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A New Vision

for Wrexham’s

Community Meals Service

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ContentsChapter

Page1. Executive Summary

32. Introduction 73. Demography

94. Strategic Context 135. Scope & Method 196. The Nutritional Needs of Older People

217. Good Practice

258. What Services Have We Got? 279. How Much Do the Services Cost? 3310. What Services Do We Want? 3511. How Will We Achieve Our Objectives?

4112. Planning Intentions

4913. Conclusion 51

References55

Acknowledgements 57


Appendices59

Appx A: Service User focus group report Appx B: Community Food & Nutrition Skills course Appx C: Community meals service mapAppx D: MoW Service User ProfileAppx E: Lunch Club/Day Service CapacityAppx F: Home Care Service User needs analysis

Appx G: Community meals service guidelines

"Many local authorities have moved away from a regular

delivery of hot meals to isolated housebound people, to a

fortnightly delivery of frozen meals. Although this is very

efficient and gives the person choice, it reduces their

precious social, daily contact. Isolation can cause as much

harm as physical illness in older people."

Community Care, July 2nd 2004


This document is available on requestin Braille, large print and audio tape.

Please contact:

Paul Swann, Planning & Commissioning Officer01978 292874 [email protected]


A New Vision for Wrexham's Community Meals Service

1.0 Executive Summary

1.1 This strategy is the outcome of a 12 month period of review, research and consultation. It includes a set of twelve recommendations which map out a new vision for Wrexham's Community Meals Service.

1.2 The review team were asked to find ways of developing the meals service while achieving cost efficiencies. The public consultation process included two well attended meetings in Llay, a small Service User focus group, presentations to various fora, and Service User representation on the task and finish group.

1.3 The review team have also established a lunch club forum and obtained Older People's Strategy funding to produce a directory and start up pack to promote the development of new lunch clubs.

1.4 Having identified Meals on Wheels delivery by Home Care Workers as a potential area for cost efficiencies, the review team recommended some initial service reconfiguration in September 2004, including the expansion of the frozen meals service. This has resulted in significant savings and freed up care staff for more specialised tasks.

1.5 The strategy recommends further restructure of the service,

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including tender exercises to commission frozen and hot meals services. The contract specifications will safeguard Service User health and safety and minimise dependence on the Social Services Department by supporting Users to make private arrangements with providers whenever possible. 1.6 The new services should also be structured to maximise Service User reablement and minimise Home Care involvement in meals delivery. New guidelines have been developed to ensure that appropriate services are provided to meet assessed need.

1.7 Two key recommendations will support continuing development of the service. An on-going Community Meals Steering Group with Service User representation will oversee implementation of the action plan and monitor progress. A dedicated Community Meals Development Officer post, to be sourced from within existing capacity, will ensure that the wide range of potential developments that the review team have identified are actively progressed.

1.8 In summary, the new vision for Wrexham's Community Meals Service is:

To provide a range of options within an enabling and rehabilitative model of care to support vulnerable people to maintain their independence in the community and ensure that assessed needs for nutrition and social interaction are adequately met.


This will be achieved by a service that is tailored to personal choice and preferences as far as available resources allow, and which encourages independence by facilitating private arrangements between Service Users and Service Providers whenever possible.

The hot and frozen meals services will be provided by private contractors working to detailed service specifications and subject to regular contract compliance monitoring and review. Support will be provided to facilitate the development of a growing network of lunch clubs throughout the county borough.

The potential for further development of the Domestic and Social Support Service will be scoped, and a wide range of other potential developments will be taken forward by a new Community Meals Development Officer and a Community Meals Steering Group.


2.0 Introduction

2.1 This strategy for developing Wrexham's community meals service is the outcome of a 12 month period of review, research and consultation with key stakeholders.

2.2 The need for a review of the meals service was highlighted in the Best Value Review that took place during 2000/01. This noted that there are inherent problems with the meals service related to the cost and quality of existing provision.

2.3 The identified action points were to review the cost effectiveness of current provision and to consider externalisation of the service. A key point in the Best Value Action Plan was to develop the meals service to present a range of options for Service Users.


2.4 The meals service review set out to achieve the twin goals of improving service quality and maximising cost effectiveness. The recommendations that the strategy puts forward have emerged from a process in which careful balancing of cost and quality have remained at the forefront of the review team’s strategic thinking.

2.5 A number of other key principles have guided the development of this strategy. In particular, the new vision for Wrexham’s community meals service seeks to ensure that individual needs for a healthy, nutritious and appetising diet are met by a service that is tailored to personal preferences as far as available resources permit.

2.6 Another key principle is the recognition that a holistic community meals service must include a social element. The potential harm of social isolation for people who are unable to engage with their local community is now well recognised. The strategy aims to meet the needs of Service Users who wish to have social interaction as part of their meals service.

2.7 A further principle is that the community meals service should adopt a rehabilitative and enabling approach to provision in line with the modern person centred, outcome focussed model of care planning. This approach aims to support people to maintain their independence in the community and reduce their dependence on social services as far as possible. One way that the Social Service


Department (SSD) may achieve this is by facilitating private arrangements between Service Users and Service Providers when appropriate.

2.8 The review and consultation has resulted in a new vision for Wrexham’s community meals service that places Service User health, wellbeing and independence at the heart of the strategy. It aims to develop a range of options for delivering high quality, cost effective services that meet assessed needs in respect of nutrition, social interaction and maintaining independence. The strategy will ensure that the new community meals service is effectively commissioned and monitored, and puts structures in place to enable continuous on-going service review and development.

3.0 Demography: Older People in Wrexham

3.1 Wrexham county borough currently has a low proportion of older people (16% of population over 65) but this will increase dramatically over the next twenty years. By 2011, it is estimated that there will be a 15% increase in people aged between 80 and 84 and a 47% rise in those aged 85 and over (as compared with 2001). This will result in an increased demand for services, including meal support, from people over the age of 90 who are


likely to have both high levels of physical and mental frailty and are less likely to have relatives who are fit enough to care for them.

3.2 The tables below show the distribution of the 50+ population by age

and sex in 2003 and the projected increase in population of people over 65

by 2012 (Source: Office for National Statistics).

3.2.1 Mid Year Estimate of Population 2003Male(total)

Female(total) Total

Male % of population

Female % of population

50-54 4,394 4,496 8,890 3.4 3.5

55-59 4,569 4,355 8,924 3.5 3.3

60-64 3,437 3,467 6,904 2.6 2.7

65-69 2,812 2,962 5,774 2.2 2.3

70-74 2,310 2,717 5,027 1.8 2.1

75-79 1,747 2,519 4,266 1.3 1.9

80-84 1,150 2,122 3,272 0.9 1.6

85-89 484 1,096 1,580 0.4 0.8

90+ 190 659 849 0.1 0.5

All ages 63,523 66,224 129,747

3.2.2 Projected increase in population 2012 – Adults 65+

Age 2001 2012 estimate Population increase

65-79 15,166 17,502 2,336

80-84 2,939 3,150 211

85-89 1,669 1,919 250

90+ 831 1,092 261


3.3 With about 25% of people over the age of 85 suffering from dementia,

there is likely to be increasing demand for intensive services in this age

group.

3.4 On average, the income of pensioner households is much lower than

that of households containing adults of working age. The percentage of

over 60’s on Income Support is suggested as a proxy measure of the

affluence of an elderly population. The proportion of over 60’s on Income

Support in Wrexham is 17.62%, the highest in North Wales (Continuing

Care of Elderly People in Wales, District Audit 1997-98).

3.5 The 1991 census indicates high levels of self-reported long-term

illness, which limits activity in both men and women over retirement age.

In Wrexham 44.1% of males aged 65 plus and 39.8% of women aged 60

plus reported a long term illness, health problem or disability that limits

daily activity. These are the highest percentages in North Wales.

3.6 Accidental falls are among the most common cause of fatal and non-

fatal injury amongst older people and can have a major impact on their

lives. 30% of people over 65 years of age fall each year. The percentage

rises to 50% at 80 years.


4.0 Strategic Context

4.1 Development of a meals strategy was called for in Wrexham’s Best Value Review and is guided by a number of national and local strategies.


4.2.1 Best Value Review During 2000/01, Wrexham Social Services Department undertook a Best Value Review of services for older people. The key finding of the review was:

“…the need to support an increasing number of older peopleto live independently in their own homes. There needs to be amore proactive, preventative approach to providing serviceswhich are flexible and more responsive to change in individualneed.”

4.2.2 The vision that emerged from the Review was that in five years time:

Service Users and Carers will have more control over services and are actively engaged at all stages of the process of assessment through to service provision and review

Service Users and Carers will have better information to enable them to participate more fully

there will be a greater range and mix of services and service providers affording Service Users and Carers


greater choice

services will be of proven quality provided to exacting standards

services will be more efficient and provided within a framework of clearly set timeliness standards.

4.2.3 One of the key areas identified for action was the Meals on Wheels Service (MoW), with the Best Value Review noting that there are inherent problems with the meals service related to the cost and quality of existing provision. The actions identified were to:

review the cost effectiveness of current provision, and

consider externalisation of the service.

4.2.4 One of the key action points in the Best Value Action Plan was to develop the meals service to present a range of options for Service Users.

4.3.1 The Health, Social Care and Wellbeing Strategy (HSCWb) has developed from Welsh Assembly Government guidelines which stated that every local authority and local health board must jointly develop a three year strategy from April 2005 to March 2008. It considers Health and Social Care in its widest context, with a strong emphasis on improving the health of the


local population as well as how to care most effectively for those needing support.

4.3.2 The HSCWb strategy is currently in draft form but has been adopted by all partners. It outlines several themes including public health indicators, six service areas and broader issues. One of the service areas is older people and within this section, ten key areas for action are put forward, of which the following are of particular relevance to the community meals strategy:

ensure the home environment is suitable to enable people to remain in their own homes

develop support systems for people who have moderate and low levels of care needs in order to sustain their levels of independence and activity.

4.4.1 The Strategy for Older People was published by the Welsh Assembly Government in January 2003. It has five key themes:

reflecting the United Nations principles for Older People, to tackle discrimination against older people wherever it occurs, promote positive images of ageing and give older people a stronger voice in society

to promote and develop older people’s capacity to continue to work and learn for as long as they want and to


make an active contribution once they retire

to promote and improve the health and well-being of older people through integrated planning and service delivery frameworks and more responsive diagnostic and support services

to promote the provision of high quality services and support which enable older people to live as independently as possible in a suitable and safe environment and ensure services are organised around, and responsive to, their needs

to implement the Strategy for Older People in Wales with support funding to ensure that it is a catalyst for change and innovation across all sectors, improves services for older people and provides the basis for effective planning for an ageing population.

4.4.2 The Wrexham Development Plan for implementing the strategy highlights the fact that the MoW service is costly and varies in its provision across the county borough. The plan identifies as an action point to review the provision of the meals on wheels service, taking into account the ‘social’ side to any meals service.

