A series of recommendations on how to improve care for older adults with complex needs in Cumbria has been made in a new report.
The report, 'Together We Care' has been produced by Cumbria's Health and Well-being Scrutiny Committee and the Adult Social Care Scrutiny Panel. Nine months in the making, the scrutiny report was funded by a £10,000 grant from the Centre for Public Scrutiny and involved consultation with service users, carers, front line staff and senior management right across the county.
The report was triggered by the publication of the Government White Paper "Our health, our care, our say: A new direction for community services" which has major implications for the planning and delivery of services for older people, particularly those with complex needs. A major focus of the scrutiny has been on how care can be improved for people once they have been discharged from hospital and are back in the community. It has examined the use of joint assessment and joint care plans by the health service and Cumbria County Council's adult social care directorate. It makes a series of recommendations on how more joined-up working would improve the service for older adults with complex needs.
Key recommendations in the report include:
- Involve user and carer representatives in monitoring hospital discharge.
- Explore options to allow close relatives living with the service user to be paid for care provision (e.g. through direct payments) in cases where no other service is available.
- Urgently develop a plan to deliver on the national target of reducing emergency hospital admissions in Cumbria by 5%. Given that Cumbria is generally considered to be under-developed in community care, a further target in excess of 5% should be set for Cumbria, with savings ring-fenced for the development of community care.
- Draw up an agreed plan, with target dates and investment, for the implementation of the "Protocol" IT system shared across both Adult Social Care and the NHS, with other providers also having a role. Joint Care Plans based on a shared IT system should be seen as a key objective.
- Develop a joint finance strategy for the Health and Well-being Board (Cumbria's top level body which co-ordinates health and social care), so that a more supportive financial framework for the pooling of funds can be developed.
Several concerns were raised over the existing service. They include:
- There is currently insufficient monitoring of patients who have been discharged from hospital.
- Turnover of care staff is too high and some of the current measures being taken - such as overseas recruitment - may not resolve the problem.
- There is an unwillingness of some frontline staff to actively promote Direct Payments.
- Inconsistency in service provision across Cumbria. For example the generic home care provided in the west of the county is a local service and has not been rolled out countywide. Further examples can be seen in the lack of 24-hour home care and district nursing service across all parts of the county. It is recognised that measures are being taken to address some of the inconsistencies, for example the appointment of a county manager for service delivery within the Adult Social Care directorate.
The report also highlighted several areas of good practice. They include:
- Front line staff working together locally to deliver the best service.
- Generally there is good practice in meeting hospital discharge performance targets. A hospital discharge survey showed good performance in many areas, e.g. discharge within 3 days of notification.
- Good examples of innovative joint work for older people with complex needs. Specific examples include the West Cumbria Generic Home Care teams and the Community Matron employed by a Furness residential home.
- The Adult Social Care directorate has a contract with carers associations across Cumbria to undertake carers' assessments and provide advice and support for carers. This provides a degree of independence, and also increases the awareness of the rights of carers to have their own assessment.
- Intermediate care services - i.e. special rehabilitation to increase independence - appeared to be well regarded by users.
Copeland District Councillor Anne Bradshaw, chair of the joint scrutiny panel, said:
"I've thoroughly enjoyed the work to get to this final report, and having consulted at all levels and taken into account everyone's comments, the task group came up with some valuable recommendations. We found some good examples of innovative and effective joint care - the challenge is to roll that out across Cumbria. I hope that the new Health & Well-being Board will incorporate our findings into any future plans for the joint working of the NHS and adult social care."
The Health and Well-being Board is requested to provide a response to the recommendations in the scrutiny report for the next meeting of the Health and Well-being Scrutiny Committee on 25th July 2007. It is also requested to provide the Health and Well-being Scrutiny Committee with a follow-up report on implementation of agreed points after a further 6 months.
Notes
The White Paper "Our Health, our Care, our Say" links the term complex needs with people in need of individual case management, estimated at 250,000 nationally and 2,500 in Cumbria. Such people may:
- have both health and care needs; and/or
- be receiving intensive support (permanently or periodically) or are at high risk of needing intensive support; and/ or
- have more than one long term medical condition; and/or
- have been regularly in and out of hospital.
Another way to define people with complex needs is people with critical and substantial needs for social care whose need is also for high care levels (over 10 hours per week), extra care housing, residential care or nursing care (this amounts to around 3,000 in Cumbria). Such people are likely also to have long term medical needs.
A copy of the 'Together We Care' report can be accessed at: www.cumbria.gov.uk/eLibrary/Content/Internet/536/2929/3921016410.pdf
ENDS
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