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Wrexham County Borough Council

Social Services Department

DRAFT

Commissioning Strategy for Social Services to Disabled People with

Physical & Sensory Issues and Long-Term Neurological Conditions

2006/09

This document outlines Wrexham County Borough Council’s strategic commissioning intentions for social services provided to

disabled people with physical & sensory issues and long-term neurological conditions. It sets out a vision for the development of

services in the period 2006-09 and considers:

how the existing service needs to change in order to meet the assessed needs of disabled people more effectively

how new services need to be developed to eliminate gaps in provision

how service users’ and carers’ needs for independence and social inclusion may be met more adequately.

The strategy considers the provision of services in Wrexham within a wider social and policy context that calls for fundamental

change in the way that services for disabled people are designed and delivered.

A public consultation process will be undertaken in January – April 2006.

Wrexham County Borough Council – Social Services Department: DRAFT PDSI Commissioning Plan 2006/09 v3.2 1

Scope and boundaries of this strategy

This commissioning strategy is aimed at the needs of adults aged 18 to 64 and children in transition aged 14-17 who have physical

disability and/or sensory issues or long-term neurological conditions, although services commissioned as a result will not be age

limited. The specific needs of people aged 65 and over are considered in the Outline Commissioning Strategy for Older People.

Dementia for all ages is covered in the National Service Framework for Older People and the specific needs of this user group are

currently being considered by a sub-group of the Mental Health Programme Group.

Definitions

It is acknowledged that the correct use of language is important to disabled people, many of whom regularly experience ‘disabilism’,

i.e. “discriminatory, oppressive or abusive behaviour arising from the belief that disabled people are inferior to others”. However,

there are differing views on “correctness” and for the purposes of this strategy, a definition of disability has been adopted from the

UK Government Strategy Unit report ‘Improving the Life Chances of Disabled People’ (Strategy Unit, 2005). This defines disability

as “disadvantage experienced by an individual resulting from barriers to independent living or educational, employment or other

opportunities that impact on people with impairments and/or ill health.” The report continues: “A clear distinction needs to be made

between disability, impairment and ill-health. Impairments are long-term characteristics of an individual that affect their functioning

and/or appearance. Ill health is the short-term or long-term consequence of disease or sickness. Many people who have an

impairment or ill health would not consider themselves to be disabled.”

Thus, disability is regarded as being primarily caused by attitudes, environmental barriers or elements of social organisation which

discriminate against and exclude people who have impairments. This ‘social model of disability’ has been widely adopted to counter

the ‘medical model’ which locates the cause of disability in the individual impairment.


This strategy for Wrexham calls for the implementation of the social model in practice and further acknowledges that disabled

people face discrimination and prejudice in their daily lives which can amount to disabilism, as the following quotation suggests:

“Disability is complex and one size fits all policies are no more applicable to disabled people than they are to the population at large.

Although there's a tendency to think of disabled people as wheelchair users, in reality 'disability' covers a whole range of

impairments, and wheelchair users make up a small percentage of disabled people. Indeed there's no such thing as an 'average'

disabled person. Some people have conditions that come and go. Some impairments can be invisible – and the adjustments that

are needed more subtle. Some people have multiple impairments; some people's impairments are more severe than others'. And

it's not just that 'disability' covers a range of impairments; disabled people also have a diverse range of opinions and identities.

Some disabled people identify themselves as disabled, some don't and some do some of the time. What they have in common is

the barriers and prejudice they face – or, in one word, disablism.”

Disablism – How to Tackle the Last Prejudice. Gillinson, S., Green, H. & Miller, P., Demos (2004).

WHY DO WE NEED A COMMISSIONING STRATEGY?

“Independent living is not a “service”. It is a way of life. It means disabled people take responsibility for their lives and live them how

they choose, irrespective of the type or complexity of their impairment or condition. Independent living does not mean living in

isolation in the community, but being supported to live the way the individual chooses, with a range of opportunities and options.

Service providers must move from a system which is led by the provider to a system which is led by the user and moves us in the

direction of independent living. That means support received by a disabled person is chosen by the disabled person, not allocated

to him or her by a funding authority through a service provider.”

Independent Living and Service Changes – A Briefing, Collins, S., Scope (2005).


Strategic Context

This social care commissioning strategy sits within the Health, Social Care & Well-being (HSCWb) strategy framework. It has been

informed by local and national research and the involvement of service users, carers, representative fora and organisations,

practitioners and providers. Wider consultation with service users is needed to ensure that their views and needs are fully

understood and represented in this strategy.

The annual implementation plans of the 2006/09 commissioning strategy will form the statutory Social Care Plan. The strategy

makes reference to single agency commissioning, joint planning and commissioning with the Public Protection and Housing

Department and other Council Departments and to joint approaches across the health and social care community.

Legal Context

Local authorities have a statutory duty to provide social services for disabled people under a range of legislation and associated

guidance. LAs also have a duty to ensure that human rights are respected and new legislation coming into force in December 2006

places a duty on all public sector authorities to promote disability equality. The ‘Disability Equality Duty’ (DED) targets institutional

discrimination and focuses on organisational change, requiring authorities to have due regard to the need to:

eliminate unlawful discrimination

promote equal opportunities

eliminate disability related harassment

promote positive attitudes towards disabled persons

encourage participation by disabled persons in public life.


National Policy Context

In the absence of a National Service Framework for disabled people with physical and sensory issues, either in Wales or the UK,

service development is guided mainly by three documents published in England in early 2005:

UK Government Strategy Unit report, ‘Improving the Life Chances of Disabled People’

Adults Social Care Green Paper, ‘Independence, Well-being and Choice’

National Service Framework for People with Long-Term Conditions.

‘Improving the Life Chances of Disabled People’ acknowledges that “Historically, disabled people have been treated as being

dependent and in need of ‘care’, rather than being recognised as full citizens…Independence comes from having choice and being

empowered regarding the assistance needed. Without this choice and empowerment, disabled people are unable to fulfil their roles

and responsibilities as citizens.” The report, which has generally been welcomed by disabled peoples’ organisations, sets out a long

term programme aimed at achieving the participation and inclusion of disabled people in society. Its vision is that “by 2025, disabled

people in Britain should have full opportunities and choices to improve their quality of life and will be respected and included as

equal members of society”.

