Community Life Choices Strategyconsultation January April 2012Executive Summary

Community Life Choices StrategyConsultation January – April 2012Executive Summary

1.0Background

In December 2011 Devon County Council (DCC) engaged the services of Fusion to coordinate a series of consultation activities to take place between January and April 2012. The purpose of the consultation was to gather the views of service users and carers on DCC’s commissioning intentions, in respect of day and respite services for adults over 18 years of age until 2015/16, as outlined in the Community Life Choices (CLC) strategy.

A series of consultation sessions took place in March and April 2012, facilitated by Fusion and attended by DCC, with representation from people with physical and sensory disabilities (22 people), people with mental health issues (11 people), people with learning disabilities (34 people), older people(15 people) and carers (66 people). All participants were provided with specialist support where necessary. Questionnaires were also sent out through the Fusion network and we received a response from 201 people (a response rate of approximately 21%). In total approximately 384 individuals gave their feedback as part of the consultation process, either through attending a focus group or via a questionnaire.

2.0 Feedback

Key Message: Analysis of the feedback shows a mixed response to the CLC strategy with some positive views of its intentions, alongside some real concerns and fears about its practical implications. Whilst the personalised focus of the strategy, with its emphasis on empowerment, choice and flexibility were generally welcomed, there were concerns about how the principles would transfer to reality.

Key statistics from questionnaire:

• 51% of respondents stated that they understood what the strategy is about but only 26% found it easy to understand.
• 64% of respondents stated that they understood why the strategy is needed.
• 35% of respondents are concerned or worried about the strategy

Key observations and concerns:

• Questionnaire results show a good understanding of why the strategy is needed.
• The emphasis on increasing choice, community participation, independence and the personalised focus of the strategy received widespread support.
• The strategy is too generalised and should include clarification of how it applies to specific client groups.
• People will ‘fall through the net’ and not receive the care they need.
• The focus of the strategy is on people with ‘lower levels’ of need, not being relevant for the needs of more vulnerable people.
• Cost cutting at the expense of vulnerable people?
• Concerns about the funding, availability and sustainability of community based services.
• Meeting the needs of people in rural communities.
• Role of the private sector and the voluntary sector – the need to develop a ‘true partnership’.
• The importance of alignment with Health strategies and other Adult Social Care strategies.
• The importance of effective communication of the aims and purpose of the strategy to all front line workers, family carers and service users.
• The strategy is too ‘complicated’ and difficult to understand.

Key message: The feedback shows a degree of confusion and concern with regard to the assessment process for the levels of support identified in the CLC strategy, and a fear that peoples’ needs will not be met because of eligibility criteria or because of delays in assessment.

Key statistics from questionnaire:

• 53% of respondents stated that they understood the 4 levels of support.

Key concerns

• Concerns about assessment procedure.
• Need for individuals to be assessed for and able to access support at level 3 from the outset in cases where levels 1 & 2 support will not be appropriate.
• The need for specialist assessment for particular client groups.

• The importance of advocacy and involving family and carers.
• Support for individuals who are not eligible for levels 3 & 4 support, i.e. once the ‘time limited’ community enabling has come to an end?

• Flexibility between the levels of support.
• Changing and evolving needs.
• Financial concerns – clarity on how far individuals are expected to contribute, how this is assessed.
• Training to be provided to front line workers to cover the principles of the strategy and the different levels of support so that people receive a consistent service underpinned by shared values and intentions.

Key message: The feedback highlights the fundamental importance of accessible and easily available local information and effective signposting. Comments across all groups suggest that the range of information and signposting systems currently in place are not all ‘hitting the mark’ and that people are not always aware of where to go for information, or what is available to them in their local communities. Furthermore, it was strongly agreed that services can only be ‘universal’ when they are fully accessible, with staff who have an awareness of the needs of people with disabilities.

Key statistics from questionnaire:

• 63% of respondents stated that they understood this level of support

Key concerns

• Local, relevant, fully accessible and easily available information is crucial.
• Effective signposting and communication are essential.
• Lack of accessibility / disability awareness in universal services.

