ITEM EX8
BEST VALUE COMMITTEE - 7 JANUARY 2002
Review Report and Action Plans
Service Area Under Review:
Support for Older People
Core review team membership	Review Leader	Lorna Brown, Assistant Director Community Care Division, Social Services
PPRU Officer	Mark Ginsburg, Performance Review Adviser (to September 2001)
	Neil Lawrence, Performance Review Adviser (from September 2001)
Designated Member	Cllr Biddy Hudson
Independent Members	Laura Spurs, Cherwell Vale Primary Care Trust
	Mary Daniels, Age Concern
	Paul Whitfield, Principal Housing Officer, Cherwell District Council
Other core team members:	Jenny Lee, Service Manager, Community Care Division, Social Services
	Rob Finlayson, Finance Manager, Social Services (Treasurers representative)	
Service Budget	£65.8m (full cost of all services to Older People)	
Terms of reference (taken from the Baseline Questionnaire)	1.	Re-examine County Council structures for involving older people in decision making about services and access to them. This will lead to options for improvement to ensure older people really do have a voice in shaping future services. A significant part of this piece of work will be consulting with older people and representative organisations.
2.	Investigate current arrangements for access to information and services for older people. Develop cost/benefit analysis of different service options and draft measures of effective performance
3.	Collate information about, and access to, all services which support older people - to ensure the overall objective of 'helping older people live as independently as possible for as long as possible' is achieved.
Particular attention will be paid to:
•	Comparison with other councils
•	Discrimination on the grounds of age
•	Hard to reach groups, eg
•	Ethnic minorities
•	Older people with
•	Sensory impairment
•	Learning disability
•	Physical disability
•	Mental frailty/Mental health needs
•	Older people who live in rural isolation 
•	Older people living in poverty
4.	Develop an overarching strategy, with strategic partners, and identify a champion, to drive 'support for older people' in order to identify how we can do it better	

Cross Council Best Value Review
Support for Older People – Executive Summary

Introduction and Review Focus 
The County Council participation in the Better Government for Older People (BGOP) pilot programme concentrated on how organisations and services relate to each other, and identified the gaps and overlaps. This Review considers how well the Council provides support for older people, and in doing so has focussed on Access to Services, Communication and Information, and Consultation, Involvement and Engagement.

The Review has not identified any cost savings, nor areas of major expenditure. The proposal to seek to become a CAREdirect pilot authority will attract start-up and revenue funding from the Department of Health if successful.

In order to effectively implement the recommendations of the Review, a lead officer with sufficient seniority will need to be identified. It is suggested that the current review of County Council structure offers an ideal opportunity to address this.

Conclusions
Access to Services
1.	Older peoples’ needs are not included in the plans and policies of the authority. This applies in particular to marginalised groups within the older population. The necessary culture change required to bring about these changes has not materialised from the BGOP project, and the initial enthusiasm to improve services has not been sustained.
2.	Despite there being a corporate Member champion for older people, there has been an insufficient corporate focus at senior officer level to drive necessary improvements through the Council.
3.	An overarching County Strategy for Older People is required to ensure that the plans and policies of the authority address the needs of older people, and that sufficient corporate attention and priority is given to this growing section of the County’s population.
4.	The Cabinet Office checklist offers a structured approach to identifying current shortfalls in access to services and should be used as an audit tool within Oxfordshire. Without further auditing it is not possible to be sure that all County Council policies are free from age discrimination.
5.	There have been notable achievements in Oxfordshire in improving transport provision, and proposed policy changes may further contribute to addressing the needs of older people. However, older people feel their transport needs are not being met The proposed Executive review of bus subsidy policy should be used as an opportunity to examine how effective current policies are in meeting the needs of older people and other socially excluded groups and therefore meeting the specific objective contained in the Local Transport Plan.
6.	Projects that grow from communities need to be regarded as mainstream activity and a mainstream responsibility and their different methods acknowledged as helping to achieve corporate objectives, particularly those of BMEC older people. Appropriate support should be given, and cross-agency funding streams clearly identified.
7.	Fair Access to Care will introduce an eligibility framework to ensure consistency in decision making. However, the current structure of the Social Services Department allows for unplanned discrimination in policy and operations.
8.	A unified assessment process is needed to remove duplication between Health and Social Services.
9.	Shortfalls in staff and funds for equipment are preventing older people with chronic illness or disability living as independently as possible.

Communication and Information
1.	There is a clear need to improve the way staff at Oxfordshire County Council communicate with older people to improve their access to services. Information made available in printed format is currently of inconsistent quality and scope. The implementation of the Customer Care Best Value Review, in particular the proposed customer care policy, will need to take this into account.
2.	There already exists a great deal of information for older people, and a large number of agencies involved in its provision. However, this activity is uncoordinated, which leads to good practice not being shared, and the information needs of older people being overlooked.
3.	There is scope for optimising the use of current information channels, or considering imaginative use of existing networks, such as home support (domiciliary care) staff, or the mobile library service. There are plenty of opportunities to spread headline information using parish magazines or local radio (both accessible to the rural housebound).
4.	Better provision of information and support to 'secondary providers', such as professionals in the statutory and voluntary sector, could realise significant improvements in support for older people. Access to IT and to the Internet for these providers are critical building blocks to achieving success.
5.	The new enhanced county web site will substantially improve delivery of information to older people – even for those without access, interest or skill with web sites themselves. Opportunities for joint work with e.g. City and District Councils will be considered and the existing ‘Oxweb‘ group led by the City Council should facilitate this.
6.	Extended access to services outside normal working hours is required but a 24-hour phone service provided by one agency in isolation, for instance, may have a limited impact. Further development of one-call resolution of problems and to act as a better-informed ‘front door’ is required. The structured, co-ordinated cross-agency approach of CAREdirect presents an excellent opportunity for this to be developed.

Consultation, Involvement and Engagement
1.	Although there has been good progress in relation to the involvement of older people there is further work to be done to develop existing mechanisms and to promote engagement with excluded groups. Opportunities should not be missed for eliciting feedback in the course of any contact between an individual and the authority

2.	There is potential for duplication in the consultation processes set up, and concerns about effective representation. If multiple for a are to continue they need a clear remit and funding stream.

3.	With the current migration to strategic health authorities it is not appropriate at this time to revise current countywide consultation co-ordination. However, this should be reviewed once the final structures have been agreed.