4.5.1 The Health Promotion Action Plan for Older People in Wales was published by the Welsh Assembly Government in


August 2004 and brings together existing and proposed health promotion initiatives for older people. The action plan has a section on healthy eating with the following key points:

a healthy diet can contribute to reduced morbidity and mortality in older age

eating habits of older people are not homogenous and can be affected by gender, age, ethnicity, socio-economic status and geographical area

barriers to nutrition in older age include functional ability, socio- economic status, poor dentition and access to social support for help with shopping

poor nutritional status can add time and financial costs to illness or operation recovery period amongst older people

limited research suggests that health professionals may be effective in influencing dietary change, however…in the UK, healthy eating interventions that target older people need further evaluation.

4.5.2 Within the actions, the Welsh Assembly Government suggests that it will work with the Wales Local Government Association, Local Authorities and WRVS to investigate the extent of provision and content of MoW schemes in 2005-6.


4.6.1 Food and Well Being is a nutrition strategy for Wales produced by the Food Standards Agency and the Welsh Assembly Government. Within the strategy, a level one priority group was identified as low income and other vulnerable consumers. This group specifically includes vulnerable older people, many of whom suffer from limiting, long term illness and are on a low income.

4.6.2 The Food and Well Being Strategy recommends a wide range of actions, of which the following are particularly relevant to the development of the community meals strategy:

investigate the options for reaching priority groups through alternative settings

investigate extent of provision and content of meals on wheels

develop sustainable local initiatives to improve access to a healthy balanced diet, especially among the identified priority groups.

4.7.1 Local Nutrition Strategy. Under the Wrexham Local Health Alliance, a Nutrition & Dental Health Strategic Planning Group has been tasked with meeting the HSCWb strategic priority to develop and implement action plans to improve the nutritional and dental health of the Wrexham Community.


4.7.2 The Nutrition Group’s objectives include:

increase the uptake of a healthy balanced diet among the general population, especially among the priority groups identifies in the needs assessment [including older people and people with physical disabilities or sensory loss], with an emphasis on tackling food equality priorities.

4.7.3 To meet this objective the Nutrition Group have identified a number of key actions, including:

produce a nutrition policy for the borough, together with an action plan to address deficiencies and remove barriers to healthy eating

review the provision of the meals on wheels service in Wrexham and develop a range of high quality options and services to meet the assessed needs of Service Users in respect of nutrition, social interaction and maintaining independence.

5.0 Scope & Method

5.1 In March 2004 Adult Services Management Team (ASMT) established a Meals Service Review Team tasked with:

reviewing existing services


identifying gaps in provision

researching alternative models of meals provision

drafting a meals strategy.

5.2 Membership of the review team included Planning & Commissioning Officers, the Community Services Manager, a Home Care Manager, a Community Development Dietician, voluntary sector representatives and Service Users.

5.3 Initial research highlighted a number of key issues, one of which – the high cost of MoW delivery by Home Care staff – was prioritised for urgent action.

5.4 A public consultation was organised in July 2004. This produced a number of recommendations that were reported to Social Services Management Team (SSMT) and approved by Scrutiny Committee in September 2004. One of the recommendations was that the frozen meals service provided by Wiltshire Farm Foods should be extended throughout the county borough.

5.5 Another recommendation was that resources should be made available to facilitate the development of more lunch clubs. A consultation meeting for people involved with existing lunch clubs was organised in November 2004. This clearly identified the need


for better co-ordination and networking of lunch clubs. To support this, Older People's Strategy funding was obtained to enable publication of a lunch club directory and start up pack.

5.6 A further meals service public consultation was held in January 2005. The meeting reviewed and broadly agreed a set of proposed recommendations for strategic development of the community meals service. These were revised following further stakeholder consultation, including a Service User Focus Group (Appendix A) and form the basis of this strategy (see section 11).

6.0 The nutritional needs of older people


6.1 Many people remain fit and well as they get older and good nutrition is an important factor in helping to sustain their health and wellbeing. Maintaining a balanced and regular nutritional intake can help to prevent the occurrence of common health problems such as constipation, other digestive disorders, anaemia, and osteoporosis.

6.2 Older adults experience some physiological changes that are important to consider nutritionally. These include changes in body composition, metabolism and possible deterioration in taste and smell.

6.3 As people become older they are generally less active and as a result do not utilise as much energy. Food intake therefore needs modifying to ensure that calorific (energy) needs are reduced whilst the overall nutrient quality of the diet is not compromised, i.e. vitamins and minerals are still obtained in sufficient amounts.

6.4 Good nutrition is vital in supporting day to day functioning related to both general health and well being needs. Detailed guidance on what constitutes a balanced diet can be found at www.eatwell.gov.uk .


http://www.eatwell.gov.uk/

6.5 In 1991, the Department of Health produced a set of Dietary Reference Values providing quantified nutritional guidelines for energy and all key nutrients. These were later followed by a report entitled ‘The Nutrition of Elderly People’ (Department of Health, 1992). The data contained within this report are still used today since no new evidence has emerged to challenge it.

6.6 Regardless of the nature of the food service preferred or required by an

older adult, the following points all require consideration:

food acceptability and palatability is largely dependant upon individual tastes and preferences, and should therefore be considered individually wherever possible

stimulating continued interest in food and encouraging older adults to actively make their own food choices wherever possible can help to maintain enjoyment in eating

an older person’s physical ability to prepare and consume a meal can often create a barrier to achieving a healthy diet, e.g. reduced dexterity, inability to grip a knife and fork, swallowing difficulties. Where there are concerns of this nature referral to the appropriate medical services should be instigated to ensure nutritional intake is not compromised

some older adults will have specific dietary needs, e.g. those with diabetes, or those that are undernourished. Appropriate meal options should be available to meet these needs. If there is doubt regarding appropriate choices,


advisory support can be obtained from the Dietetic Department located within the Wrexham Maelor Hospital.

