Contents
1.
Introduction - What is commissioning?
2.
Vision
3.
Population Needs
4.
Priority People
5.
Learning Difficulty Pooled Budget 3 Year Strategy
a) Main areas of present expenditure
b) April 04-06
c) Strategy 06-08
6.
Partnership Working
a) Planning with People and Parent/Carers
b) Into the Mainstream
c) Across Adult Services
d) Choice in Providers
7.
Process of how services will be changed (See Appendix 1)
a) Role of the Partnership Board
b) Role of the Task Groups
8.
Commissioning Intentions
a)
b)
c)
d)
e)
9.
Person Centred Support
i) Advocacy
ii) Person Centred Planning
Support Based on the Needs of People
i) People who are Becoming Older and Frailer
ii) People with Profound and Multiple Learning Disabilities
iii) Making Transition a Positive Experience
Using Ordinary Services that are Inclusive
i) Health Inequalities
ii) Supporting People Into Paid Work
Efficient and Effective In Using Resources
i) Improving People’s Housing Situation
ii) Supporting Everyone In Salford
Working in Partnership
Conclusion
1.
Introduction – What is Commissioning ?
1.1
This document will outline 5 areas:
Population of people and their aspirations
What finance is available?
What human resources are needed to deliver
customers aspirations and what skills do people need
What is the process of delivering services
Who delivers the services?
1.2
For people with a learning difficulty, and their carers this will be divided
into what the New Directions Service provides and what other
organisations voluntary, private and public sector provide to everyone in
Salford. Ordinary services should provide services that are inclusive and
in line with the Government paper Independence Wellbeing and Choice.
1.3
As well as being inclusive, support should be person centred. ‘Nothing
About Us Without Us, Direct Payments and projects such as ‘In Control’
all point to greater control being taken by individuals and their carers in a
person centred way.
1.4
We need to know both the individual needs and aspirations of people with
a learning difficulty and their carers. This information added together
provides useful planning information. This will take the form of:
 Who we will provide support to
 How support will be given
 The type of services they will need in the future
 The volume of services we will require
 Who should best provide the services, given the more organisations
that provide support the more choice is offered. This will include
community, voluntary, private, independent and public organisations.
 Using Best Value as a framework for the quality and price of services
 Where quality framework offers clear standards for services to match.
 How current supply of service can be changed. This includes the
encouragement of
innovation, flexibility and choice and the
decommissioning of redundant or inefficient services.
2.
Vision
2.1
In Salford, ‘Bringing the Future Nearer 2000–2005’ and the commitment
to the Government White Paper ‘Valuing People : A New Strategy for the
21st Century’ published in March 2001, set a new and demanding vision
for supporting people with a learning difficulty. In February 2006 the
Government White Paper ‘Our Health Our Care, Our Say A New Direction
for Community Services’ outlines what adults should expect from
Services.
2.2
The North Star or vision for what we want to achieve is “To work together
and with other agencies in Salford, sharing power with people who are
supported by services and their families and carers to provide more
choice, opportunities and support for people to become included in their
local communities, to become as independent as possible and to achieve
their hopes and dreams”.
2.3
The things that are important to us agreed by the Partnership Board and
reviewed on 28th July 2005 are:
 We want people to be in control of their lives
 We want people to be able to achieve what they want and hope for and
that in doing this, they are treated as equals who have rights and who
also have responsibilities
 We want to stick up for people, including people from minority ethnic
groups and for people who are parents who have support needs, so that
we can make sure people are not treated unfairly
 We want people to be part of the community that they live in, relax in and
work in, and for them to be able to help other members of their community
 We want people to be supported to be able to do things for themselves –
to learn new things, to be supported and encouraged to try new things
and to take risks
We want to make sure people are included in lots of community things and
that the local strategic plan does not ignore the needs of people in this plan
 We think people should be treated the same as other people and have
the same rights, like getting a job, receiving good health care, having a
nice house to live in or having a relationship
 We want to make sure that people are the most important part of the
future and that we work in real partnership with people about decisions
being made, not just asking them what they think when decisions are
made
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 We want people to have real choices that have been made when people
have all the information they need to make the choice, so that they know
what the choice is and what other choices could have been.
 We believe that people should be listened to, by the people who work to
support them and by the communities they live in
 We believe more people should be supported by general services
especially with the Primary Care Trust and Local Authority rather than
specialist or dedicated services
 We think that people should get the help they need when they need it and
that it’s the help they need, rather than just being given what’s available
 We believe everyone should be treated as individual people and that they
should be treated with respect.
“We think that though lots of people try to support people in these
ways, there needs to be a lot of change so that everyone is treated
really well and has good support.”
2.4
This sets us up to change services and the support we give people from:
People not having a voice to Nothing About Us Without Us
Being in receipt of services to being in control
Being segregated, congregated and excluded to being included
Planning for people to Planning with people
Service led to needs led
Creating dependency to promoting independence and management
of risks
Lack of information about what is available to good information
using total communication
Different points of access to one point of access
People not knowing what to expect to clear standards and quality
assurance
People living outside Salford to comprehensive local services
Specialist provision to ordinary provision
2.5
We now need continued growth in the area of people taking greater
control over their lives which includes the way support is given. For
instance, direct payments.
