Archived decisions

Contact: Jeff Pattison, ext 7321, email [email protected] or Claire Foreman, ext 7127, email [email protected]

1.0 Purpose

1.1 The progress report (October 2004) on the work of the Cabinet Priority Group for Older People identified that consideration is being given to develop a formal Prevention Strategy and a possible team to work alongside the services provided for Older People by Social Services.

1.2 Following initial consideration of this report on 17 January 2005, Cabinet requested a further report expanding the proposed implementation model. This report responds to that request and sets out recommendations to take the project forward.

2.0 Background

2.1 What has emerged during the working life of the Cabinet Priority Group is a much greater awareness of the range of initiatives, projects and outcomes across the country relevant to the focus on improving the independence and well - being of Older People. The involvement in, for example, the local Government Associations Action Learning Sets for Older People has helped develop this wider perspective on what can be done to enhance the quality of life of Older People and to assist them to live longer in their own homes.

2.2 It is well known that 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+ than children under 16. 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.

2.3 Research carried out by the group into the views and concerns of Older People in June 2004 highlighted that issues around independence such as home security, community support, financial information and health are of paramount importance in developing services.

2.4 If we wish to provide better public services to Older People we need to focus attention more widely than on health and social care. A consequence of developing action plans that have a more preventative focus may be a reduction in the anticipated growth in demand on health and social care services made by Older People whose health has begun to fail.

3.0 National Context

3.1 A response to the challenge of an ageing society is to promote the social inclusion of Older People - recognising them as citizens with rights and responsibilities. That is increasingly what Older People themselves demand.

3.2 Modern public services should be responsive to the needs and aspirations of individual Older People and key to this is the involvement by Older People in the design, delivery and evaluation of services which affect them.

3.3 The recent consultation document Link-Age builds on the lessons learnt from the Care Direct pilots and proposes integrated networks of services for Older People. The document is a collaboration between government departments and the LGA. It focuses mainly on joining up services when a need arises and is only part of a likely National Strategy for Older People.

3.4 Central and local government have agreed a shared priority to improve the quality of life for Older People. The Comprehensive Performance Assessment 05 onwards will be assessing how Hampshire County Council responds to the shared priority for Older People. A cross-departmental strategy will be needed as essential criteria for excellence is the co-ordination of services from low to high dependency.

3.5 It can sometimes appear that there is a tension between an agenda which is about the promotion of well-being on the one hand, and an agenda around intervening more effectively when a specific need arises on the other. A pragmatic approach can deliver both.

4.0 Developing our approach

4.1 A way forward needs to include a dedicated corporate initiative that focuses on the co-ordination of a range of actions and the development of wholly new initiatives (at least so far as the County Council is concerned) that empower Older People and prevent them becoming increasingly dependent. There will need to be a strategic framework within which outcomes and targets can be set, actions prioritised and performance measured. This will assist with ensuring a sustainable model of interventions evolves derived from the wants and aspirations of Hampshire's Older People.

4.2 It could mean having some dedicated team / unit whose aim would be to identify with Older People and deliver a range of actions to meet the aims of the strategy. There are already a growing number of successful initiatives in the UK and abroad that can be assessed for their applicability to Hampshire. This dedicated team could also be set targets for attracting external resources. The work of the Cabinet Priority Group has clearly demonstrated that successful implementation usually relies on the involvement of other partners especially the voluntary and community sectors and these partnerships could be developed further.

4.3 Initiatives that have proved successful elsewhere include:

i) Community Allotment Scheme

Whereby an area of land is used by older members of the local community to collectively grow their own produce - the benefits being the avoidance of social isolation, healthy physical exercise outdoors, and healthier eating from consuming the produce.

ii) Homeshare Scheme

Whereby Older People living on their own can, if they wish be brought into contact with key workers, new to the area, who cannot immediately purchase their own properties. The key worker would become a `lodger' in the older persons home, but part of the contract might involve several hours `help around the house or the garden'.

A successful scheme would avoid social isolation and assist the older person to live in their own home longer and more beneficially as well as assist the housing of key workers on low incomes.

iii) Assistance with the development of local community newspapers or even a local radio station primarily aimed at the over 55's.

iv) Development of a range of leisure and learning activities aimed at the over 55's.

v) Development of a resource (in partnership with Department for Work and Pensions) to assist Older People (in their own homes if required) to claim their full entitlement to benefits.

vi) Falls Prevention Strategy

Including slipper replacement schemes undertaken with manufacturers, because old and worn out slippers are often the cause of accidents to Older People.

Partnership with local PCT (including the potential for the receipt of funding from them) to undertake work to prevent recurrent falls amongst Older People after a hospital visit. This might include, for example, a risk assessment in their homes to identify and correct the causes of falls amongst the elderly.

5.0 Proposed model for implementation

5.1 If the prevention and empowerment agenda is to be properly addressed, it is only likely to be successful if dedicated resources are identified. Adding this important work on to existing roles and responsibilities is likely to dilute any approach and not achieve the desired outcomes.

