Has any action been taken as a result of the Review of health services for older people report being issued in 2002 and if not why

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QUESTION TO BE ASKED OF THE PRESIDENT OF THE HEALTH AND SOCIAL SERVICES COMMITTEE ON TUESDAY 29th APRIL 2003,

BY DEPUTY R.G. LE HERISSIER OF ST. SAVIOUR

Question

Would the President identify if any action has been taken as a result of the Health and Social Services Audit Committee's report entitled Review of Health Services for Older People' dated July 2002, and, if not, the reasons for this?

Answer

Several significant steps have been taken to implement the recommendations of the Audit Committee's review of services for older people.

For those who have not read the document, this report was commissioned by our own Audit Committee against a background of an ageing society which is likely to place increased demands on Health and Social Services for care and support to maintain the quality of life of older people. The report looked in particular at the plans to address  the  issues of an  ageing  population, how  services  are currently  provided and the  standards  of  care compared with best practice in other territories.

The Committee considers the services it provides for older people to be a high priority and, by way of illustration, currently needs to spend nearly £9 million on specialist rehabilitation and elderly services, together with a further £15 million on acute medical and surgical services for older people and a grant to Family Nursing and Home Care of nearly £4 million, much of which is used in caring for the elderly. One purpose of the Audit review was to ensure, in view of the severe constraints on our budget, that this investment continues to be used to achieve the most effective clinical outcomes and best quality of life for older people within the funding available.

In summary, the main recommendations of the report were that my Committee needed to –

( i)  pursue a high-level strategy to meet the future care needs of an older population, involving other States

departments, voluntary organisations, community representatives and the private sector;

( i i) f u rt her develop our working relationship with Family Nursing and Home Care to provide more

services for older people in the community;

( ii i) work closely with the Housing Committee in developing suitable accommodation for older people with

a range of different needs;

( iv ) en c o urage the provision of more private residential, nursing and continuing care homes, catering for

differing levels of assessed need;

(v ) s u p port the development of a system for comprehensive assessment and recording of needs,

involving all the health care professionals contributing to the care of older people; and,

( v i) fu r t her develop services and standards to meet the specialised or complex needs of clients with a

range of different conditions related to old age, such as strokes, fractures resulting from falls, or mental health problems, in line with UK National Service Frameworks.

It should be emphasised that these recommendations were not criticisms, but constructive proposals for the future development of services for older people. The Committee welcomed the report and the response of Health and Social Services has been extensive and significant.

The action taken so far includes -

( i) S e tt ing up an interdepartmental strategy group in March 2002, involving officers from several States

departments, to develop an Island-wide Strategy for an Ageing Society. The strategy focuses on five broad areas: health and social care, environment and access, pensions and welfare, employment and contributing to the community, and learning and leisure. The interdepartmental group is being steered and scrutinised by a public group representing members of the community and relevant external agencies who meet on a quarterly basis. A first draft strategy is nearing completion and will be available for wide consultation in the next few months;

( ii ) the department has continued to strengthen the partnership with Family Nursing and Home Care and it is

planned that a service level agreement between the Health and Social Services Committee and the Family Nursing and Home Care will be in place in January 2004;

 ( i ii) o f fi cers from the Health and Social Services, the Planning and the Housing Departments are

collaborating with a major private sector development on the L'Hermitage site, which will provide a range of high quality sheltered, residential and nursing home accommodation tailor-made for older people with different levels of need. The Health and Social Services Committee will consider the benefits of service level agreements to provide such accommodation, as a cost-effective alternative to public sector provision; and,

( iv ) the Housing Department has also been fully involved with Health and Social Services staff in planning

community care package' provision and the development of a co-ordinated service for patients with complex needs (including brain injury);

A number of detailed actions have also been taken in response to specific recommendations. For example –

( i)  the management of General Hospital medical care and services for older people at Overdale has been

integrated, with staff working across both areas and providing a better co-ordinated and more patient focused service. Following steps to integrate their services, it is intended to formally restructure the Health and Social Services organisation to reflect this change to a more patient focused service; and,

( ii ) in i ti atives to reduce the length of time that older people stay in the General Hospital has reduced the

pressure on beds and helped avoid the need to cancel or delay surgical admissions. This has involved the purchase of nursing beds in the private sector and the reopening of the McKinstry Ward at Overdale; increased multidisciplinary team working to improve rehabilitation and standards of care; the appointment of rehabilitation assistants on the wards at the Hospital; and increased input into the General Hospital from Social Services, Mental Health and Family Nursing and Home Care staff to improve the co-ordination and effectiveness of the care provided for older people.

I believe these examples show that many of the recommendations of the Review of Health Services for Older People' have been, or are being, implemented. However, there is still work to be done, and my Department continues to focus on meeting individual's needs, re-shaping services and improving performance and quality.

Finally, it is recognised that the current system of payment for residential care is complex and inappropriate, and I am well aware that this sometimes causes concern for members of the public. Currently, increased payments are being made by the Health and Social Services Committee to encourage private care providers to meet individual's additional care needs without placing undue burden on those people involved. However, there is a pressing need to consider an alternative funding system, possibly linked to social security contributions. Amongst these options, the Guernsey system for paying fees is being examined and I hope to raise this issue for wider debate in the future.