Empowering Vulnerable Adults to Improve Their Health

Transcription

1 Adult Services Department Business Plan 2007/08

2 Contents PAGE 1. Message from the Director of Adult Services Department 2. Introduction 3 Mission Statement 5 Service Aims 5 Core Values 6 Key Priorities for 2007/08 6 Adult residents in Westminster 7 Adult Services in Westminster 8 People who use Adult Services Achievements in 2006/07 External evaluation 14 Key Achievements 14 Consultation People and resources Workforce Development 16 Financial Summary Key service priorities and risk management 2007/08 National priorities and drivers 17 Westminster City Partnership Priorities 21 Corporate Priorities 23 Adult Services priorities 25 Risk Management 31 Business Plan Monitoring and Review Appendices Appendix 1 Best Value Performance Indicators Appendix 2 Outturns against key indicators achieved in 2006/07 Appendix 3 Financial schedules Appendix 4 Operational priorities and targets for adult social care Appendix 5 Adult services risk register 2

3 1. Message from Director of Adult Services This is the first business plan of the new Adult Services Department. The plan brings together our priorities for improvement in social care for adults. It also points to the plans for other departments and services which make a significant contribution to delivering improvements in health and well being for adult residents of Westminster. Our aim is to make sure that adult residents can live independent and fulfilled lives and to offer support to them when it is needed. We have strong political leadership establishing the direction for Adult Services. The Every Older Person Matters programme ensures the whole Council will be working to improve the lives of older Westminster residents. We have set up a completely new Adults Services Department to enable the Council to improve the health, well-being and life chances for adult residents. We will be starting on a sound financial footing, with an additional 2m in our budget this year to fund increased demand for services. We know that we will not be able to implement the government White Paper Our Health Our Care Our Say in isolation. This will only be possible by working closely with NHS trusts, other Council Departments and the voluntary and independent sector. Two of our most senior posts and many of our staff are jointly managed with Westminster Primary Care Trust. Westminster Adult Education Services will become part of the Adult Services Department in We intend to expand the range of preventive services we offer to keep people independent and are expecting that the Healthy Estates Project will deliver some real improvements in the heath of people living in Westminster. We will also fund schemes to assist disabled people and people with mental health problems into employment. We will use the Local Area Agreement as the way in which we monitor our success with these plans We will ensure that we offer protection for the most vulnerable residents of Westminster and support them with appropriate services. We will use our position as commissioners to ensure services in Westminster are of the highest possible quality. We are also at the forefront of the Council s WorkSmart programme using technology to improve staff working lives and enable them to spend more time with service users. We will also ensure that service users can benefit from new technology such as telecare and internet access. I am delighted to present to you the Adult Services Business Plan for 2007/8. Marian Harrington Director of Adult Services 3

4 2. Introduction The Adult Services Business Plan sets out the key strategic priorities for the adult services for the 2007/08. Alongside the priorities for improvement, the Business Plan details the resources and activity that will enable the services to achieve their priorities efficiently and effectively and the risks that will need to be managed during the year. All adult services staff contribute to meeting our priorities. This Business Plan aims to not only enable staff to understand the strategic direction of the service but also facilitate the translation of its priorities and actions into service plans and personalised targets in individual performance plans. The Business Plan is a key part of Adult Services overall performance management framework, providing a structure for discussion and scrutiny of performance at all levels of the organisation. The diagram below shows how the Adult Services Business Plan fits into other strategic plans, is influenced by external drivers and the work of planning networks and partner organisations National drivers Adult Services Business Plan : How it all fits together DIAGRAM Our Health Our care Our Say Choosing Health, CSED Gershon Review Mental Capacity Act, Wanless Review, Patient led NHS National Service Frameworks NHS financial position Changes to government funding formula Everybodys business PCT Operating Plan 2007/08 City Council One City Every Older Person Matters Prevention agenda role of other Departments WCP City Plan Local Area Agreement older people and prevention; carers Neighbourhood approach; LARPS Health & Care Network Programme for a Healthier Westminster Health Promotion Strategy Our Plans for Older People Older People; Housing and Care Everybodys Business Strategy The Big Plan (LD) M t l H lth P t hi St t 4

5 Mission Statement We will ensure that all vulnerable adult residents of Westminster have the opportunity to achieve the best possible health and well being, are enabled to have as much choice and control in their lives as they wish, are able to make an active contribution to the community and are free from discrimination or harassment. Service Aims Our overall service aims for adult social care services relate to the outcomes we want to achieve for adults with social care needs. These are complemented by care group specific priorities developed in relation to meeting National Service Framework and Valuing People standards set by government. Improved health and emotional well being: We want people to enjoy good physical and mental health (including protection from abuse and exploitation), access to appropriate treatment and support in managing long-term conditions independently and opportunities for physical activity. Improved quality of life: We want to ensure access to leisure, social activities and lifelong learning and to universal, public and commercial services for adults with social care needs. This includes security at home, access to transport and confidence in safety outside the home. Making a positive contribution: We want to encourage active participation in the community through employment or voluntary opportunities and involvement in policy development and decision-making. Enable people to exercise of choice and control: We want people to have as much choice and control as they wish to help them achieve maximum independence. Freedom from discrimination or harassment: We want to ensure equality of access to, and experience of services and that people are free from abuse and bullying. Economic well-being: We want to ensure the economic well being of adults with social care needs so that they have access to income and resources sufficient for a good diet, accommodation and participation in family and community life and are able to meet the costs arising from specific individual needs. Personal dignity: We want to ensure that people are able to maintain self respect and enjoy a comfortable, healthy and safe environment. Effective commissioning: We will work with local and other providers to ensure that services commissioned to meet the existing needs of Westminster residents are of good quality and offer value for money; we will ensure that services will be available that meet the future needs of residents. 5

6 Leadership: The Council is committed to providing strong leadership to achieve consistent, sustainable and effective improvements in adult services. Core Values Westminster City Council Core Values underpin how all Council services work to improve the lives of local residents are: Delivering excellence: We will build on our excellent services. We will continue to improve the quality of our services and the lives of those who use our services, their families and carers. Improving through innovation: We will use opportunities to innovate responding to changes in legislation and will take advantage of new technologies to develop more efficient and effective ways of working through WorkSmart. Expertise in policy and research: Our plans for improving services will be based on evidence of what works best and on listening and responding to those who use our services. Leadership and management: We will provide responsible and creative leadership to our staff and partners and support the community leadership role of Council Members. Working in partnership: We will work in partnership with other local and national agencies to improve quality of life in Westminster, supporting partner in their aims and pursuing partner support of Council aims. Equality of opportunity: We will provide equal access to services for our diverse community, ensuring services provide both choice and flexibility. Placing our customers at the heart of what we do: We will be courteous to and respect the views of all Westminster residents, listening and responding to our customers. Key Priorities for 2007/08 The Council contributes to a wide range of plans aimed at improving the health and well being of vulnerable adults. Our priorities are informed by these plans, the priorities set by the Council (One City) and the Cabinet, those set nationally by central Government and those raised by adult and older residents themselves. The Adult Services Department key priorities for 2007/08 are summarised : Achieve improved outcomes for vulnerable adults. Complete the establishment of the new Adult Services Department. Continue close working with partners to meet the requirements of the White Paper Our Health Our Care Our Say and Director of Adult Social Services guidance. 6

7 Ensure a range of services are available assist disabled people and people with mental health needs into employment and learning opportunities. Develop our long term strategic community needs assessment jointly with the Primary Care Trust. Examine options for streamlining assessment and access to services including between social care and health services, more co-location of services, integrated performance management and further integrated procurement and commissioning arrangements. Continue development of preventive services to help reduce future demand for intensive social and acute health services, through the Local Area Agreement and other mechanisms. Work with NHS partners to achieve further shifts in resources for investment in prevention and away from acute care. Contribute to the delivery of the One City policy through the Every Older Person matters initiative. Contributing to the implementation of WorkSmart through the introduction of the Electronic Social care Record and flexible and mobile working for frontline and support staff. Achieve further efficiencies in the planning and delivery of services through effective commissioning, market management and service redesign. Use the findings from the annual review of adult services by CSCI and service specific assessments undertaken by the Health care Commission and CSCI to further develop opportunities for improving outcomes for vulnerable residents in Westminster. Contribute to the City Council s Going Green initiative. Adult residents in Westminster There are nearly 209,000 residents aged 18 and over in Westminster, 183,700 are aged years and over 25,100 are aged 65 or over, with 8,900 aged between 75 to 84 years and over 3,000 aged over 85 years.. The diagram below shows the type of support or service response we aim to arrange with partner agencies to adults with different levels of need to enable them to remain as independent as possible. Nearly 50% of households are single person households and nearly 12,000 people provide unpaid care to a relative or friend, of these 3,500 provide 20 hours or more per week. Westminster is ranked 39th most deprived out of 354 districts in England (most deprived London borough on the rank of local concentration ) and experiences high levels of migration from and to other London boroughs and the rest of the UK. The mobility of the population and significant cross-border flows in relation to the use of health, care, employment, education and leisure services, represent significant challenges to planning services to meet the needs of adult residents. There are approximately 1,800 older residents suffering with dementia and about 11,250 who are physically frail. Around 9,000 residents have a severe disability with 7

