Agenda item

In attendance for this item were :

Avril Wilson, Interim Director of Adult Services

Elaine Carolan, Strategic Commissioner of Adult Services and Health

Amanda Blackton, Commissioning Manager for Adult Services

Cllr Adrian Hardman, Cabinet Member for Adult Social Care

 

Speakeasy N.O.W – Gail Greer, Expert Members Co-ordinator and Rachel Barret, Health Checkers Project Assistant

 

Worcestershire association of Carers – Mel Smith, Deputy Chief Executive Officer

 

The Strategic Commissioner of Adult Services talked through the presentation which was included in the agenda papers. The presentation included context and budgets for Learning Disability (LD) Services, information about packages of care, strategies and plans, details of the pre-consultation engagement on Day Services and Replacement Care, and next steps.

 

Replacement Care came under the budget for Residential and Nursing Care, although some was also provided as part of the Shared Lives scheme, with some examples spanning 20-30 years. The Council had invested in recruiting providers for Shared Lives provision, the model was financially very viable and recent take up was encouraging.

 

The numbers of people opting to receive direct payments were steadily increasing, in particular younger people coming through the transition from Children's Services.

 

LD strategies and plans focused on people being treated as individuals and being part of their communities; therefore organisations such as Speakeasy N.O.W and the People's Parliament were very important.

 

The six big aims were reflected in the sub groups of the LD Partnership Board;  to stay healthy, live well, have a place to live, have a job, stay safe, to have the right support for carers, and also to prepare for adulthood.

 

It was known that for those with learning disabilities, people were still treated differently and that there was still far too big a gap in average life expectancy (15 years). The Acute Hospitals Trust had done a lot of work to address this. The aim of having a job had recently been extended to those with autism. The officers reported an increasing need to support carers to be able to continue their support for family members into adulthood, which involved working with colleagues in Children's Services also.

 

A lot of positive work was taking place with Supported Living schemes, giving people stability, independence and the chance to live in their own flat for the first time. The Council was doing lots of work looking for suitable sites, which could be hard at times.

 

Referring to the pre-consultation engagement on Day Services and Replacement Care, the officers highlighted the willingness of family carers to engage. The Directorate and Speakeasy N.O.W had proactively made contact with carers and service users. Feedback had been positive and people had not felt the Council was presenting them with a 'done deal'; this was a change from previous experiences of service change. Meetings with staff had brought new ideas and had been 'a joy'.

 

The co-production approach was underlined, which for example had led to changes in the first report to Cabinet. It was envisaged that the follow up report to Cabinet would be quite detailed because of what was involved and the individualised approach.

 

Questions from the Panel were invited and the following main points were made:

·         Officers confirmed they were confident to have been able to contact a good proportion of carers, although it was pointed out that not all service users would have family carers. It was also apparent that less and less service users attended Council Day Services for all of their day activities.

·         A Panel member flagged up that he had been told that County Council employees had been saying that Connect and Resource Centres were losing money, prompting fears that decisions about their future had already been made . The Strategic Commissioner and Director expressed surprise and emphasised the very genuine desire for engagement, which, it was acknowledged had not always been the case in the past.  This information was not something which social workers would have, although the officers would reflect on messages to staff.

·         The Panel Chairman and Vice-Chairman also felt reassured that the pre-consultation engagement was genuine and both reported a trust and confidence from people at the meetings they had attended, and their contact with local centres, which had demonstrated a clear shift from previous exercises. Whilst memories of past experiences may linger for some, they did not perceive any lack of trust in the current engagement.

·         The Carers Association representative also endorsed the positive comments about the engagement.

·         When asked what had been the biggest surprise so far, the officers referred to the positive response from staff. Their service knowledge had also given greater understanding of provision, for example that the needs of some users of Replacement Care meant that the bed adjacent to them could not be used during their stay. 

·         A Panel member spoke about his own visit and had been very interested to learn about the detail and practicalities involved in Replacement Care.

·         The officers advised that demand for Replacement Care was highest at weekends, which affected services, and that more conversations were taking place to perhaps encourage people to try out Supported Living or Shared Lives.

·         In response to a query, officers gave examples of types of care provided for different costs, ranging from £100 to £2-3k a week; care packages were very diverse and included some people at the higher cost bracket who lived in Supported Living, which was the direction of travel, rather than residential care.

·         Where were the most challenging cost pressures? The officers advised that proportionately LD budgets had been very well protected, although pressures were now apparent at the higher cost end of care packages, with people living longer with more complex needs. Significant pressure was being seen amongst numbers of people living with families with elderly carers and social workers tried to work with families to encourage them to accept some support, to avoid an abrupt change for those they cared for if they were unable to continue. There were instances where families had agreed to try Supported Living after years' of discussions, and been very happy with the outcome.

 

The Chairman invited the representatives from Speakeasy N.O.W and Worcestershire Association of Carers to provide feedback on their involvement with the engagement, and any other comments.

