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Living Well in Later Life

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                  Living Well in Later Life


   An Integrated Older Peoples Strategy for
               Northumberland




                         February 2007
1. Introduction

Welcome to Northumberland‟s integrated strategy for older people.

This 5-year strategy is a dynamic document which sets out a vision
for the future, a commitment to new ways of working, our aims and
outcomes, an action plan and indicators on how we will judge our
success.

It is not a stand alone document but a synthesis of other work in
progress and should be read in conjunction with other relevant
plans and strategies (see footnotes).

It has been developed and is to be taken forward, reflecting a new
partnership between older people as citizens, the local authority
and its partner agencies from health, and the voluntary, community
and private sectors.

As an integrated strategy that looks right across the spectrum of
older people's issues, from respect and acceptance as valued
members of communities, relationships to family, friends and
neighbourhoods; facilities and opportunities such as social, leisure
and lifelong learning and services from transport, to housing,
environment and health and social care.

 The development of this strategy and its implementation should
be seen as part of an ongoing process to evolve a citizen-led
approach to promoting quality of life and well-being in older age,
and a partnership approach between older people and agencies.

Who are older people? Well in this strategy we look at people over
50, because this is increasingly the starting age that is used by
government in developing policy for an ageing population.
However, age is the only characteristic that everyone aged 50+
shares. Their needs and expectations are as different as in any
other age group. Equally, they should be able to access the same
service as everyone else.

Older people are not a homogenous group. First of all, there are
differences of culture, social class, life-style, health and
expectations, just as much as with any other age-group of the
population.



                                 2
Secondly, with its focus on people aged 50+, and given the fact
that most people are living longer than in the past, the strategy
covers at least two, and probably three generations of older
people. Traditionally, these different generations have been
characterised by age – perhaps 50-64, 65-74, and 75+. We do not
think that this is a useful way to look at older age. For example,
one person may retire aged 50, and another aged 70. One person
may live a healthy life till they die at 90+; another may experience
ill health aged 55.
The Better Government for Older People (BGOP) programme, and
many organisations, considers older people to be those aged 50
and over. However, many people in their 50s do not like being
considered as an „older person‟. The Joseph Rowntree Foundation
has been supporting a programme of research about the lives of
older people, since 2000. The views of older people in that
programme are that older people are those who „need that bit of
help as they get older‟. This is perhaps as good a definition as
any.

Generally speaking, older people are now better educated and are
living longer, healthier lives. Some are quite affluent, whilst others
struggle financially.

The aspirations of older people are changing rapidly as more and
more people are living longer. Older people:

• increasingly have higher lifestyle expectations.
• have diverse needs and views about what is important to them.
• are looking for range of high-quality services which help to
maintain their health and well-being.
• want to remain independent for as long as possible and have
choice, control and continuity in their lives.
Census 2001 – Office of National Statistics (Housing Strategy Evidence Base)
• are seeking more opportunities to contribute to society and to feel
valued for what they do.
• want much more flexibility and choice between full-time work and
full-time retirement.




                                        3
WHOLE SYSTEM OLDER PEOPLES STRATEGY




       FAMILY PERSONAL
     FAMILY and and                                     PROMOTING
        NETWORKS and                                    CITIZENSHIP
       RESPONSIBILITIES
                                                  -   Transport
 -       Parenting responsibilities               -   Culture and leisure
 -       Grand parenting                              opportunities
 -       Friends and neighbours                   -   Access to information
 -       Social contacts                              and media
 -       Caring responsibilities                  -   Employment and
                                                      volunteering
                                                  -   Community
                                                      involvement/capacity
                                                      building etc
                                                  -   Lifelong learning




                                        Older
                                      Person as
                                         ←
                                       Citizen



            PUBLIC and
          ENVIRONMENTAL                                   HEALTH and
              HEALTH                                     SOCIAL CARE

     -    Housing                                 -   Self care
     -    Public environment                      -   Care in the community:
     -    Community safety                            primary, community and
     -    Income maximisation                         social care
     -    Health promotion                        -   Care homes
     -    Control of infectious                   -   Rehabilitation and
          diseases, etc                               transitional care
                                                  -   Hospital care




