South Tyneside Local Engagement Board – Health Café in partnership with Age Concern Tyneside South (ACTS)

Thursday 8 September 2016, 1-3pm

Living Waters

South Tyneside CCG Local Engagement Board – Health Café – was held in partnership with ACTS. The café took the form of round table discussions between the CCG and ACTS and older people from South Tyneside, with coffee and cake during the break.

Summary of discussions

Musculoskeletal Services, Long Term Conditions and HealthPathways

Why is uptake of groups and activities poor?

  • People have a range of fitness and ability therefore a range of activity is needed; need to assess person and tailor activity or group work to what they can do.
  • May be reticent or frightened to attend as feel it is what they ‘should do’ but don’t feel able to do the things asked of them.
  • What is needed is time to talk and people delivering sessions need to understand the condition.
  • Parkinson’s Disease Exercise Group – set up as Age UK programme difficult to access. There is a single trainer with experience in Parkinson’s disease paid £30 per session to deliver the session at South Tyneside Museum. The trainer also delivers sessions for people with multiple sclerosis. People like the group, as of January 2016 roughly 30 people on the books. There is a link with physios and Parkinson’s nurses. It’s successful as appropriate for the people involved; it’s every week – monthly sessions less successful as people lose momentum; there is no need to go to the branch meeting to feel included; refreshments don’t seem to make a difference – in Sunderland refreshments are provided but not in South Tyneside. People find out about the group by word of mouth, leaflets and possibly via the hospital team.
  • The Alzheimer’s Society also offer group exercises such as bowling, singing for the brain, Thai Chi.
  • It is positive that community and voluntary organisations are involved; particular mention was made of Friends of the Parks, exercise and also nutrition groups at the Park and the Glen and also music/singing/karaoke groups.
  • People recognised the benefits of groups in reducing isolation and depression and saw benefit in sharing experiences, and the need to access what is already available.

Variable experiences of long term conditions; the main issues were in relation to communication between hospitals and also with the patient:

  • ‘Not informed what’s happening’.
  • Things can feel chaotic – don’t always see a consultant.
  • Continuity and improved communication would improve confidence.
  • Assessments don’t always happen – people just get on with things.
  • Appointment cancelled the day before and then the report did not reflect the consultation.
  • Felt necessary to organise private appointment with consultant Cardiologist
  • There is recognition that people are influenced by previous bad experiences.
  • There needs to be improved communication with carers?
  • Patient the priority but carers are important as they know what is happening; need to share info both ways.
  • Examples of good care – ‘treated well in heart unit, care in heart unit excellent’; ‘good physio/falls teams’.

Experiences would be better if:

  • There was better communication with person.
  • There was time to tell about the plan and what to do to help recovery.
  • You were engaged in the treatment – at the moment it feels as though treatment is happening to you.

Important features of care

  • Continuity and confidence.
  • Admin staff can over step the mark, people don’t want to say what is wrong to the receptionist, and people would like an option not to say.
  • Results need to have context.
  • Capacity and demand is an issue – there are not enough doctors so there is a need to rationalise a scarce resource.

MSK services

  • From October 2016 physio, pain specialties and rheumatologyare being brought togetherinto one integrated musculoskeletal service. Connect will be running the service; still running from the Glen, Central and Flagg Court. Physio and pain management under the same service (pain management will be the lower level pain management service not specialist intense or complex). Referral is by a GP and there is also a telephone service for physio - diagnostic advice and call-back.
  • Has Connect been brought in because it's cheaper or won't provide a high level service? On the bidding process we had the most assurance that they can provide the highest quality service, staffing, plans, etc. Services are reviewed, performance reviewed and Connect has to achieve key performance indicators. How does the tender/bidding process take place? The CCG tries to get the best value for money while providing the best service.Will the NHS stop being free with these private providers? There are a variety of providers.
  • We need to learn from the success of South Tyneside Intermediate Assessment and Treatment Service. It's very easy to give someone a prescription and patients can wait for years trying to find the answers. One of the problems is the time that healthcare professionals have to spend with the patient; professionals need the time and space to fully engage and investigate a problem.
  • Like the idea about single point of access/front door for a suite of services for MSK and the opportunity to progress appointments without need to go back to GP.
  • Ten minutes are not enough for an appointment.

HealthPathways

  • HealthPathways a good idea to establish consistency across the patch.

Mental Health

  • The council are removing services; can lead to increased isolation for the elderly- financial pressures.
  • Depression/anxiety risks at time of retirement from work.
  • Less public health awareness raising with mental health than physical conditions

Frailty Strategy (facilitated by ACTS)

Introduction: the NHS national strategy is looking at how to identify older people 65 plus and categorise their level of frailty.

What is frailty and how do we identify it?

Identifying frailty:

  • Definition of frail – not robust, fragile, weak, easily damaged
  • Mental, physical and emotional frailty – can be one or combination of more than one.
  • Self-identifying frailty/vulnerability is difficult for people especially the older population. Conversation with that person will help – what is going well; what’s not; what’s changed; how is it affecting you; what else is it impacting on? Need to find out why they are frail and then come up with a solution. Frail people don’t go to GPs because they don’t see themselves as frail.
  • Frailty is not always physical; it can include isolation, health, mental health, social aspects and anxiety. Long term conditions can cause stress; people can worry about things but don’t recognise the ‘frail’ aspect.
  • People’s perceptions – questioning blue badge holders because someone doesn’t “look ill”; to look at someone they may appear perfectly fine whereas the problem may be hidden.
  • Personal “normality” – small person not necessarily frail.
  • Frailty is a negative word, old and infirm. It’s an old word associated with “little old ladies” but it can happen at all ages.
  • Difference in people’s mind between disability and frailty.

