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Adult Social Care Local Account 2019 - 2021

The purpose of the Local Account is to provide information on where Cambridgeshire County Council Adult Social Care are doing things well, where we think we can improve and how we are planning for the opportunities and challenges ahead.

The Local Account reflects on our achievements during 2019-21. It also looks at how Adult Social Care has managed through the COVID-19 pandemic. It includes feedback that we have received through surveys carried out by both the council and local voluntary and community sector agencies.

Welcome

Welcome to the 2019-21 Local Account for Cambridgeshire County Council Adults and Safeguarding. We can all agree that 2020-21 has been an incredibly challenging year for everyone, and particularly for health and social care services. We are especially proud of the hard work that the department has undertaken, with our frontline staff going that extra mile to ensure that care is still delivered, despite the COVID-19 pandemic. We hope that you find the Local Account interesting and informative.

Councillor Richard Howitt and Councillor Susan van de Ven
Councillor Richard Howitt and Councillor Susan van de Ven, Chair and Vice Chair of the Adults and Health Committee at Cambridgeshire County Council

Activity Overview for 2019-20 and 2020-21

Below is an overview of the number of people we have worked with in 2019-20 and how different it was last year with the impact of COVID-19:​

  • 22276 – The number of contacts from people who needed some support or information and advice. There were slightly fewer requests last year, 18,569. ​
  • 8607 – The number of people we provided with technology or equipment. There were fewer people last year, 5,293.​
  • 3898 The number of people to whom we provided a short period of support to recover from illness or a stay in hospital. There were slightly fewer people last year, 3722.
  • 7558 – The number of people to whom we provided some longer term care and support. There were slightly more people last year, 7694.

How we spent our budget in 2020-21

pie chart showing where money was spent and who was supported

Where we spent the money

  • 75% on purchase of care and support
  • 8% on social care staff
  • 7% on directly provided support
  • 10% on other things

Who we supported

  • the biggest amounts were spent on older people, and people with learning disabilities, with smaller amounts spent on mental health and people with physical disabilities

Top achievements for 2019-2021

Response to COVID-19​

Adult Social Care's response to COVID-19 has focused on promoting independence, Technology Enabled Care, and supporting carers. ​

We redeployed staff to establish COVID-19 community hubs, fill gaps in reablement staffing, provide public information about COVID-19 and support shielded residents. ​

Find out more about Coronavirus support.

Supporting care providers ​

We have received positive comments and compliments from care providers about the support they have received from us throughout the COVID-19 pandemic. ​

These focused on the flow of information, support with interpreting government guidance, vaccination responsiveness and financial support.

Top three risks and challenges during 2019-21

Supporting people in their homes​

COVID-19 and lockdowns has created high levels of need in the community. We are seeing more complex cases, increased levels of frailty, reduced confidence and mobility and increased strain on carers. ​

Some of this is linked to reduced access to NHS services and changes in how people are discharged home after a stay in hospital.

People who work in social care​

The social care workforce has been under an unprecedented amount of pressure during the last year with potential longer-term impacts on health and wellbeing. ​

Indications are that older, more experienced workers might choose to retire sooner.

Financial situation​

The challenging financial position of the local NHS, and the growing costs of care, has increased pressure in the system. ​

This is not helped by the temporary nature of some current national funding streams, including those for hospital discharge and infection control.

Partnerships with other organisations

Working with GPs​

We have worked with Primary Care Networks and other parts of the NHS to support more joined up local care, that puts the needs of people first.​

COVID-19​

The system has responded in a co-ordinated way to support care providers with infection prevention and control, outbreak management and access to testing and vaccinations. ​

We have worked in collaboration with health colleagues to implement and embed the new ‘discharge to assess’ requirements which have had a positive impact on the speed of hospital discharges.

People with learning disabilities and families​

The Learning Disability Partnership continues to be an integrated health and social care service with a fully pooled budget. An example is setting up link workers from teams to work with Learning Disability Liaison Nurses in hospitals, with the person, their family and providers, to support people with learning disabilities coming home from hospital.​

Professional support for Adult Social Care​

A Public Health Consultant has been appointed to work specifically with Adult Social Care. ​

They will focus on the wider health and wellbeing of people with care and support needs.​

Campaigns​

There have been range of Public Health programmes which protect and promote the health and wellbeing of our communities:​

  • ​Stay Well this Winter​
  • #50000 Reasons (tackling loneliness and social isolation)​
  • Stay Stronger for Longer (falls prevention)​
  • Campaigns related to COVID-19​

Good practice example

Stay Well this Winter multi-agency group which works across the local health and social care system. ​

This group works to mitigate the risks associated with cold weather to the health and wellbeing of the most vulnerable members of the community, who live in cold homes due to fuel poverty. Stay Well this Winter on Be Well website.

