London Borough of RichmonduponThames

OLDER PERSONS

DAY CARE/SUPPORT

REVIEW

April 2008

GLOSSARY OF ACRONYMS

BMEBlack and Minority Ethnic

A recognised term used to refer to people who often require specific support, recognition and awareness due to race, religion, culture or language

EINAEquality Impact Needs Assessment

A means of assessing how services and administrations respond to diverse needs

FACSFair Access to Care Services

A set of criteria used by all local authorities to say who they do and do not provide social care services to

FMIFunctional Mental Illness

For example, a depression or anxiety that prevents a person from managing their daily life without some level of support

ICSIntermediate Care Service

Providing rehabilitation and support to enable older people to realise their maximum level of independence at home

KSOKey Strategic Organisation

Voluntary sector groups that are funded to represent other voluntary organisations in their area of expertise such as older people or carers

MHSWMental Health Support Worker

A local post that provides support to people with an FMI

NVQNational Vocational Qualification

Nationally recognised qualifications that are obligatory within public services

O&SOverview and Scrutiny

Cross party cabinet members overseeing strategy and services

PAFPerformance Assessment Framework

A system used by all local authorities to measure how they are serving their local population and the people who work for them

PCTPrimary Care Trust

The health service in Richmond responsible for buying and providing health services

PIBProject Implementation Board

A group of people from health, the council and the voluntary sector who oversee day care and support developments

PIRProject Initiation Report

A document that says why a certain piece of work is required, who should do it and when by

RAKATRichmondKingston Accessible Transport

A voluntary sector transport provider and service developer

RCLGRichmond Community Liaison Group

A group consisting of members from health, social care, the voluntary sector, service users, carers and local representatives with an interest in the continued development of day services in the Richmond side of the borough

RCSSCRichmond Community Support Service Consortium

A grouping of voluntary sector social centres and neighbourhood care groups in the borough, forging new links for older people

TSMTransport Solutions Model

A proposal to deliver coordinated transport services to older people who can not access public transport

SDSSelf Directed Support

A new way of assessing, planning and providing community care services to people who require them

SLAService Level Agreement

A contract to provide specific services

SLDGSheen Lane Day Group

An independent older person developed and led social group operating from the Sheen Lane complex

CONTENTS

EXECUTIVE SUMMARY 7

1.Service User and Carer Views10

1.1Statutory Services

1.2Voluntary Sector

1.3What People Want

2.Policy Context14

3.Linking With Other Reviews19

3.1Community Meals

3.2Transport

3.3Respite

3.4Domiciliary Care

3.5Intermediate Care Services

3.6Key Strategic Organisations and Grant Funding

4.Working Together – Whole Systems23

4.1Physical and Sensory Disabilities Intensive Day Care Centres

4.2Mental Health Intensive Day Care Centres

4.3Functional Mental Illness

4.4Richmond Community Support Service Consortium

4.5Social Centres and Voluntary Neighbourhood Care Groups

4.6PULSE Centres

4.7Transport

4.8Finance

5. Management Arrangements50

6.Partnership Working51

7. Operational Issues – Intensive Day Care53

8. Options Summary55

9.Recommendations – 3 Year Plan59

Appendices

Appendix 1Day Centre Changes

Appendix 2Overview and Scrutiny Requirements

Appendix 3DofH Checklist

Appendix 4Council Survey

Appendix 5Transport Solutions Model

Appendix 6Mental Health Review Findings

Appendix 7Orchard Centre

Appendix 8FMI Model

Appendix 9Richmond Community Support Service Consortium SLA

Appendix 10Day Care Matrix

Appendix 11Richmond Community Liaison Group

Appendix 12RCSSC Possible Projects

EXECUTIVE SUMMARY

The review of older people’s day care and support services is outlined in a Project Initiation Report; (PIR) dated the 9th July 2007. In summary, the purpose of the review is threefold:

  • Assessing the success of the changes made to day care and support in the last four years, (refer to Appendix 1Day Care Changes)
  • Responding to the requirements of Overview and Scrutiny, April 2006, (refer to Appendix 2 O&S Requirements)
  • Analysis of relevance with National and Local Policy

The overarching intention of the review is to gauge how day care and support services, (including transport) perform against best value with specific emphasis on outcomes for service users and carers. The report details service user and carer views on the services delivered to them and what outcomes are important. Equality issues are intrinsic throughout the body of the report and made explicit in the recommendations table.

Following service user and carer views, there is a commentary on statutory and non-statutory day services in the Borough and how they do and could continue to respond O&S requirements and to the visions laid out in national and local policy.

It should be noted that not all the voluntary sector has access to the facilities of the statutory and private sector, in particular access to legal and financial advice and support, which may affect the manner in which they are able to respond to policy. The commentary referred to above is mindful of this.

