Health and Social Care Working Group

Report on responses received and suggested ways forward

A. Process

1. At the start of 2020 Sheila Davies, Bob Welch and Jim Kent from the Steering Group conducted consultations with various support groups:

  • Stroke Awareness (Hilary Parker)

  • Stretton Cancer Care (Karol Warren)

  • Jennifer Bridge (Parkinsons Group)

  • Mayfair Care Services (Helen Crumpton)

  • Dementia Engagement and Empowerment Project

 

2. In May 2020, Bob Welch and David Howard met with Nicola Daniels, Chief Officer of Mayfair

 

3. Survey letters were sent out at that point, and again in November 2020, to gauge opinion about present concerns and ways forward, involving all groups concerned with Health and Social Care, including Care Homes and the Medical Practice.

 

4. A small group (David Howard, Bob Welch, Meg Bacon, and Bill Ross) started meeting in October 2020 to coordinate the responses and shape this report.

Responses were received from:

Mayfair Community Centre:
• Nicola Daniels (Chief Officer)
• Meredith Vivian (Chair of Trustees)
• Meg Bacon (Trustee)
• Helen Crumpton (Care Services Coordinator)
Church Stretton Town Council – Bob Welch (Mayor)
The Sandford Nursing Home
Care Home (Anon.)
Church Stretton Medical Practice
Bluebird Care, Shropshire
Parkinsons Support Group – Jennifer Bridge
Cancer Support Group – Karol Warren
Stroke Awareness Support Group – Hilary Parker
Dementia Engagement and Empowerment Project
Good Neighbours – Guy Sjögren
Fire Service

B. Context

  1. Shropshire has an ageing population. By 2041 it is estimated that the older population (65+) will represent just over a third of the total. This is even more the case in Church Stretton, where the elderly represented a third in 2011, with numbers increasing.
     

  2. This has implications for the provision of all services, but particularly for Health and Social Care, where the elderly take up a disproportionate amount of resource.
     

  3. The coronavirus pandemic has put national and local services under considerable strain; time and resources will be needed for recovery and for establishing new systems.
     

  4. Local government finances – already in a parlous state – show no sign of stabilising or improving. Devolution of responsibility from Shropshire Council to local communities (but with little or no devolution of funding), and an emphasis on supporting (or even running) services through volunteers puts a disproportionate and heavy burden on smaller communities such as Church Stretton.
     

  5. The announcement of the UK government of its intention to introduce further reforms to the NHS will add further pressure to the system, and, like any “reform” will not come cost-free. The proposed integration of Health and Social Care, though much to be welcomed and long overdue, is at present no more than a statement of intent, and there is no indication of the level of resource required or proposed.

C. Household Survey

Results from the Survey conducted in January 2020 showed that Health and Social Care was a high priority in the full sample, and also in households with children.

Mayfair and the Health and Wellbeing Centre were seen as key features to conserve.

Only a few specific issues were mentioned:

  • Increasing services

  • Faster and improved emergency services

  • Social Care

  • Waiting times for appointments at surgery.

D. Further Challenges

In addition to the challenges coming from the wider context (A. above), the following particular issues were brought forward:
 

  • Recruitment: this is a significant problem for all services, but particularly for the care sector, which is disadvantaged by low status and pay levels
     

  • Housing: the relatively high price of housing in the Strettons and the lack of affordable housing adds to recruitment problems; as elderly numbers increase, these pressures will become worse
     

  • The need for improved information sharing
     

  • The need to develop use of IT and digital services
     

  • Pressure to find sufficient volunteers to maintain and improve services
     

  • The need to take into account the rurality of the area, and shape care (and other) services locally, as against a “one size fits all” approach that only reflects urban areas
     

  • The ability to feed into national planning (e.g. the People’s Health and Social Care Commission) to help inform plans for rural areas
     

  • Identification of “hidden need”, which is often obscured by the relative affluence of the community as a whole
     

  • The consequences of the pandemic for individuals and the wider community may take some time either to be fully appreciated or to be faced. There are clear indications of the effects on health and wellbeing, both physically (e.g. long-Covid) and psychologically (levels of stress, loneliness etc.). Community systems will need to address the likelihood of increased demand, and be robust enough to adapt to new patterns


