Ppt final 150212 mrl edit


Published on

Published in: Business, Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • 0.9% for ages 65-74, 4.3% for 75-84 year olds and 20.7% if 85 and over. Women residents tend to be older, at an average age of 85.6 years, compared to 83.2 for men (Office o ). Two thirds of older people living in care homes experience some level of cognitive impairment and 75% of them are classified as being severely disabled . It is also estimated that up to 40% of residents experience depression. Depression is estimated to affect up to 40% of older people who live in care homes and it often goes unrecognised (Audit Commission 2000. Audit Commission (2000) Forget Me Not: Mental Health Services for Older People . Audit Commission, London. Two Thirds of older people living in care homes experience some level of cognitive impairment. Bebbington A, Darton R and Netten A (2001) Care homes for older people. Volume 2. Admissions, needs and outcomes . PSSRU. Canterbury f Fair Trading 2005). 75% classified as being severely disabled (OFT 2005)
  • In terms of next steps, there are probably 3 main areas on which to focus Maintain momentum Need for cultural change Workforce fit for purpose
  • Cancer and intellectual disability: a review of some key contextual issues , J Hogg/I Tuffrey- Wijne, Journal of Applied Research in Intellectual Disabilities, Nov 2008 2 Equal treatment: closing the gap: a formal investigation into physical health inequalities experienced by people with learning disabilities and/or mental health problems (Part 1 of the DRC’s formal investigation report), Disability Rights Commission, 2006 3 Social Trends No 35, C Summerfield/B Gill, Office for National Statistics, 2005
  • But don’t label – challenging to who?
  • In this area, Redbridge acute trust made significant changes following the 6 lives report and St Francis leads nationally on their models and input into LD and EOLC
  • Ppt final 150212 mrl edit

    1. 1. Friday, 17 February 2012 Local Voices, Local Choices in Essex
    2. 2. Housekeeping and Introductions Susannah Westwood
    3. 3. Welcome Cllr. Naylor, Cabinet Member for Adults, Health and Community Wellbeing
    4. 4. Liz Chidgey Acting Executive Director Adult Social Care 17th February 2012 Adult Community Learning Centre, Bishops Hill Local Voices, Local Choices
    5. 5. Setting the scene <ul><li>Good outcomes in everybody’s interest </li></ul><ul><li>Financial climate </li></ul><ul><li>Think Local, Act Personal </li></ul><ul><li>White Paper for Adult Social Care Reform Spring 2012 </li></ul><ul><li>Welfare Reform </li></ul>
    6. 6. The priorities for commissioners <ul><li>Personalisation of services </li></ul><ul><li>Sustainable outcomes </li></ul><ul><li>Value for money </li></ul><ul><li>Innovative models of both accommodation and services </li></ul><ul><li>Partnerships and integration </li></ul><ul><li>Market development activity to ensure availability of a range of accommodation offers </li></ul>
    7. 7. How does the market need to respond? <ul><li>Embrace the personalisation agenda – </li></ul><ul><li>Understand that we are moving from a wholesale model of provision to a retail model </li></ul><ul><li>Changing the relationship between commissioners and providers to encourage a range of accommodation and service offers </li></ul>
    8. 8. What can today offer you? <ul><li>Sharing expertise, information and best practice to support your future business planning including: </li></ul><ul><ul><li>How My Home Life has helped providers develop their offer </li></ul></ul><ul><ul><li>Innovative practice in End of Life Care </li></ul></ul><ul><ul><li>A provider’s perspective on Value and Outcomes in accommodation services </li></ul></ul><ul><ul><li>Introducing the Market Position Statement </li></ul></ul><ul><ul><li>Is Supported Living an option? </li></ul></ul>
    9. 9. Let us know what you think <ul><li>This event is part of our commitment to supporting the market to innovate and help individual providers to develop their business </li></ul><ul><li>Participate fully in these opportunities – evaluation forms are provided and let us know what you think, or what you might benefit from in future </li></ul><ul><li>Commissioners and service users are committed to personalisation – and we want providers to join us in working toward this </li></ul>
    10. 10. Tom Owen (National Director)
    11. 11. My Home Life Programme UK Promoting quality of life for those living, dying, visiting and working in care homes for older people.
