County Council Network Conference 2010

On Saturday I learnt that the Deputy Leader of Suffolk could not go to the CCN conference and so the Leader Jeremy asked if I might be able to go along, I said we had a family Sunday Lunch plans but I could come along after that so late Sunday afternoon I picked him up and off we drove to Gatwick Crowne Plaza, a County Council Network Conference in the middle of Gatwick!

The conference was excellent and it never ceases to amaze me that somehow over a period of time you get to know a lot of different people and beyond the sessions and discussion groups some of the most useful time is spent over coffee or a glass of wine chatting about the challenges we face, none more so as this was sort f the first get together after the announcements of the Comprehensive spending revue and we are getting a clear steer as to the cuts that are coming our way.

Ben Page from Ipsos Mori was his usual funny and very informative self as to exactly what the public think about the coalition, CSP and of course Councils, which is err…. shall we say not a lot!

In the private Conservative CCN Group Meeting each county represented gave a brief overview of their issues and a number of common themes emerged that we all agreed to work on. I thought the best quote of the session was “If you are going to stop something do it quickly don’t let it fester!” and there was a general sense that the scale of the savings required needed us all to have a very open and honest dialogue with our residents as to what is required rather than attempt to shield them from the harsh realities.

A line I am certainly taking when I speak on the Radio or write an article for a Parish magazine or two is that if you don’t agree with a cut proposal that’s fine but in commenting you have the responsibility that you must suggest where else that saving should come from, you simply cannot oppose a cut without having that thought process because there is simply not an alternative ‘do nothing’ position.

Eric Pickles MP was guest speaker at the Dinner but was not tight lipped about exactly what was to be in the Localism Bill but he did go around the tables chatting here and there.

Jeremy and I left the conference this morning with a clear sense that we are not alone in our concerns as to the scale of the saving required and the inevitable cuts that would require but that we, through our New Strategic Direction, seem to be slightly ahead of some with a strategy as to how we want to do it.

A trip around the county

As promised in the October Cabinet paper about the future of Residential Care Homes in Suffolk, we are just about to embark on visit to all 16 of the council run homes with our first tomorrow at Lehmann House in Wickham Market.

The format is that managers have had advance sight of the information and lots of information is being sent to each home for the day. Each meeting is scheduled to last 2 hours which we feel should give us plenty of time to discuss and develop ideas with people. I will open each meeting with a short presentation of facts and figures about the issues before us for about 10 minutes or so; then open up the meetings for Residents, Families and Carers; not to mention our excellent staff who welcome to come in towards the end to ask questions or in certain locations because space is tight we will be having meeting after each with the staff.

We have not made up our minds as to how to do this that is what we are now doing and I really hope from the meetings is that the discussions with officers helping me to answer what I am sure will be a wide range of questions and opinions, will give us more thoughts and a better understanding of what needs to be done.

No one is under any illusion that these meetings will be anything but difficult but if we are to make robust decisions as to which option to pursue and we pursue those options, it is right and proper that we take the time to explain on a one to one basis why we must take the actions we are taking for the good of residents in Suffolk in the future. However the programme is quite grueling for the team as each meeting, between the travelling time to and from, the actual meeting and writing up the comments and thoughts it’s a day’s work for each and we have a team of three, myself and support staff.

I really hope that the effort we are putting in is rewarded by what people have to say and I am convinced we will get a lot out of the meetings; as we decide which is the best way forward for us to no longer be a provider of Residential Care homes but use those savings to help support the market place and be able to provide Residential Care homes places for more people in the future.

Below is the notes I have written to help me articulate the slides we will be presenting as I say we need to explain why we are doing what we are doing and allow the time and space for people to develop their own thoughts and help us make the right decisions.

 “Good Morning/Afternoon, my name is Colin Noble and I am the portfolio holder for Adult & Community Services at Suffolk County Council.

This means I have the political responsibility for adult social care, and all the many varied services we provide, services that includes this care home and how we can afford to provide support for everyone who needs the Council’s help now and in the future.

I would like to say a big thank you for coming along today to meet and discuss this with our team, I can appreciate what I have to say is not welcome news and will cause immense anxiety until we have all the answers you need, and clearly understand what is going to happen, so that you can plan ahead when those decision are made.