6.7 It is also important to consider what makes food appealing and

appetising to eat, e.g. varying use of colours, textures and flavours when

planning meals.

6.8 Hot Meals ServiceIt is suggested that a number of older people who come into hospitals from

their own homes are malnourished (Gentle, 2002). This is perhaps more of

a concern for people living alone. Eating regular nutritious meals is a vital

way to support sustained energy levels and meet overall nutrient needs. At

least one hot meal a day is essential in winter to help maintain body

temperature. For older people that are unable to prepare or cook meals,

either alone or with assistance, a hot meals service is an important way to

help them continue to have their nutritional needs met.

6.9 Home Care SupportOlder people should be encouraged to keep an interest in food and the

variety of choices available to them so that they continue to enjoy what

they eat. This is also true for those requiring assistance with shopping,

preparing and / or cooking meals. Home Care staff who wish to increase

their knowledge and awareness of good nutrition could access a

community food and nutrition skills course (see Appendix B).

6.10 Frozen MealsFrozen meals that are appropriately reheated can still provide a nutritious

option so long as they follow the balanced meal principles recommended

within the healthy eating guidelines. The presentation of frozen meals is

vitally important in ensuring that the food appears appetising. Whilst a


frozen meal delivery service still enables older people to enjoy eating

within their own home, for those living alone social interaction may be

lacking at meal times. It would be valuable to signpost Service Users to

local lunch clubs. Cost may also be an important factor, and consideration

must be given to whether older adults are able to afford frozen meal

services.

6.11 Lunch ClubsBringing people together to eat around a table rather than eating alone at

home can provide a simple yet effective way of improving an older

person’s nutritional intake. Research has shown that food served in

pleasant surroundings and given in the company of others helps stimulate

the appetite and increase enjoyment of the meal (Edwards & Hartwell,

2000). Lunch clubs provide an excellent opportunity to capitalise on the

beneficial effects that social interaction can have for older people and their

food intake. Where local clubs provide a meal for older adults it is

important that the balance, quality and variety of food provided is given due

consideration. For those directly involved in the planning and provision of

meals, a local course could be made available to provide information on

food and nutrition (see Appendix B).

6.12 Day Care/ Residential/ Sheltered Housing settingsIn the majority of these environments food is provided as a service for

older adults. The nutritional guidelines recommended by an expert working

group of The Caroline Walker Trust, ‘Eating Well for Older People’ should

be consulted to ensure that meals reach the expected standards (CWT,

1995). The document also provides examples of menus that meet the

necessary criteria.

6.13 For older adults attending day care it should be noted that in some


cases breakfast may have been missed in order to be ready for the

transport service. This may be an important consideration for those

attending day care several times a week.

7.0 Good Practice

7.1 Examples of recognisable good practice in community meals service delivery are difficult to find; a web search for 'Social Services Meals good practice' had a WCBC document at the top of the list.

7.2 Some local authorities have introduced innovative support schemes to minimise dependence, such as teleshopping, food co-operatives and nutrition courses, but no outstanding examples of well co-ordinated community meals services were found.

7.3 Other local authorities have adopted various models of meals service provision:

Cheshire County Council's Community Meals Service provide hot and frozen meals, both of which are provided by the same private contractor, Sodexho.

Liverpool City Council no longer provide hot meals and have contracted Wiltshire Farm Foods to provide a frozen meals service.


Knowsley Council also engage a private contractor to provide frozen meals, which are then regenerated and delivered by a team of drivers.

Conwy County Borough Council provide hot meals that are prepared by residential homes and delivered mainly by WRVS volunteers.

Staffordshire County Council operate a MoW service and contract with FlowFood Ltd to provide frozen meals.

Enfield Council provide both hot and frozen meals in partnership with private contractors.

Highland Council recently switched to a frozen meals only service provided by Apetito Ltd which is estimated to have made a cost saving in excess of £750,000 against the previous means of service delivery by care staff.

7.4 Whilst acknowledging the potential savings from adopting a frozen meals only service, the review team concluded that this option would place an unacceptable limitation on Service User choice.

7.5 The consultation process established a consensus in favour of a holistic model of community meals provision which balances choice and economy, with the core service providing a range of options including hot, frozen and Home Care Worker prepared


meals, together with increased lunch club opportunities.

7.6 A recent All Wales Unit survey of MoW services shows that several authorities are currently reviewing their services. Swansea have recently introduced a new service which has similarities to the recommendations outlined in section 11. It may be helpful to investigate Swansea’s experience with implementing their meals strategy.

8.0 What Services Have We Got?

8.1 Meals support is provided in a number of ways (Appendix C), including:

Meals on Wheels Home Care Support Frozen Meals Lunch Clubs Day Care/Residential/Sheltered Housing settings Supporting People.

8.2 Meals on Wheels

8.2.1 The MoW service provides hot meals to Service Users in their own homes. The meals are prepared by a range of providers, including Chirk, Maelor and Penley Hospitals, Springfields Sheltered Housing Scheme, Nant Syllin and Llys


Madoc residential homes, Plas Yn Rhos sheltered supported living scheme, Cunliffe Centre and Millfarm House.

8.2.2. Service Users are charged £2.90p per meal. Although this amount covers the cost of meal preparation, the cost of delivery by Home Care staff is met by the SSD budget. The current unit cost for Home Care services is £24.41p per hour.

8.2.3 Historically Home Care have played a central role in MoW delivery. The review highlighted the practise of Care Workers operating in pairs to facilitate speedy delivery of hot meals in rural areas. This activity, carried out during what is effectively "down time" for Home Care Workers in the middle of the day, was found to have significant budget implications.

8.2.4 In May 2004 a snapshot survey of the MoW service showed that 264 Service Users were receiving 1355 meals per week. 290 Care Worker hours were allocated to MoW delivery, with travel expense claims of 1753 miles per week.

8.2.5 The meals review team highlighted MoW delivery as an unsustainable cost in its report to Social Services Management Team (SSMT) and Scrutiny Committee in September 2004. To reduce this cost, Care Management were asked to consider signposting new referrals to the frozen meals service when appropriate. It was also agreed that all Service Users receiving meals support should receive a review of their needs.


8.2.6 March 2005 data shows that the number of Service Users receiving delivered MoW has dropped by 17.5% to 218. The number of Care Worker hours used in delivering MoW has dropped by 34% to 190. Mileage claims have dropped by 36% to 1116.

8.2.7 The survey showed that 218 Service Users were receiving 1097 meals per week. 79 Service Users (36%) were male and 139 (64%) were female. 142 Service Users (65%) received MoW on 5 or more days per week. 28 Service Users (13%) lived in sheltered housing. 28 Service Users (13%) also received day care, 92 received family support (42%) and 89 received additional Home Care support (41%). The survey estimated that 61 Service Users (28%) have potential for meals preparation reablement (Appendix D).

8.3 Home Care Support

8.3.1 The role of Home Care is to provide enabling and rehabilitative care to support vulnerable Service Users to maintain their independence in the community. In some cases Home Care Workers may support Service Users in meal preparation as part of the care plan.

8.3.2 Home Care are increasingly concentrating resources on supporting Service Users with more complex needs who need


assistance with meals. This may involve support with other meals in addition to the substantial daily meal.

8.4 Frozen Meals

8.4.1 Wiltshire Farm Foods (WFF), based in Shotton, Flintshire have provided a frozen meals service in the north of the county borough since 2001. When Service Users are signposted to WFF they become a private client of the company. Meals are chosen from a comprehensive menu and are delivered weekly.

8.4.2 In May 2004 WFF were providing about 750 frozen meals per week to 200 clients in the north of Wrexham county borough. Most clients were over 65, but were not considered to be high dependency.

8.4.3 A survey of 66 WFF clients in Wrexham showed that 96% considered the service to be either excellent or good.

8.4.4.Questionnaires returned by two neighbouring local authorities indicated a high level of satisfaction with WFF with regard to service quality and contract compliance.

8.4.5 Following the expansion of WFF’s service in September 2004, the company now provide 1150 frozen meals per week to 250+ clients.

8.5 Lunch Clubs


8.5.1 Lunch clubs provide a vital service for people who wish to have some of their meals in a social setting. The importance of this type of meal provision is highlighted in the quotation on page 1 of this strategy.

8.5.2 At present there are a small number of lunch clubs in Wrexham county borough. Although the research that has been carried out may not be exhaustive, the current directory lists details of 10 known lunch clubs. Most of these operate on one day per week. Meals are charged at between £2.00p to £3.50p. 8.6 Day Care/Residential/Sheltered Housing settings

8.6.1 Meals provision in day care settings links to residential homes, which are often the provider of meals to service users in receipt of day care. MoW have been an important source of income generation for residential/sheltered housing schemes, and also for Millfarm House supported employment scheme.

8.6.2 A forthcoming review of day care will consider ways in which service specifications can be developed to increase Service User choice through alternative forms of meal provision.

8.6.3 There is also potential for developing new meals services in residential homes and sheltered housing. For instance, a successful scheme developed by Llys-y-Graig sheltered housing scheme which engaged Service User involvement in provision of communal meals to residents and people from the local area may


be replicable elsewhere, although the scheme is not currently operating. Another possibility is for residential/sheltered housing schemes to provide meals for new lunch clubs.

8.6.4 Similarly, there may be potential for supported employment schemes such as Millfarm House to develop new projects, e.g. providing outreach support to facilitate lunch club development.

8.7 Supporting People

8.7.1 Supporting People provides vulnerable adults with housing related support services which fall outside the remit of personal care, such as shopping, light cleaning and befriending. Among the Supporting People schemes in Wrexham are a project for older people with mental health problems which provides 151 hours of support per week and a domestic and social support scheme which provides 140 hours per week. The latter restricts individuals to a maximum of 5 hours support per week, provided once or twice per week.

8.7.2 Currently there are up to 100 Service Users on a waiting list for domestic and social support. With additional funding there is clear potential for expansion of this scheme, which could support some people who do not receive home care to develop meal preparation skills.


9. How Much Does the Meals Service Cost?


9.1 Internal audit reports on the MoW service carried out in May 2001 and August 2002 have highlighted the difficulties involved in establishing the actual cost of providing meals. Both reports recommended that the accounting arrangements should be reviewed to enable all catering costs and income elements to be allocated direct to the service. This will provide the detailed financial information required for future budget setting.

9.2 In the meantime, available financial information will be presented in a separate options appraisal and business case. An

implementation plan will be developed once this has been agreed.