    12. 12. Support <ul><li>Age UK, Joseph Rowntree & City University </li></ul>Other key organisations: Essex County Council Relatives & Residents Association National Care Forum English Community Care Association National Care Association Registered Nursing Home Association Care Forum Wales Scottish Care Independent Health & Care Providers National Care Home R&D Forum
    13. 13. Ethos and values <ul><li>True collaboration with the care home sector </li></ul><ul><li>Working to their agenda for quality </li></ul><ul><li>Focusing on “what works?” </li></ul><ul><li>Acknowledging challenges </li></ul><ul><li>Whole-systems approach </li></ul><ul><li>Community support </li></ul>
    14. 14. MHL UK Activities <ul><li>Synthesising evidence </li></ul><ul><li>Providing leadership </li></ul><ul><li>Developing resources </li></ul><ul><li>Creating networks </li></ul><ul><li>Supporting change </li></ul><ul><li>Maintain momentum </li></ul>
    15. 15. Creating Resources and sharing practice: Website - Newsletters – Newspaper. Awards - Charter - Event/s Leadership Support Programme & Master Classes for 80 Care Home managers Synthesising evidence: Exploring how to improve resident v oice, choice & control Inclusion & Outreach : Schools, Arts, Music, Libraries etc Supporting Change e.g. Better Transitions Network; Community Volunteers Initiative; Quality Improvement Team MHL Essex Activities
    16. 16. The emergence of the leadership support programme <ul><li>Sector acknowledged huge pressures on managers... </li></ul><ul><li>But managers pivotal to improvement </li></ul><ul><li>Often managing from a position of fear and anxiety </li></ul><ul><li>Often isolated and undervalued </li></ul>
    17. 17. What support is offered? <ul><li>Leadership support for managers in over 250 care homes for older people (80 in Essex) </li></ul><ul><li>12 month half day programme </li></ul><ul><li>Supporting managers’ own journey of change </li></ul><ul><li>Offering reflective space </li></ul><ul><li>Supporting skills training/ coaching </li></ul><ul><li>Supporting evidence-based relational practice </li></ul>
    18. 18. Emerging outcomes <ul><li>More resilient, assertive, skilled managers </li></ul><ul><li>More support to staff/ reflective spaces </li></ul><ul><li>Calm – more relational environment </li></ul><ul><li>Staff taking initiative/ advocacy </li></ul><ul><li>Greater staff connection with residents </li></ul><ul><li>Residents less withdrawn/ more involvement </li></ul><ul><li>2 way engagement between staff, residents, relatives </li></ul>
    19. 19. Factors underpinning success <ul><li>Working in true partnership and collaboration </li></ul><ul><li>Celebrating and building on the positive: ‘What works well?’ </li></ul><ul><li>Acknowledging challenges/ barriers </li></ul><ul><li>Building on energy and enthusiasm </li></ul><ul><li>Breaking down divisions, brokering dialogue across agencies </li></ul><ul><li>Engaging broader community support </li></ul><ul><li>Ownership by the sector rather than by the council </li></ul>
    20. 20. Contact Details <ul><li>My Home Life Programme </li></ul><ul><li>http://www.myhomelife.org.uk </li></ul><ul><li>Prof Julienne Meyer, Exec Director </li></ul><ul><li>Tom Owen, Director </li></ul><ul><li>City University </li></ul><ul><li>Philpot Street </li></ul><ul><li>London E1 2EA, England, UK </li></ul><ul><li>Tel: +44 (0)20 7040 5791/ </li></ul><ul><li>Fax: +44 (0)20 7040 5529 </li></ul><ul><li>Email: mhl@city.ac.uk </li></ul>
    21. 21. Clare Silvester & Linda Curran An Introduction to Quality Improvement team
    22. 22. Who we are <ul><li>Essex County Council’s Adults Health & Community wellbeing Quality Improvement Team, is committed to making the experience of people who use care services in Essex one of excellence </li></ul><ul><li>The QI team are skilled and talented, experts by experience. The knowledge of the team encompasses all specialism's operating in the Essex care market. </li></ul><ul><li>We pride ourselves on being approachable and are advocates of partnership working. </li></ul>
    23. 23. Our vision <ul><li>We will work in partnership with you and support you to positively reflect on the service you provide. </li></ul><ul><li>Celebrating what you do well and identifying development opportunities in your service. </li></ul><ul><li>We want the Essex care market to be recognised for delivering innovative, exciting and creative person centred services. </li></ul>
    24. 24. The role of QI Officer & Consultant <ul><li>By working in partnership with you, we will raise standards in your service. </li></ul><ul><li>We have proved to be a positive asset to the Older People's Residential Care Market and are currently launching the QI service into the Mental Health Sector. </li></ul><ul><li>We work in close collaboration with Health colleagues and Social care professionals, local communities and the voluntary sector. </li></ul><ul><li>We develop networks, share knowledge, resources and good practice that assists continuous improvement of care services in Essex. </li></ul>
