Agenda item

The Cabinet Member for Social Care and Health Integration (CMSC) introduced a report on how the Council was supporting older residents during the pandemic and its plans for post-pandemic support. She praised the exemplary work that had been seen from staff in delivering services safely to the community at speed during the pandemic, as well as the strong partnership working in dealing with Covid-19.

The Operational Director for Adult’s Care and Support (OD) and the Lead Commissioner for Older People (LC) provided a brief outlook in regards to the demographic makeup of older people living within the Borough before the onset of the Covid-19 pandemic, followed by a more detailed narrative in relation to the work that had been undertaken to provide support to older residents over the past 12 months. This had included mechanisms such as:

• Extensive work in relation to hospital discharges, such as the identification by BHR of designated settings (nursing homes) and one commissioned home care agency to deal only with positive cases, which had reduced transmission, and local authority brokered placements (rather than the CCG) to improve choice, cost and control;
• Utilising learning gained during the pandemic to look at the way in which staff could be used more effectively going forward, such as by moving the Joint Assessment and Discharge (JAD) team into the community;
• Supporting adult providers to provide high-class care for residents through means such as 7 day per week virtual support from the Council’s Public Health, Commissioning and Provider Quality teams, as well as through funding and uplifts to continue as businesses and to maintain the adult social care market;
• Supporting care homes to reduce isolation through Covid-safe visiting, funding and technology such as Breezie tablets (handheld devices performing functions such as enabling residents to connect virtually with relatives);
• Providing funding for the ‘Reconnections’ programme, to increase the social networks of older residents and to improve their health and wellbeing; and
• Providing support in relation to a number of issues via agencies such as the Council’s Community Solutions team, the Specialist Support Hub, BDCAN and the Central Food Hub.

The OD and LC also wished to publicly thank colleagues in BHRUT, NELFT and primary care, for their dedicated work in relation to rolling out the Covid-19 vaccine to the Borough’s care homes.

In response to several questions, the OD stated that:

• The Council had already been working towards a Home First model for quite some time, since the new hospital discharge guidance came in early 2020.

The aim of this model was to assess discharged residents, primarily older people, in their own homes, rather than the hospital and to improve resident health and social care outcomes by ensuring that a more realistic assessment of an individual’s needs took place in their home environment. This model had been working very well and as such, the Council was not expecting there to be any major issues with this going forward.

• There was no limit to the number of patients that a hospital could discharge in one day.
• Whilst the Council was not responsible for hospital transport, it was responsible for care and support in the community. By moving Hospital Discharge staff into the community, this would create a ‘receiving’ service whereby patients were pulled (rather than pushed) into the community. This had been organised through giving health partners in hospitals the authority to prescribe the first couple of weeks of patient care, to give the Council’s Care and Support staff time to visit these patients and undertake an assessment to provide them with long-term support. This was especially helpful given that patients were now being discharged from hospital earlier each year and that it took time for patients to recover before an effective assessment could be undertaken. This would also enable Care and Support staff to gain a more realistic perspective of how the discharged patient was coping, their circumstances and where they might be receiving informal carer support.
• A good partnership between the Council and health partners was essential, with Care and Support staff needing to rely on health colleagues for effective communication about which patients were being discharged and when, as well as the type of support that was being prescribed initially by health partners on behalf of the Council. Going forward, a single point of access was to be established and this was in development. The Council was working alongside health colleagues to ensure that their ‘receiving’ service was well aligned with the service established by health partners.
• The pandemic and exceptional circumstances had meant that new projects and support had had to be developed at pace, to support the Borough’s most vulnerable residents. The Council now needed to ensure that these arrangements were properly established, safe for residents to use and worked for local residents, reflecting what they wanted to see in the services.
• Residents made their own decisions and could decide whether or not they wanted to engage with Council services. If these residents had the mental capacity to make this decision, the Council would respect this. However, the Council acknowledged the risks that it saw on those occasions and would both make an offer and continue to make an offer, even if residents were not initially willing to engage with the Council.
• The Council was relying on its health partners to relay information back to it. The single point of access would replace the Discharge Co-ordination Unit (DCU) which currently co-ordinated discharges, to fulfil the same function. As such, this would be a relatively safe process, but the Council would be careful to monitor the single point of access as it was being implemented.

In response to an earlier question, the CMSC stated that the Council’s new technology bid may help to support those who may be reluctant to engage with the Council. The Careline model was now outdated, and the Council was currently looking into employing a new support model (potentially akin to an Alexa-type system) that more elderly residents may consider utilising to enable them to maintain their independence. The Council was also in the process of developing its Community Hubs model, which would enable elderly residents to participate in activities at their local community hub and potentially begin to have conversations with support workers, realising that their independence would not be lost when they spoke with the Council. As such, the Council was looking into different approaches that it could utilise to engage vulnerable residents who needed support.

The Council’s Director of Strategy and Participation (DSP), as well as Shielding Lead, also wished to thank the Independent Living Agency (ILA), who had provided extensive support to residents who were shielding. This statement was echoed by the OD, who praised the strength of the relationship between the ILA and the Council over the past 18 months, stating that the Council was planning to work more closely with the ILA to develop its new social care model.

In response to a question, the CMSC stated that she would come back to the Committee about the number of residents who were currently using Breezie tablets. The devices had also worked particularly well for those with dementia in some of the Borough’s care homes. The number of residents using these tablets was growing and the Council would pay for both these tablets and the Wi-Fi for a resident to use these, if a social worker thought that a resident could benefit from the device.

In response to several questions, the OD stated that:

• In years to come, those residents who were getting older and who may unfortunately develop memory-affecting conditions, would likely already have a basic understanding of how a tablet worked as they would have likely previously used these. As such, it would be easier for them to use modern technology more naturally. Technology was also continuously improving and Commissioning colleagues were looking more widely at digitally-enabled equipment to support residents in the future.
• He would need to come back to the Committee with a more detailed response around the provision for those with visual impairments and how they could use the Breezie tablets. However, if a resident had a visual impairment that allowed them to see some detail, they could use any laptop or Breezie device to make the detail bigger. The CMSC also stated that each Breezie was set up for the individual using it, for example, the volume could be enhanced on a tablet for those with a hearing impairment and a closer image could be shown on the tablets for those with visual impairments.

The OD, CMSC and the Chair encouraged residents to contact the Council’s Intake team or their local Councillor if they believed that either themselves or someone they knew could benefit from a Breezie tablet. The Chair thanked the OD and LC for their work in supporting the Borough’s elderly residents.