Disability Day Services Review
Disability Day Services Review
PROJECT INITIATION DOCUMENT
September 2017
CONTENTS
1.0 Introduction 3
2.0 Strategic Drivers 3
3.0 Background 4
4.0 Project Aims & Objectives 6
4.1 Objectives 6
5.0 Project Management Structure 8
5.1 Project Owner 8
5.2 Steering Group 8
5.3 Project Manager 9
5.4 Project Team 9
6.0 Reporting Mechanism 12
7.0 Timescales 12
1.0 Introduction
This Project Initiation Document outlines the work streams required to progress the modernisation of Disability Day Services - Day Care and Day Opportunities, within the Mental Health and Disability Directorate.
2.0 Strategic Drivers
This project will take into consideration all relevant strategic drivers pertaining to the development and modernisation of Day Services for adults with physical, learning and / or sensory disabilities.
The Health and Social Care Boards (HSCB) consultation on Regional Learning Disability Day Opportunities Model (2014) requires the SHSCT to review its day care provision and ensure that those who do not meet the criteria for day care avail of a wider choice of day time activities to meet their needs as recommended in Equal Lives / Bamfort Report.
· “To lead full and meaningful lives in their neighbourhoods with access to social, work and leisure opportunities, friendships and relationships”. Modernising our approach to day services is part of the Trust’s continuing efforts to implement the Bamford vision, to deliver the best outcomes for people with disabilities, increase independence and choice and improve services for people with disabilities.
· The Core principles of social inclusion and community integration are also firmly embedded as strategic drivers in the Physical and Sensory Disability strategy and its action plan (2012) which calls for the Trust to work collectively to ensure that early detection, assessment and intervention services are provided for all disabled people and assessments, particularly those involving complex conditions, are carried out by properly trained personnel. The strategy also highlights “the need to look at service models that promote the development of social networking opportunities that can heighten the community engagement of disabled people. This would have the dual impact of helping to minimise disabled people needing care and support in the first place or developing long term dependencies on health and social care provision and sustaining outcomes from traditional day care… “
· Central to all of these strategic documents is a clear call for Trusts to preserve buildings based day care for those service users with highest dependencies and complexity of conditions, by developing appropriate person centred day opportunities, as alternatives to day care, for those individuals who can access community activities, including engagement in training or supported/open employment.
3.0 Background
The modernisation of Disability day services was selected in 2013 as one of the key TYC projects within the Trust. It was accepted at that time that for many adults with a disability attending day care was one of a limited range of opportunities available for those individuals who required daily support. Day opportunities as an alternative to traditional day care was therefore viewed as a positive enabler for disabled persons by offering more choice in the way individuals could have their needs met within the local communities, rather than through attending a traditional day centre. It was also acknowledged at that time that the day centres have always been, and will continue to be, a critical part of the Trust’s service provision for persons with disabilities and their families. However developing a wider range of individual based day opportunities should allow day centres to focus on meeting the needs of those with high dependency and complex needs.
In theory this modernisation agenda had significant potential in that it would have been reasonable to assume that if a wider range of more person centred alternatives to day care in the community were developed disabled persons would transition from day care to community options, thereby retaining ‘building based’ day care for those service users assessed as in greatest need. In practice however this transition has not taken place as originally envisaged. From discussions with service users, carers, multi-disciplinary team members, day care and day opportunities staff, it would appear that the following have been significant factors in day care attenders (assessed as having low to medium dependency needs) opting to remain in day care.
· Potential impact of welfare reform. Service users and families are reported to be fearful of losing benefits if service users are perceived to be more independent or capable of availing of community options.
· Fear of losing transport or having to pay for expensive alternative transport to day opportunities. (The majority of current day care attenders receive Trust or commissioned transport to and from their day care placement.)
· Lack of accessible transport provision particularly in rural communities.
· Cost of accessing community activities – the majority of day care programmes are provided free of charge or on a subsidised basis.
· Family reluctance for their relative to opt for day opportunities if the same level of stability cannot be provided in community settings eg. same pickup and return times, security of transport provision to and from home; the provision of a base from where day opportunities can be provided and assurance of ongoing staff support. These fears appear to be more significant for families who have a relative with a learning disability.
All of the above have had a significant impact on the lack of progress of service users from day care to community alternatives over the past 3 to 4 years. Consequently many day care centres now have no physical capacity to accept new referrals. Many are exceeding and in breach of RQIA space standards. This therefore places significant restrictions on the Directorate’s ability to be responsive to the needs of young persons leaving school over the next 5 years who have been assessed as having very complex needs requiring ‘building based’ day care placements.
The need for a Day Services Review is therefore urgent and critical to clearly identify a modernised day services model within the Southern Trust, two work streams will be required to progress this work:
1 – Work stream on Day Care.
2 – Work stream on Day Opportunities.
4.0 Project Aims & Objectives
The aim of the project is to review the current models of Day care and Day opportunities within Disability services in the Southern Health and Social Care Trust and identify inherent strengths; areas for development and make recommendations for a Modernised Day Services model.
4.1 Objectives
The key objectives of the project are as follows:
· To describe the current day services model in the Southern Health and Social Care Trust.
· To identify service users who have the potential to progress from day care to alternative day opportunities in the community.
· To scope existing and planned provision, highlighting planning issues in terms of:
1 Number of attenders and their assessed level of dependency.
2 Reviewed eligibility criteria for each service in accordance with dependency criteria.
3 Projection of young people assessed as needing day care within the
next 5 years and also those who will require day opportunities
4 To identify required staffing levels within centres and day
opportunities teams.
