Agenda item

To consider a report by the Service Manager, Localities (copy attached) to provide an update on the performance of Denbighshire’s Single Point of Access for Adult Social Care and Community Health Services.

11.40 a.m. – 12.15 p.m.

Councillor Gareth Lloyd Davies declared a personal interest as an employee of the Betsi Cadwaladr University Health Board (BCUHB).

Introducing the report and appendices (previously circulated) the Lead Member for Wellbeing and Independence advised that she was a keen advocate of the Single Point of Access (SPoA) Service as she felt it contributed to the community resilience agenda.  A copy of the review report, which detailed the review methodology and service areas considered as part of it, was attached at Appendix 1 to the report.  The objective of the review had been twofold - to assess how effective and efficient the SPoA Service was in delivering its services and in improving outcomes for service-users, and to establish whether the service delivery model was suitable for the future.

Statistics were contained within the report illustrating the demand on the SPoA Service during Quarters 1 and 2 for the last three years, these demonstrated a continual increase in contact with, and referrals to the Service.  In response to enquiries received the SPoA Service provided advice about services or agencies who could assist those requiring assistance.  The Service also instigated referrals to intervention services with a view to supporting individuals to live independently for as long as possible and therefore reduce the demand and pressures on more intensive services.  The Review had concluded that the SPoA concept was valued by all stakeholders and those who utilised its services.  Whilst the Service was deemed fit for purpose it was recognised that as Community Resource Teams developed there would be a need for the SPoA Service to evolve and adapt to complement the services provided by them.  A number of areas for improvement and future development had been identified, these included:

·         the need to establish and implement a robust quality assurance framework which would measure, amongst other things, the skills, knowledge and confidence of the SPoA Team to deliver Information, Advice and Assistance (IAA) Services;

·         improving interface working with hospital and community based health and social care services;

·         a need to review and redefine the roles and skill mix in the Service;

·         making SPoA more accessible to support GP practices and for it to promote more public health messages;

·         utilising SPoA to support the development of Talking Points and the Community Navigator Services; and

·         exploring potential joint working opportunities with Conwy County Borough Council’s SPoA Service.

During the introduction the Service Manager (Localities) detailed a number of case studies illustrating the Service’s success during the “What Matters” conversation, the initial contact the public had with the SPoA Service, where relevant advice etc. had been provided at the correct time which consequently resulted in approximately 35% to 40% of those who had contacted the Service not requiring more intensive and costly support from Social Services.  She advised that as part of the “What Matters” conversation discussions took place on the type of support or services the individual may require in order to maintain their independence and their ability to fund those services.  In essence the SPoA Service was an advisory service which signposted people to services which may be available to them, whilst also acting as a prevention service by referring individuals to community health based services with a view to maintaining their overall well-being.

Responding to members’ questions the Lead Member and officers:

