Hampshire County Council

Policy Review Committee, Social Care Item 9

17 January 2003

Monitoring of Year 1 and 2 Best Value Reviews (exception report)

Report of the Director of Social Services

Child and Adolescent Mental Health Services

Purpose

The purpose of the service is to provide social work specialist input for specialist mental health clinics for children and adolescents with mental problems.

Proposed improvements

· Improve leadership and management

· Increase user involvement

· Clarify expectations between Health and Social Services

· Provide regular supervision, support and development to staff

· Develop identity for the service and staff

· Make the resourcing and model of delivery of service more equitable

· Develop and monitor performance data

Progress on implementing the improvement plan

A joint county Child and Adolescent Mental Health Services(CAMHS)Strategy group, led by Social Services meets monthly and is developing a joint strategy, building on the previous Social Services Department position statement and Best Value review. Progress had been inhibited by re-organisations in Health and Social Services. Much of the strategy has now been agreed, including the overarching vision, aims and objectives. Priority groups within this strategy remain Looked after Children, children at risk of significant harm and family breakdown. The framework for building the strategy includes a conference in March 2003 for all key stakeholders including service users and carers. It will then be made ready for a `launch'' at the joint Health/ Education/ Social Services conference on May 2^nd.

Achievements

· `Community Therapists' posts are to be introduced in order to support looked after children in the 4 specialist residential units (as per HCC SSD's residential care strategy), and to serve the Permanence teams, funded by the CAMHS grant.

Work in Progress

· Development of services across Tiers 3 and 4, the specialist and residential services

Outstanding concerns

· Distribution of, and recruitment to the specialist CAMHS social work posts has suffered as a consequence of the general social worker shortages and as managers seek to resolve difficulties in ensuring that statutory work is addressed. The matter is being addressed by the Children and Families Remodelling Implementation Steering group.

· Dedicated supervision and training for CAMHS social workers proposal for arrangements are being worked up.

Purpose

Mental health day services provide support to adults with severe mental illness. This includes support in everyday living, providing meaningful occupation, social support, and help in gaining access to education, and training, employment and leisure services. Services are provided in day service buildings, community facilities and people's own homes. There is good evidence that people with severe mental health problems have difficulty in gaining access to a range of goods and services that are part of everyday living. Support in these areas promotes recovery and helps maintain good mental health.

Proposed improvements

· Service quality: to develop a service specification to ensure all services meet minimum requirements, and introduce regular monitoring and reviewing of directly provided services.


· Each service should develop specific objectives and measurable outcomes that demonstrate effectiveness.
 

· Priority of access to highest level of eligibility, but within available resources to allow access for those of lower eligibility who need continuing support.
 

· Services should be available at times required by service users, including evenings and weekends.
 

· Ensure systematic involvement of user involvement in the planning and running of services.
 

· Efficiency improvements through combining smaller contracts; improved unit costing; and feasibility of externalising a support work service.
 

· Ensure consistency of remuneration and support for professionally non-affiliated staff.
 

· Improve collection and use of management information so that all service activity is recorded.

Progress on implementing the improvement plan

NEW SERVICES.

Havant/Petersfield.

The integrated management of social services and health community services in Havant & Petersfield. Consultation with service users has resulted in the retargeting of sessions to cater for women only groups in conjunction with local colleges. In the voluntary sector a new Community Links Worker post is reaching younger people.

New Forest.

2002 saw the official launch of a new day service in the New Forest with extended opening times covering evenings and weekends with development in progress for childcare facilities.

Basingstoke

In the Basingstoke area staff and service users are currently undertaking mental health awareness work in local schools and colleges and training for service users has been implemented through a new user trainer post.

Eastleigh/TVS.

This area has benefited from extended access to IT and employment services with the implementation of the Employment strategy.

SERVICE REVIEW

Major reviews of services in the north of the county and Winchester are currently underway with the aim of refocusing services to reflect user need and National targets. The emphasis, independence and recovery, through pre-vocational and vocational services using new models of working, increased user involvement, specialist groups and extended opening hours.

SERVICES FOR WOMEN.

A review of services for women is currently underway as part of the National programme of reform, with findings from a Hampshire Women's Listening event informing action planning and development of a Strategy for Women.

Women-only services include: therapeutic treatment groups; social groups; individual specialist counselling and crisis accommodation for women escaping domestic violence.

EXTENDED OPENING HOURS.

Extended opening hours for community services has improved with several areas e.g. New Forest, Havant and Petersfield being accessible at weekends and several evenings per week. Other services will address extending opening hours as part of the current review.

USER INVOLVEMENT.

Models of Participation

Services continue to develop user involvement/consultation through: inclusion in staff recruitment and training; reviewing , planning and development of services; responding to local and national consultation documents such as the draft Mental Health Bill; facilitating groups; receiving training to assist with membership of Local Implementation Teams.

Direct Payments.

Direct Payments for people with mental health problems are being successfully used to purchases alternative day and community services enable users to exercise more independence and control in their lives.

