The new enhanced role for councils in care and health

Last week’s national children’s and adult services conference saw health secretary, Andrew Lansley, outline an enhanced role for local government in care and public health, reports Michael Burton.

Not only was last week’s annual children’s and adult services event a sell-out, but it was also graced by a full turn-out of secretaries of state, ministers and shadow ministers from the two departments of education and health.

Education secretary Michael Gove’s speech in its exhortation for more academies and free schools opting out of their education authorities was not entirely welcome news to the predominantly local government audience.

But health secretary Andrew Lansley’s speech was another matter altogether.

For a department which has been historically the least proactive in wanting to work with local government, his content was about as pro-councils as he could manage without handing the NHS over to town and county halls altogether.

In fact, he revealed to the audience that five years ago, he had indeed had discussions with Tory London borough leaders about the feasibility of transferring the NHS to council control, but decided against it. After all, he told delegates, would councillors really want to make decisions over whether to spend money on a leisure centre or cancer treatment?

He continued: ‘If local government was responsible for health, it would dominate every decision taken by the council. It’s not the job of politicians to decide clinical priorities, but to be involved in strategy.’

Local government’s role according to the coalition’s health agenda is three-fold.

First, it needs to help reduce costs to the NHS of treating old people by devoting council care resources to helping them be independent at home.

Second, councils have a new key role in the public health agenda outlined in last summer’s health White Paper, with directors of public health coming primarily from a non-medical background. And third, although Mr Lansley did not touch on this in his speech, councils could provide back-office services, such as HR, payroll, accommodation and auditing to the new GP consortia, when they are up and running.

Much of his speech was devoted to the care agenda, in particular, the extra £2bn promised in the CSR for adult care. Mr Lansley said this had exercised the minds not just of his department but the ‘Treasury, Number 10 and the deputy PM’, not surprising, bearing in mind that councils were bearing the brunt of spending cuts and the temptation would be for them to cut back on their care costs.

He recalled: ‘It was a real concern, and we feared there would be a rise in emergency admissions to hospitals.’

As a result, ministers had agreed to find an extra £2bn divided between councils and the NHS. Mr Lansley told a press conference after his speech that this was deliberately front-loaded, with £800m earmarked for the next financial year, to offset the front-loaded cuts to council funding announced by the CLG in the Spending Review.

He emphasised that the two sectors would be expected to work in tandem, saying: ‘Health and social care must be complementary, not conflicting. Cost-sharing, not cost-shunting. We are locking health and social care together in the funding mechanism.’

The health secretary gave more details about the funding and more help for the NHS to put in place post-hospital care, or re-ablement services for people needing help regaining their independence after a spell in hospital. The NHS will be given an extra £150m in 2011/12 for re-ablement services, and £300m a year from 2012/13, part of the extra CSR social care cash. And a ‘toolkit’ has been launched that will help councils to work with the NHS on re-ablement.

Later, the chairman of the LGA’s community wellbeing board, Cllr David Rogers, said: ‘Mr Lansley’s explanation of how the extra £1bn from the NHS is going to be spent helps provide the much-needed clarity we have been calling for. There was concern about how PCTs would work with councils, and it’s reassuring to hear the Government is as committed as we are to making sure this money goes to the people who need it most.’

The health secretary also stressed that prevention, use of technology and personalised budgets would all help keep the elderly independent and in their homes, rather than ending up in hospital as a cost to the NHS.

As he said: ‘Falls alone cost £1bn a year and one-third of people with dementia who go into hospital never come home again.’

He singled out his visit to North Yorkshire CC, which has introduced a telecare service which monitors the elderly and has saved £1m by helping elderly people remain in their own homes with support. He added: ‘North Yorkshire CC told me specifically about falls where, every hour spent on the floor equalled one day in hospital, and how its approach to using technology saved more than £1m and reduced care package costs by one-third.’

