transformation of adult social services panel: letter to cabinet member 11 may 2016

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C I T Y A N D C O U N T Y O F S W A N S E A———————————————————————————————————————————————

Dinas A Sir Abertawe

Dear Councillor Harris,

Transforming Adult Social Services Scrutiny Panel, 4 April 2016

The Panel met on 4 April to discuss the evidence it had collected as a result of its work plan.

The panel discussed its findings and conclusions which it agreed to submit to you for consideration and inclusion in the current commissioning reviews and any future development of the provision of adult social services. The panel is pleased to attach the report and its evidence pack which it hopes you find useful and informative.

This report and meeting concludes the work of the TASS panel. The panel had a number of ideas that could form part of a new scrutiny panel’s work plan. These include: a) undertaking the further refining of comparative cost information of all inhouse and purchased care components that comprise the care system b) gaining a deeper understanding of the knock on effects to the total caresystem of changes in one component c) pursuing further the resilience, responsiveness and fitness for purpose ofthe present processes whereby corporate objectives for significant and high

Councillor Jane Harris Cabinet Member, Adults & Vulnerable People

Civic Centre Oystermouth Road SWANSEA SA1 3SN

Please ask for: Gofynnwch am:

Overview & Scrutiny

Direct Line: Llinell Uniongyrochol:

01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/11

Your Ref Eich Cyf:

Date Dyddiad:

11/05/2016

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on 4 April 2016. It is sets out the findings and conclusions of the panel and concludes the work plan of the Transforming Adult Social Services Scrutiny Panel

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risk changes to social care are set, embedded within the organisation, monitored, and then proactively amended, in the light of changing pressures. d)Learning disabilities, physical disabilities and mental health – care management and social work support e) Pre-decision: Commissioning reviews options reports

Your Response The panel hopes that you find its report useful and informative and we welcome your views on our conclusions in section C of the attached report.

Yours sincerely

UTA CLAY CONVENER, TRANSFORMING ADULT SERVICES PANEL

CLLR [email protected]

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REPORT OF THE TRANSFORMING ADULT SERVICES SCRUTINY PANEL – CONCLUSIONS ARISING FROM EVIDNECE GATHERING

OCTOBER 2014 – JANUARY 2016

APRIL 4, 2016

Purpose The purpose of this report is to • reflect the panel’s views and submit them to the

Cabinet Member for consideration in the relevant commissioning reviews and future development of adult social services.

This report draws the work of the current panel to a close.

Content This report provides: • A foreword by the Convener of the panel,

Councillor Uta Clay • A timetable of work undertaken by the panel• The panel’s conclusions• Evidence pack

Lead Councillor(s) Councillor Uta Clay, Convener, TASS panel Lead Officer(s) Alex Williams, Head of Adult Services Report Author Delyth Davies, Scrutiny Officer

A. FOREWORD 1. I am pleased to report on the work of the Scrutiny Panel charged with

overseeing the Transformation of Adult Social Services (TASS). What followsis a body of significant evidence that helps inform the ongoing scrutiny of howthis vital service is being changed to meet both the changing needs of thepeople of Swansea and the significant financial challenges that face both thesocial and health care systems in the City and County.

I wish to place on record my thanks to all members of the panel who haveworked diligently to explore the issues, and also my appreciation of thesupport provided by Delyth Davies.

The evidence provided is, at first glance, considerable and I think it isincumbent upon me to set out the key messages that I hope readers take fromthis work.

Our starting point was the independent review of the Council’s plans that wascarried out by Cardiff University - included in the evidence pack of this report.This well-argued paper made a number of points that helped shape theapproach of the panel to its work. The first message from the independent

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report was that the approach being proposed by the Council in respect of its residential services appeared not to recognise the linkages between all the different strands of adult social care – for example the preventive work and the roles of both day and domiciliary services - in reducing demands upon residential care. The second message was that the costing data used to compare different balances of the main components of the care system – and different provider options for these - was insufficiently precise to enable wise comparisons to be made.

From these two prompts, the panel was encouraged to see the care system as a whole, looking in more detail at how different components of the intended new model – for example local area co-ordination and the hubs – would fit together as one system. It also became clear that we needed to acquire far more detail about the robustness of current and future costs of emerging services, and their likely resilience.

As our work progressed we have also come to see the importance of the managerial and political processes currently employed to set, and then monitor the achievement of, the corporate goals for the transformation process. The advice given to the February 2016 meeting of the panel contributed in some measure to this understanding. I would expect this aspect to continue to feature in the next stage of the scrutiny process.

The report and the discovered evidence shows that the committee has gained a deep insight into the significant features that will help determine how best the adult social care function across Swansea can be transformed to meet the many pressures - demographic, financial, and organisational - upon it. The report also gives a clear lead as to those issues that could form part of a new scrutiny panel’s work plan. These include: a) undertaking the further refining of comparative cost information of all inhouse and purchased care components that comprise the care system b) gaining a deeper understanding of the knock on effects to the total caresystem of changes in one component c) pursuing further the resilience, responsiveness and fitness for purpose ofthe present processes whereby corporate objectives for significant and high risk changes to social care are set, embedded within the organisation, monitored, and then proactively amended, in the light of changing pressures.

Drawing the panel’s work to a conclusion enabled us to reflect on the considerable difficulties we needed to overcome and the lessons we learned which should inform the work of any new panel that is established and will continue to develop the crucial relationship between Scrutiny and Adult Services.

• The panel works best when it develops its own work plan, hasownership of it and sets out its aims for each piece of work within theplan, this helps to keep the work plan current, (and) relevant and avoidsrepetition.

• The original criteria had to be changed to enable the scrutiny processproceed in tandem with the timetable of Western Bay. We had to

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abandon work already in progress and thus an important opportunity to consult with carers and service users did not materialise. The panel recommends that the subsequent Adult Services Performance and Monitoring Panel will introduce direct conversations with these groups.

• Integrated health and social care services, such as network hubs, means health partners and local authority scrutiny will cross paths more frequently. The panel greatly benefitted from visits to the network hubs and the visits helped shape its views below. Any new panel should give time to consider how best to continue to develop this important relationship with health partners.

• Scrutiny is entitled to ask difficult questions and it must pursue its lines of inquiry until it is satisfied that it has been thorough in its investigations and examinations. The persistence of the panel to do so has highlighted the need for detailed information (for instance, the cost of each part of the service) and resulted in the ability to make informed choices.

• After a very difficult and uncertain period early last year, the panel has developed open and productive working relationships with the new senior managers in Adult Services and urges any new panel to continue to develop these positive working relationships, without losing sight of its role as critical friend.

2. INTRODUCTION 2.1 The scrutiny panel was established in October 2014 in response to the

Transformation of Adult Social Services programme. The programme sought to transform the delivery of adult services to meet the needs of an ageing population, to meet the obligations of the Social Services and Well-being (Wales) Act 2014, and was set against the backdrop of tighter local government finances. The overall purpose of the panel was to focus on the Transforming Adult Social Services (TASS) agenda, to looking at the change process and providing critical friend challenge to the proposed or anticipated improvements.

