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Market position statement 2012 Adult social care

Contents1. Preface 4

2. Introduction 6

3. The Changing Face of Adult Social Care 9

4. Supply and Demand 12

4.1 Older People 12

4.2 Adults with Learning Disabilities 27

4.3 People with Mental Health Issues 30

4.4 Carers 33

4.5 People with Visual Impairments 36

4.6 People who are deaf or hard of hearing 39

4.7 People with Physical Impairments 42

4.8 People with Autistic Spectrum Conditions 45

4.9 People with Substance Misuse Problems 48

5. The Likely Level of Future Resourcing 50

6. People Who Fund Their Own Care 54

7. Some Suggestions for Service Delivery Models in the Future 55

8. Useful Links 58

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One.Preface

Prospectus1 in which we set out our programme

of activities for 2010 and highlighted our

plans for 2011. The Prospectus was aimed at

individuals and organisations providing care and

support services to people in Leeds. The key

message contained in the prospectus was that

successful commissioning depends on robust

partnerships, not only between commissioning

organisations, but also with those people and

organisations delivering services on our behalf.

To this end, the Prospectus aimed to inform and

support those organisations in their business

planning and business change programmes.

Information contained in the Prospectus

about our approach to commissioning and our

practical capacity to commission still remains

relevant.

This year we have decided to build on these

Statement for Leeds Adult Social Care. This

document initially sets out the rationale for

this initiative and how it will help us and our

partners facilitate an Adult Social Care (ASC)

market for Leeds which delivers affordable

quality outcomes for our citizens. It then goes

on to describe the public policy context to

which the market will have to respond andmost notably, how ASC is set to change

radically in the coming years. Its main task,

however, is to present our best intelligence on

current and forecast supply and demand and is

meant to be a tool for decision-making, both for

commissioners and service providers. It then

provides a guide to the likely level of future

resourcing, followed by some suggestions

for future and creative, imaginative models

of service design and delivery to meet the

challenges of diminishing resources and

increasing demand. Finally, it describes a

new and emerging role for ASC commissioners

in the market for privately funded support

for people with personal care needs.

This statement has taken shape in the broader

context of the major changes taking place in

NHS Commissioning through the establishment

of Clinical Commissioning Groups (CCGs)

and associated new structures. Alongside

our colleagues in Childrens Services we

are currently engaged in transposing our

pre-existing strong commissioning relationships

with NHS Leeds onto the new CCGs. Hitherto

we have developed robust arrangements for

joint commissioning with the NHS and it is our

intention to take these to a new level with the

for localities as well as for the whole city.

In addition and where appropriate, we are

gearing up to take the commissioning lead

on behalf of our NHS partners, when the Local

Authority is best placed so to do.

Much work needs to be done to bring together

the evidence for investment and change.

Each area of business will need to better

harness all the data available to us, both in

the Joint Strategic Needs Assessment (JSNA)and in those bodies of evidence currently

hosted within all the different commissioning

organisations currently operating in the city.

The MPS will form the impetus for improved

knowledge management across the piece.

Finally, the MPS is produced at a time of great

change nationally and locally and against a

ASC services in the city have established a

programme of activity to address both the

1Adult Social Care Commissioning Prospectus 2010 www.leeds.gov.uk

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that the people of Leeds are provided with the

best opportunity to enjoy Better Lives in the

future.

We regard the MPS as a work in progress

in its initial phase. We very much hope it

will become a vehicle to take forward our

partnership with providers and are looking

forward to their comments and contributions

as we move forward. To this end, we are

convening a Market Development Forum,

meeting regularly and comprised of key

representatives of market stakeholders.

But please dont delay your contribution

and contact us with your comments and

reactions at 0113 247 4258.

Finally, we are greatly indebted to the support

and scholarship afforded to us by the Institute

of Public Care at Oxford Brookes University in

the production of this document.

Dennis Holmes

Deputy Director, Strategic Commissioning

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Two.IntroductionWhy do we need a Market Position

Statement (MPS) in Leeds?

Leeds City Council has set the ambitious

and challenging target of making Leeds the

best city in Europe by 2030. From an ASC

perspective, to make this happen we need to

ensure that a range of the highest possiblequality services are available at an affordable

personalised services a reality. Facilitating and

developing the markets for these services is

now an important role for local authorities;

the MPS seeks to draw together all the factors

in the future.

Recent research2 has indicated that local

authorities have considerable room forimprovement in how they use ASC resources.

We need to move away from a preoccupation

with expenditure, where spend on ASC services

is viewed largely as dead money, to a position

where expenditure is seen as investment,

principally in terms of outcomes for service

users but also as a contribution to wider

agendas, such as generating social capital and

tackling inequality.

The investment paradigm requires a much

more sophisticated understanding of the

market for social care and support alongside

those parts of the market that are most closely

related, notably health and housing. We are

eager to develop intelligence about how the

market responds to different stimuli and then

better outcomes and value. Along with our

commissioning and provider partners we need

to develop systems for the collation

and analysis of the evidence for cost,

quality and outcomes.

Finally, the increasing use of personal budgets

support and related markets over the next

10 to 15 years. As local authorities increasingly

relinquish their role as providers of services,

they will assume greater responsibility to

available to purchase by service users and

carers. The MPS aims to meet that challenge.

What does the MPS do?

The MPS brings together, into a single

document, material from the Joint Strategic

Needs Analysis (JSNA), commissioningstrategies and other market intelligence.

It presents the data and analysis the market

needs if it is to plan its future role and function.

and preferences of different service user

groups in the market, including privately

funded service users. It suggests the

necessary change and innovation required

to service design and delivery in the future.

Finally, it provides information on the likely

level of future resourcing.

The MPS is not an end in itself. Rather, it

represents the initiation of an evolving and

creative dialogue between Leeds City Council

and its private and voluntary sector providers.

It aims to cover the whole market and not just

that funded by ASC, thereby discharging an

emerging responsibility to ensure that those

who fund their own care can make informed

and effective choices.

2 Eg J Bolton The Use of Resources in Adult Social Care DH2010

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The MPS must take into account the bigger

picture of publicly funded services in the city.

Most notably, the wider Council and the NHS,

but also social housing providers and other

bodies investing in communities. It should also

begin to engage with industry and commerce

more broadly in order to explore opportunities

for joint enterprise. Although many parts of

the local authority will be familiar with this

approach,

it represents another new challenge for ASC.

The quality of the MPS will be judged by the

robustness of the evidence it utilises, and the

analysis derived to inform decision-making.

It will also be judged by the clarity and

accessibility of its communication for all of the

interested stakeholders in the city and beyond.

How is it arranged?

In common with the 2010/11 Commissioning

Prospectus, this Market Position Statement

is organised into the principal user groupings

and commissioning categories used by ASC. It

is currently arranged in this way because it is

largely how all Local Authority ASC departments

account their business. In the past it has been

important to organise our work in this way to

enable national benchmarking of performance.

As this requirement declines in importance,

emphasis will be in establishing categories more

colleagues.

How will it help?

All stakeholders, commissioners, providers

and service users need a better understanding

of market intelligence if they are to optimise

their experience in the market for adult care

services. The MPS is our chosen vehicle for

broadcasting the current state of marketintelligence in Leeds. We aim to achieve a

shared perspective on supply and demand,

both current and forecast, and a consensus

on what works for whom in service delivery.

