyingfromanyadvanced,progressiveorincurableconditionwherevertheyliveinAberdeenshire.Palliativecareisthetreatmentofaperson’ssymptomswherecureisnolongerconsideredanoption,usuallywhenapatientisdying.Somepeoplesurviveformanyyearswithanincurablediseaseandeffectivepalliativecarehelpsthemtoexperienceagoodqualityoflife.Palliationfocusesoncontrollingpainandothersymptoms,helpingapersonandtheirfamilytooptimisetheirwellbeingthroughsocial,emotionalandspiritualsupport.
OverthenextthreeyearsanelectronicKeyInformationSummary(KIS)ofapatient’smedicalhistoryandpreferenceswillgraduallyberolledoutnationallyandacrossGrampian,replacingpaperbasedinformationsharingbetweenGPpracticesandGMedsOutofHoursmedicalservice.Thiswillensureout-of-hoursstaffhaveuptodateinformationaboutapatient’swishesandcareneedsandwillminimiseinappropriatetransfers.
Living&DyingWell,publishedin2008,isScotland’snationalactionplanforpalliativeandendoflifecare.Aperson-centredapproachtogoodcareandadvancecareplanningisthekeytoLivingandDyingWell.Theimportanceofcommunication,collaborationandcontinuityofcareacrossallsectorsandatallstagesofthepatientjourneyisanimportantelementofsuccessfulpalliativecare.
In200835.6%ofdeathsinAberdeenshireoccurredinanacutehospital.Sincethattimewehaveputinplacenewservices,stafftrainingandpathwaysofcaretoreducethatnumberandallowmorepeopletodieinaplaceoftheirchoicee.g.athome,inacarehomeoracommunityhospital.Byadoptingastrongjointapproachtopalliativeandendoflifecare,theproportionofpeoplefromAberdeenshiredyinginacutehospitalsinDecember2012hadreducedto29.9%,whilstthosedyingincarehomesandcommunityhospitalshadrisenby3.8%and1.8%respectively.Therewasaslightincrease(1%)inthosedyingathome.
Ourforwardplan,overthenextthreeyearsistobuildontheskills,confidenceandexpertiseofcarehomeandhomecarestaffandtostrengthenexistingout-of-hoursnursingcareinpartnershipwithMarieCurieandMcMillannursesandRoxburgheHouse,sothatmorepeoplewithterminalillnessescandiewithdignityinaplaceoftheirchoice.
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Chapter 7: Workforce
7.1 OverviewHealthandsocialcareservicesrelyonaskilledandcommittedworkforceandinAberdeenshirethepartnersarecommittedtoworkingtogethertoensureasufficientpoolofpeoplecontinuetochooseacareerinhealthandsocialcareandhaveaccesstotraining,supportandgoodsystemsofrewardandrecognition.IncommonwithotherpartsofScotland,andindeed,theUK,weareexperiencingincreasingdifficultiesinattractingsufficientapplicantsofthecalibreweneedtodeliverourplansandaspirations.TheScottishGovernment’sproposalsforformalintegrationofhealthandcareareatanearlystage.However,thesewilladdanotherdimensiontothecomplexityofourworkforceconfiguration.Itisenvisagedthatstaffwillretaintheircurrentemployerbutincreasinglywillbeworkinginmulti-agencyteamswheredifferenttermsandconditionsofemploymentapplyandsomesinglemanagerarrangementsoperate.Inthenexttwoyearsco-locationofrelateddisciplinesineachlocalitywillbeapriorityforthePartnershiptoexplore.Ouraimwillbetoshortenlinesofcommunicationbetweenprofessionals,makeiteasierandsimplerforpeopletoaccesstheservicestheyneedintheirlocalityorasclosetohomeaspossible.Simultaneously,wewillbeseekingtoreducethenumberofoperationalorofficebasesweuse,accompaniedbymodernwaysofworkinganddigitaltechnologywhichiscompatiblewithbothlocalauthorityandNHSsystems.Integrationmayleadtomergingofsomeactivitiesoverthenextthreeyears,particularlysupportones,whichwillgenerateretrainingandredeploymentopportunities.
TheAberdeenshirePartnershipiscommittedtoensuringthatallprofessionalstaffhaveaccesstomentorswithintheirowndisciplinetoensurethatexcellentprofessionalpractiseismaintained.
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7.2 Community Health Partnership StaffAberdeenshireCHPemploys526wholetimeequivalent(WTE)staffworkingwitholderpeople;thisworkforcehasgrownto563WTEstafffollowinginvestmentfromtheChangeFund.Whilstmanyhealthprofessionalsareengagedindeliveringuniversalhealthcaretoallagesandcaregroups,wehaveapportionedaveragestafftimewhichcanbeattributedtoworkingwitholderpeople.Usingwholetimeequivalents(WTE)64managers,115alliedhealthprofessionalsand50staffareemployedbyAberdeenshireCHPtoworkwithgeneralpractice;208staffareemployedincommunityhospitalsand81incommunityhealthservices.Between2012and2015itisanticipatedthenumberofmanagerswillreduceslightly,alliedhealthprofessionalsandcommunitynurseswillincreaseby27and8respectively,whilstcommunityhospitalnursingstaffwillreduceby8.Atpresentthegendermixis92%women:8%men,andtheratioofpart-timetofulltimestaff1.5:1.TheCHPaimstohaveabsencelevelsat4%orlessandwithrobustmanagementin2012,absencelevelsof4.3%wererecordedamongstcommunityhealthstaff.
AberdeenshireCHPaspirestomaximisetheskillsofappropriatelytrainedstafftoensurethatpeoplearequalifiedtodothejobsweneed.Thiswillrequirechangesofgrades/bands,adjustmentstojobroles,allocatingappropriatetaskstothemostappropriategradesofstaff,deliveringthemostcosteffectiveoutcome.Weareactivelyworkingtoensurethatwherereasonableandpracticable,administrationwillbeundertakenbyprofessionaladministrativestaffratherthanclinicians.
Challenges include:
• enhancingandenrichingjobrolestomaximisebenefitstopatientsandstaff
• optimisingskillmixtodeliverthemosteffectivemodelsofcare
• maximisingbenefitstothewholesystembyimplementingrecommendationsoftheSafeAffordable NursingEstablishmentandSafeAffordableWorkforceprogrammes
• workingwithpartnerstoimproveeffectivenessthroughtheproductivecommunityprogramme
• introducinglocalperformancemanagementsystems,toensurecontinuedserviceimprovement
TheopeningofARIEmergencyCareCentreinNovember2012andreductioninAberdeenRoyalInfirmary(ARI)hospitalbedswillhaveanimpactontheutilisationofARI’sworkforce.TheCHPwillprovideopportunitiesforacuteandcommunityhospitalstafftoberedeployedtocommunitybasedrolesinlinewithourreshapingcareobjectives.
Newwaysofworkingwillformakeyelementofourworkforcestrategy,revisitingcorevaluesandreinforcingessentialattributesofgoodpractice:
• beingmorepatientcentred,involvingthepatient,theirfamilyandfriendsinthedesignoftheircareand support;
• encouragingautonomyandparticipationasfaraspossible;
• supportinganticipatorycare;
• adoptingarehabilitationandre-ablementapproachinworkwithallpatients;
• local,rapidaccesstodiagnosisandtreatment;
• minimisingdependenceonstatutoryhealthandcareservices,throughearlyinterventionandprevention.
• performancemanaginganaveragelengthofstayof12daysincommunityhospital,acutewardsand bedoccupancylevelof80%.sothat80%ofunscheduledadmissionscanbeadmittedandpeople requiringtreatmentcan,whereappropriate,receiveitlocallyinAberdeenshirecommunityhospitals.
CurrentlytheCHPisexperiencingsomedifficultiesrecruitingqualifiedandunqualifiednursingstaffinsomeareas,particularlyMarrandGarioch,andsomechallengesarepresentinginattractingGPstosomeremoteareas,particularlyBanffandBuchan.
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7.3 Aberdeenshire Council StaffAberdeenshireCouncilSocialWorkserviceemploys1,760staffworkingwitholderpeople.Ofthese139(106.6WTE)areprofessionals,suchascaremanagers,carehomemanagersandoccupationaltherapists;796(438.3WTE)areparaprofessionalsworkinginthecommunity,suchashomecarers;and699(464.5WTE)areparaprofessionalsworkinginlongtermhousingandcaresettings,suchasshelteredhousingandcarehomes.Afurther126(99.3WTE)providesupportserviceswhichincludecommissioningandcontracting,businesssystems,andaccountancy.
TheworkforcereflectsthesamedistributionofethnicityastheresidentsofAberdeenshireandreflectsthesameproportionofpeoplewithdisabilityastherestoftheCouncilworkforce,around4.5%.
Thesocialcareworkforceisprimarilyfemale.90%ofprofessionalsarefemaleand96%ofparaprofessionalsarefemale.
Thefollowingdiagramshowsthat52%ofparaprofessionalcarestaffareaged50yearsandolder,with34%55yearsandover.Itisnotdissimilarforprofessionals(49%and25%)andparaprofessionalsinlongtermcaresettings(48%and30%).
Asmostparaprofessionalsappeartomoveintothiscareerinmiddleagethisagedistributionmaybeoflessconcernthanfortheprofessionals.
Figure 23: Paraprofessional Community Social Care Staff by Age and Tenure Aberdeenshire (December 2012)
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Figure 24: Paraprofessional Residential Care Staff by Age and Tenure, Aberdeenshire (December 2012)
Wearecurrentlyexperiencingsomedifficultiesinrecruitingandretainingparaprofessionalstaffinthecontextofalocaleconomywithhighemployment.Anumberofrecruitmentinitiativesandcampaignstoattractmorepeople,especiallyyoungerpeople,intoacareerincarearebeingundertaken.
Sicknessabsenceratesamongprofessionalstaffworkingwitholderpeopleis3.4%or6.8daysperyear,whichisbetterthantheCouncilaverageof5.3%.However,sicknesslevelratesforparaprofessionalsis9.5%or15.7daysperyearandthishasadetrimentaleffectonthequalityandconsistencyofourcareforolderpeople.Managersaretakingasupportivebutrobustapproachtomanagingabsenceasameansofimprovingthequalityofcareforindividuals,improvingthewellbeingandmotivationofallstaffanddemonstratingbestvalue.
7.4 Independent Sector Care StaffTheCouncilcommissionsservicesfromprivatecarecompaniesandthethirdorvoluntarysector.Thereisnosingledatasourceaboutthethirdandindependentsectorworkforcesforolderpeoplebutweareindialoguetoconsiderhowtocapturethisinformation.TheScottishSocialServicesCouncilhasprovidedsomedataontheregisteredcareworkforceforalladultandolderpeople’sservices.Assuchitisindicativeforthepurposesofthiscommissioningstrategy.