I am going to be speaking for about 10 minutes and present the facts, not what the papers have reported or you will have heard on the grape vine, the facts and stark choices before us, then I hope we can have a discussion about the options before you.

Consultation – A word or two about consultation and what it means to me: this is about explaining the reasons early about why we can no longer afford to own and run our care homes, even though you and everyone who lives in them as well as family members will no doubt think that I am wrong. This is about allowing me the opportunity to listen to your views and to answer your questions about the difficult choices that we need to make, well in advance of when I present the final paper to Cabinet for their consideration in March 2011 to consider the options for the future of our homes.

Caring – That is not to say I do recognise that is your or your loved ones home. I remember well my Great Aunt who was so fiercely independent but came to call her residential care home,……..home.  By going to each and every one of our homes, I hope you recognise the commitment that we are making officers, my fellow councilors and I consider what the best way to make the change away from running the homes.

Misconceptions and determinations – I also thought it would be useful to clear up a couple of misconceptions about what we are doing I have heard on my travels. Firstly, let me be clear: the decision to stop being a provider of Residential Care Homes is made, but the commitment and determination to continue to support people needing Residential Care home places is undiminished, as are our aspirations to respond and develop services for those who want to stay in their own homes for as long as is possible. The aspiration to stay in your own home is one I am sure we all share for our loved one and for ourselves.

But I recognise there are a significant number of people they need a supportive, professional environment with high care standards that only a good Residential care home can provide

In Suffolk today we the County Council are very much a minority players in the provision of Residential Care homes, we support 476 in our own homes and 2,300 in the private sector we buy 40% of the entire market for those that cannot afford it for themselves and so we have real on the ground knowledge of the good and excellent standards in our homes and the good and excellent standards enjoyed by the 2300 we support in the private sector.

For those who cannot afford it for themselves, the Council has a statutory responsibility and beyond that its one that Councilors and Officers believe it is it is one of the fundamental roles a Council is there for.

But it is equally clear and decided that we are no longer going to be providers of residential care ourselves and the presentation I am about to give explains why.

Comprehensive Spending Revue -I don’t know about you but having watched all the coverage about the comprehensive sending review I really do get confused as to what it all means. But I am not confused about what it means to Local Government in this regard. They have been extremely clear, they are cutting our funding by 28% over 4 years front loaded, which mean this coming year we have to make 10% savings across the council.

People say to me what does this mean? and I simply say life changing in term so far how the what the council is able to do. These cuts are not something open to negotiation: we will simply get less money;

I make no bones about talking about money because it costs you and me as tax payers a great deal of money to support the almost 3,000 people we do in care homes across Suffolk and the 14,000 people who receive other services.

We spend £166M pounds a year supporting people across Suffolk and we are going to have to make savings now and over the coming years just to deal with less money.

But beyond this immediate financial imperative, here in Suffolk we have another issue and so I thought I would start with:

Slide 2:

Giving you a sense of the longer terms issue that I and the team have to consider, living is such a beautiful part of the county and with the great medical advances we have seen and the fact that we are all healthier, means that there will be many more older people in Suffolk and many more older people who will need our help and Support.

The figures on this slide speak for themselves and show a 90% increase in the numbers of older people between now and 20 years time and 100% increase in the numbers of older people with dementia. 

I cannot see no evidence we will be resourced to meet that demand and so it is up to us if we are to provide services to ever increasing number of people then we simply cannot afford to lose money where we know we can save money.

If we do nothing, we will over a period of time deliver less and less services to more and more people.

Slide 3:

Here we can see the actual figures that have formed a part of our decision making process.

In our homes it costs us per week £637 to deliver a care bed and yet we buy off the private sector and by private sector I mean private care homes, Charities that run homes, registered Social Landlords and the not for profit social enterprises that run homes, and we know because we pay the bill that we by those beds on a scale form £306 to £504.

Now is does not take an accountant to see that this means we are overspending between £3M to £4M on our care homes.

A simple calculation shows that if we were to buy alternative places to the ones we provide in all of our care homes at the price we can buy the care for, we would have a significant saving to contribute to the frighteningly wide budget gap. 

