adult social services prevention and transformation - promoting independence janice dane assistant...

Adult Social ServicesPrevention and Transformation

- Promoting Independence

Janice Dane

Assistant Director Early Help and Prevention

20 October 2015

Care Act

• Biggest change in social care legislation since 1948.

• Very important for Norfolk because of demographics.

• Puts various aspects of social care on statutory footing, ie Safeguarding.

• Good news re priorities including: carers; wellbeing; personalisation; safeguarding.

• Risks: whole system needs to be adequately resourced for changes in funding of adult social care.

From April 2015

• National minimum threshold for eligibility – Eligibility set nationally based on risk to the individual's wellbeing (as opposed to the risk to the individual's independence). Similar to critical and substantial, which was NCC’s policy.

• Assessments, including carers' assessment - Anyone with a perceived social care need can request an assessment. Assessments are to focus on early intervention and prevention. Assessments are to take into account the person with needs, their family and carers.

• Early intervention and prevention - Supporting people as early as possible to help maintain their wellbeing and independence.

• Personal Budgets and care and support plans - Outcomes of support planning should be continuing independence and wellbeing. New Independent Personal Budgets for anyone with eligible care needs.

From April 2015

• New Charging framework.

• Universal Deferred Payments Agreements - People who face the risk of having to sell their home in their lifetime to pay for care home fees have the option of a deferred payment, regardless of whether or not the local authority pays for their care.

• Information, Advice and Guidance and Complaints - New duty to provide advice and information to service users and carers who do not meet the eligibility threshold. Councils are required to provide comprehensive information and advice about care and support services in their area and what process people need to use to get the care and support that is available. They also need to tell people where they can get independent financial advice about how to fund their care and support.

From April 2015

• Councils are required to provide independent advocates to support people to be involved in key processes such as assessment and care planning, where the person would be unable to be involved otherwise.

• Integration - Duty on councils to join up care and support with health and housing where this delivers better care and promotes wellbeing.

• Market Development and Commissioning - Duty on councils to ensure there is a wide range of care and support services available that enable local people to choose the care and support services they want (market shaping).

• Safeguarding and Aftercare Mental Health - First ever statutory framework for adult safeguarding. Requires local authorities to ensure enquiries are made into allegations of abuse or neglect, and to establish a safeguarding adults board (SAB) in their area

• Transition Child to Adult - Duty to assess young people, and carers of children, who are likely to have needs as an adult where it will be of significant benefit, to help them plan for the adult care and support they may need, before they (or the child they care for) reach 18 years. Legal responsibility for local authorities to cooperate to ensure a smooth transition for people with care needs to adulthood

From April 2016

• Extended means test - Increase in capital thresholds /extension to the means test providing more support to people with modest wealth.

• Capped charging system - Introduction of a cap on costs of meeting eligible needs for care and support (to be set at £72,000 for those of state pension age and above when it is introduced) including independent personal budgets and care accounts. No contribution expected for young people entering adulthood with an eligible care need. Lower cap for adults of working age (level to be determined). Everyone will know what they have to pay towards the cost of meeting their eligible needs for care and support. People will be protected from having to sell their home in their lifetime to pay for any care home costs. People will be helped to take responsibility for planning and preparing for their care needs in later life.

• Care Accounts

• However on 17 July Government announced deferment of Part Two of the Care Act until 2020.

Key Statistics about Adult Social Services

• Provides Services to 13,000 users

• We have 71,000 contacts per annum

• Gross Budget 2015-16 of £359m, net £242m

• Spend with the private and independent sector £300m

• Integrated services with the NHS and work closely with the voluntary sector and other partners

Prevention and connection in communities

• Our aim is to keep vulnerable people safe and well at home in order to retain their independence - from formal care services where possible

• We know the things that help sustain people’s independence and we have an interest in seeing these in local areas:- social contact- employment or other meaningful activity- sufficient income/managing financially- appropriate housing- healthy lifestyles- carers and families who are able to cope- treatment for health needs- access to social care services where needed.

Promoting Independence

Involvement in your

community

Getting better after

being ill

Getting early help when you need it

Getting support for

your complex health needs

Running your own life – making choices and decisions

Looking after yourselfKeeping well & recovering your

healthLiving with complex health

conditions

Getting information and advice

Managing your long

term health condition


Living independently at home

Excellent in education

Real jobsQuality of life for

vulnerable people

Accountability and performance


Involvement in your

community

Getting better after

being ill

Getting early help when you need it

Getting support for

your complex health needs

Looking after yourselfKeeping well & recovering your

healthLiving with complex health

conditions

Getting information and advice

Managing your long

term health condition

=• Reduced costs of care

packages• Better use of other

resources and assets

• Change the mix of:Care at homeHousing with careResidential care

• Review personal budget process

• Transport review

• Review of the customer pathway

• Strengthen website• Enabling communities• Work with VCS

=• People find solutions

in the community• Fewer people come to

NCC• Fewer assessments

• Maximise impact of reablement

• Maximise use of equipment and adaptations

• Review N-Able

=• Reduced level of long

term packages of care• People can stay at

home longer

ACTI

ON

SO

UTC

OM

ES

Supporting People in their communities and preventing the need for long term services