Table 10: Registered Care Staff by sector in Adult and Older People’s Services Aberdeenshire 2011
Public Sector Private Sector Voluntary Sector Total
DayCare 286 587 31 904
CareHomes 428 2,064 470 2,962
HousingSupport&CareatHome
1,126 409 537 2,072
Total 1,840 3,060 1,038 5,938
(Source:SSSC)
Someprovidersareseekingtorecruitabroadfromcountrieswithhighunemployment.Fromaqualitativeperspectiveitwillbeessentialthatemployersensureallstaffarelinguisticallyfluentandculturallysensitivetotheneedsandpreferencesofourolderpopulationthroughappropriatetrainingandskillsdevelopmentprocesses.
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7.5 Challenges
ThecareworkforceinAberdeenshireispredominantlyolderi.e.50yearsplus.Manywillberetiringinthenexttenyears.ThehealthandcarepartnershipinAberdeenshirefacesarealchallengeinrecruitingandretainingsufficientnumbersofstaffwiththeskills,knowledge,trainingandpersonalattributestomeettheaspirationsofAgeingWellinAberdeenshire.Aswereshapecareforolderpeopleinthedirectionoutlinedinthisstrategy,wewilladaptourapproachto,andinvestmentin,stafftrainingandwewillreviewourexpectationstorespecttheemployer’sresponsibilitiesforcontinuallyimprovingtheirskillsandupdatingtheirknowledge.Allstaffneedtounderstandandapplyrehabilitationandre-ablementpracticeintheirworkandreduceactivitiesthatencouragedependency.
AllsectorshavetrainingplansinplacetomeettheScottishSocialServicesCouncilrequirementsforregistrationandtrainingofthesocialcareworkforceandthesewillbecloselymonitoredtoensuretheyaremet.
Informalcarersareagingtoo.Thismaymeanthattheyrequiremoreactualsupportandrespite,althoughindividualbudgetsmayallowmoretailoredandoftenmorecosteffectiveoptions.Significantlevelsoftrainingforinformalcarersarebeingprovided.Informalcarersshouldbeprovidedwiththeskillsrequiredtodeliverthebestqualitycare.Many,oncetheyarenolongercarersthemselves,stayinmanysettingssupportingothercarers.
Apreviouslyuntappedareaofskillcouldbefoundthroughmoreeffectiveuseoftransferableskillsofpatients,families/friends,informalcarersandthewidercommunitythroughthedevelopmentofco-productioninitiativesandpeersupport.TheChangeFundhasallowedanumberofcommunityworkerstobeemployedanditishopedthattheywillempowercommunities,oftenofolderpeople,toorganiseactivities,mutualaidandevensomeservicesforthemselves.
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Chapter 8: Involving and Engaging People
8.1 Capturing The Views of Older People and Their Carers
“Is it only when you become like me that you will hear what I have to tell you?”(From – ‘A Better Life’ by Sir Andrew Motion)
AgeingWellinAberdeenshirehasbeeninfluencedbytheviewsofourolderpeople,theirfamiliesandcarers,andcommunities
Listeningandrespondinghasbeenafeatureofoursocialcareservicesformanyyears.Itisstandardpracticeinthewayweplan,designandimproveservices.Weadheretothenationalstandardsincommunityconsultationandengagement.Ithaslongbeenrecognisedthatadiverseapproachtothewayweconsult,engageandlistentoolderpeople,families,carers,andcommunitiesisimportant.
Individualviewsofpeoplewhouseservicesarecapturedthroughourstandardassessment,careplanningandreviewtools.Thesehelptoensurethewaywedeliverservicesispersonalisedandresponsive.Weusesurveys,events,informationstands,toolssuchasTalkingPointsandmediacampaignstoengagelargergroupsofthepopulationandseekindividualaswellascollectiveviewsaboutthewaywedelivercareorhowitshouldchange.Wealsocommissionindependentresearcharoundkeythemes.
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Recentexamplesinclude:
• Carersconsultationeventsin2009,towhich200carerscametotalktoelectedmembersandsenior managersabouttheirexperienceofcareservices.
• QuarterlycarersforumsthroughoutAberdeenshirefacilitatedbyVSA
• ‘TalkingPoints’surveyinJune2010of320serviceusersand102carers
• IndependentresearchintoCareandAccommodationNeedsofOlderPeopleAugust2010byLowland MarketResearch
• EvaluationofveryshelteredhousinganddayservicesatDalvenieGardens,Banchory,wheretheviewsof 90peoplewererecorded.
• SurveysofcarehomeresidentsanduseofTalkingMatsinCareHomes.
• Growinganetworkofolderpeoples’forums(‘YourVoice’)
• CitizenPanelSurveysonaccommodationandcareforolderpeoplein2010;CitizenPanelSurveyon AgeingWellinAberdenshire,thisjointcommissioningstrategyforolderpeople,inNovember2012.
Consistentmessagesfromtheseconsultationsandengagementshavetoldus:
• most,butnotallserviceusers,aresatisfiedwiththeinvolvementtheyhaveinplanningtheirowncare
• mostbutnotallserviceusers,feelsafe
• olderpeopleneedbetterinformationonhousingoptions
• morepeopleshouldhaveaccesstoadiagnosisofdementiaatanearlierstageandshouldhavebetter accesstosupportwhentheyneedit
• accessingrespiteanddayservicesshouldbeeasier
• carersneedbetterinformationaboutrespitecareandshortbreaks
• moretrainingshouldbeavailableforinformalandfamilycarers
• qualityofcareinourservicesshouldbeconsistentlyhigh
• weneedtolistenmoretopeople’sviewsaboutwhattheyneedandmakeconsultationlocal
• weneedtoincreasethenumbersofcarerswhohavebeenofferedanassessmentoftheirneedsascarers
• peopleareparticularlypronetoisolationanddepressionaftertheonsetofchronicillnessand bereavement
8.2 ‘Your Voice’ – Network of Older Peoples Forums
In2010,MearnsandCoastalHealthyLivingNetworkwerecommissionedtodevelopanetworkofolderpeople’sforumsacrossAberdeenshire.Thisisamechanismforolderpeopletocollectivelyarticulateandcommunicatetheirviewsaboutthedevelopmentofhealthandsocialcareservices.
Acommunitycapacitybuildingapproachwasexpresslytaken,incorporatingtheprinciplesthatgroupsshouldaimtobeself-sustaining,identifytheirownstrengthsandthoseoftheirlocalities,developtheirownsolutionsratherthanexpecting‘moreofthesame’fromthestatutoryagencies,andcomplementotherformsofconsultation.In2012/13ninegroupsareestablishedinInverbervie,Laurencekirk,Portlethen,Peterhead,Cuminestown,Fraserburgh,Banff,EllonandInsch.Issuesidentifiedhaveincluded:
• thedifficultyofunderstandinghowthehealthandsocialcaresystemworks
• transport
• supporttoliveathome
• socialisolationandaccesstodayactivities
• remainingpartofthecommunitywhenlivinginacarehome
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Sevengroupsweredirectlyconsultedaboutthis10yearJointCommissioningStrategy.Ahealthyvarietyofviewswereexpressedabouthealthandcareservices,andtheexperienceofageinggenerally.Moreneedstobedonetoimprovesociety’sunderstandingandappreciationofageing,includingstrengtheninginter-generationalunderstandingandsupport.Viewsaredividedontheroleoffamiliesincaring–someolderpeoplefeelthefamilyneedstoplayagreaterrole,whilstothersbelievethattheydonotwishtoincreasetheburdenontheirfamilies.Havingsufficientmoneytoliveonisextremelyimportant.
Supporttomaintainindependenceathomeisseenasahighpriority,includingsupporttocombatisolation,healthscreening,improvementsincareathomeservices,assistanceinhomemaintenanceandbetteraidsandadaptations.ImprovementsinwaitingtimestoseetheGPandancillaryhealthservices,accesstohospitaltreatmentslocally,speedierhousingadaptations,hospitallaundryservicesandhospitaltransportwereidentifiedaskeyareasforimprovement.
Finally,theGPsurgeryretainsahighprofileforolderpeopleasasourceofinformation,helpandsupport.
8.3 Consultation on Ageing Well in AberdeenshireInOctoberandNovember2012apublicconsultationexercisetookplaceonthedraftJointCommissioningStrategyforOlderPeople.Anonlineandpaperquestionnairewaspublished.
201responseswerereceived,expressinggeneralsupportforthethemesanddirectionoftheStrategy(AppendixC).Feedbackwereceivedsupportedourpolicydirectioni.e.
• thatanactivelifestyleisgoodforhealthandwell-being
• diagnosisandtreatmentisbetterdeliveredinGPpracticesandcommunityhospitals
• resourcesshouldfocusonenablingquickrecoveryandre-ablementfollowingillness
• therangeandchoiceofaccommodationavailableforolderpeopleshouldbeincreasedinfuture
• thequalityinlong-termcareshouldbeimproved
Thereisnoroomforcomplacency,as44%ofresponsesdonotperceivestandardsofcareinAberdeenshiretobegoodorimproving.Furtheranalysisofthisviewandmeasurestoaddressitwillformoneofourstrategicprioritiesoverthenextyear.
8.4 Citizens PanelAberdeenshireCitizensPanelcomprisesarepresentativecrosssectionofthegeneralpublic,whoaresurveyedtwiceayear.AnonlinesurveyaboutthethemesofAgeingWellinAberdeenshirewasconductedwithasmallsampleofthePanelandthefindingsareshowninAppendixD.InadditioninNovember2012theCitizen’sPanelsurvey(Viewpoint31)featuredtheJointCommissioningStrategy.Thefullreportwillbeavailableonlineathttp://www.aberdeenshire.gov.uk/consultations/citizens/index.asp
Themajorityofthosewhorespondedtoouronlinesurveysupportedtheimportanceofourthreemainthemes,buthadalowlevelofawarenessaboutcurrentservices.Earlyinterventionandpreventionwasconsideredtobethemostimportantelementofourfutureplans.
Respondentsoverwhelminglyagreedthat:
• activelifestylesareimportant
• recoveryandsupporttoself-careindependentlyshouldbeapriority
• localtreatmentanddiagnosisisimportant
• increasingtherangeofaccommodationforolderpeopleisapriority
• improvingthequalityofcareinallsettingsisapriority
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However,therewaslessagreementthat:
• healthandsocialcareservicessupportpeopletoeathealthily,stayactiveandconnected
• standardsofcarearegoodorimproving
• peopleshouldtakesoleresponsibilityformaintaininganactivelifestyle
• thereisanappropriaterangeofaccommodationwhenpeopleneedlongtermtreatmentandsupport
8.5 Taking ActionTheprogressreportonAberdeenshire’sChangePlan2011-2013summariseswhatwehavebeendoingtorespondtothesepriorities(AppendixG).
