MH Cohort Three: Individuals with average levels of need whose packages of care are increasing significantly in cost
or change in circumstances, not an annual review), does not automatically respond to a situational change with the provision of long- term support. Evidence from within the sector has shown that the typical unplanned review results in an average increase in support of £100–150 per week, for similar reasons as to Joe’s example. The ideal response would focus on understanding the underlying concerns, such as life challenges or lack of stimulation, and seeking to connect individuals to a tailored response (often resulting in a change of what existing support is used for or making greater use of community resources and charities). An increase in support for many individuals often offers only temporary management of these needs, as it does not support the underlying cause, and can lead to a similar further request in the following years. Several years of this often results in levels of care cumulatively building up, and inadvertently reducing the level of autonomy and independence of the individual. Through successful delivery of this alternative response to unplanned reviews, evidence from the sector suggests that some local authorities have seen a 65% average reduction in increases in long-term support levels.
How can improved outcomes be delivered for this cohort? Delivering optimum outcomes for this cohort can be achieved with help from two types of enablers from adult social care services. Firstly, through working with the individual to develop a long-term plan centred around their ambitions for life, building on opportunities to navigate key life moments that all individuals experience. This involves social care staff working together with the individual and any support providers to set meaningful and aspirational goals that are relevant to their period of life. For example, those in this cohort will potentially see their 20s involve a change in setting, maybe moving away from the family home into often shared environments with other younger adults where they develop and learn independent living skills. However, this will then likely change again in their 30s. Services can enable this through regular application of the Care Act assessment and review process to ensure the individual’s voice and wishes are heard, and not expecting a person’s ambitions and life to necessarily look the same every 10–20 years. Secondly, authorities can ensure that their review process, particularly for ‘unplanned reviews’ (those taking place from a request
What are the characteristics of individuals in this cohort? Based on the data analysed for this programme from the participating authorities, this cohort represents 13% of all individuals with a mental health condition, and 12% of total mental health expenditure. The proportion of working age and lifelong disabled individuals in this cohort ranged from 1% in one participating authority to 4.8% in another. The majority of individuals in this cohort are aged 66–79 (accounting for 24%), with an equal distribution across remaining age groups. The two most common support types for these individuals are homecare (26%) and community supported living (26%). How can improved outcomes be delivered for this cohort? Individuals in this cohort tend to see sporadic fluctuations in the intensity and type of care support required during periods of particularly poor mental health. As a result, delivering optimum outcomes often involves adult social care supporting two areas. Firstly, working with the individual to develop a long-term plan that allows for response mechanisms if another period of poor health returns in the future. Secondly, similarly to individuals in cohort four with a learning disability, developing strong processes related to ‘unplanned reviews’ is key – where the ideal approach is driven by understanding and managing the reason for the request being raised, rather than using an increase in long-term commissioned support as the main response. Evidence from the sector suggests that the most effective approaches for achieving this have been where either experienced team managers or approved mental health professionals have been involved in the triage and allocation process of ‘unplanned’ reviews – particularly where there can be more complex eligibility areas for social care (such as substance dependency and misuse).
Lydia is 66 years old and has had periods of poor mental health for a few years. As her depression deteriorated, she began hoarding at home, not eating for days at a time, and developed agoraphobia.
When she initially became known to adult services, a small homecare package was put in place to help her with food shopping and meal preparation. This was increased the following year to support with the hoarding and to help Lydia maintain a safe and habitable home. After a recent visit, where Lydia became distressed and had an altercation with the homecare staff, her social worker is exploring whether they will need to change provider or increase the calls to have two staff present. Alternatively, if another appropriate homecare provider willing to support Lydia’s needs in her own home can’t be found, she may need to explore a move to a supported living placement. Why is this cohort a priority for improvement? In this cohort, typical packages of care do not vary significantly at a national level, but some variations in cost are evident between authorities. The average package cost is also increasing significantly per year. As a result, this cohort appears to be a high priority for potential improvement activity. The average weekly package is £530 per person, and this cost has been escalating since 2021, with an average weekly cost increase of £154 each year. Significant variation in cost is evident for individuals in this cohort. The average cost of packages of care for individuals in this cohort ranged from £413 per week in one participating authority to £701 in another.
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