Cabinet Report - LD Service Learning Disab Servs Jt Comm · 2007. 2. 21. · 1.3 The main features of the proposed new services are: • Jointly commissioned health and social care

Agenda Item: 7c Wolverhampton City Council OPEN EXECUTIVE

DECISION ITEM (AMBER) Committee / Panel CABINET Date 21/02/2007 Portfolio ADULTS Originating Service Group(s) ADULTS AND COMMUNITY

Contact Officer(s)/ VIV GRIFFIN Telephone Number(s) (55)5370 Title LEARNING DISABILITY SERVICES JOINT COMMISSIONING STRATEGY 2005/08 IMPLEMENTATION PLAN

1. Recommendations: 1.1 That Members endorse the attached Implementation Plan attached as Appendix A. 1.2 That progress on the Implementation Plan and these key service changes are

performance managed by the Joint Governance Group on a half yearly basis with an annual summary report to the Cabinet.

2.0 Executive Summary 2.1 Cabinet approved the ‘Joint Commissioning Strategy for Learning Disability Services’ at

its meeting held on 28th February 2006. This strategy outlined the proposals for the development of Learning Disability services over the next three years. The three key areas within the Strategy are, the development of an assessment and treatment service which includes both an inpatient and community based service, the creation of a new model for day services, and the development of local services to prevent unnecessary out of city placements. The strategy supports the key outcomes contained in the ‘Every Adult Matters’ strategy and is Wolverhampton’s response to the government White Paper ‘Valuing People: A New Strategy for Learning Disability for the 21st Century’.

2.2 During 2006/7 a detailed Implementation Plan has been developed with clear outcome

measures. It identifies the need to transform local services in order to ensure that people with a learning disability and their family carers can access the most appropriate services.

3.0 Purpose of the Report 3.1 This report seeks to gain approval for the Implementation Plan and set the framework for

performance monitoring and financially controlling the project as the strategy is implemented over the next three years. A small project team has been established to develop the detailed implementation plan. This team will continue from herein to fully implement the strategy. The project team is lead by Zaidie Orr Joint Head of Service, Learning Disabilities and will be managed within the framework of project management principles recently adopted by the Council.

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3.2 The Implementation Plan takes full account of the outcome of the public consultation

exercise on the Strategy held between September and December 2005. It seeks to:

• Further outline the service models developed • Detail the infrastructure and resources required to support the service

models • Demonstrate the financial plan required to support the service changes • Develop a detailed project management plan to timetable and identify project

leads for each of the key actions required to deliver the plan • Outline ongoing involvement of all stakeholders through out the process

3.3 The Implementation Plan contains the following sections:

• Section 1: The Service Models • Section 2: Implementing the new service models • Section 3: Day Services Project Plan • Section 4: Assessment and Treatment Project Plan • Section 5: Out of City Project Plan • Section 6: Financial Plan • Section 7: Asset management

4. Equal Opportunities Implications 4.1 The aim of this Implementation Plan is to ensure that people with learning disabilities are

treated as equal citizens and that they are given as much choice and control over their lives as possible. This Plan will greatly increase the opportunities of people with learning disabilities to participate fully in the lives of their local communities. A full equalities impact assessment has been carried out.

5. Financial Implications 5.1 The implementation of this strategy is based on the premise that the service

improvements will be achieved within existing budgets or through specific grants such as the Learning Disability Development Fund.

5.2 National demographics predict that there will be growth within the learning disability

population of 1% per annum of people with a severe learning disability. This growth will need to be taken into consideration in future budget setting plans.

5.2 Section 6 of the Implementation Plan sets out the outline financial plan for the revised

service models. The financial plan will be continuously updated throughout the project planning and implementation process to ensure that it continues to meet the requirements of the Medium Term Financial Plan.

6. Industrial Relations Implications 6.1 This report has significant industrial relations implications. The aim is to develop a

workforce that is highly skilled, trained and well motivated to meet the changing needs of people with a learning disability. Consequently, all staff will be fully informed and consulted on changes to service models and ways of working. This process will be undertaken in accordance with agreed Council and PCT procedures for the management of change and within the Partnership Agreement (Section 31 Health Act 1994). The process will also include on-going discussions with unions.

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6.2 Some new or extended roles will be developed to deliver these new services. Some job

descriptions and the grading of these posts remain assumptions prior to their evaluation. All re-structuring will take full cognizance of Single Status requirements.

6.3 No staff will be asked to take on different responsibilities without the appropriate training,

support and supervision. A joint training plan will be developed across health and social care.

7.0 Environmental Implications 7.1 There are no direct environmental implications. 8.0 Communications Implications 8.1 Continuous communication with all key stakeholders will be essential throughout the

implementation of the strategy. During the last year monthly carers meetings have been organised so that carers can discuss their individual concerns, workshops have been organised so that carers can share their views about the new service models and information has been presented at the Learning Disability Partnership Board. The new day service models have been discussed with people with a learning disability and their family carers as part of the re-assessments that have been completed. To date 177 reassessments have been completed with people with a learning disability and their family carers. This process will continue until all people with a learning disability accessing day services and their family carers have received a re-assessment.

