Archived decisions
Contact: Philippa Smart, ext 7336 e mail:[email protected]
1 Summary and purpose
1.1 At a Briefing Session for elected members in September 2006, a number of potential topics for scrutiny by the Safe and Healthy People Policy and Review Committee were identified.
1.2 Subsequently, members of the committee prioritised the range of topics and, at the November 2006 meeting of the Policy and Review Committee, six of the topics were singled out for further pre scrutiny research, to be presented at the January 2007 meeting.
1.3 Briefing notes have been compiled, sourced from a number of authors and documents, and are attached as appendices to this report.
2 Recommendation
2.1 The purpose of the information provided on the six topics is to enable a decision to be made regarding the scrutiny work programme for the Safe and Healthy People Policy and Review Committee for 2007.
3 Financial implications
3.1 None as a direct result of this report
4 Impact assessment
4.1 None as a direct result of this report
5 Crime Prevention
5.1 None as a direct result of this report
6 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 on to a material extent in the preparation of this report.
NB: the list includes:
1. Published works
2. Documents which disclose exempt or confidential information as defined in the Act.
None.
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: How is Hampshire County Council preparing for an ageing population as regards their health and well being ? |
1. Population
1.1 The population of Hampshire, excluding the two cities, is expected to increase
by 84,332 between 2006 and 2026. The bulk of this increase is projected to
occur between 2006 and 20011. This is because there are a large number of
sites with planning permission, or allocated in local plans, which on current
trends are likely to come forward for development during this period.
1.2 All of the increase in the period 2006 to 2026 is projected to occur in the 45
years and over age band. Particularly large increases are projected in the over 65 age band:
Age band 2006 - 2026 increase
65 - 74 36,498
75 - 84 40,824
85 plus 24,059
1.3 There are definite variations between Districts:
Age band 2006 - 2026 highest increase lowest increase 65 - 74 Basingstoke - 5,081 Rushmoor - 1,826 75 - 84 Basingstoke - 5,294 Rushmoor - 1,635
85 plus New Forest - 4,304 Rushmoor - 889
1.4 The proportion of people of pensionable age compared to working age will increase during the period 2006 to 2026 from 26% to 37%. This change implies growing pressures on services as a result of the diminution in the caring age population.
1.5 These changes are projected to occur in the national population and are not
features peculiar to Hampshire.
2. National policy and context
2.1 Recent government publications relevant to older people policy include the Green Paper `Independence, Well Being and Choice' 2005, and White Papers `Our Health, Our Care, Our Say' 2006 and `Opportunity Age' 2005. Another related document is the National Service Framework on Long Term Conditions.
2.2 Surrounding influences nationally in addition to the context of demographic pressure are medical advances, rising public expectation, and policy directions that emphasise the need for synergy between the NHS, local government and the voluntary sector.
3. Hampshire context
3.1 Hampshire is responding to the challenge of an ageing population in relation to health and wellbeing in a number of ways:
· Corporate initiatives:
- Older Persons Well-being Team, set up to promote, co-ordinate and enhance preventative services for older people. The Team works with the 86% of the population not in receipt of Social/NHS services. The multi agency focus of the Team's work has involved engagement with a wide range of partners: Hampshire County Council Departments, the Fire and Rescue Service, the voluntary sector, District Councils etc.
- Older Persons Well-being Strategy group. This group is working to develop a strategy on the seven dimensions of independence:
(i) housing and home
(ii) neighbourhood
(iii)social activities, social networks, keeping busy
(iv)getting out and about
(v) income
(vi) information
(vii)health and healthy living
The Strategy will cover access to universal services and be accompanied by a plan of action to be agreed by partners and updated annually.
· Local Area Agreement Flagship Initiative 2: this involves the development of six local Well Being Teams serving populations of 30,000 in targeted areas of Hampshire. The teams are multi disciplinary, consisting of nurses, social workers and community support workers. The aim of the teams is to support frail older people to continue to live independent lives at home and to reduce their need for emergency and other services. Each team is a bridge between health and social care services, and more general mainstream services.
· Local Area Agreement Priority 4: better use of older people's housing stock: meetings are being held with District Councils with a view to developing a county wide extra care strategy.
· Community Safety Initiatives: initiatives such as the Protecting Older People project, the Safe and Sound consumer and safety advice and No Cold Calling Zones are lead by Hampshire County Council Regulatory Services. Partnership working with the Hampshire fire and Rescue Service is aimed at generating referrals for fire safety visits for older people.
· Transport: Accessibility pilot projects are underway in four geographical areas. One angle that is being looked at is access to healthcare, looking at the proportion of people over pension age, the modes of transport they use and kinds of difficulties they encounter. Evidence has been gathered in one area, and is currently being analysed with a view to action planning. The exercise will extend to the other areas subsequently.
· Leisure and learning: targeted events in museums, art and libraries, and adult learning
· Involving older people: in the Flagship Initiative, in the development of the Older Person's Strategy, in the modernisation of Adult Services etc.
3.2 Adult Services restructuring and setting of future direction for Older Persons Services.
(i) restructuring involving alignment of commissioning and provision of community health and social care, and to create an Assistant Director of Well Being and Community post.