                                         4
2. National Policy

Britain is an ageing society, people are living longer and older
adults now can expect many more years of active healthy life
beyond retirement age. Society is also becoming much more
diverse with a growing and ageing ethnic population. By 2020 over
half of the population will be over 50 and there will be fewer young
people. In addition the post war baby boomer generation have
higher and different expectations of public services than previous
generations. This change in the population dynamic and
expectations has many implications for public services in how they
develop and deliver services. There are a wide range of policy
initiatives which seek to address some of the issues older adults
face and to reshape services to meet these changing needs but in
the past these have often been focussed on health and social care
which, while important, only focus on the small percentage of older
adults who need those services (only about 15% of 65+ at any one
time).
There is a growing recognition that older adults needs are much
wider ranging and that there is a need to shift the focus away from
crisis response services to a much wider engagement of all
services with older adults, encouraging and supporting older adults
to remain active citizens within their communities. There is still a
need however to make sure that the right services are available to
older adults at times of need. In 2003 the Association of Directors
of Social Services (ADSS) published All Our Tomorrows, a
consultation document which proposed a model to change the
focus of services by reversing the „Triangle of Care‟, shifting the
focus to prevention and engagement and developing the role of a
wider partnership of services and community and voluntary
organisations.




                                 5
Figure 1 – Support for People Today




              Direct Users & Carers                                    Health, Social Care, Housing
                                             Acute
                                             care



                                         Frail older people




      Individuals
      Families                                                                          Public services
      Communities                       Prevention policies                             Voluntary Sector
                                                                                        Faith Communities




 Citizens                                                                                      All Partners
                                         Community Strategy
                                    Engagement, Empowerment
                           Environment, Safety, Protection, Housing, Learning




                                               6
Figure 2-Support for People Tomorrow




                                Community Strategy
                           Engagement, Empowerment
                          Environment, Safety, Protection,       All
  Citizens                       Housing, Learning               partners



                             Promotion & Well Being
  Individuals
                             Policies                        Public services
  Families                                                   Voluntary Sector
  Communities                                                Faith
                                                             Communities


                                   Specialist care
  Direct Users & Carers                                      Health, Social
                                                             Care, Housing




In addition in 2004 the Audit Commission in partnership with Better
Government for Older People published a series of reports
focussing on the challenges to public service in promoting
independence and well being for older adults. These documents
identified seven dimensions of independence.
In recognition of the need for services to be proactively engaged
with the 60% of adults who have one or more chronic conditions
the Department of Health has recently published a National
Service Framework for people with Long Term Conditions3.
This NSF will set out a model for supporting people with long term
illnesses and again the key focus is on prevention and pro-active
support to help people manage and maintain their health.

These policies sit alongside the National Service Framework for
Older People4 published in 2001 which sets out a range of targets
and standards for improving and developing older adults‟ services.
The key focus of the NSF is on reshaping services, removing age


                                           7
discrimination, primarily in Health & Social Care, having a more
proactive and preventative role and better integrated more joined
up services. The recently published Department of Work and
Pensions Strategy Opportunity Age5 seeks to bring together a
cross-cutting range of departments and policy areas to focus on
Older Adults and an ageing population and the role of all public
services. It highlights three priority areas of; higher employment
rates and flexibility in work; enabling older adults to play a full and
active role in society and independence and control.
With the launch of Everybody’s Business6 in November 2005 the
underpinning theme of sustained mental wellbeing was brought to
the fore. It emphasises the message that older peoples mental
health cuts across health and social care, physical and mental
health and mainstream and specialist services. The government‟s
vision for social care for adults in England entitled “Independence,
Well-being and Choice”7 (2005) identified key themes that could
be used a building blocks for service change and delivery that
would improve outcome for older people.
The Age Discrimination Act8 came into force at the end of 2006,
and requires all services and sectors in terms of employment to
ensure that their policies and processes are non age
discriminatory. This is in line with Standard One of the National
Service Framework which highlights that all services should review
their policies and procedures to ensure they do not discriminate
against older adults and access to services is not restricted on the
basis of age. It will also have significant impact on employment
and recruitment practices.
In January 2006 the Social Exclusion Unit published A Sure Start
in Later Life9. This report identifies many of the key reasons why
older adults become excluded and isolated, from low incomes
through to attitudes to ageing. It recommends using the Sure Start
model of service which has been used for children and will be
seeking to bring in a number of measures to engage with excluded
older adults.
Finally the Government, in January 2006, published Our Health,
Our Care Our Say10 the White Paper which sets out the direction
for community based services for all adults across health and
social care. The White Paper aims to achieve four main goals
which are:
    Better prevention with earlier intervention
    More choice and a louder voice;
    Tackling inequalities & improving access to community
       services

