AGENDA ITEM NO. 5
REPORT TO: Executive Board
REPORT NO: CSCO/28/08
DATE: 18 November 2008
LEAD MEMBER: Councillor Joan Lowe, Social Care and Health
LEAD OFFICER: Chief Social Care Officer
CONTACT OFFICER: Maria Phillipps (Tel: 298610)
SUBJECT: Update on the progress of the Community Meals Strategy
WARD: All Wards
1. PURPOSE OF THE REPORT
Provision of an update to Executive Board on progress regarding the re-provision of the Meals on Wheels service.
2. EXECUTIVE SUMMARY
2.1 In July 2008, Executive Board approved in principle the re-provision of the Meals on Wheels service, through:
§ independent hot, chilled and frozen food providers, with or without support required by the individuals
· the provision of re-ablement support for those who are able to regain or develop skills to prepare their own meals.
· a range of luncheon club providers.
2.2 In addition, Executive Board requested that a further report be submitted for the Board’s consideration on the resources available to provide alternative provision for recipients of the Meals on Wheels Service and on the planned use of luncheon club facilities.
2.3 All 52 individuals needs have been re-assessed and their services re-provided. No complaints have been received as a result of this change and evidence from an earlier free trial of frozen foods services, showed an increase in satisfaction with regards to choice, quality and cost effectiveness of meals and flexibility of meal times. The exercise showed that a number of individuals were choosing to access the services, however did not have a need for it.
The re-provision of the Meals on Wheels service for 52 people will produce approximate efficiency gains of £49.5k per annum, to be reinvested in Older People's/ Community Meals services.
3. RECOMMENDATIONS
3.1 That Executive Board endorses the progress made on the Community Meals Strategy.
3.2 REASONS FOR RECOMMENDATIONS
The Community Meals Strategy aims to:
i) Achieve better outcomes for service users – equity of service provision, consistent high quality meals provision, increased flexibility and choice.
ii) Increase and improve the range of delivered meals and lunch club provision within the County.
iii) Ensure services are commissioned/ provided in the most efficient and effective way both for members of the public, ('service users') and the Council
Andrew Figiel
Chief Social Care Officer
4. BACKGROUND INFORMATION
4.1 In the initial report to Executive Board there were 64 recipients of the service. During the transition phase to 31st October, 52 people were either in receipt of meals or were on a suspended list due to transitionary care arrangements (e.g. being in hospital).
The Department have engaged with each of these individuals, reviewing their needs and providing information on the change of services, the reason for the changes and providing individuals with a list of the available services. Each individual has received support to assess the best range of provision to meet their individual circumstances.
4.2 Scrutiny Committee have been provided with a detailed breakdown of the changes in services for the 52 individuals affected by this change in policy; summarised as follows:
· Twenty eight individuals transferred to receiving some frozen meals
· Two individuals required residential care upon review of their needs
· Four individuals either didn't meet the eligibility criteria or have self funded arrangements with local domiciliary provider / local café.
· Seven individuals did not require an alternative service.
· Three individuals now receive more day services.
· Only one individual with dementia has been involved in this change of service and was already in receipt of 5 days day services per week.
· Four individuals were not receiving the service as are in hospital (and are likely to be discharged to a care home or sheltered housing).
· Seventeen individuals required a total of 29 additional hours of domiciliary care per week, to meet any additional nutritional needs, at a projected total cost of £25,537 p.a:
· Of which, 5 people receive a total of 10.5 hours per week from the Homecare, in-house service, at an approximate cost of £217.35 per week or £11,302 p.a.
· 12 individuals received a total of 18.5 hours per week from the independent sector at an approximate gross cost of £273.75 per week or £14,235 p.a.
4.3 Service Developments
A range of small projects are in progress to ensure that individuals' nutritional and social needs are met within their natural communities, including:
Community Meals Brochure
A brochure has been drafted, incorporating new delivered meals suppliers and the Luncheon Clubs known to the Department/ AVOW. This also provides health and well-being advice and useful contact details. Work is ongoing to ensure that the list is updated and maintained. The list is available in English & Welsh printed format and will be on the Council website.
Lunchclub developments
There have been a number of expressions of interest from Elected Members, Community Groups and private individuals, for support in identifying demand and/or setting up new luncheon Clubs. Officers from the Council and AVOW have provided support and signposting, however it has become apparent that small organisations often need access to set-up funds, for equipment, initial room hire, training of volunteers in food safety issues etc.
In order to support the Department's target for supporting the development of 3 new Luncheon Clubs within Wrexham in 2009, it will offer small grants (from a total pot of up to £20k) to organisations wishing to establish new or increased provision of existing clubs, where demand is known. The grant application process will be advertised through a range of media.
The Lunch Club Forum, establish by the Department a number of years ago has lapsed and it is proposed that the Forum is re-established to support Lunchclub co-ordinators.
Opportunities for collaboration with other Local Authorities
An initial meeting has been held with Flintshire Local Authority, to discuss.