• confirmed that managed care and support packages were only offered to those individuals who could not achieve the desired outcomes without help.  People who required these packages would be subject to a financial assessment.  If they could afford to pay for the package they would be charged up to a maximum amount of £70 per week.  Individuals who did not have the means to pay for the support package would still receive it and would not be expected to pay;
• advised that the SPoA Service shared information with all practitioners involved with an individual with a view to ensuring a holistic seamless approach to service delivery and to avoid the duplication of advice and services;
• confirmed that the majority of the funding to pay for the SPoA Service was secured via Integrated Care Fund (ICF) grant monies which was paid by the WG to the Health Board for the purpose of funding integrated health and social care services.  The remainder of the funding came from the NHS and the Council.  The Health Board managed the ICF funding, but both the Health Board and the local authority had to reach an agreement on how the money would be spent to deliver services that would improve outcomes for residents.  During the forthcoming year an extensive piece of work would take place to design the services that would eventually be delivered by the Integrated Community Resource Teams, one of which would eventually be based at the new North Denbighshire Community Hospital site;      
• advised that the Council had emphasised to Betsi Cadwaladr University Health Board (BCUHB) that it could not continue to support the SPoA Service in future if the ICF grant money was withdrawn from the Service or diverted elsewhere;
• confirmed that aspects of the SPoA Service could potentially be developed on a regional basis.  However, the Service would have to be shaped and delivered locally otherwise it would not meet the need of local people or engage with the correct local support agencies, organisations or networks;
• advised that some GP practices were better than others for promoting the availability of the SPoA Service to their patients.  The Service was planning to establish an option for GPs to refer patients to SPoA via e-mail in future.  It would also shortly undertake a feasibility study on the potential benefits of locating one SPoA hub operator with the GP Out of Hours (OOH) Service;
• outlined the difference between the information provision aspect of SPoA’s work, its advisory work, and its role in assisting people to gain access to services which may help them e.g. form filling;
• emphasised the benefits of having knowledgeable multi-skilled SPoA hub operators working in the Service.  Having access to cross-service information and knowledge, and being able to access both health and social care computer systems ensured that SPoA operators were able to provide a whole range of support, advice and assistance to those who contacted them, some of whom had complex needs or multi-faceted enquiries.  No two enquiries or referrals were the same.  In some cases the initial enquiry may seem a fairly simple one to resolve, however during the ensuing “What Matters” conversation other underlying needs may come to light which early intervention and support at that point in time may mitigate against them escalating into far larger problems, requiring costly resources, at a later date;
• confirmed that a separate SPoA system operated for mental health problems.  This Service operated a ‘triage’ approach.  SPoA hub operators were able to signpost and refer people with mental health problems to the Mental Health SPoA Service;
• advised that the Service was looking to improve the step-down cluster element of its work with a view to facilitating timely discharge from hospital.  The proposal with respect of this aspect of the work was to involve the voluntary sector early on during the hospital discharge process to facilitate an individual’s discharge to their home address with the most appropriate support package in place to ensure their safety;     
• confirmed that the 83% increase in the number of GP referrals to the SPoA Service between 2015 and 2017 was attributed to the success achieved in promoting the Service;
• informed the Committee that in order to ensure that hub operators continually maintained and increased their skills and knowledge base, weekly training and information sharing sessions were arranged for staff.  These included sessions facilitated by other public services and voluntary organisations on the services they were able to provide.  The fact that the third sector’s liaison volunteer was co-located with the SPoA hub operators helped increase their knowledge base.  Currently the WG was in the process of developing a national IAA Competency Framework, Denbighshire’s SPoA Service was working closely with the Government on the competency levels that would form part of the Framework;
• confirmed that the Service was proving costly to deliver at weekends due to low take-up levels because Lone Worker Regulations necessitated that two people had to be available at all times, even when the demand was low.  With a view to reducing costs for delivering weekend provision the Service was exploring potential options with other partners to see if a single SPoA hub operator could be located at one of their premises to deliver weekend cover i.e. OOH Service at Ysbyty Glan Clwyd.  If this was possible it had the potential to halve the staffing costs as only one member of staff would have to be on duty during quieter times; and
• confirmed that it would not be possible for SPoA hub operators to deliver the IAA service from their own homes as per agile working practices, as they would require access to partners’ IT systems, including secure NHS systems, as well as the Council’s IT systems.

At the conclusion of the discussion members highlighted the fact that people could very suddenly find themselves being carers as well as residents, which would potentially transform their lives completely.  Information and services provided following one call to the SPoA Service were invaluable to those residents and eased the burden of their responsibilities. 

Following an in-depth discussion the Committee commended the SPoA Service and its staff on the services and information they provided:

Resolved: - subject to the above observations to –

(i)           congratulate the Single Point of Access Service on the excellent services it provided;

(ii)          continue to support and promote the development of the Single Point of Access Service as a way of meeting the corporate priorities for 2017-22 and the statutory duty to provide Information, Advice and Assistance (IAA) Services as required by the Social Services and Well-being (Wales) Act 2014; and

(iii)         accept an invitation to visit the Single Point of Access Service to see how the service delivery model operated first hand.