                                   8
                     Support for people with long term needs

              This is reflected in and clearly expressed through the inclusion of
              older people in the Local Area Agreement, and the Comprehensive
              Performance Assessment requirements to:
              engage older people as partners;
              develop a strategic approach to older people that goes beyond
              health and social care; and
              ensure that a wide range of services are available that relate to
              all aspects of older people’s lives


              3. Local context

              Whilst many young people choose to move away, the county is a
              favoured destination for commuters and for older people who
              appreciate the peace and tranquillity of the rural landscape and
              choose to relocate here as they reach or approach retirement. This
              section of the community makes a significant contribution to
              community life in terms of the knowledge and experience they
              bring to localities, particularly in relation to voluntary activities.
              Harnessing the diverse skills and expertise of this group would
              undoubtedly be of great benefit to the County. Whilst we can
              continue to build on the strengths of local communities
              everywhere, it is undeniable that an ageing and sparse population
              is more expensive to cater for. Innovative ways of ensuring that all
              needs are adequately met have to be found and must to
              acknowledge the increasingly important role of the voluntary and
              community sectors in the provision of local services.


              Projected older people population figures
      AGE
OUP           2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2020

      AGES
      50-54    22.8   22.6   22.8   23.0   23.5   23.9   24.1   24.3   24.4   24.4   24.5   24.4   24.3   22.8
      AGES
      55-59    24.7   24.8   24.0   23.2   23.2   23.1   23.0   23.2   23.5   23.9   24.2   24.5   25.0   25.3
      AGES
      60-64    19.1   20.1   22.1   23.4   24.0   24.3   24.5   23.6   23.1   22.9   22.8   22.7   23.1   24.1
      AGES
      65-69    16.7   16.6   16.6   17.1   17.8   18.5   19.4   21.4   22.7   23.2   23.4   23.7   23.0   22.1
      AGES     14.4   14.4   14.6   14.9   15.0   15.2   15.2   15.5   15.8   16.4   17.0   18.0   19.7   21.9



                                                     9
70-74
AGES
75-79    11.3   11.3   11.5   11.7   12.0   12.1    12.3   12.5   12.9   13.0   13.4   13.4   13.6   15.0
AGES
80-84     8.6    8.6    8.5    8.6    8.7    8.7     8.8    8.9    9.2    9.2    9.5    9.6    9.8   10.8
AGES
85+       6.5    6.9    7.1    7.3    7.6    7.9     8.2    8.4    8.6    8.8    9.1    9.3    9.7   10.5




        There are some very wealthy communities living in high quality
        environments in the county there are also significant areas of
        deprivation where educational attainment is poor and
        unemployment is over twice the national average. Limited job
        opportunities, low expectations, poor housing and health, high
        levels of crime, drug abuse and an invasive culture of dependency
        compound the cycle of disadvantage.
        Statistics show that 14 Northumberland wards are in the 10% of
        the most disadvantaged in England. Of these, 12 are located in the
        south east of the county where the worst deprivation, however it is
        measured, occurs.




                                               10
11
Northumberland‟s population has considerably worse health than
the England and Wales average. There are marked contrasts in
health across the county which reflect social conditions ranging
from post- industrial deprivation to rural isolation and poverty. The
health issues which create the most significant demand in
Northumberland are in line with those creating most demand at
national level – heart disease, stroke, cancer and mental health.


                                  12
The problems associated with ageing, including mobility problems
and increasing dependence for the routine tasks of living in the
community, very much reflect the national trend. However, getting
the appropriate services to people who need them most when they
live in isolated and dispersed communities is a major challenge for
all local agencies.


The aims and outcomes of this strategy

Northumberland‟s community strategy „Northumberland 2010’
sets out the vision that, “By 2010 Northumberland is recognised as
The Blue Sky County – well connected and proud of its people,
heritage, excellence and ambition”
Northumberland Community Strategy is an overarching vision from
which the subsequent service and delivery plans of partner
agencies will derive. The need for a cohesive and consistent
approach in working towards the achievement of key aims and
objectives is paramount to ensure they will bring about improved
social, economic and environmental well-being.