North Yorkshire CC’s corporate director of adult and community services, Derek Law, later commented on the speech by saying he was ‘frustrated by the lack of progress in other parts of the country’, and added: ‘I can’t understand why other councils aren’t achieving the results that we have achieved.

‘Telecare ticks many boxes. For the person using the technology, it provides choice, dignity, empowerment and independence. For the carer or family member, it offers reassurance and peace of mind, 24 hours a day. And for us it offers cost-effective, person-centred care.

‘For the health service, it enables earlier discharge, reductions in hospital admissions and a more joined-up service with social care.’

Mr Lansley also devoted part of his address to highlight the local authority role in public health. As he said: ‘The principal determinant of the health of a population is socio-economic, and that’s not down to the NHS, but is the responsibility of local government.’

The heath White Paper envisages new public health directives being in place by 2013. Mr Lansley added ‘There won’t be, necessarily, medical people. We want to rebuild the public health profession.’

Cllr Rogers later responded: ‘It was encouraging to hear the health minister acknowledge councils as being at the heart of public health. This has been the core business of local government since its foundations. Closer working with the NHS will help build on our successes.’

Mr Lansley also announced a network of early trail-blazers, a ‘collection of pioneering authorities to show how health and wellbeing boards could work in future’, will be set up.

Nitrogen knocks out lone worker inside machine

The Health and Safety Executive (HSE) has prosecuted a Black Country recycling firm after nitrogen gas, used to stop explosions, made a lone worker pass out.

Halesowen Magistrates Court heard that it was usual for workers at Overton Recycling to climb into the chute of a fridge recycling machine at the company's site in Rufford Street, Lye.

On 1 June 2009, Stephen Barnes, 47, from Birmingham, was working on the machine used to recycle fridges. A chute fed the fridges inside the machine to be broken up, but as they have the potential to explode, the machine contained nitrogen gas to help reduce the risk of a blast.

Sometimes the fridges would twist and get stuck and it was usual for workers to climb in to clear the blockages. When Mr Barnes did this on the day of the incident, the nitrogen inside the chute made him pass out so he had to be rescued by a colleague.

He was taken to hospital and was off work for three days and although he made a full physical recovery, he has since suffered from a lack of sleep, flashbacks and mood swings that are only now subsiding.

An HSE inspection found the presence of the nitrogen in the chute had not been assessed before people got inside to clear blockages. The company had also failed to carry out a suitable and sufficient risk assessment that would have identified the risks of climbing into a confined space. The company should also have had a system in place for clearing blockages that did not require entry in to the chute.

HSE inspector Angela Gallagher said:

"Companies need to ensure all machinery and processes are properly assessed. Had this been done, the nitrogen would have been identified as a hazard and the chute recognised as a confined space with the right safety systems installed.

"All too often in cases like this we see multiple fatalities as people try to rescue a colleague from a confined space without taking precautions themselves. It is fortunate that no one was more seriously harmed on this occasion."

The company pleaded guilty to breaching Regulation 3(1) of the Confined Spaces Regulations 1997 and Regulation 3(1) of the Management of Health and Safety at Work Regulations 1999 and was fined £13,000 and ordered to pay £6,107 costs.

Telecare Gadgets Are Helping Elderly At Home, While Potentially Saving £270 Million For Local Authorities

Kent County Council's two year pilot programme on testing effectiveness of gadgets targeting heart and lung conditions and diabetes among older people living alone have delivered savings of £7.5 million each year while providing extra years of priceless independence and dignity for users.

If similar telecare services are rolled out across England and Wales, local authorities could save upto £270 Million according to the Local Government Association (LGA).  After several years piloting new technologies, town halls are now rolling out schemes in full and reaping huge savings - from the electronic pill dispenser which saves thousands of pounds a year to the personal satellite locator which reduces day care costs by £250 a week.

"Investing in technology like this has been proven to reduce the need for hospital admission, GP referral, home help, day care and residential care," Cllr David Rogers, Chairman of the LGA’s Community Wellbeing Board, said before adding, "this saves taxpayers’ money in the long term at a time when the demand for adult care is rising and funding is falling".

