Future provision and funding of Personal Care the

Future provision and funding of Personal Care the challenges and opportunities Tom Wright Chief Executive Age UK Your Life, Your Way, Your Choice Age UK Newcastle 23 November 2012

Good Morning……. • • A few words about Age UK The demographic challenges Personalisation – what’s it all about? Social Impact Bond – a new way forward?

About Age UK Vision: A world in which older people flourish Mission: To improve the lives of older people Organisation: A charity and a social enterprise driven by the needs and aspirations of people in later life

What we do • Offer Information and Advice – Together with our partners we offer info on benefit entitlements and how to claim, finding a care home, how to remain independent at home, staying fit and healthy etc. • Campaign – Together with our partners we have achieved abolition of default retirement age, protecting social care funding, stopping cheque phase-out etc. , and become the number one influencer at Westminster • Provide support for delivery of local services – working with our 169 local Age UK partners to enable them to deliver great local services • Fund research that makes a practical difference with the Research into Ageing Trust, and collaboration with universities and Government to encourage funding for research into ageing

What we do • Product development and delivery - addressing market failure with commercial and financial services and products that meets peoples needs • Retail - 459 high street shops + 200 independents, 7200 volunteers, signposting to the services of Age UK and its partners, providing a range of daily living and mobility aids • Training courses for people of all ages to become part of social care workforce with almost 3000 learners in 2010/11 • Age International - with Help. Age International working to support more than 300 overseas partners in more than 40 developing countries, reaching 1. 2 m people every year. Member of the Disasters Emergency Committee (DEC) – coming together when there is a pressing need for coordinated action in response to emergency situations, e. g. in Haiti, Pakistan and Horn of Africa.

The demographic challenges • For the first time in history, there are now over 14 million people in the UK aged 60 and above. • Our society is also growing older, with the numbers of people aged over 65 set to rise by over 50% in the next 25 years. • The number of people over 85 in the UK is predicted to double in the next 20 years and nearly treble in the next 30. • A baby born in 2011 is almost eight times more likely to reach 100 than one born in 1931 • By 2020 nearly 2. 7 million people aged 75+ with at least one limiting long term illness, and people living an average of 7 -9 years at the end of their lives with a disability • Society is bound by cultural conditioning and stereotyping of what old age means and looks like • Stereotyped prejudice written into the language: ‘grumpy old’, ‘silly old’, ‘boring old’ and so on……

Later Life and its opportunities There is another side to the story…… • The changing lifestyle of ‘retirement’ • Different priorities and needs • More time, and different uses • New interests and opportunities • More disposable income

What is personalisation? Personalisation of services: The aim: • Centred on the needs of individual users – who best know their own needs • Users are supported to get the best care possible • Transferring power to users It should: • Inform the way care is provided in individual settings • Give people a much greater say in how services are run • Guide professional behaviour

But it’s not just about Direct Payments… • Personal budgets and Direct Payments one of the keys ways Local Authorities have implemented personalisation • BUT they should also include a focus on: • Integrated working with the NHS • Universal I&A provision • Better and more coordinated assessment processes • Person centred planning • Supporting people to make good choices about their care • Supporting carers • Effective safeguarding

What do older people think about Direct Payments? • Most of the research focuses on their experiences of personal budgets/direct payments • Report less positive outcomes than other service user groups • Admin and bureaucracy very problematic for many • Need to make sure all options provide good choice and control – not just Direct Payments

What does Age UK think about personalisation? • Supportive of the vision for personalisation • everyone should have access to personalised care – including self-funders • Personal budgets and Direct Payments should be a choice and not imposed • Cash payments not suitable for all service users - there need to be options • Critical they are supported by good access services, I&A, assessment, supporting planning, brokerage • Continued need for local market management

What is being planned by Government? • Care and Support White Paper and draft Bill • Key opportunity to transform care and support so it’s fit for purpose • Taking forward key elements of personalisation • Right to request a Direct Payment • Better provision of I&A • Assessment and care planning for self funders in residential care • Queen’s Speech in 2013; if legislation debated and passed quickly, change could start in 2015

Integrated care for older people Age UK and local Age UKs……… Piloting a new approach to improve care and reduce hospital admissions, and investigating new funding solutions

Overview of the programme Age UK is developing an innovative invest-to-save model of service provision integrating the care that the most vulnerable older people receive from the NHS, social care and the voluntary sector. Our aim: • to improve health outcomes for some of the most vulnerable older people • reducing the number of unnecessary hospital admissions • to do so in a way which is sustainable in the long term. We expect: • to deliver cost savings to the NHS, and thus…… • to pay back the social investment used to set up initially. We are testing the service in the South West. Working together with Age UK Newcastle, we plan to develop further here in Newcastle / North Tyneside next year

The context What older people experience • too many trapped in a cycle of hospital admissions (which costs the NHS £billions) • lack of investment in effective prevention services in their own community What older people want from their services • joined-up health and care leading to better health outcomes (which costs less) • services which are responsive, promote self-care, centred on their wants and needs,

The context Challenges facing the NHS • increasing demand unaffordable pressures • cannot fund preventive services at same time as acute care • making Payment By Results work, and therefore not losing voluntary sector orgs Challenges facing local Age UKs • statutory sector underpays for good Age UK services • need more knowledge of what works, and how best to capture impact & value • opportunity for step change in performance management and tracking outcomes

The overall objectives • Improve outcomes for older people through an integrated care service • Reduce costs to the NHS and enable savings to be reinvested in preventative, community-based health and care services • Demonstrate a sustainable way of transforming people’s health and care through targeted, holistic, personalised services which produce long term savings to the NHS • Improve the quality, impact and sustainability of the local Age UK's services • Explore alternative funding solutions to kick-start change, including the Social Impact Bond

How the SIB model works financially A programme of action • Finance from public sector • Finance from ethical investors • Finance from charitable sector Creating a sum for investment in services • New services for older people delivered by local Age UK to reduce hospital admissions • Reshaping health and care services to generate cashable savings • Project managed by Age UK/Improving Care in partnership • Commitment to pay by public sector on achieving results compared to an agreed predicted baseline • Benchmarked against baseline of trajectories • Financial return to investor, surplus for public sector A commitment to and to partners repay the investor 18

What this means for ‘Mary’ Age UK peer support volunteer Access to appropriate housing, benefits and equipment Breathe easy group and community resilience Anticipatory care plan Mary and her ‘family’ GP support and escalation plan Working as part of an integrated team Agreed goals and shared decisions

Thank you