4.	The Council’s Internet site should incorporate mechanisms to allow feedback on its services (as well as the site). Written information should also offer this opportunity.

5.	There is scope to further utilise existing mechanisms across County Services: the Corporate Consultation Group can promote this. Further work is needed to co-ordinate consultation activity across the County Council and other public authorities to ensure that results are shared and overlap minimised. Options for development and a tool-kit for managers are currently under development by the County Consultation Officer and will incorporate the Review findings.

Recommendations for Action
1.	In partnership with other key stakeholders, develop a County Strategy and ensure that all services are planned and provided with the needs of older people in mind.
2.	Improve consistency in decision making and access to Social Care provision
3.	Incorporate the communication needs of older people within the plans for a proposed customer care policy, including publications and training associated with this development.
4.	Introduce a co-ordinated information delivery model for older people, either as a pilot authority in the national CAREdirect scheme, or by developing a local model based on existing delivery methods.
5.	Establish formal mechanisms through which the representative views of older people are obtained by the County Council as part of its decision making process. Successful, existing mechanisms to be built upon, with financial contributions made to any participating organisation. 

Introduction and Scope of the Review

Britain has an ageing population. The proportion of the population over the age of 50 has doubled this century and this trend is set to continue with over 40% of the population likely to be over 50 by 2021. It is estimated that by 2021 there will be over 12 million pensioners, nearly 20% of the population in the UK, over 2 million more than present levels. 

The Government expects statutory organisations to support older people to help them live as independently as possible for as long as they wish. To achieve this, statutory, voluntary and private organisations offer a range of services. Evidence shows that if the right service is available to the right person at the right time, they can remain independent for longer.

The final report on Oxfordshire's Better Government for Older People pilot (October 2000) looked to this review to undertake a fundamental review of all services that the County Council provides to older people. However, to investigate this properly would be an enormous task, and therefore too wide a scope for this review. Considerable work had already been undertaken as part of the Better Government for Older People (BGOP) pilot, which concentrated on:
•	how organisations and services relate to each other,
•	the gaps & overlaps

The BGOP project did identify that “there was scope to improve access to County Council services which either directly support or enhance the quality of life for older people in Oxfordshire”. In this respect, ‘information and access to services’ was considered to be a manageable area to review in depth. As far as possible this also encompassed the interface with District / City Councils and Health organisations.

Four main areas of work were initially identified in the Baseline Questionnaire;
•	Re-examine County Council structures for involving older people in decision making about services and access to them
•	Investigate current arrangements for access to information and services for older people
•	Collate information about, and access to, all services which support older people to ensure the overall objective of ‘helping older people to live as independently as possible’ is achieved
•	Develop an overarching strategy, with strategic partners, and identify a champion, to ‘drive support for older people’ in order to identify how we can do it better.

 New political management arrangements, introduced while the review was ongoing, have impacted on the proposed work on democratic involvement. One of three reviews being carried out for the new corporate governance scrutiny committee is on standing consultation arrangements. This work is to be carried out by April 2002. To ensure that the needs of older people are integrated into overall future arrangements made by the Council for democratic involvement it was decided to concentrate on highlighting these for consideration as part of the wider review.

Work Undertaken
The prime focus was on consulting locally with a range of stakeholders: 
•	consultation groups of older people 
•	individuals with particular experiences (e.g. visual impairment), 
•	professionals 
•	the voluntary sector (including information providers and advocates) 
Throughout, particular attention was paid to marginalised groups of older people; 
•	the Black and Ethnic Minority Community (BMEC)
•	those with sensory impairment, physical frailty and disability, mental health needs or learning disability
•	those living in rural isolation
•	those living in poverty
Reference was made to current and complete research, guidance and material produced by others. This included recently started projects of relevance to the review. Research based on Oxfordshire older people has considered decision-making about access to care services and the circumstances of older people. 
A preliminary audit of Age Related policies which would restrict older peoples’ access to services was commenced. This primarily focussed on Social Services and Health but included other County Council departments and District Councils were invited to participate.
A workshop was held to consider two ‘directions forward ‘ arising from the review, to raise awareness, and engage key people across all relevant agencies in an ongoing programme of work. This considered the Government CAREdirect initiative and a County Older People’s Strategy. An interview also took place with the DoH project director for CAREdirect.
Comparison was made with other authorities. Best Value Reviews, Better Government for Older People, Health Action Zones and Beacon Authorities were looked at. Comparisons were difficult as most examples of good practice in the area of information and access were in urban, single tier authorities and so the complexities of delivering services in a rural area like Oxfordshire were not covered. Examples of good practice with regard to support for ethnic minorities were found in urban areas.

Access to Services 

Older people value independence, dignity and control over their lives. Services must be sensitive to individual differences in the coping resources and styles that older people bring to life events and difficulties. Older people constitute around 14% of Oxfordshire’s population and meeting their requirements for services should not be regarded within local government either as marginal or as a social care responsibility alone.

The Cabinet Office published an Access Checklist in March 2000 with the aim to help managers of public services evaluate how accessible they are to their users and identify areas for improvement. It looks at the service provided, the quality of information provided and the culture of the organisation. This has not been used within the County to date.

Better Government for Older People (BGOP)

The final evaluation of BGOP was reported to Strategy and Resources Committee in April 2001, following the end of the project in July 2000. It found that the project had been significant in the county: strengthening the cross-departmental and cross-organisational work with and for older people, and raising the profile of older people's needs. Many beneficial changes resulted in the form of practical projects and raised awareness. 

At the same time, the evaluation stated that while the principles of BGOP were followed in a number of projects; "It does not seem that these have been brought together in a planned way to establish strategies for service development". A series of discrete tasks arose from the work rather than an overarching strategy or change in policies to seek to improve services for older people across the council. While Individual departments participated in the BGOP project, each continued to work in isolation rather than on a corporate basis. This was because there was no officer lead with sufficient seniority to drive through a permanent change agenda.

The Council's application for Beacon status made reference to limited collaboration between departments, limited engagement by non-social services departments with older peoples' issues, and recognised the potential for uncoordinated activity in the authority.

The last evidence of formal monitoring of the action plans associated with BGOP was a report was to Strategy and Resources Committee in April 2000. A resolution of the same Committee in April 2001 was that Chief Officers report to their programme committees on the incorporation of their action plans into departmental Medium Term Plans, and report annually thereafter on progress in meeting the needs and aspirations of older people and their level of involvement in that provision. There is no evidence of these reports having been made to programme committees prior to the introduction of the new political management structure in November 2001, and arrangements for ensuring this now takes place are unclear.

A similar story applies implementing the requirements of the Disability Discrimination Act and the Race Relations (Amendment) Act. Because there has been no overall ownership of the issues or accountability for implementation, the spirit and letter of these Acts has not been fully taken on board. Many improvements in services to older people could be realised by addressing this alone.

Age Discrimination

Standard 1 of the NHS National Service Framework: Rooting out age discrimination states that “NHS services will be provided, regardless of age, on the basis of clinical need alone. Social Care Services will not use age in their eligibility criteria or policies, to restrict access to available services’’

The Age Discrimination Audit commenced as part of the review is a preliminary step towards ‘rooting out’ age discrimination. It deals with explicit policies that exclude older people from services for adults on the basis of age. However ongoing activity is essential to heighten awareness to inadvertent or hidden forms of age discrimination. Action to tackle discriminatory behaviour associated with disability or ethnicity will also benefit older people.

The Audit found policies within Social Services that require attention: either to justify a policy or change it. Evidence of discrimination found primarily originates in the structure of the department which separates services between age groups of adults. Policy development and budgets follow this divide, and so a degree of inequity has resulted.

Trading Standards Service has no age barriers within their policy and procedures. Policies from other County Council departments and District Council’s have not yet been audited.

Other Research Findings

An understanding of the diversity of older peoples’ needs is a pre-requisite to improvements that they can recognise, as is imagination in delivering services differently. As an example, Libraries could take responsibility for Talking Books for visually impaired people from Social Services and so further promote social inclusion.

Brookes University undertook a study in 1998 of the consistency of decision making in assessment and care planning for older people in Oxfordshire Social Services. They found there was rarely unanimity amongst care managers about priorities, needs or services required although there was often agreement about certain core needs and service such as personal care and nutrition. Diverse decision making across the county persists in that the average cost of care packages varies between areas. Practitioners are expected to exercise judgement and discretion and so a certain level of variability is to be expected. However the authority needs to ensure that practice is as consistent as possible.

Access to health and social care services often involve multiple and duplicated assessment processes. Clearly, this not beneficial for older people who are interested in receiving a streamlined and seamless approach from statutory organisations. Health and Social Care ‘systems’ are required to work towards a local unified assessment process under the National Framework for Older People which should assist in improving efficiency, introducing a more seamless service and improving co-operative working between Health and Social Services. 

The implementation of ‘Fair Access to Care’ guidance will harmonise eligibility across adult care groups and address issues of consistency in decision making for assessment and care planning ensuring that no decisions are made on the basis of age alone (i.e. it will remove age discrimination).

The main barrier to older people in rural isolation in accessing services is transport. This was highlighted in Age Concern’s report ‘Lilac from the Garden'; a study focussed on Oxfordshire’s Day Services. However there were also issues of distance from services and the importance of outreach work in helping with access to services. 

Mental Health problems are a significant issue in older age. Depression can result from isolation and marginalisation. There is potential for environmental improvements to alleviate the difficulties of memory loss and early dementia. Housing appropriately adapted and a local environment with adequate signs can maintain independence for longer without personal services. Appropriate public services outside Health and Social Care can make a difference to older peoples’ experience of mental health problems.

Older people with a chronic illness or disability are similarly in need of appropriate housing and equipment. There are constant difficulties in maintaining an adequate supply of professional assessment for equipment and equipment itself. 

There is some evidence that it is unclear to the community how decisions are made to prioritise funding between different projects and services. This can lead to a feeling of injustice. There is evidence of excellent practice locally to support innovative projects that would otherwise fall between departments and agencies. An example of this is the Creativity Project in Residential And Nursing Homes, which involves the Private Sector, Social Services Training, District Councils, ITHICA, and an independent trainer. 

Other projects can be popular with older people and meet the strategic aims of a number of organisations, yet still fail to gain financial support from them. A good example is the Agewell Project in Banbury, which began as a community education project and evolved into a local charity. It has successfully integrated older Asian women with learning disabled people and ‘mainstream’ day services for older people. The project was established with the aid of lottery funding, and despite its success may fold when these funds run out in December.

There is a growing population of Black and Minority Ethnic Community (BMEC) elders. Services are not all appropriate to meet their needs, and so access is effectively restricted. A number of popular projects have ‘grown’, some with public sector assistance, but supported by funding streams of varied stability. There is significant diversity within the BMEC population and assumptions cannot be made that what is good for one sub-sector is good for all..

There is a lack of confidence that BMEC needs (such as familiar diet, appropriate personal care or appropriate library materials) will be met within standard services. Where specifically tailored services are not available, or possible, then the arrangements in place to promote inclusion should be transparent to the BMEC.

Transport 

Transport has been consistently identified as a barrier for many older people in accessing normal activities of everyday life and essential services, such as access to information centres, ‘life long learning’, voluntary work, shops, doctor’s surgeries, hospitals, Day Services etc. across the county. National research concludes that the transport needs of older people are failing to be met. 

However, older people cannot be regarded as a single group in terms of transport provision as their particular needs vary widely according to their level of activity and/or mobility. Some of the transport problems of older people can be summarised as follows;

•	Even walking as a means of transport can present difficulties. The speed and volume of traffic, along with poor road crossing facilities, can lead to an increased risk of accident, particularly where footpaths are not present in rural settlements. Where they are provided, poor state of repair or obstacles (such as advertising boards or street furniture) can lead to problems. Lack of signing to local destinations can present particular problems for people with early dementia and reduce potential for maintaining independence.

•	Older people are one of the largest groups using public transport. Bus services in rural areas can be infrequent, or run at times that may not fit in with their needs. For instance, it may be possible to get to a doctors surgery in the next village, but not to get back the same day. Unreliable or cancelled services add to this frustration. Older people can feel excluded by a lack of transportation, particularly for services such as community education.

•	Public transport can also be an unpleasant means of travel for older people. Walking distances between bus stops can be too great, and the provision of bus shelters is patchy. Buses can be difficult to board for frail, older people. The attitude of bus drivers is often cited as a problem; failing to allow older people to be seated before driving off. The behaviour of other passengers, particularly young people, can lead to a fear of using public transport

•	The different consessionary fares across District/City Council areas is perceived to be problematic by older people.