    25. 25. The role of the Quality Improvement Assistant <ul><li>Creating opportunities for service users to feedback on the service they receive </li></ul><ul><li>Compliments the work of the Quality Improvement Officer. </li></ul><ul><li>Gathers feedback from the service users to form part of QI development work with the home </li></ul><ul><li>Method of engagement: Effective face to face discussions between service users and QIA’s </li></ul><ul><li>The QIA role ensures that service users remain at the heart of all improvement work. </li></ul>
    26. 26. Service user feedback <ul><li>Essential to keep service users central to the process </li></ul><ul><li>Design of service user feedback forms </li></ul><ul><li>Provides information regarding outcomes & performance from a service user perspective </li></ul><ul><li>Person centred approach </li></ul><ul><li>Feedback gathered in conjunction with provider assessment work </li></ul><ul><li>Qualitative constructive feedback to share with the providers </li></ul>
    27. 27. Future Developments <ul><li>Room for on-going improvement and support </li></ul><ul><li>Market development- raising the bar </li></ul><ul><li>Promoting service user engagement </li></ul><ul><li>Identifying barriers and solutions identified by providers across the Essex care market. </li></ul><ul><li>Scope for a best practice website or central resource hub (similar to My Home Life Essex – utilised in the OP Residential Market.) </li></ul><ul><li>Identifying resources including specific provider training programmes </li></ul>
    28. 28. The Team <ul><li>First column bullet here </li></ul>Clare Silvester Senior Quality Improvement Consultant Business Quality Improvement Officer Lesley Cruickshank Head of External Standards & Improvement Angela Gibson Business Quality Improvement Administrator Rachel Hutchon Linda Curran Paul Hutchinson Teri Marlow Chris Mellor Jane Treadwell Carol Weyman Sylvia Woods Quality Improvement Officers Quality Improvement Assistants Karen Butler Imelda Minns Ben Fenner Jan Lockyer Project Manager
    29. 29. Contact Quality Improvement <ul><li>Telephone: </li></ul><ul><li>01245 434 652 </li></ul><ul><li>Fax: </li></ul><ul><li>01245 434 852 </li></ul><ul><li>Email: </li></ul><ul><li>[email_address] </li></ul>
    30. 30. Lesley Ferguson Commercial Team Source & Supply Commercial Team
    31. 31. Responsibilities <ul><li>Account Managers & Commercial Support </li></ul><ul><li>Over 2,000 contracts </li></ul><ul><li>Residential, Nursing, Day Care & Home Care </li></ul><ul><li>Older People & Working Age Adults </li></ul>
    32. 32. Commercial <ul><li>Strong focus on commercial awareness </li></ul><ul><li>Understanding of how the care market operates and setting up commercial arrangements with the market. </li></ul><ul><li>Encourage competition through contracting. </li></ul><ul><li>Take calculated risks to drive value and encourage innovation. </li></ul>
    33. 33. Account Management <ul><li>Management by Company </li></ul><ul><li>Innovative care service opportunities </li></ul><ul><li>Saving opportunities to benefit both parties </li></ul>
    34. 34. Procurement <ul><li>Change in approach </li></ul><ul><li>BVRL & PSRL </li></ul><ul><li>New approach creating competition on price and quality </li></ul><ul><li>Encouraging good quality care </li></ul><ul><li>Regular review of price & quality </li></ul><ul><li>Self assessments </li></ul>
    35. 35. Working Age Adult  Residential Framework  <ul><li>LD, P&SI and potentially Mental Health </li></ul><ul><li>Detail clear criteria for standards </li></ul><ul><li>Cover specific target areas </li></ul><ul><li>Autism & Aspergers, Challenging Behaviour and Move on services. </li></ul>
    36. 36. The Contract will also….. <ul><li>Specifications focus on the potential for individuals </li></ul><ul><li>Providers to realise individual aspirations </li></ul><ul><li>Lead as independent and inclusive lifestyle as possible. </li></ul><ul><li>Providers will have clarity around the expectations of ECC </li></ul>
    37. 37. Local Voices, Local Choices in Essex End of life Care Strategy and beyond ….. Tes Smith Operational Service Development Manager End of Life Care. & Social Care Lead - National End of Life Care Programme
    38. 38. Who am I? <ul><li>Operational Service Manager in Essex with EOLC lead </li></ul><ul><li>Developed the Essex EOL strategy to ensure we have an action plan to embed EOLC in all we do </li></ul><ul><li>My role is around raising awareness, promoting integration and joint working </li></ul><ul><li>Developing resources and training to support the EOLC agenda in Essex </li></ul>
    39. 39. <ul><li>Is this a risky topic to discuss? </li></ul><ul><li>In our society death seems to be considered as sex was to the Victorians- necessary </li></ul><ul><li>but the less said about </li></ul><ul><li>it the better! </li></ul><ul><li>(UKCP issue 45) </li></ul>
    40. 40. Facts: <ul><li>Someone is diagnosed in this country with cancer every 2 minutes … </li></ul><ul><li>How about adding to that </li></ul><ul><li>Those with: </li></ul><ul><li>heart failure, </li></ul><ul><li>Stroke, </li></ul><ul><li>Neuro conditions, </li></ul><ul><li>Accidents, </li></ul><ul><li>dementia ...? </li></ul>
