ADULT SERVICES POLICY FORUM
20 JUNE 2006
PRESENT: Councillors Mrs Proctor (Chairman), Richards (Vice-Chairman), Mrs
Bateson, Mrs Kemp, Mrs Moore, Mrs Napier, Mrs Newbound, and Penfold.
Also Present: Mary Forest (Maidenhead Care)
Officers: Allan Brown, Janet Dawson, Ann Dunne, Ian Hunt, Helen Latter, Kevin
Mist, and Jeannette Quirk.
PART I
DECLARATIONS OF INTEREST
Councillor Mrs Proctor declared a personal in relation to the presentation on the Older
People’s Commissioning Strategy as her husband had recently had a GP referral.
MINUTES
The minutes of the last meeting of the Forum held on 21 March 2006 were approved.
REVIEW OF OLDER PEOPLE’S COMMISSIONING STRATEGY
Members received a presentation on a review of the Older People’s Commissioning
Strategy. It was noted that the Strategy had been approved by Cabinet in May 2004,
and the review had been undertaken following issues raised by the Joint Review.
Members were informed that there were eight key priority areas:
 Older people and their carers should have more effective multi-agency assessment
and partnership working
 We will work to prevent the deterioration of those older people known to be at
risk
 We will increase the provision of rehabilitation and intermediate care services
 The quality and levels of home based services will be improved
 We will ensure that, in general, services are more responsive to the needs of older
people with mental health problems.
 We will provide better support for carers
 We will continue to increase the availability of extra care housing
 We will improve the quality and choice of long-term care for those who need it.
In relation to the first key priority area of providing more effective multi-agency
assessments, the Forum noted the following actions to facilitate this:
 Clear routes for access to an assessment. The importance of Hospital and Access
Teams for assessments by community Social Work, together with Occupational
Therapy Teams were outlined.
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 Progress on implementation of single assessment process. Members noted that an
agreed contact assessment was in use across SSD and PCT since February 2005. It
was also noted that information had been shared electronically since October
2005, and an acute trust pilot in Medical Assessment Unit would be introduced in
July 2006. The next stage was to introduce Overview Assessment.
 Developments in Occupational Therapy Services. The Forum was informed that
this would include closer working with PCT employed OTs, together with the
establishment of a small group of community based OTs with main focus of
supporting hospital discharges.
 Close working With Intermediate Care Services
Members were also provided with information relating to the pressures and challenges
to delivery against targets. These comprised:
 Demand - 1897 people referred for assessment and review in 2004/2005; 2451
older people referred for assessment and review in 2005/2006; responding to
crises/prioritising relative urgency of risk and need; protection of vulnerable
adults.
 Increasing levels of frailty impact on capacity. Members noted that numbers
referred for assessment are only part of the picture. Response to crises caused by
illness of carers as they also increase in age and frailty. More frequent changes to
level of need increases the frequency of reviews.
 Budget pressures and cutbacks in acute trust. Since October 2005, HWPH have
closed beds equivalent to 2 wards. Pressure on acute beds is constant with daily
SITREPS are black and red for the majority of the time. Consequent pressure on
Hospital Team to assist in speeding up discharge.
At this point in the meeting, the Forum also received information in relation to
preventing deterioration of health and promoting well-being. The following aspects
and initiatives were outlined:
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SMILE Project (So Much Improvement with A Little Exercise)
SMILE voluntary club
Free swimming for over 60’s
Sunrisers swimming
Specialist gym instruction for over 50’s
GP referral/cardiac rehabilitation/stroke rehabiliation
Members were provided with detailed information in relation to the Intermediate Care
Service and noted that, in 2001, the Government had laid out its programme of service
delivery for older people in NSF for Older people. Standard 3 focused on appropriate
provision of IC services, as follows:
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Preventing inappropriate acute hospital admission
Ensuring safe timely and supportive discharge
Providing rehabilitation in community settings
Preventing premature admission to long term care
The Forum noted that the current services comprised St Marks Day Hospital, The
Rapid Response & Rehabilitation Service, Christian Smith House, Henry Tudor
Ward, and Henley Suite. These services were supported by East Berkshire
Community and Intermediate Care Liaison Nursing Team, Nurse Consultant for
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Intermediate Care and Older People, and Additional Therapy Support. Members were
also provided with a summary of service activity including completed episodes of
care between April 2005 and March 2006.
The proposed way forward for these services was also outlined and the following was
reported:
 Henry Tudor Ward & Henley Suite: a) implementation of Falls Information Pack
on Henley Suite; b) introduction of standards re: nutritional assessment and care
planning; c) introduction within Henry Tudor Ward of the Liverpool Care
Pathway for care of the dying. Challenges included frailer patients with more
complex needs, expectation to provide sub-acute care, competency and training
needs of staff, availability of equipment, medical cover and transport.
 Rapid Response & Rehabilitation Service: a) short-term domiciliary service
formed by merger of RR&R service with First Response Service with increased
access to rehabilitation assessment and treatment; b) additional therapy resource
within newly formed Short-Term Service to facilitate this; c) routine transfer to
the Day Hospital of RR&R service users, where appropriate, to complete
rehabilitation programme.
 St Marks Day Hospital: a) formal falls clinic for older people; b) falls clinic for
younger people; c) regular clinic for multiple sclerosis patients; d) ‘one stop shop’
for assessment of Social Care needs/occupational therapy equipment for people
with low level needs; e) admission prevention/triage service for GP/DN referrals
to reduce A&E attendances.
The Forum also received detailed information in relation to the fourth key priority
area regarding Domiciliary Care – “The quality and levels of home based services
will be improved”. Members noted that this would be facilitated by the internal
domiciliary care reorganisation, the changing of the financial eligibility criteria, and
the external domiciliary reorganisation. The current position, together with details of
the tender process was outlined, and Members were also provided with figures
collated from the Home Care Panels between 25 July 2005 to 11 June 2006.
The impact of these changes comprised
 Royal Borough is arranging care for 19 Full Cost Services Users since criteria
changed
 It is estimated that approximately a quarter of all assessments carried out are full
cost payers
 Difficult to put a firm number on savings, as Self Funders often do not see Care
Managers
Members were informed that the domiciliary reorganisation would result in the
Borough being split into five zones as follows:
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Zone 1 – Ascot/Sunnghill/Sunningdale
Zone 2 – Old Windsor/Wraysbury/Horton/Datchet/Eton/Eton Wick
Zone 3 – Windsor
Zone 4 – Maidenhead – north of A4
Zone 5 – Maidenhead – south of A4
It was reported that the outcomes of the project would include:
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 80% commissioned hours within each zone with a single provider through a block
contract
 Charges will be applied for missed and late calls
 Call monitoring system – CM2000 – will be used by all block providers
 Service users will benefit from an Outcome Based Approach
 An estimated saving of £2m will be achieved over 5 years
The fifth key priority area related to ensuring services being more responsive to the
needs of older people with mental health problems, and Members noted the operation
of the Mental Health Team for older people, which had been established to offer:
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Integrated assessment, treatment, and care management
Early recognition and detection
Carers assessment
Information and signposting
Partnership working with Primary Care
Support and advice to residential and day care services
Links with Charles Ward
Work with Intermediate Care to prevent hospital admissions
Ongoing support
The Forum also noted the following in relation to the sixth key priority area relating
to providing improved support for carers (Princess Royal Trust):
 Provide Carer Assessment
 Provide information and advice on a whole range of issues related to the needs of
carers
 Provide practical help e.g. form filling
 Provide education and training
 Provide support for BME carers
 Provide advocacy work on behalf of carers
 Issue a quarterly newsletter
 Organise social activities and events – Carer’s week 12 – 18 June 2006
 Provide short breaks/respite care
The seventh priority area of increasing the availability of extra care housing was also
considered, and Members noted the functions of the following:
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Christian Smith House
Maudsley House
Lady Elizabeth House
Viscount Court
With regard to the final priority area relating to improving the quality of choice of
long term care, the services and care to be provided at Clara Court, Wardens Lodge
and the use of block contracts were noted.
In conclusion, the Forum also noted 10 programmes arising from the NSF Review,
and Members were informed that the Older People Partnership Board would be
looking at these areas. The programmes comprised:
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Dignity in Care
Dignity at the end of Life
Stroke services
Falls and Bone Health
Mental Health in Old Age
Complex Needs
Urgent Care
Care Records
Healthy Ageing
Independence, Well-Being and Choice
The Chairman thanked the officers for a very informative presentation, and
commented on the achievements that had been attained since the Strategy had been
established. However, the importance of building on those achievements was
emphasised, and the need to continue the hard work was paramount to continuing the
progress that had been made.
DATE OF NEXT MEETING
Tuesday 3 October 2006
MEETING
The meeting, which began at 6pm, ended at 7.30pm.
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