8 6,500 people of working age in receipt of the Disability Living Allowance and over 500 adults have a learning disability. Responding to different needs Assessment level Service response Specialist Complex needs Complex care teams Generic Early problems, single conditions Primary health and social care with specialist support Low level / Open access General population Preventive Around 32,000 residents have a limiting long-term illness. Large numbers of people are registered with GP practices in Westminster as having a long-term condition; 5,000 with coronary heart disease, 6,200 with diabetes, and 7,900 with asthma. At any one time between 16-25% of the general population are likely to have a common mental health problem and about 800 people are likely to be suffering from a psychotic illness such as schizophrenia or manic depression. There are associated high rates of people on incapacity benefit in certain parts of the City. Over a 1,000 residents are diagnosed as having HIV and the latest estimates suggest that around 1 in 30 people aged years have problems associated with their use of drugs. Adult services in Westminster The new Adults Services Department was created in November 2006, in order to meet the statutory requirement to establish the post of Director of Adults Social Services (DASS) reporting to the Chief Executive, and to create the leadership structure that would enable the Council to deliver the ambitions set out in the government s White Paper, Our Health, Our Care, Our Say. The diagram on page 12 shows the details of the new structure which will be fully implemented during 2007/08. 8

9 Adult services work with some of the most isolated, frail, disabled and vulnerable residents in the City. Social Care Services Adult social care services delivers the assessment and care management function for all adult care groups arranged in locality-based teams. Where the needs of people meet our eligibility criteria the teams arrange services to support them and regularly review care to ensure that it continues to be appropriate. The teams work in a person centred way, meeting performance targets and monitoring delivery by providers. Through their detailed local knowledge, the teams have a role in influencing commissioning. Services for older people and adults with disabilities are being re organised to cover three localities. Whilst each locality will have a generic team, there will be designated leads for specialisms such as disabilities, mental health and older adults and HIV. There is also a Health Services team based at St.Mary s hospital which provides an assessment and care management service to people who are admitted to hospital which ensures that effective discharge planning arrangements are made. A Housing with Care team, which includes Community Support Officers, providing a preventive service to older people with lower levels of need. Services to help keep people independent in their own homes include personal and home care, extra care housing, escorting and shopping, home bathing, equipment and adaptations, assistive technology services, such as alarms. These services work closely with community health services and in particular Westminster rehabilitation service managed by the PCT and joint funded with the City Council. Westminster s Community Mental Health Teams arrange support to adults with serious and enduring mental health needs. The teams are fully integrated with Central North West London Mental Health Trust and are co-located and operate in three localities across the City. The teams are fully multidisciplinary with care co-ordinating staff, either specialist social workers or CPNs. The Approved Social Work service is provided through the CMHTs. Crisis resolution, assertive outreach and early intervention teams are also operate through the Trust. The Community Services team for people with a learning disability is an integrated, City wide team of health and social care staff who assess and arrange services to support people at home or in residential care. The team also offers a range of specialist health provision such as nursing, psychology, occupational therapy, physiotherapy, psychiatry and speech and language therapy. The Day, Specialist Residential, Employment & Short Break Service, covers services that the Council and Primary Care Trust directly provide for people with learning disabilities. There is a specialist care management team for people with substance misuse needs, which provides an assessment service leading to a range of treatment options for people with drug and alcohol related problems. The funding for the team and budgetary controls are governed through a Section 31 agreement creating a pooled budget. Following a review of current arrangements proposals are being developed to provide a specialist team working with other vulnerable adults, for example people with complex needs and those that do not easily fit into the eligibility criteria of existing services. 9

