Keep caring for Cambridgeshire and Peterborough

Residents across Cambridgeshire and Peterborough are being urged by civic and community leaders from across the county to “Keep caring” for one another, as coronavirus hasn’t gone away.

A campaign has launched to reinvigorate public health messages and remind people that while lockdown restrictions are gradually being lifted – everyone needs to take action to help us all return to a more normal life.

With certain government restrictions relaxed from 4 July, including being able to meet in groups of up to two households in any location – public or private, indoors or outdoors – it remains the case that even inside someone’s home you should continue to keep a safe distance from anyone not in your household or bubble.

The two metre rule being relaxed to a ‘1 metre plus’ approach depends on the setting, and means people are being trusted to continue acting responsibly by following this and the related guidance to care for themselves and each other.

The more people we interact with, the more chance the virus has to spread. Therefore, everyone should still try to limit the number of people they see and get close to. The risk of transmission is also higher indoors, so people should take extra care including wearing a face covering on public transport and in enclosed spaces where you can’t stay two metres apart.

The Keep Caring campaign led by Cambridgeshire County Council and Peterborough City Council, and supported by Cambridgeshire and Peterborough Combined Authority, Cambridgeshire Constabulary, the Office of the Police and Crime Commissioner, Cambridgeshire Fire and Rescue Service, East of England Ambulance Service, the local NHS, community organisations and local district councils, outlines ways that people can take care of themselves and each other – for instance highlighting that:

  • Caring is keeping your distance – inside or outside
  • Caring is being responsible – staying isolated if you think you’ve got symptoms, or been close to someone who has
  • Caring is covering your face – even with no symptoms you might still spread virus
  • Caring is washing your hands – regularly, when you enter or leave a new place

It also points out that:

  • Caring is staying and buying local – to support local businesses and jobs
  • Caring is being considerate – rubbish destroys our countryside, and puts those who clear it up at risk

Dr Liz Robin, Director of Public Health for Cambridgeshire and Peterborough said:

“It is the public who have reduced the transmission of coronavirus so far. By taking care of themselves and each other, fatalities and infection rates in Cambridgeshire and Peterborough have continued to fall.

But our message today is that this caring can’t stop now, as the most important thing we can continue to do is to stay alert, control the virus, and, in doing so, save more lives.

The government updated its plan for social distancing from 4 July, but the message remains strong that to continue to reduce the transmission of the virus, we should continue good hygiene rules, washing our hands and surfaces often, remain physically distant from people outside of our household, and keep your mouth and nose covered where you can’t be sure of staying apart.”

Comprehensive advice on current government rules is available on the website.

Decision on which deckchairs to move delayed as healthcare in Cambridgeshire and Peterborough slowly sinks.

Earlier this week the Cambridge and Peterborough Clinical Commissioning Group (CCG) met to look at what funding it could cut to help it relieve its £192 Million deficit. This was of importance to local charities as they were looking at the funding for community services which includes a number of small grants that were to be ended or renegotiated. This blog concentrates charities but other community services that play a vital role are also under threat.

The first thing to say is that the groups affected have worked really hard with Support Cambridgeshire, and especially Julie Farrow from Hunts Forum to show the value of the work they do and to raise awareness of the impact of the cuts. This blog is simply CCVSs views which incorporate points raised by both Support Cambridgeshire and Healthwatch Cambridgeshire and Peterborough. You can read a statement from Healthwatch here.

The second thing to say is that the CCG are the second lowest funded per person in the country. This means that they get £350 per person less than West Norfolk CCG as an example. This is compounded by the speed at which the area’s population is growing. This is not new news, but it is relevant. What is also relevant is the fact that the CCG made a disastrous decision to contract out its older people’s healthcare and adult community services a number of years ago and lost a lot of money. It is probably also worth pointing out that this is not the first round of cuts for the sector from the CCG, I can still remember when many more projects were funded, including CCVS!

So what were the plans? I have highlighted the charity aspects from the papers which recommend

The Governing Body is asked to approve:

The outcome of the MDT process, Steering Group, COT and IPAC discussions is that we would cease funding or decommission the following:

  • Dial-a-Ride
  • The Stroke Association
  • The Alzheimer’s Society
  • The Carer’s Trust Cambridgeshire & Peterborough, Norfolk
  • The Health and Wellbeing Network
  • ECHIS (The Evelyn Community Head Injury Service)

The CCG would seek to renegotiate service provision and/or payment for the following:

  • The Care Network
  • Cambridge Hearing Help

The CCG would continue to fund:

  • The East Anglian Children’s Hospital

Just some initial thoughts.

The grant to Dial-a-ride is £6,516 a year or 0.003% of the deficit. The fact that this service is for Cambridge only and is not seen as clinical does not mean it is not saving the health service money. People can get ambulances, and in fact the CCG have a contract with the ambulance service. But dial-a-ride is so much more than just getting people to hospital, and is also I assume way cheaper per trip.