5.2 A comprehensive prevention team may comprise up to seven people although it is suggested that if this way forward is adopted, a phased approach is taken. An initial staff group of the Head of the Unit and two other project officers would ensure progress is made. On this phased basis, the Head of the Unit would be required to develop the strategic approach and enhance cross departmental working already achieved by the Older People Cabinet Working Group. There would also be a firm expectation to continue the development of existing projects and, more importantly, to initiate and develop new projects and services for the direct benefit of Older People. This would be facilitated by the agreement with the Executive of an annual action plan with SMART objectives which would be monitored annually.

5.3 There is also the opportunity, at least in the initial stages of the project, to seek secondments on perhaps a part time basis from existing County Council staff and the voluntary sector.

5.4 It should not be automatically assumed, however, that the full costs of the team should be borne solely by the County Council.

5.5 A successful prevention team should produce substantial benefits (including cost savings) not only to the County Council but also to other key stakeholders such as the NHS. It is perfectly reasonable to therefore plan for any team to be a partnership venture with the NHS and to seek funding from them.

5.6 There may be an opportunity to consider funding from the proposed DOH `Partnerships for Older People' (POPP) initiative. The overall aim of the project is to test and evaluate through pilots `new' arrangements for partnership working between health, social care and local government to deliver better, coordinated care for vulnerable Older People in settings appropriate to their needs and wishes.

5.7 Councils and their partners will be invited to apply for funding from the Department of Health in early 2005, for implementation in 2006/07. Any funding is likely to be for a two year period.

5.8 Services and interventions need to be based on the needs of the local population and may include lower level preventative measures, where these will deliver outcomes related to the development of community services. The intention is that this will be achieved by an enhanced interactive Independent Older Persons Support Group.

5.9 And finally, as mentioned elsewhere in the report, there is also the opportunity to raise external funding, particularly for specific projects. It would be reasonable to expect that in the first full year of operation, external grants of up to £100K might be obtained for specific projects of benefit to Older People.

5.10 A comprehensive team might consist of:

A Strategic Manager - able to create successful partnerships, both internally and externally and effectively coordinate a cross departmental approach to the delivery of effective services to Older People. Responsible for the supervision of the Project Development Workers and initial project identification and development. Such a manager should be persuasive, enthusiastic and an innovative thinker and prepared to take risks in developing new schemes. Possible salary range: £50-£55K

Four/five Project Development Workers - who once a project has been identified and initially worked on would ensure implementation and plan for sustainable delivery with other agencies. Possible salary £25K per worker.

5.11 During the first quarter of 2005 the DOH will publish a green paper on Adult Social Care. It is expected that councils will take a lead in bringing together a range of stakeholders to deliver a coordinated response across the spectrum of low to high levels of need, including leisure and housing, in some form of virtual care organisation. This model for prevention and empowerment would therefore be best located initially within the Chief Executive's Department to maximise the opportunities for coordination across the spectrum and with current OP service provision.

6.0 Member Involvement

6.1 It is fundamental that there is key member involvement, not only in the work of the prevention team, but with Older People services generally. It is suggested, therefore, that there continue to be designated Older Persons Champion within the cabinet.

7.0 Financial Implications

7.1 As this project is in the embryonic phase, it is difficult to be precise about costs and the proportion of them, that eventually, the County Council may be required to bear. Mention has already been made of the potential for other bodies to be involved (such as the NHS) and the opportunity for shared funding. In addition to this, the potential for other grants, for specific project work, is also a reasonable expectation.

7.2 The full proposed team would consist of a Head of Unit with 4/5 Project Development Workers, which together with on costs of 40% would amount to £245K. It should be stressed, however, that the full team would be appointed only if the actual amount of project work in place and being developed justified this.

7.3 However, it is not recommended that the full team be established immediately. It is suggested that a phased approach be adopted with the employment of a Head of Unit and two project workers likely to cost in the region of £100K. With on costs of 40% to cover accommodation, IT and salary on costs, this would bring the figure to about £140K. In addition, this team could be supplemented by part time secondments from elsewhere within the County Council where their main role is to provide services to Older People.

7.4 £100,000 has been included in the proposed 2005/06 budget on a full year basis to meet up to 50% of the team's costs. The remainder of the costs are expected to be met by external funding or internal secondments.

8.0 Conclusion

8.1 The initiatives in 4.3 are only an illustration of what might be achieved and there are others that have been successfully implemented already by the Cabinet Priority group. The development of a prevention strategy and initiatives in Hampshire would need to be derived, led and evaluated with our community of Older People.

8.2 This report raises the issue of the rising importance of a co-ordinated corporate response to improving the quality of life for Older People and the recommendation that this can be best achieved by a dedicated corporate prevention team.

9.0 Recommendation

That the Executive Member for Policy and Resources agree to the establishment of a dedicated corporate Older People's Prevention Team on the basis set out in this report.

That the costs of the team of up to £200,000 to be met 50% by increased budget provision in 2005/06 and future years of £100,000 with another £100,000 met by external income and secondments from other departments within existing budgets and that the establishment costs of the Chief Executive's Department be increased accordingly.

Section 100D - Local Government Act 1972 - Background Papers

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

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1. Published Works

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

None.