10 Commissioning This section of the Department leads on strategic commissioning across all care groups, social inclusion, management of local markets and maintenance of local services, compliance with the Council s Procurement Code, and the management of care contracts and service agreements with the voluntary sector. It brings together commissioners for all adult care groups alongside the contracting and procurement functions and the management of relationships with corporate services. The section includes a number of joint, integrated commissioning teams with the PCT including; mental health, learning disability, Drug and Alcohol Action Team. We commission a wide range of services for adults which help promote their independence so that they can remain wherever possible in their own homes. These include home care and personal care services, a range of day opportunities including help for people to access employment, education, leisure services, and supported housing services. We also arrange services designed specifically to meet the needs of carers including a range of respite, sitting services and other forms of support and opportunities. Where people can no longer be supported at home we arrange residential and nursing home care for them. Public Health & Well Being This part of the Department leads on promoting the health and well being of the whole Westminster population in conjunction with the Director Public Health through community needs assessment, addressing health inequalities, and health promotion, prevention and protection. The section is responsible for delivering the health and well being agenda described in Our Health, Our Care, Our Say, health promotion, partnership working including health scrutiny, linking with planning, including the Local Area Agreements and the Council s responsibility for the psycho-social response to emergencies. A new joint Assistant Director post has been created to lead on this work across the City Council and Primary Care Trust. Adult Education Service The vision of Westminster Adult Education Service is to inspire and develop our community through learning. It is one of the largest, local authority adult education services in the country. It offers a very diverse curriculum range with over 1,000 courses delivered to 12,000 learners each year. The service was inspected by the Adult Learning Inspectorate in November 2005 and was identified as one of the best local authority providers in England. WAES is a community focussed service delivering courses in over 80 venues across Westminster. A large part of the provision is aimed at the most disadvantaged individuals and communities. Around half of the service s work is focussed on preparation for life programme in ESOL, literacy, numeracy and ICT. 10

11 The Service is also now focussing on meeting the needs of local employers by providing training and skills development to people in work. There is an increasing demand for this as the skills needs of employers continue to rise. Support services The Strategy & Performance team provides support to the Director and Assistant Directors. It is responsible for the co-ordination of strategic performance management, management information, co-ordinating development of strategies, research and analysis to support the work of the Department. Finance and accountancy support is provided through the Corporate Finance Department with a dedicated Assistant Director for adult services and housing and adult services accountancy team. 11

12 CHIEF EXECUTIVE Director of Finance Director of Housing DIRECTOR OF ADULT SOCIAL SERVICES (DASS) Support Officers x 3 DCEX, Director of Children s Services Assistant Director Finance, Adult Social Care and Housing Sen Prin Accountant Adult Social Care Sen Prin Accountant Housing General Fund Sen Prin Accountant Coordination and Commissioning Head of Residential and Community Care Finance Assistant Director Social Care Services Adult Services Manager North Adult Services Manager Central Adult Services Manager - South Health Services Manager Vulnerable Adults Services Manager Mental Health Services Manager Assistant Director Public Health, & Wellbeing Health Policy Manager Health Promotion Manager Disability Policy Manager OPD Development Emergency Planning Officer Assistant Director Joint Commissioning (Care & Health) Commissioning Manager Older People & Phys Dis Head of Joint Service Development (Mental Health) Commissioning Manager Learning Disabilities Commissioning Manager DAAT/Subs Misuse Head of Contracts and Vol Sector Partnerships Head of Workforce Dev t and Training Adult Change Project Manager Head of Payments Westminster Adult Education Service Learn Dis Service Manager Community Health and Care Mgt Learn Dis Service Manager Day, Residential and Employment Housing with Care Manager Head of Strategy, and Performance, Adult Services ICT Business Relationship Manager CSI client and property manager Westminster Primary Care Trust 12

13 People who use Adult Services The table below shows the number of residents supported by different adult services as at March 2007: Number of people supported People supported at home with care managed services 3,726 Older people 2,138 Physical disabilities 500 Mental health 729 Learning Disabilities 289 Other vulnerable adults 70 People supported in self directed care (DP, In Control, IB) 244 Older people 111 Physical disabilities 82 Mental health 6 Learning Disabilities 34 Carers 11 People supported with telecare People supported with alarms and other telecare equipment 3,010 People supported in residential placements 801 Older people 409 Physical disabilities 14 Mental health 201 Learning Disabilities 177 People supported in nursing home placements 350 Older people 308 Physical disabilities 16 Mental health 19 Learning Disabilities 7 Carers supported with carers services 568 Older people 285 Physical disabilities 80 Mental health 76 Learning Disabilities 112 People accessing voluntary sector preventive services Older people 2,000 Adults aged years 1,100 Approved Social Worker Service Requests for statutory assessment in a year

