Archived decisions

Hampshire County Council

Social Care Policy Review Committee Item 9

19 November 2004

Hampshire's Innovation Forum Project

Report of the Director of Social Services

Contacts: Claire Foreman, Ext 7127 email: [email protected]mailto:[email protected]

1. Summary

1.1 A new project is being developed jointly between the NHS and the County Council to promote the well-being of frail older people and reduce their need for emergency services - especially emergency hospital stays.

1.2 The project is being undertaken as part of the work of the Innovation Forum of `excellent' local authorities. The project involves deploying nurses and social workers within specific primary care practices to work proactively with older people who are most at risk. The aim is to work with the older people and their families to reduce these risks and promote independence.

1.3 This report brings the Committee up to date with the project and some of the issues likely to flow from it.

1.4 The project supports Aim Number One of the corporate strategy (maximising life opportunities) and Aim Five (improving services) by contributing to the older people service and commissioning plans and supporting the work of the cabinet priority group for older people.

1.5 The Government Regulations and Inspection arrangements specify requirements concerning racial (and other form of) discrimination. Compliance with the act in terms of carrying out an Impact Assessment is confirmed, forming part of the programme of work relating to the Departments Service Plans. (see 3.4)

2. Introduction

2.1 The numbers of older people in society are growing. In the UK, the 2001 census showed that for the first time there are more people aged 60 and over than children under 16. This change is set to continue. According to the Government Actuary, over the next 40 years, the number of people aged below 65 will remain static, the number aged 65 to 84 will increase by half, and number aged 85 and over will double (Ref 1). The older age group is also becoming more diverse as the first generation immigrants of the 1950s grow older. It is also becoming more demanding as the `baby boomers', who redefined what it meant to be young after the war, start to redefine what it means to grow old.

2.2 If we are to manage these changes successfully, we need to provide an environment in which older people can thrive and live life to the full for as long as possible - contributing to society rather than being dependent on it. When asked, older people have strong views about the factors that make a difference to their lives and keep them independent. Themes such as good quality housing, safe neighbourhoods, getting out and about, and having useful, enjoyable ways of contributing to their communities were mentioned in an Age Concern England enquiry for the Audit Commission published in February 2004 (Ref 2). Having access to adequate funds and good information, and being able to exercise choice and control, and to help others were all seen as essential. The Cabinet has given priority to the co-ordination of services that help meet these aspirations.

2.3 For older people whose health has begun to fail, we need to find ways to ensure that they too can live life as fully as possible. Inevitably they make disproportionate demands on health and social services. Although consisting of only 16% of the population, people aged 65 and over occupy two thirds of general and acute hospital beds, and account for half of the recent growth in emergency admissions, according to the Department of Health's National Beds Inquiry in 2000 (Ref 3). But experience in the USA has indicated that this dependence on emergency hospital care is not inevitable (Ref 4), and certainly not desirable: with proactive management and support, dependence on emergency hospital care by older people can be significantly reduced and their well-being enhanced.

2.4 The local authorities awarded excellent status in the recent Comprehensive Performance Assessment (CPA) have formed an Innovation Forum to develop new initiatives. One of the first, being developed by ten authorities including Hampshire, involves working with health colleagues to promote the well-being of older people, and reduce their need for emergency stays in hospital and dependence on other emergency services. This project fits in with the Cabinet priority for older people.

2.5 The ten authorities are approaching this task in a wide variety of ways, reflecting the individual circumstances in each locality. Hampshire is developing a scheme that involves social workers and nurses working together within a number of primary care practices to provide proactive care and support for frail older people at risk who are making increasing use of emergency services. This paper outlines the approach being adopted.

2 Scope of the Project

3.1 Four primary care trusts (PCTs) have agreed to take part in the scheme with the County Council. They are East Hants, Fareham and Gosport, Eastleigh and Test Valley South and the New Forest PCTs. In each PCT, one or two practices are taking part initially (five in all at present), although, if successful, the approach will be extended to other practices and other PCTs.

3.2 The method of approach is to work with practice staff to identify older people who are beginning to make increasing use of emergency services, and to invite them to take part in the scheme. Typically, such people have a number of medical conditions and are increasingly struggling to maintain their independence. In a practice serving a population of 12,000 people, we might expect to work with about 50 or so older people.