Ourstrategiccommissioningintentionsfor2012-2022(Chapter6)aimtoaddresswhatpeoplehavetoldusisimportanttothem.Peoplehavetoldusimprovementsarerequiredin:
• helpingpeopletounderstandhowthehealthandsocialcaresystemworks(integrationofhealthand socialcare)
• promotingunderstandingandappreciationofageing,includinginter-generationalunderstandingand support.(Publicexpectations,chargingforcareandthemutualcaredebate)
• transportandhospitaltransport(ReducingInequalities)
• bettersupporttoliveandmaintainindependenceathome(Rehab&Reablement,CareAtHome Telehealthcare)
• reducingsocialisolationandaccesstodayactivities(LivingWellinLaterLifeandDaySupportActivities)
• enablingpeopletoremainpartofthecommunitywhenlivinginacarehome(LongTermCare)
• waitingtimestoseetheGPandancillaryhealthservices(ReducingInequalities)
• locallyavailablehospitaltreatment(ScheduledandUnscheduledCare)
• speedierhousingadaptations(IntegrationofHealthandSocialCare)
• improvingthequalityandstandardsofcareinallsettings(ImprovingLongTermCare)
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Chapter 9: Conclusions
Olderpeopleformthemajorityofthepopulationusinghealthandsocialcareservices.However,mostolderpeoplereceivenoformalongoingcare,andmanyolderpeoplearecarersthemselves.
In2011theproportionofolderpeople(17%)inAberdeenshireisslightlylowerthantheScottishaverage,buttheproportionofover85s(2%)iscomparable.Growthintheproportionofolderpeopleisthemostsignificantchangewefaceduetoincreasesinlifeexpectancy.Thebiggestincreasebyfarisexpectedinthe75+agegroup(131%in2035comparedto2010).Overall,therewillbea96%increaseinthepopulationagedover65by2035.Therateofincreaseintheover65populationissimilaracrossAberdeenshire.Thetotalpopulationisincreasingbuthasbeenrelativelyyounginthepast.InAberdeenshiretheolderpopulationiscomparativelywealthyandhealthy.
Aberdeenshireaimstochallengestereotypes,topromoterespectandvalueolderpeopleandthecontributiontheymake;toassistolderpeopletoaddhealthyyearstotheirlives;toimprovepersonalisation,choiceandcontrol;toshiftpublicattitudestoageing,recoveryandselfcare,andtoshiftthephilosophyofcarefrominterventions done to people to people helping themselves with support, guidance and access to professionals when necessary.
Someofthechallengesoutlinedinthisstrategyarisefromthefactthatpeoplearelivinglongerthanexpectedandthereisanincreasingprevalenceoflongtermconditionssuchasdiabetesanddementia,butmorepeoplehaveanimprovedqualityoflifebybeingassistedtoselfmanagetheirconditions.Infuturetherewillbearenewedfocusontargetingthepreventableormodifiablediseasesofoldagesuchasstroke,dementia,coronaryheartdisease,COPD,diabetesandcancerthroughregularphysicalandmentalexercise,diet,smokingcessationandreducingalcoholconsumption.
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AgeingWellinAberdeenshireoutlinesthethreethemesofourfuturecommissioningstrategy:
• earlyinterventionandprevention
• rehabilitationandenablement
• improvingthequalityoflongtermcare
Underpinningthesethemesisanimportantphilosophythatwewantpeopletolivewellinlaterlifebyempoweringolderpeopletokeephealthy,remainindependentforaslongaspossible,haveaccesstohighqualityhealthandsocialcarewhenrequiredandtoassumetheirrightfulplaceasvaluedmembersofthecommunity.
WealreadyhaveavibrantcommunitylifeinAberdeenshire.Whereitislessstrong,wearepromotingearlyinterventionandpreventionthroughaco-productionandcommunitydevelopmentapproach.Wewillensurethateveryolderpersonisawareofhowtokeepmentallyandphysicallyhealthyandhowtoaccesslocalopportunitiestobeactive,connectedtootherpeople,tocontinuetotakenotice,learnandgivethroughoutlaterlife.
Rehabilitationandenablementmeansthatwenolongeronlycareforpeoplebutwewillencourageandassistthemtorecoverandmaintaintheiroptimumleveloffunctioning.Improvechoiceandcontrolforthosewhousehealthandcareservicesandfacilitiesofself-care.Throughco-productionapproacheswewillhelpolderpeopletofeelsafeintheirhomesandcommunities.
Wewillimprovethequalityoflongtermcarethroughquickeraccesstospecialisthealthandcarewhenneeded;developingarangeofnewaccommodationwithcareoptionsinlaterlife,supportingpeopletomaintaincirclesofsupportandintereststhroughoutoldageandhelpingpeopletoachievetheiraspirationstoliveanddiewellinaplaceoftheirchoice.
Wewillstrive,byintegratingbudgetsandreshapingcare,toinvestinnewwaysofworkingtomeettheneedsofagrowingolderpopulation.Neverthelesswerecognisearealchallengeliesaheadindisinvestingintraditionalmodelsofhealthandcareandgeneratinggrowthinthoseactivitieswhichpeoplebelieveareprioritiesforthefuture.
WefaceotherchallengesinregardtorecruitmentandretentionofahighcalibrehealthandsocialcareworkforceinAberdeenshire.Wewillinvestintrainingtoprepareourstaffforchangeandequipthemwiththeskillsandconfidencetopracticeinanewcontext.
Inconclusionthisstrategy,developedwitholderpeopleandallcommunityplanningpartners,analysesthecurrentandpredictedtrends,reviewsourcurrentstateandoutlinesourcommissioningintentions.
Duringthelifeofthistenyearstrategy,shortandmediumtermactionplans,supportedbyajointperformanceframeworkwillbepublished,implementedandreviewedtoensurewedeliverourintentionsefficiently.ThesewillbeoverseenbyAberdeenshire’sOlderPeoplesStrategicOutcomeGroupreportingtotheHealthandCommunityCarePartnershipandCommunityPlanningPartners.
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APPENDICES
Page
A. JointResourceFramework2012-14 75
B. IntegratedResourceFramework2010-11 79
C. ConsultationResults 82
D. CitizensPanelOnlineSurveyResults 84
E. CitizensPanelInterimReport–Viewpoint31 87
F. AberdeenshireChangePlanProgressReportJanuary2013 93
The following are available on www.nhsgrampian.org/nhsgrampian/gra_display
G. EqualityImpactAssessment 96
H. HousingContributionStatement 105
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2012/13
Gross Budget
NHS Resource Transfer
Other NHS Income
Other Income
Net Budget
Recurring resources available for Investment in House
Recurring resources available for investment via OPSOG
£'000 £'000 £'000 £'000 £'000 £'000 £'000
OlderPeopleCareManagement 30,170 (3,364) - (1,526) 25,280 350
OlderPeopleDayCare 1,259 (136) 1,123
OlderPeopleHomeCare 10,554 (125) - - 10,429 150
OlderPeopleResidentialCare 11,701 (245) (3,076) 8,380 676 36
OlderPeopleRespite 1,035 1,035
OlderPeopleVeryShelteredHousing 5,212 (625) 4,587
SensoryImpairment 392 0 0 0 392
AidsandAdaptations 517 0 0 0 517
JointStoreandOccupationalTherapy 1,791 (14) (123) (275) 1,379
CommisioningTeam 862 0 (5) 0 856
AdultSupportNetwork 132 (5) 127
GeneralFieldworkandBusinessServices 4,294 (3) (23) (309) 3,958 (474) 614
67,918 (3,751) (151) (5,952) 58,064 202 1,150
NHSResources
Acuteandrehabin-patients 8177 8,177
A&E/out-patients 2462 2,462
OAPassessment/in-patients 2033 2,033 474 280
OAPdayhospitals 499 499
Substancemisuse 44 44
Carehomes 68 68
CommunityNursing 4637 4,637
OccupationalTherapy 871 871
OtherServices(IndirectManagement/Admin) 2189 2,189
Physiotherapy 1252 1,252
Podiatry 871 871
ResourceTransfer 3779 3,779 500
Appendix A: Joint Resource Framework 2012-14
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2012/13Gross Budget
NHS Resource Transfer
Other NHS Income
Other Income
Net Budget
Recurring resources available for Investment in House
Recurring resources available for investment via OPSOG
Dental 333 333
SpeechandLanguageTherapy 141 141
Pharmacy 289 289
CommunityMedicalStaff 892 892
ChronicOedema 102 102
LESAsthma-Dermo-Ortho-Diabetes 486 486
INR 80 80
PMS 17 17
Diabetes 508 508
JointEquipmentStore 123 123
ContinenceServices 458 458
MaudOldmartResourceCentre 48 48
HomeCareMedicinesManagement 15 15
30374 0 0 0 30374 474 780
NHSMemorandumFiguresprovidedvia10/11IRF
GMScosts 9276 9,276
Prescribingcosts 14797 14,797
JointResource
OlderPeople'sChangeFund 3240
Total Resources 122,365 -3,751 -151 -5,952 112,511 676 5,170
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Aberdeenshire Council
2013/14Gross Budget
NHS Resource Transfer
Other NHS Income
Other Income
Net Budget
Recurring resources available for Investment in House
Recurring resources available for investment via OPSOG
£'000 £'000 £'000 £'000 £'000 £'000 £'000
OlderPeopleCareManagement 30,672 (2,454) (927) (1,372) 25,919 350
OlderPeopleDayCare 1,112 (162) 950
OlderPeopleHomeCare 9,490 - (125) (14) 9,352 150
OlderPeopleResidentialCare 11,287 (245) (3,492) 7,550 (233) 36
OlderPeopleRespite 1,052 1,052
OlderPeopleVeryShelteredHousing 4,653 (651) 4,002
SensoryImpairment 394 - - - 394
AidsandAdaptations 596 - - - 596
JointStoreandOccupationalTherapy 1,949 (15) (139) (293) 1,502
CommisioningTeam 875 - (5) - 870
AdultSupportNetwork 133 - - (5) 128
GeneralFieldworkandBusinessServices 3,863 (3) (5) (302) 3,553 (482) -
66,077 (2,717) (1,201) (6,291) 55,868 -715 536
NHS Resources
Acuteandrehabin-patients 8177 8,177
A&E/out-patients 2462 2,462
OAPassessment/in-patients 2033 2,033 482 280
OAPdayhospitals 499 499
Substancemisuse 44 44
Carehomes 68 68
CommunityNursing 4637 4,637
OccupationalTherapy 871 871
OtherServices(IndirectManagement/Admin) 2189 2,189
Physiotherapy 1252 1,252
Podiatry 871 871
ResourceTransfer 3779 3,779 500
Dental 333 333
SpeechandLanguageTherapy 141 141
Pharmacy 289 289
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CommunityMedicalStaff 892 892
ChronicOedema 102 102
LESAsthma-Dermo-Ortho-Diabetes 486 486
INR 80 80
PMS 17 17
