Equality Impact Assessment FormReference - 4A1

Department / Health & Wellbeing - Adult & Community Services / Version no / 3.0
Assessed by / Imran Rathore / Date created / 11/11/2016
Approved by / Lyn Sowray / Bernard Lanigan / Date approved / 16/11/2016
Updated by / Imran Rathore / Date updated / 17/11/2016
Final approval / Bev Maybury / Date signed off / 13/02/2017

TheEquality Act 2010 requires the Council to have due regard to the need to

  • eliminate unlawful discrimination, harassment and victimisation
  • advance equality of opportunity between different groups
  • foster good relations between different groups

Section 1: What is being assessed?

1.1Name of proposal to be assessed.

Demand Management Strategy

1.2Describe the proposal under assessment and what change it would result in if implemented.

The latest statistics from Projecting Older People Population Information (POPPI) and Projecting Adult Needs and Service Information (PANSI) projects a 2% yearly increase in the number of service users up to 2030.

The challenge is to change the culture in Adult Social Care and, with the NHS, to move from a dependency modelto one that promotes independence and resilience (a strength based model, with a focus on what people can do, and positive risk-management so that people can live their lives to the full).

The Sustainability and Transformation Plan includes development of an Accountable Care System. The aim of this will be to use our investment to improve the health and wellbeing of people in the Bradford District. We will do this by combining our collective resources to maximise independence and resilience, regardless of age, disability or condition whilst protecting and safeguarding the most vulnerable in our communities.

The challenge in Adult Social Care is to deliver services to growing numbers of bother young and older people, whilstat the same time discharging our statutory duties.

We will where possible, support people to be safe and independent at home,thus reducing the number of people moving into residential / nursing care. We will do this by working with our NHS and community and voluntary service partners to promote independence through strength based assessments, a greater focus on prevention/early intervention and using enabling technologies. This approach will be underpinned by an integrated workforce development plan which will focus on the Home First Model:

  1. Reducing the number of people coming into care through an enhanced preventative focused (early intervention) approach. This will aim to minimise the need for long term support by addressing underlying needs at the earliest stage possible, reducing the number of people going into hospital or a care facility.
  2. Changing the culture across the care system: moving to a strength (asset) based model that will require an open dialogue with people, their families and carers to draw on these resources to maximise independence; and ensuring that people get the appropriate level and type of support i.e.not too little and not too much.
  3. Speeding up integration with Health to ensure we can establish a whole systems approach across the Health and Social Care sector and secure efficiencies and economies e.g. integration of complex care teams with partners within NHS and Voluntary and Community Sector. This will ensure that people receive the right care at the time in the right place, and that support from Health and Social Care is seamless. Ensure all service users are reviewed on a regular basis in line with the guidance set out in the Care Act, so that the appropriate package of care is delivered subject to the needs of the people.
  4. Moving away from expensive traditional forms of support through targeted care and enhanced reviews of care needs. This could include options such as extra care or improved home care services and only using residential or nursing care when people really need it.
  5. Redesigning our approach to enablement to reduce costs and maintain independence of people e.g. more investment in home care. We will do our utmost to support people to regain skills and confidence to remain independent, and where required, the use of technology.
  6. Reviewing the financial needs of people to ensure that they are provided with the appropriate level of funding to meet their care needs. When we assess people we will ensure that they get the right support from either Health or social care funders.
  1. Continuing the implementation of personalisation including the use of ISF’s (Individual Service Funds). ISFs are a third party agreement that will ensure that people can have choice and control without the worry of administering the money themselves.

Our approach builds on our local experience and research undertaken by national bodies which has demonstrated that significant amounts can be saved through effective demand management across the support system. The key underlying principle will be to ensure we deliver services in the short term, while using this time to develop the provider market to take on service delivery in the medium and long term.

These proposals are designed to enable the costs of the servicesto be contained within the proposed available resources, despite the predicted rise in demand of approximately 2% annually, and inflationary increases in costs affecting Adult Services. This proposal reflects our conclusion that we need to make changes to the way we deliver services in order to avoid annual costs of £8m that would otherwise be incurred. This level of saving is required even after the use of additional income from the Better Care Fund, and from the Social Care precept equivalent to 2% of Council Tax. This is a challenging, yet achievable goal.

Section 2: Whatthe impact of the proposal islikely to be

2.1Will this proposal advance equality of opportunity for people who share a protected characteristic and/or foster good relations between people who share a protected characteristic and those that do not? If yes, please explain further.

It will promote equality of opportunity, independence and enablement for older people and people with mental health andlearning disabilitiesthrough:

  • greater aligning of appropriate packages of care for people, families and carers
  • greater emphasis on enabling people to live as independently as possible
  • greater use of technology for flexible ways of working, care and specialist enablement
  • more personalised solutions for people’s travel arrangements
  • greater value for money derived from reducing and maximising contract values
  • restructuring of theDepartment of Health & Wellbeing structure to establish synergies and maximise the delivery of a prevention (early intervention) focussed delivery approach.

2.2Will this proposal have a positive impact and help to eliminate discrimination and harassment against, or the victimisation of people who share a protected characteristic? If yes, please explain further.

See above

2.3Will this proposal potentially have a negative or disproportionate impact on people who share a protected characteristic? If yes, please explain further.

Older people and people with mental health and learning disabilitieswill predominantly be affected by this proposal. However the focus will be on personalised services for people, therefore any impact on protectedcharacteristics will be minimised.

Also, as part of our strategy to reduce residential and nursing places, it is intended that more extra care schemes are developed, which will help to improve people’s lives and reduce expenditure across all groups.

As the proposal is developed the detail of any impacts will be assessed to ensure any potential implications on protected characteristics are minimised.

2.4Please indicate the level of negative impact on each of the protected characteristics?

(Please indicate high (H), medium (M), low (L), no effect (N) for each)

Protected Characteristics: / Impact
(H, M, L, N)
Age / M
Disability / M
Gender reassignment / L
Race / L
Religion/Belief / L
Pregnancy and maternity / L
Sexual Orientation / L
Sex / L
Marriage and civil partnership / L
Additional consideration:
Low income/low wage / L

2.5How could the disproportionate negative impacts be mitigated or eliminated?

Our approach will seek to focus on people’s strengths, and enabling people to take properly understood, proportionate and positive risks in living their lives.

We will undertake individual assessments and carry out extensive engagement with people, carers and advocates to ensure seamless transitions for any person affected. This will enable us to meet our duty under the Care Act 2014 [1]and mitigateagainst any disproportionate negative impact on any person with a protective characteristic.

By offering other options for people in terms of housing and care support, people will have the opportunity to access appropriate services (that meet their assessed needs) and be in a position to maintain their independence and to continue to have a positive contribution and be inclusive in their local community. This will ensurewhere possible people with particular characteristics are not disproportionately affected. We will further review the potential impact on protected characteristics as part of the development of the delivery programme.

Section 3: Dependencies from other proposals

3.1Please consider which other services would need to know about your proposal and the impacts you have identified. Identify below which services you have consulted, and any consequent additional equality impacts that have been identified.

N/A

Section 4: What evidence you have used?

4.1What evidence do you hold to back up this assessment?

Regular consultation with people is embedded as part of operational delivery, which provides us with the base line information to support the implementation of our strategy.

In addition to the above, we utilise the evidence base from the Care Act (2014) - implementation and performance monitoring of outcomes for people receiving services (Adult Social Care Outcomes Framework).

Our approach also builds on the lessons learnt both locally and nationally from the implementation of the:

  • Transforming Care Plan - aims to reduce people going into care homes and outlines the intention for a multidisciplinary approach to reviewing people with complex needs that enables them to achieve greater independence.
  • Asset-based Service Delivery – this is at the core of this proposal. The re-specificationof support will be based on introducing technological solutions, coupled with increased use of universal services to bring about a net reduction in the amount of paid support provided.
  • Personalisation Agenda - sets forth an operating model based on people’s abilities and encourages the full participation of people in their community.
  • Mental Health Strategy.

4.2Do you need further evidence?

  • Implementation of plans will include involvement of experts by experience including carers throughout the redesign and procurement process.
  • Performance monitoring of delivery activity

Section 5: Consultation Feedback

5.1Results from any previous consultations prior to the proposal development.

N/A

5.2The departmental feedback you provided on the previous consultation (as at 5.1).

N/A

5.3Feedback from current consultation following the proposal development (e.g. following approval by Executive for budget consultation).

Feedback received from the consultation process to date is summarised in the following points:

a)Concern over the future of dementia care and that the elderly needed more support.

