Report to Council, September 2024 – Lucy Steels-Walshaw
Executive Member for Health, Wellbeing and Adult Social Care
Public Health
Health Trainer Success
The health trainer service in York offers advice around stopping smoking, healthy eating and lowering alcohol use.
The health trainer service has shown a high success rate working with people in local communities or remotely to provide advice and support on health issues, encouraging positive lifestyle and behaviour changes, improving wellbeing and reducing inequalities.
The health trainer service in York has recently undergone a restructure which is now complete. This service will offer more opportunities for community engagement to promote meeting national smoking cessations targets. The health trainers are also working very hard on their communications strategy to reach out to harder to reach communities.
When attending the health trainer service people set goals they would like to achieve around their health and out of 366 people engaging, 86% had achieved one or more of their health-related goals. Out of 660 referrals for the stopping smoking service, 331 people set a quit date and 72% were still stopped at 4 weeks post quit date.
Oral Health
Public Health, within local authorities, has the responsibility for the prevention of poor oral health (the responsibility for access to dental care lies with the NHS/ICBs). In York we have several initiatives to prevent poor oral health by encouraging regular toothbrushing and the promotion of good oral health messages. Over the last two years we have:
· Held an oral health promotion campaign with all early years settings (nurseries), providing resources for use within the setting and for parents to take away. This included an on-line training opportunity to which over 40 early years providers attended.
· Commissioned an Oral Health Promotion service. This included the roll out of supervised toothbrushing across several settings including early years, primary schools and all special schools in York. This provides training for settings to provide supervised toothbrushing when children attend these services. The provision of free toothbrushes, toothpaste and information for parents are provided four times per year. This provision expands each year as more settings are included. The service also offers workforce development training opportunities for any professionals who have contact with children and can support good oral health.
· For the last two years our Healthy Child Service has offered a free toothbrush, toothpaste and parental information to all children in York at their 9-month child assessment. This is around the time when the first tooth erupts and encourages good oral hygiene from an early age.
· Public Health teams from East Riding, Hull, North Yorkshire and City of York Councils have been successful in securing funding for more toothbrushing packs and the extension of the supervised toothbrushing in children’s settings. Once funding is confirmed a detailed plan will be drawn up.
· In collaboration with our NHS colleagues, we have developed a “flexible” commissioning arrangement whereby health and social care staff can refer children who have a dental health need but no access to an NHS Dentist to one of the City’s dental practitioners. They will be treated and can remain on the dental practitioners list as an NHS patient. This is a fantastic step forward in ensuring improved dental hygiene and oral health for some of our youngest and most vulnerable residents.
Vaccinations at all ages
One of the most important ways to ensure people of every age remain healthy is to be vaccinated. The NHS contains a tracker so people can check whether they are up to date and contact their GP to find out further information on how to book. Health leaders in York and North Yorkshire continue to back the major campaign to remind parents of their children missing out on protection against serious diseases.
The risk from measles and whooping cough is rising in England and sadly we no longer have the levels of population immunity recommended by the Word Health Organisation to prevent outbreaks.
York to become breastfeeding friendly city
To coincide with World Breastfeeding Week (1-7 August) City of York Council last month announced its plans to make York a ‘baby friendly city’.
Plans outlined in the city’s Breastfeeding and Infant Feeding Delivery Plan have taken a step forward with the city committing to improving its support for families arou-procurement.
A specialist integrated sexual health service provides service users with open access to confidential, non-judgemental services covering sexually transmitted infections (STIs) and blood borne viruses (BBV), testing including HIV, treatment and management; HIV prevention including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), the full range of contraception provision, health promotion and prevention including relevant vaccination.
Sexual health plays a big part in preventing disease and promoting good sexual health, including relationships, sexuality and contraception.
At June 2024 Executive a report was approved for YSTHFT to extend the contract for another 12 months, including some efficiencies. This involved a staged reduction to some services as the cost of services is increasing at higher rates that the public health grants are increasing, and officers have produced options to ensure these high-quality services continue to be delivered across York. Changes will be made gradually in the second half of 2024-25 whilst continually assessing the impact on residents.
I will monitor the situation in relation to sexual health service savings, including through briefings from Public Health colleagues, to ensure integrated sexual health services in York continue to provide appropriate coverage.
The consultation on York’s sexual and reproductive health services closed on 2 September and responses are now being considered.
Adult Social Care
Leadership
A new Corporate Director for Adult Social Care (ASC) and Integration has been in post since March 2024 and since this report is a very rare opportunity, I’d like formally welcome Sara Storey who has settled in well.
