CONTENTS. 1. Introduction Links with Local and National Strategic Plans and Guidance... 3

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1 Pembrokeshire County Council Older Persons Commissioning Plan CONTENTS 1. Introduction Links with Local and National Strategic Plans and Guidance Needs Assessment, Research and Data Analysis Service Review Future Provision and Commissioning Intentions Monitoring and Evaluation Arrangement Appendix 1. Feedback on Consultation of this Commissioning Plan Appendix 2. Glossary Appendix 3. Commissioning Plan Action Plan Separate Attachment Appendix 4. Data and Data Sources Separate Attachment Pembrokeshire County Council Older Persons Commissioning Plan February

2 1. Introduction 1.1 The commissioning of social care involves making decisions about what services are required to respond to the social care needs for the population of Pembrokeshire. 1.2 The underpinning principles of this commissioning plan for older people are: Combat ageism within support services by recognising people s right of choice and to information which enables them to make well informed decisions about the way in which they wish to live their lives. Promote independence and give people the ability to have control over their lives and take responsibility to prevent dependency. Combat loneliness and isolation. Provide people with the support necessary to meet their assessed needs and enable them to continue living in their own homes or in their home communities for as long as they wish to do so. Recognise and provide support for informal carers, whether family or friends, in helping older people in these areas. Move away from the risk-averse culture limiting older people s potential and opportunities. Simplify systems and processes to ensure that they are not confusing for people. Focus on dignity and quality. Working in partnership and collaboration where appropriate. 1.3 Supported by the following: Concentrating upon outcomes for individual customers which are linked with strategic outcomes. Self directed care to enable people to influence and control their lives. Co-production where customers and communities work alongside professionals as partners in the design and delivery of services to make them more responsive to needs and deliver better outcomes. Work with partners on universal services to ensure that they are inclusive. The development of service models appropriate to the mixed urban and rural nature of the county. Responding to the needs of minority groups. Exploring the contribution that social enterprises can make towards delivering the social care agenda in the future. Develop a better understanding of the market for self funders. The development of opportunities for providers from both the third and private sectors to improve their business model and develop the technical skills required to respond to the commissioning challenges. Development of regional approaches to commissioning where appropriate. Exploring the development of incentives for high quality services. Development of a common approach to the quality assurance of providers. 1.4 Pembrokeshire County Council and its partners face a very difficult financial climate over the next few years coupled with increasing demand. This commissioning plan offers the best opportunity of responding to this challenge in a consistent and fair manner. 1.5 This plan is considered to be a working document that will be reviewed on a regular basis to ensure that it remains fit for purpose and focussed on the changing needs of older people living in Pembrokeshire. This is in line with the Pembrokeshire Health, Social Care and Wellbeing strategy. Pembrokeshire County Council Older Persons Commissioning Plan February

3 1.6 While this plan refers to data across all our services it is mainly concerned with older adults. However, we realise that many issues impact across our client groups and age ranges and as such we take all customers into account when planning service provision. We will be developing separate commissioning plans for all our client groups which include learning disabilities, mental health and physical disabilities. 2. Links with Local and National Strategic Plans and Guidance 2.1 This plan has been developed around emerging need identified through analysis of services currently offered to customers. It has also drawn on recent national and local guidance and strategic plans to inform the direction and priorities. Some of the more prominent sources are listed below: Fulfilled Lives, Supportive Communities Pembrokeshire Community Plan Health Social Care and Wellbeing Strategy Pembrokeshire Community Safety Strategy. The Strategy for Older People in Wales Hywel Dda Health Board 5 Year Framework ABC of Integrated Community Services. Pembrokeshire Workforce Plan. Rural Health Plan. Older Person s National service Framework. Carers Strategies (Wales) Measure 2010 Setting The Direction 2010 The main themes emerging in all recent and current national and local strategies are mirrored in this strategy. These all centre round enabling people to be independent, remain in the community, prevention of dependency, 24hr access to the right care, services provided in localities within easy reach of customers, tight constraints on financial and therefore other resources as well and working in partnership and collaborating to ensure joined up services centred round individuals specific needs Links with Procurement and business plans: actions arising from this commissioning plan will be delivered through the service improvement plans of Pembrokeshire County Council and its partners. 2.3 Desired Outcomes are: People are enabled to remain living in their own homes. People are able to engage in social activities. People retain control and independence. People are protected from abuse. People have good health, well being and physical functioning. People continue to feel optimistic about what they can expect in life. Pembrokeshire County Council Older Persons Commissioning Plan February

