Norfolk Older People’s Strategic Partnership Board
1st December 2010
Anglian Room, Elizabeth House, Breckland District Council, Dereham
Present:
Graeme Duncan / - / Trustee, Age UK Norfolk (in the Chair)Alan MacKim / - / Norfolk Council on Ageing
Mick Sanders / - / Supporting People, Norfolk County Council
Jan Holden / - / Community Services (Cultural Services), Norfolk County Council
Charles Ison / - / Broadland Older People’s Partnership
Joyce Hopwood / - / Norwich Older People’s Forum
Jon Clemo / - / Norfolk Rural Community Council
Chris Humphris / - / NHS Great Yarmouth and Waveney
Carole Williams / - / Norfolk Council on Ageing
Andrew Stevenson / - / Norfolk Registered Social Landlords Alliance
Emily Millington-Smith / - / Norfolk Older People’s Forum
Ann Baker / South Norfolk Older People’s Forum
Ian Southam / - / Great Yarmouth Older People’s Network
Harold Bodmer / - / Community Services, Norfolk County Council
David Harwood / - / Cabinet Member for Adult Social Services, Norfolk County Council
Andrew Marzolini / - / Department for Work and Pensions
Sarah Plume / - / James Paget Hospital
Mat Armitage / - / Voluntary Norfolk
Catherine Underwood / - / NHS Norfolk
Tracy Jessop / - / Environment, Transport & Development, Norfolk County Council
Pauline Goffin / - / Norfolk and Waveney Mental Health Foundation Trust
Hazel Fredericks / - / West Norfolk Older Person’s Forum
Ann Harrod / - / Carers Council
Hilary MacDonald / - / Age UK, Norfolk
Also in attendance:
Annie Moseley / - / Supporting the Norfolk Older People’s Strategic Board, Age UK, NorfolkPaul Anthony / - / Corporate Support Manager, Norfolk County Council
Apologies:
Apologies for absence were received from Mary Granville-White, Sam Sirdar, Kathy Chapman, Louise Cornell, Carol Congreve, Pat Wilson, Margaret Craske, Duncan Hall and Mark Taylor
Observers:
Sally Hoare, Broadland District Council
Fiona Poland, School of Allied Health Professionals, University of East Anglia
Pauline Weinstein, Future East
1 /Minutes
The minutes of the meeting held on 1 September 2010 were agreed, subject to amending bullet point 7 on page 3 to read “NHS Norfolk had contributed £150,000 to the Swifts and Night Owls Service”.
2 /Matters Arising
(i) / Preventative ServicesThe recommendations on preventative services had been referred to the commissioning agencies for a response.
(ii) / Election of Chair and Vice-Chair
Nomination forms for the election of Chair and Vice-Chair would be circulated shortly, and should be returned to Paul Anthony at County Hall by 11th February.
Candidates will be asked to provide a short election address.
At this point, Joyce Hopwood took over as Chair for the remainder of the meeting as Graeme Duncan was presenting the report in social isolation.
3 / Having a Social Life and Reducing Isolation
Graeme Duncan presented the report of the working group on having a social life and reducing isolation. He highlighted in particular:
· There was evidence of widespread loneliness amongst older people although it was difficult to quantify the scale.
· In some circumstances, ordinary social intervention could resolve the problem.
· Loneliness/isolation can be linked to anxiety and mental illness.
· Many supporting arrangements were in place to help overcome loneliness/isolation, but these were likely to face future funding problems.
During discussion, the following points were raised:
· Mick Sanders outlined the proposals to promote outreach support for older people living around sheltered housing schemes.
· Harold Bodmer said that the report would help to identify priorities in commissioning preventative services and in shaping the County Council’s priorities within a reduced budget.
· Jon Clemo explained that ‘Village Agents’ schemes involved paid individuals who live in areas identified as having high deprivation and low social capital to give advice/information/assistance to help overcome rural isolation and link people into community resources. On the other hand, ‘Good Neighbour’ schemes were entirely voluntary in providing an informal support network in the community. He pointed out that increasing numbers of older people were retiring to Norfolk thereby adding to the overall scale of the problem.
· Harold referred to the future shape of primary care services in the context of the proposed structural changes to the NHS. He envisaged groups of professionals and volunteers working together to provide a flexible system of support across organisation boundaries, which would be tailored to the needs of individual communities.
· That the limited transport in rural areas was making it difficult for people to access services, thus adding to the problem of social isolation.
· A permutation of schemes was needed that would provide different solutions for different areas, and we must think locally to commission and deliver the right solutions.
· Tracy Jessop commented that transport was often presented as a barrier in Norfolk, but it could also be an enabler and was an important part of the ultimate solution. It was about identifying demands and looking for and planning the most cost effective means of providing the service.
After further discussion, it was resolved that:
(i) / Norfolk County Council should commission a “village agents service” in ten villages identified as having high deprivation or high proportions of older residents with poor access to services and agreed by their Parish Councils to have a need, identify and signpost people needing support, and encourage them to take an active part in volunteering. (This service should cover all age groups).
The Board asked that this should incorporate a mix of different communities, both rural and urban, across the county. Such schemes would need to be flexible, and tailored towards the needs of individual localities. It was also suggested that it be renamed “Community Agents Service”.
(ii) / Norfolk County Council should commission a county-wide Good Neighbourhood Scheme to support community self-help. These services should link strongly with existing public and voluntary sector support, and should ideally form part of an integrated approach with Village Agents.
(iii) / Norfolk County Council should ensure that all libraries across the county are accessible so that older people can participate in activities which reduce social isolation.
(iv) / The’Surf-Up’ programme in libraries should be continued and expanded as this service supports older people to use the internet and thus reduces social isolation.
(v) / Norfolk County Council should review befriending services including evidence of effectiveness, to ensure quality services are commissioned.
(vi) / Partner agencies should promote the ‘Active Together’ Teleclub managed by Age UK Norfolk which provides (1) telephone befriending, (2) time-limited, outcome-focused home visits and (3) volunteer support to link people into social activities. (In September 2010 they had an average of 780 contacts per month, and 111 service users supported by 65 volunteers).
(vii) / Partner agencies should develop and promote a wide range of social opportunities, which are attractive to older people and which they can arrange themselves, or through the support of a mentor/link worker.
(vii) / Commissioners and providers of sheltered housing should endeavour to promote social contact for residents through the projects providing outreach support.
Graeme Duncan retired unwell just before item 4, and asked Joyce Hopwood to continue to chair the meeting. He gave a shortened account of his views before his actual departure.
4 / Support for Older People in Norfolk: Norfolk County Council Budget Savings Proposals and other Critical Issues
To allow more time to continue the discussion on the budget savings proposals after the formal meeting had ended, it was noted that the informal lunchtime discussion on evaluating preventative services would not take place.
Graeme made the following general observations:
· A number of the proposals would undermine people’s expectations of what services the County Council could continue to provide in the years ahead.
· Could the personal budgets for those people who were eligible for social care services be used to help ease some of the shortfall?
· Extra resources were being made available by the government so that authorities do not have to raise their eligibility criteria.
· He expected Adult Social Services and other agencies to involve the partnership in developing the new models of care.
Harold Bodmer (Director of Adult Social Services) presented the Norfolk County Council (NCC) budget proposals:
· He explained that the aim was to develop an integrated commissioning system for health and social care in Norfolk.
· That NCC wanted to invest in prevention and to support local communities.
· That the proposals were based on assumptions about the future level of grant support and demographic trends in the county.
· That the consultation was a genuine exercise, and that NCC wanted to receive people’s views on reshaping services, and how to determine priorities for the years ahead.
· Harold outlined the proposal to remove the subsidy from community meals and to reshape the service to meet changing circumstances. He explained that it was proposed to provide information about accredited suppliers to help individuals make their own arrangements to have meals delivered to their homes.
· He advised the Board that the proposals were partly about reshaping services and partly about budget reductions. He emphasised that the County Council had to prioritise services to help support people and promote independence within available resources.
