Independence, Well-being and Choice
Waltham Forest welcomes the vision and values that support “Independence,
Wellbeing and Choice”, but also recognise the challenges to local authorities
and our partners in delivering this agenda.
Consideration of the expectations of different generations of social care
service users, where different approaches to services are taken is needed, as
well as ensuring that people from all communities are able to access services.
Waltham Forest has serious concerns as to whether the vision proposed in
“Independence, Wellbeing and Choice” is cost neutral. Recent findings, in
particular the recent King’s Fund report, indicates that additional funding is
required to deliver care home services, especially in London, and any
additional requirements will further add to this burden.
1. Does the vision for adult social care summarise what social care
for adults should be trying to achieve in the 21st century?
Yes
No
Not entirely
If no, or not entirely, please explain your answer
Whilst the vision encompasses the need to address preventative services, the
vision, as outlined in the paper, does not fully address the continued needs of
adults with complex care needs.
2. Independence, Wellbeing and Choice sets out seven outcomes for
social care:
• Improved health
• Improved quality of life
• Making a positive contribution
• Exercise of choice and control
• Freedom from discrimination or harassment
• Economic wellbeing
• Personal dignity
Are these the right outcomes for social care?
Yes
No
If no, please explain your answer
Concerns have been raised that, following the experiences of “Every Child
Matters”, the outcomes outlined will be difficult to accurately, effectively and
uniformly measure, including measuring user experience and progress against
these outcomes. Development of this vision and how this will be measured
meaningfully (e.g. SMART targets) for service users and organisations will
inform whether these outcomes are deliverable.
3. What are your views about how we can strike an appropriate
balance in managing risks between individuals, the community and
the social care worker?
We will need to ensure that the service user is fully aware of the risks
associated with their decisions, enabling service users to make the decisions
most appropriate to them, and we therefore welcome the protection of care
workers in these circumstances.
The management of risk in the way outlined in the paper will require a
cultural shift, not only in the staff assessing and delivering services but also
the service users, where some adults may be more risk-averse than others.
Where service users are able to refuse residential care, consideration would
need to be taken to ensure that the resources are available in the community
to support these decisions.
It is also felt that further guidance will also be needed to take into account
where an adult is not in the position to make an informed decision about the
management of risk. Likewise where there is a variation in the acceptance of
risk between a service user and a carer.
4. Should we take forward proposals to minimise the need for
people to provide broadly the same information, for instance by
sharing information between agencies such as the local authority
and Department of Work and Pensions?
Yes
No
Please explain your answer
Waltham Forest is one of the pilot schemes for the Joint Visiting teams,
working in partnership with our local Pension Service colleagues. This service
and the information shared has seen tangible benefits for Older People in the
Borough. Age Concern Waltham Forest have also been accredited as an
"Alternative Office", and has enabled further ease of access to these services.
Further Information sharing needs to be underpinned by robust information
sharing protcols, and local services need to be supported to ensure that these
are executed correctly (specifically if information sharing extends to smaller
organisations)
The sharing of information will need to be focussed on the users rather than
systems within the local health economy, to ensure that information is shared
appropriately and within the requirements of the Data Protection Act.
5. We welcome views on modernising assessment and putting
individuals at its centre. We are particularly interested in the
practicalities of self-assessment. Do you think that there should be
professional social work involvement in some or all assessments?
Yes
No
Please explain your answer
Waltham Forest welcomes ensuring that individuals are at the centre of the
assessment, and their perspective is fully taken into account in the
assessment process, extending the principles of Single Assessment. However,
there is a concern that individuals who understand the social care systems in
the borough will benefit more from self assessment than those new to
services, this could lead to vulnerable groups having difficulty accessing
services (specifically, traditionally 'hard to reach' groups, such as individuals
from Black and Minority Ethnic communities). Where individuals are
completing self assessments, there is also a concern that individuals may look
at the services available rather than their need.
It is also a concern that individuals may "assess themselves out" of services,
where service users look at immediate need, and if there are underlying
problems, which social care could assist with, these needs may then not be
recognised.
It is envisioned that the development of self-assessment in the future will be
based around a different model, where more service users are IT literate, and
the possibilities for completing on-line (secure) assessments could be realised.
However, this again could lead to inequity in accessing these services, as
service users would be unlikely to complete on-line returns such as these
when the only access to IT available is in the public domain (e.g. in libraries).
This would therefore exclude people who did not have access to, or
understanding of, IT.
6. Do you have views on whether the Single Assessment Process
(SAP), the Care Programme Approach (CPA) and Person Centred
Planning (PCP) should be further developed to provide a tool for use
with all people with complex needs?
It is felt that the focus of these assessments is currently very different, and
have different aims and perspectives. The extension of the Single
Assessment Model to people with physical and sensory impairments would be
a welcome step. There is scope to bring the ‘contact assessment’ model from
SAP into services for people with learning disabilities and mental health
problems.
Whilst assessment processes will change over the lifetime of this paper, there
is a danger that changing these newly implemented systems could be
problematic.
7. How can we encourage greater take-up of direct payments in
under-represented groups such as older people and people with
mental health problems?
