Agendas, Meetings and Minutes - Agenda item

Agenda item

Services for Adults with Learning Disabilities

Minutes:

Attending for this Item were:

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

Elaine Carolan, Interim Director of People

Fran Kelsey, Lead Commissioner

 

The Panel received a report regarding a number of areas relating to adults with Learning Disabilities in Worcestershire.  This included an overview of packages of care for people with complex needs, an overview of the upcoming peer review of Adult Social Care, which has a learning disability and autism focus, and an overview of the Transforming Care Programme.

 

A presentation, circulated as part of the Agenda, was used as the basis of the discussion.  In summary, the following areas were highlighted:

 

Packages of Care

·         Of the overall £66m budget for Adults with Learning Disabilities, £26.4m was spent on residential and nursing care and £19.3m on supported living.  These were significant figures and demand was increasing

·         Costs per week were rising, but were generally around £850 per week on average across the 1,454 packages as of October 2019

·         However, 28 packages were over £3,000 per week and a further 211 between £1,501 and £3,000 per week.  1,215 packages were under £1,500 per week

·         Levels of support varied, but for those with very complex needs, it could involve up to 1:1 social care 24 hours a day, which would result in high staffing costs

·         In comparison, funded support could be day care opportunities, transport or access to different therapies

·         Actions were being taken, with partners, to further understand the situation and find possible solutions.

 

Peer Review

·         A Peer Review had been arranged between 5-7 February 2020 to support the Authority in its self-evaluation and service development.  The Peer Review Team from across the region was led by a Director of Adult Services and was an opportunity to gather intelligence and share ideas across the Council and its partners.

 

Transforming Care Programme

·         This Programme was focussed on care for people with a Learning Disability and/or Autism with the aim of developing sustainable community-based provision and avoid admission to inpatient locked and secure services 

·         It was recognised nationally as one of the best performing Transforming Care Programme’s in the Country

·         There were currently 11 inpatients, with 5 planned discharges in 6-9 months’ time

·         The complex needs pathway had been developed and agreed across all health and social care providers in the County.

 

In the ensuing discussion, the following key points were made:

 

Packages of Care

·         It was confirmed that all of the 1,454 packages of care were for social care provision, not continuing health care or for secure hospital provision.  However, in relation to funding for secure and locked hospital placements, there were various funding arrangements.  If the primary diagnosis was a Learning Disability, the Council would wholly fund the provision, however if partly mental health then the cost would be shared 50/50 with the Clinical Commissioning Groups

·         When asked whether the support available in Worcestershire was above the legal minimum, it was explained that the Care Act was very clear on who was eligible for support.  If there was an assessed need then there was a duty of care to meet that need, but how the need was met could be subject to negotiation

·         There was transparency in relation to the costs of packages of care, which were increasing year on year

·         Social Workers worked to a set of professional standards with ongoing supervision and caseloads were often audited

·         The Cabinet Member confirmed that although he had no doubt that all cases would be Care Act eligible, the way in which packages were delivered could be where Worcestershire was more generous than other authorities

·         The Interim Director advised that in terms of learning disability spend regionally and compared with family comparator authorities, Worcestershire spent more money on care packages

·         The Peer Review would provide an opportunity to explore in more detail the budget behind each of the packages of care, however there was a concern that Worcestershire was a victim of its success

·         Praise was given for the nationally recognised Transforming Care Programme, although was that success resulting in budget pressures

·         It was clarified that a number of family carers were now also in receipt of social care support and realistic conversations were being held about what future provision may look like.  There was no one answer and cases were assessed individually.  What a family may wish for, may not be possible

·         A Member asked for examples of spend for those 1,215 packages of care under £1,500 a week.  These included transportation, meaningful day opportunities, replacement care, respite and carers breaks

·         In relation to benchmarking, the costs involved in residential care were higher than the Council’s nearest neighbour authorities, however, the numbers were not

·         Supported Living had been developing for around 5 years and it was expected that this offer would increase over time, especially across Worcestershire and some geographical neighbours

·         It was confirmed that Supported Living packages of care cost between £300-£700 per week but were for the less complex cases

·         Annual reviews were undertaken to assess any change of need and provision.  The Panel noted that Learning Disability Social Workers had been brought back into the Council from Worcestershire Health and Care NHS Trust

·         There was no secure and locked hospital provision in the County, therefore placements were out of County yet funded by Worcestershire if the resident was eligible for social care support

·         Work was being undertaken to understand the transition from Children’s Services to Adult Services as the systems were different.

 

Peer Review

·         A Member questioned the phrase ‘proactive planning’ in relation to an aim of the Peer Review, to be informed that it was hoped that one outcome may be better planning across the system to ensure long term sustainable support for those most vulnerable in Worcestershire

·         When asked whether there was one element which was more challenging than another, it was highlighted that the life expectancy gap for those with Learning Disabilities was 15 years and this needed to be explored with health partners.

 

Transforming Care

·         A Member asked whether Deprivation of Liberty Safeguards (DoLS) affected the Transforming Care Programme to be informed that assessments would be appropriate for anyone, not just those in locked hospitals

·         The Panel agreed that it was becoming more difficult to differentiate between health and social care, not only in need, but also budgets and the increase in joint commissioning.

 

Sandra Hill, the Chief Officer from Speakeasy Now was invited to comment on the discussion and made the following key points:

 

·         The difficulties voiced around budget constraints and family carers becoming increasing frail themselves were echoed by Speakeasy Now

·         The point was made that there was always a need for additional services such as physio, but it was very pleasing that partnerships were ongoing and valued

·         Officers were commended for their work and Speakeasy was certainly proud to be associated and engaged with the process.

 

It was agreed that the Panel would be provided with some examples of anonymised cases of each type of care package, including out of County placements, and the number of young people transitioning from children’s social care to adult social care.

Supporting documents: