Archived decisions
Contact: John Clifton |
Ext: 7282 |
|
Jill Stannard |
Ext: 7260 |
1. Introduction
1.1 This report summarises the Green Paper, Independence, Well-being and Choice. It proposes the County Council's response to the direction of travel and, at Appendix 1, gives detailed responses to the consultation questions in the Green Paper.
2 Reasons
2.1 Corporate strategy aims
2.2 Impact assessment
The implementation of the Green Paper will provide opportunities for more consistently relevant and sensitive services through individual budgets, strategic commissioning across all community providers and alternative ways of assessing services eg care brokers and care navigators.
3 Consultation with local members
Not applicable.
4 Why was it written?
The Government wants a debate on moving the balance of risk between independence and protection and believes that today's society would wish a greater emphasis on personal choice and control. Alongside this, the structure of the population is changing, with the over 85s set to quadruple to 4 million by 2051. Today, the over 100s is the fastest growing population group. Considerable increases in the population of people with learning disabilities and mental health problems is also predicted. While this is taking place the workforce, as a proportion of the population, is diminishing and the paper notes that rural areas are disproportionately effected by ageing. In view of these factors and the need for the widest range of choice, the Government concludes in the Green Paper that "We cannot carry on delivering social care in the way we do today. It simply would not be acceptable to our communities." [p.21]
5 What does it say?
5.1 The Green Paper sets out seven outcomes for adults:
Improved health: enjoying good physical and mental health (including protection from abuse and exploitation). Access to appropriate treatment and support in managing long-term conditions independently. Opportunities for physical activity.
Improved quality of life: access to leisure, social activities and life-long learning and to universal, public and commercial services. Security at home, access to transport and confidence in safety outside the home.
Making a positive contribution: active participation in the community through employment or voluntary opportunities. Maintaining involvement in local activities and being involved in policy development and decision making.
Exercise of choice and control: through maximum independence and access to information. Being able to choose and control services. Managing risk in personal life.
Freedom from discrimination or harassment: equality of access to services. Not being subject to abuse.
Economic well-being: access to income and resources sufficient for a good diet, accommodation and participation in family and community life. Ability to meet costs arising from specific individual needs.
Personal dignity: keeping clean and comfortable. Enjoying a clean and orderly environment. Availability of appropriate personal care. 1
5.2 The Minister, in his vision for adult social care, wants people to have more control over services, more choice, more access to everyday activity and high quality support and protection to those in greatest need. These will be achieved by:
"● changing the ways social care services are designed. We will give people more control over them through self-assessment and through planning and management of their own services;
● developing new and innovative ways of supporting individuals;
● building and harnessing the capacity of the whole community to make sure that everyone has access to the full range of universal services; and
● improving the skills and status of the social care workforce.2"
5.3 The new roles of the Director of Adult Social Services (DASS) and the Lead Member for Social Care will have vital roles to play in ensuring other organisations work in partnership. They will need to exercise leadership across health, recreation, leisure, transport and voluntary sector providers, to promote the prevention and well-being agenda. The DASS will develop 10-15 year plans across the spectrum of population need, and there will be close liaison with the Director of Children's Services as well as the Housing Need Strategies in each District Council.
5.4 The Green Paper envisages the development of self-assessment by users, single access points across social care, housing, Dept of Work and Pensions and some parts of the NHS. It sees a streamlining of assessments across agencies. It wants to debate risk and independence, and is concerned to address low take up in Direct Payments nationally, by freeing-up the criteria and introducing individual budgets.
5.5 Individual budgets would be indicative budgets, held by the local authority on behalf of the user, against which s/he will determine expenditure. The user could purchase from the local authority in-house services or from its block contracts [Direct Payment users may not purchase from the local authority at present].
5.6 Carers are to be better supported and to be part of the local workforce plan to enable them to access work following the caring episode.
5.7 The Green Paper is concerned that social care targets only those in highest need and is not sufficiently involved in the well-being or prevention agenda. Social care should promote low level well-being services with housing, leisure, transport and community safety. However, the Green Paper envisages a well-being, prevention agenda, may be delivered in a cost neutral way. It is undeniable that targeted prevention services, like the Innovation Project designed to prevent hospital admissions, cannot be introduced without investment.
5.8 The Green Paper sees the voluntary sector as crucial in building community capacity and what it calls `social capital'.
5.9 Extra Care Housing along with Supporting People, HomeShare, adult placement and Telecare are seen as key components of the early intervention repertoire.
5.10 The Green Paper envisages realigning performance targets to meet these aspirations. Workforce planning, including major training and development for new roles, new ways of working and new thinking will be emerging to deliver the aspirations of the Green Paper.
