To receive a presentation on health and social care in Telford and Wrekin from Liz Noakes, Director of Public Health and Sarah Dillon, Director: Adult Social Care.
Minutes:
The Committee received a presentation from Sarah Dillon, Director: Adult Social Care, Telford & Wrekin Council and Liz Noakes which intended to provide an all-encompassing update on Health and Adult Social Care in Telford and Wrekin. It was established that the presentation would be split into key topics and presented by the respective senior officers, followed by a Q&A session related to that topic. The Director: Adult Social Care began by contextualising the presentation and outlined the approach that had been taken in Adult Social Care, the aims, the Adult Social Care Charter, the achievements and the response to COVID-19.
Supporting Older People
The first key topic the committee heard about related to the support that was available for older people in Telford and Wrekin, which was presented by from Victoria Worthington, Service Delivery Manager: Community Social Work and Adult Safeguarding, Telford & Wrekin Council and Amardeep Grewal, Service Delivery Manager: Community Social Work, Telford & Wrekin Council. The presentation outlined how referrals were made and support delivered in the community by three locality teams based in Hadley, Lakeside and Wrekin. These locality teams were made up of a variety of partnerships across a number of organisations and teams, while centred around a GP practice in the area of the locality team. Members heard about the key issues that were being faced and the impact COVID had on the delivery of services.
Members thanked the officer for the work they had done previously but also in response to COVID-19.
Members were concerned that there may be many isolated and lonely individuals within the borough as day care centres had been closed since March 2020 and likewise, there may be many carers who were not getting the respite they needed. The Service Delivery Manager: Community Social Care said they had worked closely with their specialist health services to respond to the needs of the community. Likewise, in response to COVID-19 and the closure of day centres, alternative means of fulfilling the social contact individuals would get from the day centres had been developed such as the shielding and guarding calls as a way of support and connect individuals and that day care centres were routinely checking on those they cared for.
Members asked about the additional support available for those living with dementia and their carer’s, in particular the council tax relief. The Service Delivery Manager: Community Social Work and Adult Safeguarding said she would need to check this with the benefits advisory service.
Members asked how support for carers was monitored to ensure that none fell through the gaps. The Service Delivery Manager: Community Social Care responded by saying that one of the lessons learnt was the importance of physically posting letters which contain important information. Likewise, in collaboration with the Carers Partnership Board, an informal local winter plan for carers was created which collated useful and practical information and sent to every known carer to the Council and every single carer known to Carers Centre. The Service Delivery Manager: Community Social Care continued by saying that Adult Social Care had a joint carers peer review with the Carers Centre who carry out carers assessments, it was a joined up approach to deciding the support that was needed. The Service Delivery Manager: Community Social Work and Adult Safeguarding added that there was some other additional support available for carers from the Wellbeing and Independence Partnership from MyChoice, Age UK, Carer Centres and the CVS.
Supporting People with Learning Disabilities
and Autism.
The committee heard about the different work streams and strategies
that had been developed across organisations in the borough and
regionally to deliver support to people with learning difficulties
and autism by the Service Delivery Manager: Community Social Work.
This included the development of Telford & Wrekin’s
Learning Disability Strategy, the development of the STP’s
overarching Learning Disability Strategy and the newly launched
Learning Disability Partnership which was co-chaired by an Expert
by Experience. Members also heard that some key issues was the
impact of COVID-19 on individuals, families and carers, developing
multi-agency working and community hubs (including virtual hubs)
and the change in care delivery.
Members asked whether those who had learning disabilities and autism had the ability to interact with others using video conferencing software such as Zoom. The Service Delivery Manager: Community Social Work responded by explaining that the My Options Connect offered that virtual platform to connect each other via Microsoft Teams and Zoom. Likewise, “social bubbles” had been developed whereby individuals with learning disabilities and autism were partnered up with one or two other people, who were an important part of their social circle and were supported with two staff to go into the community to gain some social interaction. This allowed carers to have some respite, whilst knowing that their loved ones were with people who they knew and understood them.
Members noted that often with individuals with autism they often exhibit particular strengths, and therefore members asked if these were being nurtured. The Service Delivery Manager: Community Social Work responded by saying that they don’t nurture these strengths as much as they should and it is an area of work where both the Adult Social Care and providers could be more aspirational with the individuals who have autism.
Safeguarding Adults
The next section members heard about related to Safeguarding Adults, which was presented by The Service Delivery Manager: Community Social Work and Adult Safeguarding. Members were informed on how the Adult Social Care team in the council had been working with partners to develop improved procedures to provide support for adults at risk of exploitation or abuse. Members were also told about future plans such as building up the prevention agenda into adult safeguarding and to develop new pathways for individuals who may not necessarily meet the statutory criteria to receive adult safeguarding support, but are at risk nonetheless. The Service Delivery Manager: Community Social Work and Adult Safeguarding touched on the challenges that were faced in regards to the work stream (such as COVID-19, social isolation and financial exploitation) such as and how these challenges were met by maintaining contact with the most vulnerable and working closely with partners to share intelligence and co-ordinate actions.
Members asked what support was available for individuals with care and support needs in the criminal justice system. The Service Delivery Manager: Community Social Work and Adult Safeguarding responded by recognising that those with care and support needs were vulnerable to entering the criminal justice system and that they would work probation and police colleagues to ensure that the support was there for individuals made known to them.
