Knowsley

1

• Knowsley
• Partnership for Older People Project
• Barbara Hitchins
• Head of Older Peoples Services
• Sarah Haworth
• POPPs Project Manager

2

• KNOWSLEY IN CONTEXT
• 8th most deprived district
• in England
• 33 Sq miles
• Population 150,600
• 99 Super Output Areas
• 52 of the SOAs are in the
• top 10 of the most
• deprived in England

3
Knowsley in Context The Strategic Challenges

• Deaths overall are 30 higher than the national
  average
• High rates of heart disease, cancer, and
  respiratory disease
• Life expectancy is significantly lower than
  national average
• The mental health needs are more than double the
  national rate. Knowsley has a mental health mini
  score of 2.2, compared with 1.0 nationally

4
The Knowsley Project

• Two core elements
• IKAN Team of 6 and Co-ordinator
• (with additional support from Age Concern and
  Arena Care and Repair)
• Mental Health Services
• In house flexi-care support worker service
• Voluntary Sector - Adult Placement Scheme

5
Knowsley POPPs Project Partners

• Knowsley MBC
• Knowsley PCT
• 5 Boroughs MH Trust
• Merseycare MH Trust
• Age Concern Knowsley
• Arena Care Repair
• Merseyside Fire and Rescue Service
• PSS
• Liverpool John Moores University

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The IKAN Team

• I know someone in Knowsley who can!
• Time limited team that aims to embed IKAN
  approach across the Borough
• Holistic approach
• Low level support, advice and interventions
• The IKAN approach is about empowering people to
  act!

7
IKAN Team

• Objectives
• Develop a detailed understanding of the key
  characteristics and needs of older people
• Test out different methods and effectiveness of
  engaging older people to support their health and
  wellbeing
• Through the intelligence gained, develop a
  training package that will be rolled out across
  the Borough to embed the IKAN approach in the
  longer term

8
IKAN Activity Data
9
IKAN Activity Data

• 1461 Onward Referrals made by the IKAN team

10
The IKAN Team cost benefit anaylysis

• Aimed to reduce hospital admissions, AE
  attendances, falls.
• Fractured Neck of Femurs were identified as
  costing 4,600 each.
• The Health Evidence Network puts fall rates at 1
  in 3 people over the age of 65 in any given year.
• Approximately 10 of falls will result in a
  fractured neck of Femur.

11
The IKAN Team cost benefit anaylsis

• 511 people receiving an IKAN Service
• 183 could be expected to fall
• 18 could expect to receive a fracture.
• Fractured neck of femur rates low, so reduced
  expectation to 9 fractures.
• This would present a total saving of 46,049
• Assuming IKAN team prevented 50 of these
  fractures, a conservative total saving of 22,049

12
IKAN - The learning so far.

• Marketing and case finding
• Partnership working
• Acting as a catalyst for change
• Mainstreaming prevention
• Information Service

13
Mental Health Services Adult Placement scheme

• Objectives
• Test out demand effectiveness of alternative
  service
• Work alongside mainstream services to enhance
  rehabilitation
• Support timely discharge from hospital and
  prevent re-admissions
• Provide opportunity for specialist assessment for
  use of assistive technology

14
PSS Adult Placement Service cost benefit
analysis

• 13 people referred to the PSS service,
• 70 referred for respite services, 30 for
  ongoing assessment/introduction to mainstream
  services.
• Those referred for introduction to mainstream
  services could be expected to continue rejecting
  them without PSS service.
• Could be expected to lead to a deterioration in
  condition and a hospital admission.
• Using the average 57 day stay in hospital at 311
  per day, the PSS service saved a total of 41,788.

15
Adult Placement SchemeThe learning so far.

• Greater understanding of needs
• Changing the culture
• Catalyst for change
• Influencing Service Developments

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Flexi-care Service

• Objectives
• Support effective discharges from hospital
  through providing an in-reach service
• Provide responsive flexible service that can
  respond to crisis and rapidly changing needs
• Develop transitional service that can provide
  detailed assessment of need and support
  transition to mainstream services
• Support older people with mental health needs
  through mainstream intermediate care programmes

17
Flexicare Service cost benefit analysis

• Split into 3 categories
• Crisis Prevention (8 individuals)
• Intermediate Intervention (21 individuals)
• Discharge from Hospital/Residential care (7
  individuals)
• Costs attached to Crisis Prevention and
  Intermediate interventions

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Flexicare Service cost benefit analysis

• Crisis Prevention
• The average stay in hospital for older people
  with mental health needs is 57 days.
• Each bed day costs 311.
• 8 individuals received crisis prevention,
  therefore preventing a hospital admission.
• (57 days x 311) x 8 individuals 141,816
• Intermediate Intervention
• Each Intermediate intervention prevents a
  presentation at AE.
• Each AE presentation costs 77
• 77 x 21 individuals 4,042
• Total Saving 141,816 4,042 145,858

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Flexi-care Service The learning so far..

• Developing in reach
• Catalyst for change and service development
• Developing transitional outcome focus

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Overall Savings Made

• IKAN Team Service 22,049
• Flexicare Service 145,858
• PSS Adult Placement 41,788
• TOTAL 209,695
• Conservative estimate. Care taken not to
  attribute savings to POPPs unless confident.

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The Challenges

• Timescales
• Recruitment and retention
• Culture change
• Pushing traditional boundaries
• Evidencing prevention
• Mainstreaming and sustainability

22
Critical Success Factors

• High level support and leadership
• Integrated Health and Social Care
• Health and Well-Being Board Section 31
• Effective partnership working
• Risk taking

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• Thank you for listening
• Any Questions ?