Agenda item

10.1  The sub-committee heard from Neil Hartley of St Christopher’s Hospice, who informed the sub-committee about the services that St Christopher’s provides and how they have worked out new ways to operate more diversely.

10.2  The service was set up in 1967 and provides care to all communities across the London boroughs of Bromley, Croydon, Lambeth, Lewisham and Southwark.  The services are provided in patients own homes or in one of four inpatient wards.  Palliative care is delivered by specialists at the centre and the services include, complementary therapies, psychiatric support, welfare advice, occupational therapies and physiotherapy. 

10.3  Money to deliver the services comes from the NHS partially but the service needs to raise more than 9 million to continue to provide free care for patients and to provide support for their families.  Money comes from the local community, businesses, shops and other grants.

10.4  The hospice has been looking at ways of managing how they change themselves in order to offer a more cost effective service.  Most day care centres are aimed at specific groups, a minority of people in a traditional day care model. St Christopher’s looked at the people who were using their service and consulted with them to see how they wanted their service to change. 

10.5  The findings that came out of that consultation found were that there needed to be a culture change within the service.  That referrals were rising and the hospice needed to meet the financial challenges that went with increasing numbers.  Service users didn’t want to feel hidden away and excluded from society but wanted a more open environment which was accessible to all.  The service invested in in-depth training programmes with structured support for volunteers, thereby creating a hub of volunteers of all ages and experiences. 

10.6  The centre is open between 8am and 9pm.  As well as the range of clinics and therapies available there is also a Gym which was proving to be very popular. Everyone who attended the gym gets a personalised plan and there has been a lot of interest especially amongst the 90 year olds.

10.7  The hospice provides out patient and day care services and the cafe is open to the public.  Sunday lunch is now served there and this is helping to build a sense of community.  There is internet access for patients and it is available for visitors too.

10.8  There are now between 15 – 200 people coming through the doors including children from primary schools who use the art facilities. Having a good mix of visitors from the community is helping to change and challenge attitudes cross generationally.

10.9  The hospice provides activities with other community groups, such as the Harley Davison Bikers Group, local care homes, churches and there have been organised trips to local pubs, where people might not have had the opportunity to visit.

10.10  The service found that it needed to be flexible in what it was providing and take into consideration at what times those services were available.  They now have a bar which serves alcohol and food and host themed nights such as curry nights and so on.  This is not a subsidised service. There is a £3 minimum charge for the three course Sunday lunch, although people are free to pay more if they wish to.  However they have trained volunteers to notice if service users don’t appear to be able to afford the cost of the meal and they will be encouraged to pay less.  Service users are also encouraged to bring family and friends who are also encouraged to use the facilities.  This can mean that service users are able to get lifts to the centre with transport being less of an issue. 

10.11  In answer to Members’ questions regarding how they keep costs down, Nigel informed the committee that the use of volunteers had kept costs low and the expected time of volunteer retention is approximately 4 – 5 years.  He said that it didn’t matter if voluntary staff moved on elsewhere having received comprehensive training from at the service because it was good to ensure that there was movement throughout the service ensuring diversity in the workforce.  People are encouraged to move on to develop their skills and widen their experience. 

10.12  Finding volunteers is fairly easy because the training attracts quite a lot of interest.  On average there are four courses per year with around 25 – 40 people on each course.  Usually there is a good ethnic mix and more recently, younger people are now showing a lot of interest also. 

10.13  The main building is frequently used by other groups.  Activities can be held elsewhere, off site, such as local pubs and/or libraries.  Care funding money from the PCT is crucial, without it, it would be very difficult to provide inpatient services which are the most expensive part of the operation.  If that money ceased, they would have to deliver an entirely different type of service. 

10.14  The sub-committee then heard from Steve McIntosh from Carers UK.  Carers UK provides information, advice and support for those who care for an elderly relative, a sick friend or a disabled family member.  The organisation facilitates campaigns, research and training programmes.

10.15  The organisations tries to ensure that individuals are claiming what they need to claim and that they are able to access support when needed.  It also aims to ensure that employers are sensitive to carers needs and do not discriminate against carers because of their extra responsibilities.  That employers will give flexible working conditions and appropriate considerations.  Steve McIntosh said that there had been at least one case that he knew about where a carer had taken a case of discrimination to the European Courts of Human Rights and had won on the grounds of discrimination by association.  The organisation is keen to raise the profile of those who care and to ensure they are adequately protected by law. 

10.16  People who take on caring responsibilities save the NHS billions of pounds.  It was important to note, however, that being a carer can take it’s toll on health and finances.  People can struggle in isolation and in poverty with little support.  Carers UK want to ensure that all people with caring responsibilities are respected, supported and valued for how much they contribute. 

10.17  As services face cuts in funding the focus has to be more on those who care for loved ones and friends at home.  This is not a luxury, it is essential for carers services to be sustainable, that they are looked after appropriately.  It is important that carers have access to good support including health services to support their own needs.  Carers have different abilities to access services and often their own health is ignored, prioritising those who are being cared for. 

10.18  Members asked if it would be good practice to involve carers in the commissioning of services.  Steve McIntosh said that there was good practice in Stoke where carers and service users were involved in their personalisation packages.  Service users were pooling their payments and paying for staff from those funds in the way they needed them.  They were using church halls and community rooms rather than service users remaining in their home to receive care.

10.19  Members agreed that Carers Assessments can be a ‘blunt tool’ and often an inefficient way to assess the carers situation.  They tend to be a superficial way to assess needs, often missing the wider implications of the situation.  There needs to be a better first point of contact or gateway to assess care needs and the Local Authority must be able to provide free advice and information for those seeking help, as well as assisting those who may be unaware of the help that might be available to them.  Sometimes it can take a few years before carers can realise that there is help for them, or that they might obtain additional help.  Community halls, schools and GP surgeries can be good places to display information. 

10.20  Steve McIntosh said that personalised agendas held dangers as well as opportunities.  Direct payments can give individuals more autonomy and flexibility and allow people more control over what they receive.  This care might be more suited to their needs, however, carers can be frightened about having to take ownership of their own care and may need more guidance and support when selecting services that might be right for them.

10.21  It was reiterated that more publicity is need to make carers aware of the help that is available.  Only 13 percent of those who were eligible for direct payments actually took them up.