2.6
We now need access to ordinary services for instance mainstream
primary and secondary care, health services and ordinary housing with
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support based on individual needs, where people have greater choice
around jobs and education, and have varied relationships and access to
mainstream leisure.
2.7
This moves us from a model outlined in picture (a) to a model outlined in
People
picture (b).
(a)
Money
Planning with
Government
and
Stakeholders
(b)
entitled to
money
Negotiated
service
Service
S Duffy, Paradigm
Model (a) is where the professionals are in control and make all the decisions
2.8
Model (b) is where an individual is at the centre of the commissioning
process. It is how the ‘Our Health Our Care, Our Say A New Direction for
Community Services’ sees individualised budgets giving choice and
control to individual people supported
2.9
Support needs to be person centred and individualised based on an
assessment of need, and reviewed regularly to check that support is
needed with both the people concerned and their carers.
2.10 Support needs to be available in a timely way when people need it.
2.11 Support needs to be co-ordinated with one person able to see that it fits
together and changes with changed situations.
2.12 How we achieve this has been taken forward in twelve priority areas
which are set out in ‘Valuing People’. These are:
 Listening to People
 Planning with People
 Valuing Diversity
 Supporting and Listening to Carers
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







Community Team
Staying Healthy
Transition (Move from Childhood to Adult Life)
Where People Live
Short Breaks
Fulfilling Lives
Employment
Getting Around
2.13 In Salford we have a strong Partnership Board, Business Plan Action
Team and Task Groups in each of the twelve areas. The Task Groups
are responsible for taking forward the yearly Business Plan. The
Business Plan sets the targets to take forward the vision mentioned in the
introduction.
2.14 Our strategy is informed by ‘Bringing the Future Nearer’, ‘Valuing
People’ the work of the Partnership Board and related Task Groups.
Targets are set and reviewed within the Learning Difficulties Business
Plan and the Unit Business Plan for the Community Team, Day Services
and Tenancy Network.
2.15 There are also strategic plans in place requested by the Valuing People
Team in the following areas which are reviewed on a yearly basis.
Human Resource Strategy
‘Widening the Choice’ in Housing
Modernisation of Day Service
Employment
Community Team Review
Quality Framework
3.
Population Needs
a)
Facts and Figures
During 2004/5 there were:
-
-
Approximately 715 adults with learning difficulties known to the Council
on Carefirst with 361 people having support from the Community Team
620 adults with learning difficulties receiving a community based
service including nurse and social worker support, where people live,
day services and domiciliary contracted individual support. This is
banded 5 blobs in the National Performance Criteria which is the
highest possible
420 people are supported during the day
Over 300 tenants, 50% supported by the private sector
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-
109 people with profound and multiple needs
121 adults with learning difficulties scheduled to receive planned short
term breaks
90 people with learning difficulties in work preparation
90 people in paid work
393 carers and 96 people living with carers over 65
Over 40 people with learning difficulties over the age of 65 living in the
Tenancy Network
89 people living away from Salford. 20 we know want to return.
9 people in secure accommodation
21 people with learning difficulties on Direct Payments. 1 person
having £70,000 support in a ‘Trust’ fund
35 people with learning difficulties receiving services who are from
ethnic minority communities (12 in 2002/03)
20 people with learning difficulties from a Jewish background in receipt
of support, one with Direct Payment
360 staff employed by Local Authority
150 staff employed by Primary Care Trust
52 Total Communication Facilitators
46 Trained Person Centred Planning Facilitators
35% of staff qualified to NVQ level 2
20 Graduates of Kindred Spirits and Partners in Policymaking
b)
3.2
Overall Demand
People are living longer and becoming physically frailer. Children with
complex disabilities are surviving into adulthood, and there is an
increased expectation from people and their families about an ordinary life
on a par with non disabled citizens. This will mean an increased demand
for people to leave home sooner rather than later.
3.3
Between 2001 and 2021, there will be a 36% increase in the numbers of
adults with learning difficulties over 60 (change from 35 people to 47).
There will also be an 11% increase in the total number of adults from 830
to 910 with learning difficulty. This means an increase in demand for
services and also an increase in the complexity of people we support.
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The increase in demand for services in the areas outlined whilst the budget
projection in the next 3 years remains static or shrinks (see section 5), will place
increasing pressure on services and mean increasing risk for individuals.
Services need to be vigilant and increasingly sophisticated around promoting
independence, making best use of resources and risk management.
We need to check on whether we are giving support to the right people and
therefore making best use of limited resources.
c)
3.4
3.5
Priority Areas
There are various areas we need to develop in working across adult
services with older peoples teams, physical sensory services, drugs and
alcohol services and mental health.
People who live Out of Borough
There are 89 people who live outside Salford. There is a need to bring
people back to Salford. Overall 31 people will need to return to Salford.
This figure includes people in secure accommodation. In 2005/06 it is
planned that 6 people will return to live in Salford.
Young adults with support needs
There is a growing population of people with profound and multiple needs.
The Children’s Disability Record gives information on the support needs
of children. The Register tells us that in the next 5 years, 67 children with
a learning difficulty will have moved into adult services. The numbers of
children with a learning difficulty moving into adult services are usually
between 10 –20 every year.
We know that of the 67 children with learning difficulties 18 use
wheelchair users, 22 present behaviour that challenges services, 11 have
epilepsy, 17 have a sensory impairment and 9 have a diagnosis of
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autism.
3.6
People in Transition 2005
40
37
34
31
28
25
22
19
16
13
10
7
4
1
-2
Number of people Number of people Number of people Number of people Number of people
aged 14
aged 15
aged 16
aged 17
aged 18
Information for the chart is from Salford’s Record of Disabled children and
Young People, (Salford Family Project) Annual Report 04-05
Older People with Support Needs
3.7 People with a learning difficulty now live longer. There is an ageing
population which is becoming increasingly frail, for instance, 40 tenants
are over 65. The issues that arise can be summarised by the diagram
below.
Very old carers – more people with
support needs living with carers
who are aged 80 – 90 years of age
and maybe even older
People supported who have an
early onset of dementia – notably
people with Down’s Syndrome
3.8
Older people with learning
difficulties who are too “fit” to use
the usual older peoples services.
These include 65 – 75 year olds –
people who would usually be
retired from work
Older people with support needs
who meet the criteria for older
people’s services and require
support from such services
People with Additional Needs
Research has shown that often people who use specialist services to
support them are likely to have other problems as well, with support
needs around hearing, sight, physical disability, epilepsy and mental
health.
The table below shows estimates of how many people in Salford are likely
to have other needs at some time in their lives.
Percentage %
SALFORD
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Low
Hearing
Sight
Physical Disability
Epilepsy
Mental Health
3.9
40%
30%
30%
22.5%
50%
High
(estimate)
210 - 280
157 - 210
157 - 210
118 - 158
200 - 350
Health Needs
People with a learning difficulty often have more health problems than the
general population. People with learning difficulties have an increased risk
of early death. People use more hospital services, and have less contact
with their GP. They have less screening for major diseases like cancer
(for instance woman having cervical smear tests), they are at a greater
risk from coronary heart disease, respiratory disease and stomach
disorders, People may also have problems with their mental health and
other health problems from not having very much money.
Communication
3.10 Lots of people supported need extra help to be able to talk and say what
they need. Often, this can make people behave in ways that are difficult
to manage. It is really important that all services do their best to improve
communication with people who are supported by those services. This will
involve the continuing development of Total Communication.
Autism
3.11 There is an increase in the number of people with a diagnosis of Autism
and a need to develop local services instead of placements outside of
Salford.
3.12 Salford has been a member of the Greater Manchester Forum on Autism.
From this work we have set up a local planning group to develop local
services to support people with Autism.
Ethnic Minority Communities
3.13 In Learning Difficulties there are 35 people being supported by us from
diverse backgrounds.
Services need to make sure that people know what is available and how
to access support. Support needs to be person centred to take account
of cultural and religious beliefs.
3.14 Complex Physical Needs
 There are now 109 people with complex physical needs being
supported in Adult Services and this figure is growing.
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 54 people live as tenants, 30 live in the joint tenancy network.
 55 live with their parent/carers.
 80 people go to one of the day services for support.
More support needs to be targeted to the people concerned and staff need
to develop skills in partnership with professionals such as Speech and
Language Therapists and Physiotherapists.
3.15 People who Challenge
 There are 100 people whose behaviour challenges services.
 59 of the people live with parent/carers and 41 live in the tenancy
networks. 25 live in the New Directions Supported Tenancy Service.
 5 people require physical intervention and through successful work this
number is going down.
 We know that if we support people in person centred ways their
challenging behaviour will lessen.
 We know if we understand people’s communication and respond to it their
challenging behaviour will lessen.
3.16 People who live with Carers
Over half the people we know (393) live with their parents and or
carers. We have a responsibility to support carers, and assess their
needs and see we work with them. This includes being able to get support
in a simple way. This means good clear information being available on
services.
4.
Priority People
4.1
Who do we support as a priority
Fair Access to Care for the service is based on the following four priority
areas, these are:
Critical
Substantive
Moderate
Low
4.2
:
:
:
:
People in crisis or at substantial risk
People who are in seriously vulnerable situations
To prevent the situation deteriorating
Promotion of well being
The New Directions Service have interpreted the four areas in the
following way:
 There is a significant risk to their health and welfare
 Without intervention the person will be unable to remain or return
home
 They require a complex care package involving services from more
than one agency
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New Directions Joint Learning Difficulty Service
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 The level of service required will require a high level of funding from
at least one of the statutory services.
 Without support, the carer will be unable to maintain the caring role
or the carer is under 18
 They have high levels of physical and/or psychological dependency
and require support from carers
4.3 This means that wherever possible we will support people with moderate
needs and so prevent situations going downhill.
4.4
The Fair Access to Care priorities translates into the following numbers of
people who are a priority for New Directions.
11 People who live in medium secure units
10 People who are in danger of going to medium secure units
100 People who challenge services
67 People in transition
96 People living with carers over 65
109 People with profound with profound and multiple needs
55 People with profound and multiple needs live with parents/carers
54 People living with epilepsy
45 People with mental health concerns
89 People living out of the area (includes 9 people in medium secure
units)
22 People who have a diagnosis of Autism
4 People who have children
35 People from ethnic minority backgrounds
Because some people may have more than one priority need, the actual
number of people is approximately 480. Half live with Parent/Carers.
For the people concerned we are committed to seeing that as a minimum
each individual has:
Co-ordinator from the New Directions Community Team
A plan which is reviewed yearly
A Health Facilitation plan
Where relevant, a Carers Assessment
Priority people may need ongoing support from co-ordinators. The a
mount of support will be decided on an individual basis.