Sara has been leading work with the Adult Social Care management team to develop leadership approaches and behaviours, and to prioritise transformation projects and savings plans. Through regular engagement with front line teams, partners, and citizens, directorate leadership is developing positive relationships and opening discussions about opportunities for more integrated working. Sara is also taking up the role of ADASS (Association of Directors of Adult Social Services) regional commissioning network chair; and SRO (Senior reviewing officer) for a key workstream under the urgent and emergency care board to further develop the MDT (Multidisciplinary team) discharge hub model.
Earlier this year, a peer review team supported the department to identify areas of good practice and areas where we can strengthen performance – this feedback has been incorporated into our transformation planning. Some of the senior team will be joining or leading peer reviews elsewhere in the region, providing excellent opportunities to bring back learning and examples of good practice elsewhere. I welcome this approach of looking at what is happening outside the council to learn how we can strengthen the services we provide here in York.
Mental Health
There continues to be increased demand on mental health services due to a mix of economic, social, and financial factors. Within Adult Social Care this has required additional statutory resource due to an increase in Mental Health Act assessments for those most acutely unwell or in crisis.
The team has worked hard over the last 18 months to improve the staffing position. Recruitment has been positive and there is much less reliance upon short term contract work to cover gaps, and this is enabling service improvement.
The team has been piloting different ways of working to forge better links with TEWV (Tees, Esk and Wear Valley Mental Health Trust) Crisis Team and this has been positively received to date. Alongside this, the team is engaged with the Right Care, Right Person agenda with North Yorkshire Police, TEWV and other partners to ensure where possible residents get access to the right response and are not diverted into Police custody.
The Connecting Our City projects, supported via York Mental Health Partnership, have made significant progress in the opening in May of the first Mental Health Hub. This is a multi-agency team, co-located within 30 Clarence Street to offer a new service, transforming the approach to mental health provision in the city. The Hub is a team made up of social prescribers, peer support workers, clinicians, carer support workers, social care worker, a group facilitator and recovery workers. It offers responsive support in a flexible manner to connect people with their local communities.
The Mental Health Partnership has successfully secured funding to develop a new mental health hub in the West of the city. This hub will be open 24/7 and available to all adults without needing a referral. There are plans to deliver a third hub in the East to ensure provision across the whole of York so residents are supported in their communities. This is an exciting step forward and an innovative project which will benefit residents in York.
Service Improvement
Adult Social Care has commenced several service improvements across the directorate, developed through engagement with our workforce. Amongst these improvements, they are developing a new Assurance Forum where staff and managers can engage to discuss the work they have completed and the recommendations they make. This process will allow officers to ensure a strength-based approach is embedded in practice and all opportunities to maximise an individual’s independence have been explored. Learning from the Assurance Forum will be passed directly to our workforce development colleagues to inform training plans.
Running parallel is a range of other service improvements, focussed on, Quality and Audit, Voice of the Person, CQC preparation, improvement of Direct Payment provision and developing a Review project team.
The Review Team is a new team which will be focussing on utilising a multi-disciplinary approach, working in partnership with individuals to identify and utilise their strengths. The Review Team will address a backlog of overdue reviews and ensure the support residents receive is proportionate, appropriate, and cost-effective. The new team is aiming to be operational towards the end of the year.
Adult Social Care is also developing with partners a research and co-production strategy. The ambition includes identifying opportunities for practitioners to undertake research relating to social care and we are working with the Curiosity Partnership and the voluntary sector to co-produce this work supported by our researcher in residence. This work will build research capacity and literacy within Adult Social Care teams, providing opportunities for colleagues to build skills and use evidence-based practice and research in ways that can enhance and assist with the work the Local Authority is already doing. This will ultimately improve outcomes for people who have contact with social care.
Adult Social Care is working with our local People First self-advocates who are leading on designing a Learning Disability Partnership Board. We have approved ‘easy read’ training for several of our colleagues who can then help us to produce information for people in more accessible formats.
ASYE (Assessed Year in Practice)
The quality of our Social Work practice is key in ensuring the high quality of service that citizens expect. Ensuring that new social workers flourish and can demonstrate and celebrate their achievements is a vital part of this.
Adult Social Care recently introduced an ASYE Moderation Panel. This consists of the Principal Social Worker, an Assistant Director, Head of Service and the Practice Educator; and it involves our ASYE practitioners submitting their portfolios and receiving feedback and recommendations of their first year in practice. There has been a high standard of portfolios and received helpful feedback from practitioners of their experience in their first year. On successful completion, Social Workers are presented with their certificates by the Principal Social worker and the Corporate Director of Adult Social Care. This has been an important process to introduce as it formally recognises the hard work and excellent commitment from our social work practitioners.