14 3. Achievements in 2006/07 External evaluation In December 2006, published the results our the national assessment of all authorities providing adult social care services fro 2005/06. The results for Westminster showed significant improvements from the previous year, enabling the attainment of 3 star status. The judgment for Westminster is as follows Social Care Services for adults Serving MOST people well EXCELLENT Capacity for improvement Adult Social Care Star Rating: Social services performance rating is 3 stars Three star rating entitles the council to increased freedoms in the use of grants, and to a proportional programme of inspection and monitoring. Key improvements in 2006/07 Building on the successfully attainment of 3 stars in 2005/06, further significant improvements in performance were achieved in 2006/07. In summary these include: Corporate and political support for adult services is strong; Successfully delivering the Council s Every Older Person Matters initiative, with measurable action plans in place across key Council services to deliver positives outcomes for older people. New Adult Services Department created from Children and Community Services following the appointment of the Director of Adult Services. Further integration with the Primary Care Trust has been achieved including the creation of two new joint funded senior management posts, Assistant Director for Commissioning and Assistance Director for Public Health and Well-being. We successfully used the new partnership opportunities through the Local Area Agreement and Neighbourhood Renewal Fund to expand our approach to prevention for older people, people with low level mental health needs, people with alcohol problems, people with diabetes and carers. As part of the Local Area Agreement we undertook a Quality of Life Survey of older people in receipt of preventive services the results will be used to help redesign our approach to prevention with the voluntary sector. Improving health and emotional well being of adults using voluntary sector services by moving to commissioning services with clearer outcome measures. Promoting economic well being by helping more vulnerable adults with learning disabilities, severe and common mental health needs into employment, through day care services and other dedicated schemes. Supporting more carers with carers services and helping more carers to pursue opportunities outside their caring roles. 14

15 Continuing good progress in promoting independence achieving increases in the numbers of people supported to live at home across all service user groups. Increasing the rate of adults enabled to continue to live in their own homes through the provision of intensive social care. Substantial increase (75%) in the rate of people on direct payments giving them more personalised services, choice and control. Taking forward plans to develop the next phase in extra care housing for older people. Delivering the transforming Intermediate Care review with partners at the PCT, effectively reducing emergency admissions to acute care, unscheduled bed days and delayed transfers of care. Continued good performance of the Westminster DAAT in meeting national targets and local needs of people who have problems with substance misuse. In the he Tackling Drug Supply Awards 2007, The Westminster Drug Intervention Programme was commended in the Best Example of Enforcement Linkages with DIP category. Day and Employment Service for people with a learning disability at 131 Droop Street won the City Council team of the year award. Adult Education Service achieved a very successful inspection outcome. Achieved approval for a new adult education unit as part of the Pimlico School rebuild. Inclusion in cross London Partnerships to deliver Train to Gain programmes for local employers Demonstrated significant improvement or sustained good performance against all key national performance indicators. Other National Performance Indicators Against all 6 Best Value Performance Indicators covering adult social care services all improvement targets will be met or surpassed by March Performance against Budget Expenditure in 2006/07 was 76.3m, which was 1.6m over budget. The overspend is due to historical under funding in a number of areas including the cost of supporting Failed Asylum Seekers/Failed Habitual residents, the high demand and costs of residential care placements for people with learning disabilities or mental health needs and people with substance misuse problems who have longer term care needs. Consultation User and carer involvement is at the centre of our approach to planning and delivering services. We use a comprehensive range of mechanisms to ensure effective user and carer consultation and feedback to measure satisfaction and outcomes we are achieving. We make use of the corporate processes such as the City Survey and Area Forums to gain feedback from adult residents about their concerns. In 2006/07 we undertook specific consultations through our partnership groups about the development of strategic plans, including our Older People; housing with care strategy and Mental Health Partnership Strategy. 15

16 A range of user surveys were undertaken during the year which focused on what outcomes different interventions and support are achieving. These included a survey on the quality of life of older residents using preventive services; people with mental health needs in supported accommodation; people in receipt of direct payments, and one asking what difference the provision of equipment had made to people s lives. We have well developed quality assurance systems in place as part of contract monitoring, these are used to make sure concerns about service quality are acted upon and resolved. The annual complaints report demonstrates how issues raised through the complaints process are addressed and taken into account when developing services. In order to fully engage different groups of vulnerable adults we continue to developed specific approaches to involvement and consultation, these include multi media work with people with learning disabilities, and these include multi media work with people with learning disabilities, through to user focused monitoring of services for people with mental health needs. 4. People and resources Workforce development The Development and Training Commissioning Plan 2007/08 sets out the priorities for workforce development for the Adult Services Department and aims to maintain our position as an Employer of Choice with excellent and consistent standards of management, through the Investor in People programme, in the highly competitive London social care market. A key national priority is for a more integrated workforce designed around the needs of residents supported by common education and career frameworks which can deliver more person centred care, more efficiently. In Westminster we will continue our work with the Primary Care Trust, other health and care partners and the voluntary sector to achieve better integration of the workforce across health and social care boundaries. Key priorities for 2007/08 are summarised:- Support the development of the new Adult Services Department. Including, - a review of the existing workforce to ensure that the composition and skill mix is fit for delivering the challenges of the White Paper and the priorities of the City Council. - exploring further integration with the PCT - implementation of WorkSmart. - building our managers and leaders skills in working in multi-disciplinary teams. Continue work to meet the requirements of Options for Excellence, Government s vision of the social care workforce to 2020 aimed improving standards and ensuring that the health and social care workforce that can look after people effectively. Continue to produce a joint learning directory with the PCT. Ensure that we comply with, and exceed National Minimum Standards for care. 16

