NottinghamshireCounty Council Adult Social Care and Health Department
Chapter Four - Commissioning Strategy for People with a Physical DImpairments,disability, or Sensory DImpairmentsdisability and or Living with HIV/AIDSids 2007-2009
1Introduction...... 2
2key Drivers...... 32
2.1Relevant legislation and guidance...... 32
2.2Local drivers...... 65
3current service provision...... 65
3.1Employment...... 65
3.2Direct payments...... 76
3.3Preventative services...... 86
3.4Information and communication...... 87
3.5Fieldwork Teams...... 98
3.6Equipment and adaptations...... 1110
3.7Home care...... 1211
3.8Housing and housing related support...... 1211
3.9Day Services and short breaks...... 1312
3.10Care Homes...... 1513
3.11Long term neurological conditions...... 1514
3.12Transitions...... 1615
3.13Transport...... 1615
4Achievements 2002-2005...... 1615
5Performance and activity...... 1817
5.1Numbers of people provided with services over the past 4 years.....1917
The number of people receiving short break services are included in the figures for “community based service in own home” and not in the figures for residential and nursing care. 1918
5.2PAF Indicators...... 1918
6Finance...... 2019
7Commissioning Intentions...... 2019
8Commissioning plans...... 2120
8.1Developing and sustaining partnerships...... 2220
8.2Developing self directed care...... 2221
8.3Community engagement...... 2422
8.4Reducing institutional care...... 2523
8.5Carers services...... 2625
8.6Advocacy and involvement...... 2725
8.7Managing the market...... 2726
8.8Diversity...... 2826
8.9Quality and performance...... 2826
9Workforce Implications...... 2826
1Introduction
1.1Why we need a strategy
2key Drivers
2.1Relevant legislation and guidance
2.2Local drivers
3current service provision
3.1Employment
3.2Direct payments
3.3Preventative services
3.4Information and communication
3.5Fieldwork Teams
3.6Equipment and adaptations
3.7Home care
3.8Housing and housing related support
3.9Day Services and short breaks
3.10Care Homes
3.11Long term neurological conditions
3.12Transitions
3.13Transport
4Achievements 2002-2005
5Performance and activity
5.1Numbers of people provided with services over the past 4 years.
5.2PAF Indicators
6Finance
7Commissioning Intentions
8Commissioning plans
8.1Developing and sustaining partnerships
8.2Developing self directed care
8.3Community engagement
8.4Reducing institutional care
8.5Carers services
8.6Advocacy and involvement
8.7Managing the market
8.8Diversity
8.9Quality and performance
9Workforce Implications
1Introduction......
1.1Why we need a strategy......
2key Drivers......
2.1Relevant legislation and guidance......
2.2Local drivers......
3current service provision......
3.1Employment......
3.2Direct payments......
3.3Preventative services......
3.4Information and communication......
3.5Fieldwork Teams......
3.6Equipment and adaptations......
3.7Home care...... 12
3.8Housing and housing related support......
3.9Day Services and short breaks...... 13
3.10Care Homes...... 15
3.11Long term neurological conditions...... 15
3.12Transitions...... 16
3.13Transport...... 16
4Achievements 2002-2005...... 16
5Performance and activity...... 18
5.1Numbers of people provided with services over the past 4 years.....18
5.2PAF Indicators...... 19
6Finance...... 19
7Commissioning Intentions...... 20
8Commissioning plans...... 21
8.1Developing and sustaining partnerships...... 21
8.2Developing self directed care...... 22
8.3Community engagement...... 23
8.4Reducing institutional care...... 25
8.5Carers services...... 26
8.6Advocacy and involvement...... 27
8.7Managing the market...... 27
8.8Diversity...... 27
8.9Quality and performance...... 28
9Workforce Implications...... 28
1Introduction
Thisstrategy forms chapter 4 of the Adult Social Care and Health Department’s (ASCHD) commissioning strategy It sets out what the Department will commissionover the next two yearsforadults, aged between 18 and 66 65 years, with,
- with a Pphysical impairmentsdisability,which have a substantial and long-term adverse affect upon their ability to carry out normal day to day activities.
- with a sSensory impairmentsdisability
- People lLliving with a HIV orand AIDS.
It also covers the assistance support offered to young people to assist help them to make the transition from children’s to adults’ services.
The strategy has been developed after consultation with service users, carers and partners including Nottinghamshire County Teaching Primary Care Trust (PCT) and Bassetlaw PCT.
1.1Why do we need a strategy
Building upon our existing services and achievements, our overall vision is to be one of the, “top performing authorities for people with a disability in the country”.
In order to achieve this we need to have a strategy that meets the needs of the communities that we serve and one that service users, carers, Members, staff and the public can be proud of. A strategy that:
- Pputs service users in control
- Ssupports carers
- pPromotes well being
- pProvides value for money
- iIs delivered in partnership through a competent workforce
- aAnd is forward thinking
The philosophy of our strategy is based on empowerment and independent living.
“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 and Service Changes – A Briefing, Collins, S., Scope (2005).
We want people to be able to remain in their own homes with more flexible and responsive ways of meeting their needs.
