Seminar discussing First Contact Schemes & community assets

I wrote the following for our health & social care research website. For my blog, I'd like to make a couple of additional points:

Community Assets - really interesting how this plays out. I guess big question is how local agenda is shaped or dominated by larger third sector organisations.

Who should be targeted? Care Act 3 categories defined by Prevent, Reduce, Delay - nice model. But does this gloss over complexity. i.e. for 'single' LTC this may be appropriate, for multi-morbidity, or disability, it may be that a health or social need becomes acute that is not (directly) connected to the main LTC/disability - i.e. just because someone is in receipt of 'reduce' services doesn't mean that they don't also need 'delay' services, but this need might be missed if the person is categorised as a 'reduce' or 'prevent' category - I guess concern is that ppl are being put in boxes. rather than person-centred or comprehensive.

Re-blogged from 'Frail Older People Knowledge Hub'

http://emfop.org.uk/blog/health-maintenance/2014/july/seminar-discussing-first-contact-schemes

I attended this seminar on 30^th June 2014 organised by Age Action Alliance (AAA) and Elderly Accommodation Council (EAC), hosted by AgeUK in London. It was great to meet with a range of stakeholders including representatives of First Contact schemes across England.
The meeting followed publication of a second edition of a report into progress of First Contact Schemes, by AAA & EAC. First Contact schemes were described as ‘practical ways to ensure older people can lead healthy independent lives’. These often include multi-agency referral (or signposting) pathways, coordinated by a ‘single point of contact’.
Michael Rodden (EAC) and Simon Wilkinson (AAA Department for Work & Pensions) jointly chaired the meeting and did a great job of introducing people and facilitating group discussions – with lots of flipchart capturing of discussion (see pics on twitter!)
During the seminar we discussed the role of the various schemes; differences and similarities. In particular issues such as partnerships involved, evaluation and funding. Many programmes hoped to be part of Better Care Programmes (led by Health and Wellbeing Boards). See flipchart schematic of Dorset SAIL
Coming from a health research perspective, it was great to hear more from the local government perspective. It was fascinating to discuss how these schemes may help to meet the aims and ambitions of the new Care Act. This places a new duty of improving wellbeing within all local government policy and activity. Helping people to stay healthy and independent is discussed within the consultation document (currently open for responses) as:

• Prevention
• Reduction of need
• Delay of need

Groups discussed how various aspects of First Contact schemes could contribute to these 3 approaches.
Of particular interest for our research in CLAHRC-EM was discussion of standardised assessment of needs. This was seen as a benefit to demonstrate reach of programmes, but also was a challenge to deliver within a multi-agency collaboration. Challenges included both strategic agreement and operational delivery (completion rates). Although sharing data was acknowledged, particularly by Evan Morris (Chief Fire Officers’ Association) this was not discussed in terms of commissioning or Joint Strategic Needs Assessments (or Wellbeing Strategies). There was also interest in developing wellbeing indicators, which may be brief but pragmatic, especially for audit purposes.

On the way home I was pondering three questions:

Could data sharing bring more benefit than risk? Does the benefit of reaching people who may otherwise slip through the net, or the benefit of avoiding duplication, outweigh the privacy and security risks of data sharing. This is particularly salient in the context of the care.data (#caredata) debate.
How to demonstrate added value? If much of referral is about one agency increasing their reach to people who happen to be in contact with another agency – can we demonstrate increased referral rate, increased reach – and hence helping agencies to meet their mission aims? Maybe these are sufficient outputs of First Contact, rather the ambitious aims of showing health or social outcomes for individuals?
How do First Contact schemes relate and interact with Integrated Care programmes, locally? This was briefly mentioned, but it would be interesting to explore how First Contact may identify people with needs that are not identified by risk stratification tools, for example.

See some of the debate from the day by searching on twitter for @ageactalliance @age_uk @endloneliness

A week after the seminar, it was great to see Sue Warr from Dorset SAIL programme featured on the BBC national news!

Support for older people in the community: Part 2 Assessments, signposting and outcomes

In part 1 I described some of the broader or policy changes which will impact how health and social care sector interacts with and funds the voluntary and community sector. The following is a brief overview of some of the ‘mechanisms’ which may have a new role in this ‘new world’.

Assessments

Preparations for the Care Act has stimulated a lot of activity around assessments – whether these are carer’s assessments or assessing people’s needs for social care before they are eligible. There are assessments for personal budgets and joint health and social care assessments which will be important for integrated care. We have been studying assessments for ‘low level’ needs; which may be addressed by voluntary or community services. There is widespread use of checklists such as ‘First Contact’ which offer a brief assessment to highlight where a range of organisations could help, including housing and fire safety. There are benefits in assessing people’s comprehensive needs, across health, social inclusion, housing etc. This approach may highlight an issue and enable access to other forms of support, which may not have been considered previously. It could also be an opportunity for outreach to isolated individuals. A key issue is how various assessment relate or overlap with each other and also whether core information from such assessments can be shared, with consent, with other services. Collating information could build up a picture of needs within neighbourhoods.