5 To identify environmental issues across day care taking cognisance of
RQIA space standards, required refurbishments, business cases for new builds and status of same.
6 To review current registered numbers of attenders in day centres in
accordance with attendance levels, space standards and statutory
requirements. To follow up required actions through agreement with RQIA in a managed manner.
· To outline the legislative base for provision of day services and requirements within standards, NISCC, RQIA, NME etc.
· To determine future models for day care / day opportunities and to identify actions required to transition the change process.
· To identify any transport considerations relevant to supporting the future model of day service and day opportunity provision.
· To consult with independent sector providers in considering implications of future models of day service provision on their respective service areas and any managed reconfigurations required to existing service provision.
· To work with Finance colleagues in costing of any reconfigured model and consideration of affordability factors.
4.2 Desired Outcomes
To design and implement a Modernised Disability Day Services which is fit for purpose, affordable and meets the needs of adults with a disability.
5.0 Project Management Structure
This section defines the organisational structure for the project.
5.1 Project Owner
Bryce McMurray Director, Directorate of Mental Health and Disability will be the project owner. The key responsibilities of the project owner are:-
· To ensure the aim and objectives of the project are achieved.
· To provide regular progress reports to the Steering Group during the review.
· To ensure that adequate resources are made available to the Project Team to fulfil their commitments.
· To appraise appropriate bodies, such as the SMT and Trust Board, at key stages in the review.
5.2 Steering Group
As the project owner, the Director of Mental Health and Disability Services will lead the Steering Group. The Steering Group will be the Mental Health and Disability SMG and they will have the overall responsibility for the modernisation of Disability Day Services. It will provide strategic direction and co-ordination to guide and support the project.
The specific responsibilities of the Steering Group will be:
· To approve the plans developed by the Project Team
· To identify particular issues requiring policy decisions by the Senior Management Team or Trust Board
· To ensure that the project is undertaken in a timely and effective manner and that it is properly co-ordinated
· To ensure effective communication with key stakeholders within and external to the Trust throughout the Project
5.3 Project Manager
The Project Manager, Bronagh McKeown Head of Disability Day Services will be supported by members of the Project Team and will have the following key responsibilities:-
· To ensure the review is undertaken within the timescales specified by the Steering Group
· To manage interfaces between members of Project Team and subgroups
· To arrange regular project team meetings to take forward the project
· To agree any variations to the programme with the project owner
· To establish appropriate communication and reporting mechanisms
· To ensure that service users and staff are consulted and engaged throughout the review
· To provide monthly reports on progress to the project owner
5.4 Project Team
The Project Team is representative of all key stakeholders and includes the following members:-
· Miceal Crilly, Assistant Director of Disability Services (Chair)
· Bronagh McKeown, Head of Disability Day Services , Project Manager
· Janet McConville, Head of Planning, Mental Health & Disability Services
· 3 Day Care Managers
· 2 Service User Advocates, Disability Action, Physical Disability and Learning Disability TBC
· Communication Department Representative TBC
· Local Estates Department Representative TBC
· Finance Representative TBC
· Staff Side Representative TBC
· HR Representative TBC
· Governance Representative TBC
· Barry Collins, Head of Transport
· Noreen McComiskey, Head of Specialist Services
· Donna Curley/John McEntee Fieldwork Representatives
· Day Opportunity Co-ordinator TBC
· Independent Sector Representative TBC
· RQIA Representative TBC
· Carer Representative /Day Care & Day Opportunities TBC
· Multi-agency Day Opportunities Group Representative TBC
Whilst the Project Team will have a function distinct from the Steering Group it has been agreed that wherever possible and practical members of the Project Team will be invited to be in attendance at meetings of the Steering Group particularly where they are presenting on specific area of their work. The Project Team will have the following responsibilities:-
· Establishing robust arrangements to practically review and report on the project objectives as set out in Section 4.0 above
· To ensure meaningful stakeholder engagement and involvement in the review
· To bring to the attention of the Steering Group particular issues that may impact on the proposed modernisation of Day services
· To identify resource requirements for consideration by the Steering Group
· To document findings and bring forward recommendations for the approval of the Steering Group prior to being brought to Senior Management Team and Trust Board.
The Project Team will be responsible for taking forward the key work streams which will be led by agreed members of the Project Team who will report progress to the Project Manager. The work streams are outlined below and explained in further detail in the implementation plan. A number of sub-groups will be established to take forward elements within each work stream. Specific areas of work to be taken forward are as follows:
· A Model of provision - To determine the most appropriate service model to meet current and emerging future need. To agree revised registration numbers for Day Care provision based on need, capacity etc and to consider staffing of requirements.
· Eligibility Criteria
· Assessment of Need -
1. Day Care
2. Day opportunities
To identify service users who require day care and day opportunities placements based on assessment against eligibility criteria, which is also to be agreed within this project.
· Estates Review - To determine the suitability of day care buildings, and future changes required to ensure services are fit for purpose.
· Support Services Review - To identify supports required to ensure the effective delivery of service eg. Housekeeping, Catering, Transport provision relevant to Day services and Day opportunities.
· Staff Engagement and Human Resources - To examine the impact on current staffing and the future staffing requirements including consideration of skill mix for the new model of service provision. Identification of training requirements and the management of the change process.
· Communication and Stakeholder involvement - To develop and implement a Plan to communicate with services users, carers, families, staff, local communities, organisations and other stakeholders throughout the change process.