Directorate and Service Area: Social and Community Services
What is being assessed?
The Big Plan: Oxfordshire’s draft Learning Disability
Strategy 2015-18
Responsible owner / senior officer : Benedict Leigh
Service and Community Impact Assessment written by: Sam Casey-Rerhaye
Date of assessment: 4th November 2014
The proposed new strategy is a change for services for people with learning disabilities. It will have a number of impacts on people with learning disabilities and their friends, families and carers, people with learning disabilities using current services, service providers and the council. It updates the way services are provided in line with the latest research and reports for this area.
The most important mitigating actions are:
 gaining further data for a clear picture of the Oxfordshire learning disability population;
 having an extensive communication plan for working with council services, providers and the learning disability population, their friends, families and carers;
 developing a clear picture of current use of learning disability services, including community health services;
 scoping the work that the proposed Reasonable Adjustment Team would need to undertake;
 linking with the existing strategy for transitions to adult services;
 continuing to revise the strategy to take into account consultations with users and providers.
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In preparation for the end of the current commissioning strategy for people with learning disabilities and their carers and families - the Big Plan (2011-2015), a new commissioning strategy has been drafted. This is the Big Plan: Oxfordshire's Draft
Learning Disability Strategy.
The purpose of this assessment is to consider the impact of the proposed new strategy on people with learning disabilities, carers, service users, social and health services, other service providers and the wider Oxfordshire community.
The Big Plan is subject to Section 149 of the Equalities Act 2010.
Section 149 of the Equalities Act 2010 (“the 2010 Act”) imposes a duty on the
Council to give due regard to three needs in exercising its functions. This proposal is such a function. The three needs are:
 Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Equality Act.
 Advance equality of opportunity between people who share a protected characteristic and those who do not.
 Foster good relations between people who share a protected characteristic, and those who do not.
Complying with section 149 may involve treating some people more favourably than others, but only to the extent that that does not amount to conduct which is otherwise unlawful under the new Act.
The need to advance equality of opportunity involves having due regard to the need to:
 remove or minimise disadvantages which are connected to a relevant protected characteristic and which are suffered by persons who share that characteristic,
 take steps to meet the needs of persons who share a relevant protected characteristic and which are different from the needs other people, and
 encourage those who share a relevant characteristic to take part in public life or in any other activity in which participation by such people is disproportionately low.
 take steps to meet the needs of disabled people which are different from the needs of people who are not disabled and include steps to take account of a person’s disabilities.
The need to foster good relations between different groups involves having due regard to the need to tackle prejudice and promote understanding.
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These protected characteristics are:
 age
 disability
 gender reassignment
 pregnancy and maternity
 race – this includes ethnic or national origins, colour or nationality
 religion or belief – this includes lack of belief
 sex
 sexual orientation
 marriage and civil partnership
 Social Value
Under the Public Services (Social Value Act) 2012 the Council also has an obligation to consider how the procurement of services contracts with a life value of more than
£173,934 might improve the economic, social, and environmental well-being of the area affected by the proposed contract, and how it might act to secure this improvement. However, it is best practice to consider social value for all types of contracts, service delivery decisions and new/updated policies. In this context,
'policy' is a general term that could include a strategy, project or contract.
The Social & Community Services vision is to support and promote strong communities so that people live their lives as successfully, independently and safely as possible. Development work and discussion with people with learning disabilities and their carers reviewing the previous strategy meant that there was a clear view about what we could do differently as the current strategy ends.
Alongside local discussion and development, national policy has also altered; in particular the impact of the Winterbourne View Joint Improvement Programme outlining that all services for people with learning disabilities should ensure personalised care and support in appropriate community settings. The Care Act
2014 comes into force in April 2015 and aims to develop a clearer, more personcentred and fairer system in social services.
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There are also demographic pressures. The number of people with a learning disability in Oxfordshire is rising, and so is the demand on services. This has created budgetary pressures in the service and overspends also needed to be addressed.
A new strategy needed to be developed, with the last one scheduled to end in April
2015.