10.0 What Services Do We Want?

10.1 The new vision for Wrexham's community meals service began to take shape at the first public consultation in July 2004. The meeting was asked to envision an ideal service and produce some key ideas for development, giving due consideration to economic realities. These ideas included:

a dedicated post to co-ordinate, develop and support lunch clubs and meals service development, and to produce a meals service resource data base

a lunch club in every community, building on existing networks

tapping into available community resources, e.g. building a volunteers network, co-ordinating transport more effectively, effective asset management

linking more closely to day centres and respite services

adopting a social enterprise approach

utilising pubs in rural areas and linking to high school citizenship and mentoring schemes

clarifying a pathway for introduction to appropriate


services as Service Users' dependency needs progress from low-medium-high

the meals service to be developed as part of a holistic approach to meeting health and social care needs

a one stop shop to promote the availability of older peoples' services

a 3 - 5 year strategic plan for service development and accessing funding.

10.2 The review team's recommendation to reduce Home Care involvement in delivering Meals on Wheels has lowered service costs. Further savings may be possible through developing a more enabling and rehabilitative approach to meal support.

10.3 In February 2005 Home Care conducted a needs analysis to determine the proportion of Service Users who have the potential to regain lost meal preparation skills or to gain new skills (Appendix F). This indicated that only 15% of the sample group of 91 people have reablement potential. It is possible that a care management review of Service Users' meal support needs in line with new guidelines would identify a higher proportion with reablement potential.

10.4 Although some Service Users who lack reablement potential will continue to need to have hot meals delivered by Home Care staff, it may be possible to introduce alternative means of


delivery following the commissioning of a new hot meals service.

10.5 Alongside the reconfiguration of MoW delivery, a commitment was made to develop more lunch clubs throughout the county borough in order to increase opportunities for social interaction.

10.6 A series of meetings held with existing lunch clubs has shown that there is enthusiasm for developing a Lunch Clubs Forum to facilitate networking and information exchange, and to co-ordinate activities more effectively.

10.7 The review team secured Older Peoples' Strategy funding to produce a directory of existing lunch clubs and a start up pack to encourage and support new initiatives. Encouragingly, two new initiatives are in the early stages of development.

10.8 Continued reconfiguration of the MoW service and the development of more lunch clubs are central to the new vision for Wrexham's community meals service.

10.9 Although the recommendations made in this strategy are designed to maximise Service User independence and reduce the need for meal support where possible, demographic trends suggest there will be an increasing demand for intensive Home Care services for older people, particularly people with dementia who rely on regular support.


10.10 Because of this, where possible we will need to retain savings generated by cost efficiencies for re-investment in specialist services for older people with mental health problems. The potential role of assistive technology in the future development of services for this group needs to be explored.

10.11 The Older Peoples’ Commissioning Plan will propose day centre and Trio service developments and address the potential for innovation in meals support in these settings.

10.12 Forward Planning Rationale

10.12.1 Current service levels

March 2005 May 2004Service Users

Meals Service Users

Meals

Frozen Meals 250 1150 200 750Hot Meals 218 1097 264 1355

Total 468 2247 464 2105

10.12.2 The above figures establish that a total of approx. 2250 meals are

provided to about 470 Service Users per week.


10.12.3 It is anticipated that care management reviews of the 218 Service

Users who currently receive meals support will identify a minimum of 30%

with reablement potential who can be supported to become independent

clients of meal providers.

10.12.4 This would reduce the level of the hot meals service to about 150

Service Users receiving 775 meals per week, and increase the frozen

meals service to 318 Service Users receiving 1475 meals per week.

10.12.5 The population of older people in Wrexham is expected to rise by about 1500 people between now and 2012 (see section 3.2). This will include growing numbers of Service Users with mental health problems who will require intensive levels of support.

10.12.6 It is likely that the reduction in demand for a hot meals service by the promotion of rehabilitation and independence will be largely offset by the demographic trends.

10.12.7 It is therefore assumed that the current level of provision for hot

meals will be maintained over the next 3 – 5 years, while frozen meals will

increase to approx. 1500 per week.

10.13 A true ringfenced budget must be established to enable accurate

accounting of the restructured community meals service.


11.0 How Will We Achieve Our Objectives?

11.1 The process of review and consultation lead to agreement on a set of key recommendations for developing the community meals service.

11.2 Recommendation 1

A Community Meals Steering Group to be established to oversee implementation of the action plan and monitor progress. Consideration to be given to the eventual transfer of steering group responsibilities for monitoring and strategic development to the Older People’s Programme Group.

11.3 This first recommendation will ensure that implementation


of this strategy is taken forward in a proactive manner and that the community meals service is subject to on-going monitoring, review and development within the strategic context of the HSCWb planning structure.


Commissioning, Contracts and Procurement Teams to liase in drafting service specifications, testing the market and conducting tender exercises to commission (1) a frozen meals service and (2) a new hot meals service to replace Meals on Wheels.

11.5 In order to secure high quality, best value services the Council have adopted a commissioning approach to procurement in place of grant aid. In response to this development, recommendation 2 proposes that both the hot and frozen meals services should be externalised through formal tender processes.


People who have the capacity to manage their finances themselves or with the support of a Carer or nominated appointee will be enabled to access a hot or frozen meals service. Appropriate support will be provided to people who are assessed as being in need of assistance with meals.


11.7 This recommendation supports a shift towards lessening Service User dependence on the Social Service Department. Whenever possible, Service Users will be encouraged to access services independently and manage their own private arrangements with providers, including payment.


Hot and frozen meals service specifications to include a clear requirement and protocols for providers to inform a single point of contact in Care Management about changes in Service Users’ health and wellbeing.


Protocols for Social Services quality assurance, performance monitoring, data collection and audit trail measures to be included in the hot and frozen meals service specifications.