6 Hampshire's position
6.1.1 The vision and values of the Green Paper sit well with the County Council's own strategies. Hampshire has had a Direct Payment scheme for 22 years. Over 1,000 people use direct payments and are supported by contracts with support workers as well as by care managers. Person-centred planning [PCP] is part of our core learning disability services. There is a network of independent advocacy groups to underpin PCP. There is a degree of self-assessment in the award winning OT Direct.
6.1.2 The well-being of older people is promoted by the Cabinet's older persons' champion and £100K start up has been made available to develop low level prevention schemes. The Innovations project to prevent admission to hospital and residential care is being extended to other Primary Care Trusts. Work is taking place under the Department of Work and Pensions Link-age schemes to explore the integration of financial assessments for benefits with the assessment of financial contribution for care services.
Key partners to ensure inclusion of marginalised groups such as older people, disabled people and people with mental health problems are Recreation and Heritage, Environment in terms of transport, and PB&R in terms of access to public buildings.
Examples of good practice include:
· PB&R working with local access groups to ensure public buildings are fully accessible to disabled people.
· Gosport Discovery Centre staff consulting with people with learning difficulties about signage and how to make the service more accessible.
· The local transport planning process including the views of people with learning disability.
7 Response
7.1 `Community Care' magazine [19 May 2005] said "The Green Paper promises nothing less than to turn adult social care on its head: rather than rationing services, social workers will be enablers and facilitators. Rather than passive recipients of whatever services happen to be available, service users will decide what they get and how they get it. At the same time the renewed emphasis on prevention will demand unparalleled leadership and engagement with services well beyond the walls of health and social care. It is a tall order." 3
The seven outcomes of the Green Paper are to be welcomed. These, including health improvement, are clearly the right direction of travel of adult social care.
7.2 User choice, user control and the freedom to take greater risk are all advocated and, on the face of it, hard to disagree with. However, greater choice implies some increase in cost as spare capacity is often a pre-requisite for choice. It is of course right to allow a service user to take reasonable risks. Many older people prefer to die at home than in residential care and it is an unforgiving media that reports adversely on those who die at home alone. Apart from obvious concerns about litigation, it will be important for the Government to lead a debate on risk and set out a clear framework in which greater risk may be taken.
7.3 The Green Paper's length of vision is in inverse proportion to the brevity of its comments on funding. Indeed, no new funding is envisaged, although the DoH does target funds for specific developments eg Partnerships for Older People Projects [POPPs]. Since the inception of community care in 1993, apart from its first year, there has been an ever-increasing tightening of eligibility criteria to target those in the most profound need. Demographic changes have increased the numbers of over-85s requiring support and care. Low level `well-being' prevention services have been difficult to fund and sustain, though Hampshire has some notable exceptions. At the very least the implementation of the Green Paper's vision will require transitional funding to allow the development of well-being services, while the high-level intensive support services are reduced. However, the demands from demographic change make the latter hard to envisage.
The financial requirements of the Green Paper also need to be set against the backdrop of serious budget shortfalls in the Hampshire NHS system which are likely to lead to service changes which will impact on social care.
7.4 The leadership role of the Director of Adult Social Services and the Executive Member for Adult Social Care envisaged in the Green Paper is welcome. The voluntary sector as well as Recreation and Heritage and District Councils are most likely to be able to develop low level well-being service. It will be important for the new Adult Social Services Department, as it is initiated, to have adequate capacity to exercise that leadership across Hampshire and within local communities. Work with Local Strategic Partnerships [LSPs] and within the context of new local area agreements [LAA] will be important building blocks to ensure the outcomes of the Green Paper.
7.5 The means of delivery by which the individual exercises control and choice have a high profile in the Green Paper. A more flexible form of direct payments, called individual budgets will be welcomed. It will be important to allow people to purchase from the Local Authority's own internal provision, or from its block contracts, or from a list of assured providers established by the Local Authority. Again, these developments are not without resource implications, particularly in the so called backroom areas of contract management and negotiation. These of course are the very areas that Gershon wishes to reduce!
7.6 The Green Paper advocates increased self-assessment for the user to enjoy more control. However, of course there will be limitations to the extent of self-assessment, particularly in the light of rationing and eligibility criteria as outlined in 7.3. Care brokers who put together care packages for individuals after the Care Manager has assessed need and agreed the types of service required, are already working in older persons teams, in hospitals and in Learning Disability Day Services. The role of care navigator appears to be one of advising on services that might be purchased from individual budgets. The County Council has offered the National Director of Social Care when she visited recently, to pilot and develop brokerage as well as self assessment based on the award winning OT direct service.
Information shared with the Dept of Work and Pensions to reduce the intrusiveness of assessment does seem sensible. However, a move in that direction needs to be well judged in the light of adding complexity to information technology, management and costs.
