About Us
Healthwatch in Devon, Plymouth, and Torbay (HWDPT) are the three local independent consumer champions for people using health and social care services across Devon. The scope of HWDPT is to listen to what people say about their local health and social care services, to identify what works well and what could be improved, and to make those views known to those involved in the commissioning and scrutiny of health and social care services; ensuring the voice of the community is used to influence and improve services for local people.
Introduction
A draft Adult Social Care Strategy has been produced by Torbay Council and Torbay & South Devon NHS Foundation Trust, setting out priorities to improve adult social care services for residents in Torbay. Torbay Council approached HWDPT with an aim to hear real views from across Torbay on whether the priorities they identified will help meet their vision and whether the strategy effectively describes the next steps for adult social care in Torbay. As a real opportunity for people to influence the strategy, HWDPT organised six focus groups across the Torbay locality between 11 July 2023 and 26 July 2023 to engage local residents into providing feedback and experiences on the local Adult Social Care landscape. 70 people from across Torbay joined the focus groups and gave their feedback based on the presentation and information given.
Background
The draft Adult Social Care Strategy - entitled 'Thriving Communities Where People Can Prosper' - sets out how Torbay Council and Torbay and South Devon NHS Foundation Trust will work towards that vision, setting out key priorities to improving adult social care services for residents in Torbay. The priorities identified in the Strategy include:
- Helping people to live well and independently
- Helping people to regain their independence
- Helping people with care and support needs to live independently, safely and with choice and control.
To gain feedback on these priorities Torbay Council produced a publicly distributed survey which was promoted via the Healthwatch Torbay website, social media accounts and bi-weekly Email Bulletin, and also in paper format. The results from this survey will be used in combination with the feedback gained from the forums to create an overarching consultation report produced by Torbay Council’s Strategic Lead for Adult Social Care Quality and Assurance. This consultation report will go through the Torbay Council’s governance process to assess whether any adjustments to the draft strategy are required. The strategy aims to be published by Torbay Council on their website by Autumn 2023.
Our Methodology
Healthwatch was approached by Torbay Council to assist with the promotion of the survey and to provide an independent presence at forums held across the Torbay locality. To ensure maximum participation, the Torbay Council survey in relation to the strategy was circulated via Healthwatch Torbay’s website, social media platforms and the bi-weekly Email Bulletin. A link to the survey was also sent out to all the local members of the Healthwatch Assist Network and the wider Voluntary Sector network in Torbay. Healthwatch Torbay arranged a series of forums in liaison with local groups and services where people had an interest in adult social care and wanted to participate. An online virtual forum was also advertised for anyone who wished to participate but could not attend in person. The survey was also made available as a hard copy during the forums for participants to complete in combination to the verbal feedback they provided during the sessions.
Engagement Forums
The forums were led by Cathy Williams, Torbay Council’s Strategic Lead for Adult Social Care Quality and Assurance, with participant feedback independently recorded by Healthwatch Torbay. In total six forums were conducted with local groups who have an awareness, understanding, and experience of adult social care and who wanted to participate in the engagement being undertaken. The groups participating included four Carers groups, the Torbay Deaf Club and the Be Well group, which is run by Step One Charity. The sessions were run in a participatory manner with an initial presentation about the strategy followed by an open feedback session. A series of six questions were posed following the presentation, however, the feedback was presented in an experiential way rather than in response to the specific questions. The initial questions proposed by Torbay Council were:
- How well do you think the priorities we’ve identified will help us meet our vision?
- Does the strategy effectively describe the next steps in Torbay’s adult social care story?
- Is it understandable and does it resonate with you?
- Does it make sense?
- Does it focus on the right things?
- Is there anything missing?
Healthwatch Torbay independently captured over 230 comments in relation to the feedback given and this has been summarized for sharing with Torbay Council to form part of the final report. In addition, Healthwatch identified various concerns from participants which will be considered for further examination as part of the ongoing work of Healthwatch Torbay as the independent consumer champion for health and social care.
Key Findings
This section summarises the feedback independently gathered by Healthwatch during the engagement forums. Where possible, verbatim comments have been included as examples. As such, these comments are the view of forum participants and not the view of Healthwatch. It is important to note that during the sessions people referred to their own experiences and issues that they had encountered when navigating their local health and social care services, for example, when requesting a social care assessment or arranging a care and support plan review. Healthwatch offered to follow up any individual concerns that were raised during the session afterwards, outside of the session, so that they could be signposted to the correct point of contact who would be able to help them to resolve the concern that they raised.
