The Local Account for Bristol Adult Social Care

April 2013 – March 2014

This report is in 10 sections:

SectionPage number

Introduction 1

What is the Local Account?2

What is Adult Social Care? 3

What we know about the people of Bristol4

What we did in 2013/146

Listening and Learning9

Key facts, figures and performance10

Keeping People Safe14

Plans for Improvement16

Reviewing the Local Account, and contacts17

1. Introduction

Cllr Brenda Massey, Assistant Mayor for People:

“I am pleased to introduce the first Local Account for adult social care in Bristol. As Assistant Mayor I have been asked by Mayor George Ferguson to take special responsibility for adult social care, which sits within the People Directorate of the Council.

As part of my role, I work with council officers and others to support the improvement of services for adults who need support from social care. The need for good quality services for adults at risk is something that we can all appreciate and I’ve been pleased to find out over the course of the year just how much effort is put into monitoring the quality and safety of the services the Council arranges or buys (see page 14). I would also like to see continuous improvement in the way the Council delivers social care support for adults so it was important for me to have an emphasis on the Council’s plans for improvement (see page16) in this Local Account too.

As well as improving social care services, I want to ensure that adults who have social care support are also able to benefit from the other things that Bristol has to offer. For that reason, it has been heartening to see a focus on promoting independent living and I would draw your attention to some good achievements in the section on Working with our Partners (see page 8), many of which have been achieved with the strong engagement of local people.

I hope you will find this Local Account to be an informative overview of the work undertaken in 2013/14 and look forward to seeing the plans for the future take shape over the course of the next year.”

John Readman, People Director:

“I joined Bristol City Council during a time of much change and wanted to establish a regular way to report publicly on our performance. This Local Account represents an ongoing commitment from me to inform people about our work.

Safeguarding is at the heart of our work and we are committed to working with partners to deliver good quality services. There are some very good services and approaches in Bristol, but we know we can always improve and our ambition is to be excellent in all aspects of our work. I am keen that we lead and inspire our staff and partners to make this happen so that they are able to help realise the Council’s Vision for Bristol people to live healthy, happy and safe lives (see

The Council has had to make savings over the course of the past year. With increasing demand for our services this is likely to continue, but I will be keen to work with local people and partner organisations in the months ahead to ensure we continue to deliver good quality services.”

2. What is the Local Account?

The pace of change in local government is getting faster and we have produced this annual ‘Local Account’ to tell people living in Bristol what our adult social care teams have achieved in 2013/14 amidst much change.

The Local Account focuses on areas that may impact directly on people who use social care services. It explains:

The significant achievements we are pleased to have made in adult social care
What services and support we spent public money on
The changes and challenges we are facing going forwards and
Our ambitions and plans for further improvement in future

We will review the Local Account every year to help us assess our performance, set priorities for improvement and gather feedback on how well we’ve done.

A big opportunity for us this year has been to work more closely with the Bristol Clinical Commissioning Group (CCG), to better integrate health and social care. The CCG is the organisation which designs and buys local hospital and community health services. It is led by GPs, nurses and other health professionals. For more information please see

Together with the CCG and other partners we have developed a Health and Wellbeing Strategy for Bristol, with a vision for all health and social care. You can find out more about this at:

Please let us know what you think of the Local Account and if there is anything more you would like us to include in future. You can find out how to contact us at the end of this document.

3. What is Adult Social Care?

Adult social care provides support in a variety of ways to people living in Bristol who have a disability or a long-term illness. Our ‘Care Direct’ telephone line is the first point of contact with us for most people. Through Care Direct, we give information and advice, tell people about other organisations that are able to help, or recommend a social care assessment to help people arrange their support. Contact details for Care Direct can be found at the end of this document.

The aim of social care is to improve a person’s quality of life, and that of the people who care for them. The way that support is delivered is often the factor that has the biggest impact: we try to put the person at the heart of all we do by planning the support they need with them. In order to give people choice and control, we give a personal budget to everyone who is eligible, and offer this as a Direct Payment to them wherever possible. We believe that everyone has the right to live as independently as possible and that services should support and encourage people’s independence. The support we give includes:

Advice and Information
Direct Payments of money so people can buy their own support
Help at home
Short-term support for people coming out of hospital until they’re able to live more independently
Services to give carers a break
Equipment and adaptations to make it easier for people to manage at home
Extra Care Housing
Residential and nursing care
Prevention of abuse of adults at risk and protection to adults who are being abused

The support we arrange is bought from the private, voluntary and community sectors, but we also provide some services ourselves. This is so that people have more choice and can use services which are more local to them, while we can get the best value for money.