Diabetes 508 508
JointEquipmentStore 139 139
ContinenceServices 458 458
MaudOldmartResourceCentre 48 48
HomeCareMedicinesManagement 15 15
30390 0 0 0 30390 482 780
NHS Memorandum Figures provided via 10/11 IRF
GMS costs 9276 9,276
Prescribing costs 14797 14,797
Joint ResourceOlder People's Change Fund 3240
Total Resources 120,540 -2,717 -1,201 -6,291 110,331 -233 4,556
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2008/09
Notes ABERDEENSHIRE
LA NHS Total
(£000's) (£000's) (£000's) spendperweightedhead(£)
HOSPITAL BASED
Emergencyadmissions 47,240 47,240 1,331
Electiveadmissionsanddaycases 18,122 18,122 511
Outpatients ACUTE 9507 9,507 268
A&E ACUTE 492 492 14
Daypatients ACUTE 1,295 1,295 36
Directaccess ACUTE 1,716 1,716 48
COMMUNITY BASED
GPServices GMS 10,985 10,985 310
GPPrescribing 15,620 440
DistrictNursing 1,486 42
CommunityAHPs 1,394 39
CommunityMentalHealthServices MILD 2,675 2,675 75
LAOlderCareHome COE 23,050 23,050 649
LAOlderHomeCare COE 13,577 13,577 383
LAOlderOther COE 11,132 11,132 314
OtherCommunityServices 353 5,202 5,555 157
0
TOTALS 48,112 115,735 163,847 4,616
Weightedpopulation(000's) 35
Expenditure/head(£) 4,616
Institutional 2,858 62%Non-
institutional 1,759 38%
check 4,616 100%
Appendix B: Integrated Resource Framework
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2009/10
Notes ABERDEENSHIRE
LA NHS Total
(£000's) (£000's) (£000's) spendperweightedhead(£)
HOSPITAL BASED
Emergencyadmissions 38,414 38,414 1,082
Electiveadmissionsanddaycases 29,171 29,171 822
Outpatients ACUTE 11343 11,343 320
A&E ACUTE 1,857 1,857 52
Daypatients ACUTE 3,126 3,126 88
Directaccess ACUTE 1,667 1,667 47
COMMUNITY BASED
GPServices GMS 11,868 11,868 334
GPPrescribing 15,990 451
DistrictNursing 2,413 68
CommunityAHPs 1,443 41
CommunityMentalHealthServices MILD 3,746 3,746 106
LAOlderCareHome COE 25,661 25,661 723
LAOlderHomeCare COE 13,901 13,901 392
LAOlderOther COE 11,578 11,578 326
OtherCommunityServices 3,254 3,254 92
0
TOTALS 51,140 124,292 175,432 4,943
Weightedpopulation(000's) 35
Expenditure/head(£) 4,943
Institutional 3,134 63%
Non-institutional 1,809 37%
check 4,943 100%
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2010/11
Notes ABERDEENSHIRE
LA NHS Total
(£000's) (£000's) (£000's) spendperweightedhead(£)
HOSPITAL BASED
Emergencyadmissions 0 41,075 41,075 1,157
Electiveadmissionsanddaycases 0 29,932 29,932 843
Outpatients ACUTE 0 10,295 10,295 290
A&E ACUTE 0 1,657 1,657 47
Daypatients ACUTE 0 2,755 2,755 78
Directaccess ACUTE 0 1,642 1,642 46
COMMUNITY BASED
GPServices GMS 0 10,640 10,640 300
GPPrescribing Prescribing 0 18,876 18,876 532
DistrictNursing Community 0 2,570 2,570 72
CommunityAHPs Community 0 1,463 1,463 41
CommunityMentalHealthServices MILD 0 3,745 3,745 106
LAOlderCareHome COE 24,957 0 24,957 703
LAOlderHomeCare COE 13,173 0 13,173 371
LAOlderOther COE 12,670 0 12,670 357
OtherCommunityServices Community 0 4,261 4,261 120
0
TOTALS 50,800 128,909 179,709 5,063
Weightedpopulation(000's)NRAC 35
Expenditure/head(£) 5,063
Institutional 3,164 62%
Non-institutional 1,899 38%
check 5,063 100%
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Appendix C: Consultations Results
Consultation on Draft Joint Commissioning Strategy
InOctoberandNovember2012weundertookaconsultationprocesswiththegeneralpublic,includingsettingswheretherewereolderpeople,carersandcarersforums,staffintheCouncilandHealthandwithourproviders.Webrieflyoutlinedthepurpose,rationaleandthemeddirectionforourJointCommissioningStrategyforOlderPeopleandusedanonlineandpaperformatquestionnaire.
Therewere211writtenresponsesalthoughnoteveryoneansweredallquestions.Theresultswereasfollows:
86% were broadly content with the direction of the strategy.
Ofthosewhoexpresseddisagreement,3remainedangryaboutchangestothewardenserviceinShelteredHousingand3wereunhappyaboutlackofoutofhourshealthandsocialcaresupport;7werecynicalaboutwhethertherewouldbestaffand/orfundingtodeliverthestrategy,1commentedonchargingforcarehomes,1onrespectforwhatolderpeoplewanted,1eachcommentedoncomputeraccessforolderpeople,wantedsamedayaccessforfrailolderpeopletoseeGPandthatby2025workingto70soshouldwechangedefinitionofolderpeople.
100% were aware that an active lifestyle throughout old age is good for a person’s health and wellbeing.
Peoplewereinvitedtomakesuggestionsastohowtogetolderpeopletobemoreactive,engagedandlearning.
• 27suggestedthatolderpeopleneedtobeencouragedtogetorstayinvolved,
• 20suggestedexerciseisimportantandsuggestedgentleexercise,walks,TaiChi,danceandsessionsfor olderfolkatswimmingpoolsandsportscentres,
• 21suggestedmoreactivitiesshouldbearrangedandmorecommunalcentres&shelteredhousing openedformealsandactivities,
• 13focusedontheneedfortransportandlowcostorfreeactivities.
• 10saiditisimportanttokeepdoingallonecanandtobeawareofconsequencesofstopping,
• 8remindedabouttheimportanceofdiversityandchoice,
• 7suggestedmorepublicityforlocalactivities,circularsetc,
• 6advisedolderpeoplesskillscanbeusedbycommunities
• 3wantedmoreintergenerationalactivities
• 2suggestedvolunteering,
• 1suggestedtrainingincomputerskillsopeningmanydoors
90% agree that it is better for older people to receive diagnosis and treatment at their GP practice and local community hospital than in Aberdeen.
• Mostofthosewhodisagreedmentionedtheneedforadditionalexpertiseorresources,2criticisedone communityhospitalandonetheirGP
95% agree that the NHS and LAs should focus their resources on supporting older people who experience illness to recover quickly and regain their abilities to self care independently, as far as possible.
• Concernsexpressedfocusedonthecurrentpositionwiththelackofsufficientstafftime,especiallythe lackofphysiotherapistsandoccupationaltherapistswithanumberwantingtoknowhowtoaccesssuch aservice.
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86% were aware local health and social work services are already supporting people in Aberdeenshire to recover from illness and helping them to manage independently.
• However,14felttheyknewlittleaboutsuchaservice,26complainedaboutlongwaitsand/orlackofhelp especiallyfortherapies,rushedorpoorsupport,9praisedservicestheyhadreceived,afewmade commentsaboutloneliness/lackofencouragementandnotbeingvaluedorlistenedto.
90% agreed that over the next ten years we should focus on increasing the range of accommodation available for older people in Aberdeenshire to help them live independently.• Concernswereexpressedby15aboutthecurrentlevelofcareandsupportinShelteredHousing complexesand3aboutpeoplewithhighneedsnotreceivingtherequiredlevelofsupport
85% agree that we should focus on improving the quality of care in all settings not least by encouraging more voluntary, family, and community involvement. • 18worryaboutfamilieswhoaretoofaraway,aboutpeoplewithoutfamilyandforexistinginformal carersgettingoldandtoomuchbeingexpectedofthem,4resentitasa“cheap”optionand4worry aboutthereliability/vetting/HealthandSafetyandmanagementofvolunteers
56% perceive standards of care for older people in Aberdeenshire as good and improving • 27werecriticalofcurrentservicesingeneral,18specificallycriticisedrecentShelteredHousingchanges, 13criticisedlackofhomecarersandpressureonthemtodeliverintooshortatime,3referredto loneliness,2expressedconcernaboutthelackofmonitoringoffrailolderpeoplewholivealone,one statedneedtoexpandrehabilitationteamsandanotherwasconcernedbythelackofahousework service.
89% do not think we have omitted any thing from our strategy• Areasthatpeoplefelthadbeenomittedfromthestrategyincludetheneedtoinstilconfidenceandself esteeminolderpeople,betteraccesstoequipment,transportforruralcommunitiesincludingcommunal facilities,continuityofcare,beingincludedindiscussionsaboutcare,complementarytherapies,better outofhoursmedicalcare,earlierdiagnosisofbladderandbowelproblemstoreduceurinarytract infections,andmoreminihospitals.
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Appendix D: Citizens Panel Online Survey Results
InAberdeenshirewealsohaveaCitizensPanelcomprisingofarepresentativesectionofthegeneralpublic.Anonlinesurveywasundertakenwithasubsetofthepanel,whoarewillingtoparticipateinextraonlinesurveys,togaugetheirinitialthoughtswithregardtoourJointCommissioningStrategy’semergingthemesof:
• Preventionandearlyintervention
• Rehabilitationandenablement
• Quality,choiceandcontrolinlongtermcare
Atotalof164responseswerereceived(aresponserateof39.5%)andtheseresponsesformthebasisofthefollowingfeedback.
RespondentswereaskedtowhatextenttheyfeltthatthethemeofearlyinterventionandpreventionwasimportantandtheresultofthisisshowninFigure25.
Ascanbeseen,amajorityofrespondentsfeltthatthisthemewas‘veryimportant’(73%ofthosewhogaveadefinitiveanswer)withafurther24%feelingthatitwas‘quiteimportant’.Only3%ofrespondentsfeltthatthisthemewas‘neitherimportantnorunimportant’.
Figure 25: Importance of Early Intervention and Prevention
Respondentswerethenaskedaboutintegratedrehabilitationandenablement.Theirperceivedimportanceofthisthemeisillustratedbelow.
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Figure 27: Importance of Integrated Rehabilitation and Enablement
Again,amajorityofrespondentsfeltthatthisthemewas‘veryimportant’with73%answeringthiswayand24%feelingthisthemetobe‘quiteimportant.3%feltthatthisthemewas‘neitherimportantnorunimportant’.