(ii) review of the commissioning plan for Older Persons Services, working with service users and partners. Key elements include:
- review of Day Support Services
- use of assistive technologies
- support for people at or as near to home as possible
- capacity plan for commissioning long term care
- jointly commissioning care through care pathways
- clear agreements with the NHS for the commissioning and delivery of Health and Social Care
4. Issues
How sustainable are the current initiatives over time ?
How are the various projects and developments linking up to ensure a coherent approach ?
How are the population trends, both Hampshire wide and District, influencing the current approaches ?
How are difficult to engage older peoples' future needs being addressed ?
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: Is access to mental health services available early enough for patients? |
A Access to mental health services in general
1. National policy context
1.1 National guidance includes:
- NHS Plan 2000
- National Service Framework for Mental Health 1999
- Policy Implementation Guides (various years following 1999)
- Joint (Healthcare Commission and Commission for Social Care Inspection) Review of Community Mental Health Services 2005/06
- Delivering Race Equality in Mental Health Care 2005
2. Hampshire context
2.1 Access to mental health services takes place at a number of different levels,
depending on the severity and complexity of the problem experienced by the
individual and/or their family. For common mental health problems, such as
mild depression and stress related symptoms, support and treatment may be
available from the following:
· self help groups
· voluntary sector groups and services
· primary care services, both mainstream and mental health specific eg. graduate mental health workers, counsellors.
2.2 For more acute or long term problems, access to specialist mental health
services may be appropriate, typically a referral to a Community Mental
Health Team acting as a gatekeeper to other specialist teams.
Hampshire Partnership NHS Trust, as the main provider of specialist services,
in partnership with Hampshire Adult Services, provides a number of Community Mental Health Teams in both its Adult and Older Adult Services.
2.3 One particular specialist team, the Early Intervention Service focuses on
developing early contact with young people from the age of 14 years to mid
thirties. National targets set within the Local Delivery Plan for
developing Early Intervention Services have not been achieved as quickly as was expected; the Hampshire Partnership NHS Trust has put such a team in place during 2006.
2.4 The national review of community mental health services for adults aged 18 to 65 years, carried out in 2005/06 was intended to assess the achievements within National Service Framework Local Implementation Team areas relating to there being in place genuinely community based services, organised in partnership and accessible to people who need them. One of the three criteria looked at in the review was accessibility:
`services are accessible to people according to their presenting circumstances'
2.5 The ratings for this criteria for the Local Implementation Teams in Hampshire are as follows, where a score of 1 equates to Weak, 2 to Fair, 3 to Good and 4 to Excellent:
East Hampshire |
3 |
Eastleigh and Test Valley South |
3 |
Fareham and Gosport |
3 |
Mid Hampshire |
3 |
New Forest |
3 |
NE Hampshire and Surrey Health |
2 |
North Hampshire |
3 |
Question themes within the criteria were:
- access and waiting times for key services
- the interface with primary care and in-patient services
- the provision for accessing out of hours help
One LIT achieved an `excellent' rating for the sub criteria of `provision for
accessing out of hours help'. All other ratings scored were `good' apart form three that were `fair'.
3. Issues
Is the target for the number of patients accessing the Early Intervention Service back on track?
What improvement plans have been developed following on the Joint Review ?
What impact are recent changes to Health organisations having on accessibility, and the improvement plans being worked to ?
What progress are providers of mental health services making in relation to minority communities access to appropriate support and treatment ?
B Access to mental health services for people with alcohol problems
1. Introduction
1.1 The question of access for alcohol and drug misusers is key for modern mental health services. The Department of Health issued guidance in 2002, summarising good practice in relation to the assessment and treatment of those with a dual diagnosis, setting out a programme for local implementation.
1.2 The Autumn Assessment recently announced by the Department of Health has identified Dual Diagnosis as the topic for the 2006 themed review in order to undertake a national review of progress.
1.3 The purpose of the Mental Health Dual Diagnosis Themed Review is to ascertain what quantitative and qualitative information is available about services for people of all ages who have both mental health and substance use needs.
1.4 Local submissions will be subject to review by the Strategic Health Authority and Local Authorities during early February 2007 and a draft summary report of the national findings will be available around summer 2007. This timescale may be helpful for Members to consider, when developing their programme of scrutiny for the coming year.
2. Context / Prevalence
2.1 An estimated 80-90,000 adults in Hampshire are drinking at harmful levels and could benefit from alcohol services. It is estimated that at least 5,000-8,000 will seek help each year for alcohol misuse, with services currently only able to see approximately 2,500 clients per year.
2.2 Research suggests that between 22% and 44% of adult psychiatric inpatients also have problematic drug or alcohol use, up to half being drug dependent. Urban patient populations have higher prevalence figures than those in rural services.
2.3 In high secure hospitals between 60% and 80% of patients have a history of substance use prior to admission. It has been suggested that fewer than 20% of psychiatric inpatients with substance use receive treatment for it. In the UK, the National Treatment Outcome Research Study (NTORS) has found that around 10% of substance misuse patients had had a history of psychiatric admission during the previous two years.
2.4 In March 2004, The National Alcohol Harm Reduction Strategy (NAHRS) was published highlighting increasing concerns from across the country relating to the misuse of alcohol. To date, no new funding has been allocated to increase access or improve alcohol treatment provision in order to implement the treatment element of the strategy.
3. Process
3.1 In order to prepare this briefing paper the views of a number of key stakeholders were canvassed, in an attempt to provide a balance of perspectives.
