Appendix 4: Note of visit to Torbay
Summary Note of Visit to Torbay 24 January 2013
MEETING WITH REPRESENTATIVES OF NHS AND LOCAL AUTHORITIES
Sam Barrell, Chair, South Devon and Torbay Clinical
Commissioning Group
Caroline Taylor, Interim Chief Operating Officer
& DASS, Torbay Council
Councillor Stuart Barker, Devon County Council
Jennie Stephens, Strategic Director, People, Devon
County Council
Tim Golby, Head of Social Care Commissioning, Devon
County Council
Carolyn Elliot, Assistant Director, Health and Social
Care (Southern), Torbay and Southern Devon Health and Care NHS
Trust
Mandy Seymour, Chief Executive, Torbay and Southern
Devon Health and Care NHS Trust
Dr Sonja Manton, Chief Operating Officer, Torbay
and Southern Devon Health and Care NHS Trust
Julie Foster, Zone Manager, Brixham
James Drummond, Lead Officer for Integrated Carers'
Services, Torbay Trust
Paul Cooper, Deputy Chief Executive, South Devon
Healthcare NHS Foundation Trust
Dr John Lowes, Medical Director, South Devon Healthcare
NHS Foundation Trust
Torbay has a large elderly
population which suffers from a high degree of co-morbidity. There
is a large health inequality gap, with poorer people dying up
to nine years earlier than others. To help tackle this, community
healthcare and adult social care services were integrated in 2004
to create a Care Trust. Health and social care staff are co-located,
with well established links with GPs.
There is also a joined-up Health and Care Cabinet
for South Devon and Torbay. There is a long history of senior
managers and clinicians working together on health and social
care in Torbay, and not necessarily always within national policy
guidelines. There are moves afoot which could lead to the integration—via
acquisition—of the Health and Care Trust with the acute
Foundation Trust to improve integration.
The Brixham Zone Team explained how health and social
care workers are brought together to tackle complex care problems
in Torbay. There are pooled budgets, integrated commissioning
and shared HR and IT. Close working with GPs and acute hospitals
to identify the problems of service users and their carers is
a key part of the system. Care home placements have come down
and there is a very low rate of hospital deaths, and one of the
shortest average lengths of hospital stay. Financial constraints
and the loss of some "coterminosity" between local authority
and NHS boundaries are making it more difficult to operate the
Torbay system. It is getting harder to share risk.
Much of Devon is rural, while some areas have
a very large population of elderly people. Investment in prevention
services was increased some years ago, and the benefits are coming
through now. Prevention measures can be innovative; singing groups
were among the ideas that have been tried. They can be funded
by pooling of personal budgets.
Under S 256 of the 2006 NHS Act, Primary Care Trusts
have a power to make payments towards expenditure on community
services, and this can be put to good use in investing for the
future. The East Devon Hospital at Home scheme is a good example
of S256 spending, which has helped to reduce admissions to both
acute health care and long-term care. [One comment during this
session was that S256 money was the single most important intervention
to support and encourage joint working between health and social
care, and needed to be maintained].
In Devon some care homes have been converted into
dementia centres of excellence, offering both residential and
homecare services. Better support for carers has reduced care
costs to the local authority. Extra-care housing places will be
provided for people with dementia and learning disabilities, but
the Council is struggling to find enough providers and has had
to shape the market with funding to encourage developers and providers
to take up the idea.
- The draft Care and Support Bill was welcomed,
but there were criticisms, and the following main points were
made by various people at the meeting:
- The draft Bill should contain explicit provision
for resource flexibility between health and social care and should
have more on joint commissioning
- The emphasis on prevention and the underlining
of the need to identify carers are very valuable aspects of the
draft Bill
- The practical implications of a 'duty to co-operate'
need to be explained in more detail than they are in the draft
Bill
- The Bill might make it easier to share information
between health and social care providers; the multiplicity of
providers envisaged under NHS reforms makes it harder to share.
- The duty to provide information is important,
but not everyone can access information via the cheap routes,
especially online.
- The Bill needs to address the needs of young
carers, and not perpetuate age-related barriers in the system.
- Giving authorities a power to charge for services
to carers is a "fundamental mistake"; carers should
be seen as partners in caring, not recipients of services
- Regulations must make clear that identifying
and keeping in contact with carers are the responsibility of all
health and social care professionals, including GPs
- One gap in the draft Bill is something on carers'
physical and mental wellbeing
- Hospital discharge remains a fundamental problem,
and the Bill does not encourage proactive approaches to it
OUTREACH EVENT
During the visit, members of the Committee held an
outreach event in Torquay, at which they heard the views of around
60 care and support service users and carers on the key practical
issues in the draft Care and Support Bill. We are very grateful
to all those who took part, for giving up so much of their time
to share their wide experience of the care and support system
with the Committee, and for telling us what they believe the Bill
can do to make it work better.
