Poole Adult Social Care
A vibrant Poole of healthy, safe,
informed and independent people.
Looking back at Adult Social Care‟s achievements,
challenges and learning in 2010/11
Review of Performance
Contents
Contents...... 2
1. Foreword ...... 2
2. Summary by Jan Thurgood, Strategic Director ...... 2
3. So how did we do in 2010/11? ...... 5
4. Taking this forward in 2011/12 ...... 19
1.
Foreword
Adult Social Care exists to help Poole‟s service users, carers and families to identify
and meet their care needs and ambitions, maintain their well-being, remain or become
more independent in their own homes, help vulnerable adults stay safe from harm or
abuse and contribute to services for parents in order to ensure children have the best
possible start in life.
Increasingly this work is carried out in
partnership with Health colleagues,
voluntary, community or faith groups, the
private sector or with other parts of the
Council.Our other vital and valued
partners are service users and carers.
In 2010/11, our services were delivered
against a Government framework based
on seven outcomes which were used by
our governing body, the Care Quality
Commission (CQC) to assess whether the
services we provided were working well
for the people of Poole.
This document is a summary of some of
our challenges and achievements in
2010/11. It can be read as a standalone
review of the year but is best read in
conjunction with our current Business Plan
which describes how we will be taking
forward some ofachievements and
learning and our other plans for
improvements in 2011/12.
We hope you find both documents useful
and informative.
2.
Summary by Jan Thurgood, Strategic Director
Achievements and Challenges in 2010/11
2010/11 was a period of unique change both nationally and locally for all
of us in Adult Social Care. It is a testament to the professionalism of all
our employees and our partners, including our clients and carers, that
through this period we continued to deliver good outcomes and services
for Poole residents and achieved some significant improvements in a
wide range of areas.
We also tackled a small number of key challenges where we needed to
improve performance and had some difficult decisions to make about
priorities, given the Council‟s need to make significant savings as Government
funding for the Council and other public sector organisations was reduced.
The following sets out our key areas of improvement:
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Sustained improvement in the management
and practice of adult safeguarding and
recognition of those significant improvements in
the Care Quality Commission‟s judgement of
Poole Adult Social Care announced in
November 2010.
Further development of services and support
for carers with an increase in the percentage of
carers who received assessments and services
and the introduction of an Emergency Card
giving carers reassurance that they and their
cared-for person would be supported in an
emergency.
Increased choice and control with the full
introduction of new Supported Assessment
processes and Personal Budgets to help
people identify and meet their needs and
aspirations. There was an increase in the
numbers of people using direct payments and
personal budgets and a new advocacy service
ensured that all service user groups had access
to advocacy.
The Moving from Hospital Programme for
Poole was completed in May 2011. The
programme has enabled 29 Poole residents
with a learning disability to move from a hospital
setting to a home of their own in the community
giving them more choice and independence.
The percentage of residential and nursing
care commissioned from good and
excellent providers rose from 83% in 2009/10
to 92% in 2010/11. NHS Bournemouth and
Poole and Adult Social Care worked closely
with homes to support them to reduce
infection rates and improve end of life care.
Health, the voluntary sector and adult social
care developed new and more effective ways of
supporting people who have dementia in the
Westbourne/Lilliput area. This work will inform
the development of services for people with
dementia across the Borough.
A new Extra Care facility was opened in the
town centre with 45 flats available to support
people with a wide range of needs (including
highly complex needs) to live in their own home
with access to 24 hour care and support.
The Gateway mental health service cont-
inued to provide open access to mental health
assessments and Brief Intervention Therapy for
people with common mental health problems.
Over 5000 people were seen in the year.
Drug and Alcohol Services continued to
develop and to deliver good outcomes with an
increase in the number of people in treatment
due to alcohol misuse.
The Social Services Helpdesk continued to
provide good quality advice to Poole residents
as was recognised in a national survey
published by the Care Quality Commission in
early 2011. Information was enhanced by the
introduction of the “source” website which
provides comprehensive information on
servicesacrossPoole,Dorsetand
Bournemouth.
We continued to place listening and acting on
the views of people who use services and their
carers at the centre of all aspects of our work.
This included involvement in training and
recruitment of staff; in planning and prioritising
services and in making decisions on contracts
and in monitoring services. A new Service
User and Carer Framework was developed
with service users and carers.
The Learning and Development team have
continued to deliver high quality training, at the
same time as making substantial savings. E-
learning is an important emerging element of
the learning and development strategy.