The social care green paper outlines an agenda for introducing “person-centred, proactive and seamless services”. It states that

“The vision we have for social care is one where services help maintain the independence of the individual by giving them greater

choice and control over the way in which their needs are met, and local authorities give high priority to the inclusion of all sections of

the community…We want to move to a system where adults are able to take greater control of their lives…(and are) at the centre of

assessing their own needs and how those needs can best be met.” The green paper will be superseded by a joint white paper

designed to integrate health and social care systems.


The National Service Framework (NSF) for Long-term Conditions aims to bring about a structured and systematic approach to

delivering treatment and care for people with long-term neurological conditions, including acquired brain injury. The NSF, which

applies to health and social care services working with local agencies involved in supporting people with long-term conditions to live

independently, details 11 quality requirements for implementation by 2015. These set out a clear vision of how to improve the

quality, consistency and responsiveness of services and personalised care.

While there is no specific policy strategy for disabled people with physical & sensory issues in Wales, the social services white

paper ‘Building for the Future’ puts forward a number of principles, including:

promoting an inclusive society

providing support, for those who need it, in a safe environment which preserves dignity

encouraging and supporting those who can do so to build their independence.

Underlying these priorities is the modernisation programme for health and social services promoted by the Wanless Review of

Health & Social Care in Wales and highlighted in ‘Designed for Life: Creating World Class Health & Social Care for Wales in the 21 st

Century’ (National Assembly for Wales 2005). The latter will be complemented by a social services directions paper and a

document aimed at LAs and their partners on the remodelling of social care, in which housing and telecare will be emphasised.

Links to Other Plans in Wrexham

Outline Commissioning Plan for Older People’s Services: For the purpose of this plan, ‘older people’ are defined as aged 65 or

over. The plan also identifies the intentions for services for older people with mental health problems and services for all people with

dementia, irrespective of age or other primary disabilities or conditions. The needs of people over 65 with a primary learning


disability are also considered. The aim of this plan is to contribute to enabling older people to remain independent in the home of

their choice for as long as possible, and to support older people to have an active role in their community.

Outline Commissioning Plan for Services for Carers: Although no specific data is available for disabled people, in 2001 14,875

people in Wrexham identified themselves as providing unpaid care, 3,391 of them for over 50 hours per week. The needs of carers

of disabled people are not thought to differ significantly from the needs of carers of other user groups. However, the particular

needs of young carers (under 18) of disabled people and the parent carers of disabled children need to be reviewed, particularly in

relation to transition into adulthood.

Supporting People Operational Plan 2006/07: Habinteg Housing Association provides 16 adapted houses for people with

physical disabilities and a low level housing support scheme through a Community Assistance Officer. Spot purchasing agreements

enable disabled people with physical and sensory issues to receive tenancy support. Other generic housing support schemes offer

a tenancy support service to people with physical and sensory disabilities. £88,565 (1.3%) of the total funding is allocated to support

services for people with physical disabilities and sensory impairments (PDSI).

Review of Direct Payments: The direct payments scheme is under review and the Department intends to make provision for a

longer term commissioning arrangement for the third party support scheme to commence on or before April 2007. The aims of the

review are to:

evaluate the success of the direct payment scheme to date in relation to its intended outcomes and in relation to the extension

of the scheme to parents of disabled children and children aged 16 to 17 who are unable to be employers

identify whether the current arrangements will meet the needs of those young people in transition into adulthood


predict likely take up of direct payments over the next 3-5 years and detail how this will impact on the way services are

commissioned in the future and the likely budgetary considerations

evaluate the contract for provision of independent support services.

The adults social care green paper promotes the use of individualised budgets as a method of increasing control and empowerment

of disabled people. Individualised budgets aim to work within a streamlined person centred assessment process for people seeking

support and provide the opportunity for disabled people to use the allocated funds in a way that best suits them; i.e. self directed

support services. The Department is piloting individualised budgets for people with learning disabilities as part of a programme with

Paradigm and will follow the development of the English pilot programme for disabled people.

Advocacy Strategy: Currently there is no independent advocacy service specifically for disabled people with physical and sensory

issues in Wrexham. In partnership with the SSD, Local Health Board (LHB) and other stakeholders, a local group who wish to start

a scheme will be part of a 3 year project lead by Voices Through Advocacy to produce, implement and monitor an advocacy plan for

all user groups in the county borough. One of the models under consideration is to provide specialist advocacy for each user group

within a generic service linked to a Centre for Independent Living (CIL). ‘Improving the Life Chances of Disabled People’ calls for all

local authorities (LAs) in England to develop user lead CILs by 2010. The SSD is committed to consulting with local people to

determine a preferred model for a CIL which will actively promote independent living as a way of life, and to develop an options

appraisal should this be considered a priority area for development.

Accessible Information: Poor performance in the provision of information in accessible formats is known to be a priority issue for

many disabled people with communication needs. The Equality Manager has completed an audit and a staff training programme

and awareness raising campaign will start in 2006. This will ensure that both staff and customers are aware that information is


available in accessible formats and that a translator or BSL interpreter can be arranged. A guide to accessible services is to be

published for staff.

Transition into Adulthood Strategy for Young People with Disabilities: It is thought that fewer young people are entering the

social care system because of cultural change as a consequence of integrated education and the social model of disability.

However, as only 10 young people with physical and sensory issues aged 14-17 years were known to the authority in September

2005, more work needs to be done to identify potential users of adults services. It is estimated that there may be 40 disabled

children across user groups who are due to leave school in July 2006 and will need a full assessment. Further development of

preventative approaches to working with young disabled people at an early age would help to minimise the need for crisis

interventions as transition approaches.

A number of issues with the transition process have been identified, including the capacity of adults services to respond to

transitional referrals within an appropriate timeframe and lack of clarity about when a young person becomes entitled to adult

services. There are also concerns about the requirement for families to undergo a full assessment when disabled children require

small items of equipment. Closer partnership working is needed with education and housing to meet the housing and re-settlement

needs of young disabled people. The implications of the merging of children’s services with education need to be considered,

particularly in relation to the separation of budget responsibilities and maintaining good working relationships and practices.

A Vision for Adult Mental Health Services 2005/06: This document sets out a strategic vision for the development of mental

health services in Wrexham, Flintshire and NE Wales Trust.

Social Services Department Annual Performance Review and Service Business Plans: The Social Services Department

(SSD) publishes an annual business plan and each service area also identifies its development objectives through business plans.


WHAT DO WE KNOW ABOUT NEED?

Demography

A Disability Register is not maintained for the adult population in Wrexham. However based on the Local Government Data Unit

Disability Register in 20041, the following information has been determined:

Deaf with

speech

Deaf

without

speech

Hard of

hearing

Blind Partially

sighted

General

disability

Total

WCBC 31 45 343 298 559 669 1,945

Wales 1,949 970 9,163 9,643 10,565 52,700 84,990

WCBC incidence as a proportion of the total Welsh population

1.6% 4.6% 3.7% 3.1% 5.3% 1.3% 2.3%

Although the 2001 census showed that 4.4% of the total population in Wales were resident in Wrexham, the county borough

accounts for only 2.3% of the total of people in Wales on the National Disability Register. People who are registered as Deaf with

speech or who have a general disability are particularly under-represented.

The data on p16 shows that in November 2005, 253 disabled people aged 18-64 with physical & sensory issues and long-term

neurological conditions were receiving direct services from the department.

1 Including all County Borough residents registered under Section 29 of the National Assistance Act 1948.


Black & Minority Ethnic Population

At present little information is available about the Black and Minority Ethnic (BME) population in Wrexham. Still less information is

available about the prevalence of disability among the BME population, although it is likely that disability will increase the

vulnerability of people who are already vulnerable by virtue of their race.

The 1991 census showed that there were 872 non-white residents in Wrexham, 0.7% of the total. This figure had grown to 1,403 in

2001 (1.09%). Of the 1,403 non-white residents:

514 were Mixed Race

385 were Asian or Asian British

119 were Black or Black British

385 were Chinese or Other Ethnic.

As Wrexham has continued to receive asylum seekers under the UK government dispersal programme, it is likely that these figures

have increased significantly since 2001.

In view of the lack of information about the needs of disabled people in the BME population, there is clearly a risk that this user

group are particularly disadvantaged in terms of social care services. Action should be taken on a series of recommendations made

in a recent report published by the Rowntree Foundation titled “Making Change Happen for Black and Minority Ethnic Disabled

People”.

Migrant Workers & Refugees


Again, there is little information available about the needs of disabled people in the migrant worker and refugee population, for

whom language and cultural differences are likely to be an additional barrier. It is estimated that there are approx. 40 refugees and

4-6000 economic migrants in Wrexham. Recently the largest increase in the ethnic population has been economic migrants from

Portugal and Poland. New links have also been established between China and North East Wales Institute (NEWI), which could

result in Chinese students studying in Wrexham. The local Health Trust has also recruited extensively from the Philippines.

Currently there are more than 35 different ‘first’ languages spoken in the Wrexham area.

Local Need

The Health, Social Care and Well-being (HSCWb) Strategy identifies a number of issues and challenges for people with physical

and sensory disabilities or long-term neurological conditions. A Physical Disability & Sensory Issues (PDSI) Programme Group has

met regularly since September 2004 with the objective of monitoring the progress of specific initiatives in the following key areas:

Address the transition issues between children and adult services

Provide information in a variety of formats

Seek to enhance employment opportunities with statutory, private and voluntary organisations

Ensure up-to-date information is collated on the number of people with a disability

Develop local support for people with neurological conditions.

Service Evaluation: National


SSIW Overview Report on Inspection of Services for People with a Physical or Sensory Impairment

In July 2004 the Social Services Inspectorate for Wales (SSIW) published an Overview Report on six inspections of services for

adults with physical or sensory disabilities carried out during 2001-02. Wrexham was one of the authorities inspected.

The report draws together the key messages from the series of inspections in seven areas:

Clarity of purpose – there needs to be a clear vision for services & guidance for staff

Planning – arrangements must be made for joint planning & commissioning

Service provision – services must be modernised, are purchased as a result of strategic planning and are responsive to

demand

Access – buildings & services are accessible, people can access information appropriate to their needs

Care Management & Customer Care – staff have up to date guidance, assessment focuses on needs rather than services

and

users & carers needs are reviewed regularly

Managing Resources – operational managers have the support, skills & guidance appropriate for financial management

activities

Managing Performance – workforce strategies are further developed, a staff and service performance culture is embedded,

disability awareness and equality training is provided and Directors report complaints and investigations to elected Members.

Service Evaluation: Local


Inspection of Services for People with a Physical or Sensory Impairment

The 2001 SSIW inspection of PDSI services in Wrexham found that although the positive features of the service outweighed the

weaknesses, some of the weaknesses were fundamental and inhibit the Department’s ability to offer consistent services of a high

standard. The inspection made 19 recommendations for action, a review of which indicates that there is only one point outstanding,

relating to SSD internal processes.

Joint Review of Social Services in Wrexham

A Joint Review of Wrexham Social Services was carried out by the Audit Commission in 2003. Among the key messages of

particular relevance to PDSI services were the following:

Services to [the PDSI] user group have suffered as a consequence of being merged into the generic responsibility for all adult

services, in which older people inevitably predominate

The current organisational structure presents a confused mix of generic community-based services and specialist, user group

services, which is ill-suited to the comprehensive development of integrated working with other agencies

All user groups are disadvantaged by the absence of any family-based options, either for short- or long-term care. The residential

respite provision for those with learning and physical disabilities is limited in terms of beds and the cost is prohibitive because

they are distributed across one- to three-bed units

The ethnic minority population is very small but it is still under-represented in most services because policy in this area has not

yet fully permeated into practice

Consider developing a more seamless, integrated service with Health for those with physical disabilities and sensory

impairments.

The priorities for action include:


Give greater emphasis to re-ablement and the promotion of independent living in adult assessments, expanding the number of

Direct Payments recipients

Consider reviewing the employment practices of the Authority with a view to…providing more job opportunities for adults with

disabilities, as an example to other employers.

