Contact: Glyn Jones ext: 7257

Contact Peter Knight ext:7144 for a large print version

Description of Service

Hampshire Sensory Services Sensory Service consists of:

1) The Deaf Services teams which provides care management services for Deaf Sign language users with additional needs

2) The Area based sensory teams primarily provide a rehabilitation service for people with an acquired sensory loss.

1 Summary

1.1 This report concludes the second phase of the Sensory Services Best Value review. The review project brief was agreed by Social Care PRC on 27th September 2002.

1.2 The vision for the review was:

"Sensory services need to operate within the social model of disability, recognising that barriers need to be removed to ensure people who are Deaf, hard of hearing or visually impaired have the opportunity for full inclusion into society."

"Within this, staff involved in sensory services need to offer a consistent, high quality and accountable service which manages the care pathways across agency boundaries."

1.3 The issues to be addressed were identified as:

1.3.1 The "whole systems approach" needs to be developed across agency boundaries and the role of rehabilitation in sensory services clarified.

1.3.2 Strategic direction and planning needs to be developed in support of greater consistency throughout the County.

1.3.3 Working relationships need to be improved with providers and all partners.

1.3.4 The profile of sensory services needs to be raised.

1.3.5 Meaningful involvement and consultation with users and carers needs to be achieved.

1.3.6 The following human resource issues also need to be addressed:

- staff qualification and competency based awards

- career pathways

- clinical supervision

- role and practice of contracted posts

- management of sensory teams in the recently remodelled department

- competence of managers within specialist teams

2 Progress in phase two

2.1 Our approach to the review (as proposed in the Project Brief of 27/9/02) was to convene a Core Group of Officers to oversee and coordinate activities associated with the review. Each member of the Core Group had responsibility for convening and chairing a working Topic group. Information acquired by each Topic Group and emerging recommendations were shared at the Core Group meetings. This enabled exploration of the effects different proposals would have upon discrete aspects of the services.

e.g. making the processes more efficient have implications for the deployment of staff, whilst changes to the configuration of staff teams have an impact on partnership arrangements.

2.2 The Core Group has met on 6 occasions

Countywide working groups (Topic Groups) comprising sensory service workers, external stakeholders and users and carers were convened around the 4 topics of :

- communication

- processes

- people

- partnerships.

2.3 These groups identified and examined issues relating to each topic and developed proposals to improve service structure and delivery. These are detailed below under point four.

2.4 How the 4 C's were approached

2.4.1 Consult

2.4.2 User service evaluation forms for the Deaf and Hard of Hearing Service are routinely distributed 6 weeks after service delivery. These have been collated and analysed and the most significant findings, based on 252 questionnaires returned, are:

- 99% of users agreed that the "the service provided was helpful"

- 99% of users agreed that "the equipment provided has helped"

Please see Appendix 1 for the full results of users perceptions of the outcomes derived through contact with Sensory Services.

2.4.3 In addition, each sensory team was asked to distribute questionnaires to service users on our behalf and we had a 30% response (71 questionnaires returned from approximately 200 sent). These results are presented in Appendix 2 and the qualitative comments are presented in section 3.12 below. In summary, these results support the findings of the previous questionnaire returns, inasmuch as users of sensory services report a high degree of satisfaction with the quality of the service received and comment that it has been of substantial help in retaining their independence. However a number of respondents also identified time delays and difficulties in accessing the service.

2.4.4 An electronic discussion board was set up within Hantsnet 2000 for all staff to comment on sensory services. Since going on line in January this has attracted over 300 visits and staff are encouraged to debate the issues and proposals relating to improving sensory services.

2.4.5 An article in Hampshire Now informing people about Sensory Services has been published, with the intention of raising public awareness and stimulating comment.

2.4.6 A questionnaire to all sensory staff has been developed and distributed, the results of which will be included in the final Outcome report.

The review process has profited from the involvement of Elected Members, who have been able to represent the views of their constituents and apply the emerging recommendations to the experience their constituents have had.

2.4.7 To ensure that the views of visually impaired people on the service are gained, telephone interviews with users have been commissioned. These are being undertaken by members of the Social Services Direct and will be included in the Options report to Policy and Resource Committee.