Members asked how individuals with care needs and support who received personal payments were supported to ensure they are not exploited or subject to financial abuse. The Service Delivery Manager: Community Social Work and Adult Safeguarding responded by saying that any direct payment for a support plan included looking for risks and putting contingencies in place to mitigate them. Likewise, if individuals did not have the capacity to manage their money, then there was the deputyship team in the council who could assist with this. The budget was set by the social worker and the individual, as well as all the correct measures necessary to avoid financial abuse.
Prevention and Enablement.
The next section the committee heard about was Prevention and Enablement from Michael Bennet, Service Deliver Manager: Prevention and Enablement, Telford & Wrekin Council. Members heard about how the delayed transfer of care per 100,000 in Telford & Wrekin had consistently came down in the last three years and was below the national average, how the Integrated Discharge Team had reduced the average length of stay for patients with complex needs by two days and how the Health and Social Care Rapid Response Team delivered services in the community and consequently had a 93% admission avoidance rate and had saved 252 beds over a space of five months. The Service Deliver Manager: Prevention and Enablement concluded his section by outlining the use of Independent Living Centres which provided support for individuals to live independently.
Members referenced a recent publication from Healthwatch England which stipulated that patients were being discharged late at night, without proper medication and potentially into a home that wasn’t safe for discharge, and therefore asked how we can be sure this isn’t happening in Telford and Wrekin. The Service Deliver Manager: Prevention and Enablement responded by saying that it was not common but had happened on occasion and that the system tracked any adverse discharges. He continued by saying that Healthwatch Telford & Wrekin were undertaking a survey to collate feedback about this topic. The Integrated Discharge Team worked to ensure that all patients that were discharged had the right medicine and transport available.
Members asked if there were any care homes who were able to accommodate COVID positive patients who had been discharged. The Service Deliver Manager: Prevention and Enablement confirmed that there was one care home that offered this and that careful due diligence was undertaken to ensure they could maintain the patient. Likewise, additional capacity was available in other providers to take on COVID positive dementia patients.
Supporting Adults with their Mental Health
Members heard about the support that was available and the work that had been undertaken to support adults with their mental health by the Service Delivery Manager: Community Social Work and Adult Safeguarding. The update included information about the Mental Health 5 Year Plan that had been produced by the Shropshire, Telford & Wrekin Sustainability and Transformation Partnership and co-produced with people who had lived experiences and across the health and care sector. Members heard about the distinctive role of Mental Health Social Workers who were able to humanise and personalise the mental health service individuals received. Likewise, Members heard about the ongoing work within the borough to support adults with mental health issues. These included improving access to mental health services to ensure that there was no wrong door, strengthening partnerships with voluntary and third sector organisations and improve user feedback and involvement in service delivery. The presentation concluded on the key challenges such as the increase in demand (which had seen a 47% increase in mental health act assessments since 2015/2016) and the impact of COVID-19 on the delivery of services faced looking to the future and initiatives that had been created to combat these challenges.
Members asked for further information surrounding the work relating to street triages in Telford and Wrekin to support adults with mental health. The Service Delivery Manager: Community Social Work and Adult Safeguarding explained that this was not only for adults already known to system and would be available for the police to use as a resource if they were called out to an individual who may need mental health support. The Service Delivery Manager: Community Social Work and Adult Safeguarding said that a number of models were being explored, but highlighted one model based in Leicestershire where a mental health professional travels around with police in a street triage police car and then provide support to the individual and resolve the issue without taking the individual to a police station.
Members asked if any Calm Cafes were planned to be opened in the north side of Telford as the ones currently operated did not cover this area. The Service Delivery Manager: Community Social Work and Adult Safeguarding responded by confirming that they had intended to open additional Calm Cafes across the borough but had been set back by COVID-19, especially as the ones in Meeting Point House and Hadley had been well attended prior to COVID-19 and had resulted in a lot of positive outcomes. Members followed this up by referencing Oakengates Town Council and The Wakes and how they had been working with the Citizens Advice Bureau and therefore it may be an opportunity for Oakengates to be a location for the Calm Café to be opened in the future. Members also referenced community assets in Donnington as potential locations for Calm Cafes.
Looking Forward.
Due to time restraints, it was agreed that the remainder of the planned presentation would come to the next Telford & Wrekin Health Scrutiny Committee meeting on 2nd December 2020. Therefore the Director: Adult Social Care concluded the presentation by outlining key points and areas looking to the future, such as managing the resources to meet the demand of the population, continued work with partnerships and to improve performance and ensure co-production of service delivery with individuals with lived experiences.
The Chair of the Telford & Wrekin Health Scrutiny Committee invited the Cabinet Member for Health and Adult Social Care to comment on the health and adult social care landscape in Telford and Wrekin at present. The Cabinet Member for Health and Adult Social Care responded by saying there were some positive messages and examples coming out of the borough to meet the demand for health and adult social care as show in the presentation. He made reference to the Integrated Discharge Team in Shrewsbury and Telford Hospital NHS Trust and the Health and Social Care Rapid Response Team and how this would benefit both the provider and the council. The Cabinet Member for Health and Adult Social Care followed these points up by saying that the council did not run the health service and therefore hoped that the health authority were equally concerned about the delivery of some services. He noted that the relationship on the ground with the health service was positive and that was evidenced in some of the aforementioned projects. The Cabinet Member for Health and Adult Social Care believed that Adult Social Care had historically received inadequate funding and in need for a settlement to allow it deliver more services. Likewise, he believed that there had been a lack of investment and planning in regards to the workforce for carers in the borough.