Thethirdthemeis quality,choiceandcontrolinlong-termcareandtheperceivedimportanceofthisthemeissummarisedbelow.
Figure 28: Importance of Quality, Choice and Control in Long-Term Care
Asomewhathigherproportionofrespondentsconsideredthiselementtobe“veryimportant”(84%)andnorespondentsconsideredthiselementtobeunimportant.
Giventhattherewasahighlevelofimportancegiventoeachofthethreethemesthatarethefocusofthesurvey,itisimportanttoconsidertherelativeimportanceofeachofthesethemes.Todoso,respondentswereaskedtorateeachofthethemesinorderofimportance(rankingthese1,2and3);theresultsofthisareshownbelow.
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Figure 29: Importance of Themes
Fromthisanalysis,itisclearthatthemostimportantthemetorespondents(relativetotheotherthemes)isthatofearlyinterventionandprevention(58%ofrespondentswhoprovidedaresponsetothisquestionrankeditasthemostimportanttheme)followedbyquality,choiceandcontrolinlong-termcare(24%rankingthisasthemostimportanttheme)andintegratedrehabilitationandenablement(18%rankingthisasmostimportant).
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Appendix E: Citizens Panel Interim Report – Viewpoint
Citizens Panel Interim Report Feb 2013
ThefollowingquestionwasposedtorespondentstoidentifytheirviewsonprioritiesfortheJointCommissioningStrategyforolderpeople:
“ThedraftAberdeenshireJointCommissioningStrategyhasthefollowingthreethemes.PleasetellushoweffectiveyouthinkeachoftheseapproacheswillbeoverthenexttenyearsinhelpingtomeetthehealthandcareneedsofolderpeopleinAberdeenshire.”
Respondentswereaskedtorankthesethreeelements1,2and3.TheresultsforthemostimportantelementareshowninFigure30below: Figure 30: Joint Commissioning Strategy for Older People (Most Effective Theme)
Overall,asignificantmajorityofrespondentshighlighted“preventionandearlyintervention”asthe“mosteffective”approachfromthethreechoicesprovidedwithabroadlysimilarproportionidentifying“quality,choiceandcontrolinlong-termcare”and“rehabilitationandenablement”asthemosteffectiveapproach(21%and19%respectively).
Thefullresults,containingrespondents’topthreerankingsareshowninTable11.Itshouldbenotedthatsomefiguresmaynotsumto100%duetoroundingandalsothatresultshavebeenexpressedasaproportionofthosethatprovidedanyratingsforthisquestion(i.e.averysmallnumberofrespondentsprovidedatopratingbutnotasecondand/orthirdrating).
Thesefiguressuggestthatthemajorityofrespondentsoverallplace“rehabilitationandenablement”astheirsecondchoiceforthemosteffectiveapproachbehind“preventionandearlyintervention”.
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Table 11: Joint Commissioning Strategy for Older People (prioritisation of all three themes)
ThemeRanking of Themes
1st 2nd 3rd Base
Preventionandearlyintervention 60% 16% 24%
713Quality,choiceandcontrolinlong-termcare 21% 27% 50%
Rehabilitationandenablement 19% 56% 25%
Wehavebrokendownresultsforthisquestionbylocation,ageandgenderinTable12below:Table 12: Joint Commissioning Strategy for Older People “Most Effective” Theme (Breakdown)
Respondent Characteristic
Prevention and Early Intervention
Quality, Choice and Control in Long-Term Care
Rehabilitation and
EnablementBase
Area
BanffandBuchan 60% 15% 25% 96
Buchan 53% 28% 19% 113
Formartine 59% 19% 22% 146
Garioch 62% 18% 21% 130
KincardineandMearns 59% 23% 18% 110
Marr 64% 21% 16% 107
Age
Under45s 56% 24% 20% 162
45-64s 61% 19% 20% 376
Over65s 59% 24% 18% 164
Gender
Male 64% 19% 17% 324
Female 55% 23% 22% 378
Overall 60% 21% 19% 722
Whilstthegeneralpatternofresponsesisbroadlysimilar,therearesomemodestdistinctionsthatareworthnoting:
• BanffandBuchanrespondentswereslightlymorelikelytosee“rehabilitationandenablement”asthe mosteffectivetheme.
• Buchanrespondentswereslightlylesslikelythanotherstosee“preventionandearlyintervention”asthe mosteffectivetheme,althoughamajoritystilldidso;theyweresignificantlymorelikelythanothersto see“quality,choiceandcontrolinlong-termcare”asthemosteffectivetheme).
• Under45swereslightlylesslikelytosee“preventionandearlyintervention”asthemosteffectivetheme (althoughamajoritystilldidso).
• Malesaremorelikelythanfemalestosee“preventionandearlyintervention”asthemosteffectivetheme (althoughitisstillamajorityforbothgroups).
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Separatedatatableshavebeenprovidedwithafullbreakdownofresponses.
Afurthersetofstatementswereputtorespondentsandtheywereaskedabouttheirlevelofagreementordisagreementwiththesestatements.TheoverallresultsaretabulatedinTable13below:
Table 13: Joint Commissioning Strategy for Older People (Response to Statements)
Statement
Response
AgreeStrongly Agree Neither/
Nor Disagree DisagreeStrongly
Don’tKnow Base
Anactivelifestylethroughoutoldageisimportantforaperson’shealthandwellbeing.
63% 35% 2% <1% 0% <1% 732
PeopleshouldtakesoleresponsibilityformaintaininganactivelifestyleandtheNHSandCouncilhavenoroletoplay.
5% 22% 23% 40% 9% 1% 729
LocalHealthandsocialworkservicessupportpeopleinAberdeenshiretoeathealthily,stayactiveandremainconnectedinthecommunityastheygetolder.
9% 39% 32% 9% 2% 8% 724
ItisbetterforolderpeopletoreceivediagnosisandtreatmentattheirGPpracticeandlocalcommunityhospitalthaninAberdeen.
46% 44% 7% 2% <1% <1% 732
90
Statement
Response
AgreeStrongly Agree Neither/
Nor Disagree DisagreeStrongly
Don’tKnow Base
ApriorityforNHSandCouncilresourcesoverthenext10yearsshouldbesupportingolderpeoplewhoexperienceillnesstorecoverquicklyandregaintheirabilitytoself-careindependentlyasfaraspossible.
42% 53% 4% 1% <1% 1% 733
TheNHSandsocialworkservicessupportolderpeoplewhoexperienceillnesstorecoverquicklyandregaintheirabilitytoself-careindependentlyasfaraspossible.
24% 39% 22% 6% 2% 6% 730
ApriorityforNHSandCouncilresourcesoverthenext10yearsshouldbeincreasingtherangeofaccommodationavailableforolderpeopleinAberdeenshire,tohelpthemliveindependently.Thismayincludefewerhospitalsandcarehomes,moreshelteredhousingandmoreadaptationstoexistinghousingsopeoplecanstayathome.
38% 46% 11% 3% 1% 1% 729
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Statement
Response
AgreeStrongly Agree Neither/
Nor Disagree DisagreeStrongly
Don’tKnow Base
ThereisanappropriaterangeofaccommodationchoicesinAberdeenshireforwhenpeopleneedlongtermtreatmentandsupport,whetherathome,insupportedaccommodationorinhospital.
9% 17% 26% 25% 7% 16% 729
ApriorityforNHSandCouncilresourcesoverthenext10yearsshouldbeimprovingthequalityofcareinallsettings(i.e.,athome,inhospital,carehomesetc.)notleastbyencouragingmorevoluntaryfamilyandcommunityinvolvement.
30% 51% 13% 4% 1% 1% 730
StandardsofcareforolderpeopleinAberdeenshirearegood.
3% 27% 37% 12% 3% 18% 731
StandardsofcareforolderpeopleinAberdeenshireareimproving.
2% 22% 40% 10% 2% 23% 731
Inrelationtosomeofthesestatements,thereisanoverwhelminglevelofagreement(albeitasignificantproportionindicatethatthey“agree”ratherthan“stronglyagree”).Examplesinclude:
• Theperceivedimportanceofactivelifestylesforolderpeople(98%agreement).
• Theviewthatitshouldbeaprioritytohelppeoplerecoverandself-careindependently(95%agreement).
• Thepreferenceforolderpeopletoreceivetheirtreatmentanddiagnosislocally(90%agreement)
• AgreementthatapriorityforNHSandCouncilresourcesoverthenext10yearsshouldbeincreasingthe rangeofaccommodationavailableforolderpeopleinAberdeenshire,tohelpthemliveindependently (84%agreement).
• AgreementthatapriorityforNHSandCouncilresourcesoverthenext10yearsshouldbeimprovingthe qualityofcareinallsettings(81%agreement).
OverallagreementissomewhatlowerbutstillrepresentsaclearmajorityofrespondentswithregardtotheviewthattheNHSandsocialworkservicessupportolderpeoplewhoexperienceillnesstorecoverquicklyandregaintheirabilitytoself-careindependentlyasfaraspossible(63%agreement).
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Withrespecttotheremainingstatements,opinionsaremuchmoredividedwithonlyaminorityexpressingoutrightagreementwiththestatements.Thestatementsinthiscategoryinclude:
• AgreementthatlocalHealthandsocialworkservicessupportpeopleinAberdeenshiretoeathealthily, stayactiveandremainconnectedinthecommunityastheygetolder(48%ofrespondentsdidagreewith thisstatementandonly11%expresslydisagreedbuttheremainderofrespondentsgaveaneutralor “don’tknow”response).
• AgreementthatstandardsofcareforolderpeopleinAberdeenshirearegood(30%agreedwiththis statementand,whilstonly15%expresslydisagreed,37%gavea“neither/nor”responseandafurther 18%gavea“don’tknow”answer.
• Theviewthatpeopleshouldtakesoleresponsibilityformaintaininganactivelifestyleandthatthe NHSandCouncilhavenoroletoplay(although28%agreedwiththisstatement,49%expressedoutright disagreement).
• AgreementthatthereisanappropriaterangeofaccommodationchoicesinAberdeenshireforwhen peopleneedlongtermtreatmentandsupport(26%agreedwiththisstatementbut32%expressed disagreementwiththebalancegivingneutraland“don’tknow”responses).
• AgreementthatstandardsofcareforolderpeopleinAberdeenshireareimproving(24%agreedwiththis statementand,whilstonly12%expresslydisagreed,40%gavea“neither/nor”responseandafurther 23%gavea“don’tknow”answer.
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Appendix F: Aberdeenshire Change Plan Progress Report January 2013
Theme 1 – Early Intervention and Prevention
Early screening for falls Significantnumbersofindividualsidentifiedandofferedsupport
Falls classesClassesarecontinuingandthoseindividualswhohavecompletedtheprogrammehaveimprovedfunction.Patientsatisfactionwiththeclasseshasbeenhigh.