Services:

  • The NHS sees frailty as costing more money because of not identifying early enough and therefore becomes a blue light issue.
  • Holistic care if an emergency happens: sometimes police, fire brigade, ambulance have first contact with isolated and frail people. Services need to look more holistically when dealing with a person? “Every contact counts”.
  • Break up of statutory services that are now competing for funding.
  • Voluntary sector can see someone and know that another service may help but without permission we cannot refer and leave it to the person. Referrals between agencies are important.
  • Services have to hit targets and registers of numbers; targets don’t always reflect the needs of individual.
  • Frailty is about identifying people at risk earlier and incorporating preventative measure. Identifying the problem that’s causing frailty and then working towards fixing it.
  • Once someone is identified – what can we do to improve the person’s life?
  • Hospitals focus on issues at a time whereas a GP can see the whole picture. Is it possible for all health professionals to have some concern for holistic approach?
  • Even emergency admissions can create anxiety and frailty.
  • Communication about treatment and prognosis need to improve.
  • Terminology used by professionals leaves people confused; without an explanation this can lead to anxiety.
  • How to capture people who are making a ‘downward slide’ to get the situation helped before it hits crisis?

Moving on:

  • Involvement in social interventions; cutbacks and physical limitations impact on opportunities to overcome frailty.
  • Change whole outlook – need to stop looking at what I could do to what I can now do.
  • Disability – lifelong but not necessarily frail but frailty may be something that you can overcome.

Services for Older People through the Voluntary & Community Sector (VCS) (facilitated by ACTS)

Session 1 – how do older people access information from health or find out what is available within their local community and which services are missing?

Transport:

  • Key issue about transport/travel and concerns about hospital changes and travelling to Sunderland for appointments etc.
  • Real positives in project that used Age Concern minibuses to transport patients although there are limitations on availability of sessions.

Isolation:

  • Many older people only engage with services linked to their personal experiences, ill health or, often in later life, after a life changing event.
  • Mental health – social isolation is a big problem.
  • Until retirement many don’t think about what to do with their lives which can lead to social isolation and loneliness, therefore services need to consider broadening coverage and sharing information better.
  • Could we have local community champions to act as a point of contact to oversee neighbours?
  • There is a different view of being older now, changing cultures in that older generation are from a different era e.g. they have difficulty using mobile phones etc. Conversation and social fabric is changing.

Funding:

  • Concerns about losing development, skills and expertise due to funding/grants ending with VCS organisations and lack of sustainability

Prevention:

  • Gap in provision/services for older people 65 plus who only access health when they are ill, what about keeping well?
  • How do we improve prevention at an earlier age? Could volunteers contact isolated older people to carry out questionnaires?
  • Working in partnership is better – don’t be precious about clients
  • Branding “older people” can be off putting as many are still fit and active and associated images can give out mixed messages or negativity.

Communication:

  • Communication – there are steps being taken to improve and target those not engaging but more needs to be done.
  • Organisations need to communicate better and overcome barriers to information sharing to offer more holistic services taking into consideration data protection issues.
  • How or to what extent do we use libraries to share information and utilise resources in the best way?

Session 2 – how do older people find out about services delivered by the voluntary sector?

  • Adaptations to houses and caring accommodation are becoming increasingly important to cope with ill health and life changing events.
  • Access to buildings and lifts is very important for those with limited ability.
  • Public transport and access to activity sessions is lacking. Bus routes have changed.
  • Parking at ACTS is an issue – issue linked with Parkinson’s group and their attendance

How do service users know about or how can they access local services?

  • Information was provided through diagnosis of Parkinson’s by nurses and a local charity and Alzheimer’s through personal experience.
  • If people see or experience positive service from a local charity, they are more likely to donate to or support local causes.
  • Volunteering is vital to support delivery of VCS services.
  • The more joined up services are, the better provision will be and where charities are working together.

Session 3 – what are the health issues being experienced by older people and how can we make information on services more accessible?

Health Services:

  • Lack of support from hospital discharge if leaving a hospital in Newcastle or Sunderland but living in South Tyneside.
  • Ambulances take you to the nearest hospital but care in specialist areas is lacking with some confusion about what advice health professionals give to patients.
  • Cost of taxis hospitals use to send people home is a big expense to the NHS.

Communities:

  • Lack of connections with churches and other community activity.
  • Day centres are now reduced and are very limited which has opened up a gap in offering services from a central point within a local community.
  • Older people more hesitant to access community services.
  • South Shields town centre and social scene is changing, younger people aren’t as sociable or willing to chat/socialise, e.g. visiting the market was often a good way to see friends and socialise.

Carers:

  • Carers find it difficult to engage due to caring responsibilities – their life goes on hold.
  • There was a scheme available that supported carers to take a break from their caring responsibilities. This was very useful, something similar would be good to see again.

Information:

  • Lack of information sharing across the VCS sector.
  • Word of mouth is a useful way to signpost within communities but there is no single point of contact.
  • Can information about local services be displayed or made available in the new council facility The Word?
  • More information could be shared through GP surgeries – on display screens and reception areas.

Closing Comments

The chair thanked the audience for attending the meeting and for their contribution to the round table discussions.

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LEB report 8 September 2016