We often think of Council’s Adult Social Care as just being for the elderly – but a significant part of the service is also for adults with learning difficulties. Many councils have made substantial progress in improving the lives of disabled residents with taking part in the Shared Lives scheme. This offers an alternative for those currently in supported living or institutional care. It is of them being placed in a family environment in someone’s home. It can also provide respite for parents with grown up sons or daughter that they are caring for.

As well as providing better care and increased choice it also reduces the cost. I am pleased that Hammersmith and Fulham Council is now planning to make some placements. However it is very disappointing that we are so far behind. There have been 13,000 placements nationally. We are still on nil.

The Council’s Director of Strategic Commissioning and Enterprise Adult Social Care and Health has sent me the following briefing:

Shared Lives Scheme

Our local Shared Lives scheme was established in April 2016 and operates across the three boroughs. The scheme is funded as an 18 month pilot and is being delivered by Grace Eyre Foundation following a successful tender. The initial aim is to establish 5 Shared Lives arrangements in Hammersmith & Fulham.

The scheme, which is registered with CQC, recruits and trains local people to become Shared Lives carers. Carers go through rigorous vetting and training. Once approved by a multi-agency panel, they are matched with a person with care and support needs who requires accommodation. Carers must be able to offer a room for which they’ll receive rent. They also receive a weekly fee and the person lives with them as “part of the family”. Matching ensures a good fit of personality, lifestyle, skills and knowledge of the carer with the needs and preferences of the person. This offers a real community alternative to residential care or supported living as well as providing employment opportunities for local people.

Whilst the initial focus is on people with learning disabilities (age 16 upwards), there is scope to extend to other health and care needs. The scheme will also offer short breaks and could offer day provision. A steering group including the H&F Learning Disability Team and Children’s Services identifies referrals. Links with Adoption & Fostering enable arrangements to transfer to adulthood where appropriate.

Several local events and publicity campaigns have attracted potential carers: reaching community members remains a key priority to recruit more carers. Six carers are going through the assessment process.

The Grace Eyre charity is an experienced Shared Lives provider supporting people with learning disabilities and mental health needs across Sussex as well as a fairly new scheme in Lambeth. Please see links below to our local scheme:

http://www.sharedlives3b.com/

http://www.peoplefirstinfo.org.uk/health-and-well-being/learning-disability/accommodation-for-people-with-learning-disabilities.aspx

There are over 150 Shared Lives Schemes across the UK supporting 13,000 people. National evidence shows positive outcomes and good value for money compared to other forms of care. This a growing sector: schemes elsewhere are supporting people with dementia, older people, people coming out of hospital, people with complex behavioural needs and young people in transition.

Shared Lives Plus is the UK network for shared lives schemes. They have set standards for schemes and provide evidence to support the effectiveness of Shared Lives. Grace Eyre is a member of Shared Lives Plus – enabling access to best practice networks, resources, guidance, learning and training materials.

http://sharedlivesplus.org.uk/

On Saturday morning just before 8.30am on BBC Radio 4 Today programme the Leader of Hammersmith and Fulham Council Cllr Stephen Cowan made the startling claim that “they’ve been cut 70 per cent since 2010, local government budgets.”

In 2010/11 total local authority spending was £104.2 billion (this included £57.6 billion from central Government grants, £26.3 billion in Council Tax). In 2016/17 the total is £94.1 billion (this includes £54 billion from central Government and £26 billion in Council Tax).

So in terms of cold hard cash that’s a cut on nine per cent. When we start start trying to talk about the change in “real terms” it gets more complicated. There is seven years of inflation – which is another 23 per cent. On the other hand some of the “cuts” are notional – for instance if a school converts to academy status it is funded direct by central government rather than via the local authority.

Thus there is some room for argument about the precise figure. But a claim of a cut of 70 per cent – or anything approaching such a figure – is wildly dishonest.

That was not the only muddled part of the interview with Cllr Cowan. He said in Hammersmith and Fulham using the adult social care Council Tax precept as enough savings had been found instead from banners on lamp posts.  But then he said that more money was needed:

“I meet people at my surgery. I meet old people who lie in bed and wonder how they are going to get out to go the toilet. You meet people you can’t get out the house, or can’t keep the house clean.”  He said that “we are compassionate society” and the answer was to “provide the funding.”

Some would argue it is simplistic to believe that more spending means a better service. There is little evidence to show a correlation between spending and outcomes in different local authorities. It is about better management. But if as council leader Cllr Cowan feels the social care service the Council provides is unacceptable and that increased spending is the answer then why doesn’t he take that decision? What does he promise those who go to his surgery? To send himself an angry email?

Last month on Conservative Home I wrote about the “crisis” in adult social care and noted:

“In my local council of Hammersmith and Fulham last year there were ten people on an average day, per 100,000 of the population, needlessly stuck in hospital due to Council delay in making alternative arrangements.  In Wandsworth the figure was below half of that:  4.4 per 100,000.  Why?  This is not a rhetorical question; I have logged the query with my Council for an explanation. But I would be surprised if the answer comes back that Wandsworth spends twice as much proportionately on adult social care as we do or has twice as high a proportion of elderly residents.”

I still haven’t had a an answer to that.

But there is another measure of how the service is performing – the satisfaction level among the “service users”. My query was as follows:

“I see that according to the “Measures from the Adult Social Care Outcomes Framework” the national figure has 64.4 per cent say they are extremely or very satisfied with their care. 85.4 per cent “reported that the services they received helped make them feel safe and secure.”  76.6 per cent “reported they have control over their daily lives.” 45.4 per cent “reported they had as much social contact as they would like”.

Please advise what the local equivalent satisfaction ratings are.”

I have had a response on this. For Hammersmith and Fulham Council overall satisfaction is 58.0 per cent (against 64.4 per cent nationally). The feeling safe measure is 68.9 per cent (against 85.4 per cent nationally). 78.1 per cent fell they have “control of their daily lives (against 76.1 per cent nationally) and 42.9 per cent feel they have as much social contact as they would like (compared to 45.4 per cent nationally).

So on three out of four measures we are behind. Also on two of them we are behind by quite a significant margin – including the most important judgment of “overall satisfaction”.

It’s just another opinion poll, of course, and we know how unreliable they can be. Yet surely the figures are of at least some concern.

Always talking about more money as the answer is simplistic – although the Council’s Public Health budget could be used on preventative measures. Where the Council could be doing much better is with a better relationship with the NHS – and for that matter between the Adult social care department and the sheltered housing team within the Council.

I have been in correspondence with council staff recently over a resident who was unable to safely use her bath.

After two months delay came the following response from the Occupational Therapy Service in Hammersmith and Fulham Council’s Adult Social Care Department:

“Due to client difficulties with transfers and lack of space/restricted bathroom layout and close proximity of bath to WC as well as need for long term independence with bathing, the OT has agreed to support level access shower with drop down seat in place of bath.

“This will be processed as a Major Adaptation and sent to the adaptations team as required for the installation of a level access shower.”

Good news. Except that it is estimated it will take another six months for the work to be done. What actually makes this all the worse is that it is entirely typical. I was told:

“I can confirm that the estimated time line for all major adaptations is approx. 6 months, some do happen faster but some do take longer, this is due to the vast myriad of different contributing factors.”

Six months is too long, isn’t it? If I broke a leg and needed some adaption done in my house it wouldn’t take a builder that long to get the work done. I wouldn’t have to strip wash for six months.

I am told other councils are as bad or worse. So what? We should minimise delay to the greatest possible extent. It
is much cheaper to help people stay in their own homes than for them to be put into care.

The assessments take 2-6 weeks even before we get on to the six months delay. I was told this is due to shortage of staff. Yet I have already highlighted how the £22.7 million a year in the Council’s Public Health budget is largely wasted.

The contracting process is very cumbersome and bureaucratic – apparently due to EU procurement rules.

Anyway I put through the following queries:

1. I note the point about a shortage of staff to process the work. Could we get more staff using funds from the Public Health budget? And/or more efficiency through a tri-borough arrangement or tendering the service? It seems to me that the 2-6 weeks it takes to get an initial assessment is an avoidable delay.

2. I also note there is sometimes delay getting a surveyor. Could we find retired surveyors willing to work for free.

3. I note that we take two weeks to send out the Disabled Facility Grant form. Could we email it to those who are on email? Could we get volunteers from Age Concern to help send out the forms and help people fill them in quickly? Also what if someone is too rich to be given a Disability Facility Grant – shouldn’t they be warned about this earlier so they could get on with paying for the work themselves making private arrangements? Also pleased provide the figures for the funding from central government for the Disabled Facility Grant for the last two years and for the Council’s spending on these grants.

4. I note that there is more delay with the contractors needing to get three competitive quotes from subcontractors for each individual job. Could that not be streamlined? For instance one firm contracts for all stair lifts in Shepherd’s Bush, or all adapted baths in Fulham, etc? I can see that requiring individual quotes for each job would cause delay – and perhaps increase costs?

5. What are the comparative costs to the Council for assistance for people to remain in their own homes and paying for them to have residential care? Would not a quicker service for adaptions reduce the risk of their condition deteriorating and thus reduce the number and thus cost of residential care placements.

This was the reply I had:

Dear Councillor Phibbs

Thank you for your recent enquiry.

Thank you for your email and concerns regarding trying obtain an efficient and cost effective Occupational Therapy Service for your residents.  We also share your concerns and are constantly looking at ways to improve to meet the growing demand for the Service.