11.10 Recommendations 4 and 5 highlight key elements to be built into the service specifications for the hot and frozen meals services. Recommendation 4 requires a robust reporting system to be put in place to ensure that Social Services are notified of changes in Service Users' circumstances at an early stage. Recommendation 5 highlights the need for adequate monitoring systems to provide data that enables on-going evaluation of the


service and informs future commissioning plans.


Community Services Manager to continue to facilitate the Lunch Clubs Forum in the short term to enable the network to consolidate and to begin to address the range of identified issues.


Consideration to be given to establishing the equivalent of a Community Meals Development Officer post within current resources, as part of a review of existing capacity.

11.13 Recommendations 6 and 7 respond to the identified need for a dedicated post to drive forward the Community Meals Strategy and co-ordinate services. Currently the Community Services Manager has delegated responsibility for developing the Lunch Club Forum. This has resulted in the production of a directory and start up pack, and organisation of a series of meetings to consolidate the network.

11.14 The range of issues to be addressed by a lunch club network includes:

training and recruitment of volunteers


motivating continued commitment

exchanging information and skills sharing

identifying suitable venues

transport provision

information on sources of funding and training in fund raising

ensuring quality meals provision

health & safety and other legal issues

11.15 In the longer term there is a need for a Community Meals Service Development Officer to work on a wide range of potential developments, including:

facilitating on-going development of the lunch clubs network

targeting up to 3 areas in which to work alongside community development officers to establish new lunch clubs

maintenance of the lunch club start up pack and directory support for increased utilisation of volunteers by lunch

clubs seeking funding for nutrition courses for lunch club

volunteers liaison with secondary schools and public houses in lunch

club development motivate and support communities to set up social


enterprises specialising in meal provision research the potential of assistive technology development of innovative forms of meals provision in day

care, residential / sheltered housing settings, and by work opportunities

scoping the potential for introducing a smart card system for meals payments

data collection to enable on-going strategic development scoping the potential for other developments, e.g. a

teleshopping scheme, food co-operative. 11.16 Recommendation 8

Community Services Manager to audit current lunch clubs transport arrangements and liaise with Transport Coordination section and HSCWb Strategy Officer to ensure that available resources are used effectively to meet lunch clubs’ needs.

11.17 This recommendation highlights the need for efficient transport services to enable effective development of the lunch clubs network. At present the inadequacy of transport provision is regarded as a major obstacle to expanding lunch club opportunities. The Community Services Manager's input into current transport planning initiatives is intended to ensure that the issues identified by lunch clubs are adequately addressed.



Needs mapping to be carried out to determine the level of unmet need in the Domestic and Social Support Service prior to consultation on development of the Supporting People Operational Plan for 2006/07. Potential for further development of enabling Supporting People services to be scoped, e.g. meal preparation/shopping/kitchen cleaning with Service User engagement.

11.19 The Domestic and Social Support Service has a growing waiting list, including Service Users who would benefit from support with meal preparation which falls outside the remit of Home Care. This recommendation highlights the potential for development of this service with additional funding.


Implementation of the recommendations made in the internal Meals on Wheels audit reports of 2001/02, and of any additional recommendations that emerge from the current audit. As a short term outcome and to provide accurate costs of current service provision, the accounting arrangements to be re-structured to enable allocation of all income and cost elements directly to the meals service.

11.21 Implementation of this recommendation will enable more


detailed financial information to be produced, e.g. calculation of an accurate unit cost to enable accurate budget setting.


Community Meals Service Steering Group to agree guidelines on which form(s) of meals Service Users should receive, balancing social interaction, re-ablement and nutritional needs, and encouraging provision of tailored services to meet individual needs wherever possible. Guidelines to be circulated and explained to care managers and other stakeholders.

11.23 The review team have produced a set of meals service guidelines (G) linked to the Council's eligibility criteria which require further consultation and clarification. Once agreed, the necessary steps must be taken to ensure that the guidelines are properly understood and applied.


All Service Users accessing Home Care meals support to be given a care management review by March 2006 to re-assess need for meals provision and/or support. Outcomes to be identified in service delivery plans to be agreed with Service Users and Carers, and to be subject to regular review.


11.25 This Recommendation is designed to ensure that appropriate enabling/rehabilitative services are provided to all Service Users who have the capacity to either prepare their own meals or be involved in meal preparation with appropriate support.

11.26 An action plan for implementation of the above recommendations is attached (H).


12.0 Planning Intentions

12.1 In 2005-06 we will:

establish a Community Meals Steering Group

complete tender processes to contract out approx. 1500 frozen

meals and 1000 hot meals per week

provide Care Manager support to enable Service Users to

manage their own meal arrangements wherever possible

establish appropriate protocols and a single point of contact in

Care Management for notification of changes in Service Users

health and well being


put protocols in place to enable accurate collection of meal

service activity data

continue to develop the Lunch Club Forum, including support for

a new lunch club in each of two prioritised areas

establish a Community Meals Development Officer post from

within existing resources

develop a strategy for lunch club transport within wider

community transport strategy development

scope the potential for developing the Domestic and Social

Support Service within the Supporting People Operational Plan

for 2006-07

implement the recommendations made in the internal Meals on

Wheels audit reports of 2001-02

agree, circulate and implement Community Meals Service

Guidelines

conduct care management reviews and develop outcome

focussed Service Delivery Plans for all Service Users who

receive meals support

develop a plan for reinvestment of cost savings in continued

Community Meals Service development


13.0 Conclusion

13.1 In developing the community meals strategy the review team have engaged in a full consultation process with key stakeholders over a period of 9 months. Throughout this process the review team have striven to meet the challenge of achieving substantial cost efficiencies while simultaneously finding ways to develop a new community meals service.