STAFF TRAINING

Several staff across all areas have successfully undertaken the new Certificate in Mental health with others currently on the present course. Review of staff grades is taking place as part of the County Council's Pay and Benefits programme of evaluating the relative remuneration and benefits for all staff.

CONTRACTS.

Work is underway to combine contracts for the Appropriate Adult scheme and the Rape and Sexual Abuse counselling services across the county which will give service users a more equitable and accessible service in reinvestment in services.

SERVICE SPECIFICATION.

A new service specification exists for day and community services across the county for In-House and Contracted Day services, which complies with existing departmental guidelines and meets the requirements of the National Care Standards Commission. This will be reviewed with the publication of further national standards due in 2003.

DATA COLLECTION.

Data collection continues to improve and the PAF indicator for people with mental health problems helped to live at home has increased year on year from 1.0 per 1000 in 1999/2000 to 3.2 per 1000 in 2001/02, which represents "very good- 5 blobs".

The new service specification will include several targets and monitoring mechanisms which will assist reviewing and development of the service.

INTEGRATION

The integration of Social Services and NHS Mental Health Trust management is well underway with completion expected by April 2003. This development will assist in the provision of a seamless mental health service.

Plans for future implementation

PLANS OUTLINED ABOVE WILL CONTINUE.

ADDITIONAL ISSUES INCLUDE:

1) Strengthening partnerships with the Voluntary sector.

2) Integration strengthens joint commissioning with PCT's and mental health Local Implementation Teams.

3) Proposals to improve services for women.

4) Remodelling of services in North and Mid Hampshire.

5) Review of the impact of community services on the new crisis and assertive outreach teams developed as part of the National Modernisation programme.

6) Linkages with the action plans of other Best Value Reviews of Carers services, Care Management ( Care Programme Approach for mental health) and Residential and Housing with Support to ensure efficient and effective service delivery
   

Receivership Unit

Purpose

The Receivership Unit enables the Social Services Department to manage the financial affairs of a person with mental disorder when the Court of Protection gives the Director of Social Services the necessary legal powers.

Proposed improvements

The review recommended that:

· the services of the Receivership Unit should continue to be provided as a service of last resort when no suitable alternative person could be found to undertake the duties
 

· feasibility of whether it should become a business unit should be carried out
 

· work should continue to systems to improve financial and management information
 

· the Unit's business with Southampton and Portsmouth Cities should continue, and in the longer term to consider other business opportunities
 

· access to information about the Unit was improved
 

· various steps be taken to improve the management of staff through staff performance reviews, and additional staff and additional accommodation
 

· the County Council review its policy on appointeeship (assistance with the management of the financial resources of people with mental disorder who have very limited assets) with a view to providing an improved level of service.

Progress on implementing the improvement plan

· The business case is being investigated for the Receivership Unit to expand its role to include Appointeeship of Social Services clients. It is anticipated that this would provide an enhanced level of service and any expansion of service would be financed by improved income generation and fees. The case for Business Unit status will be reviewed at the conclusion of this project.

· Financial and management information systems continue to be enhanced to improve service efficiency and effectiveness.

· The Unit's business with Southampton City will continue but Portsmouth City will establish their own service from 2003/04. The loss of income from Portsmouth will be compensated for by additional activity and from income from within Hampshire.

· The Social Services Department achieved IIP status in 2002. The Unit has recruited new staff and further proposed changes resulting from an expanded role will be in the Social Services Workforce Plan.

Plans for future implementation

The major area of service development is the feasibility of increased business through managing Appointeeships and implementing these changes. Any expansion to staffing levels will be through additional income. The Unit will also be working with Portsmouth City to transfer this business with least disruption to service users.

Day care services for older people

Purpose

Day care services for older people have two main aims:

· to provide a variety of support which help older people and their carers to remain in their own homes
 

· to help maintain or improve skills of daily living.

Proposed improvements

The current way in which the service is delivered (mixed provision with approximately 40% across the county being delivered by in -house services) is highly valued by users and carers and was considered to be particularly effective at preventing social isolation. However, accurate information about the service in terms of activity, cost , need and demand was not easily available.

The action plan identified a number of areas for improvement, falling into two categories:

· work at a strategic level to put systems are in place to ensure day care services are more effectively commissioned, from a sound knowledge base;
 

· work at an operational level that can run concurrently or subsequently, dependent on the status of specific services in localities.

Progress on implementing the improvement plan

· Most of the nine objectives in the improvement plan have been achieved. However due to staff vacancies in the commissioning team, work on he Day Care Forum to provide further training for commissioning and provider staff is not complete.

Disabled persons parking permits scheme
(The Blue Badge scheme - formerly the Orange Badge scheme)

Purpose

The Social Services Department's statutory role in the scheme is to administer the application and issuing process for a badge on behalf of the Department of Transport, Local Government and Regions.

