Agenda item

Richard Munn (North Kent and Swale Service Manager – KCC), Jenny Walsh, CED – Red Zebra),  Fiona Keyte – Social Prescribing Manager – Red Zebra), Melinda May, Newly Qualified Social Worker – KCC),  Debbie Williams (Case  officer Adult Social care – KCC), Kerrie Lane (Senior Occupational Therapist – KCHFT), Cathy Bellman (Local Care Lead – K&M STP) and James Shaw- Cotterill (Project Manager – K&M STP) attended for this item.

(1)                          The Chairman welcomed members of the Multi-Disciplinary Team to the meeting and invited them to introduce themselves, explain their role and answer questions from Members.  

(2)                          Richard Munn explained that his areas of responsibility included managing and promoting the supporting independence teams which included Occupational Therapists and other staff who carried out assessments to promote independence.  They also carried out supporting independence reviews and responded to urgent changes in need.

(3)                          Jenny Walsh stated that Red Zebra received referrals from GPs and also self-referrals – they saw 50 new clients a month.  The Red Zebra team visited people in their home and, rather than focusing on what was wrong they discussed with the client – “what was strong” – a large percentage of referrals related to loneliness.

(4)                          Fiona Keyte informed the Committee that the Red Zebra social prescribing team consisted of 3 part time and 1 full time worker.  Their aim was to help people to help themselves.  They promoted a database called “Connect Well Kent” – which listed local services and activities which could be matched to the individual’s interests.  This database could be accessed by individuals as well as the prescribing team.

(5)                          In relation to a question on referrals, it was explained that there was a weekly Multi-Disciplinary Team meeting, which considered referrals from GPs, health professionals, self-referrals and referrals from neighbours or other members of the community.   Red Zebra’s services were promoted by GPs and various other methods including talks to community groups.  People requiring support were visited in their own homes or in a community setting, wherever the referred person preferred.  They might be lonely and want to get out into the community, so they would help them to access the database and see what there was that they were interested in.  Most people wanted social activities but there was also a need to provide assistance with housing or welfare needs, including referring them to services for advice/support.   It was about the community assisting in providing support and signposting to what was available in people’s local area.   An example was given of a client who had been widowed and was socially isolated.   He was referred to Red Zebra and visited in his home, he wanted to meet people in the community and enjoyed reading and chatting, he went along to Talk Time events and made friends, this gave him the confidence to try other activities.

(6)                           Another example given was a lady who lived in Kent but worked in London and had no family or friends in her local area.   She was due to retire and was concerned that she would be lonely.  She had lots of energy and wanted to give something back to the local community.   Red Zebra referred her to the local volunteering bureaux so that she had something in place when she retired.

(7)                          Melinda May explained that she was a newly qualified social worker who saw people in the community and assessed their current needs.

(8)                          In response to a question it was confirmed that Red Zebra has been established from a pilot in 2016 and each year the number of referrals had increased, from 176 in the first year, to 600 in the second year and in the current year they were on track to deal with over a thousand referrals.

(9)                          Debbie Williams explained that as a case officer her role was to go out and assess people with the aim of enabling them to remain in their own home.  She used Red Zebra for ideas about community activities, as one method of addressing a client’s needs.  She also met with colleagues from other agencies to share ideas regarding support that could be provided.   She confirmed that referrals came from many sources such as GPs, self-referral, referrals from family or friends or others in the community.

(10)                       In response to a question on the value of heritage, arts and music related activities and whether these were the most popular activities for older people.   It was confirmed that the most popular activity was attending a lunch club, there were waiting lists in some areas as this and other activities were run by smaller organisations. It was confirmed that there were organisations who did not have funding to deal with increased demand.  One of the most popular requests was a befriending group which where they exist had a long waiting list – so funding bids were being drafted. 

(11)                       It was confirmed that there was a difference between what people wanted and what was available.  Some activities were, free, some were low cost and some were market rate.  Art and exercise classes were expensive, but attempts were being made to plug gaps in activities and support.

(12)                       Kerrie Lane stated that Occupational Therapists saw clients in their own homes to assess needs for adaptations to keep them in their own homes.  Occupational Therapists liaised closely with colleagues and had a multi-disciplinary team approach and could refer if there was an issue with social exclusion. 

(13)                       In response to a question it was confirmed that as part of integrated discharge support was given for up to 6 weeks, as it was a short-term service, other support could be identified if needed for longer.