General View of the Strategy
The overall response to the strategy was positive, with participants feeling it was a good approach, particularly with the focus on listening to those who are at the center of service provision. There was no disagreement about the focus of the strategy. Verbatim comments from participants noted by Healthwatch included:
- “I agree that it is important that the strategy prioritized that people are listened to”.
- “You have recognized the system is fractured and are trying to do something about it”.
- “It’s a good thing you are doing – you have to start somewhere.”
Overall Feedback
The importance of the flexibility of Torbay Council in enabling the facilitation of open discussion elicited a greater depth of information, which we were able to categorize into the four main areas below for ease of reporting: Information, Communication, Access to Services, and Finance.
Information
23% of comments referenced access to information. Participants highlighted the difficulties of finding the right service or someone who can help them with the information they need. Some participants felt that they had to constantly retell their story, which was highlighted in most of the forums with people having to repeat information time and again. Information sharing presents a constant problem for individuals trying to access and use services. Participants expressed difficulties of the reliance on online and phone-based services which exclude many people and can be difficult to use. Participants reported using the assistance of other people who can provide access to face-to-face information and support and groups such as the Deaf Club provide a valuable resource, as do Carer Support Workers. Peer-led support groups are valued highly, and they form an essential role in information and advice sharing, as well as providing support for people’s well-being when other services are difficult to contact. Verbatim comments from participants noted by Healthwatch included:
- “You don’t know where to go for help... I don’t know what to do”.
- “Everything is online, but some people are not online and don’t understand it – people need people they can talk to”.
- “There is a high turnover of staff, so you have to tell your story over and over again”.
Communication
20% of comments referenced communication. Communication was highlighted is a key issue and a barrier for people who are in receipt of services and for those seeking support. For the communities of people who need reasonable adjustments, there is a clear requirement for services to be aware of an individual’s communication requirements and to make suitable arrangements accordingly. Older Deaf people in residential care may be at risk of isolation and poor health outcomes due to a reported lack of access to BSL users.
- “I received a letter from the hospital … I had to phone to contact them, but I can’t use the phone, so I had to actually go there, and they told me to use my son to interpret for me”. (Verbatim comment from a BSL language user)
- “We need people who can sign properly and where are they? We are stuck. We have things that need sorting out- we can't just email in.”
- “We have difficulties reading, it goes over our heads- lots of deaf people can't read or can't write. It is the utmost important we have BSL.”
Concerns were expressed about trying to contact services who either did not respond or moved people onto another service, who then moved them on again until they seemed to be in a continual loop without achieving an outcome. This impacts negatively on their health and well-being.
- “We got signed off (Mental Health Support) when more urgent cases came up. We contacted the doctor who put forward a referral again and the team said no. I don’t know where to go now, help with medications, etc. She is a lot worse now. I am lost in a vacuum.”
In several cases, people expressed the need for flexibility in the involvement of other people in communication about an individual. Carers and members of the Deaf community stated their frustration when services do not accept involvement from someone such as an interpreter or family Carer because it restricts the information which is given and can deny people the services they need.
- “More listening to families- there need to be mechanisms to assure the family are recognized as experts on the person’s life. Not everyone has someone to fight in their corner but those who do need to be listened to.”
As previously mentioned, people-based services were consistently highlighted as an effective source of information and communication which was highly valued. A verbatim comment related to this was:
- “Building a relationship with a person who you can communicate with is essential, human contact is so important”.
Access to Services
35% of comments referenced access to services. The discussions covered many topic areas related to access to services, including housing, health and care services, replacement care, and preventative support, which promotes health and well-being. The delays and waiting lists for services were evident in the discussions. Regular reviews of care and support packages were an issue, and being able to get help was reported to be a problem. The ability to challenge a service or make complaints was also raised because people lacked information and did not know where to go to get resolution. In social care situations, participants highlighted experiencing problems with constant staff changes and, in particular, the lack of consistency and continuity of care. Participants highlighted the frustration of the current system where an individual is assessed, and the case is then ‘closed on the system’. If subsequent changes are needed or a reassessment is required, a new referral must be made, which is then placed back on the waiting list where it could take many months to be addressed. At this point there is often a new worker allocated who is unaware of the background of the situation, leading to the repetition of individual stories. Verbatim comments from participants noted by Healthwatch in relation to housing included:
- “There are not enough places for people to live, there are people who need to move for their well-being but there is nowhere, Devon Home Choice doesn’t work for people”.
- “The lady is trying to care for her husband who keeps falling because they need ground floor accommodation but there isn’t any”.
Verbatim comments from participants noted by Healthwatch in relation to access to replacement care included:
- “Trying to get a week’s holiday as a carer when you know what week you want, we are told to contact 1 week before to see if they may or may not have a vacancy. As a carer being able to review a register of availability would be really helpful so we don't have to go around searching. This is very stressful as a carer.”