5) Learning Difficulty Pooled Budget 3 Year Strategy
a) Main Areas of Present Expenditure from April 05 to April 06
SERVICES
GROSS OVERALL SPEND £000’S
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NEW DIRECTIONS TENANCY NETWORK
INDEPENDENT SECTOR TENANCY NETWORKS
DAY SERVICES
COMMUNITY SUPPORT
(DIRECT PAYMENTS 250)
RESIDENTIAL NURSING CARE
EMPLOYMENT/WORK EXPERIENCE
ADULT PLACEMENT
ONE STOP SHOP
GRANVILLE
OUT OF BOROUGH PLACEMENTS
CALDERSTONES OR SECURE ACCOMODATION
DEVELOPMENT FUND
MANAGEMENT ADMIN AND COMMUNITY TEAM
TOTAL
INCOME FROM SPECIAL AREAS:SUPPORTING PEOPLE
NEIGHBOURHOOD RENEWAL FUND
(EMPLOYMENT/WORK EXPERIENCE)
CHARGES FOR SUPPORTING/SERVICES
INDEPENDENT LIVING FUND
3,785
3,865
2,183
2,460
669
821
465
503
3216
1,766
625
1200
21,558
4,900
340
3,000
180
b)
April 2004/06
5.2 In April 2005 we were one of the few Learning Difficulty Services to be
within budget. It appears that we will also be able to be within budget
for
05/06.
This was achieved by firstly monitoring expenditure in the Community
Team on support to individuals provided by the Independent Sector.
Secondly, monitoring expenditure in the Joint Supported Tenancy
Network, by timely recruitment to vacancies and lowering overtime and
lowering use of agency staff. This has included a focus on managing
risks. This meant efficiency savings of £200,000. This helped towards
finding up to £288,000 for Supporting People as they had a 5% cut in their
funding. This work and more will need to continue over the next 3 years to
see the best use of our money.
c)
Strategy 2006/08
5.3
There are 6 areas, which are causing budget pressures
Increasing number of people who require services
Increasing number of people becoming older and frailer
Supporting People Funding
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5.4
Young People who have become 18 and are coming into Adult
Services from Children’s
1f someone needs to move to an expensive out of borough placement
People and their carers wanting better services.
These pressures will need continued commitment to invest in Learning
Difficulty Services
There is the bigger pressure of year on year savings from the Supporting
People grant. The Overall spend on people with Learning Difficulty is £4.9
million Presently 39% of SUPPORTING PEOPLE expenditure in Salford
is on people with learning difficulties. The Supporting People Strategy
states that this percentage needs to lower so reinvestment in other
services can occur. This means that
increasing demand will be managed with decreasing money unless more
money is found or services become more efficient and effective.
5.5
Partnership arrangements will therefore continue with Supporting
People around reviews and seeing that staffing costs in tenancy
networks are efficiently and effectively delivered but also that
commissioning decisions are taken understanding the affect on tenants
around managing risk.
Movements of people from out of borough placements back to Salford will
occur at either no extra cost or with savings. The Partnership Board
agreed a report in January 2005, which outlined which people want to
return to Salford. There are 20 people who will be returning over the next
three to five years.
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d)Three Year Forecast 2006/07 – 2008/09
3 YEAR FORECAST
Current
05/06
£m
Learning Difficulties
Gross Budget
21.54
Add – Additional Funds
Inflation
Local Authority:Employees
Contracted Services
PCT:Employees
Contracted Services
TOTAL BUDGET RESOURCE
Potential Budget Pressures
Funding
People
2005/06
2006/07
2007/08
2008/09
Reductions
in
21.54
07/08
£m
22.27
08/09
£m
23.00
0.17
0.22
0.17
0.22
0.17
0.22
21.54
0.34
22.27
0.34
23.00
0.34
23.73
Current
05/06
£m
06/07
£m
07/08
£m
08/09
£m
0.13
0.26
0.13
0.25
0.24
0.13
0.25
0.24
0.23
0.34
0.34
0.36
0.34
0.36
0.80
0.73
0.13
0.60
1.32
0.13
1.19
2.35
0.13
2.22
Supporting
0.15
Potential Growth – People Moving
through from Children’s Disabilities
06/07 Young People
07/08 Young People
08/09 Young People
0.15
Less: Savings Achieved
TOTAL PRESSURES
06/07
£m
0.15
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e) Assumptions – Pressures
1.
The Learning Difficulty Service was set an efficiency target of £270,000 by the
Supporting People Team to be achieved by April 2006. This has been achieved
(£150,000 in 2005/06 and £130,000 in 2006/07).
2.
Further Supporting People efficiencies have been estimated at 5% p.a. over the 3
years.
3.
Work with children’s disabilities services has identified 75 children coming through to
Adults Services over the next 3 years 2006/07 to 2008/09. For planning purposes an
average cost of £20,000 per person per year has been assumed as the cost of care
for these young adults.
The analysis shows that the Learning Difficulty Service could face new budget
pressures of:
2006/07
2007/08
2008/09
£0.6m
£1.19m
£2.22m
These pressures will have to be met by a combination of:
(a)
Maintaining as much of the existing Supporting People funding as possible to
support people who are living independently in tenancies, or agreeing a charge
reduction from providers.
(b)
Working with young people coming through from children’s disabilities to meet
their needs in the most cost effective way.
(c)
Review all areas of service to develop annual action plans to reduce costs of
existing services, so that budget resource can be made available to meet the
new pressures.
(d)
Ensuring that the pressures in Learning Difficulties are recognised within
Central Government planning of resources for Local Authorities and Health.
(e)
Maintaining the profile of Learning Difficulties within the budget priorities of the
City Council and the Primary Care Trust so that consideration of pressures is
maintained and additional resource considered.
6)
Partnership Working
a)
6.1
Planning with people and Parent/Carers
Planning with people in partnership includes the following.
-Strong representation on the Partnership Board task groups and
development committees
-Strong advocacy services
-Strong commitment to person centred planning
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-One point of access with joined together services
-Good individual assessments, which are completed as quickly as
possible and reviewed on a yearly basis.
-Good information, which is available and reviewed regularly.
b)
6.2
Into the Mainstream
Partnership working needs to occur for people to have choices and
opportunities that are ordinary and open to everyone.
6.3
As commissioning develops we will be buying less services in
congregated and segregated settings. We will buy support for people to
access ordinary services.
6.4 This means Partnership working with:
Health Service
Culture, Leisure Services
Housing
Employers
Colleges and Lifelong Learning
6.5 First of all we need to jointly plan what the organisations need
to
do to be inclusive. As organisations become inclusive so the
need for
specialist services will lessen but there will still be a
need for specialist
support.
c)
Across Adult Services
People do not fit neatly into boxes. For people’s needs to be met
there needs to be stronger links made across and between services
such as Learning Difficulty, Children’s, Physical and Sensory, Drugs and
Alcohol, Mental Health and Older People’s Services. Single
assessments
and one point of access are the cornerstones of this
approach. It will not
be an either/or approach but a mix and match approach depending on people’s
needs at any one time.
6.6
d)
Choice in Providers
6.7
Part of choice is having a variety of providers from the statutory,
independent and voluntary sectors. We need to commission support in
a way that is helpful and manages the market. This includes open,
honest communication, using the quality framework, where standards
are clear and a co-ordinated approach between the different
Inspectorates around monitoring and reviewing.
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7)
Process of how services will be changed
7.1
On January 24th 2005, there was a successful day where 100 people
came together to review the previous strategy ‘Bringing the Future
Nearer’ and to set objectives for the next 5 years.
The objectives took into account the information outlined in this plan.
7.2
7.3
Overall it was felt that a great deal had developed in the last 5 years.
People were positive and upbeat about the future.
a)
7.4
Role of the Partnership Board
The Partnership Board takes the lead in developing services as set out in
Valuing People. Monitoring progress on developing services through an
annual picture Business Plan and making strategic links to take the
service forward. The Board is comprised of senior officials of the Council
and Primary Care Trust, family carers, people supported and influential
allies. The Partnership Board has been meeting for four years on a
monthly basis and is seen as one of the best in the region.
b)
7.5
Role of the Task Groups
The Task Groups look at the areas for development set out earlier in
this document.
7.6
Each Task Group sets out objectives in line with this document and on a
yearly basis Task Groups outline how we will know that we have met the
target.
7.7
The Task Groups continue to develop yearly targets, reviewable at 6
months to see the positive developments continue. This is done through
their section of the picture Business Plan. They then monitor and review
the yearly Business Plan. This progress is monitored by the Board.
7.8
Yearly Unit Business Plans are also completed by the New Directions
Community Team, Day Services and the Supported Tenancy Network.
7.9
To understand fully the Board’s aims, people need to read the Business
Plans, the document named ‘Review of the Blue Book’ along with this
Commissioning Strategy.
8)
Commissioning Intentions
8.1
The following is a list of intentions which takes forward the information
provided from:
Consultation Day ‘Review of the Blue Book’, 24th January 2005
Partnership Board meetings
Task Group discussions
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Service Reviews
CSCI report dated September 2004
On page 6 of this document we have already stated what we need to do.
The main points are that support we offer needs to be:
Person centred
Based on the needs of people and their carers
Using ordinary services that are inclusive
Using many providers from the statutory, independent and voluntary
sectors
Efficient and effective in using resources (staff, financial and
information)
This will only be successful if we make connections, build relationships and
work in partnership with everyone and every organisation.
The following outlines how we will do this:
a)
Person Centred Support
i)
Advocacy
8.2
 Support the development of Salford Being Heard as a local self-advocacy
scheme.
 Continue core funding for Salford Being Heard once they are independent of
Manchester People First.
 Support the development of Salford Citizen Advocacy as a Citizen
Advocacy Scheme to support people with learning difficulties.
 Development of a “user led” Direct Payments scheme managed by
SUGGEST using core funding from Salford City. SUGGEST is an
independent user led organisation.
 Participate in the second wave ‘In Control’ project to develop
individualised funding. The project will focus on transition.
 Develop an understanding of the use of Trusts and other individualised
service models.
ii)
Person Centred Planning
8.3 Support the development of an infrastructure in doing Person Centred
Plans through funding the full time Person Centred Planning
Co-ordinator
Post. Funding posts to speed development in provider
services
(Person
Centred Planning Co-Worker). Funding Total Communication Co-ordinator to
increase the effectiveness of the locally developed Total Communication
Strategy.
