The Joint Strategic Needs Assessment identifies that the population of Angus is growing older and that the population of Angus will continue to age for the next 20 years. It is anticipated that this change in population demographics will place a further increase in demand on services if they continue to be delivered in the same way. The Strategic Commissioning Plan 2019/22 aims to continue to address demographic change by changing the way that services are provided and to shift the balance from care to supporting more people at home. The focus of the Strategic Commissioning Plan 2019/22 is to support care needs at home by enhancing opportunities for technology enabled care; further progressing self-directed support; and delivering change in care at home services through the Help to Live at Home project.
Our Measures
1 in 55 Adults received Personal Care in 2019/20. A 6% increase over the previous year.
507, 465 hours of Personal Care was delivered in 2019/20. 14% more than the previous year.
92% of people spent their last months at home or in a community setting. Up from 91% the previous year.
More Detail on the measures can be found here.
Our Practice
Dundee Carers Centre are commissioned to provide support to people using option 1 (Direct payments)
Mr and Mrs R are a couple who live in Angus and had been getting informal support from a friend for a long time. Mrs R’s needs have recently increased, and Mr R has increasing health concerns meaning that he is unable to provide as much support as he has done previously.
Their Care Manager has suggested Option 1 for their situation as it would enable them to formalise the support they were getting without having to recruit a stranger. This was important for them as they did not want a team of people coming to their house and they wanted the support to be more personal. They were given a budget which included a carer’s budget so Mr R could get a break from his caring responsibilities using the same Personal Assistant that provided personal care for his wife. The advantages of taking this option were that they had a choice about who was providing the support and when they wanted them to come. There would also be flexibility if they changed arrangements at short notice as hours were agreed by themselves and the Personal Assistant.
The SDS advisor met with the couple to explain the benefits and responsibilities of taking on Option 1 (Direct Payments). The advisor assisted them to get the employment side of things set up, by helping with creating a Job Description and Contract of Employment.
The couple felt a bit overwhelmed with the amount of paperwork and processes to get through to get things set up initially, so things were broken down into smaller steps with regular home visits and they said this was beneficial for them. As they weren’t confident about the monitoring paperwork, the advisor suggested this could also be part of the Personal Assistant role. We met with the potential PA who was happy to support them with this as part of her role and she was also going to provide regular respite breaks for Mr R as well as assisting with all of Mrs R’s personal care needs.
Everything was set up apart from payroll, but we then entered lockdown due to Covid-19. Things were a bit tricky as our workforce moved to working from home and there was a delay with getting payroll set up. It was difficult to get Mrs R registered as an employer with HMRC as they had also changed their usual working arrangements.
To help reassure the couple, the SDS advisor kept in regular touch with them during this period and liaised with payroll until things were finally set up. The Personal Assistant needed to have interim payments made by the employer until payroll could be processed, but the SDS advisor supported them with this.
The next step will be supporting with financial monitoring and we will do this as soon as we are able to, either face to face or by post. In the meantime, they are keeping all relevant paperwork in preparation for this.
The couple told the advisor about the impact on their lives: “We now have more stability in our home and feel a lot more happy than before because we know that there is someone making sure that we are being looked after, we are both a lot more settled in our mental health as because a lot of worry regarding (what is going to happen to us) has been removed and we can actually start thinking of some type of future security and happiness.”
Dundee Carers Centre are commissioned to provide support to people using option 1 (Direct payments)
Miss Smith is a young woman with a fluctuating health condition that affects her mobility. During a period of ill health, she was offered Option 1 (Direct Payment) and with the support from an advisor, recruited a team of staff to support her.
Option 1 (Direct Payment) was the best option for Miss Smith. Miss Smith knew that she did not want a provider, and that she wanted more personalised care. Option 2 (provider) would mean that Miss Smith would be unable to choose the exact time personal Assistants were in, and they would be able to help with light household work, and also socialising activities. If Miss Smith went with a provider it would mean she would only get an hour for household work and would not get the benefit of support with social activity.