Development in 2009/10 and beyond
An options appraisal and action plan will be carried out by Quarter 2 2009/10, following the outcome of the small development grant initiative, to consider how any available savings would best be utilised, whether in offering grants or in commissioning an organisation to provide support to developing clubs.
This will consider whether the Council and its partners are able to provide the practical support required by potential Lunch club co-ordinators from within existing resources (including Over Fifties Forum, Community Dietician, Food Safety Service, School Catering Services, Community Development Projects, Planning Officer for the Strategy for Older People and Social Care Commissioning Officer)
5. CONSULTATION
5.1 A Community Meals Steering Group was established in 2005 and consists of a range of stakeholders, including the representation from the Over 50’s Forum, Community Dietician, Older People’s Strategy Development Officer, Environmental Health Officer, Caia Park Partnership, the Departments Contract Officer and Homecare Manager. The steering group has overseen the progress of the Community Meals strategy and have supported the recommendations.
6. SCRUTINY COMMITTEE COMMENTS
6.1 On 11th June 2008, Scrutiny Committee supported the option to transfer of the current recipients of Meals on Wheels to alternative provision (with support as individually required) within the short term provided that safeguards were put in place to ensure that each service user be provided with a review of their care package and assistance with the transfer.
6.2 Scrutiny Committee received a progress update on this objective on 12th November 2008. (Due to the timings of each meeting, a verbal update will be given on Scrutiny Committee's comments).
7 IMPLICATIONS
7.1 Policy Framework
The aims of the Community Meals Strategy are consistent with the following policies and strategies:
Corporate Priority: Providing support to Older People to remain independent.
The recommendations herein aim to provide the best quality of service and value for money for Older People and enable the development of new services aimed at health prevention for those who do not yet meet the Department’s eligibility (access) criteria.
Health, Social Care and Well-being Strategy: Key areas for action include,
· Ensure the home environment is suitable to enable people to remain their own homes
· Develop support systems for people who have low and moderate levels of care needs in order to sustain their levels of independence and activity.
The Strategy for Older People (2003), promotes the provision of quality services and support that enables older people to live as independently as possible and ensure services are organised around, and responsive to their needs.
The Food and Nutrition Strategy for Wales produced by the Food Standards Agency and the Welsh Assembly Government recommends a wide range of actions for vulnerable groups - these proposals are consistent with this.
7.2 Budget
Cost of Meals on Wheels provision
The budget for delivery of the Meals of Wheels service for 2008/09 is £79,592, which includes £25k for purchasing meals from the NHS, Homecare delivery hours and mileage costs. The budgeted income for the service is £4,480.
The net cost to the Local Authority, therefore, being £75k
Costs of re-provision
One-off costs
A one-off amount of £673 has been spent on purchasing freezers and microwaves for the small number of individuals requiring them and wishing to utilise delivered frozen meals options. Future requests for equipment to support meals, can be directed to the Social Fund or funded by Community Care budgets in individual cases.
Ongoing costs
There is an estimated £25.5k gross cost, per annum, of providing alternative domiciliary care services to support with meals.
Net impact on budget
An estimated £49.5k annual efficiency gain will be produced by this change in service. Further detailed analysis will be required to identify the exact cashable savings from this project and to prioritise how the available budget will be re-invested into an improved range of community meals options.
7.3 Legal
There is no legal obligation to provide Meals on Wheels, although Local Authorities have a duty to ensure that those people assessed as needing meals assistance receive it (1948 National Assistance Act). Additionally there are currently no food standards Local Authorities are legally obliged to follow, although the Advisory Body of Social Services Caterers has set national standards for the supply of meals. Whilst the English Care Inspectorate CSCI (Commission for Social Care Inspection) has adopted these standards, the Welsh Inspectorate, CSSIW (Care & Social Services Inspectorate for Wales), to date have not.
7.3 Equalities/Diversity
Consideration has been given with regards to an Equalities Impact Assessment throughout the process of updating and implementing the Community Meals Strategy.
In summary, the assessed impact on service users is moderate in the short term and thought to be negligible in the medium term as those meeting eligibility criteria will receive ongoing monitoring via other additional services (e.g. homecare and/or day care). The proposed change to having a monitored list of a range of meals suppliers is felt to provide a wider ranger of choice for service users on specialist or ethnic diets. This has been discussed with the corporate Equalities Manager who has advised that a full equalities impact assessment is not required.
8. EVALUATION OF OPTIONS
A summary of the Options Appraisal was provided in the previous report (CSCO/22/08)
BACKGROUND PAPERS / LOCATION / WEBSITE INFO.‘ Options appraisal for the future of Meals on Wheels service’
Executive Board Report - 15/07/08
(CSCO/22/08) / Intranet / None
‘ Options appraisal for the future of Meals on Wheels service’
Social Affairs, Health and Housing Scrutiny Committee Report - 11/06/08
(CSCO/18/08s) / Intranet / None
‘Community Meals Strategy ‘
Social Affairs, Health and Housing Scrutiny Committee Report – 13/04/05
(CSSO/15/05S) / Intranet