2.5 Challenge / compete

2.5.1 Two distinct aspects of challenge have been applied to this review:

- should these services be delivered at all?

- should Social Services continue to take a lead role in assessing and responding to people's sensory needs?

2.5.2 In answer to this first question, we were grateful for the work of the Financial Services Unit who calculated, in financial terms, the costs and benefits of providing rehabilitative Sensory Services (ref Appendix 4, "Sensory Loss Services", approved by Personnel and Resources sub committee on 17^th March 2000). Essentially, this compares the cost of employing different sensory specialists and the domicillary care they purchase against the projected cost of the client receiving no service and using residential care.

2.5.3 This conservative comparison demonstrates that supplying low level sensory services generates a net saving to the Department of £1,737,103 that would otherwise have been expended to meet the cost of residential care. Fuller details of these calculations are included in Appendix 3 of this report.

2.5.4 Alongside the financial dimension, members of the review team have discovered repeated examples of people with sensory loss identifying profound improvements to the quality of their lives through the provision of relatively inexpensive aids and services. Combining these findings left the review team in no doubt as to the value of continuing to deliver sensory services.

2.5.5 Other models of service delivery, including externalisation, have been examined. However initial work in this area has not demonstrated convincingly that this is either a viable option in Hampshire, nor that the disruption to services during the transition phase would result in any commensurate improvement to the quality of the service subsequently.

2.5.6 A dedicated challenge group was set up composed of users and carers, voluntary organisation representatives and Dr. Alys Young from the Human Communication and Deafness Group at Manchester University. This group examined and endorsed the emerging proposals from the Topic Groups and identified where further clarification was needed. In addition, colleagues from Health and the Voluntary sector are represented within topic groups to afford ongoing challenge throughout the process.

2.6 Compare

2.6.1 Quantitative data relating to the performance of sensory services nationally has been hard to obtain, which has made benchmarking problematic. Qualitative data has been more readily accessible, and suggest strongly that Sensory Services in Hampshire are high performing, although service access issues continue to be our major concern.

2.6.2 A site visit to the highest rated Shire Authority is being coordinated for the purpose of benchmarking.

2.7 Consideration of the key strategies

2.7.1 Equalities

2.7.2 The review team are at an early stage of completing an Excellence in Equalities assessment. This is an instrument designed for detailed audit of the performance of any organisation against equalities issues. This will have been completed by the Outcome stage of the review.

2.7.3 E-government

2.7.4 In 2001/2 a body of work was undertaken by sensory specialists and a Communications Officer to enable people with sensory loss to gain information about sensory services and refer themselves as appropriate, using the Internet. However, following detailed exploration of the issues involved, this has not proved to be a fruitful area and therefore the review team has not extended further research into it.

2.7.5 A more promising area for development relates to sensory practitioners accessing up to date information about local voluntary, charitable and private sector organisations through the Intranet. This work is being developed through normal service planning.

2.7.6 Crime and disorder

2.7.7 Crime and disorder issues are not relevant to the content of this review

2.7.8 Sustainability

2.7.9 The underpinning principles of the Sustainability Strategy have the informed the operation of all of the Topic Groups, especially in seeking to develop a stable and well trained workforce.

3 Analysis of information

3.1 Quantitative information based upon statistics gathered for 2001/02 are presented below, however due to errors in the recording process there is a strong suspicion that these figures under-represent actual activity. Within the clinic settings requests for information and advice are not always recorded as referrals and therefore are not included in these figures.

3.2 Referrals for Visual Impairment services - total 1,215 across the County last financial year.

3.3 Referrals for Deaf /Hard of Hearing services - total 849 across the County last financial year. This figure is extrapolated from the incomplete recorded data available. A detailed breakdown of recorded referral patterns across the County is contained in Appendix 4.

3.4 In addition, referrals to Technicians Service for equipment repairs, advice, installation and removal (Deaf/Hard of hearing) - total 1,065 across the County last financial year. Thus, by amalgamating these figures we arrive at a total activity level of 1,914 referrals per year.

