Focused examination of learning disability assessment and care management services 2010 Scope of examination As identified through discussion of the Director s report for 2009/10, Jill Lewis, Regional Social Services Inspector, undertook a brief examination of the assessment and care management services for adults with learning disabilities. The fieldwork took place over 1.5 days (18 th August file reading and 11 th October - meetings). The examination was assisted by the reference to the underpinning evidence provided to CSSIW alongside of the Director s report, and the Health Social Care and Wellbeing strategy. There was some opportunity to follow up aspects of learning disability services highlighted in the previous Focussed Review and the national inspection of Adult Protection services in Caerphilly. Methodology The work focussed on adult social services. The inspector read a sample of ten files, selected according to agreed criteria from a larger list, and also met with the following: One Service User whose file had been sampled A focus group of service users receiving services, but whose care management had been closed to review. A focus group of parents and carers. A focus group of learning disability service providers, in-house and independent. Team Managers, Assessment and Care Management and Health Services, Learning Disability Services Service Manager, Integrated Services Interim Assistant Director, Adult Services Evaluation was based on the themes, domains and associated standards that have been used for Annual Performance Evaluation Report. Overall Conclusions Discussion with service users and examination of a sample of files provided evidence of improved consistency and satisfaction with services. 1
The focus on independence and supporting service users to decide and attain their own goals was apparent in discussion with those people seen during the fieldwork. Examination of files provided evidence of skilled working by the social work team supporting people who had a complex range of needs. There were examples of service users supported to achieve their potential in a variety of settings. Where social workers worked in partnership with health colleagues, responsibilities were appropriately delineated. In one case the anticipated outcome for the service user was not achieved, but the individual had been given high levels of support coupled with a flexible and risk managed approach. There are still some areas to address, which have been identified by managers. They have agreed strategies to improve the outcomes for individuals through improving service delivery. These are being implemented and have not yet achieved full impact. There is the opportunity to evaluate the benefit to service users during 2011-12. The transition process from children s services to adult services is a vital framework for young people to move towards greater independence. It is essential that young people and their families are able to understand during the period of transition and beyond what support will be available to them and who will deliver it. The eligibility for services to Children with a Disability and eligibility for services to adults are different. This causes anxiety to parents and carers and it would be helpful to reconcile these differences as far as possible during the transition period. Social services has focussed on support to carers and continues to do so. This is evidenced in the Director s Report and the Health Social Care and Wellbeing Strategy. However, carers who formed part of the Focus Group continued to speak of inconsistencies. They were uncertain about the value of receiving a carer s assessment and could not identify any benefits which stemmed from assessment. There were individuals who felt well supported and confirmed that they and their family member had received good social care services. For other carers, the balance between their needs and the needs of their family member had not been maintained and they felt unsupported. Social services needs to use the research already undertaken to ensure that support offered to carers is sufficiently robust. People with learning disabilities may require services over long periods of time, so that inconsistencies where standards fall below the accepted level make a very strong and lasting impression. There was an issue which service users, carers and service providers alike found difficult and for which there was no plan in place to resolve. To manage workload demand, the assessment and care management team has adopted a practice of closing a case when the expected intervention 2
has taken place and services have been provided. The circumstances of each service user should then be reviewed at least once in 12 months, or sooner if issues arise. This process has been termed closing to review. The reviews are then undertaken either by members of the Learning Disability team or where the individual s needs are relatively straightforward, by the generic Review Team. Although the team manager described a process where a letter is sent to the service user explaining what closed to review means, none of the people spoken to understood it. Service providers also spoke of calling to contact the social worker who had introduced an individual to a service, and being told that the case was now closed to review. Social services have to manage workloads effectively. They also have to ensure that the process is transparent and acceptable to stakeholders including service users. Closing to review at 12 weeks meant that some people did not get social work support which might avert a crisis, but rather had a social worker re-allocated once a crisis occurred. More generally as part of their focus on improving outcomes for service users, social services must satisfy themselves that all reviews are effective in identifying outcomes for service users, and highlighting further action to reduce dependence. Overall, the examination of assessment and care management services indicated a more confident team that is working hard to implement continuous improvement. The following key themes were examined in detail and evidence was collected and provided which support the summary points set out below. Getting Help Allocates social work support in timely way to staff that work skilfully to improve outcomes for people with a complex range of needs. Unified Assessment is embedded and when necessary used alongside the Care Programme Approach. Transition from Children to Adult services the process needs to be better embedded with a clearer focus on outcomes for young people. Linking carers assessments to carers having a clearer understanding of the potential benefits. Social services have given this priority and improved the rate of carers receiving assessments. All service users receiving services but closed to review need to have their care plans reviewed at least annually to ensure that services support the most effective outcomes. 3
Services provided Arranges individualised services for people with learning disability in community settings. The assessment and care management team are working to review fee structures and care packages, to ensure that providers offer service users quality services that are good value for money. This is work in progress and once completed should support more consistent outcomes. Effects on People s Lives Responds effectively to allegations of abuse and works with service users to mitigate the consequences of abuse. Works with people with learning disability to consider how they can recognise and avoid potentially abusive situations. Direct payments have been used to support person centred solutions and increased independence. Welcomes advocacy and ensures that people with learning disability have the opportunity to shape services. Create clearer processes for transition for young people and support to carers that are readily understood. Continue to focus on supporting independence and countering unnecessary dependence with individuals while recognising that the care relationship is an important part of the service. Delivering Social Services Trains and develops its own staff, and at the same time, offers a range of appropriate training to a wide range of social care staff through its Social Care Workforce Development Partnership. Ensures that Assessment and Care Management guidance is in place. Recognises the value of supervision and is seeking to increase its effectiveness to all staff, whether newly qualified or very experienced. 4
Shaping Services Works effectively in partnership with stakeholders, particularly people with learning disabilities Has an effective planning and commissioning framework, which links overarching vision to service and team plans Moving collaboration with health services to joint plans and pooled budgets Building on existing contact with stakeholders, reaching a wider group of carers and families Ensuring that community orientated supported accommodation is provided appropriately to support choice and independent living, and that sufficient safeguards are in place to protect individuals who are using services that fall outside of the current regulatory framework. Providing Direction Has a vision which links the overall corporate improvement priorities to improved outcomes for people with learning disability Supports a climate of learning and continuous improvement Recognises the contribution that service users make to service development Continue to implement the vision and values so that all service users have consistent experience of effective intervention Balance the longer term impact of learning disability services and potential for higher cost individual packages, with a continued search for value for money, and equity across service user groups. 5