Services such as Direct Payments require a cultural shift, both in the staff and
the service user. Creating a more enabling environment of service delivery
will help this transition. This could be reinforced in training, including greater
emphasis in social work qualification.
One of the barriers to developing Direct Payments for people with Mental
Health problems is the fact that Direct Payments cannot be used to purchase
NHS care. Greater flexibility in this area would help to deliver this agenda. In
addition to this, Direct Payments could be included in the Mental Health
Autumn assessment.
Offering better, co-ordinated support would assist under-represented groups
to access services.
A current issue that may account for older people being underrepresented in
the uptake of Direct Payments is that Older People, when they begin to
receive services may already need a substantial or critical level of care. These
service users therefore may not be able to undertake the additional
responsibilities entailed in Direct Payments. The greater emphasis on
prevention, may improve take up in older people’s services, where services
are delivered at an earlier point in the care pathway.
Waltham Forest is reviewing its procedures and business processes to analyse
the constraints in our system and best practice guidance that prevents the
take up of Direct Payments. Initial findings indicate that the bureaucracy,
timescales and paperwork involved leads to Direct Payments taking twice as
long to set up as providing a direct service and is therefore a major
discouraging factor for assessors, care managers and potential clients. A
reduction in this bureaucracy would therefore be welcomed.
Waltham Forest supports the development of a centralised support service to
deliver Direct Payments.
8. The term ‘direct payment’ can cause confusion with DWP payment
services. What phrase could replace it to allow its purpose and value
to be understood better?
Direct Care Scheme – emphasising the care elements rather than the financial
aspects, as confusion can arise where service users consider an additional
funding stream.
9. We would like views on the proposal to extend direct payments
via an agent to groups currently excluded, namely those unable to
give consent or unable to manage a payment, even with assistance.
Users need to be able to self-select the level of support, for example around
HR and employment issues, as needed. This could be done by extending the
support services already provided, and service users will be able go to the
group for support when required. Waltham Forest welcomes the proposals to
develop a national organisation to provide Direct Payments, streamlining
processes and ensuring that all groups of social care users are able to access
services.
10. We are committed to the introduction of individual budgets to
give people greater control over their lives. We would welcome
views on the proposals to pilot individual budgets.
Individual budgets offer the opportunity to extend choice and improve the
flexibility of services. The use of these flexibilities will need to be closely
monitored to ensure that all communities are able to take advantage of the
opportunities it presents.
The implementation of individual budgets will require some consistency of
budget setting. Concerns have also been raised that block contracts and
economies of scale could be affected by this initiative.
In order to implement these changes, more resources are required, to ensure
that adult social care users are offered real choice, and the funding to be able
to shape that choice.
11. We are proposing to introduce a care navigator/broker model
and would welcome views on these proposals.
It is felt that these are existing skills within the workforce, rather than roles in
themselves, and the re-naming could cause confusion. These skills should
also be reinforced through ongoing training.
What are your views on the skills needed to perform the function
and whether such a model might free social worker expertise to deal
with the most complex cases?
It is felt that the care navigator and broker role is in itself complex. People
with more complex care packages could be assisted by qualified staff, while
people with less complex needs could still benefit from navigation through the
system, and may be assisted by support staff.
12. What do you think will be the impact of shifting the balance of
services from high-level need to earlier, preventative interventions
on the eligibility criteria and what this might mean for Fair Access to
Care Services (FACS)?
We welcome the shift in focus to preventative services, however this will
require double funding for a period of time, as the impact may not be felt
immediately. Clearer, evidence-based models and needs analysis would be
required in order to ensure that the aims of a preventative model are realised.
By shifting to a longer term preventative model, across services, the choice
available for people requiring high level need could be reduced for future
provision, and care would need to be taken to ensure that vulnerable adults
will continue to access appropriate services.
The application of the FACS criteria will be greatly affected, as a 2-tier system
will need to be implemented, if local authorities are to provide both
preventative and reactive services.
Shifting to prevention will also require improved work with other departments,
such as children and families.
13. What is the best approach to strengthening leadership at council
member level?
Provision of training for Members would ensure that there is a better
understanding from an operational level.
A role in inspections could also strengthen leadership (possibly involved in
CSCI inspections in other boroughs).
Building on the ‘corporate parenting’ model adopted for local authorities’
responsibilities to children and young people, a similar model could be
implemented for adults supported by the council. By allowing councillors to
be accountable for the quality of care of adult social care users, and
vulnerable adults as a whole will strengthen leadership. This model should
not be confined to social care services, rather, it should be a council-wide
commitment to supporting vulnerable people.
14. Do you support the introduction of a strategic needs assessment
to inform the development of the social care market?
Yes
No
Please explain your answer
It is felt that a strategic needs assessment for social care cannot be
completed without also investigating health and other services, which support
people with social care needs. A whole systems approach to tackle the
interdependency in the system would be more helpful to address service user
needs.
Supported by the Department of Health, the development of a strategic needs
assessment would improve the understanding and vision for local social care
services for adults. This could also be investigated across the sector, with
neighbouring authorities.
