Learning Disability Services Learning Disability Services ––

Capitation ShareCapitation Share

Briefing

15th September 201615th September 2016

OverviewOverview

l Context

l Next StepsNext Steps

2000/012000/01

l “� the inherently underfunded nature of the

Programme was first identified in 1996 as a

deficit of some £4.4 million.”

WHSSB Learning Disability Report (2000/1)

Context : Context : -- 2000 2000 -- 20052005

l A concentrated Resettlement Programme was implemented in the

Western area between 2000 – 2005. Given that other Trusts were not

at the same stage in their resettlement plans, investment that would

have been attributed to the above programme, was invested in

community services in other Trusts. This may have resulted in a

different funding position between Trusts

l During this period, parents/carers and Trust representatives met with l During this period, parents/carers and Trust representatives met with

the Western Board to highlight funding variances and the lack of

investment in the West.

l As a result of these meetings, the Western Board developed a 3 year

plan to further enhance the community infrastructure.

20042004

The fourth report of the Capitation Formula Review

Group revised significantly the percentage

attributable to Learning Disability with the West from

18.25% to 19.51% (there has been no change to the capitation formula since this report was issued, however, annual updates were made formula since this report was issued, however, annual updates were made

for population etc.)

It should be noted that the Capitation formula is a

statistical exercise which gives an estimate of the

share of funding to Trusts and across Programmes

of Care.

2007/08 2007/08

l 1 April 2007 the WHSCT was established. The

merger included the former Foyle and Sperrin

Lakeland Trusts which had provided LD services

across the West.

l From this time service planning changed to reflect l From this time service planning changed to reflect

the change in structures

2009 (April)2009 (April)

l The 4 local health and social services Boards

were dissolved and the new Regional Health and

Social Care Board was formed.

l Since the creation of the new Board, the Western

Trust has received its fair allocation of resources, Trust has received its fair allocation of resources,

year on year, for LD services based on capitation.

l Every pound of investment in LD has been spent

in Learning Disability services.

2013 (August)2013 (August)

RQIA carried out a review and produced a report

on findings in the document ‘A Baseline

Assessment and Review of Community Services

for Adults with a Learning Disability, August 2013’.

As part of the recommendations from the report,

the HSCB were requested to review the ‘equity of

investment in community staffing across the

Board area’.

In a workshop in May 2015 with Western Trust

Board, the Director of Finance of the Health

and Social Care Board gave a presentation on

equity which highlighted that the Trust had

more than its overall capitation share of

May 2015May 2015

more than its overall capitation share of

investment and there was a difference in

investment across Programmes of Care in the

Western LCG area.

The Trust makes a decision to allocate

£350k from its additional recurring allocation

as a step towards redressing the balance in

Learning Disability. This funding has been

invested in Phase 1 of a Community

Infrastructure Development Plan, employing

June 2015June 2015

Infrastructure Development Plan, employing

an additional 9 staff.

December 2015December 2015

As requested within the RQIA report, the HSC Board

shared a report with the Trust which identifies a gap

in funding for the West in comparison to other

Trusts. Trusts.

Given that this report is a ‘working document’ no

agreed deficit can be confirmed at this stage without

further investigation.

February 2016February 2016

Consultation is launched in December 2015 by the

HSC Board on the proposed changes to the NI

Weighted Capitation Formula. The Trust highlights

that there is a need to review the Learning Disability

component of the Capitation Formula as it was last component of the Capitation Formula as it was last

reviewed in 2004 using 2002/03 data.

April 2016April 2016

l Trust advised by HSC Board that it will receive

£2.1 million for Learning Disability services in

2016/17

l The Trust will divert additional funds for Phase 2 of l The Trust will divert additional funds for Phase 2 of

the Community Infrastructure Plan employing an

additional 11 staff.

l This will result in a welcome significant additional

investment in LD services in 2016/17.

May 2016May 2016

l On the 6th May a meeting was held with

parents/carers and advocates and

agreement to work in partnership.

Next Steps (May 2016)Next Steps (May 2016)

l Ongoing liaison with the HSCB.

l HSCB to update Learning Disability component of

Capitation Formula.

l Establish a working group with families.

Trust making decisions regarding its 2016/17 l Trust making decisions regarding its 2016/17

demography funding

l Long term plan to redress balance to be

developed.