· HAAG - Hampshire Alcohol Awareness Group (Service Users)
· DAAT Alcohol Strategy Co-ordinator
· Community Substance Misuse Services
· Mental Health Locality Manager
· Substance Misuse Service Manager
· Nurse Consultant Substance Misuse/Dual Diagnosis
· Voluntary Sector Substance Misuse Providers
4. Information
4.1 Is access to mental health services available early enough for patients, with particular reference to alcoholism ? The feedback from professionals working in either the mental health or substance misuse sectors indicated 4 key areas:
· current provision is inadequate to meet need
· the issue of access to services
· a lack of consistent response across the county
· the issue of who should lead
4.3 Service users gave examples relating to their own personal experiences which echoed the comments above.
5. Issues
5.1 Currently, mental health services may not be available to clients that are drinking, unless the mental illness is serious such as bipolar disorder or schizophrenia. Clients are being advised that they can't be assessed or worked with until they are sober, if they have common mental health problems such as depression or anxiety, which are very prevalent within this client group.
5.2 Early intervention and preventative work is essential, it is much easier to work with clients before their alcohol use becomes problematic and an entrenched part of their behaviour, potentially causing or exacerbating mental health symptoms.
5.3 The Modernisation of Mental Health Services, nationally and locally, has seen a significant reduction in in-patient beds with a corresponding increase in community services like Assertive Outreach and Crisis Resolution and Home Treatment teams. It is a local priority for 2007/08 to review Community Mental Health Teams and the role that Primary Care plays in the treatment of common mental health problems. A move towards early intervention and preventative work is integral to this.
6. Conclusion
6.1 There is a need for a countywide dual diagnosis strategy developed in consultation with all stakeholders, to provide an overarching framework to those dual diagnosis strategies being developed within individual agencies and NHS Trusts. Clear protocols are required to clarify the roles and responsibilities across the mental health and substance misuse sectors to ensure equity of access and provision of services to clients using both drugs and alcohol. This should be reinforced by further joint training countywide, to establish more effective liaison and support between the sectors for the benefit of dual diagnosed clients.
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: making best use of the voluntary and community sectors in public service delivery. |
1. National context
1.1 Increasingly, the `third sector' - voluntary, community and faith sectors -
are being placed at the heart of public services. The encouragement given to
the development of social enterprises is a strand in this trend, as is the `Change Up' initiative, whereby funding has been made available to voluntary, community and faith sectors to strengthen IT and training infrastructure.
The most recent government guidance is:
a) `Partnership in Public Services: an action plan for third sector involvement' 2006. The plan brings together the opportunities for the third sector to play an enhanced role in public services and includes a national programme to train 2,000 of those who commission public services on how to involve the third sector in services and £30 million funding for community groups to work with local authorities to take over management or ownership of local assets.
b) `The future role of the third sector in social and economic regeneration - interim report' 2006. The report makes clear a commitment to passing on the stability of three year funding to third sector organisations as the norm rather than the exception.
In addition to the above, the Chancellor, in his Pre Budget Report in December 2006, announced the allocation of an extra £6.5 million within the Safer and Stronger Communities fund in Local Area Agreements, with a focus on building the capacity of local community groups and to help strengthen the voice of the third sector.
2. Hampshire context
2.1 The `One Compact for Hampshire', launched in 2001, provides the framework
for Hampshire County Council's work with voluntary and community
organisations. The `One Compact Code of Good Practice: Funding' provides
guidance on the relationship between Hampshire County Council and the
voluntary and community sectors vis a vis grant and other funding. The
e.Volve database and website provides a complete picture of voluntary and
community groups across Hampshire.
2.2 Funding to the voluntary and community sectors includes grants and
contracts. A grant is a contribution towards an organisation's core activity or
services and may be approved for up to three years. A contract should be used when the council purchases or commissions a service. Grants and contracts will replace service level agreements over time.
2.3 Hampshire County Council's website includes a site that displays the council's
grant funding programmes, providing general information to the public,
application forms and advice about how to apply.
