1 Summary

The following decisions are sought.

1.1 That the Executive Member approves the direction and initial work on the changes laid out in the main report.

1.2 That the Executive Member receives further detailed reports about the specific areas of development as noted in sections 3,4 and 5 of the main report.

1.3 That detailed and costed action plans for implementation are scrutinised by the Social Care Policy Review Committee prior to further consideration by the Executive Member.

2 Reason(s)

To provide the agreed framework for the future development of learning disability services within the County Council. This will assist with the delivery of Corporate Aim 1 (Maximising Life Opportunities) through the promotion of social inclusion and access to community resources, Corporate Aim 3 (Achieving Economic Prosperity) through facilitating increased access to employment and Corporate Aim 5 (Improving Services) through ensuring that services are fit for purpose and reflect current service requirements and ambitions within the resources available.

3 Impact Assessment

This broad strategy for learning disability services has been impact assessed. It is recognised that larger scale services are less likely to meet the needs of people with a learning disability from black and minority ethnic groups. The future focus on direct payments, use of community resources and individualised service solutions as set out in this report are likely to promote fairer and more equal access to services. Individual project plans will be impact assessed in their own right.

4 Other options considered and rejected

To continue the current models of service procurement and delivery. This would not provide for high quality services that meet the expectations of people with a learning disability and their family and carers in line with "Valuing People; a new strategy for learning disability for the 21^st Century" (DoH March 2001) and would not be consistent with the current balance of demand and resources.

5 Conflicts of Interest declared by the decision-maker or other Executive member consulted

None

6 Dispensation granted by the Standards Committee

None

7 Reason(s) for the matter being dealt with if urgent

Not applicable

Approved by: Date of decision:

1 Summary

1.1 The purpose of this paper is to brief the Executive Member about current developments within Adult Learning Disability Services. It follows on from an earlier paper presented to the Policy & Resources Committee on 30 March 2005 and to the Executive Member on 1st April 2005 by County Manager (Learning Disability - Strategy) which set out to (1) to advise members of the progress made to date in Hampshire in implementing the 2001 White Paper "Valuing People" and of the key challenges ahead and (2) to gain member approval for the policy changes needed to ensure that Learning Disability Services are fit for the future and can deliver services within the resources available. The earlier paper was endorsed and supported by the Executive Member.

1.2 The pressures on learning disability services are such that they can no longer be provided or managed within the budget management approaches that have been historically used. These pressures, combined with the modernisation agenda set out in Valuing People, mean that much more significant service re-modelling is required. This will involve looking to deliver services in different ways, undertaking a different approach to the purchasing of services and looking to directly provide and re-provide some services. This approach does offer the opportunity to use overall resources in a more efficient way. Some initial investment will be required to develop these approaches and support the services re-modelling process in order to achieve the desired outcomes.

1.3 This paper sets out the developments needed to achieve the above and seeks Executive Member approval for these changes.

2. Introduction

2.1 The white paper "Valuing People: a new strategy for learning disability for the 21^st century" (March 2001 DoH) lays out the future vision for learning disability services. This vision reflected the direction of travel set out by Hampshire County Council Adult Services Department in "Changing for Choice" and the "1999-2004 Commissioning Plan". The key principles of Valuing People emphasise the importance of "Rights", "Choice", "Independence" and "Inclusion" for people with a learning disability and promote a model of citizenship and social inclusion. These key principles are reflected in other drivers and performance indicators, to which the department is currently working.

2.2 The principles detailed above are fully compatible with, and reflect the ambitions of, the Hampshire County Council Corporate Strategy. In particular, they reflect Corporate Aim 1 (Maximising Life Opportunities) through the promotion of social inclusion and access to community resources, Corporate Aim 3 (Achieving Economic Prosperity) through facilitating increased access to employment and Corporate Aim 5 (Improving Services) through ensuring that services are fit for purpose and reflect current service requirements and ambitions within current resources.

2.3 The proposed developments for learning disability services have been impact assessed. It is recognised that larger scale services are less likely to meet the needs of people with a learning disability from black and minority ethnic groups. The future focus on direct payments, use of community resources and individualised service solutions are likely to promote fairer and more equal access to services. Individual project plans will be impact assessed in their own right.

3. Short stay & residential care services

3.1 Respite opportunities :. The provision of respite care is an important means of support to carers. Currently, Hampshire County Council Adult Services Department has a significant portfolio of directly provided residential respite services that have varying levels of take-up. Feedback from services users and carers indicated the value of this provision, but also the need to develop more flexible alternatives to residential respite. One of the key issues highlighted in consultation exercises with service users and carers is the current mix of unplanned and planned respite beds within the same units. This has caused concern to both service users and carers as it has resulted in planned stays being cancelled at the last minute to accommodate an unplanned admission.