Such an approach should give the market a

shape and structure, where the outcomes

which commissioners require are agreed.

according to need and demand, for example,in the shift away from a reliance on residential

care towards housing with care options for

older people.

Alongside improving our approaches to sharing

structures, the MPS will make plain the kind of

interventions in the market that commissioners

will need to make, by way of the commissioning

cycle. This will make plain the kind of markets

that will be required for any given community.

How can stakeholders make a

contribution?

It is intended that the MPS will be a living

document, regularly updated by commissioning

staff and the product of an ongoing

dialogue between commissioners and other

stakeholders, particularly service providers. All

stakeholders will be encouraged to comment

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on and challenge the form and content of the

Statement with the aim of developing common

ownership and continuous improvement.

The submission of market intelligence will be

actively sought, as well

as ideas on market structure and facilitation.

We have set up a market development

forum, comprising representative provider

organisations, which meets on a quarterly

basis and is chaired by the Deputy Director,

Strategic Commissioning. The group will act

as a sounding board for ASC market initiatives,

including the MPS. In addition, we intend

to hold events for the broader stakeholder

community to allow people to make a

contribution.

The overall aim is to make market development

a joint enterprise for investors, providers and

customers of services.

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Three.The changing face of adultsocial care: a new offer

Local Authority commissioning intentions and

closely aligned to - the developing public policy

agenda concerned with personalising the health

and social care received by adults and older

people. This policy is not only radically altering

the nature of care and how it is provided, but

it will also transform the role of Adult Social

Services in the coming years and decades.

Thus far, personalisation has been concerned

with enabling choice and control for service

users over the support and care they receive

as individuals, for example, through individualbudgets and self-directed support. However,

the balance of power in relation to decision-

making and the control of resources has

largely remained with the statutory authorities.

In order to move away from this, the

government has issued a raft of guidance

aimed at introducing engagement and

co-production as key elements in the process

of producing health and social care3.

First Communication Toolkit:

Co-production is when you, as an individual,

or when groups of people get together to

commissioned and delivered.

The greater involvement and control of

individuals and communities in decision-

making will further devolve the power of all

public bodies and, in particular, Adult Social

Services departments, to control resource

allocation. This change will fundamentally alter

the traditional role of commissioners in parallel

with the way the increasing use of self-directed

support has begun to fundamentally shift the

scale of directly provided services. Similar

processes are under way in the NHS, Education

and Childrens services. Thus, the statutory

sector will need to develop its attributes as an

enabler and supporter of decision-making, andcommissioners will perform a key role in this

new offer from Local Authorities.

This revised role for ASC will be developed

in three domains:

services, ASC will co-ordinate the provision

of information and advice to people

and their carers about the care options

available to them, and what might producethe best outcomes for them. It will also

fund directly or through third parties, the

costs of care services, wholly or in part,

support. This information and advisory role

will be extended to those who fund their

own care.

3 The NHS White Papers, Equity and Excellence: Liberating the NHSA Vision for Adult Social Care; Capable Communities and Active Citizens;Think Local, Act Personal

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responsible for stimulating and shaping

the market for personal care, social care

and related housing support services. It

will forge new partnerships with health

care commissioners and service providers

in the voluntary and independent sectors

services are available at an affordable price

to enable real choice. It will also provide

intelligence and information to the markets

to assist their business planning processes.

The analysis and forecasting of demand

trends will lead to the creation of business

creative providers.

that citizens have better life opportunities

in terms of their health and wellbeing.

It will inspire and oversee care providers

in the delivery of better outcomes for

service users. Quality will be incentivised

and failure will be discouraged. If Leeds is

to become the best city to live in by 2030

then those most vulnerable citizens must

quality services available to enable them

The new face of ASC will have four priorities

in terms of improving outcomes for people:

Prevention

It will strive to prevent avoidable harm

to vulnerable people wherever possible.

For example, it is commonly acknowledged

that at least 30% of unplanned admissions

of older people to hospital are not necessary

and those admissions often lead to poor

outcomes, including admission to long-term

care. Services need to be re-aligned, therefore,

to face the front door of the hospital rather than

the back door.

Personalisation

In future, ASC will only invest in services

which can evidence personalised outcomes for

the service users they support, which are both

effective and affordable.

Partnerships

It is envisaged that, in future, all services

will be delivered via partnership arrangements.

Provider organisations, including those in the

statutory sectors of health and social care,

will be encouraged to develop formal and

informal collaborations and integrated services.

Evidence of co-production as integral to service

delivery will be incentivised. New service

models, including social enterprise and

co-operatives will be supported, and ways

of engaging business and commercial

enterprises will be explored.

Productivity

In the past, the production of care was seen

as an end in itself. The move away from a

focus on outputs to emphasising improved

outcomes for people has shifted commissioners

perspective from expenditure to investment.

Also to the kinds of return that can be realised,

for example in the form of increasing social

capital within communities, stimulating

enterprise in business and promoting

co-produced care and support. Organisations

and companies providing these services areincreasingly being encouraged to evidence

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activities with individuals. This will directly

Traditionally, ASC has organised services for

individuals or whole communities. However,

the new public policy agenda promoting

localism will mean that some services will

be commissioned for neighbourhoods and

communities of interest, thereby creating

more opportunities to invest in community

cohesion and tackling health and social

inequalities. Thus, local interest groups will

need to be better and more strongly engaged

in commissioning processes.

constraints and ever-increasing demand forservices, exposes ASC to a range of service

challenges if it is to successfully deliver on its

responsibilities:

Firstly, ASC must act to reduce demand through

investment in prevention rather than cure.

needs to be diverted away from specialist

social care services into the mainstream by

means of better signposting and information

and by sponsoring the generation of socialcapital and community infrastructures.

Thirdly, remaining demand needs to be better

managed by ensuring the use of evidence-

based interventions, the avoidance of

institutional options, more timely interventions

and smarter solutions, including maximising

the potential of new technologies to provide

answers to the care needs of citizens.

In general terms, ASC is challenged to provide

improved leadership with its health partners to

ensure the drive forward to create a successful

and diverse health and social care market

capable of meeting the care and support needs

of all the citizens of Leeds.

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Four.Supply & demandThis section of the MPS sets out for each service

user group some detailed information about

our current knowledge of supply and demand.

It explains the salient demographic features,

the extent to which demand is expressed in

presenting needs, information on the current

supply of commissioned services to meet those

needs and a description of our commissioning

intentions for the future. Much more work

is required to build this intelligence base for

commissioning decision-making, by capturing

and bringing together knowledge, data and

analysis from all sections of the market. We aim

to do this on a step-by-step basis, building the

picture year on year.

As it grows and develops, the JSNA (now in

its third year of development and publication)will form the hub of health and social care

data, information and analysis upon which

commissioning decisions will be taken. In

addition, in recent years we have built strong

relationships with a number

of academic institutions which have assisted

us in assembling and making sense of health

and social care factors prevailing in Leeds,

as well as evaluating our attempts to deploy

innovative services which meet prescribing

needs more effectively. These include theUniversity of Leeds, Leeds Metropolitan

University, the University of York, the University

of Kent, Birmingham University and Oxford

Brooks University.

