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Joint Commissioning strategy: adults with
learning disabilities in Powys
2015-2020
Version 1.2 August 2015
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Contents
Foreword ................................................................................... 3 Purpose ..................................................................................... 3 Aim ............................................................................................. 3 1 NATIONAL CONTEXT .......................................................... 4 2 REGIONAL CONTEXT………………………………………….4 3 LOCAL CONTEXT ................................................................ 5 4 NEEDS AND DEMAND ........................................................ 8 5 CURRENT PROVISON ......................................................... 9 6 MARKET ANALYSIS .......................................................... 12 7 FINANCE ............................................................................ 13 8 GOOD PRACTICE .............................................................. 15 9 KEY MESSAGES ............................................................... 15 10 PRIORITIES ........................................................................ 16
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Joint Commissioning strategy: adults with learning disabilities in Powys.
Foreword
We are pleased to present this first integrated strategy for learning disability services for the population of Powys. We have worked together with service users, providers and professional through engagement to produce a clear direction for the future of learning disability services in the county; we have built it based on need and following consultation with what people have said is important to them.
Purpose
The purpose of this strategy is to set out how Powys County Council Adult Social Care and Powys Teaching Health Board together with our providers and professional staff will work with our service users to understand and meet their needs within the context of national guidance, wider local plans and available resources. This strategy will provide a clear direction regarding the future planning and delivery of services for adults with a learning disability who live within or have services commissioned by Powys. It describes the core principles that are fundamental to service provision and outlines the key issues that need to be addressed in forthcoming years in order to deliver high quality, safe and cost effective services. Powys County Council Adult Social Care and Powys Teaching Health Board are partners on the Mid and West Wales Health and Social Care Collaborative. The Collaborative, which also includes Carmarthenshire County Council, Ceredigion County Council, Pembrokeshire County Council, Hywel Dda University Health Board, Pembrokeshire Association of Voluntary Services and Powys Association of Voluntary Organisations, is in receipt of funding through the Welsh Government’s Regional Collaboration Fund. This supports an ongoing programme to modernise Learning Disability Services in the region. It is likely that a number of the priorities identified at the end of this strategy will be tackled with partners across the wider regional footprint.
Aim
Our aim is to transform the health, care and wellbeing for people with a learning disability and their carers over the next five years based on the principles of person centred care and the promotion of independence and social inclusion. Powys is committed to improving opportunities for people with a learning disability through planning and commissioning services that work with people to meet their needs and fulfil their choices. Health and Adult Social Care believe that we should deliver the support and services that people need so that people with Learning Disabilities are able to lead their lives like any other person. People with learning disabilities should have the same opportunities, be treated with dignity and respect and be supported to make decisions and take responsibility about their lifestyle choices.
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At the same time, the requirements of fairness and equity mean we must always seek to deliver support and services in the most cost effective manner possible.
1 NATIONAL CONTEXT
This strategy has to be delivered within the context of Welsh Government Strategies including:
Fulfilling the Promises – proposals for a framework for service for people with Learning Disabilities (2001),
Learning Disability Strategy – Section 7 Guidance on service principles and service responses (2004),
Welsh Government Statement of Policy and Practices for Adults with a Learning Disability (2007),
Carers’ Strategies (Wales) Measure (2010),
Practice Guidance on Developing a Commissioning Strategy for people with a Learning Disability (2011),
NHS and Community Care Act 1990,
Equality Act 2010,
Social Services and Well-being (Wales) Act 2014.
The full implications of the Social Services and Well-being (Wales) Act 2014 are still being worked through, and new guidance will assist in that process. However, this strategy seeks to reflect that legislation and particularly its key elements including the new eligibility framework and the focus on outcomes.
2 REGIONAL CONTEXT
Learning Disability services were identified as an early priority by the Mid and West Wales Health and Social Care Collaborative Board (MWWHSCCB) and funding was secured to support transformation across the region via the Welsh Government’s Regional Collaboration Fund (RCF). Oversight of the resulting ‘Modernising Learning Disability services in Mid and West Wales’ project, and the wider transformational activity is the responsibility of MWWLDP and it progress is monitored through the Learning Disability Strategic Board. The members of which represent the Mid and West Wales Learning Disability Partnership (MWWLDP). The desired outcome of Collaboration for the MWWLDP is based on the following shared ambitions for people with Learning Disabilities:
To improve community resilience and enablement through choice, self-direction and control over decisions that, affect the lives of people with a learning disability in line with The Social Services and Wellbeing Act.
