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1 Summary

1.1 This report presents the outcomes and improvement plan resulting from the review of Sensory Services. At the meeting of 14/3/03 the Social Care Policy Review Committee received a report outlining the options for improvement. This report asks members to agree an improvement plan based on the main options which were:

1.2 To consolidate the deployment of Area based sensory workers into 4 larger teams

1.3 To introduce a new service ("First Focus") to the care pathway, so that information and support can be given much earlier to people with recently diagnosed sensory needs. This service will be introduced in a phased way as and when departmental resources allow.

2 Introduction

2.1 The vision for this service is:

"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."

2.2 The issues identified at the first phase of the review were:

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

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

2.2.3 Working relationships need to be improved with providers and all partners

2.2.4 The profile of sensory services needs to be raised

2.2.5 Meaningful involvement and consultation with users and carers needs to be achieved

3 Review process

3.1 The review has been undertaken by a joint team of County Council officers, elected members (Councillors Mrs Frankhum, Mrs Randall, Mrs Steele, Mr Heath and Mr Davies-Dear), service users and representatives from partner agencies. The review has included fresh consultation with staff and service users and detailed secondary analysis of existing data. This has been supplemented with comparative performance information from other local authorities, both through published data and a site visit to Kent.

3.2 The direct costs associated with this review is £2,520. The review has so far taken an estimated 100 person days to complete

4 Review findings

4.1 User satisfaction levels (99%) are substantially higher for this service than for general care management or provider services. This was evidenced both through large scale questionnaires and through individual comments

4.2 Annual referrals for Visual Impairment, Deaf, deaf and hard of hearing services (including Technician's Service) amount to 1,914. Based on national prevalence statistics, this is significantly below the actual number of people in Hampshire who have sensory needs.

4.3 The main concern expressed by users, and shared by the review team, is the length of time that elapses between sensory needs being identified and an assessment of need being offered. Bearing in mind the emotional and functional impact of acquired sensory loss, the review team find this level of delay to be unacceptable.

5 Outcomes

5.1 The principal thrust for this review has been to drive down waiting times between first diagnosis and initial contact with a social care sensory specialist. This has crystallised in the proposed formation of "First Focus" service across the County.

5.2 Based in tertiary health settings, this dedicated service will provide advice, information and support to people with a recently diagnosed sensory loss. To facilitate mutual client emotional support and maximise the efficiency of this service, it is intended that they be conducted on a group, rather than individual, basis. Where more complex individual needs are identified by this service, more detailed work can be undertaken with that person subsequently.

5.3 Initial projections indicate that this change in the care pathway will result in an average 84% reduction in the longest waiting times for assessment, whilst simplifying the process through which vulnerable people access social care services. Service users in authorities that have adopted this approach (e.g. Islington) have had positive experiences, with benefits seen to include:

- retention of independence

- mitigating against the emotional impact of acquired sensory loss, which can profoundly affect functional abilities

- reducing risk to the individual and the perception of risk, both major contributory factors in the use of residential care

5.4 The projected effect of this service on longest waiting times for assessments is detailed in Appendix 1

5.5 Therefore this initiative alone is seen to have a major positive effect in pursuit of the vision for sensory services, outlined at section 2.1 (above).

5.6 The second proposal of the review is to rationalise the number of sensory teams down to 4 larger teams. This will also reduce longest waiting times regionally, through both economies of scale and an enhanced ability to deploy staff to cover the absence of colleagues. However it's principle aim is to enhance the fitness of the service to deliver high quality and consistent responses through:

- increasing clinical, professional and peer support

- raising the profile of the service, to promote effective intradepartmental working practices

- developing a skilled workforce with access to professional qualifying courses thereby supporting the retention of staff within the service

5.7 These outcomes are as follows:

· The creation of the "First Focus" service

· Reconfiguring sensory teams into 4 larger teams

5.8 The development of the `First Focus' service involves the reconfiguration of the existing service together with an additional 9.7 fte posts and associated administrative support. The indicative cost of this is £271,000. The initiative will be introduced in a phased way as and when departmental resources allow.

6 Improvement plan

6.1 A number of issues identified in the Scoping and Options stages of this review are being addressed through normal service planning and development, therefore it is not proposed to describe them in detail in this report. These include:

- staff development and reward measures

- Markovian modelling of capacity and client flow

- interagency strategic planning with Health colleagues

- partnership work with significant stakeholders

- standardisation of contracting arrangements

6.2 The improvement plan for implementing the outcomes of this review is contained within Appendix 2.

6.3 This will be supported by a comprehensive change management strategy, based on informing stakeholders of the outcomes of the review and seeking their active support for their achievement. Examples of this include briefings for social care staff, convening a large stakeholder event in September 2003 to discuss the impact of the options and briefings to local Primary Care Trust management committees.

7 Outsourcing

7.1 Considerable attention has been focussed on whether an improved service would be delivered if it was outsourced. This was explicitly addressed as an option in the Options report and was also considered through benchmarking and site visits to other local authorities.

7.2 Based on information received from service users, other local authorities, local charities and local voluntary organisations and the views of Members of the Social Care Policy Review Committee, outsourcing of core functions is viewed as neither a viable nor desirable option.

8 Conclusions

8.1 Adopting the proposals detailed above will result in a substantial (84%) reduction in waiting times between diagnosis and receiving an initial assessment. This time saving will have a major impact in promoting the independence of people with sensory needs, whilst simultaneously reducing the emotional effects of acquired loss on clients and pressure on carers.

8.2 Following consultations within the Social Services Performance Management Unit, it is clear that the adoption of these proposed review outcomes will also help the Department to strengthen it's position within the Performance Assessment Framework. Specific indicators that this relates to include:

- C32 Number of older people helped to live at home

- C29 Number of adults with physical disabilities helped to live at home

- New indicator (operational from 1/4/03) measuring the time elapsed from first contact to completion of an assessment

- New indicator (operational from 1/4/03) measuring the time elapsed from completion of the assessment to all services in a care package being delivered to a client

- C26 Admissions of supported residents aged 65 or over to residential/nursing care

- C27 Admission of supported residents aged 18-64 to residential/nursing care

- E49 Assessments of older people per head of the population

8.3 Reconfiguring into larger sensory teams will enable the Department to meet the new requirement under Section 7 of the Social Services Act (1970), issued in March 2001 ("Social Care for Deafblind Children and Adults"). This new Duty, to ensure that the specific needs of Deafblind people are assessed by specifically trained people, is closely monitored through annual reporting to the Department of Health, with a penalty of judicial review for non complying authorities. This Duty can now be met through the dedicated sensory team managers.

8.4 Therefore the review team recomends that the Social Care Policy Review Committee supports the proposed outcomes arising from the Best Value review of Sensory Services

Section 100D - Local Government Act 1972 - background papers

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.

Records of the Sensory Services Best Value review team meetings and working papers of the Best Value Review, held by the Review Team Leader.