Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

1.1. The purpose of this paper is to seek endorsement of the inter-agency Learning Disability Strategy for Hampshire "Ordinary People Leading Ordinary Lives".

1.2. The paper is today appearing before the Safe & Healthy People Select Committee for information.

1.3. This paper seeks to:

· Improve the lives of people with a learning disability.

· Provide the national and local context for the development of the strategy.

· Show that the strategy provides a framework for aligning work programmes across agencies and identify specific resources that have been utilised in achieving the outcomes required.

· Identify key areas where the performance of Hampshire County Council will improve as a result of implementation of the strategy.

2. Contextual Information

2.1 In December 2007 the Department of Health issued the first draft of the revised White Paper "Valuing People Now". This was designed to update and strengthen, but not replace, the original White Paper "Valuing People" which was published in 2001.

2.2 Hampshire Learning Disability Partnership Board drafted a response to this document in the form of an outline strategy, entitled "Ordinary People Leading Ordinary Lives". The Board is made up of service users, carers, elected members, Hampshire County Council officers and representatives from statutory and voluntary organisations.

2.3 Hampshire County Council is the lead agency for ensuring that people with a learning disability receive effective services. This responsibility is being discharged through the implementation of this strategy, which will drive service change. The strategy is based on consultation with local people and as such reflects local views and local choice. It will be the driving force behind the changes that will be made to enable people to have real choice and control.

2.4 The Executive Member for Adult Social Care gave permission for a formal consultation exercise on 22 February 2008. The Partnership Board then undertook this exercise between 1 April 2008 and 1 July 2008 (see Appendix C). The purpose of the consultation exercise was to gather the views of service users, carers, elected members, voluntary organisations, social care professionals and other stakeholders. The consultations took place in nine venues across Hampshire and involved over 550 people, many of whom were service users. People were supported to express their views either on a one-to-one basis or in small facilitated groups.

2.5 Further consultation then took place through the Local Implementation Groups, which are local sub-groups of the Partnership Board.

2.6 The key outcomes of the consultation exercise were as follows:

· Employment and education: many people would like to learn and to go to work.

· Day Services: some people were concerned about potential changes to in-house services.

· Housing: people want their own home and to choose with whom they live.

· Carers want better support and want more respite in the evenings and weekends.

· Health: people working in primary and secondary health need more knowledge of the needs of people with a learning disability.

· Social life: People want more things to do in their spare time.

· Transport: this needs to be improved, especially in rural areas. More effective use will be made of Hampshire County Council's specialised transport (such as day service vehicles). More work will also be undertaken with district councils to improve consistency of approaches in supporting people to access public transport.

The full results are available on Hantsweb: http://www3.hants.gov.uk/adult-services/aboutas/consultation-involvement/consultation-outcomes/learning-disabilities-consultation.htm

The results of the consultation exercise were incorporated into the strategy.

2.7 The key points of the strategy are as follows:

· Employment and education: more people will be enabled to work in both paid employment and voluntary activities. Through working with Hampshire Learning and the Further Education colleges, people will be enabled to gain the skills needed to improve their chances of gaining employment.

· Day Services: more work is being done to move to a model of resource centres in socially integrated settings that will enable people to access mainstream services such as education and leisure.

· Housing: more people will live in "settled accommodation" such as supported living and shared ownership schemes.

· Carers: we will develop better forward planning for people living with older carers.

· Health: we will work with NHS Hampshire to ensure that people with a learning disability are offered an annual health check and that primary and secondary health services are better able to respond to people with a learning disability.

· Social life: Hampshire County Council Adult Services are working with Hampshire County Council's Culture, Communities and Rural Affairs Department (CCRA) to promote access to cultural and leisure facilities for people with a learning disability. A post is dedicated to this purpose within CCRA.

· Transport: a review of transport is being undertaken to support access to mainstream activities.

· An action plan is being developed to implement the key points of the strategy.

2.8 As a response to the Equalities Impact Assessment, the following work has been progressed:

· Transition workers are now responding to young people coming into the country over the age of 14 more rapidly to ensure that they have a statement as quickly as possible. The issue identified was that young people were not receiving a statement at this age and therefore were not receiving the services that they needed.

· Information on translators and interpreters has been improved and made more accessible so that more people are able to use these services.

· A sub-group of the Partnership Board has been established to work on hate crime, which can be specifically aimed at people from black and minority ethnic groups and people from newly arrived communities.