3.5 Waiting times for assessment by the Sensory teams range from six weeks to 13 weeks. Please see Appendix 5.

3.6 Longest waiting times for assessment

3.7 Staffing levels

3.8 Qualitative data - user views

3.9 The results of the questionnaire to users found that users are generally positive about communication between themselves and the Department. However the questionnaire was primarily distributed to people who already received a service, and many used this opportunity to comment on the service that they received and not on how effectively we communicate.

3.10 Positive comments about the service included the following:

3.10.1 "I have great admiration for the way you do your work."

3.10.2 "Local services excellent."

3.10.3 "Most satisfied and happy with the assistance I have received."

3.10.4 "Very efficient so far, and most helpful."

3.11 However other comments received reflect user frustration with accessing services when they are most needed.

3.11.1 "More social workers for sensory services so as to drastically reduce waiting times. Currently 6 months for urgent cases."

3.11.2 "I feel things fail from when that person sees a consultant and is not informed of who is around to help you through that initial difficult time."

3.11.3 "It would be nice if you kept in touch."

3.11.4 "When I ask for help, they give me a phone number. How on earth does one lip read on the phone."

3.12 These findings are echoed by a recent independent review of Deaf Services which identified that the main issue for service users is the accessibility of the Deaf Services team. The methods of contact via e.mail, fax do not inform the user whether the message has been received and it is therefore requested that an automatic response system is put in place. The centralised location of the Deaf Services team means that for many people it feels remote - `I wonder if they are really there' - and users would prefer a more locally based services. These issues are being addressed through normal service planning.

4 Identified review options

4.1 Preferred Option One A -Restructuring existing staff resources

4.2 It is proposed that, instead of the current arrangement of sensory specialist care managers being dispersed around the county through being attached to 7 teams, they be consolidated into fewer teams of larger number. An example of this would be to amalgamate sensory care managers from the South West (New Forest and Eastleigh / Romsey) to give one staff group of 9 practitioners. Repeating this pattern across the County will arrive at there being a maximum of 4 teams across Hampshire. It is of note that a parallel study undertaken by the County Treasurer's Management Consultancy service also argued for this reconfiguration.

4.2.1 Key advantages of adopting this proposal

1) Greater peer and professional support for practitioners

2) Enhanced consistency of practice and output

3) Raising the profile of sensory workers

4) Greater ability to manage workloads during the absence of team members

4.2.2 Larger teams could lead to dedicated administrative support. This will effectively increase the amount of administrative support available to sensory workers, thereby having a positive effect on their capacity to deal with core tasks. In addition administrative workers could also have a greater role in developing their skills, giving information to the public and potentially becoming care managers themselves.

4.2.3 Disadvantages of adopting this proposal

1) Interruption to work during transition

2) Greater mileage costs & down time

4.3 Option 1b - Restructuring Existing Staff Resources

4.3.1 That a new service, "First Focus", be developed for people with a newly diagnosed sensory loss. Essentially, this is a groupwork based information and advice service, to be located within a hospital setting.

4.3.2 The primary advantages associated with adopting this approach is a reduction in the waiting time before users can receive general information from sensory specialists relating to their condition. Authorities that have adopted this approach have found that this type of service, delivered at this stage of the process, promotes independence and reduces subsequent demand for services.

4.3.3 The main disadvantage will be a reduction in the number of people worked with on an individual basis.

4.3.4 Option Two - completely outsourcing the service to the voluntary sector

4.3.5 This option was actively considered, but had to be discounted when it became apparent that the voluntary sector in Hampshire was unable the meet the level of demand that is currently being serviced. Allied to this was a body of qualitative evidence from a neighbouring Authority that had adopted this approach. This indicated that the outsourced service they provided was of a lesser quality than that received by Hampshire residents.

4.3.6 Option Three - integrating sensory workers into existing physical disability or older persons teams

4.3.7 The primary advantage of this approach could lie in transferring the skills from the specialist worker to client group specific care managers. In addition, the sensory worker would be more accessible to the wider care management team to act in a consultancy capacity for specific issues and cases.

