Care, Learning and Wellbeing

The Keys to Life in

South Ayrshire

Adult Learning Disability Strategy

2013-2016

Contents

1. Introduction Page 1

2. National and local policy context Page 4

3. Where are we now? Page 23

4. Where do we want to be? Page 39

5. How will we get there? Page 44

1

1. Introduction

In South Ayrshire we can be proud of the support we provide to local people with

learning disabilities. We value the contribution that people with learning disabilities

make to our communities and we are committed to improving quality of life and

increasing opportunities for all.

The Scottish Government‟s definition for learning disability is that:

People with learning disabilities have a significant, lifelong condition that started

before adulthood, which affected their development and which means they need

help to:

understand information;

learn skills; and

cope independently.1

There are approximately 670 people in South Ayrshire with learning disabilities. Like

everyone else they have many different roles including as parents, partners,

employees, friends and carers. We want to ensure that people have their rights

respected, are treated equally and fairly, and are supported in their many roles. We

also want to make sure that people are supported to make their own decisions and

to live as independently as they choose.

People with learning disabilities experience significantly worse health outcomes and

have lower life expectancy compared with the rest of the population. We agree with

the Scottish Government that this is unacceptable and we will continue to work to

reduce health inequalities for local people with learning disabilities.

South Ayrshire‟s Community Health Partnership (CHP) has developed an ambitious

three year strategy (2013-2016) to underpin our approach to supporting people with

learning disabilities. The strategy will be carried forward by the new Health and

Social Care Partnership with the integration of health and social care services.

The strategy is based on the strengths and assets of individuals and local

communities in South Ayrshire. We want to help individuals with learning disabilities

to make their own choices in life. And we are confident about the ability of local

communities to provide support and innovative approaches. Our strategic vision is

that:

“South Ayrshire is a place which supports people with learning disabilities to

build healthy and fulfilling lives.”

1 Scottish Government, The Keys to Life – Improving quality of life for people with learning disabilities,

Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf

2

The strategy focuses on the key outcomes that we want to achieve in South Ayrshire

and demonstrates how these relate to the wider outcomes contained in our Single

Outcome Agreement (SOA) and national policy. It provides an assessment of local

needs and outlines the approaches we will take to deliver outcomes over the next

three years.

Development of the strategy has been highly participative, drawing on the views of

individuals, families, communities and partner organisations. A series of focus

groups and consultation events were held with stakeholders and service users. The

emerging draft strategy was put out to wider public consultation with a consultation

survey. The views expressed and the actual experiences of people with learning

disabilities and their carers have informed the content of our final strategy.

The strategy has been developed within the context of national and local strategies

and follows the publication this year of The Keys to Life2, the national learning

disability strategy for Scotland. The national strategy reflects the growing emphasis

on stronger support in the community and more person-centred delivery. It has a

strong focus on human rights, supporting independent living and tackling health

inequalities.

The strategy has a strong focus on providing support to adults with learning

disabilities. It does not set out specific interventions for children and young people

as these are covered by the pan-Ayrshire children‟s health strategy “Looking After

Every Child: Children and Young People‟s Health Strategy for Ayrshire and Arran”3.

The Ayrshire learning disability health improvement strategy, “We Want Good

Health...the Same as You”4 supports interventions for children and adults. While the

current strategy focuses on adults, it recognises the high level of crossover between

children‟s and adult services in relation to learning disability. The strategy does

address the need to support service users as they „transition‟ from children‟s to adult

services. It also promotes better access to supported parenting services for people

with learning disabilities.

Autism Spectrum Disorder is not covered specifically in this strategy. A pan-

Ayrshire Autism Strategy is currently being developed.

The strategy links closely with a number of local plans and strategies including, for

example, South Ayrshire Carers Strategy, South Ayrshire Mental Health Strategy,

2 Scottish Government, The Keys to Life – Improving quality of life for people with learning disabilities,

Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf 3 NHS Ayrshire and Arran, Looking After Every Child: Children and Young People‟s Health Strategy

for Ayrshire and Arran, 2008-2017, September 2009.

http://www.nhsaaa.net/media/199707/cyphsmay13.pdf 4 NHS Ayrshire and Arran, „We Want Good Health...the Same as You‟ - A Strategy to Improve the

Health of Children with Learning Difficulties and Adults with a Learning Disability, 2009-2014, May

2009

3

the South Ayrshire Dementia Action Plan as well as the Children and Young

People‟s Health Strategy for Ayrshire and Arran and the emerging Ayrshire Autism

Strategy. The strategy also highlights linkages between learning disabilities and

other key policy areas such as employment, early years services and housing.

The success of the strategy will depend upon continuing strong partnership between

partner agencies and community groups. We intend to further develop our

partnership working and strengthen engagement with service users and carers. This

will ensure that the skills and experience of local people will help deliver the

outcomes established in this strategy.

4

2. National and local policy context

2.1 National policy context

The Keys to Life – Improving quality of life for people with learning disabilities

The Scottish Government published a new national strategy for learning disability,

The Keys to Life5, in June 2013. The 10 year strategy makes more than 50

recommendations, the majority of which relate to health. The strategy aims to

address the health inequalities facing people with learning disabilities. It has a

strong focus on improving health outcomes in the widest sense including prevention,

health improvement activities and equal access to health services. The strategy also

supports better understanding of epidemiological and public health trends in relation

to people with learning disabilities through the recently created Scottish Observatory

on Learning Disability.

The Keys to Life is underpinned by a human rights based approach to equality and

inclusion. This includes making sure that people with learning disabilities are

involved in the decisions that affect them.

The strategy also looks at the commissioning of public services with a focus on Self-

Directed Support to deliver better outcomes for individuals. It has a strong focus on

independent living and considers national approaches in relation to accessing

housing, education and employment. The strategy makes recommendations in

relation to more training and educational opportunities and greater access to

volunteering opportunities.

The Keys to Life aims to „shift the culture‟ in relation to learning disability. It puts

forward recommendations in relation to supporting relationships (through things like

befriending services), promoting short breaks for people with learning disabilities and

their carers, and increasing access to local supported parenting services.

The strategy also makes recommendations in relation to supporting people with

learning disabilities using the criminal justice system, and supporting people with

complex needs through better approaches to hospital discharge and developing

more specialist provision to ensure that people are supported to live near their

families.

5 Scottish Government, The Keys to Life – Improving quality of life for people with learning disabilities,

Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf

5

The Same as You?

The previous national strategy for learning disabilities „The Same as You?‟6 was

published in May 2000. It reviewed the services then available to people with

learning disabilities (and people on the autism spectrum). It said that people with

learning disabilities have the right to be included in, and contribute to, society, to

have a voice, and to have access, with their families, to support to live the life of their

choosing. It contained 29 recommendations intended to drive a change programme

to improve services.

The Same as You? stated that it wanted people with learning disabilities to:

be included, better understood and supported by the communities in which

they live;

have information about their needs and the services available, so that they

can take part, more fully, in decisions about them;

be at the centre of decision-making and have more control over their care;

have the same opportunities as others to get a job, develop as individuals,

spend time with family and friends, enjoy life and get the extra support they

need to do this; and

be able to use local services wherever possible and special services if they

need them.

An evaluation of The Same as You? was carried out to inform the development of

the new strategy7. The evaluation found that over the last decade there have been

more opportunities and greater inclusion for individuals, and a shift from health-

dominated approaches towards a social model focusing on personalisation and

individual potential. The evaluation found that there is still work to be done to ensure

that outcomes for heath and independent living are equal to those for other groups. It

also noted that current financial pressures require more imaginative approaches

including supporting people with learning disabilities into employment.

Health Needs Assessment Report: People with Learning Disabilities in

Scotland

NHS Health Scotland undertook a health needs assessment for people with learning

disabilities in Scotland in 20048. The study presented evidence showing that life

expectancy is lower for people with learning disabilities. It also found that life

expectancy is increasing and that “in future there will be more people with learning

disabilities, more older persons with learning disabilities, and more persons with the

6 Scottish Executive, The Same as You? A Review of Services for People With Learning Disabilities,

May 2000. http://www.scotland.gov.uk/Resource/Doc/1095/0001661.pdf 7 See - Scottish Government, The Same as You? 2000-2012: Consultation Report, 2012.

http://www.scld.org.uk/sites/default/files/say_consultation_full_version.pdf 8 NHS Health Scotland, Health Needs Assessment Report: People with Learning Disabilities in

Scotland, 2004. http://www.gla.ac.uk/media/media_63872_en.pdf

6

most severe learning disabilities in all age cohorts”. It also found that people with

learning disabilities have greater, and different, health needs compared with the rest

of the population. The study showed that people with learning disabilities also have

a higher level of unmet health needs compared with the rest of the population.

The report made 25 recommendations aimed at reducing health inequalities and

promoting social inclusion. These relate to the following five areas:

Leadership and accountability - both nationally and locally, and including

health improvement strategy development;

Infrastructure development, planning and monitoring - including a programme

of research focused on health improvement for people with learning

disabilities and database development;

Specific interventions - including a health screening programme specifically

for people with learning disabilities, development of national governance with

an audit of all deaths of persons with learning disabilities, enhancing primary

health care services, increased availability of advocacy, and specialist

community-based services for children, adults and older persons with learning

disabilities;

Information - including dissemination of health improvement information,

identification and networking of directly-accessed practitioners, and a better

understanding of the needs of persons with learning disabilities from ethnic

minority communities;

Education - including work on staff induction in NHS Scotland, initiatives at

pre and post registration / graduation, and with paid and family carers.

National Community Care Outcomes Framework

The Community Care Outcomes Framework was published in 2008 to assist

Community Health Partnerships to understand their performance at a strategic level,

and how well they are improving outcomes for people who use Community Care

services or support, and their carers. It also allows partnerships to share this

information across Scotland and compare performance directly on the basis of

consistent and clear information. The Framework includes four national outcomes

and 16 performance measures and covers: people‟s satisfaction with services,

waiting times, quality of assessment, shifting the balance of care, carers' well-being,

unscheduled care and identifying 'people at risk'9.

The Scottish Community Care Benchmarking Network is made up of Local Authority

Social Work Services, Community Health Partnerships, NHS Boards, Scottish

Government and NHS Information Services Division. The Network undertook a

9 National Outcomes for Community Care. http://www.jitscotland.org.uk/downloads/1209565691-

1182957501-National%20Outcomes%20Framework%20-

%20quick%20reference%20summary%20June%202007.doc

7

review of the Outcomes Framework in 201210. The recommendations, which have

been accepted, relate to developing the national outcomes framework and promoting

the local use of personal outcomes approaches:

continue to encourage and support local use of the Talking Points: Personal

Outcomes Approach11 to focus practice on personal outcomes and to draw

information from that process to inform performance management and joint

commissioning;

build on the learning from the Community Care Outcomes Framework to

inform the development and use of a single suite of outcomes and indicators,

for both reshaping Care for Older People and the Integration of Health and

Social Care, particularly in relation to personal outcomes;

support local partnerships to take a whole systems approach in their use of

the single suite of outcomes and indicators; and

promote the use of contribution analysis at local level to develop logic models

for use in devising local joint performance management frameworks.