4 3. Needs Assessment, Research and Data Analysis /10 The 2009 mid year estimates show that adults make up 78% of the overall population (117425) in Pembrokeshire. The age group seen to be those who usually provide caring roles is and at 2009 this group makes up 36.4% of the adult population. The 80+ is 7.2% of the adult population and the is 18.9%. 43% of the total community care budget is spent supporting 500 people at any one time in residential care homes (including nursing homes). There are a further 75 people living in nursing homes funded through continuing health care plus approximately 400 people who are self funding their service within these environments. Enquires for community care services are received by the Council s contact centre and on average 325 referrals are made each month. A further 350 individuals per month have their care plan reviewed. The majority of admissions into institutional care directly follow a hospital admission. We are carefully monitoring this position. The majority of people entering residential and nursing home care are over the age of 80. Despite people entering at an older age there is no change to the average length of stay. At any one time approximately 1300 people are supported by long term home/ community support services with the vast majority having critical or substantial needs. 55% of lone pensioner households do not have access to their own vehicle. This equates to 4248 people. 12% of households with more than one pensioner do not have access to their own vehicle. This equates to 662 households (or at least 1,324 individuals) 3.2 Projections from 2010 to 2015 Daffodil Cymru is a statistical website that provides projections based on data gathered from sources such as Welsh Assembly Government and Social Services Improvement Agency. These have proved useful in conjunction with other sources to provide an estimated position over the term of this plan. The Full Needs Assessment for Pembrokeshire can be found on the Health Challenge Pembrokeshire website or by following the link below It is projected that this by 2015 the age group will only make up 34.9% of the adult population this is a drop of 2% from the 2009 mid year estimate. It is also projected that in the age range the decline will be as much as 4% by The population of people aged over 80 years to increase by 15% from 6,920 to 7,960. Nearly two thirds of these will be female. Statistically it would be expected that at least 50% of these individuals will have a dementia. This would mean that an increase of 520 individuals with dementia could be reasonably expected during this period. The population of people aged over 65 years living alone to rise by 15% from 11,654 to 13,434. The number of people of working age will reduce by 1%. 76% of people over the age of 65 years are owner occupiers and this should rise to 78% by The population of over 75 s classified as obese to rise by 13% from 1,561 to 1,757. The number of over 70 s treated for stroke could rise by 13% from 1283 to Pembrokeshire County Council Older Persons Commissioning Plan February

