Market Position Statement: Wellbeing & Prevention Services 2013-2014
North East Lincolnshire CCG
Market Position Statement –
Wellbeing & Prevention Services 2013/14 to 2015/16
DRAFT v1, 15th April 2013
1.1 Purpose of the document
This document provides details about the way in which the Clinical Commissioning Group (the CCG) will work with providers of wellbeing and prevention services to secure the support that the people of North East Lincolnshire need over the next 3 years and beyond.
1.2 Underpinning principles
The Framework Market Position Statement states how the CCG seeks to encourage quality, consistency and innovation in all the services it secures for local residents. This ensures the right balance between value for money and the best possible outcomes for people. Care should be close to home wherever this is safe and appropriate, and should be supported by appropriate technology.
We also want to make sure that the relationships between the CCG and the organisations that provide services that we buy is healthy. This is a corporate responsibility, but also needs to be reflected in behaviours at all levels of the CCG and our partner organisations. Openness about the nature of our commitment to the services we currently buy, and what might make us review this commitment, is the basis of a trusting relationship. However, we expect this openness to be reciprocated through the ongoing dialogue in which all partners commit to the principles outlined above.
2 Future Demand and needs
2.1 Demographic context
Staying healthy and preventing the likelihood of future poor health for people in North East Lincolnshire is central to the CCGs strategy. The majority of people, including those over the age of 65, are in good health and are actively ensuring that they remain so. The role of public health is critical in this respect and the CCG works alongside its public health colleagues in the Local Authority to ensure this situation continues and is built on.
When people do report poor health they often have carers and other local neighbourhood or community networks that provide the care and support they need. However, where these networks are absent or where they can be enhanced and sustained over longer periods through additional support, it is clear that a proactive approach to prevention and wellbeing services would be helpful.
When people approach statutory services with a potential need the Priorities Framework (see Appendix 1) provides the context within which decisions are made. Whenever there is a situation that requires something more than satisfying the need for advice the contribution of prevention and wellbeing services can play a part. This can sometimes supplement the care and support for people deemed to be at the highest level of need. The increasing number of people receiving individual budgets makes those supported at this level able to secure prevention and wellbeing services alongside the more traditional social care and support. However, in a larger number of cases it will be the primary response, particularly after a period of CCG funded support through intermediate care services.
An analysis of local census data using overall life expectancy and healthy life expectancy provides an indication of the potential number of people that could benefit from prevention and wellbeing services. Figure 1 identifies the projections to 2017 for people self reporting as being unhealthy in comparison to healthy.
Figure 1 Expected number of people (1000's) over the age of 65 who are healthy compared to those who self report as being unhealthy by gender
- The number of people self reporting as being unhealthy in 2012 is estimated at 4,450. This will include those who are supported by the CCG as ‘Priority 1’ clients.
- This market will grow by nearly 800 people or c.18% to 5,240 by 2017 (plus any further shifts from care home to provision of P1 services in the community who will be able to ‘buy into’ these services).
- That the number of men experiencing years of ‘unhealthy’ life over the age of 65 will increase to match that of women over the period of the strategy.
- Sustaining a pool of carers to support people with P3 or P1 needs will be a challenge although some factors, such as the increased life expectancy amongst men, will moderate other socio-demographic factors such as increased mobility and divorce rates.
- That in 2017/18 the size of the P3 market would be in the order 6,000 people at a value of £1.4M and that were this to be funded in thirds (charges, LA grant and fund-raising activities) there would be no additional burden on the Local Authority given the opportunity to adjust P1 block contracts to reflect spend on individual budgets.
2.2 Demographics and healthy life expectancy
The following headline facts and figures about the population in NE Lincolnshire are relevant to understanding the local market for care and support now and for the next 5 years:
- The overall population of NE Lincolnshire is stable over this period at c.155,000 but the number of people over 65 will rise from 30,000 to 32,700 (+9%);
- The rise in the older population is due to a combination of the ‘demographic time-bomb’ associated with the ‘baby boomers’ (those born between 1945 and 1965) and the increased survival rates of people since then from previously fatal diseases;
- Life expectancy (LE) at 65 is therefore rising and is currently 17.7yrs for men and 20.2yrs for women in North East Lincolnshire, and will rise to 18.7yrs and 20.6yrs respectively by 2017;
- The fact that life expectancy for men is increasing by more than for women will mean that the proportion of men in the older population will rise over this period, particularly amongst the very old. The % of the >65 population who are men will rise from 44.4% to 45.1% but for >85’s the increase will be from 31.6% to 34.1%;
- Healthy life expectancy at 65 (HLE ) is also increasing and will moderate the impact of the increased number of older people who have care and support needs. For men HLE will rise from 13.4yrs to 14.1yrs and for women from 15.7yrs to 16.4yrs;
- Taken together, the LE & HLE estimates suggest that for men years spent after 65 being ‘unhealthy’ will increase from 4.3yrs to 4.7yrs, whilst for women there will be a decrease from 4.5yrs to 4.3yrs;
- With the higher rate of increase in the number of older men in the older population, and the fact that HLE is not keeping pace with LE for men, meeting the care needs of older men will become more important over the time of this strategy.
The factors noted above with regard to men’s needs is further illustrated in the figure below which breaks down the potential P3 & P4 populations by gender.
2.3 The ‘market’ for care and support needs
What does this mean in terms of the ‘market’ for care and support over the next five years? By using the above data it is possible to apportion people to the groups identified in the local priorities framework. If, for example, we assume that people over the age of 65 who are enjoying years of HLE are effectively Priority 4, i.e. those who need to stay healthy; whilst those experiencing poor health are either Priority 3 or Priority 1. We now have the beginnings of a care ‘segmentation’ approach for the population as a whole. For these purposes people accessing Priority 2 (short term intermediate services) can come from any three of the other groups (1, 3 & 4) and do so on a temporary basis.
People experiencing an ‘unhealthy’ period of life would then be split between P3 and P1. How this split will be a function of the Use of Resources Policy and the effectiveness of the strategy to support P3 with preventative services. To get an indication of the current P1 group, at the start of 2012 there were approximately 1,200 people in care homes (including self funders) and 1,100 people supported at home with a care package. We have assumed that these represent the P1 population in terms of levels of need and that they should be netted off those who are ‘unhealthy’.
In the diagram below we have further assumed that the continued application of the Use of Resources policy will see the size of the P1 cohort reduce further over the next five years. The factors noted above will mean that much of the growth in the older population will be in people with increased HLE so that P4 grows from 22,549 to 24,858 (+10%). The P3 group for whom care and support of a preventative kind needs to be provided sees an increase from 4,451 to 5,242, or 18%, over the next five years.
2.4 Informal carers
Informal care is normally provided by partners or friends of a similar age or by the children of an older person. Trends that are relevant to the availability of informal carers therefore include:
- The ratio of 50-74 years (the care givers) to those over 75 (the care receivers): in North East Lincolnshire this ratio falls from 3.34 to 3.28 between 2012 and 2017. This represents a small decrease in the pool of available carers from the younger generation of 1.8% over 5 years;
- The number of people living alone (this being one predictor of social care need): in NE Lincolnshire 25.7% of 65-74’s and 43.3% of over 75’s live alone (equating to a total of c.6,800 people). Whilst this is forecast to increase to 7,400 in 2015 and to 8,100 in 2020 the increasing life-expectancy of males (which is catching up with females) does modify this increase.
There are therefore anticipated pressures from a small to modest reduction in the availability of informal carers for the older people of North East Lincolnshire.
3 Strategic direction
3.1 Funding the P3 market – what might it look like in 2017/18
The funding sources for the P3 market are:
- Grant funding from the Local Authority to set up P3 services with suitable guarantees of targeted spend.
- For these targeted prevention services the ability to charge a maximum of £10pw.
- The opportunity to raise funds through charitable and other fund raising activities and to manage costs through the use of volunteers where appropriate.
The estimate of a ‘market’ of c.5,240 people by 2017/18, plus those in P1 who choose to buy part of their support from this sector, suggests a pool of approaching 6,000 people who will need some sort of preventative service. These services will provide a mixture of regular and short term inputs, meaning that the number of ‘support weeks’ envisaged remains difficult to forecast. However, were this group to access an average 8wks of P3 support a year this would equate to 48,000 support weeks.
To gauge the scale and the opportunity of the new market a comparison with current spend for P1 clients is instructive. On the 1st April 2012 c.1,100 people were supported with a package at home, at an average cost of c.£84pw. This amounts to an annual budget of c.4.9M. Evidence about what older people would secure from an alternative market given the availability of personal budgets is not robust. However, were 10% of this spend to be moved, through the individual choices of people, then the initial ‘seed-corn’ investment would be in the order of £490k. Ensuring that any ‘block-contract’ arrangement with providers in the P1 market were defunded to reflect this shift would be an important part of this strategy.
The 48,000 support weeks noted above would vary in terms of cost and input. Taking the cost of the P1 client group as an indication it is unlikely that the average cost of a P3 service would be more than £30pw. The total market, on this basis, would be worth £1,440,000. Were the funding of this to be apportioned as thirds across the funding sources noted above this would equate to £480,000 in charges, £480,000 in LA grants (secured from the defunding of block contracts) and £480,000 ‘equivalent’ in fund-raising and the use of volunteers
3.1.7 Public Health services
NHS Screening & Immunisation Programme
In relation to screening and immunization, these programme are directly commissioned by NHS England. The CCG plays a supporting role in ensuring best possible take up of these programmes and understanding any implications arising from this provision, but does not commission the service from local providers
Key points are:
- Each CCG has a nominated screening and immunization coordinator
- Support quality improvement in primary care
- Ensure surge capacity, requiring an immunisations response, is embedded in relevant provider contracts through liaison with NHS England
NHS England and Executive National Body has been responsibility for commissioning screening and immunization programmes in England from 1 April 2013.
Area Teams have been set up to support the commissioning process in clearly defined geographies and providers are established in each area with their own quality and performance monitoring.
[Note: influencing not purchasing]