8.2 The Learning Disability Partnership Board and its newsletter will be used as the primary

method of communication with people with a learning disability and their carers. In addition people with a learning disability and carers will be members of the steering groups supporting the implementation process.

8.3 Communication with other key groups such as staff, the private, independent and

voluntary sector, other council and PCT departments and The Valuing People Support Team will be undertaken through existing forums.

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Learning Disability Joint Commissioning Strategy

Implementation Plan

1.0 Introduction 1.1 The Learning Disability Joint Commissioning Strategy agreed by Cabinet in

February 2006 envisages that everyone with a learning disability will have an individualised health and social care plan, based upon a person centred approach and an assessment of all their needs, embracing health, personal and social care, education, employment and leisure.

1.2 Wherever possible, those needs will be met either through mainstream

community services or through fully integrated health and social care services. The expansion of Direct Payments will be encouraged and facilitated to maximise the independence, choice and control that people with a learning disability have over their own lives.

1.3 The main features of the proposed new services are:

• Jointly commissioned health and social care services, using a pooled budget, under the Partnership Agreement Section 31 (Health Act 1999) between Wolverhampton City Council and Wolverhampton City Primary Care Trust

• Fully integrated Learning Disability Teams (Adults) under single line

management, servicing each locality

• A specialist Assessment and Treatment Service for those people with complex needs, comprising of a 5 bedded unit and an Assertive Outreach Team

• A revised transport and catering service to support the revised

service requirements

• A short-breaks and emergency response service to enhance support to carers

• A revised Housing and Supporting People Strategy to increase

supported living opportunities, reducing the number of people in residential care, with focus on individuals in out-of-city placements

• A Workforce Strategy to develop and support staff in delivering the

new range of services • A revised model of service delivery for day services

APPENDIX A

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2.0 Implementing the New Service Models 2.1 The Implementation plan is designed to deliver the improved services

over a three year period and will be governed by the following principles:

• Before any service change is implemented the needs of service users and their carers will have been assessed to ensure that any new service is customised to their individual needs

• All service changes will be openly discussed with the individual

and carers, well in advance of any changes being implemented • Services will be adapted to meet the changing needs of both

service users and their carers

• The safety of service users will remain a paramount consideration in any new form of service provision

• No service user, currently placed out of city, will be forced to

return to Wolverhampton against their will

• The formulation of plans will be continuously informed by feedback from service users and carers, throughout the Implementation Programme

• Every service change will be subject to review and will be

measured by the beneficial outcomes it has achieved for service users and/ or their carers

2.2 Within the main body of the strategy there are a number of initiatives

previously agreed by Cabinet which will promote the independence well-being and choice of adults with a learning disability. These initiatives are included in the Implementation Plan and the commissioning activity is:

• Review NHS funded residential placements and re Commission

services as required • Evaluate the needs of older family carers and commission

independent housing advice, guidance and information service

• GP’s to include monitoring and evaluation of Health Action Plans as part of their involvement in the Locally Enhanced Service

• Secure funds and recruit into the Health Facilitator post

• Develop existing Advocacy services

• Fully understand the needs of the Learning Disability population

within the city

• Increase the take up of Direct Payments

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2.3 Progress has been made against a number of these initiatives to support the development of the Joint Commissioning Strategy, this progress includes:

• An agreed programme for reviewing and re-commissioning NHS

funded residential placements, for delivery over the next two years • All family carers of people in day services have been assessed or

reassessed and a data base of older family carers has been created, this involved 408 assessments/re-assessments

• A revised specification for the locally enhanced service has been

agreed which includes the need to supply monitoring and evaluation information to the PCT

• Advocacy services have been reviewed, a new service specification

has been agreed which includes a ‘drop in’ service, and a new contract is in place

• The need to increased advocacy in day services has been

identified, and a new service being designed

• The take up of direct payments has increased by 50% 2.4 Further targets have been set for the delivery of key areas within the

strategy by April 2008 and these are outlined below:

• All people living in NHS funded accommodation within the city will have been reviewed by December 2007

• Needs analysis of the older family carers data base will be complete

and presented to the Learning Disability Partnership Board in September 2007

• The Health Facilitator post will be recruited into and will be linked to

the Enhanced GP service. A target of 120 action plans directly supported by the health facilitator has been set and a further 100 completed by GP’s and signed off by the health facilitator.

• Advocacy to be available to a further 60 people in 2007/8

• Direct payments to be increased by 25% in 2007/8

3.0 Day Service Project Plan 3.1 Analysis of need 3.1.1 The majority of day services are provided to adults with a learning disability

via three large day centres. The centres were originally staffed to support 378 people. There are currently 283 people attending one of the three centres on either full or part time basis using 259 full time equivalent

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places. Of these people 178 live at home with family carers, 69 live in residential accommodation and 36 live in their own tenancies with support.

3.1.2 When day centres were originally opened, they were the only service

available to support families and enable people to remain at home. The provision of short breaks and a range of housing choices were not available for people with a learning disability and their families. This is no longer the case, and the significant reduction in the number of families using day centres is evidence of this.

3.1.3 The majority of people attending the day centres (55%) are between the

ages of 30-49, and none of the young people coming into adult services in transition this year are accessing day centres.