13.2 The review team believe that the core recommendations set out in this strategy lay the foundation for on-going development of a high quality, cost efficient community meals service that meets the needs of Wrexham's vulnerable older residents.

13.3 In particular, the setting up of a Community Meals Steering


Group will ensure that the recommendations are implemented within agreed timescales, that the service is subject to on-going monitoring and evaluation, and that further strategic developments can be discussed within an appropriate forum. It is suggested that the Older People's Programme Group within the HSCWb planning structure would be the natural home for the steering group in the longer term.

13.4 The main cost efficiencies will be achieved by clarifying the purchaser-provider split and externalising services through formal contract tender exercises. In house involvement in the production and delivery of meals has substantial budget implications which are unsustainable.

13.5 The success of the frozen meals service in the north of the county borough and it's subsequent introduction in other areas offers greater choice and flexibility to some Service Users. A competitive contract tender exercise will ensure that WCBC obtains best value for this element of the community meals service.

13.6 A similar exercise to commission a new hot meal service to replace MoW will result in further cost efficiencies as well as increased Service User choice.

13.7 While it is recognised that some Service Users will continue to need Home Care support with their hot or frozen meals, a more enabling approach to care management through outcome


focussed Service User Plans is likely to result in a more targeted use of Care Worker time and a significantly reduced demand for support.

13.8 In some cases it is entirely appropriate for Service Users to have support with preparing a hot, frozen or freshly prepared meal, according to their level of ability. In these cases it may also be appropriate for Home Care Workers to deliver a hot meal.

13.9 However, it is anticipated that the meals service guidelines and the service reconfiguration outlined in this strategy will significantly reduce the involvement of Home Care in meals delivery, freeing up staff for more specialised care work and reducing the financial burden on the SSD budget.

13.10 One of the many avenues for development that a dedicated Community Meals Service Development Officer might pursue is the involvement of volunteers in meal support, particularly in rural areas. Although the logistics of organising volunteers to deliver meals on a large scale make this approach probably unworkable, a more realistic approach may be to target local volunteer resources on assisting Service Users with re-heating frozen meals.

13.11 The review team consider the social element of the community meals service to be key to its overall success. While some Service Users choose not to attend a lunch club, many do value having opportunities for social engagement linked to their


meals. Lunch club development will be a key task for the Community Meals Development Officer.

13.12 Ideally every community in the county borough would have a lunch club. The continued development of a Lunch Club Forum will support this aim.

13.13 The Forum has identified as a high priority the need for improvements to the community transport infrastructure to meet lunch clubs' needs more effectively.

13.14 It is anticipated that the production of a directory and start up pack will strengthen lunch clubs' presence in the community and encourage new initiatives.

13.15 There is also scope for new meals provision initiatives in day care, residential and sheltered housing settings. Work opportunity and social enterprise schemes could be developed within the new commissioning framework.

13.16 A wide range of other potential developments could be explored, such as teleshopping, food co-operatives and collaboration with secondary schools and pubs in providing meals for vulnerable local residents. 13.17 The key to ensuring the success of the community meals service is to continue developing this strategy from a holistic perspective, linking meals provision to the wider issues addressed within the Health, Social Care and Wellbeing Strategy.


References

Best Value Review


Adult Services Best Value Review 2000/2001 – Final Report. Report given

to Social Affairs, Health and Housing Scrutiny Panel on 8th February 2001

by Chief Social Services Officer, Wrexham County Borough Council.

Health, Social Care and Wellbeing Strategy‘Caring for our Health’ - The Health, Social Care and Well-being Strategy

for Wrexham 2005-8. Wrexham Local Health Board and Wrexham County

Borough Council. April 2005.

Strategy for Older PeopleThe Strategy for Older People in Wales. Welsh Assembly Government,

January 2003.

The Health Promotion Action Plan for Older People in WalesThe Health Promotion Action Plan for Older People in Wales: A response

to Health Challenge Wales. Welsh Assembly Government, August 2004.

Food and Well BeingFood and Well Being: Reducing Inequalities through a Nutrition Strategy

for Wales. Food Standards Agency and Welsh Assembly Government.

February 2003.

Local Nutrition Strategy Nutrition and Dental Health Strategic Planning Group Draft Action Plan

April 2005 – March 2008.

The Nutrition of Elderly People. Report of the Working Group on the

Nutrition of Elderly People of the Committee on Medical Aspects of Food

Policy. Department of Health (1992), London: HMSO.


Eating well - tips for older people at home. Gentle, J. (2002), Working

with older people, 6 (1), 17-18.

Practical and nutritional guidelines for food in residential and nursing homes and for community meals. The Caroline Walker Trust (1995).

Report of and Expert Working Group. London : CWT. (www.cwt.org.uk)

Acknowledgements

The author wishes to acknowledge the invaluable contributions that


http://www.cwt.org.uk/

many people have made to the development of this strategy. This

includes participants in the two public consultation meetings at Llay

Church of the Nazarene in July 2004 and January 2005; participants

in the Lunch Club consultation meeting at Brynteg Memorial Centre

in November 2004; participants in the Service User focus group at

Caia Family Centre in March 2005; Pat Williams, Jill Game, Tony

Bate and members of the Meals Service Review Team, including

Sarah Shannon, Nigel Williams, Pam Blackwell, Andrea Basu and

Bill Cawley.

Paul SwannPlanning & Commissioning OfficerMarch 31st 2005


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