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 Consolidate the New Directions Joint Community Team for Learning
Difficulties working in a local patch (four) basis.
 Fund a second Families Leading Planning Course to increase the
number of family members able to use person centred planning to
develop individualised packages of support. This second course (2006)
to focus on family members of children and young adults.
 Fund a course of Person Centred Planning for self-advocates in 2007/8.
 Review all people receiving support from New Directions Community
Team on an annual basis.
 Ensure all Providers use the Person Centred Planning tools in their
responsibility to assess and review annually individual’s services. Main
tool, Listen to Me, Listen to Others Workbooks.
 Fund the post of Development Worker and Development Link (2005) to
support effective involvement in the Partnership Board and it’s Task
Groups.
 Fund further places on Partners in Policy Making for people supported
and/or family members to build on the existing number of effective
advocates in the planning systems of statutory agencies.
 Investment in accessible information for people supported, families and
partner organisations.
 Support Dream Team Trainers.
 Continue modernisation programme for Day Services to enable support
to be given to people to access mainstream services from leisure to
learning and volunteering to paid work.
8.4
Rationale
In order to make Choice and Control effective, considerable involvement
is required to support people. The investments are intended to achieve
an active and largely self supporting advocacy sector in Salford in 5
years. Ensure that participation in the planning and commissioning
mechanisms in Salford is effective and drives decision making through
proper investment in support to “non professionals”.
Use Person
Centred Planning as the means to drive individual service design and
commissioning of services. Develop mechanisms for individualised
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funding linked to Person Centred Planning so that plans can drive service
design and delivery.
8.5 Funding Sources
 Advocacy is supported through Learning Disability Development Fund
(LDDF) and grants/bids. In Control will require an investment of LDDF.
 Service User Development posts are funded from LDDF.
 Person Centred Planning posts and Total Communication post funded
from LDDF.
 Person Centred Planning tools are used by Providers as part of their
existing specification.
 Individualised funding (In Control, Direct Payments, Life by Design) uses
Community Care Funding, mainstream budget and money released from
existing sources.
b)
Support Based on the Needs of People
i)
People who are Becoming Older and Frailer
One of the health inequalities that has shown improvement in the past 30
years is the increasing number of people with Learning Difficulties living
into middle age. This is good news, however just as a general population
this means more people are experiencing age related health problems
such as dementia. It is also time that many people are looking to “retire”
rather than seeking work.
In such areas it is important to work in partnership with services to access
the skills to support people with age related health needs and help
inclusion in services and lifestyles of age peers in the wider population.
ii)
People with Profound and Multiple Learning Disabilities
There has been great success in supporting people with complex health
needs. This success led to the development at Waterside and pressure
for access to Allied Health Professionals. The 53 people living with their
parents/carers are a priority to see that carer’s assessments are in place.
The extensive joint working between Social Care, Healthcare and
Education that is supporting children and younger people with very
disabling complex needs is very successful. This sort of joint work
properly resourced will have to be replicated to reduce the disabling
effects of such complex needs as people become adults.
iii) Making Transition a Positive Experience
 There will be good information on what people can expect which is
available and reviewed yearly
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 Each person in transition will have a Transition Plan.
 Support Salford Citizen Advocacy to recruit citizen advocates for young
people (15-25 years).
 Fund joint training of New Directions and Salford Families Project
(Barnardo’s).
 Fund Families Leading Planning course following successful 2005
programme.
 Develop transition role of learning difficulty community nurses in Children’s
Services. One post already funded from pooled budget.
 Participate and run a local “In Control” project. Fund a part time worker to
support Person Centred Planning and In Control.
(In Control –
individualised funding to commission person centred local services).
Rationale
8.6 The Transition Task Group has developed protocols for a better transition
process. Mindful of the development of transition elsewhere, the Task
Group will see there is co-ordination between the services involved
around the use of person centred planning and the In Control project.
Investment will be to increase the ability of families to develop person
centred plans (especially Essential Lifestyle Plans). This will assist them
to evaluate options and prospects with their family member.
Individualised funding will develop a more sophisticated approach to
commissioning support, reducing dependence on “off the peg” external
placements. Early involvement, through virtual team members of adult
services with young people will see plans are developed with a long term
(post 18) perspective. Support from Salford Citizen Advocacy and Salford
Being Heard will help young people gain a greater voice in their future.
8.7
Funding Sources
LDDF (£8,000 In Control)
LDDF (£14,000 Families Leading Planning)
BILD (£20,000 Salford Citizen Advocacy)
Pooled Budget
LDDF (£15,000 PCP Co-ordinator Transition)
c)
Using Ordinary Services that are Inclusive
i)
Health Inequalities
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8.8
One year funding with Salford Primary Care Trust to address health
inequalities in mainstream health services will finish in 2006. We will
need to review the findings of this project.
 Training video My Life My Health My Say has been completed for use with
mainstream health services, Primary and Hospital. This will be circulated
for national use.
 Pilot of 100 accessible well person checks with practice nurses and GP
Practices.
 Introduction of accessible Health Action Plans for all people supported by
services.
 Project focussed on complex needs (PMLD) to formulate skills
requirements for staff supporting people with complex needs will be set up.
 Re-develop Craig Hall building and staff team to support people with
complex needs.
