Adults’ Services Department
Business Plan 2008/09
Version 15
1
Contents
page
Message from the Director of Adults’ Services
1. Introduction and summary
- Business planning in Westminster
- Adults’ Services strategic vision
- Summary of Key Priorities for 2008/09
2. Service profile – where are we now
- Service accountability and scope
- Adults’ Services – service users
- Adults’ Services organisational chart
- Review of performance in 2007/08
- Operating context
3. Priorities and objectives – where we want to be
- Partnership priorities
- Westminster City Partnership
- Local Area Agreement
- LARPs
- Corporate priorities
- One City
- Worksmart
- Equalities
- Go Green
- Adults’ Services priorities
- Adults Transformation programme
- Social care Services
- Commissioning for health and care
- Carers
- Telecare
- Adult Education
- Workforce development
4. Action plan – how do we get there
- Objectives, priorities and performance indicators
- Managing Risk
Appendices
 Appendix 1 –Financial schedules
Version 15
2
Message from the Director of Adult’s Services
Last year was a very successful year for Adults services in Westminster. We
achieved the highest rating in the country from the Commission for Social Care
Inspection for our performance. More importantly we provided a wider range of
services to more people in Westminster than ever before.
The challenges that lie before us are even greater. We know we are facing
unprecedented demand for services and that budgets are limited. We are going to
have to make sure that we make best use of resources and also transfer control over
those resources to the users of our services wherever possible.
In order to do this we have established a Choice and Control Board chaired by a
local disabled person who is a champion for individual budgets and direct payments.
This board will establish the model for individual budgets in Westminster and ensure
that the necessary support is in place for people who wish to manage their own care.
We will also introduce self assessment on line for simple services to help people get
help quickly and easily.
We will have an increased emphasis on safeguarding vulnerable people this year
and our training programmes will ensure all agencies are aware of their roles and
responsibilities keeping people safe.
We now have joint arrangements with the National Health Service for commissioning
and public health and wellbeing. We want to make sure that this year we join up
front line services wherever possible and look at how we can link up with GP
practices to provide one stop services. We will work with rehabilitation services to
make sure we are helping people to be as independent as possible.
We have developed a partnership with Counsel and Care for the Elderly to ensure
that older people who are funding their own care get the best information and advice
when they are making these important decisions.
We have launched our Housing with Care strategy which is an ambitious programme
to make sure our housing for older people is fit for the future. We plan to make sure
that there are increased opportunities for people with learning disabilities to live
locally and as independently as possible.
We have an efficiency programme which is part of the Council’s WorkSmart initiative.
We are planning to introduce electronic monitoring of services wherever possible
and electronic access for people who prefer this. Staff roles will need to change to
reflect the new work for Adult Social Care and we will develop our workforce strategy
with providers to make sure we have the right staff for the future.
Our Every Older Person Matters programme has won national recognition and we
plan to ensure that Council departments and partners continue to make their
services respond to the needs and demands of older people. Westminster City
Partnership will focus on reducing the health inequalities currently present in
Westminster and our Adults’ Services Department will be assisting to co-ordinate the
response to this. We will use the Joint Strategic Needs Assessment to identify
priority areas for action in 2008 and inform future commissioning.
I hope you enjoy reading our Business Plan and would welcome your comments on
our proposals.
Marian Harrington, Director of Adults’ Services
Version 15
3
1. Introduction and summary
Business Planning in Westminster
The Business Plan is a key part of Adult Services overall performance management
framework, providing a structure for discussion and scrutiny of performance at all
levels of the organisation. The plan sets out the key strategic priorities for 2008/09,
detailing the resources available to achieve them, activity to be undertaken and
performance measures that will be used.
Our close partnership working with Westminster Primary Care Trust and continuing
closer integration of services, is reflected in the alignment of priorities between this
Plan and the PCT Operating and Business Plans for 2008/09. Business Planning is a
key process which assists us to provide the best possible services for local people
which meet their needs and continually improve performance. Across the Council
there is a three-year financial planning process which is part of the annual Strategic
Review which determines the resources available to support the delivery of priorities.
The diagram below shows the key milestones in the annual business planning cycle.
Westminster’s Performance Management Process 2008-09
LAA Programme
agreements signed off
Business
Plans 09/10
completed
Leader’s Speech
LAA agreed
Strategic
Review
February
sets out Leader’s vision,
corporate aims
and priorities
Westminster
Performance Plan
Estimates, Service
Plans and review
programme
agreed
Q3 Key Performance
Indicators & LAA
monitoring
Changing Priorities
Quarterly Performance
Monitoring
January
Business
Planning
09/10
started
Quarterly reporting of
service plans
and reviews
CAA
Use of Resources,
Risk assessment,
Direction of Travel
statement
m
ce
De
M
ay
rch
Ma
Budget and
Council Tax
agreed
RSG
announced
Review of
2007/08
performance
April
r
be
Management
letter & Audit
report
City Survey
r
be
m
e
v
No Star Chamber
proposals finalised
October
ne
Ju
Publication
of BVPP
Annual Review and
assessment of existing
performance measured
against key PI’s and
the new priorities
July
Q1 Key Performance
Indicators & LAA
monitoring
Setting Budget
Options
Consultation on
new One City priorities
Closing of
accounts
Growth and savings
options agreed
Mid year
review
Se
pt
em
Au
gu
st
be
r
Audit of BVPP
and key Performance
Indicators
The implementation of the business plan is closely monitored and reviewed through
out the year. A quarterly performance information report is prepared for Health &
Community Services Overview and Scrutiny Committee. Progress against priorities
and performance indicators is reported to the Cabinet member, Senior Management
Team and to Corporate Management Board on a monthly basis and there is regular
reporting at an individual service level.
A new performance report will be produced for the Health and Care Network which
will show progress against the new National Indicator set for health, well being and
social care.
Version 15
4
Adults’ Services - Strategic Vision
Mission Statement
We will ensure that all adult residents of Westminster have the opportunity to
achieve the best possible health and well being, are able to have as much choice
and control in their lives as they wish, are able to make an active contribution to the
community and are free from discrimination or harassment.
Key objectives
Improved health and emotional well being: We want people to enjoy good
physical and mental health (including protection from abuse and exploitation),
access to appropriate treatment and support in managing long-term conditions
independently and opportunities for physical activity.
Improved quality of life: We want to ensure access to leisure, social activities and
life-long learning and to universal, public and commercial services for adults with
social care needs. This includes security at home, access to transport and
confidence in safety outside the home.
Enable people to make a positive contribution: We want to encourage active
participation in the community through employment or voluntary opportunities and
involvement in policy development and decision-making.
Enable people to exercise choice and control: We want people to have as much
choice and control as they wish to help them achieve maximum independence.
Enable freedom from discrimination or harassment: We want to ensure equality
of access to, and experience of services for all groups and communities and that
people are free from abuse and bullying.
Improved economic well-being: We want to ensure the economic well being of
people so that they have access to income and resources sufficient for a good diet,
accommodation and participation in family and community life and are able to meet
the costs arising from specific individual needs.
Ensure people are able to live with personal dignity: We want to ensure that
people are able to maintain self respect and enjoy a comfortable, healthy and safe
environment.
Ensure that we commission effectively: We will work with local and other
providers to ensure that services available in the City and commissioned from
outside, are designed to achieve improved outcomes, are of good quality and offer
value for money; ensuring that existing needs are met and future needs of residents
effectively planned for.
Demonstrate effective leadership: The Council is committed to providing strong
leadership to achieve consistent, sustainable and effective improvements in all
services across the City to help achieve improved outcomes for adult residents.
Workforce development: We are committed to working with our partners to develop
a competent and confident workforce that will enable the achievement of improved
outcomes for residents.
Version 15
5
Summary of Key Priorities for 2008/09
Adults Services contributes to a wide range of plans aimed at improving the health
and well being residents. Our priorities are informed by these plans by the Council’s
One City initiative; Westminster City Partnership priorities, the Westminster Primary
Care Trust Operating and Business Plans; national priorities set by central
Government; and importantly what local residents have told us. Our key priorities for
2008/09 are summarised:
 Meet key targets in the Adults Services Transformation Programme to ensure
services are redesigned to meet future needs and expectations of residents.
 Place a stronger emphasis on prevention keeping people fit, healthy and well
with earlier intervention where necessary with a focus on re enablement.
 Enhance signposting, information and advice services to encourage residents
to access services which can help support them, earlier.
