Agenda item

In attendance for this item were the:

Interim Director of Adult Services

Strategic Commissioner of Adult Services and Health

Interim Lead Commissioning Manager for Adult Services

The Lead Commissioning Manager explained that Replacement Care, sometimes referred to as respite, was support provided to carers of someone with learning disabilities so that they could have a break. A report had been presented to Cabinet in February, and the engagement planned on how learning disability replacement care services should be delivered in the future, would be ahead of going out to consultation – an approach modelled on the recent engagement on Learning Disability (LD) Day Services. The engagement timetable would be made available to members shortly and was due to start the following week.

A presentation had been circulated to the Panel in advance of the meeting, which would also form the basis for the engagement meetings planned. The Interim Lead Commissioning Manager highlighted the key points.

LD Replacement Care was being looked at because of the need to get the best value for money from the Council's budget and initial analysis showed that because of block contract arrangements, 1,800 nights per year were not used, at a cost of approximately £450k. More detailed analysis would look at whether this stemmed from reducing demand or whether a different type of care was needed for people's needs. The Council needed to plan for changing future needs which included supported living options, increasing complexity of need and changing expectations from families.

Engagement was taking place during March and April which included staff, carers, wider meetings and with service users with assistance from Speak Easy N.O.W.

The total budget 2017/18 budget for LD Replacement Care was £2.6million, which included block contracted provision plus a small amount of 'spot purchased' provision in external care homes. Around 175 individuals received regular replacement care funded by the Council. Additionally some people also received emergency replacement care. The Panel was shown an overview of the 5 locations, which varied in size. Average occupancy ranged from 74% to 95% and officers advised the aim should be for 90%; 100% would never be aimed for because of the type of service involved.

Main discussion points

·         It was confirmed that members were being invited to the engagement meetings with carers, although it should not be a problem if a member wanted to attend one of the meetings with staff.

·         A member pointed out that smaller centres would always be more expensive, such as the Pershore Short Breaks with 4 beds

·         The process for arranging emergency care was explained, which would also form part of the engagement. In-house provision gave a degree of flexibility and was time efficient.

·         Officers were asked what was being targeted and the Director explained the need to be as efficient as possible given the financial pressures, and to have a better used service, and at this stage the engagement exercise was open minded and very much about talking to people. There may be an opportunity for co-production.

·         It was confirmed that the criteria for access had not changed and was set out in the Care Act.

·         Officers also explained that currently, quite a lot of replacement care was taken at weekends, so use of the service was not consistent, and a better balance may be possible, without being too prescriptive.

·         Officers acknowledged a member's point about the danger of raising expectations about change, and stressed that the engagement on LD Replacement Care was engagement and not actual consultation. Feedback from recent engagement on LD Day Services had been very positive and it was hoped to use learning from this experience.

·         Members sought assurance that the effects of media speculation were being managed and a Panel member who was also the Chairman of the Council, referred to the emotional statements made by families at the recent meeting of Council (in respect of the consultation on the future provision of overnight unit-based short breaks for children with disabilities). Officers advised they were working very hard to reassure, and acknowledged that the Council's consideration of three different areas (consultation on short breaks for children with disabilities, alongside Adult Services' engagement on Learning Disability Day Services for Adults and LD Replacement care for adults) had led to confusion which had required a lot of work with families – officers were very aware of the need to avoid stress for those involved and were available to talk and welcomed the opportunity to provide clarity.

·         The Director offered to return to the Panel to explain the wider picture and direction for overall learning disability services.

·         One member was unaware of provision in his division and the officers offered to arrange a visit for him.

·         Panel members agreed that the service in its current form was being underused.

·         The members present appreciated the openness of the presentation to the Panel, and the empathetic approach to the engagement exercise.

·         Concerning the challenge of looking into the number of nights when available care was not used, a member suggested that the most straight forward thing to do would be to speak with eligible service users and their carers who were not currently making full use of what was available to them. The officers explained that Replacement Care was part of an individual's assessed need and the number of nights allocated therefore varied which made provision complicated; some may have 7 nights a year, others 100. The engagement was more directed at finding out why some individuals did not use the service at all, rather than not using their full allocation. The engagement would also seek to 'future proof' the service, since officers were aware of numbers of young people coming through the system who would need replacement care with nursing provision.

·         A Panel member was aware that some families made use of every hour they were given.

The Chairman invited comments from the organisational representatives present.

From Speakeasy N.O.W Sue Daniels (Business Co-ordinator and Health Checkers Project Worker) advised that the organisation was helping with the engagement using staff who were very experienced in communicating with adults with complex needs.

Jo Ringshall, a Director from Healthwatch, said that Healthwatch welcomed the pre-engagement and co-production approach.

In summing up, the Panel Chairman observed that the Panel and HOSC members present were very supportive of the planned engagement on Learning Disability Replacement Care and the Directorate's approach. 

It was agreed that a further session on findings from the engagement on Replacement Care and also the overall Learning Disability strategic direction would be arranged, which would enable the Panel to make comments ahead of further discussion by Cabinet in June.

Details and dates of the engagement sessions would be sent out to all councillors.