3.2 Additionally, concern was expressed that the high needs of service users following an unplanned admission reduces the service's ability to maintain the unit at full capacity. This, combined with compatibility issues between service users needs results in a poor experience for service users and planned stays being re-arranged. CSCI have raised concerns about current arrangements and would prefer to see a separation of planned and unplanned respite, particularly where unplanned respite results in stays of a long duration. Furthemore, our ability to meet the respite needs of people with high levels of support within the current building portfolio is limited given the style of buildings and the facilities they offer.

3.3 Recent research on in-house residential respite services has shown that services are currently operating under capacity. Total occupancy for units ranges from 57% to 86% with the highest occupancy figures being found at Orchard Close, a service that offers service users and their carers a more traditional `break' and which does not accept unplanned admissions. In the other units, planned respite only accounts for 34% to 59% of total occupancy. Therefore, at present, we do not have the correct configuration of planned and unplanned respite beds and services to meet the changed and evolving needs of people, particularly those with higher support needs. Feedback from service users, family carers and local managers suggests the need for more diverse forms of respite as opposed to the more traditional residential models, of which we currently have an overcapacity in some areas.

3.4 In addition, we are currently working in conjunction with PCTS and NHS provider trusts, as well as local families and groups on a number of projects, one of which is to develop Highfield House in Bishopstoke. This entail a purpose built extension to the building to accommodate people with more profound disabilities.

3.5 From the research it would appear that, to achieve the optimum volume of residential respite and meet CSCI expectations, we need to re-designate one of the units into a unplanned short stay service and review usage of beds at other units. This will reduce excess planned respite capacity and ensure a more effective way of meeting the demand for "emergency" placements, both to manage short term crises and allow longer term assessment and support work with individuals in order to make more appropriate, person centred, long term placements.

3.6 Redevelopment of Meadowcroft. Meadowcroft is a 10-bedded residential respite unit in Aldershot. It has seven planned short stay beds and three unplanned admission beds. Its average total occupancy for all beds is about 67%. Planned admissions only represent about 35% of total capacity whilst over half of admissions are unplanned admissions. Meadowcroft has the largest proportion of unplanned admissions out of all the short stay units within the county. As a consequence, it no longer effectively serves its original function as a planned respite service. The proposal is therefore to re-provide the planned respite currently offered at Meadowcroft and to make alternative use of the building and staff resources within the context of residential services to people with a learning disability.

3.7 As part of the process of reducing excess planned respite capacity in the county and better managing unplanned admissions, it is hoped to redevelop this service into an unplanned admissions service. This will alleviate the pressures on the other in-house residential units allowing them to be freed up to concentrate solely on planned respite provision and therefore substantially reducing the need for cancellations. This will make all the in-house units more effective and provide a better service to service users and carers. In addition, for those people who require an unplanned admission, this will be able to take place in a more supportive environment which maximises potential and reduces the need for subsequent high cost placements. The work of this unit will be supported by the development of clear admission, support and discharge protocols as well as work with the care management teams to improve care pathways for service users.

3.8 Service users who use Meadowcroft for unplanned admissions will be supported by staff focussed on understanding the causes of the unplanned admission (usually a placement breakdown) and developing person centred responses that will ensure the success of subsequent placements.

3.9 Service users who currently use Meadowcroft for their usual respite needs will be fully consulted, have their needs reassessed and alternative options developed. These may include respite within another in-house unit, adult placement respite or direct payments.

3.10 The overall redevelopment of our short stay services projects significant cost savings in terms of high cost placements being reduced through more planned and supported processes. The cost savings predicted for this initial reconfiguration are £159,000 for the year 06/07. A more detailed paper on this providing more detailed financial and activity data will be presented to members early next year.

3.11 Merryfield Reprovision. Merryfield is a 5 bedded residential home for adults with a learning disability owned by Hampshire County Council. It is located just outside the village of Liss a few miles from Petersfield. There are currently four people living at Merryfield, one of whom remains the funding responsibility of Portsmouth. A fifth person recently moved as the service could no longer appropriately meet their specific needs. Those living at Merryfield remain the financial responsibility of the local Primary Care Trusts through the wider Section 28a Transfer agreements across the South East of Hampshire. The income received as part of the Section 28a Transfer and other revenues received from Adult Services does not cover the actual cost of meeting the increasing needs of the current users at Merryfield. In addition, the relatively small size, location and changes needed to meet CSCI requirements mean that Merryfield is no longer economically viable in its current state or for its current purpose.

3.12 Individual re-assessment work has shown that individual needs can be better met in alternative accommodation, particularly in the light of the already depleted number of clients in the home This alternative accommodation is in more appropriate locations which permit better access to community resources. Across South East Hampshire, there are several block contracts for residential services that currently have void beds which can appropriately meet the needs of each individual. It is therefore proposed to re-provide Merryfield through individual solutions and consider the future of the site whilst the needs of the current residents are better met elsewhere. There are a number of vacancies in local learning disability services that can potentially employ staff currently at Merryfield. Consultation with other stakeholders will be carried out as part of the reprovision.

3.13 There are a number of modifications needed to current in-house residential buildings across the County in order to meet future CSCI requirements. The future of Merryfield will have to be considered in this context.