Last year from April 2015- April 2016 the Occupational Therapy Service received over 1,400 referrals.  In order to ensure that clients with urgent needs such as people who are terminally ill, at risk of injury, or a breakdown in family relationships and care we operate a priority system as follows :-

*       If the case is urgent the client is seen within  1- 2 days and are seen by the Rapid Response Team.
*       If the case is awarded a Priority 2 they are seen within 2 – 4 weeks  depending on the urgency of the case.  This may be for Stair lifts, Ceiling Track hoists. Difficulty with Access.
*       A P3  is a low priority and will be seen within  6 weeks.  This may be for bathing assessments and showers..

The Occupational Therapy posts funded via the Public Health Funds (CLCH) will deal with Rapid Response urgent  cases.  The OT’s funded from the Local Authority will see the  P2’s and P3’s the more complex long term cases.

In regards to point 2,3,5 the Adaptation process is currently under review and a proposal has been drawn up to move the management of the Adaptations Service back to the Housing Department.  This should happen within the next 2 months.   Your comments will be passed to onto the relevant people who are looking at the existing processes and what needs to change to improve the Service.

The Disabled Facilities Grant is a very complex process. You first have to be assessed by an Occupational Therapist to determine if you meet the functional criteria for the provision of the Grant.  At this stage clients will be informed of the process and sent out a Preliminary Test of Resources Form to complete. Most people prefer to be assessed even if they do not meet the criteria and are over the financial threshold for a Disabled Facilities Grant  This is due to the fact that the  Occupational Therapist can still provide equipment, minor adaptations, advice, information, and if the client decides to pay for the Adaptations privately the OT can still work with the Contractor commissioned by the Client on their behalf.

I do not feel that using Volunteers from Age Concern would help this process as most clients struggle to divulge their personal financial information.  You also require specialist training to ensure that  the financial information received is processed accurately. I will provide the information you have requested separately regarding the funding for the Disabled Facilities Grant.   This is also under review by the Housing Department so I will also pass on your comments and suggestions.

In regards to point 5 I can assure you that once an Occupational Therapist or Social Worker completes a comprehensive assessment  if it possible for the client to remain at home in their own home environment then this would be the preferred choice. Placing someone in a residential establishment is the last resort and is only considered as an option if the person is unsafe , the family unable to cope or the home is not suitable to accommodate their needs.

Janice Blake

Manager of  the Occupational Therapy Grants and Adaptations Team
Hammersmith & Fulham Council

Hammersmith and Council has given great prominence in its public relations to reducing the charge for meals on wheels to £2 a meal down from £4.50. (The cost to the Council is £7 a meal). In heralding this change the Council has implied that many elderly people will benefit.

As so often the facts are rather different to the spin. There are 180,000 residents in this borough. The last census suggested that includes 7,000 lone pensioner households. In May 2014 there were 120 people who had meals on wheels delivered every day. It is now 70. So that’s one per cent of the lone pensioner households. Or 0.036 per cent of all borough residents.

In terms of the money the change is also pretty modest. A subsidy of £2.50 a day for 120 people cost £109,500 a year. A subsidy of £5 a day to 70 people costs £127,750. So the extra funding is £18,250. Frankly I suspect the Council spent more with all the special videos and glossy brochures boasting about how generous and caring it was being.

Anyway let us accept that this is a very small amount of extra spending to help a very small number of people. Furthermore that some of those 70 people will be wealthy and the financial saving of little consequence – the service is not means tested.

The question is why is the service in such rapid decline despite the increased subsidy. The explanation is that it doesn’t suit many people. Either the elderly are able to cook for themselves – at least on the modest scale of being able to use a microwave. Clearly that is an advantage for them to be able to choose what to eat and when to eat it – rather than something congealing on the way from Bagley’s Lane though the traffic jams. In any event they would not be eligible to receive meals on wheels.

On the other hand for those unable to cook, Meals on Wheels is really not enough. Most of the 70 recipients suffer from dementia. But usually for those in that condition it is better to have a carer cook for them and stay with them while they eat and drink.

Some others are mentally alert but unable to cook for themselves due to being physically incapacitated. Loneliness is often a terrible problem for them. Often by paying for a neighbour or voluntary organisation to provide their meals they can get rather more company than from the Meals on Wheels service.

Mike Boyle, the Director of Strategic Commissioning and Enterprise and Adult Social Care and Health, for Hammersmith and Fulham Council tells me:

“People can be offered a direct payment as an alternative for meals provision. The Direct Payment given is at the same gross unit cost rate as the commissioned meals, and the charge made to customers is the same charge as that for the commissioned home meals service. There is also provision in the home care contract for carers to prepare and cook meals when required.”

The upshot is that it is no surprise that the number of meals on wheels users is falling. While the needs and circumstances of the elderly vary widely there are nearly always better arrangements they can make – or that their relatives can make on their behalf.