The Strategy for Older People has a key role to play in achieving this
vision. The overarching aim of the Strategy is to improve the quality
of life of older people in Northumberland.

Although all stakeholders have targets to meet there is
fundamental agreement that this strategy should be focused on
achieving improved outcomes for the older people of
Northumberland


To progress with this important agenda and taking guidance from
national and local policy eight areas have been highlighted as
essential for the development of a comprehensive strategic
approach. These are:

   1.    Involving older people
         -     Processes in place to engage with a range of older
               people on a regular basis, involving hard to reach
               groups
         -     Older people supported to participate fully e.g. by
               offering induction or training


                                  13
     -    Older people are involved in different ways,
          including planning services, governance structures
          and delivery of services

2.   A picture of the local population of older people
     -     Information about the composition of the population
           of older people, not just users of services, e.g.
           ethnicity, housing status, income level, health
           inequalities
     -     Projections of future changes

3.   A strategic approach
     -     A strategy is in place about how lives of older
           people can be improved and which goes beyond
           care services to address the dimensions of
           independence, housing, neighbourhood, social
           activities and networks, information, health and
           healthy living
     -     Based on the principle of older people as citizens,
           not just users of care services, and has a strong
           focus on inclusion and tackling ageism
     -     Linked to and reflected in the community strategy
           and local strategic partnerships


4.   Commitment and leadership is demonstrated
     -   The local authority has identified an elected
         Member, to lead on older people‟s issues across the
         authority
     -   There is a corporate lead for older people in the
         officer structure, as well as officers with a
         designated lead in other relevant service areas, e.g.
         transport

5.   Partnership/Whole System Working Approach
     -    Key agencies outside the local authority, including
          the NHS, pension service and voluntary
          organisations are formally committed to the strategic
          approach




                            14
  6.    Communication and information
        -   There is information for older people, preferably in a
            range of formats, which signposts them to a broad
            range of services and opportunities
        -   The strategic approach has been communicated to
            older people, e.g. through newsletters or a summary
            of the document
        -   Updates on progress are provided to older people

  7.    Evaluation and impact
        -    The community has systems in place, built in from
             the outset, to measure the impact of the strategic
             approach across the system, including surveys of
             older people‟s views
        -    Evaluation process includes outputs and outcomes,
             and older people play a central role in this process


  8.     Development of preventative and community services
         -     Resources need to be shifted away from acute and
               specialist services, to more community based,
               holistic services.
         -     New services need to be developed which empower
               more older people, e.g. direct payment
         -
Using the government‟s vision for social care for adults in England
entitled “Independence, Well-being and Choice” (2005) as a
building block, with some slight adaptation for local use, the
following outcomes have been identified. They clearly apply to all
services for older people, not just social care.


         Improved Health
          This includes physical and mental health, including
          protection from abuse and exploitation. Access to
          appropriate treatment and support in managing long
          term conditions

         Improved quality of life
          This includes access to leisure, social activities and
          life-long learning and to universal services. Also having
          good quality and appropriate housing, security at



                                15
          home, access to transport and confidence in safety
          outside the home.

        Making a positive contribution
         Including active participation in the community through
         employment or voluntary activities. Being involved in
         local activities, policy development and decision
         making.

        Exercise of choice and control
         Includes access to information, and the enablement of
         maximum independence. Being able to choose and
         control services and managing risk in personal life.
         Access to advocates where necessary.

        Freedom from discrimination or harassment
         No age discrimination. Equality of access to services.
         Freedom from abuse.

        Economic well-being
         Sufficient income and resources for a good diet,
         accommodation, and participation in family, community
         life and leisure opportunities. The ability to meet costs
         arising from specific individual needs.

        Personal dignity
         Keeping clean and comfortable and promotion of
         independence. Availability of appropriate personal
         care. Enjoying a clean and orderly environment

Involvement of older people

  The vision for involvement of older people is identified with the
  intention to move beyond consultation with older people, to their
  full engagement in the planning, delivery, management,
  direction and evaluation of the service development at every
  stage. In doing so, we have developed a robust and ambitious
  model for involvement which can be applied throughout the
  planning and delivery of services in Northumberland for older
  people and for others.