The strategy proposes the following principles:
 People with learning disabilities will have access to all the services that everyone else has.
 An expectation of living a productive life, with minimal dependence on services. The specialist Learning Disability service provided or commissioned by Oxfordshire County Council and Oxfordshire Clinical
Commissioning Group will be focused on eligible needs that arise solely as a result of a learning disability.
Therefore the commissioning intentions from the strategy will focus on the following:
 Physical and mental health services for people with learning disabilities will be the same services as for the general population, but with reasonable adjustments made, supported by a reasonable adjustment team. This will include any intensive bed-based support needed as a result of mental health problems.

There will be intensive support for people with learning disabilities who have eligible needs and require specific support in relation to the impact of their learning disability on their behaviour. This will focus on early intervention, training and support and there will be a particular focus on autism advice, support and additional overnight capacity.
 Working on the 'Lean' principles of the Adult Services Improvement Program support will be provided through three functions: first response, complex and reviews. Oxfordshire County Council will continue to work in an integrated way with health providers.
This plan has been developed in consultation with the Learning Disability Partnership
Board and a Big Plan Group which has met 3 times since March 2014 and will meet again before the strategy begins to be implemented. The group consists of service users, parents and carers, health workers, care managers and commissioners.
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The group agreed the priorities for the plan should be:
 improved access to health services and completed health action plans
 more health care in people's own homes
 people to have good advocacy, not just in times of crisis
 clearer service offers and better training of professionals across all council and health services to work with people with learning disabilities
 better choice of living options
 better planning for transition to adult services
 more focus on meaningful employment
As a result of this input, the strategy focuses on enabling and supporting people with learning disabilities to have an active life in the community that they are living in, have control over their lives and the decisions made about their lives.
The Council has signed up to the Driving Up Quality Code which outlines the need to go beyond minimum standards, support people with learning disabilities to live an ordinary and meaningful life, to take risks and for care and support to be about the whole person and their families and carers as active members of the whole community.
Improving data on people with learning disabilities has shown that there are a larger number of people with learning disabilities that do not have any contact with social services than was previously known, and additionally, there is a growing need for services as a result of a growing and ageing population, and decreased mortality of those with learning disabilities (Improving Health and Lives Learning Disabilities
Observatory, www.improvinghealthandlives.org
.
There is also new research showing that different ways of working with people with learning disabilities, especially those with autistic spectrum disorder diagnosis can have better outcomes. Research shows that the prevalence of autism in adults with learning disabilities is between 20 and 30%, and so the strategy takes this into account by focusing on autism ('The Estimated Prevalence of Autism among Adults with Learning Disabilities in England'- Improving Health and Lives, as above).
Therefore it is important that services are available to all people who need them while ensuring that the services are of high quality. In doing so at a time when significant savings need to be made in social services budgets means a redesign of services is vital.
Learning disability services are also part of the Adult Services Improvement Project, which is recommending changes on working practices, as outlined in the Tier 3 services in the Commissioning Intentions.
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There will be a 12 week consultation with all stakeholders from 10th November 2014
- 10th February 2015.
As the current strategy is coming to an end in March 2015, and contract for a large provider of learning disability services finishes in December 2015, there is a need to plan for the future regarding learning disabilities services. The alternative of refreshing the Big Plan 2011-2015 was rejected as there has been so much change in policy, in population and in research in the years since it has been written. There is also a significant overspend in the Council' s share of the budget of over £4m, as a result in an increasing demand for services over and above the 2.7% expected.
General
Risks
The strategy is not clearly communicated to people with learning disabilities, their friends, families and carers and therefore their voice is not heard in the consultation on this strategy
People with learning disabilities, their families and carers who are not using any council or health services are unaware of the strategy and do not feed into consultation or development.
Mitigation
The strategy has been developed with as many service users, staff and families as possible during 2014-15. Easy Read version of the strategy is made available during the 12 week consultation process and My Life My Choice involved in the consultation.
