Agenda item

The discussion session has been planned to last approximately 90 minutes and representatives of interested bodies have been invited to the meeting.  The Joint Health and Wellbeing Strategy (Closing the Gap) is attached. 

Deb Watson, Strategic Director Adult Social Care, Health and Housing and Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group will also give a presentation.

Deb Watson, Strategic Director Adult Social Care and Health and Simon Freeman, Managing Director, Leicester City Clinical Commissioning Group gave a presentation on Priority 3 of the ‘Closing The Gap Strategy’ on supporting independence.  A copy of the presentation is attached.  In addition to the points shown in the presentation the following comments were made:-

·         Whilst good progress had been made there was still more to be achieved, especially around making the community aware of the issues surrounding dementia and the support that is available.

·         There had been a 30% increase in the uptake of Carers personal budgets. Out of approx. 1,800 family carers who are receiving support from adult social care, 978 are now purchasing their support through a personal budget, giving them increased choice over their support and increased control over arrangements.

·         250 carers had received training to support them in their role, including developing coping strategies, recognising the various trigger points when things can go wrong and information on where to get help.

·         Although there were 30,000 carers in the City, only a small proportion of carers made formal contacts to seek help.  More needs to be done encouraging people to identify themselves as carers and to promote the use of services available to them.

·         Significant contributors to the poorer life expectancy for people in the City were diabetes, cardio-vascular and respiratory diseases.

·         Leicester had low rates of recorded diagnosis of respiratory conditions but a high rate of hospital admissions resulting from respiratory conditions.

·         Up-skilling of GP’s, using risk stratification to focus interventions on people at high risk of deterioration and using a case management approach for people with multiple illnesses/conditions are vital to reduce/prevent people from a ‘revolving door’ syndrome of discharge and re-admissions to hospitals.

·         Half of the hospital admissions for people aged over 65 years accounted for 65% of the time and resources for emergency admissions.

·         The Integrated Commissioning Board has submitted an application to become one of 10 ‘Integration Pioneers’ pilot sites for integrated health and social care delivery.

The Healthwatch representative commented that there were a number of initiatives in primary care where people are supported to be independent with the aim of reducing the incidence of hospital admissions.  The large number of small initiatives could result in a larger cumulative impact.

The Age UK representative stated that there were a number of good ideas and pilot schemes but often it was difficult to sustain these and integrate them into strategic level and statutory service provision.  There was specific funding for ‘supporting carers for those approaching end of life’ but it was very hard to contact the right people to talk to and it often felt as though they were operating in isolation.

Professor Farooqi commented that, whilst there was widespread support for an integrated approach to service delivery, this often required reducing expenditure in the acute service sector and this presented a huge challenge.  As more systems for delivering services in the community were introduced, they usually identified and uncovered unmet needs whilst there was still the same demands being made upon acute service provision. 

The Alzheimer Society’s representative stated that the increase in dementia sufferers of 800 cases per year would place increasing demands upon services as the current dementia carers advisory service was saturated at present, and more sufferers wished to retain their independence and remain in the community with support.  There were also pressures on the follow on and emotional support for carers and dementia sufferers. 

Following a member of the public’s question raising the following issues:-

·         Was the strategy to care for people in community and remain at home driven by a need to reduce costs of hospital services;

·         It was difficult to monitor the quality of care provided in a person’s home compared to that in a hospital;

·         The quality of care could also be affected by multiple procurements with private providers; and

·         Hospital services could be destabilised once services were taken out of hospitals and put into the community.

In response it was recognised that most patients preferred their conditions to be managed at home rather than in hospital.  Conditions such as diabetes and respiratory diseases could be managed equally well in the patient’s home as in hospital.  Often there were benefits in better patient outcomes through an increased awareness and knowledge of their conditions.  

It was equally important to monitor the quality of care irrespective of whether it was provided in hospitals or in the community. There were checks and balances in place for both.  It was, however, recognised that the care provision was cheaper to provide in someone’s home as there were no ‘hotel costs’ involved.  Providing care in the community was not about dismantling hospital services but providing care in a different way.  Consultants and expert clinicians delivered services in both hospitals and community facilities and local health practices.