We need to engage other market stakeholders,

particularly providers of health and social

care and support services, in this thinking

about the rationale for investment in

particular pathways, interventions or indeed,

localities. In 2010 we commissioned Cordis

Bright Ltd., an independent consultancy to

undertake a detailed analysis of supply and

demand in relation to residential care and

associated housing options for older people

in Leeds over the next 20 years. This piece

of work formed the foundation of our current

strategy for supported living for older people

over the same period, shifting the emphasis

towards extra care, supported housing and

assistive technology, and away from long-term

institutional care solutions.

The results of the 2011 census are set to be

published this year and will form a further key

resource for demographic, economic, social and

health data to inform commissioning decisions.

development is in relation to the markets for

people who wholly fund their own support and

care. We need to form a new partnership with

the existing and prospective providers of a

range of care and support services, in order

to collaborate on generating market intelligence

for this sector.

4.1 Older peoples services

Demographic Trends

in the next 20 years. In 2006 the University

of Leeds was commissioned to analyse the

demographics of the city by ward, particularly

age population. The study also generated a

range of valuable intelligence in relation to,

for example, emerging trends among minority

ethnic groups and increasing rates of people

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living alone. Although the wards that contain

people are almost entirely in the outer areas of

Leeds, there are smaller populations of more

vulnerable older people remaining in the inner

city wards. Currently there are relatively few

older people from ethnic minority communities.

However 70% of the ethnic minority population

live in only nine wards, the majority being in

the most deprived 10% Super Output Areas.

the population of Leeds will contain growing

numbers of people over the age of 85, although

this is not likely to impact noticeably until about

2020. Given the prevalence of dementia, other

illnesses and long term conditions among this

age group, we know that more people are likelyto require care and support to help them (and

their carers) to manage as independently as

possible.

Figures taken from The Projecting Older

Peoples Population Information (POPPI)

system during September 2010 estimate that

in Leeds there are 38,491 people over 65 who

are unable to undertake at least one self care

activity and 47,000 unable to complete at least

one domestic task.

Cordis Bright used information from POPPI

during 2009 to estimate the social care needs

of the over 65 population in Leeds. They found

as having a social care need was close to the

national average at 35%. They estimated

that this was the equivalent of 39,500 people

over 65 in Leeds with some level of need. Of

these they proposed that 3,300 of these were

potentially in need of high levels of statutory

social care with the remainder being supported

through less intense packages of care and

beyond that by informal support networks

and carers.

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Projections from POPPI show that the numbers

of older people who are unable to perform

at least one domestic or self care task are

estimated to increase by around 2,500/3,000

to 20,000 over the next 20 years. The Cordis

Bright report urged the need to develop

alternatives to residential care, particularly

Extra Care, to ensure affordability in the future.

Once published, the 2011 census will give

us crucial current insights into the unfolding

picture of our ageing society, and its particular

characteristics for Leeds, as well as valuable

comparative data for other core cities.

Expressed Demand

ASC in Leeds collate two types of informationon people seeking assistance: those people

referred and then moving on to receive

a statutory social care service following

assessment and validation of eligibility via the

application of the Fair Access to Care (FACS)

criteria. Secondly in terms of those people

assessed and then signposted to use non-

statutory support services. (Table 1)

of older people.

particularly within acute hospital settings

people, in particular older people with

long-term conditions, including dementia.

NHS service responses at the intermediate

tier to support people to maintain

independence and prevent unnecessary

long-term admissions to care homes.

and control over how the resources and

support are used.

(as documented within the Cordis Bright

report).

i.e. over 85s

Table 1:New referrals received by ASC 2006/07 - 2010/11 by outcome

25000

20000

15000

10000

5000

0

2163

2163

13999

2006/07 2007/08 2008/09 2009/10 2010/11

NumberofReferrals

2426

2416

14633

3628

3628

14264

3165

3165

12896

3034

3034

13185

Other Outcome

Sign Posting

Further Action

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Current Supply

Overall

The table below (Table 2) shows the broad

trends in service provision. There has been a

reduction in the number of people receiving

traditional services, previously largely provided

by the Local Authority, such as day care, mealsand homecare. More recently however, the

numbers of people in receipt of equipment

including telecare and self directed support

have increased, with these kinds of services

largely provided by independent and third

sector providers (including directly employed

personal assistants). These trends are in line

with recent developments and national guidance

in relation to the promotion of preventative and

personalised ASC services.

Homecare/ Community Support/

Reablement

Leeds ASC currently provides or arranges

homecare (community support) to adults who

are assessed as eligible for assistance under

Fair Access to Care Services (FACS). Leeds

ASC has set the level of eligibility at eithersubstantial or critical levels of need in order for

people to be entitled to statutory support.

Prior to November 2010 homecare support

was provided by a relatively large in-house

service called the Community Support Service

alongside a block contract with six external

providers. In November 2010, in conjunction

with NHS colleagues, a Framework Agreement

was established with 36 independent sector

home care providers. The directly provided

Table 2: Numbers of people aged over 65 receiving community based service by type of service 2006/07 -08/09

Day Care

DirectPayments

Equipmentand

adaptations

Home Care

Meals

Other

Overnightrespite, notclient home

ProffessionalSupport

Short Termresidential not

respite

0 1000 2000 3000 4000 5000 6000 7000

2008-09

2007-08

2006-07

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Community Support Service is now being

restructured into a short term homecare

reablement service called the SkILs (Skills for

Independent Living) Team and a much smaller

long term service.

45000

40000

35000

30000

25000

20000

15000

10000

5000

02006 2007 2008 2009 2010 2011

7934

19215

9502

18376

13778

14320

21224

128842

23984

8024

Ind Sector LA

6351

23479

Table 3: Home Care Hours Attributable to LA / Independent Sector

Table 4: Proportion of Home Care Hours Attributable to LA / Independent Sector

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%2006 2007 2008 2009 2010 2011

Ind Sector % LA%

21.3%

78.7%

29.%

70.8%

34.1%

65.9%

49.0%

51.0%

62.3%

37.7%

74.9%

25.1%

to the independent sector as depicted in the

two graphs below (measured in September

of each year). (Tables 3 and 4)

Numberofho

mecarehours

P

ercentageofhomecarehours

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The total numbers of service users receiving

home care is illustrated here, and shows a

decline in numbers of over 25% from 4063

to 3025. (Table 5)

4500

4000

3500

3000

2500

2000

1500

1000

500

02006 2007 2008 2009 2010 2011

Table 5: Home Care Service Users 2006-2011

Table 6: Black Minority Ethnic Home care users 2007-2009

9.0%

8.0%

7.0%

6.0%

5.0%

4.0%

3.0%

2.0%

1.0%

0%2007 2008 2009

4.2%

6.2%

7.8%

4.4%

6.0%

7.8%

5.4%

6.6%

7.8%

BME as % Users

BME as % Hours

BME as % Population

PercentageofUsers/Hours/Population

Numberofserviceusers

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The proportion of homecare users from BME

groups has increased year on year, however

this still represents an under-representation in

relation to the makeup of the population. (Table

6)

Providers on the Framework Agreement will

produce the majority of long term homecare

support in the future. As the Local Authority

continues to reduce the size of its workforce

in this area, and to increasingly specialise in

providing reablement support alongside NHS

intermediate care services, remaining demand

for long term homecare support will be provided

by independent sector contractors, either on

the framework arrangement or retained directly

by people using individual budgets to purchase

their care.

The advantages of the Framework

Agreement are:

has greatly extended customer choice in

relation to homecare providers, with 36

providers now offering more personalised

services for customers.

has increased capacity and is enabling

ASC to better meet increased demand for

homecare provision.

ensuring that customers needs are met

more effectively.

seen by the fact that 3000 Hours of

homecare support have transferred from

the Community Support Service (CSS)

3 months of 2011.

achieved affordable prices for homecare

for ASC.

agreement is a good example of

partnership commissioning as it has

been jointly commissioned by Adult

Social Care and NHS Leeds.

A growing number of adults are electing to

receive their Individual Budget as a Direct

Payment, a cash payment which they can

use to purchase their own services. In this

way, more people are choosing to meet their

domiciliary care needs through contracting

with homecare agencies themselves or

employing their own personal assistants.

as using an individual budget to purchase

their own support through an agency; byAugust 2011 this had risen to 485. Including

August 2010 and 1083 by August 2011.

(Table 7)

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ASC is developing a reablement service which

includes the Homecare Reablement Service

(SkILs Team), an Outreach Service and

Assistive Technology. The reablement servicecompliments the work of the Intermediate

care services provided by health colleagues.

The intention is to establish a fully integrated

Intermediate Care Team (ICT) and Homecare

Reablement Service.

The SkILs Team provides short term

interventions for people with poor physical

or mental health to help them cope with their

illness by learning or re-learning the skills

necessary for daily living.

After a local pilot in 2010, from April 2011

the service was offered city-wide to new

customers and people being discharged from

from reablement. From November 2011, the

service expanded further so that it is now also

offered to existing customers of Adult Services;

meaning that the service is now a fully

operational in-take and discharge service.

Gains demonstrated thus far include:

customers required hours of care down,

with an average reduction of care hours of

62% over the programme of reablement.

to live independently in their own homes,

with 70% of reablement customers not

requiring an ongoing package of care once

their reablement programme has come to

an end.

authority money, with an average saving

per head for reablement customers of

2,020 per year.

improvements in terms of customer

perceptions of the outcomes they are

achieving from the service.

With the service at full capacity, in 2012/13

we aim to provide homecare reablement to

approximately 2000 customers per year;

equating to the provision of 144,781 hours

of homecare reablement delivered by 150.50whole time equivalent workers.

Looking forward, on the reablement outcomes

evidenced above, we can now say with

the delivery of reablement city-wide will

contribute to a reduction in the long-term needs

of the customers who use the service.

1200

1000

800

600

400

200

02010 2011

Personal Assistant Home Care Agency

Table 7: Service Users using Individual Budgets(IB) to Directed Purchase Support

NumberofserviceusersusingIB

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However, to work effectively, the Council will

continue to require adequate independent

sector home care capacity at the end of a

programme of reablement to enable the smooth

transfer of individuals into homecare services,

through the service. Further work is required

aggregated hours required of the independent

sector to meet this requirement.

Accommodation options including

residential and nursing care

Leeds currently commissions around 3000

permanent residential and nursing placements

with around 2500 of these being for people over

the age of 65. The vast majority of the total are

commissioned in Leeds with around 500 beingcommissioned in out of area placements.

consultation on the future of its current stock

of residential care facilities, in September the

Executive Board of the Council determined that

six of the homes should be de-commissioned

and a further two homes re-commissioned

as specialist intermediate care facilities to be

provided in partnership with the NHS Leeds

Community Healthcare Trust (LCHT).

In three localities Rothwell, Morley and

Otley, it was agreed that the decommissioning

process would actively begin once appropriate

independent sector local alternative provision

was on stream. In Rothwell this also includes

the potential for a local community group to

take over the existing establishment and to

run it as a community owned facility. In the

coming years ASC will wish to continue to

promote this approach wherever possible, to

stimulate the re-provision of residential stock

in the localities of Leeds nearing the end of

alternatives.

ASC is developing Extra Care Housing schemes,

in partnership with independent sector housing

and social care providers, as part of a rangeof alternatives to care homes. In addition to

the cost effectiveness of such schemes, they

promote independence, increase choice and

control and enable the use of self directed

support.

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Social care policy in recent years has aimed

to reduce the need for residential and nursing

care through the commissioning of preventive

services and community based support. Whilst

trend has been downwards in placements and

admissions. This has been against a background

of demographic changes which includes an

increasing aging population. (Tables 8 and 9)

1600

1400

1200

1000

800

600

400

200

0

129

1277

101

1299

94

1073

58

1071

64

949

80

909

70

943

69

783

70

912

33

838

96

911

NumberofAddimissions

2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Adults Aged 18-64

Elderly People

Table 8:Admissions to Permanent Placements 2000/01 - 2010/11

Table 9: People supported to live in permanent residential/nursing placements at 31st March 2006/07 - 2010/11

4000

3500

3000

2500

2000

1500

1000

500

0

1607

1202

564

2006/07 2007/08 2008/09 2009/10 2010/11

N

umberofPeople

1505

1131

488

1409

1054

502

1434

1044

539

1458

1066

538

Aged 85+

Aged 65-84

Aged 18-64

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Individual Budgets / Direct Payments

A recent development has been the introduction

and promotion of self directed support which

includes a range of options for people to wholly

or partly organise their own support by being

provided with a cash payment.

228 people received payments including 83

had risen to 1279 including 704 over-65s.

An analysis was undertaken of older people

receiving direct payments using information

which had been recorded relating to the

intended use of payments. From a total of

715 recorded uses of direct payments, it was

found that at least 60% were intended forhomecare type services employed as a private

arrangement or through an agency. (Table 10)

Use of Self Controlled TotalPersonal Budgets*

Personal Assistant 116

Agency Support 284Respite 130

Practical 57

Meals 9

Social/Leisure 7

Transport 13

Insurance/Stationery 39

Equipment 12Other 48

*(Count of services recorded, not people)Grand Total 715

Table 10:

the potential for using personal budgets and

self directed support remains largely untapped

in the coming years. (See Map 1 for distribution

by wards across Leeds)

Telecare

Leeds City Council provides people with

a range of telecare services which aim to

support people alone or in combination with

other services to continue to live independently

in the community.

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The Care Ring emergency alarm call service

involves a pendant-style monitor connected

to a response centre. When activated the

alarm alerts staff in the response centre thathelp is needed. The use of this service have

increased in recent years from around 1,300

in 2008/09 to over 2,000 new service users

in 2010/11. Telecare builds upon the existing

Care Ring pendant alarm system to offer added

security at home by providing equipment

such as movement sensors and medication

reminders, and extends this service to people

confusion. The number of new people provided

with telecare each year is around 1,200 with

an aim to increase this to 2160 in 2012/13.

(Tables 11 and 12)

Initially the programme focused on older

and disabled people but in 2010 the remit

of the programme was broadened to include

all social care client groups, bringing it in line

with the personalisation agenda and Putting

People First.

Map 1:

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Early Support Services

ASC also commissions a substantial range of

community based services for older people

delivered largely by third sector organisations

whose aims include: the reduction of isolation;

increased participation and involvement of

older people in the communities in which theylive; choice and control over their own lives;

and enhanced wellbeing and healthier life

choices. These include both generic services

as services for people with dementia.

This commissioning activity includes jointly

funding, with NHS Leeds, 37 Neighbourhood

Networks with coverage across the city who

between them work with 16,000 older people and

harness a volunteering workforce of 6,000 people.

An example of work to support the

personalisation agenda ASC funds Keeping

House. This has been running since 2005

and aims to help people to continue to live

independently. The programme has three key

strands of activity:

(http://leedsdirectory.org), so that people

can make informed choices about which

services to buy.

up new socially enterprising services which

support independence.

stimulate the development of the market

for independent living services.

New Installations Upgrades Overall Activity

200

180

160

140

120

100

80

60

40

20

0

97

141 140

161

133 122

128 128

144

116

128

115

158166

139153

157161 158

79 76

102102

10292 93

127

113

130

118

105

118 128

96 98

88

44

6157 59

2630

40 3831

36

2231 26

36 35

5243

30

Installations

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec10 10 10 10 10 10 11 11 11 11 11 11 11 11 11 11 11 11

Table 11: Leeds Telecare Service Activity

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Future commissioning priorities

Commissioning activity is to be supported in

four distinct areas;

and wellbeing opportunities for older people

and their carers is sustained, providing

information people need to gain easier

access to a full range of local services and

a broad range of early intervention and

preventative services.

enterprising care and support services arestimulated in local communities, generating

volunteer and employment opportunities

for local people, stimulating development

opportunities in care and support

occupations and encouraging the creative

use of Individual Budgets to support this

process.

services at the intermediate tier and

provide a service that is responsive and

2,500

2,000

1,500

1,000

500

02007/08 2008/09 2009/10 2010/11 20011/12 2012/13

Table 12:Actual and Planned New Telecare Service Users 2007-2013

prevents older people needing to access

more intensive care and support services.

The aim is to support people to leave

hospital earlier where it is medicallyappropriate.

housing, care and support options.

These overall imperatives will be supported

by resources redirected from traditional,

directly provided care and support models,

such as day care and residential care and by

generating better value and more effective

use of those remaining directly provided and

mass commissioned services. For example, in

future, resources will be directed increasingly

towards Telecare and Telehealth, improved

housing (including more extra care housing)

and a continued reduction in the use of all types

of residential and nursing care. Commissioning

will be done as a joint enterprise with the NHS

whenever it is appropriate.

NumberofTele

careusers

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Examples of commissioning activity to support

this will include:

Neighbourhood Network Schemes

to encourage greater enterprise and

innovation within the networks which

support older people to diversify in the

scale of their offer and plan for the future

needs of people in their locality.

Keeping House (KH) Support the

Keeping House programme to develop the

Leeds Directory as the premier source of

information which enables older people

to make informed choices on services

they may want or need, as part of the

development of a regional E-Market

Place. Using the KH vehicle to maintaininvestment in local social enterprise

organisations and to encourage market

development of activities and services

that support older people to remain

independent.

Residential and nursing care framework

contracts with independent providers -

the use of block specialist provision will

be reduced due to a fall in demand and in

recognition that older people wish to exertgreater choice and control over where they

live. There will be a joint approach with

health to purchase care at the intermediate

tier for people with continuing health care

needs. Commissioning framework contracts

will emphasise the respective roles in

improving safeguarding and dignity

Home care a jointly commissioned

framework contract for homecare will

advertise an approved list of providers

of care and support to direct payment

recipients and to ensure that service

recipients wishing to exercise choice and

control over their care arrangements are

able to access a wider range of potential

care providers.

Day services consolidating work within

centres and introduce more personalised

services targeted on greatest need. This

follows the national direction of travel for

day services and the move away from

buildings accommodated day services.

Supported housing developments

to commission additional extra care

housing facilities learning from the recent

partnership approach of the Hunslet Model.To extend the range of sheltered housing

and housing outreach support available to

older people and disabled people within the

city.

Dementia services future commissioning

Strategy and the local Living Well with

Dementia and wider Older Peoples Mental

Health strategies. This will include day

opportunities, home care, intermediatecare, information, support and guidance.

We intend to enter into discussions with our

partner commissioners and providers on the

following long term solutions:

care by two-thirds over the next 20 years.

a diverse range of housing with support,reablement and assistive technologies.

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residential care linked to a quality

framework, raising the overall quality

of care in a diminishing market.

shrink and occupy vital specialist areas of

the market.

in service delivery will be a favoured model

for investment.

housing available by 2020.

required to produce evidence of thegeneration of social capital in their

enterprises.

older peoples mental health and delivery of

specialist short term care options.

towards shorter stay bed usage

(intermediate care, respite) and reduction

in long stay beds.

4.2 Adults with learning disabilitiesDemographic trends

The number of adults with learning disabilities

in Leeds is increasing year on year, this is in line

with national demographics. More young people

with severe and complex disabilities survive

into adulthood with a lifelong need for care and

support. Improved healthcare means that there

disabled people in the 60 plus age group.

The estimated total adult population with a

learning disability is 15,582, with a predicted

(an increase of 22%). For people with moderate

or severe learning disability (and those likely

to be eligible for services) the estimated 2010

4,125 in 2030, an increase of 26%. Further

detailed information is available in the JSNA.

In Leeds in 2005, 35 young people with

moderate to severe learning disabilities left

school at 19 and by 2009 this had risen to 89.

Expressed demandConsultation with stakeholders, including

carers and service users, in developing the

Learning Disability Strategy and through the

Leeds Learning Disability Partnership Board has

learning disabled people in mainstream

services e.g. leisure, education and

employment.

range of need in the community and at

home.

of individuals within shared support

environments.

with very complex needs in Leeds and

prevent them from being sent out of area.

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Current Supply

In Leeds, services and support for adults with

learning disabilities are funded by ASC, NHS

Leeds and Supporting People.

ASC directly provides some services,

predominately day care, care managementand accommodation. NHS Leeds directly

contracts with Leeds Partnership Foundation

Trust for specialist health services which

includes in patient beds, respite and some

day opportunities.

ASC provides a range of services for people

with learning disabilities. These include:

Over recent years the in-house services have

transformed the way they support people with

learning disabilities and this work will continue

in coming years.

The priority in Leeds is to support people

in their own tenancies. Where appropriate,

a number of people have been given the

opportunity to move back to Leeds from

out of area residential placements to newly

commissioned supported living services.

The Independent Living Project began in

2008 with the ambition of moving people

with learning disabilities out of the 13 hostel

sites across the city into more stable housing

where individuals had more choice and control

over where they live. Over 230 people with a

learning disability are now supported in a range

of housing options, including home ownership

and individual tenancies.

The day services transformation has seen

the closure of Moorend, a large segregated

day service, and investment into smaller

community-based services and support

provided by the voluntary sector.

This transformation of services will continue

through disinvestment in in-house services to

fund organisations to develop and deliver new

services and support for people with learning

disabilities. Thirteen community based projects

have been newly commissioned to offer people

with learning disabilities opportunities to accessa more personalised service. People will have a

choice about the types of things they do during

the day, and be able to do this close to where

they live.

Together with the grant funded services, the

Council will also develop small community

bases. This will ensure that all customers

will be able to have their needs met in

services in their local community. Both

Centres will close in 2012 and 2013. The

new grant funded projects will start running

between November 2011 and April 2012.

The Learning Disability Pooled Budget is made

up of contributions from Leeds City Council

and NHS Leeds. Payments from the Pooled

fund are made to providers in the independent

sector who deliver a wide range of services and

support to adults with learning disabilities.

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72% of learning disability spend is in

the independent sector.

In 2009/10 there were approximately 700

people with moderate to severe learning

disabilities in Leeds supported to live in their

own tenancies. A further 390 people lived

number of these people live in specialist

provision outside the Leeds area. A considerable

number of people continued to live in the family

home and of these it is estimated that 280

people lived with family carers over the age

of 65.

When making new placements, Leeds strives

to achieve good value for money by using the

National Care Funding Calculator (CFC) toolwith providers. This is a tool that was developed

Partnerships (RIEPs) to support commissioners

in ensuring improved outcomes for service

users and the best use of resources. The tool

works by assessing and identifying in detail

the level of staff support required to meet an

individuals needs and agreeing a price based

on relevant market knowledge for that and

other elements of the package, such as non

with providers in order to fully understand

their costs of providing accommodation based

care for each individual.

Future Commissioning Activity

To meet the challenge of demographic trends

ways of supporting individuals with highly

complex needs in order to ensure that they can

continue to live in Leeds. ASC and NHS Leeds

are currently working in partnership to develop

a plan for how best to meet the needs of this

group of individuals.

There is a range of respite services available

provided by ASC, Leeds Partnerships Foundation

Trust, an independent sector provider and a

shared lives scheme. A full review of these

services will be undertaken to ensure that

they can meet the demands of the future

demography.

In Leeds we spend less than the national

average on care homes and we expect

this to further decrease as commissioners

work with current residential care providers

(predominantly small group living situations)

to de-register their provision.

Take up of individual budgets has been slow,

although it is increasing. The implementation

of the learning disability supported living

framework will support individuals and care

managers to respond to the need for local

solutions.

There will be a continued move away from

segregated specialist building-based services

in favour of more personalised, communitybased services and support.

We intend to begin a dialogue with our

commissioning and provider partners

on the development of an investment

plan based on evidence of need and

effectiveness of outcomes. We will also

explore the opportunities afforded by

enterprise development partnerships with

the Independent and Voluntary Sectors

for the delivery of new services.

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4.3 People with mental health issuesMental Health Services for working

age adults (16-65)

Demographic Trends

Mental ill health is the single largest cause of

disability in the UK, contributing up to 22.8%of the total costs, compared to 15.9% for

cancer and 16.2% for cardiovascular disease.

The wider economic costs of mental ill health

in England have been estimated at 105.2

billion each year. This includes direct costs

of services, lost productivity at work and

reduced quality of life. Of the 2.6 million people

have a mental or behavioural disorder as their

primary condition. At least one in four people

will experience a mental health problem at

some point in their life and almost half of all

adults will experience at least one episode of

depression during their lifetime.

The Leeds Mental Health JSNA, published in

2011, concludes that the patterns of mental

picture, however there are inequalities in

mental health outcomes within the population of

Leeds. Higher levels of poor mental health andwellbeing are linked to deprivation and one in

are amongst the 10% most deprived in England.

Some mental health problems are becoming

psychotic disorders reported in Leeds compared

to the national picture. It is estimated that there

are 86,337 people, aged between 18 and 64

years, living in Leeds with a common mental

disorder (such as depression or anxiety). This

101,690 by 2030 ( an increase of 18% on 2010).

The number of people with a psychotic disorder

(such as schizophrenia or bi-polar disorder)

was estimated to be 2,145 in 2010 and this

number is projected to rise to 2,523 by 2030.

An estimated 38,648 people in Leeds have 2

or more psychiatric disorders. These numbers

represent 5.9% of the 18 to 64 year old

population in the city and this is predicted

to rise to 45,891 by 2030.

Expressed demand

In March 2011 there were a total of 726 service

users accessing services provided by Leeds

City Council ASC across the city. The spread ofservice users across the city using each centre

is represented in the diagram below. (Fig. 1)

Community Alternatives Team

The ValeLovell Park

Stocks Hill

290

177130

129

Fig. 1:ASC Day Services: Number of service users as of

March 2011

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Lovell Park day centre is located in the Inner

North East of the city, having relocated to newly

refurbished premises from Roundhay Road last

year; Stocks Hill is in the West of the city in

Armley; and The Vale is in the South of the city

on the Hunslet/Middleton border. These bases

serve the approximate geographical areas in

which they are based.

At any one time during 2010/2011, on average

1964 individuals were using the services

commissioned by ASC across the city. Over the

same period, an average of 1130 service users

were being supported by the services that are

jointly commissioned by ASC and NHS Leeds,

although systems are not in place to identify

if service users are accessing more than one

service.

The Leeds Mental Health JSNA indicates that the

relationship between ethnicity and deprivation

of BME communities live in the deprived

neighbourhoods of Leeds. For example, 50%

of the Asian-British/Asian-Pakistani residents

live in the 10% most deprived areas of Leeds.

Ethnic population projections suggest that non-white groups in Leeds are likely to increase in

growth across the city and providers will need

to ensure that they are able to respond to

the growing culturally diverse makeup of the

population of Leeds.

Current Supply

ASC provides a wide range of in-house mental

health services. These include the following:

and day services.

The directly provided mental health day

services are building based, one in each wedge

of the city. In recent years they have moved

towards providing more community located

activity, whilst continuing to offer buildings

based groupwork and drop in sessions. In

addition, centre staff provide one to one

support for service users, helping users access

other services, activity groups in community

venues and peer support in a variety offormats. Each Centre has a community day

where all activity is undertaken off site.

The Community Alternatives Team is a city-

wide service, supporting service users to access

mainstream activities and resources within their

own communities.

Ten mental health organisations are currently

commissioned by Leeds ASC and these provide

14 services throughout the city. Eight of these

are jointly funded with NHS Leeds. Each of the

services fall into the following groups:

Community services. These include two

generic mental health services and two

an employment service and a carers

support service.

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Residential support. This provides 24-hour

support in a residential setting.

Crisis service. One service can be directly

accessed by users and the service is able

to provide one to one support. The other

service offers a telephone helpline.

Information and advice. Three services are

commissioned to ensure that service users

are able to receive information and advice,

to allow them to make informed choices.

The services are offered at a variety of

locations across the city.

Advocacy support. This service provides

independent advocacy advice for people

experiencing mental distress and dementia.

Counselling. One service provides

counselling and therapy for women

with moderate to severe mental health

problems, and the other provides a more

generic counselling service.

Future commissioning activity

The commissioned organisations were reviewed

between April 2008 and August 2010. The

reviews very clearly demonstrated the diversity

and quality of the work carried out within each

of the services. However, despite the quality of

what was provided, the reviews highlighted a

number of areas that needed to be addressed.

These included unequal citywide access to

services and gaps and duplication in provision.

Building upon these reviews and other sources

of information, including the i3 Project

research, the report The Future of Mental

Health Day and Accommodation Services made

recommendations about changes to the way

in which services are delivered across the city.

This report was approved by Executive Board

and consultation with service users is currently

taking place regarding the proposed model.

Recommendations include the reorganisation of

in-house mental health day services, reducing

the reliance on building-based services and a

commissioning exercise to procure a new and

comprehensive day services system.

The new model of support will:

the service user and ensure that serviceswhich promote inclusion are available

citywide.

outcomes that can be demonstrated

organisation and delivery of the services.