B. TIMETABLE OF WORK

When/Where What/Who Working group briefing October 2014 Civic Centre

• TASS Briefing – understanding the drivers for change – Chief Social Services Officer

Working group briefing November & December 2015 Civic Centre

• Independent Review of Older People Executive Board Report with Chief Social Services Officer

Work planning January 2015

• TASS programme timeline and briefing with Chief Social

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Civic Centre Services Officer Work planning March 2015 Civic Centre

• TASS Programme Priorities Report with Chief Social Services Officer

• External residential care costs with Head of Finance Meeting 1 April 2015 Civic Centre

• Local Area Co-ordination with the Local Area Co-ordinator Jane Tonks, councillor Mark Child, Cabinet Member for Well Being and Healthy City and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

Meeting 2 May 2015 Civic Centre

• Social Services and Well-being (Wales) Act Seminar with the Minister for Health, Mark Drakeford, Assembly Member

Meeting 3 June 2015 Guildhall

• Domiciliary Care Commissioning Review Briefing with the Head of Adult Services, Bozena Allen

Meeting 4 August 2015 Guildhall

• Swansea Integration with Abertawe Bro Morgannwg University Health Board, Hilary Dover Director, Primary and Community Services and Karen Gronert, Community Nursing and Intermediate Care

• Integrated Community Services Network Hubs with Head of Adult Services, Alex Williams and Alison Ransom Community Resource Service Manager, West Integrated Community Network Hub

Meeting 5 & 6 September Site visits to Network Hubs

• 15/9/15 Visit to the West Integrated Community Services Network Hub – Civic Centre, Alison Ransom Manager, West Integrated Community Network Hub

• 22/9/15 Visit to the North Integrated Community Services Network Hub, Gorseinon Hospital with Helen St. John, Community Resource Service Manager and Andrea Preddy, Manager Intake Team

Meeting 7 September Guildhall

• Financial Analysis of Council provided residential care and domiciliary care with the Head of Adult Services, Alex Williams and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

Meeting 8 October Guildhall

• Financial Analysis of Council provided residential care and domiciliary care with the Head of Adult Services, Alex Williams and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

Meeting 9 December Guildhall

• Integrated Services – performance monitoring • Income Generation from older peoples services • Local Area Co-ordination Evaluation Report

With Alex Williams, Head of Adult Services and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

Meeting 10 January 2016 Guildhall

• Pre-decision Beeches and Abergelli Day Services • Mental Health and Learning Disabilities Commissioning

Review Scope With Alex Williams, Head of Adult Services and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

Meeting 11 February 2016

• Draft Budget proposals • Performance Management Framework for senior officers

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Guildhall With Stephen Rees (HR), Dave Howes, Chief Social Services Officer and Councillor Jane Harris, Cabinet Member for Adults and Vulnerable People

C. CONCULSIONS The panel’s conclusions detailed below have been drawn from the key concerns and views captured at each meeting from discussions on reports and communicated to the Cabinet Member in convener’s letters (see table in section 22 in the evidence pack). The panel wishes for its conclusions to be provided to the Cabinet Member for consideration during the Commissioning Reviews and future developments in the provision of Adult Services. 1. Unit costs

Understanding the unit costs on in-house provided residential care, domiciliary care and day services is important to ensure that services are planned and delivered in line with available budgets and that if savings need to be made they are based on a real understanding of costs which reflect different clients and are dependency related. The panel welcomed the transfer of financial control from social services to the finance department; this delivered greater clarity of costs.

2. Swansea Integration – Network Hubs

a) Cabinet responsibility for the integrated hubs should fall under one Cabinet Portfolio

b) Important to jointly develop performance management indicators across health

and social care and continue to develop and refine these in order to be useful and remain relevant

c) The panel supported the review of the Intake Team located in the Civic Centre

to ensure that the team was able to better challenge at the first point of contact and provide effective triage

d) Arrangements for scrutiny, oversight and governance need to be developed

e) The panel was concerned about the lack of consultation on hub location but the

panel also recognised that the hubs do not have public access and are staff accommodation

3. Local Area Co-ordination

a) There were a number of risks that the panel identified in relation to Local Area

Networks – sustainability, financing the development of the project across Swansea, resilience of the local area networks, the volume of referrals and the ability of local area co-ordination to deliver its intended outcomes.

b) The panel felt that Local Area Co-ordinators should work with, and develop

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relationships with the integrated Network hubs.

c) This is an area that should remain in any future adult services scrutiny panel’s work plan, particularly the next evaluation report when it becomes available from Swansea University

d) Development and collection of data and performance indicators will help the development of local area networks

4. Social Services and Well-being (Wales) Act

a) The panel supports the Act and sees the opportunity it creates to allow for

innovation and diversification of the local care market which could help the local authority manage the risk in the local private care market.

b) Accountability and governance - the panel welcomed the Minister’s view was

that local scrutiny committees should scrutinise health boards on issues that affect the local area.

5. Risks

a) The panel concluded that there were a number of risks associated with the

capacity of the private care market to provide the care needed: • the difficulty in delivering complex care packages in rural areas • staff retention • the increase in minimum wage

b) The panel was also concerned about the risk that the impact of the increase in

the minimum wage could have on future costs of in-house provided services.

c) The panel also highlighted as a risk the withdrawal of a local authority contract from a provider because of concern over the quality of the provision.

6. Commissioning Reviews – General Comments

a) The panel welcomed the engagement it had to date in the commissioning

reviews. It agreed that it was important to continue to involve non-executive councillors in the appropriate stages of the different commissioning reviews.

b) The panel suggested that pre-decision scrutiny of commissioning review reports should take place prior to submission to Cabinet.

c) The panel agreed that all commissioning reviews should identify service

specifications to evaluate required staff ratios and skills that Council staff need to provide current and future good quality care with a range of strengths and dependencies in care homes both in-house and the private sector.

d) It is the panel’s view that quality in-house services require a stable workforce

and this should be addressed in the relevant commissioning reviews.

e) The panel agreed that the viability of charging for day services should be

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included in the commissioning reviews.

f) The panel supported giving equal weighting and consideration to each of the learning disability, mental health and physical disability commissioning reviews.

7. Commissioning Review: RESIDENTIAL

a) The panel requests that the Cabinet member seeks verification during the

Residential Commissioning Review of proposed savings if en-suite provision leads to a reduction in clients.

b) The panel felt that the Residential Commissioning Review should evaluate

occupancy and vacancy rates across in-house care homes and consider how problems can be managed more successfully in future service delivery.

c) The panel suggested that the Residential Commissioning Review should

consider and offer guidance on how the service monitors and communicates that clients admitted to Bonymaen have the capacity to be reabled and returned home.

d) The panel agreed that consideration needed to be given to the development of

extra care provision with attention paid to the environmental standards which could bring financial benefits to the Council

8. Data and population projections

The panel agreed that robust data and sound population projections, jointly agreed by partner agencies, were key to plan future services that were sustainable and met the needs of the local population.

9. In-house domiciliary Care Service The panel felt that the Council’s service was a positive element of the local care market and that social contact and interaction is important to maintain independence and well-being. The panel agreed that loneliness and lack of cleanliness were likely to have a detrimental effect on health and well-being.

10. Prevention and independent living The panel agreed that this was an important issue in the local care market.

11. Reablement

a) The panel felt that reablement was a positive contribution to the local social care sector and should be undertaken as soon as the need was identified to prevent loss of independence prolonged by a lengthy hospital stay

b) The panel agreed that reablement beds should be maintained for those who

had the capacity to be reabled.

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c) The panel’s view was that in-house domiciliary care should be focussed on reablement, complex needs and market development

12. Performance Management Frameworks

a) The panel supported the development of a new Adult Services Performance

Management Framework and agreed that this framework should be used to shape the future work plan of any new adult services scrutiny panel.

b) The panel agreed that any new framework needs to be more robust and

commensurate with the change process

13. Finance The panel was pleased that moving income collection to central finance services had improved recovery and performance and it supported strategies used to recover deferred fees and debt to maximise income

14. Budget The budget increase and overspend in Adult services was highlighted by the panel. Changes to Adult Services could pose a further risk to the budget and monitoring of the budget needs to be in place to ensure financial information is robust.

15. Respite The panel felt that the importance of all respite services including services such as day services, residential, sitting services etc to enable carers continue in their caring role needs to be recognised.

Evidence

2. SERVICE BRIEFING FROM THE ADULT SERVICES DEPARTMENT(OCTOBER 2014)

Purpose: To provide Scrutiny Panel with a summary of the Social Services and Wellbeing (Wales) Act’s key changes and how they are likely to impact on Adult Services; To consider City and County of Swansea’s current position in terms of readiness to implement the Act by the expected date, and what the next phase of the Transforming Adult Social Services (TASS) programme needs to address so that the Council is ensuring compliance with the Act by April 2016.