17 Continue to invest in Westminster Care Partnership to enable other services and local care providers to access Skills for Care and NMS funding. Design and deliver specific training to staff to enable them to ensure wider health and well being, benefits advice, education, learning and employment issues are fully incorporated into assessments and care planning. Continue to an NVQ centre and contribute to the development of care staff Continue to build pathways into employment for local people; Support access to qualifications for adult services staff to access the Degree in Social Work to ensure a supply of qualified social workers; Maintain access to Continuous Professional Development for all professional groups; Financial Summary In 2007/08 planned net expenditure of 81.5m including: m on services for older people 9.8m on services for adults with a physical disability 16.6m on services for adults with a learning disability 11.2m on services for adults with mental health needs 1.5m on services for adults with substance misuse needs Savings and efficiencies of 1.7m are planned in 2007/08 and these will be achieved through increasing our income, workforce efficiencies as part of the establishment of the new Department, more effective contracting and reductions in expenditure on equipment and placements for people with a physical disability. There is planned growth of 4.5m in 2007/08. This covers the costs of increased numbers of people supported on direct payments, the increasing demand for and cost of placements for people with a learning disability or mental health need and the cost of supporting failed asylum seekers/failed habitual residents. Further details are included in Appendix Key improvement priorities and risk management for 2007/08 National priorities and drivers Local Government White Paper In October 2006 the Government released a White Paper for Local Government, with its vision of revitalised local authorities, working with their partners, to reshape public services around the citizens and communities that use them. Central to the Government s plan is empowering citizens to influence how local services are planned and delivered to them. Our Health, Our Care, Our Say The Government published the White Paper Our Health, Our Choice, Our Say; a new direction for community services in January The requirements set out in the paper form the blueprint for the future direction of adult social care and community health services and represent significant change. In Westminster we have already 17

18 made good progress in meeting the initial requirements through the creation of the new Adult Services Department. The Paper emphases the need to focus on : improved outcomes for vulnerable adults greater person centre approach and personalisation of services, a greater focus on prevention supporting people with long term conditions effectively at home achieving a shift from intensive social care and acute health services enabling vulnerable people to access mainstream services greater integration between health and care services, streamlining access and service delivery to improve To effectively deliver the ambitions of the White Paper will require a new partnership between local authorities, primary care trusts and the voluntary sector. Achieving these aims will be particularly challenging to achieve within the current national financial position and devolved budgets in primary care through practice based commissioning. A more integrated, seamless future for health and social care services will require investment in health and social care workforce development and the development of more integrated frontline services delivered in more convenient ways for individuals. Commissioning framework for health and well-being The commissioning framework for health and well-being provides commissioners of health, social care and well-being services with a framework for: identifying current and future health needs; jointly planning services; engaging in a dialogue with local people and service users about the future development of services; engaging with providers of services to ensure that services are appropriate, effective and outcome-focused. The consultation on the framework will end in May The commissioning framework for health and well-being is an important new tool for bringing together health and social care commissioning into a coordinated framework, that focuses on outcomes and is tailored to meet local needs. Particular implications for implementation locally will include: Support the move from a medicalised view of health and well-being, to considering the social, economic and environmental determinants of ill-health Agreeing a definition of well-being to support commissioners in commissioning services to achieve it Considering how empowering GPs to commission social care will work in practice Decommissioning of services. The framework sets out an expectation of evidence based decommissioning of services to generate resources to support the commissioning of preventative services. 18