The needs of people who use our services

In 2013/14 we were contacted by 27,999 people and gave them advice, information, and in some cases referred them for an assessment. 11,374 people used adult social care services this year; an increase of 20 people on the previous year. The following figures show the number of people who use our services, by their primary needs.

[Key: The proportion of the total number of people as a percentage, and the total number of people in figures]:

54%6,209Physical disability, frailty and/or temporaryillness

12%1,347Learningdisability

12%1,333Carer

9%1036Dementia

8%868Mentalhealth

3%308Visualimpairment

1%103Dual sensory loss

1%74Othervulnerablepeople

<1%70Hearingimpairment

<1%26Substance misuse

4. What we know about the people of Bristol: health and needs

We know that nationally people are living longer and with more complex needs, that children born with serious disabilities are much more likely to survive into adulthood, and that the number of people living with dementia is increasing.

It is important that we understand what people in Bristol need, both now and in the future so we gather information in a number of ways to help usplan:

We talk to people. When people contact us for help and support, we talk to them about how best to meet their needs. We also ask people who use our services what they think about them and how we can make them better. We regularly talk to the most vulnerable people in the city, such as disabled people
We gather statistical information. We look at Census data and local population trends to help us build a picture of the population of Bristol in five, ten and twenty years’ time. We put this in a document called ‘The State of The City’ which can be found on our website here:

Together with NHS partners, we use the information gathered to write the Joint Strategic Needs Assessment (JSNA). We then use the JSNA to plan and buy current and future services. The JSNA report can be found on our website here:

We know that Bristol’s population is increasing; particularly the numbers of children, and that generally health and wellbeing is improving. However there are big differences within the city, for example:

An inequality in life expectancy between the most and least deprived areas, with over 10 years’ difference between some areas
On average women spend 19.4 years in poor health compared to 14.9 years for men, due to men dying younger
Increasing numbers of people reaching 90+ years who tend to require more support
Social isolation is a growing issue nationally, impacting on health and wellbeing

Bristol’s population is ageing at a slower rate than the national average, but the number of people likely to need social care is still expected to rise significantly over the next 25 years. The numbers of people living with dementia, learning disability or poor mental health will all increase and this does pose a significant challenge at a time of reduced budgets. We have already begun to address this through the way we plan, buy and deliver services.

Black and Minority Ethnic Population (BME)

The BME population make up 16% of the population in Bristol, or 68,600. This is an increase from 8.2% of all people in 2001 and is higher than the national average of 14% (England and Wales).
28% of children are BME, 15% of the working age population are BME and just 5% of older people are BME

Lesbian, Gay, Bisexual and Transgender population (LGBT)

The Census does not collect information on the LGBT population. Stonewall, the national lesbian, gay and bisexual charity estimate 5-7% of the population is LGB. The Gender Identity Research and Education Society estimate that 1% of the population is Transgender.

Population at a glance

432,500 is the estimated population of Bristol
18.6% of the population are children aged under-16, in line with the national (England and Wales) average of 18.9%
13.2% of the population are aged 65 years or over – below the national average of 17.0%

(Source: ONS 2012 mid-year population estimate)

Population Projections

The latest official population projections suggest that the population of Bristol will increase to 528,200 by 2037 with:

17,400 more children (under 16 years); the proportion of the population who are children remaining around 19%

50,400 more people of working age (16-64 years); 65% of the population, a small reduction from 68% in 2012

27,900 more people aged 65 or over; an increase from 13% to 16% of the population

4,600 more people aged 90 or over; an increase from 0.8% to 1.5% of the population
(Source: ONS 2012-based Sub National Population Projections)

5. What we did in 2013/14

This chapter is in 4 sections

Spending money effectively
Delivering services well
Implementing a new approach to supporting people with dementia
Working with our partners

Spending money effectively

In 2013/14 we spent £138.7m on adult social care: 39.3% of the Council’s net revenue budget. This included an additional £7.2m in funding from the CCG for support for carers and for people who also have significant health care needs. We delivered our services within budget.