3.1.4 A comprehensive programme of re-assessments has been undertaken of

all people who attend the centres, and their family carers. In completing the re-assessments it has emerged that many people accessing the current day centres do not know about advocacy services, how to access them or how the services could support them. It will be necessary to increase advocacy services to support people through the modernisation of day centres.

3.1.5 The key outcomes that emerged from the completion of the carers

assessments are:

• 90% of carers could arrange to be at home if the person they care for became ill while in services, and needed to come home

• 82% of carers say the day centres offers them respite and an

opportunity to complete normal daily tasks

• 75% of carers are happy with services only being available during the day

• 45% of carers have few or no concerns about payment for

community activities • 78% of carers are very concerned about future transport

arrangements 3.2 Agreed Service model 3.2.1 The service model agreed in February 2006 as part of the Joint

Commissioning Strategy is based on a service design that includes the development of new services within each of the localities within the city. All people accessing services and their family carers have been offered a reassessment of their needs and an opportunity to comment on the current and agreed new services. The outcomes of these reassessments are summarised in Appendix 1 and have driven the further development of the new service model in the following key ways:

• The Specialist Support Service will provide a base for people with

high support needs, including those people who may need to have

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personal care needs met before and after community-based activities, in response to concerns and issues raised by carers

• The Community Access and Leisure Service will include a ‘drop-in’

base for those people who choose not to access other service models and who cannot return home during the day, in response to concerns and issues raised by carers and in response to service user wishes

• The Specialist Support Service will provide services to people with

complex needs and will include the Older Person’s Service in response to issues raised in Staff Workshops and the Older Person’s Service Working Group.

• Employment and work-related services are acknowledged as a

specialist area and are therefore provided as a separate model in response to issues raised in the Employment Workshop and service user wishes expressed through the reassessment process

• The service models take account of the anticipated needs of young

people likely to enter the service, in response to information obtained through the service user audit process, meetings with transition workers and schools staff

• Demand for the different service model types and subsequent

staffing requirements have been revised in response to the outcome from reassessments

• The staffing structure of the new services has been revised to

provide a more ‘specialism-based’ approach. This has resulted in a flatter structure with service leads reporting directly to the locality management structure. This has been discussed with current managers, day service staff and carers via the Carer Workshops and feedback has been very positive

3.3 Details of new Service Models:

Specialist Support Service This service is aimed at meeting the needs of those people who need specialist assessment, intervention, environment and/or equipment on either a long-term or a sessional basis. It will provide a place for people to access these services, which will include the provision of activities aimed at achieving therapeutic or health-related outcomes for people. The service will work closely with health professionals such as physiotherapists, occupational therapists, speech and language therapists and psychologists. A Specialist Support Service of this type will be provided in the North and South East localities. In the South West locality the Specialist Support Service will be in the form of a specific Older Person’s Service. The Older Person’s Service is aimed at meeting the needs of people with age-related conditions who require low-stimulation or gentle activities specifically aimed at maintaining skills, preventing deterioration and keeping physically and mentally well. It will

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include a luncheon and social club in line with the expressed wishes of service users. The Older Person’s Service will also provide an ‘outreach’ service and/or specialist advice to the other two localities through their Specialist Support Service models. The Specialist Support Service will provide a high staffing ratio of approximately 1 staff to 3 service users to enable people to be supported to access the other service models such as Community Access and Leisure Services and Skills Development Services. The Older Persons Service will provide a staffing ratio of approximately 1:6. Staff support in both services will be provided by Day Support Workers and Assistant Day Support Workers reporting to a local Specialist Support Service Co-ordinator and a local Older Persons Service Co-ordinator.

Skills Development Service

This service is aimed at meeting the needs of those people who want to learn and who cannot, or choose not to access mainstream learning opportunities such as college or adult education. It will provide a place for people to receive structured learning and skills development on a short-term or long-term basis and will also provide a small element of outreach to teach skills which must be learned in the person’s home environment. The service may also provide specific training for family and unpaid carers in response to identified needs and wishes. The service will provide a staffing ratio of approximately 1:4. Staff support will be provided by Day Support Workers and Assistant Day Support Workers reporting to a local Skills Development Service Co-ordinator.

Community Access and Leisure Service

This service is aimed at meeting the needs of those people who need support to access community-based activities and services and/or who want leisure-based activities organised and provided for them. The service will also provide a safe environment where people using other service models can go if they have a problem during service hours, but cannot return home. A signposting and information service will also be provided to service users and carers, together with a small element of outreach where people are enabled to access community services directly from home. The service will provide a staffing ratio of approximately 1:4 for community-access activities and 1:8 for leisure-based activities. Staff support will be provided by Day Support Workers and Assistant Day Support Workers reporting to a local Community Access and Leisure Service Co-ordinator.

Employment Services

This service is aimed at meeting the needs of people who want to work, either in an ordinary working environment, voluntarily or earning a comparative wage, or in a therapeutic work-like environment that meets work-related outcomes, including ‘wage-like’ earnings. The service will provide support to access ordinary employment, including voluntary work, through an Employment Team. The service will also provide Therapeutic

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Work Services through a horticulture-based project and a café-based project, providing a range of work-like opportunities for those people who cannot, or choose not to work in an ordinary working environment. The Employment Team will work on a caseload basis of 1 worker to 12 ‘active service users’ and the Therapeutic Work Services will provide a staffing ratio of approximately 1:9. Staff support will be provided by Day Support Workers and Assistant Day Support Workers reporting to a local Employment Co-ordinator.