So simply put in the provision of residential care beds we are currently losing money where we know we can save money.

At this point I must state my appreciation of the dedication of our staff working in our homes: it is because of their professionalism that the quality of care provided in our homes is judged by inspectors to be good or excellent. Unfortunately, our buildings’ layout and room sizes do not help: they are costly to maintain and run.  This will be an increasing problem as residential care homes provide more places for people with dementia and complex physical needs.

Slide 4:

Rooms are on average twice the size of ours with private en-suite facilities to support the dignity and privacy of people living in homes are something that we will all increasingly expect but we cannot offer these in some of our homes.

They increased use of personal Budget swill also effect the decision that people make.

All of this means that our care homes will fall behind in comparison in the standard of accommodation the independent sector can provide, they may be great today but we simply so not have the money we will need to invest in the future.

How much do we need over the next ?? years Peter?

And do we have that money? – No we do not but the private sector does and people will increasingly vote with there feet.

Slide 5:

So here I want to move from the theory to the actual, here is an example of a new private Care home being build at Balham as we speak, and the people who are building this one, run another couple in Suffolk and are very active members of the Suffolk Association of Independent care providers which we work very closely with.

Its an example of the independent sector investing in a new care home for people with dementia.  It will provide an environment which is comfortable, safe and affordable for people with dementia.

Slide 6:

Here is an example of a brand new very sheltered housing scheme where people can buy or rent an apartment with care on site.

These are examples of standards that we will all increasingly demand.

What are the options for our care homes? The options we are considering must reduce our costs.  They must deliver quality services and they must be realistic.

 Slide 7, Option 1:

This option would mean that your home would close, but I must stress that this would not be straight away.  We would spend time working with you and your family and make sure that you had the necessary social work time and support to help you find an alternative home to meet your preferences.  This might include help to attend open days in other homes so that you could meet the other residents and see what it would be like living there.

Slide 8, Option 2:

This option would mean that another organisation would take over the running of your home and employ the staff who care for you as well as look after the building.

You could choose to stay in your home, if this was to happen, but the new organisation would be asked to modernise the home and make it more efficient.

Slide 9, Option 3:

This option would mean that some homes would close and be sold, which would provide us with money to help pay for changes.  The rest of the homes would be transferred to another provider so that they could be re-developed.

With this option, we would be able to influence the new services.  These could include new, larger and more efficient homes for people with dementia which would be more affordable.

We have named some homes, but these homes might not necessarily be the ones that would close in this option and  decisions about this would depend on conversations with the market.

The new provider would be required to develop new homes in the areas of most need.

Slide 10, Option 3 (continued):

If your home was to close under this option, it would not close immediately but, again, we would spend time working with you and your family and make sure that you had the necessary social work time and support to help you find an alternative

home to meet your preferences.

Slide 11, Your Alternative Options:

I want to consider any other options you can suggest for the future of our homes, other than the ones I have spoken about. These might include other ways in which the home could be run or developed and the type of services it could provide.

As I have explained, all options must reduce costs as well as deliver quality services and they must be realistic.

Slide 12:

I will end this short presentation by saying that your views are very important, if they were not and this was a box ticking exercise, it would be precisely that and we would not be here today. This is why we have arranged to come here today and am going to all 16 of our homes to listen to your comments and to answer your questions.

In closing my bit I must emphasis that the decision to continue to support people needing Residential Care home places is undiminished, as are our aspirations to help people who want to stay in their own homes for as long as possible do so.

We recognise that for a significant number of people in our neighbourhoods need a supportive, professional environment with high standards of care that only a good Residential care home can provide.

And as I said at the start, for those who cannot afford it for themselves; not only does the Council has a statutory responsibility, its one we welcome as an important part of our role to support people and we will continue to do so.

As we go thought this morning / afternoon we will be taking notes of what is said and these will be published on our web site where you can see what was said here today and importantly what is being said in our other homes, At the end of out time here today Peter Tempest will sum up the threats of our discussions and we’ll be here at the end if you did not get the chance to ask your question, you are most welcome to my business card to contact me personally and if you think of other things later the consultation is open until on the 24th January.