It is apparent that there is scope for continued improvements to services with particular regard to local application of the key themes within ‘Our Health, Our Care, Our Say’.

There are commissioning challenges ahead as the Borough works towards further success in the take up of Direct Payments and the roll out of Self Directed Support, (SDS). This may well culminate in competition to provide intensive day care, (IDC) and in-house services should be enabled to position themselves to face these challenges.

Carers could continue to be well provided for within day services, building on positives that already exist with regards to the provision of respite and associated support mechanisms.

The day service review has links with other reviews, specifically community meals, domiciliary care, respite, transport and older people mental health. This review elaborates on these links and in the absence of a cross cutting Older Peoples Strategysuggests how aims can be shared and achieved with all partners.

Although centre based services are highly valued there is a need to continue developing current levels of supportto assist older people to access wider community living and so introduce more opportunities outside the traditional centre based setting.Work has been initiated, for example via the Richmond Community Support Service Consortium, (RCSSC) and Age Concern to drive wider community living forward.

Additionally, IDC managers welcome the opportunity to extend their practice further into the community and suggest that identifying opportunities and types of support needs to be evidenced at assessment stage. The community teams need to have a sound awareness of options available to older people and how the choices people make can be achieved, whether that is through IDC or another route detailed in the person’s support plan.

The review refers to day care service standards as outlined by the DofH ‘Learning Improvement Network “A Whole System Approach to Day Opportunities, (Appendix 3DofH Checklist’) which covers developing a vision, management arrangements, partnership working and operational issues.The remainder of the review, concentrating on IDC, is laid out under these four headings.

The options and recommendations focus on:

  • Refining the IDC model and structure to ensure parity across the services, enhance health care input, set clear performance targets and enable the release of money to provide for choice with the roll out of SDS
  • Exploring opportunities within the independent sector to take the IDC model forward, for example, opportunities to provide new fit for purpose buildings
  • Changing how we invest in the voluntary sector, (specifically the grant funding cycle from one to three years) to ensure that partners are equipped to respond to the prevention agenda by providing for older people with lower care needs and their carers
  • Supporting the development of the Transport Solutions Model, (TSM) by identifying resources that will enable the provision of borough wide transport services to those older people unable to access public transport
  • Building on existing achievements across statutory and non-statutory services so that wider community living and social inclusion continues to have a high profile within day care and support deliveries

1.SERVICE USER AND CARER VIEWS

1.1 Statutory services

The following views are taken from three sources

  • A survey conducted by the Council through its Quality Assurance Policy and Performance division
  • IDCC quarterly reports and monitoring meetings
  • Consultations carried out with service users and carers as a part of this review

2.1.1Survey

The survey of services users’opinions about IDC offers a general picture of how people who use these centres feel about them and what changes they would like to see put in place. These changes include improving transport services and meals, better use of the keyworking system, information sharing, bathing facilities and responses to cultural or religious needs. A summary of the key findings is attached as Appendix4 Council Survey.

2.1.2IDC Quarterly Reports and monitoring meetings

The quarterly reports cover six key quality areas:

  • Keyworker systems
  • Establishing centre plans
  • Reviews
  • Carer’s needs
  • Cultural Competency
  • Service User and Carer Involvement

On the basis of these reports conducted over the last 18 months, the service user and carer response to the keyworker system and establishing centre plans has been very favourable. People have expressed their pleasure about having an identified contact person and being involved in setting up ‘tailor made’, ‘detailed’ and ‘reflective’ plans that leave people feeling motivated about and in control of their placement. Some people felt that they were unnecessary, ‘a waste of time’.

People were encouraged by the attendance of care managers, therapists, community psychiatric nurses and domiciliary care in a number of the plans and likewise the subsequent reviews, but would like this to be more consistent.

In all four centres carers positively refer to the support they receive, how they are involved in service delivery, the attention given to the person they care for and the skill of the staff group.

On the whole service users and carers are pleased with the manner, (suggestion boxes, meetings, open door policies, surveys) and frequency of their involvement in IDC service delivery and change. Matters include changes to meal provisions, choices around activities and outings, making requests for further input from health services, requesting talks and more information on social care matters such as Direct Payments and Individual budgets. However, there was also a consensus opinion that their involvement in any major decision making, such as charging policies, is tokenistic.

Discussions have taken place around the need for improvements with regards to transport services, but with little success in terms of changes to journey times, which also have a roll on effect with regards to the use of transport during the day, service start times and the time a person returns home.

2.1.3Consultation conducted as a part of this review

Responses have been largely favourable with people taking the opportunity to talk about how pleased they are with the staff members at each centre. Phrases such as kind, professional, attentive, available and skilled are often used.

As with the quality assurance survey, there was specific reference to meals, transport and the desire for a better range of activities at the centres.