Unmet Need & Gaps in Services

In April 2005 a self-assessment of PDSI services was carried out in response to a request from the Association of Directors of

Social Services (ADSS Cymru). Standards which were assessed as not being fully met and needing improvement include:

The SSD has effective channels for identifying unmet need and feeding into the planning system

The SSD has agreed, with local health colleagues, time-scales for receipt of BD8 from ophthalmic units; initial contact

arrangements with user after receiving the BD8; and allocation of practitioner and first visit

The SSD has clear arrangements in place internally and with other agencies, which ensure the provision of co-ordinated and

coherent local services

The SSD has a written plan or strategy for providing information about services to the public and other agencies

Information systems provide adequate, timely information about workloads, activities, use of resources, outcomes and quality

measures

The SSD has agreed measures by which to evaluate service quality

Disabled people and their families have made contributions to the development of quality measures.

WHAT DO WE KNOW ABOUT CURRENT SERVICES?


Service Mapping – Direct services received by disabled people aged 18-64 2 with physical & sensory issues

Home Care (LA)

HomeCare (indep.)

Day Care (High dependency)

Night Sitting (LA)

Project/ Support Work

Care Home (LA)

Nursing Home

Respite (LA)

Supported Housing

Physical Disability /Frailty 47 69 1 0 14 0 13 17 11

Sensory Disability 2 0 0 0 0 0 0 0 0

Total 49 69 1 0 14 0 13 17 11

Day Service(indep.)

Respite (indep.)

Night sitting (independent)

Care Home(indep.)

Respite (Nursing)

Day & Work Opportunities (LA)

OVERALL

Physical Disability /Frailty 3 1 4 9 1 47 4 241

Sensory Disability 0 0 0 0 0 10 0 12

Total 3 1 4 9 1 57 4 253

2 The table details services captured by the Client Information System and further data collection as at 14/11/05.


Investment into Services

Service Performance


PDSI BUDGET ALLOCATION 2004/05AIDS AND ADAPATIONS 62,616COMMUNITY CARE 920,931DAY CARE 330,047HEARING IMPAIRMENT 10,488HOME CARE 356,863PROFESSIONAL SUPPORT 651,752SHORT TERM BREAKS 420,576VISUAL IMPAIRMENT 10,448Total 2,763,721

Professional Support includes Care Management and Occupational Therapy.

PDSI BUDGET ALLOCATION 2005/06AIDS AND ADAPATIONS 148,833COMMUNITY CARE 1,226,000DAY CARE 331,911HEARING IMPAIRMENT 10,488HOME CARE 387,767PROFESSIONAL SUPPORT 861,934SHORT TERM BREAKS 247,008VISUAL IMPAIRMENT 10,448Total 3,224,389

Local Authorities are required to produce a set of key performance indicators (PIs) on an annual basis. Four of these are particularly

relevant to PDSI services:

Ref: Performance Indicator 2004-05 2005-06

Target Out-turn Status Target Out-turn StretchLocal

AO/L1

Number of adults accessing

Direct Payments

25 31 Doing well 35 40 50

Local

AO/

3.14a

Number of adults with a

physical/sensory disability

helped to live at home

4 per 1,000

of the pop-

ulation

6.5 per 1,000

of the pop-

ulation

Doing well 6

Local

AO/L8

Number of people on

occupational therapy waiting

list*

60/9 48/2.5 Doing well 50/6 40/6 30/2

Local

AO/L10

5 items of equipment delivered

within 7 working days

85% 76% Improving 75% 85% 90%

* Total number of people on the waiting list divided by the average number of months wait for service, excluding OT Assistants.

Care Management


The Contact & Assessment Team (CAT) provides a single point of access to services for disabled adults. Approximately 5% of the

assessments carried out by this team are for adults with disabilities. The CAT team commissions services when immediately

required and/or may request further assessment from a community care team.

When service users have multiple disabilities they are allocated to the most appropriate community based care management team.

The case holder then has responsibility for ensuring that all identified needs are met. However, in some cases a lack of expertise in

service users’ secondary disabilities may lead to specialist assessments not being sought and consequently some needs not being

given as high a priority as the primary disability. Production of an internal resource directory and clear protocols for the transfer of

cases from CAT to the specialist teams would minimise this risk.

Community care management services to both older people and people with PDSI are provided by two teams covering different

geographical areas. One of these teams (Adults Team 2) has a specific remit in relation to sensory impairments and manages the

assessment of adults with disabilities.

At present none of the teams have a specific remit or expertise in relation to people with Acquired Brain Injury (ABI). It is

recommended that all cases involving ABI should be allocated to the adults team on a geographic basis.

The current structure in adults care management, in which social workers with PDSI cases are situated in both teams, allows

valuable flexibility in case allocation as expertise and skills can be drawn upon as required. However, some adjustments to the line

management and supervision structure may enable a more co-ordinated approach to PDSI to be developed within the generic

teams.


It is recommended that the newly appointed Service Manager for Older Peoples and PDSI Services should consider the scope for a

Senior Practitioner to be given a more targeted role in supporting and supervising social workers with PDSI cases.

It is also recommended that the effectiveness of the Sensory Support Services Team should be reviewed and consideration given

to developing the model to include all PDSI service areas (including long-term neurological conditions and ABI) within a specialist

team, or ‘model of excellence’, within the generic adults team structure.

A stronger commitment to the implementation of outcome focussed Person Centred Planning (PCP) is needed within the

Department to ensure that disabled people are empowered to define the direction of their own lives and are placed in control of the

services they receive. This should result in the mainstreaming of innovative services to meet individual needs.

Service Areas

Visual Impairment: A Sensory Support Services Team located in Adults Team 2 includes two specialist Social Workers for people

with visual impairment. The Social Workers register adults and children referred by the Ophthalmology Department, who certify the

person using a ‘BD8’ form. The Social Workers also provide visual impairment awareness training. Co-located with the specialist

Social Workers are two part time Rehabilitation Officers employed by Vision Support. The waiting list for rehabilitation has been

eliminated since the service increased from 1 day to 4 days per week in December 2004. Improved joint working between health

and social care would be facilitated by an Eye Clinic Liaison Officer and an information shop at the Maelor Hospital.