5 It is predicted that there will be a 16% increase in the number of people entering residential care if we continue to practice in the way we currently do. It is predicted that the number of people requiring community based services including specifically adaptations to their homes and respite within their own homes, especially for those with a dementia, will increase by 16%. This increases to 19% for those customers with learning disabilities. The number of people aged over 65 years who will have issues with mobility, self care, continence, A&E attendance due to falls and A&E admission into hospital due to falls, is predicted to increase by 16%. 3.3 Analysis of Data The growth in potential levels of need is increasing significantly with the prediction being 16% over the five years of this commissioning plan. Financial resource available to the Authority over this same period is predicted to reduce by at least 2.5% each year. This could mean an annual shortfall of 5.7% per annum. The cost of delivering traditional services such as residential care and home support continue to rise above the rate of inflation. Maintaining current models of service to meet this level of increasing demand is not sustainable within the resources available to the Authority. An increase in residential/ nursing home fees of 60 per week, for example will require a reduction in current purchasing by the Authority of 17%. Increased cost will have to be contained within the financial resource available through efficiency savings by providers, reduced purchasing, and increasing income and the utilisation of alternative cost efficient and effective alternatives. Vulnerable older people will continue to require assistance to achieve the outcomes detailed in this plan. A new approach based upon individual rights and responsibilities supported by community focused non-institutional models of support. The Authority s Cabinet has endorsed the principle of reducing its dependency upon old style traditional services such as long term home care and residential care. Research undertaken in Pembrokeshire (1999) with potential customers of residential care services found that the majority did not view residential care as a positive option but recognised that if they became unable to care for themselves then their family or G.P. would make the decision for them. With almost 14% of our over 80 year old population living in institutional care it may be reasonable to assume that our society views this as an acceptable option for older people. It is, however, questionable whether or not society would accept this level of institutionalisation for any other group within our society and whether this achieves the principles and outcome objectives of this plan. Technology continues to develop to provide varied and imaginative means by which people can be supported to live fulfilled and safe lives at home. There needs to be a more proactive embracing of new technologies, particularly those based upon digital technology and universal services becoming more inclusive. People who take responsibilities for themselves, receive good information and with reablement have outcomes which prevent, or at least delay, them from requiring ongoing long term support. With so many older people being owner occupiers there exists a significant asset resource which could give them a choice as to how they can meet their current and future needs. However, alongside this we must consider that it is ever increasingly difficult for younger adults to purchase their own properties and many are residing with parents for longer. The older adults may sell their properties to provide their children with money to purchase their own property and not retain enough to utilise for future care needs. Additionally there may be a shift to closer multi-generational families residing together Pembrokeshire County Council Older Persons Commissioning Plan February

6 the effect of which will only become apparent later on. Further research and analysis in this area is needed. Dementia, stroke, falls, cardiac and respiratory disease often trigger the need for long term health and social care. How reablement and support networks are delivered impacts directly on the ability to continue to live in the community outside of institutional care. Social interactions affect human capacity, health and physiological resourcefulness. Social isolation and loneliness will seriously impact upon an individual s ability to remain living as independently as possible within their own home or community. 3.4 Consultation Data Analysis During 2009/10 Pembrokeshire undertook several consultation exercises with customers. Overall the suggested improvements and comments made all refer to people being supported to remain independent in their own homes. Negative feedback was mostly expressed around waiting times for service or assessment. Positive feedback included comments that the services received had helped people to remain independent and enhanced their quality of life, allowing them to manage daily tasks better. When asked what services are important to help older people remain independent at home, high importance was given to a range of basic services that include gardening, cleaning, shopping, laundry, assistance with finances and adaptations. Many cited wanting more contact/social interaction with other people. In our Citizens Panel consultation, of the 637 respondents to the question of whether people would like to remain in their own home, 97% agreed. With regard to residing in care homes concern was expressed about the consistency of care in care homes, the fear of being dependent and preferring sheltered accommodation. In response to what local community support is needed, community volunteer schemes like neighbourhood watch, good neighbours who are aware and keep an eye out, assistance with household chores and support through various groups were mentioned. Home support suggestions include regular visits/checks by volunteer groups, assistance with household chores and greater access to professional help and care networks. 4. Service Review 4.1 Pembrokeshire is in the process of setting up Community Resource Teams (CRT s) across the County in 4 localities. During the first quarter of 2011/12 the current care management teams will combine with the CRT s. Our Pembrokeshire Professional Hub will comprise a Professional Help Desk (PHD) which will deal with all new referrals before referring on the more complex cases to the CRT s. The PHD should be established in part of the County from July 2011 with social care staff. We will add OT rota cover, followed by input from Physiotherapists and then district nurses during 2012/ The Joint Discharge Team based in Withybush General Hospital and the Multi Disciplinary Assessment Support Team work closely together to prevent inappropriate discharges through A&E. They also ensure that for those admitted to hospital their discharge back home is successful. 4.3 The homecare team is currently moving customers over to independent providers so that capacity can be made available for the service to respond quickly (rapid response service) and the reablement agenda to be moved on. All new customers will be assessed for reablement. We offer customers up to 6 weeks reablement where appropriate. Pembrokeshire County Council Older Persons Commissioning Plan February