2.4 Hampshire County Council Departments giving grants to voluntary and
Community sector organisations are as follows:
Adult Services Community Transport
Arts Museums and Archives
Children's Services Policy and Resources
Community Support Social Services
Sport
A summary of grant funding for the financial year 2005-2006 is as follows:
HCC Grant Funds for financial year 0506
Grant Type |
Department |
Section |
Fund |
No of Grants awarded |
Remaining Funds |
Major Capital |
R and H |
Arts |
0 |
0 |
0 |
Minor Capital |
R and H |
Arts |
0 |
0 |
0 |
Revenue |
R and H |
Arts |
840000 |
18 |
512 |
Arts Programme |
R and H |
Arts |
17000 |
5 |
0 |
Festival |
R and H |
Arts |
28200 |
14 |
0 |
Project |
R and H |
Arts |
24100 |
30 |
-3200 |
2 for 1 |
R and H |
Arts |
6800 |
17 |
1200 |
Partnership Funding |
R and H |
Hampshire Outdoor Service |
0 |
0 |
0 |
Small grants from Record Office |
R and H |
Museums and Archives |
800 |
1 |
0 |
Community Association and Village Hall Trusts |
R and H |
Community Support |
150000 |
30 |
66796 |
Partnership Funding |
R and H |
Museums and Archives |
0 |
0 |
0 |
Annual Running Costs, Partnership Funding |
R and H |
Community Support |
174200 |
0 |
0 |
European Sporting Exchange |
R and H |
Sports Development |
2415 |
6 |
-1014 |
Partnership Funding for Vol Sports Orgs |
R and H |
Sports Development |
0 |
15 |
0 |
Grants to Voluntary Organisations |
Social Services |
Social Services |
851000 |
134 |
-1082 |
Early Years Development and Childcare grant |
Early Education and Childcare |
Early Education and Childcare |
6674434 |
7 |
6615759 |
Grants to Voluntary Organisations |
Early Education and Childcare |
Early Education and Childcare |
0 |
4 |
0 |
Toy Libraries |
Early Education and Childcare |
Early Education and Childcare |
20000 |
6 |
2135 |
Annual Revenue Grant |
Education |
Youth Service |
160000 |
20 |
44920 |
Project Development |
Education |
Youth Service |
35600 |
14 |
3425 |
Policy and Resources Grant |
Chief Execs |
Policy and Resources |
280050 |
113 |
-265564 |
LAC Grants |
Chief Execs |
Policy and Resources |
0 |
0 |
0 |
Vehicle Grants |
Environment |
Community Transport |
5000 |
9 |
2567 |
HCC Totals |
|
|
9269599 |
443 |
6466454 |
2.5 Clearly, the voluntary, community and faith sectors play roles in relation to a wide range of public services commissioned and provided by Hampshire County Council either in its own right or in partnership with other agencies. Specific pre scrutiny information has been provided by a number of departments. In terms of contributing towards strengthening the `safety and wellbeing' of Hampshire residents, Adult Services plays a significant part and more detailed information is provided in the following paragraph.
Adult Services
2.6 The role of the voluntary, community and faith sectors in Hampshire has changed over the last few years from being grant-aided to providing services by contract. Some grants are still being made but the emphasis will change from the next financial year to focus on supporting the wellbeing agenda
The Joseph Rowntree Foundation defines wellbeing as:
Within a healthy community people thrive with positive access to good housing, transport, education, leisure services, companionship, and work that suits them and gives them a sense of self-worth and independence: 'well-being'.
It sets forward seven dimensions of wellbeing: Housing/home; Neighbourhood; Social activities (network, keeping busy); Getting out and about; Income ; Information & Health/healthy living.
There has been a move over the last few years from grants to contracts in service delivery. The voluntary and community sector has emerged as a major service provider of community services in the county for people who meet the eligibility criteria of critical or substantial need.
Through contracts the voluntary and community sectors provide:
_ Virtually all mental health services
_ The majority of learning disabilities and physical disabilities services
_ All older persons community services
There are also health (primary care trust) contributions to some of these services. Adult Services spends £45m on contracts with this sector, which breaks down by care group as follows:
ASD Spend with Voluntary Organisations 2006/07 | |
Physical Disability |
£4,007,144 |
Learning Disability |
£24,744,803 |
Mental Health |
£3,581,161 |
Older People |
£13,215,890 |
Total |
£45,548,998 |
These voluntary sector organisations are usually highly localised. None operate on a county-wide basis.
There are very few national voluntary organisations with branches in Hampshire. This is probably partly due to issues around the costs and difficulties of having to set up a base and recruit staff. Recruitment has been a big issue until recently. This has been because Hampshire has had almost full employment and so some lower paid care jobs are not seen to provide such attractive terms and conditions as other comparable jobs in the private sector. This situation is just changing, with care jobs starting to become easier to fill.
Some voluntary organisations are nationally affiliated (eg Age Concern Hampshire, Princess Royal Trust for Carers), but this national influence is limited. The organisations have a local identity and provide services that are responsive to local needs.
It should be pointed out that Adult Services is but one of many funders to the voluntary, community and faith sectors. They may also receive funding from other parts of the county council, as well as, for instance, district councils, health and national charities. There is a lot of activity, especially on a very small, local scale, that Hampshire County Council may not be aware of.
The current pattern of grant funding needs revision. At the moment, the process is fairly static and provides funding for relatively few organisations and provides few incentives for development. The faith sector is on the margins and is only supported by a few small grants, although there is possibly more local support being given by district councils.
A review of all Adult Services grants has just been carried out. From the next financial year the grants programme will become more focused on activity that supports wellbeing, thereby becoming more congruent with Hampshire County Council priorities. The criteria for allocating resources under this umbrella have yet to be developed. However, we need to ensure that we are clear what we mean by wellbeing and that we find ways to stretch out to groups we do not usually fund. There is also a massive potential contribution to wellbeing that can be harnessed through the social capital that exists in local networks and the faith communities.
Adult Services are planning a workshop in February with Community Action Hampshire to review how we work together and the role of the voluntary sector in the future, including the impact of contracts on voluntary organisations and volunteering.
2.7 The 2002 Audit Commission inspection of Support for the Voluntary and Community Sector in Hampshire reported that the council's work with those sectors was `fair'. Recommendations included:
- clarifying and confirming overall objectives
- developing targets to meet the challenges set by the Hampshire Compact
- making stronger links between the Compact targets and the corporate strategy
- improving relationships with the voluntary and community sector in order to enhance the capacity to meet local needs
- developing ways to learn from others, including from the knowledge and experience of the voluntary
2 Issues
Have all the Audit Commission inspection improvement recommendations been achieved?
