NCoA 05/14
NORFOLK COUNCIL ON AGEING
Minutes of the Norfolk Council on Ageing Meeting held at 10.30am
on Wednesday 30 April 2014 in the Training Room, Great House
Training Centre, Age UK Norfolk, 300 St Faith’s Road, Old Catton,
Norwich, Norfolk NR6 7BJ
Members
Present:
Jonathan Bolton (Chair of Age UK Norfolk), John Bracey (Broadland
Older People’s Partnership), Judith Brown (West Norfolk Carers),
David Button (Age UK Norwich), John Carrick (Norfolk Rural
Community Council), Colin Chambers (The Royal British Legion),
Stephen Drake (Co-opted Member/Trustee of Age UK Norfolk),
Margaret Drury (Age UK North Norfolk), Colin Futter (Norfolk County
Council Unison Branch [Retired Members Section]), Joyce Hopwood
(Norwich Older People’s Forum), Helen Jones (Vice-Chair of Age UK
Norfolk), Pat Kingerlee* (U3A Wymondham Group), Dr Derek Land
(Civil Service Pensioners Alliance [Norfolk]), Emily Millington-Smith
MBE (President of Age UK Norfolk), Pam Spicer (Norfolk Deaf
Association) – Proxy for Aliona Laker, Cllr Sue Whitaker (Norfolk
County Council Adult Social Services Committee), Pat Wilson
(Norfolk and Norwich Pensioners Association / Norfolk Older
People’s Forum) and Dr Peter Woodhouse (Norfolk and Norwich
University Hospitals NHS Foundation Trust)
In
Anne Bunting (The Norfolk and Norwich Association for the Blind), Dr
Attendance: James Desborough (UEA), Hilary MacDonald (Chief Executive of
Age UK Norfolk), Lin Mathews (Age UK Norfolk), Maggie Parsons
(NHS Great Yarmouth and Waveney CCG), Angela Rayner (Age UK
Norfolk), Paula Skelton (Age UK Norfolk) – minute taker, Alex
Stewart (Norfolk Healthwatch) and Peter Walker
Apologies:
*Denotes
Voting
Member
Ann Baker* (South Norfolk Older People’s Forum), Bett Barrett* (Coopted Member), Gaye Clarke* (Department for Work and Pensions),
Dr Graeme Duncan* (Co-opted Member), Aileen Francis (Age UK
Norfolk), Susan Fraser* (Co-opted Member/Trustee of Age UK
Norfolk), Margaret Hardingham* (Vice-President of Age UK Norfolk),
Polly Hauxwell-Baldwin* (Co-opted Member/Trustee of Age UK
Norfolk), Aliona Laker* (Norfolk Deaf Association), Ann Leigh* (Coopted Member/Trustee of Age UK Norfolk), Barbara Lock* (Age
Concern Swaffham and District), Rachel McLean* (Co-opted
Member), Jacqueline Middleton* (Age UK Norwich), Catherine
Morgan* (The Queen Elizabeth Hospital King’s Lynn NHS Foundation
Age UK Norfolk is the operating name of Age Concern Norfolk, a Charitable Company limited by guarantee
Registered in England No 03783205. Registered Charity No 1077097. The Registered Office is 300 St Faiths
Road, Old Catton, Norwich, Norfolk NR6 7BJ
Trust), Annie Moseley (Age UK Norfolk), Chris Mowle* (Co-opted
Member/Trustee of Age UK Norfolk), John Perry Warnes, Jack
Sadler* (Norfolk Association of Local Councils), Dr Charlotte Salter*
(Norwich Medical School, UEA), Vernon Simmons* (Breckland Older
People’s Forum), Paul Slyfield* (Treasurer of Age UK Norfolk),
Richard Watson* (Co-opted Member/Trustee of Age UK Norfolk),
Carole Williams* (Co-opted Member) and Jean Wilson* (Norfolk
Federation of Women’s Institutes)
The Chair welcomed everyone to the meeting and gave information on a number of
housekeeping items.
Action
1.
Minutes of the Norfolk Council on Ageing Meeting held on
Wednesday 22 January 2014 (NCoA 05/14)
The minutes of the Norfolk Council on Ageing (NCoA) meeting held
on 22 January 2014 had been circulated prior to the meeting and
were agreed as a correct record and signed by the Chair.
2.
Matters arising
2.1 Clause 48
The Chair reported that following a campaign led by Age UK to
overturn Clause 48 of the Care Bill, there had been a successful
outcome. The result meant that the loophole (Clause 48) would be
closed for people who received care in their own home where this
was arranged or paid for by the Local Authority. Up to now, this group
of people had no protection under Human Rights Law.
The Chair thanked everyone who had signed Age UK’s petition and
the news was welcomed by members.
2.2 Adult Social Services
The Chair invited Cllr Whitaker to update on the Norfolk County
Council (NCC) budget.
Cllr Whitaker reported that 60% of people who received support from
the Adult Social Services Department (ASSD) at NCC received
Personal Budgets. People in residential care usually received only a
very small Personal Budget. It was normally people who had
intensive home care needs and younger people who received more
substantial Personal Budgets.
Cllr Whitaker explained that some Personal Budgets included a care
element and a “social” or “wellbeing” (discretionary) element. The
care element would be unaffected by the re-assessments of Personal
Budgets and it would be the “wellbeing” element that might be
affected.
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Cllr Whitaker reported that the Council was required to save
£6,000,000 over two financial years with the bulk of changes to
Personal Budgets taking place in the next financial year.
In the current financial year, people who receive a Personal Budget
will not see a change. Everyone who receives a Personal Budge will
have a face-to-face assessment, with the exception of those in
residential care who have a very small Personal Budget.
Following the assessment, any changes would be made in the
following financial year. Cllr Whitaker gave an example whereby an
individual assessed in April would have the changes implemented the
following April. To help meet the challenge of undertaking the
assessments, an extra £1,000,000 was being used to resource the
additional staffing required.
Ms Brown commented that the number of face-to-face assessments
would be very high and Cllr Whitaker said that the Council recognised
this, hence recruiting additional staff to undertake the work.
Ms Drury asked about the possible effect on day centres and Cllr
Whitaker referred to Independence Matters, a joint staff and councilowned community interest company, which provided a range of care
and support services to people across Norfolk. Ms Drury said price
was often a factor in people choosing not to attend a day centre. Cllr
Whitaker said that it was possible that the environment put some
people off and investment could help with this.
Mr Wells asked about the likely savings and Cllr Whitaker said that it
was likely to be £11,000,000 over three years. This was out of a total
of £205,000,000 budget on care for people in Norfolk.
The Chair thanked Cllr Whitaker for her update.
2.3 Acle Day Support Club
The Chief Executive reported that work was continuing to assess the
needs around transport to Age UK Norfolk’s Acle Day Support Club.
3.
Maggie Parsons, Cancer and End of Life Programme Manager for
NHS Great Yarmouth and Waveney Clinical Commissioning
Group (CCG): Update on the work of the Norfolk and Suffolk
Palliative Care Academy
The Chair introduced Ms Parsons and she thanked him for the
invitation to speak at today’s meeting, which followed on from the
presentation given by Sue Spooner at the April 2013 meeting of the
NCoA.
Ms Parsons explained that the Norfolk and Suffolk Palliative Care
Academy had been established to improve palliative and end of life
care through raised awareness and education. Ms Parsons explained
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the structure of the Academy.
Ms Parsons explained that palliative care was not currently
commissioned but is delivered by hospitals because there is a need.
The Academy’s activities included:
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Raise awareness:
o “Be ready for it” campaign: www.bereadyforit.org.uk.
o Sponsorship of the Norfolk Care Award for effective coordination of palliative care.
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Enhance the quality of education and training:
o Education providers group.
o Learning location for palliative care www.learncare.org.
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Enhance and align education and care commissioning:
o Collaborative commissioners group.
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Promote involvement in research:
o Improve the infrastructure for palliative care research.
Ms Parsons explained that the “Be ready for it” campaign aimed to
address the taboo surrounding discussion by people about death and
dying, and their wishes surrounding their own death. This was also a
challenge for those staff who worked in palliative care, dealing with
patients at the end of their life. The campaign encouraged people
who were at the end of their life to talk about their wishes when they
died, to help their relatives cope and know what they want at a difficult
time. Ms Parsons said a public awareness campaign might help with
this.
Ms Parsons commented that it was important not to be defensive
about the Liverpool Care Pathway (LCP) and that lessons should be
learned by medical staff around patients’ fears and concerns.
Ms Parsons said that gaps in palliative care included Occupational
Therapists (OTs) who had very little training around palliative care
and training for medical staff, which included one week of training
during their five year’s training.
Ms Parsons said that implementation of key elements of the
Academy’s work included investment plans for transformation of the
workforce, care of older people, people affected by long-term
conditions and dementia and more support for informal carers.
Preparing for possible illness and death included:
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Making a will.
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Putting in place guardianship wishes regarding the care of
one’s children.
Setting up a Lasting Power of Attorney (LPA).