7 4.4 Customers who require respite and qualify can receive up to 6 weeks of respite a year. In special circumstances as determined by the assessed need of the individual and/or their primary carer this can be extended. 4.5 Day care is provided at our day centres and social activity centres for customers who have been assessed as needing this service. The day centres are not all appropriate to provide services to our customers with dementia and this will be addressed during 2011/12 as part of the Pembrokeshire Dementia Action Plan to refocus day services. 4.6 In order to promote independent living we will need to focus on those services which allow the greatest measure of independence. Some customers will require a range of services and these can include homecare, day care, equipment/aids, reablement. Some customers prefer to commission their own care and therefore prefer to receive direct payments. During 2009/ customers aged 65 + received services, this equates to 2,937 customers supported in the community, many of whom are in receipt of more than one service. Based on the 3358 customers aged 65 + receiving services during 2009/10: Homecare % Equipment & Adaptations % Day Care % Direct Payments % Meals on Wheels % 4.7 The net expenditure for residential and nursing home placements during 2009/10 amounted to 13,054,000 this equates to an average expenditure of 17,176 per customer for the year. This is inclusive of respite placements in the care homes. In contrast the net expenditure for services commissioned to support people to remain in the community amounted to 13,592,000 this equates to an average expenditure of 3,147 per customer for the year. Further detailed analysis of which community services have the largest customer base and which cost the most will also inform future planning. 4.8 During 2009/10 98 adults aged 65+ assessed as needing support with mental health concerns, received services in the community. 53 adults aged 65+ assessed as needing support with mental health concerns, were in care homes and of these 33 were diagnosed with dementia. 4.9 Those adults supported in the community received various services which included: homecare; day care; respite and reablement. We finalised our Pembrokeshire Dementia Action Plan in response to the All Wales Dementia Action Plan. This was developed in partnership with health and the 3 rd sector. It is aligned with the 1,000 lives intelligent targets for dementia We will be developing a Commissioning Plan for people with a learning disability during 2011/12. However, as person centred assessment and planning is central to producing meaningful outcomes, links will be made with the Older Adults Commissioning Plan. Of the 283 adults with learning disabilities who were supported in the community during 2009/10, 29 were aged 65+. These customers were supported with services such as day care, supported accommodation, community supported day care and respite. 84 customers with learning disabilities were in care home placements and of these 12 were aged of the 65+ adults were in nursing home Of the 2,937 customers aged 65 +, 2,757 were assessed as requiring support for physical disabilities, frailty or sensory impairment. 1,215 received homecare and 1,751 were provided with equipment/aids and/or adaptations. Meals on wheels were provided for 594 Pembrokeshire County Council Older Persons Commissioning Plan February