Early Steps taken by the Trust for Early Steps taken by the Trust for

short term impact short term impact –– August 2016August 2016

l Having received the information at its Trust Board

in May 2015, in 2015/16 the Trust drafted a

phased investment plan for community

infrastructure, based on assessed areas of highest infrastructure, based on assessed areas of highest

need, and allocated an additional £383k to Adult

Learning Disability services to make a start on

reducing the differential.

Table 1: Phase 1 Investment Table 1: Phase 1 Investment

Community Teams £383k 2015/16Community Teams £383k 2015/16

Post Total Activity Status

2.0 WTE Band 6 Social Workers £80,000 80-90 caseload Completed

8.0 WTE Band 4 Family Support

Workers

£303,00 95-100 caseload 5 staff recruited

2nd recruitment round

commenced

2.0 WTE Band 5 Managers

Total WTE 12 Staff £383,000

High Cost Community Cases and Young High Cost Community Cases and Young

People Transitioning (2016/17) 1.8M People Transitioning (2016/17) 1.8M

16/17

Detail

FEITR /

GS1 Ref

No

FYE

£

TYE

£

Sources of Funding

Community LD Cost Pressure - Alloc 001 1,800,000 1,800,000

Sub-total Sources of Funding 1,800,000 1,800,000

Applications of Funding

High Cost Cases

High Cost Client 2015/16 (SS) 22,000 22,000

High Cost Client 2015/16 (SS) 23,000 23,000

High Cost Client 2015/16 (SS) 140,000 140,000

High Cost Client 2015/16 (SS) 79,597 79,597

High Cost Client 2015/16 (SS) 25,000 25,000

High Cost Client 2015/16 (NS) 60,000 60,000

Learning Disability - £1.8m Cost Pressures Funding 2016/17

Spending Plan

Trust Lead: Rosaleen Harkin

High Cost Client 2015/16 (NS) 60,000 60,000

High Cost Case 2016/17 (SS) 177,163 69,409

High Cost Case 2016/17 (SS) 98,464 98,464

High Cost Case 2016/17 (SS) 9,235 5,772

High Cost Case 2016/17 (SS) 228,000 142,500

High Cost Case 2016/17 (SS) 29,512 24,594

High Cost Case 2016/17 (SS) 0 10,772

High Cost Case 2016/17 (SS) 33,000 33,000

High Cost Case 2016/17 (NS) 11,993 7,268

High Cost Case 2016/17 (NS)

High Cost Case 2016/17 (NS)

Further Estimated Costs For Clients in 2016/17

High Cost Case 2016/17 (SS) 300,000 75,000

High Cost Case 2016/17 (SS) 104,000 104,000

High Cost Case 2016/17 (SS) 200,000 116,667

High Cost Case 2016/17 (SS) 27,000 11,250

High Cost Case 2016/17 (SS) 150,000 75,000

High Cost Case 2016/17 (NS) 350,000 175,000

High Cost Case 2016/17 (NS) 100,000 100,000

High Cost Case 2016/17 (NS) 100,000 100,000

High Cost Case 2016/17 (NS) 50,000 29,167

High Cost Case 2016/17 (NS) 188,000 78,333

High Cost Case 2016/17 (NS) 250,000 104,167

High Cost Case 2016/17 (NS) 170,000 70,833

High Cost Case 2016/17 (NS) 170,000 70,833

3,095,964 1,851,626

Young people transitioning from children’s Young people transitioning from children’s

to adult services (2016/17) 339K (TYE) to adult services (2016/17) 339K (TYE)

678(FYE)678(FYE)Facility Post Cost (TYE) Status

Benbradagh 1.2 WTE Band 3 to support 4 transitioning clients £17,100 Recruitment initiated; agency staff will be deployed in the interim

Maybrook 1.0 WTE Band 3 to support 1 transitioning client £9,500 Recruitment initiated; agency staff will be deployed in the interim

Glenside Reconfigured staffing structure to facilitate 4 transitioning clients £6,100 Recruitment initiated; agency staff will be deployed in the interim

Lisnaskea Enterprise Centre 1. WTE Band 3

to support 1 transitioning client

£13,200 Recruitment initiated; agency staff will be deployed in the interim

Berryburn 1.0 WTE Band 5 £20,300 Recruitment initiated; agency staff will be deployed in the interim

New Directions 1. WTE Band 6 £24,300 Recruitment initiated

Social Worker 1. WTE Band 6 £24,300 Recruitment initiated

Admin Support 1. WTE Band 3 £14,300 Recruitment initiated

18 Day Opportunities places £140,000 Work in progress

Whole Life model of day opportunities for existing service users to

create capacity in day care for young people transitioning

Between 7 and 10 places £70,000 Clients currently being identified

Total £339,100 (TYE)/ £678,000 (FYE)

