Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

1.1. The purpose of this paper is to propose a public consultation on the implementation of a policy to promote independence and choice for Adult Services, which will support Personalisation and the introduction of Self Directed Support, and will strengthen the governance of Adult Services regarding assessment and decision making in professional practice. In supporting people who have needs which are eligible for support from Adult Services, risk is always present. This policy to promote independence and choice sets out a new approach to dealing with risk, and is part of the journey to move away from institutional care and towards supporting people in the community.

1.2. The proposed consultation will take place October - December 2009.

1.3. This paper seeks to:

· Provide an overview of the policy to promote independence and choice

· Describe the development of the policy and its context within Care Governance and the Personalisation agenda

· Consider the financial implications of the project in terms of delivery and budget management

· Consider how the implementation of the policy will impact on the performance of the County Council

· Describe the context in which the policy will be implemented and consideration of future work to refine and improve the policy, particularly with regard to consistency of approach across both commissioning and provider services, and the interface with partner agencies

2. Contextual information

2.1. The policy to promote independence and choice includes the following:

a) An explanation of the principles of positive risk taking

b) A framework which places support for positive choices within the Care Governance framework of Adult Services

c) Links to the main procedures and processes for Adult Services which include risk assessment, including Fair Access to Care Services (eligibility criteria) Safeguarding, Mental Capacity

d) Guidance for staff and managers about how to carry out and record a risk assessment which supports positive choice

e) Guidance for staff and managers about how to record decisions and the rationale for decisions which are made following an assessment

f) Clarity about the roles and responsibilities of staff and managers

g) Assessment formats for use by service users and staff carrying out assessments

2.2. The need for a policy to promote independence and choice has been identified through "Getting Personal - a fair deal for care and support", the report of Hampshire County Council's Commission of Inquiry into the future of social care - Appendix E of the Commission Report) and Care Governance.

2.3. In this context the key drivers for the implementation of this policy are:

a) The identification of a policy gap. National case reviews have highlighted the need for balanced decision making which is clearly evidenced in recording on case files, and improved information sharing between agencies (Inquiry into the death of Baby P in Haringey, Inquiry into the murder of Stephen Hoskin in Devon). Currently Adult Services has policy and practice guidance for risk assessment which is embedded in a large number of different procedures and protocols across practice, recording and health and safety, e.g. Adult Protection/Safeguarding Policy 2008, Records Management Data Protection Act Policy & Procedure 2007 and Risk Assessment 2006, but there is no overarching policy for Adult Services which supports managers and practitioners in a consistent approach to risk management which has a focus on supporting positive choice.

b) The need for an approach to supporting positive choice which supports the Personalisation agenda and specifically the roll out of Self Directed Support in Adult Services. The principles of Self Directed Support include increasing the choice and control of service users and carers and providing greater flexibility in the way people who are eligible for Community Care support can arrange their support. The delivery of high quality and safe services will require a robust framework for supporting choice during the assessment and support planning process which promotes the choice and independence of individuals, whilst balancing this with assessment of potential harm to the person or 3^rd Party. This approach is supported by practice guidance issued by the Department of Health in May 2007: Independence, choice and risk: a guide to best practice in supported decision making. Adult Services has, in common with a number of other local authorities, used this practice guidance to underpin the development of a policy which promotes independence and choice.

2.4. The work to develop this policy has been in progress since 2007 and has involved information sharing and collaborative work with other local authorities together with a programme of work within Adult Services which has included direct work with staff and managers together with learning from examples of good practice.

a) Interim staff guidance was issued in November 2007 through the Care Governance framework. This reinforced the need for recording of decision making and also provided information about the Department of Health practice guidance.

b) Workshops for Team Managers in Care Management, Occupational Therapy and Sensory Teams were delivered in 2008 with the purpose of supporting teams in using the interim guidance and exploring with managers what support they would need to be able to lead their teams in delivering a positive approach to supporting choice. The key outcomes of these workshops were the identification of a need for clear policy and guidance for practitioners and managers and a practical risk assessment framework which could be used by staff, along with improved recording systems for evidencing decision making. It was also identified that a programme of training to launch the policy, together with ongoing training and development for staff, would be required.

c) A draft policy to promote independence and choice was presented to Adult Services Departmental Management Team in January 2009 and was agreed as a working document for further development during 2009 alongside the Self Directed Support project to provide a cohesive approach to supporting positive choice for the implementation of Self Directed Support.