Self-Directed Support

Self-Directed Support is the principle that people have informed choice about the

way that their social care and support is provided to them. A ten year National

Strategy for Self-Directed Support12 was produced in 2010 by the Scottish

Government and COSLA. The strategy supports a cultural shift around the delivery

of care and support in Scotland, with Self-Directed Support becoming the

mainstream approach. The focus of the strategy is on delivering better outcomes

through focused assessment and review, improved information and advice, and a

clear and transparent approach to support planning. It states that, “If we are serious

about enabling people to exercise choice and control over their lives, then they

should be able to maximise choice and control over any formal support they require

too.”

The Scottish Parliament recently passed the Social Care (Self-Directed Support)

(Scotland) Act 2013. The Act gives people a range of options for how their social

care is delivered. They can choose to take a lot of control over their support – for

example, through a direct payment or individual service fund – or can choose to take

less responsibility and ask the local authority to arrange support on their behalf. The

Act requires local authorities to offer people four choices on how they can get their

social care. The choices are:

Option 1 - direct payment;

10

Joint Improvement Team (JIT) / SCCBN, Review of the Community Care Outcomes Framework,

April 2012. http://www.jitscotland.org.uk/downloads/1335533380-

Review%20of%20Community%20Care%20Outcomes%20Framework.doc 11

See http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/ 12

Scottish Government / COSLA, Self-Directed Support: A National Strategy for Scotland, October

2010. http://www.selfdirectedsupportscotland.org.uk/downloads/1332171629-

National%20Strategy%20SDS.pdf

8

Option 2 - the person directs the available support;

Option 3 - the local authority arranges the support;

Option 4 - a mix of the above.

The Act contains some other duties and powers, for example a power to local

authorities to support unpaid carers and duties on local authorities to give

information to help service users make an informed choice.

Shifting the Balance of Care & Reshaping Care for Older People

Demographic pressures (particularly the projected rise in the number of older

people), workforce issues, the need to improve health and social care outcomes, and

the increasing cost of institutional care mean that current patterns of care delivery

are not sustainable. Long-term conditions will be one of the main challenges facing

health and social care providers. The increase in demand for services will have

huge resource implications across Scotland. As a means of responding to this

challenge the Government is striving to shift the balance of care and resources from

institutional to community settings through the development of local partnership

mechanisms, most obviously Community Health Partnerships. The Shifting the

Balance of Care agenda supports changes at different levels across health and

social care – all of which are intended to bring about improvements in health and

wellbeing and better service outcomes through earlier diagnosis and intervention,

preventative work, and support services tailored more closely to each person‟s

needs and delivered closer to home.

The Shifting the Balance of Care Improvement Framework (July 2009)13 identified

eight broad impact areas to support the delivery of national and local outcomes:

Maximise flexible and responsive care at home with support for carers;

Integrate health and social care and support for people in need and at risk;

Reduce avoidable unscheduled attendances and admissions to hospital;

Improve capacity and flow management for scheduled care;

Extend scope of services provided by non medical practitioners outside acute

hospital;

Improve access to care for remote and rural populations;

Improve palliative and end of life care;

Improve joint use of resources (revenue and capital).

„Reshaping Care for Older People – a Programme for Change‟14, published by the

Scottish Government in 2011, set out what change is to take place to ensure the

right services and support are in place to meet the needs of older people across

13

Scottish Government, Shifting the Balance of Care Improvement Framework, July 2009.

http://www.shiftingthebalance.scot.nhs.uk/downloads/1249894242-

Improvement%20Framework%20July%202009.pdf 14

Scottish Government, Reshaping Care for Older People – a Programme for Change 2011-2021,

http://www.scotland.gov.uk/Resource/0039/00398295.pdf

9

Scotland in the 21st century. The programme follows the principle of „shifting the

balance of care‟ away from hospital based services to the community, with an

increased need for prevention and stronger community based services. The

Reshaping Care agenda promotes an „enabling‟ approach and supports people to

maximise their independence and quality of life.

National guidance was issued to CHPs requiring them to develop plans to jointly

commission services for older people covering a ten year period. Locally, a pan-

Ayrshire approach has been taken with NHS Ayrshire and Arran, North, South and

East Ayrshire Councils developing a Ten Year Vision for Joint Services – Reshaping

Care for Older People. The Vision is based on the model below which reflects the

way in which resources, both finance and staff, will be deployed to support the

reshaping care agenda.

Figure 1: Model for Reshaping Care

Commission on the Future of Public Services (Christie Commission)

The Christie Commission looked at the future delivery of public services in Scotland.

Their report15 states that services must be redesigned as demographic change will

mean there will not be enough people of working age to support current service

15

Public Services Commission, Commission on the Future of Public Services, June 2011.

http://www.scotland.gov.uk/Resource/Doc/352649/0118638.pdf

Hospital Based

Services

Shifting

the

balance of

care and

resources

10

provision, or the money available to pay for it. It also calls for a shift towards

preventative spending, arguing that pressure on public services is the result of “our

failure up to now to tackle the causes of disadvantage and vulnerability, with the

result that huge sums have to be expended dealing with their consequences”.

The four key recommendations of the Christie Commission were that:

Reforms must aim to empower individuals and communities receiving public

services by involving them in the design and delivery of the services they use;

Public service providers must be required to work much more closely in

partnership, to integrate service provision and thus improve the outcomes

they achieve;

We must prioritise expenditure on public services which prevent negative

outcomes from arising;

Our whole system of public services – public, third and private sectors – must

become more efficient by reducing duplication and sharing services wherever

possible.

Integration of Adult Health and Social Care Services

To support the Shifting the Balance of Care agenda and the principles for public

sector reform outlined in the Christie Commission, the Scottish Government is

driving forward the integration of adult health and social care services in Scotland16.

Integration will be progressed at the local level and will change the way that the NHS

and local authorities work together and in partnership with the third and independent

sectors. This will see changes to the way adult health and social care services are

planned and delivered, with the aim of delivering a more coordinated service and

better outcomes for patients, service users, carers and families. The Bill to integrate

adult health and social care services was introduced to the Scottish Parliament in

May 2013.

Achieving Sustainable Quality in Scotland’s Healthcare – A 20:20 Vision

In 2011, the Scottish Government published its strategic vision for achieving

sustainable quality in the delivery of healthcare services across Scotland, in the face

of the significant challenges of Scotland‟s public health record, shifting demography

and the economic environment17.

The Scottish Government's 2020 Vision is that by 2020 everyone is able to live

longer healthier lives at home, or in a homely setting and, that we will have a

healthcare system where:

We have integrated health and social care;

16

See: Scottish Government, Integration of Adult Health and Social Care in Scotland – Consultation:

Scottish Government Response, February 2013.

http://www.scotland.gov.uk/Resource/0041/00414332.pdf 17

Scottish Government, Achieving Sustainable Quality in Scotland‟s Healthcare – A ‟20:20‟ Vision,

September 2011. http://www.scotland.gov.uk/Resource/0039/00398668.doc

11

There is a focus on prevention, anticipation and supported self-management;

When hospital treatment is required, and cannot be provided in a community

setting, day case treatment will be the norm;

Whatever the setting, care will be provided to the highest standards of quality

and safety, with the person at the centre of all decisions;

There will be a focus on ensuring that people get back into their home or

community environment as soon as appropriate, with minimal risk of re-

admission.

Commissioning Social Care, Audit Scotland

In 2012, Audit Scotland identified the substantial gaps and uncoordinated way in

which services have tended to be commissioned. The main recommendations made

in their report18 include:

the need to develop commissioning strategies;

the need to manage the risks of contracting services from voluntary and

private providers;

implement Self-Directed Support in a way that service-users will get

information, advice and support and processes are in place to monitor the

outcomes of the support; and

the need to work very closely together with all partners, including the Third

and Independent Sectors.

The Scottish Strategy for Autism

Scotland‟s national autism strategy was launched in November 201119. The strategy

clearly places autism as a nation priority and states that strategic action is needed

both nationally and locally. The strategy recognises that people on the autism

spectrum each have a unique set of conditions which will not necessarily fall within

the categories of learning disabilities or mental health, although these conditions

may be present. The strategy advocates a holistic, joined-up approach and

emphasises that people with autism and their carers need to be supported by a wide

range of services including social care, education, housing, employment and other

community-based services. The strategic vision is that “individuals on the autism

spectrum are respected, accepted and valued by their communities and have

confidence in services to treat them fairly so that they are able to have meaningful

and satisfying lives”.

The strategy made 26 recommendations aimed at improving diagnosis and

assessment, establishing more consistent service standards, matching resources to

need, and delivering appropriate research and training opportunities. It also

established 10 best practice indicators for the provision of Autism Spectrum Disorder 18

Audit Scotland, Commissioning Social Care, March 2012. http://www.audit-

scotland.gov.uk/docs/health/2012/nr_120301_social_care.pdf 19

Scottish Government, The Scottish Strategy for Autism, November 2011.

http://www.scotland.gov.uk/Resource/Doc/361926/0122373.pdf

Shifting the

balance of

care and

resources

12

(ASD) services. These indicators provide a framework for local implementation of

the strategy and state that good ASD provision should include: a local autism

strategy; multi-agency service delivery; strong planning and access to training and

development; easy access to practical information on ASD; a process for data

collection; a multi-agency care pathway; a framework for engagement and

stakeholder feedback; clear procedures and multi-agency transition planning.

See Hear: A strategic framework for meeting the needs of people with a

sensory impairment in Scotland

The Scottish Government published its draft strategy for sensory impairment in April

201320. The draft strategy offers a strategic framework for the development of

sensory impairment services and support and provides a model care pathway to

ensure better working relationships and service provision for users and carers. The

pathway acknowledges that not all needs are similar, and service users may have

different needs and expectations.

The draft strategy sets a 10 year timescale for implementation. It acknowledges that

different types of sensory impairment will require different responses. It recognises

that while the responsibility for systems of care lies with the statutory agencies, these

can be delivered across a wide range of agencies and settings. It states that a

partnership approach is essential, with the active engagement of a wide range of

statutory and third sector agencies in the health and social care sectors, as well as

wider public services, and including people with a sensory impairment themselves

and their carers.

The draft strategy makes six key recommendations relating to:

an audit of all current spending on sensory impairment;

development of options for the introduction of basic sensory screening;

training in sensory awareness;

local partnership working and service planning;

systems for maintaining information locally;

compliance with the Equality Act 2010 in relation to sensory impairment.