How is Hampshire County Council providing strategic leadership to respond to the changing role of the third sector ?
What arrangements are in place, linked to the One Compact for Hampshire, for the effectiveness of grants and contracts to be monitored both county wide and within individual departments ?
What role is the faith sector playing in the third sector, and how is Hampshire County Council supporting and promoting this ?
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: the resourcing of the social care workforce |
1. Introduction
1.1. This briefing note summarises the current use of resources to support the recruitment and retention of the social care workforce, both provider and commissioning. It covers recruitment, remuneration and learning and development activity.
1.2. Recruitment is carried out for Adult Services by the Human Resources Resourcing Centre. The work is done currently in two streams - Younger Adults and Older Persons, reflecting the "old" departmental structure. Next year, it is likely that the team will reconfigure to reflect the new structure - Wellbeing & Community, Commissioning, Partnerships and Provisions, and Business & Performance Management.
2. Recruitment for Older Persons
2.1. In this current financial year, Older Persons has recruited 342 new starters, whereas at the same point last year, 218 new starters had been recruited. Recruitment pressures seemed to have eased slightly with the exception of Senior Practitioners and Senior Nurses.
2.2. Joint advertising of vacancies either in a particular area or dual site units (both Residential and Nursing Care) has continued to prove cost effective, significantly reducing advertising spend.
2.3. The last 2 of the 10 Nursing Care units are currently being recruited to (Westholme in Winchester and Forest Court at Totton). The successful recruitment of staff has ensured that all homes were sufficiently staffed to open. The recruitment of Senior Nurses, as mentioned above, remains difficult. This may be due to the fact that Hampshire County Council pays slightly under that of the NHS and Hampshire County Council does not pay enhancements. This may be resolved following the Pay and Benefits Review. The Resourcing Centre has also been working in partnership with NHS Hospitals where ward closures are expected, promoting Hampshire County Council nursing opportunities.
2.4. Adaptation Nurses - An advert offering adaptation nurse placements was placed in late July in the Nursing Times and the Nursing Times website. This resulted in over 50 applications. The 6 available placements have been recruited to and training starts in January 2007 in partnership with Bournemouth University.
2.5. Residential Homes - A tool kit has been produced to assist managers in the recruitment of staff. The pack contains postcards and posters that can be placed in the local shops, community halls etc. Adverts continue to be placed in local papers, the Hampshire County Council Website and the Job Centre Website.
2.6. The closure of a few residential units have resulted in a freeze on recruitment in certain areas whist staff are redeployed to other units.
2.7. Care Assistants continue to receive a temporary market supplement which is due to cease on the implementation of the Pay & Benefits Project.
2.8. Home Care - Recruitment is still on hold in this area due to the planned modernisation programme for home care and the development of the reablement approach. Existing staff are developing the skills required to support skills for independent living for service users, recovering from illness or hospitalisation.
2.9. Fieldwork. The main area for concern remains the recruitment of Senior Practitioners. Adverts have been placed in Community Care Magazine, Community Care's Website as well as Hampshire County Council's Website.
2.10. As part of the Local Area Agreement Flagship Initiative, the County Council is looking to offer 6 Care Managers/Occupational Therapists secondment opportunities to the Well Being team. These opportunities were cascaded internally by managers and has resulted in a good response. Interviews are due to take place in January 2006.
3. Recruitment for Younger Adults
3.1. Over the past year the restructure within Adult Services has impacted on the levels of recruitment undertaken within Younger Adults. By December 2005 in the last financial year, the department had recruited 175 new starters, whereas at the same point this year only 97 new starters have been recruited. Recruitment pressures appear to have eased slightly as demand has not been as high as it has been in the past however pressures do remain in a few key areas. Whether the perception that recruitment pressures have reduced is a true picture will remain to be seen over the next 12-18 months as the new Adult Services structure becomes established and the need to recruit possibly increases.
3.2. Learning Disabilities - The main pressure area within Learning Disabilities is with Qualified Care Managers / Social Workers. Although the number of applications received for jobs advertised at this level has improved over the last year, the main problem lies with attracting good quality, experienced applicants. There are currently no market supplements paid within Learning Disabilities.
3.3. Physical Disabilities - In the past one of the main areas of difficulty for Physical Disabilities has been Qualified Occupational Therapists and regular campaigns were run in national press in order to fill vacancies as they occurred. However recently this approach has not been adopted. During this financial year very few Occupational Therapist vacancies have been advertised, so it has been difficult to measure whether this skills shortage is still as acute. Nationally however there is nothing to indicate that the situation has improved.
3.4. Qualified positions within Sensory Services and Deaf Services are also difficult to fill when they arise due to the lack of suitably qualified people in these very specialist areas. Vacancies in these teams have been few and far between this year, but these skills shortages do still remain at a national level.
3.5. As with Learning Disabilities, it remains difficult to attract good quality, experienced Qualified Care Managers / Social Workers.
3.6. There is currently only one market supplement paid within Physical Disabilities. This is paid to all Qualified Occupational Therapists and Senior Practitioner Occupational Therapists who are entitled to a £1,000 per annum, pro rata supplement.
3.7. Mental Health - Mental Health experience difficulties when trying to attract Qualified Social Workers and Approved Social Workers for both Community Mental Health teams and Crisis Resolution Home Treatment teams. Again the volume of response to adverts placed has been improving, but attracting applications from experienced practitioners is still proving difficult.