"New technology helps deliver round-the-clock support to users, allowing them to manage their own health budgets, ensuring timely and preventative care, and peace of mind for them and their loved ones," he added.

The Kent County Council pilot project was the largest of its kind in Europe where the County council worked with health trusts to deliver the services to pensioners. vast savings were made through reduced hospital admissions, accident and emergency, bed days of care, home visits and GP contact. When the reduced costs were expanded across all areas of health, it estimated an annual saving of £7.5 million.

North Yorkshire County Council has saved more than £1 Million on residential care by providing telecare services to 12,000 users.

Blackpool Council’s Vitaline service is one the country’s most advanced 24-hour telehealth monitoring and response centres and provides care, reassurance and protection to thousands of residents. This has reduced hospital admissions by 75% and GP contact by 85%.

Cllr Rogers added:

“Councils have been the trailblazers with telecare and telehealth and the whole of society is now reaping the benefits. But this is only part of the solution. Also essential if we’re to manage our ageing population is improved public health, leisure and transport schemes, and more adaptable housing. And what will never happen if technology is being seen as a replacement for human contact, nothing is more vital to keep older people independent and happy.”

O2 Health ink first NHS deals

O2 Health has announced it is roll out its telehealth and telecare services across three NHS organisations.

The company, which entered the market in July and is part of the Telefonica Group, will deliver pilot programmes to NHS Western Isles, Berkshire East Community Health Services, and NHS Rotherham in an effort to “focus on developing new and innovative healthcare systems”.

Keith Nurcombe, head of O2 Health, said the NHS departments had “all shown a real appetite to embrace innovation to drive better patient experiences”.

“The programme is an industry first – it gives us a great opportunity to learn directly from clinical teams,” claimed Nurcombe. “We plan to expand the programme over the next few years to other like-minded health organisations.”

Union anger as care wardens for the elderly face job cuts (Yorkshire Post)

A TRADE union has attacked East Riding Council's plans to sack mobile care wardens. The GMB union is protesting after the authority stopped the regular visits made by wardens to the homes of 13,000 vulnerable and elderly people to check their "Telecare" equipment is working.

East Riding Council says the equipment can be remotely tested, and those who feel they are missing out on a visit will be able to sign up to a "befriending" service instead.

There will be job losses, but the authority will not know how many until a review has been carried out. However, the GMB has lodged a grievance with the council, saying there has been no consultation.

Regional organiser Rachelle Wilkins said "The proposals reek of David Cameron's Big Society plans of using volunteers at the expense of cutting decent, caring working class people's jobs.

"Wardens believe that the reduction in the service will have a massive detrimental effect on the vulnerable and elderly service users within the community and will also put a further strain on emergency services that are already overstretched to the limit.

"Not only did East Riding Council fail to consult with the GMB, but they have already removed the wardens from community schemes and stopped
all visits."

However East Riding Council said only monthly maintenance visits would be affected. A spokeswoman said: "This is not about cuts. It's about advances in technology."

A statement added: "We are aware that some people will miss the social contact aspect of someone coming to check the equipment and we will be offering them the opportunity to be referred to Age UK or other befriending service providers when we visit current customers to discuss whether they wish to remain on their current service level or wish to take advantage of one of the two new services available."

The situation for people in sheltered accommodation and those in Bridlington who get weekly visits will not change.

However campaigner Mick Pilling has collected around 300 names on a petition against the cuts.

He said: "If the wardens service ceases we will be going backwards rather than forwards."

Firms Warned After 23 Workplace Deaths

Businesses in Scotland have been warned to take safety seriously after figures showed 23 people were killed last year at work.

The Health and Safety Executive (HSE) said there were three fewer fatal injuries in Scotland between April 2009 and March 2010 than the previous year, but remained concerned about the number of workplace accidents.