Health and social care working together​

A Section 75 Agreement delegates the responsibility for Mental Health Social Work to Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). ​​

This enables a close working relationship between the council and the trust and for health and social care needs to be considered jointly. ​​

A trust lead for social work is in place to ensure that social care is a high priority.​

The trust has developed an Annual Work Plan for Mental Health which is reported against regularly.

The Good Life Service​

There is strong engagement with the mental health voluntary and community sector. ​​

Services are jointly commissioned with NHS Cambridgeshire and Peterborough where appropriate. ​​

The Good Life service is commissioned by Cambridgeshire County Council, Peterborough City Council and the CCG and provides a recovery and community inclusion service for people with mental health needs.​​

Find out more about The Good Life.​

Children’s Social Care​

The 0 to 25 Service transferred from Children's Social Care to Adult Social Care in September 2020. This team supports children with disabilities and their families.​

There is a clear commitment to ensuring that transitioning to Adult Social Care services should be planned early in order to support young people to achieve their best potential.

We have positive relationships with District Councils and providers. ​

A Housing Related Support Strategy has been produced and was consulted on across a wide range of stakeholders. The strategy will inform the re-procurement of housing services planned for 2021-22 introducing more flexible approaches based on the person's need, rather than available accommodation. ​

Adult Social Care implications of homelessness and domestic violence, including new legislative requirements, have been considered within the Strategy.

Working together​

A countywide community resilience group of 40+ voluntary and community sector services and community groups, plus all public sector partners (including Adult Social Care) has been established.​

Care Together​

The council has an active strategy for developing community resilience. We are looking at how we can work differently locally, starting in East Cambridgeshire. ​

Care Together is a partnership between health, social care, communities and local groups with the aim of support by local people to local people.

Community Projects​

Delivering projects that help people to participate and gain support within their communities. ​

  • Innovate & Cultivate Fund​
  • Against Scams Partnership​
  • Time Currencies

Good practice example

The Innovate & Cultivate Fund ​

This funding stream supports the creation of community projects delivering preventative work that builds community capacity and supports people to remain independent, safe, well and living a fulfilled life.

Community engagement

Healthwatch Cambridgeshire and Peterborough, who are commissioned by the council, bring together individuals and local partners through groups such as the five Adult Social Care Partnership Boards and their four place-based Health and Care Forums.​

These groups support the continuous improvement of health and social care.​

The Partnership Boards met virtually during 2020-21. ​

More information on Healthwatch website.

We worked with Healthwatch on surveys relating to COVID-19, such as: ​​

We have also benefited from the learning shared from other work carried out by Healthwatch, such as: ​

Engagement and co-production activities took place with specialist lived experience groups such as:​

Performance

The Adult Social Care Outcomes Framework (ASCOF) measures how well care and support services achieve the outcomes that matter most to people. ​

The ASCOF is used both locally and nationally to set priorities for care and support, measure progress and strengthen transparency and accountability. The latest published figures are for 2020-21.

Go to NHS Digital Measures from the Adult Social Care Outcomes Framework webpage.

Social Care Related Quality of Life

The Social Care Related Quality of Life score is made up of indicators around different aspects of people’s lives including nutrition, personal care, safety, social contact, how people are helped, control over daily life and whether people can spend time doing what they want to do.​​

The regional score was 19.25. ​

Cambridgeshire’s result was better at 19.4.