Miss Smith, felt that being able to access the payroll, was a huge relief for her, as she just filled in the time sheets and they worked out the pay and dealt with HMRC on her behalf.
Miss Smith became very confident in her role as an employer, but her health improved and so the Direct Payment stopped.
During this period, Miss Smith started a job which suited her condition, but then suffered a relapse which meant she needed support again, but not always on a regular basis.
With advice from the advisor Miss Smith was able to employ staff again, with flexible support which suited her condition. She was able to have the support she needed when she needed it, without the worry of what would happen if her health temporarily improved.
The impact of option one on Miss Smith, was huge, this gave Miss Smith independence to go out with carers, when she wanted it, also gave Miss Smith peace of mind, knowing when the carers will be in and also knowing who will be coming in and when they will be here.
Angus Health and Social Care Partnership (HSCP), manages the implementation of the Florence Home Mobile Health Monitoring (HMHM) system which uses a simple texting system that sends messages to peoples’ mobile phones reminding them to take their blood pressure reading or weigh themselves and then text back the results. The system receives the texts and people may then receive further texts providing advice and instructions if necessary. People with conditions such as high blood pressure, chronic pain and fatigue as well as those seeking support with weight management are participating in this HMHM initiative.
In April 2019 an evaluation report, Towards Scaling Up Home Mobile Health Monitoring in Tayside, commissioned by the Scottish Government, praised the home mobile health monitoring (HMHM) initiative led by Angus HSCP.
In 2019/20 Angus HSCP was awarded £139.456 to implement the Scale-Up (BP) Programme across Tayside. This is an example of how digital technology can be used to optimise care, support and enable increased self-management and improve health outcomes whilst helping Primary Care Services to make best use of available resources. Eight GP practices in Angus have signed up to this initiative. Technical challenges with integrating Flo data with GP systems has caused a delay with recruitment. One GP Practice in Forfar has recruited 31 patients to Flo to support with contraceptive advice and BP monitoring.
On 8th May 2019 Angus HSCP, supported by the Scottish Government Technology Enabled Care (TEC) Programme hosted an event to accelerate the update of HMHM across Tayside. NHS Tayside’s director of public health, Dr Drew Walker, said “Remote monitoring is just one of a range of digital approaches which can improve health and there is now a real need to push that much harder and further so that its full potential to improve health and reduce health inequalities can be realised.”
Near Me is a secure form of video consulting approved for use by the Scottish Government and NHS Scotland and provides appointments and consultations virtually meaning people do not need to travel to attend but can be seen by their service provider in the comfort of their own home, at work or while on the move.
Angus HSCP has been working closely with NHS Tayside who are working to embed the system into everyday work practise for outpatient and GP services. The aim is to have Near Me offered routinely as an option for appointments and consultations. By the 2nd of April 2020, all Angus GP’s were enabled with the Near Me kit and training links. The roll-out continues to be progressed.
Telecare
In 2019 we were awarded £9696.46 from the TEC Programme to expand the Angus initiative called Check TEC Out which enables vulnerable older people to test a range of low cost, easy to use technology. In addition to LED Night Lights, Wireless Remote Control Sockets, Ownfone, Projection Clock we now offer Alexa Shows and associated set up equipment (Wi-Fi travel unit, SIM cards and support stands) and Echo Dots with Wi-Fi and SIM support.
In May 2019 we re-launched the Technology Enabled Care section of the Angus HSCP website. This includes an interactive poster will illustrates the range of telecare available to support people and keep them safe within their own homes we created an interactive poster.