Communication plan developed with a number of different ways of engaging different communities, rural, ethnic minorities, young and older people, men and women. Work on understanding the
Oxfordshire population of people with learning disabilities will feed into this. We will work with current providers and other charities in this area to ensure the consultation on strategy has extensive publicity.
Age
Risks
There are a proportion of existing service users who are ageing and
Mitigation
The proposal provides a specialist resource (the Reasonable Adjustments
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whose health may be deteriorating.
They may face considerable difficulties in accessing mainstream health services and their health and well-being may decrease.
Team) to enable and support access to mainstream services. This team will work with mainstream health services to ensure successful access by people with a learning disability.
We will work with health services to gather good data on how many people with learning disabilities are already in community health services.
The impact of a set of services that emphasise choice, control and independence should enable these older carers some respite.
There may be resistance by older carers to directing the person they care for into work or accommodation that increases the person independence. However, there are an increasing number of people with learning disabilities who are being cared for by older and frailer people.
Young people who are transitioning from children's services to adults may find the expectation of independence, choice and control difficult.
An ageing population of people with learning disabilities brings other health needs, such as dementia, which increases pressure on mainstream health services, particularly geriatric health services.
Preparation for moving into adulthood should start with carers and young people early. The work on transitions is covered by a separate strategy and will take this work into account.
Service specifications will be developed based on the evidence of current use and access patterns for people with learning disabilities to current services.
Disability
People with learning disabilities often have other physical disabilities such as mobility issues, communication limitations, as well as other areas of health needs such as mental illness etc.
Risks Mitigation
People with learning disabilities will find it difficult to access mainstream health services for physical health needs and may need to wait longer than presently
The proposal provides a specialist resource (the Reasonable
Adjustments Team) to enable and support access to mainstream services. Waiting times will be based on clinical need.
Where additional resource is necessary this will be identified and be part of service specifications.
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People with learning disabilities will find it difficult to access mainstream health services for mental health needs and may need to wait longer than presently
The proposal provides a specialist resource (the Reasonable
Adjustments Team) to enable and support access to mainstream services, and waiting times will be based on clinical need.
Where additional resource is necessary this will be identified and be part of service specifications.
Gender Reassignment/pregnancy and maternity/religion or belief/sexual orientation/marriage and civil partnership
Risk
In prioritising choice and control in the strategy, expectations may be raised to the extent that services cannot meet these
Mitigation
Communicate clearly with all communities and service providers where the limitations of the strategy are
Race
There is some evidence that an increasing number of people with learning disabilities come from black and minority ethnic communities.
Risks
Services may fail to provide appropriate culturally appropriate and sensitive services
Mitigation
We will consult with appropriate groups in the development and evaluation of specifications and will ensure that this issue is part of a continuous improvement plan
Gender
Risks
In the strategy the drive towards independence, choice and control needs to take account of the different needs of women and men.
Mitigation
Better understanding of data taken into account – e.g. are more men than women likely to be on Autistic
Spectrum Disorder or is this a diagnostic issue? In Oxfordshire, more men than women with learning disabilities are known to services: 58% men and 42% women (in line with the whole population of people with learning disabilities in the county).
What the specific needs of men and women with learning disabilities are will be included in service specifications
Rural Communities
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Risks
Differences in access to services for families in rural communities and town and city communities have not been addressed in the strategy.
Budgetary constraints will mean that people with learning disabilities living in rural communities will have access to a reduced service.
In supporting people to use personal budgets to purchase support and care, they will be able to avoid isolation and access opportunities in their local areas, at times they choose.
In developing services that emphasise independence and participation in the community, people with learning disabilities living in rural communities will be supported to access local networks.
Areas of deprivation
The strategy will have no specific impact on people who live in areas of deprivation or these communities over and above what has been outlined above.
Impact on Staff
Risks
The strategy involves a redesign of services that may have an impact on county council staff
Impact on other Council services
Risks
The strategy involves a redesign of services that may have an impact on property in the council and the uses of this. This will impact on the volume of work in this service
Mitigation
In aligning much more of the services for people with learning disabilities with mainstream health services, access for people living in rural areas will be the same as for any other part of the community. This is likely to lead to improved access.
