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
Partnershiplanguage 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
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:
1996Ambleside Bank Older Person's
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).
1997Rapid 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).
1999Philips 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.
2001Alexander Court Assessment and Rehabilitation
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:
|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
|Palliative Care Team||95
|Extension of Rapid Response Team||68
|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||26
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.
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||397,000
|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||80,000
|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