Thank you for listening to me and who would like to ask the first question?”

A short Speech

A few weeks ago I did something new!

I was contacted by the Dioceses of St.Edmundsbury and Ipswich who run a progrmme for church elders to provide a ministry to older people, they asked me to come and address the opening of their next course and not thinking I said yes, happy to. Having said yes I asked how long they wanted thinking, 5 maybe 10 minutes, and they said casually ‘oh about 40 minutes maybe with a few slides and then Q&A’, glup!, I don’t think I had ever spoken for more that 10 minutes in my life, but in for a penny in for a pound! – here is what I said:

“A ministry to older people

Good afternoon, my name is Colin Noble and I am the portfolio holder for Adult & Community Services at Suffolk County Council. This means I have responsibility for adult social care, which includes the many varied and innovative ways of supporting Suffolk’s older population.

I would like to say a big thank you for inviting me to talk to you today.

I am going to be speaking about how the county council is working with its partners in Suffolk to enable older people to live independent, longer and more fulfilling lives.

At the end we have a hand out and a copy of the slides and I will send on to Kathleen a transcript my words and any questions and answers we discuss today.

To start, I would like to begin with an overview of the environment in which we are working. This will be the first half of my presentation, and I will then invite questions. The second half will focus on the range of services available to support older people in Suffolk.

It is certainly true that we live in interesting times. The public sector is facing unprecedented change, largely brought about by the government’s priority to reduce the deficit. For local government on a national scale, this means in year cuts of some £1.165bn, which in turn demands some serious thinking about delivering services that are more cost efficient and more joined up.

But it’s not just an issue that affects local councils. Health is in a similar position, with the recent announcement to have a major reshuffle to the NHS with changes to strategic health authorities and primary care trusts. Our latest thinking is about the many ways that social care and health cross over in people’s lives, and how we can work better on a more local level to reduce costs and improve the care and support that people receive. This has to be good sense as it saves unnecessary hospital admissions and the number of people who need long term, more expensive care.

These far reaching changes will also impact the police and voluntary and independent sector partners, many of whom supply services to the county council.

Suffolk’s demographic profile is also of interest here. Suffolk is a large county, and is home to around 715,000 people. In figures just published by the Office for National Statistics, Suffolk outstrips the national average for residents aged over 65 over the next 20 years. This means more pensioners than people under 16. On the one hand, it is very positive that people are living longer in Suffolk. On the other, demand for local services is likely to increase in direct proportion to the rising elderly population.

At the same time, the number of people living in Suffolk affected by dementia is set to rise by 65% for those aged 65 and over – from approximately 10,000 people in 2008 to more than 16,000 people in 2025.

So, what is to be done? While we face key challenges, many of them financial, we also have a golden opportunity to do things differently.

The county council is meeting these challenges head-on with its New Strategic Direction. This is a blueprint for how we will work to become a leaner, more dynamic organisation over the coming years. It is a direct response to central government’s call for more responsive services delivered locally, and to the formidable and sobering target of working with up to 30% less funding. Of course we’ll know more after the government announces the results of its Comprehensive Spending Review next month.

All of this will be possible only if we accept that no single organisation can work on its own. The county council is excellently placed to spearhead this collaborative approach, and to do so we must work much more closely with our partner organisations.

 

It is also the case that we must empower people to do more themselves, within their community. To use just one example, people in Debenham in Mid Suffolk have set up their own local support network for people suffering from dementia, their families and family carers. This is only possible with the enthusiasm, commitment and energy of local people to run lunch clubs, produce fact sheets, provide friendly local support with day to day tasks, and a whole host of other supporting information.

This theme of encouraging people to do more themselves will be more embedded in the way we do our business over time. Please don’t think this is about the county council shirking its responsibilities – far from it as I hope you will come to see by the end of this presentation.

We have just commissioned some local research with older people across the county to determine their expectations from the state when it comes to receiving services and support.

 

The vast majority of participants told us they were firmly of the opinion that they had to take responsibility for their wellbeing. This could be everything from getting involved in local clubs, organisations, to learning new things through adult learning to keeping a close network with friends and family.

Older people taking part in this research were well aware of the challenging financial circumstances that we face, and gave us plenty of advice about promoting the many positive ways that people can stay active, keep healthy and get involved. We will be using the outcome of this research to promote the many ways that we can encourage this self-sufficiency.

In her work around the psychological aspects of ageing, Dr Ellen Langer identifies a self-perpetuating cycle in which many people believe they get worse and worse over time, and therefore can do less.

As she puts it: “People assume that everything is to do with age – from forgetting keys to aches and pains – and don’t take steps to make changes. If you believe you can’t do something, you don’t try, and if you don’t try, you get more and more evidence that you are not able to.”

Of course, this positive attitude approach is not always possible for people who have an acute illness or disability, or need more intensive support.

However, if we can give people the support they need at the earliest possible opportunity, we may be able to avoid them getting any worse. In other words, we can help people sooner, therefore benefiting them mentally and physically, which will ultimately reduce costs for social care and health with fewer unnecessary hospital admissions or demands for long term care.

At this point I would like to take a short break by inviting any questions on what I have said so far.

So in this Part 2, I am to give you some examples of how our approach to supporting older people to remain independent is operating in practice. On the broadest scale, social care is working closely with health to keep people in their home for longer. We are considering plans to bring together community matrons, social workers and many other crucial staff from both NHS and the county council so that people can benefit from their combined expertise and skills. This means better, more responsive services for people in their area, and in theory only one professional visiting a customer’s home to give them the support they need.

On the subject of working with our partners, I am also proud of the steps we are making when it comes to accommodation and housing for older people. We have an obligation in Suffolk to consider current and future housing needs. With the rising older population in Suffolk, this is going to be more important than ever. Time and time again, older people state that they want to remain in their own home. This is essential for supporting a longer, healthier life and the number one priority for us in reducing the number of people going into long term residential care unnecessarily.

 

In the summer I invited colleagues from district and borough councils, housing associations and provider organisations to commit to a strategy to create a vision through to 2020. Suffolk Flexicare is the result, and will be crucial as we plan ahead to deliver a sustainable infrastructure for housing, technology and innovative services in the years to come.

But there is plenty that we are doing now. Major advances in technology mean we are installing special equipment in people’s homes, making it easier for them to carry out day-to-day tasks from getting out of bed in the morning to boiling a kettle.

We have introduced a 24 hour telephone support service, linked to a community alarm, which gives people reassurance at all times of day and a quick response in an emergency. Finally, people are taking up the opportunities provided by the Disabled Facilities Grant to adapt and improve their home. This council grant offers significant support for people who are frail, or who have a disability, making it possible to install essential home modifications from handrails to moving bathrooms downstairs.

One of the points of interest about delivering services in the new world is that the county council is not necessarily the best organisation to provide those services. You may have seen recent headlines to the effect that we will be handing over responsibility for delivering some aspects of adult care to other organisations.

This is only one possibility, but with a very well managed and effective network of local organisations proving support locally, it would make sense if they were to take on more responsibility over time.

The second consideration is how we give older people choice to take the decisions that affect them. This is key to keeping people safe and well in their own home, and studies have clearly shown that greater choice prompts more control, and this is better for all.  

Everyone benefits from having a network of people around them, from neighbours to friends and family. This is what central government wants to see as part of its ‘Big Society’.

Take the example of the ‘Home from Hospital’ scheme which we run alongside the British Red Cross. Consider this: if someone is going into hospital, who is going to look after their pet, or put out the rubbish? This can create a huge amount of anxiety, and with this scheme, help is at hand from volunteers to do just that.

 

We’re also taking theBig Society’ theme one step further with the introduction of the Suffolk Circle. This is a pioneering project based on a similar idea in Southwark in East London. The Suffolk Circle is a membership organisation which enables people to volunteer their skills to help others, from fixing a leaky tap to doing the shopping.

It means that older people can register to find out what services and support are available in their area. If they choose to do so, members can then pay for tokens which entitle them to a specific task provided by a volunteer such as mowing the lawn, or taking the dog for a walk.

But volunteering can of course be free, and we would want to encourage more communities to get involved with helping one another.

 

I cannot overstate the important role played by the less formal networks and groups that run in our communities. By this I mean the lunch clubs, book clubs, family carers’ networks and others.