Scotland’s National Dementia Strategy

Scotland‟s National Dementia Strategy21 was published in June 2010 and sets out

actions to improve services and support for people with dementia and their carers.

The strategy focuses on two main areas of change:

post diagnosis - ensuring that excellent support and information to people with

dementia and their carers is offered following a dementia diagnosis; and

20

Scottish Government, See Hear: A strategic framework for meeting the needs of people with a

sensory impairment in Scotland (Draft for consultation), April 2013.

http://www.scotland.gov.uk/Publications/2013/04/2067 21

Scottish Government, Scotland‟s National Dementia Strategy, June 2010.

http://www.scotland.gov.uk/Resource/Doc/324377/0104420.pdf

13

hospital settings – improving the response to dementia, including through

alternatives to admission and better planning for discharge.

In 2012, the Scottish Government made a commitment to guarantee that people

receiving a diagnosis of dementia will be offered a minimum of one year of post-

diagnostic support. This commitment will involve a link worker who will be assigned

to work with the person, their family and carers in coordinating support and building a

person-centred plan.

An update to the National Dementia Strategy was launched in June 2013. The new

three-year strategy focuses on the following key themes22:

Continuing to focus on promoting and supporting early, accurate diagnosis of dementia;

Supporting a significant improvement in the quality and consistency of post-diagnostic support;

Engaging and involving people with dementia and their families and carers as equal partners in care throughout the journey of the illness;

Supporting people to live a good quality of life at home for as long as possible, as they move from self-management to needing more intensive community-based support;

Ensuring people get safe, appropriate and dignified care in hospital and in care homes on every occasion;

Nurturing dementia-enabled and dementia-friendly local communities.

South Ayrshire CHP has developed a local Dementia Action Plan in line with national

priorities. The local action plan recognises the support needs of people with learning

disabilities and dementia.

Caring Together: The Carers Strategy for Scotland 2010-2015

Caring Together23 acknowledges the vital contribution unpaid carers make to the

health and social care system and commits to working with carers as equal partners

in the planning and delivery of care and support. It is recognised both nationally and

locally that Health and Social Care services depend on the significant amounts of

caring provided by partners, family members and others to respond to the increasing

challenges posed by an ageing population.

The economic contribution that unpaid carers make to the economy is significant. It

is estimated that carers save statutory services £7.6 billion per year in Scotland. The

high social and economic value of unpaid carers is fundamental to society‟s ability to

cope with the increasing demand for services.

22

Scottish Government, Dementia Strategy 2013-16 Proposition Paper, February 2013.

http://www.scotland.gov.uk/Resource/0041/00415388.docx 23

Scottish Government, Caring Together: The Carers Strategy for Scotland 2010 – 2015, October

2010. http://www.scotland.gov.uk/Resource/Doc/319441/0102104.pdf

14

Adult Support and Protection

The Adult Support and Protection Act 200724 provides greater protection to adults at

risk of harm through powers to investigate and take action to support and protect

adults in situations where concern exists. It places a duty on Councils to make

enquiries and investigations to find out whether or not further action is required to

stop or prevent harm from occurring, and introduces a range of protection orders

including assessment orders, removal orders and banning orders.

Adults who are at risk of harm are aged 16 years or over and are unable to

safeguard their own well being, property, rights or other interests. They may be at

risk of harm because they are affected by disability, mental disorder, illness or

physical infirmity. In terms of the legislation an adult who is at risk of harm because

another person‟s conduct is causing or is likely to cause the adult to be harmed or

the adult is engaging in conduct which causes or is likely to cause self harm.

Equality Act 2010

The Equality Act 201025 places duties on bodies, including service providers in the

statutory, Third and Independent Sectors not to discriminate on the basis of certain

protected characteristics and make „reasonable adjustments‟ in certain situations.

Whichever models of care are adopted in the future, the CHP is fully committed to

promoting equality and diversity within all future Joint Services. This will be ensured

through a robust process of Equality Impact Assessment (EIA), which is already

embedded into practices across all public bodies, including NHS Ayrshire & Arran

and each of the local authorities. A full EIA has been carried out on this strategy to

assess the potential impact of any actions or proposals on particular equality groups.

Welfare Reform Act 2012

The Welfare Reform Act26 came into law in March 2012. The Act makes a wide

range of changes to the UK's benefits system. Key changes include:

Universal Credit: This new benefit aims to simplify the system by combining a

number of different benefits into one payment, including income-related

Employment and Support Allowance. It is a key part of the Government's

pledge to make work pay and cut fraud in the benefits system.

Personal Independence Payment (PIP): This new benefit will replace

Disability Living Allowance (DLA) for working age people from April 2013.

Between 2013 and 2016, existing DLA claimants who are aged 16 - 64 will be

reassessed to see if they are entitled to this new benefit. PIP uses a new

assessment process that will take account of a range of abilities, but

maintains a very similar structure to DLA.

24

http://www.legislation.gov.uk/asp/2007/10/contents 25

http://www.legislation.gov.uk/ukpga/2010/15/contents 26

http://www.legislation.gov.uk/ukpga/2012/5/contents/enacted

15

There are also a wide range of changes introduced in the Act to cut fraud, change

the Housing Benefit system and overhaul child support payments. Understanding

the implications of the reforms, and keeping up to date with developments will be a

key concern for those supporting people with learning disabilities.

16

2.2 Local policy context

South Ayrshire Single Outcome Agreement

The Scottish Government along with Local Authorities and partners are working

together to achieve a number of national outcomes. What local partners are doing to

achieve the national outcomes is set out in the South Ayrshire Single Outcome

Agreement (SOA)27.

The SOA sets out key strategic outcomes relating to: economic growth; supporting

children and families; health inequalities and physical activities; caring for older

people; supporting strong and safer communities; and, protecting and enhancing the

environment. The SOA sets out some underpinning principles which are central to

the delivery of outcomes in South Ayrshire. Of particular relevance are the following

principles:

Building on the assets of individuals and communities: moving away from a

focus on „deficits‟ – recognising and supporting people‟s capabilities rather

than focusing on barriers alone;

Early intervention and prevention: breaking cycles of poor outcomes – shifting

priorities and resources from crisis intervention to prevention;

Designing services together – involving individuals and communities to get

services right;

Equalities – eliminating discrimination, advancing equality of opportunity and

fostering good relations.

In relation to health improvement, the SOA establishes the following long-term (5 to

10 year) outcome:

“Individuals and communities are able and motivated to look after and improve their

health and wellbeing resulting in more people living in good health for longer with

reduced health inequalities.”

This will be met by a number of intermediate (3 to 5 year) outcomes which will be

supported by this strategy, including:

“People have positive experiences of health, social care and support

services, which help to maintain or improve their quality of life.”

“People who provide unpaid care to others are supported and able to maintain

their own health and wellbeing.”

27

South Ayrshire Community Planning Partnership, Single Outcome Agreement for South Ayrshire,

May 2013

17

‘We Want Good Health...the Same as You’ - A Strategy to Improve the Health of

Children with Learning Difficulties and Adults with a Learning Disability, 2009-

2014

We Want Good Health...the Same as You28 is a pan-Ayrshire partnership strategy

that was developed in response to the recommendations in the NHS Health Scotland

Health Needs Assessment Report (see above). The strategy has two key aims: „To

improve health, well-being and social inclusion‟ for the target group and „To reduce

health inequalities‟. The strategy also sets out the following objectives:

Define the population groups to which services need to respond;

Outline the health improvement needs of these groups;

Propose solutions to address the health improvement needs of the target

group;

Highlight and scope resource implications for proposed solutions;

Highlight development needs for services, including those for specific

groups of staff;

Ensure the needs of the target group are reflected in all health care

strategies and health promotion activities;

Ensure that inclusive leisure, active living and respite needs are

considered as part of the strategy.

We Want Good Health...the Same as You makes a number of recommendations in

relation to general health issues (for example, recognising issues around co-

morbidity), improving access to health services and development of effective clinical

pathways, development of better service models, support and information for carers

(and development of respite). The strategy also recommends greater awareness

raising and training for health staff and other service providers, as well as stronger

research and auditing on health interventions for people with learning disabilities.

We Want Good Health...the Same as You will be reviewed in 2014. The strategy is

the key policy for improving health outcomes for people with learning disabilities in

Ayrshire. As such, this strategy will link into the existing actions committed to in the

existing health improvement strategy and support the review and continuation of the

strategy from 2014 onwards.

New Horizons – review of the NHS Ayrshire and Arran Learning Disability

Service

In 2011, NHS Ayrshire and Arran‟s Learning Disability Service (LDS) commenced a

process of service review aimed at informing its structure and function over the next

5-10 years. The New Horizons review29 was carried out in two phases, with Phase 1

28

NHS Ayrshire and Arran, „We Want Good Health...the Same as You‟ - A Strategy to Improve the

Health of Children with Learning Difficulties and Adults with a Learning Disability, 2009-2014,

May 2009 29

NHS Ayrshire and Arran, Initial Report on New Horizons Consultation, July 2012 & NHS Ayrshire

and Arran, New Horizons – Report on Phase 2 Interviews, October 2012.

18

focusing on engagement with the service‟s own staff, service users and carers.

Phase 2 of the review involved discussions with a wide variety of partners who work

regularly with or have an interest in the LDS. The initial phase highlighted a number

of areas for service development, including:

Stronger linkage between the community and in-patient arms of the service;

Developing a flexible staff resource, extending across in-patient and

community settings;

Developing the Health Assessment process;

Developing broader concepts of „health‟ including enablement and asset /

outcome based approaches;

Exploring the potential for a greater focus on health promotion activity within

the LDS;

Filling care gaps through encouraging partnership work and demonstrating

innovation;

Engaging with carers and service users consistently, and on their terms.

The second phase of the study reinforced much of the earlier learning and also

focused on developing multi-disciplinary working and the way forward for service

integration. The review also considered ways of improving communication and

developing skills within the LDS. Key topics considered as priorities for skills

development and training reflect the importance of the LDS linking into other

services, including:

Dementia;

Substance misuse;

Mental health;

Parenting.

South Ayrshire Carers Strategy

South Ayrshire Carers Strategy (2012-2017)30 establishes the strategic approach to

helping and supporting unpaid carers (including young carers) until 2017. The

strategy recognises the huge contribution that partners, family members and other

unpaid cares make in supporting the health and social care needs of the local

population. It also recognised the economic impact of unpaid carers, noting that

unpaid carers save statutory services £7.6 billion nationally, and £180 million in

South Ayrshire.

The strategy identifies the outcomes we wish to achieve for unpaid carers taking into

account the national and local policy context and specific issues in relation to young

carers. It outlines the gaps in the current provision of services available to support

unpaid carers in South Ayrshire, and sets out separate action plans for adult carers

and young carers.