3.4 Management of the new service models

A staff structure chart for the new services is attached as Appendix 2.

The Service Lead will have overall responsibility for the management and development of their service and will operate across the city, managing the function in all three localities. There will be 4.0 whole time equivalent Service Leads, one for each of the specialisms, i.e. Specialist Support Service, Community Access and Leisure Service, Skills Development Service and Employment. The Local Co-ordinator will have responsibility for the day-to-day co-ordination of people and activities in their particular locality. There will be 12.0 whole time equivalent Local Co-ordinators, one for each specialism in each locality, including Employment and Work-related services and they will have supervisory responsibility for both Day Service Workers and Assistant Day Service Workers. Day Service Workers will plan, lead and deliver and monitor activities in accordance with the service model and service users’ individual Leisure, Employment and Education Services plans. There will be 27.0 whole time equivalent Day Service Workers allocated according to the skill mix requirements of the particular specialism. Assistant Day Service Workers (ADSW) will provide the direct support, observation and supervision necessary to assist service users to participate in activities in accordance with their individual plans. There will be 37.0 whole time equivalent Assistant Day Service Workers allocated according to the skills mix requirements of the particular specialism.

3.5 Reassessments of Need

The following service model summaries are based on information obtained from service user and carer reassessment of need. A summary of the outcome of these reassessments is shown in Appendix 1.

3.6 Summary of Service Models

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Service Model How many people will use service?

Staffing Requirements (Whole time equivalents)

Location and times of Service

North

Up to 36 per day

Lead 0.33 Co-ord 1.0 Dsw 3.0 Adsw 7.0

Oxley D.C. Mon-Fri 9am to 4pm

South East

Up to 24 per day


Stowheath D.C. Mon-Fri 9am to 4pm

Specialist Support Service

South West (OPS)

Up to 24 per day


Albert Road D.C. Mon-Fri 10.30am to 3pm

North

Up to 24 per day


Oxley D.C. Mon-Fri 9am to 4pm with some evenings

South East

Up to 24 per day


Stowheath D.C. Mon-Fri 9am to 4pm with some evenings

Skills Dev. Service

South West

Up to 24 per day


Albert Road D.C. Mon-Fri 9am to 4pm with some evenings

North

Up to 30 per day


Oxley D.C. Mon-Fri 9am to 4pm with some evenings & w/e

South East

Up to 30 per day


Stowheath D.C. Mon-Fri 9am to 4pm with some evenings & w/e

Comm. Access and Leisure Service

South West

Up to 30 per day


Albert Road D.C. Mon-Fri 9am to 4pm with some evenings & w/e

Employment Team

Up to 12 per day


Central base to be decided. Mon-Fri 9am to 4pm with flex.

Horticulture Project

Up to 18 per day


To be decided 7 days week? 8am to 8pm?

Empl. Service

Café Project

Up to 18 per day


To be decided Mon-Sat? 8am to 6pm?

Total 294 Lead = SSS/SDS/CALS/Employment Lead Co-ord = SSS/SDS/CALS/Employment Locality Co-ordinator DSW = Day Support Worker

KEY

ADSW = Assistant Day Support Worker 3.7 The Commissioning priorities in 2007/8 are to:

• Pilot each of the new service models within the day centres

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• Re-commission the older peoples service into the new service model

• Evaluate educational services

• Review service models for transport

The Implementation Plan will be completed in 2008/09 and the newly developed services evaluated.

4.0 Assessment and Treatment Project Plan 4.1 Analysis of need 4.1.1 A survey of admissions of people with a learning disability to Pond Lane or

Penn Hospital between 1st January 2004 and 31st December 2005 identified the following information:

• 23 admissions over the 2 year period • 18 people accounted for these admissions

• 4 people experiencing more than one admission

• 65% were male and 35% were female

• There was a wide spread of ages

• Cultural backgrounds were made up of white 61%,

African/Caribbean 22% and Asian 17%

• 74% had a mild or borderline learning disability

• 23% of people were admitted with a diagnosis of challenging behaviour

• The duration of admission varied, 74% of people stayed less than 4

months 4.1.2 Most of the admissions were from family homes and, indeed, some of the

referrals were made by family members with no apparent access to outreach support. Of the two referrals made by family members, one had no involvement by the Community Teams and no Care Programme Approach in place despite the individual having a long standing mental illness. The other family referral occurred at the weekend. This highlights the need for:

• All those with established mental illness to have a key worker from

the community learning disability team

• Families to have access to contacts in crisis situations and particularly for out of hours periods

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• All people with a learning disability and an established mental illness to be on Care Programme Approach

4.1.3 There was not the anticipated peak of admissions at the end of the week

and over the weekend. This suggests that workers are being more pro-active in arranging admissions and supporting people in the community.

4.1.4 Further evaluation of people admitted identified that 6 people could have

been supported in the community to prevent admission or could have been supported during their discharge if an Assertive Outreach service had been available.