Key Message: Respondents welcomed the support and enabling opportunities proposed at this level and the emphasis on community participation, independence, choice and equal access. However, there were a number of significant concerns, including: rural and transport issues; that support is ‘time limited’; the provision for the ‘less able’; accessibility of universal services and support; availability of a range of services for all needs; and ensuring the sustainability of community groups.

Key statistics from questionnaire:

• 56% of respondents stated that they understood this level of support.
• Support for emphasis on increased choice, community participation, equal access and promoting independence.
• Meeting the needs of people in rural communities.
• Concerns about ‘time limited’ support.
• Community activities and provision needs to be coordinated and ‘joined up’ and to ensure it meets the wide variety of needs.
• Who will be providing the ‘community enabling’?
• Advocacy / input from family and carers.
• Quality and accessibility of community and universal services.
• Community activities and provision – funding and sustainability issues.
• The value of peer support and community support.
• Recognition that level 2 support may not be appropriate for some people.

Key message: Whilst people agreed with the personal and social benefits of employment, there was considerable fear around the suggestion that for adults of working age the primary focus will be on supporting people to access employment, before giving them a Personal Budget (PB) or considering DCC funded day and respite services. There were a number of factors that respondents felt would need to be addressed for employment to be a viable option.

Key observations and concerns

• Personal and social benefits of work.
• The need to be realistic.
• Concerns about assessment process.
• The need for flexible working arrangements.
• Lack of available employment opportunities.
• National changes in policy regarding supporting disabled people into employment
• Training and support for employers.
• Support for employees with disabilities.
• Support to find employment.
• Financial concerns – paying for support and training, transport issues, impact on benefits.

Key message:Feedback indicates widespread support for the notions of increased community participation, independence and choice. However, respondents expressed considerable anxiety surrounding Personal Budgets (PBs), and commented on the need for information, advice and specialist support at all stages of the process. A number of concerns were raised including: the increased pressure on carers; the importance of ensuring that there are services available to suit all needs; that services are monitored and regulated; that community providers are sustainable and that the needs of people in rural communities are considered.

Key statistic from questionnaire:

• 54% of respondents stated that they understood this level of support

Key observations and concerns

• The need to improve awareness and understanding of PBs.
• Specialised support to manage PBs is crucial and should be provided for all stages of the process, whether by DCC or the voluntary sector.
• The importance of providing advocacy.
• Additional pressures on carers.
• Choice of providers rather than a single provider offering a range of activities
• Voluntary & Community organisations – offering independence, flexibility, value for money, continuity of care, local presence and accountability.
• Differing views on pre selected list of DCC approved providers as opposed to a completely open marketplace.
• Concerns about ensuring the quality of services and how providers will be monitored and regulated.
• Suggestion that DCC should provide monitoring, assistance ‘when things go wrong’, consistency, business and financial support.
• Concerns about the continuity and sustainability of services.
• Concerns about the availability of community based services and activities especially in rural areas.
• Transport issues.
• Financial concerns – clarity on an individual’s contribution and how this is assessed, impact on benefits, potential for abuse.
• Assessment and eligibility issues.

Key Message:There were strong reservations about the notion that fewer people will require buildings / placed based services in the future, and considerable fear around the suggestion that fewer services of this type would be available.Respondents highlighted the benefits of buildings/ placed based services including respite for carers, social interaction, peer support, activities, stimulation, skills development, a secure non discriminatory place to go, continuity, routine and structure and not least the availability of knowledgeable, specialist, well trained staff.

There was support for the view that day centres, respite care service and care homes may need ‘modernising’ to align with principles of personalisation, promoting independence and integration in the community, whilst providing the care, support and stimulation people need. It was suggested that, if developed appropriately, day centres will be of benefit to all groups, and will continue to be essential to those who need specialist support, for example, people with learning disabilities, people with mental health problems, people with dementia and people with severe or multiple needs.