COMMENTS—A SELECTION
INFORMATION AND ADVICE
- Information on care and support locally has been
improving year by year since the early 2000s, but I fear that
it is going backwards
- There is too much duplication of information
and advice - it needs co-ordination
- There should be a national standard for information
and advice
PREVENTION
- The voluntary services in Torbay fill the gaps
and help to prevent care needs developing
- There is a need for drop-in centres to support
prevention
DISCHARGE
- There needs to be more aftercare following discharge,
to stop people having to go back into hospital
- Discharge from hospital is terrible; there is
no proper liaison. The family needs to know about discharge arrangements
CARERS
- I cared for years without knowing I was a carer
- There is a stigma to being a carer
- Being a carer can be isolating
- Being a carer demeans you as a person
- Carers are reluctant to say "I'm a carer"
- especially if the cared-for person has a mental health problem
- I want to live in a normal world - not to be
a carer
- Services look at the cared-for person, not the
carer. Once the cared-for person is over 18, the service providers
listen to them, not their carer
- There needs to be a better link between the healthcare
provider and the carer
- I was a young carer for a mother with mental
illness. I thought that all young people looked after their parents
- In one school for youngsters with moderate learning
difficulties, six out of 100 students are carers—aged about
14
- There are also 90 year old carers
- One carer did not get an assessment because his
father didn't want an assessment of his own
- Cutbacks to the physiotherapy service are making
it harder for me to care for my wife
- Carers may not have the skills to be employers
and the ground rules from the local authority seem to be lacking—no
help to set up the care plan etc
- Carers may not want to say everything in front
of the cared-for person, especially when there are differences
of view
- If the Bill allows local authorities to charge
carers for services, people will not take up the services
- There is a strong need for advocacy to support
individuals and their carers - people are stumbling around in
the dark
- What would make life better for carers?
- Regular
contact, someone to ask how I am doing
- Advocacy
- Stop patronising
us—be sensitive in communication
- Extra financial
help in recognition of the careers we have given up
- Training
for local authority staff and carers
ASSESSMENT AND CHARGING
- It was not clear where to go for an assessment.
There was not enough information available. An old leaflet was
sent to me
- Assessments are looked at by panels—the
bar is moved depending on funding levels and diagnosis rates
- Care needs were assessed, then I was told amount
was being halved and that if I appealed it might be taken away
- Assessors are too focussed on the financial implications
of their assessments
- Assessments are done by people who don't understand
what they are assessing
CARE AND SUPPORT PLANS
- People don't know they have a care and support
plan
- My care and support plan doesn't work—the
occupational therapist cut back on my care
- A care and support plan is good if it is kept
up to date
- I had a good package of care, but once I got
it I was left to get on with it. It hasn't been reviewed for 2
years
PERSONAL BUDGETS AND DIRECT PAYMENTS
- It would help me to have direct payments. At
the moment, my careworker only gets £75 out of the £130
they are paid, with the agency taking the rest
- Personal budgets should be available but not
imposed
- Not everyone would be better off with direct
payments—for example my daughter with mental health problems
- Having choice and control is very good—but
only if it is explained and supported
PORTABILITY
- There is a risk that under the portability provisions
local money will be used to fund services for the many 'incomers'
- There should be the same services wherever you
live
SAFEGUARDING
- Difficult to get information relevant to safeguarding
issues from local authorities—they hide behind data protection
- You need independent Safeguarding Adults Boards,
not ones set up by local authorities, which may be under scrutiny
themselves
- Hate crime against people with disabilities is
poorly recorded by the police
- You could have another Winterbourne View—people
with learning disabilities are an easy target
- Concerns and complaints have to be reported to
the provider, not the commissioner. Serial complaints therefore
may go undetected
- People don't know how to distinguish good care
from bad care
- There is massive potential for exploitation,
especially with direct payments
- There need to be better ways to whistleblow—the
CQC is paper-based and under-resourced
TRANSITION
- I am the mother of two disabled children. When
they were in education all was fine, but after they became 19
I was just pointed towards the cheapest option.
LOCAL SERVICES
- The Signposts service (run by the Torbay Care
Trust) gives good information and support to carers in Torbay
- The integrated Torbay model is good—the
benefit is the very local approach
- I have had a good experience of Torquay.
- Joined- up health and social care works brilliantly
in Torbay
- The carers' lead in Torbay gave great help when
I became a carer
- Torbay's joined-up services are OK once you know
how to access them
- Not many people know the number to call in Torbay
- There is no single website about services in
Torbay because there is no agreement on who pays and who would
update it.
- There needs to be better communication between
different services
- Many care agencies are 'sprouting up' but there
is no choice
- GPs are not always linked in to the care and
support system, although some practices and individual GPs are
very good at liaison
- People on the ground don't know about the Health
and Well Being Board
- There are so many different workers involved
with care and support. It is essential to have just one key worker.
- There is a risk with funding cuts that the NHS
and local authorities will retreat into their silos and start
'cost shunting'
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