Current Provision

Rural Oxfordshire is designated as an Associated Health Action Zone. Work is underway with the community, across organisations, to map out opportunities and barriers to improve access to services in Local Strategic Partnerships. However the project is in too early a stage to make an impact.

Age Concern and The Department of Psychiatry of Older Age are running memory clinics in GP surgeries with the aim of identifying problems early, giving advice and appropriate information, and encouraging access to services. This is an innovative solution to engaging and supporting a hard to reach group of older people.

Many imaginative strategies have improved access to professional Occupational Therapy assessment and equipment for those with chronic illness or disability (such as funding for Dialability Service, links with Small Repairs Schemes, information to advise individuals on private purchasing). However, demand continues to out-strip supply both of staff (due to national recruitment problems) and Health and Social Services budgets for equipment. This remains a major issue for older people, and for the county, with strong evidence about the crucial role that aids and adaptations play in maintaining independence.

Access to services for older people with a Learning Disability is explored in some depth in a recent consultative study and findings have been incorporated in the Joint Strategy for commissioning and developing services for this client group, to be reviewed in summer 2002. The plan is to achieve greater integration with mainstream services. For instance, providing information on the transport needs of older people with a learning disability to the Rural Transport Initiative and County Transport Strategy.

In Social Services, work is underway to evaluate and ‘slot’ appropriate community-grown projects such as Agewell, Banbury into the mainstream Day Services Strategy and funding
Age Concern’s innovative Parish Link scheme has volunteer representatives in many parishes. ‘Links’ help by offering encouragement to improve older peoples' confidence in using services as well as having an early crucial information role.

Oxfordshire has had notable successes in improving transport provision;
•	30mph speed limits are being introduced in all settlements across the county. Maintenance expenditure on footways has been maintained even during years of successive budget cuts, and recently increased as part of the Medium Term Financial plan
•	40 existing pedestrian crossings were refurbished in 2000/01 to include tactile surfaces and sensory/audible alerts. 12 other locations were selected for improved crossing facilities in 2001/02. Assessment criteria for pedestrian crossings include the flow and composition of pedestrians using current crossing points, the time taken for able and elderly pedestrians to cross, any difficulties they experience and an analysis of nearby destinations, including hospitals and post offices.
•	A Walking Strategy has been published which aims to adopt improved design standards for new footpaths, progressively reduce obstructions to pedestrians, and devise a network of core pedestrian routes to reflect local journeys. Oxfordshire is amongst the best performers in terms of adult pedestrian casualties (0.28 per 1000 population).
•	Oxford City has the highest proportion of ‘kneeling’ buses in the country, with around average provision in the rest of the county. Incentives to increase the level of provision have operated for a number of years with some success. Preferences have been given in subsidy contract awards, and more recently capital grants, for services running accessible buses.
•	The subsidy to Ring-a-Ride services held constant while the overall bus subsidy budget was reduced by 37% between 1993 and 1998. 
•	Bus driver awareness training was once compulsory on all subsidised routes. However, low unemployment in the county together with high turnover rates has frustrated this scheme as operators are no longer willing to release drivers for training. More recently, a number of rural bus services have come under threat due to bus companies withdrawing from contracts, requiring an additional £133,000 contribution from the Council to preserve them.
•	The Council jointly funds two advisors on community transport, giving advise to community groups seeking to set up their own transport schemes to meet particular needs.
•	A programme of bus shelter installation is ongoing using a grant scheme to assist Parish Councils, although the County Council is now installing shelters as part of Integrated Transport Schemes.

Proposed changes in policy also promise to address some of the transport needs of older people
•	A Bus Strategy is to be developed and be the main vehicle for improving bus services in Oxfordshire. It is to build on the premise of establishing core '‘premium” routes with high frequency services to a high standard, including bus shelters, real-time information displays and bus priority measures. 
•	A Public Transport Information Strategy is to be formulated to set travel information standards in the County. Two Information Officer posts have been appointed with the intention of introducing high, well-enforced standards. This Strategy will cover provision of information on routes, timetables of local services, fares & concessions, facilities for disabled people and connections with other public transport services, and will cover information available to homes, bus stops, community centres & drop-in centres etc. The Council is also participating in the national Traveline system, establishing a database of all bus services, accessible by phone or Internet. The scheme is hoping to include signposting to community transport schemes and eventually travel planning software to allow destination specific queries. To support this work, an exercise is being carried out to map individual bus stops to enable enquiries to Traveline to focus on a traveller’s nearest stop
•	The introduction of Bus Quality Partnerships will give agreed improved standards of service from operators in exchange for the Council providing bus shelters, enhanced bus priority measures and excluding other operators from the route.

Oxfordshire’s Local Transport Plan (LTP) encapsulates the Council’s vision for transport in the county. It has a stated objective to ensure that "suitable integrated transport networks are provided which are easily accessible for all, particularly those at risk of exclusion by virtue of mobility difficulties, location, income or other reasons". However, there are no direct performance indicators to measure progress against this objective. There are separate objectives to increase the proportion of the population in settlements with access to at least an hourly service (daytime) to 88% by 2011, and to increase bus use in rural areas by 2% per annum, but progress on these has not been quantified in the LTP Annual Progress Report.

In pursuing its public transport policy, in particular the Premium Routes approach, the Council’s aim is to develop a viable alternative public transport service available for the majority of people using a single service in order to achieve economies of scale. It is unclear how this will meet the specific needs of older people, particularly those in rurally isolated locations. A major review of bus subsidy policy has been called for by The Executive in response to the recent difficulties with rural timetabled services, which presents an opportunity to investigate this area of support for older people in greater depth than can be addressed in this review.

Information from other authorities

A County Strategy for Older People, such as exists in Surrey, may ensure that departments share common goals in working with older people and declare a standard by which the public could measure performance. It could improve the confidence of older people that their needs would be met in any transaction with the authority. It would best be shared across other agencies thus further minimising barriers to users of services. However, the Surrey strategy has not been evaluated to date, and so its effectiveness as a vehicle for change cannot be judged. No such Strategy exists within Oxfordshire.

West Sussex have developed the Cabinet Office Access checklist into an Access Questionnaire for use within their authority and to compare themselves with other authorities.

