Scottish Government

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EFFICIENT GOVERNMENT FUND

WESTERN ISLES
INTEGRATED HEALTH AND SOCIAL CARE WORKING IN A RURAL ENVIRONMENT

Stage 1 application - expression of interest

Part 1: Summary Table

Part 2: Narrative bid

Introduction

Comhairle nan Eilean Siar and NHS Western Isles have taken an approach to the delivery of its social care services that respects the clear wishes for people, where possible, to receive services within their identifiable local community. This is evidenced by the extensive range of home care services provided, including mobile night-time care services that cover 70% of the island population and which operate in the area covered by the proposed new care service.

The options for care at home have been opened up over the past two decades by the extensive investment in improved housing quality, including the engagement through the Care & Repair project in services that can respond to the changing accommodation needs of older and disabled people.

The Comhairle maintains, and is investing in the renewal of, a network of 24-hour care homes throughout the island area. However, the principal focus continues to be on home-based care as (a) a response to user preference and (b) an alternative to further capital and revenue growth in residential care facilities to meet the increasing needs of dependent elderly people.

The context of this proposal, in relation to the efficient delivery of services, is set against an increasing elderly population, and a constant pressure for growth of services to accommodate the needs arising form this. The savings are computed against the suppression of the unavoidable growth rate of services, rather than absolute savings against current levels of expenditure.

Nature of Project

The Electronic Data Sharing and Carloway Care project seeks to bring together a wide number of public sector agencies to work together to deliver health and social care services to local communities. The first phase of this is a care centre on the West Side of Lewis to provide integrated service management across public sector agencies. The project will provide:

• A network of area based health and social care staff operating in an integrated working environment, physically and electronically.
• The establishment of an initial integrated care centre in a rural part of the islands, as a model for development into other areas.
• The development of flexible services, accessible 24-hours, as a realistic alternative to residential care for some users (see notes on residential care costs under the section on estimated project benefits)
• Provide more direct access for service users and enable reviewing of services to users to focus on those with greatest needs.
• The establishment of home care management alongside health care services to provide locality management in Carloway based in the proposed Centre, as part of a model of service development in other rural areas
• SVQ training (including use of IT) to enable Home Carers to become multi-skilled and to promote joint training across the health and social care sectors;
• Move to fixed hour contracts with 'freed-up' hours being absorbed by home carers providing support for day care and respite activities based in the Centre.

The training for developing multi-skilled Home Care staff has been shown to be both effective and efficient in Clackmannanshire Council.

In the development of Carloway as a pilot project for joint locality working, the centre will provide:

• Additional interview/consulting rooms in the new Centre to provide locally-based Health Clinics;
• Local provision for day respite for local carers;
• The enhancement of Physiotherapy and Podiatry services including training for Home Carers and informal carers provided by the Podiatrist;
• The provision of community dentistry from the centre.

The new centre proposed for Carloway will provide day care activities for older people, provide health and social care services on the premises including day support for carers. The centre will be the base for outreach services including all aspects of home care and overnight support, with the possible addition of a meals-on-wheels service. The centre will also provide a one-Stop-Shop facility for the community, providing a crucial local base for key information.

Financial Benefits and Costs

The financial support requested for this project comprises:

1. The provision of electronic data sharing systems accessible to 50 lead assessors across the health and social care fields.
2. £50k capital, to be added to the commitment by the Comhairle of £550k and the 'in principle' commitment by the Health Board of £120k to meet the estimated full capital cost of the development.
3. £50k revenue to be added to £124k committed from the Better Neighbourhood Services Fund ( BNSF) to match the estimated first full year revenue requirement of £174k, necessary as bridging funding to permit the Comhairle and the Health Board to make the transition form existing service commitments to the reconfigured and enhanced services within the Carloway Care Centre.

The projected benefits from the project are considerable and much will be realized in the second year of operation. The benefits are reoccurring from 2008/9 onwards. They comprise essentially:

• Enhanced single assessment and care management processes across the health and social care sectors, through co-location and integrated working
• Transfer of certain services that are either provided by clinic centrally in Stornoway or by domiciliary visits, such as podiatry and physiotherapy
• Increased focus on mobility and wellbeing as a strategy to defer or remove dependency on higher-level health and social care services.
• Efficiency through having one point of organization for round-the-clock home-based care, from which the overnight support service, night-time community nursing, and local response to NHS24 will operate. This approach is consistent with the national objectives for reducing avoidable hospital admissions and all their consequential problems.

Notes on Financial Benefits

The measurement of financial benefits needs to be considered in the context of continuing pressures for the growth of services for an ageing population.

In home care alone, there are 780 service users, the majority with daily service. It is estimated that the electronic data-sharing will increase the capacity to review these cases by 20%, increasing the number of annual case reviews from 1200 to 1440. Operating on an assumption that the average review releases 1 hour care per week per additional review to redistribute to other care needs, this will free up £9.65 x 240 x 52 per annum (£120k).

This computation excludes the benefits of integrated assessment, leading to the reduction in duplication of effort across professional staff, and the shortening of the period of access to services for users.

The Carloway Centre pilot is developed on the principle of co-location for all care staff, the promotion of services that maximize independent skills (for example, through the maintenance of mobility for older people), and the more efficient use of resources (such as care and meal provision within the day centre facilities).

Carloway is being developed as a direct alternative to an extension of residential care places in Lewis. There are currently 15+ people awaiting care home places in Lewis and the redesign of community care services is designed in the long-term to suppress the need for growth in this sector. A residential care home for 12 people has revenue costs of £515k per annum; so the successful development of alternatives based on care at home can redirect significant levels of essential growth to alternatives that are (a) the demonstrably preferred care arrangements for service users and (b) can meet the needs of a wider group of users. The summary of financial benefits does not include these computed savings against future growth of residential care.

Current Status

• For the Carloway Care Centre, there is a capital commitment of £550k from Comhairle nan Eilean Siar in place.
• NHS Western Isles have an 'in principle' commitment of £120k towards the capital costs, which is due to be confirmed imminently
• There is an estimate shortfall (although this will only be confirmed when the project proceeds to tender) of £50k capital.
• The estimated first full-year revenue costs for Carloway are in the region of £175k.
• This part of the project is built upon the basis of long-term funding being secured from the transfer of existing revenue commitments by both the NHS and the Comhairle to a more efficient and encompassing service in the proposed Care Centre
• BNSF revenues are available to support approximately 70% of the estimated full-year revenue costs for one year. It is more realistic, in transferring a complex range of services from one model to another, to base the transition on securing bridging funding for the full fist year of operation.
• Comhairle nan Eilean Siar has recently committed an additional £37k revenue to support the development of area-based management of the home care service.

27 July 2005