These activities contribute to supporting people in their communities:

• Information and advice

• Carers support

• Day opportunities

• Housing support - Floating support, handy persons, alarms

• Volunteering services

• Community transport – wider NCC function

• Assistive Technology

• Aids and adaptations

• Strong and Well grant funding

• Development workers

• Norfolk First Support Reablement Service

• Swifts

Shifting our approach – some examples

• Information and advice: improving our offer by supporting self-help and self-management. Development of self-service options through enhanced functionality of website, ability to produce personalised support guides, health and well being plans. Greater emphasis on triaging by our contracted specialist information and advice providers and supported self-service

• Ageing Well and Strong and Well grants: focus on older people with emerging health and social care needs, reducing social isolation and delaying onset of formal care needs. Working with statutory and voluntary partners to pilot new approaches, eg North Norfolk ‘enhanced’ handyperson service to support older people to live independently in their homes for longer. Aim for the model to be self-sustaining and innovative inter-generational approach using young people NEET as volunteers. Ageing Well: projects in Norwich, Gt. Yarmouth and Broadland used to fund community agents, provide small grants to support new local grass roots community groups and stimulate a ‘grow your community’ approach.

The Norfolk Directory• Help people to help themselves.• Resource to support development of community capacity and help

connect people to their local communities.• Available to share with partners on their websites.


• Development Workers: shifting the focus from eligible people to earlier help and intervention at first point of contact. Short-term focused work with individuals to enable them to engage in their communities and delay the need for formal care services. Work with groups of individuals around shared interests and provide support and tools for groups to be self-sustaining, eg the Costessey Memories Local History Group – blogs, exhibition at Bridewell museum, local walk

• Community meals: removal of meals subsidy in day centres, lunch clubs etc. Range of new suppliers accredited with Trusted Trader offer greater choice and control for customer and achieved £1.2million saving. The White Horse in Upton provides meals on wheels to older people in their local community. The Chequers Pub in Wimbotsham has set up a Dementia Friendly Lunch Club. A ‘Hints & Tips for lunch clubs’ has proved useful for people who are considering setting up lunch clubs in their local communities

Costessey Memories Group• Chance conversation between development workers and two local

residents who were keen to share collection of photos and memories of local area spanning 50 years

• Although residents were in touch with old schools friends, they didn’t meet up socially

• Development workers worked with library service, adult education and museum service to create Costessey Memories Group

• Now independent with 20 – 30 regular members. Monthly meetings with host speakers, wellbeing walk and picnic by local stream, exhibition at Bridewell Museum

• Reduced social isolation, enhanced wellbeing, stronger social networks , inter-generational links with relatives via online blogs. Meet outside the group for other social / leisure opportunities


• Pub is the Hub (PITH): jointly funded by Adult Social Care and Economic Development (£.030m) with funding from national scheme and other sources. Encourages rural pub owners, licensees and communities to work together to revitalise local services by making their pubs a focal point in the community and address gaps in services identified by communities. Includes community shops, cafes, lunch clubs and improving accessibility

• Assistive Technology (AT): working with N-Able to develop marketing the benefits of AT for people who are not eligible for services to support them to remain independent for longer. Looking at social work practice to maximise opportunities for AT to be part of a wider package of care. Evidence from Learning Difficulties service that can be effective in reducing the need for waking night staff in supported living.


Commissioning:

• developing models that build in increased use of volunteers and peer support. Meets Social Value Act requirements. e.g. Mental health floating support service includes peer support from people with lived experience of mental health. Benefits to the individuals volunteering and increased capacity in service at reduced cost.

• New home support model. Greater focus on provider’s role in reablement and maximising opportunities for people to regain skills and reduce the need for/dependency on care and support and utilising assets and skills in local communities.

Prevention Case Study – Sensory Support Deaf Team

• Male 32, Sign language user with additional mental health needs. J has little insight into social interactions, value of money and keeping himself safe. Despite being deaf without speech, he seeks people out to befriend and has many hours each day to fill.

• Deaf team input: Provide a crisis intervention to build up J’s confidence and to provide an updated support plan to deal with current issue. Previously In 2013-2014, Sensory Support Unit (SSU) has dealt with homelessness, financial abuse, physical assault and several instances of daily living needs requiring one-off interventions.

• Outcome: J remains living independently without a personal budget. He uses the Deaf centre several times week for support and social interaction to improve his personal skills and social awareness. Deaf Connexions contact SSU as unpredictable situations arise and require social work involvement.

• Without intervention: J would almost certainly require a large financial package to manage his safety and well-being. This would also have an inferior outcome due to the communication barriers and having a “time-tabled” service rather than one that is accessible when needed.