February 2013

Joint Commissioning Strategyfor Older People 2013 - 2023

Ageing Well in Aberdeenshire

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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