Report Author(s): Carol Rea, Head of Adult Services; Simon Jones, Performance & Improvement Officer

Finance Officer: Mike Hawes

Legal Officer: Janet Hooper

Access to Services Officer: Euros Owen

FOR INFORMATION

1. Background-1.1 The Social Services and Wellbeing (Wales) Act received Royal Assent in May 2014. The Act is a landmark of social care legislation in Wales and builds on the White Paper, Sustainable Social Services in Wales. This report relates to the new Act’s key changes and how they are likely to impact on Adult Services. It goes on to consider City and County of Swansea’s readiness to implement the Act by the expected date, and what the next phase of the Transforming Adult Social Services (TASS) programme needs to address, so that the Council can ensure full implementation by April 2016. 1.2 Whilst much of the legislation is expected to be reinforced by further national guidance, there is clearly a significant change in the nature of the social care offer put to citizens.

The most significant changes include:

− Introduction of a principle of wellbeing to be the focus of all public services

− A National Framework for eligibility;

− Carers being placed on an equal footing with service users;

− General duty on local authorities to provide information, advice and assistance;

− Every person receiving managed care from the local authority to be reviewed against outcomes they set for themselves;

− Regional Safeguarding Boards becoming a statutory requirement; and

− Local authorities having to promote greater integration with the NHS and collaboration with regional partners

1.3 The Social Services and Wellbeing (Wales) Act (hereby referred to as new Act) also promotes the importance of excellence in social work practice and across the social care workforce, through investment in Continuing Professional Education and Learning for social workers, and new National Occupational Standards for social care workers and managers published by Care Council for Wales. http://www.ccwales.org.uk/national-occupational-standards/ The new Act is expected to be implemented fully within Local Authorities by April 2016. 1.4 At a recent Reclaiming Social Work event, to herald the new Act, and the emphasis on reskilling and professionalising the social care workforce, the following definition of social work was used:

“The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.” (International definition of social work)

2. Changes and impact of the Social Services and Wellbeing (Wales) Act

http://www.ccwales.org.uk/national-occupational-standards/

2.1 This section gives further consideration to changes arising from the new Act, and how they are likely to impact on Adult Services. The Act has been drawn up to address a number of significant challenges: - Population growth particularly among those aged 65 and over - Demand in the adult social care sector is expected to increase over the coming years - More people are living longer, with an expected increase in the number of very frail, elderly people with complex needs, and increasing demand from adults aged 18-64 with disabilities. - More people, who previously may have managed on their own, are likely to seek support for their needs from public services, especially in a harsh economic climate - People have greater expectations of how public services should respond to their particular individual needs - Rising costs of adult social care, and ensuring what is delivered is high quality - Health and Social Care spending as a proportion of the total spend on public services, and social services spending pressures in relation to local authority budget. 2.2 In responding to these challenges, Local Authorities throughout Wales have been faced with a number of strategic and financial choices: - Do we increase the size of existing services to deal with increasing demand from people in crisis or vulnerable people who need a service intervention? - Respond to demand by tightening eligibility to meet highest (critical) level of needs, and leaving people with substantial needs, with a vulnerability, and/or in crisis, unmet. - Manage demand by investing more in prevention and early intervention work, and by improving social work and customer facing practice. - Pool resources by working collaboratively with regional partners - Reduce demand by intentionally working to support individuals, families and communities to stay strong; diverting people from formal services wherever possible through sustainable, local, flexible individual and community solutions 2.3 As mentioned Social Services & Wellbeing (Wales) Act will create a clearer legal framework to help meet the many challenges. Under the Act which encompasses services both for Children and Adults, the term ‘people in need’ is being used. The Act is divided into sections covering a number of important themes: 1. Wellbeing

2. Prevention 3. Eligibility 4. Integration 5. Safeguarding 6. Direct Payments 7. Adoption 8. Carers 9. Information, Advice & Assistance 10. Social Enterprises Wellbeing and Prevention is at the heart of new Act, and the agenda to transform social services. That is why the Bill places duties on local authorities to deliver preventative services and contains a range of other measures to enable and require local authorities to lead the preventative agenda, by working with partners including local health boards, and the third sector. 2.4 The pressures on public sector and local government resources are almost unprecedented. However Wales spent a total of £1.8 billion on social services in 2012/13, and within this year, Swansea spent £121 million. Total Wales expenditure on Local Authority social services can still account for roughly £1 in every £8 of Welsh Government controlled expenditure.

Total Gross Expenditure on Social Services 2012/13- £

Total Spend per Head of population on Social Services 2012/13 - £

Population

Wales £1,813,801,000 £ 590.03 3,074,067

Swansea £121,129,000 £ 505.48 239,633

Cardiff £151,649,000 £435.16 348,493

Newport £78,012,000 £533.94 146,106

NPT £88,780,000 £633.65 140,108

Source: StatsWales Calculated locally StatsWales

Table 1 Comparative Resources 2.5 The new Act aims to achieve to simplify the law, policy and regulation behind social care in Wales. At the same time this is expected to deliver systemic change and to re-balance the way we meet a citizen’s needs, both at an individual level, and across the population

https://statswales.wales.gov.uk/Catalogue/Local-Government/Finance/Revenue/Social-Services/SocialServicesRevenueExpenditureSubjectiveAnalysis-by-Authority

https://statswales.wales.gov.uk/Catalogue/Population-and-Migration/Population/Estimates/NationalLevelPopulationEstimates-by-Year-Age-UKCountry

The table below shows the emerging model of social care services, under the new Act.

Old Model of Social Care

(Poor Law / National Assistance Acts)

Recent Model

(NHS & Comm. Care Act)

Target Operating Model (new Act)

- Paternalistic / Social Control

- ‘Community Care’ model

- Sustainable Social Care

- Generic social worker - Social worker as Care Manager

- Reclaiming social work - agent of social change

- Addressing deficiencies - Assessment led - Strengths–led / Outcomes based / reablement

- Public Assistance - Eligibility Criteria - Universal Wellbeing / Promoting Independence

- Welfare/ Handouts - Service orientated - National Eligibility/ Integrated Managed Care

- Next of kin - Supporting Carers Carers needs in own right / Family resilience

- Route into Institutions - Purchaser –provider split

Local Area Coordination / Supportive Communities

- NHS from 1948 / Local Committees / Spot purchasing / in-house

- Needs assessment

- Commissioning within social care market

Market shaping / outcomesbased commissioning

- Focus on abuse in institutional settings

- Elder abuse / Protection of vulnerable Adults

- Safeguarding as everybody’s business

Table 2 New definition of social care 2.4 Fundamentally the new Act changes the social care ‘offer’ to citizens from local authorities, health services and their partners. Local Authorities are expected to communicate directly with their local population to shape a localised network for a new model of social care support. We therefore have to place voice, choice and control at the centre of the planning process, to strengthen our approach to cooperation, co-design and coproduction of services by engaging citizens in defining what services should be available, and working within communities to shape the kind of services that can help them achieve outcomes, and to prevent their needs from developing or escalating. Through the new integrated assessment (older people) and specialist assessments, we expect people with some support to know what will help them, and often it can be a ‘little bit of help’ which if this can be accessed.in the right place, at the right time can make all the difference. To

ensure that this happens we must draw on the knowledge and experience of people who use services now and their families as well as understand the expectations of those who may require services in the future. 2.5 There is a white paper introducing a new Regulation and Inspection Bill into the Wales Government legislative programme in 2015. This is expected to give regulators powers to hold social care staff and services to account, and to transform how agencies, and the quality of social care are externally monitored, inspected and regulated. Key Messages of the Regulation and Inspection Bill: As well as ensuring implementation of Social Services and Wellbeing (Wales) Act, the Regulation and Inspection Bill will look at:

− increasing the voice of service users and carers in the inspection system;

− developing a coherent Welsh approach to regulation to take account of changes elsewhere in the UK, including the fact that the Care Standards Act no longer apples in England;

− responding to high-profile failures of care, such as those at Winterbourne View;

− creating a framework for regulation that is flexible enough to keep pace with changes to social care.