The Best Value review therefore was limited to consideration of the effectiveness of the administrative function rather than the criteria for a badge and the guidance issued by the Department of Transport, Local Government and the regions
 

Proposed Improvements

Four improvement outcomes were identified as a result of the review:

1. applicants to be confident of consistency about the process of decision making in relation to their application
 

2. criteria for a badge is equitably and appropriately based upon proven, demonstrated evidence
 

3. customers continue to be satisfied with the speed of the department's response to applications
 

4. customers continue to be satisfied with the quality of customer care.

Progress on Implementing the improvement plan

The scheme transferred to the County Treasurers in March 2002 and is no longer the responsibility of Social Services. However it is reported as working well and most applications to the scheme are processed within the established timescales.

Occupational therapy, equipment & technician services

Purpose

The combined role of these services is to assist people with physical disabilities, living in the community, to regain and /or maintain as much independence as possible. Service users of all ages are assisted and some may have associated learning disabilities or mental health problems.

Occupational Therapists (OTs) and their Assistants (OTAs) assess the disabled person's needs , provide advice and may recommend items of equipment and/or adaptations to their home environment.

Subject to assessment by an OT or OTA:

· Equipment items are provided free on loan, by the Joint Equipment Services (JES) of which there are three in Hampshire which have been set up in partnership with local health authorities. The JES for North and Mid Hants is run by the County Council. The service covering SE Hants is purchased from the Portsmouth JES (run by Portsmouth City Primary Care Trust) and that for SW Hants from the Southampton JES (run by Southampton City Council).

· Minor adaptations (ramps, grab rails etc) are provided by the Social Services Technician Service.

Proposed improvements

The key outcomes of the Best Value review were as follows.

· The current national performance measure for all three services is the percentage of equipment costing under £1000 delivered within 3 weeks. The County Council is within 3% of the top quartile for performance by similar shire counties and has set itself to achieve this target by 2003.

· Average waiting times were found to be equal to the national average of 10 weeks but still unacceptably long for some users and it was proposed that waiting times should be reduced to existing County target levels by 2005.

· Pressure on OT teams is intense . Hampshire Social Services OT staff have the highest number of cases per OT by comparison to other similar sized counties. Many of the recommended actions were therefore largely aimed at managing demand to try to maintain and improve performance on waiting times for assessment without further restricting eligibility criteria or the range of services offered. 

· There was a strong message from users that given trustworthy, independent advice and information about equipment and adaptations, many people with simple needs would prefer to take the initiative to meet their own needs rather than access Social Services. It was proposed to introduce a county-wide self-assessment form and better information to enable such people to do so, enabling OT resources to be refocused upon those with higher levels of need. 

· Equipment services in Hampshire were found to be in line with the Audit Commission's recommendations for community equipment services (`Fully Equipped' - March 2000). Two out of three JES exceed the Commission's suggested 70% target for recycling of equipment, by over 20%.

· Users are generally satisfied with the delivery time for equipment which currently averages 90% of all equipment delivered in 3-7 days but would like more choice as to colour, style and quality of equipment supplied. 

· There was some concern about the delivery and collection performance of the JES in SW Hampshire . It was therefore to be monitored and benchmarked against the best performing JES. 

· The Technician Service was found to be well run and well received, with the potential to trade as an independent business unit. It was proposed to exploit this potential subject to further advice from the County Treasurer. 

· A pilot project to operate a combined OTA/Technician service providing simple assessments, fitting of equipment and grab rails in one visit, was to be pursued as a possible model for an improved fast track service. 

· Health and Housing partner agencies and service users regard improved integration of community based services for people with disabilities as highly desirable. The NHS Plan may enable such integration and pooling of resources and this would be explored via strategic joint planning.

Progress on implementing the improvement plan

· For the year 2001/02 the performance for equipment costing under £1,000 delivered within 3 weeks now includes minor adaptation work carried out by the technician service and was 88%.

The predicted performance for 2002/03 is 90%

We continue to work with the services to improve efficiency.

· Since completion of the review the Department of Health has published guidance with set target dates for the `Integration of Community Equipment Services' This requires the integration of Social Services and Health Equipment Services under pooled budget arrangements by 2004. In tandem with this there is an expectation that the numbers of people benefiting from equipment services will increase by 50% by the same year. A county-wide Strategic Steering Group has now met and this is overseeing the work of the joint implementation teams which includes representatives from the PCTs, Social Services and the voluntary sector.

· Waiting times for OT assessment are improving especially for category 1 cases where the wait is now 4 weeks or less (see revised plan).
 

· Care Management is offered only where the category 1 waits are down to 4 weeks or less and only to users with high OT need as part of the referral.
 

· A county-wide self assessment form is in widespread use together with an information pack to users with identified simple needs.

· Disability team continues to work with designers to get suitable material on to the new County Council website , with links to `Social Services Direct'.
 

· Proposals to engage with the independent sector over the use of complementary services is included to the integration of Community Equipment Services.

· The benchmarking of the 3 equipment services continues to drive standards up in all of the areas in terms of recycling of equipment and delivery times. For the first six months of 2002/3, 94.6% of equipment was delivered within 7 days and 100% was recycled.