Indicators where Cambridgeshire did better than the regional average

  • Higher social care related Quality of Life ​
  • Higher satisfaction with care and support ​
  • More people with control over their daily life​
  • More people with as much social contact as they want​​​​​
  • More people receiving self-directed support​ ​
  • More adults with learning disabilities living in their own home or with family​​​
  • Fewer permanent admissions to care homes​
  • More people completing reablement who need no further long-term care and support​​

Indicators where Cambridgeshire did worse than the regional average

  • Fewer people said they find it easy to get information and advice​​​
  • Fewer people accessing long-term support receiving Direct Payments​
  • Fewer adults with learning disabilities in employment​
  • Fewer older people still at home 91 days after leaving hospital​​​​
  • Fewer older people receiving reablement services after leaving hospital​
  • Fewer people who use services who feel safe​
  • Higher number of delayed transfers of care

Impact of COVID-19

The impact of COVID-19 on the council and on social care has been unprecedented. Adult Social Care has been given high priority, with additional resources and dedicated public health support.​​

The system-wide response to COVID-19, including voluntary and community sector colleagues, has provided an opportunity to build sustained relationships, levels of trust and mutual understanding.​

Leaving hospital​

During the pandemic the NHS funded short-term care for people leaving hospital.​​

This was called ‘Discharge to Assess’ (D2A) and meant that people being discharged from hospital were able to access NHS funding whilst decisions were taken on their future care needs. ​​

Although the NHS funding is expected to stop Discharge To Assess is to continue, to support decisions about long-term care to be made at the right time.

Family carers​

Family carers have been particularly impacted by COVID-19. This has led a focus on proactive contacts and emergency ‘What If?’ contingency plans being developed for carers in partnership with Caring Together.​​

Staff redeployed from frontline roles, due to shielding status, were in contact with carers to offer support and link carers into wider COVID-19 support such as access to shopping, prescription delivery, etc.​

Working with providers​

Continued working with providers has been central to delivery of our local plans. This included ensuring that where we have discretion about use of infection control funding, we have consulted providers to understand what will achieve the greatest benefit.​ ​

Also, providers were given access to Personal Protective Equipment (PPE) and COVID-19 testing to support them in maintaining the safety of their services​.​

Working with the local community​

We have mobilised the community sector, to support low level prevention and early intervention provision. ​​

There was a particular effort to support carers with various voluntary and community sector groups and the community hubs providing proactive support and outreach​.​

New web pages have been created on our website to share messages about COVID-19.​

Go to our COVID-19 webpages.

A countywide newsletter called ‘Highlights from the Hub’ was produced which included lots of useful information about support available locally and nationally during the pandemic. Also, it highlighted local good news stories.

Leaving hospital during COVID-19 survey​

Healthwatch Cambridgeshire and Peterborough undertook a survey with people who left hospital between June and August 2020 (during the COVID-19 pandemic). Key issues from the report were:​

  • Three in four people said they definitely felt prepared to leave hospital or felt prepared to leave to some extent​
  • Nearly three in four people discussed where they were being discharged to and went to the place they wanted to go to and most people were positive about the care put in place

Information on leaving hospital during COVID19 on Healthwatch website.

However,

  • A significant number of people reported lack of communication during discharge meaning that they did not know what support they should expect when they got home, and they did not have information on who to contact if they needed help. Only one in five people were given information about the voluntary sector and the support they could offer​
  • Just over one in three people waited over 24 hours to go home, there were lots of reasons for the wait but the main one was transport ​
  • Some patients reported not having the equipment they needed, or not knowing how to use it

What the council has done

  • The council has started to work with the Adult Social Care Forum to look at access to information and advice more widely. The forum membership includes NHS Cambridgeshire and Peterborough.​​
  • A new information sheet specifically covering hospital discharge has been created and promoted for staff to use in the hospitals and social care.
  • A review of hospital discharges is currently underway and learning from this survey will feed into that.​

COVID-19 experiences survey – what happened next​

The survey feedback was reviewed at the Cambridgeshire and Peterborough Adult Social Care Forum in October 2020 and used to help improve current and future services. The feedback included: ​

  • How people had coped with the shift to online/telephone services rather than face-to-face support due to the pandemic. ​
  • The disruption caused by some local health services stopping or being put on hold. ​
  • How people had experienced increased anxiety and mental health issues – often linked to feelings of loneliness and isolation – due to shielding and lockdown measures. ​
  • The pressure on those with a caring role due to the lack of respite opportunities during lockdowns.​
  • How people had appreciated regular welfare check calls from council service teams.​
  • How people would like to keep the option to have a mixture of online and in person meetings and services going forward.

Printable version of the 2019-2021 Local Account