3. The Hampshire Model

3.1 The Learning Disability Strategy is a key component in the effective implementation of the Hampshire Model.

3.2 The Universal Offer: universal services (services that everyone uses) such as health, housing, employment and leisure are the key components of this strategy. Wherever possible, people with a learning disability should receive the support that they need to use the same services as anyone else.

a) Health: people will be supported to use mainstream services wherever possible, such as their General Practitioner, dentist and hospital.

b) Housing: more people will live in mainstream housing, either through their district council or through shared ownership. Fewer people will live in residential care homes.

c) Employment: people will be supported to find jobs by having better pre-employment training and preparation and through work with employers to find suitable opportunities.

d) Leisure: Hampshire County Council Adult Services and Culture, Communities and Rural Affairs departments are working closely together to improve access to libraries, recreation centres, clubs and other mainstream leisure activities.

3.3 Self Directed Support: self-directed support means that people will have control over the money that is allocated to them. They will also have a person-centred support plan showing how they are going to spend their money to meet their needs. They will be able to choose the services that they want and make choices about how they want to live their lives. People will be able to take reasonable risks, in line with Hampshire County Council Adult Services Department's draft Policy to Promote Independence and Choice.

3.4 Learning Disability Transformation: to mark the importance of this area of work, changing services for people with a learning disability has become a priority in its own right. This means that decisions about key pieces of work for adult services can be made in one targeted group. This will include looking at Hampshire County Council's own in-house services.

3.5 Market Development: In order for people to have more choice, there needs to be a wider variety of services available. Within Learning Disability services, we will work with service providers to support them to develop services that respond to what people want. We will also identify where there are gaps in the services that are available and encourage new providers to come into Hampshire to offer more choice for individuals. In order to be able to develop new services more efficiently, we have conducted a strategic needs assessment of all people with a learning disability who use services paid for by Hampshire County Council's Adult Services Department. We are also developing a Framework Contract for supported living and Individual Service Funds to support people's choice and control over their services.

3.6 The Strategy will also promote improved service user involvement which is critical to the implementation of the Hampshire Model. Work is presently underway with the Learning Disability Partnership Board and the Local Implementation Groups to strengthen the voice of service users in the decision-making process. This will build on the already developed network of service user groups.

4. Finance

4.1 Finance is not an explicit element of the strategy, but implementation should have an impact on the way in which key agencies use their resources.

4.2 More in-depth planning is underway which will involve detailed analysis of the financial implications (both capital and revenue) of key aspects of the strategy, such as the development of Resource Centres. This will result in subsequent reports to the Executive Member for Adult Social Care.

4.3 Hampshire County Council Adult Services Department has allocated £600,000 for one year to support the implementation of the changes proposed (see budget plan).

4.4 Hampshire County Council has been able to pursue the interests of people who either now live, or in the past have lived, in NHS campus accommodation through use of the Campus Reprovision Programme Revenue Grant.

4.5 The Learning Disability Development programme grant of £699,000 has been used directly to implement key areas of the programme, most specifically:

a) Expansion of the Universal Offer

b) Advocacy and Person-centred Planning

5. Performance

5.1 The strategy will improve performance in the key areas included in PSA16 (Public Service Agreement 16), which includes National Indicators 145 and 146:

a) Increase the number of people with a learning disability in paid employment

b) Increase the number of people with a learning disability in settled accommodation.

6. Future direction

6.1 The strategy will result in a period of intense development up to the end of 2011.

6.2 Further reports will be submitted to the Executive Member for Adult Social Care on the key aspects in the strategy, specifically those with resource implications for Hampshire County Council.

7. Recommendations

7.1 That the Executive Member for Adult Social Care endorses the inter-agency strategy developed by the Learning Disability Partnership Board "Ordinary People Leading Ordinary Lives".

7.2 That further reports are submitted to the Executive Member for Adult Social Care on key aspects of the strategy, specifically those with resource implications for Hampshire County Council.

7.3 That the strategy is presented to the Health and Wellbeing Partnership Board and the Health Overview and Scrutiny Committee for further consideration of the health elements contained within it.

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

Other Significant Links

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

1.1. This strategy will have a positive impact on young people in transition and for adults with learning disabilities to be trained for, and enter, paid employment.