 Training Assistant Health Practitioners as a new role able to provide
support to people with complex needs.
 Use the National Autistic Societies ‘Audit Tool’ to identify people using
services fall into this area of work.
 Autism Accreditation of Day Services to ensure services are able to
support people who have needs in the Autism Spectrum.
 Link to Mental Health Society’s ‘Audit Tool’ to work with people have only
a diagnosis of Autism.
 Bid to increase availability of Speech and Language Therapists to support
Total Communication.
 Development of the Physiotherapy Service from reliance on one post.
 Build on recent development of the Psychiatric and Psychology Service in
New Directions.
 Implement the Challenging Behaviour Policy.
 Training Programme in Hope Hospital to support work done in Hospital
Project. To ensure health outcomes for people with learning difficulties
who have to go into hospital.
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 Link to customer care quality development programme in Salford Royal
Hospital Trust.
 Set up Management arrangements for Allied Health Professionals to coordinate and develop their services.
 Establish joint protocols with Mental Health Services to support joint
assessments and better support for people who have mental health needs.
Rationale
8.9 It is clear that the population profile in Salford will present challenges to
local services.
People will need support with health needs especially as the population of
the “baby boom” are ageing and will experience increased health needs
associated with the ageing process.
There are 109 people supported who have profound and multiple learning
difficulties this number is growing and services are being developed to
meet support needs of such people. Services will need to combine the
skills of what have more usually been termed Health Services and Social
Care Services.
Investments are being made to maximise the competence of the support
that can be expected from generic health so that specialist services can
focus on support to people whose needs require specific skills.
8.10 Funding Sources
INCA bequest £25,000
Primary Care Trust £50,000
Craig Hall Re-development £200,000 (£100,000 LDDF, £100,000 Salford
City Council)
ii)
Supporting People Into Paid Work
8.11 We need to improve work experience and paid employment to do this
we need to build on the Salford Employment Plan Skills Partnership
bring in best practice from the Greater Manchester area via someone who
does this well.
 Relocate the Buffet Service to St Georges resource unit to expand the
Buffet Service as a work training scheme.
 Re-develop the Bizzie Lizzie Café as a catering training site.
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 Develop Princes Park Garden Centre to provide more focussed training
opportunities. Develop the Landscaping contracts to provide a way for
workers to access paid work.
 Co-locate Independent Advocacy Services (IAS) Jobshop and Salford
Supported Employment team to co-ordinate resources. Apply for funding
to extend Workstep contracts.
 Full involvement in the Buile Hill regeneration project to maximise
outcomes for people supported.
 Concentrate staff resources from Orchard Mount to increase support to
employment and people with profound disabilities.
 Locate team and associated technology for production of accessible
materials to St Georges and develop skill training team.
 Support the Primary Care Trust and Local Authority to be exhibitors of
best practice in employing disabled people.
8.12 Rationale
In order to improve the support available to people seeking work, the
modernisation of day services will increase the resources devoted to
preparing people for and supporting them into work and employment.
Existing work training schemes (mainly in Irlam and Buile Hill) will be
developed to provide greater focus on achieving employment, some
training will re-locate to St Georges which has more space and is on the
edge of the Chapel Street and Broughton Regeneration areas.
Development of Salford Supported Employment and Jobshop following
work by a Consultant in 2005 will build a larger Supported Employment
Service.
8.13 Funding Sources
LDDF for relocations and minor developments (Estimate £30,000)
Bids to major funders (£47,000)
IAS Contract (£180,000 per annum)
Pooled Budget (£412,000)
d)
Efficient and Effective In Using Resources
i)
Improving People’s Housing Situation
8.14 Reduce the number of tenancies supported by New Directions Supported
Tenancy Service through reviews of the support requirements of tenants.
The service to focus on support to people with complex needs using the
particular combination of social and health care staff.
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 Increase the number of Direct Payments for people each year (20 in 2005)
 Increase the availability in Salford of floating and minimum support
services through planned developments with the sector.
 Use Person Centred Planning to specify services for 30 people currently
supported “out of borough” who wish to return and commission local
services to house and support these people.
 Fill vacancies within 2 months, review tenants needs annually.
 Work with families of 5 people to find housing for people wanting to be
supported in their own home.
 Work closely with Supporting People on reviews of Supported Tenancy
Services both on costs and quality. Achieve necessary savings.
 Pilot Extra Care Housing project (Moving On Making Space) for people
who are older and frailer and increase housing options for people.
 Increase the percentage of tenancies supported in the independent sector
to increase the viability of small providers.
 Increase the use of Independent Living Fund and other funding to support
greater activity levels and independence for people in supported tenancy
service.
 Set up ‘One Stop’ Short Break Service to increase the flexibility of short
break support to family carers.
8.15 Rationale
There has already been considerable investment in services locally in
terms of Person Centred Planning and Total Communication. This is
linked to Supporting People reviews and to Health Needs Assessments to
be clear of the support needs of people supported by the current services
in Salford. This person centred approach is fuelling change in services to
reduce the number of people supported by 24 hour services.
In order to meet future needs the ‘in house’ service will complete it’s
integration (PCT and City Council Service) and focus on providing support
to people with complex needs, especially health related needs. More use
will be made of floating support/minimum support services and variations
such as “keyring” schemes. Investment of funding currently going out of
the City in terms of “out of borough” placements will be reversed by
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continuing the programme of returning people to Salford using Person
Centred Planning to commission appropriate services.
