Dorset Services for Adults with a Learning Disability

Joint Commissioning

Strategy 2010-13

Glossary of Terms

Advocacy There are two distinct types of advocacy provided in Dorset:
  • Consultation/group advocacy provided by Dorset People First.
  • Independent Advocacy provided by Dorset Advocacy.

Campus Reprovision: Campuses are homes for people with a learning disability, staffed by the NHS and often built on the sites of old long stay hospitals. The Government requires all campuses to close by March 2009/10. There is a campus reprovision programme across Dorset, Poole and Bournemouth for 142 people, Dorset has responsibility for 55.
Changing Places: Disabled toilets that provide safe, secure, spacious facilities, including hoists. If people are to use community facilities these need to be available in shopping centres, leisure centres and other "ordinary" venues.
Community Employment Service (CES): Support for people with disabilities into employment. Comprises Stepping Stones (less than 16 hours per week) and Workstep (over 16 hours per week).
Direct Payments: Cash payments to people using social care services. (They cannot be used to purchase nonsocial care services, or Local Authority services.) Have been available since 1996.
Dorset Advocacy provide a range of independent advocacy services for vulnerable and disabled people across Dorset, Poole and Bournemouth. They also provide the IMCA service. For people with a learning disability their role is to provide an independent voice to represent that person's interests. Referrals to DA can be made by professionals, carers or people can selfrefer. They have specific funding for work with parents with a learning disability. In 07/08 DorsetAdvocacy supported114 Dorset residents.
Dorset People First. DPF provide a voice for people with a learning disability. They have a forum that is linked to a wider membership and countywide network of groups. Around 180 people are involved in this network each year. DPF are key to the success of the LD Partnership Board and there is an established process of briefings and information to maximise their involvement in strategic developments (this was set out in the self assessment).
Dorset Strategic Partnership (DSP): A partnership of public, private, community and voluntary sectors to ensure that different services and initiatives support each other and work together for the benefit of local people.
Fair Access to Care Services (FACS): The Department of Health has issued guidance to local authorities to help them decide who is eligible for social care services. Local authorities must decide what levels or bands of need they will meet. The guidance describes four bands of need: Critical, Substantial, Moderate and Low. Dorset County Council will provide services to meet critical and substantial needs.
Fairer Charging Policy: There is currently a review of Dorset’s charges for social care services. The need to review policy has been brought about by the emergence of the Transforming Social Care agenda and in particular the introduction of Self-Directed Support (SDS). Government guidance on fairer charging relating to SDS says that service users should pay a contribution towards their agreed outcome based care package subject to their ability to pay. Service users will be able to buy a range of services to meet their outcomes including day care or activities instead of day care. To be fair and equitable service users who receive day care services should be charged in the same way that others are charged for elements of their care package.
Family Carers Forum: Six Family Carer groups based around day service networks
Families Leading Planning: Training for families in how to use Person Centred Planning.
Friendship Club: Social and leisure activities using ordinary community locations.
Joint Commissioning Board (Learning Disability): Representatives Dorset County Council and NHS Dorset that has overall responsibility for services and spend. The LD JCB meets quarterly.
Learning Disability Development Fund (LDDF): Revenue funding allocated by the Government to support new ideas and initiatives. Dorset currently receives about £250,000 per annum. Details of how this is spent are on the LDPB website.
Learning Disability Partnership Board (LDPB): All areas were required to set up LDPBs by Valuing People. They bring together: people with a learning disability; carers; local authority; health and partner agencies to plan and coordinate support for people with a learning disability.
Microenterprise: A one person business.
No Secrets consultation: No Secrets is national guidance national guidance on safeguarding vulnerable adults.
Partnership for Older People Project (POPP): A Department of Health initiative focused on enabling older people to stay healthy and live independently within their local communities. It aims to: provide more low level care thus preventing more costly care; reduce hospital admissions; supporting more people to stay in their own homes or other supported housing rather than admission to residential care.
People and Places: Social networking web-based computer software that can link people together. A pilot will start in 2010
Person Centred Planning (PCP): A way of supporting people to make plans that meet their individual needs. Dorset has worked hard over the last 2 years to integrate Person Centred Approaches and Thinking into services by using a series of "tools" to describe what is important to people, their communication needs and their future aspirations.
Personal Budgets (Personalisation): Cash payments allocated by Local Authority Social Care Services so people can buy their own support. They are more flexible than Direct Payments in that individuals can "mix 'n' match" with Local Authority support and, if signed off in a support plan, can buy nonsocial care services. The Dorset pilot started 3 December 2008.
REACH Standards: A set of standards by which to measure the quality of accommodation and support. Examples of the standards include “I can choose where I live”, “I can choose who I live with” and “I can choose who supports me”.
Settled Accommodation: Refers to accommodation arrangements where the occupier has security of tenure/residence in their usual accommodation in the medium to long term, or is part of a household whose head holds such security of tenure/residence. This includes supported housing but not residential care.
Shared Lives: Family based accommodation and support formerly called “Adult Placement”. There are currently 29 families offering long term and short break support.
Social Enterprise: A business which trades in goods or services for a social purpose. It aims to accomplish targets that are social and environmental as well as financial.
Supporting People: Supporting People brought together a number of funding streams into a single budget to support vulnerable people in a local area. Dorset receives a grant of about £10m of which about £3m is allocated to LD Services for supported lodgings, supported housing and other schemes to help people live independently.
Third Sector Organisations: Voluntary and community groups; social enterprises; charities; cooperatives and mutuals. The Cabinet Office has an "Office of the Third Sector" that supports these groups.
Time Banking Schemes: Local community based mutual aid networks in which people exchange all sorts of goods and services with one another without the need for money.
Transitions: The change from support from Children's Services to support from Adult Services between the ages of 18 to 21. Planning for transition can start at the age of 14.
Valuing People (2001): The national strategy for people with a learning disability.
Valuing People Now (January 2009): An update of Valuing People that has a greater emphasis on implementation.