 

Gail Greer from Speakeasy N.O.W talked through the organisation's engagement which she had been involved in, along with Rachel Barrett. Their experience had been very positive, they had encountered no distress and the Council's officers had been very clear in wanting a soft approach.  Easy read reports for both Day Services and Replacement Care feedback had been produced.

 

Regarding Day Services, Speakeasy N.O.W had visited 6 Connect centres (seeing 59 people) and 4 Resource centres (seeing 61 people), as well as 32 school pupils and 70 people at Leisure Link. Gail had been struck by the range of service users, varying from those who lived very independently, to those receiving care 24/7. They had engaged with 18 people at 3 Replacement Care provisions.

 

A key observation of both services was that many had been using services for a long time and valued the relationships, felt safe with the staff and were having good quality, varied and service user-led experiences, which differed to the more traditional services previously. Self-esteem was good. Transport was an issue and time spent travelling could reduce the opportunities available during the day.

 

Those at Connect Day Services knew about their local communities but were less aware of other external services available. Service users liked the freedom and space and some service users had more opportunities to be independent than they would at home.

 

Another observation was that when they asked a service user what they would like to do, they waited for you to make suggestions.

 

Leisure link services were popular, traditional, sociable and had a low turnover.

 

Mel Smith from Worcestershire Association of Carers (WAC) welcomed the Council's approach which had removed the fear from consultation and created an openness to change that would hopefully result in a much more meaningful consultation. WAC had worked closely with the Council in attending sessions and found the team approach to work well. Carers absolutely valued and trusted services, gave practical feedback and acknowledged there would be changes ahead. WAC recognised the increasing numbers of families still caring in later life and endorsed the Council's approach to this.

 

The Chairman thanked both organisations for their input, which added greatly to the value of the Panel's work. It was very good to know that those involved felt listened to and that issues from past engagement had been learned from.

 

The Panel was invited to ask any questions of the engagement feedback and the following main points were made:

 

·         Members agreed the feedback was reassuring, lovely to hear and a comment was made that it reflected the Personalisation Agenda and the fact that increasingly, employment was an important option.

·         Did the positivity reflect the fact that those in the system had experienced improvement (from previous changes), and would feedback from those entering services now be different? The officers advised that year on year numbers attending Day Services dropped, which could be partly because social workers saw it as old fashioned,  college opportunities had increased and also because none of us would choose to do the same leisure activity 5 days a week. Officers also believed some families were unaware of Replacement Care, which was being addressed since the Care Act required local authorities to provide support services and for some people there was not a viable alternative.

·         A Panel member said that he identified with all of the feedback from Speakeasy N.O.W and WAC, which reflected messages from the places he worked in. During the previous changes to Day Services he had been concerned about the impact on relationships and those attending Resource Centres Connect being split, however he was a great supporter of Day Services and hoped that they would continue in-house in their vibrant form, rather than through other providers.

·         There was concern about transport being an issue and the Panel was advised that the Council had a healthy programme of travel training although availability of bus services was a hindrance. Conversations were taking place around the idea of people employing someone to transport them, instead of using a mobility car.

·         Regarding provision in prisons, there were now named social workers and some provision of domiciliary care.  Whilst many prisoners had learning disabilities, they often did not meet the Care Act thresholds, so care tended to be provided  to those experiencing age-related and/or physical disabilities

·         The Director referred to the Transforming Care Programme (for long-term placements in residential hospitals), which was being developed alongside colleagues in other councils due to the specialist nature of this care.

·         Panel members would be interested to visit Day Centres, and the officers advised that the centres were keen for councillors to visit.

 

Next steps

The Panel would be interested to know which service areas would be affected by emerging plans and were advised that these would be part of the report to Cabinet on 14 June.

 

Comments to the Cabinet Member with Responsibility (CMR) for Adult Social Care were invited and the following main points were made:

·         The pre-consultation engagement work on Day Services and Replacement Care were seen as 'gold standard' and leading the way in local authority pre-consultation approaches, and members hoped to see more of this approach across the Council.

·         The positive feedback demonstrated the importance of working with those service users when services were being redesigned.

·         It was important to remember that this was a vulnerable group of people, who often had great personalities but very little power – within the environment of cost savings, it was important that the Council did the best job it could.

·         It was not just the approach which was important to recognise, but also the communications skills of the officers involved, which was a real change from previous consultations on Learning Disability Services.

 

The Strategic Commissioner also pointed out the value of having an experienced, consistent team and the work which had been done with service staff, as well as the service user and carer organisations present today.

 

The CMR agreed that the engagement had worked very well and agreed that communication was more challenging when working with people who were not used to making decisions. The Directorate would continue to work with stakeholders as it considered future plans for services.

 

The Panel agreed that next steps were important and that it would like to be involved in and to help with any future consultation, which would be part of a future meeting agenda once plans had been submitted to Cabinet on 14 June.

 

It was agreed that the Speakeasy N.O.W reports referred to, and contact details for day services would be circulated to members.