30

South Ayrshire Council, South Ayrshire Carers Strategy 2012-2017, 2012

19

Key themes covered in the strategy include:

Better identification of Carers;

The involvement of Carers in planning and designing services;

Improving the uptake and quality of assessments for Carers;

Information and advice for Carers;

Health and well being of Carers;

Time-out for Carers (respite, short breaks);

Training for Carers;

Housing and Housing Support;

School based support (for young carers);

Use of assistive technology to assist Carers in their role;

Advocacy Support;

Employment and Skills;

Poverty and financial inclusion.

South Ayrshire Dementia Action Plan 2013-2016

South Ayrshire CHP has developed a three year South Ayrshire Dementia Action

Plan31 to support people with dementia and their families and carers. The local plan

is in line with national and pan-Ayrshire priorities. The actions set out in the plan will

help deliver the following key outcomes:

People with dementia and their carers receive the best health and support

services;

People with dementia and their carers receive the best possible support and

information following diagnosis;

Dementia is diagnosed as early as possible for people in South Ayrshire;

People with dementia have their rights respected and do not experience

discrimination, stigma or harm;

Our communities are inclusive and supportive and dementia friendly;

The needs of carers are fully met.

South Ayrshire Adult Mental Health Strategy 2013-2016

South Ayrshire CHP has produced a three year strategy and action plan to support

adults experiencing mental ill health and their carers32. The strategy focuses on the

strengths of local people and communities in South Ayrshire. Following the priorities

set out in the national Mental Health Strategy for Scotland 2012-15 it sets out a

range of key outcomes to support improved mental health and wellbeing. The

strategy has a strong focus on providing support to adults experiencing mental ill

health and with continuing mental health problems. The strategy aims to empower

people with mental ill health to make their own decisions and live as independently

31

South Ayrshire CHP, South Ayrshire Dementia Action Plan, 2013 32

South Ayrshire CHP, South Ayrshire Adult Mental Health Strategy 2013-16, 2013

20

as they choose. It also aims to increase opportunities for people experiencing ill

health and ensure that our local communities are actively supportive.

South Ayrshire Alcohol and Drug Strategy 2011-2015

South Ayrshire‟s Alcohol and Drug Partnership (ADP) developed a four year

strategy33 to reduce the harm of alcohol and drug misuse on local individuals,

families and communities. The strategy aims to build on the strengths and assets of

individuals and communities and takes a whole population approach to tackling

substance misuse. The strategy is based around the following five key work areas:

A whole population approach to prevention and education - helping people to

reduce their alcohol and drug use;

Enforcement, availability and safer environments - helping local communities

to feel safe and secure;

Children and families affected by others‟ substance misuse - protecting and

caring for children and young people;

Developing a Recovery Orientated System of Care - helping individuals to

recover and remain free from alcohol and drug misuse;

Communication, engagement and workforce development - Encouraging

understanding of the effects of alcohol and drug misuse.

The ADP strategy recognises the relationship between substance misuse and

mental health and wellbeing. This strategy has been developed in consultation with

the ADP and in line with the objectives they are working towards.

Looking after Every Child: Children and Young People’s Health Strategy for

Ayrshire and Arran, 2008-2017

The Children and Young People‟s Health Strategy34 was developed by NHS Ayrshire

and Arran and covers all three Ayrshire local authority areas. It is a nine year

strategy, underpinned by an action template which is updated every three years to

ensure alignment with the integrated children‟s services plans in each locality. The

next update of the action template is due to be completed by March 2014. The

strategy draws together a number of workstreams and sets out the broad vision for

improving and promoting health, developing health services and addressing

inequalities for children and young people in Ayrshire and Arran.

The strategy aims to ensure that children and young people are as healthy as

possible, have access to suitable health services, receive support to develop healthy

lifestyles and have resilience to protect them against adversity. The strategy has a

33

South Ayrshire ADP, South Ayrshire Alcohol and Drug Strategy 2011-2015, 2011. http://ww4.south-

ayrshire.gov.uk/portal/page/portal30/INTRANET_CA/Community%20Planning%20Partnership/Alcohol

%20and%20Drug%20Partnership/Reports%20%20Publications/ADP%20Strategy%20FINAL%20201

1.pdf 34

NHS Ayrshire and Arran, Looking after Every Child: Children and Young People‟s Health Strategy

for Ayrshire and Arran 2008-2017, 2008. http://www.nhsaaa.net/media/199707/cyphsmay13.pdf

21

preventative focus. It recognises that health inequalities in childhood can have a

lasting effect throughout life and that children continue to experience health

problems which are preventable. The strategy targets the most vulnerable groups

including children and young people who:

are looked after children (LAC) or looked after and accommodated (LAAC);

are homeless;

have complex health needs;

have learning disabilities;

are in need of protection from physical, sexual or emotional abuse;

are living in a substance misusing household;

are young carers;

are experiencing domestic abuse.

An autism strategy for Ayrshire

In accordance with the Scottish Strategy for Autism, local authorities are being

supported to lead the implementation of the strategy in their local areas. In Ayrshire,

the three local authorities and the NHS have agreed to develop an Ayrshire-wide

implementation plan to support people with autism, their families and carers. The

local plan will outline how the 10 good practice indicators and the recommendations

from the national strategy will be delivered across Ayrshire.

Key areas of focus are expected to include:

Strong communication, coordination and cooperation between those working

with autism;

Training and improved understanding of autism (across service areas);

Improving access to information for people with autism and signposting to

appropriate services and support;

Effective engagement with people with autism and carers.

A pan-Ayrshire strategy for sensory impairment

There has been significant partnership working across the three Ayrshire local

authority areas towards the development of a shared approach to supporting people

with a sensory impairment. Discussions between the three councils, the NHS,

national and local voluntary groups, service users and carers have led to a shared

approach and an agreed set of priorities.

The partners have agreed to develop a pan-Ayrshire strategy for sensory

impairment. This will be underpinned by three local delivery plans which will reflect

the assessed needs and resources within local communities. Development work is

also underway to establish an Ayrshire-wide Sensory Impairment Team.

Partners and service users have agreed the following priorities for supporting

sensory impairment in Ayrshire:

22

To provide appropriate and proportionate support for all people with sensory

impairment;

To give our young people the same life chances as their peers;

Families - to provide support for carers and young carers, making advice

available;

Schools – to support attainment and recognise that schools often provide the

important links across family, education and health services;

Adults – to support meaningful activity and particularly access into work;

Older people – to recognise the increasing incidence of sight and hearing loss

in older people and offer support to help people to remain independent.

Partners have also prioritised work with people who have hidden sensory

impairment. This includes people with learning disabilities through continued support

for the Bridge to Vision project. This project supports the delivery of eye healthcare

services to people with learning disabilities.

23

3. Where are we now?

3.1 Who are people with learning disabilities?

The Scottish Government‟s current definition for a person with learning disabilities is

someone who has a significant, lifelong condition that started before adulthood,

which affected their development and means they need help with:

understanding information;

learn skills; and

cope independently.

However, this can only ever be part of a description and will not define a person.

People with learning disabilities have many roles – a family member, a friend, a

parent, an employee or employer, a student, a community activist (to name a few

possibilities).

People with learning disabilities have different levels of need and the level of support

that individuals require can vary greatly. For example, a person with learning

disabilities may need:

occasional or short-term support;

limited support, for example, only during periods of change or crisis;

regular long-term support, perhaps every day; or

constant and highly intensive support if they have complex or other needs

which are related.

The Keys to Life35 states that people with learning disabilities should have a range of

support and services to meet the following categories of need:

Everyday needs – for example, a place to live, security, social and personal

relationships, leisure, recreation and work opportunities;

Extra needs because of their learning disabilities – for example, help to

understand information, support to make decisions and plan, learn skills, help

with communication, mobility or personal care;

Complex needs – for example, needs arising from both learning disabilities

and from other difficulties such as physical and sensory impairment, mental

health problems or behavioural difficulties.

3.2 National trends

Data on the number of school age children with learning disabilities is available from

all publicly funded schools in Scotland (accounting for 95% of all school-age children

35

Scottish Government, The Keys to Life – Improving quality of life for people with learning

disabilities, Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf

24

in Scotland). In September 2012 there were 15,979 school children with additional

support needs due to learning disability: 64% were boys and 36% were girls.

National statistics on adults with learning disabilities are gathered via the eSAY

project36 where local authorities return annual statistics on their adult users of

learning disability services. The other main data source on the learning disability

population is General Practice registers. Most GPs (96%) are required by their

Health Board to keep a database of their registered patients who have learning

disabilities and are over 18 years of age.

In 2011, the eSAY return included 25,331 adults with learning disabilities over the

age of 18 (using local authority services). Of these, 58% were men and 42% were

women. For 2011-12, GP databases included 24,998 adults aged over 18. This

figure has been adjusted to 26,097 to take account of the non-participating GP

practices.

The eSAY return also collects information on ethnic groups. The 2011 data showed

that 22,589 adults with learning disabilities were classified as „white‟ and 374 people

were recorded as being of a different ethnic background.

Data from the eSAY returns (and preceding Same as You? Annual Surveys) shows

that the number of adults using local authority learning disability services has

increased steadily since 2003. Figure 1 shows that the total number of recorded

service users rose from 18,066 in 2003 to 26,117 in 2012 (having peaked at 27,671

in 2009). These figures include people with Autism Spectrum Disorder.

36

See - http://www.scld.org.uk/scld-projects/esay

25

As with the rest of the population in Scotland, people with learning disabilities are

living longer. Research studies predict a 36% increase in the number of older

people living with learning disabilities between 2001 and 2021 as a result of

improved health and social care. This means that increasingly, people with learning

disabilities will encounter many of the conditions associated with ageing, including

dementia. Research has also shown that people with learning disabilities experience

higher rates of dementia than the general population. Studies suggest that

prevalence rates are four times higher regardless of the cause of learning disability

and that onset of the condition is about 10 years earlier than the wider population.

People with Down‟s syndrome experience significantly higher prevalence rates and

earlier onset of the condition has been reported as being between 30 and 40 years

younger on average compared with the general population.37

1 - 2008 figures have been updated to include all 32 Local Authorities by using 2007 data for the three Local Authorities who

did not return data in 2008. 2 - In 2008 the survey question was changed therefore figures are based on those who either owned their home or where in

social/rented housing. Source: Scottish Government, SLCD - eSAY return and ISD Scotland

Figure 3 shows the changing balance of care for people with learning disabilities in

Scotland between 2001 and 2011. Generally, the data reflects the shift from

institution-based care towards more community-based support and greater

independence for people with learning disabilities. The chart shows the reducing

number of people with learning disabilities in long stay hospitals, reflecting the

Scottish Government‟s policy to reduce the number of continuing care beds. The 37

Scottish Government, The Keys to Life – Improving quality of life for people with learning

disabilities, Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf

26

number of people with learning disabilities living in care homes and the number

attending day centres for adults with learning disabilities have also been reducing

over the period. There has been an increase in the use of alternative day

opportunities (i.e. non-local authority run activities). Greater numbers of people with

learning disabilities are living in their own tenancies. The provision of home care has

been increasing and there has been a consistent rise in the uptake of direct

payments for the purchasing of services.