There were 2548 serious workplace injuries in Scotland recorded last year, a fall of 120 from the previous year. An estimated 2.5 million working days were lost – an average annual loss of 1.2 days per worker.

The estimated number of Scots suffering from work-related illnesses also fell by 7000 from 104,000 in 2008/09 to 97,000 last year, and the number of people killed at work across Britain fell to the lowest on record.

Paul Stollard, the HSE’s regional director for Scotland, said: “Again this is a step in the right direction. However, these figures show that there are still numerous cases where the health and safety of workers is not being taken seriously.

“Employers have a legal duty to protect their employees. Health and safety needs to be at the very heart of the business and not seen as an add-on, tick-box exercise at best or an unnecessary burden at worst.”

The HSE figures show that across Scotland, England and Wales there were 152 workplace deaths last year, down from 179 the previous year, a rate of 1 death per 200,000 workers.

Health And Safety At Work

Not many would be aware of this, but the government has laws for well being and safety forpeople at work. The Well being and Safety at Work and so forth Act 1974 requires that employers have correct health and security management techniques at work. The Act makes provision for securing the health of individuals at work, welfare and security of the workers including the people who are in a roundabout way employed by the company like contractors and visitors.

Whereas the law exists and it’s obligatory for the employers to comply with the rules, it is also vital for the workers to find out about their rights and duties relating to their own well being and safety. Employers should conduct a General Risk Evaluation to ensure the health and security of their employees.

To create awareness about health and safety at work, the employers should have proper worker induction and well being and safety coaching programs at any time when new employees join a company. The induction program should educate the employees about the security requirements and procedures, and insurance policies of the company.

The fundamentals of health and safety at work begin with having correct First Aid. Each organisation huge or small should have correct First Assist Kits and systems. While at work, individuals can undergo an injury or fall ill. It is extremely necessary for the company to have correct preparations in order that the workers can obtain instant medical attention. A person who has received correct coaching for administering First Support should be appointed for this.

Fire safety is of prime significance at work. The potential hazards and sources of gas, oxygen and ignition should be identified. Correct Heat detection and warning systems ought to be in place to forestall any mishaps. Fire extinguishers must be kept ready in different places all through the building. There ought to be exit doorways and escape routes out of the building. Electrical equipment and wiring ought to be correct and checked at frequent intervals. The employees ought to be given training on coping with fire emergencies. Fire drill and Risk Assessment should be completed regularly.

Stress in the work place is common, but when it begins affecting the well being of the worker; then it is a problem. Employers should establish the components causing excessive stress to the employees. A stress threat assessment ought to be carried out to identify the potential hazards and risks. Correct measures must be adopted to regulate extreme employee stress. Employees must be given proper coaching, assist and care to assist them and relieve the stress.

Employers ought to follow the norms of the Control of Substances Hazardous to Health Regulations. They need to assess the health risks confronted by the workers from the chemical substances or substances used in the workplace. Correct management measures should be adopted and the identical needs to be adopted by the employees. Training and details about the health risks need to be supplied to the employees.

The employers are additionally required to have correct insurance policies for incapacity, well being and safety. Workers with cognitive, physical, sensory, ambulant and different disabilities have a right to correct arrangements and services in the workplace. There must be correct access, lighting, signage, seating preparations for the disabled. Different workers of the company also needs to be sensitized about the same.

New and expectant moms have to have to correct care inthe workplace. The employers should establish the potential hazards to the mother, as well as the newborn while at work. The employers can provide alternative work, different or much less work timings or paid leave to ensure the well being and security of the mother and baby. Equally, preparations ought to be made for young individuals at work and lone workers. A common risk evaluation needs to be performed for the security, well being and security of such employees.

It will be important that the employer in addition to the worker is conscious of the rights and duties pertaining to health and safety at workplace. For particulars you may take the companies of a well being and safety consultant or simply seek for “health and safety at work” on any major search engine.