· The OTA/Technicians pilot project is now completed. This still needs full evaluation.

· Local Authorities are now unable to charge for Equipment and Technician Services following the latest government report on delayed discharges.

Plans for future implementation

· Joint working with partner agencies will continue, with a view to meeting the requirements of the NHS Plan by 2004.

· The use of Social Services Direct will be investigated to improve access to OT, Equipment and Technician Services.

· Further work will be undertaken with the Technician Services and home improvement agencies to improve effectiveness.

· The opportunity for income generation will need to be explored in the context of the recent government paper on delayed discharges.

Day and Resource Centres for Physically Disabled People

Purpose

The Social Services Department provides a Day Service for disabled people between the ages of 18 and 65 years who have a range of impairments, and who require assistance and support to remain in the community. Access to the service is through a Care Management assessment of needs.

Disabled people's organisations promote the `Social Model of Disability' which identifies that barriers to social inclusion are not within the disabled person but within society's response to disability, citing ignorance, negative attitudes and poor physical access to the environment as the most important barriers for disabled people.

The objectives of day care within the independent living model are therefore:

· provide information relevant to services supporting independent living and in particular direct payments

· enable respite for carers which is unable to be provided in the home or other setting

· provide skill and learning development and routes to work and training

· rehabilitation in partnership with Health and others

· routes to accessible community activities for social and educational needs.

Proposed improvements

Seven key objectives were identified in the report:

1. to implement the strategic direction in community support for physically disabled people

2. all key staff to receive training on independent living

3. support users to access employment services

4. to enable a more flexible support service for carers

5. to promote direct payments as an option to maximise user control

6. to identify suitable performance indicators to benchmark services against

7. to clarify unit costs to enable comparative analysis.
 

Progress on implementing the improvement plan

1. Uptake of college courses' use of community leisure facilities has increased in the last 12 months. With increased use of the Signpost employment service - staff continue to be recruited to fill vacancies.

2. Team training programmes are being developed to ensure all staff are trained in the independent living model, the social model and equalities.

A successful conference was held and a follow up conference is anticipated within the training programme.

3. Information is now provided on employment options. This is done through independent disability and advice centres, as well as through the Signposts project. The target of identifying 5% of users who want to pursue routes to work has been achieved. Audleys have arranged one sheltered employment placement and have specifically designed a pre-employment placement within the Centre. One individual has secured full time employment.

4. All carers are invited to user's review meetings. Information is also provided through Carers Support meetings, and mailshots to carers who do not attend.

5. Various discussion groups have taken place on direct payments with invited speakers, for users and carers. Information is available for users and carers from in-house services. However, further staff training is required in this area. Although staff are aware of the Direct Payments Website, access to the internet is currently limited, until the roll out of IT 2000, currently planned for 2002.

6. Performance Indicators have not yet been set.

7. The Financial Services Unit are currently working on unit costings. Work is in hand to progress this.

Over the past 12 months in-house services have undergone a reduction in staffing levels but have still maintained their level of provision, as well as meeting many of the objectives set out in the action plan, as described above.
 

Plans for future implementation

Further plans for implementation and improvement include:

· as with other services, Day Services aim to develop partnerships with local Health Service and local District Councils.

· further work on developing the brokerage model
 

· continued work to improve access to employment options and information, as well as specific individual programmes tailored to meet service user's goals
 

· furthering links with colleges and community facilities to widen the range of opportunities currently available to users
 

· improving recording of carers needs for respite
 

· more staff taking up direct payments training 
 

· development of the Direct Payments Website to provide more accessible information across care groups
 

· developing a set of performance indicators to benchmark against
 

· rolling out development across independent day care providers.

Day activities for adults with learning disabilities

Purpose

· To maximise personal potential and increase independence through a range of stimulating activities, provided wherever possible in integrated, community based settings.
 

· To support family carers to continue to care for as long as this is appropriate for both them and their relative(s).
 

· Service provision is based on the principle that people with learning disabilities should have access to the same rights, choices, dignity and respect as any other and that equality of opportunity is afforded to all people.

Proposed improvements

· Social Services providers of day activities will make £15,000 available in 2001/2 for direct payments, to allow an increase in the number of people with learning disabilities who arrange their own day/evening or weekend activities.

· By the end of March 2003, costed plans will be prepared for the redevelopment of day activities across Hampshire, based on the needs and aspirations of people with learning disabilities and designed to provide more flexible and responsive services. This work will form the basis of reports to the Social Services Committee to gain approval for the implementation of plans. 

· Links will be established with employment agencies and leisure services across Hampshire that will work pro-actively to support people with learning disabilities to have greater access to employment and leisure opportunities.

Progress on implementing the improvement plan

To bring this work in line with the structure set up to deliver on the objectives of the Government's White Paper, Valuing People, each of the four Locality Implementation Group (LIG) has a subgroup focusing on day service modernisation. These interagency groups include Social Services staff, Health service colleagues, carer and user representatives and other providers of day activities. Links will need to be made by these groups with local leisure services, employment organisations and other community resources to expand the opportunities for people with learning disabilities to integrate with their local communities.

The Hampshire Learning Disability Partnership Board is supporting the modernisation of day services through an allocation from the Learning Disability Development Fund. This small fund has been made available by Central Government to support the implementation of Valuing People.

Social Services Transport Services

Purpose

Transport is provided to enable service users to attend services provided both in-house and purchased.

Section 2 (1) (d) of the Chronically Sick and Disabled Persons Act 1970 places a duty on local authorities to provide facilities for assistance to and from home to participate in any service provided by the local authority under section 29 of the National Assistance Act 1948.

The Best Value Review completed in March 2001 supported the option for testing out what the benefits would be of organising Social Services transport needs corporately. Anticipated advantages of this option are around economies of scale in purchasing, policy, co-ordination and brokerage.

Members endorsed a pilot approach for a period of one year. Discussions are underway with the Environment Department to utilise the demand centre as part of this pilot project.

In addition to the Social Services review of transport, the Environment Department undertook a review of Passenger Transport, the Education Department reviewed Home-to-school transport and a corporate cross-cutting transport review took place in 2001.

The Best Value Inspection of the cross-cutting review was carried out in October 2001 and the Feedback Session and Final Report were received in December 2001.  

Proposed improvements

The action plan included in the outcome report itemised 18 outcomes, and listed below is the progress being made in various areas. 

Progress on implementing the improvement plan

· Eligibility criteria have been drafted and circulated to all County Managers for comments.

· In-house accident report forms have been amended to ensure that the manager has to authorise the report.

· Consistent Health and Safety Standards are to be applied across the County Council. A corporate working group has been set up to co-ordinate the development of suitable standards.

· The increase in the number of unit reviews (from two to four per annum) commenced April 2002.

· Integration of `home' to school transport for looked after children has been included within the cross cutting review of transport.

· Closer working arrangements with the Department's Health and Safety Advisers are now in place with regard to transport issues.

Plans for future implementation

Work will continue with our partners listed below who provide transport services to ensure that our service objectives are being met.

Hampshire Transport Management

Education Department

Environment Department

Social Services Complaints Service

Purpose of the service

The purpose of the complaints service is to deal with the concerns raised by people about the quality of the service they, or someone they care for, have about the service received. Local managers, who can resolve the problem, deal with most complaints. However a small number of people's concerns are not resolved informally and they can request an investigation into the situation which has given cause for concern. The complaints section will organise such an investigation, using someone independent of the department and, if the report from the investigation does not satisfy the complainant, a review panel can be organised. The complaints service also monitors complaints made about the department's services and can use this information to help staff improve all services. The review proposed that the role of using information from complaints to improve services be extended so that information can be used from a variety of other sources, such as investigations under the Children Act.

The review further proposed that the extended service would include a responsibility for the implementation of a range of departmental policies and procedures, all connected by the common theme of the investigation and review of the department's performance when `things went wrong'.
 

Proposed improvements

The review identified an action plan to achieve the improvements to be made to the service.

· Publication of clear service objectives and performance measures and a revised complaints procedure.

· New complaints information leaflets to be produced and published 

· Support to and supervision of Independent Persons to be consistently given. 

· The staffing structure of the service to be amended to include additional staff time and changes to roles and responsibilities.

Progress on Implementing Improvement Plan

There is a full time complaints and customer care manager in post.

Funding has been secured for Children's Participation Officer. Recruitment will commence in 2003.

Discussions with key staff in the new structure have led to an agreed framework for a revised complaints procedure.

The Information Analysis Service

Purpose

Information Analysis is a small service costing about £160,000 a year providing and analysing statutory information to central government and management information to support the Social Services Department. It has 6 key objectives:

· to provide central government with sets of information that every Council with Social Services Responsibilities (CSSR) is required to produce
 

· to supply staff, Members and partner agencies (such as National Health Service) with key information about the Department's activity, resources and performance
 

· to make sure data about the Department systems is accurate, complete and timely
 

· to analyse information to help the Department assess how well it is performing
 

· to encourage the use of such information as part of decision-making processes by managers within the Department
 

· to interpret, define, incorporate and audit data standards, especially in response to Central Government initiatives.

Proposed improvements

The Best Value review found that a step-change in the performance of the service was necessary if it was to fulfil its crucial role in helping the Department meet the mounting demands of Best Value, Social Services Inspectorate monitoring and other modernisation initiatives.

With the additional funding of £28,000 Phase one improvements included:

· Central Government will receive complete and accurate sets of statistical data from Hampshire County Council Social Services Department within the specified deadlines
 

· 100% returns will be complete and delivered on-time by the end of 2002/3 (from a level of 45% in December 2000).

With the proposed funding of £108,000 remaining, Phase one improvements expected are:

· a report analysing current and past performance against an agreed set of standard indicators/targets will be regularly provided for the department's managers and for elected members
 

· 100% planned reports will be delivered by the end of 2002/3 (from a level of 28% in December 2000).
 