Similarly we want to be able to support carers and at the same time enable them to have their own lives.
“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).
2key Drivers
2.1Relevant legislation and guidance
2.1.1The Disability Discrimination Acts 1995 & 2005
The 1995 Act gives disabled people the same rights as anyone else in key areas such as goods and service delivery, employment, housing, education and transport. It defines a disabled person as “someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal every day activities.” For the purposes of the Act:
- Ssubstantial means neither minor nor trivial
- Llong term means that the effect of the impairment has lasted or is likely to last for at least 12 months (there are special rules covering recurring or fluctuating conditions.
- Nnormal day-to-day activities include everyday things like eating, washing, walking and going shopping.
- Aa normal day-to-day activity must affect one of the “capacities” listed in the Act which include mobility, manual dexterity, speech, hearing, seeing and memory.
Provisions allow for people with a past disability to be covered by the scope of the Act. There are also additional provisions relating to people with progressive conditions.
The 2005 Act widens the definition of a disabled person to include people who have been diagnosed with cancer, multiple sclerosis or HIV. It introduces a disability equality duty for the public sector. This duty started in December 2006 and local authorities and other public bodies are now required to promote equality for disabled people.
2.1.2New Directions for Independent Living
In 2000, the Social Services Inspectorate published its findings from the inspection of independent living arrangements for younger disabled people. It found that “most councils and their staff have fully to absorb and carry through the independent living philosophy.” Independent living was described as,
“…the concept of empowering disabled people to control their own lives as far as possible and to have freedom to participate fully in the community. It is not the name of a particular service or provision but should be the objective of services and provision.Support for independent living includes personal assistance, information, housing, education, access to public goods and services, employment and training and access to the environment and the political arena.”
This definition of independent living guides the development of our services for people with physical and sensory impairments.
2.1.3Social Care for Deafblind Children and Adults LAC (2000)8
In March 2001 the Department of Health issued guidance which gave new rights to Deafblind people. Under this guidance local authorities are expected to:
- Iidentify people who have a dual sensory impairment within their area.
- Kkeep a local register of Deafblind people.
- Eensure that specialist assessments are carried out by a specially trained person.
- Iidentify the need for services.
- Pprovide information in appropriate formats.
- Pprovide communicator guide support.
2.1.4Independence Matters
In 2003 the Government published “Independence Matters: an overview of the performance of social care services for physically and sensory disabled people”. It included 7 key findings which required improvement by local authorities. These are:
- Hhome care is not sufficiently reliable or flexible and is not provided in a way that promotes independence.
- Aalthough waiting times for equipment and minor adaptations have improved some people wait unacceptably long times for major adaptations using the Disabled Facilities Grant (DFG).
- Sservices for those with brain injury are not well developed across the country.
- Cculturally sensitive services for disabled people are not well developed.
- Ddisabled parents are often not effectively supported.
- Dday services need shaping to be more community based, inclusive and linked to increasing employment opportunities.
- Aalthough the numbers receiving direct payments are increasing there is still a long way to go before they are part of mainstream provision.
2.1.5National Service Framework for Long Term Neurological Conditions
This NSF focuses on the needs of people with long term neurological conditions, but it is relevant to people with other long term conditions also. The NSF defines a long term neurological condition as a condition that results from disease of, injury or damage to the body’s nervous system, for example, the brain or spinal cord, which will affect the person and their family in one way or another for the rest of their life. The conditions include people with acquired brain injury, people with progressive conditions, like motor neurone disease and multiple sclerosis, and people with stable neurological conditions like cerebral palsy. The NSF sets out eleven requirements to ensure the provision of good quality services.
2.1.6Improving the Life Chances of Disabled People
In 2005, the Prime Minister’s Strategy Unit published this report which sets out a strategy for promoting and protecting disabled people’s rights, improving choice and supporting disabled people in education, employment and other forms of participation.
The report recommends:
- Iindividualised budgets which can be used to access support and services across a range of fragmented funding streams.
- Iimproving the availability of independent advocacy services.
- improving the provision of accessible housing.
- improving the availability of information.
- increasing the number of disabled people in employment.
2.1.7The Needs of People Living with HIV in the UK
This report was published by the National AIDS Trust in 2004. It describes the diverse profile of people infected and affected by HIV/AIDS. Although the incidence of AIDS has been reduced by the use of combination therapies, this report highlights the problems which are experienced by people living with HIV. These include isolation, poverty, poor housing conditions, mental health problems and weakened physical health.It concludes that many people are living without any unmet need, but that others are profoundly needy – facing multiple problems on a daily basis. It recommends that health and social care professionals should:
- tTake a holistic perspective, considering the broader context, including the values and goals that motivate people.
- Rrecognise the interdependence of health and social care needs, such as those arising from poverty or treatment side effects; and
- sSupport formal and informal carers
.
The report concludes that community-based support, especially peer support, should remain a critical component of any HIV health and social care strategy.