Executive Summary

1. Introduction

Nationally social care services are changing more rapidly than at any time for 40 years. Individuals and their families have also begun to engage and ask for changes. There is a need to update our plan for Learning Disability Services. The key drivers are:

  • A response to Valuing People Now (January 2009);
  • A new database that has significantly improved our knowledge of the Dorset learning disabled population;
  • Better information about young people in transition from Children’s Services;
  • An emphasis on better healthcare following the Healthcare for All (2008) report;
  • To look at the campus closure and as an opportunity to build a better future for all;
  • The requirement from Putting People First (2007) to introduce Personal Budgets
  • The need to build/invest in stronger communities and raise aspirations beyond current service boundaries

This strategy provides a delivery plan for the implementation of Valuing People Now and the introduction of Personal Budgets in Dorset.The development of this strategy has been overseen by the Dorset Learning Disability Strategy group, accountable to the Dorset Learning Disability Joint Commissioning Board.

2. Background

Dorset County Council and NHS Dorset have statutory responsibilities to support people with a learning disability. There are around 1,300 adults supported by Dorset Community Teams for Adults with a Learning Disability and the total joint spend on Dorset LD services is in the region of £40m. This strategy is a 3 year plan for DCC and NHS Dorset that sets out a development programme for both specialist services and support into mainstream activities – to help people “get a life not a service”. The strategy:

  • Draws together existing materials, reports and activities including the Joint Review of LD and Complex Needs Action Plan, Partnership Board targets and emerging priorities from national guidance;
  • Takes a longer term view of these issues, looks to set out the direction of travel for the next 3 years;
  • Explores some areas which are not being addressed elsewhere in more depth;
  • Secures significant improvement in the needs and resources information which forms the basis of the strategy;
  • Uses the analysis of data (including information from Person Centred Plans) to inform a clear statement about the direction of travel that the commissioners want for the market and for providers in the market;
  • Uses an “outcomes based” approach;

In conclusion, the aim is to develop a very strong evidence base which underpins a 3 year strategy and sets out a longer term direction for areas which that are currently being addressed short term.

3.Shared Values and Vision

Our principles are those reaffirmed in Valuing People Now: Rights, Independent living, Control and Inclusion. There is a very wide spectrum of needs within the learning disability population. Valuing People (2001) provided the following definition:

"A significantly reduced ability to understand new or complex information, with a reduced ability to cope independently, which started before adulthood, with a lasting effect on development". Having an IQ below 70 is not of itself sufficient - social functioning and communication skills need to be taken into account when determining the need for health or social care support.

Valuing People Now (2009) made it clear that everyone with a learning disability must be included: people with complex needs; people from black and minority ethnic groups and newly arrived communities; people on the autistic spectrum; and offenders in custody and the community. The delivery plan 2010/11 lists six priorities: Partnership Boards, health, housing, employment, commissioning and personalisation.