  • There was a suggestion that more money should be sought from the government in the same way that the North Yorkshire authority did.
  • It was also suggested that a focus on reducing waiting times between referral and support was needed.
  • More money going to support the increasing numbers of elderly people was felt to be important, with more help with home care.
  • The suggestion of closure of any care homes causes concern, especially those supporting people with dementia.

b)More dynamic and creative support is needed e.g. supporting someone to become more independent by helping them learn to cook. To begin with they will need more support but less as time goes on. People need to be in homes they can maintain themselves and have the additional support to remain independent as long as possible.

c)Concern over reductions in social care will lead to more bed blockages in hospitals.

d)The idea of supported living is to enable people to become more independent, but it was felt that this doesn’t happen; many places just offer care and don’t encourage independence.

e)Digital solutions increase the possibilities of isolation and loneliness.

f)To deliver such a scheme will require greater provision of domiciliary care at a time when the new Living Wage is causing a number of providers to close. These closures are contributing to the delays in care packages being made available, so there is already a vicious circle of contributing factors that are likely to be exacerbated by trying to keep more people safely in their own homes. The early assessment of needs will require greater input from community health and social care staff who are already stretched.

5.4Your departmental response to thefeedback on the current consultation (as at 5.3) – include any changes made to the proposal as a result of the feedback.

a)We are committed to support older people and people with complex care needs (e.g. dementia, physical and learning disabilities)and will work with both them and their advocates to ensure the support they receive meet their needs as set out under the Care Act (2014).

We will undertake individual assessments with people, which will be implemented in a compassionate manner to ensure the provision of safe and high quality care and support that provides them with choice and control and locality based support. We will also focus resources on time limited interventions, such as reablement services, to help people get back on their feet and support people to be able to actively engage in their local community.

Where people do need long term residential and nursing support we will work with providers to ensure this is delivered in a way which maintains the dignity and wellbeing of people. For example the provision of extra care facilities that will enable people to access care and support on call 24 hours a day, seven days a week, whilst maintaining their independence, living within their own home. They will be able to access andagree a package of care and support that meets their needs

Living in an apartment in an extra care housing scheme gives people the reassurance of having care and support on call 24 hours a day, seven days a week, whilst keeping them independent, living in their own home. They will have access to a personally tailored package of care and support 24 hours a day, seven days a week, while being able to receive the healthcare they need in their own home.

We are working with out partners to review the way we provide support services to people and to ensure that we can meet their needs in a timely manner. This will include ensuring that our first contact services across health and social care are better enabled to direct people to the right type of support, at the right time and in the right place.

Our political leadership continue to raise the need for investment in additional resources for Adult and Social Care with central government through various formal and informal platforms are committed to do this in the future. However the only increase that the Government has announced is through the provision of increase in Council tax precepts.

b)We recognise that the need for maintaining independence and living within their own communities is essential for the wellbeing of people. This is reflected in our vision and ambitions for the wellbeing of Bradford District, and will be set out in the Home First vision document, which is currently being developed.

The delivery of this vision will result in an enhanced focus on (where possible) supporting people in Bradford who are in receipt of Health and Adult Social care support to stay in their own home, with choice and control over the support they access, so that they can continue to be active members of their local community while being able to participate in activities across the wider District.For example we will take a strength based approach .

As a result of our approach, it is likely that, in future there will be fewer people receiving ongoing, longer term social care support – however this is in the context of the drive to support people to live independently as outlined above.

We are taking an inclusive approach to the development of the vision and associated delivery plans. The approach and principles behind the vision has been discussed with a range of stakeholder groups in draft form to help support itsdevelopment and seek input on the overall approach and direction. Presentations have been given to the following groups, and feedback sought:

  • Department of Health and Wellbeing staff road shows
  • Health and Social Care Overview and Scrutiny Committee
  • Integrated Change Board
  • Strategic Disability Partnership, Older People Partnership, Learning Disability Joint Budget Consultation Workshop
  • Bradford Talking Media – user group

Further presentations and consultations are also planned with:

  • Health and Wellbeing Board
  • Adult Social Care Provider Market Forum
  • Older People’s Partnership Board
  • Strategic Disability Partnership Board

Feedback from these groups will be used to refine the vision, the related success measures and delivery activity. However, in general the feedback received to date has been supportive of the overall approach and direction set out within the vision document.