3.3 The learning disability population in South Ayrshire

Population profile

NHS Quality and Outcomes Framework (QOF) data38 for GP practices in South

Ayrshire gives a profile of patients on GP registers with a diagnosed learning

disability.

There are 20 GP practices in South Ayrshire with a total of 117,086 registered

patients at March 2012;

In 2011/2012 there were 665 patients registered as having learning

disabilities;

Based on these figures, the prevalence rate for learning disability in South

Ayrshire is 0.57 per 100 patients.

The prevalence of learning disability in South Ayrshire is higher than the average

prevalence for Scotland (0.47 per 100 people).

The eSAY Statistical Return for 2012 recorded data on all adult service users known

to Social Work at the time of data collection and those who had had contact with

Social Work services within the past 3 years who were believed to be still residing in

South Ayrshire. The eSAY population figures tend to be lower than GP registers due

to individuals not accessing Social Work services. The eSAY return showed that

there were 521 service users living within South Ayrshire. This was an increase of

8% from the previous year.

The eSAY data shows that there are more males with learning disabilities (57%) than

females (43%).

38

NHS QOF data, 2012. http://www.isdscotland.org/Health-Topics/General-Practice/Quality-And-

Outcomes-Framework/

27

Figure 4 – Gender of people with learning disabilities in South Ayrshire

57%

43%Male

Female

Source: eSAY, 2012

Figure 5, below, shows the number of adult service users within the learning

disability population by age band. Eight per cent are aged under 20, 83% are aged

21-64 and 10% are aged over 65.

Figure 5 - Age profile of people with learning disabilities in South Ayrshire

0

50

100

150

200

16-17 18-20 21-34 35-49 50-64 65+

933

160140

128

52

No. of Service users

Source: eSAY, 2012

Further analysis of the ages of the current learning disability population shows that

within the next 3 to 5 years the older population is expected to increase significantly.

Figure 6 - Projected increase in learning disability population aged 65+

0

20

40

60

80

100

2012 2015 2017

52

68

81

No of service users aged 65+

Source: eSAY, 2012 – figures not adjusted for mortality rates.

28

Based on the above figures there will be a 25% increase in those aged 65 over the

next 3 years and a 37% increase in those aged 65+ in the next 5 years.

Housing

People with learning disabilities live in a variety of accommodation types. As Table

3.1 shows, the largest group of adults with learning disabilities in South Ayrshire live

in mainstream housing.

Accommodation type Number %

Mainstream housing with support 255 50%

Mainstream housing without support 5 1%

Mainstream housing, support status unknown 16 3%

Specialised housing 99 19%

Sheltered housing 22 4%

Supported accommodation 80 15%

Registered adult care homes 39 7%

NHS facilities / hospitals 3 1%

Not know 2 <1%

Total 521 100% Table 3.1: Accommodation type – Adults with learning disabilities in South Ayrshire 2012

Source: eSAY, 2012

Half of adults with learning disabilities in South Ayrshire known to social work (255 -

50%) live in mainstream housing with support. A small number of people (5 – 1%)

live in mainstream housing without any support provision. A fifth (99 – 19%), live in

specialised housing and 15% (80) live in other supported accommodation. Smaller

numbers live in care homes (39 – 7%) and sheltered housing (22 – 4%).

The proportion of adults with learning disabilities living in mainstream housing has

been increasing in South Ayrshire in recent years according to the eSAY data.

Figure 7 shows that the proportion of people living in this tenure rose from 40% in

2009 to 53% in 2012. This reflects the national trend, but remains below the Scottish

average (which reached 66% of adults for whom information was available in 2012).

29

Family carers

The eSAY data records the number of adults with learning disabilities living with a

family carer. Table 3.2 shows that most adults with learning disabilities do not live

with a family carer.

Family carer Number % of total % of known

Person does not live with a family carer 283 54% 58%

Person lives with family carer – parent 171 33% 35%

Person lives with family carer – other 37 7% 8%

Not known 30 6% -

Total 521 100% 100% Table 3.2 - Adults with learning disabilities living with family carers, 2012

Source: eSAY, 2012

More than half of adult service users for whom this information was available (283 –

58%) do not live with a family carer. More than a third (171 – 35%) live with parents

and 8% (37) live with other family carers.

Education and employment

The eSAY return captures the number of adults with learning disabilities in

employment or further education. Table 3.3 shows the number of adult service users

in further education for 2012.

Further education Number % of total % of known

Not currently in education 360 69% 86%

In education, time not specified 1 <1% <1%

2.5 days per week or fewer 37 7% 9%

3 days per week or more 23 4% 5%

Not known 100 19% -

Total 521 100% 100% Table 3.3 - Adults with learning disabilities in further education, 2012

Source: eSAY, 2012

30

Fourteen per cent of adult service users for whom this information was available (61)

were in further education. Nine per cent of adult service users (37) undertook further

education for less than 2.5 days per week and 5% (23) undertook further education

for 3 days or more each week.

The eSAY data also record the employment status of adults with learning disabilities.

Table 3.4 shows the number of adult service users in employment or training for

employment.

Employment status Number % of total % of known

Open employment opportunity 23 4% 5%

Non-open employment opportunity 2 <1% <1%

Not currently in employment, but in training for employment

3 1% 1%

Person not in employment or training for employment

457 88% 94%

Not known 36 7% -

Total 521 100% 100% Table 3.4 - Adults with learning disabilities in employment / training, 2012

Source: eSAY, 2012

The vast majority of adult service users for whom this information was available (457

– 94%) were not in employment or training for employment in 2012. Twenty-three

people (5%) were in „open‟ employment – i.e. mainstream jobs that are not

specifically for people with learning disabilities. Just two people were in „non-open‟

employment – likely to be a workplace established specifically for people with

learning disabilities.

The proportion of adults with learning disabilities that are either in employment or

training for employment has been decreasing in South Ayrshire in recent years

according to the eSAY data. Figure 8 shows that the proportion of adults with

learning disabilities in employment / training fell from 11% in 2009 to 6% in 2012.

This decline reflects the national trend. However, the rate for people with learning

disabilities accessing employment / training in South Ayrshire is below the Scottish

average.

31

3.4 Summary of existing learning disability services in South Ayrshire

There is a wide range of local services and activities impacting on health and

wellbeing. Specialised services are provided by NHS Ayrshire and Arran, South

Ayrshire Council and by voluntary and independent sector organisations.

The NHS Ayrshire and Arran Learning Disability Service works with people with

learning disabilities to help them to be as physically and mentally healthy as

possible. The service also provides support, advice and information to carers and

other staff involved in the provision of care. The service involves a lot of different

types of staff working in both the Community Learning Disability Teams and the

Assessment and Treatment Unit. The service includes:

South Ayrshire Community Learning Disability Team – the South Ayrshire

CLDT are based at Arrol Park Resource Centre, Ayr. People who are referred

on to the CLDT will be appointed to a health professional in line with the

reason for referral. Staff include community learning disability nurses, music

therapists, art therapists, clinical psychologists, occupational therapists,

physiotherapists, speech and language therapists, dietitians and psychiatrists.

The service also links in with other support providers such as social workers.

The Team worked with 536 people in the past 12 months and had an active

caseload of 476 at August 2013.

Assessment and Treatment Unit – the ATU provides intensive treatment for

people with learning disabilities. In particular circumstances, it may be best for

individuals to have a short period of admission when it is not possible to

continue treatment where they live.

South Ayrshire Council‟s Learning Disability Social Work Team is based at Arrol

Park, Ayr and Municipal Building, Troon and comprises one Team Leader, 9 Social

Workers and 4 Review Officers. The team works with around 460 service users at

32

any one time. During 2012/13 the team completed around 25 new assessments and

350 reviews. The Learning Disability Team also dealt with 11% (31) of all Adult

Support and Protection (ASP) referrals during 2012/13.

Day services

The Council provides day care services for people with learning disabilities. Day

services support individuals with a variety of needs who require a high level of

therapeutic input to maintain their well being. People using the service can expect a

high level of support to meet their physical and emotional needs. There are currently

80 service users attending learning disability day services across South Ayrshire.

Table 3.3 shows the number of attendees by gender at the 3 day centres in South

Ayrshire.

Male Female Total

Arran View, Ayr 5 2 7

Kyle Support 20 14 34

Girvan 24 15 39

Total 49 (61%) 31 (39%) 80

Table 3.3: Learning Disability Day Service attendees, South Ayrshire, July 2013.

The vast majority of day service users are aged between 21 and 64 with only small

numbers in younger or older groups. Figure 9 shows the age profile of service users

across the three day centres.

Figure 9 - Age profile across Day Services

0

5

10

15

18-20 21-34 35-49 50-64 65+

0

5

20 01

7

13 12

11

12 11 11

4

Arran View

Kyle Support

Girvan

Source: SAC Community Care Team, 2013

The Arran View service users are mainly aged between 21-34, with no service users

aged over 50.

The Kyle Support population is mainly aged between 35 and 64. There is currently

only one service user aged over 65. Projections indicate that this age group will

increase to 3 people aged over 65 by 2017.

33

The Girvan service user profile is fairly evenly spread across all age groups,

however it has the largest number of service users aged over 65. It is expected that

that this figure would increase to 7 service users aged over 65 over the next 5 years.

The eSAY data records the number of adults with learning disabilities that have

access to alternative day opportunities – e.g. activities taking place in the community

and not provided by the local authority.

Alternative day opportunities Number % of total % of known

Person does not have alternative opportunities 105 20% 21%

Person has alternative opportunities 404 78% 79%

Not known 12 2% -

Total 521 100% 100% Table 3.4 - Adults with learning disabilities in employment / training, 2012

Source: eSAY, 2012

Most adult service users known to South Ayrshire Council (404 – 79%) had access

to alternative day opportunities in 2012. A fifth of adult service users (105 – 21%)

did not have access to alternatives.

Figure 10 shows that over the past 4 years there has been a slightly declining trend

in access to alternative day opportunities for adults with learning disabilities known to

South Ayrshire Council. However, access remains higher than the average rate for

Scotland.

Community-based support services

There is a wide range of community-based services delivered by partners in the

voluntary and independent sectors. Key service areas include:

34

Home Care – personal care to support people with learning disabilities to live

independently at home. A range of independent and voluntary sector

organisation deliver this support in South Ayrshire;

Residential Care – supported accommodation for people with learning

disabilities;

Supported Living Services – support for people with learning disabilities to

live independently in their own tenancies;

Telecare services – using technology to allow people with learning

disabilities to maintain their independence at home;

Advocacy services – including specialist advocacy for people with learning

disabilities;

Advice and Information – self help organisations, groups and phone lines;

Support into education, volunteering and employment support –

supporting people into opportunities that will increase independence.