· requests for management information received by the Information Analysis service will be met in a timely fashion
 

· 80% customers will be very satisfied with the completeness of information by the end of 2002/3 (from a level of 37% in December 2000)
 

· 50% customers will be very satisfied with the timescales that are achieved by the end of 2002/3 (from a level of 29% in December 2000).

Progress on implementing the improvement plan

With the additional funding of £28,000 the IS Information Analysis Team (IS/IAT) have recruited an additional member of staff and consequently have completed and delivered all their statutory returns to DoH deadlines for 2001/02.

As yet, the Information Analysis Service has not received the proposed funding of £108,000 requested in the Best Value Review so no monitoring arrangements have been put in place for associated improvements.

Phase 1:

The new member of staff has settled in very well and is producing key management information. She is extending the skills, capacity and work turnover of the team, including the production of some regular PAF information for the department. The re-allocation of resources resulting from this investment has contributed to a direct improvement in several of the Department's PAF indicators where a full count of activity has been undertaken for the first time.

With the imminent implementation of SWIFT, a replacement care management system covering all the department's activities, the emphasis has been changed from producing information from existing systems using Business Objects towards preparation for SWIFT implementation.

Statutory and key management reports have been created in a way which means they can be re-used frequently. This has increased the efficiency of the IS/IAT in meeting ad hoc requests and increased the amount of management information which is regularly available within the department.

Phase two:

Much work has been done to standardise DoH data definitions with those used internally by Hampshire Social Services. Some significant PAF indicator improvements have resulted from our better understanding of SSD business process and activity definitions.

Data quality reporting mechanisms have been addressed in line with PAF reporting requirements, but are awaiting resource to properly address the results. Although the resources identified in the original Best Value Review were earmarked for the Performance Management Unit, the increasingly close working relationships between the teams means that the work of both teams is affected by the under investment. This impacts upon the quality of support offered to the department in developing a Performance Culture.

Employment services for people with mental health problems and people with learning disabilities

Purpose

Employment Services are paid for by Social Services and provided by independent organisations for people with physical or learning disabilities or mental health problems. The aim is to support people into open employment, where this is possible. This can take various forms from preparing people for the job through to supporting people in employment.

Proposed improvements

Two key objectives were identified for both service user groups

1. to assist the maximum number of service users into open employment 

2. to assist the maximum number of service users moving into useful and meaningful activity such as training or voluntary work.

Progress in achieving these objectives should be monitored by measuring these numbers for each service, along with the movement of people in and out of schemes, and the satisfaction of users of the service. A number of targets were set including a minimum of 15% users on a scheme moving into open employment, and 80% schemes conducting user satisfaction surveys by January 2003. Due to the lack of readily available information it was not possible to establish for most schemes an indication of their current performance.

Other objectives included:

1. improved contract monitoring
 

2. gain a better understanding of the costs of the service
 

3. improved consultation with service users
 

4. develop the department's work with other agencies
 

5. the County Council to use its strong position as an employer in order to ensure that more people with disabilities are employed by the County Council.

Progress on implementing the improvement plan

Mental Health Progress

All employment services across Hampshire are being remodelled to focus on enabling individuals to move into open employment. This approach is supported by pre-employment activities that include building of self-confidence and interview skills.

Where services had already adopted this model, they are continuing to produce good results and elsewhere, as contracts are renewed or re-tendered, this model is being specified.

A review of community and day services (including employment services) being carried out across Aldershot, Alton, Basingstoke and Winchester will provide the opportunity to see how the new model for employment services can be supported by other services.

Learning Disabilities Progress

The work on employment services for people with learning disabilities is being incorporated into the work of the Hampshire Learning Disability Partnership Board, which is required to develop a strategy on employment by winter 2002/3. The overarching aim of the strategy will be to increase the number of people with learning disabilities in employment and through this improve their quality of life. This work will inform the future direction of employment services and will need to address the issue of how to more people from supported employment into open employment. Links will be made with Mental Health colleagues to discover what elements of the model they are developing could be transferred into the field of learning disabilities.

Looked after children services: that is services to children who are in the care of the local authority either by court order or by agreement with parents.

Purpose of the service

The requirement to provide services to looked after children is statutory; there are national objectives set by the Department of Health, which are described in the Quality Protects Programme. The main aim is:

· to ensure that children are securely attached to carers capable of providing safe and effective care for the duration of childhood and are protected from emotional, physical and sexual abuse and neglect.

In addition Hampshire has an over-arching Children and Families Strategy which includes objectives for looked after children services which state:

·  when a child is separated from his or her parents for even a short time, the Council will give high priority to a full assessment of his or her needs, and the emphasis throughout discussions will be on planning for the child's return home. All plans and decisions will be made in partnership with parents and will take the child's wishes into account.

Finally Hampshire also has a Looked After Children's Strategy which supports both the above programmes and also aims to help children remain at home.  

Proposed improvements and how they will be achieved

The review has identified 6 outcomes in its improvement plan.

