Appendix 2ii

Half Yearly Report Intermediate Care Fund 2015/6

Preventative Interventions Project

City Of Cardiff Council

Half Year Report: City Of Cardiff Preventative Interventions

Independent Living Services

Through our multi-skilled telephony and visiting services we will help people remain independent for longer and reduce the cultural expectations of social care by providing a comprehensive and timely service to older people. We will provide information, support and advise that ensures we are meeting our requirement under section 2 of Social Care and Wellbeing act. By Acting as community navigators our Visiting Officers will provide a service where older people will meet the aims of

  • Being Well
  • Being at Home
  • Being Social
  • Being Safe
  • Managing their money.

Through our Day Opportunities Model many older people can independently access social events and activities in their community but may need information and advice about the range of activities on offer:

We will offer

  • One Point of Contact for services to older people – providing advice and information tailored to their individual need including signposting to local social activities and events.
  • Directory of community based activities for both council and partners to use – this information to be developed and provided online for citizens to access directly or by telephone

We will build community capacity to support the long term vision which will be achieved by

Encouraging Volunteering - Building on the successful Health & Active Partnership (HAPS) pilot project which has been funded to explore volunteer based service delivery which addresses the social isolation of older people.

Creation of a Volunteering Portal to provide information for current and potential volunteers and match them opportunities in Cardiff

Our intention as a Council will be to work with the wide range of partners to develop a ‘Team Cardiff’ approach which links these opportunities to make it easy for people to find out where they can access opportunities.

Transport - transport is crucial to enable access to universal services. The Council currently provides funding to support community transport through VEST. This funding will be continued and services reviewed to ensure those who need it can access it

One Point of Contact telephony and visiting Service

The New one point of contact went live 1st October, early indicators show that 43% of calls are dealt with at this initial stage, opposed to 30% previously , this should result in less people being referred into Social Care.

  • One Point of Contact for Independent Living Services and Adult Services
  • A new number for the contact service with priority access to the Health Service went live on 1/10/2015.
  • Working with clients to maintain and regain their independence
  • Working with the 3rd Sector for alternative services
  • Providing information, advice and assistance to encourage independent access to social activities and engagement opportunities
  • Providing assistance to those who need it to access community services and activity through targeted intervention and support
  • Supporting the most vulnerable through high quality specialist day services
  • Access to a range of professionals when needed

Progress

  • A robust training plan has been developed is 75% of training was completed by 1/10/2015, including shadowing of independent Living Officers, signposting, bespoke telephony training and third sector organisation briefings.
  • Commander Resource Call Manager access and training given to line management of Contact Team to enable effective call management.
  • Gap Analysis of Hospital Contact Officers has been undertaken and training needs have been established.
  • A working group across Adult Services and Independent Living has ben established to work on improvements to processes and administration.
  • Telephony Contact Officers are now call handling at first point of contact as opposed to providing call backs. Quality checks are carried out to ensure process is effective and preventative agenda is delivered.
  • Presentations on Independent Living Services and One Point of contact have been delivered to partners in Health, Social Care and Aging Well groups.
  • Health Targeted mail drop letter and poster have been delivered.
  • Promotional poster submitted for inclusion on Health Intranet and weekly Newsletter.
  • Visiting Officers have taken part in the Shared Well Project undertaking 2 guided conversations a week in addition to normal visits. All feedback has been returned to Citizen Driven Health for their evaluation.
  • All visiting Officers have been issued Mobile Working Tablets that are now being used in the field.
  • Interim Independent Living Web page wire frame has been completed. Amendments are awaiting approval.
  • Independent Living Services are working in partnership with the First Point of Contact project on the implementation of the all wales solution ‘Dewis Cymru’
  • Occupational Therapy and the Joint Equipment Store have been realigned into Independent Living Services to provide a more streamlined service.

Telephony Achievements

  • 6475 Calls answered in first half of year.
  • 93% Answer rate for inbound calls

The graph below demonstrates that since the development of One Point of Contact who became part of Independent Living Services in July, the reduction in referrals and dependency on Social Care is beginning to shift.

Visiting Officer Achievements

  • 631 visits have been undertaken in quarters 1 & 2.
  • 47% of service users had their income Maximised
  • Cumulative income maximisation of £712,332 per annum has been identified for those service users.
  • 31% of service users received a preventative intervention.
  • 29% of service users were referred for assistive technology.
  • 97% of service users were happy with the service received and felt it helped them to live more independently

Case Study for Independent Living Services

Background

Mr X Lives alone, he contacted his councillor to see if he could be moved, as he felt isolated as his family live on the other side of Cardiff and can only visit him occasionally. Mr X has been in poor health for while and finds it difficult to get out of the house to do his shopping, pick up prescriptions and meet people.

What we did

A Visiting Officer called to Mr X, at his home, where they discussed his housing and personal and financial concerns. During the discussion it transpired the Mr X use to be a member of the Welsh Guards. The visiting officer discussed a number of 3rd sector agencies that may help, with his getting out and about more, established if he were to move what would be his preferred location, they also discussed how he managed getting in/out of bath/shower, along with any issues he may have getting in, out, or around his home.