3. Position Statement 3.1 This section considers Swansea’s readiness in meeting the requirements by April 2016. 3.2 Over the last three years, Adult Services has being working to achieve readiness, and a sustainable model of social care through the corporate strategic Transformation of Adult Services (TASS) programme. We identified three pillars to form a framework for taking the transformation agenda, as set out in Fulfilled Lives, Supportive Communities – A Strategy for Social Services in Wales over the next decade ( 2007) and Sustainable Social Services – A framework for Action (2011): Redesigning our operating model, towards wellbeing, prevention, and

self-managed care. Reclaiming social work by promoting a person centred model focused on giving service users and carers more choice, voice and control. Improving social work practice in the use of tools to support assessment and support planning, that builds on a person’s strengths and then agree the individual’s own outcomes and achievements.

Reshaping and Remodelling services – services are commissioned to be more person-centred, flexible, innovative, and better value for money. They are focusing on each client’s reablement, on their unique

journey, the achievement of outcomes and promoting independence. As well as what service users need, we are also considering can contribute as well.

Refocusing on communities to ensure that we are linking citizens into local resources and networks, forming strong links with other community organisations and introducing a local area co-ordination approach to lower level intervention

In delivering this TASS programme, we have been working closely with colleagues across the Council, with partners and communicating the programme to elected members, citizens and all stakeholders. 3.3 Summary of achievements through the TASS programme would include: • Improved access to public information, advice and support through additional capacity at Intake who now manage hospital, and safeguarding enquiries, • Development of Social Services web pages to support service transformation. • We can continue to build on exciting new approaches to prevention and early intervention, for example our team of Community Connectors is already demonstrating an impact through their work across five health networks. • Fewer people are experiencing delays in their discharge from hospital due to delays in receiving home care. • we have successfully developed new, and integrated reablement opportunities, as well as residential assessment beds to help people remain in, or return to, their own homes. • more people are having their care plans reviewed regularly. • reduction in the number of older people placed in residential care, and in the period of time people remain in long term residential / nursing care. These reductions contribute to improving the overall balance of care. • Improvements to commissioning of services closer to home, and through availability of supported living for adults with complex needs. • Carers are being offered an assessment of need in their own right, and can now directly access a range of support services. • Following process changes to ensure Safeguarding Adults is ‘everybody’s business’, we remain effective in managing risk. • Collaboration and integrated working across local, regional and national partnerships. • Development of an intermediate care tier, through a successful regional bid to the Welsh Government’s Intermediate Care Fund (1 year), with plans for a shared access point and 3 Network hubs, multi agency/disciplinary

teams team which can offer citizens a simpler, more seamless way to access local health and social care services. 3.4 We recognise that the time has now come to adapt the TASS programme to the next phase to meet greater level of expectations in terms of implementing the new Act, by working in collaboration both regionally through Western Bay Regional Health and Social Care Programme, in partnership working with Health and the Third Sector and by engaging with citizens, service users, carer and staff about a future model of social care. 3.5 A key part of a sustainable model is to ensure that carers can quickly access the right information, advice and assistance at the right time, to find the right support that can enhance their wellbeing, and to achieve the help they need. The new Act provides a wider definition of carers than that which exists in current legislation to include those who provide, or intend to provide, care. Consultation with carers, and the involvement of, carers is important, and Swansea has strong arrangements in this area, through a positive commissioning relationship with Swansea Carers Centre, and regular training and support events, including Carer’s Rights Day (next event planned on 27TH November 2014, at Liberty Stadium). Carers are seen as an integral part of the assessment process for the person cared and they may request a specialist carers assessment in their own right. We are involved with a Carers Action Support Group, and there is a local carers strategy action plan agreed with partners to drive improvements, and linking to a regional Carers’ Measure action plan lead by ABMU Health Trust. 3.7 In order to take this huge agenda forwards a new Adult Services Management structure is being implemented (see Appendix 1, subject to change). 3.8 We are well placed to meet the challenge of implementing the Social Services and Well-being (Wales) Act by April 2016 and, as the new management structure is put in place, to take forward will be a new phase of Transforming Adults Social Services programme. 4. Next Phase of TASS Programme 4.1 This section set out the main priorities for change within the next phase of the Transformation of Adult Social Services, and the implementation of a

new model for Adult Social Care. The corporate Sustainable Swansea – Fit for the Future programme supports a shared focus on wellbeing and prevention, and that promoting these as community and personal outcomes, is best managed as “everybody’s business”. An As Is model would place a high number of long term managed care cases at the top of a triangle, a Swansea To Be model shows the complete change in direction needed, with Intermediate care / reablement services as a crucial enabler in the change approach.

Figure 1 Swansea To Be Model 4.2 The next phase of the TASS programme will include a project to ensure that all citizens have the offer of up to date information, advice and assistance to access the support they need to enhance their well-being. There will be improved access to a range of universal, preventative and reablement options, and support for safeguarding vulnerable adults and carers. Our Intake Team, currently based at the Civic Centre, helping us manage demand for social care more effectively. They undertake a simple assessment; listening to the outcomes people want to achieve, helping the person to find solutions and access suitable support within their community and through universal services. Where people need the help of a social worker, where there are safeguarding concerns, or a specialist assessment is required, the intake

team refer on to the social work teams. Collaboration with health partners, and the development of a single point of access will enable people to access community, health and social care services through our front door in the future. 4.3 We must continue to focus our resources effectively by developing commissioning plans that continue to reshape and remodel services. In order to support people remain or become independent, we need a wider range of services that are person-centred, outcomes focused and working to regain the person’s independence, for example on returning home from a stay in hospital. Service quality is to be considered in respect of the user experience. 4.3 We will have to support the changes required to support a new Operating Model for managed care. There needs to be a change in culture and social work practice to ensure that managed care is built on a stronger relationship between professional and citizen. Social workers ensure support planning and outcomes are carried out and agreed with the vulnerable adult and carers. Interventions are focused on safeguarding, reablement and promoting independence. 4.4 We are committed to ensuring Adult services are sustainable, and well placed to meet the increasing demand that comes from a growing, and aging population in Swansea. We can only do this by changing the model of how we work, by improving the professional skills of our social care staff who work directly with people and families in their homes, communities and in services. Social workers will also need to focus on the strengths that exist within people, families and communities, become more innovative and creative in coming up with solutions that can make a difference to peoples’ lives, and to agree on support plans which can deliver the outcomes that people set for themselves 5. Recommendations 5.1 For Scrutiny Panel to note the changes arising from the Social Services and Wellbeing (Wales) Act and their impact on the Council; 5.2 For the Panel to note the Council’s state of readiness to implement Act’s requirements 5.3 For the Panel to affirm the changes being proposed within the next phase of the Transformation of Adult Social Services (TASS) to ensure compliance by April 2016

6. Appendices

3. LETTER TO THE CABINET MEMBER FOR ADULTS AND

VULNERABLE PEOPLE FOLLOWING THE SERVICE BRIEFING (OCTOBER 14)

Dear Councillor Harris

Transformation of Adult Social Services Working Group, 13 October 2014

The working group met on 13th October to consider the best way for scrutiny to engage with the Transformation of Adult Social Services programme. I would like to thank you and officers for attending the panel. The working group discussed at length with you the importance of ensuring that the report on the Independent review on the commissioning and provision of social services to older people was made available as soon as possible to the group. The working group understood that the report was received by Social Services at the beginning of September but was being withheld. The group expressed in very uncertain terms, its frustration about such an unacceptable delay and also pointed out that panel members need time to study its findings. Therefore, in order to do justice to this responsibility the report needed to be released to scrutiny members without delay. The working group welcomed your agreement to circulate the report as soon as possible. Ed Hammond from the Centre for Public Scrutiny attended the meeting to discuss and help the group develop its ideas on how best to provide challenge, assurance and scrutiny engagement in the TASS process. With regards to this, the panel agreed to explore the following:

• Understand why the transformation was necessary, the drivers of change

• Understanding the user need and perspective, how to establish what local needs are

Councillor Jane Harris Cabinet Member, Adults & Vulnerable People Civic Centre Oystermouth Road SWANSEA SA1 3SN

Please ask for: Gofynnwch am: Overview &

Scrutiny

Direct Line: Llinell Uniongyrochol: 01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf: TASS/01

Your Ref Eich Cyf:

Date Dyddiad: 6 November 2014

Overview & Scrutiny / Trosolwg a chraffu

City and County of Swansea / Dinas a Sir Abertawe Civic Centre, Swansea, SA1 3SN / Canolfan Ddinesig, Abertawe, SA1 3SN

• Identify areas to focus the scrutiny work on and tailor the work to the TASS cabinet timetable.