Improved quality of life through improved choice for housing and accommodation for people with a learning disability, with the majority being the same as for other people in the community.
People with learning disabilities if given more opportunities for personal development and life experiences would have improved wellbeing and a better quality of life.
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The quality of life for people with learning disabilities would be improved when they are given every opportunity to be independent, exercise and enjoy their rights, and meet their individual obligations.
3 LOCAL CONTEXT
Powys adheres to the Welsh Government definition of Learning Disability: ‘What do people with learning disabilities have in common? From birth or early childhood they will have had an impairment of intellectual function that significantly affects their development and leads to difficulties in understanding and using information, learning new skills and managing to live independently. They are, therefore, more likely to require support and services to lead an ordinary life.’ Also, we endorse the Welsh Government statement on Policy and Practice for Adults with Learning Disability that says: “All people with a Learning Disability are full citizens, equal in status and values to other citizens of the same age. They have the same rights to:
Live healthy, productive and independent lives with appropriate and responsive treatment and support to develop to their maximum potential.
Be individuals and decide every day issues and life defining matters for themselves, joining in all decision making which affect their lives, with appropriate and responsive advice and support where necessary.
Live their lives within the community, maintaining social and family ties and connections that are important to them.
Have the support of the communities of which they are a part and access to general and specialist services that are responsive to their individual needs, circumstances and preferences.”
These principles underpin this strategy and inform the more detailed plans that flow from it. The Powys One Plan 2014-2017 is the new transformational plan for Powys Local Service Board to enable us as partners to work together to provide improved outcomes for citizens. The strategic objective for learning disabilities is:
‘To enable People with Learning Disabilities to lead meaningful and valued lives within their own communities.’ The vision that we have for our services is:
‘By services working together with service users and their families people with a learning disability in Powys have improved lifestyle outcomes; choice, control, and opportunities to live as independently as possible. Peoples needs are met in the least restrictive settings as possible and their social inclusion and economic participation is fully promoted.’
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We aim to deliver the following outcomes:
People with a learning disability receive services that work with them to meet their needs to enable them to maximise their independence and live in the community of their choice
People with a learning disability have improved health and well being
People with a learning disability have improved opportunities for valued occupation including employment
People with a learning disability experience smooth and effective transitions from childhood to adulthood
Powys has over 90 people in placements outside of the county and enabling the people who wish to return to the county is a key local ambition because they can be extremely expensive, hard to monitor as they are usually at a distance from the commissioning authority and can be of low quality. Furthermore, it is felt that the greater the reliance on specialist services, the more likely it is that competency to manage behaviours that challenge within general learning disability services decreases and specialist services have to respond to an increasing volume of referrals. We therefore need to look at the competence of mainstream learning disability services to improve their capability to prevent problems arising, to manage them when they occur, and to implement long-term solutions. Specialist services will then be able to concentrate on people with the most complex and difficult needs. This will also include access to mental health services that are appropriate and accessible to people with both a dual diagnosis of learning disability and mental health. Consultation with People with a Learning Disability and Carers People themselves are best at identifying their needs. In order to find out what is important to people we have met with a number of groups to ask them to help us shape the strategy. We met people before, during and after the strategy was developed to be sure that we had got the strategy right. We also need to ensure we have ongoing arrangements for engagement, consultation and co-production of services. What have we done?
We met with service user and advocacy groups, carers and staff to get a broad understanding of what was most important to them before the strategy was written.
We periodically tested the validity of the priorities over the period of time between major consultations to make sure that what people originally told us was still relevant.
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Following the strategy being drafted we had 15 events across the county for services users, providers, staff and families and carers and we had a public consultation online and in the libraries.
We made changes to the strategy based on what people had told us to ensure that the plans for the future reflected what people really need.
Analysed National information.
Analysed the numbers of people we support and will need to support in the future.
Analysed where we think there are gaps in services.
Analysed resources available – budget and staff.
Analysed services currently available.
From these consultations we have been able to identify the key priorities for service users and carers. Priorities for service users and carers
1. Information
About what is available
About how to access it
6. Work leisure and
learning
Support through transitions
Inclusive opportunities
2. Staying Healthy
feeling good
joining in
7. Staying safe
Advocacy services
Checking things are OK
3. Choice and Control
About how you and your carers are supported
8. Moving on
Good support to move on to
4. Right time, right place
Specialist treatment
Response in a crisis
9. Good support
Training and supporting staff and Carers
5. Somewhere to live
Independently
Close to family and friends
10. Consultation Talking about changes
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4 NEEDS AND DEMAND
Population Powys is the largest county in Wales covering a quarter of Wales’ landmass, with a total population of 133,000 in an area of just over 2,000 square miles. In Powys Welsh is the first language of 12% of Montgomeryshire residents and 13% of Brecknockshire and Radnorshire (source: 2011 census). Learning Disability Population Powys in comparison to the Welsh average has a high percentage of the population who are 30-75 year olds with a learning disability and particularly higher than the national percentage of the population in the category 60-75 and 75+. The projected age structure of the learning disability population for Powys shows an increase in older people with a learning disability: People in Powys predicted to have a learning disability
2013 2015 2020
People aged 18-24 58 57 50
People aged 25-34 65 69 75
People aged 35-44 91 84 77
People aged 45-54 102 102 93
People aged 55-64 95 95 102
People aged 65-74 63 67 70
People aged 75-84 22 23 27
People aged 85 and over 8 8 10
Total population aged 18 and over 505 506 504
Source, Daffodil
Some things that are important to know about the people who live in Powys with a Learning Disability and receive services are:
About 500 adults with a learning disability are known to Adult Social Care teams.
As they reach adulthood 20-30 people move from services provided for children and their families into adult Social Services every year.
Around 200 adults with a learning disability live with their families.
There is an ageing population of people with learning disabilities in line with current population trends, which has an impact on them and their carers. There are an increasing number of older carers that are struggling with continuation of support.
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There are a higher number of young people with complex needs requiring support into adulthood than in previous years
Health needs People with learning disabilities often have additional health needs. For example:
1/3 will have a physical disability,
1/3 will have epilepsy,
1/3 will have visual problems,
40% will have hearing problems,
Up to 50% will have mental health problems,
50-90% will have communication problems.
In addition, these problems can be compounded by:
Unequal access to health services,
Inequality in provision of health services,
Poor care within mainstream and acute services,
Increased negative determinants of health (financial, housing, employment etc.).
5 CURRENT PROVISON
Systems and processes Powys has a number of systems and processes in place to support people to access services and support. These include things such as assessment and care management systems, resource allocation systems, continuing health care, health checks, direct payments, transition arrangements, ongoing consultation, planning and strategy systems. In 2015 following public consultation the cabinet took the decision to move to supporting clients in the future with critical and substantial eligible needs only. However adult social care will continue to provide targeted and time limited support around those clients who have needs related to sensory loss, supported employment, reablement, and other areas such as advocacy. These will be delivered in line with an overarching prevention strategy which is current in development which will enable the service to signpost people to services; which support them to find their own solutions. Powys has a system for people to have a direct payment (a sum of money each week), so that people can arrange their own care through recruiting a personal assistant to help them reach their agreed outcomes. We currently support 65 people with a learning disability who are supported to live where they want to with a support and/or care provided through a direct payment. Specialist services The role of specialist services should be to develop high levels of skill in their area of expertise, to provide a direct service to those most in need and then to work to disseminate their expertise as far as possible throughout relevant care systems. Learning disability services in Powys are provided by the two statutory authorities and by independent sector providers.
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Health and social services learning disability provision The joint learning disability services in Powys are divided into two teams (one North and one South). The staffing within those services include:
Consultant Psychiatrist,
Psychologist,
Social Workers,
Speech & Language Therapist,
Occupational Therapist,
Community Support Officers,
Health Care Assistants,
Community Learning Disability Nurses,
Physiotherapist,
Clinical Nurse Specialist,
Team Leaders.
Residential and supported living accommodation A range of long-term and short-term accommodation services are commissioned in Powys, including residential care placements and supported living tenancies. However, there are also people that are placed out of county. These placements include small domestic settings, residential homes, residential specialist colleges, specialist behavioural facilities and larger residential communities catering for a diversity of service users with differing disabilities, care needs and behaviours which challenge services. To enable these people to return home would require an appropriate infrastructure within health and social care to sustain local placements. People move from time to time however the average figures in 2014 were: 90 People living in placements out of the county, 30 people living in residential colleges which are also out of the county 195 people living in supported tenancies spread across the county Short stay accommodation is delivered through 3 registered care homes located across Powys. Advocacy services Powys Council commissions services to support individuals to make choices within their day to day lives. This includes the provision of self-advocacy, citizen and crisis advocacy. These are currently provided by three different organisations across Powys.
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Day and employment services Day and employment services are currently delivered from twelve bases across Powys along with social enterprises located in the Brecon and Montgomeryshire areas. Services are generally delivered between 9 a.m–5 p.m. and attended by those living in the local areas surrounding the bases. A variety of activities and opportunities for valued occupation are available within the services both within the base and the surrounding community. The service is trying to achieve outcomes working with the service users that enable community presence and networking, along with skills development and opportunities for volunteering. In addition the Council also contracts a number of day service hours working with individuals within their own homes. There are currently 263 individuals in receipt of day and employment services across Powys. Employment services are delivered on a one to one basis through the support of job coaches with the aim of acquiring employment in posts of 16 hours and above. This service although aligned with Day Services now has its own resource base and is managed through a separate service specification. Quality of Services The joint role of Adult Social Care and Health is to continue to develop and support person centred planning, empowerment and maximise autonomy and capability. We aim to enable people to make their own choices and decisions, gain control over their own life and to feel valued and taking responsibility for their own health and wellbeing. We need to focus on what people can achieve and how best to support their full potential. Professionals need to work in collaboration with the service users and families to get the best possible outcomes for the individual. There are a wide range of resources available that identify for us what good practice and quality services look like and we need to draw upon these as we progress the strategy. In May 2014 ahead of a supported tenancy retender, Powys County Council conducted a survey of people in supported living accommodation and their families/carers to ask about the quality of services. They were asked for comments on what was good about the support needed, and what could be improved. The chart below shows the balance of comments between the two:
Feedback
Number of comments regarding good support
Number of comments regarding suport which needs improvement
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When people were asked what might improve the support they receive answers focussed upon better communication, continuity of care, better staffing levels and more varied activities. In March 2014 Montgomeryshire day services undertook a survey with service users about the services provided. The main points to emerge were that people:
Valued the service,
Liked all the activities they did,
Liked choice in activities,
Felt able to do new things,
Felt well-supported,
Were positive about staff.
Non-specialist services In addition to the specialist services identified above, people with a learning disability and their families/carers also use more generic services, but may need some special provision within those services. Services of this sort include: Primary Care Services (GPs, opthalmists, dentists, etc) Housing/Accommodation Advocacy Carers Support Adult Education As we support and plan with people with learning disabilities we need to take account of these non-specialist services and how they can contribute to those plans and the service delivery that follows on from them.
6 MARKET ANALYSIS
As identified above, there is a range of services provided by the independent sector, both inside and outside of Powys. Powys Teaching Health Board and Powys Adult Social Care jointly agree accommodation and support packages each year. Currently there is a framework contract for delivering support to people to enable them to live independently in their own rented accommodation. There are 20 organisations on the framework, with 4 currently providing a service of support for people with a learning disability to live in their own tenancies. Powys County Council works with a number of different providers both within Powys and out of the county. Part of our strategy for the future is to make sure that these partner agencies are able to work with us to gain contracts using the most appropriate process whilst ensuring the council remain within the requirements of procurement law and council standing orders. One provider is contracted to deliver respite services which support and work with people with learning disabilities in 3 locations across the county. That may change when the contract is re-tendered.
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Day and employment services are mainly in-house but there are 4 providers delivering some day service work in Powys. There is also an in-house employment support service working with people with learning disabilities. In the last few years Powys has developed 3 social enterprises in the Brecon area and also through partnerships, a number of workshops and employment opportunities in Montgomeryshire. Most of the service provision for people with learning disabilities has been in a static state for a number of years. We will be looking at different ways of developing services over the next 5 years. We want to work with service users and providers to develop support for people that enables than and helps them to achieve positive outcomes. Future procurement plans Powys already has plans in place to help us to move forward. These are:
Current retender of supported tenancies,
Further development of supported tenancies. We aim over the next 5 years to offer 15 people the opportunity to move back to Powys,
Imminent retender of Short stay housing,
Reviewing all of the care and costs of people placed out of county,
Reviewing day services to develop an improved service model,
Continued partnership with our neighbouring authorities through the Mid-Wales Consortium (a procurement hub which we work together in)
Further development and opportunities for integration.
7 FINANCE
Powys County Council learning disability budgets in 2014/15 are set out below
Area Budget 2014/15 (£)
Independent Residential Care Out of County 5,337,9030
Council managed Supported Tenancies 583,340
Short Stay Houses 428,700
Community Houses 1,451580
Resettlement Houses 2,891,380
Day and Employment Services 3,301,340
LD Home Care (Domiciliary care) 535,960
LD Social Work 759,940
Other Services 190,740
Total 15, 480,910
Council learning disability budgets have declined since 2012/13 when they stood at over £17 million. However, at that point Powys spent significantly more than other authorities for every person with a moderate or severe learning disability. On average Powys spent 30% more per person. Powys also supported 50% more
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service users with learning disabilities than other local authorities (mainly due to resettlement out of long stay hospitals). However, it is clear from the current financial position of the Council that there will be no new money to invest in the delivery of new services. In fact, more will need to done for less. The Teaching Health Board expenditure is as follows:
£1.7m is transferred by Powys teaching Health Board to the Local Authority. This is Welsh Government funding for provision of community-based services to people with a learning disability that replaced the old hospitals. There may be a £400k reduction in this going forward.
Some highly specialist services are procured to meet complex health and care needs. Approximately, £1.47m is spent annually on placements for 40 people. These costs vary from £16,000 to £200,000 per placement per year.
In the current financial climate and increasing demographic demands the current pattern of services is not sustainable into the future. Annually £22.5m is spent on services for people with a Learning disability:
Area £m
Adult Social Care 13.7
Powys teaching Health Board 4.7
Supporting People 4.1
Total 22.5
Some areas of reduced funding are already known to us; the amount of money available to support people with a learning disability was reduced in 2013/14 as follows:
Welsh Government Grant reduction due to formula change
£349,000
Welsh Government Supporting People Grant reduction
£252,000
Total reduction in Welsh Government Grants
£601,000
In addition to this the Supporting People Grant which makes up a proportion of our total spend will be reduced by a further 9% in 2015/16 which amounts to £284k and further reductions are anticipated in 2016/17 and 2017/18. Powys teaching Health Board have also indicated that they will be reviewing the £1.7m resettlement grant that supports people living in the community who, prior to the closure of the old Mental Handicap Hospitals, would have been supported in these institutions. These reductions in funding introduce a range of challenges and opportunities.
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Demographic pressures in 2016.17 on the adult social care budget are estimated to be £2.3m – pressures that need to be met from a reducing budget. Powys County Council face increasing budget shortfalls over the next 5 years. Further financial pressures in the future will mean that we need to be more innovative and creative about how services are delivered.
8 GOOD PRACTICE
The joint role of Adult Social Care and Health is to continue to develop and support person centred planning, empowerment and maximise autonomy and capability. We aim to enable people to make their own choices and decisions, gain control over their own life and to feel valued and taking responsibility for their own health and wellbeing. We need to focus on what people can achieve and how best to support them to reach their full potential.
9 KEY MESSAGES
There are a number of clear challenges that will inform our strategic direction: 1) New legislative duties - The new Social Services and Well-being Act 2014 will influence all elements of adult social care practice. 2) Demography - The number of people in Powys with a learning disability is increasing, particularly in the older age categories and this has significant implications for the type and volume of support likely to be needed in the future. 3) What people have told us - People identified clearly what their priorities were and that they wish to be involved in choosing their services and support. We have used what they told us in setting our priorities for the learning disability services in Powys. 4) Financial resources – The financial climate is difficult and not likely to improve in the foreseeable future. Reductions in spending have been made and further reductions are likely. In the interests of fairness and equity, efficiency has to be a priority but may not alleviate all the reductions. We have added delivering cost effective services to our priorities set out below. 5) Services – Currently, too many people are placed out of county. To enable them to return home would require an appropriate infrastructure within health and Adult social care to sustain them in local placements. Also, the choice and control that people have is limited due to the inflexibility of the current service model and a lack of options. Consultations and discussions have identified a number of areas of service development in Powys: Assistive technology.
Preventative services such as Telecare and Telehealth.
Further development of Social Enterprise Model.
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Further development of flexible respite services.