    41. 41. The outcome of some of these will be: <ul><li>Someone dies in this country every minute … ( dying matters - NCPC ) </li></ul><ul><li>56 -70% of people would prefer to die at home, yet of the 500,000 people who die each year in England, 58% die in hospitals. </li></ul><ul><li>In Essex good work is being done – mare needs to happen </li></ul>
    42. 42. Dying matters… www.dyingmatters.org/site/why-talk-about-it <ul><li>81% of people have not written down any preferences around their own death, </li></ul><ul><li>only a quarter of men (25%) and just over one in three women (35%) across England have told anyone about the funeral arrangements they would like to have after they die. </li></ul><ul><li>Nearly two-thirds of people (60%) have not written a will – including a quarter (25%) of over-65s. </li></ul>
    43. 43. National End of Life Strategy 2008 <ul><li>National End of Life Care Strategy set out core principles:- </li></ul><ul><li>People approaching end of life are on an EOLC register </li></ul><ul><li>Each person is offered a care plan and their wishes and preferences are identified </li></ul><ul><li>Staff receive training and support </li></ul><ul><li>There is appropriate access to GP, district nursing and specialist palliative care </li></ul>
    44. 44. All the BIG society reports and policies are well and good but the challenge is to achieve this in Essex ...
    45. 45. So how? - your role? <ul><li>All professionals and care providers have a vital role to play in supporting people to live and die well, in the place of their choosing. </li></ul><ul><li>Greater integration is needed across all care and support services, particularly social and health care, to improve the experience of dying for the individual and those around them. </li></ul><ul><li>Raising awareness - This includes tapping potential in the wider community (and other public services) to enhance quality of life at this stage. </li></ul>
    46. 46. How do you ensure the individual gets heard? <ul><li>The individual is absolutely at the heart of all conversations about them and for them. </li></ul><ul><li>People are ‘worked with’- patients are ‘done to’ … </li></ul><ul><li>Ensure all assessments start with a ‘rest of your life’ plan – early conversations </li></ul><ul><li>Support plans clearly state aspirations of the individual and where appropriate family & carers </li></ul>
    47. 47. How do you ensure this as an individual? <ul><li>Be curious and look for the clues or cues … </li></ul><ul><li>People, staff and service users often don’t know how to start the conversations either and will often hint at what may be on their mind. </li></ul><ul><li>This may be in words or actions … </li></ul>
    48. 48. <ul><li>There are currently approximately 1.5 million people in the UK with a learning disability. People with learning disabilities account for about 2.5% of the English population with an average GP surgery likely to have 50 learning disabled people on its register . </li></ul>
    49. 49. <ul><li>Where the dying person with learning disabilities has challenging behaviour, mental health problems or profound learning disabilities then careful consideration needs </li></ul><ul><li>to be given to the best place in which to provide their care and to the support needs of those around them. </li></ul>
    50. 50. <ul><li>Many hospitals and hospices and care services may not have experience of caring for people with learning disabilities who are dying. </li></ul><ul><li>It is therefore important to seek educational opportunities to ensure they are fit for purpose to care for this client group at the end of their lives. </li></ul><ul><li>Previous bad experience of mainstream health and social care may make service users reticent </li></ul><ul><li>to engage with those organisations which do take care of the dying. </li></ul>
    51. 51. Tools to use? ‘ Route to success in end of life care – achieving quality for people with learning disabilities’ www.endoflifecareforadults.com
    52. 52. <ul><li>It is intended that the guide will support </li></ul><ul><li>practitioners and staff (working in all the settings in which people with learning </li></ul><ul><li>disabilities live) to develop their awareness and understanding of the end of life care pathway and how it relates to people who have learning disabilities </li></ul>
    53. 53. Preferred Priorities for Care document - easy read version <ul><li>This easy read version of the Preferred Priorities for Care (PPC) document is designed to help people with learning disabilities prepare for the future. </li></ul><ul><li>It gives them an opportunity to think about, talk about and write down their preferences and priorities for care at the end of life www.endoflifecareforadults.com </li></ul>
    54. 54. Question for you  … Which key do you hold for someone in your little bit of Which conversation can you start ?