Deaf BSL users: A Social Worker with Deaf People assesses adults and children in transition to adulthood in the county borough

who are British Sign Language (BSL) users. Acting as a facilitator to ensure a comprehensive, equitable and needs lead service,

the Social Worker accesses and liases with internal and external agencies, including collaboration with neighbouring authorities and

local voluntary organisations to develop and promote services for Deaf people. The Social Worker is supported by a part time


Community Support Officer for Deaf People who carries out assessments for assistive technology, i.e. environmental aids,

adaptations and equipment for all service users throughout the county borough who have a hearing loss. A Deaf Community

Support Worker post has been identified as a priority for this group. Funding has been approved and the contract is due to be

tendered within the current financial year (2005/06). The authority is working towards implementing British Deaf Association

Guidelines for improving services to BSL users.

Deafblind: Deafblindness is defined as: “Combined sight and hearing impairment causing difficulties with communication, access to

information and mobility (and, with children, developmental and educational problems).” In October 2004 an 18 month project was

initiated in line with Welsh Assembly Government guidance on developing services for adults and children with dual sensory loss.

Deafblind UK were contracted to identify and assess the needs of deafblind people, set up a register and provide deafblind

awareness training. On December 1st 2005 there were 76 people on the deafblind register, 8 under 65, 62 over 65, and 6 with date

of birth unknown. Three young people under the age of 18 are known to have dual sensory loss. The Development Officer has also

provided 6 internal training sessions in deafblind awareness and 11 public awareness raising sessions. On December 1st 2005 only

one person with dual sensory loss had been assessed as being in need of a specialist support package, which is being provided by

Deafblind UK.

In view of the low numbers of younger deafblind adults (three in December 2005) there is a preference for developing an in house

service to build on existing services for people with a single sensory impairment. This will be an objective in the PDSI business plan

(2006/07). A pooled budget could be established with the Child Health & Disability Team (CHDT) and other health commissioners

for equipment, aids and adaptations, and for developments in assistive technology. The potential for establishing a deafblind

development network with neighbouring authorities should also be considered.


Hard of Hearing: The role of the Community Support Officer with Deaf people includes responsibility for assessing and accessing

assistive technology and adaptations for hearing impaired people. The Wrexham Voice Forum for people who are hard of hearing

does not receive funding or admin support from the Social Services Department, although they are represented on the PDSI

Programme Group and a Joint Working Group that also includes the Audiology Department, voluntary organisations and Social

Services. The Forum have identified sustainable provision of lip reading classes as their highest priority for service improvement.

Responsibility for this service currently lies with health. A rolling programme of awareness training is needed for hard of hearing and

deafened people.

Deafened: Although it is recognised that deafened people often suffer serious emotional and psychological trauma from the

experience of hearing loss, which can result in isolation, loss of communication and poor access to services, there is currently no

tailored service available for this user group. Consideration should be given to how the needs of deafened people and their carers

can be met by the PDSI care management team.

Physical Disability & Neurological Conditions: This covers a wide range of health problems and long term conditions. Service

users’ conditions vary greatly, both in the range of health problems and the nature of each individual’s symptoms and stage of

progression. In October 2005 there were 58 active cases, most of which are complex and long term. Many involve supporting

service users to access finances through the Independent Living Fund and Direct Payments. There is a need to develop the

availability of resources for people with neurological conditions, particularly day opportunities and specialist short term break

facilities for people who have neurological conditions which require nursing.

Acquired Brain Injury: A lack of co-ordination between the SSD and Trust results in people with ABI being transferred in and out

of hospital without consultation with social workers. A review of the health and social care needs of people with ABI is identified as a

high priority.


Domiciliary Care: Provided by the in house Home Care Team and several independent sector agencies. In October 2005 Home

Care were delivering 283 hours of care per week to 35 service users who have a physical and/or sensory impairment or a

neurological condition. This represents 9.5% of the total care delivered by Home Care. As most service users with PDSI have long

term conditions that are not responsive to reablement, the current restructure of domiciliary care services is likely to result in an

increase in the percentage of care provided externally. There is potential for developing a project worker role to support users with

communication issues and reduce isolation.

Occupational Therapy: The Occupational Therapy (OT) team provide functional assessments for adults and children which may

lead to provision of equipment and/or adaptations, for which Disabled Facilities Grants may be available. OTs also carry out manual

handling risk assessments, provide manual handling equipment and train care workers in appropriate techniques. Two of the OT

staff are based at Plas Madoc Housing Office and have responsibility for housing assessments and matching people to available

housing stock. The team also includes a jointly funded OT for people with neurological conditions. In 2004-05 the OT team received

1500 referrals, excluding the housing OTs who receive approx. 40 referrals per week. Many cases are complex and involve a

number of different agencies.

Although OTs work with a wide range of service users, many of whom have a disability or multiple disabilities, the OT team is

currently located in Older Peoples Services. There is a need to review the OT Team’s capacity to meet growing demands within the

reablement, health and wellbeing agendas, and consideration should be given to how joint working with health can be improved.

Major adaptations (i.e. with a cost in excess of £2500) require the OTs to work with housing colleagues who are responsible for the

allocation of the Disabled Facilities Grant. Currently this process can take up to 2 years and this lengthy process has a detrimental

impact on carers as well as on the independence of the person in need.


Residential and Nursing Accommodation: On August 31st 2005, 24 service users with physical and/or sensory disabilities were in

residential or nursing care.

Short Term Breaks: GATE is an in house 4 bed unit that enables carers of disabled people to have a short term break, although

the service is provided to the cared for person. The service is currently booked up to 12 months in advance, but one of the beds is

for emergency use. GATE is accessed by some people with learning disabilities who also have physical and/or sensory disabilities.

The higher level of need of this user group has an impact on the service which needs to be reviewed. The arrangements and criteria

for accepting bookings should ensure that the service has sufficient capacity to meet the needs of people with physical and sensory

disabilities or acquired brain injury.