15. How can local authorities stimulate the market to offer a range
and diversity of provision that meets the outcomes demanded by the
vision?
The development of flexible contracts, which are needs led rather than
service led.
Following from the needs assessment, neighbouring authorities could work
together to ensure that needs are met. This may also be developed at a subregional level, working in partnership with organisations such as the Strategic
Health Authorities.
16. Do you support the proposal to develop a strategic
commissioning framework?
Yes
No
Please explain your answer
A strategic commissioning framework would need to be directly linked with
the needs assessment, which again, should be a whole systems appraisal of
the service needs in the area.
17. Is the proposed shift to a preventative model of care the right
approach?
Yes
No
Please explain your answer
Whilst we should be highlighting the need to provide preventative services,
the services for people with complex care needs, will also need to be
modernised, as outlined in question 12.
18. What are your views on approaches to promoting and
developing partnership working across agencies and effective
models for so doing?
Waltham Forest is committed to partnership working, and has forged links
across the sector, with health and other statutory services, and with the
voluntary and community sector. In Waltham Forest, social care services for
adults and older people sit within the integrated health and social care
directorate of the PCT, and we would welcome clearer messages for local
authorities and their partners on partnership requirements.
19. What help and support do local authorities and other social care
providers need to work with people using services and carers to
transform services?
Further information on successful pilots where power has been devolved to
the community, including toolkits would be welcomed.
Best practice and details on existing, effective models would also help us to
further develop our engagement with the community.
20. Do you have innovative models of provision that support the
outcomes of our vision?
Yes
No
If yes, please give details below
Case finding – working in partnership with Age Concern WF, we have
implemented a pilot programme, based on GP practice lists, to send short
questionnaires to older or vulnerable people. These questionnaires have then
been used to assess low level needs that can be easily met (for example
through the provision of one-off pieces of equipment). This programme has
picked up unmet prevention needs, and avoided more complex care packages
being needed in some cases. People who were assessed as needing some
low level support in order to maintain their independence were also put in
contact with other voluntary services, for example the healthy ageing
programme.
Joint Visiting Team – as noted earlier, Waltham Forest’s Joint Visiting Team
is at the forefront of innovation, and incorporates, not only the visiting arm of
the local pension service and community care financial assessment unit, but
Age Concern WF has also been accredited as an ‘Alternative Office’ to give
service users further flexibilities and choice.
21. Do you have views on appropriate performance measures to
encourage the implementation of the vision?
Performance will need to be monitored across organisations, with different
leads for different measures – learning from fully evaluated LAA pilots.
Benchmarks will need to be developed early for partnership monitoring.
The vision outlined relates to 10 to 15 years, and we would welcome
outcomes and targets also reflecting the long-term agenda, with
improvements being measured over the longer term and targets set for
gradual progression.
22. How can central government best enable Local Strategic
Partnerships develop and monitor progress on cross-cutting issues?
As a LAA pilot, Waltham Forest are already working with our partners across
the borough to develop outcomes, with GO support, we would like further
mentoring on the development around cross-cutting issues. Further guidance
would also be welcomed to ensure that new barriers are not created by
working towards shared outcomes within the LAA blocks.
More joined up government at the centre, to reflect local developments,
would also support LSPs and monitoring.
Toolkits for implementation of key areas would help facilitate development.
23. Do you think the direction proposed for strengthening and
developing skills in the workforce is right?
Yes
No
Please explain your answer
In addition, a greater emphasis on core skills, such as literacy, numeracy and
IT skills, in the workforce would assist the ongoing development of our staff.
A ‘skills escalator’ approach to developing staff would strengthen the ability of
the workforce, and enable staff to be able to manage the changes in skills as
staff progress through the organisation. It is also anticipated that this would
have a positive impact on recruitment and retention.
24. How can we improve and better integrate local workforce
planning?
Development of a joint HR training strategy, between the local authority and
local health providers would assist in a joined up approach to recruit and
retention in the local market. Initiating local, joint training where there are
common themes should also be investigated further on a national level.
25. What actions are needed by Government and others to assist
employers in recruiting, retaining and developing the workforce?
Joint training and working with the universities providing social care and
nursing training (e.g. common modules) would help to ensure that new staff
are enabled to understand the interdependence within the health and social
care economy
26. How can we strengthen the links with the voluntary and
community sector, and increase community capacity?
Involvement at the beginning of the strategic needs assessment and planning
stages. Involving the VCS in the delivery and development of services would
also strengthen the links, including involvement in the LSP and LAA
frameworks.
Central departments could also develop plans in partnership with national
voluntary sector organisations, to facilitate local implementation.
Name: Mimi Konigsberg
Job title (if appropriate): Executive Director, Community Services
Organisation name (if appropriate): London Borough of Waltham Forest
Address:
Leyton Municipal Offices
Leyton High Road
Leyton
E10 5QJ
Email address mimi.konigsberg@waltham.forest.gov.uk
Telephone number: 020 8496 5382
Would you be interested in attending a consultation event to discuss
these issues further?
Yes
No