 Contribute to the delivery of the One City policy through delivering the next
phase of the Every Older Person Matters initiative; with an increased
emphasis on keeping older people fit and well and independent of health and
care services.
 Use the opportunities provided through the Westminster City Partnership and
Local Area Agreement to reduce health inequalities.
 Ensure greater personalisation of services with more choice and control for
individuals.
 Establish User led Choice and Control Board, introduce self assessment
evaluate our individual budgets pilot and achieving a step change in the rates
of people accessing self directed care.
 Develop more integrated services with the PCT to support people with long
term conditions.
 Publish our initial Joint Strategic Needs Assessment with the PCT and
develop the process to inform the development new commissioning priorities
and evaluation of outcomes.
 Develop a more flexible and responsive range of local services available to
support increased personalisation.
 Work with the voluntary sector to enhance their role in service provision to
meet local needs.
 Work more closely with the NHS partners to develop more integrated
approaches and services, deliver greater efficiencies together; achieve shifts
in resources into the community and preventive services and use buildings
more effectively.
 Achieve further increases in the rates of people with disabilities helped into
employment and mainstream services.
 Review safeguarding policies and continue to ensure that safeguarding is
regarded as a high priority by all agencies in Westminster.
 Continue contribution to WorkSmart through rolling out Electronic Social Care
and flexible and mobile working to all adult services.
 Modernise the adult education accommodation.
 Contribute to the Families at Risk review particularly in relation to mental
health services and substance misuse issues.
 Deliver planned efficiencies through the Transformation Programme,
WorkSmart, further integration with the PCT and effective commissioning.
 Develop the local care workforce so that expert staff deliver more of what
they’re qualified to do, with better use of IT, and work across departments and
partner organisations.
 Contribute to the City Council’s ‘Going Green’ initiative
Version 15
6
2. Service profile – where we are now
Service accountability and scope
Cllr Ian Adams is the Cabinet member with responsibility adults’ services and health
and Marian Harrington is the Director of Adult’s Services. The Adults’ Services
Department was established in 2006 to meet the statutory requirement to establish
the post of Director of Adults’ Social Services (DASS) reporting to the Chief
Executive, and to create a leadership structure that would enable the Council to
deliver its ambitions to achieve further improvements in outcomes for residents and
meet national priorities. The service is divided into four main parts in additional to
cross cutting support services.
Social care services
Zena Deayton is the Assistant Director, Adults Social Care. These services work with
some of the most isolated, frail, disabled and vulnerable residents in the City. they
provide assessment and care management for all adult care groups arranged in
locality-based teams. Where the needs of people meet our eligibility criteria,
(‘moderate’ or above Fair Access to Care criteria) the teams arrange services to
support them and regularly review care to ensure that it continues to be appropriate.
For people with lower levels of need information, advice and some preventive
services are available to meet certain needs. The teams work in a person centred
way, meeting performance targets and monitoring delivery by providers. Through
their detailed local knowledge and case management, the teams have a role in
influencing commissioning.
Adult social care services for older people and adults with disabilities are organised
to cover three localities, north west, north east and south. Each locality works in a
generic way with designated specific workers for disability and HIV and mental
health and older adults. There is also a Health Services team based at Imperial
Hospital Trust which provides an assessment and care management service to
people who are admitted to hospital which ensures that effective discharge planning
and re enablement arrangements are made.
A Housing with Care team, which includes Community Support Officers, providing a
preventive service to older people with lower levels of need. Services to help keep
people independent in their own homes include personal and home care, extra care
housing, escorting and shopping, home bathing, equipment and adaptations,
assistive technology services, such as alarms. These services work closely with
community health services and in particular Westminster rehabilitation service
managed by the PCT and joint funded with the City Council which focuses on re
enablement.
Westminster’s Community Mental Health Teams (CMHTs) arrange support to adults
with serious and enduring mental health needs. The teams are fully integrated with
Central North West London Mental Health Trust and are co-located and operate in
three localities across the City. The teams are fully multidisciplinary with care coordinating staff, either specialist social workers or Community Psychiatric Nurses.
The Approved Social Work service is provided through the CMHTs. Crisis resolution,
assertive outreach and early intervention teams are also operate across the City.
A Joint Homeless team provides a specialist outreach, assessment and care
planning to vulnerable adults with mental health needs who are homeless.
Version 15
7
The Community Services team for people with a learning disability is an integrated,
City wide team of health and social care staff who assess and arrange services to
support people at home or in residential care. The team also offers a range of
specialist health provision such as nursing, psychology, occupational therapy,
physiotherapy, psychiatry and speech and language therapy. The Day, Specialist
Residential, Employment & Short Break Service, covers services that the Council
and Primary Care Trust directly provide for people with learning disabilities.
There is a specialist care management team for people with substance misuse
needs , which provides an assessment service leading to a range of treatment
options for people with drug and alcohol related problems. The funding for the team
and budgetary controls are governed through a Section 31 agreement creating a
pooled budget.
Following a review of current arrangements proposals are being developed to
provide a specialist team working with other vulnerable adults, for example people
with complex needs and those that do not easily fit into the eligibility criteria of
existing services.
Commissioning services
Cath Attlee is the Assistant Director of Joint Commissioning Care & Health, a joint
position with Westminster PCT. This section of the Department leads on strategic
commissioning across all care groups, social inclusion, management of local
markets and maintenance of local services, compliance with the Council’s
Procurement Code, and the management of care contracts, service agreements with
and grants to, the voluntary sector. It brings together commissioners for all adult care
groups alongside the contracting and procurement functions and the management of
relationships with corporate services.
The section includes a number of joint, integrated commissioning teams with the
PCT including; mental health, learning disability, Drug and Alcohol Action Team,
older people and physical disabilities.
We commission a wide range of services for adults which help promote their
independence so that they can remain wherever possible in their own homes. These
include home care and personal care services, a range of day opportunities including
help for people to access employment, education, leisure services, and supported
housing services. We also arrange services designed specifically to meet the needs
of carers including a range of respite, sitting services and other forms of support and
opportunities. Where people can no longer be supported at home we arrange
residential and nursing home care for them.
The Supporting People commissioning team is based within the Housing Department
but works closely with the care group commissioning teams in managing contracts
with housing with care providers and in the development of new services.
Public Health & Well Being
Tessa Lindfield is the Assistant Director for Health and Well Being, this is a joint post
with Westminster PCT. This part of the Department leads on promoting the health
and well being of the whole Westminster population in conjunction with the Director
Public Health through community needs assessment, addressing health inequalities,
and health promotion, prevention and protection.
The section is responsible for delivering the health and well being agenda described
in Our Health, Our Care, Our Say, health promotion, partnership working including
health scrutiny, linking with planning, including the Local Area Agreements and the
Version 15
8
Council’s responsibility for the psycho-social response to emergencies. The section
has strong links into the Public Health Intelligence and leads on the development of
needs assessment.
Adult Education Service
Barbara Holm is the Head Westminster Adult Education Service. The vision of of the
service is to ‘inspire and develop our community through learning’. It is one of the
largest, local authority adult education services in the country. It offers a very diverse
curriculum range with over 1,000 courses delivered to 12,000 learners each year.
WAES is a community focussed service delivering courses in over 80 venues across
Westminster. A large part of the provision is aimed at the most disadvantaged
individuals and communities. Around half of the service’s work is focussed on
preparation for life programme in ESOL, literacy, numeracy and ICT.
The Service is also now focussing on meeting the needs of local employers by
providing training and skills development to people in work. There is an increasing
demand for this as the skills needs of employers continue to rise.
Support services
Finance and accountancy support is provided through the Corporate Finance
Department with a dedicated Assistant Director for adult services and housing and
adult services accountancy team. The Workforce Development and Quality
Assurance team works across both Adult’s and Children’s Services to shape and
develop the workforce we need for the future and to collect customer feedback
through the statutory Social Care Complaints function. The Strategy & Performance
team provides support to the Director and Assistant Directors. It is responsible for
the co-ordination of strategic performance management, management information,
co-ordinating development of strategies, research and analysis to support the work
of the Department.
Version 15
9
Adults’ Services in Westminster – service users
People supported
at March 2008
People supported at home with care managed services
Older people
Physical disabilities
Mental health
Learning Disabilities
Substance Misuse
Other vulnerable adults
4,245
2,488
595
830
267
15
50
People supported in self directed care (DP, In Control, IB)
Older people
Physical disabilities
Mental health
Learning Disabilities
Other vulnerable adults
Carers
352
125
145
13
40
4
25
People supported in residential placements
Older people / physical disabilities
Mental health
Learning Disabilities
788
337
246
205
People supported in nursing home placements
Older people / physical disabilities
Mental health
Learning Disabilities
324
275
40
9
Older people / Physical disabilities
Mental health
Learning Disabilities
358
40
133
Voluntary sector support
323
People supported with preventive services in the community
Older residents
Younger adults
1,348
1,118
People supported in housing with care services
Older residents
Younger adults with disabilities or mental health problems
Single homeless & rough sleepers accommodation
2,184
531
809
Adults using Adult Education Services
9,000
Version 15
10
DIRECTOR OF ADULT SOCIAL SERVICES (DASS)
Director of
Finance
Support Officers x 3
Assistant Director
Finance, Adult Social
Care and Housing
Assistant Director
Social Care Services
Adult Services Manager – North West
Head of Adults Finance
Assistant Director Joint
Commissioning (Care &
Health)
Assistant Director
Public Health, &
Wellbeing
Health and Wellbeing
Policy Manager
Commissioning Manager
Older People & Phys Dis
Public Health Co-ordinator
Head of Joint Service
Development (Mental
Health)
Head of
Workforce
Dev’t and
Quality
Assurance
Adult Services Manager – North East
Head of Financial
Services and Systems
Adult Services Manager – South
Adult Change
Project
Manager
Health Services Manager
Commissioning Manager
Learning Disabilities
Vulnerable Adults’ Services Manager
Commissioning Manager
DAAT/Subs Misuse
Mental Health Services Manager
Learn Dis Service Manager –
Community Health and Care Mgt
Westminster Adult
Education Service
Learn Dis Service Manager –
Day,
Head of
Strategy, and
Performance,
Adult Services
Emergency
Planning
Officer
Head of Contracts and Vol
Sector Partnerships
CSI client and property
manager
ICT Business
Relationship
Manager
Housing with Care Manager
Westminster Primary Care Trust
Version 15
11
Review of Performance in 2007/08
Westminster is recognised nationally as a high performing Council achieving an excellent
rating in the Comprehensive Performance Assessment in 2008. Adult’s services have
consistently achieved excellent external ratings.
Our social care services were assessed by the Commission for Social Care Inspection
against Our Health Our Care Our Say outcomes in 2006/07, we achieved the highest
rating in the country, only equalled by two other authorities. The judgement and ratings for
Westminster against each outcome are set out below:
Area of judgement
Delivering outcomes
Improved health and well being
Improved quality of life
Making a positive contribution
Increased choice and control
Freedom from discrimination and harassment
Economic well being
Maintaining personal dignity and respect
Capacity to improve (combined judgement)
Leadership
Commissioning and use of resources
Star Rating
Grade
awarded
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Excellent
Good
Excellent
3 stars
Other performance highlights in 2007/08
• Continued strong Corporate and political support for adult services.
• Further established the new Adults’ Services Department, including more joint
senior posts with health.
• Successfully delivering the Council’s Every Older Person Matters initiative, with
measurable action plans in place across key Council services achieving positives
outcomes for older residents.
• CSCI noted 54 key strategic strengths in how we were improving outcomes for adult
residents; seven areas for further development (all now been addressed).
• From a high baseline, demonstrated improved or maintained performance against
all key national indicators used to evaluate adult services by CSCI.
• Commenced our ambitious Adult’s Services Transformation Programme, a ‘gold
star’ WorkSmart project, to radically redesign services to improve outcomes for
residents, create more personalised services, meet the policy, demographic and
financial challenges ahead.
• Reorganised care management services creating a more generic service not based
on age, whilst maintaining expert specialists.
• Substantial increase in the rate of people on direct payments giving them more
personalised services, choice and control.
• Adult services priorities continued to feature in the Local Area Agreement and
Neighbourhood Renewal Fund successfully used to develop our Healthy Futures
initiative based on a deprived estate; expand our approach to prevention for older
Version 15
12
•
•
•
•
•
•
•
•
•
•
•
people, people with low level mental health needs, people with alcohol problems,
people with diabetes and carers.
Published and commenced implementation of our joint strategy for older adults with
mental health needs.
Continued to develop service level agreements with voluntary sector organisations,
with specified outcomes to improve quality of life, health and emotional well being.
Helped more disabled adults achieve economic well being by helping them into
employment, work like settings and use of ‘job carving’.
Achieving our ‘stretch’ target for supporting more carers with their own services.
Taking forward plans to develop the next phase in extra care housing for older
people and develop older people’s ‘hubs’ providing improved access to services
locally.
Further development of intermediate care and rehabilitation services with PCT
partners reducing emergency admissions to acute care and the development of
specialist services.
From a high base increased the number of people in receipt of telecare services in
their own homes and developed a number of innovative projects for people with
particular needs.
Continued good performance of the Westminster DAAT in meeting national targets
and local needs of people who have problems with substance misuse.
Taken forward work to provide a new adult education unit as part of the Pimlico
School rebuild.
Achieved an excellent outcome of the Audit Commission, Supporting People
inspection; reflecting close working relationships between the Adults Services and
Housing departments.
Again established Westminster as an Employer of Choice with excellent and
consistent standards of management by maintaining our Investor In People (IIP)
badge across Adults’ Services.
Financial performance
In 2007/2008 Adult’s Services effectively managed considerable demand from some
services to achieve a projected outturn of within 0.7% of budget with a projected
overspend of £607k. The table below shows the projected outturn by care group against
the revised estimate.
Service Area
Budget
Year End
Variance
£k
Prediction
£k
£k
Older People
39,862
40,237
375
Physical Disabilities
9,985
10,305
320
Learning Disabilities
16,623
16,433
-190
Mental Health
12,719
12,834
115
Failed Habitual Residents
1,076
1,063
-13
Service Strategy & Support
4,142
4,142
0
Services
Westminster Adult
307
307
0
Education Services
Total
84,714
85,321
607
The overspend (of 0.7%) was caused by a number of pressures including:
Version 15
13




impact of the single status agreement for staff in the City Council’s residential
homes for Older People - £250k
increase in the number of referrals for occupational therapy and equipment to help
people remain living at home independently - £360k
additional staffing costs arsing from the re-organisation of Adults Services covering
teams for older and disabled people.
higher numbers than planned of people requiring support of mental health services
Operating context
National priorities and guidance
The 1998 White Paper, Modernising Social Services, set the direction for reform and
aimed to ensure that adult social care services in England:
• improved consistency and quality of provision;
• integrated provision with health services and non-statutory provision;
• improved access for both service users and carers;
• introduced more personalised models of care.
In Independence, Well-being and Choice, the goals of the social care modernisation
agenda were framed in terms of a clearer focus on the outcomes described, alongside
continued concern with the protection of vulnerable adults, and the
targeting of services in a resource-constrained environment.
Our Health, Our Care, Our Say
The Government published the White Paper Our Health, Our Choice, Our Say; a new
direction for community services in January 2006. The requirements set out in the paper
form the blueprint for the future direction of adults social care and community health
services, representing a significant shift in the focus of how services are commissioned
and delivered. The Paper emphases the need to:











improve outcomes for vulnerable adults
promote more choice and control, enabling greater independence and personalisation
of services
promote well-being and prevent ill health
achieving a shift to a more preventive approach
supporting people with long term conditions effectively at home
achieving a shift from intensive social care and acute health services
enabling vulnerable people to access mainstream services
greater integration between health and care services, streamlining access and service
delivery to improve
protect vulnerable adults;
change the culture of care;
modernise the workforce.
To achieve the ambitions of the White paper will require closer partnership and integration
between local authority, health, providers and voluntary sector services. A more
integrated, seamless future for health and social care services will require investment in
Version 15
14
health and social care workforce development and the development of more integrated
frontline services delivered in more convenient ways for individuals.
Commissioning framework for health and well-being
The commissioning framework for health and well-being provides commissioners of health,
social care and well-being services with a framework for:
 identifying current and future health needs;
 jointly planning services;
 engaging in a dialogue with local people and service users about the future
development of services;
 engaging with providers of services to ensure that services are appropriate, effective
and outcome-focused.
The framework is an important new tool for the further alignment and integration of
commissioning for health and care into a coordinated framework, focused on outcomes,
tailored to meet local needs. Particular implications for implementation locally will include:




Support the move from a medicalised view of health and well-being, to considering the
social, economic and environmental determinants of ill-health
Agreeing a definition of well-being to support commissioners in commissioning services
to achieve it
Considering how empowering GPs to commission social care will work in practice
Decommissioning of services. The framework sets out an expectation of evidence
based decommissioning of services to generate resources to support the
commissioning of preventative services.
Putting People First
Putting People First was launched by the Government in 2007, it sets out a shared vision
for the transformation of adult social care, and establishing a collaborative approach
between central and local Government, the sector’s professional leadership, providers and
the regulator.
The aim is to ensure that people, regardless of illness or disability, are supported to
 live independently
 stay health and recover quickly from illness
 exercise maximum control over their own life and where appropriate the lives of
their family members
 sustain a family unit which avoids children being required to undertake
inappropriate caring roles
 participate as active and equal citizens both economically and socially
 have the best possible quality of life irrespective of illness or disability
 retain maximum dignity and respect
Local authority leadership is to be accompanied by partnership working with the NHS,
other statutory agencies, third and private sector providers, users and carers and the wider
local community to create a high quality care system which is fair, accessible and
responsive to the individual needs of service users and their carers.
Version 15
15
Social Care Green Paper
In the Comprehensive Spending Review in 2007 the Government signalled their intention
to publish a new Green Paper on the future of Social Care, this is expected in late 2008
and will contain proposals for the future funding and shape of adult care services.
Changing demography
There are currently 210,000 residents aged 18 and over in Westminster, 195,200 are aged
20-64 years and over 25,100 are aged 65 or over, with 8,900 aged between 75 to 84
years and over 3,000 aged over 85 years. Population projections show that Westminster’s
population will continue to grow in the coming years with the adult population aged over 20
years increasing to 247,000 by 2011. Within this overall increase there are expected to be
between 1,900 and 2,000 more older residents and 24,300 adults aged 20-64 years.
Currently 0.22% of resident adults aged 18-64 years, 6.8% of older people aged 65 to 74,
16.1% of those aged between 75 and 84, and 43% of those aged 85 and over are
supported with a social care service and receive care management.
The changing size and make up of the local population is in itself a challenge. The
Wanless Social Care Review ‘Securing Good Care for Older People’ demonstrated that
over the next decade and beyond, current funding arrangements for social care services
are unsustainable, by 2010/11 in Westminster we estimate that an additional c.480 – 500
adults will require support, placing increased pressure on services designed to help people
stay independent.
High levels of migration from and to other London boroughs, the rest of the UK and the
world is particularly significant. Westminster has the highest volume of international
migration per 1,000 population of any LA in the UK with over 9% either arriving from or
leaving to go to another country between 2001 and 2006. Overall annual population churn
is around 25%. (ONS Ad-hoc migration Paper, 2007). The resident population is highly
mobile and there are significant cross-border flows in relation to the use of health, care,
employment, education and leisure services, which represent particular challenges to
improving the health and well being or residents and planning health and social care
services.
There are significant health inequalities in the City reflected in significant difference in
mortality rates for different social classes and genders in different parts of the City. The
recent Index of Deprivation shows that Westminster is ranked 69th most deprived out of
354 districts in England (now 7th most deprived London borough on the ‘rank of local
concentration’).
As the population is set to grow, we expect the proportion of older and younger adults with
specific care needs to grow also. Currently there are approximately 1,800 older residents
suffering with severe dementia (likely to grow to x,xxx by 2011) and about 11,250 who are
physically frail, these numbers are expected to grow to x,xxx and x,xxx respectively by
2011. Numbers of people with a limiting long term illness are likely to rise from 32,000
residents to around xx,xxx, with similar rises in the number of people registered with GPs
in the City who suffer from a long term condition e.g. coronary heart disease from 5,000 to
x,xxx; diabetes 6,200 to x,xxx, and asthma 7,900 to x,xxx.
Version 15
16
Locally there are over 500 adults known to services who have a learning disability. At
present around 9,000 residents have a severe disability with 6,500 people of working age
in receipt of the Disability Living Allowance. Currently there is a high level of people with
disabilities on incapacity benefit; a key challenge is to help more people with disabilities
back into work.
At any one time between 16 - 25% of the general population are likely to have a common
mental health problem and about 800 people are likely to be suffering from a psychotic
illness such as schizophrenia or manic depression. Local Community Mental Health
Teams typically work with around 3,000 people who are subject to the Care Programme
Approach, of whom around 850 are likely to be on enhanced CPA. The high incidence of
mental health problems locally creates particular cost pressures on budgets.
Over a 1,000 residents are diagnosed as having HIV and the latest estimates suggest that
around 1 in 30 people aged 15-49 years have problems associated with their use of drugs.
Westminster is characterised by a high proportion (nearly 50%) of single person
households, so there is high potential for increased social isolation for some residents.
However, there are a significant number (around 12,000) unpaid carers who provide
valuable support to help others stay independent at home; as many as 3,500 provide 20
hours or more of support per week . A key challenge is to provide effective support to this
group to enable them to continue to undertake their caring roles and enjoy a fulfilling life.
Consultation, engagement and involvement
User and carer involvement is at the centre of our approach to planning and delivering
services. We use a comprehensive range of mechanisms to ensure effective user and
carer consultation and feedback to measure satisfaction and outcomes we are achieving.
Within the Health & Care Network, each care group specific partnership board includes
user and carer representation and participation, with links to wider reference groups.
During the coming year we will be establishing a Local Involvement Network. We make
use of the corporate processes such as the City Survey, Area Forums and LARPS to gain
feedback from adult residents about their concerns. A range of user surveys were
undertaken during the year which focused on what outcomes different interventions and
support are achieving.
In 2007/08 we undertook survey of older residents the results of which have been used to
inform the next phase of Every Older Person Matters, supported the Helping Older
Peoples Empowerment study and undertook a survey of the outcomes people achieved by
the use of equipment.
We have well developed quality assurance systems in place as part of contract monitoring,
these are used to make sure concerns about service quality are acted upon and resolved.
The annual complaints report demonstrates how issues raised through the complaints
process are addressed and taken into account when developing services.
In order to fully engage different groups of vulnerable adults we continue to developed
specific approaches to involvement and consultation, these include multi media work with
people with learning disabilities through to user focused monitoring of services for people
with mental health needs.
Version 15
17
Financial challenges
There have been several significant changes to the funding for Adults’ Services
announced as part of the Governments Comprehensive Spending Review and grant
settlement in 2007, which will influence the funding available for 2008/2009 and the
following two years.
The first is the full implementation of new distribution formulae for adults and children’s
social care which has had the effect of reducing London’s underlying social care funding
by £420m. The reduction for Westminster is equivalent to £25m in grant terms before the
application of overall floor damping or 40% per resident child (for children’s services) and
25% (£8m in monetary terms) per 18-64 year old for younger adults’ services. This
reduction has had the effect of putting Westminster at the floor for grant increases in
2008/09.
The current indicator used in the low income adjustment element of the older person’s
formula is the proportion of older people living in rented accommodation. From the
2008/09 settlement onwards, this will be based on the proportion of older people receiving
income support or pension credits. Westminster has a low benefit take up rate in general
so this option is disadvantageous and has reduced Westminster’s underlying grant by
around £1m.
The revised 2004 based Sub-National Population Projections have been used for the
2008/09 to 2010/11 settlements. No allowance has been made for short-term migrants or
other population pressures faced by London boroughs including Westminster. This has
resulted in a reduction of the estimated adult population aged 18-64 years and has, along
with the full implementation of the new distribution formulae above, resulted in the Council
receiving less adults and specific grant income than it otherwise would have done.
There have been significant changes to the grants received for Adult Services. Both the
Access and Systems Capacity and Delayed Discharges grants have been subsumed
within the formula grant from 2008/2009 and will add £3.6m to the base budget. A further
seven specific grants totalling £4.1m will be subsumed within a new non ring fenced
general grant known as the Area Based Grant (ABG). The ABG comprises most of the
grants currently paid through the local area agreement pooled grant which will no longer
exist next year plus the vast majority of the Council’s funding for youth services, adults and
children’s social care. It is completely un-ring fenced and the entire sum can, in principle,
be spent on anything the Council wishes. It is therefore for the Council to decide
corporately how this money is spent to meet local and national priorities including Local
Area Agreement targets.
The Government has agreed the need to explore options for the long term funding of the
care system to ensure that it is fair, sustainable and unambiguous about responsibilities of
the state, family and individual and has announced the intention to produce a Green Paper
setting out the key issues and options for reform later this year.
The Government is also currently consulting on policy changes for learning disabilities and
one of proposals is that funding and commissioning responsibility for learning disability
social care services transfers from the NHS to local government.
Version 15
18
Financial resources for 2008/09
The net Adults’ Services budget for 2008/2009 is £95.5m and includes:
£45.4m
£11.1m
£18.9m
£12.5m
£1.6m
on services for older people
on services for adults with a physical disability
on services for adults with a learning disability
on services for adults with mental health needs
on services for adults with substance misuse needs
This includes planned growth of £1.9m covering the increased number of people we aim to
support with self directed care, the increasing demand for and cost of residential and
nursing home placements, for older people, people with a physical disability, people with
HIV, people with a learning disability and people with a mental health needs. There is
additional new investment of £125k to develop a social network and self support service
for older people. To cover increased workforce costs associated with the ‘single status’
agreement and legislative changes to the statutory minimum holiday entitlement for staff
there is some further growth.
Savings and efficiencies of £1.4m are planned in 2008/2009 and these will be achieved by
increasing our collection of income and from efficiencies from the WorkSmart and Adults’
Transformation programme.
In order to support the transformation of adult social care the Government has made
available a new ring fenced Social Care Reform Grant to help Councils to redesign and
reshape their systems over the next three years. The grant allocation for Westminster is
£508k in 2008/2009, £1.2m in 2009/2010 and £1.5m in 2010/2011.
Version 15
19
3. Priorities and objectives – where we want to be
Partnership priorities
Westminster City Partnership
One of the key ways in which we will achieve improved outcomes for adult residents is by
using our strong local partnership networks to assist with the delivery of our objectives.
This means effectively influencing the priorities of these strategic networks to address the
health and care needs of adult residents.
The Westminster City Plan is our Community Strategy and aims to improve the quality of
life and well being of Westminster residents, visitors and businesses. The plan is the
responsibility of the Westminster City Partnership (WCP). The partnership brings together
representatives from Westminster City Council, other public sector agencies and the
voluntary and community sectors, local businesses, regeneration partnerships and
residents’ groups. The 2006-2016 Plan was published following extensive consultation
with stakeholders and residents, it sets out a vision for :
•
•
•
•
an improving environment;
better life chances;
strong, united and engaged communities;
customer tailored services.
The partnership priorities of the Health & Care Network feed directly into the City Plan. All
adult services strategic commissioning priorities are reported to the Network and
contribute towards delivering the Programme for a Healthier Westminster.
Within the Westminster City Partnership, the Adult Services Department directly works
through the Health & Care Network, but also works closely with other thematic networks
particularly the Housing, Liveability, LEN and Safer Westminster networks on areas of
interest for delivering improved outcomes for adult residents.
Adults Services play a significant role in supporting community cohesion. Westminster
Adult Education Service provides a comprehensive range of ESOL provision and the
Contracts and Voluntary Sector Partnerships team lead on supporting a range of
community groups and organisations in the voluntary sector which reach a wide range of
the diverse communities within the City, including BME communities and local lesbian, gay
and transsexual residents.
Local Area Agreement (LAA) 2008 - 2011
Local Area Agreements are one of the key mechanisms enabling a more effective
partnership approach to addressing local issues. They provide the opportunity for local
priorities to be addressed across networks, agencies and services and enable the pooling
of resources. They aim to change the relationship between the local authority, its partners,
and central government and develop new ways to deliver better outcomes for residents.
Westminster’s first LAA ran from April 2006, this has been updated into a new Agreement
to run from 2008-11. There are nineteen locally agreed priorities in the Agreement and we
Version 15
20
have been particularly successful in securing a high profile for health, well being and social
care. Specific priorities aligned to the work of Adults’ Services include:
•
enabling people to live longer and healthier lives.
The LAA is the mechanism for the whole of the Westminster City Partnership to address
the health inequalities agenda and we are undertaking a wider range of initiatives which
will result in improved health and improvements in overall mortality. In 2008/09 we will be
rolling out the findings from of Healthy Futures project in Queens Park, again be giving a
high priority to smoking cessation and improving signposting into healthy lifestyles.
•
tackling anti-social behaviour and reduce the number of people who feel it is a
problem in their area, including alcohol and drug misuse;
A key focus is on improving the effectiveness of brief interventions following attendances
at A&E for incidents which have involved alcohol use, and training staff to support this.
•
enabling people with long term conditions and their carers to achieve the best
health possible, with increased control and choice of their health and care.
With a focus on improving the assessment, review of carers and the provision of support
services to them including advice and information; we will continue to prioritise achieving
our ‘stretch’ target to support more carers, we will also be developing more training and
development for carers using the ‘expert carers model’. We will strengthen the ‘carer voice’
in our strategic planning through Carers Action and improve the identification of carers,
focusing on those at risk of damage through their caring role.
Acknowledging the role which the wider City Partnership has in enabling more choice and
control to be enjoyed by people who use adult services, we have included a target in the
LAA.
•
enabling older residents to live independently and enjoy a good quality of life.
We have made falls a theme of the new LAA. Falls are frequently the most significant
factor in an older person loosing their independence. Partnership working is important in
delivering an effective falls prevention service involving health, care, housing and safer
Westminster services. Responding to Help The Aged recommendations on Pensioner
Poverty, we will also look at developing local indicators to measure improved take up of
benefits in Westminster.
We are continuing our work with voluntary sector organizations designed to ensure the
services they offer make a measurable difference to peoples’ reported sense of health,
well being and quality of life. Our Quality of Life Survey undertaken in 2006, will be
followed up in 2009, and expect to be able to demonstrate that our approach over the last
three years has improved outcomes for older people.
The replacement of the Neighbourhood Renewal Fund with the Working Neighbourhoods
Fund has disadvantaged Central London in particular, with a significant reduction of
resources available to Westminster over the next three years. However, the Health & Care
Network are committed to continue a number of initiatives designed to support improved
Version 15
21
outcomes for particular groups of excluded residents and the PCT will pick up some of the
funding to enable this:
•
•



Healthy Futures project, this aims to develop new approaches to assessing the
needs of, and engaging individuals with local services to help achieve real
improvements in health and well being for some of the most disadvantaged
residents. Focusing on two estates initially, we aim to roll out learning from this
project to other estates in the future.
assistance for people with common mental health needs seen in primary care to
access employment opportunities.
assistance to carers in accessing services to help them achieve more fulfilling lives
outside their caring responsibilities
helping people with long term conditions stay healthy
various healthy eating and healthy lifestyle initiatives
Local Area Renewal Partnerships
Since 2003, Westminster City Partnership has supported the creation of Local Area
Renewal Partnerships (LARPs) to improve the quality of life of people who live and work in
Westminster’s most disadvantaged areas:
-
Church Street
Queen’s Park
Harrow Road
Westbourne
Various areas across South Westminster
There is also a sixth LARP function in the West End to reflect the particular challenges
posed by the unique characteristics of the area to the quality of life of residents,
businesses and visitors. LARPs receive funding through the Local Area Agreement (LAA)
to coordinate partnership working at a neighbourhood level and to deliver programmes to
reduce deprivation. They bring together service providers (including the Council, Police,
the Primary Care Trust, the voluntary sector) and residents, to identify and address key
local issues across a range of areas (crime, health, housing, education, employment,
environment). Adults Services are represented on each LARP and help shape local
priorities.
Corporate priorities
One City
One City is an initiative that sets out the Council's vision for the City. It has four main
themes, Order, Opportunity, Enterprise and Renewal as well as its four Cross Cutting
priorities:




Neighbourhood Focus
A tolerant City
Active Citizenship
Customer Focus
Version 15
22
The programme for 2008/09 has a strong focus on strengthening communities through
public respect and personal responsibility. The new Neighbourhoods agenda is central to
the goal of building strong communities. This is a ground breaking initiative designed to
strengthen the community leadership role of elected members and deliver better, targeted
services. One City also maintains a focus on improving the health and well being of
residents and the underpinning principles will help provide the context within which we
deliver improved outcomes for adults.
Every Older Person matters
In 2008/09 there are 30 new One City initiatives being launched, these include the
expansion of the nationally acclaimed Every Older Person matters programme.
The programme is comprehensive and covers health and care, leisure, community
protection, libraries, housing and other council services has been put in place for the
coming year and incorporated into service and departmental Business Plans for 2008/09.
The overall aim of our approach is to keep older people fit and well so that they are less
likely to require health and social care services. Key priorities have been informed by
booth the recent Older Peoples Survey undertaken by the Council and its partners, and
the Helping Older People’s Empowerment study undertaken by the local voluntary sector.















Improve information for older people including an A-Z of services via the Council’s
website, enhance the Senior Passport, including better signposting information for
callers and a new proactive service to monitor vulnerable residents linked to housing
estate teams; publish the popular Westminster Plus quarterly .
Work with Counsel and Care (a national charity) on a groundbreaking project to provide
better information for older people funding their own care.
Providing further free events such a ‘Silver Sunday’, using sponsorship, following the
successful Tea Dance last year
Providing a Fuel Switching Service so that older residents get the best deal on their
fuel bills
Delivering a renewed focus on opportunities for older people to take part in paid
employment
Improving opportunities for older people to volunteer, with a particular emphasis on
intergenerational initiatives
Maintaining the most Taxicard scheme in London, and successfully transferring
Freedom Passes.
Introduce parking concessions for carers and people visiting older relatives
Increasing the number of step-free and dropped crossing points to make the City more
accessible for older people
Expanding on the network of activities available for older residents in libraries, including
book clubs and classes
Delivering a Seniors Online project to reduce the digital divide which will see over 280
older people trained to use the internet by March 2009
Delivering new initiatives to tackle the number of older people who fall on
Westminster’s pavements
Using the Home Improvement Agency to provide a proactive service for potentially
vulnerable older people, involving housing condition, security and other issues.
Working in partnership with the PCT on new public health initiatives
Working with Participle (a social enterprise) to deliver innovative solutions in service
delivery (e.g. expansion of the community hubs for older residents)
Version 15
23






Investing an extra £50k in exercise opportunities for older people - in leisure centres
and the wider community
Delivering the Council’s wider WayFinding project to make it easier for older people to
navigate around the City by foot
Providing more support to carers through the Local Area Agreement and, to raise the
profile of this important work, launching an annual Caring for Older Neighbours award.
Expanding the Exercise Referral Scheme by working with practice based
commissioners (GPs) in the South of the City
Improving the proactive handyman service which provides support with light jobs
around the house, which is currently oversubscribed
Increasing older residents’ awareness of the Go Green programme and participation in
‘green’ initiatives
Worksmart
WorkSmart is a major Council-wide initiative that aims to modernize the way we work,
deliver greater efficiency and more cost-effective business processes across all services,
and improve the services provided to residents. WorkSmart and making better use of the
opportunities presented by IT is at the heart of the Adults Services Transformation
programme. It will help change the way teams operate so that care are able to focus
deliver more on work with service users and carers.
The Adult Services Department is at the forefront of delivering the two key themes of the
initiative;


Flexible, location and independent working, and
Electronic Social Care Record
The Department has already made significant progress against both projects, with a lead
implementation for ESCR already started, and successful application of FLOW to a wide
range of teams. During 2008/09, both initiatives will be fully rolled out to all teams.
Equalities
The Council is committed to achieving Level 4 of the Equality Standard for Local
Government by October 2008. A key part of this is ensuring that we have robust
monitoring systems are in place and that information is used effectively to plan new
policies and procedures to increase equality of opportunity for service users and staff.
Targets for sexual orientation, age, religion and belief also need to be in place in March
2008, and progress made against them by 2009.
During 2008-09 we will ensure that all Adults’ Services are in line to meet level four in
terms of leadership, service delivery, consultation and employment and training, and each
service contributed to a detailed Departmental action plan monitored regularly by the
Senior Management Team and Health and Care Network.
Go Green
Westminster’s Go Green programme sets out the ways in which the City Council intends to
lead in creating a more sustainable city. The programme’s aim is to re-establish
Westminster as an exemplar ‘green’ authority. It will contribute towards making London a
greener, more liveable city. ‘Go Green’ will deliver a wide-ranging programme of
environmental schemes and projects, and maps out a challenging agenda for the future.
Version 15
24
Adults’ Services will contribute to the initiative and is working in partnership with the PCT
to undertake an audit of activities using a dedicated NHS tool.
Adults’ Service priorities
Transforming Adults Services
To meet the challenges of delivering on local and national aspirations with the reducing
financial resources available, in 2007/08 we commenced an ambitious phased
transformation programme. This will affect our policy, priorities, use of resources,
relationship with traditional users and providers of services and partner agencies, and
organisational culture and the skills and competencies required of its staff.
The programme is designed to:
 Meet the national agenda and government policy shifting the balance of power and
control to users of our services;
 Address the Council’s ambitions to exploit new technologies and ways of working to
create efficiencies and to free up resources through Worksmart;
 Enable future projected demand for services to be meet arising from the changing
population, within the context of with potentially fewer resources;
 Meet the ambition of the Department to achieve continuous improvement, beyond
our current 3 star status.
Social Care Services
The key priorities of Social Care Services are informed by the transformation programme.
Redesign of first contact
Our vision is, that as close to the point of first contact as possible, people can identify their
own needs utilising self assessment and establish the outcomes they want. Where
appropriate, they will be signposted to other services which will help them, or they will be
given the information they require to make informed choices about how their needs can be
met.
Where appropriate, services up to an agreed level will be arranged at this first point of
contact, ensuring a quick response to identified needs.
Focusing future role of care managers
We want to target the role of the care manager to those people who have more complex
needs. Where it is required professionals would visit to undertake a more thorough
assessment with the service user or their carer to agree the outcomes they want and a
care plan. This assessment process would continue to be multidisciplinary in nature,
subject to the agreement of the person being assessed.
Re-ablement as a way of working
We want to shift the whole basis of our approach to focus on re ablement of individuals.
There will be a strong focus on ensuring people’s capacity for independent living is
restored and maintained as much as possible. Whilst re ablement is at the core of all
assessment work, we also aim to develop more resources to provide intensive short term
interventions.
Version 15
25
Extending choice and control
To help strategically drive forward this agenda we will establish a user led Choice and
Control Board. Building on progress we have made in increasing the numbers of people on
direct payments we now want to achieve a step change in the extent of choice and control
people who need our support and care can exercise. By the end of 2010/11 we are aiming
to support 80% of adults who require support on individual budgets or direct payments. In
2008/09 we will extend and evaluate our Individual Budgets pilot and achieve further
significant increases in take up of DP across all care groups.
We want to broaden out the scope of our approach to self directed care and with be
discussing with the PCT how best to include the local Expert Patient Programme in this
work.
We aim to simplify and streamline the processes associated with direct payments to make
them more attractive to service users. To do this we will introduce preloaded payment
cards that will provide an alternative to a standard bank account and will reduce
administration and bureaucracy for both service users and the Council. The introduction of
Smart Payments will help our service users by giving them access to simple bank
accounts and simplify our accounting procedures.
Recognising that individuals and their carers are experts in their own rights we aim to
introduce a self assessment tool for Westminster. We are exploring potential partners for
the development of this. We will compliment this with the provision of different levels of
assistance for residents of different abilities.
Financial costs and assessment.
We will introduce systems to ensure that the costs of services are clear at the point of
assessment. The financial assessment of individuals will be brought forward and
undertaken y a visiting officer shortly after the care assessment is completed.
Safeguarding
As we work to introduce more choice and control for service users and their families, we
will continue to give a high priority to minimising the risk of abuse and protecting
vulnerable adults from harm. We will review and strengthen procedures and management
arrangements, ensuring that all staff in the Council, NHS, police, ambulance and fire
services, voluntary sector and members of the public are made aware of their roles and
responsibilities in relation to adult protection. Training for staff and managers will continue
to be rolled out.
Older Adults with Mental Health needs
Jointly with CNWL Foundation Trust we will take forward the next phase improving joint
working arrangements to support older adults with mental health needs. This will include
having dedicated workers with the new generic Adults Social Care services teams
specialising in older adults with mental health needs.
Community Mental Health Teams
In October 2008 we plan to enter into a new partnership agreement with CNWL for the
future provision of CMHT services to younger adults, subject to the national review of the
Version 15
26
Care Programme Approach, expected in the Autumn, which is likely to focus the work of
secondary mental health services more exclusively on people on ‘enhanced’ CPA. A key
focus is to more clearly define how local services work to improve a broad range of
outcomes for Westminster residents with serious and enduring mental health needs.
People with long term conditions
People with particular long term conditions often have a range of complex health and
social care needs requiring co-ordinated support to improve outcomes for them. We are
working closely with the PCT to develop options for improved case coo-ordination and
virtual team working between care management and community matron services.
Telecare
To promote good health and well being and foster a greater sense of safety in vulnerable
adults we offer telecare to all people supported at home, and include this in all care
management reviews. We already support a higher than average number of people with
alarms and our approach will increase the use of telecare as a preventive service further.
We have made a bid to the Assisted Innovation Living Platform with BT and Design
London. Westminster’s Pathways to Well being project is designed to address the needs
of older people with long term conditions at risk of emergency admission. Other projects in
development this year include, older people with dementia in a residential home, joint work
with community matrons service to support people with long term conditions; tele
medicines and tele health projects with the PCT and CNWL; implementing proactive caller,
where people who have activated their alrm are checked, this approach will be lined to the
community support officer role.
Commissioning for health and care
The key aims of the Adults Transformation programme related to commissioning are:
-
to ensure that our plans for each care group address the need to develop a wider
range of services available to local people, and
to ensure a greater amount of personal adviser/advocacy to support individual budget
management.
From a contracting perspective we will be exploring the development of different contract
models and evaluating their impact on cost, quality and access. We shall be working
closely with both contractors and in-house service providers to take this work forward.
The transformation themes will also underpin our approach to the development of new
commissioning strategies for different groups.
Joint Strategic Needs Assessment
Westminster’s Joint Strategic Needs Assessment is being designed as an ongoing
development tool which will help prioritise the review of existing commissioning and
partnership plans, inform the development of new commissioning priorities and help to
evaluate the outcomes our actions achieve. It is utilising the Corporate CoWStat project to
draw together a wide range of information, including community intelligence, with the aim
of being able to analyse this by neighbourhood, community, equalities strands etc. Our
initial assessment will be made available from April 2008.
Version 15
27
Home care services
To meet the need for greater flexibility in provision during 2008/09 we will commence work
on redesigning home care contracts and look for what short term adaptations of existing
contracts can be made to allow more flexible use. We will also consider tendering a
contract for a preferred provider list for a new personal care contract
Residential and nursing home provision for older people
During the Summer 2008 we will undertake a review of review of residential and nursing
provision for older people to ensure that local services will be able to meet the projected
changes to Westminster’s population, national and local policy drivers and latest market
developments. We want to ensure that local provision meets the needs of all communities,
is of high quality and offers improved value for money.
During the year we will be implementing our strategy for older adults with mental health
needs designed to improve both the quality and range of provision, deliver earlier
identification, rehabilitation and intervention.
Promoting independence of people in residential care
In response to issues raised in Valuing People Now, we aim to achieve a measurable
increase in numbers of people with learning disabilities living independently or in
supported housing who were previously in institutional care. To achieve this we have
revised our Learning Disabilities Strategy for Independent Living.
For people with severe and enduring mental health problems who require support, we
want to ensure that their independence is maximised, and aim to achieve ‘move on’ to
achieve this. We have set ourselves a target to achieve increases in the numbers of
people with living independently or in supported housing
Substance misuse services
We are undertaking a major re-letting exercise for our substance misuse services in the
year with the aim of fundamentally transforming the model of service. The new model
providing a one stop solution across drugs and alcohol to meet the needs of different local
communities.
Help into employment
Increasing access to employment for adults with a learning or physical disability or mental
health need is a key priority in order that they might achieve greater health and economic
well being. We have a number of schemes and initiatives in place across different service
groups. We are seeking to extend our collaboration with other agencies to enable
vulnerable adults to move from volunteering and supported employment to formal
employment and/or to keep people in work
Voluntary sector
The voluntary sector have a key role to play in assisting with the delivery of improved
outcomes for adults. We are committed to giving them a higher profile in Westminster. To
achieve this we will be monitoring the effectiveness of longer term funding and
commissioning arrangements as part of the annual grants programme. We will be
exploring opportunities for voluntary sector services to deliver further services, building on
the work undertaken to health improve the quality of life of older residents as part of the
Version 15
28
LAA. During the year we will also be revising the Voluntary Sector Compact agreement
and developing a new strategic view of future work with the third sector in Westminster.
Community engagement
Building on existing involvement and engagement initiatives, we will be establishing a
community intelligence work stream as part of our approach to the development of the
Joint Strategic Needs Assessment. The aim is to ensure that information collected through
consultations and other mechanisms is better co-ordinated and more directly influences
strategic planning. During 2008/09 we will also be establishing a Local Involvement
Network.
Adult education
A key priority for Westminster Adult Education Service in 2008/09 is to develop
modernised accommodation. Our aim is to deliver a hub and spoke model, with a new
purpose built centre in Marylebone and 3 satellite centres in Pimlico, Soho and Queen’s
Park. We have secured approval and substantial funding to deliver the project.
Workforce Development
In support of the delivery of the Adults’ Services transformation programme we will be
working closely with partner agencies in developing a new comprehensive workforce
strategy for all Adults’ Services in Westminster.
Priorities for this year are:
 to support the development of new ways of working that promote re-enablement, the
personalisation of services, and increased choice and control by service users,
supported by improved use of technology through the WorkSmart programme;
 to encourage and enable registered services in Westminster to meet National Minimum
Standards workforce requirements for qualifications and staff management and to
prepare for social care workforce registration and NMDS-SC;
 to ensure that our services are safe through the continued roll-out of Safeguarding
POVA, “Safer Recruitment”, Mental Capacity Act, Deprivation of Liberty (DoL) and
managing challenging behaviour training;
 to contribute to building pathways into employment for local people;
 to support access to qualifications for unqualified staff and to foster access to the
Degree in Social Work to ensure a supply of qualified social workers;
 to maintain access to Continuous Professional Development and Post-Registration
Training and Learning for all professional groups to improve the quality of our
workforce;
 to build our managers’ and leaders’ skills in working in multi-disciplinary teams and in
leading change in all our settings;
 to support the diversity of our workforce and the achievement of level 4 of the Equality
Standard.
 To encourage and enable our provider services to develop new ways of working and
new skills to meet the changing needs and aspirations of service users.
In order to deliver these priorities, we will work with our partner agencies in the statutory,
private, independent and voluntary sectors to align our resources for workforce
development within Westminster to achieve efficiency, effectiveness and equity of access.
Version 15
29
4. Action plan – how do we get there
Objectives, priorities and performance indicators
This section of the Plan sets out in more detail how we will measure progress in delivering
our priorities and what outcomes we are achieving.
Version 15
30
Version 15
31
Improve the health and emotional well being of adult residents
Priorities
Link to:
Performance indicators
lead
Timescales
Reduce health inequalities
and enable people to live
longer and healthier lives
LAA 12; NI
120
Reduce all-age all cause
mortality rate.
TL
March 2009
LAA
Achieve local smoking cessation
target
TL
March 2009
NI Place
Survey
LAA 14
Residents perceptions of their
health and well being;
Increased take up of the falls
prevention service
TL
March 2009
CA
March 2009
Reduce drug and alcohol
use and the contribution to
anti social behaviour.
NI 40 NTA
CA
March 2009
TL
March 2009
Provide effective approach
to re ablement
Local
Increase the proportion of drug
users in effective treatment
Increase the number of
attenders at A&E for alcohol
related incidents who take up
brief interventions.
All hospital discharge cases to
be reviewed at 2 week and 4
week intervals to maximise re
ablement potential
Maintain or reduce rate of
delayed transfers of care from
hospitals
Effectiveness of intermediate
care and rehabilitation services.
ZD
Ongoing
ZD
Ongoing
CA/ZD
From Sept
2008
Reduce the number of
emergency bed days per head
of weighted population
Reduce rate of acute psychiatric
admissions
ZD/CA
March 2009
ZD/CA
March 2009
Local; NIS
Maintain low level of delayed
transfers of care
ZD
Ongoing
Local
Respond to all requests for
assessment under the Mental
Health Act in 2 hours.
Record all requests for
assessment under the Mental
Health Act
ZD
Ongoing
ZD
Ongoing
LAA
NI 131
NI 125
NI 134
Local
Provide effective service to
people in crisis
Local
Version 15
32
Improved quality of life of adult residents
Priorities
Support more people with
preventive services and
reduce demand for
intensive interventions
Link to City
Plan, LAA
improvement
priorities
Local
NI 136
Local
Increase the proportion of
adults with disabilities who
live independently.
LAA 9, NI 145
Local
NI 150
Local
NI 141 & NI
142
To enable people with long
term conditions and their
carers to achieve the best
health possible, with
increased control and
choice of their health and
care
Version 15
LAA 13, NI 135
NI 135
Performance indicators
lead
Timescales
Increase number of older
people supported through
preventive services
Maintain rates of people
supported to live independently
through social services
Increase take up and
effectiveness of signposting
services
Increase the rate of people with
learning disabilities in settled
accommodation
Increase in numbers of people
with learning disabilities living
independently or in supported
housing who were previously in
institutional care.
Increase the rate of people with
mental health needs to be in
settled accommodation
Increase the rate of people with
mental health needs supported
in their own homes, compared
to residential/nursing home
care.
Increase number of vulnerable
people achieving independent
living (through housing with
care services) and stability of
placements
Ensure all known carers are
offered an assessment / review
in the year
Increase the rate of carers
receiving carers services or
advice and information.
CA
March 2009
ZD /CA
Ongoing
ZD/CA
March 2009
ZD/CA
March 2009
ZD/CA
March 2009
ZD/CA
March 2009
ZD/CA
March 2009
ZD/CA
March 2009
ZD / TL
March 2009
ZD/TL
March 2009
33
Enable adult residents to make a positive contribution
Priorities
Link to :
Performance indicators
lead
Timescales
Enable vulnerable residents
participation in volunteering
and community action
Ensure adults with
disabilities have access to
education
LAA
Increase the number of older
residents participating in
volunteering
Increase numbers of disabled
adults receiving social services
accessing learning
opportunities.
TL/CA
March 2009
CA / ZD
March 2009
Further develop consultation
and involvement
opportunities
Local
Working with the community
establish a Westminster LINKS
CA
Summer 2008
Local
Implement community
intelligence workstream of the
Joint Strategic Needs
Assessment.
TL
Spring 2008
Local
Service user and carer
involvement in service redesign
and evaluation
Develop action plan arising from
HOPE and Older Residents
survey
Achieve improved satisfaction
rating with home care services
Increase carers take up of
opportunities outside their
caring roles
Maintain and increase take up
of ESOL classes
ZD/CA
Ongoing
TL/CA
June 2008
CA
Feb 2009
TL
Ongoing
BH
Ongoing
Local
Local
Ensure carers are supported
to have lives outside their
caring roles
Promote community
cohesion
Version 15
NI, User
Survey
Local
Local
34
Enable people to exercise more choice and control over their care
Priorities
Link to:
Performance indicators
lead
Timescales
Achieve a step change in
choice and control enjoyed
by adults who need social
care
LAA 13, NI
Increase the rate of people
supported at home using self
directed care to 80% by
2010/11, setting milestones
targets for each care group
10 people with learning
disabilities on individual budget
pilot.
ZD
March 2011
ZD
September
2009
Extend IB pilot to other care
groups and achieve numbers
from other care groups on IB
Implement pre loaded payment
cards achieve 50 users on
cards for pilot
Reduce petty cash use by
setting up simple bank accounts
for 40 service users.
Improve the rate of people with
long term conditions who report
that they are supported to
manage their condition
ZD
March 2009
PF
September
2008
PF
October 2008
ZD
tbc
Increase the number of carers
using self directed care,
including for short breaks and
holidays
Introduce model of self
assessment
ZD /
TL
Ongoing
ZD
March 2009
Complete 91% of assessments
for social care within 4 weeks of
referral
For 91% of care packages to be
fully in place within 4 weeks of
assessment
Ensure all people who are
supported with social care for
12 months or more are
reviewed at least annually.
Exceed 3,000 users per annum
of the Senior Passport
ZD
Ongoing
ZD
Ongoing
ZD
Ongoing
ZD /
CA
March 2009
LAA 13
Local
WorkSmart
WorkSmart
NI 124 Place
Survey
Local
Provide a responsive
person centred assessment
options
Local
NI 132
NI 133
Local
Ensure there is an effective
signposting service for
people to arrange their own
care
Version 15
Local
35
Ensure that freedom from discrimination and harassment
Priorities
Link to:
Performance indicators
lead
Timescales
Meet requirements of
Equalities Standard for Local
Government and Single
Equalities Scheme
ESLG
Achieve Equality Standard for
Local Government level 4
Review and update
Departmental Action Plan to
comply with Single Equalities
Scheme
Ethnic details recorded for 95%
of social care staff
Ethnic details recorded for 97%
of adults
- assessed or reviewed in the
year
- provided with a service in
the year
Full equalities details to be
recorded for 95% of adults
- assessed or reviewed in the
year
- provided with a service in
the year
MH
October 2008
MH
June 2008
ZD
Ongoing
ZD / CA
Ongoing
ZD / CA
September
2009
Review programme of EQIAs
and update programme taking
account of Transformation
projects
ZD/CA
April 2008
ESLG
Local
Local
Local
Ensure new service
developments are non
discriminatory and meet all
communities needs
ESLG
Work to ensure the economic well being of adults with care needs
Priorities
Improve the proportion of
disabled service users
helped off benefits and into
employment.
Link to :
LAA 14 NI
Performance indicators
Increase the % of people with
learning disabilities who are in
employment.
lead
ZD
Timescales
March 2009
LAA 14 NI
Increase the rate of people
using secondary mental health
services in employment to 15%
of those known.
ZD/PR
March 2009
LAA 14
Increase the % of people with
learning disabilities who are in
employment.
ZD
March 2009
Ensure timely financial
assessment take place to
maximise independence and
income
Local
PF
April 2008
Maximise the income of
service users
Local
Complete 95% of financial
assessments for people
receiving home care within 7
days of completion of the care
assessment
Ensure all adults who receive a
social care service get a
benefits check
Increase number of new claims
generated for benefit and the
extra amount of benefit
generated
ZD/CA
April 2009
CA
Summer 2008
Local
Version 15
36
Enable people to maintain self respect, and enjoy a comfortable, healthy and safe
environment
Priorities
Link to :
Performance indicators
lead
Timescales
Ensure vulnerable adults
are effectively protected
from abuse
Local
Undertake review of safeguarding
procedures and processes
All POVA alerts to be captured
and recorded
HB
Summer 2008
ZD
April 2008
Hold a strategy
meeting/discussion for 100% of
cases where an adult protection
enquiry is required within 5
working days of the decision to
proceed.
Complaints achieve stage 1 target
ZD
Ongoing
PB
Ongoing
Complaints achieve stages 2 & 3
target
PB
Ongoing
Local
Local
Provide a responsive
complaints service
Local
Statutory
Version 15
37
Risk management
Risk management enables us to identify and manage key obstacles to the achievement of
our objectives. It is a strategic tool that is an integral part of effective and efficient
management and planning. Risks to Adult Services achieving our objectives in the
2008/09 financial year are summarized below:
Version 15
38
Risk No
Risk Owner
Likelihood
Impact
Score
RAG Status
Direction of
Travel
ADULT SERVICES RISK REGISTER 2008/09 Summary
1
MH
High
Critical
15
R
↑
Effective implementation of new technology
2
MH
High
Critical
12
A
↑
Managing increased demands within existing
3
CA /
ZD
Critical
12
A
↑
Achieve shift in emphasis to more self directed
4
ZD
Critical
12
A
↓
Failed Habitual Residents / Failed Asylum See
5
CA/ZD
Critical
12
A
→
Effective Management of cost pressures
6
ZD/CA
Signific
ant
Signific
ant
Signific
ant
High
Critical
12
A
↓
Implementation of NHS continuing care criteria
7
ZD
High
Critical
12
A
↓
Quality of some commissioned services
8
CA / TL
High
Marginal
10
A
→
Balancing investment in prevention and maint
9
CA
High
Marginal
10
A
→
Young people in transition to adult services
10
MH
High
Marginal
8
A
↓
11
MH
High
Marginal
8
A
↑
Recruitment and retention of care staff - comp
competitive London market
Data security and data sharing with the NHS
Version 15
Short Descrip
39