Directly provided care services continue to
innovate and provide high quality. The COAST
Team delivered good employment outcomes
for people with a learning disability, in
partnership with other local organisations. A
recent audit of Poole Day Centre showed very
high levels of satisfaction amongst the people
who use the service and the housing support
provision for people with a learning
disability at Ashmore House has now been
re-modelled in partnership with East Boro
Housing Association.
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What about the challenges?
Nationally, the issues of budget deficit reduction
led the Coalition Government to announce
significant reductions in the funding for all
Councils over a three year period. Poole‟s
Council made decisions in October 2010 to
raise the eligibility threshold for adult social
care from moderate to substantial and critical.
The Council also introduced the national
guidance on Fairer Contributions which saw
18% of people pay more towards their care
although 11% now pay less. We worked hard
to involve service users and carers in the
development of the above policies and changes
were made to both policies as a result of
consultation.In addition, we sought to
introduce the changes in a way which is open
and fair and to support people who have
ceased to be eligible for services. We are
committed to working with Poole LINks and
other user-led organisations to review the
impact of the changes and the way in which
they were implemented in an open manner
during 2011.
The reduction in Government funding for
Adult Social Care was compounded by a
number of local factors such as Poole‟s
increasingly ageing population, market
pressures and a budgeted commitment to
delivering savings and efficiencies. In
addition, during the course of the year,
further significant cost pressures presented
themselves. Prompt action, some difficult
decisions and considerable effort meant that
savings and efficiencies totalling £2.122M
were delivered with a modest overspend
of 1.4% of the total net budget. This was
managed within the Council‟s total available
resource at year end.
Benchmarking shows that Poole Adult Social
Care offers comparably good value for
money, performing well among SW Councils
in terms of helping people maintain
independence and live in their own homes.
Improving the quality of care at home
services we commissioned was a priority as
the percentage of care commissioned from
good and excellent providers was well below
the national average. By the year end, new
contracts had been tendered and the nine
successful providers, which all have a track
record of excellent and good quality, will in
2011/12 be delivering new locality-based
services.
Throughout 2010/11, a key concern for the local
health and social care community has been to
ensure that people do not go into hospital if
this can safely be avoided and to reduce the
number of people who are delayed in
hospital once they are medically fit to leave.
We worked closely with health colleagues to
understand the reasons behind a high number
of delays and as a result, commissioned new
residential beds. By the end of March 2011
delays had reduced, but further improvement is
still required. Improving community health and
social care services and further reducing
delayed hospital discharges are a priority of the
2011/12 Business Plan for both health and
social care.
Much work was undertaken to improve how
Adult Social Care does its business. A priority
was to ensure all staff fully understand and
implementpoliciesandtheirown
responsibilities in relation to the protection of
confidential data and information. This will
continue in 2011/12.
We have also learnt during 2010/11 from
external examination of cases through an Adult
Safeguarding Board Serious Case Review,
Ombudsman findings and through our own
complaint investigations. We will implement
actions to improve services based on findings
and recommendations from these cases.
I would like to thank everyone involved in
Adult Social Care for their commitment and
skill in delivering and improving outcomes for
local people in 2010/11 and look forward to
working with employees, partners, service
users and carers in delivering the priorities
set out in the 2011/12 Business Plan.
Jan Thurgood, Strategic Director Adult Social Care
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3. So how did we do in 2010/11?
In the Review of Performance for 2009/10, we listed a number of priorities and areas for
improvement that we particularly wanted to address in 2010/11. These issues were clustered
under seven outcomes used at the time by the Care Quality Commission (CQC), to assess
whether our services were working well for the people of Poole. These seven outcomes form
the main headings below.
1)
We said we would improve Poole people‟s health and well-being.
We wanted to improve re-ablement services so that people could regain skills, confidence
and independence to maintain independent living. We also planned to reduce health
inequalities and improve dementia services. In addition, we knew that moving people with
a severe learning disability from a hospital setting into the community would significantly
improve their well being and were also committed to improving end of life care.
We knew that investing in Reablement
Services would help keep people out of
hospital and independent in their own homes
for longer, thereby improving their health and
well-being so we worked closely with the
Primary Care Trust to develop a Poole and
Bournemouth model which is being rolled out
in 2011/12.
Over the course of the year, Poole‟s
Intermediate Care Service continued to
support people at home for short periods of
time to reduce the need for hospital
admissions.This service received 50
compliments this year (21% of all
compliments received by Adult Social Care).