4.2 Agreed Service Model 4.2.1 The new service model for the Assessment and Treatment service will be

progressively re-modelled into a service with two elements, a five place Bed Based service and in addition a community based Assertive Outreach Service. Both elements will work on a city wide basis and will provide specialist services to individuals, family carers and service providers.

4.3 Current situation 4.3.1 In line with the priorities set out by ‘Valuing People’ the people living in

Pond Lane have been supported to move into more appropriate accommodation. Three people are still living at Pond Lane, they will have moved into their new homes by March 2007.

4.3.2 In order to support the development of the Assertive Outreach Service, an

existing community service is to be remodelled into an Assertive Outreach resource which can be purchased by the community team. The purpose of the service will be to provide specialist services to adults with learning disabilities who have behaviour that challenges and their carers during periods of crisis. The aim of the service is to support people within their home environment to prevent unnecessary admission. The service will be available from April 2007. This will be first phase of a community based Assertive Outreach team which will include care support staff and clinical expertise.

4.4 Implementation plan 4.4.1 A detailed three year project plan has been developed for implementing the

Assessment and Treatment service changes. This will be monitored by the Assessment and Treatment steering group, a sub group of the Partnership Board, against the outcomes measures set. This process will ensure that all relevant stakeholders are engaged in the transformation of the service.

4.4.2 The commissioning priorities for the first year are:

• Commission services to facilitate the discharge of the remaining three permanent residents at Pond Lane

• Commission the first phase Assertive Outreach Service

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• Increase staffing within community teams to support implementation of Care Programme Approach and effective discharge

4.4.3 The Implementation Plan will be completed in 2008/09 and the newly

developed services will be evaluated. 5.0 Out of City Project Plan 5.1 Analysis of need

5.1.1 The adult out of city placements are all funded via the pooled budget, and

are provided by the private and voluntary sector. The annual projected expenditure from the pooled budget for 2006/7 on out of city placements will be £2.6 m. The placements are country wide however of the 60 people placed outside the city, 49 are placed within the West Midlands area. Comparisons of local and out of city placement indicate an average cost of £35,000 per local placement compared with £43,000 per annum for out of city placements.

5.1.2 The demand for residential and specialist placements for both children and

adults will continue. Out of city placements constitute a high proportion of expenditure for both children and adults services. However in 2006 the number of out of city placement remained stable due services being developed locally for some young people in transition.

5.1.3 The following table shows the number of people by their primary need and

the cost of their service divided in to the following four cost brackets: Low price up to £20,800 per annum Medium cost from £20,800 to £52,000 per annum High cost from £52,000 to £93,600 per annum Critical cost over £93,600 per annum Identified needs No’s

Per year

Low medium High Critical

Autism

12 1 6 5

Moderate Learning disability

12 3 9

Severe LD plus other related health needs including sensory impairments

10 4 6

Challenging behaviour 9 5 2 2 LD plus mental health needs

6 1 4 1

Mental Impairment

4 2 2

Acquired Brain Injury

1 1

Safeguarding Adults

2 1 1

Not specified

1

In hospital 2

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5.1.4 Half of all new placements funded by the Adult Learning Disability Service

via the pooled budget annually, are children in transition who are already in Out of City placements, and funding is required to continue the placements. In 2006/7 all of these placements fell within the Critical cost bracket.

5.1.5 The Highest proportion of high cost placements are for adults with Autism.

This supports the need to develop local services for people with this identified need.

5.1.6 All of the placements for adults with a moderate learning disability are in

the low or medium cost bracket. These people could be supported to move back to the city should they wish to, by extending existing housing and support arrangements funded by The Supporting People Grant.

5.2 Agreed service model 5.2.1 The new service model for Out of City placements supports the philosophy

that no one has to move out of the city because appropriate social care services cannot be provided within the city or Specialist Health services provided within the Strategic Health Authority area. It represents a clear commitment to developing local services for those people with complex needs and who are most vulnerable to being placed out of city.

5.3 Current Position 5.3.1 An outcome focused multi agency reviewing tool has been produced. This

tool enables a consistent approach to be taken when reviewing placements, and is designed to be completed by professionals from a range of backgrounds. All out of city placements have been reviewed using the tool, and as a direct result an up to date data base has been produced of all out of city placements. This identifies the priority needs of the individuals, cost and quality of the placement and identifies those placements at risk of breaking down.

5.3.2 Analysis of the data base has identified the need to develop local

accommodation and support services for 6 adults with a diagnosis of autism. Half of whom will be young adults in transition and half will be adults who wish to return to the city. The business plan for this development will be completed in April 2007.

5.3.3 The Contract for the Approved Provider list for Supported Living and

Domiciliary Care has been re-tendered and 3 organisations have been identified to receive contracts for this service. These providers are skilled at supporting people with complex needs, behaviour that challenges and autism.

5.4 Implementation Plan 5.4.1 A detailed three year implementation plan has been developed to support

the changes, this will be project managed by the Out of City Steering group, a sub group of the Learning Disability Partnership Board.