    55. 55. Contact me: <ul><li>Tes Smith </li></ul><ul><li>[email_address] </li></ul><ul><li>or </li></ul><ul><li>Social Care Lead, NEoLCP </li></ul><ul><li>[email_address] </li></ul><ul><li>National End of Life Care Programme: </li></ul><ul><li>www.endoflifecareforadults.com </li></ul>
    56. 56. Personalising the Offer for Residential Care
    57. 57. Our Vision <ul><li>“ RCHL exists to support vulnerable people to lead their lives as they wish and to challenge barriers that prevent individual choice and fulfilment” </li></ul>
    58. 58. Regulation? <ul><li>Is Regulation the barrier or is it our practices ? </li></ul>
    59. 59. Commissioning <ul><li>Its not just about the money, Personal Budgets are only a mechanism? </li></ul>
    60. 60. Challenges <ul><li>Investment & Resources </li></ul><ul><li>Challenging established working practices – even for TUPE staff! </li></ul><ul><li>Staff Behaviours being aligned with RCHL Core Values. </li></ul>
    61. 61. The Way Forward? <ul><li>Community Connecting. “Real Lives” </li></ul><ul><li>Organisational Learning </li></ul><ul><li>Partnership Working </li></ul><ul><li>Measuring REAL Outcomes </li></ul><ul><li>Values Led Behaviours </li></ul>
    62. 62. HI MY NAME IS EMILY
    76. 76. I GO OUT SOCIALLY
    78. 78. Local Voices Local Choices Friday 17 February 2012
    79. 79. Our vision is a world where disabled people have the same opportunities to fulfil their life ambitions as non-disabled people. Our purpose is to drive the changes that will make our society the first in which disabled people are able to realise their full civil liberties and human rights. Our vision and purpose
    80. 80. David's Story
    81. 81. He is 25 years old He has cerebral palsy He has significant learning difficulties He uses a wheelchair He communicates verbally but needs assistance to understand what is going on around him Who is David?
    82. 82. <ul><li>When David came to Scope as an adult he found things difficult to manage </li></ul><ul><li>Noise </li></ul><ul><li>The people he lived with </li></ul><ul><li>His behaviour </li></ul><ul><li>David lacked the capacity to decide where he lived </li></ul>David’s Story
    83. 83. David gained a place at our transition service where he developed strategies to help him cope with the things he finds difficult. David consistently demonstrated his desire to live on his own David’s team worked with David, his family and key professionals to understand how this could be possible David’s Story
    84. 84. <ul><li>David’s family were afraid he would be, </li></ul><ul><li>Lonely </li></ul><ul><li>Isolated </li></ul><ul><li>Vulnerable </li></ul>David’s Story
    85. 85. <ul><li>Scope provided David with a flat within the transition service where he was safe and had the support he needed to develop within his new environment </li></ul><ul><li>David was happy </li></ul><ul><li>David’s family could see he was happy and not lonely or isolated </li></ul><ul><li>David demonstrated his capacity to choose where he lives </li></ul>David’s Story
    86. 86. David continued to thrive and has now moved to his own flat where he is the tenant Scope continue to support David in his new home David takes part in the wider community and activities such as Tai Chi, doing voluntary work and spending time out with his friends David’s Story
    87. 87. Everything we do at Scope is about inspiring belief in the possible. And the thing we absolutely believe is possible is that by working together our society can change for the better. So that disabled people have the same opportunities as everyone else. That’ s why we share stories of inspiring real life experiences, aspirations and ambitions of disabled people and their families or friends. The things they tell us they ’ d like to do in the future – the things we support them to achieve. Every day. It’s the reason were here. Why stories are important to us
    88. 88. David’s story and others like his have set Scope on a mission to transform our services in Essex and across the country Our beliefs
    89. 89. We see the person and we set no limit on potential . We believe in independence , inclusion and freedom to choose . Everyday life equality . No more. No less. Together we can create a better society . Our beliefs
    90. 90. What is value? Mick Davies Regional Manager Learning Disabilities and Mental Health
    91. 91. Value to commissioners <ul><li>“ VfM is about obtaining the maximum benefit from the resources available” </li></ul><ul><li>“ VfM not only measures the cost of goods and services, but also takes account of the mix of cost with quality, resource use, fitness for purpose and timeliness to judge whether or not, together, they constitute good value” ( The Improvement Network ) </li></ul><ul><li>Price is what you pay. Value is what you get ( Warren Buffett ) </li></ul>