As part of our discussions we came up with the following list of possible area on which we could focus our scrutiny work:

• Independent Review • Western Bay work • Strategic integration • Network hubs and health • Joint commissioning of services and pooling funding • Costs • Transport • Housing • Different service areas such as Learning disabilities, Mental health • Local area co-ordination and community development, drawing on

the approach in Scotland and Australia • Safeguarding & risks • Signposting

The next step for the working group is to identify a set of dates so that a timetable of work can be drafted and agreed. I hope you find this letter useful and informative. Yours sincerely CLLR UTA CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]



Report of the Chief Social Services Officer

Independent Review of Older Peoples Services

Purpose: This report presents an initial response to the

Independent Review on the Commissioning and Provision of Social Services to Older People in the City and County of Swansea and is presented to cabinet/executive away day to stimulate discussion and inform the final report.

Report Author: Deborah Driffield 1. Background 1.1 Proposals were submitted earlier in the year as a response to the

Councils ‘Sustainable Swansea – Fit for the Future’ Budget consultation.

1.2 The proposals included plans to close a number of LA Care Homes, as

well as remodelling Day Service provision 1.3 Following the consultation on the proposals a decision was made to

commission an independent review of the commissioning and provision of services to older people

1.4 A stakeholder group was set up which formulated a specification for a

Tender for the review, which was published in June 1.5 A number of bids were received and evaluated and the tender was let

to Cardiff University. 1.6 The university undertook work over July and August, including an

evaluation of Adult services transformation agenda and preparedness for the future, an academic evaluation of research and a number of stakeholder events

1.7 A report was concluded in early September. A copy is enclosed as

Appendix 1 2. Main Findings of report 2.1 The report endorses the overall ‘direction of travel’ as evidenced by the

Western Bay and Transformation of Adult Services (TASS) programmes and views the initiatives as ‘desirable and necessary’

2.2 The report is more cautious in endorsing the rebalancing of provision in

favour of supporting a greater proportion of older people in their own homes and rightly points out that the individuals well-being must be a factor in determining when the ‘tipping point’ has been reached between continuing to support people in their own homes or in a care home

2.3 The report also urges further work to be undertaken to identify unit

costs more accurately to enable better cost comparisons between internal and external services

2.4 The report proposes a number of strategic levers which the Council

could utilise to ensure sustainability of services. Six levers are referenced in the body of the report, although only five are identified as strategic levers, as the sixth option would be for the Authority to increase resources available to meet increased demand for services.

2.5 The five identified strategic levers are: Ration Care to those most in need Ration Care on those on low incomes or raise charges Invest in prevention and reablement services Reduce Unit Costs of Care Support policies which boost incomes for citizens 2.6 The report acknowledges that these ‘levers’ are not mutually exclusive

and that the main focus should be on the balance which should be struck between them.

2.7 The reviewers preferred approach seeks to focus mainly on prevention

and reablement, but suggests that a modest contribution to sustainability could be achieved by also focussing on reducing unit costs and maximising charging opportunities. The reviewers are of the opinion that concentrating resources on those most in need (i.e. raising eligibility thresholds) should be very much a last resort

2.8 The reviewers are not convinced by the rationale for immediate

proposals of home closures. They believe that the argument that the built environment is not fit-for-purpose in three LA homes is strong, but does not extend to all six homes. They are not convinced that the proposal requires immediate action, however, and advocate a ‘wait and see’ approach.

2.9 The reviewers have not made concrete recommendations about day

services, but caution against an approach which tries to direct older people with substantial and critical levels of need towards alternative day opportunities where their needs might not be met.

3. Analysis and Response 3.1 It is reassuring to note that the reviewers are impressed with the level

of preparedness evident in Adult Services to meet the challenges of the future

3.2 It is also reassuring to note that the review has not identified any

initiatives, ideas or proposals which have not been considered under our transformation programme or through local or regional policy initiatives

3.3 The preferred option of the reviewers – to focus primarily on prevention

and reablement – amounts to a clear endorsement of developments already in train.

3.4 The reviewers are right to identify the relatively sparse evidence which

exists to support the longer term impact of reablement services and we should take heed of their reference to ‘practice-based evidence’. We will need to ensure more robust measures are developed to identify the longer term impacts of reablement on users of our services

3.5 The reviewers also point to the lack of good evidence for the positive

impact of integration of services with Health. They note that integration may be driven by managerial thinking and results in users being moved to ‘cheaper’ parts of the care system. The reviewers do not see this as a difficulty in principle if the quality of that support is maintained.

3.6 The reviewers again point to the need for good practice based

evidence to support the continued development of integration 3.7 The reviewers argue that rebalancing care in favour of supporting

greater proportions of older people in their own homes does not lead to an overall reduction in the absolute numbers of residential care beds, because of the impact of demographic increases.

3.8 This analysis is correct, insofar as it compares current and future

service provision. The reviewers acknowledge that future demand for residential forms of care is more likely to be for more complex forms of care (referred to as ‘nursing care’) but they are unconvinced by our arguments that this will lead to a fall in the more ‘basic’ levels of residential care currently provided. They are clear that the built environment in some LA homes would require significant investment to enable them to provide the levels of care which will be prevalent in such environments in future.

3.9 The reviewers therefore conclude that it is questionable whether the

‘specific homes’ could contribute to sustainable services in the future.

3.10 The reviewers also raise issues around how robust the external marketplace is at present (for residential and domiciliary care) and advocate the Welsh Government view that the Local Authority takes a much more active role in shaping the mixed market of care. The inference here is that the LA should retain a stake in the marketplace as one way of ensuring it is more robust – although they appear to draw the line at increasing our presence in that marketplace.

3.11 The reviewers also raise concern about the current commissioning

arrangements for provision of domiciliary care. They rightly identify the issue of travelling time and suggest that geographically focussed commissioning using ‘framework documents’ could be one way of addressing this. We would concur with this approach and work is already underway to seek ways of achieving this.

3.12 The reviewers note that the changes underway and proposals for a

more sustainable approach to service provision in Swansea will also need to consider the impact on other services (especially for carers respite). We will need to ensure that support for Carers is a key feature in all service redesign.

4.0 Conclusion The Independent Review has provided robust validation for the

strategic approach being taken to develop services for older people in Swansea, but has failed to take into account or pose a solution to the immediate financial challenge of finding significant savings in the short term, apart from suggesting that the local authority consider investing more into Adult Social Care to meet the future rise in demand.

We would concur with the reviewer’s analysis that the national

‘intelligence’ available at present regarding future demand and financial modelling is sparse. However, It would seem unrealistic to wait a further 3 years before we make a decision on the future viability of in house residential service provision, bearing in mind the ongoing issues of; under capacity, constraints regarding size and lay out, future refurbishment and maintenance requirements and lack of on suite facilities etc.

We would be of the opinion that we need a clear strategy to push

forward the change agenda and that the longer we provide outdated models of care the longer people will rely on them.

If a more detailed analysis of likely demand (including the impact of the

reablement interventions to date) is required by Cabinet before they can make a decision to reduce the number of care homes provided by the council, then this should be pursued in parallel with implementing a robust prevention and reablement approach.

This will ensure that when and if the decision is made to review the amount of residential care provision we require we already have a variety of alternative provision available in the community.

I would therefore suggest that we adopt the following recommendations

contained within the review and incorporate them into a revised commissioning framework (legislative requirement) based around the three key themes of Prevention, Reablement and Managed Care.

It should be noted that due to the complexity of this work and the

recent reductions in staffing, additional capacity/capability will need to be secured to ensure the objectives are achieved in a timely fashion.