As part of our commitment to the Technology Charter for People with Dementia we have been actively promoting the uptake of the Purple Alter app across Angus. Purple Alert is a free mobile phone app designed by people living with dementia and their carers’ with Alzheimer’s Scotland, Police Scotland, Social Work, Dementia Friends, Dementia Friends Scotland, HSCPs and telecare services. The app allows carers to share the person living with dementia’s profile if they lose their way and allows for others to report a sighting of that person. Staff have been enabled to use the app on their work phones so that as many people as possible are available to search in case of an alert. We have also been working closely with colleagues from NHS, Scottish Fire & Rescue service and Police Scotland (Tayside) to promote and encourage uptake in the use of this app. The app is currently going through a major redesign and Alzheimer’s Scotland are looking to launch a new app in August 2020.
In November 2019 the North East and North West Locality Improvement Groups awarded funding to introduce Advanced Risk Modelling for Early Detection (ARMED). ARMED supports vulnerable people to participate in wearing a polar loop bracelet (fit bit) which monitors their health statistics and collates this information using a mobile phone app to build up a picture of the person’s general health and fitness levels. The polar loop also serves as a prompt to remind the person to move/exercise regularly to maintain and build upon their core strength, improve mobility and overall wellbeing. The start of the project, originally planned for March 2020, has been put on hold due to the COVID-19 pandemic, but we are eager to commence as soon as possible because evidence suggests people are not moving as much whilst in lockdown and motor skills are deteriorating. Which increases the risk of falling.
The Analogue to Digital transition of the Community Alarm service in Angus was progressed towards the end of 2019 when tender for contracts was submitted and awarded. Work is now in process to manage the upgrade to the Community Alarm Control Room and migration of all current dispersed alarm units with a digitally enhanced version.
An introductory E-Learning Induction Course on Technology Enabled Care incorporating both Home Mobile Health Monitoring and Telecare is now available to all HSCP staff. The module helps to inform new and existing staff of the differing types of TEC and provides examples of how it utilises within their work practice.
A number of telecare promotion events have been staged throughout 2019/20 where we have tried to reach as many people as possible and raise awareness of the benefits of telecare. Venues have ranged from shopping centres, leisure centres, libraries, Angus Community Hospitals and Sheltered Housing facilities. Meetings have also taken place at Angus Carers Group and a variety of staff meetings. A rolling program of refresher training is currently in development to ensure staff are continually updated about the range of available telecare.
The FIRST (Falls Integrated Response and Support Technology) Falls Pathway was launched September 2019. The aim being to improve the experience & outcomes for people living with frailty who fall, are uninjured and require assistance from services to get up from the floor. The FIRST pathway now ensures a response and support for people who do not need an ambulance response and have not subscribed to a community alarm response service and allows for follow up action to be taken in the event of concerns being raised regarding the person who has fallen. Since the introduction of this pathway there have been 3 incidents recorded.
Access to long term social care support requires an assessment of need by Care Management Teams Individuals then make choices about what services would meet their needs and personal outcomes, how and when those supports will be delivered/accessed and who will provide them. Self-directed support is the mechanism by which these choices are provided. The options available are:
Option 1 – direct payment
Option 2 – person directs the available support
Option 3 – local authority arranges the support
Option 4 – mix of the above
Self-Directed Support Uptake of Options
| Indicator | 2015/16 | 2016/17 | 2017/18 | 2018/19 | 2019/20 |
| Option 1 | 4% | 8% | 6% | 7% | 7% |
| Option 2 | 13% | 15% | 22% | 23% | 25% |
| Option 3 | 79% | 73% | 67% | 65% | 61% |
| Option 4 | 4% | 4% | 5% | 6% | 7% |
2646 people have care plans in place that include support that is subject to self-directed support options in 19/20. There has been a shift towards greater choice and control with a greater proportion of supported people accessing options 1, 2 and 4. Most people in Angus continue to access option 3, asking Partnership staff to organise support on their behalf, although the proportion of people using option 3 continues to decrease.
Option 1 (direct payments) give people the maximum amount of choice and control over the way their support is arranged. Angus HSCP commissions Dundee Carers Centre to provide support for those who wish to use option 1.