Into the Spotlight Conference

Into the Spotlight Conference Report – 2 December 008

Into the Spotlight Conference

Report

2 December 2008

16

Into the Spotlight Conference Report – 2 December 2008

Over 350people attended the Into the Spotlight conference, with good representation from health, housing and social care sectors and from statutory, voluntary and independent sectors. This is the first in a series to consider the ways in which housing, care and health services can work in partnership to enable people to remain living independently and with dignity in their own homes. The conference, held at Crieff Hydro on 2 December 2008, was jointly sponsored by the 3 professional bodies representing community health partnerships, housing and social care, along with the Joint Improvement Team.

Key speakers from throughout the sectors provided opportunities to explore current experiences, future developments and look at how a more integrated approach across the sectors could provide better and more sustainable outcomes.

Common Themes

There were a number of common themes which emerged from the contributions from speakers and the discussions at workshops.

1.  Importance of care at home services

It was clear throughout the conference that there was huge interest in improving care at home services. The number of delegates from across the three sectors, health, housing and social care, alone confirms this. In addition throughout the discussions in the day, speakers and delegates emphasised the importance of the agenda to Scotland. Being cared for at home is the choice of most people receiving services, and of their carers, but the current profile of services has too much emphasis on care in institutions and hospital settings - it is not what people want.

The following are illustrations of the important role played by care at home services:

·  Elliott Davies, who cared for his wife for 7 years before her death. Care at home services provided huge support in the later stages of his wife’s illness from Parkinson’s and enabled her to remain living at home until her last day.

·  The story of Gerry, who had wanted to remain living at home, but was admitted to hospital as an emergency when an intensive package of care for a short period would have helped him through the crisis. The cost of the period in hospital was also higher than the community alternative and crucially it was also not what Gerry wanted.

·  Effie, a service user, whose experiences as a service user had been recorded on DVD and were played to delegates at the morning plenary session.

2.  Status quo not sustainable

Both speakers and delegates stressed that the current profile of services is not sustainable in the face of the projected growth in the number of older people and the economic climate. The need for change is immediate and undeniable. The point was made graphically and in a number of different ways:

·  If the current rate of unplanned admissions of older people continues at the same rate as the population increases, the equivalent of one new district general hospital would need to be built in every year from now until 2021.

·  If the current rate of provision of sheltered and very sheltered housing were maintained, the capital cost alone would absorb nearly all of the current investment programme for social housing.

·  The demand for care staff would be so great that it could only be met if nearly all of the local working age population was employed by the sector.

3.  Frustrations at the slow pace of change

Frustrations were expressed in a number of sessions about the slow pace of change in the overall balance of care and in particular the development of care at home services. This was set in the context that the policy priority to shift the balance of care has been in place for a number of years, and the implications of demographic change have also been known. But in spite of this, the debate and the issues seem to be very similar and key barriers have not been removed. This point was picked up and discussed in the final session of the day, and a commitment made by the professional associations sponsoring the conference to collaborate in giving greater emphasis to this agenda.

4.  Very significant range of policies are already in place – need is for implementation

Linked to the frustrations about the slow pace of change, comments were made at a number of the sessions that policies which worked and achieved change had been developed and tested, but were not being taken forward consistently across the country or at the pace which was needed. Reference in this context was made to:

·  The contribution of telecare and telehealth.

·  The work of the long term conditions collaborative.

·  Benefits of a re-ablement philosophy in home care services.

·  Greater integration of services which provide home care, housing support and community nursing.

5.  Service users and carers need to be in the driving seat

Shona Robison referred in her keynote speech to the need ‘to trust and empower service users and carers more – allowing them to determine the type of support they require and the ways that support can be provided’. Councillor Ronnie McColl referred COSLA’s commitment to encourage ‘the move to provide more care at home, to sustain the autonomy of the client, and to promote choice and empowerment in decision making.’ These views were supported and reinforced throughout the conference in both plenary sessions and workshops, but there were also comments that currently too many policies work against this principle. Policies on personalisation and self directed care were all supported, and the focus on outcomes should lead to listening more to what service users and carers want. The role of UDSET (the User Defined Service Evaluation Tool) was seen as offering a means of capturing service user views and enabling these to influence the shape of services.

6.  Greater integration is essential

The current profile of care at home services was generally seen as too fragmented, making it more difficult to deliver quality services which respond to what service users and carers are looking for. There was specific discussion about the benefits of greater integration of housing support, home care and community nursing. Discussions in other workshops reflected similar views that services need to be willing and able to offer a broader spectrum of services.

7.  Staff providing care at home services are a key resource and need support and development

The level of change required in the profile of services will have significant implications for staff working in the sector. Home care staff in particular have considerable experience and insight, which can inform service re-design, changes to the management of the workforce, creating smaller teams and encouraging the development of a strong team commitment was seen as a way forward. Greater integration and more flexible working will mean that staff will need a wider range of skills, but there will also need to be clarity about what still needs to be done by those with specialist skills. Investment in recruitment, retention, training and development will all be important.

8.  Private and voluntary sectors are not sufficiently engaged

The conference had speakers and delegates from the private and voluntary sectors, but there was a general view that much more collaboration between the sectors is needed. The private and voluntary sectors had a greater degree of flexibility and could, and had, developed new and different service models which were equally relevant to the public sector. They were also able to offer some services at a lower cost. The public sector must recognise their key contribution and be willing to contract from the sector best able to meet requirements and best meet the interests of service users.