1.2. Increased communication and consultation will help alleviate any concerns raised through this change programme.

1.3. The Ethnic Minority Learning Disability project will be key in ensuring that the objectives of this strategy are understood by minority groups and that these groups are supported to benefit from it and access support services. Professional interpreters and translators should be consistently used by all services in their relations with clients if people for whom English is a second language are to benefit from this strategy. Faith should be recorded so that needs associated with religious beliefs are not ignored. Training should include Lesbian, Gay, Bisexual and transgender issues so that people from these groups can benefit from the full personalisation agenda.

1.4. We are working with people from Black and Minority Ethnic groups and newly arrived communities to support people in improving their skills in English. Support is offered both to people with a learning disability themselves and to their family carers.

1.5. Young people aged 15+ to 19, newly arrived in this country, from Black and Minority Ethnic groups have been identified as being at risk of not benefiting from this strategy.

2. Impact on Crime and Disorder:

2.1. The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all decisions it makes on the prevention of crime.

2.2. Work is underway to reduce the incidence of Hate Crime against people with Learning Disabilities.

3. Climate Change:

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

The Learning Disability Strategy proposes to support local organisations providing services within local communities. This reduces the need to travel and therefore reduces both the carbon footprint and energy consumption.

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

The Learning Disability Strategy recognises the need to adapt to climate change.

Ordinary People Leading Ordinary Lives

An analysis and commentary of the material collected in note form at the county wide meeting and the local meetings held as part of the formal consultation process.

Introduction

The questionnaire which was used as the format throughout the meetings asked 7 specific questions (see below) however service users and carers also developed, as requested, a further 9 issues (see below) that are included.

This analysis is taken from the notes taken at the meetings by a range of people and although they record the points discussed these notes cannot necessarily reflect the mood of the discussions or the underlying themes that were spread across the meetings.

At Appendix 1 of this paper are the key perceptions of the meetings which were all attended and observed (bar 2) by the author of this paper. The author discussed the 2 meetings he did not attend with the members of the commissioning team who were present.

At Appendix 2 is a short commentary on the consultation programme.

Questionnaire issues:

1. Will the plan help

2. Work and training

3. Health

4. Housing

5. Community membership

6. Priorities for service

7. Choice, control & the `parliament'

Additional issues:

A. Personal relationships

B. Social Opportunities

C. Trust

D. Safety

E. Support staff

F. Range of individual abilities and needs

G. Transport

H. Carer support

I. Information

Analysis in order of the number of comments made

1. Training, skills and work

The issue that caused the most comment was from question 2 - work and training. There were four main comments in this section:

· Training

· Life skills

· Obtaining work

· Suitable Occupation

In addition there were several comments concerning the effectiveness, or more commonly otherwise, of the supported employment providers, the suggestion being there was not enough flexibility in the contract and that finding work was not happening.

Training - there were several comments concerning changes in adult education provision that had not been to the advantage of people with a learning disability. I.e. courses being certificate focussed and time limited and often a lack of support in colleges.

In relation to training and life skills it was emphasised that if skills are not maintained and used, for example, through someone being able to move into a house and use what they have learnt, the skills are quickly lost. Too often, training does not coordinate with what else is taking place in the person's life.

Many respondents want to work however there are issues around benefit payments which do not encourage work and the increasing difficulty of finding work, with employers not being willing to take on people with a learning difficulty. Work means different things to different people, ranging from paid employment via voluntary work to realistic occupation.

Many comments were made around people's differing abilities and needs and that although many may never formally work, everyone needs occupation in order to feel valued.

2. Will the plan help?

The second most common issue to be raised is in response to question 1. The plan is generally well received and theoretically seen as supportive to people. However, as reported elsewhere there is very considerable scepticism over the outcome.

There were a number of comments that directly challenged whether this was an exercise in simply closing day services in order to save money. In a few cases, these were then reinforced by written comments.

There was also a significant number of comments concerning the need for the plan to address the different needs and abilities of people - it was thought that the plan focused too heavily on those with the most ability as this is where the successes can be more easily seen.

3. Housing

Of almost equal interest was the subject of housing. Other than people wanting access to the right housing for them and demonstrating how important this is by the number of comments made, there were two particular issues that arose:

· The ability to choose who people live with - many users thought they had no choice who they shared with. Also a number of responses indicated people wanting to live with their partners and not always being able to.

· Support staff - finding the right support staff who are able to work with people by encouraging further development through providing choice and greater control to the individual.

4. Carers' support

The fourth subject and the first to be raised as an issue outside the questionnaire is carers' support. A summary of the most frequent comments are:

As is reported elsewhere, there was often anger or very strong feelings expressed at the meetings. There is often a clear demarcation between what carers want and what the service users want, e.g. service users reporting that they `are not allowed' to do certain things. In addition, there were statements that only carers really understand what the person they care for wants and/or is capable of.