    92. 92. Valued by service users <ul><li>To be protected from harm </li></ul><ul><li>Dignity and Respect </li></ul><ul><li>To have the right to choose where, and with whom, they live </li></ul><ul><li>Equal access to health care </li></ul><ul><li>To be free to make choices </li></ul><ul><li>Access to work and other meaningful activities </li></ul><ul><li>To be heard </li></ul>
    93. 93. Value. A providers eye view
    94. 94. Value. A providers eye view <ul><li>Key issues: </li></ul><ul><li>Agreeing concepts of quality – involving service users </li></ul><ul><li>Establishing framework to negotiate fees (CFC etc) </li></ul><ul><li>Large home efficiencies v small home life quality benefits </li></ul><ul><li>Investment in the future – commissioning commitment </li></ul><ul><li>Partnership for strategic planning. Sharing information about future capacity requirements, specialist needs etc </li></ul><ul><li>Sympathetic consideration of provider cost changes (NMW increases, new regulations etc) </li></ul>
    95. 95. Value. A providers eye view <ul><li>Financial stability/viability </li></ul><ul><li>Threats: Reducing fee levels & fewer referrals. </li></ul><ul><li>Increasing costs due to changing regulations, commissioner/service user expectations </li></ul><ul><li>“ Tipping point” closer for small, independent providers </li></ul><ul><li>Financial failure usually results in unmanaged home closures (little warning or opportunity to arrange alternative placements) </li></ul>
    96. 96. Value. A providers eye view <ul><li>Conflicts and contradictions </li></ul><ul><li>Funding of LA operated homes </li></ul><ul><li>Matching approved/preferred provider arrangements to independent audits of services (CQC/HSE/EHO etc): Higher quality = more referrals = higher fees </li></ul><ul><li>Consistency in values across commissioner organisations: </li></ul><ul><li>ECC staff expenses provision for 24 hr subsistence (Bed + meals only)= £130 per day/£920 per week </li></ul><ul><li>Current ECC placement in THG in Essex range from £380 per week (Bed, meals, 24 hour personal care, transport etc). </li></ul>
    97. 97. <ul><li>Whilst independent sector providers are often seen as the poachers of the care field, it must be said that the gamekeepers wear some suspiciously furry coats. </li></ul><ul><li>( Anon) </li></ul>
    98. 98. <ul><li>Mick Davies </li></ul><ul><li>[email_address] </li></ul><ul><li>Springbank </li></ul><ul><li>[email_address] </li></ul><ul><li>01255870237 </li></ul>
    99. 100. Context – learning disabilities In 2010 /11 the council spent £54.4 million on residential and nursing care for adults with learning disabilities, and supported 1,072 adults (18+) in registered care. <ul><li>We spend more on registered care for adults with learning disabilities than other similar authorities .  </li></ul><ul><li>The amount we spend on registered care for adults with learning disabilities is beginning to fall. </li></ul>
    100. 101. Context – physical impairments In 2010 /11 the council spent £9.4 million on residential and nursing care for adults with physical impairments, and supported 240 adults (18+) in registered care. <ul><li>The amount we spend on registered care adults with physical impairments is increasing, and we are concerned about this. </li></ul>
    101. 102. Progression <ul><li>People should wherever possible be supported to achieve greater independence. </li></ul><ul><li>Providers working with people on a daily basis are best placed to support this progression. </li></ul><ul><li>As commissioners we need to find a way that incentivises providers to achieve this.  </li></ul>
    102. 103. Issues <ul><li>We still spend too much money on registered care for adults with learning disabilities (45% of our budget compared to an average of 38% for similar councils). </li></ul><ul><li>Too many adults with physical impairments are being admitted into registered care, and the number is increasing. A major cause is homelessness and a lack of suitable accommodation. </li></ul><ul><li>Too many young people are admitted into residential colleges outside Essex. </li></ul><ul><li>Young people admitted to registered care, and people admitted due to an emergency too often get “stuck”. They become dependent on the support provided, and their families become accustomed to the safety and stability that these placements provide. </li></ul>