Carers of people who attend Tangley Hall and Ham spoke about the confidence they have in each centre.

2.2Voluntary Sector

The views of service users in the voluntary sector are more informal, which gives rise to proposing the need for more formal monitoring, especially with those services funded by the Council through service level agreements.

Feedback gives a sense but not a concrete measure of the outcomes of the social aspect offered by voluntary sector services. They include:

  • Happy to meet old and new friends
  • I feel relaxed when visiting the centre
  • The activities at the centre help to stimulate my mind and increases confidence
  • It is a very vibrant community
  • Staff members are very understanding and helpful
  • The centre is a life line to me, I would probably die at home and no one would think of me

Social centres and voluntary neighbourhood care groups, in line with the prevention agenda and social inclusion are offering more activities and access to health checks and awareness sessions, (refer to Whole Systems). The feedback on offer doesnot give full justice to these developments. People should be given the opportunity to talk about these changes and the difference they are making to their lives.

A monitoring system needs to be put in place that will enable voluntary sector service users to provide opinions and contribute to the success of services and identify any areas for development. The monitoring should be able to support the notion of ‘equality of quality’ and therefore a standard approach should be developed. There will need to be a decision about how this monitoring is conducted. For example, RCSSC may be in a good position to develop an agreeable system for its members, which the separate social centres could then implement and report back via the consortium network.

2.3What People Want

2.3.1Broad Strokes

Broadly speaking[1], older people consulted by Age Concern South East regional office, have said that they expect three things from day care and support services:

  • Somewhere to go
  • Something to do
  • People to meet

This is echoed locally.

Outcomes for older people in receipt of day care and support services, (in no particular order) include:

  • Feeling welcomed, valued and safe, (from door to centre)
  • Social contact
  • Personal aspirations being met
  • Increased stimulation
  • Socially included
  • Improvements to the quality of life for carers
  • Maintained or improved levels of independence
  • Sense of well being from personal care services
  • Assurance of sustained well being from regular care and monitoring

These outcomes are explained further in the body of the report.

2.POLICY CONTEXT

2.1National Policy – Local Response

2.1.1Our Health Our Care Our Say

“Our health, Our care, Our say: ANew Direction in Community Services” (DH 2006) sets out the Government’s intentions to change how community services are planned and delivered. Themes relate to:

  • The assessment of local, strategic needs in order to plan services over the longer term
  • The development of health and local community provision to promote wellbeing and reduce hospital admission
  • The development of strong carer support systems
  • Service co-ordination with the PCT to provide integrated services for people with long-term conditions and more broadly the development of integrated workforce planning
  • The strengthening of strategic and practice based commissioning arrangements between the PCT and the Directorate

A key theme is individual budgets and self directed support, (SDS).

SDS is a system aiming to offer people the optimum control and personalisation of their support.It is a method of ensuring that people are central to the design of their service, which they can then choose to manage in a variety of ways to suit their willingness and capacity.

It is acknowledged by the Department of Health that the roll out of SDS may result in the decommissioning of services and a plethora of commissioning with third sector, specifically with regards to the prevention agenda, which in itself calls for joint commissioning particularly with health partners, hence a gateway to SDS for health through health act flexibilities.

Day care services are as open as any other services to change as a consequence of SDS with user control and choice as the lead factors. For example, IDC will need to compete with other services if they are to attract a service users and carer group, especially if the developing voluntary sector and other providers are able to offer comparable services to meet assessed needs.

As service commissioners and navigators the Council and Primary Care Trust need to embrace healthy competition, as it encourages choice. To help put this in place work is necessary with voluntary and other independent sector providers who may be looking to SDS as a form of income. For example, some of these services may not be accustomed to the level of quality assurance and outcome monitoring statutory funding streams expect. Understanding the implications of SDS as a provider needs to be made clear. To encourage parity and healthy competition these providers need to be included in SDS planning so that they can develop this understanding.

2.1.2The Commissioning Framework For Health and Well Being

Structural changes are taking place within Adult Social Care. The changes are in line with The ‘Commissioning Framework for Health and Wellbeing’ issued by the Department of Health in 2007. This framework promotes a commissioning approach across health and social care which includes:

  • The address of strategic planning and leadership
  • Commissioning from a range of external providers
  • An infrastructure that supports SDS, and
  • The development of a quality assurance framework

Already a quality assurance team monitors and develops standards across external services.

More formal monitoring should be applied to in-house services, which calls for the development of service contracts. The monitoring of independent sector provision that is being developedthrough SDS should be applied across the IDC centres as well. This monitoring will help set IDC as a benchmark for excellence if a decision to explore options within the independent sector is agreed.

The proposed changes in the local authority structure will see the introduction of a commissioner and provider split.