In addition there were a number of comments on the need for respite, both during the day and for longer periods to allow holidays. It was also pointed out that there was often no alternative than for people with a learning disability to be at home in the evening and at weekends and on the days when no outside activity was provided.

5. Health

Comments in respect of service provided varied from excellent to poor in terms of the service received. Great value was put on having a good GP, one who would listen and take the time required. The long term GP/patient relationship is valued and essential.

Although there were reports of excellent secondary care, the majority of comments were that in secondary care there are not the person skills required to support people with a learning disability and little attempt is made to give them.

It was reported that someone who knew them and was able to communicate with them could never leave people with a learning disability unattended in hospital; it was too much of a risk. This is often a severe challenge both for families and care staff.

Also comments on the apparent gap between Learning Disability services and Mental Health services where people have a dual diagnosis.

6. Priorities

These reflect the order outlined in this paper.

7. Social opportunities

This was the second issue raised outside the questionnaire. A range of comments were made about the lack of social opportunities for people with a learning disability as well as the importance of those social opportunities.

It was pointed out that people with a learning disability often are not accepted by the wider community and also are not necessarily safe or feel safe in that community. People who have moved into their own houses often reported that they had nothing to do at night and weekends. Carers commented on their frequent driving role to enable people to access what there is.

8. Choice, control and a user `parliament'

The latter was not well received, although this may be due to unfortunate timing as the national parliament was very much in the news at the time of the consultation and not always to its credit.

Service users also strongly reported that they did not want to be represented but wanted to speak for themselves.

Some carers suggested that service users would always agree with whatever was put to them so they were sceptical of the value of a `parliament'. Other carers pointed out that many people would not be able to take part in such a forum so their views would not be heard. This latter point is referring to those with high support needs and communication needs.

Through this consultation, choice featured in many aspects not only from service users but from carers who both commented that they did not get choice but were told what was, or was not, available.

9. Trust

Of equal importance to the above point is the subject of trust. Many carers feel they are not able to trust the authorities and they have to rely on themselves. There were a number of comments reflecting that people had been often let down in the past and did not, on the surface, see why they should trust the authorities now.

10. Transport

Varied comments on transport - safety, lack of public transport in rural areas, need for specific training for individuals, long transport routes to day centres, need for dedicated transport to be provided for additional activities, and transport to work opportunities.

11. Support staff

Where will they come from? Who will train them? There is a lack of consistency. The whole plan needs support staff but there are not enough.

12. Information

Many comments on the challenge of finding practical service information as well as policy information - often other parents are thought to be the best source.

13. Range of individual needs and abilities

There were not so many specific comments but spread throughout the consultation was the fact that it will be important to specifically address the range of needs. In particular, autistic spectrum and those with high support needs, challenging behaviours, and dual diagnoses.

14. Community membership

There was a distinct note of caution in response to this issue. This was about safety and opportunity. When commented upon, hate crime was referred to as an issue, but general risk of being out and about was the concern. The issue of available staffing and support arose as it is thought this is provided on a minimal level.

15. Safety

Raised in respect of 1, 10 and 14. It is a constant concern, particularly for parents of young women.

16. Personal Relationships

Only mentioned by a few - though perhaps this is a difficult subject in a mixed group - but a strong demand for support and encouragement for long term relationships. Also mentioned under housing in the context of choice and how some people want to live with their chosen partners.

Conclusion

A positive overall reaction to the Draft Learning Disability Strategy but with a wide range of issues that are seen as particularly important. Almost without exception those who took part were concerned about:

1. Having their scepticism and lack of trust removed

2. Having the opportunity to be further involved in the development of a real future.

3. An action plan that is deliverable, meeting the needs of individuals.

Geoff Woollan

Commissioning Officer

June 2008

Appendix 1

Key Perceptions from observing the consultation meetings

(from the author of this paper)

1. Who speaks for whom - there can often be a wide gap between the expressed needs of carers and the expressed needs of service users.

2. `Ordinary people leading ordinary lives' - neatly sums up the aspirations of the service users in all respects.

3. Trust - perhaps the single most important issue i.e. there is a real lack of trust by parents/carers of the authority based on history and aggravated by the recent financial adjustments. Frequently the issue that had to be dealt with first was whether the consultation was an exercise in closing down the local day service.