Setting up an advance directive.
Talking about and informing relatives of wishes around
treatment in the event of serious illness.
Writing a “bucket list”.
Ensuring that close relatives were aware of one’s wishes and
where key documents such as an advance directive were held.
Ms Parsons reported that future plans included participating in the
Dying Matters Week taking place from 12 to 18 May 2014 and a major
event at The Forum in Norwich on 14 May. Ways of working with Age
UK Norfolk included linking in with the advocacy service and
encouraging people to think ahead about their wishes. This could be
done by mentioning the Be Ready for It campaign during talks. Ms
Parsons said volunteers were required for their talks and invited
members to consider volunteering.
In response to a query, Ms Parsons confirmed that work was taking
place in the West of the County where her contact was Hanna Lene
Schierff, Commissioning Manager - West Norfolk, Integrated
Community Health and Social Care.
Ms Parsons said that the issue of assisted suicides was a very difficult
one and the Academy hoped to create an environment where people
did not have to think about suicide as an issue, because they were
being adequately supported.
Dr Land asked about support required to set up an LPA or advance
directive which could be costly where solicitor’s needed to be
involved. Dr Land said it would be helpful for solicitors to have
resources available which would allow them to signpost people to
organisations which could help. It was noted that if mental capacity
was an issue, then it might be preferable to instruct a solicitor to
ensure that the legality of any documents were not compromised.
The Chair noted that a family solicitor was also likely to know about
family circumstances which was helpful when dealing with sensitive
issues.
The Chief Executive noted that Age UK Norfolk provided a service for
older people wanting help to complete paperwork for LPAs.
The Chair thanked Ms Parsons for her presentation and wished the
Academy well in its work. The Chief Executive also thanked Ms
Spooner and Ms Parsons for the work they were undertaking on
palliative care and end of life issues.
4.
Board of Trustees Report to the NCoA (NCoA 06/14)
4.1 A report from the Board of Trustees prepared by the Chief
Executive had been circulated prior to the meeting.
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The Chair reported the sad news that Carole Williams’s, NCoA
member, husband, David, had recently died. Mrs Williams hoped to
return to her volunteering role on the Information and Advice Line in
due course. Mr Button asked if Mrs Williams would be continuing with
the work she had undertaken on buses and Mrs Hopwood said that
she had discussed this with Mrs Williams who had confirmed that she
no longer wished to continue this. Mrs Pat Wilson had confirmed she
was willing to undertake this role and this was welcomed. Mrs Wilson
said she would report on her work to the NCoA.
4.2 Ten-Minute Update – Results from the CAREMED Study
(Multi-professional medication reviews in care homes for older
people): Dr James Desborough, Lecturer in Pharmacy Practice,
School of Pharmacy, University of East Anglia
The Chair introduced Dr Desborough and he thanked the Chair for the
invitation to the meeting to update on the work he had previously
reported on at the April 2011 NCoA meeting, when the project was
being established.
Dr Desborough acknowledged the research teams, GPs and care
home staff involved in the project.
Dr Desborough reminded
members about the background to the project:
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Management of medicines in care homes.
Pharmacist led medication reviews show promise.
Novel approach in Cambridgeshire.
The aim of the project was to determine the clinical and cost
effectiveness of CAREMED service. The objectives were to:
Determine impact of CAREMED on:
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Number of falls.
Potentially inappropriate prescribing.
Medication costs.
Primary care time (NHS resource use).
Emergency hospital admissions.
Mortality.
Dr Desborough explained how the project had been undertaken and
who had been involved and said his project had focussed on falls
reduction and inappropriate prescribing.
The need to encourage MFE consultants to intervene and avoid
hospital admissions was highlighted.
Dr Desborough reported that the CAREMED model currently costs
£100 per patient but there were ways to reduce costs such as
maintaining e-records and holding virtual meetings. GPs attending
care homes was expensive.
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In conclusion Dr Desborough reported that the research showed no
statistical difference in falls but the quality of prescribing had
improved.
There was a discussion around a number of items:
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5.
It was agreed that the slides would be made available to NCoA
members on Age UK Norfolk’s website.
GP involvement in the project.
Dr Desborough said that it was better for the patient where one
team was responsible for one person.
Over-medication issues outside care homes.
Pharmacy teams visiting people in their own homes.
Repeat prescriptions and annual reviews.
Verbal Report from the Norfolk Older People’s Strategic
Partnership Board (NCoA Representatives: Carole Williams,
David Button and Dr Derek Land)
Mrs Hopwood, Chair of the Norfolk Older People’s Strategic
Partnership (NOPSP) Board, reported that the last NOPSP Board
meeting had focussed on end of life care for people with dementia.