- “We can't access respite care locally- she's not getting away from us and we are not getting away from her. We paid privately, but places are closing, and it is more expensive, so she is not getting a break from us and doing what she wants to do.”
Financial
22% of comments referenced finances/budgets. Participants recognized the difficulty of the current economic climate and the financial requirements placed on Torbay Council. However, aligning to the strategy, they also raised the need to have preventative services in place, which can reduce longer-term costs caused by individuals going into crisis. Families want support for planning long term, yet some people felt like this isn't always happening. Verbatim comments from participants noted by Healthwatch included:
- “It’s frustrating that all the money goes into dealing with crisis, and we have nothing for preventative work, which would help cut costs in the long run”.
- “Stop cutting costs and services because we need help to stay well and independent”.
- “When Carers ask for a break, they need it – they can’t wait, but there are limited places, and you have to book, but you can’t book in advance – it's very stressful”.
- “My passions (frustrations) are that because of the lack of money, we put everything we have into crisis support rather than preventative. If we could aim it at preventative in the first place, there would be less crisis, and people’s lives would be so much better.”
The impact of finance was mentioned in relation to thresholds and the balance between being just over the financial threshold, then going below it, also being unable to get relevant support in time to prevent financial difficulties. Verbatim comments from participants noted by Healthwatch included:
- “Financial threshold- When you are getting near the allowance, (…) it starts to get financially difficult, and we get low on money - you think what the hell do we do? Backdating does not pay the bills.”
- “The financial side is important. If you’re working and you don't receive any carer’s allowance it is very hard.”
Other comments mentioned the additional pressure placed on family when an assessment is undertaken, but the actual support and care hours provided fall below what is required, and the family is required to fill the gaps.
Healthwatch Observations
The opportunity to be involved in this important work with Torbay Council has provided valuable insight about people’s experiences and knowledge. The flexibility in approach taken by Torbay Council has also enabled participants to engage in a meaningful way, ensuring that they have felt listened to. The Adult Social Care Strategy identifies the following key aims-
- Helping people to live well and independently
- Helping people to regain their independence
- Helping people with care and support needs to live independently, safely, and with choice and control
The Strategy, as presented, has been well received at all focus groups. On consideration of the implementation of The Strategy moving forward, the following suggestions have been drawn from the feedback recorded during the focus groups, which relate to the key aims of the Adult Social Care Strategy.
To help people live well and independently:
- Effective person-centered communication, which is essential for people to be able to access information in a way that they can understand when they need it.
- Information made available to people in a variety of accessible formats, including face-to-face and paper-based.
- Preventative services, which form an equally important part of service delivery.
- A wide range of suitable accommodation options are to be made available.
- Replacement care services that can be accessed in a timely and more responsive manner, including at short notice or as a planned break in advance.
To help people regain their independence:
- Access to services is timely and proactive.
- Financial support and assessments are up to date.
- A wide range of suitable accommodation and support needs are available.
- The voice of those providing care and support or additional support such as Interpreters should be accepted and valued.
To help people with care and support needs to live independently, safely, and with choice and control:
- Regular checks are undertaken about the quality of services used in providing care and support.
- Access to complaints and routes for feedback are easy to find and include all methods of communication.
- Services are developed to be responsive to the needs of the individual, providing preventative care and support as required.
- The needs of those providing care and support, advice, and information are recognized, valued, and promoted.
- Access to regular breaks and replacement care services are available to ensure health and well-being is maintained and to avoid crisis.
As a result of some of the issues raised at the focus groups in relation to people’s experiences of health and social care services, Healthwatch Torbay will consider looking further into these in the development of its workplan to ensure that the voices of local people are heard.
Statement from Torbay Council
“I would like to thank Healthwatch for their support during the Torbay Council’s consultation in relation to the Adult Social Care Strategy. Healthwatch was a great organization to work with and pulled the consultation events together in a very professional way, and they added an element of independence to the process, which the Council greatly appreciated. By working together in partnership, we were able to maximize the benefits of the client feedback we received for both health and social care. The work will be used to further develop the Council’s Adult Social Care strategy, ensuring it is reflective of what people think is important, in readiness to be approved by the Council in the Autumn.”
Catherine Williams, Strategic Lead for Adult Social Care Quality and Assurance
Recognition
Healthwatch in Devon, Plymouth, and Torbay express their gratitude to Cathy Williams from Torbay Council for asking Healthwatch to organize this consultation. They would also like to extend their heartfelt thanks to all the groups, Carers, and individuals receiving adult social care in Torbay. Their valuable participation and willingness to share thoughts, experiences, and feedback have been greatly appreciated.