It is proposed that the following elements will

make up the new service:

service will operate in the community,

providing individual tailored support to

overcome barriers service users may

experience and will focus upon their

recovery and inclusion.

will assist service users in engaging with

mainstream opportunities and provide

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advice and information about staying well

and healthy.

users to access and sustain economic

independence through training, education

and employment.

process. These skills-based, time-limited

group and individual activities, such as

gardening and cookery, will equip service

users with the resources to improve their

daily living skills and prevent relapse.

remain over-represented in the mostrestrictive parts of the mental health system

whilst, at the same time being least likely

services. The BME day service will continue

to address issues associated with stigma

and exclusion. It will strive to provide a

culturally sensitive service that meets the

varied and complex mental health needs of

BME communities in the city.

It is also intended that grants will be availableto service users who wish to run initiatives such

as drop ins and peer support groups within the

community.

The existing in-house Mental Health Reablement

Service is currently being aligned with the

generic reablement service in Leeds to ensure

that all service users receive the same level

and quality of service and that they receive the

most appropriate service to meet their needs.

This should also ensure that those who require

ongoing support, transfer from reablement to

other services in a smooth and timely manner.

We intend to explore the opportunities for

enterprise partnerships between the Local

Authority and Voluntary Sector for the delivery

of these services.

4.4 CarersDemographic Trends

According to the 2011 Census there are 70,500

carers in Leeds. This has changed very little

since the 2001 Census (70,446).

Detailed analysis of the latest Census is not yet

is taken from the 2001 Census analysis:

per week, eleven percent were providing

20-49 hours, sixty nine percent were

providing 20+ hours per week.

black or ethnic minority community. This

whole which may indicate that people

from BME communities do not identify

themselves as carers.

85+, over half were providing 50+ hours of

care per week.

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Expressed Demand

Carers and service users in Leeds who were

involved in refreshing the National Carers Strategy

in September 2010 expressed their need for:

greater understanding of the impact ofcaring; systems to record carers in patient

records; provision of information on

conditions and treatments; prescription

of gym membership or complementary

therapy sessions to relieve stress and

improve mental wellbeing of carers

as fellow professionals by GPs, health

professionals and social workers

take breaks

information generally

that help sustain them in their caring role,

thereby preventing carer breakdown

planning for the cared-for person,

particularly for hospital discharges

to be more proactive in offering support

to carers and not assuming that they can

cope with the caring situation they are in

they should review the carer as well as the

care plan

carer and cared-for person can attend

together

for the cared-for person, enabling the carer

to have their own life

Current Supply

A wide range of carers services are

commissioned by Leeds City Council and the

Leeds Primary Care Trust:

information and support service which

operates from a city centre venue. It

publishes bi-monthly newsletters to 7,000

carers, and facilitates carers groups,

training and social activities.

agencies in Leeds: a young carers support

service; a support service for carers overage 65 who care for an adult with learning

disabilities; a mental health carer support

service; and a dementia carers support

service.

are commissioned from internal and

independent sector agencies, providing up

to eight hours of support per week to the

cared-for person in their own home, in all

parts of the city. This includes a specialistservice for BME carers who require a care-

worker of a particular cultural background.

Approximately 700 carers are supported

each year to have a regular break in this

way.

provided in a number of local authority and

independent residential settings for older

people, and younger adults with learning

disabilities, physical disability or mentalhealth needs.

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grant to up to 400 carers for a single break

opportunity or holiday for themselves.

for approximately 2,700 carers of adults

who use their services

commissioned services, a small grant is

provided to 20 self-managed carers peer

support groups across the city.

a range of information in printed form and

on our carers website, www.leeds.gov.uk/

caringinleeds

commissioned by ASC and supports 1,400

carers. This service is due to be re-

commissioned in 2012.

ASC can expect that awareness of the

needs of carers will continue to develop

as a result of the national governments

focus on their importance, and health and

social care services will need to adjust

and change accordingly, to ensure carers

can maintain a decent quality of life.

Future commissioning activity

One of the priorities of the National Carers

their needs. This is likely to mean an increase

in the number of people identifying themselves

as carers and ultimately lead to an increase in

demand for support.

It is anticipated by Care UK that demographic

change, coupled with the direction of

community care policy, will see a 60% rise in

the number of unpaid carers needed by 2037

an extra 3.4 million carers nationally.

Based on the 2001 Census data, in Leeds there

were 12,634 carers over age 65 years in 2010

and this is projected to rise to 13,792 in 2015,

14,416 in 2020 and 16,683 in 2030.4

As self directed support is now in place to meet

the needs of individuals with care or support

needs in the community, carers are becoming

aware of the possibility of receiving personal

budgets for their own needs and ASC will be

responding to this. It is likely that growing

numbers of individual carers will be looking topurchase respite care services for themselves,

or on behalf of the person they care for.

carers breaks is being provided in 2011/12

to NHS Leeds to pool with the Local Authority

to provide carers breaks, through Direct

Payments. This funding will continue for three

further years. A joint plan between the Local

Authority and the NHS for respite services is in

preparation.

A review of the overall pattern of investment

and effectiveness of carers services will

be conducted in partnership with provider

organisations.

4

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4.5 People with visual impairmentsDemographic Trends

The Royal National Institute of Blind People

(RNIB) estimates that there are approximately

2 million people in the UK with sight loss that

is severe enough to affect everyday life and

around 1 million people have serious sight loss

that are eligible to register as blind or partially

sighted. It is estimated that among people aged

over 65 in the UK around 300,000 have sight

loss that meets the registration criteria and a

further 800,000 have sight loss, which seriously

affects their everyday life.

approximately 5,200 people registered in Leeds

as blind or partially sighted; 2,760 peopleare registered as blind and 2500 people are

registered as partially sighted. Of those people

registered, approximately 632 people are in

receipt of social care services such as day care,

home care and residential care.

BME communities comprised of less than 4% of

the total population. However, national and local

impairment in some BME groups. For example,

people of African Caribbean descent are up to

eight times more likely to suffer from Glaucoma

than the general population and it tends to

appear 10-15 years earlier than in other ethnic

groups and South Asian people have a higher

prevalence of diabetic retinopathy.

The majority of registered people are over 65

years of age. The Leeds population aged over 65

is expected to increase by over 25% by 2030,

from 109,900 in 2005 to 137,768 in 2030.

People with sensory impairment in comparison

to non disabled people are more likely to be

in receipt of a lower income; be employed in a

low level occupation; have fewer educational

live in a home that may not meet their social

care and support needs.

A Rapid Ophthalmic Assessment was under

taken in Leeds in 2004 to estimate the number

of people with each of the major eye diseases

across the city. The assessment estimated the

number of people affected by cataract, age

related macular degeneration, glaucoma and

diabetes and made appropriate adjustments for

age, genetic mix and gender. (Table 13)

plan future service provision in reaching those

who are at risk or affected by eye disease and

a guide to how many people can be expected

from each area of Leeds.

Expressed Demand

Following a service review and extensive

consultation with approximately 450 sensory

impaired people through out 2009/2010,

vision impaired individuals and service users

supported the following key elements of the

support plans and person centred

approaches

opportunities

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available in the evening and weekends

access to social networks.

Current Supply

In 2011, Leeds Vision Consortium (LVC) which

comprises of Action for Blind People, SENSE

year contract to provide and develop blind and

partially sighted services for Adults. Action

for Blind People is a national charity providing

practical help and support to blind and partially

sighted people of all ages. The Wilberforce

Trust is a regional organisation for visual

impairment that provides a range of services

that include emotional support for the newly

diagnosed, assistive technology, communication

charity supporting children and adults who are

deafblind.