9.  Whole system change needed

Piecemeal changes to parts of the system of housing, care and support will not be effective. Speakers and delegates repeated the need for whole system, integrated change. For example:

·  Telecare and telehealth have been shown to have huge potential, but to achieve the greatest benefits other services need to be re-designed so that appropriate call handling and response services are available.

·  Enabling more people to live independently requires growth in housing services, such as adaptations and conversions, and small repairs services at the same time as the existing supply of sheltered housing is reviewed and additional very sheltered/extra care housing is developed.

·  Care at home can appear fragmented and disjointed to service users, separately organised community nursing, home care and housing support services don’t make sense from a client perspective. A single point of contact to co-ordinate all service inputs is rarely available.

10. Leadership and partnership required to achieve change

Delivering the major change to the profile of services and achieving a shift in the balance of care requires clear, strong leadership at both national and local level. Currently it is more comfortable to continue to deliver services in the same way, there does not seem to be enough pressure for services to change, perhaps because decision makers are too distant from the experiences of service users.

In addition the incentive structures do not reward people for making the changes needed or to provide services which people want. For care at home services, the local leadership needs to be provided from health, housing and social care partnerships, who are committed to achieving the outcomes wanted by service users rather than being pre-occupied by defending their own organisational interests.

11. Effective use of existing resources is key - there is enough money in the system

Speakers and delegates referred frequently to the difficult financial context within which the development of care at home services and a shift in the balance of care had to be achieved. It was generally accepted that additional funding was very unlikely in the short term and that changes had to be made within current resources. There was also a commonly expressed view that there could be much more effective use of existing resources, that the current balance of services not only did not represent what people overall wanted, and it was sometimes wasteful. Specific opportunities identified to make better use of resources were:

·  Further development of telecare and telehealth.

·  Understanding better the current use of resources and the key points, at which different decisions might produce better and cheaper outcomes.

·  Providing viable community alternatives that could avoid unplanned hospital admissions achieving better outcomes and at less cost.

·  Shifting from maintenance/reactive services to re-ablement/ rehabilitation focus.

Plenary Sessions

Morning

Lesley Riddoch welcomed everybody to the conference

Shona Robison MSP welcomed the joint sponsorship of the conference. She noted the importance of good quality, coherently organised and reliably delivered care at home services and that these require housing, health and social care professionals and agencies to work together in an integrated way. The Minister noted that the current profile of services in the community care sector was not sustainable in the face of demographic changes and financial pressures and encouraged a new understanding and a greater focus on promoting independence. The Minister emphasised the importance of greater partnership between service users and carers, service providers, and service commissioners with the development of a ‘mutual care’ approach.

Councillor Ronnie McColl stressed the important role he saw for partnerships, in particular Community Health Partnerships, in delivering quality care at home services. He emphasised the need to think hard about the type of care that Scotland can afford to deliver, in the context of a growing number of older people, a diminishing economic base and reduced public expenditure. Cllr McColl also welcomed the Minister’s reference to the future of care at home being embedded in a philosophy of mutuality.

A copy of Shona Robison MSP and Councillor McColl’s speech is available from the JIT website.

http://www.jitscotland.org.uk/news-and-events/into-the-spotlight-series/

The following points were made in discussion after the speeches:

·  Assisting people to remain in their current home by adapting it as necessary should be the first option, but sometimes the home may not be suitable or provide a sufficiently safe environment. It was noted that equipment and adaptations is one of the most pressured of local budgets.

·  The important contribution and potential of telecare and telehealth was recognised and remained a priority for the Scottish Government, but there was equally a need for local partnerships to commit to extending provision.

·  Achieving a shift in the balance of care involves integrated, linked changes in services provided in the community by partners. Budgets and human resources need to be shifted if the change is to be delivered.

·  Better use of the existing housing stock as part of delivering care at home services. Issues such as fuel poverty will need to be addressed. Investment in new social housing and programmes such as Warm Deal have an important role to play.

On the Receiving End: Reflections from a Carer

Elliott Davies was interviewed by Lesley Riddoch about his experiences of care at home services, provided to his wife who had Parkinson’s and died two years ago. Elliott cared for his wife full time for 7 years, and particularly in the later stages of his wife’s illness, she received a wide variety of services. These included home care, community nursing, specialist nursing, chiropody and equipment and adaptations services. As a result his wife was able to stay at home until her final day. Overall their experience of care at home services was very positive, although Elliott would like to see more resources available for specialist nursing and improvements in the local continence service.

Innovation & Integration 1: Delivering joined up care

Speakers: Søren Larson, Director, Adults & Older People’s Services, Ballerup Kommune, Denmark

Gerald Pilkington, National Lead, Care Services Efficiency Delivery Programme, England

Chair: Peter Gabbitas, Director of Health & community Services, Lothian Community Health Partnership

This session focused on the benefits of a re-ablement approach to home care services and considered the benefits and challenges of greater integration of care at home services. It also covered the nature/form of services and heard about different approaches to re-designing home care services, including greater integration, from contributors from Scotland, England and Denmark.