1.       Looked after children gain the maximum life chances from education, health and social care provision.

2.       Through appropriate care placements looked after children are securely placed with carers capable of providing safe and effective care for the duration of their childhood.

3.       There is a competent and committed workforce within a participative and supportive management culture.

4.       Looked after children's individual needs and choices are met through maximising resources to deliver effective services that demonstrate value for money.

5.       Users and carers are involved in planning their individual care packages and the delivery of services.

6.       Services are planned to meet strategic objectives through accurate management information.

  The main performance targets are in relation to improvement generally in the areas of care placements and staffing. For care placements, they cover more children looked after reported as having appropriate health services provided, improvement in statutory reviews being completed on time, improvement in the long term stability of placements for looked after children, improvement in children and parents participation in planning and improvement in contracting with external providers. For staffing they relate to improvement in recruitment and retention generally and specifically in vacancy levels, sickness, morale, staff communication and training.

Progress on implementing the improvement plan

Overall work on the improvement plan is on schedule and a number of new initiatives are already underway. The following section describes some of those initiatives.

A Corporate Action Planning group for looked after children has been set up chaired by Assistant Directors (Education and Social Services). They have developed a joint corporate development plan for the education of looked after children.

A children looked after support panel (CLASP) meets every 20 days to problem solve any looked after children admissions to school.

A new social inclusion post has been appointed to develop a new corporate unit for the Education of Looked After Children, which will include education support workers.

New Government Guidance has come out requiring service level agreements with all PCTs on looked after children and includes developing a shared database.

Additional reviewing managers are now in post to ensure that care plans are reviewed on time and increase the involvement of children in their care plans.

There is now a strategy for Family and Friends carers, which is being implemented in line with the Public Service Agreement (PSA).

The recruitment and retention strategy for the Children and Families sector has been approved. Implementation will commence from December 2002.

The participation posts are being developed and job descriptions drawn up. The original recommendation has been reviewed and modified and is now a single participation post. It is expected to have a participation officer in post by April 2003. Responsibilities will include support to the Care Action Team and advocacy for children.

The appointment process for a Contracts Support manager is underway and is expected to be in post from April 2003.

The Care Management Manual is being consulted on at present and will be available for staff by February 2003.

A group for developing the new software to support an integrated information system has been set up, chaired by the County Manager (Strategy).

A Looked After Children website will be in place by February 2003. Children are being consulted on the format but it will include opportunities for looked after children to discuss issues with the Assistant Director online on a regular basis.

Adult residential and accommodation services encompassing older people, mental health, learning and physical disabilities

Purpose

The overarching aim of long-term adult residential services is to provide a comfortable and safe environment resulting in a high standard of physical, social and emotional care and support for people who, as a result of mental or physical illness and/or impairment, are no longer able to remain in their own homes.

Proposed improvements

For older people:

The key outcomes that are expected are;

· Address gaps in the market regarding types of provision;

· Respond rapidly to changing agenda;

· Improve market capacity to enable timely appropriate placements;

· Meet user aspirations and values;

· Secure value for money on behalf of residents of Hampshire;

· Achieve market sustainability for the future within available resources.

For people with disabilities:

The key outcomes that are expected to be achieved through the implementation of the action plan are:

· A strengthening of the Adult Placement Scheme with a mix of registered care and Supported Living.

· Flexible use of vacancies in in-house services.

· Options appraisals carried out for all in-house services in response to the standards set by the National Care Standards Commission.

· Joint working with NHS colleagues and providers to identify gaps in services and progress new service developments within Hampshire.

· Purchasing co-ordinated across the County, to ensure most effective use of resources.

· Collaborative approach to providing appropriate services for people with health and social care needs, within the framework of the Continuing Care Eligibility Criteria.

· Increased number of Supported Living arrangements.

· Use of benchmarking tool for comparison of residential services.

For people with mental health problems;

The key outcomes are:

1. Development of a range of residential care and housing with support in each locality informed by the needs analysis in the ROCC report.

2. Development of integrated planning processes incorporating the NSF and Supporting People agendas

3. Development of robust joint financial and management information

4. Improved housing practice in mental health services through joint training

5. Services are responsive to specialist needs

6. There is effective user and carer involvement

7. Revenue and capital resources are maximised across agencies to meet need and promote independence

8. Services have clear, jointly owned and published care standards

Progress on implementing the improvement plan

For older people

Work is underway to meet the target dates set out in the action plan, presented to Members in July 2002. The nursing care strategy is being developed and a mixed economy of residential care provision is already in place. The work still to be done is scheduled in the strategic team workplan.

For people with disabilities

Adult Placement Officers are working with Adult Placement Carers to achieve a mix of registered care and supported living.

In-house services have been reviewed against the standards prescribed by the National Care Standards Commission. This work now needs to be collated and the implications explored.

Partnerships with NHS colleagues are being strengthened through closer joint working, particularly within the framework of the Continuing Care Eligibility Criteria.

A Countywide approach is being taken to the purchasing of services, in particular, the future tendering of services.