                                16
                                      SPECTRUM OF INVOLVEMENT




 Partnership Board and Reference                                            Wider involvement facilitated by
 Groups                                                                     skilled community link workers


               NORTH                                                                     CENTRAL
              LOCALITY                                                                   LOCALITY

                                               Wider Community
                                                  Networks


                                               Local forums linked to
                                                   local activity




                                                 Reference Groups


                                                        OLDER
                                                       PEOPLES
                                                     PARTNERSHIP
                                                        BOARD




                                                 Reference Groups



                                              Local forums linked to
                                                  local activity



                                               Wider Community
   WEST                                           Networks                                          SOUTH
   LOCALITY                                                                                         LOCALITY

Local Reference Groups
The board will seek information from and channel information back through reference groups. These groups will be
geographical, one in each locality and comprise a number of people each with an interest in different elements of the
agenda. Reference groups will meet quarterly and prior to the Management Board meetings and arrange focus group
activity within their community around the themed elements.

Wider involvement
                                                          focus
To involve people who take the opportunity to take part in17 groups within their community. Involvement should also
include invitations to people who do not take advantage of the prevention schemes on offer.
  Where we are now

  Through focussed, whole systems working Northumberland‟s
  partner agencies have attained against key national agendas.
  Achievement against the milestones laid down in the National
  Service Framework for Older People (NSFOP) is considerable.

  Subsequent work linked to key policies and the older people‟s
  agenda have also delivered significant improvements in the
  outcomes experienced by older people in Northumberland.


Personal dignity

   There are a number of developments within the home care
  services in Northumberland taking place

  The NCC Scrutiny committee on Home Care which is :

 Examining current and proposed arrangements for providing
  home care
 Monitoring the impact of changes to the role of the Council's
  directly provided home care services
 Overseeing a review of arrangements for securing home care
  from independent providers
 Considering how new approaches, including the development
  of "telecare" technology, can broaden the range of options for
  supporting people in their own homes
 Considering how to ensure that people with specialist needs get
  an appropriate service

  The Development of START within NCC domiciliary care.

  This Short Term Assessment and Re-enablement Team will
  provide a service for up to 6 weeks for all new older service
  users with an emphasis on promoting independence and
  ensuring that the level of care is appropriate in the vital first
  weeks of contact




                                  18
The service is now operating in Blyth locality and across parts
of Central locality and Alnwick, with work to commence START
in Berwick and West Northumberland through 2007.

START will work in partnership with Independent home care
agencies to effect smooth transitions to other services and help
continue enablement work with a longer term home care
provider

The Review of Independent Sector Domiciliary Care
services

This review of the 6 independent home care providers (3
charities, three businesses) has aimed to address the following
issues:

Improving service quality with new models of care
 including outcome focused work and independent sector
  staff managing more of the complex care
 consistent and reliable service with local capacity seven days
  a week
 ability to link productively with START service
 staff better informed by service user and carers needs and
  personal knowledge of individuals
 ensure that service users can be offered a choice of provider
 ensure Best Value in our contracts with providers and work
  to ensure that CSCI standards are improved.


Increasing Staffing
 recruit and train new people into the domiciliary care market
   through working with NCC regeneration/Job Centre plus
 encourage providers to consider how conditions of service
   affect recruitment

Improving Staff retention
 Develop brokerage services to improve communication
 encourage the promotion of team working and more
  autonomy to lead to cost and quality improvements
 develop an outcome based approach-proved to increase
  retention and job satisfaction



                              19
The options for developing the services in partnership with local
providers are now being decided and will be implemented over
2007.

Everybody‟s Business, the service development guide for older
people with mental health problems was published by the
Department of Health in November 2005. Within it there were 6
key messages to commissioners

   Older people with mental health problems are everybody‟s
    business and that mainstream services (e.g. acute
    hospital care) need to gear their practice accordingly
   That meeting the requirements of Everybody‟s Business
    will meet national targets (e.g. NSF OP)
   That access to mental health services should be based on
    need not age
   That people need holistic care in mainstream services
   Workforce development in central to improvement-
    particularly at the front line (e.g domiciliary care)
   Whole system commissioning is vital across health, social
    care and independent and voluntary organisations

Within Northumberland many of the issues raised within
Everybody‟s Business have been tackled through the
historically close working relationship between health and social
care including joint planning processes and a well established
integrated community team approach. This has also led to
commissioning of new services which will allow
Northumberland‟s older people mental health services to meet
more of the needs identified within the document (e.g. support
for people with complex needs in residential care)