Dr Jawahar referred to the improvements in training in the primary care sector in increasing the diagnosis of COPD and encouraging patients to stop smoking. This could reduce the demands on secondary care services in future years.

Councillor Patel commented that recent evidence clearly demonstrated that there had been a large increase of people since 2007 electing to have personal budgets and purchase their own care packages. An increasing number of people prefer to remain in their own homes.  The emphasis was now on personal choice and if the individual was not happy with their care they could change providers.  There were good care providers in the community as 80% of individuals with personal care packages purchased services from the private sector.  It was becoming harder to provide these services centrally as there were now less central support staff to provide them following the reductions in local government spending in recent years.

It was important to continue to integrate care provision through health workers and carers in the community and to incorporate the goodwill already within the community and existing services.  The community and voluntary sector had many examples of good practice and building partnerships was essential to providing quality of care services.  The challenge in the current economic climate was to achieve more with less resources.  There are also some very good groups such as the Forum for Older People which recently had a presentation on memory cafes for people with dementia.  The initiative was well supported and those who came from areas where there was no memory cafe provision were fully supportive of wanting one in their area.

Councillor Palmer commented that part of the solution required a stronger national framework.  He also referred to the growing trend whereby 1 in 5 staff employed by care agencies were on Zero Hours contracts and questioned how care staff could be expected to remain motivated and improve quality under these difficult circumstances.

Tracie Rees commented that with the growing trend of personal budgets, there was a greater need to maintain adequate measures to ensure safeguarding.  Council contracts amounted to £11m on domiciliary care with providers and the council were hoping for a national framework. The Council have put in place a local Quality Assurance Framework for residential care homes and will develop one for domiciliary care.   Joint work was also progressing with the Care Quality Commission looking at themes and trends relating to quality to see the whole picture and to avoid having an isolated approach.

Deb Watson commented that Adult Social Care services were being driven by two main drivers: the changing expectations of individuals and people wishing to have a wider choice of service provision. There was a clear preference for sheltered and home provision with extra care support to maintain a person’s independence, and individuals only wanted to go into residential care when it is unavoidable.  The Council have made improvements in commissioning these alternative services which makes it possible for people to remain in their homes longer.  This type of care can be both cheaper to provide and more beneficial for the individual, although price is not the main driver. Everyone shares concerns for the quality of care provision post Francis and Winterbourne, but whenever there is poor care someone will know and as long as the system is open, approachable and transparent the system will be able to respond quickly to any safeguarding concerns that are raised

The Healthwatch representative commented that if Healthwatch was to be an effective voice for patients then it must be able to asses that care services are what people want them to be, especially for the most vulnerable.  Healthwatch will also need to engage with all involved to create a reliable framework in which anyone feels able to raise concerns over the quality of the provision of care services.

The importance of the community getting involved to support clinicians, community carers, local authority and NHS staff was stressed.  There was a great deal of potential support in the community but this needed to be identified and incorporated into the strategic response, which would be a significant challenge.  Carers and family members need more information about where to go for help.

Councillor Sood felt that an integrated care approach was a better way forward as it could be more easily geared to the needs of the individual.  It was also important to engage with new communities that were settling in Leicester to understand their specific health needs.  Communications was also important between multiple providers of health services in order to reduce re-admissions.

It was recognised that too many resources were currently directed at providing acute services and there was a need to move away from this ‘fire-fighting’ response to one of investing resources into earlier intervention and prevention initiatives in the primary and community care sector. Too many people had high health needs and there should be investment into procedures and initiatives that would give rise to changes in generations to come.  There were a number of current initiatives for providing a single point of contact for patients which should contribute to better care for patients, such as Health and Social Care Co-ordinators and ‘named clinicians’ for patients care.

Lorraine Austen stated that there were now inpatient rehabilitation beds in the city for people coming out of hospital. Services for mental health were being re-designed for patients discharged from hospital to receive additional support in the community in an attempt to reduce the occurrence of future re-admissions. 

The Chair thanked everyone for contributing to the discussion.