Cambridgeshire Hearing Help (CHH) work with 6500 users at 43 clinics across Cambridgeshire plus house bound provision to help them with hearing aids, they receive £34,682 or £5.34 per user. Specsavers receive £1,682,653 a year for their audiology service and charge £17 a session and people have to get to the shop. So, if these are to be renegotiated as per the papers lets hope loads more money goes to CHH. These figures do not even start to think about the value added of the CHH delivery model and the benefits of working with volunteers.

Why is the first main finding on the East Anglia Children’s Hospice (EACH) entry in the papers is “This service has great reputational impact on CCG if funding was ceased.” I think that the work EACH does is fantastic and needs to continue, and I hope that the proposal to continue to fund it was not because of the possible reputational impact and simply because EACH is fantastic!

So what’s the problem and what’s the solution?

There is undoubtedly a lack of money in the system and things need to be fairer. The local MPs are on the case

We should be putting pressure on whoever we can to get a fairer funding settlement, just as we are for education (what has Cambridgeshire done to upset the Whitehall mandarins to get such lousy settlements in education and health?)

Along with this we need to help the CCG understand the true value of funding the voluntary sector and the added value we bring. The savings that family carers make to the health system is massive, and so funding them to be better able to continue seems like a no brainer, but the CCG feel that the service supplied by Carers Trust is not cost effective as

“ this service provides services for carers rather than patients themselves and is more of prevention and crisis management rather than clinical provision.”

So if it prevents people accessing expensive services and helps the management of crises outside the system it should be welcomed. At an event I attended recently a Carers Trust volunteer and ex carer stated (and I paraphrase this)

“Carers Trust didn’t save my life, but they definitely saved my sanity and allowed me to continue to provide care for my partner”.

I know all the charities facing possible grant cuts would have similar stories, and I know that much work has gone on to ensure that these are shared with the CCG decision makers. At the end of the day they have to decide if it is making decisions based on just the basic figures, or if it recognises that prevention is always better than a cure.

Is the whole really greater than the sum of its parts?

As someone involved in too many partnerships to list I really hope so!! Because if not we are all wasting our time.

LHP Priorities Plan 2014_15_Page_1

South Cambs LHP Priorities

It was this question that the South Cambs Local Health Partnership was trying to answer when it looked at what solutions and actions we could take to make a real difference to the revised priorities they have developed.

A long and animated discussion led to a number of completed pages of flipchart followed by the rest of the agenda.

If all that happens is that the flipchart gets either

  • A) rolled up and put away or
  • B) written up, rolled up and put away

Then I say let’s make this the last meeting of this group and we can all use our extra time to do something useful on our own.

HOWEVER if we can start to make links and join projects together; if we can share vital knowledge across networks that improves services; if we can complement the work of one partner with the work of others and provide a more joined up service – then let’s get on with it!

What this can not be is simply a South Cambs District Council responsibility, and as such for once I have come away from this meeting with an action, rather than simply attending, reminding people how great the voluntary and community sector is and how unrecognised the work they do is, and then coming back to the office.

My argument was that we do not know how much the sector does to address the priorities that have been set. As the recognition that prevention is cheaper than cure (see my blog prevention, prevention, prevention) gains traction I believe that the sector has to be recognised and funded for the work it does – even if this takes away from the shiny acute health sector and all their big hospitals and bigger budgets.

My problem is that I do not know what impact the sector has on the priorities, or any other priorities to be fair. I know what great work many groups do, but I know that only a fraction have links with CCVS. I know that many groups provide a service but that this may not be linked directly to a priority even if it addresses it. I know that I have to start putting more flesh to the bones of my belief in the work of the sector. CCVS does this through its annual survey as well as picking up on informal feedback but now I have a small project. I am going to look at one South Cambs village; I am going to look at listing the work of the sector in that village and then mapping that against the LHP priorities. I hope it will show me a healthy and vibrant community as I have picked the village I know the best, I also hope it will help me demonstrate the impact that small community organisations have and why they should be at the forefront of preventative services.

I will post an update once I have done some work 🙂

The search for someone to provide Older Peoples services continues

The consultation on the Older People’s Programme dominated the latest meeting of the Fenland Health and Wellbeing Partnership. And so it should it my opinion.

This is the biggest change in the way that health services are delivered in the county for a long time, and Cambridgeshire and Peterborough CCG are leading the way nationally in commissioning such a big piece of work. So the first thing to say is – have your say – check out the consultation website and encourage all those you work with to do the same. Spoiler alert – this page is quite long as is the consultation so it is not particularly user-friendly.

I guess for me there are three questions about this.

The first is what will the impact of the consultation be, especially the first question that asks

“On page 11 of the consultation document, Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) explains the reasons behind these changes. Please can you rate on the scale below how supportive you are of these reasons for changes?”

If everyone strongly disagrees will they not go ahead with the process? There was a hint at the meeting that this project could still be stopped if the prospective suppliers did not meet standards etc. So could people power really make a difference?

The second question I have is how this all adds up for services, for those using them and for those proving them. In effect the contractors are being asked to provide comparable services for less money. I am sure that there are efficiencies to be made in the current system that contractors could exploit to drive costs down, but introducing an extra layer of monitoring and a whole new infrastructure will surely cost so will services remain the same, will standards really improve and can we be assured that those delivering services on the ground continue to have the same salaries and benefits as they currently have. As those that know me will attest I am not a financial genius but I cannot see how these companies can deliver the same services for less money, and that overall that this way of working will save the NHS and us significant amounts of money.

My third question is where do the Voluntary and Community sector sit in this process? The consultation document talks a lot about community services and even has a section on the voluntary sector that states

“We believe that the use of the voluntary sector is very important in supporting independence and healthy living. One of the questions the CCG is asking bidders is how they will work with the voluntary sector. For bidders to answer this, we would expect them to make contact with voluntary organisations and to develop an understanding of what benefits the voluntary organisations can deliver to our patients.

As part of the procurement process a number of events have been held to provide an opportunity for voluntary sector organisations to meet with bidders to showcase the services they provide.

Bidders will be asked to explain how they will work with and fund services offered by the voluntary sector.”

So there you have it we should be expecting to receive funding – grants as well as commissions I hope. That said I don’t think that any of the shortlisted providers have been knocking on the door of CCVS to find out what the sector is doing and what they might like to do. If you have met with the shortlisted providers do let me know I would be interested to hear your experiences. CCVS will continue to push for a greater dialogue with all parties on the sectors role. We feel that it is essential that some guarantees are built into the contracts.

Getting back to the wider Fenland Health and Wellbeing Partnership I am pleased to say that future minutes and agendas will be published on the FDC website. I will post a link once they become available.

There continues to be a real feel of joined up working across some of the key priorities that the partnership have identified. Despite not getting funding to become a Local Alcohol Action Area the council are looking at how to reduce issues caused by alcohol both around health and crime and will be looking at the impact of a super strength campaign similar to the one underway in Ipswich. Similarly there is some great work underway about reducing Coronary Heart Disease and encouraging people to get a health test. More info on the FDC website.

Update the latest newsletter about the Older People’s Service is available here

Prevention, Prevention, Prevention

Kirsty and Phill’s evangelism about location is nothing compared to health planners new-found fixation with prevention.

Fenland Health & Wellbeing Partnership 16 Jan 14

South Cambs Local Health Partnership 21 Jan 14

Attend any health meeting at the minute and the importance of reducing attendance at primary care and acute services (Doctors and Hospitals) is the consuming topic of conversation.It is not rocket science to work out that prevention is cheaper than cure. Stopping someone from falling is better for then and people’s budgets than dealing with a broken leg. Likewise keeping someone active both physically and mentally will help reduce their health problems and save the NHS money.

You may note that both these examples effect older people in a disproportionate way, and sometimes sitting in health meetings it seems only older people use their services. This may be because of the work happening in the county around older people’s procurement, it may be because of the aging population, or it may be because they use the health service more.

The Voluntary Sector has being doing prevention for years, often without realising it and certainly without measuring the savings made to the health and care providers. The lunch club that provides hot meals and activities for older people in a local village. The local history group that keeps people active and engaged in their community (although you do not have to be over 65 to be a member!), or on a larger scale the work of the U3A or organisations like Suffolk Circle. All these organisations and many many more like them provide help for people to stay healthy, to remain in their home and support them when they are in need. A great deal of it is not innovative or new, but it is tried and tested, and it does meet the need of local communities which is important in the more rural areas where public transport is non existent.

So when commissioners and planners are looking to increase funding for preventative work they need to look no further than what is already under their noses! The problems are that savings can be hard to prove, and they must understand that voluntary does not mean cheap or free. Money must be invested in groups and often these will not want to be scaled up, but with some work services could be replicated where they did not exist. At the same time funding has to be long term and ongoing not for short projects, and investment has to be made in support services for these groups  – Well what did you expect me to say 🙂

All this takes time to set up and put in place; mechanisms to evaluate projects that do not put an unrealistic burden on groups have to be found; needs and gaps in provision need to be identified; publicity campaigns are needed to recruit volunteers as well as let people know what is happening. This does not happen with a three-week deadline which is what the sector have been given with the Better Care Fund, but with planning, forethought, and the desire to take some risks the voluntary sector can deliver better services and support for older people and save the health system money.