Agenda item - Funding for Adult Social Care

Discussion with Councillor Rob Jarrett, Cabinet Member for Adult Social Care and Health; Terry Parkin, Strategic Director People; and Brian Doughty, Head of Adults Assessment

Introductions

 

The Chair of the Older People’s Council Jack Hazelgrove welcomed everyone to the meeting. It was pleasing to see members of the public (around 12 people) and representatives of local groups here today.

 

Delegates of older people’s organisations introduced themselves and later made comments as follows:

 

Sue Howley, Chair of Pensioner Action (funded by Primary Care Trust/NHS; publishes ‘The Pensioner’ and organises public city-wide and neighbourhood meetings). Sue Howley said a long-term view was needed. How to mobilise volunteers was a key issue. Neither older nor younger people should be stereotyped. There were concerns about end of life care and care homes. Older people did not necessarily want choices, only a quality service, she said.

 

Isla Robertson of Brighton & Hove Pensioners’ Association (holds monthly meetings; everyone is welcome to attend). Isla Robertson strongly emphasised that everyone gets older.  Funding care for older people should not be shelved or regarded as just an ‘add-on.’ That message was not glamorous, so it was difficult to get it across. The quality of care becomes more important as a person ages. Attitudes had to change.

 

Kat Pearce Interim Director of Age UK Brighton & Hove (formerly called Age Concern; a change of name only – not a change to the work being done.) Kat Pearce said Age UK was happy to work collaboratively. The organisation was working locally and at a national level, and continuing to campaign for dignity and respect in care provided by residential and nursing home and in NHS settings. The Care in Crisis Campaign launched in February aimed to collect 100,000 signatures. People were encouraged to look to sign this. Age UK can advise on benefits for older people. A range of Information and Advice Services are available. Preventive Services needed to be looked at, as a whole, she said.

 

Funding the Future of Adult Social Care - Discussion

 

Councillor Rob Jarrett (RJ), Cabinet Member for Adult Social Care and Health; Terry Parkin (TP), Strategic Director, People, and Brian Doughty (BD), Head of Adults’ Assessment gave short presentations and later replied to questions.

 

Councillor Rob Jarrett was currently Cabinet Member for Adult Social Care and Health. Under new governance arrangements from May, the ASCH Committee would have 10 Members including a Chair.

 

Councillor Jarrett said he had no prior experience when he was elected in May 2011. There was a lot of good work to see in the City; he had visited care homes, nursing homes, sheltered housing, and day services, plus third sector organisations in the City and had attended regional and national meetings eg Local Government Association.   Much was happening on funding Adult Social Care at present; the government reply was still long-awaited to the Dilnot Commission.

 

It was beneficial to everyone locally, that there was a large number of actively interested and engaged people in Brighton & Hove and it was hoped to build on this involvement, potentially with some influence at a national level.

 

TP said officers’ role was to implement politicians’ decisions. A balance had to be achieved between local decisions and the national picture. In recent years ASCH spending in the City had been maintained at a time when other authorities had seen significant reductions.

 

Nationally there was now a move away from Council-run services, to more independence for service users, who themselves were best placed to decide how money for their care is spent. This meant a change in Councils’ roles – towards supporting service users in their spending, focussing on those for whom the funding is intended. A change to personal budgets has shown that people don’t necessarily choose to use the Council’s day centres, for example.

 

BD explained he was responsible for assessing people’s social care needs and responsible for the Adult Social Care budget. Demographic changes, especially in the numbers of people over 80 years of age would have a ‘critical’ effect on the budget in future years, so changes were essential.

 

The Council was looking to protect services for vulnerable and older people. Unlike some Local Authorities, significant savings, improvements in effectiveness and efficiency had been achieved in the ASC budget without changing the eligibility criteria.

 

The clear strategy was to divert people away from nursing homes and to keep people in their own homes as long as possible.  The number of people newly going into nursing homes was continuing to decline but many had been living in nursing homes for a considerable time and this indicated scope for further improvements. The focus now was on new techniques and technology enabling people to stay in their homes for longer.

 

Brighton & Hove had considerably exceeded the former government target of 30% uptake of personalised budgets. The target was now 100% and service users would continue to be offered personal choice. It was important to raise awareness, and strengthen safeguarding, of people at risk.

 

Councillor Jarrett said there were some 10 million people in the UK over 65 years old and the number was expected to grow by 5 million over the next 20 years. The proportion of those in work compared with retired people would decline considerably, leading to enormous extra costs. The Dilnot report had recommended a cap on an individual’s expenditure on care of £35,000, which could cost some £1.7 billion annually.

 

Crisis and emergency services would always be needed.  Severe financial pressures meant that it would be impossible to continue to protect the total social care budget. However ways could be found to protect the amount that individuals receive.