8 customers aged In contrast with these aforementioned service levels 88 customers aged 65 + utilised direct payments for their assessed care needs. One of our priorities is to increase the awareness and utilisation of direct payments thereby assisting customers to remain independent and take responsibility for and control of their own care needs. 443 customers aged 65 + assessed as requiring support for physical disabilities, frailty or sensory impairment were provided with care home placements and of these 157 are in nursing care placements Most adults aged 65+ with substance misuse concerns are supported by care management teams in the community as part of a package of care or with input from the 3 rd sector. The substance misuse team is working closely with other community care teams to ensure that adults aged 65 + assessed as needing support with substance misuse issues have access to the care they require. Substance misuse is part of the remit of the Safer Pembrokeshire Joint Commissioning Group (multi-agency) and provides strategic and operational support for shaping, planning and provision of services for customers with substance misuse issues. 5. Future Provision and Commissioning Intentions 5.1 Services which we believe will promote our stated outcomes will include: Support to carers to cope effectively. Targeted services to minimise escalation in care needs. Routinely providing opportunities to restore independence or adapt to changing needs. Enabling customers to make optimum use of universal services. Ensuring the physical care environment maximises independence. Making the most effective use of staff resources. Seek the optimum balance between capital and revenue costs. Deliver investment to secure benefits. Provide support for family carers. Support that enables individuals to reduce their reliance on social care services. Services which are linked to outcomes. Provision of information and signposting for customers. 5.2 Collaborative options: During the period covered by this plan the Authority will prioritise the fullest utilisation and/ or the further development of the following interventions: o Re-ablement and assistive technologies as the first response to requests for support. Traditional assessment and care management will only be considered once this has been completed and the complexity of the situation warrants that level of intervention. o Intermediate interventions for those individuals whose situation cannot be resolved as a result of the re-ablement approaches. o Extra care and sheltered housing developed and enhanced as viable alternatives to residential and nursing home care. o Adult family placements developed and enhanced as viable alternatives to residential and nursing care and other mainstream services. o Community based night time cover and rapid response/ responder services (which includes a response to telecare for people with no key holder). o Good neighbour schemes. o Virtual friendship and befriending networks eg SKYPE. The Authority in partnership with the Local Health Board, neighbouring authorities, private and third sectors will focus upon: Pembrokeshire County Council Older Persons Commissioning Plan February

9 o The development of a professional hub as first point of contact for new referrals and checking how customers who are receiving long term health and social care interventions are managing. At this point many of these contacts will be completed through information giving, direct access to certain support and sign posting. o Re-ablement, including the provision of assistive technologies, as the first response to those who enter the system with the anticipated outcome that at least 50% will remain at home with no long term formal support (e.g. home care). Re-ablement teams will be multi disciplinary/ agency with re-ablement assistants being employed by the Authority. o For those individuals unable to become self supporting after a period of reablement intermediate services including assessment and care management, social work, district nursing etc will be provided. The anticipated outcome will be that a further 40% of individuals will remain living at home self supporting with limited formal support. Home support will be purchased through a mixed economy. o For those individuals with long term or chronic conditions long term support purchased from the private and third sector will be available together with professional health and social service services. Direct payments will become the primary vehicle for ensuring personal control and independence. 5.3 Service quality and human rights: It is recognised that service providers will be at the forefront of improving quality and delivering better outcomes as they have the most regular, often daily, contact with customers and carers. All social care providers are registered with the Care and Social Services Inspectorate Wales (CSSIW), guaranteeing that essential standards have been met. These basic standards for quality and safety act as a bedrock from which improvement can be made towards the higher levels of practice and outcomes required. To establish which providers are successfully going beyond those essential standards, and striving for excellence, a further assessment mechanism will be needed. In England NICE, the Care Quality Commission and the Social Care Institute for Excellence are already working to develop a bespoke method of assessing high quality practice in social care providers. When this work has been completed the Authority and its partners will consider the appropriateness of its application to Pembrokeshire. It is anticipated that this developmental work will be comence during the financial year 2011/ 12 for completion in 2012/13. Developments initiated as a result of this commissioning plan will be tested using the Equality Impact Assessment in order to ensure compliance with human rights. 5.4 Financial and Contract Standing Orders and the development of the local social care market: Building upon its current commissioning capacity and utilising existing skills within its workforce the Authority will work with partners to develop the local social care market which will promote outcome based and citizen focused services and interventions to enable older people to remain living in their own homes. Utilising its financial, planning capacity the Authority will work with partners to ensure that the changes are managed, destabilisation minimised and the impact upon existing and potential customers assessed and considered in full. 5.5 Value for money and fit for purpose Best Value: The goal of achieving better value for money and greater efficiencies will be supported by the Quality Standards which evidence best practice, and improved data which demonstrates progress. Pembrokeshire County Council Older Persons Commissioning Plan February