4. Cynicism - `we've heard it all before, but it never happens !', `where is the money for all this ?' - comments prevalent at every meeting.

5. Safety - a major concern for parent/carers, and probably a barrier to progress from their point of view.

6. Parent/carers - often feel unsupported and desperate to hang on to what they have. Feel they are not understood and also feel bitter as a result of past experience and the prospect of having to `carry on in to the future'.

7. Surprise - expressed both by parent/carers and some staff, that `headquarters' has come to listen. Not expressed by service users but probably only because of a lack of understanding of the strategic role.

8. Communication and information - much valued and much sought after.

9. Choice - a complex issue, one that service users say they want, but do not get. One that parent/carers say they personally never get and the people they care for often cannot cope with it and are unable to make real choices anyway.

10. Self directed support - there appears to be a considerable amount of misunderstanding among parent/carers especially, but also some real interest.

And finally - almost simultaneously there has also been a survey of service user views conducted by Hampshire County Council Adult Services (Physical Disability Commissioning team) of those who attend physical disability day services. In broad terms exactly the same issues and comments arise. In detail the implementation issues are also often similar.

Geoff Woollan

Commissioning Officer

June 2008


Appendix 2

The Consultation Programme - comments

A 3 month consultation period - 3^rd March to 3^rd June 2008 (13 weeks) was held.

First communication was undertaken by Hantsweb publication and widespread stakeholder e-mails. Every communication asked that the receiver `pass it on'. Unable to say how effective this was but sense that it was very varied. Certainly although word of the consultation may have been passed on, the documentation possibly was not.

An early public meeting at The Maltings (3^rd April) was followed by local meetings organised by local day services units who were requested to extend invitations throughout the `local Learning Disability community' to include all stakeholders. There was no meeting at Borden or Alton due to the meeting at The Maltings and there was no meeting at Locks Heath due to the needs and abilities of those who attend there - parent/carers were invited to contribute in writing. The service users at Locks Heath were enabled to take part by a programme run by a student on placement who, through individual interviews sought to judge degree of satisfaction with the service.

Each public meeting was attended by members of the Learning Disability Commissioning Team and a brief presentation was made on the overall theme of the strategy followed by small work groups that used the questionnaire as a guide for their discussions.

Hindsight on the local meetings

Where meetings were arranged and took place in the local day services unit, it would seem that the local community may have seen the event as only pertaining to those who attended the day service. Where the event took place away from the day service unit a) this was not quite so strong a perception and b) comments/discussion appeared to flow more freely.

The exception to the above was Andover where Andover Day Services may be seen as the centre of the Learning Disability community and comment/discussion was fast and fulsome. The other exception was Basingstoke which was organised by the local Learning Disability broker who is based away from the day services and a much wider range of people attended and again comment was fast and fulsome.

Greater public communication and explanation was needed as to the purpose and opportunity of the consultation and staff in the department may need at times to accord consultation and therefore involvement a higher priority in their workloads.

`One size does not fit all'. Communication with people with a learning disability covers a wide range of abilities and skills - clear evidence that they were better able to communicate in small separate groups or individually. In the public meetings the presentation was nearly always not understandable, but parent/carers and other stakeholders may not have valued a much easier access version. However also evidence that many service users wanted to be part of public meetings even if they did not understand it all - they did not want to miss out.

Should a strategy consultation also include an action plan consultation ? Especially where the strategy is one that people are probably going to sign up to in broad terms; implementation becomes the key factor.

Overall consultation numbers - estimates

Public meetings

Over 450 attended the public meetings.

Written responses

Over 65 people responded in writing plus groups which add another estimated 50 to the total.

Total

In total well over 550 people with an interest in learning disability services took part in the formal consultation. It is not possible to accurately estimate the number of service users who took part but observation suggests a minimum of one third of the total.

At risk

Every piece of written material has been reviewed and there is no indication of any situation that requires individual follow-up.

Conclusion on consultation process

There is no substitute for direct contact in consultation for this group of people.

It would be an expectation that a subsequent series of events linked to the implementation and outcomes of the strategy combined with clearer expectations of the process would lead to greater involvement on the part of both service users, parent/carers and other stakeholders.

Although initially the public meetings often felt like a one way event (service users and carers, and occasionally staff, `at' the commissioning team) in nearly every case a real dialogue developed within a short period indicating people's keenness to be actively involved. Almost universally everyone who took part welcomed the opportunity to be involved and looked forward to a further opportunity.

Geoff Woollan

Commissioning Officer

June 2008