    103. 104. The Role of Registered Care <ul><li>There is a need for good quality registered care provision for working age adults in Essex. </li></ul><ul><li>There is an increasing demand for placements that can support people who display behaviours that place themselves or others at risk, and people with profound and multiple disabilities. </li></ul><ul><li>There is a need for placements that can support young people to mature and develop the skills required for more independent living. </li></ul><ul><li>There is a need for placements that can respond quickly to emergency situations, however these should help people prepare for the next phase of their life. </li></ul><ul><li>There is also demand for placements that can support people towards the end of their lives. Dementia and other age related conditions are increasingly prevalent. </li></ul>
    104. 105. The Role of Registered Care <ul><li>Personalisation is about how people experience the support they receive on a day to day basis, and the relationships they have with the people providing this support. Registered care can and should be delivered in a personalised way. </li></ul><ul><li>We want to find a better way to reward providers who enable people to progress to more independent living. </li></ul><ul><li>We believe there is sufficient demand from young people entering adult services to ensure a healthy throughput of people for providers with the skills to support progression. </li></ul><ul><li>We want to work with providers to help this market to grow. </li></ul><ul><li>More information about our commissioning intentions for working age adults can be found in our Market Position Statement . </li></ul>
    105. 106. Cllr. Brown, Deputy Councillor as Member for Adult, Health & Community Wellbeing
    106. 107. <ul><li>Key Issues to Consider - Housing and Support for People with Learning Disabilities </li></ul><ul><li>Steve Strong, Housing and Social Inclusion Project Manager, NDTi </li></ul>people lives communities
    107. 108. <ul><li>About the NDTi </li></ul><ul><li>The NDTi is a not for profit organisation concerned with promoting inclusion and equality for people who risk exclusion and who need support to lead a full life. </li></ul><ul><li>Our aims are to: </li></ul><ul><li>Shape and influence policy and public debate </li></ul><ul><li>Enable a stronger voice of people to be heard </li></ul><ul><li>Support services to work differently so that they promote inclusive lives </li></ul><ul><li>Support communities to be welcoming and inclusive. </li></ul>
    108. 109. Housing and Social Inclusion Project <ul><li>Work with an identified number of people and support them to move from residential care to ‘settled accommodation’ </li></ul><ul><li>Learn from experiences across the 8 sites about what does and does not help this process the impact of the move on people’s community connections </li></ul><ul><li>Develop learning and good practice materials that support this change </li></ul><ul><li>Share the learning across the country </li></ul>
    109. 110. Policy shift towards independence, choice and control <ul><li>Valuing People & Valuing People Now </li></ul><ul><li>Improving the life chances of Disabled People </li></ul><ul><li>Personalisation and personal budgets (including a move away from residential care) </li></ul><ul><li>And NB people’s expectations are changing </li></ul>
    110. 111. Facts and figures <ul><li>33,000 adults with learning disabilities live in 6255 residential care homes (30% of people) </li></ul><ul><li>55% of adults with learning disabilities live with their families </li></ul><ul><li>15% of adults with learning disabilities have a secure tenancy or own their own home </li></ul>
    111. 112. Supported Living Residential Care Own home or tenancy. Security of tenure. Licence agreement with no security of tenure. As a tenant or homeowner the person has a right to choose who provides their support and can change support arrangements without moving home or move home without changing support arrangements. Support is provided as part of a package with housing and either element cannot be changed. As a tenant or homeowner the person has a right to choose who they live with if anyone. Good practice in residential care dictates that housemates should be well matched as much as possible but in practice many people live with people they do not choose to live with. Tenants and homeowners have rights to full welfare benefits including housing benefit, income support and disability living allowance. People in residential care have rights to limited amounts of welfare benefits and most people access a residential care allowance of approximately £20 per week to purchase personal belongings, clothes and holidays. Can access Direct Payments, Personal Budget, Supporting People Grant, Independent Living Fund for support. Cannot access additional funding for support.
    112. 113. Valuing People Now says... <ul><li>People with learning disabilities: </li></ul><ul><li>Can live successfully in different types of housing </li></ul><ul><li>Can cope with the full range of tenures, including home ownership </li></ul><ul><li>Should get help with person centred approaches to making choices </li></ul>
    113. 114. Valuing People Now says.. <ul><li>People with learning disabilities must have the same housing rights as everyone else </li></ul><ul><li>People should be able to get ordinary housing more easily </li></ul><ul><li>No-one with a learning disability should live permanently in NHS services </li></ul>
    114. 115. Valuing People Now says.. <ul><li>People still have little choice of where or how they live – most live with family carers </li></ul><ul><li>Mainstream housing needs to be more inclusive </li></ul><ul><li>Increase focus on access to home ownership and assured tenancies rather than residential services </li></ul>
    115. 116. Potential Impact <ul><li>More people: </li></ul><ul><li>Want choice </li></ul><ul><li>Want ordinary and individual housing solutions (not shared registered care) </li></ul><ul><li>Need advice and support to get individual housing </li></ul><ul><li>Expect rights and security </li></ul><ul><li>Choose how their support is provided </li></ul>
    116. 117. The Issues <ul><li>Lack of information </li></ul><ul><li>Limited choice of housing and support </li></ul><ul><li>Reliance on residential care in many areas </li></ul><ul><li>Lack of involvement of people and families </li></ul><ul><li>Safety and support needs </li></ul><ul><li>Managing funding pressures, resources </li></ul>
    117. 118. The Issues <ul><li>Need better use of existing housing </li></ul><ul><li>Choice based lettings systems not always working well </li></ul><ul><li>Better communication between services </li></ul><ul><li>Need better planning systems </li></ul><ul><li>Market driven by providers </li></ul><ul><li>Historical patterns of provision in parts of the country </li></ul>
    118. 119. The Issues <ul><li>People living out of county in residential care – issues with ordinary residence </li></ul><ul><li>Providers not really giving tenants control over their home </li></ul><ul><li>Lack of understanding of what supported living is </li></ul><ul><li>A need to clarify the different responsibilities of being a landlord from being a Registered Care Home provider </li></ul><ul><li>Providers feeling nervous about regulation and legality of new housing and support services </li></ul>
    119. 120. The Issues <ul><li>Cultural - a belief that people with learning disabilities need something different to everyone else </li></ul><ul><li>Housing & social services not working together </li></ul><ul><li>Weak commissioning </li></ul><ul><li>Focussing on a service response to housing </li></ul><ul><li>Lack of knowledge of what can work for people </li></ul><ul><li>A major issue is the current and likely future impact on housing benefit </li></ul>
    120. 121. The REACH Standards <ul><li>I choose who I live with </li></ul><ul><li>I choose where I live </li></ul><ul><li>I have my own home </li></ul><ul><li>I choose how I am supported </li></ul><ul><li>I choose who supports me </li></ul><ul><li>I get good quality support </li></ul><ul><li>I choose my friends and relationships </li></ul><ul><li>I choose how to be healthy and safe </li></ul><ul><li>I choose how to take part in my community </li></ul><ul><li>I have the same rights and responsibilities as other citizens </li></ul><ul><li>I get hep to make changes in my life </li></ul>
    121. 122. Examples of useful practice <ul><li>Look Ahead </li></ul><ul><li>Feeling Settled </li></ul><ul><li>Up2us </li></ul><ul><li>Housing Brokerage in Essex </li></ul>
    122. 123. Examples of useful practice – Look Ahead Choice and Control Offer to Customers
    123. 124. Examples of useful practice – Feeling Settled <ul><li>NDTi have developed a tool to help change residential care into supported living where people continue to live in the same place </li></ul><ul><li>Focus on people who want more rights, choice and control over how they live </li></ul><ul><li>Supporting services to change from residential care to supported living where people decide to stay in the same place </li></ul><ul><li>A complex process which needs careful planning and co-ordinating </li></ul><ul><li>Can help make sure that resources are used more effectively </li></ul>
    124. 125. Examples of useful practice – up2us <ul><li>HACT (Housing Association Charitable Trust) are looking at how providers can help people pool their personal budgets </li></ul><ul><li>What is up2us? </li></ul><ul><li>6 pilots exploring group </li></ul><ul><li>buying by people who use social care services. </li></ul><ul><li>Why up2us? </li></ul><ul><li>Increasing buying power </li></ul><ul><li>Increasing choice </li></ul>
    125. 126. Examples of useful practice – Housing Brokerage in Essex <ul><li>ECC are working with Dimensions to offer a brokerage service to a number of people with learning disabilities </li></ul><ul><li>Focus on people with learning disabilities whose current accommodation doesn't meet their needs </li></ul><ul><li>A pilot initially delivered by Dimensions </li></ul><ul><li>Aim is to provide support to access a range of housing options promoting independent living and support people to choose who they live with </li></ul><ul><li>Will be evaluated by NDTi </li></ul>
    126. 127. Thank you! www.ndti.org.uk @ndtirob ndti.org.uk
    127. 128. Cllr. Brown, Deputy Cabinet Member for Adults, Health & Community Wellbeing