Staffing and management issues (e.g. vacancy management) have contributed to a lack of service development. A review of the

needs of existing service users and others would help to identify development options. One possibility is to develop GATE as a hub

for outreach and provision of project worker support to promote service users’ independence in their own homes. Consideration

should also be given to a potential role for GATE in promoting timely discharge from hospital into the community, and to giving

support to individuals and their Carers in crisis situations. The present building’s capacity and fitness for purpose should also be

reviewed and consideration given to the potential for developing a more responsive service in partnership with a social landlord.

This could be taken forward alongside the development of specialised adapted housing for disabled people. Consideration should

also be given to the potential for an Adults Placement Scheme to meet some of the short term break needs of disabled people.

In the shorter term, closer liaison with the adults social work teams would be facilitated by joint management meetings with the

Direct Services Service Manager and Adults Team 2 Team Manager. To ease staffing problems, existing Human Resources issues

which prevent the transfer of care staff across services without an interview should be reviewed. The potential for developing a

peripatetic team across services should also be explored. It would be desirable to develop the skills base within the staff team to


enable more rehabilitation and reablement to be offered to people who have profound disabilities. Facilities for people with sensory

impairment could also be further developed to enable the unit to meet users’ needs more effectively.

Day Opportunities: The Cunliffe Centre provide a range of day opportunities, including two small businesses, leisure and drama

activities, and skills training. In November 2005, 82 users were accessing the service, including 41 with physical disabilities, 10 with

sensory impairment and 7 with acquired brain injury. It is recognised that Cunliffe needs to move away from providing centre based

services towards supporting disabled people through short term interventions to access community resources that facilitate social

inclusion. There is potential for developing a service based on the Centre for Independent Living (CIL) model, with Cunliffe as an

umbrella for a range of services that enable disabled people to make independent living a way of life. CILs can provide a range of

services including advocacy support, advice and information, peer support, user and carer participation, skills training and

accessing employment.

Disability Equipment Stores: The joint health and social services disability equipment stores stock and supply equipment to

people with physical and/or sensory disabilities. The stores have a budget of £125,000 for provision of social services equipment .

Overall the stores issue equipment from stock to the value of £750,000 - £1 million p.a. The premises do not have sufficient space

and are not DDA compliant. Accommodation for visual impairment and Deaf and hard of hearing equipment is inadequate. There

has been no increase to the hearing impairment (£10,488) and visual impairment (£10,448) equipment budgets for several years.

Development of the stores is dependent on progress with the joint stores project across Flintshire and Wrexham, which will include

shared management and budgets, and new premises. This is scheduled for completion by 2008, in line with requirements set out in

the NSF for Older People.


Service User and Carer Participation

Consultation with service users and carers takes place through various mechanisms, including the HSCWb planning framework.

The PDSI Programme Group membership includes representatives of Wrexham Disability Forum (WDF), the Deaf Forum, the Hard

of Hearing Forum and the Vision Support Forum.

The SSD has a Service Level Agreement with WDF, who receive an annual grant of approx. £12,000. Although WDF is open to all

disabled people, some user groups and individuals do not support the forum. Other concerns include the lack of funding for the

other service user fora within the HSCWb planning framework, and the Direct Payment Recipients User Group’s lack of

representation within the framework. Other options for supporting the development of a pan disability representative group need to

be explored, including the potential of a Centre for Independent Living.

It is recommended that a review of the arrangements for user and carer participation in PDSI service planning should be

undertaken, linked to the evolving role of the HSCWb Programme Groups and to developments in Public & Patient Involvement

(PPI) in the health service. This should aim to achieve the genuine involvement of disabled people in designing and commissioning

services that meet identified needs.


WHERE DO WE WANT TO BE?

OUR VISION

The Social Services Department is committed to achieving social inclusion and will strive to ensure that through a strong

commitment to outcome focused person centred planning disabled people can access integrated mainstream services

and experience independent living as a way of life.

This commitment recognises the need to build dynamic partnerships with local disabled people and their representative

organisations to facilitate the inclusion and active involvement of disabled people and their carers in service design,

planning, delivery and quality monitoring.


IMPLEMENTATION

This commissioning plan outlines a broad and ambitious programme of service development for the period 2006-09. Following

completion of the consultation process (i.e. in May-June 2006) the Department will be in a position to prioritise its commissioning

objectives for the period 2006-08. Some objectives can be implemented immediately and work can commence on other objectives

during 2006-07 (see Key Priorities 2006-08 below).

Implementation plans will be drawn up for the periods 2006-08 and 2008-09. The draft implementation plan for 2006-08 that follows

has five sections: Care Management, Equal Access, Planning & Performance, Social Care Commissioned Services and Jointly

Commissioned Services. The following Headline Outcomes have been identified for each section.

HEADLINE OUTCOMES

Assessment and Care Management services are co-ordinated within a ‘model of excellence’

All social services contact points, mainstream services, public information and consultation events are accessible

Outcome focused person centred planning ensures that services are planned and delivered by or with service users

Disabled people will be supported to access mainstream services wherever possible

Opportunities for joint commissioning will be maximised where clear benefits can be obtained.


KEY PRIORITIES 2006/08

Develop a PDSI business plan separately from Older Peoples Services

Co-ordinate PDSI services more effectively as a ‘model of excellence’

Review the effectiveness of the Sensory Support Services Team

Review equitability of access to social care services for disabled people across the county borough

Raise public awareness of the social model of disability

Produce an internal resource directory & establish clear eligibility, pathways & protocols for the transfer of cases between teams

Establish a rolling programme of sensory impairment awareness and disability equality training

Review support needs of disabled black & minority ethnic, refugee and migrant worker communities

Establish & maintain a disability register jointly with health and improve availability of accurate data for commissioning purposes

Address identified issues with Transition into Adulthood Strategy

Consult on the need for a Centre for Independent Living

Commission a Deaf Community Support Service before April 2006

Implement the principles of outcome focused person centred planning

Review access to, and unmet need for, short term breaks

Review all Occupational Therapy and Joint Disability Equipment Stores budgets and waiting times

Develop joint working with health to implement the quality requirements of the NSF for long-term neurological conditions

Review the need for specialist services to support people with acquired brain injury

Jointly with health develop services for deafblind people

Review funding & commissioning arrangements for user & carer participation in service planning & delivery

Review equitability of health access for disabled people, including psychological support.