Occupational Therapy
Occupational Therapy (OT) undertakes a central role in working with colleagues to ensure York residents remain at home as confidently, safely, and independently as possible.
To achieve this, Adult Social Care undertakes a strength-based approach working alongside individuals to realise their goals. This can include provision of low-level equipment such as, bathing, aids, grab rails and toilet equipment. In addition, Adult Social Care also provides assessment and provision of specialist equipment such as beds and seating, including safe moving and handling. The OTs also assess on behalf of the healthy and sustainable housing team for appropriate adaptations. Over recent years we have continued to see an increased demand for Occupational therapy and equipment. This has resulted in waiting lists, which the OT team prioritise and monitor on a consistent basis. The OT team is very experienced team and can support individuals with complex challenges to continue to live in their own homes. OTs are looking forward to the opportunity to work alongside social work colleagues to undertake a multi-disciplinary strength-based approach to overdue review work.
CYC Adult Social Care providers
· CYC Telecare – Digital telecare practitioners have been in post 2 months and have been providing education and support to Be Independent in transition from analogue to digital technology.
· Learning Disability Provider Services – The CYC learning disability provider service includes Pine Trees (a day centre for people with complex needs), Flaxman Avenue (short breaks),
community-based support and The Bungalows (day provision that supports integration) have all recently undergone a restructure. This has led to increased capacity of all services. A key element of this restructure was to introduce short term interventions to reduce the need for long term care for customers with learning disabilities.
· Personal Support Service – PSS is also regulated by CQC and has a ‘Good’ rating. There is currently a restructure to strengthen and improve the service.
· Commissioning - There is a new interim joint head of service for our all-age team, who while also working for the ICB York Place team, is supporting the team to identify opportunities to develop one integrated commissioning team.
· There has been engagement around several new commissioning contracts this year, including reablement, advocacy, sensory services, dementia model, and community contracts, and officers have been bringing more assurance and efficiency to our contracts through developing approved provider lists and frameworks.
Safeguarding and Deprivation of Liberty Safeguards
The council plays a major role in protecting the human rights of those who lack the mental capacity to decide where they live and how they are supported. Requests to support people through the Deprivation of Liberty Safeguards process continue to increase. A review of Adult Social Care processes and systems has commenced to ensure ASC is able to safeguard as many people as possible in the most effective way. The directorate is improving its capability and capacity to deliver these safeguards by investing in its staff through commissioning more Best Interest Assessor Training for staff.
Local Safeguarding Adults processes have also been reviewed along with our multi-agency policies and procedures ensuring they are up to date and effective for the community that are supported.
ASC has undertaken some positive and well received work, and awareness raising, with our partners to enable concerns to be raised more easily. It also enabled sharing of the kind of information that helps staff to act in a timely manner to support adults at risk, to help them manage risk in their lives and plan how to live more safely.
There have also been some significant developments in operational and strategic safeguarding pathways to support and safeguard young people as they grow into adulthood. This includes the launch of a Transitional Safeguarding protocol endorsed by the both the Safeguarding Adults Board (SAB), and the Children’s Safeguarding Partnership.
The SAB has also successfully appointed to some key positions recently which include a SAB Business Manager and a new Independent Chair. Both these appointments will be pivotal in developing the SAB’s assurance, governance, and performance arrangements so that we are able to maximise the impact we have.
ASC professionals understand the contribution Adult Social Care can make in helping to tackle domestic abuse. Work is underway in Public Health to identify training needs amongst ASC colleagues in relation to domestic abuse. This has initially focused upon delivering MARAC (multi agency risk assessment conference) training to our frontline safeguarding practitioners.
Cllr Steels-Walshaw
10 September 2024
Abbreviations used in this report:
ADASS - Association of Directors of Adult Social Services
ASC - Adult Social Care
ASYE - Assessed Year in Practice
BBV - Blood Borne Viruses
CQC – Care Quality Commission
CYC – City of York Council
GPs – General Practitioners
ICB – Integrated Care Board
MARAC - Multi Agency Risk Assessment Conference
MDT - Multidisciplinary Team
NHS - National Health Service
OT - Occupational Therapy
PEP - Post-exposure prophylaxis
PrEP - Pre-exposure prophylaxis
PSS - Personal Support Service
SAB - Safeguarding Adults Board
SRO - Senior Reviewing Officer
STIs - Sexually Transmitted Infections
TEWV - Tees, Esk and Wear Valley
YSTHFT - York and Scarborough Teaching Hospitals Foundation Trust