Outcomes for Service Users

The National Outcomes for Community Care include four experience measures

around the themes of User Satisfaction and Support for Carers. The performance

information for service users known to the Learning Disability team is shown in

Table 3.5.

Over the past three years the percentage of adults satisfied with opportunities for

social interaction increased from an average of 55% at the point of assessment to

an average of 90% at the point of review which highlights the effectiveness of

services in increasing service users opportunities for social interaction.

The percentage of service users feeling safe has increased from 97% to 98% over

the past three years.

The level of service user satisfaction with their involvement in the design of their care

packages has remained consistently high at 99% over the past three years.

The percentage of carers who feel able to continue in their caring role has also

increased from 97% to 99% over the past three years.

35

Measure 2010/11 2011/12 2012/13

% of Adults satisfied with opportunities for

social interaction (at point of assessment) 53% 59% 54%

% of Adults satisfied with opportunities for

social interaction ( at point of review) 91% 91% 88%

% of Adults in receipt of community care

services feeling safe 97% 96% 98%

% of service users satisfied with their

involvement in the design of their care

packages.

99% 99% 99%

% of carers who feel able to continue in their

caring role 97% 98% 99%

Table 3.5 – Outcomes for learning disability service users

Source: SAC Community Care Team

3.7 Findings from the stakeholder consultation

Gathering the views of a wide range of stakeholders has been an essential part of

developing this strategy. The process has been highly participative and involved a

range of consultation events including stakeholder events, focus groups and a public

consultation questionnaire.

A series of five themed „logic modelling‟ focus groups were held. Logic modelling

involves establishing key strategic aims and intended long-term outcomes, medium

and short-term outcomes and key actions for delivery. The groups brought together

stakeholders from public agencies (the Council and NHS) as well as the third and

independent sectors.

Service user and carer engagement took place in partnership with local groups and

providers. We held a series of small group discussions. More than 50 people with

learning disabilities gave their views on priorities for the strategy.

Consultation was undertaken with a range of existing groups and forums as well and

individual discussions with stakeholders. Groups consulted included the South

Ayrshire Providers Forum, Voluntary Action South Ayrshire (VASA) Community

Health Mirrored Theme Group, Hansel Alliance, Turning Point, Girvan Opportunities

and others.

A third sector stakeholder event was held to discuss emerging priorities for the

strategy. Participants highlighted key local issues and priorities for improving

outcomes.

Discussions were held with colleagues in North and East Ayrshire to consider

strategic approaches, ensure consistency and identify potential areas for partnership

working.

36

In July and August 2013 the draft strategy was put out to public consultation giving

local residents and community groups the opportunity to comment on the emerging

strategy. The strategy was widely circulated with a consultation questionnaire. The

Easy Read version of the Strategy was publicised at events during the Learning

Disability Awareness Week 2013.

Key messages from the consultation

A wide range of views were expressed during the consultation exercise. The

following issues were the key messages that came out of the consultation with

service users.

People with learning disabilities expect to have their voices heard – by those

providing services and by people that make decisions that affect them. The

people that we spoke to are involved in regular consultation events and have

been involved in developing local approaches (for example, in relation to the

Scottish Social Housing Charter and Adult Support and Protection). Local

service users are also involved in campaigning about local issues through

engagement with local and national politicians and public bodies (through the

Girvan Opportunities „Have Your Say‟ Group).

Many of the people we spoke to felt that there needs to be better provision of

information – about services, leisure activities and opportunities such as

education and training. Online information could be better and websites could

be more user-friendly for people with learning disabilities.

Although service users were very positive about advocacy and saw it as a

valuable service, there was concern about limited availability – and the lack of

choice when using an advocate (e.g. being able to change your appointed

advocate if there were any issues). Consultees were particularly concerned

about the long waiting times to access advocacy services.

Service users told us about a variety of leisure activities that they are involved

with locally – through both mainstream and specialised services. Activities

ranged from physical activities such as swimming and bowling to arts, craft

and music. Lots of people spoke about their social lives and were positive

about the range of restaurants, pubs and cafes in South Ayrshire.

Experiences were very positive but some issues were raised about wheelchair

access at specific venues.

Many people felt that there could be more access to physical activities – some

felt that leisure facilities need modernised and improved so that they are

better able to support people with learning disabilities. Mainstream services

need to be more welcoming, supportive and understanding of people with

learning disabilities.

37

Consultees had varied experiences of volunteering and paid employment.

Some people felt that it is difficult to find work and volunteering opportunities

that are appropriate – and that there should be more help with this.

Most people that we spoke to were satisfied with their housing situation and

their neighbourhood. Service users were clear that housing location is very

important and some people described being supported to relocate following

difficulties with neighbours. An important aspect of tenancy support was help

with paying bills and setting up direct debits.

A key issue for service users was access to holidays and short breaks.

Consultees were disappointed that they have been unable to take holidays

due to limited availability of care hours. Service users felt that there could be

more flexibility in the use of allocated care resources to facilitate holidays /

short breaks. There were also concerns about funding for short breaks and

the need to cover the cost of care workers during breaks.

Some people that we spoke to, particularly those living in more remote areas,

raised concerns about the availability of local transport. There were issues

about the frequency of public transport in some areas and concerns about

wheelchair accessibility, including at train stations. There were also some

concerns about the suitability of pavements and crossing for wheelchair users

in some places.

Other stakeholders, including service providers and support organisations,

highlighted the following key issues during the consultation:

Services need to improve the way they engage and gather the views of

service users – including addressing communication needs. Consultees

mentioned, for example, the importance of images and visual story boards for

people with limited communication skills. Periods for consultation need to be

appropriate for the service user group.

There needs to be more innovation in the way we support people with

learning disabilities. We need to support more community-based responses

and approaches that are designed and led with the involvement of service-

users.

We need to ensure that all activities taking place in the community (including

in day centres) are worthwhile, focusing on skills for life and health and

wellbeing.

There needs to be more strategic planning for provision of respite / short

breaks. Respite solutions need to be innovative and flexible – and

approaches need to be developed through partnership between public

agencies and local providers.

Service delivery for learning disabilities needs to be outcomes focused. This

is starting to happen and needs to be supported moving forward.

There needs to be more sharing of good practice and innovation. Locally,

there could be more opportunities for networking and sharing of ideas.

38

We need to continue to develop support services that are person-centred and

support the aspirations of people with learning disabilities. We need to ensure

that the benefits of Self-Directed Support (SDS) are being maximised locally.

Communication around SDS needs to be clear and people need to

understand what can be achieved through the use of SDS.

We need to encourage more preventative work and activities that support

good physical health and mental wellbeing.

We need to continue work to increase understanding of learning disabilities.

This means improving understanding among the wider community and

improving knowledge and skills among those that provide services (of all

types).

There needs to be strong support to help people into employment and other

meaningful activities. Stakeholders felt that we need to maximise the amount

of appropriate volunteering opportunities for people with learning disabilities.

We also need to develop intermediate employment opportunities and increase

the number of supported employment places for people with learning

disabilities.

Housing was recognised as a key issue by service providers. Consultees felt

that we need to be more „forward thinking‟ in relation to housing. There was

support for the development of supported „stepping stone‟ housing models to

help people towards greater independence. Stakeholders also felt that the

needs of people with learning disabilities should be considered in the planning

of all future housing development.

There was also support for greater availability and uptake of independent

advocacy in South Ayrshire and stakeholders were in support of more

specialised advocacy services for people with learning disabilities.

Unpaid carers need greater access to information, particularly in relation to

health and financial issues (including welfare issues).

39

4. Where do we want to be?

4.1 Our strategic vision

The overarching strategic vision for South Ayrshire promoted by the Adult Learning

Disability Strategy is:

“South Ayrshire is a place which supports people with learning disabilities to build

healthy and rewarding lives.”

Our vision supports the priorities set out in the national strategy The Keys to Life39

and recognises the new approach to public services being driven forward by the

Shifting the Balance of Care agenda. This promotes an „enabling‟ approach, and

supports people to maximise their independence and quality of life.

Using local information and a participative „logic modelling‟ process40, the Learning

Disability Sub-group established the following high-level strategic outcomes which

will support the delivery of our vision:

People with learning disabilities experience optimum health and wellbeing.

People with learning disabilities have their rights respected and do not

experience discrimination, stigma or harm.

People with learning disabilities are empowered to make their own life

choices.

Our communities are inclusive and actively supportive of people with learning

disabilities.

The needs of families and carers are fully met.

4.2 Our strategic approach

Our key strategic approach takes as its starting point the human rights of people

with learning disabilities. Human rights are the rights and freedoms that everyone

should have. For us, this means equal access to the services that other members of

the community receive including health services. It also means that people with

learning disabilities are able to live as independently as they choose and have the

opportunity to contribute to the communities in which they live, work and socialise.

39

Scottish Government, The Keys to Life – Improving quality of life for people with learning

disabilities, Edinburgh, 2013. http://www.scotland.gov.uk/Resource/0042/00424389.pdf 40

„Logic modelling‟ is a planning process that involves agreeing the long-term objectives you want to

achieve, medium and shorter-term outcomes, and the actions you need to take in order to deliver

these.

40

Our approach also focuses on supporting independence and building on the

strengths and assets of our communities rather than deficiencies. The strategy

recognises the role that we all can play in supporting people with learning disabilities.

4.2.1 Promoting the human rights of people with learning disabilities

In South Ayrshire, people with learning disabilities are valued as equal members of

our community. People with learning disabilities have the same human rights as

everyone else. These include things like the right to life and the right to feel safe.

These rights are enshrined in legislation most notably The Human Rights Act 199841,

the United Nations Convention on the Rights of People with Disabilities 200742, and

the Equality Act 201043.

For many people, including people with learning disabilities, human rights are not

always respected and they face barriers to full inclusion in society. The formal

evaluation of the previous national strategy for learning disability, The same as you?,

found that people with learning disabilities were concerned about basic issues such

as the availability of accessible information. Other concerns related to equality

legislation being properly implemented to ensure that people with learning disabilities

are not disadvantaged. People with learning disabilities also felt that more needs to

be done to tackle discrimination and abuse where this occurs.

We want to make sure that people with learning disabilities, their carers and the

wider community are aware of human rights. In particular we want to help people

with learning disabilities and their carers to put their human rights into practice

through appropriate support and access to advocacy.