3.3 The nurse and / or social worker then work with the older person and his or her family to review their circumstances and develop a care plan that helps improve their independence. The plan may include such aims as better management of medication and symptoms for a medical condition, getting out and about more to tackle loneliness, reviewing income and benefits, and generally sorting out worries and problems. As such, it involves both the health skills of the nurses and the social skills of the social worker working together (tackling social problems to relieve clinical conditions such as depression).

3.4 The wishes, priorities and concerns of each older person and his or her family are central, and shape the priorities of the care plan. The particular needs and wishes of people from minorities will be given special attention, in case their needs need to be addressed differently. We will ensure the project complies with the duties and requirements of the Race Relations (Amendment) Act 2000. The one-to-one nature of the work by nurses and social workers will allow this specific attention to individual issues and concerns.

3.5 People included in the scheme do not get any preferential treatment for services over people not included, although the extra time available to work up the care plan may allow better use of services that are already in use such as equipment or home care. Also, it may be possible to make better use of help provided by voluntary agencies.

3 Setting up the Project

4.1 The project is in its very early stages. It is due to run for three years initially, and funding for the first year (2004 / 05) has been secured as follows:

4.1.1 Hampshire County Council (Community Development and Regeneration) (£50,000)

4.1.2 Social Services Department (£50,000 plus management support)

4.1.3 The Department of Health Change Agent Team (£10,000)

4.1.4 PCTs (full cost of nursing staff and their accommodation and support)

4.1.5 Chief Executive's Department management, funding and co-ordination support.

4.2 Most of the staff are now in post. Numbers differ between PCTs because of different levels of investment by the PCTs.

4.3 The staff are beginning to develop their approach. Issues that are being addressed and resolved as part of the project include:

4.3.1 Identifying people for inclusion in the scheme;

4.3.2 Developing ways of working that improve people's well-being;

4.3.3 Integrating the project with other services and staff;

4.3.4 Supporting and developing the staff engaged on the project;

4.3.5 Monitoring the outcomes of the project.

4 Monitoring

4.1 Monitoring is key to the project, as it will be essential to be able to demonstrate that the gains in well-being and reduced use of emergency services significantly outweigh the investment in staff if the project is to be adopted more widely. Three strands of enquiry are being developed

4.1.1 First, the well-being of older people included on the scheme will be assessed initially and then periodically through the scheme to see if there is any improvement. Various ways of assessing well-being are being investigated.

4.1.2 Second, for individuals included in the scheme, patterns of use of emergency services before inclusion on the project are to be compared with patterns after inclusion to see if there has been any reduction (and to estimate any cost savings if there has).

4.1.3 Thirdly, the overall pattern of emergency hospital use by all people aged 75 and over from the practices included in the scheme will be monitored to see if it reduces in absolute terms and relative to other practices within each PCT.

4.2 The Innovation Forum has secured the support of a network of academic experts to advise on the monitoring arrangements, funded primarily by the Department of Health and the Office of the Deputy Prime Minister. The Hampshire scheme is being supported by the London School of Economics. The results are being validated by Professor Martin Knapp and his staff. At all stages of the monitoring process, protecting the confidentiality of the individuals and practice staff involved will be paramount.

5 Management Arrangements

5.1 The different agencies involved are managing their own staff directly, requiring good joint working and cooperation. Thus nurses are being managed directly by PCT staff, and social workers are being managed by the Social Services Department Older People's Teams. Claire Foreman, County Manager is leading the development with support from Martin Covington, an experienced older person's team manager. Corporate issues are coordinated by Paddy Hillary of the Chief Executive's Department.

5.2 The project as a whole is being co-ordinated by David Browning. David was an Associate Director with the Public Services Research Team of the Audit Commission for many years leading national studies of community care and services for older people. From September 2002 to August 2003 he was seconded part time to Hampshire as partnership manager in East Hants and Fareham and Gosport. Since January 2004, he has been working part time on the Innovation Forum Project.

6 Summary of Progress to date.

6.1 During the first six months, most of the effort has gone into establishing staff groups in individual GP practices, developing ways of working, and developing monitoring arrangements.

6.2 Progress has been fastest in Fareham and Gosport PCT with sizable caseloads now being established. The other three PCT's have been more limited by resourcing issues but are now getting underway. Joint working at the operational level has been excellent.

7 Recommendations

7.1 To note that this project has started in Hampshire.

7.2 To receive future reports on progress with the project.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB the list excludes:

    1. Published works

    2. Documents which disclose exempt or confidential information as defined in the Act.

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