An emergency (or unplanned) admission to
hospital may be the right course of action for
a person with a serious/life threatening
conditionrequiringurgentspecialist
investigation or treatment in hospital.
However, an admission to hospital can be
followed by complications such as loss of
confidence which might compromise a
person‟s independence and their ability to
return home quickly so it is important to
prevent avoidable emergency admissions
where possible and to reduce the number
of emergency bed days once an admission
has taken place. Good co-ordination of
health and social care support meant that at
the end of December 2010 Poole were
performing well, exceeding the target and
improving on what has been good
performance in comparison to the national
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picture for a number of years.
“
When I first assessed Mrs X just
after Christmas, she had been in
bed for approximately a month. She
was not eating or drinking properly, not
managing her medication and not
getting dressed at all. Mrs X was very
un-motivated and very down and
tearful. It was apparent that she
required some support daily to help
get her back on her feet as previous
to this she had been very
independent and managing. I
implemented Rehab Homecare to
provide encouragement and support
to help Mrs X get back to
independence. After Rehab Homecare
had been attending for 5 weeks, I
reviewed her to see how the care had
been going. I visited her and she was
up, washed, dressed and walking
around the flat like a new woman. Her
son advised how it had really benefit-
ted her and given her a new lease of
life. She does not require any ongoing
support, and in this case Rehab has
really improved this client’s wellbeing
and brought her back to independence.
Given the good performance on avoiding
emergency admissions, one of our biggest
challenges in 2010/11 was to reduce the
number of patients whose discharge from
”
hospital was delayed. Delays occur for a
number of reasons including difficulties in
sourcing residential, nursing and domiciliary
care. We continued to implement steps to
actively address these challenges including
using respite beds in residential homes;
ensuring social care staff stayed in contact
with clients when they were admitted to
hospital; mapping delays to understand
reasons and make changes as well as
increasing the rehabilitation home care
contract by 90 hours per week. We know
there are various factors that increase the
length of a delay that we may be able to
avoid, such as staff not assessing at the
point of admission. We will continue to
reduce the level of delays from hospital in
2011/12.
Poole‟s Intermediate Care Service has the
dual function of improving a patient‟s
experience by either assisting them to
remain at home in situations that might
previously have led to a hospital admission
or by enabling a supported transfer back
to the patient‟s home or community
following their stay in hospital. One of our
measures of Intermediate Care is the
number of people who are still at home 91
days following their discharge from hospital.
In 2010/11, 77% of patients discharged
home with an intermediate care package
were still at home 91 days later which is 3%
below our target for 2010/11. We will be
seeking to improve this service further in
2011/12.
Most people say that, wherever possible,
they want to live independently in their own
homes (with support from a carer, social care
etc if required) rather than being admitted to
permanent residential care; evidence
shows that people are healthier both
physically and mentally if they can remain
independent so one of our key aims is to
ensure this is happening wherever possible.
As a result of dedicated care work and
careful monitoring to ensure best outcomes
for individuals as well as good value for
money, we reduced the number of adults
admitted permanently to residential/
nursing care (only 0.85 adults per 10,000.
were admitted, a significant improvement on
last year‟s performance of 1.7). In terms of
older people, performance was not quite as
good as we had hoped with 213 older people
being admitted rather than the 203 we had
predicted based on local demographics.
There was an increase in the number of
older people who were previously self-
funding or receiving services under
Continuing Health Care, whose change in
circumstances meant they required Adult
Social Care commissioned services.
Health Inequalities affect both localities
and individuals. To address this we
established integrated health and social
care teams aligned to GP surgeries teams
who will use demographic information to
understand local issues with staff trained to
respond to these needs.
We also worked in partnership with NHS
Bournemouth and Poole (the Primary Care
Trust) to improve use of yellow Health
Books to support adults with a learning
disability when they needed to go into
hospital.
Together with Health and the voluntary
sector we developed new and more effective
ways of supporting people with dementia
in the Westbourne area which will inform the
development of services across the Borough.
We prevented 348 hospital admissions
through the new care service for people with
dementia and memory loss.
Working with the Primary Care Trust and
Bournemouth Borough Council, we established
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a Joint Commissioning Dementia Board to
oversee roll out of a number of pieces of work
resulting from the national Dementia
Strategy. We know from our Dementia
Needs Analysis that we will require 433
additional beds in care homes by 2025.
352 of these bed spaces already have
planning permission and 61 are currently
under construction leaving only 20 still to
agree. In addition, we worked with Health
partners to establish a team of Nurses to
provide direct support to Dementia Homes
across east Dorset. We also provided a