Further development of Adult Placement/Shared Lives Scheme.
Further development of employment opportunities.
More support and help to access Mental Health Services.
Better Secondary acute services, e.g. District General Hospitals.
Rural proof services – to ensure the needs and interests of people living in rural areas are considered.
Alternative options for young people to Residential Colleges – to look at local opportunities and the skill base required to achieve this.
10 PRIORITIES
We think it is important that the key priorities reflect what people told us was important to them in the consultation, and draw upon what we know about services currently. At the same time, we have to be mindful of the current financial context. This means we have to continue to look at cost effectiveness and value for money. In order to drive the transformation there are further choices to be made about prioritisation in the future, so we also need to ensure there are arrangements for future consultation and co-production so that we can work together on the challenges the future holds and make them a positive opportunity for innovation and change. We can also draw upon examples of good practice from elsewhere to help us develop and improve our services. PRIORITY 1 – Information
People have said that they do not always know what services or support is available. They need to have accessible information in easy to read formats and this information needs to be in a variety of locations. Information should always be accessible in pictures and words and audio/ braille when required. When we look at what formats information is created in we also need to consider sustainable resources.
To do this we will:
Produce information in formats that people understand and create wider opportunities to access information through the internet.
Increase the number of venues and distribution points from which information is available
Work with colleagues in Speech and language and occupational therapy services to ensure information is as accessible as possible.
2016/17
2016/17
2015/16
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PRIORITY 2 – Staying healthy People with learning disabilities often have additional health needs, and people said that they want to be able to access a range of health services in their chosen communities with a minimum travel distance. People have said that they want more care and attention by nursing staff for people with a learning disability when they are in hospital.
What we are doing already:
What we are going to do next:
Joint development Complex Behaviour Intervention Pathway for prescribing and reviewing appropriate medication and provision of specific treatments/interventions.
Improving Support and advice on complex health matters and on sensory impairment and loss
Improving access to, and appropriate support available within acute general healthcare services.
Appropriate infrastructure to support locally individuals with complex need including behaviours which challenge on a long term basis and to sustain local placements.
Adaptive methods for assessment which will employ a more collaborative decision making process between people with learning disabilities and professionals.
Improve access to primary care services.
Improved and appropriate access to Mental Health services.
Clear pathways into and out of specialist regional and national services based on a model of commissioning services based on individual needs.
2016/17
2015/16
2016/17
2015/16
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PRIORITY 3 - Choice, control and relationships People have said that they want to be able to have choice and control over the way that their support needs are met. We want to enable and support participation, engagement and involvement. This means we need to strengthen the voice of the service user in planning, delivering and evaluating care at a strategic, local and personal level.
In addition, people want to develop relationships and have a choice in how they live their lives. They also want to be able to build friendships and gain access to services that will support them, such as family planning. To achieve this we require good, co-productive person centred planning, and access to high quality advocacy. Many service users with a learning disability need long term support to engage in the community, develop their self-esteem and self-confidence. Whilst we already have systems for direct payments and to commission services to support individuals to make choices within their day to day lives, (including the provision of self-advocacy, citizen and crisis advocacy) we need to be sure these are being provided and working properly. To do this, we will:
Make resources available to support advocacy services and improve them.
Further develop our person centred care planning.
Continue to develop direct payment opportunities and opportunities for people to use assistive technology.
Look at the way we commission services and build flexible options into our contracts.
2015/16
2016/17
2015/16
2019/20
PRIORITY 4 - Right Time, Right Place (Flexible support)
People said that a range of flexible service options, where and when they need them, are important. We need to make sure that support, whether or not this in a crisis, is local, responsive and appropriate to the situation. We recognise that people’s needs will change over time. People want to find out about accessible events, activities, holidays. Some people have greater needs than others so we should have a range of services and responses. Some of these services are provided already in the communities.
There are also a wide range of residential services, the majority of which are out of county. They include small domestic settings, residential homes, residential specialist colleges, specialist behavioural facilities and larger residential communities catering for a diversity of service users with differing disabilities and care needs. Where possible people should be able to live locally.
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To do this, we will:
Review our existing contracts and ensure that there is sufficient flexibility within the contracts to give people choices and options in the way that they are supported.
Ensure that we are getting value for money along with efficient and effective use of our resources in meeting eligible needs on an ongoing basis.