4. National, Regional and Local guidance

Rather than start with a “blank sheet”, the following national, regional and local documents have provided the basis for strategy development:

4.1Joint Review Action Plan

In autumn 2008 Joint Review Teams from the Commission for Social Care Inspection, the Mental Health Act Commission and the Healthcare Commission assessed the quality of commissioning for learning disability services in 9 areas of England. Dorset was one of those selected. The report on Dorset made 23 recommendations. The most significant areas (2 recommendations each) were:

  • Community Teams – increased resources and to work in the same way across the county.
  • Campus – the pace of the closure programme needs to be stepped up.
  • Transition – better information for young people and their families and better planning for the needs of young people requiring adult support.

4.2 Transforming Social Care – Personal Budget Pilot

The Government requires all areas to introduce Personal Budgets in adult social care. Dorset has a target of 3,200 PB allocations (one third of the 10,000 users of Dorset Adult Social Care) by March 2011. The new Dorset LD Day Service strategy has been based on the principles of Personal Budget allocations.

4.3Campus Re-provision

At the start of the campus re-provision programme there were 142 people in campus accommodation across Dorset, Poole and Bournemouth. Dorset has responsibility for 55 people. Seven care and support and three housing providers have been appointed and it is expected that the majority of people will move to alternative accommodation by December 2010. Dorset is also re-providing for The Whitehouse day service on the site of The Albany campus unit in Sherborne.

4.4Person Centred Planning (PCP)

Dorset has made a significant investment in PCP over the last two years. All staff within DCC day and residential services have received training and everyone using those services has a person centred description. As more people choose Personal Budgets and services become more diverse and “individualised”, then PCP offers a way to inform strategic planning and commissioning. Some initial work has started to look at integrating person centred planning tools within the Personal Budget process so that data can held on a central adult services database can be used more efficiently for strategic planning.

4.5Dorset Learning Disability Day Services Strategy (2009)

Day Services provide very significant support for people with a learning disability and their family carers. Our aim, with guidance from Valuing People Now, and feedback from individuals and their families, is to begin to roll out the “outreach” approach across the county. With the introduction of Personal Budgets people will have a choice as to whether they maintain their current day services or spend their money on different forms of support. Personal Budgets are flexible so people can also choose to “mix and match” by changing some of the services but keeping others. We don’t know what choices people will make. However we do need to support people in their communities by ensuring they have a person centred plan, they have information about the services and supports that can meet their wants and needs identified in the plan, and if necessary, have somebody to arrange those services and supports. This type of arrangement already happens in some areas of Dorset, albeit on a small scale. Our proposal is to use this model as a way of improving people’s lives.

4.6 South West Regional Health Authority Self Assessment (2009)

The NHS South West Strategic Health Authority has introduced a new self assessment process that has the ultimate aim of improving the healthcare of people with a learning disability. The assessment is divided into four areas: campus re-provision; primary care; safety and safeguarding; and other specialist services. The Dorset Health Action Group co-ordinated the first return and there is action plan to address the issues identified.

5.0 Needs Assessment

5.1 Numbers of adults with a learning disability

The LD database has been cross referenced with figures from NHS Dorset surveys of GPs to provide the figures for adults with a learning disability by district:

District / Total Population / LD Population
Christchurch / 45,600 / 110
East Dorset / 87,700 / 180
Purbeck / 45,500 / 98
North Dorset / 68,600 / 187
West Dorset / 98,700 / 290
WeymouthPortland / 66,400 / 365
Campus Residents / 142
(inc Poole & Bournemouth) / 51
Total / 412,500 / 1,281

The figures give a prevalence of learning disability of 0.33 per 1000, within the range of national figures. They also show that more than a quarter of people with a learning disability live in the Weymouth & Portland Borough Council area.

5.2 Transition

The Connexions Transitionssupport workers have estimated the number of young people who will be eligible for adult services. This gives a consistent picture of 36-42 young people who will need support as adults for each of the next 3 years. To coordinate transitions support, there is small joint Transitions Team, led by the Connexions Service (Ansbury), on behalf of the Adult and Childrens Directorates who each second or fund a post to work alongside 3 Connexions staff. The team has been in place for 3 years. Its focus has been on ensuring coherent planning takes place for young people with complex physical, learning and behavioural needs who are likely to continue to need services as adults.

There is a multi-agency Transitions Programme Board to coordinate planning.Dorset proposals for development are set out in Transitions Strategy and Plan, endorsed by the Transitions Programme Board in April 2010. Some of the key areas for development are: