Minutes:
Gary Collier - Health & Social Care Integration Manager, provided a witness report as part of the Committee's review into Loneliness and Isolation amongst older residents. Mr Collier was supported by Nina Durnford - Assistant Director, Older People & Physical Disabilities , Kevin Byrne - Head of Health Integration and Voluntary Sector Partnerships, Julian Lloyd - CEO Age UK Hillingdon, Steve Curry - Hillingdon 4 All (H4All), and Dr Anil Raj - General Practitioner.
The Committee was advised of the strategic context of the review, which included the Health and Wellbeing Strategy and the Better Care Fund (BCF). The Chairman confirmed that the BCF plan would come to the Committee's November meeting as an information item.
The Health and Wellbeing Strategy 2018/21 was also to be brought to the Health and Wellbeing Board in September, and once approved, would be put into effect. The Strategy will implement the Hillingdon aspect of the North West London Sustainability and Transformation Plan and has three key aims:
1. Improving health & wellbeing;
2. Improving care & quality; and
3. Improving productivity & closing the financial gap.
Reducing social isolation was listed as one of the priorities within the Strategy. Hillingdon's Better Care Fund Plan (BCF), which is a government scheme intended to deliver better health and care outcomes for residents through integration between health and social care, includes actions that will contribute to meeting this priority. The 2017/19 BCF plan includes six schemes but scheme 1, entitled 'Early intervention and prevention', includes actions that are relevant to the Committee's review and these include:
· Improving access to information and advice to enable residents to help themselves;
· Risk stratification to identify people at risk of escalated needs earlier;
· Developing the third sector preventative role; and
· Keeping older people physically active, therefore supporting both physical and mental wellbeing
Early intervention was felt to be key to reducing instances or mitigating the effects of social isolation, and work was ongoing about how best to ensure residents were able to find the services available to them. It was likely that partnership working with the voluntary sector would be important. More specific details around services, particularly physical activities, were due to be heard at the Committee meeting scheduled for 2 October.
The role of adult social care in identifying social isolation, and the process for residents to access care and support, was outlined. The Committee was informed that social care assessments included a review of the resident's needs, their family circumstances, what pastimes they enjoyed, and activities that interested them. Care plans for people with eligible social care needs could include referrals to partners such as Age UK or other community based organisations and support to access locally run activities. Personal budgets for people with eligible social care needs can be used creatively to support with external trips, such as fishing or the cinema, depending on their needs and preferences There is also the opportunity to refer older residents to services provided by Age UK Hillingdon, such their befriending services, and also to other locally run activities.
In order to support the safety of older residents, the Committee was also informed that the Council provided free access to the Telecareline for residents aged 80+. This service is also available to people aged under 80 for a weekly charge.
The Committee was informed about the Leader's Initiative. This has been established by the Leader of the Council in his capacity as Hillingdon's Older People's Champion. It is intended to address practical issues identified by older residents that will help to improve their quality of life.
Projects run through the Leader's Initiative had included free installation of burglar alarms for older residents, as well as various group activities. This year, activities had included the Barnhill Community summer trip and the Bell Farm Christian Centre coach trip. Additionally, smaller activities such as fish and chip suppers were run to help residents come together and socialise. The cost of such activities was less than £1,000per activity.
Dr Anil Raj of St Martin's Medical Centre advised the Committee from the perspective of a General Practitioner. Dr Raj confirmed that he had been a General Practitioner for approximately 5 years, and in those 5 years he had seen significant change within GP practices. Previously, GPs worked predominantly in isolation to other support services, and were often only made aware of a patient's circumstances when that patient was admitted to hospital. However, this was changing in Hillingdon due to the new development of integrated care which allowed GP's to proactively share information and foster closer ties with community care programmes and activities. A patient who was now considered to be socially isolated and/or lonely could be referred directly to nearby community programmes or services.
Care Connection Teams have been formed and piloted in the north of the Borough and are being extended to the rest of the borough. There will be a total of 15 teams once fully operational. The teams include a community matron who sees patients with chronic illnesses such as asthma, diabetes and dementia, and who are being trained to be able to proactively prescribe medication and care solutions, under consultation with the GP. In addition, the teams include a care coordinator who is involved in care planning and administration.
The teams meet weekly and patients deemed to be at risk highlighted through practice intelligence from GP surgeries, together with dashboard tools and a risk identification system which incorporated data such as hospital admissions and medication, together with a frailty index tool. From these meetings patients deemed to be risk are offered proactive care management in order to prevent escalated needs. Prevention can include a referral to the H4All Wellbeing Service.
The caseload for a single Care Connection team was approximately 50 patients, across several practices, and 15 teams, covering 44 practices, had signed up to the Care Connection scheme. New matrons and care coordinators had been recruited, and the teams would now be a key point of call for GPs. Although this initiative remained a work in progress, testimony from GP's showed that they were enthused at helping to better support patients suffering from poor health or depression due to loneliness and isolation.
Julian Lloyd, CEO Age UK - Hillingdon, and Steve Curry, Hillingdon 4 All (H4All), addressed the Committee on the work of H4All, a collaboration between 5 third sector charities: Age UK, DASH, Hillingdon Carers, Hillingdon Mind, and Harlington Hospice, funded by Hillingdon's Clinical Commissioning Group (CCG).