DRAFT IMPLEMENTATION/ACTION PLAN: 2006/08

Action Lead Budget Implication Timescale for CompletionSavings Pressures

CARE MANAGEMENT Outcome: Assessment & Care Management services are delivered from within a model of excellence.1.1 Develop a PDSI business plan separately from older peoples services.

Commissioning & Partnership Manager

N/A Commence Feb 2006 & Ongoing

1.2 Review effectiveness of Sensory Support Services Team, within a wider review of Adults Care Management team structures, to co-ordinate PDSI services more effectively as a ‘model of excellence’.

Service Manager TBC

1.3 Produce an internal resource directory & establish clear eligibility, pathways & protocols for the transfer of cases between teams

Service Manager

1.4 Bi-monthly strategic development meetings for PDSI practitioners and health colleagues.


1.5 Produce a quarterly e-bulletin to update practitioners on local and national developments in relation to PDSI services.


N/A Commence Feb 2006 & Ongoing

EQUAL ACCESS Outcome: All social services contact points, mainstream services, public information and consultation events are accessible.

2.1 Conduct a training needs analysis to establish additional communication skills training required by customer liaison & reception staff to support the needs of people who are Deaf or have sensory impairments.

SSD HR Manager/ Support Services Manager.

Training budget -TBC March 2006

2.2 Human Resources/Workforce Plans will make provision for disability equality training; this will ensure an awareness of key legislation and ensure communication skills training is provided.

SSD HR Manager Training budget -TBC Commence April 2006

2.3 Map the user journey across related health, housing & social care services & make recommendations for changes to referral pathways.

PDSI programme group -TBC

TBC



2.4 Review equitability of access to social care services for disabled people across the county borough.

TBC

2.5 Raise public awareness of the social model of disability. Commissioning & Partnerships Mgr

On-going

2.6 Support corporate initiatives to improve provision of information in accessible formats.

Support Service Manager -TBC

2.7 A Departmental policy will be developed to ensure that all consultation events and public information are accessible to all members of the public.

TBC – Equalities Manager & Performance Mangrs

TBC

PLANNING & PERFORMANCEOutcomes: Outcome focused person centred planning ensures that services are planned and delivered by or with service users.

3.1 Identify gaps in social care services for disabled people within BME communities and refugee & migrant worker groups.

Commissioning & Partnerships Mgr

N/A March 2007

3.2 Identify the need for adapted housing and assistive technology within the county borough.

Commissioning & Partnerships Mgr

TBC December 2006

3.3 Establish and maintain a disability register jointly with health. Performance Manager

N/A April 2006

3.4 Establish a commissioning data set and agree local key performance indicators with all partners.


N/A October 2006

3.5 Identify support requirements of Direct Payments Peer Support group.


October 2006

3.6 Commissioning & Planning staff to be involved in transitionary planning for young disabled people.


N/A Commence April 2006 and ongoing

3.7 The impact upon carers supporting disabled people will be identified and services planned within the Commissioning Strategy for Carers.


April 2006

3.8 Commission briefing sessions on the social model of disability for all staff.


March 2007



SOCIAL CARE COMMISSIONED SERVICESOutcomes: Disabled people will be supported to access mainstream services wherever possible.4.1 Explore the potential for developing a Centre for Independent Living in Wrexham within 5 years incorporating: A funded pan disability representative group, Independent advocacy, Direct Payments support, Resource centre (services) Information centre


Options appraisal required to determine

July 2006

4.2 Commission a Deaf Community Support Service. Contracts Manager April 20064.3 All commissioned services will implement the principles of outcome focused person centred planning.

Contracts Manager & Provider Managers.

March 2007

4.4 Access to short term break services will be reviewed and unmet need/gaps in services identified.


October 2006

4.5 Support will be provided to maximise income through welfare rights support and access to employment. SLA with welfare rights service to be reviewed SLA to be set up with job-finders service Social firm model for community meals service being explored

Contracts ManagerContracts ManagerEconomic Development

4.6 Support the ‘Voices Through Advocacy’ project in developing advocacy services for people with disabilities.

Commissioning & Partnerships Manager

4.7 Review the OT/ stores equipment budgets re: achieving best value and minimising dependence upon support services

Service Manager

4.8 Review the capacity of the SSD OT team & identify opport-unities for joint/integrated working with the health OT service.

Service Manager

4.9 Service & contract monitoring activity will identify the % of people with disabilities accessing commissioned services.

Contracts Manager N/A Ongoing from April 2006



JOINTLY COMMISSIONED/ PLANNED OR DELIVERED SERVICESOutcome: Opportunities for joint commissioning will be maximised where clear benefits can be obtained.

5.1 Develop joint working arrangements with health, prioritising:

1. implementation of the NSF for long-term conditions 2. development of services for people with dual sensory loss 3. improving co-ordination of services for people with acquired brain injury

4. review of day and short-term break services for people with neurological conditions who require nursing support

5. improving liaison with the eye clinic.

TBC

5.2 Incorporate equipment from sensory services and assistive technology within the joint stores initiative.

Joint Project Manager/ & ACSSO

TBC – storage capacity TBC

5.3 Review the budget and waiting times for:

1. major adaptations

2. childrens adaptatations through the disabled facilities grant

Service Manager

5.4 Review equitability of health access for disabled people, including psychological support.

TBC

5.5 Lead on the review of funding & commissioning arrangements for user & carer/ public & patient participation in service planning & development.



Summary of services available for disabled people with physical and/or sensory issues and long-term neurological conditions. Service DescriptionVisual Impairment Specialist Social Workers (Sensory Support Services Team) register people with VI (including children) and carry

out Community Care Assessments.Maelor Hospital Eye Department register people with VI and provide a low vision clinic.Ophthalmology Department certify people with VI.Vision Support Rehabilitation Officers provide 4 days rehab per week.Other vol. orgs. provide specialist services, e.g. N. Wales Society for the Blind, RNIB, Wales Council for the Blind.Education: specialist teacher for children/colleges.Vision Support Forum meets bi-monthly.VI awareness training provided by Social Workers.Low Vision Clinic, Maelor Hospital.Low Vision Committee.Vision Support Resource Centre, Grosvenor Road.