Ongoing Strategic Projects (endorsed by review) Continue to develop Integration and evaluate Continue to develop Reablement services and evaluate Continue with TASS programme Continue with Western Bay programme Further develop robust consultation engagement Short Term Actions (0-6 months) Develop a fully costed Prevention Strategy as part of SSF4F

workstream and supported by the Prevention Fund. Establish accurate unit costs – supported by Corporate Finance Develop Direct Payments programme Commence work to explore developing Social Enterprise micro-sites Prioritise a review of income and charging as part of SSF4F Develop/Implement Assistive Technology strategy as part of Integration Medium Term Actions (6-12 months) Review how we shape and influence the market re Dom Care Review Commissioning arrangements – Domiciliary Care Reduce unit costs – efficiencies/effectiveness Identify tipping point – quality of life Review quality monitoring – Domiciliary Care Review and report back on proposals to remodel day care Longer Term (Residential Care) (12-18 months) Review commissioning arrangements to include; Determining future demand (including choice, aspirations of OP) Financial modelling information Review how we shape the market re Residential care Confirm balance between in-house/external provision Review quality monitoring – Residential Care Review respite (residential) requirements Review accommodation with support available jointly with Housing Present proposal on future costed model for 24 hour care

5. LETTER FROM THE MEETINGS HELD IN NOVEMBER AND DECEMBER – INDEPENDENT REVIEW OF PROVIDED AND COMMISSIONED SERVICES FOR OLDER PEOPLE


Transformation of Adult Social Services Working Group, 17 December 2014

The working group met on 17th December to discuss the independent review report Independent Review Report The panel was concerned that the consultation meeting about services for people with learning difficulties was cancelled and asked officers to explain this. Officers informed the panel that the decision, taken previously by cabinet, was under review and that consultation had therefore been suspended. Officers stated that the overall direction of travel of Adult Social Services had been endorsed however some caution was expressed about some assumptions particularly in terms of the rebalancing of services between community and residential care. The panel engaged in the following discussion points and would like to bring the following comments to your attention: Budget The influence of the budget has accelerated and this has become more of a priority than expected. The panel expressed how important it was to ensure the Council targeted its scarce resources at the right people in the right places. Local Area Coordinators There needed to be more people helping other people in the community. Local Area Coordinators are a step up from community connectors and the



Scrutiny


e-Mail e-Bost:

[email protected]


Your Ref Eich Cyf:

Date Dyddiad: 22 December 2014



evidence has shown that that this approach works once it gets going. There will be investment in the systems to support it. Jane Tonks has been appointed to lead this and Adult Services will be employing people for each of the three hubs and shifting posts into this structure as they become available. The panel learned that Jane Tonk’s post will be funded for 1 year by a Western Bay Prevention Fund bid. The Intention will then be to seek other sources of funding from partners, other departments. The panel felt that CCS was some way behind other councils in terms of this approach and we would like to know how you intend to evaluate the success of this approach. Community Hubs The panel learned that there were 3 community hubs located in the civic centre, SA1 and Gorseinon hospital. The panel was unhappy with the choices of locations for the community hubs and we will make arrangements to consult with Jan Worthing about this matter. Western Bay The Panel had concerns about the scrutiny of the Western Bay and the balance of risk between the Council and Health partners. We noted that an event will be held in the new year by Western Bay to explore this and that the chair and vice chair of the Scrutiny Programme Committee had been invited. The panel will request feedback from the SPC on this event. Private Sector Concern was expressed about the vulnerability of the council to the collapse of private health and social care providers or other market failures. Officers reported that the independent review report questioned whether the Council’s policy of taking more services in house will reduce this risk – it suggested that council unit costs are not sustainable in the long term. Health You expressed the need scrutiny of interfaces between council and health and perhaps this is something that can be explored further when we discuss our work plan on 9th January. Agreed

• Further meeting needed to discuss report with you and officers • The panel needs to be provided with more detail on short term actions • Invite Jan Worthing to future meeting

Letter from 8th December We agreed to make the following amendment to the previous letter and it will be re-sent to you with this letter. Paragraph 4… “we asked that your officers clarify the date that the report was provided to the authority and when it was presented to the Cabinet Away Day. This information has since been received and we are grateful for the



timeliness of the response. However, we would also like further detail on what happened to the report from the time it was received by officers to the time it was received by the cabinet member. I hope you find this letter useful and informative and I look forward to your response by Monday 19th January 2015 Yours sincerely CLLR UTA CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]



6. Timeline for proposed changes within TASS Programme -

Implementation Phase (Two) (January 2015)

Proposed Change Sustainable Swansea Workstream

Yr 1 2015/16

Yr 2 2016/17

Yr 3 2017/18

1. Implement Local Area Coordination within target communities

Prevention & Demand Management

2. Swansea Integration Plan: Common Access Point to simplify access arrangements


3. Support to Carers Changes linked to Carers Measure/ Regional Strategy and Local Action plan


4. Volunteering & Befriending to address social isolation and increase daytime opportunities


5. Adult Family Group Conferencing - support families through crisis in caring relationship to prevent breakdown


6. Reduce number of Assessments and Reviews carried out by social workers


7. Divert referrals at front door (6 week follow up)


8. Swansea Integration Plan: Intermediate Care Tier - 1 year Funding agreed through regional business case- to deescalate social care needs

New Models of Service

9. Swansea Integration Plan: Network Hubs


10. Western Bay – Dementia Care Services

New Models of Service TBA

TBA

TBA

11. Development of pathways to help people remain in their own homes


12. Development of Reablement across YA


13. Capacity within Domiciliary Care by offering Direct Payments to help people employ Personal Assistants


14. Change focus of reviews to ‘Promoting Independence’ Reviews by using Telecare and OT


15. Reclaiming Social Work/ Signs of Safety to implement new ways of working with citizens

Efficiency

16. Right sizing of existing care packages based on the pathways to independence (pti) methodology

Efficiency

17. Remodelling Domiciliary Care Efficiency

18. Remodelling Swansea Vale to provide more skills/ employment based support

Efficiency

19. Remodelling Ty Cilla to support complex respite needs

Efficiency

20. Retendering Llansamlet Physical Dis. Service

Efficiency

21. Audit & Review Direct Payments (linked to Item 13)

Efficiency

22. Redesign Home Care / Day Care for those with Complex Needs

Efficiency

23. Reduce the need for Long Term Support Timescale:

Efficiency

24. Re-commission Dom. Care based on outcomes

Efficiency

25. Review Procurement Efficiency 26. Review Charging / Income Generation Efficiency

27. Changes to Residential Service External LDS

Efficiency

28. Changes to Residential Service (Ext.) Mental Health

Efficiency

29. Independent Review of Care and Support to Older People – Timescale: OPS Review Report to Cabinet, awaiting decision/ response:

Stopping Services

7. WORK PLAN BRIEFING - TASS PROGRAMME PRIORITIES (MARCH 2015)

Purpose: This report provides a follow up to the previous report to TASS Scrutiny Panel: FOLLOW UP BRIEFING REPORT (dated 8th December 2014).

This report provides Scrutiny Panel with summary of the timelines on a number of key transformational activities taking place within the next phase of the TASS programme. TASS Panel are asked to consider these timelines in developing a work programme to oversee the progress of this change programme, and to consider how the programme is supporting the Authority’s readiness towards implementation of the Social Services and Wellbeing (Wales) Act.

Report Author(s): Carol Rea, Head of Adult Services; Simon Jones, Performance & Improvement Officer Finance Officer: Mike Hawes Legal Officer: Janet Hooper Access to Services Officer: Euros Owen

FOR INFORMATION

1. Background 1.1 The TASS programme is now moving into a second phase, namely ‘Implementation’ which has been scoped out to ensure Swansea’s readiness to meet the requirements of the Social Services and Wellbeing (Wales) Act. 1.2 TASS programme is now an integral part of the Council’s strategic Sustainable Swansea – Fit For The Future programme. This headline, corporate programme is intended to drive significant improvements in efficiency, demand management, stopping services and service outcomes by doing things differently 2. Social Services and Wellbeing (Wales) Act 2.1 Introduction The main legislative change is the Social Services and Wellbeing (Wales) Act which is to come into force by April 2016. The Act will have significant implications for how social services are delivered. The Act is designed to transform the delivery of social services by focusing on achieving outcomes that promote people’s wellbeing, as individuals, and as members of families and communities.

TASS Panel –Transformation Update, February 2015.

2.2 The first tranche of consultations has been taking place. Swansea has been contributing towards a regional response through Western Bay, and locally by working though the local implications in a number of task and finish groups in the areas of:

Within the new Act there are some additional/ new requirements, place on Local Authorities: local authorities to provide or arrange for the provision of preventative services (Part One,

section 15); requires the promotion by local authorities of social enterprises, co-operatives, user led

services and the third sector in the provision in their areas of care and support and support for carers (Part One, section 16);

requires the provision by local authorities of a service providing information and advice relating to care and support and support for carers and assistance in accessing it (Part One, section 17);

2.3 A second tranche of consultations is due to be released in May this year, and these are likely to include:

3. TASS Panel Scrutiny Work Priorities The following five areas have been identified as priorities in the development of the current work programme. 3.1 Local Area Coordination (LAC) is a new and systematic approach to ensuring that people can prevent their ordinary needs becoming major problems, and one that is organised by public bodies working closely in partnership with local people and communities. LAC is a way to transform a whole local system as people develop the skills to strengthen their everyday citizenship and their communities in order to provide the support themselves as needed. Through a coordinated leadership, this approach can move what is currently a central, and formal “front end” of access to public services: referrals, assessment, applications, funding and services, and towards a more sustainable, localised response that listens into emerging needs, by building on creative energy and drawing up innovative solutions, harnessing mutually minded citizens as a

Part Covers Part 2: General Functions Code of Practice; regulations & guidance on exercise of Social

Services function; partnership arrangements in relation to part 2; wellbeing; population assessments; prevention; social enterprises; provision of information; advice and assistance

Part 3: Assessing the needs of individuals

Code of practice; regulations on SS functions in relation to Part 2;

Part 4: Meeting needs Code of practice; regulations on SS functions in relation to Part 4; eligibility; care and support planning; direct payments

Part 7:Safeguarding Regulations and statutory guidance in relation to Part 7; adult protection and support orders; duty to report and enquire; safeguarding boards and national independent safeguarding board

Part 11: Miscellaneous and General

Code of practice; regulations on SS functions in relation to Part 11; adults and children in prison, youth detention and bail accommodation and ordinary residence

Part Section Part 5: Charging and Financial Assessment Part 6: Looked After and accommodated children Part 9: Co-operation and Partnership Part 10. Complaints, Representations and Advocacy services


potential capacity to be responders and to grow and sustain a social capital within communities; in so doing this diverts people from the Local Authority service system. (See Appendix 2 Briefing)

How will it work in Swansea?

The project will start operating in three areas at first, one in each of the three Health and Social Care Integrated Hubs; North, West and Central. Funding is available for one year in the first instance from the City and County of Swansea Prevention Fund and Western Bay for three Local Area Coordinators and an Implementation Manager.

The areas were selected by the Local Area Coordination Leadership Group (elected Members, Social Services, Housing and Health and the Council for Voluntary Services) to ensure that:

• three different communities are represented (urban and suburban / semi-rural, mix of housing stock / tenure, diverse range of age groups / ethnicity),

• the population sizes were right (10—15,000 per area)

• includes an area with a significant Welsh-speaking population.

3.2 Procurement - The City & County of Swansea operated under a Category Management methodology in which there are currently 12 categories. Once of these categories is Social Services and is led by a dedicated Category Manager. The Category has a hub coordinates the procurement and commissioning activities within Social Services which aim to reduce cost, improve efficiency, quality and add value whilst ensuring compliance with all relevant Legislation. Membership of the category hub comprises of Social Services Contracting Officers, Planning Officers, and Legal representative and is chaired by the Category Manager. Work the hub undertakes is fed through to Commercial Panel and through to Social Services DMT. The category hub was established in August 2014 and now meets on a monthly basis. 3.3 Volunteering & Befriending – volunteering and befriending can contribute to improving the health and well-being outcomes of vulnerable people at risk of social isolation or exclusion if they were forced to move home or leave their communities for reasons of their own social care. Swansea aims to establish a Volunteering and Befriending service, one that is brokered by the 3rd sector, as a new response to requests for help, with support that can be personal, sensitive and flexible enough to meet a person’s individual outcomes, so they can take on a range of forms in response to different needs. 3.4 Integration Plan- Network Hubs – current project aim is to establish multi-professional teams co-located in three Integrated Community Network hubs. The main driver for this change is that increasing numbers of older members of the population coupled with increased longevity will result in increases in demand for health and social care. These additional pressures on health and social care services – evidenced by increased unscheduled care or domiciliary care capacity issues – will continue to grow unless we change what we do. A Framework for Delivering Integrated Health and Social Care for Older People with Complex Needs has been published by Welsh Government (http://wales.gov.uk/consultations/healthsocialcare/integration/?lang=en), and states that partners have to accelerate the development of integrated services, with a requirement for the publication of a ‘statement of intent’ setting out how they would respond to the key requirements to be submitted by the end of January 2014.


http://wales.gov.uk/consultations/healthsocialcare/integration/?lang=en

The City and County of Swansea and Swansea Locality of ABMU have already jointly invested in integrated innovations in response to national policy and operational pressures. Some examples of these are as follows: • Integrated Gower Team - the team compromises co-located health and social care staff,

providing support for hard to reach areas of the Gower. This model has been successful in reducing delays for care in the Gower area, and the unnecessary time spent in acute hospital beds waiting for care provision.

• A local Joint Community Resource Team (CRT) Manager, who has been in post for the past two years in anticipation of integration of services.

• Co-location of the Local Authority Occupational Therapy team with the Health Community Resource Team (CRT) as another step towards integration, with the development of a single job specification for an integrated Occupational Therapist being trialled.

• Development of an integrated Care Homes Quality Team with Health and Social Care staff all sharing in a set of aims and objectives for supporting people in care homes is under way.

• Joint emergency duty daytime service between the older peoples community based assessment and care management staff and the community resource team to provide emergency assessment to any older person during working hours.

• Step up/step down residential reablement facilities provide a service aimed at either preventing longer term institutional care or for the reablement of people leaving hospital. A successful model is now available at Bonymaen House and Ty Waunarlwydd

• Community Connectors who provide a community focal point for supporting people to live independently.

• The development of the role of primary and community health networks as a platform for key approaches to minimising impact on services and joining up services across geographical areas for the benefit of citizens.

• Better links with the Third Sector such as signposting to the provision of voluntary sector, and greater presence of information and 3rd sector services in GP services

• Each of the 3 Integrated Community Network hubs are a key enabler towards moving to a ‘strengths-based’ approach –by focussing on helping people to live independent lives in their own homes. By sharing skills, building excellence in professional practice and pooling resources, it is expected they can shift the model of care towards prevention, and early intervention; promoting effective work with third sector and other partners through the innovative approaches to help people to be supported in different ways, within their own communities. We also expect this project to develop consistent pattern of services available across localities, and within the 24/7 period across the Swansea Health Board area. 3.5 Support to Carers City and County of Swansea are committed to supporting unpaid Carers in our area. In recognition of the number of unpaid Carers in Swansea (over 30,000) and the significant levels of support they provide to relatives, friends and neighbours, the City and County of Swansea Social Services currently commission a range of support services from a variety of service providers. This is in addition to ongoing, direct Social Services interventions where Social Workers and staff such as Community Connectors regularly identify and support carers on a daily basis As well as providing some direct support to carers, who can have an assessment of need in their own right, Swansea also commissions support through 3rd sector providers and is considered to evidence the best practice in Wales in these relationships, with services such as Swansea Carer’s Centre, Crossroads, Hafal and the Alzheimer’s Society. http://cssiw.org.uk/docs/cssiw/report/140416swanseacommen.pdf (p5-6)