ASC commission LVC to provide assessment

and support planning, casework, advocacy, sign

posting, information and support to enables

service users to maximise their independence,

reduce social isolation, and maintain their

individual dignity, privacy and freedom of

Table 13:Estimates of cases of the major 4 UK blinding conditions across Leeds

Leeds Area

North West

North East

East

South

West

Total

Area

Populations

185,372

149,709

149,128

145,067

110,189

739,465

Cataract

No (%)

12,516 (6.7%)

11,939 (8.0%)

11,959 (8.0%)

10,627 (7.3%)

8,463 (7.6%)

55,503 (7.5%)

Age Related

Macular

Degeneration

No (%)

1,223 (0.6%)

1,152 (0.7%)

1,090 (0.7%)

964 (0.9%)

773 (0.7%)

5,204 (0.7%)

Glaucoma

No (%)

1,140 (0.6%)

1,093 (0.7%)

1090 (0.7%)

964 (0.7%)

770 (0.7%)

5,057 (0.7%)

Diabetes

No. (%)

5,561 (3%)

4,491 (3%)

4,473 (3%)

4,352 (3%)

3,305 (3%)

22,183 (3%)

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choice. LVC services focus on the principles of

maximising and sustaining choice, involvement

and inclusion through the use of support plans

and quality person centred approaches that

facilitate opportunities for people who are blind,

partially sighted or deafblind to live meaningful

adults aged 18+ whose sight loss affects their

potential to live independently.

This includes people who are registered as well

as those who are not, whether sight loss is

permanent or temporary and whether it co-

exists with other impairments.

Current services available at LVC include:

A service for older people with dual sensory

loss SENSE delivers specialised services

for people who have both hearing and

visual impairment.

Transition coordinators primarily

working with young people aged 17-25

in their transition from school to college,

university, employment or training. The

service encourages independence and

the development of physical skills in asupportive environment.

Assistive technology - provides advice

and practical support to enable individuals

wishing to use technology to communicate

more effectively and to interact with others

at home and in the workplace.

the service

is based at St Jamess Hospital and liaises

with clinical staff and ASC in providing

information and advice for people who have

been diagnosed with an eye condition.

The ECLO supported approximately 899

individuals during 2010/11.

Independent living coordinator (ILCO) -

offers information, advice and support with

day-to-day living, welfare rights, housingissues and managing personal budgets.

ILCOs provide tailored support

in all aspects of life after sight loss enabling

service users to make informed choices

and be in control of the way individuals

maintain independence.

Employment service provides help in

developing skills, providing career advice,

staying in employment when faced with

sight loss.

Locality based satellite support groups

in line with the move away from

traditional building based activities, support

services are being developed in local

neighbourhoods across the city.

Outreach activities focus on prevention

initiatives and increased uptake of

registration amongst diverse BME

communities.

Health and wellbeing service provides

self care management programmes and

information to help newly registered

adults to take control of their emotional

and physical well being and improve their

quality of life.

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Leeds City Council rehabilitation services

provide specialist assessment, early

intervention, practical training, counselling

therapeutic skills, information and

independent living skills to enable blind

and newly registered individuals to remain

independent

Future Commissioning Activity

The development of future services within LVCs

contract will be shaped and consolidated by the

following:

encourage uptake and access to eye care

prevention and support services particularly

amongst BME communities and people with

learning disabilities.

for adults with a visual impairment or dual

sensory loss.

We intend to improve the quality of the

evidence base for investment decisions in the

coming year, drawing together the JSNA with

data systems held by the NHS and the City

Council, and those being developed by our new

providers of services.

4.6 People who are deaf

or hard of hearingDemographic Trends

The Royal National Institute for the Deaf (RNID)

estimates that there are over nine million

people in the United Kingdom who are deaf orhard of hearing, 28% of affected individuals

are aged between 16-60 years, with 72%

over the age of 60 years. The severity of the

impairment appears to increase with age, with

38% of those over the age of 70 years having a

mild impairment, and 10% severe impairment,

compared with 52% of those aged of 50 years

having mild hearing impairment and 7% severe

impairment.

The NHS Information Centre for Health and

Social Care recorded at 31 March 2010 56,400

people on the deaf register and 156,500 people

on the hard of hearing register for England.

As of 31st March 2008, 88,500 people were

registered as blind or partially sighted with an

addition disability and of these, 25,300 (29%)

were recorded as having a hearing impairment

(Deafblind) as their additional disability.

The register of Deaf and hard of hearing is

not compulsory so the statistics recordedwith Councils with Adult Social Services

Responsibilities (CASSRs) and submitted to the

NHS Information Centre for health and social

care, will not provide a complete picture of the

number of people in England who are deaf or

hard of hearing.

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There are between 50,000-70,000 British Sign

Language (BSL) users in the UK and only one

language users. An estimated 2 million people

in the UK use a hearing aid and there are more

than 1500 hearing dogs for the deaf.

Leeds has a population of approximately

770,000 (2009) and there are an estimated

107,000 people (one in seven) affected by

hearing loss. Age, genetics and noise pollution

are the main factors leading to hearing loss.

The most common type of hearing loss in the

UK is amongst people who are gradually losing

their hearing as part of the ageing process.

Of the 2,035 people registered Deaf or Hard

of Hearing in Leeds, 58% (1,100) of the total

number of people affected by hearing loss areaged 65 and over. (Table 14)

Expressed Demand

Following a service review and extensive

consultations with approximately 450 sensory

impaired people through out 2009/2010 service

users supported the following key elements of

person centre approaches

available in the evening and weekends

interpreters

Table 14:Leeds Data: Breakdown of individuals who are deaf or hard of hearing

Category

Deaf and Hardof Hearing

Current numberof Deafblindaccessingcommissionedservices

Total

Under 65s

375

5

380

Over 65s

1,660

42

1,702

Total

2,035

47

2,082

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hearing impaired

hard of hearing and Deafblind people with

learning disabilities.

Current Supply

In 2011, Birmingham Institute for Deaf (BID)

Services, in partnership with SENSE and

to provide and develop a city wide service for

adults with hearing loss. SENSE is a leading

national charity supporting children and adultswho are deaf blind and Signhealth supports the

mental health and well being of deaf people.

The Leeds service, called Deaf Across Leeds

Enablement Service (DALES) provides a variety

of services that focus on the principles of

maximising and sustaining choice, involvement

and inclusion through the use of support plans

and quality person centred approaches that

facilitate opportunities for people who are

deaf or hard of hearing to live meaningful and

The service is inclusive to adults aged 18+

whose hearing loss affects their ability to

to live independently. This includes adults

who are registered as well as those who

are not, whether deafness is permanent or

temporary and whether it co-exists with other

impairments.

Current services available

at DALES include:

Single Point of Access (SPA) this is a drop-in

facility for individuals without an appointment

assessed for support services. The SPA service

is staffed by a full time worker and is availableMonday -Thursday (9-5pm) and Friday (9-

4.30pm)

Assistive Technology and Equipment DALES

provides assistive technology equipment,

assessments and home installation for adults

and young people aged 17+ in transition.

During 2010/11 over 1500 people used the

service to access resources such as doorbells,

alarms and room monitors as well as more

sophisticated products to ensure independence,safety, enhance quality of life and keeping

people in their own homes.

Specialist Social Work Team DALES is currently

recruiting two specialist s

Documents

Mps 2012