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5.4.2 The commissioning priorities for 2007/8 are to complete the following

action:

• To develop a supported living scheme for 6 adults with autism with a specialist support provider

• To develop needs analysis of the adults with mental impairment and

forensic needs and work with commissioners in neighbouring authorities to identify sub-regional needs and develop appropriate services around named individuals

• Re-commission Supporting People services for adults with a

learning disability, to increase capacity within the city to support more people with moderate learning disabilities, and prevent the need to place people out of city

• Develop and extend the data base into an enhanced data set which

includes the needs of people living in residential services within the city, the needs of people living with older family carers, and young people in transition, to influence the commissioning of local services to prevent the need to place out of city

• To launch ‘The Housing Pathway’ this will support families plan for

the future. It will provide families with a clear process and information on how to plan where the person they care for will live in the future and how they will be cared for

5.4.3 The Implementation Plan will be completed in 2008/09 and the newly

developed services evaluated. 6.0 Financial Plan 6.1 This section sets out the financial resources that are currently invested in

the Joint Learning Disability Service. It gives the projected cost of the proposed service developments and the sources of funding to meet the re-commissioned services over a three year period.

6.2 In establishing these costs the following prior commitments were assumed:

• Any savings from decommissioned services will be ‘ring fenced’ and re-invested in services for people with learning disabilities

• Monies currently allocated for the provision of Day Services

holidays will continue to fund holidays in 2006/07 in line with assessed needs. In future years holidays will be provided following an assessment of need of users and/or their carers. However charges will need to be levied to cover the cost of these holidays. Monies from current day services holidays will be redirected to fund the priority of holidays for those users in in-house residential services

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• Service users will have a say in how daily allowance monies are used in future to modernise day services, as individual payments are phased out

6.3 The financial plan is based on the following features:

• The service is an integrated service • The implementation plan will take full account of human resource

and asset management planning

• That all necessary resources are reflected in the short and longer term financial plans of partner agencies

• That level’s of commissioned and decommissioned services in

financial plans reflect the changing levels of needs and activity. 6.4 The following table identifies the summary of existing expenditure within

leaning disability services 2006/7:

6.5 Over the three year period of the financial plan the following resource

adjustments will be made through the commissioning and decommissioning of services.

2006/7 2007/8 2007/8 2007/8 2008/9 2008/9 2008/9 current savings Re- net savings Re- net budget invest budget invest budget £ £ £ £ £ £ £ Day services budget 2,907,000 Reconfiguration

Current day staffing (908,000) (1,817,000) Into new service staffing models outlined

Specialist support services 300,000 601,000 Community access and leisure 202,000 403,000 Skills development service 271,000 542,000 Employment service 135,000 271,000 2,907,000 (908,000) 908,000 2,907,000 (1,817,000) 1,817,000 2,907,000

LD Budget ( as at 2006/07) WCC

ResourcesPCT

Resources Total £ £ £Day Services 2,907,000 2,907,000Out of City 2,797,000 2,797,000Specialist Services 131,000 131,000Assessment and Community Teams 617,000 1,496,000 2,113,000Residential and Domiciliary Care 3,722,000 3,722,000Outreach 1,028,000 1,028,000PCT Non - NHS Contracts 2,308,000 2,308,000PCT Contracts 997,000 997,000 11,202,000 4,801,000 16,003,000

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Out of city placements 2,797,000 0 0 0 Reduction in number of out of city placements (188,000) Set up new specialist autism supported living 188,000

2,797,000 0 0 2,797,000 (188,000) 188,000 2,797,000 Specialist services 131,000 Decommission Mencap service (66,600) (66,600) Commission the assertive outreach

66,600 66,600 66,600 Reallocate complex out of city placements (64,400) (64,400) Into local specialised services 64,400 64,400 131,000 (131,000) 131,000 131,000 (131,000) 131,000 131,000 PCT provider assessment and community

1,496,000 Resettle remaining clients (307,000) (307,000) Commission local services for clients 307,000 307,000 Decommission long stay specialist health

to pond lane (354,000) (354,000) Commission assessment and treatment

354,000 354,000

1,496,000 (661,000) 661,000 1,496,000 (661,000) 661,000 1,496,000 WCC assessment & community teams 617,000 0 0 617,000 0 0 617,000 Residential and domiciliary care 3,722,000 0 0 3,722,000 0 0 3,722,000 Outreach 1,028,000 0 0 1,028,000 0 0 1,028,000 PCT Non - NHS Contracts 2,308,000 0 0 2,308,000 0 0 2,308,000 PCT Contracts 997,000 0 0 997,000 0 0 997,000

Total 16,003,000 (1,700,000) 1,700,000 16,003,000 (2,797,000) 2,797,000 16,003,000 Over the next three years the Learning Disability Development Fund will target the following areas:

6.7 National demographics predict that there will be growth within the learning disability population of 1% per annum of people with a severe learning disability which equates to 7-9 new people per year. This growth will need

Commissioning activity

Costs required

06/07 07/08 08/09

Health Facilitator Post

£35,000 £35,000 £35,000 £35,000

Housing Information advice and guidance service for carers

£42,000 £ 18,000 DTI grant

£ 24,000 Learning Disability Development Fund

£42,000 £42,000

Review of NHS funded residential care

£30,000 £30,000 £30,000 Not required

Develop Advocacy

£30,000 £30,000 £30,000 £30,000

Increased uptake in Direct Payments and other individualised budgets e.g. ILF

£35,000 £35,000 ongoing funding to be secured as a result of saving made by the post.