(14)                       Cathy Bellman explained that in relation to primary community services over the past few years the way services had been commissioned had created barriers leading to a negative impact on communicating and sharing information between organisations. Organisations were not talking to each other for fear of information being used to the detriment of any possible tender bids.   The STP were trying to address this and to get statutory organisations to use their workforce in an efficient way.  A game changer was recognising the value in the voluntary sector.  There was growing demand but not growing funding so there was a need for organisations to work together e.g. GPs working together (for populations of 30,000-50,000) and services developed around the practices to build a community of health and social care workers.   She had been talking to people who ran clubs and if evidence of demand was provided to clubs they would be able to address that need. Investment in community services was important. 

(15)                       James Shaw - Cotterill confirmed that the STP provided support across Kent and Medway to CCGs and KCC. One of the objectives was care navigation and social prescribing which meant talking to CCGs and Councils about, for example, models of care.  He had written a case paper on social prescribing for NHS England, working to reduce the pressure on the health care system, such as primary care.  He gave the example of a patient who used to ring his doctor’s surgery 4 times a week to speak to the practice. The patient was referred by Red Zebra for befriending and gardening help.  The patient’s confidence improved, and he began accessing activities in his community, as his social needs were met.  Contact with the doctor’s surgery reduced to once a week and the calls were more focused and medically based.

(16)                       James stated that in London a company called I5 Health was supporting CCGs with social prescribing. I5 Health helped to identify patients at GP level, on specific disease registers that would benefit from social prescribing.  The tool suggests invitations, cost and savings from social prescribing.  This was a great example of evidence based proactive preventative social prescribing that made a difference to the individual, system and to service costs.

(17)                       It was suggested that more should be done to market the service available rather than waiting for a referral or self-referral.   James explained that the ethos behind the Multi-Disciplinary team meeting was preventative and identifying patients who were at risk or in need.

(18)                       It was confirmed that Red Zebra and the Multi-Disciplinary team were looking at waiting lists and the capacity issue and presenting this to the CCG, they tried to apply for other funding as well to fill the gap. The example was given of someone who had been referred for debt counselling with their first appointment at the end of December.

(19)                       Reference was made to the example of the Mental Health contract when over 100 grants to groups were reduced to 4 lots.  This led to the risk of people not fitting into the smaller number of specific services.  If the Multi-Disciplinary Team and Red Zebra were taken away, the example of other contracted services, showed the risk that this would leave a gap in service provision.

(20)                       In relation to barriers to accessing support, Cathy stated that there was a need for consistency across the County.  The Strategic Commissioning Steering Group were forming and their function would be to look at making strategic decisions around big ticket items; social prescribing being an example of where a strategic approach would give consistency of provision rather than just filling gaps. 

(21)                       In response to a question regarding transport to e.g. lunch clubs – it was confirmed that there were community transport schemes, which used volunteer drivers, for an annual fee and a charge of 45p per mile.

(22)                       Regarding how much could be done to get the community involved including community wardens and flood wardens, it was important to support the community to support local people and encourage local people to support the community.  Community meetings were a forum for raising awareness of social prescribing and led to referrals. Community Wardens and others used the Connect Well Kent database. It was a way of bringing organisations together.

(23)                       An example was given of the need for social prescribing to mitigate social isolation and to benefit not only the older person but also their wider family who were feeling the stress of supporting a multi-generational family whilst also working.

(24)                       In response to a question about gender, ethnicity and the impact on social isolation, Richard stated that in East Kent there was a tendency for older women who did not have English as a first language to become isolated.  Direct payments were a means for individuals to control how their care needs were met, rather than imposing services, individuals chose who provides their care.

(25)                       In relation to integrated discharge it was confirmed that neighbours could be involved if the patient agreed and this would be welcome by the services.

(26)                       The importance of a GP referring patients and their families to social prescribing, illustrated by a specific example was highlighted.

(27)                       Cathy explained that the essence of the Multi-Disciplinary Team ambition was to get services wrapped around GP practices to identify vulnerable and frail patients who would benefit from support but who might not seek it themselves. 

(28)                       The emphasis should be on doing more to prevent or reduce social isolation and James stated that there were examples of where social prescribing had made a difference which he would supply to the Committee. It was important to be more consistent and proactive across Kent and Medway when it comes to social prescribing. It was important for GPs to be involved and aware of the importance of social prescribing including the positive impact it could have on GP services by freeing up capacity. 

(29)                       A way of doing this could be social prescribing clinics in GP practices to signpost or just to have a cup of tea with a patient and identify ways of mitigating social isolation. There was a tendency for older people who were socially isolated to go to their GP

(30)                       Another suggestion was to work towards parity of opportunity for social prescribing across Kent.  Also, people who were referred to services should have their needs looked at holistically, social care was about more than just making sure that people were fed and kept clean.

(31)                       The Chairman thanked the members of the Multi-Disciplinary Team for attending and for answering Members questions.  He invited them to submit written evidence in support of the Select Committee’s work.