10 The Authority and its partners will consider the use of direct financial incentives for providers to support the focus on quality and outcomes and encouraging a culture of continuous improvement and best practice. One possible approach is to develop a framework for locally agreed quality schemes in which the achievement of ambitious quality improvement goals is linked to a small proportion of a provider s overall contract income. An example of this is Commissioning for Quality and Innovation. The Authority and its partners will explore means by which service providers can be enabled and supported in becoming more fit for purpose and providing value for money. 5.6 Costs of directly provided and contracted services/ service sustainability: Respite care is a key service for carers and there is no intention to reduce this. This being said it is recognised that short term care in residential settings has the real potential of resulting in long term admissions. During 2011/12 specific short term services including community based alternatives to standard residential homes will be procured. Customers will continue to be able to exercise personal choice of setting through self funding or direct payments but the Authority will only purchase directly from providers who have been through our qualification process. A managed reduction in the number of state funded older people living in residential homes not providing specific dementia care services. A target of 10% reduction of current numbers per annum by the end of 2015/16 may be challenging but is in line with the principles and outcome objectives of this plan. Most people who are surveyed want to remain in their own home for as long as possible. Our assessment process which includes the assessment of risk is carried out in consultation with customers and their family to determine the best option to meet their assessed needs. Most people, with an average age of 85+, who enter residential care have substantial needs and require 24hour care for chronic conditions which can include dementia. The Authority will review the fees for purchasing residential and nursing home care on an annual basis. The Authority will adopt a modified methodology of reaching a guide figure for fees. The Authority will continue to review, in consultation with customers, partners and providers, the processes used for the setting of fee levels based upon local and national political, economic, social and technological determinants. The guide figure will be considered together with factors, including the impact on customers, general council services market sustainability and representations from the providers. New developments will only be supported if they provide high quality cost effective/ efficient services which deliver the outcomes of this commissioning plan. Although it is recognised that many residential and nursing homes in Pembrokeshire have fewer than 20 beds it is also recognised that homes of this size may potentially be more costly to operate at the required regulatory quality standards. The Authority does not intend encouraging the operation of financially inefficient homes in either the private or public sector. It is recognised that measuring efficiency is a more subtle process than simply comparing costs. Quality and outcomes for customers are also essential components together with accessibility and service coverage. Direct payments will be promoted so that those who require long term care and support will have control about how their care is delivered with outcomes being closely monitored. The commissioning of long term domiciliary care will be further developed to ensure that it is person centred and outcome focused. It will also need to have an increased emphasis on flexible care planning and risk management embracing a risk taking approach involving creative solutions supported by contingency arrangements. Care plans will be able to be stepped up or down within agreed parameters on a daily or weekly basis by the individual or their carer. Pembrokeshire County Council Older Persons Commissioning Plan February

11 Delivering support for carers to sustain their role for as long as possible involving advice, information, training and emotional support. It is recognised that day services provide both a significant support service for carers as well as a stimulating environment for the people who attend. Day services will need to develop a more rehabilitative focus and work with customers to access universal services. Day hospitals and day centres need to come together and change to become locality resource centres which offer a one stop service with people accessing when required and moving in and out all the time. The development of the social enterprise model, based upon the success of FRAME, will be explored as an approach to this agenda. Consideration will also be given to staff groups wishing to provide other services through this means. The active implementation of the relevant sections of the Health, Social Care and Wellbeing Strategy, with particular reference to falls prevention, exercise and personal wellbeing. The active promotion and positive implementation of the mental capacity act to ensure that it is the needs and wishes of the individual customer which are paramount in terms of making informed choices about their futures. No individual with mental capacity should enter institutional care to meet the needs or aspirations of others. Further development of access to universal services delivered by the Authority or its partners with the outcome of building local community capacity, reduce social isolation and include those hard to reach populations. 6. Monitoring and Evaluation Arrangement This commissioning plan and the action plan will be monitored at a service level as well as the Health, Social Care and Well-being Partnership. National performance measures and others set up specifically to measure progress against action plans will be included in our evaluation of progress. As part of the annual review we will be referring to the commissioning standards as set out in the national commissioning framework guidance. Pembrokeshire County Council Older Persons Commissioning Plan February