We want to see wider awareness and understanding, and more positive attitudes in

relation to learning disability – in our communities and across service provision. This

requires more education and awareness raising for members of the public. It also

means targeted interventions to ensure that environments are welcoming and

supportive – for example, ensuring that frontline/first-point-of-contact staff (in a range

of settings) understand the needs of people with learning disabilities. We want to

make sure that our town centres, neighbourhoods, workplaces and places of

education and leisure can be described as supportive environments for all members

of the community including people with learning disabilities.

41

See - http://www.justice.gov.uk/human-rights 42

See - http://www.equalityhumanrights.com/uploaded_files/publications/uncrpdguide.pdf 43

See - http://www.equalityhumanrights.com/legal-and-policy/equality-act/

41

4.2.2 Individual and community-based asset approach

The South Ayrshire Learning Disability Strategy is a strengths-based strategy which

emphasises making use of the „assets‟ and community capacity that already exist

within our local communities.

„Assets‟ have been described as the collective resources that individuals and

communities have – internally, externally and collectively. They can be social,

financial, physical and environmental. Typically, assets mean people, skills and

available opportunities.

Asset-based approaches are ways of working that promote and strengthen existing

local assets:

“Central to assets approaches is the idea of people in control of their lives

through development of their capacities and capabilities. It is thought that such

control enables people to become better connected with each other and

encourages a spirit of cooperation, mutual support and caring.”44

We are strongly committed to an asset-based approach to supporting people with

learning disabilities and their carers. It is appropriate since it marks a departure from

the „deficit‟ approach that has been the traditional approach to delivering health and

social care.

Deficit models focus on identifying problems and needs of populations which require

resources (e.g. services) to resolve them. This results in high levels of dependence

on services which do not support active involvement of the individuals receiving

support.

Asset-based approaches are closely linked to the idea of co-production. This is a

participative approach to service design and implementation and has been described

as “delivering public services in an equal and reciprocal relationship between

professionals, people using services, their families and neighbourhoods”.45

Co-production can bring a holistic approach to working towards outcomes –

mobilising community resources and individuals in the process. It involves citizens

and communities, as well as service users and their families, as the source of

44

McLean J and McNeice V, Assets in Action, Glasgow Centre for Population Health, August 2012.

http://www.gcph.co.uk/assets/0000/3650/Jan_2013_update_of_assets_in_action_report_WEB_SMAL

LER.pdf 45

Boyle and Harris, The Challenge of Co-Production, NEF and NESTA, 2009.

http://www.nesta.org.uk/library/documents/Co-production-report.pdf

42

valuable assets and resources.46 Table 4.1 shows the key differences between a

deficit approach and the asset-based approach that this strategy promotes.

Deficit Approach Asset-based Approach

Starts with deficiencies and needs of an individual or community

Starts with assets / resources in an individual or community

Responds / reacts to problems Proactively identifies opportunities and

strengths

Provides services to users Invests in people as active participants

Emphasis on the role of services Emphasises the role of civil society

Focuses on individuals in isolation Focuses on individuals in communities / neighbourhoods and the common good

Sees people as clients and consumers receiving services

Sees people as participants and co-producers with something to contribute

Treats people as passive and „done-to‟ Helps people take control of their lives

Tries to „fix‟ people Supports people to develop their potential

Implements programmes as the answer Sees people as the answer Table 4.1: Deficit vs Asset-Based Approach

47

4.3 Delivering our vision

Development of the strategy has been through an outcome-focused planning

process. Figure 11, on the next page, shows our „outcomes triangle‟ which gives the

high level outcomes and intermediate outcomes we will work towards in order to

deliver our vision. It also shows the relationship with the Scottish Government‟s

National Outcomes. Section 5 gives more detail on the short-term outcomes and

activities that we will be delivering as we implement the strategy.

46

Foot and Hopkins, A Glass Half-full: How an asset-based approach can improve community health

and wellbeing, Improvement and Development Agency, 2010.

http://www.local.gov.uk/c/document_library/get_file?uuid=fc927d14-e25d-4be7-920c-

1add80bb1d4e&groupId=10171 47

McLean J and McNeice V, Assets in Action, Glasgow Centre for Population Health, August 2012.

http://www.gcph.co.uk/assets/0000/3650/Jan_2013_update_of_assets_in_action_report_WEB_SMAL

LER.pdf

43

44

5. How will we get there?

5.1 Improving health and wellbeing

“People with learning disabilities experience optimum health and wellbeing”

The partnership is committed to continually improving health and wellbeing in South

Ayrshire. We see this as a right for all people, including people with learning

disabilities. We are committed to ensuring that people with learning disabilities and

their carers have access to services and activities that respond to their specific

needs, are person-centred, varied and flexible.

We think that it is unacceptable that people with learning disabilities have some of

the poorest health of any group in Scotland. We want local people with learning

disabilities to enjoy better health and wellbeing and we are determined to tackle the

health inequalities that impact on the learning disability population. Key to this is a

preventative approach and ensuring that people have access to good quality health

promoting activities as well as truly equal access to mainstream health services.

These principles are enshrined in the health improvement strategy We Want Good

Health...the Same as You48. This strategy promotes a range of health improvement

interventions for local people with learning disabilities including community-based

physical health activities and work to improve access to health services (including

development of effective clinical pathways). The partnership will support the full

implementation of the existing strategy and support the updated strategy from 2014.

We want to ensure that staff delivering universal services (beyond specialised

services) understand, and are responsive to, the needs of people with learning

disabilities. This includes staff providing frontline health services but also staff

providing leisure and other recreational services. We will ensure that training and

awareness raising is delivered in a more consistent and coordinated way across

service provision in South Ayrshire.

Our strategy supports increasing personalisation in the planning and delivery of

services. We will promote greater flexibility in the way support is delivered by health

and social service providers, and encourage a wider and more responsive range of

activities in the community. People with learning disabilities and their carers will be

supported to choose and direct the support they receive through the roll-out of Self-

48

NHS Ayrshire and Arran, „We Want Good Health...the Same as You‟ - A Strategy to Improve the

Health of Children with Learning Difficulties and Adults with a Learning Disability, 2009-2014, May

2009

45

Directed Support49. SDS builds on the existing programme of „direct payments‟ but

will give individuals a range of options in terms of level of control, and flexibility in the

use of resources.

Our commitment to an asset-based approach means that we want to support and

develop the innovative practice that we see in community-based services. Many

community organisations are delivering physical health improvement activities and

there are clear benefits in terms of building relationships and reducing isolation.

As well as building the capacity of local community groups and organisations, we

want to ensure that people with learning disabilities can easily access appropriate

support in the community. We will work to widen knowledge of community-based

health improvement opportunities among support providers and explore the role of

technology and online community portals to improve access.

Figure 12 shows the key outcomes that the South Ayrshire Learning Disability Sub-

group is working towards to improve health and wellbeing for people with learning

disabilities.

49

See http://www.selfdirectedsupportscotland.org.uk/

46

Figure 12 – Improving health and wellbeing

Short-Term Outcomes Intermediate Outcomes High-Level Outcome

People with

learning

disabilities

experience

optimum health

and wellbeing

Improved physical health and mental

wellbeing among people with learning

disabilities

Reduced health inequalities for people

with learning disabilities

Increased healthy lifestyle behaviours among people with learning disabilities

People with learning disabilities receive health and care services that meet their needs.

Reduced incidence of physical illness

Equal access to health services

More personalised and appropriate care

More flexible service delivery

Positive relationships / networks and reduced isolation

Individuals are more aware of their rights in relation to health and care services

Increased access to health improvement opportunities in the community

Improved health and fitness levels

47

5.2 Human rights, reducing stigma and harm

“People with learning disabilities have their rights respected and do not experience

discrimination, stigma and harm.”

The human rights of people with learning disabilities are at the heart of this strategy

and inform all aspects of our approach. Although there is now greater inclusion of

people with learning disabilities many people in South Ayrshire continue to encounter

discrimination and face barriers when trying to access services and activities that

should be open to all.

We are committed to raising awareness about learning disability and the human

rights of people with learning disabilities. We will work to raise awareness of rights

among service users, carers and the wider community though events, training and

the provision of information.

A key aspect of promoting rights and reducing discrimination is ensuring that people

with learning disabilities are aware of their rights in relation to accessing services –

and are supported appropriately. The value of independent advocacy is well

recognised and we are committed to ensuring that there is better availability and

uptake of advocacy services in South Ayrshire.

Just like everyone else, people with learning disabilities play a variety of roles

including as parents, carers and employees. Our strategy aims to support local

people whatever their circumstances in life. We are particularly focused on the

support requirements of people with learning disabilities who are parents and will

work to ensure that there is appropriate access to supported parenting services.

Another key issue is ensuring that people with learning disabilities exercise their

human rights when they are in contact with the criminal justice system. This includes

contact with the police, courts, prison or other related services. We want to improve

our understanding of how well the criminal justice system operates in relation to

people with learning disabilities. And we will ensure that individuals are adequately

supported when they are in contact with criminal justice services.

We want to ensure that our communities are supportive places and that people in

South Ayrshire have a good understanding and positive attitude towards learning

disability. We recognise that attitudes are formed by a wide range of influences. As

a partnership we are conscious of the negative impact that can result from outdated

or poorly-informed representations of people with learning disabilities and hope to

influence the way learning disability is represented locally. Through existing

programmes and events (relating to arts, sport, education etc) we will aim to

challenge preconceptions and highlight the positive contribution made by people with

48

learning disabilities. Through communications work we also aim to promote more

positive representations through our local media.

As well as promoting rights and minimising stigma, our aim is to minimise incidences

of harm (including self-inflicted harm) experienced by people with learning

disabilities. We will continue to develop our work in relation to Adult Support and

Protection (ASP) to ensure greater safety for people with learning disabilities.

Figure 13 shows the key outcomes that the South Ayrshire Learning Disability Sub-

group is working towards to reduce discrimination and harm for people with learning

disabilities.

49

Figure 13 – Reducing discrimination and harm

People with

learning

disabilities have

their rights

respected and

do not

experience

discrimination,

stigma or harm

Reduced levels of stigma in relation to learning

disability

People are able to live their lives free

from harm

Increased safety (perceived and real) for

all

Communities have a positive attitude

towards learning disability

Better understanding of learning disability and

needs

Reduced incidences of harm against people

with learning disabilities

Increased positive outcomes where Adult

Support and Protection (ASP) issues have

been recognised

Individuals are more aware of their rights in

relation to support services

Better understanding of barriers to accessing

services / opportunities in the community

Short-Term Outcomes Intermediate Outcomes High-Level Outcome

Equal access and participation in

universal services and opportunities in

the community

More supportive environments for people with

learning disabilities

50

5.3 Supporting people to make their own life choices

“People with learning disabilities are empowered to make their own life choices.”