19 Mental Capacity Act The Mental Capacity Act 2005, provides a statutory framework for adults who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity in the future. It sets out who can take decisions, in which situations and how they should go about this. Care staff who are acting for or making decisions on behalf of someone who lacks capacity are legally required to have regard to relevant guidance detailed in the Mental Capacity Act Code of Practice. Westminster staff will also be required to assess people s capacity to make decisions using the new capacity test. For important decisions, such as moving accommodation or serious medical treatment, individuals whom lack capacity and have no family, friends or informal carers to speak for them will be referred to an Independent Mental Capacity Advocate (IMCA). New Deal for Carers In February 2007 the Government launched a national consultation on updating the 1999 carers strategy together with a 32m New Deal for Carers. The new deal has three main strands: a national telephone advice line and website to help carers make decisions about the personal support and opportunities available to them and the needs of the person for whom they are caring 25 million for the provision in each local authority of short-term, home-based, respite for carers in crisis or emergency situations 5 million for an expert carer programme to provide training for carers to better self-manage their own health and the health of those for whom they are caring The updating of the strategy will be a cross-government process. The consultation will cover topics such as employment rights and flexible working, the attitude of the NHS towards carers (in particular the role of GPs in identifying carers and helping them to access services) and the role of social care services, and will involve carers and carers organisations across England. Everybody s Business In November 2005 the Department of Health, in partnership with the Care Services Improvement Partnership, published the service development guide Everybody s Business. This guide seeks to help agencies decide locally how services should be commissioned and delivered to ensure that older people with mental health needs, and their carers, have their needs met wherever they are in the system, without experiencing discrimination or barriers to access. It is underpinned by a commitment to four main themes: improving people s quality of life meeting complex needs in a co-ordinated way providing a person-centred approach promoting age equality Implementation of Everybody s Business is now a core element of the second phase of the National Service Framework for Older People and the inspection agencies will use 19

20 the guide to benchmark mental health services for older people and to inform their inspection processes. We have set out our response to Everybody s Business in our draft Mental Health Strategy for Older People in Westminster , which was launched for consultation on 30 April The draft strategy sets out our vision for older people with mental health needs and their family carers in Westminster and the key steps we are proposing to take over the next three years across the whole range of service areas that make up a comprehensive mental health service from services that promote positive mental health through services that support older people to remain at home to services for people who are no longer able to remain at home. Funding of adult social care services Over the last two years adult services have already made progress in meeting the requirements of the Care Services Efficiency Review, delivered through effective contracting and commissioning. However, there are significant external financial risks in relation to the funding of adult social care services over the next few years. The Wanless Social Care Review Securing Good Care for Older People demonstrated that as a result of changing demography over the coming years, current funding arrangements for social care services are unsustainable, given anticipated pressures on budgets. The challenge in delivering the objectives of the White Paper is to achieve a shift in health and social care resources from the acute health and intensive care sectors to invest in the development of increased preventive services in the community. Through improving access to preventive services the aim is that this will help ensure that future demand for acute health and intensive social care is reduced. There are two external national reviews which will have a bearing on the future funding of adult services and are likely to have a particular impact on Westminster. The Office of National Statistics are undertaking a review of the methodology for calculating the mid year estimated population which are used as a basis to determine the level of Government grant to local authorities. It is likely that this will result in a reduction in the estimated adult population aged years which will have a bearing on the level of grants for social care for this group. The national review of the Relative Needs Share for adults aged years old makes significant use of the take up rates for Disability Living Allowance. Such a change would disadvantage Westminster and the Council is lobbying the Government on this issue. Other external changes to the funding of adult services which have an adverse impact on Westminster include, an across the board reduction in grant for Drug Intervention Programmes of 20%, irrespective of local performance and effectiveness; the ending of the Learning Disability Development Fund after 2008 and the year on year reduction in the AIDS Support Grant. 20

21 Westminster City Partnership Priorities City Plan The Westminster City Plan is our Community Strategy and aims to improve the quality of life and well being of Westminster residents, visitors and businesses. The plan is the responsibility of the Westminster City Partnership (WCP. The partnership brings together representatives from Westminster City Council, other public sector agencies and the voluntary and community sectors, local businesses, regeneration partnerships and residents groups. Following and extensive review of the first City Plan and extensive consultation with stakeholders and residents a new City Plan for was published. The new City Plan sets out a vision for: an improving environment; better life chances; strong, united and engaged communities; customer tailored services. A summary and the full City Plan are available from The Programme for a Healtheir Westminster is the key overarching strategy document for the Health & Care Network feeds directly into the City Plan. All adult services partnership plans and strategies are reported to the Network and contribute towards delivering the Programme for a Healthier Westminster. Local Area Agreement (LAA) Westminster s LAA came into effect on 1 April 2006 and will run until March The aim of the LAA is to change the relationship between the local authority, its partners, and central government and develop new ways to deliver better outcomes for residents. The four key themes of the Westminster LAA Outcomes Framework are: visible improvement on the street; community cohesion and engaged citizenship; customer-tailored services; better life chances for all our citizens. The Adult Services Department plays a significant role in delivering these outcomes. Within the Westminster City Partnership, the Adult Services Department directly works through the Health & Care Network, but also works closely with other thematic networks particularly the Liveability, LEN and Crime and Disorder networks on areas of interest for delivering improved outcomes for adult residents. The LAA is one of the key mechanisms enabling this partnership approach. The Adult Services, within the Health & Care Network play a key role in delivering the following outcomes: Improve the health and well being for adults and older residents Improve the quality of life of people in the most disadvantaged wards 21

