Social care and support services in Barnet –activity, demand and trends

During 2007/08, Barnet Adult Social Services dealt with 6119 referrals for adults of which over 3400 resulted in assessments of individual need. This activity has increased steadily over the last 5 years for each of the care groups, however with a decrease in 2007/8.

Table 1 Referral and assessment volumes 2003-2008 Barnet Adult Social Services

Referrals and Assessments Adult Social Services

6119 5133 5734 4680 4799

3406 5310 4932 3183 2388

2217 2835 3626 2022 2438

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2007/08 2006/07 2005/06 2004/05 2003/04

New assessments leading to service

Passed for further assessment

Dealt With at point of contact

The type of activity relating to adults in contact with social services has changed according to how the system has managed demand. In general there has been an increase in ‘signposting’ to alternative sources of help. In common with the national picture for councils, Adult Social Services has developed more filtering mechanisms for screening people at the point of referral so that some people have been excluded from services at an earlier stage. There has been greater reliance on the voluntary sector to offer low level support and interventions where direct referral by the council is not necessary. The council has continued to strengthen relationships with the voluntary sector through a steady funding stream and the numbers of people helped through the grant funded sector have increased.

What is not fully known is how people with ‘low or moderate needs’ are able to get their needs met and what level of unmet need there is in the general population. It is important that more is known about the consequences of unmet need both in terms of assessing the outcomes for those individuals and their families, and in terms of predicting the numbers of adults who may develop care needs which are ‘substantial and critical’ over the next 10 to 20 years and where an earlier intervention may have prevented referral to social services, acute or specialist care for longer.

The data shows that the number of new assessments each year which led to a service provision has varied from year to year and from client group to client group for example

historically Barnet has always had high numbers of ‘self funders’, particularly older adults, many of whom in the past would have contacted social services for an assessment. Increasingly there are alternative sources of help and advice for people who pay privately for care and an increasing consumer awareness of private equity schemes and other types of financial arrangements. However the total activity levels in terms of referrals and assessments have increased by 32.5% over the period 2003/04 to 2007/08 the cumulative impact of which is increased demand on care management and assessment capacity and purchasing budgets.

New Assessments leading to Service

213288

17 36 49 23 29

616

180

421

15921518

2666

2278

1703

213253

490

272281

0

500

1000

1500

2000

2500

3000

2003/04 2004/05 2005/06 2006/07 2007/08

No

of

Ass

essm

ents

Physical & Sensory

Learning Disability

Mental Health

Adults 65+

More analysis is required of referral patterns for social care and support services by ward / locality, however there are some identifiable trends in needs and demand by location. Use of services by older people tends to be spread across the borough however with higher demand in the more deprived wards. A recent analysis of homecare referrals showed that there was a lower turnover of service users in deprived areas indicating that people may start using services earlier because of higher rates of illnesses and the lack access to alternatives sources of support for those individuals.

Map of homecare service users by ward

The demand for mental health services correlates with wards known to be more deprived. The Joint Commissioning Strategy for mental health is targeting interventions in the wards of Burnt Oak, Colindale, West Hendon and Coppetts where there are known to be higher levels of mental illness.

Table 3 Sources of referrals to Barnet Adult Social Services

2007/08 2006/07 2005/06 2004/05 2003/04Primary care 1612 1466 1627 1278 1377Secondary health care 2674 3532 3561 2605 1487Self referral 1919 1760 1588 1373 741Family/friend/neighbour 1639 1649 1545 1380 1046Barnet Adult Social Services 494 522 575 3 4Housing 200 209 173 99 84Local Authority 240 351 541 427 346Criminal Justice Agencies 50 186 374 153 66Other 677 716 506 377 571Not known 20 52 176 168 1465

There has been an overall increase in referrals from healthcare services, reflecting trends in hospital care for shorter stays and more rapid discharges and the need for a joined up response across health and social care. The importance of this has been reflected through the inclusion of a performance measure related to intermediate care in the Barnet LAA. Demand for intermediate care services, equipment and rehabilitation /enablement have increased as a result as set out below

Number of people funded by the council receiving intermediate care in a residential setting (rapid response) to prevent hospital admission

2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 Plan

Barnet 6 10 8 9 42 46

IPF Data 37 52 49 40 37 41Number of people funded by the council receiving intermediate care in a residential setting (supported discharge) to facilitate timely hospital discharge and / or effective rehabilitation.Barnet 34 38 43 32 482 530

IPF Data 70 91 105 130 162 166

Number of people funded by the council receiving non-residential intermediate care to prevent hospital admission.Barnet 194 206 163 181 823 905

IPF Data 214 205 219 256 313 336

Number of people funded by the council receiving non-residential intermediate care to facilitate timely hospital discharge and / or effective rehabilitation.Barnet 568 603 684 843 523 575

IPF Data 440 449 461 519 512 527

Number of places funded by the council in non-residential intermediate care schemes.

Barnet 50 65 85 95 130 143

IPF Data 125 149 165 164 170 178

Increased focus on upstream interventions across health and social is essential to reduce longer term dependency on health and social care. The prevention of falls remains a key priority due to the associated mortality, physical injury, loss of function and loss of independence experienced by older people. Falls are a major contributor to hip fractures and are also associated with a significantly increased risk of many other fractures, including wrist, pelvis, and upper arm. As the average age for a fracture of the hip is 83 years; 80% of such

people are likely to be women and 68% of patients will have fallen within their own home we can expect without upstream interventions for a higher demand for health and social care services related to falls. More effective prevention of falls will reduce the demand for acute and community health care and on social care services such as homecare and residential care.

It is also interesting to note the considerable increase in self referrals and from informal carers. These have grown in line with changes in access to social services supported by developments in advocacy and more recently the introduction of self assessment tools and a policy of increasing access to advice and services for carers.

The above table also demonstrates that referrals to Adult Social Services from housing have also increased as people wish to remain living in their own homes in the community as opposed to a move into more formal care settings such as registered care requiring access to personal care and housing related support.