CUMBRIA LEARNING
DISABILITY PARTNERSHIP
BOARD
STRATEGIC COMMISSIONING
INTENTIONS
2010 – 2013
Here to Help
Your county council is here to help in a huge number of different ways. You will
find us lending a hand in all walks of life – from making sure our children get the
best possible education to ensuring older folk get the care they need. We look
after most of the county’s roads, run the fire service, and even register births,
marriages and deaths. We take great pride in providing the best possible service
to the people of Cumbria.
Most of what we do is paid for by the council tax you pay, and overseen by the
councillors that you elect. That’s why we think it is really important that we let
you know how we’re doing.
Our mission is ‘Building pride in Cumbria’ by providing high quality
services to make our county:
Healthier
Improving the health and well-being of adults
Wealthier
Making Cumbria more prosperous
Happier
Improving the life chances and well-being of children and young people
Greener
Creating and protecting a high quality environment for all
Safer
Creating safe and secure communities
Better
Improving council services
Contents
Page
Item
4.
Introduction – from the Chairs
5.
Background
7.
Policy guidance for the new Strategic Commissioning Intentions
10.
About Cumbria
10.
Learning Disability Service Users 2009-2010
11.
Strategic Commissioning (planning with money)
12.
Our In-House Service Provider
13.
Budget Details
13.
Our Approach to Commissioning
14.
Commissioning Intentions
15.
Employment – our intention
16.
Health & Well-being – our intention
16.
Accommodation – our intention
17.
Person Centred Approaches - our intention
18.
Transition; moving on well – our intention
18.
Transport – our intention
19.
Breaking the Cycle – our intention
3
Contents continued…
Page
Item
19.
Reviewing the Strategy
20.
Our Thanks
21.
Appendix A – Useful documents and guidance
23.
Appendix B – Glossary of Terms
25.
Appendix C – Cumbria Learning Disabilities Partnership Board Sub
Group Structure
26.
Appendix D - Circle of Evidence
27.
Appendix E – Equality and Diversity Policy Statement
4
Introduction from the Co-Chairs of the Partnership Board
Although we have made progress over the life of the last Strategy, 2007-2010,
there is still a lot more to do. That is why we are showing our commitment to the
continued improvement of services and opportunities for people with learning
disabilities.
These strategic intentions, September 2010-2013, tell you about the direction of
services and what needs to happen.
These intentions are for adults aged 18
years and over with a learning disability, currently in receipt of services and for
those people who may chose formal support services over the lifetime of this
document.
These strategic intentions have been planned and developed over many months.
They take account of feedback from a wide range of people who use learning
disability services and those who have a keen interest in service development.
The Learning Disability Partnership Board has been working hard to transform
itself over the past year, with a review of membership and themed agendas. The
Board has also established a structure of sub groups who will contribute to the
overall implementation and success of these intentions
The sub groups all feed into the Board’s themed agendas. The Board has web
pages on the Cumbria County Council web site which allows the public access to
information on the activity of the Board and its sub groups.
We hope that these strategic intentions will promote equality, maximise
independence and transform the life experiences of people with learning
disabilities living in Cumbria.
Name
:
Signed
:
Date
:
Approved by Cumbria LD Partnership Board 19 October 2010
Approved by Richard Parry, Corporate Director, Adult& Local Services (20/05/11)
5
Background
In 2007 Cumbria Learning Disability Partnership Board launched its first three
year commissioning strategy in response to an appreciative consultation and
enquiry. The programme of consultation included people with learning disabilities,
their families and carers as well as others interested in learning disability
services.
Key priorities were:
Making the system easier to understand
•
We now share information using plain and understandable language,
including pictures; and
•
However people say “easy read is still jargon and difficult to understand”
and “information sharing is still poor”.
Having the same housing choices as everyone else
•
There are now fewer people living in Registered Residential Care and more
people living in settled accommodation; and
•
Carers said “fewer people living in residential care is not necessarily a
positive move”.
Making it easier to get a job
•
Service providers in Cumbria are working in partnership with employment
agencies to facilitate moves into employment. Contractors and statutory
partners are being encouraged to offer employment opportunities; and
•
People still feel that attitudes to employing people with a learning disability
need to change to break down barriers.
More choice and variety
•
People are now using their resource allocations to meet their support
needs in new and varied ways. Some people are directing the full range of
support they require.
6
Improved support and breaks for Carers
•
Carer’s assessments are identifying their need for breaks and resources
are being made available.
Resources are being made available to meet
this need in new and innovative ways; and
•
People commented on “respite services not being equally allocated” and
“bed blocking is a problem”.
Better health and experiences of health services
•
GP’s now hold registers of people with a learning disability.
All people
using services have access to Health Action Plans and records.
Annual
health checks are available to those who choose to access them.
Community Learning Disability Nurses are available to support people to
access primary and secondary care;
•
Some people said “they had never heard about annual health checks”
while others had been contacted by their GP practice;
•
Work is ongoing to improve access to mainstream mental health services.
In Cumbria, where assessment and treatments are required, these are
now delivered in a new facility; and
•
People said they found it hard to understand how Green Light works and
how this would improve the people experiences of mental health services
More control
•
In some organisations people with learning disabilities are included within
their management structure; and
•
Support planning has enabled individuals to decide on how their assessed
needs can be met
7
Knowing what is going on in Learning Disability services
•
Membership of the Learning Disability Partnership Board is being reviewed.
Sub groups of the Partnership Board, which report on areas such as
health, housing and employment all have Terms of Reference;
•
Valuing People Now ‘Making it Happen For Everyone’ (2008) has helped
the Board to be more focused on outcomes;
•
There is now an “annual report” which is presented at the Partnership
Board’s Annual General Meeting to inform all interested people how things
are going; and
•
People said “The Learning Disability Partnership Board is not well
publicised” and “could improvements be made to the web site so that
people get timely information?”
Policy guidance for the new Strategic Commissioning Intentions
Valuing People Now is a three year strategy which was launched on 19th January
2009. It aims to improve the lives of people with learning disabilities, their
families and carers.
It is based on the belief that people with learning disabilities have the right to
lead their lives like any other people, with the same opportunities and
responsibilities.
The Strategic Commissioning Intentions are based on the objectives set out in
Valuing People Now ‘Making It Happen For Everyone’ (2008) and the findings of
reports Healthcare for All, (an Independent Inquiry Report, 2008) and Cumbria
Checks In’, KoZan (2009).
8
Commissioners for Learning Disability services face a number of challenges these
are:
•
A disproportionate increase in the numbers of adults with a learning
disability who will develop dementia;
•
A rise in the numbers of young people belonging to ethnic communities;
•
An increase in the number of people with learning disabilities engaged with
the criminal justice system;
•
An increase in the proportion of people requiring ground floor/adapted
accommodation due to age and disability; and
•
Caring for family members with learning disabilities who are reaching old
age is impacting on the caring ability and health of families;
•
Increased survival rates among young people with multiple and complex
disabilities;
•
More young people are reaching adulthood with complex and multiple
disabilities;
•
People returning to Cumbria from out of county placements who have a
broad range of support needs which will require accommodation with
support;
•
People with learning disabilities and associated complex needs are living
longer;
•
The forecasted spending pressures linked to overall increase in demand.
We face a number of policy changes through national drivers and the new
coalition Government. These will impact on the current commissioning and
service delivery arrangements and this strategy may need to adapt to the new
circumstances.
9
Some of the key changes are contained within:
•
The Department of Health White Paper ‘Equality and Excellence :
Liberating the NHS’ (2010); and
•
The Department of Health White Paper “Building the National Care
Service” (March 2010).
Both White Papers have a strong focus on preventative services and increased
support at home.
This has a greater impact on the way statutory service
partners meet their obligations and duties.
In addition to these changes we anticipate increased budgetary pressures driven
by the new coalition Government’s commitment to reducing the Country’s
financial deficits. These strategic commissioning intentions will need to adapt to
any new Guidance and Legislation.
10
About Cumbria
Cumbria is made up of six district Councils. Many areas are rural and isolated
with a network of local roads providing transport links and boundaries to main
towns. The M6 motorway serves the County and provides a major north / south
link.
Cumbria has a population of just fewer than 500,000; mainly white, with 4%
from the Black, Minority and Ethnic (BME) backgrounds (mid-year estimate
2007). The learning disability BME population for 18+ based on 2001 census was
at 2.1%. The general population is on average older than that of England.
Prevalence data shows that there are 1,900 people with a learning disability per
500,000 population and this is reflected in the number of people with learning
disability featuring on GP’s registers. It is assumed that some people’s needs are
being met informally or they do not meet Fair Access to Care eligibility criteria
and this is reflected in the number of people known to local authority social work
services.
Learning Disability Service Users 2009-2010
Age
Number
18-49
917
50-64
336
65-74
110
75-84
47
85+
7
No Value
3
Total
1420
Source: RAP Return 2009-2010
Section: Packages of Care
11
Strategic Commissioning (planning with money)
The newly elected coalition Government, formed in May 2010, is pushing forward
its comprehensive spending review of Public Sector services.
At the time of
writing this document the comprehensive spending review outcome was
unknown. However, the review is expected to have a financial impact on Local
Authority and Health services that will require greater consideration about the
way we spend public money.
This will present a challenge as the demand for
services continues to grow. Commissioners will have to ensure that appropriate
services for people with learning disabilities are made available within the given
financial framework.
We will ask Providers, including our statutory provider, to demonstrate that their
provision is person centred and represents best value.
Commissioners will be using financial modelling and forecasting to show how
investing in some new services will reduce cost pressures in the future.
services, which are no longer required, may be de-commissioned.
Other
We will be
pro-active in developing a service market that will ensure services are
continuously fit for purpose and competitive.
We shall be looking for opportunities to invest more in preventative services such
as the third sector, and increasing the use of assistive technology to promote
independence, maximise individual potential and where appropriate, keep people
out of more formal care services.
Commissioners will work with operational staff to embed the Resource Allocation
System (RAS), facilitating a fairer and more equitable system and, enabling
people with learning disabilities to direct their own support.
12
Our In-House Service Provider
Cumbria Care Disability and Mental Health (DMH) service is the County Council’s
in house provider, delivering day services, residential and respite care services
and domiciliary care services to supported living schemes. We will work closely
with DMH to maximise their capacity to deliver a broad range of support.
Day Care
We are aware that there is a high level of satisfaction with regards to day care
provision. Some feedback has indicated that some people would welcome greater
opportunities to access employment and training and we will be asking DMH to
consider ways of increasing these opportunities and support people to move on
from traditional day service.
The day services are able to meet the needs of people with very complex and
profound disabilities and will seek to provide opportunities for this group of people
to have greater access to their community and to maximise their individual
potential.
Residential Care
Although Supported Living will remain the accommodation model of choice for
most people, Residential Care will continue to be a resource for specific groups of
people, in particular, for some people who are at risk of losing their home as a
result of increasing needs, or those people returning to Cumbria following a long
stay in specialist services away from their communities.
Where we require Residential Care to provide care and support for those people
experiencing a range of crisis’, which could impact on their accommodation
arrangements we will look to develop this in-house.
We will further develop Residential Care to provide support to some people
returning to Cumbria who may need a period of on-going clinical intervention
within a regulated environment.
13
Budget Details
For April 2010 to March 2011 the budget available for Learning Disability services
is £47million funded by Cumbria County Council and NHS Cumbria.
How we spend our money
Adult Social Care
Staffing
4%
Transport
6%
Residential/Nursing In Cumbria
18%
Cumbria Partnership
Trust
7%
Advocacy
1%
Residential/Nursing Out of Cumbria
6%
Day Care
14%
Residential Block
Payments
8%
Support at Home
36%
Our Approach to Commissioning
Cumbria has a Section 31 Agreement under The Health Act (1997) that allows
NHS Cumbria and Cumbria County Council to pool monies to buy health and
social care services on behalf of people with a learning disability in Cumbria. This
is known as a Pooled Fund. Following the Valuing People Now Transfer (2009)
contributions to the Pooled Fund budget were adjusted to reflect the increased
financial responsibility of the Local Authority.
Whilst self-directed support aims to change the way services are commissioned it
does not change the legal responsibilities placed on these statutory agencies to
ensure people’s assessed health and social care needs are met.
The Learning Disabilities Commissioning and Contracting Group will make
decisions about what is commissioned, based on needs analysis. The Partnership
Board will be advised of the decisions made with reference to the objectives set
out in the Strategic Commissioning Intentions and Valuing People Now.
14
As part of the commissioning cycle service needs will be evidenced and will inform
future planning and development. Please see appendix D.
1. Analyse: how well things are working?
2. Plan: strategic planning based of evidence of need;
3. Do: procure commission and contract for services and manage the provider
market; and
4. Review: contract and performance monitoring.
Commissioning Intentions
Following consultation and feedback we have now prioritised some key areas
which will make up our Commissioning Intentions.
•
Employment;
•
Health and well-being;
•
Accommodation;
•
Person Centred Approaches including Self Directed Support;
•
Transition; moving on well; and
•
Transport.
15
There are Partnership Board Sub Groups to respond to each intention. The subgroups are task focussed; reporting to the Partnership Board on how well the
statutory partners are doing to meet the commissioning intentions.
There are
other groups contributing to the success of these intentions:
•
Breaking the Cycle; enabling people to return to Cumbria
•
Commissioning & Contracting Group: the senior decision making
group; and
•
Green Light: who are promoting access to generic mental health
services?
Employment – our intention:
To breakdown the cultural barriers which prohibit people with learning disabilities
accessing work opportunities afforded to others in their communities. To equip
people with necessary training skills and experiences to enable them to access
work opportunities.
How:
•
Person centred plans will identify those people wanting to move into
employment;
•
We will ask our contracted service providers, including our statutory
provider of day services, to consider employment as a realistic alternative
to traditional day time activities providing skills and training to facilitate
this;
•
We will work with Job Centres to promote better off for work calculations
to address perceived loss of Benefits; and
•
Cumbria County Council and NHS Cumbria will work with HR Officers
regarding
the
provision
of
employment
organisations.
16
opportunities
within
their
Health & Well-being – our intention
To address the health inequalities experienced by people with learning disabilities
and improve their experiences of mainstream health services.
How:
•
Specialist health and clinical services will be commissioned from Cumbria
Partnership NHS Foundation Trust to support those with the most complex
needs to access health services;
•
People using learning disability services have the opportunity to access an
annual health check from their GP and, if required, be supported by a
health professional;
•
People will be encouraged to have a Health Action Plan to help promote a
healthy lifestyle. Contracted service providers will be expected to help and
improve the health and well-being of service users by utilising these plans;
and
•
There is now a health pathway lead nurse to address the full range of
health
related
needs
of
people
with
learning
disabilities
including
promoting areas such as people’s access to generic mental health services
which will be monitored by Green Light.
Accommodation – our intention
To make available clear information on how to access accommodation that is
affordable for those people intending to live in their own home.
How:
•
We will improve the way we engage with District Councils and housing
providers to develop housing options that meet the needs of people with a
learning disability;
•
To make available accommodation with care for those people with
profound and complex needs;
•
To make available accommodation with care for those people being
discharged from, out of county, specialist services and for those in crisis;
17
•
To make available accommodation with care for those people in crisis and
at risk of losing their home. This will ensure the continued availability of
respite services for planned breaks rather than emergency placements;
and
•
We will ask service providers to work with us in identifying suitable
accommodation and to put forward proposals on how accommodation
needs can be met.
Person Centred Approaches - our intention
We will encourage better use of Person Centred Plans and Support Plans to allow
people to choose and control the way they are supported to enable people to
identify the lifestyle of their choice.
Support Plans will further indicate how
people would like their support delivered, where and by whom.
How:
•
Service providers are required to undertake person centred plans with the
people they support. These will be reviewed as part of contract audit;
•
People with a learning disability will have a clear up to date support plan
that shows how assessed needs are being met using their resource
allocation.
This will demonstrate, in practical terms, how they will use
their budget.
Social Workers will support individuals to develop and
approve their Support Plan; and
•
We will ask providers to work with us, and put forward proposals to
develop innovative ways of delivering support, including the introduction of
Individual Service Funds, to promote independence, choice and control.
18
Transition; moving on well – our intention
To support young people to make the transition to adulthood and to achieve their
maximum potential in terms of education, health, development and well-being.
How:
•
We will work to develop a revised protocol in Cumbria that outlines the
responsibilities of all services and providers for young people moving
through into adult services (aged from 14 to 25 where appropriate), and
points of access to services;
•
We will have clear and accessible information available for young people
with learning disabilities to plan for their transition. Transition Coordinators will support this process; and
•
We will develop a more effective process for sharing information between
the commissioners of services for children and those of adults so that
people’s needs are properly assessed and planned for.
Transport – our intention
To change the way we think about providing and funding transport. This means
people using their personal resources to meet their own transport needs.
How:
•
To encourage the use of personal benefits to access ordinary means of
transport and move away from the dependency on segregated transport
wherever possible;
•
To consider the impact of the County Council’s transport review on people
with a learning disability. To contribute to any re-design representing the
needs of people with disabilities; and
•
People will be encouraged to report incidents on public transport through
the disability hate crime reporting book; this will enable accurate data to
inform appropriate actions.
19
Breaking the Cycle – our intention
To identify, and plan for, people in out of county placements now requiring local
accommodation and support and who wish to return to Cumbria. To identify, and
record, those people who are in appropriate out of area service and do not wish
to return.
How:
•
We will commission Cumbria Partnership NHS Foundation Trust to take a
lead role in supporting people placed out of county wishing to return; and
•
We will develop a pathway to facilitate a smooth transition back to
Cumbria including those people with complex support needs.
Only in exceptional circumstances, for example to meet a very complex clinical
need, would we consider placing a person with learning disability in a service
outside of Cumbria.
Reviewing the Strategy
The Learning Disability Strategic Commissioning Intentions sets out a three year
plan of priorities.
The document provides a basic framework for strategic
planning against which progress can be measured.
The primary responsibility of the Partnership Board is to oversee how the
statutory partners are delivering these intentions. A report will be given at each
Learning Disability Partnership Board Annual General Meeting over the life of the
strategy.
Where areas are highlighted such as resources or Government guidelines,
recommendations will be made to make reasonable adjustments to our
commissioning intentions to address these areas and action plans updated
The substantial review of the strategy will take place during January 2013 for the
period 2013 – 2016.
20
Our thanks
We would like to thank all those who have contributed to the development of the
strategy; special thanks to People First, Mencap Carers Network, and KoZan,
Provider Forum as well as staff from Cumbria County Council, NHS Cumbria and
Cumbria Partnership NHS Foundation Trust.
We would also like to say a big thank you to all those who have attended our
consultation events over the past nine months.
21
Appendix A - A List of Useful Documents and Guidance
Care Quality Commission Strategic plan 2010-2015 – Care Quality
Commission 2010
Commissioning services and support for people with learning disabilities and
complex needs – Care Quality Commission (2009)
Commissioning Strategy 2007-2010 - Cumbria Learning Disability Partnership
Board
Cumbria Checks In – KoZan Consultants (2009)
“Cutting the Cake Fairly” CSCI review of eligibility criteria for Social Care
Disability Hate Crime – Home Office (2009 now archived)
Independence, Well-being and Choice - Department of Health, (2005)
Key Actions for Making Valuing People happen locally and regionally –
Partnership Boards 2009 – 2012 – Department of Health (2009)
Number of People with a Learning Disability in Cumbria – Health and
Wellbeing (2008) Cumbria Intelligence Observatory
Our health, our care, our say - Department of Health (2006)
Person–Centred Approaches – A good practice checklist for commissioners –
Valuing People/Paradigm (2004)
Population Data, People with Learning Disabilities Lancashire and Cumbria –
Pam Thomas (2008)
Relentless Optimism – Creative Commissioning for Personalised Care – Care
Quality Commission (2006)
Service Needs of Today and Tomorrow - Emerson E, Hatton C, Lancaster
University, Health Research Unit (2006)
Six Lives – Local Government Ombudsmen (2009)
Smart Commissioning – In- Control (2008)
22
Supporting Learning Disability Partnership Boards to implement the National
Carers Strategy – DoH (2009)
The Cumbria Carers Strategy - Cumbria County Council
The Cumbria Housing Strategy – Cumbria County Council
The Cumbria Supporting People Strategy 2008-2011 Cumbria County Council
The National Framework for NHS Continuing Healthcare and NHS-funded
Nursing Care - DoH (2009)
Valuing People – a new strategy for learning disability for the 21st century – a
White Paper – Department of Health (2001)
Valuing People Now - from progress to transformation - Department of Health
(2009)
Valuing People Now Delivery Plan – Department of Health (2009)
World-class commissioning for the health and wellbeing of people with
learning disabilities – DoH (2009)
23
Appendix B - Glossary
Acute Care:
Care for a disease or illness with rapid onset, severe symptoms and brief duration
Annual General Meeting:
A big meeting every April when the Cumbria Learning Disability Partnership Board
explains to everyone how well it is doing, and asks for everyone’s ideas.
Assistive technology:
This can be a combination of equipment, monitoring and response that can help
individuals to remain independent at home.
Care Quality Commission (CQC):
The regulator and inspector for all social care services in England
Commissioning:
The full set of activities that local authorities and Primary Care Trusts (PCTs)
undertake to make sure that services funded by them, on behalf of the public, are
used to meet the needs of the individual fairly, efficiently and effectively
Community care:
Care or support provided by social services departments and the NHS to assist
people in their day-to-day living
Direct Payments:
Money given to individuals so that they can organise and pay for the social care
services they need, rather than using the services offered by their local authority
Fair Access to Care:
Guidance issued by the Department of Health to local authorities about eligibility
criteria for adult social care
Independent sector:
An umbrella term for all non-statutory bodies delivering support, including a wide
range of private companies and voluntary organisations
Individual budgets:
Individual budgets bring together a variety of income streams from different
agencies to provide a sum for an individual, who has control over the way it is
spent to meet his or her care needs.
Independent Living Fund:
This is a system of advance payments to a provider of choice to enable
individuals to be supported at times of their choice drawing down from their
personal funds.
Personal budget:
The money made available by the local authority to meet your assessed, eligible
support needs.
Person Centred Plan:
These are plans that outline dreams and aspirations and include issues that are
not related to social care needs.
24
Primary care:
The collective term for all services, which are people’s first points of contact with
the NHS.
Primary Care Trusts:
Free-standing statutory NHS bodies, with responsibility for delivering health care
and health improvements to their local areas. They commission or directly
provide a range of community health services as part of their function.
Secondary care:
Treatments at both in-patient and out-patient clinics in hospitals.
Social enterprise:
Businesses involved in social enterprise have primarily social objectives. Their
surpluses are reinvested principally in the business or community
Supporting People:
A grant programme providing local housing-related programmed support to
services to help vulnerable people move into or stay independently in their homes
Support Plan:
The means by which necessary information is presented to a local council in order
to agree to release funds as a personal budget.
Valuing People Support Team:
A Department of Health team working to improve services for people with
learning disability
Voluntary and Community Sector:
A term referring to registered charities as well as non-charitable non-profit
organisations.
25
Appendix C – The Cumbria Partnership Board Sub Group Structure
Appendix D
Circle of Evidence; with reference to Page 14 above.
27
Appendix E - Equality and Diversity Policy Statement
Equality and Diversity
Policy Statement
The County Council is committed to achieving equality for everyone who lives and works in Cumbria. For this reason we
have signed up to the Equalities Review’s vision for an Equal Society:
‘An equal society protects and promotes equal, real freedom and substantive opportunity to live in ways people
value and would choose, so that everyone can flourish.
‘An equal society recognises people’s different needs, situations and goals, and removes the barriers that limit what
people can do and can be.’
Fairness and Freedom: The Equalities Review (February 2007)
So what do we mean by Equality and Diversity?
Equality
Equality is about everyone having the same chances in life and getting the same access to the services they need.
Diversity
Diversity is about recognising and understanding people’s different experiences. We cannot achieve equality without
addressing diversity.
Equality is not about treating everyone the same
28
29
Here to help
How you can contact us
You can access many of our services through our website Cumbria.gov.uk
Please feel free to e-mail us at information@cumbriacc.gov.uk or call our
switchboard on 01228 606060
Cumbria County Council is committed to providing high quality services. Your
feedback is essential to this and we welcome all comments, compliments and
complaints.
Write to:Customer Services
Cumbria County Council
FREEPOST NWW6059A
The Courts
Carlisle
CA3 8NA
Telephone 01800 121 8800
Email: complaints@cumbriacc.gov.uk
Muriel Nixon
Strategy Development Manager
Learning Disability Pooled Fund
Tel 01228 608319
muriel.nixon@cumbriapct.nhs.uk
If you need this Commissioning Intentions Strategy in another format (for example
CD, audio cassette or Braille) or in another language, please telephone 01228
606510.
31