The visiting officer arranged for the Welsh Guards, to visit Mr X on a social basis, for the Befriending Society to do light shopping and pick up prescriptions, the Visiting officer arranged for an OT to evaluate his washing needs, which resulted in a new shower. A community alarm has been installed, and he is now in receipt of Attendance Allowance.

Mr X has been put onto the waiting list to see if anything comes up in his desired area

How they are better off

He is safer accessing washing facilities preventing slips trips and falls, he has additional income from the attendance allowance, he feels more secure with community alarm, and is in contact with people on a weekly basis therefore he is less isolated and lonely.

Client feed back

The visiting officer called back a few weeks after they had arranged the aforementioned, and had noticed a marked difference in his demeanour and confidence, he looked better.

Mr X said he did not know this type of help was available and he felt that he’d taken back control of his life; he now felt there was a purpose for getting up in the morning, as his life was now more meaningful

Feedback from Health on Independent Living Services

Improving Medicines Management in Domiciliary Care: A Partnership Approach

Awaiting info

Healthy And Active Partnership (HAP) - Age Connects

The continuation of funding for the HAPS pilot project with Age Connects has remained focussed on the reduction or prevention of social isolation of older people in the community. The project is based on the use of volunteers to support individuals and requires Age Connects to liaise with other 3rd Sector organisations to support the project and to help to support the sustainability of those organisations.

There are two distinct strands to the project. The overarching aim of the project is to help gain intelligence of what is in the community for older people and to facilitate easy access to the information for those who are able to access services and activities independently.

The second strand is to develop a volunteer support program helping to alleviate isolation.

The main purpose of the Healthy Active Partnership is to keep older people healthy, active and connected with their communities. The volunteer support program entitled “Keeping People Connected” is a strand of the Healthy Active Partnership.

Progress

  • Data regarding users of the service and volunteers are being reported on a regular basis
  • Directory of activities continues to be developed ready for transfer into the Council website information service.
  • Events have been held to engage with luncheon clubs to better inform the picture of provision, and to identify issues encountered. These have been reported on as part of the evaluation process and this work continues to be progressed.
  • Neighbourhood Partnership events have been held to engage other third sector organisations and community groups.

Achievements

  • 125 new referrals into the service
  • 67 volunteers recruited
  • Luncheon clubs and other groups have been supported by participating in these events. Practical assistance has been provided eg Age Connects successfully helped one of the luncheon clubs to apply for funding to purchase a mini bus to provide transport and enable more individuals to access the facility.
  • The identification of gaps in existing provision, ideas for tackling barriers and bridging gaps have been reported on and will be used as part of the ongoing work.
  • The HAPS project is continuing with alternative funding until 31st March 2015. All of the information gained via the project will be used to fully inform the requirements for the recommissioning of a service April 2016 onwards.

Feedback From a Service User,

Development of New Models of Day Service Opportunities

The aim is to prevent social isolation and enable older people to achieve their chosen outcome by:

  • Providing information, advice and assistance to encourage independent access to social activities and engagement opportunities
  • Providing assistance to those who need it to access community services and activity through targeted intervention and support
  • Supporting the most vulnerable through high quality specialist day services

The Council has moved away from Day Centres being the only service for individuals who have a identified need for social isolation as means of prevention.

Through working with individuals, the service has successfully supported them to access a range of community based services as a positive alternative to Day Centre attendance

This has meant that from the previous 243 Day Centre users, 92 service users remain

These 92 are now users with eligible needs due to dementia or high care and support, which a Day Care environment is the most appropriate setting to meet these needs

Day Opportunities Model

Achivements

  • All service users within the 4 day centres have been reviewed over the timescale of the project, October 2014 to July 2015 (25 in Q1). The reviews were undertaken to identify individuals within the day centres for whom the only identified need related to social isolation and attendance at a day centre was a means of prevention.
  • Through working with the identified individuals, and providing a reablement intervention, the project has successfully supported these individuals to access a range of community based services as a positive alternative to day centre attendance.
  • There has been a great deal of engagement with third sector and community groups and these links are continuing with Council staff to support the ongoing work.
  • A process has been developed to support individuals looking for opportunities for social engagement approaching Adult Social Services specifically, and the Council in general.
  • The project has left a legacy of information which is being incorporated into the Council’s Directory of Services being developed in response to the Social Services and Well being (Wales) Act 2014.
  • The project has contributed its learning experience and evidence to support the ongoing work to develop and support a broader neighbourhood day opportunities approach across Cardiff. This is in partnership with third sector and other organisations and group.

Case Studies

  • GT is 99 years old and cared for by his wife. Both feel that regular respite by day centre attendance 3 days a week is helping them holdthings together and is the only service they wish to receive.
  • SL is 82 years old and receives a care package 7 days a week. He requires a great deal of reassurance & supervision. Regularity & consistence of Day Centre attendance 5 days a week helps to sustain his wife’s carer role
  • CH is 84 years old and attends a day centre 1 day a week which enables his daughter with whom he lives and who is his main carer to have a regular break from her carer role and prevents the need for a care package.

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