Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Director of Social Services, Wigan (DD 32)


  The foundation for Wigan's success in managing delayed discharges is the work that was done to introduce the NHS and Community Care Act in 1993. It was recognised then that the Local Authority and NHS were an interdependent system and good performance could only be achieved by working together. It is symbolic that the Chief Officers and senior managers worked together under a framework explicitly titled the Community Care Partnership—language which was not common at that time.

  This group has continued to work together with many of the same personnel still involved. This has been significant in developing a high level of trust which facilities effective joint work. Throughout this period Wigan has consistently been one of the best performing authorities nationally in respect of low numbers of delayed discharges, with an average of between eight and 10. The Authority's target required by the Building Capacity Grant of a reduction of 20 per cent in delayed discharges is six. Throughout this period the Council has made Social Services the top priority of its budget strategy in order to bring expenditure up to the level of SSA from a low base.

  The Social Services Inspectorate inspected the provision of Social Care services for older people in Wigan in September, 2001. The report concludes that "Wigan Social Services Department was working well with a range of partner agencies, particularly health to implement strategic objectives for older people's services. Service users and carers were well served by an improving range of services and, in particular, those which helped people remain independent in their own homes. There were many examples of innovation, moving away from the more rigid and "service led" patterns of the past. The Department was strong in attention to quality and performance management. We judged that Wigan Social Services were serving most older people and their carers well, and that prospects for improvements were good."


  The basis of our joint approach to minimising delayed discharges has been to develop services which now are defined as Intermediate Care. This has been achieved through effective Joint Commissioning, which was recognised by the Social Services Inspectorate in October, 1998.

  The elements of our service are:

    —  1996—Ambleside Bank Older Person's Resource Centre.

  This was the first purpose-built centre in the country and commissioned using the Special Transitional Grant for Community Care. It has 30 beds, 10 day care places, together with an assessment and treatment suite for therapy staff. The Social Services Department has a contract with an independent sector provider with the therapy staff funded by the Health Authority and provided by the local NHS Trust.

  It aims to maintain older people in their homes and prevent admissions to residential care wherever possible. About 70 per cent of older people admitted to Ambleside Bank return home. (The Secretary of State for Health visited Ambleside Bank when a Junior Minister).

1997—Rapid Response Team

  This comprises nurses, therapists and a social worker. It initially accepted referrals from Accident and Emergency and Medical Admissions Unit. The team carries out a rapid interdisciplinary assessment and provides follow-up care, with the primary aim of preventing admissions to hospital. In 1999 the service was extended to allow direct access from all GP practices. The Social Services Department strengthened the team through the allocation of home care services using the Partnership Grant (see below).

1999—Philips Intermediate Care Centre

  This is a ward in a non-acute hospital which offers convalescence and rehabilitation for older people. It was set up because many people were not well enough to be discharged from hospital to residential care so were admitted to long-term nursing home care. There was no opportunity for them to maximise their recovery through active rehabilitation. An inter-disciplinary team now provides this for people in hospital who are medically stable. The rapid response team has access to staffed beds when they are unable to maintain someone in their own home, but do not require an acute admission.

2001—Alexander Court Assessment and Rehabilitation Centre

  This is a 40-bed assessment and rehabilitiation centre jointly funded by the Health Authority and the Social Services Department. The focus is on restoring older people to independence after an episode of acute illness. It is registered as a nursing home and provides free care as part of the Health Authority's responsibility for Continuing Care. As with Ambledside Bank it is owned and staffed by a private provider with therapy and consulting rooms staffed by the Trust.

Social Services Modernisation Fund

  The Authority has used the specific grants for Social Services as a creative and imaginative way through the Joint Commissioning process in order to continue to have a low number of delayed discharges.

  The funds available can be summarised as:

Partnership Fund
Prevention Fund
Promoting Independence Grant
Building Capacity Grant

  The reduction in the Promoting Independence Grant is very difficult to deal with as, in common with all other Social Services Departments, it has been used to cover ongoing commitments.

  Some examples of schemes funded through these specific grants which address delayed discharges and reduce hospital admissions are:

Palliative Care Team
Extension of Rapid Response Team
Extended opening hours for Central Duty Team
Contract with Voluntary Sector to carry out low level assessments for equipment
Contract with Age Concern to visit people discharged from hospital
Contract with Age Concern to help people choose a residential care or nursing home
Development of an Acquired Brain Injury Service
Hospital Discharge Service for Taylor Ward
Approved Social Worker for the Accident and Emergency liaison Scheme
Additional Hospital Social Workers to support the EMI Strategy
Adaptations Co-ordinator and technician
Assessment Centre at Heathside EMI Unit
Team Manager Intermediate Support

  The Authority has also continued to invest in mainstream provision for Social Services. For example, in 1997 the Home Care Service undertook 18,000 visits per week. In 2001 this had increased to 24,000 visits per week. Unlike many other authorities there has been no reduction in the investment in residential and nursing home places. This recognises the increased numbers of people who require a service, a key factor of which is increased activity in the hospital.

BUDGET 2002-03

  The Social Services Department is facing a very difficult position in the coming financial year. Some of the main elements of this are:

Transfer out of SSA
This is for the management costs of the National Commission for Care Standards together with the loss of income. It is significantly higher than the costs of the staff transferring, £141,000.
In addition, there has been a further reduction in SSA to cover the costs of the Guardian ad Litem and Reporting Officers (CAFCASS) Service which was transferred to the Lord Chancellor's Department in 2001. There was therefore no expenditure on this in 2002-02.
The conclusion appears to be that once services are transferred from the Local Authority they will be adequately funded. Those that remain are not in that position.
Short-fall on Preserved Rights
The grant is not anticipated to meet the full costs of this new responsibility.
Reduction in the Promoting Independence Grant
Loss of Income from Intermediate Care charges

  The only approach available to the Authority is to fund this shortfall through the Building Care Capacity Grant or the Performance Fund. Some services may be able to be funded by our NHS partners and will be included in the dialogue in respect of the SAFF process. It is particularly disappointing that an Authority which has performed consistently well in respect of delayed discharges over the past 10 years has been disadvantaged through the distribution mechanism for the Building Capacity Grant. Some authorities who have received the higher allocation are known to have reduced investment in some of the services which contribute to good performance. Authorities, such as Wigan, are therefore penalised for their positive approach over recent years.

  There needs to be flexibility in the conditions for the use of the Building Care Capacity Grant and the Performance Fund which enable these services to continue. A continuation of the requirements of the former for 2001-02 that "The grant should not be used to substitute resources already in the system, to reduce existing budget deficits or to switch priorities" would not be helpful. It would penalise Authorities who have maintained their investment in the Personal Social Services to take into account growing demand and increased activity in the NHS. Many of the services outlined above are at risk because of the current situation. These are areas that authorities with historically less good performance than Wigan will be using the grant to invest in. Similarly our extensive provision of intermediate care should be a legitimate use for the Performance Fund. This approach has the support of both the new Ashton, Leigh and Wigan Primary Care Trust and the Wrightington, Wigan and Leigh NHS Trust.

  The difficulties outlined above are in addition to continuing structural difficulties in the Department's budget which requires an additional £900,000 to continue providing existing services. These are in areas such as Agency Placements for Children, salaries and wages in Home Care and Supported Accommodation.

  This reflects the general concern about this year's financial settlement expressed by the Local Government Association and the Association of Directors of Social Services. There is nothing within it to assist Local Authorities either with the £1 billion budget gap between SSA and actual expenditure or with the £200 million overspend identified in the Budget Survey published in September 2001.

14 January 2002

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