Through joint work with local providers, landlords, Housing Departments, the Supporting People Team and the National Care Standards Commission has increased the number of opportunities for supported living.

For mental health

Local Implementation Teams

Mental Health Local Implementation Teams (LITs) are currently required by the Department of Health to produce 3 year Local Development Plans to address priorities in each local area and these will include action plans to meet the accommodation needs. This work will build upon the analysis and mapping recently completed for Stage 4 monitoring of the National Service Framework (NSF) for Mental Health.

Most LIT's have active Housing sub-groups or Housing Inclusive Forums and have strengthened links with local Housing agencies to improve the awareness of special needs and the development/provision of appropriate services.

Users and Carers are actively involved in each LIT and are consulted/included in specific housing developments.

Training

Training for integrated Community Mental Health Team (CMHT) staff continues to promote holistic assessment of need which includes accommodation with new training programmes specifically focussing on housing, benefit and employment, commencing in early 2003.

A current audit of all CMHT against national standards will result in team development plans to ensure recording, assessment and review targets are met.

Information Systems

Development of the Pan-Hampshire Adult Mental Health Information System (PHAMHIS) is progressing with the aim of commencing phased implementation in late 2003/04, subject to the availability of financial resources.

Electronic care planning (eCPA) has been implemented across Hampshire, using in most areas, the Social Services system ACMS. This development allows for much improved access to service users care plans.

Developing The Market

Transitional Housing Benefit

The adult mental health service has achieved over £200,000 Transitional Housing Benefit (THB) through the deregulation of social landlords and plans are being developed to create new services in the community.

Providers
Plans to develop a market strategy working with PCTs and Housing and Support Providers are underway.

Joint Commissioning

An agreement to develop models of integrated commissioning for 2003/04 is in place, working with the National Institute for Mental Health England (NIMHE) through the South East Development Centre (whose primary function is to support local services and stakeholders in the development of services and expertise).

Forensic

An accommodation subgroup of the Wessex Consortium (Prisons and Secure Services) is developing plans in line with national targets to move Mentally Disordered Offenders (MDO's) from medium secure services to more suitable accommodation in the community.

Gender Sensitivity

A Hampshire "Strategy for Women's Services", will be developed following the current national consultation and a local Women's Mental Health Listening event which will include accommodation issues.

Care management for adults and older people

Purpose

To assess the needs of vulnerable adults and older people and provide services in response to this assessment.

Proposed improvements and how they will be achieved

The review has focussed on:

· making it easier and quicker for people to have their needs assessed

· changing internal processes so that more people can have their needs and services reviewed in a timely fashion

· making it easier and more convenient for people to contact the right person in social services.

Thus the major proposals concentrate on increasing the availability of front line care management personnel to respond to the public. This will be achieved through radical changes to the internal processes of the care management system, many of which are not visible to the public.

Based on the pilot projects trialling these innovations, the tangible improvement to the public will be:

· in excess of 10% more care management time, to respond to people more quickly. In real terms, this will "feel" like 40 additional care managers dedicated to assessing and responding to the identified needs of vulnerable people 

· a new service from a specialised finance team who will help users to claim financial benefits they are entitled to and inform you quickly of any charges made for services 

· easier access to someone who understands the care the user receives and who can make minor adjustments to it.

Social Services performance in this area will be evaluated against:

a)      the proportion of people whose assessment of need is completed within 6 weeks of their first contact with a care manager (target = 10% improvement over 2 years)

b)      the proportion of people in receipt of care who have their needs and services reviewed (target = 15% improvement over 2 years)

c)      the proportion of people in receipt of care who receive written details of the care they receive (target = 45% improvement over 2 years).

Progress on implementing the improvement plan

Care Brokers are being recruited across the County and it is clear that this policy initiative is generally well received by managers. Barriers to implementation are primarily budget constraints that affect our ability to recruit. Analysis of PAF data i.e. waiting times for assessment and no of people getting copies of care plans will be reported when the programmes are run.

In relation to recruitment and retention, a MORI poll will be carried out next year to re-evaluate staff satisfaction. Upgrading issues are being considered as part of a budget bid for next year. However, the dept has severe projected financial difficulties and whether this is a top priority is hard to gauge. Vacancies are being aggressively tackled through our recruitment and retention initiative which we believe will reduce the % of agency staff. Financial reward for practice teachers has been overtaken by changes in the training requirements of the dept in relation to our awarding bodies and we can report further in due course. Staff will be rewarded but in a slightly different way that will offer better career and support opportunities.

In terms of partnership working, care managers attached to GP practices are progressing well especially in Basingstoke, where it is being facilitated by a Partnership Manager. New Forest is working with the PCT on new developments beyond this concept to provide Older People's community teams and is part of the Lymington Infirmary reprovision. Single assessment is progressing steadily. On record sharing, there are new developments in New Forest, which are breaking down some barriers but progress is difficult.

The financial assessment benefits team is going well. A detailed evaluation is underway including user perspective/satisfaction.