3.8. Acute recruitment difficulties are experienced by Forensic Services due to its specialist nature. However we have successfully recruited two Qualified Social Workers for this service this year who have both relocated to Hampshire.
3.9. There are several market supplements paid in Mental Health, these include:
_ All Qualified Social Workers, Approved Social Workers and Senior Practitioners in the Aldershot/Farnborough Area teams (Hollies and Conifers) are entitled to a £1,500 per annum, pro rata market supplement.
_ If recruiting an Approved Social Worker, they are appointed as a minimum at the bottom of higher grade (SCP33) and are able to progress through the top of the bar to SCP37.
_ All Approved Social Workers and Senior Practitioners are entitled to a £3,000 per annum, pro rata market supplement.
General Comments
3.10. Unqualified roles within Younger Adults usually attract in good response and most roles can be filled by advertising on the Hampshire County Council website only, which has reduced spend on recruitment advertising over the last 12 months. The main bulk of spend on recruitment advertising within Younger Adults is on Qualified positions across the three sectors. Given the competition within the Social Care environment, the use of local and national medias is sometimes needed to generate response.
3.11. A common trend across all sectors is that recruitment difficulties are more acute in the north of the county. This appears to be for two main reasons, firstly North Hampshire may be less attractive to those relocating from outside of Hampshire, and secondly for those who already live in North Hampshire they are within commuter distance to Surrey and London Boroughs where salaries are higher than Hampshire.
3.12. Another common trend across the sectors is difficulty in filling particularly low paid roles, such as kitchen and domestic assistants. It is thought that competition from other low skill roles within the private sector where pay is more attractive is the main cause of these difficulties.
4. Remuneration
4.1. Hampshire County Council's new pay framework will hopefully be implemented in July 2007. This is the culmination of several years of work and represents a significant investment in its staff.
4.2. Adult Services is a significant beneficiary of the new framework as it recognises previous inequalities in pay for staff who prior to the Single Status Agreement in 1997 were paid under Manual Worker terms and conditions
4.3. As a result of the new evaluation system, some posts currently in receipt of market supplements will no longer require them as salaries will become competitive with the market. In other cases, supplements will be reduced.
4.4. Once the new structure is finalised, a further review of required roles and skill mix of staff is likely to need a review of market supplements.
5. Learning and Development
5.1. Hampshire Learning Centre's Learning and Development Team for Social Care provides social care training for all social care staff in both Adults and Children's Services. In addition, the County Council actively supports the private and voluntary sector through the Partnership in Care Training (PaCT) Programme.
5.2. Much of the programme, both internal and external is developed through strategic workforce development activity working with the Sector Skills Council for adult social care - Skills for Care, at Regional and Sub-Regional level. Critical to the work with the private and voluntary sector is the identification of new and existing income streams to support workforce development activity to support achievement of departmental performance targets. Current examples of external funding sources - SEEDA, Learning and Skills Council and Skills for Care.
5.3. Another key element of the team's work is the co-ordination of workforce development activity across organisational boundaries for key stakeholder groups, private and voluntary sector, neighbouring Local Authorities, Strategic Health Authority and primary and secondary care trusts.
6. Learning and Development plan for Adult Services
6.1. The aim of the plan is to develop an integrated workforce capable of delivering a quality service meeting the needs of the department, partners and the community of Hampshire by the establishment and maintenance of a sufficient and appropriately competent workforce able to meet:
_ The needs of service users and those who care for them
_ Employers' needs for workforce development structures that support their responsibilities for a competent workforce
_ Legislation requirements, service regulations and minimum standards
_ Requirements of individual registration with the General Social Care Council
6.2. The Adult Services workforce development strategy supports the delivery of the mission, vision and values of the department within available resources; the management of change; it empowers the managers and workforce to deliver the vision by effective skills development; demonstrates the effectiveness of workforce development interventions in meeting service objectives; and it will evolve in response to changing needs and will be a dynamic strategy
6.3. Partnership in Care Training Programme - PaCT
_ Comprehensive workforce development programme managed by Adult Services to support private and voluntary sector organisations located in Hampshire, and providing contracted social care services to Adult Services.
_ Where changes to types of services / new ways of working / new worker roles emerge as a result of Adult Services modernisation the PaCT programme will re-focus the programme to provide targeted support to employers in the private and voluntary sector to met the skills gaps and workforce development activity needed.
_ The core programme covers Adult Protection; Dementia Care; Moving & Handling; Medicines Management; Infection Control; Palliative Care; Leadership & Management
_ Employer organisations make financial contribution for all courses.
_ The Programme supports private and voluntary sector employers to meet the priority areas for learning and development activity identified in the National Minimum Care Standards. All programmes are linked to the relevant national occupational standards, Skills for Care knowledge and skills sets and Common Induction Standards to enhance value to both employer and employee.
6.4. Other Support
_ All training courses in the Adult Services Social Care programme are open to private and voluntary sector partners subject to available capacity
_ Basic Awareness Adult Protection training programme for voluntary sector organisations delivered on behalf of PaCT in partnership with ROCC.
_ Support to private and voluntary sector organisations providing learning disability services to introduce and embed person centred planning within their services.
_ Funding for completion of National Vocational Qualifications units (level 2, 3, 4 and Registered Managers Award) and Induction Standards
7. Summary of PaCT activity
7.1. 271 private and voluntary sector organisations have engaged with the PaCT project and accessed direct training courses or targeted funding - equates to approximately 42% of private and voluntary sector organisations in Hampshire.
8. The South East Care Advice Service project
8.1. Hampshire Adult Services Department have provided strategic direction and support to the Private and voluntary employer associations in the county which has secured £571,000 funding over the next 18 months (from a total pot of £2.1m for the South East) from the South East Learning & Skills Council to deliver The South East Care Advice Service (SECAS) project.
8.2. SECAS is being introduced to provide small and medium sized private sector adult social care employers with advice and support on workforce development issues such as skills profiling, accessing the right training and workforce planning. Hampshire Care Association hold the contract for delivery of this service across Hampshire.
8.3. The information from the data collection process will give a much clearer profile of the adult social care workforce, the skills gaps, and learning and training needs. Using this information we will be better placed to target the current limited resources to increase capacity in the sector, as well as improving ability to attract new funding to the sector thus relieving the pressure on Local Authorities.
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: Care Pathways: efficiency and effectiveness of Pathways between Adult Services and Health, with particular regard to hospital discharge. |
1. National policy and context
1.1 Across the range of client/patient groups supported by Adult Services and
Health there are a range of national approaches to the delivery of care and
treatment pathways that support shared or integrated assessment of need and
planning of appropriate care and treatment:
· Single Assessment Process - older adults
· Care Programme Approach - people with mental illnesses
· Person Centred Planning - people with Learning Disabilities
· Models of Care - people with substance misuse problems
1.2 Within each approach, a named worker is identified with lead responsibility for aspects of care co-ordination eg. Care Co-ordinator
1.3 A new `Common Assessment Framework' across health and social care for adults was identified in the White Paper `Our Health, our Care, our Say' 2006. The aim of the framework is to build on the experience from implementing the existing care and treatment systems referred to above.
1.4 Local authority responsibilities in terms of delayed discharges from hospital are set out in The Delayed Discharge (Community Care Act 2003).
2. Hampshire context
2.1 Increasingly, health and social care staff groups are working closely together,
often in co-located and sometimes jointly managed teams. Examples of the latter are the mental health services and the Local Area Agreement Flagship Initiative Well-being Teams.
2.2 Since the implementation of the Delayed Discharge guidance, Hampshire
Adult Services have implemented designated Hospital Discharge Teams in
each of the Acute Hospital sites in Hampshire.
2.3 Within the above working arrangements, use is made of the shared approaches to personal needs assessment and to care and treatment planning, achieving positive results. For instance, intermediate care services, involving the use of care in a residential setting, prevented sixty five acute hospital admissions and enabled the discharge of fifty five further people.
2.4 Within acute medical healthcare, the Hospital Discharge Policy is key to efficient and effective care pathways.
2.4.1 The key features of that policy are:
_ The discharge policy is agreed by all partners, health, social care, service users and carers.
_ The policy follows the care pathway for the whole of an inpatient episode and the process for timely discharges.
_ Discharge planning should begin on admission to hospital.
_ Delayed Transfer are agreed and signed off jointly by Health and Social care representatives to ensure that individuals are agreed fit for discharge. Information is then recorded on a joint data base which can be used for performance monitoring and will identify specific pressures that Acute Hospitals may be experiencing.
_ Admitting nurses should identify and refer to adults services if it is likely that a service may be required and if the patient/ family consent to the referral.
_ Carers should be identified early, to ensure referral to adults services for support, advise and Carers Assessment. Again consent for referral is required.
Examples of both the Discharge Policy and the Care Home Discharge Policy have been made available from one acute hospital Trust. Agreed audit standards in relation to the latter policy include an expected target of zero for patients delayed for more than eight weeks while awaiting placement in a care home of their choice, and practice of a recommended maximum of two weeks for discharge to take place once the clinical team has assessed that someone no longer needs to be in hospital.
2.4.2 It is recognised that multi disciplinary team working supports patients to make choices about their future wellbeing and therefore supports effective & efficient care pathways. Effective and efficient partnership working will have a direct effect on an individuals potential to return home. The key principles are:
_ Joint assessments for the most vulnerable and at risk patients are essential for clarification of the issues and managing the identified risks.
_ Home should always be the first consideration when looking at discharge planning. This should not be compromised by resource implications for either health or adults services.
_ All Acute Trusts should ensure that the principals outlined in the National Service Framework are implemented and evidenced by all professional groups to encourage improved outcomes for service users and carers.
_ NSF meetings are key to maintaining equity of services in this challenging environment and should also involve the voluntary sector and user groups.
_ The White Paper `Your Health, Your Care , Your Say` sets the agenda for the future in terms of promoting and enabling individuals to maximize their potential through joint discharge planning and services.
2.4.3 Further developing joint working is essential to tackle the key challenges in an environment that has depleting resources. The key challenges are:
_ Balancing Department of Health discharge targets with best practice around promoting independence.
_ Making best use of local resources, if areas of good practise are identified, look at implementation in a wider area especially discharge schemes.
_ Avoiding duplication of assessment material, by applying the principals of the Single Assessment Process.
_ Better use of locality health and social care resources to facilitate discharge home.
_ Greater use of Assistive Technology and Community Matrons for discharges of people with Long Term Conditions.
_ Assessments for Continuing care need to be robust and timely.