Review all of our out of county placements to ensure that people are getting the best services available as close to home as possible, and support people to move back to Powys if they wish to.
Establish systems to review the care of people being supported out of county to ensure their care is of a good quality, continues to meet their needs and remains cost effective to Powys.
Review the opportunities to re-allocate resources to allow individuals to return and to support more people in county in the future.
Develop our respite and short term break contracts to make sure that there are services available on a fair and equitable basis across Powys. And to develop an information hub about breaks and holidays
2015/16
2015/16
2015/16
2016/17
2017/18
2015/16
PRIORITY 5 – Somewhere to live (Accommodation/ housing)
People said that they wanted a range of good quality accommodation choices for people with a learning disability, including a choice of accommodation e.g. flats, houses, shared houses, cluster of accommodation in a community, with appropriate support. They also want options for extra care type small schemes for range of service users/tenants and low-level support e.g. floating support.
Also, the appropriate level of support relating to the personal care of the individual should be identified along with options for meeting the ongoing housing related needs of tenants. Any service provided would work together with the people within the scheme to ensure that they have appropriate levels of service. An accommodation strategy is being developed alongside this joint learning disability strategy, and we need to develop more flexible opportunities for people to enable real choice.
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To do this, we will:-
Work together with our housing colleagues in all sectors to ensure that they understand what the housing needs are now and in the future.
Develop Core and Cluster Accommodation (where one team will support several people living independently in a local community and people are able to step-up and step-down as they move towards independent living.).
Explore the potential for “key-ring” schemes which aim to support members to build real and lasting relationships in the community and less reliant on paid support.
Seek opportunities to develop extra care accommodation in Powys.
2015/16
2017/18
2017/18
2015/16
PRIORITY 6 - Opportunities for work leisure and learning
People with learning disabilities have said that they want the same opportunities as other people in being able to work and to learn new skills that will be useful in the working environment. How people spend their time during the day is of considerable importance and appropriate opportunities will maximise an individual’s potential enabling them to develop new academic, work related and life skills.
In addition meaningful opportunities enable individuals to develop relationships, promote self-esteem and make a valuable contribution to society. It is necessary for a range of options to be available for individuals to choose from including employment/supported employment, education, leisure and day services which can be delivered directly or through the use of Direct Payments. There must be real collaboration with people about changes prior to them happening and this needs to be communicated with each individual in a way that they can understand and fully participate in. Access to appropriate transport can be difficult and individuals need appropriate support to access a range of options that can meet their mobility needs eg easy read transport information, accessible public transport, travel training and access to Personal Independence Payments. What we are doing already:
Support the need for service user lead developments on a day to day basis in services. Further developing service user’s engagement forums so that we are working co-productively with service users and their day service activities are built of choice.
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What we are going to do next:
Develop more flexible services across 7 days where possible,
Review transport and access to services,
Develop volunteering as a way to learn and support valued citizenship,
Explore how Direct Payments can be used for individuals to work together to develop cooperative solutions to support participation in meaningful activities,
Work with local colleges to improve educational provision.
Explore use of a wider range of opportunities, including those within universal services,
Work with the third Sector to develop independent options and solutions to service provision,
Develop more social enterprises and trading companies,
Develop better links with colleges.
2016/17
2016/17
2016/17
2016/17
2016/17
2016/17
2016/17
2016/17
2016/17
PRIORITY 7 – Staying safe
Everyone wants to be able to feel safe in their communities and within services. This is a major concern of people of all ages. The Community Safety Strategy Group are already looking at this major issue and link need to be strengthened with them to ensure proper consideration of the needs of people with a learning disability. Some really good services such as the Polices’ Pegasus scheme are helping a lot of people with learning disabilities to feel safer.
However we know from the Winterbourne View enquiry that people in services, especially those located some distance away, can be vulnerable. Adult Protection within Powys in currently monitored and managed through the Adult Protection Committee that has instigated a number of projects with third sector agencies to work with service users and members of the community to develop specific Keeping Safe courses. We need to be more robust in monitoring all services to make sure people are safe and Powys County Council have recently agreed to put more funding into this service so that we can check that people are getting the right quality of service to meet their needs and that they are being supported to be safe in their communities.
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What we are doing already:
Promote and develop the Keeping Safe Training that is delivered by service users, for service users through Powys People First.