12 Consultation of the Commissioning Plan for Older Adults Appendix 1 Methodology The consultation was carried out during March The draft plan was published on the Council website under the Have Your Say section inviting comments with links from the Health, Social Care and Wellbeing website. A press release, which appeared in the local press on 16 th March, was issued inviting people to take part in the consultation. Details of the consultation were sent to the following: All PCC community care staff PCC Procurement staff Head of Housing Commissioning Social Care Workforce Development Programme staff GP Practice Managers Social Care in Partnership local group Community Health Council Senior Managers Hywel Dda Health Board Adult Social Care providers via the PCC Contracts Team Voluntary Sector via PAVS they included it in the Network News and held a consultation/discussion group 50+ Forum Older Person s Champion Chair of Older Persons, Health and Wellbeing Overview & Scrutiny Committee Attendees at the 50+ Annual Conference had a copy of the document and consultation in their conference packs Responses 18 responses were received from a range of individuals/organisations. These included 1 response from a carer, 6 from social care staff and the rest from partners of whom there was 1 from a social enterprise, 1 individual response from a service provider, 1 joint response on behalf of service providers, 1 joint response on behalf of the voluntary sector (4 organisations), 3 from Health. Many provided narrative responses and other provided responses to the questions as well as narrative. Summary of Responses 7 out of 8 agreed with the underpinning principles, desired outcomes & services to promote outcomes. 6 out of 8 agreed with the commissioning intentions and found the plan easy to read. Some of the narrative refers to the fact that there is not enough detail around what input the 3 rd sector will provide. We consider this level of detail is better defined per individual project and because this and the action plan are considered working documents they provide flexibility to take account of changes in direction, commissioning and provision. These changes will be dictated by annual analysis of progress and service / customer data and feedback. While we have referred to national and local guidance and plans from which we have drawn some of our information to develop this plan, it is not deemed necessary that we include specific references. The main themes and recommendations in most guidance are consistent in their direction. As set out in the Setting The Direction guidance document NHS policy will impact on our services and how we commission and provide them to customers. Pembrokeshire will have an integrated management structure across primary and community care services and will therefore as a matter Pembrokeshire County Council Older Persons Commissioning Plan February

13 of course take appropriate guidance from both organisations into account as required. There is a considerable amount of collaboration and joined up working that takes place already and whole systems thinking is part of how we will plan future service delivery. Many responses were concerned with providing services in the community and how we can help people avoid becoming dependent on institutionalised care and providing customers with choice. It is recognised that 24hour care is costly and there is an increasing number of customers presenting with greater complex needs. A balance will need to be struck between providing customers with choice and the constraints we have on resources. That is why we intend to look at innovative ideas for services. There is a lot of information available for customers on how to stay healthy, independent and live well. We will need to make sure that this information is consistent across all sectors and easily accessible. Some of the ideas proposed include using local authority residential homes for step down or rehabilitative care; supporting people to manage their finances, developing quality assurance for care providers and providing information on benefits and voluntary services. Some responses request further information is provided on carers, the reablement process and the referral process. These items will be taken into consideration when we review the information we have available. While there is a lot of information already available it will be considered against suggestions and requests that have been made as part of this consultation. Finally, it is important to reiterate that Pembrokeshire County Council considers partnership working and collaboration as a key element to current and future service design and delivery. Therefore as we work through our action plan appropriate partner organisations will be approached. The Health, Social Care and Wellbeing partnership board will be monitoring progress against this plan and as such will provide guidance on future partnership working. Pembrokeshire County Council Older Persons Commissioning Plan February