Mitigation
Appropriate engagement and consultation with staff will take place as advised by the Human Resources team
Mitigation
 Early inclusion in the planning process of all the council services that may be affected is part of consultation plan.
A significant amount of work will need to be done to prepare the providers and existing council services in this area for the change at a time when there are already significant financial pressures and staff changes
Parts of the learning disability service that may not be changed at the same

Market preparation work is included in the timetable for the procurement process.

Work levels will be monitored during the transition period of all
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time as other services included in this strategy (day services, for example) may have increased demand as a result of the difficulty some people may find the change in the other services
Impact on providers
Risks other services that may be adversely affected and action taken as necessary.
The strategy involves commissioning of some services through a competitive tender process which poses both risks and opportunities to providers in this field and current providers of council services.
Mitigation
The consultation phase will give providers in this area time to feed into the proposals.
Costs of TUPE and the reputational damage that providers may incur when staff are TUPEd over from other organisations that may not have had the training etc. of that particular provider
Market development work will be done to prepare providers for the change in the service and the new contracts to be awarded.
Oxfordshire County Council will work with providers to manage TUPE costs and training, and method statements will require providers to specify how they manage TUPE issues.
Social Value
If the Public Services (Social Value) Act 2012 applies to this proposal, please summarise here how you have considered how the contract might improve the economic, social, and environmental well-being of the relevant area.
How might the proposal improve the economic well-being of the relevant area?
The introduction of the strategy acknowledges that council services for people with learning disabilities have not always succeeded in enabling these people to have full and independent lives that have meaning and are part of the community. This strategy intends to improve this and focus services on enabling people with learning disabilities to have more independence, to be able to contribute to the economic well-being of the area through services that encourage independence and ambition.
The strategy offers a change that at a time when there will be more demand on services but financial constraints, specifically:
 Recognition that people with learning disabilities can move in and out of service need, and that they do not always need to be accessing support services, especially if those services are focused on a pathway to independence.
 In identifying opportunities to work and volunteer, and purchase care when needed, there will be a reduction in costly over-provision.
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 In integrating health services with mainstream health, with reasonable adjustments, there will an opportunity to streamline these services while ensuring the needs of people with learning disabilities are truly understood.
How might the proposal improve the environmental well-being of the relevant area?
The environmental impact is difficult to calculate as this is a high level strategy that will not have an obvious environmental impact until services have been more fully developed.
Action plan
Develop better/more detailed picture of people with Learning Disabilities and population information, on gender,
Oct 2014 – Feb 2015 Learning Disability Joint
Management Group ethnic groups particularly
Gain better picture of level of service and numbers of people with Learning
Disabilities engaged with services or not and patterns of current use of current services.
Scoping of work for
Reasonable Adjustments
Teams & numbers of people who are in community health services already
Oct 2014 – Feb 2015
Oct 2014 – Feb 2015
Learning Disability Joint
Management Group
Learning Disability Joint
Management Group
Link with strategy on transitions to adult services
Develop communication plan with all stakeholders
Consult with particular groups to ensure culturally appropriate and sensitive services
Consultation to include all council services and staff
Note baseline of current services to aid monitoring of work levels after April
2015 when new strategy starts.
.
Oct 2014 – Mar 2015
Oct 2014 - Nov 2014
Nov 2014- Mar 2015
Nov 14 - Jan 15
Nov/Dec 2015
Learning Disability Joint
Management Group
Learning Disability Joint
Management Group
Learning Disability Joint
Management Group
Learning Disability Joint
Management Group/HR
Learning Disability Joint
Management Group
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Monitoring and review
Person responsible for assessment:
Version Date Notes
(e.g. Initial draft, amended following consultation)
Draft v1 20 October 2014
Draft v5 4 November 2014
- initial draft to N Lachkou, B Leigh; I Bottomley
Consultation draft
Draft v6 Mid-February 2015 Revised draft following consultation
Draft for consultation
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