Comment on Wandsworth Joint Strategic Needs Assessment 2008

The Council and the Primary Care Trust have jointly prepared this analysis of the health and social care needs of the Wandsworth population to inform priorities for commissioning and development of services.

Wandsworth Older People’s Forum have recently considered the document and have the following comments.

Demand for health and social care is higher from the more disadvantaged areas which also show the worst health outcomes, particularly Latchmere, Roehampton, Queenstown, Tooting and Graveney wards. Wards generating higher level of social care referrals are Roehampton, West Putney, Latchmere and Furzedown which are the wards with the highest proportion of people with long-term limiting illness. Within the population receiving social care there is an overrepresentation of people from Black communities and of Asian communities in those receiving help for physical disability but not for mental health.

Comment
Therefore there should be an effort put in to ensuring that access to services in better in these areas. Ensuring good health care means having good primary care services within walking distance of the communities they are to serve. We hope that the current developments in primary healthcare in Battersea will give more accessible services.

A good community centre with access to information, advice and a meeting place are essentials . Library with its access to books and information is also essential but it does not provide the social meeting place that a good community centre can. Access to adult education for training for work and for keeping the minds of retired people active are also essential

Roehampton and the part of Battersea to the East of Battersea Park Station are areas where further work is necessary to ensure good access to services for areas of greater material disadvantage.

Safeguarding vulnerable adults has become of importance recently and as a result of local training and heightened awareness there has been increased number of safeguarding alerts and investigations.

Comment
Safeguarding should include psychological abuse as well as the more obvious physical and financial abuse. Dignity in care is an important part in ensuring that people are happy and secure in that care. Bullying is perhaps more obvious lapses but it is not easily detected and older people are very frightened about standing up for themselves with carers on whom they are very dependent. There are lesser evils but very important. Ensuring they are clean and appropriately dressed. Ensuring that there are at least two people on the staff of a home or ward who have talked with the cared-for person and know their needs and wishes. Home carers should not be given so little time that they have to carry out the tasks in the most time-efficient manner. Physically frail people should be entitled to take a bit longer with tasks that the more able, ie the carer, could do more quickly. The carers should know what matters for the person they are caring for.

Obesity, alcohol consumption and smoking are the key problems. Awareness of and quick response with treatment for stroke is a priority.

Comment
Alcohol can be used by older people to cover their misery about increasing frailty or loneliness. Older people are entitled to acknowledgement of the problem, to treatment and to having their problems being talked through.

Older people are entitled to having stroke dealt quickly and as competently as younger people. Many older people fear that if they are ill they will be written off as “geriatric” and not given appropriate medical care and appropriate rehabilitation. The emphasis now is on rehabilitation and keeping people out of hospital and getting them home again as quickly as possible. Going home safely depends on the ward staff having understood the person’s home situation and have ensured that social care has been organised when necessary.

On consultation with older people it is said they have higher levels of satisfaction with Wandsworth as a place to live than younger residents. Clean streets and health services were seen as important factors for older people in making a place good to live in. Streets, pavements and traffic were seen as important for improvement in Wandsworth.

Comment
Although it is said from surveys that Wandsworth residents get on well with each other the Forum does not accept that this is the case on a street level. Older people, responding to our survey, tend not to talk to neighbours about local problems. Neighbourhood wardens have been appointed in some other parts of the country. We have Neighbourhood Watch working well in some areas. It can be a focus for action on neighbourhood problems and when the Neighbourhood Watch person is active s/he should know the people on the patch and also those who live alone and might be vulnerable. The Forum hopes that greater effort can be put into generating active Neighbourhood Watches in all streets.

The Older People’s Strategy has been recently adopted and some key priorities have emerged:-

• Potential benefits of introducing a single point of access to information from where appropriate signposting and referral could be facilitated;

Comment: There is concern that the independent source of information, which Careline is, will not be funded and all information will come through WBC’s Access team, which is not, and will not be seen as, independent. Whatever is planned to change will be seen as likely to involve a means test and only those at critical or substantial risk will be helped. Forum’s view is that each of WBC, PCT and St George’s should have one access number which will convey a call to the right person in any department with the first call . At present Careline also keeps information on many social events and programmes run by voluntary groups and inexpensive holidays with starting points in Wandsworth, often preferred for less able older people. The Forum urge that this should continue to be provided in whatever the future service will be.

• Improving well-being and reducing the negative impact of social isolation through provision of a variety of social, leisure and community based activities to help maintain independence and promote a good quality of life. Consultation responses strongly indicated that, for social activities, most older people wanted to join in with groups of all ages but a sizeable minority of older people of 75+ prefer to socialise in groups restricted to older people;

Comment: This is an important arm of the Preventive Strategy for Older People. Some good actions have already been taken such as ensuring the continuation of Active Days and the development of Age Concern’s Be-a-Friend and Out and About and the development of the Shopping and Gardening projects , both of which will fill needs. What has not been seen is any development to meet the need for local centres. The view of the Older People’s Forum and Network is that there should be more places like Furzedown Project, the Age Activity Centre and Balham Pensioners Centre. There should be one within half a mile of all parts of the Borough just as primary schools are placed. The Doddington Estate, the far east of Battersea, Roehampton and Tooting are places of real need with many older people with low incomes and no easily accessible places to go for company and advice. Older people are more likely to pick up information in chatting to others informally. Without such places people can be very isolated.

The Safer Neighbourhood teams have a plan (Older People Strategy Action Plan 3.1) to have limited surveys of all disabled and older people on their patches but there is no way to identify these. An active Neighbourhood Watch coordinator is likely to know any relatively isolated older person in their street. A collaboration with active coordinators and a development of Neighbourhood Watch where there is none would be a fruitful way to carry out this plan.

Lack of accessible transport and also fear of falling when going into crowded bus stop queues and buses prevents many older people from going far from home. Accessible transport needs improvement. A review of door-to-door transport is promised. Taxicard is widely criticised as not reliable either on the outward journey or the homeward one. A locally organised service run under WCT or a local minicab service might well provide a better service in Wandsworth, many parts of which are seen as beyond the bounds of many black cab drivers. Services like Access to Art, Share and Housebound Learners should be supported as ways of getting housebound people involved in activities outside their home.

• Agencies and organisations working collaboratively to ensure appropriate health and social care pathways that focus on the needs of the service user are in place.

Comment: Health and social care should be able to initiate and carry out an assessment but a single assessment process seems not to be working as yet. This is an urgent priority.

All people, whatever their needs and whatever their income should get an assessment of their needs when they ask for help. The Forum and Network is not sure that this happens. When people apply for Attendance Allowance are they given an assessment of need? They have expressed a need for help. Should they not get an assessment? How much help and monitoring is available to people who pay and organise their own services? Will Direct Payments cover Maternity pay and sick pay if that is needed?

The Wandsworth LINk, replacing the PPI forums, will be a valuable resource for patient and public. It will be monitoring social care, as well as health, and should be involved in service monitoring and redesign in the future.

Comment: The Forum and Network would like to be sure there are sufficient people taking an interest in the various aspects of services for older people and that the LINk is sufficiently involved with the relevant committees of Council, PCT and health providers. This group should be fully involved in the consultation on the JSNA.

Health Service delivery concerns

Key factors to make a rapid difference are commissioning to reduce the number of smokers and effectively finding and managing cases of both high blood pressure and high cholesterol. The inequality gap can be further narrowed by early detection of cancer and alcohol-related disease.

Comment: This points to GPs monitoring older patients regularly and knowing those at risk. Are all GPs ensuring that they know all their older patients and know those at risk?

A grave concern among older people is the perception that they are not treated as thinking individuals with whom discussions can be held on the same basis as with younger people. They often feel patronised. Also the dignity of all older people should be respected in all care, health and social.

Social Care delivery concerns

Increased focus of care and support is that it should be provided on an individualised basis and that service users should have greater control and choice in how their care and support will be provided. Emphasis will be on reablement and rehabilitation.

Comment
The Forum and Network support this aim. This will need very good information provision. Advocacy for older people, who do not have relatives or friends nearby to help, needs strengthening. Recently funding has been made available. The Forum and Network has yet to see widely available information about this and also about help for those without the capacity to decide on their own placements. There is not much help for those who have to organise and fund their own care. Risk monitoring and safeguarding arrangements also need strengthening to ensure vulnerable adults are not exploited or abused.

Again older people should always be treated respecting their dignity. Professional carers, whether in residential or home care, should always be required to spend some time talking to the cared-for person and finding out their past life and their wishes for their present life. All people receiving care should have a care plan and it should be a requirement that at least two of those providing care should have read it and should spend one-to-one time with the person regularly.

Activities will be sustained and developed to combat social isolation and provide practical support to avoid or delay the need for people to access more formal service provision.

This has been commented on above.

Retaining and improving services in disadvantaged areas and even expansion is seen as important.

Comment
Development in Roehampton, Latchmere and Queenstown should be happening.

Health and Well-being An increased focus will be needed on the delivery of integrated preventive services provided by mainstream provision such as leisure, lifelong learning and culture.

Comment
This is wholly agreed but needs monitoring. Lifelong learning seems to stop at retirement age and the Forum and Network hope to see an increase in opportunities for learning for older people who are not likely to be looking for work.

Carers’ services

The needs of carers will require development of wider opportunities for carers for learning, leisure and employment and improved respite services.

Comment
Carers’ assessments are slow to take off. This process needs speeding up for many older carers particularly, parents of learning disabled offspring or of spouses, friends or siblings. A little help would present them collapsing under the strain and would enhance the lives of carer and cared- for.

The appendices list the plans already in place through existing strategies and through the Local Area Agreements (agreed with Government and attracting extra funds if targets are achieved). There have not been many targets in the LAAs of importance to older people but in the strategies the following are important to note:-

• Implement cardiovascular risk assessment programme;
• Extend scope of Exercise on Referral scheme and Physical activity clinics;
• Increase the proportion of people needing intensive care being looked after in their own home;
• Improve preventive and rehabilitative services to promote independence;
• Increase in proportion of carers receiving assessments;
• Increased number of adults receiving Direct Payments.

Comment
Increase in self-directed support is probably of more interest to older people.

*Reduced number of emergency bed days occupied by over-75s.

All of these are supported and the Forum and Network look forward to their implementation.

One of the principal causes of disadvantage in older people is lack of money which can result in poor care for their home, poor provision of food and heating and general isolation unless there is a suitable inexpensive drop-in for older people nearby. The Pension Service and WBC Benefits service have amalgamated and are advertised as having the ability to do home visits and do have some scattered surgeries across the Borough. A Local Area Agreement with a target on the numbers of benefits gained and the amount of benefit gained could generate increased activity and could make some progress to ensuring that all who are entitled to more benefit are getting it.

Lilias Gillies
Hon Secretary
Wandsworth Older People’s Forum 11 March 2009