2.1.8Independence, Well-being and Choice: Our Vvision for the Ffuture of Social Care for Adults in England
This Green Paper published in March 2005 outlines an agenda for introducing “person-centred, proactive and seamless services”. It states that “tThe 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 recommendations from the Green Paper formed the basis of the Government’s White Paper, “Our Health, Our Care, Our Say”, published in January 2006. Details of this are set out in Chapter One.
2.2Local drivers
The Department undertakes regular reviews of its services and contributes to reviews undertaken by others. It also consults with service users to find out what they think of the services they receive.Recent reviews include:
- Review of HIV/AIDS services in 2005
- Best Value service review, young disabled adults in April 2005
- Review of services for people with a dual sensory impairment inMarch 2006
The findings of these reviews show areas of good practice in the County and also demonstrate the need for improvement in some of the areas identified in Government guidance.
3current service provision
3.1Employment
3.1.1Supported Employment
The supported employment programme via the Ready4Work team provides support in obtaining employment for people with disabilities who have more complex barriers to finding and keeping work, but who, with the right support are able to make a valuable contribution in their job, and, where appropriate, develop and progress to open employment. The objectives are to:
- pProvide tailored support that enables disabled people to develop their full potential.
- Ddevelop and improve job skills and employability, including the ability to work with others and sustain a job.
- eEncourage personal development and promote independence for disabled people.
- Iinvolve the employer in the development and support of the employee
- Eenable the employee to work effectively in a job, focusing on their and their employers requirements in a planned and structured way.
Nottinghamshire County Council has been awarded a European Social Fund contract in partnership with Nottingham City Council and Northamptonshire, Leicestershire and Lincolnshire County Councils. This will mean that for two years from April 2006 Nottinghamshire will support 200 people who are on long term incapacity benefit to develop the skills to return to work. Each person will get a 26 week programme to help them to return to work.
3.2Direct Ppayments
The Department recognises that direct payments enable people to have more control and choice about how their needs are met and it is committed to increasing the number of people receiving direct payments, in line with the Government’s expectations. The As a method of giving increasing control and to empowering disabled people. The Department makes direct payments to disabled people aged 16 years and over, if they prefer to arrange their own services. expectation is that direct payments will become the preferred way of providing and arranging services for people who meet the Department’s eligibility criteria. The following table shows the increase in the numbers of disabled people aged 18 – 64 years in receipt of direct paymentsfrom31st March 2005 to December 2006:
Locality / Numbers using direct payments March 2005 / Numbers using direct payments March 2006 / Numbers using direct payments December 2006Ashfield & Mansfield / 26 / 40
Broxtowe, Gedling & Rushcliffe / 91 / 114
Bassetlaw & Newark / 106 / 126
Total / 223 / 280 / 293
In order to provide sSupport for people who want to useusing direct payments the Department has a contract with theis provided by the Direct Payments Support Service, which provides practical support, advice and information for people managing their own care. The current cost of this service is £221,000. and by specialist field work teams.
A pilot project is currently underway in Bassetlaw and Newark to look at the possibility of the Day &Community Support Service supporting and reviewing less complex cases. The outcome of the pilot project will determine whether or not this arrangement will be extended across the County.
There are currently difficulties in recruiting the number of personal assistants needed to make direct payments a viable option for support in the community.
Feedback from service users and carers who receive direct payments has been positive and we expect to see take up continue to grow. A further £730,000 has been identified for direct payments for disabled people for 2007/08.indicates that direct payments can be a successful way of funding short breaks, but there is a problem about the limited range and availability of good quality services, especially when these are wanted at short notice.
There are problems regarding the relationship between direct payments and the Independent Living Fund that need to be addressed.
3.3Preventative sServices
The ASCHD supports a range of voluntary and self help groups using funding from, for example, Grant Aid, the Prevention Grant and the Carers Grant.
A range of preventative services aimed at people with “low level” needs are also being developed in Nottinghamshire using funding from , for example, the Link Age Plus grant. The purpose of these services is to provide early intervention and support to stop deterioration that might lead to the need for more costly services. Preventative services are largely aimed at people aged 50 + because of the conditions attached to the Government grants.
See the commissioning strategyservice delivery plan for preventative services, which forms chapter two of the ASCHD’s commissioning strategy, for further information about the development of preventative services in the County.
3.4Information and Ccommunication
3.4.1Public Information
A range of public information leaflets are currently produced by the Communications Unit.In addition, Nottinghamshire’s CountyContact is a source of information for service users, and the development of NottsConnect call centre potentially offers a wide range of information to disabled people. Information and advice is also available from the Physical Disability Teams and from the Day & Community Support Services.
The Best Value Review in 2005 recommended that the portal project for older people should be extended to provide information to disabled people.
3.4.2Communication equipment
A Speech and Language Therapist is employed part time by the NHS in the south of the County to offer assessments and support to adults needing communication aids. She has a budget of £15,000 from the NHS to cover all aspects of her work. The County’s Adult Social Care and Health DepartmentSCHD contributed £15,000 (non-recurrent) towards her work in 2006 and gave an additional £5,000 to support communication aid users in the north of the County.The therapist is supported one day a week by a technical instructor. The majority of people using the service are physically disabled.