Catherine Underwood, Assistant Director of Commissioning, Community Health and Care, NHS Norfolk and NCC Community Services, gave a power point presentation on the Norfolk Health System QIPP Plan (quality, improvement, productivity and prevention) to inform the Board about current developments in the Health Service running alongside the NCC budget proposals. The QIPP aims to ensure that the right care is provided in the right place at the right time – at the right cost.
(The Norfolk Health System is made up of the health commissioners and providers in the county, including the 92 GP practices which are currently in 8 commissioning groups.)
Catherine explained that there were three key workstreams:
(i) / Frail Elderly Central Norfolk Focus – redesigning the pathway for the frail and elderly and those at the end of life (£23M).
(ii) / Frail Elderly West Norfolk Focus – redesign of emergency pathways based on the Queen Elizabeth Hospital (£8M).
(iii) / Referral Management and Pathway Development (£50M).
Hilary MacDonald, Chief Executive, Age UK Norfolk, raised the following points:
· That she would be seeking a commitment from NCC about the ringfencing of additional Government money for adult social care.
· That NCC should retain the current service eligibility criteria and meet their statutory obligations to older people in full.
· That any redesign of services must ensure that the changes would not be detrimental to the end user.
· That, if implemented in full, the Big Conversation proposals would hugely impact on the lives of older people generally, and must not be allowed to impact on the most vulnerable.
Hilary raised four questions:
· What assurances could NCC give that the additional resources allocated by the Government for adult social care would be committed for that purpose?
· Would the additional funding impact on the budget proposals?
· Was Adult Social Services bearing a disproportionate share of the overall budget reductions?
· Rather than reducing services, why did NCC not consider alternative means of reducing costs/raising revenue, such as increasing council tax or saving on back office functions/outsourcing?
In reply, David Harwood reported that the Leader had given an assurance at a full Council meeting that the extra Government money would all be allocated for the purpose intended, and he fully endorsed this commitment.
Harold pointed out that some 40.58% (£235M) of the total NCC budget was allocated to Adult Social Services and that is why the department appeared to be taking a large share of the reductions. He also assured the Board that NCC was looking at all measures to increase efficiency in order to protect frontline services; and he explained that council tax would only be increased if absolutely necessary, because to do so would have a detrimental affect on the many older /vulnerable people in Norfolk who are living on fixed incomes.
Jon Clemo commented on the proposals on behalf of the Rural Community Council:
· Whilst the RCC recognised the need to make savings, they must not disproportionately affect rural areas.
· The current situation would also provide an opportunity to reshape/redesign services to better suit rural communities.
· That recognition was needed that there are limitations on what can be achieved with volunteers.
· That a considerable amount of change was being proposed over a short period and, therefore, the complexity and volume was difficult to comprehend.
· That there was a strong tradition of self-reliance in rural areas, but it was important to realise the limitations of this approach.
During a general discussion, the following points were raised:
· That the proposals represented the start of a new era for social care in Norfolk and that, if implemented in full, would have a significant impact on older/disabled residents, their carers and families.
· That there were instances of people in substantial (if not critical) need who are unable to access social care even before the budget proposals are implemented.
· Harold explained that if the care budget had been reduced further in these proposals, the County Council would have had difficulty in meeting their statutory obligations to the most vulnerable, and for this reason a significant amount of savings had to be identified from non-statutory services such as preventative services.
· David pointed out that the aim was to have locality budgets with discretion to use the resources to meet the needs of older people in those communities.
· A number of comments were made about the lack of rural transport and, for example, the problems facing many older people in attending GP appointments. However, Tracy Jessop reported that there were examples of good practice in the county linking GP practices with dial-a-ride schemes and of helping people access services generally
· Catherine Underwood undertook to pick up the issue of public transport linking to GP appointment times with the team currently working on primary care.
· Tracy Jessop, Head of Passenger Transport, NCC, pointed out that, unlike many other authorities, NCC was proposing to continue to support community transport, even though there was no statutory requirement to do so. She also explained why the park and ride buses were not permitted to pick up passengers along their routes in and out of Norwich.