7.7 The Government must underpin any proposals emanating from the Green Paper with a programme of workforce development, particularly to enable people to develop skills around navigator / care broker roles. NVQ programmes would be an obvious way forward but, again, there needs to be some investment in this process.
7.8 There is much talk of the effectiveness of low level / well-being interventions. The County Council's own Innovations project aimed at reducing dependency of older people on hospital admissions is underpinned by research into effectiveness. It would be important to ensure that Adult Social Services Departments are well informed by organisations such as Social Care Institute for Excellence [SCIE] of well researched evidence into what works and what does not.
7.9 The County Council entirely supports the importance of developing sensitive performance measures and indicators. It will be necessary to develop more qualitative indicators through surveys and also through impacts on other organisations, most notably the NHS and acute care.
Recommendations
1. The PRC consider this report and the appendix and advise the Executive Member for Adult Social Care of any changes or additions.
Section 100 D - Local Government Act 1972 - background papers
The following documents disclose the 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.
NB the list excludes:
1 Published works
2 Documents which disclose exempt or confidential information as defined in the Act.
Appendix 1
Independence, Wellbeing and Choice
Hampshire's Response to the Consultation Questions
1. Does the vision for adult social care as set out summarise what social care for adults should be trying to achieve in the 21st century
The Green Paper on Adult Social Care is welcomed. The Council supports the vision for adult social care but if it is to be implemented, it will need to be followed by more detailed strategy, policy and practice guidance.
2. Are these the right outcomes for social care?
The Council believes these are excellent high level outcomes. Attention will need to be paid to how they are measured and how they are to be achieved. A more holistic and coherent inspection regime such as that being piloted by the Audit Commission, CSCI and CHI may enable more effective inspection over the totality of services for adults of all ages.
Adding an outcome measure to protect adults from abuse would be an important addition.
Much of the document reflects the social model of disability which is essential for a more inclusive society. Ensuring the full implementation of the Disability Discrimination Act 2005 will enable greater participation in community and public life. If disabled people are to contribute more through work then there needs to be easier access to Access to Work funding so that disabled people can have the support/equipment they need before they start work and not to have to wait. Current initiatives to assist disabled people into work should actively target people with significant disabilities rather than just those people most likely to be supported into employment
3. Managing Risk
Social care workers and local authorities will need guidance on "managing risk" especially in this increasingly litigious culture. For example now we require all providers to have insurance up to £10 million before our service users can be recommended to their service. This is a problem for many smaller providers. Good practice guidance will be needed for social care staff to fulfil their duty of care and balance choice through direct payments and individual budgets with users taking personal risks and learning through mistakes.
As plurality of provision develops, the vicarious liability of local councils will need clarification otherwise expensive and bureaucratic pseudo regulatory regimes will emerge.
4. Sharing Information between agencies DWP and local authorities
The Council believes this to be a positive development in information sharing but major investment will be needed in IT systems to support this alongside effective training and support packages for staff. Thorny problems in information sharing with other agencies in support of Children Act objectives are already being encountered and can be expected in this area as well. In addition to this future integration with the developing nationwide information systems supporting the NHS will need to be planned for and implemented.
5. Modernising Assessment
Modernising assessment systems will be crucial to achieving the outcomes for adult social care. Self assessment can have positive outcomes for users and save the time of qualified staff. However, clarity is needed to determine where self assessment is appropriate and where professional help is needed. Hampshire has established a service called OT Direct where the public can `phone a call centre and speak to a trained service advisor. This service has won a BT Award for Innovation - Best Service Government to Citizen. Items of simple equipment can be delivered directly after a self assessment. However, more complex cases are referred to qualified occupational therapists. OT Direct call centre staff handle 90% of calls but occasionally a call is very traumatic and skilled professional help is needed, even at the point of referral. Hampshire staff would be willing to provide more information on this if it would be helpful. Pilots are essential to test how far self assessment can led to real empowerment for the numbers of people requiring support.
The Green Paper is disappointingly quiet about strengthening the need for advocacy, a crucial component of empowering service users, and one that is recognised in new mental health legislation. There is a need for Directors of adult services to take a key role in establishing local commissioning framework for these services, and ensuring appropriate links with the NHS.
6. SAP/PCP/CPA - should they be developed to provide a tool for people with complex needs
The challenge here is to ensure assessments are comprehensive whilst at the same time not being overly bureaucratic. Another prescription tool or form is not required. Person centred approaches should be at the centre of SAP, CPA and all assessments. There is no standard way to record these as each person will require an individual approach so it is impossible to standardise this. The concept of involving people who are important to the individual i.e. their circle of support, the carer is paramount in all these as is listening to an individual's dreams and wishes and responding to their recovery. The Council believes that what is required is cultural change and outcome based approaches not inputs (i.e. tools to record on).