Point of Care testingGPshavebeentrainedandtheprojectcontinuestoproducegoodoutcomesforpeople.Projecthasbeenevaluated.PatientexperiencehasbeenimprovedbyprovidingtestslocallyandreducingtheneedtotraveltoAberdeen.
Cardiology in AboyneThisservicehasnotyetstartedduetoshortageofcardiologystaff
ColonoscopyGPtrainingunderwayandwillbecompletedbyMay2013.Theservicewillbeevaluated
X-Ray facility in Aboyne/InverurieThisisexpectedtobeoperationalduring2013/14.
Low Vision ClinicThiswillstartinApril2013
Redesign of heart failure serviceThreespecialistnursesprovidesupporttoprimarycarepatientsandareaneducationalandadvisorysupporttoGPpractices,communityandwardbasesnursesandthemulti-disciplinaryteams.
Uptake of LESPatientswithahighriskofadmissiontohospitalareidentifiedandwillbenefitbyhavinganAnticipatoryCarePlanwhichwillreducetherisk.Forearlyimplementerpractices,anaverageof10%reductioninemergencyoccupiedbeddayswasachieved.
Action Learning SetsActionLearningSetsorALShavecreatedopportunitiesforGPs,teammanagersandpractitionerstocometogethertoconstructivelychallengeandimprovepractice,behavioursandpathwaysofcareforolderpeople,towardsasharedoutcomeofshiftingthebalanceofcare.
Enhanced Pulmonary RehabilitationClassestakingplacethroughoutAberdeenshiredeliveredbyaphysiotherapistandsupportworker.
Improvement of assessment and care managementAllcaremanagershavebeentrainedinoutcome-focussedassessment.Assessmentislocatedincaremanagement,andadditionalseniorpractitioner,caremanagementandlocalareacoordinatorpostshavebeencreatedtoimprovecapacity.
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Investment in Preventive Services and Co-Production 16projects,managedwithinthethirdsector,havebeeninvestedin,buildingcommunitycapacityanddevelopingpreventiveservices.TheseincludesignpostingGPpatientstocommunitysupportsandconnectingindividualstoprovidemutualsupport,shoppingservices,screeningforfallsandquickaccesstorepairsbyCareandRepair,amen’sshed,artsparticipation,developingcommunitycapacityinshelteredhousing,creativeartsworkwithpeoplewithdementia,developingwalkinggroups’networksandawalkingstrategy,developmentofolderpeoples’forums,befriendinginhospital,andhospitaltransport.
Link Workers, Alzheimer ScotlandThreelinkworkerswillprovidepostdiagnosticsupporttopeoplenewlydiagnosedwithdementia.ProjectstartedFebruary2013.
Psycho-social programme for family carers of people with dementiaThis18monthprojectaimstodevelopandimplementapsychosocialprogrammetoimprovepostdiagnosticsupportandtrainingforpeoplewithdementiaandtheircarerswholiveinthecommunity.
Theme 2 – Rehabilitation and Enablement
Early Implementer Rehab and Enablement TeamsThreeearlyimplementermulti-disciplinaryrehabandenablementteamshavebeenfundedtoproviderehabandenablementtoindividuals,increasingindependenceandreducingtheneedforcareathome,usinggoal-setting,andcareplanningoverashortperiodofintervention.IndependentevaluationhasbeenfundedtocommenceFeb2013(2.1.11).
TelehealthcareInvestmentinadditionaltelehealthcareequipmentandtechniciansupportisincreasingtheproportionofpeoplesupportedathome.
Liaison Nurses AMAUThisprojectaimstodischargepatientshomeortransferpatientstoalocalcommunityhospitalwithin72hoursoftheiradmissiontoAMAU.
Additional Physiotherapy at Aboyne HospitalPhysiotherapynowprovided5daysaweekinsteadof2.5days.Thishasreducedlengthofstay.
Expansion of ARCHMajorinvestmentmadetodevelopandexpandout-of-hourshomecareresponseservice.Recruitmentandredesignofshiftpatternsisunderway.
AMPS TrainingThiscoursewillruninSeptember2013(1weekoftuition)andwillimprovethestandardisedqualityofOTassessmentsintheareaofA.D.L.
Staffing levels at Joint Equipment Store increased
Increase in AHP time at Community HospitalsIncreasedOTandPhysiotherapycoverforcommunityhospitalstodelivera5days/weekservicetoreducedelaysandlostadmissiondayswherepatientisnotseenandassessed
Redesign of Day Care ProvisionProjectOfficerpostfundedtoleadonaredesignofdayservicesforolderpeople.
Use of dementia design principles for housing providersTwohousingstafftrained.
Senior Improvement Officer for ALSActionLearningSets
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Theme 3 – Improve Quality of Long Term Care
Increase number of VSH UnitsInvestmentinremodelling3shelteredhousingcomplexestoveryshelteredhousing.Anotherisatfeasibilitystudystage.
Redesign of 24 hour community based palliative careAprojectwithMarieCurietoprovideconsistentandequitableout-of-hoursnursingcaretopalliativecarepatients.TheserviceoperatesfromPeterheadandStonehaven.Thisallowspatientstoremainintheirpreferredplaceofcare.
Palliative care training for care home staffAllrelevantcarehomestaffinAberdeenshirecarehomestrainedinpalliativeandend-of-lifecare.Projectcompleted.
Project Manager Palliative CareTheprojectmanagerwillcontinuetovisitcarehomes(see3.2.2)andisprovidingthistrainingtostaffincommunityhospitals.
Short Breaks and Respite OptionsDevelopmentofopportunitiesforcreative,innovativeandflexibleshortbreaksforcarers,andinparticularoldercarers.
Carers Co-ordinatorsAdditionallocalareacoordinatorsappointedtocarryoutcarers’assessments.
Support for Older CarersThreeCarersSupportandDevelopmentWorkersandInformationOfficerhavebeenappointedinVSAtosupportoldercarers.
Best Practice in Dementia CareStaffsecondedandtrainingpackspurchasedtodelivertraininginbestpracticeindementiacareforcarehome,careathome,dayservicesandhealthcarestaff.
Independent Sector MentorProjectofficerappointedtosupportcarehomemanagersinsharinggoodpractice.
Communications Officer Communicationsofficerappointedtopromotepositivemessagesaboutageingandraiseawarenessofreshapingcareforolderpeople.
ALS Facilitation for Health and Community Care Strategic PartnershipActionLearningSetswithmembersoftheHealthandCommunityCareStrategicPartnership.ThesewillbecompletedbyMay2013.
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Appendix G: Equalities Impact Assessment
EQUALITY IMPACT ASSESSMENT
Stage 1: Title and aims of the activity (“activity” is an umbrella term covering policies, procedures, guidance and decisions)
Service HousingandSocialWork(inpartnershipwithNHSGrampian,ThirdSectorandrepresentativesofprivatesector)
Section OlderPeoplesServices.
Title of the activity etc 10yearJointCommissioningStrategyforOlderPeople2013-2023
Aims of the activity
ScottishGovernmentrequiresalllocalauthorityandNHSPartnershipstodevelopa10yearstrategytoreshapethebalanceofcareforolderpeopleintheirarea,asaconditionofreceivingadditionalfundingfromtheChangeFund.TheStrategyoutlineshowcareforolderpeopleistobedeliveredwithinacontextofanageingpopulation,andconstrainedpublicfinance.TheStrategyhasbeendevelopedoverayearinpartnershipbytheLocalAuthority,AberdeenshireCHP,ThirdSectorrepresentatives,andrepresentativesfromtheprivatesector.Arangeofconsultationsandengagementswithgroupsofolderpeoplehavealsobeenundertaken.
Signature PatriciaMaclachlan Date 18.02.2013
Stage 2: List the evidence that has been used in this assessment.
Internal data (customer satisfaction surveys; equality monitoring data; customer complaints)
AberdeenshireChangePlanPerformanceIndicatorsSingleOutcomeAgreementP.I.sHousingandSocialWorkServicePlanP.I.sEthnicMonitoringDatafromLAandNHSsystemsActivitydatafromHousingandSocialWorkCarefirstandNorthgatesystems,andNHS(LocalHealthIntelligenceandISD)
Internal consultation with staff and other services affected
ResponsesfromconsultationonJointCommissioningStrategyforOlderPeopleviaonlinesurveyandpublicleaflet.
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External consultation (partner organisations, community groups, and councils.
AgeingWellConference2008TalkingPointsSurvey2010‘YourVoice’OlderPeoplesForumsNHSGrampianPublicForumOctober2012CitizensPanelSurveys–Viewpoint22(TransportandAccommodationandCareforOlderPeople)2011•Viewpoint24(CaringforOthersintheCommunity)2011•Viewpoint31(JointCommissioningStrategyforOlderPeople)•OnlineCitizensPanelSurvey(JointCommissioningStrategyforOlderPeople)Nov2012
External data (census, available statistics)
GeneralRegistrarofScotlandPopulationProjectionsandEstimatesScottishIndexofMultipleDeprivationJointStrategicNeedsAssessmentforAberdeenshire(AberdeenshireCouncilandNHSGrampian)
Other (general information as appropriate)
ResultsfrompublicconsultationonJointCommissioningStrategyforOlderPeoplecarriedoutvialeafletandonlinesurvey.
Stage 3: Evidence Gaps.
Are there any gaps in the information you currently hold?
Commentfromrepresentativesofprotectedgroups(Race,Religion,SexualOrientation,GenderReassignment).
Stage 4: Measures to fill the evidence gaps.
Whatmeasureswillbetakentofilltheinformationgapsbeforetheactivityisimplemented?Theseshouldbeincludedintheactionplanatthebackofthisform.
Measures: Timescale:
SharedraftstrategyforcommentwithGrampianRegionalEqualityCouncil Dec2012/Jan2013
SharedraftStrategywithrepresentativeofcommunityofolderLGBTpeople(AgeScotland) Dec2012/Jan2013
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Stage 5. Are there potential impacts on protected groups? Please complete for each protected group. by inserting “yes” in the applicable box/boxes below.
Positive Negative Neutral/No Unknown
Age–Younger Yes Yes
Age–Older Yes Yes
Disability Yes
Race–(includesGypsyTravellers) Yes
ReligionorBelief Yes
Sex–i.e.men/women Yes Yes
Pregnancyandmaternity Yes
Sexualorientation–(includesLesbian/Gay/Bisexual) Yes
Genderreassignment–(includesTransgender) Yes
MarriageandCivilPartnership Yes
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ImpactsPositive
(describetheimpactforeachoftheprotectedcharacteristicsaffected)
Negative(describetheimpactforeachoftheprotectedcharacteristicsaffected)
Please detail the potential positive and/or negative impacts on those with protected characteristics you have highlighted above. Detail the impacts and describe those affected.