The NCT response document to the Everybody‟s Business
guide has been developed into an action plan, in partnership
with NTW Trust. This is a key document within the MHOP
Executive and agrees responsibility for making progress across
particular areas including
    Service user and carer involvement
    Assessment and care planning
    Workforce development
    Primary Care


                              20
        Home Care and Day services
        Memory assessment Services


Exercise of choice and control
The older people commissioning plan focuses specifically on the
care needs and services for older people purchased or provided
through Northumberland Care Trust and its partners in the
statutory, voluntary and private sectors.

It describes current care management team activity and focuses
on purchased care within

      Domiciliary Care
      Residential Care
      Short Break Care
      Intermediate care
      Day Services
      POPP and the preventive agenda
      Equipment
      Direct Payment and Individualised Budgets
      Assistive Technology
      Supporting People funded services
      Meals on Wheels

The commissioning plan outlines actions for 2007 including key
issues in

    Domiciliary care
    Day services
    Residential care services

It also describes priorities for efficiency savings and issues arising
from the particular current challenges to commissioning including

      Financial constraints
      Organisational change (internal and external)
      Cultural change
      Geographical Disparities

The commissioning plan emphasises the need to build robust
service user and carer involvement in the development of services

                                  21
and ways to achieve this through partnership with existing
organisations and direct work with people who use services,
whether they have physical or mental health problems.

The Commissioning role for older people in Northumberland will
develop capacity to concentrate on developing services with
vision, that allow for
    Choice
    Prevention of avoidable ill health and social isolation
    Maximisation of independence
    Development of services that require specialist skills and
      knowledge

  Freedom from discrimination or harassment
  In November 2005 the Association of Directors of Social
  Services published a paper outlining National Standards for
  what they called “Safeguarding Adults. The Care Trust has
  adopted these standards and has formed a new multi-agency
  partnership called the Northumberland Safeguarding Adults
  Committee and a full time Adult Protection Coordinator has
  been appointed to take this work forward. A new Safeguarding
  Adults Policy, together with supporting guidance for staff and a
  new Training Plan has been presented to the partnership and
  will be published in the early summer. The partnership will
  continue to work towards improving arrangements for the
  protection of vulnerable adults in Northumberland, including of
  course older people who may be at risk of abuse.

  Economic well-being
  The take up of benefits for older people is included in the LAA
  with targets for Attendance Allowance and Council Tax Benefit.
  Northumberland Care Trust has a joint working arrangement
  with The Pension Service to identify older people who aren‟t
  claiming benefits and to give them practical support to claim.
  Any older person who receives home care will be offered a full
  benefits check by a Financial Assessment and Benefits Officer
  working for Northumberland Care Trust. The Financial
  Assessment and Benefits Officers receive training and expert
  support from the Trust‟s Welfare Rights Unit to ensure benefits
  are maximised.
  The Welfare Rights Unit also provides training and support to
  care managers so that they can identify entitlement to benefits
  and support older people making claims. Care Mangers are well

                                22
placed to encourage people to claim benefits because many
older people in Northumberland are reluctant to approach the
Pension Service, or an advice agency such as Citizens Advice
Bureau. Often this is to avoid being seen as “asking for charity”
or admitting the full extent of any disability because of a fear of
being moved into residential accommodation. A Care Manager
can reassure people that they are only getting back out what
they have put in and that the extra income can actually help
them to remain independent in their own home.

Northumberland currently has 52 older people (inc Mental
health) receiving direct payments in lieu of social care.
They are split by locality as follows and represent 27 % of the
total number of adults receiving direct payments in
Northumberland.

North 18
Central 12
South 3
West 19

The majority of payments are made in lieu of homecare
although some clients choose direct payments to buy
alternatives to day care.

We have found that older clients have not struggled with the
paperwork or responsibilities attached to receiving a direct
payment and have actually felt very empowered by being able
to choose who provides their care and when.

Clients have often recruited care workers via adverts in local
church halls, library etc and these workers tend to be people
who do not want to work for an agency but prefer the 1:1
relationship provided via direct payments. Once recruited the
1:1 relationship is such that staff turnover is much less than
experienced by agencies. Some care workers have been older
people themselves who still want to be involved in work and are
not yet ready to fully retire.