Ensure that consideration is given to the lessons learned from the Winterbourne View enquiry within all commissioning development
Ensure that all of our support contracts for people with learning disabilities require that our providers give full attention to the safety needs of people with learning disabilities.
What we are going to do next:
Make stronger links with the Community Safety Strategy Group
Continue to work with advocacy services to promote safeguarding issues
Develop a programme of monitoring of services provided by organisations that support and work with people with a learning disability.
2015/16
2015/16
2015/16
PRIORITY 8 – Moving on and transition
People with learning disabilities and carers said that they often experienced difficulties in moving from children’s services into adults’ services. Whilst there are examples of good practice, many individuals and their carers report ineffective transition planning. Younger people have differing needs and priorities to those of older people. We therefore need to ensure that our services fit with an individual’s different stages of life
and that we work together with each individual to make sure that they are involved in and happy with their transition plan. We need to ensure there are clear pathways in place so that all individuals have a well-planned and co-ordinated transition from child to adult services. In addition to the transition from child to adult services individuals will also need well planned transitions with other life events e.g. retirement, moving home, marriage. To do this, we want to:
Ensure that there is a robust transition policy in place and clear pathways which have been jointly approved by the individual and their representatives, adult social care, the Teaching Health Board, children’s services and education,
2017/18
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Work with young people who have gone through the transition arrangements to fully understand their experience of moving from children’s services to adult services and ensure that we learn from these positive and negative experiences,
Develop closer working between learning disability and mental health services, around transition,
Develop transition focussed social work posts.
2017/18
2016/17
2015/16
PRIORITY 9 – Good Support
People have said how important it is for their employed staff to be competent and well trained and this is widely acknowledged as being vital to the delivery of good, safe services. In addition to the staff that are employed by the Adult social care and the Health Board it is equally important to have appropriately trained and qualified staff to deliver services that are contracted to different organisations. This is achieved through:
Continuous learning and team development to support staff in realising their
individual potential.
Ensuring that any change in role is accompanied by appropriate and effective induction, mentorship and training.
Valuing the diversity of the individuals who collectively make up the workforce.
Promoting the health, safety and well-being of staff.
Valuing and supporting carers.
Carers also play a vital role in supporting people with a learning disability and they too need have access to appropriate information and a flexible and creative range of training and support options. Support for carers needs to be in line with the Welsh Government Carers’ Strategies (Wales) Measure which places a legal duty on both the Health Board and Local Authority to implement a joint strategy for carers. We want people to have a flexible work force to support them but we also want to be sure that people are able to have the support staff that are familiar to and can work with them most appropriately.
What we are doing already:
Develop and deliver in collaboration with providers a comprehensive staff development programme,
Implement the Welsh Government Carers’ Strategy (Wales) Measure, linked to the implementation of local strategy
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What we are going to do next:
Ensure our tender processes, contracts and contract monitoring processes include specific requirements relating to staff training and development,
2016/17
PRIORITY 10 – Consultation and co-production
People said that they want to be involved in the planning and development of services at an individual, service and strategic level and we know that this approach is supported as good practice in the Welsh Government Statement of Policy and Practices for Adults with a Learning Disability (2007) and in the Practice Guidance on Developing a Commissioning Strategy for people with a Learning Disability.
People with learning disabilities and carers have been involved in the development of this strategy both at an early stage and in commenting upon a draft, and high levels of involvement need to be maintained and further developed with strategy, plans and services co-produced between service users, carers, commissioners and providers. The plan will be kept under continual review and has been developed with all stakeholders who were involved in both pre and post strategy consultation To do this, we are:
This is a live document. This means that it will be reviewed on a regular basis and will be robustly managed by the Learning Disabilities Thematic board for us to make sure that we are following it and that it is still relevant. Annual reviews will be published and the strategy will be available on the council’s website. We will also make available the accountability framework alongside the strategy; this document will set out what projects and actions are in place to achieve each priority and how and when it is going to happen.
Having real discussion with people about changes prior to them happening, discussions need to happen in a timely way so that people can have an impact on the way change is made.
Continue with the Learning Disability Engagement Forum with service user and carer representation as the main partnership forum for discussion and deliberation.
Use a person centred approach to planning and create opportunities for people to engage in forums and focus groups to influence how services develop.
Engage with providers to support people to be involved in the developments that are discussed and considered.
Work together to review the strategy annually