 

E. Positives

  1. Despite the “elderly” profile, the Strettons form an active, engaged and committed community. Residents have a wide range of experience and expertise to share. In addition to involvement in a staggeringly large numbers of clubs and societies, residents find time to volunteer for a wide range of support activities, from running Scouts groups to delivering meals to the housebound. There is a strong tradition of giving to the community, which showed strongly during the pandemic and the lockdowns, where extraordinary efforts were made to ensure that everyone was supported and helped where necessary
     

  2. Mayfair is already recognised nationally as a centre of excellence. From Ring and Ride, through exercise classes, the provision of clinics, social and volunteering opportunities, the provision of Daycare services, the support of people both in Mayfair and in their own homes through Maysi (Mayfair Supporting Independence), and Compassionate Communities projects, the organisation is a key feature of provision in the Strettons. Mayfair is keen to identify further areas for development, and is always looking to promote cooperation with other service providers. (It is accepted that Mayfair would need significant extra resource in order to take on any additional commitments.)
     

  3. The prospect of the detached youth work initiative this summer, followed by the planned re-opening of the youth club at Mayfair in the autumn, with a trained youth worker and, hopefully, some trained community volunteers will make a contribution towards addressing some of the post-pandemic needs of local adolescents
     

  4. Social prescribing is a means of enabling health professionals to refer people to local, non-clinical services, and to address their needs in a holistic way, enabling individuals to take greater control of their own health. It is designed to support people with a wide range of social, emotional and practical needs, and can involve a matching range of activities that are typically provided by voluntary and community sector organisations
     

  5. Social prescribing can operate in many ways, and whilst supporting the model adopted by public health, currently commissioned by the south west PCN for the practice, is one way - we also want to encourage local groups to get involved, register their activities and services, and offer additional options for social prescribing. The current cooperative model between the Medical Practice and Mayfair (Maysi) provides a good basis for future development
     

  6. The Patient Participation Group provides a potentially valuable opportunity to develop an on-going dialogue about medical practice, patient concerns, and future developments
     

  7. Communications can be enhanced by building on networks such as Community Messaging and the digital neighbourhood groups in All and Little Stretton

Key Question: How do we build on the significant advantages that the Strettons already enjoy so that we can face and surmount the challenges of future years?

F. Key Themes emerging from the Consultation

  1. Promoting health and well-being, rather than simply dealing with ill-health
     

  2. Accepting the uncertainties which arise from (lack of) government policy, coordination issues (balkanisation), and from (inadequate) national and local funding, and using the strengths already present in the community, its people and organisations to build an enhanced local model, predicated on the identified needs and aspirations of residents
     

  3. Building links and cooperation across and between all organisations concerned with Health and Social Care (NHS, Care Providers, Shropshire Council, Charities, Independent Agencies)
     

  4. Developing a prophylactic model of Health and Social Care throughout the community through:
    (a) A Healthy Living agenda and programme, including fitness and healthy eating, across all age groups
    (b) Enhancement of support for independent living for the elderly
    (c) Better identification of the vulnerable and establishment of support pathways, including befriending, counselling and group work
    (d) Development of a young persons’ agenda, including community service, placements, training, and support for young carers
    (e) Development of a family agenda (e.g young mothers)
     

  5. Building on experience gained during the pandemic (e.g. on-line consultations) to push for a digital transformation in health care (including addressing the identified “digital gap”), and making more active use of data on public health
     

  6. Exploring possibilities for developing research projects with university departments
     

  7. Developing volunteering (using experience and expertise from Mayfair), and links with professionals
     

  8. Reaching out to outlying villages and hamlets
     

  9. Using the above, and the growing reputation of the Strettons as both a model of good practice and a beacon of excellence, to attract funding and resources for further development.

