Hampshire County Council

Adult Social Care Policy Review Committee Item 6

27 July 2005

Best Value Review of Sensory Services

Report by the Director of Social Services

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims.

The aims contribute towards the achievement of Hampshire County Council' s Corporate Strategy in particular.

Aim 1 - maximising life opportunities: creating opportunities for people with sensory loss.

Aim 5 - improving services: making sure services continuously improve to meet the changing needs of the whole community, including people with sensory loss.

Aim 6 - developing councillors and staff: ensuring they have the appropriate training and resources to respond to the needs of the people of Hampshire.

1.

Summary

1.1

The purpose of this report is to inform the Policy Review Committee of the developments which have taken place during the past two years in Sensory Services following the Best Value review of the service.

1.2

The outcome report following the Best Value review of sensory services was presented to Social Care Policy Review Committee on the 16 May 2003 and made the following recommendations:

1.2.1

To consolidate the teams into 5 specialist sensory teams and a deaf services team with core services delivered in house

1.2.2

To introduce a new service, so that information and support can be given much earlier to people with recently diagnosed sensory needs.

1.2.3

To provide staff with a career and progression route within the service in line with other fieldwork teams.

1.3

The implementation of the recommendations in the best value review has been introduced in a phased way as departmental resources have allowed and the process is ongoing

2

Background

2.1

The Sensory Service is one of the three field work services within the Physical Disabilities and Sensory Services care group - the others being Occupational Therapy and Care Management Services for adults with a physical disability. The service plan for Physical disability and Sensory states that: `Physical Disability and Sensory Services by working in partnership will ensure consistent quality services, promoting independence, choice, empowerment, skills, rights and participation'

2.2

The Sensory Service within Hampshire Social Services works with people of all ages who have a sensory loss which affects their ability to live an independent life. Working with service users they identify their needs and potential outcomes, which may include rehabilitation training to promote and maintain independence and provision of specialist equipment. The Deaf services team provides care management for Deaf people who are British Sign language users.

2.3

The service supports the Social Model of Disability which defines disability as the disadvantage or restriction of activity caused by society which takes little or no account of people who have impairments and this excludes them from mainstream activity.

2.4

The Sensory Service in Hampshire Social Services has a well motivated workforce committed to service improvements and interfacing with other organisations to promote independence and achieve positive outcomes for service users.

2.5

The major challenge for the service is balancing the demand from an increasing number of people who have a sensory loss with the resources available as well as maintaining a skilled and competent workforce in a climate where there are both national and local shortages of skilled and qualified sensory staff.

2.6

The Best Value review recommended that in order to deliver an effective and timely service an early intervention service should be introduced into the care pathway as part of the sensory loss teams. This necessitates an increase in staffing levels for the sensory teams whilst the Deaf Services team would remain at the same staffing level.

2.7

The implementation of the increased staffing levels was to be staged over a two year period and a initial resources commitment of £200K made to develop the service. In the first year £100K was made available and this has enabled the staffing levels to be increased to 40.5 fte established posts within the sensory loss teams and introduction of early intervention to some parts of the county. On the identification of further resources the balance of staff will be recruited to fully implement the recommendation.

2.8

Within this resource there are Sensory Officers who work in the following specialities:

2.8.1

Rehabilitation training

2.8.2

Children services

2.8.3

Equipment Services

2.8.4

Health and Clinic bases

2.8.5

Volunteer programmes

2.9

The overarching aims of the service match the aims of Social Services as a whole and are:

2.9.1

Promoting independence and personal development

2.9.2

Protecting vulnerable adults and children

2.9.3

Arranging services which are accessible, convenient and user centred

2.9.4

Striving for best value and greater consistency across Hampshire

2.9.5

Ensuring a workforce is competent and confident

2.9.6

Developing our partnerships with other agencies

3

The National Context

3.1

Key government guidance, legislation and performance measurement impact on the service can be found on the following website, www.doh.gov.uk

3.2

In the United Kingdom sensory staff are mainly employed by the Local Authority Social Services Departments or Voluntary organisations.

3.3

Recruitment and retention of Sensory staff is problematic across the country. This is even more challenging for Hampshire in view of the differential in pay, benefits and post qualification opportunities between Local Authorities. For example a Rehabilitation Officer - Visual Impairment (ROVI) of similar experience and competence employed within Hampshire earns up to £24,000 for a 37 hour week whereas in Oxfordshire that ROVI would earn up to £29,500 - this is being reviewed as part of the pay and benefits process but is affecting current recruitment.

3.4

Waiting times for Sensory Services assessments and service provision especially is a national issue highlighted in the SSI inspection report ` A Service on the Edge' (1997) which led to `Stepping Away from the Edge' (1999), national best practice standards on `Services for Deaf and Hard of Hearing people (1999), `Progress in Sight' for VI people (2002)and Services for Adults who are Deafblind, Deaf Children: Positive practice standards (2002) and Section 7 Guidance for services for deafblind people, (2001).

4

Creating Specialist Teams

4.1

There are now 5 teams of Sensory staff across the County plus the county-wide Deaf Services team, each with their own team manager.

4.2

The specialist Sensory team structure has strengthened the service, improved peer support and improved links locally with health colleagues, housing, the voluntary sector and service users. The current financial provision in the Sensory service is £1,061,000 including £100,000 in contracts with voluntary organizations, £85,000 for Equipment services and £80,000 in the Sensory Technician service.