_ Support for `End of Life Care` should be consistent throughout the county.
_ Permanent long term placements [except in exceptional circumstances] should not be made from acute Hospitals.
_ Development of enabling services for home care packages.
2.4 The Commission for Social Care Inspection record of performance
Assessment for Adult Social Care in Hampshire in 2005 - 2006 commented
on delayed transfers:
`Delayed transfers of care have been variable and need close monitoring and
control. The combined arrangements of the NHS and the County Council in
2005/06 have resulted in outcomes for users that were not as good as for the
average for comparator council areas'.
2.5 In response to requests for pre scrutiny information, Health organisations in Hampshire have reported that all delays in discharge, not just those attributable to social care, are increasing. The highest % of delays appear to be within NHS and NHS partner systems rather than in social care.
3. Issues
What preparations is Hampshire County Council making in anticipation of the introduction of the Common Assessment Framework?
Is maximum use of the existing national integrated frameworks being made to the benefit of patients/service users and their carers ?
What are the difficulties that the absence of integrated Information Technology poses for the successful implementation of integrated approaches to care and treatment delivery?
In the light of Commission for Social Care Inspection comments, what outcomes have been set to improve on current practice in relation to hospital discharge ?
SAFE AND HEALTHY PEOPLE POLICY REVIEW COMMITTEE Briefing Note: Residential care - the take up of beds in the new Hampshire County Council nursing homes. |
Summary
The purpose of this paper is to provide an update on the operational implementation of the Enhance Nursing Care project. The project is nearing the end of delivery with all 500 beds due to be operational by March 2007.
The Nursing Care Strategy has commissioned 10 nursing homes to be built in Hampshire, to deliver nursing care capacity by creating 500 places by March 2007. This has been lead by Hampshire County Council in partnership with local NHS organisations in Hampshire, the prime focus being the need to create long-term care capacity for older people. In developing this project there has been a focus on improving the experience for service users through the design of modern facilities and providing environments that promote privacy, dignity and security.
Eligibility and Admission to Nursing Home Beds
The delivery of nursing care is legally delivered through a section 31 agreement which sets out the eligibility for these services.
Throughout the operational delivery phase of the project there has been close working with Care Managers to identify the individuals who are priority for admission to the new nursing home beds. This has involved close partnership working with the NHS to ensure we are delivering the stated aim of increasing long term nursing capacity which will assist in reducing delays in hospital. The priority for admission of residents to the nursing home beds has been targeted at:
Those who have been waiting in hospital as delayed discharges awaiting nursing home placement or for those that have been placed in interim, short-term nursing placements.
Assessed through the care management process using the Social Services eligibility criteria for Older People.
Hampshire Residency as defined through ordinary residence rules as set out in Circular LAC 93/7.
Registration with a General Practitioners within one of the seven Primary Care Trusts who were our partners as determined by the Section 31 Agreement. The responsibilities within this agreement have now been transferred to the newly established Hampshire Primary care Trust.
This is the overall framework for admission and eligibility which allows us to apply consistency but also should be seen in our overall approach to care for Hampshire residents which is based on all referrals being treated on an individual basis.
Operational Progress
3.1 This section of the report details the operational progress of the implementation of the Enhance project . The position at of December 2006 is that there are 367 of the 500 beds that are fully operational with the remaining 133 to come on stream by March 2007. All of the new units have an agreed programme for phasing the opening of beds as we are still in the implementation phase the average occupancy rate is 86%, when fully operational we will be aiming to achieve 95% , this figure is reflected in those units that have been fully open for a period of time such as Hawthorn Court and Willow Court.. The information is presented on a geographical basis that is aligned to the populations in the 3 localities across Hampshire.
South East
On the completion of the project there will be 128 Nursing Home beds in this locality. These will be located at:-
4.2 Hawthorne Court was the first of the nursing homes to become operational Emsworth House admitted first nursing residents in 2006 and currently has 20 beds operational. Following the completion of the refurbishment of the Residential unit the remaining 28 beds will open in late February 2007.
North
5.1 On the completion of the project there will be 136 Nursing Home beds in this locality. These will be located at:-
Total Beds Occupancy (November 2006)
Ticehurst, Aldershot 48 beds 82%
Oakridge, Basingstoke 48 beds 76% (36 beds open)
Marlfield, Alton 40 beds 71%
5.2 All of the units are fully operational and in the final phases of working towards full occupancy.
South West
6.1 On the completion of the project there will be 140 Nursing Home beds in this locality.
These will be located at:-
Total Beds Occupancy (November 2006)
Fleming House, Eastleigh 30 beds 76%( 20 beds open)
Forest Court, Totton 80 phased opening of beds from end of November
Bickerley Green, New Forest 30 phased opening of beds from December Willow Court, Andover 66 beds 92%
Westholme, Winchester 30 beds, no nursing beds open till early 2007
6.2 The first of these units to become fully operational was Willow Court in Andover, Fleming House admitted first nursing residents in May 2006. Forest Court became operational in late November and is currently in the first phase of admissions . Bickerley Green is scheduled for first admissions in December. Westholme is one of the final two refurbishments to be completed and will admit first nursing residents in mid February.
7 Conclusion
7.1 The report summarises progress to date on the implementation of the Enhance nursing strategy. In 2007 we will be in the final phases of implementation with the final 133 beds being completed and becoming fully operational.