14 Glossary Appendix 2 Assistive Technologies Assistive technologies refers to equipment and systems such as telecare, telehealth and community alarms. Community Based Services These are services that can be provided in a community rather than concentrated in a central location. Community Resource Teams The teams are made up of different health and social care professionals and could include the following: General Practitioner (GP) district nurse social worker occupational therapist physiotherapist dietician Chronic Conditions Nurse practitioners community psychiatric nurse (CPN) support workers voluntary service broker They operate in four localities across Pembrokeshire, namely: North East; North West; South East and South West. Community Supported Day Care Day care services provided for our customers with learning disabilities. Support to access a range of leisure, education, training and work experience. Continuing Health Care Continuing health care is provided by the NHS local health board for qualifying applicants who are assessed as requiring 24hour continuing care or nursing care. Co-production Co-production is based on the premise that people and communities have resources that can be brought together to provide services to the public. Criteria for establishing level of need Critical/Substantial Critical Needs - for example, someone who is unable to undertake vital tasks essential to daily living. Substantial Needs - for example, when there is an inability to carry out the majority of personal care tasks. Day Care Day care is a service provided in Day Centres to older people who are assessed as needing some support. These centres allow carers to have a break and give customers the opportunity to socialise with other people and join in with group activities. Each centre is run by a manager and appropriately trained staff. Pembrokeshire County Council Older Persons Commissioning Plan February

15 Direct Payments Direct payments are designed to give people more independence, choice and control, in order to help them manage their own lives in their own homes. Customers who have been assessed as requiring care and are willing and able to manage the direct payments, with or without assistance, can purchase their own care privately. Extra Care Scheme Extracare housing schemes are similar to sheltered accommodation but provide extra facilities to enable older people to live in their own homes and maintain their independence in a safe and secure environment, with an on-site, 24 hour, 365 day care service specifically tailored to meet individual needs. Institutional Care Care provided in formal settings such as care homes and hospitals is referred to as institutional care. Joint Discharge Team This team consists of social care and health staff who deal with referrals from the hospital wards and help facilitate safe discharges. This team is based at Withybush hospital. Mid year estimates The annual mid-year estimates on population are produced by the Office for National Statistics (ONS) and can be found on the Statswales website. Multi Disciplinary Assessment Support Team The Multi Disciplinary Assessment Support Team (MAST) is made up of a nurse, social care and therapies professionals who work with people who present at A&E in order to ensure that where applicable admission to hospital is avoided unless appropriate. Professional Help Desk The Professional Help Desk in Pembrokeshire will form part of the Pembrokeshire Professional Hub and will be the second point of contact after the contact centre. This team will comprise social care and health staff once it is fully operational. Reablement Reablement is aimed at people with poor physical or mental health or disability to help live as independently as possible by learning or relearning the skills for daily living. It is provided by reablement assistants, Occupational Therapists and Physiotherapists Respite Care Respite care is offered to our customers for a designated period of time (dependent on level of need) in an appropriate setting or via a direct payment. The aim is to provide a period of rest for the individual, and their carer, who may be finding it difficult to maintain their full independence at home, or in their care setting. Self-Funders The term self-funder is used to describe someone who is responsible for the full cost of their care under s22 National Assistance Act This is usually because their assets, including property, are worth over the current threshold set by the government. Sheltered Housing Sheltered housing is sometimes known as supported accommodation. It is intended for people who are able to live independently, but who would benefit from the service of a warden. Pembrokeshire County Council Older Persons Commissioning Plan February

16 Third Party Payments Some independent care homes charge fees which are higher than the maximum amount that Social Services can contribute. This maximum amount is often referred to as 'the usual costs'. If Social Services is contributing towards your care home fees, and you choose to move into a home which charges a higher fee, the difference between the two amounts is paid by a third party, usually a relative. Third party payments are sometimes referred to as 'top-up' payments. Vulnerable Older People A vulnerable adult is a person who is or may be in need of community care services by reason of mental or other disability, age or illness. Pembrokeshire County Council Older Persons Commissioning Plan February