Transition worker £32,000 £32,000 £32,000 £32,000

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to be recognised in future budget setting plans. Any available additional resources will be targeted at:

• Young people with very complex needs including sensory

impairment • Adults with profound autism • People with a dual diagnosis of learning disability and mental health

or challenging behaviour 7.0 Asset Management 7.1 As the detailed plans for the service changes are finalised any asset

management requirements will be incorporated into the respective organisations asset management plans.

7.2 Proposals for the development of the locality service bases have already

been included in the joint PFI/LIFT programme. 7.3 The three existing Day Centres will be retained for as long as services

continue to be provided from these bases but the model of those services will change, as will the usage of the buildings.

7.4 Negotiations will take place with managers responsible for other public

buildings, such as Community and Leisure Centres, to ensure that they are safe.

1

Appendix 1

Summary of re-assessments of need of people currently using learning disability day centres

Service Area (to include the number of people currently accessing service)

Identified needs

Current services

User views Carers views New service model

notes

Albert Road older peoples unit 17 people currently attend

Older group with age related needs including dementia, poor mobility and increasing health needs, e.g. diabetes high blood pressure and deteriorating hearing and sight

Most people attend five days a week, the activities are low key Most people live in residential accommodation and the remaining live in their own tenancies

Meeting friends is a high priority Activities enjoyed have a social bias e.g. playing games, cooking, listening to music Having a job and earning money is not important Being part of a big group is not important and having time on their own is important

No family carers, all people currently using this service live in residential care or their own tenancies

Therapeutic activities and social club Mix of low key therapeutic activities e.g. gentle exercise Remembrance therapy Physiotherapy and a social element via lunch. People come specifically to join in the timetable activities. The service is delivered on a shorter day

This group of people do not get attendance money for going to the centre

2


Identified needs

Current services


notes

Albert Road main centre 63 people currently attend including the work schemes

The group need supervision advice and guidance in most tasks. People can undertake personal care needs with supervision either verbal or direct support People are mobile but need supervision and assistance in the community 54% people are between 30-49

People have mixed timetables accessing both college and the day centre Access to college is via the day centred 90% people attend 5 days week People attend the work schemes as part of their timetable on either a full or part time basis, but can choose to join in on a daily basis

92% people who go to the day centre say seeing their friends are important 76% said being in a big group was not important 56% of people said having a job was important to them 52% said meeting new people was important 78% said getting out to new places was important People did a range of things in the evening and weekends that are similar to the main population, e.g. shopping, going out with family, watching T.V.

88% Carers could arrange to be at home if the person they care for became ill while in services and needed to come home 76%Carers say the day centres offers them respite and an opportunity to complete normal daily tasks 81% of carers do not get respite in any other way 84% said they would find it extremely difficult to get people to day services if transport was not provided 80% Carers do not believe that they would benefit from evening and weekend services

Skills Development Learning in a structure way through short and long term programmes, to develop or maintain specific skills Community Access and Leisure Introduction to community based activities plus a drop in service and information advice and guidance Employment service Access to ordinary employment work placements work like occupation

There is a correlation between those people who have a holiday with the centre and do not get a holiday anywhere else 68% of people receive lower rate DLA, 12% receive higher rate DLA mobility. 20% not know or do not get DLA mobility

3


Identified needs

Current services


notes

Oxley special care unit 34 people currently attend

People who have multiple learning and physical disabilities. Limited mobility, most using wheelchairs and who require space for specialist equipment e.g. hoists and changing tables etc, and to have physio, relaxation and other therapeutic activities Most people require individual staff support to go out and about

All service users attend centre 5 days a week The service is provided within the existing services with separate space for activities and quiet time

Awaiting outcomes of assessments currently being undertaken

80% have few or no concerns about paying for community activities 90% of carers could get home if the person they care for became ill during the day 75% felt they would not benefit from evening and weekend services 75% families have short breaks service via Muchall Grove

Specialist Support Service Providing specialist therapy on an individual or group basis Access to specialist equipment Close links with health colleagues Support to access other service models as required

90% have DLA mobility at high rate 90% of people who live with family who have a holiday do not go via the day centre Carers want a safe and secure base for the service

Oxley special needs unit 26 people currently attend

People who have extra support needs due to more challenging behaviour The level of support required may vary depending on the environment and other people using

People have a mixed timetable of activities which includes some structured sessions, attendance at college, and community activities

People liked doing a mixed range of activities including drama, dance, shopping, computers and being out and about Being in big groups was not important and doing the same

50% of carers receive a short breaks service 90% of carers get a break from caring when the person goes to the day centre 35% of carers could

Across the special needs unit and the main centre people will be able to access the following services

30% of people only get a holiday via the day centre 66% of people get DLA mobility

4


Identified needs

Current services


notes

the service thing every day was not important People liked meeting their friends, and relaxing

not get home if the person was ill and could not stay in the service 65% of carers had concerns about transport linked to the new services

Skills Development Learning in a structure way through short and long term programmes, to develop or maintain specific skills People will have skills based assessments and individual development plans