4.3.8 The disadvantages associated with this approach are that the quality of the service would be diluted and diminished, specialists would lack professional peer support and the profile of sensory issues would be reduced.

4.4 Service improvements

The review team believe it is important to support the development of a competent and confident workforce, the quality of which is sustained through developing and retaining experienced and skilled practitioners. To this end competencies linked to national qualifications and NVQ are being completed for all sensory staff. This will allow progression of staff skill and competence to be recorded. In support of this, we propose that:

- New sensory care managers complete at least 1 relevant CACDP(Council for the Advancement of Communication with Deaf People) registered course (e.g. Deaf Awareness, Lipspeaking, etc.) within 4 months of being employed. This falls within the probationary period for new workers and will form one of the progression criteria.

- That fees associated with sensory specialists attending relevant CACDP registered courses are reimbursed.

- That, on successful completion of a relevant CACDP registered course, that the worker receives recognition and reward

- That an updated directory of relevant CACDP registered courses be maintained on the Intranet.

- The cascade training pack (aimed at provider services) be relaunched to allow non specialist staff to be aware of sensory issues.

- That team structures are created to encourage explicit career development opportunities in a graded structure.

4.4.1 A networking group of Health, Social Services and the voluntary and charitable sectors will meet quarterly to update on developments. It may also look at how best to put the Hampshire Compact into practice. This group will consider options of tying in to existing liaison groups. It will share information about what liaison channels exist and attendees will share this information. It will also support a network with Health partners to enable an understanding of what underlies variations in patient experience across the county.

4.4.2 The main advantages with this approach will be in simplifying and shortening care pathways and strategic planning with all partner agencies to design more effective and efficient services.

4.5 In summary, the review team recommends Option One, detailed at 4.1 above and the service improvements detailed at 4.4 above

5 The review team is convinced that the adoption of the proposals described above, combined with a host of other recommendations for service development that are not detailed in this report, will help the service to deliver on its stated vision. The area of slowest progress, but which may yield the greatest results, continues to be in developing improved working arrangements with our colleagues in Health. The working of the Partnerships topic group in this respect have been promising, but both the review team and the challenge group acknowledge that there is considerably more work to be done to build on the successes already gained.

5.1 Challenge event results

5.2 The Challenge group have supported the initial findings and agree the general direction being proposed by the Topic groups. They have identified areas in where they would like further work undertaken, including:

5.2.1 Engaging and consulting more effectively with sensory clubs.

5.2.2 A more detailed exploration of aspects of partnership working, including trans-agency working arrangements, multi-agency working arrangements and joint training opportunities

5.2.3 Investigation of how new initiatives in partner agencies (e.g. Modernising Hearing Aid Services) impact on sensory services.

5.2.4 Developing standards of service and eligibility in line with the expectations associated with Fair Access to Care.

5.2.5 Measuring the current designed and actual capacity of the sensory services and predicting how they will cope with projected demand. Additionally, developing models of the services with increased capacity on which mathematical simulations can be run, to assess the impact on waiting times and internal speed of process of having an enhanced service.

5.2.6 Examining the prevalence of different care professionals repeating assessments on one client and advancing proposals to mitigate against this. In doing so, we will be conscious of the impact of the Single Assessment process for older people.

5.2.7 Work on all of these areas will have been completed by the time that this report is submitted to Policy and Review Committee.

5.2.8 For the purposes of clarity, we have tied the findings of the review to the actions that will be taken to address them. A number of these proposals fall within normal service planning and development, so have not been described in this report.

5.3 Any issues that Cabinet may need to be made aware of

The review team believes that Cabinet should be aware that a significant proportion of the population of Hampshire have sensory needs, and there is a danger that they could be excluded from democratic processes.

Therefore It is important that all publications are made available in alternative formats and that other access needs are checked in order for auxiliary aids to be provided that will overcome barriers to participation.

Corporate guidance is available http://www.hants.gov.uk/TC/cg/accindex.html

and this review will contribute to a review of this document. Members should be aware of this requirement as not only is it expected under the Disability Discrimination Act but also as it will improve communication with their constituents

Section 100D - Local Government Act 1972 - background papers

Options Report Template12

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.