Much of this work is carried out by volunteers who offer their own time and skills to help others. The selfless contribution from Suffolk’s 98,000 family carers is hugely important for two reasons: firstly and most importantly for the many friends and loved ones who benefit from their support, but also to our local economy. The economic contribution made by family carers throughout the UK per year is a staggering £87billion, so we cannot for one minute underestimate the major role that family carers play in our society.

In recent months, there have been plenty of innovative services to support family carers. I could name many examples, including support for carers to plan ahead in case anything should go wrong, accessing better information, and identifying short breaks through the pioneering Time For Carers website.

In Suffolk we enjoy a positive working relationship with Age Concern Suffolk and others with our Partnership for Older People in Suffolk, or POPS. The purpose of POPS is to bring together older people with others to look how they can be supported to remain independent and have an enhanced quality of life. This includes all aspects of healthy living, promoting positive attitudes to ageing and challenging perceptions of what older people want and what they can and cannot do. POPS has established forums across the county for discussion and debate on these topics and more.
Local agencies also signed up to a Charter for Older People, a joint commitment which outlines:

  • the rights that older people in Suffolk should be entitled to enjoy;
  • the opportunities they should expect; and
  • the responsibilities and aspirations of those who provide their activities, services and support.

In addition, the Voice panel consults older people from their home, employing short interviews to enable people to have their say when influencing the way their services are provided. 

The latest Voice report, entitled ‘My House: My Home: My Life’, found that 60% of participating older people lived on their own, and of that number 17% had no close network of support. In the same report, people were asked what made them most happy about where they live, and answers included the location, being near family, friends or amenities.

These are the challenges that we must confront with our voluntary sector partners, and with the organisations that provide services to older people. We must get better at doing more to spot potential problems early on. The Home Shield Plus service is making great inroads by ensuring that anyone visiting an older person in their home can report any maintenance or related problems to be fixed by the relevant agency.

By calling our Customer First service and reporting the problem during or after a visit, hazardous objects, leaking pipes or faulty smoke alarms can be fixed without leading to any further problems. In this way, the wellbeing of older people becomes the responsibility of every home visitor.

 

Customer First is the county council’s dedicated first point of contact for social care enquiries. Staff handle around 4,000 calls every week – that’s over 200,000 calls per year! If you consider the sheer variety of services provided by adult social care – everything from simple information and advice to the specialist expertise needed to manage often sensitive adult and children safeguarding enquiries – this is no mean feat.

Libraries are a lynchpin in the community when it comes to information and for opportunities for people to get involved. Take Top Time for example, with its combination of book and theatre groups, arts and crafts and local history. Top Time events are organised in libraries across the county, with many older people getting involved and meeting others. LEAP centres are now an integral part of some of our libraries, offering courses and opportunities for people to try something new or learn a skill.

For many years the perception has been that older people ‘do not do computers’ but this simply isn’t the case. Recent studies into the way we use media at home and work shows that older people represent a significant share of the market when it comes to regularly accessing broadband to surf the web.

Libraries offer free Internet access, and there are many more opportunities to join the worldwide web for all ages. In the 21st Century, the county council, like the majority of other organisations, is relying more than ever before on the website as a source of information and advice.

As part of the ethos for encouraging people to do more themselves, we have created a web directory of local services, from clubs and societies to GP surgeries, called Suffolk InfoLink.  This website contains a wealth of information so that people can find what they need, when they need it.

Intergenerational projects are worth mentioning, and run in conjunction with our partners such as Artlink. These fascinating projects encourage people of all ages to work together on projects from Suffolk’s history and heritage to a photographic catalogue of our countryside. 

 

Finally, I would like to reiterate that we face a great opportunity in Suffolk to transform the way we work together to support older people. This is as much about challenging perceptions and myths about ageing as it is about offering choice enabling people to do more themselves. It is true that we are facing acute challenges in the cost of providing services with the backdrop of reducing funds and growing demand. But I hope I have illustrated the many ways that we are working together to offer the help, advice and collective support for older people to live better, more fulfilling lives than ever before.”

If you read thought that lot, thanks and well done!

 

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