Age - Younger Astrategicpriorityisthedevelopmentofpreventivehealthinterventionstopromotehealthyliving.Thiswillimpactonthehealthofyoungerpeople.Supportofyoungcarersandcarersundertheageof65isapriority.Promotionofintergenerationalactivitytoimproveolderpeople’swell-beingwillimproveyoungpeople’swell-being,skillsandabilities.Employmentandcareeropportunitiescreatedinthecaresectoroftheeconomy.Youngerpeoplewillbeabletoplanforoldagewithconfidence.
Age –YoungerMoreyoungerpeoplewillberequiredtoparticipateinthecareofolderfamilymembersandoldermembersofthecommunity.
Age – OlderThewholeintentionofthestrategyistocreatethebestpossibledeliveryofhealthandsocialcareforolderpeople,“tooptimiseindependenceandwell-beingofolderpeopleinAberdeenshire”,andachievethebestpossibleoutcomesforthem.Olderpeoplewillhavemorecontrolovercareprovided.Olderpeoplewillhavegreateropportunitiesforinvolvementintheircommunities.Olderpeoplecanhaveincreasedconfidencethattheywillbeabletoliveathome,independently,andinsafety,foraslongaspossible,andthattheywillbeabletoendtheirlivesinaplaceoftheirchoosing.
Age – OlderThestrategicemphasisonincreasedindependence,supportfromcommunities,andgreaterabilitytomanagetheirownlong-termconditions,withlessrelianceontraditionalprovisionofstatutoryservicesmayimpactonolderpeople’sconfidenceintheirfuturewell-being,safetyandindependence.Someolderpeoplewillnotwishtobesupported,andcaredfor,bytheirfamilies.
DisabilityThestrategypromotesdevelopmentofsupportforcarersthatismoreflexible,innovativeandtailoredtotheneedsoftheindividual,manyofwhomwillbeolderpeople.Thepromotionofrehabilitationandenablementwillimpactonindividuals’abilitiestoliveindependently,reducingdependency.Theintroductionofself-directedsupportandthefurtherpromotionofpersonalisationinassessment,careplanningandcaredeliverywillpositivelyimpactonindependence,andcontroloverpersonalcircumstancesandallowmorebespokesupport.
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Race (incl. Gypsy Travellers)Introductionofself-directedsupportandpersonalisationofserviceswillenableindividualsandfamiliestomakechoicesaboutcareandsupportthatwillbesuitedtotheirparticularneeds,cultureandcircumstances.Focusonimprovedqualityoflongtermcarenecessitatesmoretraininginrespectoftheequalitiesandrespectagenda.
Religion or BeliefIntroductionofself-directedsupport,outcome-focussedassessmentandpersonalisationofserviceswillenableindividualsandfamiliestomakechoicesaboutcareandsupportthatwillbesuitedtotheirparticularneeds,cultureandcircumstances.Focusonimprovedqualityoflongtermcarenecessitatesmoretraininginrespectoftheequalitiesandrespectagenda.
Sex – i.e. men/womenIntroductionofself-directedsupport,outcome-focussedassessmentandpersonalisationofserviceswillenableindividualsandfamiliestomakechoicesaboutcareandsupportthatwillbesuitedtotheirparticularneeds,cultureandcircumstances.Increaseininvestmentincommunitycapacitytoshareindeliveryofpreventiveservicesandotherserviceswillrequireculturechangeintraditionalgenderroles.Strategyrecognisesparticularneedsoftheageingmale,especiallyintermsofcombatingsocialisolationandmaintenanceanduseofskillsdevelopedthroughouttheirworkinglives.
Sex – i.e. men/womenImpactonwomenfromincreasedexpectationsanddemandsintheirroleasinformalcarers.
Sexual orientation – (includes Lesbian/Gay/Bisexual)Introductionofself-directedsupport,outcome-focussedassessmentandpersonalisationofserviceswillenableindividualsandfamiliestomakechoicesaboutcareandsupportthatwillbesuitedtotheirparticularneeds,cultureandcircumstances.Focusonimprovedqualityoflongtermcarenecessitatesmoretraininginrespectoftheequalitiesandrespectagenda.
Gender reassignment – (includes Transgender)Introductionofself-directedsupport,outcome-focussedassessmentandpersonalisationofserviceswillenableindividualsandfamiliestomakechoicesaboutcareandsupportthatwillbesuitedtotheirparticularneeds,cultureandcircumstances.Focusonimprovedqualityoflongtermcarenecessitatesmoretraininginrespectoftheequalitiesandrespectagenda.
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Stage 7: Have any of the affected groups been consulted? Ifyes,pleasegivedetailsofhowthiswasdoneandwhattheresultswere.Ifno,howhaveyouensuredthatyoucanmakeaninformeddecisionaboutmitigatingsteps?
NHSGrampianPublicForum27Oct2012GeneralpublicconsultationinNov.2012.CitizensPanelOnlineSurveyNov2012CitizensPanelSurveyNov2012EngagementwithOlderPeoplesForumsDraftstrategysentforcommentto:a)GrampianRacialEqualityCouncilResponse:b)AgeScotland(includingLGBTolderpeoplerep)Response:
Stage 8: What mitigating steps will be taken to remove or reduce negative impacts?
ImpactsThese should be included in any action plan at the back of this form.
Mitigating Steps Timescale
Age- youngerDevelopmentofbespokerespitecare,andoutcomefocussedassessmentsoftheneedsofyoungcarers.Supportforyoungcarers’supportgroups.
Implementationofself-directedsupportin2014-15.
Age – olderDevelopmentofthecapacityofcommunitiestoparticipateinthecareandsupportofolderpeople.Promotionofthecontributionolderpeoplecanmaketotheircommunities,usingtheirskillsandexperience.
Lifetimeofstrategy–2023.
Sex – i.e. men/womenDevelopmentofflexibleandbespokerespitecareservices.FurtherdevelopmentofsupportgroupsforcarersUseofoutcomefocussedcarersassessmentsDevelopmentofcapacityofcommunitiestoparticipateinthecareandsupportofolderpeople
Mid-waythroughimplementation–2018
Currentandongoing
Current–2014withimplementationofS.D.S.Lifetimeofstrategy-2023
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Stage 9: What steps can be taken to promote good relations between various groups?
These should be included in the action plan.
Trainingofhealthandsocialcarestaffdevelopstheskillsoftheworkforceinpromotionofgoodrelationshipsbetweengroups,includingconflictresolution,riskassessment,andtheachievementofgoodoutcomesforallserviceusersandcarers.
Thedevelopmentofcapacityincommunitiestocareandsupportolderpeoplethroughco-production,communitylearninganddevelopmentandcommunityplanningstrengthenslinksbetweengroupsinthecommunityandstrengthenscommunitynetworks.
Stage 10: How does the policy/activity create opportunities for advancing equality of opportunity?
ThestrategyaimstooptimisethecareandsupportforallolderpeopleinAberdeenshireirrespectiveofage,disability,race,religion/beliefsystem,sex,sexualorientation,gender,ormaritalstatus.Anexplicitaimofthestrategyistoenableequalityof,andequityin,accesstocareandsupportservices.
Stage 11: What equality monitoring arrangements will be put in?Theseshouldbeincludedinanyactionplan(forexamplecustomersatisfactionquestionnaires).
TheimplementationofthestrategyismonitoredbytheOlderPeoplesStrategicOutcomesGroup.EthnicmonitoringdataisroutinelycollectedaspartofsocialworkandNHSpatientandserviceuserdatacollection.AnnualUserandCarerSatisfactionSurveys
Stage 12: What is the outcome of the Assessment?
Please complete the appropriate box, Choose 1, 2 or 3.
1 No impacts have been identified –please explain
2 Impacts have been identified, these can be mitigated - please explain
Negativeimpactsonyoungeragegroups,olderagegroups,andwomenhavebeenidentified.Mitigationoftheseimpactsisachievedthroughimplementationofthestrategy,includingthedevelopmentofself-directedsupport,outcome-focussedandpersonalisedservices,communitycapacitytoprovidecareandsupport,andtrainingofhealthandsocialcarestaff.
3 The activity will have negative impacts which cannot be mitigated fully – please explain
*PleasefillinStage13ifthisoptionischosen
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* Stage 13: Set out the justification that the activity can and should go ahead despite the negative impact.
Stage 14: Sign off and authorisation.
Sign off and authorisation.
Department Social Work
TitleofPolicy/Activity JointCommissioningPlanforOlderPeople2013-2023
Wehavecompletedtheequalityimpactassessmentforthispolicy/activity.
Name:LindaReid/BillStokoePosition:ProjectManager(Integration)/StrategicDevelopmentOfficerDate:18.02.13
AuthorisationbyDirectororHeadofService
Name:PatriciaMaclachlanPosition:HeadofOlderPeoplesServicesDate:18.02.13
Pleasereturnthisform,andanysupportingassessmentdocuments,toyourServicesCorporateEqualitiesGroupRepresentative.
ActionPlan
Action Start Complete Lead Officer Expected Outcome Resource Implications
ShareJointCommissioningPlanforcommentwithGrampianRegionalEqualityCouncil
Dec2012 Feb2013 BillStokoe CommentandrecommendationsforamendmentstoPlantoaddressanyequalitiesimpacts
None
ShareJointCommissioningPlanforcommentwithrepresentativeofolderLGBTpeople
Dec2012 Feb2013 BillStokoe/AlanYoung
CommentandrecommendationsforamendmentstoPlantoaddressanyequalitiesimpacts
None
Developbespokerespitecare
Sept2012 March2014 IainRamsay/SheenaSwinhoe
Rangeofflexibleandbespokeshortbreaksavailableforallcarers
£50kChangeFundinvestmentinCreativeBreaks2012-14
Developoutcomefocussedcarersassessments
July2012 2015 IainRamsay/SDSTeam
Rangeofoptionsforself-directedsupport,includingassessmentandcareplanningpathway,implemented.Allcarersofferedanassessment.
InvestmentinTeamManagerpostfor2years.£25kChangeFundinvestmentinadditionalstafftoundertakecarersassessments.
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Action Start Complete Lead Officer Expected Outcome Resource Implications
Supportyoungcarersgroups
2013 2018 BobDriscoll Youngcarersidentifiedandsupportedbycarerssupportworkersandthroughparticipationincarers’forums
Existingresources
Developcapacityofcommunitiestoparticipateinsupportandcareofolderpeople
2013 2023 Co-productionGroup/ChairAlanYoung
Communitiesengagedandinvolvedincareandsupportofolderpeople
ResourcesforimplementationofJointCommissioningPlan
Promotecontributionbyolderpeopletotheircommunities
2013 2023 StuartRitchie
Olderpeoplefullyactiveandinvolvedintheirlocalcommunities
£70k2yearinvestmentincommunicationsofficerpostfromChangeFund.