G. Proposals

  1. In order to move forward on this topic, organisations and individuals within the town will have to pick up the baton.
     

  2. There are four key organisational players:
    (a) Church Stretton Town Council, with its overall responsibility for developments within the town, and a specific (but not sole) responsibility for the implementation of the Community-Led Plan can use its best offices to facilitate developments and smooth communications;
    (b) Mayfair, with its centrality to the developments mentioned above, and current involvement in many of the activities;
    (c) The Medical Practice, whose commitment to an integrated model of Health and Social Care is vital;
    (d) Local schools, both in terms of promoting healthy living and in raising awareness of future career paths;
    (e) The identification of these four players does not diminish, for the future, the vital role that others, including Care Homes and private providers, have to play.
     

  3. We propose the establishment of a Health and Welfare Forum, to bring together all interested parties, to establish a vision for health and welfare in the Strettons, and to develop patterns of cooperation to bring this about. The Forum would be a significant means of bringing individuals, groups and organisations together, and sharing intelligence, with a community focus. It would be a statement of the determination of the Strettons to chart a sustainable way forward for the community;
    The Forum would have as its key priority for action the development of a new model of Health and Social Care for the Strettons;
    The Forum should be called by the four key players, with the Town Council taking the chair initially;
    It will be essential to identify and bring on board key committed individuals who share the vision and have the energy to pursue the ambition;
    The Forum would need to decide whether it needed to have a supervisory Board, and how it would operate and report to the community.
    It is anticipated that the Forum would meet twice a year, with the minimum of bureaucracy, would use digital communication wherever possible, and would allocate particular topics to working groups;
    It is to be hoped that the existence of the Forum and its ongoing work would enhance the ability of the community as a whole to campaign for and attract funding;
     

  4. We propose that the Forum, when established, takes the key themes identified in Section F as its agenda.


 

H. Additional Ideas Suggested

  1. Expansion of Ring and Ride service

  2. Improved transport links

  3. Linking to proposals from other groups (e.g. proposals on cycling and walking from Environment working group)

  4. Linking to tourism (provision of workshops on health, healthy eating, complementary therapies, etc.)

  5. Better physical access to shops and businesses in town:

  6. Volunteer register for small household jobs

  7. Increase in number of clinics at Mayfair and HWBC

  8. Make better use of available data

  9. Make more use of pilot schemes/link with research opportunities

  10. Increase Mayfair’s opening hours

  11. Involve schools in Healthy Living agenda

David Howard (Chair/Clerk), Meg Bacon, Bill Ross, Bob Welch
29.04.2021

Appendix1: A digital future?

One of the consequences of the coronavirus pandemic has been a noticeable shift towards digital care, for example, online consultation with doctors and the use of mobile phone apps for contact tracing and the monitoring of patients.

New technology enables diagnosis, monitoring, and, in some cases treatment without the patient having to visit the surgery.

On-line diagnosis has already shown itself to be as effective as face-to-face consultation. A patient’s health can also be monitored remotely through wearable devices, and the use of smartphones with dedicated apps.

It is possible to measure and monitor over time vital signs like temperature, blood pressure and oxygen saturation at home at very low cost, obviating the need to visit a clinic. A clinician can also adjust – remotely - dosage on machines installed at home. Devices can be used to give reminders to take medicines, exercise and do physiotherapy.

Home-based care can be more effective for the treatment of chronic health problems such as diabetes.

In short, digital provision offers a real opportunity to deliver better health care at lower costs. The physical link between the Medical Practice and the Health and Wellbeing Centre is a unique added bonus. There is also the potential to work with the Digital Health Research Unit at the Shrewsbury University Centre; joint research projects could enhance future thinking and provision.

When plans were being made for the Health and Wellbeing Centre, the possibility of having a hub for telemedicine was factored in. Though this idea has been left hanging, we believe that now is the time, when the pandemic has brought such far-reaching changes to our lives, to revive thinking on this issue, and to explore possibilities. We recognise the importance of maintaining a balance between new digital services and the important human aspects of the relationships between health professionals and patients.

The rural nature of the Practice, with its patients dispersed, often in surrounding villages and remote farms, and with poor transport links, suggests that there is much to be gained, for patient convenience, for more effective use of clinicians’ time, and for reduction of continually increasing health costs, by investigating innovative technology, and piloting developments where possible.

DAH/06.06.2021