'Happy hubs', palliative care and the 'double dilemma' - the issues facing adult social care in South Tyneside

From helping people to live independently to improving quality of life for those with a long-term illness or disability, adult social care is a vital service.

While the service is delivered and mainly funded locally, decisions by government shape how much money councils have to do this.

In recent months, experts have warned of a national ‘crisis’ due to the rising demand of an ageing population and people living longer with serious conditions.

Although government have permitted a 2% increase in council tax bills to be ring-fenced to help meet adult social care costs, some council leaders have said it isn’t enough.

For deputy leader of South Tyneside Council and cabinet member for independence and wellbeing, Coun Tracey Dixon, adult social care is facing a “double dilemma.”

“There’s an increase in demand but we’re not getting the resources to actually support that demand,” she said.

“This green paper which has been sitting on the shelf down in Westminster for many a year is just not budging.

“They’re prioritising on Brexit but they’re forgetting about the impact on our most vulnerable.

“For me, that’s something they need to get over, get the green paper through and let’s see what we can get done with regard to the social element.”

In South Tyneside, the number of residents over 85 years old is expected to more than double in the next 20 years.

Despite overall reductions in government grants over the last decade and a historic council overspend of millions of pounds in adult social care, town hall bosses say the tide is turning locally.

Coun Dixon believes new ways of working have improved the way the council delivers services for those who need it most.

Let’s Talk

In 2017, the council introduced the ‘Let’s Talk Programme’ giving social workers more autonomy to talk to residents.

Calls to the council go through a three stage process with the first conversation with a specialist team helping to decide the “next step forward”.

The first call can include both self-referrals and professional referrals from the health sector while the second stage can include cases which require an urgent care package.

Meanwhile, the third stage covers more long-term decisions such as residential care.

The main focus of Let’s Talk includes linking people to resources in the community rather than going down a formal care package route.

According to Coun Dixon, the model has helped the council to reduce its overspend, manage demand and match services to the needs of residents.

Social worker, Jodie Reid, has seen the changes first hand after starting her career on the Let’s Talk team as a student before moving to the Integrated Team in June.

She said that the new approach is a lot more “person-centred” and can have a real impact on both carers and service users.

An example of the model in action included a man who was struggling to cope caring for his wife with dementia.

Jodie explained: “In the old way of working we would have generally went down the route of putting carers in or his wife into respite which is just sticking plasters.

“In this case, we found out what his wife enjoyed doing and linked her with a community resource, South Shields-based charity Ocean Choices, which provides classes for people including floristry and cooking.

“We linked her with something she enjoyed doing for an entire day and that gives him a break, we also linked with a ‘befriender’ from Age Concern and they come to the home so he can also have time to relax.

“It’s more sustainable that way and he has that continuity rather than putting his wife into respite for a couple of weeks and then going back to square one.”

Jodie followed in the footsteps of her mum to become a social worker and trained at Northumbria University.

Although she was left “shocked” at the levels of deprivation in South Tyneside, she said residents were “accepting, easy to get along with and really community-minded.”

“I think a lot of people have a negative view of social services and what they can provide,” she added.

“But the majority of people I have worked with have felt positive about that experience and that it was worthwhile, but I still think you have that stigma attached.

“People still see it as a power imbalance but it’s about remaining on the same level as them and working with them.

“It is tough, don’t get me wrong, and you do question if you have made the right choices but it is very rewarding when you see the outcomes.”

Tackling the crisis: loneliness, technology and residential care.

As one of the main statutory services, social care is one of the biggest areas of council spend in South Tyneside.

The vast majority, around 70% of the council’s discretionary budget, is spent on vulnerable adults and children.

In adult social care, challenges can range from winter pressures to organised crime in the form of County Lines gangs, who are known to prey on vulnerable tenants.

Another emerging challenge includes loneliness and social isolation, which can be linked to fear of crime, welfare issues and caring responsibilities.

At a wider strategic level public health leaders are looking to develop a new plan to stamp out loneliness in the borough.

According to 2017 data, council experts predicted that up to 2,980 over 65s were often or always lonely.

While Office for National Statistics Figures estimated that up to 21,000 adults across South Tyneside face loneliness.

When compounded with deprivation, unemployment, drug and alcohol use and poor mental health, some vulnerable people are at risk of slipping through the net.

However, services such as ‘Happy at Home’ – developed by the council and Churches Together – can offer a lifeline with a range of befriending services.

Several ‘happy hubs’ in Jarrow, Whitburn, South Shields and East Boldon also host a range of activities from crafts and cards to sing-alongs and puzzles.

Another new project set to be introduced in 2020 is the ‘Help to Live at Home’ model, with a focus on elderly people.

While residential care has historically been a core service of adult social care, the scheme aims to support residents into independent living as an alternative.

This includes long and short-term living and rapid carer responses during crises – with residential care only considered as a last resort.

The role of technology in adult social care is also a key driver for helping residents live healthier more independent lives.

The Living Better Lives Resource Centre in Jarrow, previously the Star Suite, offers a range of equipment for the elderly and disabled, with referrals through the NHS or Let’s Talk Team.

Visitors to the centre can try out equipment in home environments in an “independence suite” before taking it away.

Although the council already supports 2,500 people with assistive technology, new innovations including GPS ‘wandering alarms’ for people with dementia could be explored in future.

“There’s so much technology out there and as an authority we’re trying to support that for our residents and their families,” Coun Dixon added.

“That’s a key part of the adult social care strategy.”

The future of palliative care

In January, St Clare’s Hospice in Jarrow collapsed into insolvency after more than 30 years of providing end of life care to South Tyneside residents.

While NHS bosses have been working on plans for the future of palliative services in the borough, they have previously confirmed a like-for-like replacement for the hospice would be unlikely.

Following consultation, the prospect has been raised of a ‘spoke and hub’ model with ‘spoke’ community services supported by a ‘hub’ providing inpatient beds.

This includes a dedicated facility within the borough, preferably close to South Tyneside District Hospital.

A firm decision on the future of palliative care and the hub’s location is expected from South Tyneside’s Clinical Commissioning Group (CCG) later this year (2020).

Coun Dixon has previously welcomed plans to re-establish palliative care in the borough, with the caveat that residents have a choice over their care.

“It needs to be something that is going to be comfortable and has to be right for the needs of the individual,” she said.

“The CCG have given us assurances it’s going to be in South Tyneside and that’s where it needs to be.

“At the end of the day, it has to be down to the individual’s choice or the family choice if the individual can’t make their own decision.

“For me, it can’t be bed space in a residential home, it has to have break out area where you can sit, it has to be tranquil, it has to be right.

“I have been quite involved, my husband lost four family members to cancer, that’s why I feel quite passionate about it.”

Looking forward

Along with many areas of the country, South Tyneside is facing significant demographic pressures.

As the council finalises its 2020/21 budget in coming months, council leaders have pledged to work to protect key services and fight for fairer funding.

While there are difficult challenges ahead, deputy council leader Tracey Dixon added it was important to reflect on the changes that have been made so far.

“When I took on the portfolio in 2016 it was a huge huge challenge and something that I didn’t have a lot of experience in,” she said.

“Over the last three years seeing what changes we have made and how it has improved the quality of life for our residents, it has been extremely rewarding.

“We have made some quite radical decisions but we have seen quality of life improve.

“For me, as a resident of South Tyneside, it’s something I feel quite proud to have been involved in.”

She added: “For me, I just want to have a healthy older community living at home for as long as they possibly can with the right care and support from the council and community partners we have out there.”

To access support in South Tyneside call the Let’s Talk Team on 0191 424 6000 or email [email protected].