Traininghealthandsocialcarestaff
2013 2023 RhodaHulme/EuniceChisholm/JillianBrannan
Healthandsocialcarestaffequippedtopromotegoodrelationsbetweenindividualsandgroups,includingconflictresolution,riskassessmentandachievementofgoodoutcomes.
£124kChangeFundinvestmentindementiatraining.£56kChangeFundinvestmentinpalliativecaretrainingandstaffsupport.£39kChangeFundinvestmentinmentorforindependentcarehomesector.InvestmentinworkforcedevelopmentaspartofimplementationofJointCommissioningPlan
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Appendix H: Housing Contribution Statement Thistemplateshouldbecompletedjointlybyappropriateleadofficersfromlocalauthorityhousingandthehealthandsocialcarepartnership.OncecompletedthetemplateshouldbeincorporatedasadiscreteelementwithintheJointStrategicCommissioningPlanforOlderPeople.
ItshouldbesignedoffaspartoftheoverallJointStrategicCommissioningPlanforOlderPeoplebythesignatoriestothatoverallplanandtheChiefHousingOfficer.
Theme Detail
Outcomesrelevanttothehousingcontribution(Note1)
TheScottishGovernment’sNationalOutcomeStatement10states-“Weliveinwelldesigned,sustainableplaceswhereweareabletoaccesstheamenitiesandservicesweneed.”
NationallytheHousingStrategy“Age,HomeandCommunity:AStrategyforHousingScotland’sOlderPeople:2012-2021”respondstotheNationalOutcomeandSBCpolicytosupportpeopletoremainindependentlyathomeaslongaspossible.FivekeythemesaresettoachievethisandtheLHSencompassesalltheseelementsinourworkstreams.Ensureanappropriatebalanceofhousingprovision.Providespecialisthousingwithcareandsupport.Providehousingadaptationsandotherpreventativeproperty-relatedservices.Buildnewhousing.Supportlocalcommunitiesthroughwideractivities.Locally,AberdeenshireCouncilaimstomeetthehousingandsupportneedsofanincreasingagingpopulationandnumberofpeoplewithdementia.
TherearetwostrategicdocumentsthatidentifythemainissuesandkeyactionsinrelationtoOlderPeople:TheAberdeenCityandShireHousingNeedsandDemandStatement(HNDA)andtheLocalHousingStrategy(LHS).
Chapter5oftheLHSfocusesonParticularNeedsGroupswhichincludeOlderPeople.Itstates:
“TheParticularNeedsHousingStrategicOutcomeStatementaimstoenablepeoplewithanidentifiedparticularneedhaveaccesstoappropriateaffordablehousingandsupporttoallowthemtosustainandimprovetheirhealthtoliveasindependentlyaspossible”.
The3keyoverarchingactionsare:1.Ensurethereissufficientdiversityinallhousing,allsizesandtenuretomeetthechangingneedsofAberdeenshireresidents;ensuringaminimumof15%ofnewbuildaffordablehomesaredevelopedeachyearandexistingstockisreconfiguredforthosewithparticularneeds.2.Continuetoreviewwaystobestmaximiseexistinghousingstock,throughtheprovisionofequipmentandadaptationsinordertoreducethenumberofhouseholdswithanunmetparticularhousingneedby2,310,1,550intheprivatesectorand760inthepublicsectorperyear.3.IdentifycurrentandfuturehousingsupportneedsandharmonisehousingsupportservicesacrossAberdeenshire.
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LinktotheLHShttp://www.aberdeenshire.gov.uk/about/departments/LHSSupplementaryReport-SOS2012-2017_000.pdf
LinktotheHNDA
http://www.aberdeenshire.gov.uk/about/departments/HNDA2011_000.pdf
StrategicdirectionoftravelandproposedinvestmentchangeswithinthedraftJointStrategicCommissioningPlanforOlderPeople(Note2)
Retainshelteredhousingasatenureforolderpeopleinareaswheretherecontinuestobeidentifieddemand.Consideralternativeuseofshelteredhousingcomplexeswheredemandindecreasing,forexample,useforpeoplewithlearningdisabilities.IncreasethenumberofveryshelteredhousingcomplexesacrossareasofAberdeenshirewherethereisidentifiedneed.ProvideresidentialcarehomesforolderpeopleanddeliveraprogrammeofnewbuildcarevillageconceptsacrossAberdeenshire.
Develop,wherepossible,affordablenewbuildpropertiessuitableforolderpeople,incorporatingdementiadesignprinciples.
Maximisebestuseofexistinghousingstocktomeetthevaryingneedsofolderpeople.Forexample,propertieswithadaptationsordementiadesignprinciples.Increasepreventativeandproactiveresponsetoolderpeoplehousingneeds;holisticassessmentofhousing,careandsupportneedsaspartoftheirhousingapplication.Housingandplanningpolicysupportsthedeliveryofnewbuildsmallerpropertiessuitableforolderpeopleacrossalltenures.PromotetheCareandRepairserviceasprovidingessentialservicestoolderpeopletoretainindependenceandremainathomeforlonger,eg,adaptationgrants,smallrepairsservicesanddementiadesignassessments.Contributestounnecessaryhospitaladmissionsandsupportsearlydischarge.
Thehousingcontribution–investmentalreadyplannedonthebasisoftheLHS(andifappropriatetheLAHousingBusinessPlanforitsownstock)(Note3)
Chapter5and7includingtheresourcesstatementsoftheLHSsetsouttheplannedprojectsandinvestmentinnewbuildandexistingstock.Howeverthemainprojectsandinvestmentcanbelistedas;Remodellingof5ShelteredHousingComplexestobecomeVeryShelteredHousingcomplexesacrossAberdeenshirebetween2010and2015.Approximatetotalinvestment:£1.6mTwonewbuilddevelopmentsincorporating6x1and2x2bedbungalowstocomplimenttheproposednewbuild60bedcarehomes,creatingacarevillageconcept.Approximatetotalinvestment:£100kperunit.
Maximiseexistingstockbyinvestinginaidsandadaptationsacrossalltenures.PrivateSectorHousingGrant(PSHG).Committedannualinvestmentof£1.2m.2013/13,2014/15.SocialWorkequipmentandadaptationsincludingTelecare.Approximateannualinvestment:£250k.Stage3adaptationgrant:Approximateannualinvestment:£250kStage3adaptationgrant:Approximateannualinvestment:£250kShelteredHousingSupport.Approximateannualinvestment£700kCommunityAlarm.Approximateannualinvestment£180k
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Increaserevenuecoststodeliverproactiveandreactivelevelsofhousingsupport.Likelyfutureimpactofplanuponhousingresources(Note4)
Meetingidentifiedhousingandsupportneeds–capitalandrevenueimpact.Futurelegislativerequirements,forexample,welfarereforms,buildingandfireregulations.
IncreasedcapitalcostsandcapacityofHRAprudentialborrowingaswellasaccesstoSGgranttodevelopnewbuildhousingsuitableforolderpeople;1bedbungalows/groundfloorflats,SH,VSH.
Fundingcapacitytodeliverthepredictedincreaseinaidsandadaptationsacrossalltenures.CapacityfornecessarycapitalupgradesofSHandVSHtomeetstatutoryregulations,e.g.fireregulationsrequiringinstallationofsprinklersystems.
ReducingdemandforSH;resultinginlongtermvoidsandlowdemandcomplexesimpactingonrevenueincometotheHRA.
Competingprioritiesbetweenolderpeopleandgeneralneedshousingrequirements.
ProcessforintegratingthehousingcontributiontotheJointStrategicCommissioningPlanforOlderPeopleinfuture(Note5)
TheOlderPeoplesStrategicOutcomeGroupandtheHousingforParticularNeedsStrategicOutcomeGrouparethetwomainoverarchingstrategicjointplanninggroupsinrelationtoolderpeople.Membersfromhousing,healthandsocialcarearerepresentedonbothgroupsandjointlyplanthedirectionofolderpeople’saccommodationandserviceslocally.TheidentifiedprioritiesarerepresentedintheLHSandJCSidentifyingthekeyissuesandactionstodeliverpositiveoutcomesforolderpeople.
Outlineandunderstandingofshareddatasources,andgapstobeaddressed(Note6)
AberdeenCityandShireHousingNeedsandDemandStatement(HNDA)LocalHousingStrategy2012-2017GPPopulationdataPrevalenceratesofdementiaGROSdataNorthgateSX3-housingstockdataHousingStrategicLocalPlan–proposednewbuildprojectsoverthenext3yearsApply4homes-NumberofolderpeopleonthehousingwaitinglistCarefirst6-numberofolderpeopleusinghousingsupport,socialcareservicesandhealthservices;homecare,communityalarm,telecare
Keychallengesgoingforward(Note7) Competinghousingandsupportprioritiesacrossallsocialworkclients.Continuedcapacitytodeliveraffordablehousingandsupporttomeettheneedsandaspirationsofolderpeopletoremainathomeforlonger.LowdemandforsomeexistingSHcomplexes;consideralternativeusesSufficientfundingtodelivertheanticipatedincreasingnumberofmajorandminoradaptationsrequiredtoallowpeopletoremainindependentathomeforaslongaspossible.
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Note1:Thisshouldreflectthosehealthandsocialcaremeasures,includingoutcomes,thatareconsideredmostlikelytobeimpactedbythehousingcontribution.Theyshouldincludenationalandlocalmeasures,asdetailedintheJSCPlanforOlderPeopleNote2:Thisshoulddescribetheproposedoverallshiftinthebalanceofcareandoutlinethekeyservicere-designproposalsintheJSCPlanforOlderPeoplethatareintendedtodeliverthisshiftNote3:ThisshoulddetailthoseaspectsofthecurrentLHSthatcontributetodeliveryoftheJSCPlanforOlderPeoplefocusingonchangeinservicedeliverytosupporthealthandsocialcareoutcomes,andshouldalsoreferencethelocalauthority’sinvestmentplansforitsownstockwhereappropriate.Note4:Thisshouldoutlinethepotentialimpactthattheplanislikelytohaveonhousingresources,bothservicesandbricksandmortar,goingforwardNote5:ThisshouldexplainlocalproposalsforensuringthatthehousingcontributionisclearlyarticulatedandhowastrongerhousingperspectivewillbeincorporatedintofutureJSCprocessesandplansNote6:ThisshoulddescribethedatasourcesthathavebeenusedbybothhealthandsocialcareandhousingincompilingtheJSCPlanforOlderPeopleandtheLocalHousingStrategyandidentifyanycurrentlyapparentgapsinthedatathat,weretheytobeaddressed,wouldbettersupportjointworkingbetweenthesectorsNote7:Thisshouldhighlightanyparticularissuesregardinghousings’contributionthathaveemergedfromdiscussionsrelatingtothecompletionofthisHCSand/oranyotherrelatedprocesses