Better future planning with people with older carers and other people
wanting to be supported in their own home will help in increasing the
available property.
Close joint commissioning with Supporting People and Housing will
continue to make best use of available housing and housing support
resources. This will be within the framework of the 5 year Supporting
People Strategy and working as part of the Local Authority to negotiate
supporting people grants to Learning Difficulty Services.
The commissioning actions will increase the available housing and reduce
the dependence on one model (24 hour) support. A more balanced
approach to risk and independence will increase housing options for
people by making it possible to move support to people rather than
moving people into “schemes”. Investment in Advocacy, work with
families on housing options and Person Centred Planning will support
more people to obtain their housing through legacies, ownership,
inheritance, Trusts or mortgage.
8.16 Funding Sources
LDDF capital from NHS Capital injections (Calderstones, £410,000)
Out of Borough placement lines in pooled budget
Supporting people grant
Funding released from “contraction” of New Directions Supporting
Tenancy Service.
ii) Supporting Everyone In Salford
8.17 Co-location of all specialist services to facilitate close team work.
Psychologists, Psychiatrist, Community Team, Physiotherapist, Art
Therapists and Speech and Language Therapists.
 Employ Specialist Psychiatrist full time.
 Develop staff in line with the Challenging Behaviour Policy.
 As part of the Autism Accreditation Programme, training staff in supporting
people with complex needs.
 Develop skills if staff in area of profound and multiple learning difficulties,
for instance, Assistant Health Practitioners introduced as a new hybrid job
in Salford.
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 Person Centred Planning used to commission services locally.
 Provide Hydrotherapy for people with profound and multiple needs.
 Review the use of buildings and develop better buildings for people with
profound multiple needs.
8.18 Rationale
The Commissioning Strategy is to develop locally based skills and
services able to respond flexibly. This will be done through effective
working with other key agencies. Incorporation of key professions into
New Directions. Development of a local skills base in Providers
commissioned to support people “returning” from out of borough
placements.
The framework to help services capacity build is the Challenging
Behaviour Policy which was reviewed and re-launched in July 2005.
8.19 Funding Sources
Skill mix reviews as and when vacancies arise.
Bids to the Primary Care Trust including the Local Delivery Plan.
e)
Working In Partnership
i)
With People Supported and Parent/Carers we will continue to
stronger links with people in the areas outlined on page 18
ii) With ordinary services
develop
Health
As already stated, we will build on the Health Action Plans and the Health
Project to improve the outcomes for people.
Culture, Leisure
Culture and Leisure are now part of the new Community, Health and Social
Care Directorate. There will be opportunities for Leisure Centres, Libraries
and Museums to be inclusive.
Housing
There needs to be greater choice in the way housing is provided with people
owning property and shared ownership.
We need to build up a picture of people’s housing needs and offer choice
around how support is given according to individual need.
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We also need to give people choice around who they live with.
With these three areas in mind, a secondment from the Housing Directorate
will occur in 2006 to help the ‘Where People Live’ Task Group commission
support based on needs.
Employers
In 2006, we will commission work to match the skills of people we know with
opportunities for both work experience and the gaining of qualifications via
time limited courses. This will lead to work opportunities with employers in
Salford and in particular the Local Authority, Primary Care Trust, Hospital
and University as the main employers in Salford.
Colleges and Lifelong Learning
We will need to work with the Local Authority, Colleges and Learning Skills
Council to co-ordinate skills training and lifelong opportunities for people.
iii) Across adult services
We will work on setting up partnership working in the following ways:
 Joint Assessment and Protocols with Mental Health Services.
 Joint Assessment and Protocols with other Adult and Disability Services.
 Joint Assessment and Protocols with Children’s Services
 Joint Assessment and Protocols with Drug and Alcohol Services
 Development of a strategy for the use of Meadowbrook.
 Partnership working with local agencies in Adult Protection.
iv)
-
With a choice of providers
We will increase the percentage of tenancies provided by the independent
sector by:
Tendering for the support for the Extra Care Housing Project
Moving some support from the in-house provider to the independent
sector
Having a preferred providers list for domiciliary support
Bringing people back to live in Salford
We will strengthen the links with the voluntary sector especially MENCAP by:
Continuing to commission a Leisure Co-ordinator from the
Development Fund (cost £30,000 a year)
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9.
See if the three MENCAP organisations can become one Salford
MENCAP
See what further opportunities there are for groups such as the DIY
Drama Group.
Conclusion
The Commission for Social Care Inspection report dated January 2005
recognised the developments in service in Salford over the last four
years. We are a 3 star service, which is the highest possible and means
we serve all people well and have excellent prospects for the future.
This has been possible because of a strong commitment from the Local
Authority and the Primary Care Trust to see the partnership working
succeed. The section 31 partnership integrated management structure
and pooled budget has set the tone for an enthusiastic, hard working and
dedicated staff group to improve the quality of people’s lives.
We need to continue to develop Person Centred Services offering greater
access to ordinary services, choice and opportunities to people and their
carers. This will occur if we develop better planning and use limited
resources more effectively and efficiently to support people to be
included. If this occurs we will continue to see improvements in the
quality of people’s lives. However with increasing demand comes the
need for increasing investment if the vision outlined in valuing people is to
be realised.
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