7. Direct Payments - encourage take up in Older People and people with MH problems
Budget for recovery are important for people with mental health problems. At present we are national leaders in Direct Payments for people with mental health problems.
Extending Direct Payments to people with diminishing capacity will be challenging as real fears exist around potential misuse and exploitation. However, with the right support arrangements this could be a real opportunity to enable more flexible, person centred support and services.
8. Direct Payments
The Council believes that exclusions should be reviewed although Hampshire has found it possible to get over these barriers by being flexible. It would however, help more reluctant councils tackle the barriers. The issues raised in Making a Difference : Direct Payments DH/Cabinet Office April 2005 need to be addressed, specifically:
_ users to enable their own CRB checks
_ users to purchase in-house services if they choose to
_ users to be given the support they need to manage a DP and this to be funded
_ a flexible approach to be taken to the definition of "willing and able" e.g. "able with support" which is how Hampshire has interpreted it.
_ Support for voucher schemes which offer the key characteristics of Direct Payments e.g. choice and control with fewer administrative inputs from users.
In addition the government should consider reducing costs and bureaucracy through explicitly not requiring registration with CSCI as a care agency for the following:
· independent living (user controlled) trusts
· agents
· people having a relevant last power of attorney
9. Name of Direct Payments
Direct Payments started in Hampshire 22 years ago and the scheme was called the Self Operated Care Scheme (SOCS). This would reduce any confusion with the DWP, however users would prefer the DWP to find another name for its Direct Payments.
10. Pilot Individualised Budgets
Hampshire welcomes the proposals on individualised budgets and would be keen to be a pilot site for:
¬ Young People in Transition to adult services
¬ People with mental health problems having a "recovery budget"
¬ Older People
11. Care broker/navigator role
Hampshire is piloting care broker role in learning disability day services where brokers help people with learning disability access local community activities. This is working really well and could be extended to other excluded groups.
The `Care Worker' role is widely used in Hampshire enabling the more effective procurement of residential, nursing and domiciliary care. To extend this to people with an Individualised budget needs careful consideration relating to the earlier points about risk.
Both broker and navigator roles free up scarce social worker resources for more complex cases and are welcomed.
12. Impact of shifting balance from high level needs to earlier preventative interventions on eligibility criteria and FACS?
This is really a question of funding for social care. Whilst there is some anecdotal evidence that preventative services save money in the longer term, more research is needed on this - perhaps along the lines of Innovation Pilots in Hampshire, see Appendix 1 (get innovation paper) - although the savings are not necessarily made on SSD budgets e.g. preventing hospital admissions is a PCT saving.
What will also be needed is a cultural shift in other service providers in reinvesting in services determined through greater citizen choice.
13. Strengthening leadership
The Council values the emphasis on the role of the DASS alongside the Director of Children's Services. Hampshire has already recruited to these key corporate posts demonstrating commitment to this agenda.
The Council has a Cabinet lead for Adult Social Services as Members see this as the best approach to strengthening leadership at Council Member level.
14. Strategic Needs Assessment
This will be essential to harness the community and voluntary sector resources to meet ever increasing need and design new and innovative ways of meeting need. In two tier council areas, LSPs and LAAs will become a crucial catalyst for change across all council services. Consideration should be given to making the production of a strategic plan for adults a statutory duty.
15. How can local authorities stimulate market?
In part this can be achieved by building on person centred approaches and giving users' budgets to determine how their needs can be met. There is some evidence in Hampshire that staff employed by Direct Payment users are different to the traditional domiciliary care staff. Working with providers to encourage them to develop person centred services e.g. in Hampshire we are asking providers to sign up to a Person Centred Charter which commits them to listening to users' needs and responding individually to these needs.
Stimulating new market responses rests on a clear vision for adult services and an assured income stream over many years, if commercial interests are to respond. There is clear evidence this has been successful following the Community Care reforms during the mid `90s.
16. Do you support the proposal to develop a strategic commissioning framework?
A strategic commissioning framework across all adult groups and all relevant services is a step change beyond current practice. It is essential if we are to deliver responses to the longer term demographic challenges. Partnership is the key to developing a coordinated strategy and Hampshire welcomes the view that decisions about the best models to suit local circumstances should be made locally.
17. Is the proposed shift to a preventative model of care the right approach?
The approach is commendable and something Hampshire aspires to. However, there is little evidence that preventative services actually save money. It will not be possible to invest substantially in preventative services as well as meet the needs of the increasing numbers of older people without additional investment. We can achieve a gradual reinvestment from `traditional' services, if demand and expectations change. But this cannot replace the need for new resources and we await the Wanless review of social care funding with great anticipation. The Partnerships for Older People Projects investment is welcomed.