The following figures show a breakdown of how we spent this money effectively. The percentages are rounded up. The headings we have used are consistent with national guidance, to enable accurate comparisons to be made.

£73.9mOlder people, including those with mental healthproblems

£43mAdults under 65 with learning disabilities

£13.4mAdults under 65 with a physical orsensoryimpairment

£10mAdults under 65 with mental health problems

£3.5mManagementcosts (known as‘service strategy’)

Delivering services well

During 2013/14 we have continued with our programme of improvements to enable choice, dignity and independence for people who need support:

Setting up 3 community hubs (known as ‘Bristol Community Links’) and modernising 3 drop-in centres to help support people with needs, of all ages, to get out and about during the day, develop and maximise their potential to live independently
Planning 3 new, state-of-the-art care homes for people living with dementia, and increasing the size of our Resource Centre in St George: a place where reablement services are provided to older people
A new approach to social work, which puts safety, community and consistency at the heart of what we do. Our changes mean that:
people using our services will receive a more timely review of their needs
there is a reduced waiting time for new people who start using our services
a new database will make our services more efficient and will save money
Planning for 200 new, high-quality Extra Care apartments for older people in Hengrove and working in partnership with South Gloucestershire Council to plan more new Extra Care homes for older people on our shared boundary in the north
Working with older people and local organisations to develop and submit a successful bid for £6m of Big Lottery funding, to tackle social isolation of older people. Age UK Bristol are the organisation now leading this work which is known as ‘Bristol Ageing Better’
Working with partners to secure £10m of Big Lottery funding over 8 years to improve the lives of people who have ‘complex needs’: those who are homeless, in or out of probation and prison, dependent on drugs and alcohol and have serious mental health problems. Second Step are the organisation leading this work, known as the ‘Golden Key’
Re-launching Bristol Shared Lives, which offers support and accommodation for people with learning disabilities in a family environment
Working with carers and the NHS to make innovative changes and speed-up our assessments, ensuring people have access to breaks from caring and the support they need to maintain their caring role
Developing a safe social networking site, Bristol and Me,
for vulnerable people, giving them access to
Advice
Information
Education
Work and volunteering opportunities, and the chance to socialise
Launching a modern Joint Autism Strategy to ensure a coordinated response from health and social care across children’s and adults’ services

Lynne’s Story

“I’m 55 and I’ve been coming to Bristol Community Links South since September 2013. I used to go to New Horizons day centre until it closed. I like knitting, going out to my weekly singing group, art groups and keep fit groups when we do armchair exercises. I have been to the zoo and the museum. I also like shopping trips and trips to the garden centre and stopping off in a café for a drink. After having two operations I am working on keeping fit with my walking and visiting the hydro pool and I’m following a healthy eating plan. BCL South is a happy place, I like meeting all my friends there. It’s important to me to be with my friends for my wellbeing because I can become depressed if I don’t see them.”

A new approach to supporting people with dementia

Dementia Friendly City

We have been working with key public and voluntary sector partners to develop Dementia Inclusion. The NHS, Alzheimer’s Society, Age UK Bristol and the Retired Senior Volunteer Programme are involved. Our aim is to develop and promote Bristol as a city where:

people with dementia can live fulfilled and creative lives
support services are well-connected and available as and when they are needed
neighbourhoods and communities are welcoming and accessible

We are working in three parts of the city, (Easton, Westbury-on-Trym and Knowle West) to try out new ways of supporting people with dementia to live well, using familiar facilities withoutstigma or embarrassment.

With the NHS we have jointly commissioned the Alzheimer’s Society to find a way to identify what a good ‘journey’ through care services would look like for a person with dementia, and how every person who needs this support could get it (known as a ‘dementia care pathway’). This will show the range of services, community groups and activities available to people with dementia, their families and carers, from their first diagnosis right through to end-of-life care. This new way of working, including an information pack for people newly-diagnosed with dementia is being trialled now and if successful it will be used across the city.

We have also linked our Dementia Support Team with our Intermediate Care Service(jointly funded and managed by the NHS and the local authority) so that there is a greater understanding of the needs of people with dementia and to enable shared learning.