Conclusions

1.	Older peoples’ needs are not included in the plans and policies of the authority. This applies in particular to marginalised groups within the older population. The necessary culture change required to bring about these changes has not materialised from the BGOP project, and the initial enthusiasm to improve services has not been sustained.
2.	Despite there being a corporate Member champion for older people, there has been an insufficient corporate focus at senior officer level to drive necessary improvements through the Council.
3.	An overarching County Strategy for Older People is required to ensure that the plans and policies of the authority address the needs of older people, and that sufficient corporate attention and priority is given to this growing section of the County’s population.
4.	The Cabinet Office checklist offers a structured approach to identifying current shortfalls in access to services and should be used as an audit tool within Oxfordshire. Without further auditing it is not possible to be sure that all County Council policies are free from age discrimination.
5.	There have been notable achievements in Oxfordshire in improving transport provision, and proposed policy changes may further contribute to addressing the needs of older people. However, older people feel their transport needs are not being met The proposed Executive review of bus subsidy policy should be used as an opportunity to examine how effective current policies are in meeting the needs of older people and other socially excluded groups and therefore meeting the specific objective contained in the Local Transport Plan.
6.	Projects that grow from communities need to be regarded as mainstream activity and a mainstream responsibility and their different methods acknowledged as helping to achieve corporate objectives, particularly those of BMEC older people. Appropriate support should be given, and cross-agency funding streams clearly identified.
7.	Fair Access to Care will introduce an eligibility framework to ensure consistency in decision making. However, the current structure of the Social Services Department allows for unplanned discrimination in policy and operations.
8.	A unified assessment process is needed to remove duplication between Health and Social Services.
9.	Shortfalls in staff and funds for equipment are preventing older people with chronic illness or disability living as independently as possible.

Options for Change

1.	In partnership with other key stakeholders, develop a County Strategy and ensure that all County services are planned and provided with the needs of older people in mind.
Such a strategy will need to take into account the issues detailed above, and would involve;
•	agreement with key stakeholders in its development (a draft Strategy is attached as Annex 1) 
•	an audit of access to services based on the Cabinet Office’s checklist.
•	each Department producing an action plan to address shortfalls identified in the audit, with policies and plans subsequently reflecting the requirements of the Strategy

2.	Improve consistency in decision making and equitable access to social care services by;
•	the introduction of a revised eligibility framework for adult services
•	the introduction of a unified assessment process for Health and Social Care

In addition, the Executive review of bus subsidy policy be used as an opportunity to investigate the effectiveness of current public transport policy in meeting the objective of the LTP of addressing the transport needs socially excluded groups, including older people. 

Communication and Information

The main findings of research into older peoples’ communication and information needs are set out below;

Communication
Locally, older people and other stakeholders (e.g. advocates) expressed clear frustration about getting in touch with departments across the public sector. Once beyond initial contact and engaged with a department, standards of response to messages and attempts at contact with officers are variable.
Public sector staff and those offering services on our behalf do not always respond sensitively to undeclared communication difficulties of older people. Sensory Impairment is more likely in older age, often both visual and hearing. Disability and frailty are more common. Living in a rural area may not have been an isolating factor until a driving licence is lost. Second language skills amongst ethnic minorities are less likely or can disappear in sickness or early stages of forgetfulness. It will not be immediately obvious that a person in the early stages of dementia has difficulty with complex messages or memory. There are also an increasing number of older people with a learning disability.
Older people cannot be regarded as a homogenous group and there must be sensitivity to individual difference. Many older people manage independently and enjoy generally good health. However as older people get older then the likelihood of certain characteristics becomes greater. Older people are less likely to identify themselves as having a disability but to accept impairment as part of the ageing process. They may not wish to risk inadvertent humiliation or being singled out as ‘different’
Older people need to have confidence that their needs will be met without fuss. No assumptions can be made, but planning for the fact that impediments are more likely allows for greater participation and access

Information 
Producing information has tended to be seen as an end in itself, with little attention paid to how the information is received and used by recipients. It is important to start from older people's identification of their own needs rather than from a provider perspective on information. 
Older people are not always well informed and often do not readily seek information. Their information needs change over time and often arise in response to specific life events, such as bereavement. 
Many older people have access to the phone, and many to computers, but evidence shows they are reluctant to use them to get information. The main source of help remains informal 'word of mouth' information via family, friends and neighbours, although this can also include professionals (GPs etc). This is particularly true of BMEC older people, for whom information is poorly provided or accessed.
To be effective these secondary providers need to know where to get more detail plus accompanying advice and advocacy if necessary. Staff, advocates and voluntary sector providers would like adequate IT to link them into an up-to-date information system with simple dated ‘signposting ‘information (one paragraph plus contact number) with more detail available if required. 
Older people need unified information sources which offer information about a subject area rather than what a department provides. Also, they are interested in information about availability of a service – if there is a waiting period then they would prefer to know and plan accordingly.
Basic information needs to be available beyond normal office hours in order to be accessible to busy older people, relatives and carers at convenient times.
The voluntary sector approach to information provision centres around topics or key life episodes which offers greater independence and is likely to result in effective information reaching the socially excluded. 
Linked information messages are appreciated. For example, a Social Services Home Support charging letter could carry an offer to provide a smoke alarm from the Fire Service.
Information about Benefits is the most common enquiry to the Age Concern Information and Advice Line. Benefits take-up campaigns reduce inequalities amongst older people, at the same time increasing independence, and so should be supported by all public sector bodies.
Printed material is still important and combined information sources are particularly valued. But there are issues with this type of media being adequately circulated and kept up-to-date. There is a unified information booklet about Services for Older People provided in ‘Vale and South’, supported by the Carers Centre.
Older people with early dementia need information which is simple and in short sentences but not ‘childish’. A special version of information may be necessary and useful for those in early stages of dementia. For older people with learning disabilities, materials are necessary to back -up verbal communication.
Delivering information to those in rural areas, who are frail, housebound, or depressed is a real issue. Day Services offer opportunities and Age Concern are active in developing this option. However, the importance of improving the knowledge of ‘secondary’ providers and their access to information is particularly important for this group. 

Current Provision
There are two services provided exclusively for older people;
•	The Age Concern Information and Advice Service offers a county telephone service and outreach worker. This is in part funded by Social Services.
•	An ‘Age Resource Desk’ operational from November 2001 which will allow County access to the Age Concern National website. Age Concern volunteers will add local information. This was established with £7,000 of  ‘pump priming’ funding from the County Council. It is a partnership between Oxfordshire Trading Standards Service, Ealing Family Housing Association and Age Concern, who are running it with the use of volunteers. It offers net access to older people at The Clockhouse, Greater Leys, Oxford with opportunities for IT Training. However, the website will be accessible from any computer with Internet access
A pack with information for older people has been put together for social services staff that are likely to visit older people. This consists of leaflets about the different services available to them. 
There are some examples of mobile, unified information and advice services that currently reach rural areas. This includes a Cherwell District Council ‘Health bus', which is currently working jointly with Social Services and the Primary Care Trust to deliver preventative services. However, this is an isolated example, and much information provision remains uncoordinated across providers.
The Rural White Paper refers to primary care one-stop shops or mobile units to be provided nationally. There is a small one-stop shop forum, largely run by District Councils and Oxford City Council, but the network is not comprehensive and currently they do not offer information across all public services. There are moves to develop this and encourage better joint working. Oxfordshire's local network could be used more effectively, and work has started on this. However, expansion of this network could be a costly option and still fail to meet all the information needs of older people. 
GP surgeries and libraries, in particular the mobile library service, could be better used to reach the ‘rural marooned’. Options to use mobile libraries, an existing resource, more effectively will be taken forward in the current Best Value Review of the Library Service
The County Council's web site is currently undergoing redevelopment. Although it currently contains a large database that includes health & social care-related community groups, it does not have any information specific to older people. In addition, its existing structure does not lend itself to easy navigation and there is no search function. These deficiencies will be addressed in the new web site, which is due to be launched in April 2002.
The Citizens Advice Bureaux offer comprehensive advice and information but can be difficult to contact by phone because of the volume of work they manage (80% of calls to Witney CAB get the engaged tone). Witney CAB has an outreach worker for those needing a home visit, in particular for help with completing Benefit applications. A network of legal advice providers operating under local Legal Service Community Partnerships bring together those who fund legal and advice services (such as the Legal Services Commission, the local authority, local and national charities) with those who supply these services (such as lawyers and advice centres). 
The NHS employs staff in a Health Advocacy Service for ethnic minorities, which provide assistance, on a one-to-one basis, to help with interpretation and give health advice and information, and also to reinforce information from health professionals. This service is valued by BMEC older people.
Dialability is a service offering information for people of all ages with disabilities. It offers particular expertise on equipment including displays. Most contacts are with its helpline though Occupational Therapy appointments, a drop-in facility and mobile unit are also offered. Returns from a recent postal survey of customers showed that 50% were over 60 and 11% over 80 years of age. Over 50% could be regarded as living in poverty. It is a service highly regarded by users, including professionals. However funding is insecure although it is a long established project that enables people to manage their disability.
Those participating in consultation work universally commended the service offered by the three Carers Centres in supplying information. These autonomous facilities are excellent examples of voluntary involvement. The Governments own National Strategy for Carers acknowledges that helping carers is one of the best ways of helping people they are caring for.
The County Council has comprehensive guidance for staff in relation to the Disability Discrimination Act, and some training options, which covers clear print guidelines, arranging public meetings etc. but they are not easily accessible. Nor is guidance included on translation and interpretation for those whose language of preference is not English. Enhancements are needed to raise awareness of staff to issues for people with early dementia
Social Services Customer Service Unit (CSU) now takes a substantial volume of calls from the public as Social Services single point of contact. However the potential to give information to the public and deal with questions on first contact is severely limited, CSU staff are frustrated by the capacity of the IT system and the limited information it is fed by the rest of the department and other agencies. For example, the Unit was unaware of the 'Services for Older People' booklet in ‘Vale and South’ and so could not play its part in distribution
The Customer Care Best Value Review made the following recommendations;
•	Develop and implement an up-to-date customer care policy in the light of changing public expectations, including guidance on how to reduce costs in communication
•	Engage in high profile redevelopment of the internet site with the aim of making it interactive and delivering as many services as possible through it
•	Improve telephone service to customers by extending opening hours and answering a greater proportion of queries at first point of contact
•	Adopt a "connected departmental" approach to using ICT facilities available now, that can assist staff in handling queries from the public
•	Develop, introduce and evaluate a customer care 'driving licence', which is supported by a set of core competencies, to ensure that customer facing staff are equipped with the skills and knowledge they need to provide the required standards of service to their customers
•	Introduce standards for libraries and offices where members of the public are routinely received
•	Re-develop County Hall reception to address a range of customer care and health and safety issues; to include considering management arrangements for reception
Subsequently, the Council has taken the decision to develop a Customer Contact Centre by 2005, which will manage all enquiries to the County Council and as such, be a major interface between the Council and the citizen

Information from other authorities

Hillingdon’s joint Health, Alzheimer’s Society and Social Services book on Dementia gives information for clients and carers about the condition and services across the system, with 5 integral summarised translations.
The Borough of Spelthorne and The London Borough of Hammersmith and Fulham are examples of authorities that publish comprehensive guides on services for older people. The latter is available in full on the Council website with updates, has been printed twice and has had positive feedback. It is combined with a single number ‘Helpline for Older people’. However even in a unitary authority there is evidence that this aspect of the county site is not entirely up to date
Authorities such as Gloucestershire and Kingston have dedicated sections for older people on their websites, bringing together information on all relevant services, such as transport, residential care, health and benefits. Westminster's website has a searchable database of community care services (WELDIS). Devon offers a web site with information for the public and a ‘closed’ field for staff. However, the information provided to the public is not of much greater substance than Oxfordshire’s currently limited site. Authorities appear to be recognising the need but struggling with the complexity of information provision. 
The London Borough of Camden and Islington produced a booklet ‘A Guide to Communicating with Older People’ in collaboration with the NHS and the voluntary sector in May 2001. Evaluation of this is expected by December 2001. This is good example of communication standards for working with older people, and could be followed in Oxfordshire
West Sussex, a similarly rural area to Oxfordshire, achieved Beacon status primarily for its one-stop shops or ‘help points’ which are hosted by different public authorities, are joint funded and offer joint information, surgeries and access for callers: in person by phone, by fax and by email. However, the highest volume of calls is about Benefits and Tax – public agencies that make no financial contribution. Substantial investment is made in West Sussex to ensure staff are up to date with changes in services and to manage the published information. However the service does not meet all the information needs of older people. West Sussex is now developing a network of voluntary information providers for older people. The intention is to take information to where people gather (such as Day Centres) and to homes. They feel that older people wanting, for example, Benefits Advice are reluctant to make this public and prefer integrated information provision for this reason
CAREdirect
CAREdirect is a new service being developed by the Department of Health in partnership with local councils for people aged 60 years and older and their carers and relatives. Based on the successful NHSdirect scheme, its aim is to make it easier for older people to get information and help when they need it. It provides information on community health, housing issues, social security benefits and social care and support by physically bringing together the agencies that provide these services. Rather than signposting to services it seeks to resolve issue on behalf of older people by 'active help'; assisting them in completing forms, navigating services, making appointments etc. Local CAREdirect centres are made available for face-to-face assistance, with evening and weekend cover and trained advisors. An outreach befriender and advocacy scheme is also offered. 
Pilot CAREdirect schemes have recently started in six authorities in the South West, and are being implemented in different ways in each authority according to existing local infrastructure and conditions.  A further 14 pilot sites are planned for implementation in October 2002 which will complete the South West region. Another 30 sites are planned for implementation in October 2003, but at present the Department of Health (DoH) has not decided on how to select suitable areas. It is anticipated that, like NHSdirect, the scheme will eventually cover the whole country, although the timetable for doing so is by no means certain. Broad cross-agency support for pursuing this option in Oxfordshire was secured at a workshop at which Gloucestershire, one of the pilot authorities gave a presentation.
One-off grants are provided by the DoH for set-up costs, and other grants made available for ongoing running costs. Councils are expected, as a minimum, to contribute current resources allocated to information provision for older people to the scheme
Conclusions
1.	There is a clear need to improve the way staff at Oxfordshire County Council communicate with older people to improve their access to services. Information made available in printed format is currently of inconsistent quality and scope. The implementation of the Customer Care Best Value Review, in particular the proposed customer care policy, will need to take this into account.
2.	There already exists a great deal of information for older people, and a large number of agencies involved in its provision. However, this activity is uncoordinated, which leads to good practice not being shared, and the information needs of older people being overlooked.
3.	There is scope for optimising the use of current information channels, or considering imaginative use of existing networks, such as home support (domiciliary care) staff, or the mobile library service. There are plenty of opportunities to spread headline information using parish magazines or local radio (both accessible to the rural housebound).
4.	Better provision of information and support to 'secondary providers', such as professionals in the statutory and voluntary sector, could realise significant improvements in support for older people. Access to IT and to the Internet for these providers are critical building blocks to achieving success.
5.	The new enhanced county web site will substantially improve delivery of information to older people – even for those without access, interest or skill with web sites themselves. Opportunities for joint work with e.g. City and District Councils will be considered and the existing ‘Oxweb‘ group led by the City Council should facilitate this.
6.	Extended access to services outside normal working hours is required but a 24-hour phone service provided by one agency in isolation, for instance, may have a limited impact. Further development of one-call resolution of problems and to act as a better-informed ‘front door’ is required. The structured, co-ordinated cross-agency approach of CAREdirect presents an excellent opportunity for this to be developed.

Options for improvement identified

Communication
Introduce a communications standard in the County Council and incorporate the communication needs of older people within the plans for a proposed customer care policy, including publications and training associated with this development.
This can be carried out as part of the wider Customer Care programme being implemented during 2002/03.

Information 
Introduce a co-ordinated information delivery model for older people, either as a pilot authority in the national CAREdirect scheme, or by developing a local model based on existing delivery methods.
Other work in this area would include developing the Council’s website to include relevant information for older people, and developing a cross-agency information database and network to feed into any new model for information delivery adopted.

Consultation, Involvement and Engagement  

Support for older people can only be achieved if their needs and aspirations are reflected in Council policy and action Effective mechanisms must be in place to consult, involve and engage older people in the democratic process for this to happen.

The Regulations governing new political management arrangements in the County Council require mechanisms for consultation to be built in to the decision making process. There must be a clear path between decisions taken by the Executive and information from stakeholders used to inform these decisions. 

Research Findings 
•	Those who are frail, housebound or less assertive are more difficult to reach than other members of the community.
•	There are issues for the Black and Minority Ethnic communities in participating in mainstream consultation groups, as dominant culture and language can be a barrier.
•	Consideration is needed of those with sensory impairment who have specific communication needs. 
•	Research shows that with the right support individuals with dementia can express opinions about services they are using
•	Telephone surveys are an acceptable option for many. There have been specific research projects locally involving interviews at home by researchers, but this is not ongoing. There is research evidence that people would like to express their views to Senior Managers visiting their homes.

Current Provision

As part of the BGOP project, an independent County Older People’s Panel was established and funded by BGOP (National). In addition, Age Concern have established District Older People’s Panels. Age Concern Forums are also held twice a year at District level with an open invitation to any stakeholder. The Forums and Panels are actively used across County Council, District Councils and Primary Care Trusts. Oxfordshire received positive feedback about these initiatives from the Advisory Council on Beacon Councils

The focus of the County Panel is on issues relating to the County as a whole, and its main link is therefore to the County Council. It has struggled to gain focus/direction and needs to develop its role and effectiveness.

The Age Concern panels are thriving, with a healthy programme of recruitment. Their forums are well facilitated, and are developing ‘rules of engagement’ to ensure they can act as an effective mechanism for consultation. It is also possible to draw from the Panels to create special interest reference groups to support particular issues or initiatives. An example of this is the recently created Health and Social Care Panel to support the National Service Framework for Older People and the Older People’s Taskforce. However, funding for these panels is far from secure, which must be resolved to ensure they continue.

A County Citizens Panel has been established for consultation purposes, which has demographically proportionate representation from older people and black and minority ethnic communities. It is surveyed quarterly by questionnaire, and can be used for focus group work by Council departments.

Two mechanisms have existed in Oxfordshire to co-ordinate consultation across public services. One forum is chaired by the County Consultation Officer and has a council focus, the other by the Health Authority with a health focus, though there is cross-representation. However prevention of consultation overload, in particular of smaller interest groups, remains potentially problematic. There is also a Corporate Consultation Group within the County Council to co-ordinate consultation work between Departments and to share best practice.

A Race Reference group is being established by the Joint Development Manager (Ethnic Minorities). Meetings have been held with the Asian community which have been well received and found to be productive from both a council and community perspective. However, these initiatives are not currently focussed on older people’s issues.  Mainstream panels should use BMEC media to recruit panel members.