The NOPSP’s paper on the dementia strategy had been adopted by
the Norfolk Health and Wellbeing Board on 08 January 2014 and Mrs
Hopwood agreed to send a copy to Ms Skelton for circulation to NCoA PS
members.
6.
Joint Health, Social Care and Voluntary Sector Strategic Forum
and the Health and Wellbeing Board – Joyce Hopwood, NCoA
Representative
Mrs Hopwood reported that there was concern amongst the
representatives sitting on the Joint Health, Social Care and Voluntary
Sector Strategic Forum about the level of activity of the Forum.
Mrs Hopwood reported that an additional meeting of the Health and
Wellbeing Board took place on 01 April to discuss the Better Care
paper before submitting it to NHS England. The paper had been
drawn up by the five CCGs in Norfolk.
Mrs Hopwood said that the Health and Wellbeing Board was driving
forward work around health and social care integration.
7.
Presentation: Alex Stewart, Chief Executive of Norfolk
Healthwatch: Norfolk Healthwatch’s Priorities for 2014-2015
The Chair introduced Mr Stewart and he thanked the Chair for the
invitation to talk about the work of Norfolk Healthwatch.
Mr Stewart explained that Healthwatch had been established on 01
April 2013 as a result of the Care Bill (now Care Act), to help the
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public, patients and users of social care influence the way that
services are planned and delivered in Norfolk. Their partners
included NHS England, NCC and the CCGs.
Mr Stewart said that to help with a smooth transition from LINks
(Local Involvement Networks) to Healthwatch, a shadow Healthwatch
Board had been meeting for some time before the official launch on
01 April. Mr Stewart reported that Healthwatch covered all areas of
care from pre-natal to death. The Chair of Healthwatch is William
Armstrong and the office is based in Hethersett. Mr Stewart’s
background was in health and social care.
Mr Stewart reported that Healthwatch’s priorities for 2014-2015 were:
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Access to services by vulnerable groups.
Avoiding unnecessary hospital admissions.
Child and Adolescent Mental Health Services.
Children and Young People’s engagement.
Community Nursing Review.
Dementia.
East of England Ambulance Trust (including non-urgent patient
transport).
Handling of Complaints.
Integration Agenda.
Maternity Services.
Mental Health Provision in Norfolk.
Personal budgets.
Residential provision for adults with learning difficulties.
Unpaid family carers.
Work had focussed on encouraging integrated care and specific
research had been undertaken on:
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How individuals interacted with homeless people and people
with drug and alcohol problems in Waveney.
Bed availability for people under the age of 18 who have
mental health illnesses.
Mr Stewart responded to a number of items:
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Versatility of Personal Budgets.
Healthwatch had no regulatory powers although it works
closely with CQC (Care Quality Commission).
Challenges around transport in such a rural county as Norfolk.
Respite care was not included in the priorities.
The number of priorities was raised as a potential issue and a
question was raised as to whether this was realistic in terms of
achieving them. Mr Stewart said that Healthwatch had worked with a
number of organisations to formulate the priorities and surveyed
Norfolk residents via the “Your Norfolk” magazine about their
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perception of health and social care. A quality control panel checked
each project and priority.
Healthwatch was also working with a
number of partners to undertake the work, as well as benefiting from
57 volunteers who were experts in their respective specialisms.
Mr Stewart commented that he would be happy to attend another
NCoA meeting next year to update members on the priorities and
work of Healthwatch.
The Chair thanked Mr Stewart and wished Norfolk Healthwatch well
with its work.
8.
Any Other Business
8.1 Bills
Mrs Pat Wilson reported that she had noticed on a telephone bill she
had recently received that she was being charged an additional £1.50
because she received a hard copy of her bill (rather than an electronic
bill).
It was felt that most older people would prefer to continue to receive a
hard copy of their bills and there was a push by companies to force
people into receiving electronic copies by making them pay for paper
copies.
It was agreed that the Chief Executive would contact Age UK to raise HM
the issue.
9.
Date of Next NCoA Meeting: At 10.30am on Wednesday 29
October 2014 (subject to confirmation at the Annual General
Meeting) in the Training Room, Great House Training Centre, Age
UK Norfolk, 300 St Faith’s Road, Old Catton, Norwich, Norfolk
NR6 7BJ.
There being no further business, the Chair closed the meeting at 12.40pm.
Signed ………………………………
Position ……………………………..
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Date ………………………………….
Circulation:
NCoA Members
NCoA Non-Members
Age UK Norfolk Website
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