In a recent service evaluation an older person suggested that;

"This type of care giving is so very much superior to getting an
agency in.


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This method is superb…..we are allowed to hire excellent staff
who are not asked to go to more jobs than they can handle. The
carers get to know the family and are not moved on at the whim
of office staff"

Direct payments have been used successfully to enable speedy
discharge from hospital through using a friend or neighbour to
provide the care. This has avoided delayed discharge when
there has been no traditional agency care available.

Some older people are using direct payments to stay in their
own homes and avoid residential care for longer by taking a
direct payment in lieu of the care we would have provided and
topping it up privately to buy in 24 care at home.

Improved Health
Older people are included in the Northumberland Public Health
Directorate‟s Health Improvement Plan (HImP) with the overall
goal being,
“To improve the health and well being of older people in the
general population and to specifically work to reduce inequalities
in health status”
In particular the plan has embedded the health and well-being of
older people into the other work programmes including physical
activity, mental well-being and smoking cessation. This is to
ensure that older people are appropriately considered and
included in all relevant health improvement plans and actions.
Some activity is specifically targeted at older people especially
work to reduce the number of excess winter deaths and this
includes maintaining flu vaccination rates at over 70% and
pneumococcal vaccinations rates over 60% across the county.
Also to combat cold related illnesses, there is partnership
working with Northumberland Warm Zone who carry out
assessments for energy efficiency measures and ensure benefit
entitlements are taken up.
A countywide „Opportunities for Older People‟ meeting is held
quarterly to share good practice across organisations who work
with older people and this group maintains a collated document
of relevant activities. Since May 2006 this has included work
developed as a result of the Northumberland FISHNETs Project
such as the Young at Heart events in sports and leisure centres,


                               24
falls fairs in community settings and the website
www.northumberlandfishnets.org
In 2005 Northumberland was successful in its bid to be one of
the 19 Partnerships for Older Peoples Projects (POPPs) first
phase sites for this work and received a £2million grant to
progress a preventative approach for services for older people in
the County.
POPPs pilots are testing new ways to improve the health and
quality of life of older people, which will give them greater
personal control over their physical and emotional health,
enable them to remain independent wherever possible and
helping them to feel good and to participate fully in their
community.

The Northumberland „FISHNETS‟ project, which commenced in
May 2006, helps older people keep FIT, INVOLVED, SAFE and
HEALTHY, through investment in sustainable community
NETWORKS.

It addresses health, social and environmental factors to support
older people‟s wish to maintain independence, quality of life and
inclusion in society. This will be achieved by:

 Reducing emergency hospital admissions
 Reducing the number of falls leading to fractures and
hospital treatment
 Increasing the number of people helped to continue to live at
home

A comprehensive prevention programme, from universal primary
prevention, to targeted interventions for those most at risk of falls,
is being delivered through inclusive partnerships using community-
based initiatives.

FISHNETS, therefore, goes beyond the core business of health
and social care to develop neighbourhood and community support
networks with those whose work includes regular contact with
older people (e.g. housing, pension services, fire service, post,
utilities, and retail).

It‟s a comprehensive prevention programme, from universal
primary prevention, to targeted interventions for those most at


                               25
risk of falls, will be delivered through inclusive partnerships
using community-based initiatives such as handy person
schemes, falls prevention classes, staff training, physical
activity opportunities and organisational accreditation.

There is still some way to go and challenges to overcome in
meeting the needs and expectations of the current and future
older population of Northumberland.

Turning the strategy into action

How we plan to address these challenges and achieve the
outcomes is identified in the attached Action Plan.

For each of the 6 outcome areas the Action Plan:

• identifies the action;
• sets out a date when the action will be achieved by;
• identifies who will do it; and
• provides ideas for measures for how will we know we are
making a difference.

The action plan is set out in the next part of the strategy

By signing up to this strategy, partners will commit to working
together better and developing new ways of planning and
delivering services to meet the needs of Northumberland‟s older
people and an ageing population.
However, the cultural change required cannot be
underestimated.
Innovation and creativity are essential, in a climate where
people are living longer but pressures on budgets, finances and
resources are increasingly putting strain on existing services.
Finding sufficient resources to deliver this strategy is part of the
challenge.




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Description: Living Well in Later Life