Deafblind Deafblind UK register people with dual sensory loss.Social Workers carry out specialist assessments.Deafblind awareness training.

Deaf Social Worker with Deaf People care manages BSL users Community Support Officer for Deaf People assesses and accesses equipment.Deaf Association Wales provide advocacy.Deaf Forum meets bi-monthly.Deaf Club for Adults meets once weekly and once fortnightly.Deaf Stars Youth Club for 11-17 year olds in WCBC, Flintshire & Denbighshire meets fortnightly.N. Wales Deaf Association, befriending, day trips.Odeon Cinema programme of BSL signed performances.St Davids School, integrated education.Residential schools in Manchester, Doncaster, Derby, Margate (depending on behaviour).Child Health & Disability Team carry out assessments and provide care management for children in transition.Deaf equality training.

Service Description


Hearing Impaired Maelor Hospital Audiology Dept. Carry out assessments.Wrexham Voice Hard of Hearing Forum meets bi-monthly.Glan Clwyd Hearing therapists.Joint Working Group: Sensory Services Team + Audiology + Hard of Hearing Forum.Lip speaking classes provided by health.Borras partial hearing unit.

Physical Disability Wrexham Disability Forum.ALAC – Artificial Limb & Appliance Centre.

Disability Stores Joint health and social care disability equipment, Whitegate.

Day & Employment Cunliffe Centre: day opportunities for people with PDSI..Services Employment Placement Officers support users to access the workplace & find work (time limited).

Outreach Centre for Yale College.Work opportunities: sheltered employment, small businesses.Welfare benefits surgeries.Wrexham Access to Lifestyle & Employment Solutions (WALES) network.Disability Employment Advisors.Trio (Older People).Day Opportunities panel: Signpost.

Carers Newcis: NE Wales Carers Information Service – advice & support for Carers.Crossroads – support & relief for carers.

Short-term Breaks Gate: short-term breaks.Community based short-term breaks, e.g. Trio.Tapley Avenue Respite Centre: short-term breaks to children and young people with a disability.

Residential / Nursing Homes

Ashgrove Residential Home, Chester Road, Wrexham.

Pendine Park - Bryn Bella, Summerhill Road, Wrexham.Service Description


Residential / Nursing Homes (cont.)

Pendine Park - Highfield, Summerfield Road, Wrexham.

Dolywern Cheshire Home, Cartref Dyffryn, Ceiriog, Dolywern, Llangollen, Wrexham.Rhos Hall, Stansty House, Bod Llwyd, Coed du Hall and others with variations.

Supporting People Community Assistance, Habinteg (16 places).Spot purchase (6 places).

Occupational Therapy Assessment for equipment and adaptations.

Other Links to specialist services, e.g. Mental Health, Learning Disability, Older Peoples services.Lunch Clubs.AVOW Volunteer Bureau.Community House, Brymbo.Housing – adaptations & re-housing.Transport.Access to services: Inland Revenue, DSS, DLA, Tax Credits.Disability & Domestic Abuse project.AVOW Direct Payments Support Scheme.Wrexham Advocacy (not operational).Care & Repair – home repairs, renovations and adaptations.Chariotts community transport scheme.Headway: information line for people with brain injury and their carers & families.N. Wales Brain Injury Services: multidisciplinary service based in Colwyn Bay Hospital providing assessment & support to people who have suffered brain injury.Shopmobility: wheelchairs & scooters to enable people with limited mobility to shop in Wrexham town centre.St Christophers Special School, Stockwell Grove, Wrexham.Joint Disability Equipment Stores service user group (with LHB funding)WCBC Deaf Equalities Advice / Support Focus support group.Springfield Sheltered Housing with Support Rehabilitation Flat, Rhosddu Road, Wrexham


WHAT DO WE NEED TO DO NEXT?

In order to establish a consensus in relation to our assessment of needs and priorities for service development, we will undertake a

period of consultation with key stakeholders between January and April 2006.

A public consultation meeting will be organised at the Memorial Hall, Wrexham on April 4 th 2006. Dr. Neil Thompson is the keynote speaker for this event and will give a presentation on implementing the social model of disability.

We also invite individual responses to the content of this document, particularly in relation to the following:

1. Analysis of local need [further evidence of local need will be gratefully received from individuals, carers and organisations]

2. Proposed outcomes for commissioned services [evidence of additional outcomes required by disabled people and their carers]

3. Gaps in services [evidence of other gaps in services and unmet need]

4. The draft implementation plan [respondents are asked to identify any other development areas not included in the draft

implementation plan for 2006/8 and to specify their top 5 priorities for action].


Please direct all correspondence regarding this document to:Paul Swann, Planning & Commissioning OfficerWrexham County Borough Council, P.O. Box 1286, Lambpit Street, Wrexham LL11 1WG.Tel: 01978 292874 Fax: 01978 282880 Email: [email protected]

REFERENCES & BIBLIOGRAPHY

A Statistical Focus on Disability and Long-term Illness. National Assembly for Wales (2003).

Caring for our Health: The Health, Social Care and Well-being Strategy for Wrexham County Borough 2005-08.

Designed for Life: Creating World Class Health & Social Care for Wales in the 21st Century. Welsh Assembly Government (2005).

Disabilism – How to Tackle the Last Prejudice. Gillinson, S., Green, H. & Miller, P., Demos (2004).

Improving the Life Chances of Disabled People. Prime Minister’s Strategy Unit (2005).

Independence Matters: An Overview of the Performance of Social Care Services for Physically and Sensory Disabled People.Department of Health (2003).

Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England. Department of Health (2005).

Independent Living and Service Changes. Collins, S., Scope (2005).

Independent Living – The Right to be Equal Citizens. Gillinson, S., Green, H. & Miller, P., Demos (2005).

Making Change Happen for Black and Minority Ethnic Disabled People. Joseph Rowntree Foundation (2005).

National Service Framework for Long Term Conditions. Department of Health (2005).

Overview Report on Inspection of Services for People with a Physical or Sensory Impairment. Social Services Inspectorate for Wales (2004).

The Duty to Promote Disability Equality: Statutory Code of Practice for England & Wales. Disability Rights Commission (2005).

Wanless Review of Health & Social Care in Wales. Welsh Assembly Government (2003).


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