4. Maximising day opportunities:

4.1 This programme is a key component of Valuing People and emphasises the move away from large-scale day services in isolated locations towards individual support to access local community resources, develop social networks and to enter employment. This will need to be underpinned by significant changes in current day services buildings, capital investment in new buildings, the continued development of direct payments and re-modelling of existing supported employment services.

4.2 The future shape of day opportunities is likely to be local resource centres that offer direct support to people with more complex needs and a resource and signposting service that enables individuals to access local community services. Some day services, notably The Grove in Winchester, the cluster of services in Aldershot and the South East and the new service in Alton already broadly meet this model, other services will require significant change. This model moves away from larger scale group service provision and will promote choice, social inclusion and the achievement of individual wishes. Whilst this shift will be consistent with Valuing People, current and historic departmental policy and achieving key performance indicators, it is a more resource intensive method of working.

4.3 Basingstoke Day Service: Basingstoke has one of the largest in-house day service buildings in Hampshire. This, plus day services purchased with external providers currently offer support to more than 70 adults with a learning disability in the area. The main part of the in-house service is currently provided in a outdated building which does not comply with modern building regulations and is no longer fit for purpose, with the consequence that a large part of the building is not used.

4.4 We are seeking to re-model our arrangements for day services in Basingstoke, including the re-provision of the in-house building, reflecting increased service user choice whilst at the same time delivering a cost saving of £165,000. The intention is both to improve and individualise service quality while at the same time achieve a proportion of cost savings by utilising community facilities. All service users receiving day services within Basingstoke will be consulted, with alternative models and methods of service provision explored. Other stakeholders will also be consulted, with a further report to be presented to Members early in 2006

4.5 Cost pressures: In order to manage the current mis-match between demand for services and resources available, all day opportunities in the county will be reviewed. This review work will cover the relative costing of internally and externally provided services, including both spot and block purchased services, the provision of services to people from other local authorities and to people in residential care, the volume of service provided to individuals and the continued provision of activities such as swimming without a cost to each individual. Changes are likely to be made in some or all of these aspects following the review work and a period of consultation.

4.6 Through this process, it is hoped to derive economies that will allow services to be provided within the resource envelope available and move towards the aspirations expressed by service users. This will sit alongside the current tendering work for supported employment that will see a new model of service provision with effect from 1^st April 2006 that will more closely link supported employment and day services.

4.7 Where feasible the indicative financial implications have been included in the paper, however these figures will require refining as the re modelling of services takes shape.

5. Integration:

5.1 As previously reported to Members, the process of integrating the Community Learning Disability services currently provided by the Adult Services Department and Hampshire Partnership Trust has begun. The model will be similar to that successfully developed in adult mental health services and proposes the achievement of single line management arrangements with common operational processes by April 2007.

5.2 Adult Services will have the lead responsibility for the delivery of community services across health and social care. The ultimate aspiration is to achieve co-located teams based in community resource centres that house the care managers, nurses, occupational therapists, day support staff and a range of other organisations such as supported employment providers. This would move towards a "one-stop shop" for service users and family carers. Achieving this will require a number of current day services to be re-modelled and re-provided in smaller, more community focussed buildings.

5.3 There has been outline consultation on a proposed framework for the process of integration. The consultation process included staff, service users, family carers, self advocacy groups, PCTs, Hampshire Learning Disability Partnership Board and Local Implementation Groups. There was enthusiasm and support for the broad principle of integration and the proposed framework, particularly the opportunity to develop improved care pathways for service users. People welcomed the clarity that the framework provided about employment roles, the opportunity for closer working and more consistent responses for service users and family carers. People raised concerns about how issues such as budgets and professional accountability would be managed. These concerns are similar to those raised at the start of the mental health integration process and the learning from that work will be applied to this project.

5.4 Integration is part of a wider process of modernising the way in which health and social care services are provided for people with a learning disability in Hampshire. This will ultimately include re-focussed community day services, more flexible respite, improved support for people whose residential or living arrangements break down, the continued growth in direct payments and improved specialist health services for people whose behaviour significantly challenges services, for people with a learning disability who have significant mental health problems or who have offending behaviour. The project plan covering integration and modernisation is now being developed and will set out the key milestones and the processes that need to be followed to ensure project success.

6. Conclusion:

6.1 The aim of this paper has been to brief Members on the current direction within Adult Learning Disability Services and inform Members of the major developments within this service. All of the changes are designed to ensure that these services both modernise and reflect the resources available and the increasing demand for services. We will, as identified in the main body of this paper, produce more detailed reports for Members' consideration early next year.

7. Recommendations

7.1 That the Executive Member accept this paper as an update on the progress made since the earlier paper presented in April which has already been endorsed.

7.2 That the Executive Member notes the development under consideration for Merryfield and agrees to formal consultation taking place.

7.3 That the Executive Member notes the development under consideration for Meadowcroft and agrees to formal consultation taking place.

7.4 That the Executive Member notes the developments under consideration for Basingstoke Day Services and agrees to formal consultation taking place.