 

Community support was key; by helping neighbours a single volunteer can save £100,000 per year of public costs. Money should not be the prime consideration but public money did have to be spent wisely.

 

Typically, councils had a reputation of ‘doing things to people.’ One size did not ‘fit all’ but it was increasingly important to hear what people want and work towards providing it, he said.

 

Mike Bojczuk outlined a palliative care project run by Kings College Hospital investigating better ways of caring. There was plenty of care for cancer patients, that was not necessarily available for people with other illnesses.

 

Francis Tonks said ‘Well-being in Old Age’ was a Brighton University project in partnership with Age UK and older co-researchers, due to launch its findings on 3 April in the Brighthelm Centre. Related to this project, ‘As Time Goes By’ was a guide written by older people for older people. Details would be circulated to OPC.

 

Colin Vincent said he was continuing to consult on the current draft Adult Social Care ‘local account’.

  

Other comments and questions were:

 

Some BME families have a different approach to looking after older people; this should be taken into account in the City, where there are significant minority communities.

 

Should we as parents or grandparents spend our children’s/grandchildren’s inheritance?

 

Why are younger family members/friends not paid to look after older people?

 

As an 80-year-old, how do I find out about all the benefits that I’m entitled to?

 

Why are care and nursing homes free in Scotland but not free in England?

 

What can be done about the fraudulent use of blue badges?

 

How can I find out about meals on wheels?

 

There is high demand for sheltered accommodation in the City – and care for people in their own homes can be inadequate. How will extra care work in future, for example, for the increasing number of people with dementia?

TP said it was important that people knew how to get information. He gave details of the Council’s Access Point that provided information and advice on adult social care.

How can I contact the Adult Social Care Access Point?

Telephone: (01273) 295555

Minicom: (01273) 296388
Write to: Access Point
3rd Floor Barts House
Bartholomew’s Square, BN1 1JE
Email: accesspoint@brighton-hove.gov.uk 
This is a secure email address which is part of the GCSX network that is used for all Government departments, including the NHS and Police.

TP said better procurement via intelligent commissioning had already saved £3.5 million for children and adult services. However similar savings were unlikely in future contracts with care homes and carers suppliers. Social care formed a large part - around half - of government spending. Therefore even large scale cuts in other spending areas could not cover the publicly-funded social care demand at current levels, that would be created by future demographic changes.

 

Regarding dementia services, TP told the meeting that the Sussex Partnership Foundation Trust was investing significantly over the next three years.

 

Councillor Jarrett said that people who had saved for their retirement should not be penalised. There were national pressures and local government was taking a share of the budget cuts. There were ways of improving the efficiency of delivering care to older people and these were being pursued. Personal budgets did give increase older people’s choices.

 

Councillor Jarrett emphasised the Council’s statutory duties and additional work with partners including supporting the third sector, and signposting. Preventive work eg on trip prevention and fire safety checks, plus benefits advice was available.

 

He said a wide variety of community support was in place – the ‘Embrace’ information project with the Federation of Disabled People was working to collect details of all the available services/activities. Local services needed to be better known and better joined up.

 

Prevention could be improved by helping people that had not been in contact with the council. One local authority had contacted all those over 65 years of age, offering visits from trained volunteers to give relevant information and advice; that approach could be considered in Brighton & Hove.

BD pointed out that overall spending can be reduced significantly by preventative investment. Re-ablement interventions in the first six weeks of leaving hospital were shown to be beneficial.

 

BD noted that 90% of the adult care budget was spent on non-Council services and ‘the quality was not always great.’ Cost and quality had to be balanced. Providers often found it difficult to recruit staff.

 

BD pointed out that in line with 80—90% of other local authorities, BHCC had agreed eligibility for publicly funding of services for people with ‘Substantial’ and ‘Critical’ needs. These criteria were kept under review but neither the staff to assess people nor the funding to buy services was available to support a move to including people with ‘Moderate’ needs. Prevention was important to stop people with ‘Low’ or ‘Moderate’ needs moving to ‘Substantial’ category.

 

Increased capacity for dementia care was being planned. A peer support system in Lancashire had been successful in putting families and carers in touch, to help share information and ideas.

 

Councillor Jarrett summarised by pointing out that some authorities had moved to funding only those assessed to be in ‘Critical’ need. Anyone in need was entitled to an assessment. He wanted to ensure that support was given fairly.

 

Councillor Jarrett encouraged older people and carers to contact the Council via the Access Point  with their issues and suggestions for improvements in services. The Council could offer advice guidance and referrals and was open to new ideas. This would also help improve knowledge about the level of need in the City.

 

The Chair Jack Hazelgrove thanked all the speakers and visitors for attending this part of the meeting.