Some doubts were expressed with regard to the suggestion in the strategy that day centres and respite care services are experiencing reduced numbers. Some respondents felt that this may be due to tightened eligibility criteria and the fact that facilities are closing.

Key statistic from questionnaire:

• 57% of respondents stated that they understood this level of support

Key observations and concerns

• Day and respite services are essential both for carers and for the cared for person

• The need for re-evaluation and development of day services, to be aligned with the personalisation agenda.
• Cost cutting at the expense of vulnerable people?
• Day care and respite services, if developed and adapted, are of benefit to all groups, but also play an essential role for people who require specialist support.

3.0Summary

The emerging view from the CLC consultation has been a generally positive response to the strategy, with an appreciation of the underpinning principles and suggested outcomes amongst the majority of respondents. However, respondents highlighted some strongly felt concerns and fears about the practical implications of the strategy and required reassurance and clarity on the following issues:

• Clarity about the support and provision planned for specific needs i.e. how the strategy applies to particular disabilities and health needs.
  
• Concern that the strategy should not lose sight of the needs of individuals who require significant ongoing care and supervision, ensuring that they too can benefit from a more personalised service.

• Concern that individuals will not receive the care and support they need, for a number of reasons including: lack of information or support; lack of recognition that peoples’ needs change and evolve; the notion of ‘time limited’ support; eligibility criteria; inappropriate assessment; not being able to express needs or negotiate the system; and lack of available services for all needs and in all areas (rural and urban).
  
• Fears that peoples’ needs will not be met appropriately and responsively and that people will ‘fall through the gaps’.
  
• Fears about cost cutting at the expense of vulnerable people.
  
• Reassurance that buildings / placed services would continue to be provided for all levels of need, whilst agreeing that they need to be developed to offer a more personalised service. A strong theme was the suggestion that PBs and place based provision should not be seen as mutually exclusive.
  
• Appreciation that the strategy clearly acknowledges the contribution made by family carers to the support of vulnerable individuals and the need to support carers in their role but a concern that the emphasis on PBs and community based support would in reality impose further pressures on them.
  
• Strong concern about the needs of people living in rural communities (availability of services and transport issues).
  
• Assurance that community based service provision will meet the wide variety of needs, and that it will be coordinated and ‘joined up’, making sure that noone ‘misses out’
  
• Concerns about quality assurance and regulation of community based service provision
  
• Concerns about the funding and sustainability of the voluntary and community sector and the impact of this on the provision of a continuous service.

• Fears that the strategy is about ‘cost cutting’, at the expense of the proper care and support of the most vulnerable groups in society.
  
• The role of advocacy and the importance of involving family and carers in any decisions and discussions
  
• Effective communication to front line workers, service uses and carers, about the aims and purpose of the strategy and the four levels of support, so that people receive a consistent service underpinned by shared values and intentions
  
• Detailed observations, concerns and issues with regard to the four levels of support including:-

-clarification of assessment procedure for all levels of support, including the need for specialist assessment for particular client groups;

-the value of peer support;

-the importance of easily available, local, accessible information and effective signposting and support;

-the accessibility of universal services;

-ongoing support at level 2 for those who need it;

-the need to assess people for level 3 support without delay where appropriate

-concerns about eligility criteria

-the importance of raising awareness of Personal Budgets (PB) amongst family carers and service users;

-the importance of support at all stages of process of managing a PB;

-the need to be realistic when assessing people for employment; the need for training, support and incentives for employers, proper support for employees, with an emphasis on flexibility; and

-preference for a choice of providers and an appreciation of the benefits of Voluntary & Community organisations – offering independence, flexibility, value for money, continuity of care, local presence and accountability, whilst emphasising the need for quality assurance systems and regulation.

Feedback from the consultation has demonstrated strongly felt opinions and views amongst service users and carers about the strategy and a need for the key issues outlined above to be acknowledged and addressed in order to allay fears and reservations and provide people with the reassurance they need.

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Community Life Choices consultation report April 2012, Executive Summary
Fusion/Engagement Contract/ Gateway/ Consultations/GR-0112-CLC