Agenda item

11.40 am

Members will recall the work that was done on the subject of the “demographic challenge” a joint working group comprising members from the HOSC and the Social and Community Services Scrutiny Committee. Their work resulted in a report that contained a number of "red flags" and members would be interested to know what progress has been made in dealing with the concerns raised in the report. The summary of the report that was accepted by the Cabinet in January last year is attached for your information at JHO8(a).

Furthermore, and closely related to the above, the papers "Successful Ageing in Oxfordshire: a high level strategy" JHO8(b) and the associated "Proposal for Integrated Planning and Commissioning Arrangements for Ageing Successfully" are attached at JHO8(c).

The following people will attend for this item in order to provide a report on progress and also to inform the Committee about how they intend to come together in order to contribute to the work on the demographic challenge:

Councillor Jim Couchman, Joint Chairman of the Health and Wellbeing Partnership Board;

John Jackson, Director of Social & Community Services;

Alan Webb, PCT Director of Service Redesign;

Marie Seaton, Head of Joint Commissioning (Older People);

Nick Welch, Head of Major Programmes in Social & Community Services; and Jonathan McWilliam, Director of Public Health.

OJHOSC members recalled that previous work had been undertaken by a joint working group comprising members of this Committee and of the former Social & Community Services Scrutiny Committee on the subject of the ‘demographic challenge’. Their work had resulted in a report which had contained a number of ‘red flags’ representing concerns. The summary of the report that was accepted by Cabinet in January 2009 was attached to the agenda for information (JHO8(a)).

In addition to, and closely related to the above, the Committee had before them a paper entitled ‘Successful Ageing in Oxfordshire: a high level strategy’ (JHO8(b)), together with an associated paper entitled ‘Proposal for Integrated Planning & Commissioning Arrangements for Ageing Successfully (JHO8(c)).

The following people attended for this item in order to provide a report on progress and also to inform the Committee about how they intended to join together to contribute to the work on the demographic challenge:

-                      Councillor Jim Couchman, Joint Chairman of the Health & Well-Being Board and Cabinet Member for Adult Services;

-                      John Jackson, Director of Social & Community Services;

-                      Jonathan McWilliam, Director of Public Health;

-                      Marie Seaton, Head of Joint Commissioning (Older People);

-                      Alan Webb, Director for Service Redesign, Oxfordshire PCT.

Alan Webb thanked the Committee for inviting him to participate with this item, pointing out that this was an excellent example of joint working in action in relation to the taking forward the commissioning of services for the Oxfordshire population. He added that Oxfordshire benefited from having a large number of pooled budgets in operation.

Marie Seaton introduced herself stating that she was a joint appointment of Health and Social & Community Services. She added that her key remit was to bring together the appropriate teams and to pull together the ‘Ageing Successfully’ Strategy for the older people of Oxfordshire. Moreover, it was not a community plan, rather a direction of travel to support older people ageing in Oxfordshire. It considered how people might be engaged in following a healthier lifestyle, following a listening exercise when people were asked what they valued for keeping their health as they got older. She added that a better outcome to deal with increased demand had to be a joined up approach with different organisations looking at how they could intervene with different approaches, and funding streams, as people aged. There was a need to reduce the demand on Health and Social Care, although essential components, and to bring in transport, Extra Care Housing etc.

John Jackson cited, as an example of the significant amount of partnership working which had begun to take place as shaped by Marie, the work undertaken to improve the quality of  people’s experience following a stroke. He directed members’ attention to a paper which had been prepared for the forthcoming meeting of the Health & Well Being Partnership Board.

Members of the Committee asked a number of questions from the Panel and some of the responses are included below:

Q         To what extent do you consult with the older people themselves?

R         (Marie Seaton) The Strategy refers to a raft of consultation which has already taken place. The PCT commissioners work to ensure that engagement with older people will be ongoing.

Q         How much work is going into the mental health elements of the project?

R         (Marie Seaton) Age related dementia is a big issue. This is a priority for the County Council and the PCT and there is a pilot project in operation, with the aim of improving dementia awareness. The key issue is the early diagnosis of dementia and there has been a significant amount of good work with the Oxfordshire & Buckinghamshire Mental Health Care Foundation Trust and the Oxfordshire Radcliffe Hospitals NHS Trust.

Q         What steps have you taken to target middle aged people, or those in their thirties and forties, to encourage them to change their lifestyles?

R         (Marie Seaton) There is indeed the need for a radical shift in perception and, to address this, Public Health  have employed a large raft of initiatives aimed at encouraging people to gear up to seeing themselves as valuable citizens within the local community, as against old or dependent.

Q         Will you also have some depression awareness in place. Depressive illness is the predominating illness for middle aged and older people. Until their depression is treated they will be unable to move forward.

R         (Dr McWilliam) I agree that depression is certainly part of the risk. This Strategy needs to join up with the strategy for adults with mental health difficulties and with the Psychological Therapies service.  Scrutiny has a role in ensuring this happens and in checking to ensure that older people understand the services that are in place.