4.3

The role of Senior Practitioner is being developed to assist the Team Manager and to take the lead on more complex cases.

4.4

To support the sensory staff, specialist county meetings are held regularly to discuss practise issues and to provide a forum for sharing information. These meetings are chaired by Sensory Team Managers.

4.5

To support the development of the service qualified Rehabilitation Officers, VI (ROVIs) provide placement opportunities for ROVI students. The Deaf Services team have offered supervisory support to DipSW students and to students on the Deaf Studies degree course at Bristol University.

5

Social Services Direct - Sensory Direct Pilot

5.1

In line with the development of OT Direct which aims to reduce waiting times for assessments and gives service users the necessary information to make informed life choices through a telephone assessment service, a sensory pilot has been established .

5.2

This pilot offers Visually impaired people in the South of the County telephone access following receipt of their registration form from Health. The telephone contact provides an initial assessment of needs and a screening process.

5.3

Review of the pilot is underway and will involve both staff and service users.

6

Early Intervention Service

6.1

The early intervention service provides support and information to people experiencing functional difficulties from their sensory loss - this can take place at diagnosis or later when deterioration is experienced. This service works closely with health colleagues and takes place in a number of health and voluntary sector bases

6.2

The service has provided the opportunity to develop volunteer programmes and explore with health the expert patient approach

6.3

Where this new service has been established it has enabled us to provide support to a much greater number of people many of whom have their needs met via a single session with an early intervention officer. For example in the Winchester / Andover area 2,459 people were seen in a twelve month period.

6.4

To enable this service to be extended across the county is dependent on resources being identified and the recruitment of staff with the appropriate skill and competence.

6.5

A successful bid to Training Organisation for the Personal Social Services (TOPSS) has funded for one year a research and training project to support the ongoing development of this service which represents a major change in service delivery

6.3

Waiting times for sensory services vary across the County, with an average waiting time for assessment currently 19 weeks this has reduced from an average wait of 30 weeks in 03/04. This will include cases who fall in the moderate or low need in the FACS criteria e.g. someone in early stages of sensory loss with other support mechanisms. Where Early Intervention services are established more people are seen and waiting times for initial contact are much lower, i.e. 8 weeks.

7

Partnership Arrangements

7.1

Sensory Services have developed working relationships with a number of partners to improve the service available to users and simplify the patient/user pathway. The following lists some of these arrangements.

7.2

District Councils

7.2.1

The Sensory Service interfaces with District Councils and Housing Associations with respect to the installation of specialist equipment for the home.

7.3

Health

7.3.1

The Service works closely with Health colleagues in the development of the Early Intervention service. This is an on-going development with services currently at different stages across the county.

7.4

Voluntary sector

7.4.1

Sensory services work closely with a number of specialist voluntary sector organisations in the development of user participation and in the provision of some services. These working relationships provide better outcomes for service users and help to avoid duplication.

8

Training

8.1

The Best Value review identified the need to provide more extensive training opportunities for sensory staff to ensure continued high levels of competence and a commitment to professional development.

8.2

Sensory competencies have been developed for all sensory staff. These take people from induction and offer progression through competency levels commensurate with their role and where appropriate towards the taking of a nationally recognised qualification.

8.3

The TOPSS project will provide the forum for joint training initiatives with Health to be researched and where possible implemented. This will improve the opportunities for closer working relationships and a simplification of the care pathway.

9

The Challenges

9.1

There is an increasingly elderly and disabled population which will need access to services.

9.2

Recruitment of sensory staff into Hampshire Social Services during the past year has been increasingly challenging, despite a flexible approach to recruitment and work is progressing with respect to pay and benefits; opportunities to undertake further professional development qualifications; and a drive to increase the number of staff who undertake qualifying training.

9.3

The steps taken in the implementation of the best value review recommendations have led to a greater consistency in outcomes for service users across the county however the best value recommendations need to be fully resourced for the service to achieve its targets, reduce waiting times and service vulnerability

9.4

There is a need to further explore developmental opportunities with local NHS organisations.

10

Conclusion

10.1

The Sensory Service in Hampshire Social Services is a service which has user outcomes and independence at the core of its activity.

10.2

The reconfiguration into specialist teams together with the development of the early intervention service has achieved improved outcomes for service users and staff morale.

10.3

The interface between NHS organisations, district councils and voluntary organistions is positive.

10.4

The implementation of the best value review recommendations to date have

shown an improvement in service outcome and in staff morale demonstrating that this is the correct approach to achieve improved services.

10.5

Currently people from black and minority ethnic populations are under represented as service users. The development of the early intervention service should enable more people from those populations to access services.

10.6

This report has been impact assessed with regard to race equality. The outcome of that assessment identified that this plan should have a positive impact for disabled people from black and minority ethnic groups.

10.7

For information a case example has been appended to this report (see Appendix I) showing what happened before Early Intervention Service and what happens where the Early Intervention Service has been implemented

Recommendation(s)

That:

1

The achievements made to date within the service since the best value review are noted.

2

Recognition that further service improvements will be achieved as part of service improvement plans.

3

The continuing development of the career pathway for sensory officers is supported.