As already stated, this strategy is based on a commitment to support the human

rights of people with learning disabilities. It is also focused on the existing strengths

and assets of our communities and the individuals living and working in South

Ayrshire. As a partnership we are committed to supporting people with learning

disabilities to live as independent a life as they choose to lead. We want individuals

to be empowered to make their own life choices and build the fulfilling life that they

want.

We see the ability to direct your own life and to participate in your community as

essential to a rights-based approach. This is reflected in the following description of

independent living from the Independent Living in Scotland project:

"Independent living means disabled people of all ages having the same

freedom, choice, dignity and control as other citizens at home, at work, and in

the community. It does not mean living by yourself, or fending for yourself. It

means rights to practical assistance and support to participate in society and

live an ordinary life."50

Our focus in this part of the strategy is on providing appropriate tailored support to

individuals and empowering them to build on their skills and aptitudes. This means

developing confidence and self-esteem to help people to live more independently.

We are committed to comprehensive change in the way we plan support, and will

move to a system characterised by personal goal-based planning for people with

learning disabilities. This new focus on setting and working towards meaningful

outcomes will build on individual strengths and skills, and encourage people to focus

on their own abilities.

As appropriate, interventions will focus on developing life-skills for people with

learning disabilities. This includes helping people develop practical skills for

independent living but also support with „softer‟ skills such as decision-making and

developing and maintaining healthy relationships.

We recognise the importance of positive relationships and reduced isolation to help

people grow in confidence. We want to increase opportunities for social interaction

through activities that emphasise peer support and better access to mainstream

services and activities.

50

Scottish Government, “Our Shared Vision for Independent Living in Scotland”, April 2013.

http://www.scotland.gov.uk/Resource/0041/00418828.pdf

51

We are committed to continually improving the quality of education provided in South

Ayrshire including mainstream and specialised courses provided to people with

learning disabilities. We will increase the number of accredited courses available

and increase participation among people with learning disabilities.

We are also aware that some local people with learning disabilities, particularly those

with higher levels of independence, do not regularly engage with support providers.

We want to ensure that these people can access information and support if and

when they need it. As a partnership we will look at how we can develop more

innovative and flexible models to provide accessible support for this group.

We want to ensure that people with learning disabilities are able to control key

aspects of their life including financial security. We will ensure access to wider

support services such as income maximisation services and will support individuals

to mitigate the impact of ongoing welfare reform.

We want to support people to live as independently as they choose to, including

when their health and care needs change. This often means providing support that

is innovative and makes the best use of emerging technology. We will continue to

support the uptake of solutions such as telehealth and telecare for people with

learning disabilities and be responsive to future opportunities from new technology.

We will develop and expand our engagement with people with learning disabilities to

ensure that services and local activities are influenced by their views. We will work

with local people to agree the best methods of engagement and explore how

technology can be used for better engagement with (and between) people with

learning disabilities.

Figure 14 shows the key outcomes that the South Ayrshire Learning Disability Sub-

group is working towards to support the empowerment of people with learning

disabilities.

52

Figure 14 – Empowering individuals

Short-Term Outcomes Intermediate Outcomes High-Level Outcome

People with

learning

disabilities are

empowered to

make their own

life choices

Increased ability to effect change

(increased control, mastery, self-efficacy

and self-determination)

Increased financial security

People have positive relationships and

social networks

People are supported to identify strengths and

solve problems for themselves

People are supported to maximise incomes

and manage their finances

People are supported into meaningful activities

in the community

Increased positive relationships for people with

learning disabilities

Increased self-esteem and confidence for

independence

Appreciation of own skills, attitudes and

environment

People are supported towards paid

employment

More personalised and appropriate care

Increased opportunity for people to contribute

People have access to high quality

services that are influenced by their views

More flexible service delivery

53

5.4 Communities that actively support people with learning disabilities

“Our communities are inclusive and actively support people with learning disabilities”

The partnership is committed to making South Ayrshire a place that is inclusive for

all members of the community and fully supportive of people with learning

disabilities. We want people with learning disabilities to feel valued and able to

access the same opportunities as everyone else.

Our aim is to ensure equal access to universal services and activities in the

community. We want to build our understanding of the barriers that individuals

experience and support inclusion through greater variety and innovation. We will

improve access to opportunities in the community through better signposting by

partners and strong local information provision (including through directories and

online portals).

Through our third sector infrastructure we will continue to support the development of

organisations providing opportunities for people with learning disabilities. We will

support existing and new community organisations providing inclusive activities and

look to replicate successful models from elsewhere.

We want people with learning disabilities to have access to high quality services

which are influenced by their views. We are committed to fostering a culture where

service users and carers play a central role in the design and delivery of services

and activities. We will support the development of co-production approaches locally

and will explore the most effective methods for involving people with learning

disabilities in the process. This may be through establishing new approaches to

involvement, or building on the positive service user engagement being taken

forward by local organisations and service providers.

We are committed to ensuring that all people in South Ayrshire are supported into

meaningful activities and have access to good employment or volunteering

opportunities. We want to ensure that there is an appropriate suite of options to

support people with learning disabilities into employment. We will encourage the

development of more appropriate volunteering and intermediate employment

opportunities and support uptake of employment support among people with learning

disabilities. In particular, we will aim to increase the number of supported

businesses / social firms providing direct employment opportunities for people with

learning disabilities.

We want to ensure that people have access to housing options that meet their needs

and appropriate housing support. In particular, we want to explore the provision of

more supported, „stepping stone‟ housing options to support people towards

independent living. Models such as „core and cluster‟ accommodation allow for

54

„core‟ support provision and „clustered‟ accommodation where individuals can reduce

their level of support as they move towards greater independence. We will also work

to ensure that the needs of people with learning disabilities are taken into account in

the planning of new housing development.

We are also determined that people are adequately supported when they „transition‟

between services – for example, moving between children‟s and adult services. We

will take a multi-agency approach to transition planning and develop agreed

protocols to ensure good practice.

Figure 15 shows the key outcomes that the South Ayrshire Learning Disability Sub-

group is working towards to ensure our communities are inclusive and supportive.

55

Figure 15 – Communities that actively support people with learning disabilities

Short-Term Outcomes Intermediate Outcomes High-Level Outcome

Our

communities

are inclusive

and actively

support people

with learning

disabilities

Better understanding of barriers to accessing

services / opportunities in the community

People have access to employment (paid / unpaid)

Equal access and participation in universal services and opportunities in the community

People with learning disabilities have access to high quality services which are influenced by their views

People have better options on accessing support

whether through mainstream or specialist provision

There is an appropriate suite of options to support

people into employment

Continued support to the Third Sector for inclusive,

community-based activities

More comprehensive and effective structure for

engagement with service users and carers

People are supported into meaningful activities in

the community

Increased social support and social networks

People have access to appropriate housing and support

Increased knowledge of and access to local

services and activities

A range of appropriate housing options are available

for people with learning disabilities

People feel supported through transitions between

services

56

5.5 Supporting families and carers

“The needs of families and carers are fully met”

The South Ayrshire Carers Strategy (2012-2017) already establishes our strategic

approach to helping and supporting unpaid carers until 2017. Consultation for the

Learning Disability Strategy confirmed wide stakeholder support for the priorities that

have been established for supporting carers. The partnership fully endorses the

Carers Strategy and will support its implementation in the years ahead.

The Carers Strategy supports both adult and young carers. Although the Learning

Disability Strategy focuses on adult services we are sensitive to the needs of family

carers including children and young people that support parents and siblings with

learning disabilities. In many cases young people do not recognise themselves as

„carers‟ and we need to ensure that all of South Ayrshire‟s unpaid carers can access

the support they need.

The South Ayrshire Carers Strategy contains a series of interventions that will

support carers of people with learning disabilities. In the development of the

Learning Disability Strategy stakeholders emphasised the importance of the

following outcomes (contained in the Carers Strategy):

The needs of carers are properly identified and assessed.

Carers have easier access to advice, information and support.

The views and opinions of carers are listened to and acted upon.

Carers experience improved physical and mental health and well being.

Carers have the skills and capacity to cope with their caring responsibilities.

Carers know their rights and are empowered to enforce them.

The following actions were considered to be particularly important:

Develop dedicated advice and information materials and make them available

throughout the community (SACS 1.1AC)

Review the carer assessment (SACS 3.2AC)

Develop clear referral pathways into support services for carers (SACS

3.3AC)

Consult with carers to determine the advice and information they need (SACS

4.3AC)

Develop a referral pathway into health services for carers (SACS 5.2AC)

Work in partnership to increase the provision of creative short break (respite)

options for older people (SACS 5.3AC)

Develop more dedicated advocacy services for carers (SACS 10.1AC)

Develop advocacy training for staff in existing advice and information services

(SACS 10.2AC)

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Figure 16 illustrates the key intermediate and short-term outcomes from the Carers

Strategy that were considered to be particularly relevant by stakeholders.

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Figure 16 – Supporting families and carers

Short-Term Outcomes Intermediate Outcomes High-Level Outcome

The needs of

families and

carers are fully

met.

The needs of carers are properly

identified and assessed.

Carers have the skills and capacity to cope with their caring responsibilities.

Carers have easier access to advice, information and support.

All relevant frontline staff adequately trained on carer assessments

Clear referral pathways developed and implemented

Increased provision of independent advocacy services for carers in the community

The carer assessment is reviewed and amended accordingly

The views and opinions of carers are listened to and acted upon.

Carers experience improved physical and mental health and well being.

Carers know their rights and are empowered to enforce them.

Consultation sessions carried out with carers and materials developed in response.

Increase in the range of respite options available

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5.6 Implementation and monitoring

Implementation of the strategy will be led by the South Ayrshire Community Health

Partnership (CHP) Learning Disability Sub-group. As appropriate, implementation

sub-groups will be established to drive forward specific sections of the Learning

Disability Action Plan, for example, developing housing options, improving health

and wellbeing, co-production / developing community-based opportunities.

Reporting on progress against the Action Plan will be coordinated by the Learning

Disability Sub-group. The Sub-group is accountable to the South Ayrshire Adults

and Older People‟s Officer Locality Group (OLG) within the structure of the South

Ayrshire CHP. Monitoring reports will be submitted to the OLG periodically.

Regular consultation will take place with local learning disability groups and

organisations, services users and carers throughout the lifetime of this strategy to

ensure that the desired outcomes are achieved.

Figure 17 shows the local framework that will be responsible for implementing the

South Ayrshire Adult Learning Disability Strategy.

Figure 17 – South Ayrshire Learning Disability Strategy Planning and Implementation

Structure

South Ayrshire CHP Learning

Disability Sub-group

South Ayrshire Adults

and Older People‟s

Officer Locality Group

South Ayrshire Council

Leadership Panel

South Ayrshire

Community Health

Partnership

Stakeholder

involvement: service

providers, service user

and carer groups

Implementation Sub-

groups: e.g. Health and

wellbeing; Housing

options; Community

opportunities

Contracts and commissioning