The practice of paying expenses (e.g. travel and care costs) for attending groups is a good way to encourage participation, particularly for those on a low income.

There is a successful ongoing consultation group for people with a Learning Disability that involves advocates, ‘My Life My Choice’, which could be used for wider topics. However a recent consultation exercise concentrating on older people was conducted primarily at an individual level though there are two Seniors Groups in County which could be a useful focus

Information from other authorities

Specialist reference groups (as above) can build confidence so that individuals can choose to contribute to mainstream consultation exercises. However, in the longer term it is preferable to offer opportunities in mainstream groups. An example of assisting in this process comes from North Devon who have produced guidance for engaging those with Sensory Impairment in consultation.

Oxford City Primary Care Trust has an example of good practice in consulting the ‘hard to reach’. A third party agency (The Claimants’ Union) engages with people they are in touch with who may prefer not to contact local authorities. They are invited to raise issues of concern to them rather than being asked specific questions. Any findings that relate to county services will be shared.

Conclusions 

6.	Although there has been good progress in relation to the involvement of older people there is further work to be done to develop existing mechanisms and to promote engagement with excluded groups. Opportunities should not be missed for eliciting feedback in the course of any contact between an individual and the authority

7.	There is potential for duplication in the consultation processes set up, and concerns about effective representation. If multiple for a are to continue they need a clear remit and funding stream.

8.	With the current migration to strategic health authorities it is not appropriate at this time to revise current countywide consultation co-ordination. However, this should be reviewed once the final structures have been agreed.

9.	The Council’s Internet site should incorporate mechanisms to allow feedback on its services (as well as the site). Written information should also offer this opportunity.

10.	There is scope to further utilise existing mechanisms across County Services: the Corporate Consultation Group can promote this. Further work is needed to co-ordinate consultation activity across the County Council and other public authorities to ensure that results are shared and overlap minimised. Options for development and a tool-kit for managers are currently under development by the County Consultation Officer and will incorporate the Review findings.

Options for Improvement Identified

1.	Consolidate formal mechanisms through which the representative views of older people are obtained by the County Council as part of its decision making process. Successful, existing mechanisms to be built upon, with financial contributions made to any participating organisation. 

The review on standing consultation arrangements due to be carried out for the new corporate governance scrutiny committee be asked to decide on the final arrangements, informed by the research carried out as part of this review, and incorporating principles for involvement and participation established in a county strategy for older people.

2.	Use the Council's website as a vehicle for both disseminating policy information and obtaining the views of older people.

Actions for Improvement

Action 1	Introduce a County Strategy for Older People	
	Description	In partnership with other key stakeholders, develop a County Strategy and ensure that all services are planned and provided with the needs of older people in mind	
	Objective
	Effective support for older people forms part of the plans and policies of all Council departments	
	Proposed service improvement target(s)	•	Produce a joint County Strategy for Older People in agreement with key stakeholders (April 2002)
•	Complete a Countywide audit of access to services based on the Cabinet Office checklist (December 2002)
•	Produce action plans for each Department to address shortfalls identified in the audit (February 2003)
•	Departmental policies and plans reflect the requirements of the Policy for Older People and their action plans (April 2003)	
	Issues to consider – areas that will be affected by implementation:
A lead officer with sufficient seniority is required to ensure that a County Strategy is implemented on a corporate basis. The current review of the County Council’s structure should be used as an opportunity to address this shortfall.	
	Implementation plan to achieve improvement targets
To be developed by March 2002	

Action 2	Improve consistency in decision making and access to Social Care provision	
	Description	Introduce revised systems to ensure that decision making is consistent across adult groups and that duplications in assessment procedures are eliminated.	
	Objective
	Ensure there is no discrimination on the basis of age in the provision of social care	
	Proposed service improvement target(s)	1.	Introduce a revised eligibility framework for adult services (April 2003)
2.	Introduce a unified assessment process for both Health Services and Social Services (April 2003)	
	Issues to consider – areas that will be affected by implementation:
‘Fair Access to Care’ guidance (yet to be issued)
National Service Framework for Older People	
	Implementation plan to achieve improvement targets
To be developed by March 2002	

Action 3	Introduce standards to improve how County Council staff and their agents communicate with older people	
	Description	Introduce a communications standard in the County Council and incorporate the communication needs of older people within the plans for a proposed customer care policy, including publications and training associated with this development.	
	Objective
	Improved access to Council services for older people through better communication.	
	Proposed service improvement target(s)	1.	Publish a single communications standard for staff, incorporating the needs of older people, as part of new customer care standards (June 2002)
2.	All staff trained in requirements of new standards (December 2002)	
	Issues to consider – areas that will be affected by implementation:
	
	Implementation plan to achieve improvement targets
To be developed by March 2002	

Action 4	Develop, consolidate and co-ordinate information delivery for older people in Oxfordshire	
	Description	Introduce a co-ordinated information delivery model for older people, either as a pilot authority in the national CAREdirect scheme, or by developing a local model based on existing delivery methods.	
	Objective
	All agencies provide better information to older people about their services 	
	Proposed service improvement target(s)	1.	Reach agreement with all key agencies to participate as a CAREdirect pilot (March 2002)
2.	Develop an Older People section on the new County Council web site, to include topic areas agreed through local consultation, and links to other relevant sites (March 2002)
3.	Develop a cross-agency information database and network, to include the requirements of the DoH Information Strategy for Older People when published (July 2002)
4.	New model for co-ordinated information delivery service fully operational (April 2004)	
	Issues to consider – areas that will be affected by implementation:
Proposed Government Strategy on Information for Older People (due November 2001)	
	Implementation plan to achieve improvement targets
To be developed by May 2002	

Action 5	Develop appropriate mechanisms to consult, involve and engage older people in the democratic process	
	Description	Create formal means by which the representative views of older people are obtained by the County Council as part of its decision making process, which reflects the wide variety of 	
	Objective
	Decisions made by the County Council affecting older people are taken after proper consideration of their views and needs.	
	Proposed service improvement target(s)	1	Establish a representative forum, or range of consultation mechanisms, for obtaining the views of older people as part of the corporate review on democratic involvement (May 2002)	
	Issues to consider – areas that will be affected by implementation:
	
	Implementation plan to achieve improvement targets
To be developed by May 2002