The Committee was informed that H4All was delivering an enhanced provision of the former Primary Care Navigator Service (PCN) that was previously provided by Age UK Hillingdon. This included a free service working with local GP surgeries to support Hillingdon patients aged 65 and over with long term health conditions, including supporting people experiencing social isolation and/or loneliness.
The Committee was provided with some key statistics relating to social isolation and loneliness taken from several reports commissioned by groups such as Age UK and DWP:
Isolation
Loneliness
Academic research had determined that the impact of loneliness on health was the equivalent of smoking 15 cigarettes per day. Preventing and alleviating loneliness was therefore vital to enabling older people to remain as independent as possible, and therefore reduce the need, and cost, for health and social care services.
Referral routes open to partners included:
· Self referral
· Relative or friend
· Statutory provider
· Neighbour
· Voluntary sector provider
· GP
The number of referrals was seen to be lowest through self referrals, and somewhat higher through relatives or friends or well recognised brands such as Age UK. New referral pathways through the Care Connections team and GPs, as outlined above, would help to bring new people into the system and enable better identification, assessment, and triage. This was helped by H4All having a shared record system to enable easy, efficient sharing of information.
For those older residents referred, sector interventions included:
The aim was to refer residents to 'doorstop' services to preclude the need for personal transport and enable greater attendance. Libraries were often used as a meeting point for activities due to their location and ease of access for a majority of residents. The impact of these services was being measured in a variety of ways, including motivational interviewing and goal setting, an Outcomes Framework, and the Campaign to End Loneliness Outcomes Measurement Tool.
Looking forward, H4All was reviewing how other groups were run, to identify and implement new models of working. For example, more traditional befriending services, while valuable, were often on a one to one basis and designed to support the achievement of a particular goal. As such, these were difficult to scale within existing models. Previous questionnaires issued by the Wellbeing service had found that traditional models were often focussed on people already engaged with services, and so new thinking was being employed to find and work with people who had a lower level of activation. Work was also being undertaken to identify new, more cost effect and self-sustaining working models.
Case studies were briefly referred to, and it was agreed that these be circulated, alongside all presentation slides, to the Committee following the meeting.
The Committee thanked those present for their presentations, and sought further information on a number of points.
To Dr Raj, the Committee sought clarity on why GP's were previously only aware of a patient's circumstances upon that patient being admitted to hospital, and why GPs were not aware of what voluntary or community services were available to their patients.
Dr Raj confirmed that while new GPs underwent lengthy training to prepare themselves for the role, they would only be made aware of patient circumstances and the services available to patients if they were proactive in engaging with the local community. Work was now being undertaken to develop GPs who had a specialist interest or a willingness to engage further. It was also recognised that the prevalence of locum GP's, who were only present at practices for a short time, did not allow for the continuity of care that a more long term GP could provide. However, GP's were more likely to stay for longer, if provided more detailed training. In addition, the fact that all 44 surgeries had signed up to the Care Connection, reporting to H4All as a single point of access, would result in a more efficient use of GP time and a better level of information sharing that would ultimately benefit patients.
The issue of engaging with those residents for whom English was not their first language was raised, and Members suggested that any literature available was produced in a wide variety of languages.
In response, the Committee was informed that further outreach was needed, to ensure people were made aware of the benefits of the services. For those without English, faith groups were often useful in helping this message to be spread. However it was recognised that languages were an issue and attempts had therefore been made to recruit multilingual staff. On the suggestion that literature be provided to religious locations such as mosques, for in-house translation, it was agreed that literature could be made available upon request. It was agreed that Mr Kevin Byrne would forward a selection of booklets, detailing all available services, to Councillor Ahmad-Wallana for dissemination.
The Committee raised the question of counselling, and whether elderly residents who had experiences a significant event, such as the bereavement of a spouse, were spoken to, to assure them that it was 'ok to be frightened'. Members were informed that several counselling services existed, such as through Hillingdon Mind. In addition, volunteers at service groups were often elderly, and it was recognised that their participation was not only beneficial for themselves, but their presence and word of mouth could help to draw in other attendees.
Members requested that training on the topic of H4All be added to the schedule of Member Development.
The Committee highlighted concerns over how residents were informed of the services available, and suggested that the feasibility of amending correspondence sent by the Elections team be explored, to include notices of services available to elderly residents.
Members requested that more data be provided on exactly what percentage of Hillingdon's elderly residents were known to be isolated and engaging with services.
Members suggested amending the title of the review to make it clearer that the focus of the review was on the elderly residents of Hillingdon.
The Chairman raised the prospect of a Member visit to Bell Farm Chistian Centre, to review the work the Centre was doing for elderly residents. It was agreed that Members be informed of the date of the visit, once finalised by the Chairman and the clerk.
RESOLVED:
1. That the witness testimony be noted;
2. That available literature detailing services be forwarded to Councillor Ahmad-Wallana;
3. That a request for a training session on H4All be made to the Member Development team;
4. That the feasibility of adding literature on available services to Electoral correspondence be explored;
5. That further detail on isolation and engagement statistics be made available to the Committee;
6. That the title of the review be amended to confirm that the focus was on elderly residents; and
7. That the Committee be notified of a date for a visit to the Bell Farm Christian Centre, once finalised between the Chairman and the clerk.