Oxley main centre 55 people currently attend including 2 people who attend the work scheme

People who have a level of Independence, who can mange their personal care with verbal prompts They may need extra support to complete certain tasks, and need advice and guidance to problem solve

The service offers a combination of structured and unstructured activities Adult education provide courses within the centre The centre support people to attend activities in the community

People liked social activities such as gardening, swimming, art, and seeing their friends Getting out to new places was important to people as was meeting new people and earning money Being in big groups was not important

Carers would like to see more staff, activities and more stimulation for people Some carers said that they could transport people to services 77% of carers did not think they would benefit from evening and weekend services

Community access and Leisure Introduction to community based activities plus a drop in service and information advice and guidance Support for people to get to and from generic community based services

85% of people get DLA mobility with 42% getting high rate mobility 60% of people go on holiday with the day centre 60% of people have a holiday not provided by the day centre

5


Identified needs

Current services


notes

People attend college via the day centre People attend the work schemes as part of their timetable on either a full or part time basis

nor was doing the same thin every day People said they like to visit friends and family at weekends as well as watching TV and shopping

90% of carers did not work 80% of carers could be at home if the person they care for was ill 65% of carers had few or no concerns about paying for community activities

To provide and environment for people to meet up with their friends Employment Service Access to ordinary employment Supported work placements Work like occupation in a therapeutic setting

Stowheath special care unit 14 people currently attend

People who have multiple learning and physical disabilities Limited mobility, most using wheelchairs Require space for specialist equipment e.g. hoists and changing tables etc, and to have physio, relaxation and other therapeutic activities

All service users attend centre 5 days a week People have a timetable of low key activities, including physiotherapy, some community access with individual support There are some opportunities to integrate into activities within the main centre

People like seeing their friends and listening to music Relaxing and seeing familiar people every day were very important Earning money and getting a job were not important

Awaiting outcomes of assessments currently being undertaken.

Specialist Support Service providing specialist therapy on an individual or group basis Access to specialist equipment Close links with health colleagues Support to access other service models as required

Awaiting outcomes of assessments currently being undertake

6


Identified needs

Current services


notes

Stowheath special needs unit 19 people currently attend

The level of support required may vary depending on the environment and other people using the service People need more intensive support with certain activities As a result of: Challenging behaviour Autism Anxiety issues They may need less support with other activities

People have a mixed timetable of activities which includes some structured sessions, attendance at college, and community activities

. People liked seeing friends, cooking, and computers The following things were very important: Having a job Being able to come and go and they liked Earning money Getting a qualification

Awaiting outcomes of assessments currently being undertaken

Across the special needs unit and the main centre people will be able to access the following services Skills Development Learning in a structure way through short and long term programmes, to develop or maintain specific skills People will have skills based assessments and individual development plans

Awaiting outcomes of assessments currently being undertake

Stowheath main centre 72 people currently attend including 34

People who have a level of Independence, who can mange their personal care with

People have individual timetables Adult education provide courses

Seeing friends and doing computers were very important to people

Carers use the day centres to give them a break and to work 50% of carers said

Community access and Leisure Introduction to community based activities plus a drop

60% of people do not have a holiday via the centre

7


Identified needs

Current services


notes

people who attend the work schemes on a full or part time basis

verbal prompts They may need extra support to complete certain tasks, and need advice and guidance to problem solve

within the centre The centre support people to attend activities in the community People attend college via the day centre People see their friends and socialise at the day centre People attend the work schemes as part of their timetable on either a full or part time basis

91% of people liked doing cookery people also like sport, shopping, dancing, gardening and going out for meals 75% of people said doing the same thing every day was important 90% of people liked going out and about 30% of people said earning money was important 83% of people said relaxing was important

they would be interested in evening and weekend services 80% of carers were not concerned about paying for community activities 80% of carers were concerned about future transport arrangement 90% of carers could be at home if the person they care for was ill during the day

in service and information advice and guidance Support for people to get to and from generic community based services To provide an environment for people to meet up with their friends Employment Service Access to ordinary employment Supported work placements and voluntary work with short or long term support Work like occupation in a therapeutic setting

60% have holidays with friends and family 83% of people get DLA mobility

C:\Documents and Settings\Dlas201\Local Settings\Temporary Internet Files\OLKE3\Learning Disab Plan Appendix 2.doc

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Printed 13/Feb/2007 at 13:57

Appendix 2 – Leisure, Education and Employment Services – Staffing Structure

Key: S.S.S Specialist Support Service T.W.S Therapeutic Work Services C.A.L.S Community Access & Leisure Services D.S.W Day Service Worker S.D.S Skills Development Service ADSW Assistant Day Services Worker

Community Services Manager

S.S.S. Lead

North S.S.S. Co-ord

S.East S.S.S. Co-ord

S.West S.S.S. Co-ord

C.A.L.S Lead

North C.A.L.S Co-ord

S.East C.A.L.S Co-ord

S.West C.A.L.S Co-ord

S.D.S Lead

North S.D.S Co-ord

S.East S.D.S Co-ord

S.West S.D.S Co-ord

Employment Lead

Emp Team Co-ord

T.W.S Horticulture Co-ord

T.W.S Café Co-ord

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW

ADSW

DSW