18. Views on approaches to promoting and developing partnership
The Council welcomes the flexibility to build on local partnerships and that there is no one prescribed model.
19. What help and support is needed to help local authorities and other social care providers to work with carers to transform services?
The Council and other social Care Providers have been able to engage carers in service planning and delivery though this could be more effective and deliver more outcomes if the following were addressed:
· Additional resources
To enable carers to participate in service transformation, additional resources are required.
There are costs involved in carer representation: training; travel; alternative provision of care. Hampshire already supports carer representation and meets associated costs, but further resources would help and support the Local Authority to ensure that carer involvement was developed across all care groups and in all areas of the Authority.
It is mentioned that there are resources which are locked within the system and it is intended to `un-lock' these as part of the process. In the absence of additional, transitional resources any disinvestment or `un-locking' of existing resources may not be supported by carers who rely on existing service provision. Carers may resist plans to un-lock resources if their needs are not taken into consideration and may not participate fully in the change process as a result.
· Support Social Care Providers to move toward long-term planning
Social Care Providers can improve working with carers if supported to develop long-term plans for the provision of that care.
Responding to changing priorities and initiatives has encouraged short-term planning for social care provision. Independence, Well-Being and Choice presents a longer-term vision for social care which, if enacted, should enable the establishment of effective, cross sector networks and partnerships.
From this basis, these partnerships will be better placed to offer the co-ordinated response desired by all stakeholders.
· Effective mechanisms for partnership working
Investment and development of Local Strategic Partnerships LAAs and Compacts could offer more effective, multi-agency platforms for partnerships. If supported to develop these partnership mechanisms, carers could be involved as part of the ongoing decision-making process.
· Support to develop outcome-focused strategies
Carers do not always believe that they see proportionate outcomes as a result of their efforts within service planning and development frameworks. They report feeling that `nothing ever changes' or that they were `making up numbers' on committees or groups. Support to develop outcome-focused strategies as presented within the Green Paper and could assist working with carers for change.
20. Do you have innovative models of provision that support the outcomes of our vision?
Hampshire has a range of innovative models of provision including the innovation pilots aimed at preventing admission to hospital, adult placement schemes, shared home ownership for people with learning disability, extra care housing strategy and homes. We would be willing to share the learning from these as they develop.
21. Do you have views on appropriate performance measures to encourage the implementation of the vision?
As stated above, performance measures need to be focussed on user experience rather than numbers and measurement. Performance measures need to be joint with the NHS and other partners to reduce the bureaucracy where many services are already integrated.
22. How can central government best enable LSPs develop and monitor progress on cross cutting issues?
23. Do you think the direction proposed for strengthening and developing skills in the workforce is right?
The Council believes that the direction proposed is sound. However, it is very important not to see skills development as the whole answer. The change in culture and attitudes that is required to deliver the vision is unlikely to be delivered solely by training and development programmes, important though they are. This goes to the fundamentals of an individual leader/manager's values and if they are not aligned with the aspirations in the vision, it is unlikely that they will be able to deliver it. What is required is a paradigm shift that encompasses leaders and managers across all delivery sectors, including the very diverse and therefore more difficult to reach, forms of delivery in the private and voluntary sectors. Thus the strategy needs to encompass other methods to achieve the shift across the country, as well as training and development.
24. How can we improve and better integrate local workforce planning?
Great moves forward have been made with this in recent years through the local and regional planning groups. However, contracting processes with Skills for Care and confidence in continuity of government funding need to improve if organisations are to be willing to enter into arrangements to deliver objectives.
As greater inter-agency working moves forward to deliver Independence, Well Being and Choice, the way power and resources are distributed amongst the partners needs to be balanced so that none is a `poor relation' of, and therefore disempowered with respect to, the other. Learning Skills Council and Regional Development funding needs to become easier to access for social care. Their national objectives, as well as of FE colleges and HEI's, need to explicitly include support for Independence, Wellbeing and Choice so that there is synergy across the workforce planning piece.
25. What actions are needed by Government and others to assist employers in recruiting, retaining and developing the workforce?
The Council believes that social care should be promoted as an attractive career that embraces the purpose and fundamental worth of delivering person-centred care. There is a need for improved reward, progression and status; but also there is a need to analyse what triggers the motivational response in people that in earlier times the county might have described as `vocational'. This should not be an excuse for poor pay and conditions but rather a valuing term - a way of engaging with higher level aspirations for fulfilment in workers and thereby developing the culture and vision expressed in the paper.
Until the popular mythology and perceptions of what social work and social care are about are reframed, (and drama and the media have a great part to play in this), then it will remain difficult to sell social care as an attractive career.
26. How can we strengthen the links with the VCS and increase community capacity?
Hampshire has excellent links with the voluntary sector who provide many local services. We recognise that by including them into a strategic commissioning framework there could be some potential to expand the range of services available. However, this will not be sufficient to meet the demands of the demographic changes. Many volunteers are already elderly and stretched to capacity.
Appendix 1
Independence, Wellbeing and Choice
Hampshire's Response to the Consultation Questions
1. Does the vision for adult social care as set out summarise what social care for adults should be trying to achieve in the 21st century
The Green Paper on Adult Social Care is welcomed. The Council supports the vision for adult social care but if it is to be implemented, it will need to be followed by more detailed strategy, policy and practice guidance.
2. Are these the right outcomes for social care?
The Council believes these are excellent high level outcomes. Attention will need to be paid to how they are measured and how they are to be achieved. A more holistic and coherent inspection regime such as that being piloted by the Audit Commission, CSCI and CHI may enable more effective inspection over the totality of services for adults of all ages.
Adding an outcome measure to protect adults from abuse would be an important addition.
Much of the document reflects the social model of disability which is essential for a more inclusive society. Ensuring the full implementation of the Disability Discrimination Act 2005 will enable greater participation in community and public life. If disabled people are to contribute more through work then there needs to be easier access to Access to Work funding so that disabled people can have the support/equipment they need before they start work and not to have to wait. Current initiatives to assist disabled people into work should actively target people with significant disabilities rather than just those people most likely to be supported into employment
3. Managing Risk
Social care workers and local authorities will need guidance on "managing risk" especially in this increasingly litigious culture. For example now we require all providers to have insurance up to £10 million before our service users can be recommended to their service. This is a problem for many smaller providers. Good practice guidance will be needed for social care staff to fulfil their duty of care and balance choice through direct payments and individual budgets with users taking personal risks and learning through mistakes.
As plurality of provision develops, the vicarious liability of local councils will need clarification otherwise expensive and bureaucratic pseudo regulatory regimes will emerge.
4. Sharing Information between agencies DWP and local authorities
The Council believes this to be a positive development in information sharing but major investment will be needed in IT systems to support this alongside effective training and support packages for staff. Thorny problems in information sharing with other agencies in support of Children Act objectives are already being encountered and can be expected in this area as well. In addition to this future integration with the developing nationwide information systems supporting the NHS will need to be planned for and implemented.
5. Modernising Assessment
Modernising assessment systems will be crucial to achieving the outcomes for adult social care. Self assessment can have positive outcomes for users and save the time of qualified staff. However, clarity is needed to determine where self assessment is appropriate and where professional help is needed. Hampshire has established a service called OT Direct where the public can `phone a call centre and speak to a trained service advisor. This service has won a BT Award for Innovation - Best Service Government to Citizen. Items of simple equipment can be delivered directly after a self assessment. However, more complex cases are referred to qualified occupational therapists. OT Direct call centre staff handle 90% of calls but occasionally a call is very traumatic and skilled professional help is needed, even at the point of referral. Hampshire staff would be willing to provide more information on this if it would be helpful. Pilots are essential to test how far self assessment can led to real empowerment for the numbers of people requiring support.
The Green Paper is disappointingly quiet about strengthening the need for advocacy, a crucial component of empowering service users, and one that is recognised in new mental health legislation. There is a need for Directors of adult services to take a key role in establishing local commissioning framework for these services, and ensuring appropriate links with the NHS.
6. SAP/PCP/CPA - should they be developed to provide a tool for people with complex needs
The challenge here is to ensure assessments are comprehensive whilst at the same time not being overly bureaucratic. Another prescription tool or form is not required. Person centred approaches should be at the centre of SAP, CPA and all assessments. There is no standard way to record these as each person will require an individual approach so it is impossible to standardise this. The concept of involving people who are important to the individual i.e. their circle of support, the carer is paramount in all these as is listening to an individual's dreams and wishes and responding to their recovery. The Council believes that what is required is cultural change and outcome based approaches not inputs (i.e. tools to record on).
7. Direct Payments - encourage take up in Older People and people with MH problems
Budget for recovery are important for people with mental health problems. At present we are national leaders in Direct Payments for people with mental health problems.
Extending Direct Payments to people with diminishing capacity will be challenging as real fears exist around potential misuse and exploitation. However, with the right support arrangements this could be a real opportunity to enable more flexible, person centred support and services.
8. Direct Payments
The Council believes that exclusions should be reviewed although Hampshire has found it possible to get over these barriers by being flexible. It would however, help more reluctant councils tackle the barriers. The issues raised in Making a Difference : Direct Payments DH/Cabinet Office April 2005 need to be addressed, specifically:
_ users to enable their own CRB checks
_ users to purchase in-house services if they choose to
_ users to be given the support they need to manage a DP and this to be funded
_ a flexible approach to be taken to the definition of "willing and able" e.g. "able with support" which is how Hampshire has interpreted it.
_ Support for voucher schemes which offer the key characteristics of Direct Payments e.g. choice and control with fewer administrative inputs from users.
In addition the government should consider reducing costs and bureaucracy through explicitly not requiring registration with CSCI as a care agency for the following:
· independent living (user controlled) trusts
· agents
· people having a relevant last power of attorney
9. Name of Direct Payments
Direct Payments started in Hampshire 22 years ago and the scheme was called the Self Operated Care Scheme (SOCS). This would reduce any confusion with the DWP, however users would prefer the DWP to find another name for its Direct Payments.
10. Pilot Individualised Budgets
Hampshire welcomes the proposals on individualised budgets and would be keen to be a pilot site for:
¬ Young People in Transition to adult services
¬ People with mental health problems having a "recovery budget"
¬ Older People
11. Care broker/navigator role
Hampshire is piloting care broker role in learning disability day services where brokers help people with learning disability access local community activities. This is working really well and could be extended to other excluded groups.
The `Care Worker' role is widely used in Hampshire enabling the more effective procurement of residential, nursing and domiciliary care. To extend this to people with an Individualised budget needs careful consideration relating to the earlier points about risk.
Both broker and navigator roles free up scarce social worker resources for more complex cases and are welcomed.
12. Impact of shifting balance from high level needs to earlier preventative interventions on eligibility criteria and FACS?
This is really a question of funding for social care. Whilst there is some anecdotal evidence that preventative services save money in the longer term, more research is needed on this - perhaps along the lines of Innovation Pilots in Hampshire, see Appendix 1 (get innovation paper) - although the savings are not necessarily made on SSD budgets e.g. preventing hospital admissions is a PCT saving.
What will also be needed is a cultural shift in other service providers in reinvesting in services determined through greater citizen choice.
13. Strengthening leadership
The Council values the emphasis on the role of the DASS alongside the Director of Children's Services. Hampshire has already recruited to these key corporate posts demonstrating commitment to this agenda.
The Council has a Cabinet lead for Adult Social Services as Members see this as the best approach to strengthening leadership at Council Member level.
14. Strategic Needs Assessment
This will be essential to harness the community and voluntary sector resources to meet ever increasing need and design new and innovative ways of meeting need. In two tier council areas, LSPs and LAAs will become a crucial catalyst for change across all council services. Consideration should be given to making the production of a strategic plan for adults a statutory duty.
15. How can local authorities stimulate market?
In part this can be achieved by building on person centred approaches and giving users' budgets to determine how their needs can be met. There is some evidence in Hampshire that staff employed by Direct Payment users are different to the traditional domiciliary care staff. Working with providers to encourage them to develop person centred services e.g. in Hampshire we are asking providers to sign up to a Person Centred Charter which commits them to listening to users' needs and responding individually to these needs.
Stimulating new market responses rests on a clear vision for adult services and an assured income stream over many years, if commercial interests are to respond. There is clear evidence this has been successful following the Community Care reforms during the mid `90s.
16. Do you support the proposal to develop a strategic commissioning framework?
A strategic commissioning framework across all adult groups and all relevant services is a step change beyond current practice. It is essential if we are to deliver responses to the longer term demographic challenges. Partnership is the key to developing a coordinated strategy and Hampshire welcomes the view that decisions about the best models to suit local circumstances should be made locally.
17. Is the proposed shift to a preventative model of care the right approach?
The approach is commendable and something Hampshire aspires to. However, there is little evidence that preventative services actually save money. It will not be possible to invest substantially in preventative services as well as meet the needs of the increasing numbers of older people without additional investment. We can achieve a gradual reinvestment from `traditional' services, if demand and expectations change. But this cannot replace the need for new resources and we await the Wanless review of social care funding with great anticipation. The Partnerships for Older People Projects investment is welcomed.
18. Views on approaches to promoting and developing partnership
The Council welcomes the flexibility to build on local partnerships and that there is no one prescribed model.
19. What help and support is needed to help local authorities and other social care providers to work with carers to transform services?
The Council and other social Care Providers have been able to engage carers in service planning and delivery though this could be more effective and deliver more outcomes if the following were addressed:
· Additional resources
To enable carers to participate in service transformation, additional resources are required.
There are costs involved in carer representation: training; travel; alternative provision of care. Hampshire already supports carer representation and meets associated costs, but further resources would help and support the Local Authority to ensure that carer involvement was developed across all care groups and in all areas of the Authority.
It is mentioned that there are resources which are locked within the system and it is intended to `un-lock' these as part of the process. In the absence of additional, transitional resources any disinvestment or `un-locking' of existing resources may not be supported by carers who rely on existing service provision. Carers may resist plans to un-lock resources if their needs are not taken into consideration and may not participate fully in the change process as a result.
· Support Social Care Providers to move toward long-term planning
Social Care Providers can improve working with carers if supported to develop long-term plans for the provision of that care.
Responding to changing priorities and initiatives has encouraged short-term planning for social care provision. Independence, Well-Being and Choice presents a longer-term vision for social care which, if enacted, should enable the establishment of effective, cross sector networks and partnerships.
From this basis, these partnerships will be better placed to offer the co-ordinated response desired by all stakeholders.
· Effective mechanisms for partnership working
Investment and development of Local Strategic Partnerships LAAs and Compacts could offer more effective, multi-agency platforms for partnerships. If supported to develop these partnership mechanisms, carers could be involved as part of the ongoing decision-making process.
· Support to develop outcome-focused strategies
Carers do not always believe that they see proportionate outcomes as a result of their efforts within service planning and development frameworks. They report feeling that `nothing ever changes' or that they were `making up numbers' on committees or groups. Support to develop outcome-focused strategies as presented within the Green Paper and could assist working with carers for change.
20. Do you have innovative models of provision that support the outcomes of our vision?
Hampshire has a range of innovative models of provision including the innovation pilots aimed at preventing admission to hospital, adult placement schemes, shared home ownership for people with learning disability, extra care housing strategy and homes. We would be willing to share the learning from these as they develop.
21. Do you have views on appropriate performance measures to encourage the implementation of the vision?
As stated above, performance measures need to be focussed on user experience rather than numbers and measurement. Performance measures need to be joint with the NHS and other partners to reduce the bureaucracy where many services are already integrated.
22. How can central government best enable LSPs develop and monitor progress on cross cutting issues?
The Local Area Agreements provide an opportunity to develop and monitor progress on cross cutting issues. Criteria for central grant provision could include evidence of partnership working via LSPs with an indication of which LAA "block" the funding request fits. A joint performance framework of existing targets for each LAA block could be developed and monitored. It would be helpful to establish a national learning set on LAA/LSP to include central government policy makers and publicise good practice.
23. Do you think the direction proposed for strengthening and developing skills in the workforce is right?
The Council believes that the direction proposed is sound. However, it is very important not to see skills development as the whole answer. The change in culture and attitudes that is required to deliver the vision is unlikely to be delivered solely by training and development programmes, important though they are. This goes to the fundamentals of an individual leader/manager's values and if they are not aligned with the aspirations in the vision, it is unlikely that they will be able to deliver it. What is required is a paradigm shift that encompasses leaders and managers across all delivery sectors, including the very diverse and therefore more difficult to reach, forms of delivery in the private and voluntary sectors. Thus the strategy needs to encompass other methods to achieve the shift across the country, as well as training and development.
24. How can we improve and better integrate local workforce planning?
Great moves forward have been made with this in recent years through the local and regional planning groups. However, contracting processes with Skills for Care and confidence in continuity of government funding need to improve if organisations are to be willing to enter into arrangements to deliver objectives.
As greater inter-agency working moves forward to deliver Independence, Well Being and Choice, the way power and resources are distributed amongst the partners needs to be balanced so that none is a `poor relation' of, and therefore disempowered with respect to, the other. Learning Skills Council and Regional Development funding needs to become easier to access for social care. Their national objectives, as well as of FE colleges and HEI's, need to explicitly include support for Independence, Wellbeing and Choice so that there is synergy across the workforce planning piece.
25. What actions are needed by Government and others to assist employers in recruiting, retaining and developing the workforce?
The Council believes that social care should be promoted as an attractive career that embraces the purpose and fundamental worth of delivering person-centred care. There is a need for improved reward, progression and status; but also there is a need to analyse what triggers the motivational response in people that in earlier times the county might have described as `vocational'. This should not be an excuse for poor pay and conditions but rather a valuing term - a way of engaging with higher level aspirations for fulfilment in workers and thereby developing the culture and vision expressed in the paper.
Until the popular mythology and perceptions of what social work and social care are about are reframed, (and drama and the media have a great part to play in this), then it will remain difficult to sell social care as an attractive career.
26. How can we strengthen the links with the VCS and increase community capacity?
Hampshire has excellent links with the voluntary sector who provide many local services. We recognise that by including them into a strategic commissioning framework there could be some potential to expand the range of services available. However, this will not be sufficient to meet the demands of the demographic changes. Many volunteers are already elderly and stretched to capacity.