Q         What about the position with regard to delayed transfers of care?

R         (Alan Webb) We continue to focus our efforts on these, which are still too high. The latest report indicates that they total 70 across the whole Health system within Oxfordshire.

(John Jackson) There is a section focussing on tackling Delayed Transfers of Care in the Strategy. Addressing this problem is integral to reducing the numbers of people entering acute care and, allowing people to go along a chosen pathway  towards re-enablement in their own home. Help could be provided within the community by the district nurse or by social care. The vast majority of personal care is not paid for by the state, it is provided informally by friends and relatives. We are very grateful to many people working collectively in town and rural parishes who assist and encourage older people to remain active and independent for as long as possible.

(Councillor Couchman) In order to do this it is important that the right service is available at the right time. For example, a great deal of effort has been put into the redesign of the continence services to ensure that people do not have to go into residential homes too early.        

Q         How far have you got with the work being done with the ‘red flags’ which featured in the scrutiny review?

R         (Councillor Couchman) Partnership working is now playing a significant part in addressing the required  work, as indicated by the red flags. For example, three of Dr McWilliam’s Public Health priorities are in this area and have made a significant contribution to ‘Ageing Successfully’. Virtually all of the red flags are under scrutiny and under action. Marie’s appointment will draw us even closer to our goals. In Oxfordshire we enjoy one of the closest relationships between Health and Social Care compared to most authorities.

John Jackson directed the Committee’s attention to the County’s partnership working with the district councils with regard to Extra Care Housing. He added that there was still much work to do across all organisations.

Q         How do you target rural isolation issues?

R         (John Jackson) The data available to us, as set down in the  Oxfordshire Joint Strategic Needs Analysis, breaks down the need for support at ward level. This document found that there was a significant amount of support already in place for older people, which is rural based, and it is very important. We counted 300 different activities for older people available within Oxfordshire from Rotary/Lions Club dinners to day centres.

With regard to the rural isolation issue, Councillor Couchman pointed out that there was also a further consultation opportunity for older people to contribute to the Local Transport Plan (LTP3).

Q         At the moment the Council is coping financially, but are you confident that you will be able to sustain your aims and objectives in the future?

R         (John Jackson)  We recognise the scenario and, to this end, we are working hard to adhere to our aims and objectives, to reinforce the importance of joint working and to have a clear Strategy in response to it. The problems will centre on  rising demand and resources and on the question about how  to reduce the need for more expensive forms of care? The paper prepared by Dr McWilliam addresses part of the discussion, focussing on the prevention agenda.

Alan Webb stressed the importance of the healthy living agenda, adding that the Strategy would enable partnership organisations to do that. He cited as an example the work of the Falls Service and of stroke prevention. All were crucial, enabling the partners to focus on reducing the level of resources to ensure that people who really require the acute services and residential care, received it.

Marie Seaton added that in the longer term there would be a generation of people coming through with differing expectations from the current older generation. On this basis, the Strategy was achievable, though its impetus would be on the financial pressures on the public sector moving forward.

Q         How can volunteers help to keep older people stimulated and healthy, for example, those suffering from early dementia, particularly those living in the rural areas?

R         (John Jackson) The Healthy Walks Scheme has proved successful to date, as has the jointly funded training, for example seated exercise classes. There are also Memory classes held in Wantage and the Oxfordshire Loans Collection (heritage services) are both designed to keep people’s minds and bodies as active as possible.

Alan Webb pointed out that the PCT were working with Oxfordshire GPs to find ways of diagnosing dementia earlier so that patients could embark on a course of treatment earlier.

Individual members of the Committee put forward the following issues which they felt to be of direct relevance:

• Older people living in both rural and urban areas tend to worry about lack of transport available to them when they cease driving. There were many community transport providers who operated in a flexible and creative way by tailoring their services towards the needs of the community. Could there be more of this? ;
• Older people also worried about isolation and the loss of companionship resulting from the policy of more care in the home and less emphasis on residential care. Many people’s zest for life was reignited on entry to a residential home. More ‘halfway houses’ offered by providers such as those by McCarthy Stone, offered independence and activities could be the answer; and
• Subsidies for rural bus services as part of the Strategy (via the LTP3) could be the key.

John Jackson pointed out that the above issues were considered within Age Concern’s ‘Age and Social Care Plan’. He added that this was a very significant issue and more work was to be undertaken on it. Older people would be encouraged to make their points heard from a local perspective and to get involved. He cited a voluntary link-up scheme which was jointly funded by OCC as an excellent example of a the way in which a pot of money could be taken and used successfully.

The Committee thanked Councillor Jim Couchman, Cabinet member for Adult Services; Marie Seaton, Head of Joint Commissioning (Older People); Alan Webb, Director of Service Redesign, Oxfordshire PCT; John Jackson, Director of Social & Community Services; and Dr Jonathan McWilliam, Director of Public Health for their attendance and for responding to questions from the Committee. The Committee gave their support to the ongoing work and requested that they be given a further progress report in a maximum of 12 months time.