d) The draft policy has been used throughout 2009 in a series of briefings, workshops and training with senior operational managers, team managers and a cross section of practitioners from all teams across Care Management, Occupational Therapy and Sensory Teams. These events have been used to deliver the principles of supporting positive choice and to inform staff about how Adult Services proposes to implement the policy, and have also been used as a mechanism for gaining feedback from staff about the draft policy and what support staff will need to successfully implement the policy. This feedback has provided valuable information to support refinement of the policy and helped to identify further development work required. The overall response from staff to this training has been very positive and feedback suggests that staff are receptive to the policy, as it supports best practice and provides a consistent framework for assessment in social care practice.

e) Work has been carried out with departmental leads within Adult Services Care Governance Framework to ensure that the policy is consistent with other key areas of policy within Adult Services, including Safeguarding, Mental Capacity Act, and Quality Outcomes and Contract Monitoring framework, as well as Adult Services Provider Services.

f) In addition to the above, work with service users and carers was ongoing through the Commission on Personalisation in 2008. The draft policy has been discussed with User and Carer groups including Completing the Circle and the Personalisation Expert Panel, prior to full consultation.

2.5. Through this programme of work Adult Services has developed a policy which will support the department through the delivery of change and implementation of the personalisation agenda. This policy is seen as dynamic and will be further refined as the change delivery programme is underway.

2.6. It is intended to review the policy by March 2010 to ensure that it is fit for purpose for the implementation of Self Directed Support across Hampshire.

3. Finance

3.1. The policy will be applied within the current context of eligibility for Community Care Services (Fair Access to Care Services) and will therefore not have any impact on the Community Care budget.

3.2. Delivery of the policy will be achieved within the context of the overall implementation of Self Directed Support and the training budget for this. The programme of workshops and training already delivered has been achieved within the existing training budget for Adult Services.

4. Performance

4.1. The development and implementation of a policy to promote independence and choice supports Adult Services Risk Policy and the County Council's Corporate Risk Strategy and will contribute to the Corporate Risk Assessment.

4.2. The development of this policy has been identified as a requirement in the Strategic Risk Assessment for Care Management.

5. Future direction

5.1. The roll out of Self Directed Support, alongside the other pillars of the Hampshire Model, and improvements in procedures around quality assurance including the Quality Outcomes Framework are dynamic developments which will take shape in the next 1 - 5 years. In particular, changes which require market development and quality assurance systems e.g. for non-regulated care, are at an early stage and will need to be considered in the context of the provision of safe and high quality services. It is therefore recognised that any policy around supporting positive choice needs to be a dynamic policy which is regularly reviewed and is able to take account of, as well as informing, future changes. It is therefore proposed that the initial review of the policy will take place early in 2010 and regularly thereafter.

5.2. This policy is initially aimed at staff in Adult Services who support people to manage their own support through self directed support, or who commission services and equipment through traditional service models including Care Management, Occupational Therapy and Sensory Services. Initial work has been carried out with Adult Services Provider Services to explore how a consistency of approach to supporting positive choice can be achieved and this work will continue in 2009 - 2010.

5.3. Work is currently ongoing to establish agreed joint principles for a policy to promote independence and choice with partner agencies, particularly with NHS Hampshire, Hampshire Community Health Care, and Hampshire Partnership Foundation NHS Trust. This will be particularly important for integrated teams. Staff and Managers in integrated Learning Disability Teams and integrated Mental Health Teams have been involved in the workshops and training events in 2008 and 2009, and further work will be carried out to establish support for the principles of the policy to promote independence and choice atTrust board level, and to ensure that the principles of the policy are supported in all multidisciplinary assessments carried out by front line teams whether integrated or working within a multidisciplinary framework.

6. Recommendation

6.1. That Cabinet gives permission for Adult Services to consult on the implementation of the Policy to Promote Independence and Choice between October and December 2009.

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

Other Significant Links

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

1.1. An overall Equalities impact assessment has been carried out. This highlights that the implementation of the positive risk taking policy offers benefits across a wide range of groups in terms of increased equity, choice and control. The assessment highlighted the need for the implementation plan to include assessments to ensure that all current and potential service users are communicated with effectively. The assessment also highlighted the need to ensure that adult services staff who will be working with the policy will need access to training and development in positive risk assessment. These areas will be addressed in the implementation plan

2. Impact on Crime and Disorder:

The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all the decisions it makes on the prevention of crime. The proposals in this report have no proven impact on the prevention of crime.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

No impact has been identified.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

The approach to implementation has not considered the need to adapt to climate change in detail, however this will be taken into account in detailed planning.