Draft Care and Support Bill - Joint Committee on the Draft Care and Support Bill Contents

Appendix 4: Note of visit to Torbay

Summary Note of Visit to Torbay 24 January 2013


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


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.



  • 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


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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.


  • 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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Prepared 19 March 2013