Table 4: Phase 2 Community Teams Table 4: Phase 2 Community Teams

£466K£466KPost Total £ Activity Status

6.0 WTE Band 6 Social Worker £266,868 250-270 Caseload Recruitment initiated

2.0 WTE Band 7 Social Work

Practitioner

£105,610 Practice Development across SW

workforce

Recruitment initiated

1.0 WTE Band 6 Nurse £44,478 800 contacts per annum Recruitment initiated1.0 WTE Band 6 Nurse £44,478 800 contacts per annum Recruitment initiated

2.0 WTE Band 3 Admin Support £49,738 To support increased workload

generated by additional Social

Work Staff

Recruitment initiated

Total 11 WTEstaff £466,694

Summary of early investment Summary of early investment

decisionsdecisions

£m Status

Investment Plan to date

June 2015 - Community Infrastructure

Development Plan (Investment Phase 1) 0.4 In progress

2016/17 HSCB Allocation £2.1m WHSCT 2016/17 HSCB Allocation £2.1m WHSCT

Iinvestment Phases 2 & 3)2.1 In progress

2016/17 WHSCT Demographic Allocation -

Community Infrastructure Plan (Investment Phase

4) 0.5 In progress

Total Investment Draft Plan 3.0

Medium term Investments planned Medium term Investments planned

(2016/2019)(2016/2019)Description Investment £k Status

Transport Vehicles 160 Approved

Short breaks 267 Work in progress

Refurbishment of Community Facilities

Glenside

Other day centre requirementsLakeview Hospital

491

To be determined24

Work in progress

Work in progress

Infrastructure, Equipment and Vehicles

Equipment

Other

Total 942+

Future Medium/Long term Investment Future Medium/Long term Investment

PlanningPlanningTotal Investment Planned to date (see short

term actions) 3.0

New Investment Plan (suggested areas)

Allied Health Professionals (AHPS) 0.3

Under development (for

comment by carer groups

Domiciliary Care 1.0

Community Medical/Dental 0.4

comment by carer groups

and subject to

equity/capitation review)

Grants, Goods and Services/ Daycare/Day Opps 0.8

Nursing/Residential/Supported Living/Respite

Short Breaks 2.0

Social Work 0.2

Other 0.3

Total New Investment Plan 5.0

Total Draft Plan 8.0

Meeting with WLDAG July 16 Meeting with WLDAG July 16 -- Actions Actions

ArisingArisingAction Timeframe Lead

WHSCT internal working group established (T

Millar, Paul Quigley and Rosaleen Harkin) It may be

necessary to co-opt staff onto LD working group as

and when required.

July 2016

Completed

Trust Director

AMHD

Extend working group to include communications

plan including HSCB, WLDAG, DOH

July 2016

Ongoing

Trust Director

AMHD

Share indicative investment plans areas with

WLDAG for comment

July 2016

Completed

Asst Director

Finance/ Asst

Director LD

Implement 2016-17 Investment Plan - £3m July/August

2016

Ongoing

Trust Asst

Director LD

Develop business case(s) for approval at CMT July-Sept 2016

Spending Plans

for initial

investment

Trust Asst

Director LD

l WLDAG

l 4th March 2016

l 6th May 2016

l 16th June 2016

l 7th July 2016

l MLA BRIEFINGS

l 20th May 2016investment

developed.

Attend HSCB LD Capitation Scoping Workshop

Receipt of HSCB Report - LD

September

2016

Summer 2016 –

actual date

TBC

Trust Director

AMHD Asst

Director LD,

Asst Director

Finance

HSCB

Share WHSCT final LD investment paper with Trust

Board, HSCB

Autumn 2016 Trust Director

AMHD

Undertake high level LD productivity assessment by

LCG

Autumn 2016 Trust Asst

Director

Finance

Develop an Infrastructure, Vehicle and Equipment

Plan

September

2016

Trust Asst

Director LD

Developing an information, training and education

plan for LD families

September

2016

Trust Asst

Director LD

l 24th May 2016

l 3rd June 2016

l TRADE UNIONS

l 8th June 2016

l 31st August 2016

l Fermanagh & Omagh Council

l 24th May 2016

Any Questions?

Thank YouThank You

Any Questions?