Signposting

Some people may find it difficult to know who to turn to for help. It can seem that there are a confusing number of similar services. If community and voluntary services can work together this may help to meet older people’s personal needs in ways that are appropriate to their preferences and culture. There are a range of approaches here, which may work in different settings, and they may all benefit from sharing information from needs assessments. Within ‘signposting’ I would include; social prescribing, care navigators, single point of access and home from hospital.

Outcomes

Increasingly, funding is dependent on showing outcomes for individuals who have accessed services. This can be referred to as ‘outcomes-based commissioning’ and it is also an important aspect of personal budgets. Outcomes should relate to the actual health or social benefit that an individual experiences, this contrasts with ‘process’ or ‘output’ measures which might be number of people attending an event. Outcomes may be specified by the commissioner (funder) and there is also a whole series of national outcome indicators. Just to be confusing there are separate indicators for health (NHS Outcomes Framework), public health (Public Health Outcomes Framework) and social care (Adult Social Care Outcomes Framework).

The idea is that commissioners (NHS Clinical Commissioning Group or Local Authority) specify the outcomes they expect and the community and voluntary sector organisation writes a programme bid to explain how they will deliver services to enable people to achieve these outcomes. The hope is that this gives freedom for innovation and flexibility for organisations to design services which will meet the preferences and be culturally appropriate to their community members. There is also an aspect of sharing risk between funder and provider; in theory money isn’t wasted on services that aren’t attended, whereas popular services can receive more funding. Whilst this sounds good on paper, in reality both commissioners and providers may need time to get used to this new way of working. Furthermore some people feel that the policy direction is tending to favour a corporate-style managerialism within the voluntary sector, which may ignore or stifle the very strength of the sector – that is; the voluntary and community sector offers a distinct way of representing the needs of a neighbourhood and outreach to people who, for various reasons, may not access public or private sector services.

These are big issues for older people and organisations who offer support. Within our research study, we hope to explore some of these issues, and to feedback to organisations across East Midlands to enable better communication between the voluntary sector and the health and social sector. We welcome any views or input. Please tweet @nchadborn

Support for older people in the community: Part 1 Care Act

For my research at CLAHRC-EM, we’re in the middle of analysing our survey of health and social care commissioners across East Midlands (UK). We asked them about community services to help older people maintain their wellbeing and independence. In particular we’re interested in how services are funded and whether services are provided by voluntary, private organisations or social enterprises.

Screen grab from My Maps, Google

I presented an update to East Midlands Later Life Forum a short while ago and then read an article where Campaign to End Loneliness highlighted need for ‘range of support’ for older people in the community. This prompted me to summarise a few thoughts on these areas:

Care Act

The postponement of the cap on care costs has meant that much of the Care Act is not being implemented. I’d like to find out from local authorities which aspects are being implemented (answers on a postcard please…?) but I’m sure the broader agenda of addressing wellbeing will still be followed. There were questions as to whether the work on carer’s assessment and support will still be implemented?

Changing context

Alongside the Care Act, there are many other changes affecting community and voluntary sector services. There are concerns from all sectors that austerity and ‘efficiency’ measures are threatening what services and support is available to older people in the community. On top of this there is an awareness of needs of greater numbers of older people with dementia and other long-term conditions. I heard from older people’s forums that, whilst these groups are important to highlight local needs and to inform councils about prioritising their services, they are reaching a critical point of lack of funding. Similarly, several local Community and Voluntary Services (CVS) which provide infrastructure support, are also having to restructure in the face of lack of funding.

Resilience, community assets and wellbeing

There is much talk of ‘resilience’ and this word can be used in many different ways. It can be used to describe an aspect of mental wellbeing of an individual but it is also used to describe a community more generally. A recent publication from The Health Foundation gives a good introduction to these various interlinked topics. It also touches on one criticism of this approach, that is may be used as a cover for a neo-liberal agenda of individualisation and privatisation. When working to improve local services, we should consider whether this may gradually erode the strengths within communities and the impacts on inequality (health and social inequalities). For example, a service that responds to the demand of an individual, may lead to withdrawal of funding from forums which are designed to represent the broader needs of the community?
If you have any thoughts - please comment below or tweet including: @nchadborn
 

In part 2 I will discuss some of the mechanisms of support in the community; Assessments, signposting and outcomes.