22 Improve pathways into training and employment. The LAA includes 12 targets where delivering a 'stretched' performance is offered in exchange for pump-priming money, reward grant, freedoms and flexibilities. Three stretch targets are being delivered though the Health & Care Network, two directly related to Adult Services: Improve the quality of life of older people who use preventive services Increase the number of carers whose needs are assessed and who receive carers specific services The Health and Care Network have effectively used Neighbourhood Renewal monies to support new initiatives to help deliver these outcomes. With funding for two years commencing in April 2006 these included: help to people with common mental health needs accessing employment opportunities. assistance to carers in accessing services to help them achieve more fulfilling lives outside their caring responsibilities assistance to people with needs arising form their use of alcohol helping people with diabetes stay healthy various healthy eating and healthy lifestyle initiatives In 2007/08 the Health and Care Network is leading on a key project resource through Neighbourhood Renewal funds to deliver the Healthiest Estate. The project aims to develop ways of assessing the needs of, and engaging individuals with local services to help achieve real improvements in health and well being for some of the most disadvantaged residents. One aim will be to develop approaches which can be used in other estates and settings in the future. Local Area Renewal Partnerships The delivery of the local/neighbourhood elements of the LAA is achieved through Local Area Renewal Partnerships (LARPs). The LARPs aims are to improve the quality of life of people who live and work in Westminster s most disadvantaged areas: Church Street Queen s Park Harrow Road Westbourne West End Specific targets relating to the LARP areas are shown at appendix X. Neighbourhood agenda Recognising that electoral areas do not always reflect natural neighbourhoods we have mapped out a number of areas, with which local residents identify. The heart of these proposals are regular Area Integration Meetings (AIMs), focused on sharing information about the full range of local services, consulting on proposals, and 22

23 problem-solving more complex local issues, raised by residents through Area Forums, or by ward councillors as a result of their casework or local experience. Corporate Priorities One City priorities One City sets out the City Council's vision for the next five years. The programme is the successor of Civic Renewal and has a focus on Excellent Services Strong Communities. The policy has four key themes, opportunity, order, enterprise and renewal. There is a strong focus on improving the health and well being of residents and the underpinning principles will help provide the context within which we deliver the change agenda for adult social care services to meet the requirements of the White Paper. Every Older Person Matters A major theme of One City is Every Older Person Matters focusing policy on achieving better outcomes for this group. This is being delivered taking whole Council approach through an Older People s Board chaired by the Cabinet member. The Board has taken reports from Adult Services and other Council Departments and partner agency. An Every Older Person Matters strategy has been developed and an action plan covering social care, leisure, community protection, libraries, housing and other council services has been put in place for the coming year and incorporated into service and departmental Business Plans for 2007/08. Key priorities and developments include: Improving quality of life of older people, including using the results of the Quality of Life survey undertaken last year as part of the Local Area Agreement will be used to assist in work with voluntary sector organisations to help make sure the services they offer have a positive benefit in terms of health and well being, security and social isolation. Consultation with older people about their experiences and priorities, including a major new initiative Helping Older People s Empowerment, will be undertaken jointly between the City Council and Westminster Older Peoples Network. The focus will be on the experience of older people living in the City and how we can develop services to improve their well being further in the future. Senior Passport delivering the next phase of its development to be the gateway for all older people services and information. The scope of the single point of access will be extended to provide a wider range of information about more services including adding the WELDIS database into the initiative; increase the range of services which can be accessed, including the joint benefits advice and assessment service. Neighbourhood hubs; through the Local Area Agreement, in partnership with voluntary sector organisations and other providers we will implement the next phase in the development of two new hubs which will enable improved access to a wide range of information, preventive services and support, through a single neighbourhood based resource. 23