http://cssiw.org.uk/docs/cssiw/report/140416swanseacommen.pdf

Swansea Carers Action group was established over 10 years ago, as a multi-agency group of service providers, meeting quarterly to share information, discuss policies and initiatives. This energetic group, along with the Carers Planning group, are also a sounding board and the arranging of key consultation events such as Carers Rights Day and Carers week. They also contribute to the developing and delivering of the Carers Action Plan. In addition to the services which are provided directly to the carer the local authority also commissions or provides through in house services a range of respite services. These services cannot be categorised as a service provided to the carer although they do enable the carer to have a break from their caring responsibilities. It is important to remember that City and County of Swansea are core members of the ABMU Carers partnership. This more strategic partnership was responsible for developing the ABMU Information and Consultation Strategy and Action plan (also known as the Regional Carers Measure Action Plan). They are responsible for implementing the action plan and ensuring that an awareness of Carers and Carers issues are constantly raised within Health and Social Care settings. A number of initiatives have been introduced as a result of the strategy and action plan, so that staff within all settings, are becoming more carer-aware, and to ensure that carers are provided with the right information at the right time. The emphasis of this development work is to ensure that carers are consulted and involved in Care planning at every stage, so that they can contribute fully to the caring role and at the same time achieve their own wellbeing outcomes. Carers make a vital contribution to a sustainable model of social care. 3.6 Transformation (TASS) Timelines (Table 1 in Appendix One) sets out a summary of these change priorities, project leads, what we are expecting to take place, and expected timescales. This should help the TASS panel and elected members to decide when to request progress reports and to engage further with the changes taking place. 4. Recommendations 4.1 The Panel is asked to reflect the Transformation Timescales for their priorities as summarised in Appendix One in the TASS Panel work programme.


APPENDIX 2: Transformation (TASS) Timelines

Ref: Project (Programme) / [£ if Funded project]

Lead Officer

Project Lead

Project Description Progress to Date Key Future Dates

Date of Completion

RAG

1 Local Area Co-ordination (Prevention Stand- Prevention Fund / TASS) [£150k in 2014/15]

Deborah Driffield

Jane Tonks This work overlaps with the Western Bay Programme and looks to develop & build community capacity to provide and sustain natural support services.

• Information produced previously as part of TASS

• Leadership group established

• Resources agreed

• Localities Map • Job Description

Agreed

• Presentations to Stakeholders (Feb 2015)

• Coproduced recruitment to LAC posts

• Start-up plans/ access arrangements (April 2015)

• Reporting under Prevention strand

• Funding in Year 2

• Evaluation /timescales to be agreed

Current timeline to June 2015 Project to run until end 2015/16

Green

2 Procurement (Reduction of third party spend project within Efficiency stand within Sustainable Swansea / TASS)

Deborah Driffield Corporate Lead: Dean Taylor

Rachel Evans Lee Morgan

To coordinate the procurement and commissioning activities within Social Services through category hubs which aim to reduce cost, improve efficiency, quality and add value whilst ensuring compliance with all relevant Legislation.

• Stakeholder analysis,

• Responsible officers identified.

• Working group established to draft a standard form contract for Social Services.

• Mapping of current services commenced

• Action plan agreed (Feb 2015)

• Completion of Mapping of services and the contracting arrangements in place

• Agree action Plans for each Hub

• Hub leads to deliver on action plans

Current action plan runs to 1/4/16, with plans for each hub to run for a longer period

Green


3 Volunteering and Befriending (Prevention Stand-Prevention Fund / TASS) [£70k in 2014/15]

Carol Rea

Rachel Evans

Creation of a new Volunteering and Befriending arrangement and befriending network hub.

• Proposal written • Outline case

identified • Success

measures

• Project Brief

Project to commence by end of 2014/15

Red

4 Network Hubs (Swansea Integration Plan –Western Bay Regional Health and Social Care Programme / TASS) [ICF Funded for 1 year, then Sec. 33 agreement]

Carol Rea

Julie Burroughs Operational Lead: Ffion Larsen

To establish three community hub sites in Swansea which can host integrated teams of health and social care staff

− West Hub − Central Hub − North Hub

• Locality Maps – 3 Hubs

• Terms of Reference for Workstream

• Hub sites agreed and work commenced

• Workforce consultation

• Expressions of interest from health and social care staff

• Progress Report to Swansea Integration Board (end Jan 2015)

• Staff to be informed

• 3 Hubs - Go Live April 2015 (may be phased)

• Sec. 33 Agreement

• Review of staffing/ capacity/ requirements (by end 2015)

3 Year Swansea Integration Plan to end March 2017

Green

(Resources = Amber)

5 Support to Carers Deborah Driffield

Cathy Richards

To jointly meet local and regional requirements under the Carers’ Measure.

Swansea Local Action Plan in place

Presentation to CAC 4th March

No specific timeline

Green


APPRENDIX 2 What is Local Area Coordination? Local Area Coordination is a long term, evidence based approach to supporting disabled people, people with mental health problems, older people and their families and carers to:

• Stay strong, safe and connected as contributing citizens • Build more welcoming, inclusive and supportive communities

Research and evaluation studies show that where implemented correctly, Local Area Coordination supports:

• The building of community capacity and resilience • The prevention of, or reduced demand for costly services • Service reform and integration, leading to high quality services becoming a valued back up

to local solutions These outcomes reflect the direction of travel in the Social Services and Well-Being Act (Wales) 2014 and will support Swansea to meet the requirements of the new legislation. What do Local Area Coordinators do? Local Area Coordinators support people (children and adults) to build and pursue their vision for a good life. They work with people who are not yet eligible for formal social services (helping them to stay strong and connected), with those who are at risk of requiring services/in crisis (sometimes in partnership with other services), and with people already dependent on services (reducing that dependence through local non service solutions, relationships etc.) Local Area Coordinators are based in communities of between 10—15,000 people. They provide a local, accessible and single point of contact for individuals and families. They work on two levels; most people will just need straightforward information or connection to other people, groups or agencies in order to solve their particular issue, to stay strong and connected. For others, a more in- depth involvement is required. Local Area Coordinators will work with between 50 and 65 people in this situation. They take time to get to know the person and their strengths and ask “what is your vision for a good life and how can you get there?” Evidence shows that when asked this question, people rarely identify extreme things like winning the lottery; many descriptions of a good life are simple and Local Area Coordinators support people to determine and express their goals to make them realistic and measurable. Local Area Coordinators support people to:

• Access information in a variety of ways • Be heard, stay in control and make choices • Identify their personal strengths, goals and needs • Find practical (non- service) ways of doing the things they want or need to do • Develop and use personal and local networks (thus reducing isolation). • Plan for the future. • Connect with, be part of and contribute to local community life. • Access support and services if required.

In addition, Local Area Coordinators work alongside the local community to:

• Understand, nurture and share the strengths and opportunities in communities. • Build partnerships to make communities more welcoming and inclusive

Sometimes formal services are complicated and difficult to navigate. Local Area Coordinators help with this by:


• combining traditionally separate roles to provide a single point of contact across service types and age groups, making things simpler and helping people to be in control

How do we know that Local Area Coordination works? Over the past 26 years, evaluations (including in Western Australia, Scotland, Cumbria, Thurrock and Derby) have shown that where designed properly with local people, and with strong, connected leadership, Local Area Coordination achieves consistently positive outcomes, including:

• People diverted from traditional services or needing less service provision • Increase in valued, supportive, personal relationships • Increased capacity of families and carers to continue in caring role • More inclusive, supportive, better resourced and resilient communities • People feeling more in control of decisions, support and services • People feeling more confident in the future

How will it work in Swansea? We will start in three areas at first, one in each of the three Health and Social Care Integrated Hubs; North, West and Central. Funding is available for one year in the first instance from the City and County of Swansea Prevention Fund and Western Bay for three Local Area Coordinators and an Implementation Manager. The areas were selected by the Local Area Coordination Leadership Group (elected Members, Social Services, Housing and Health and the Council for Voluntary Services) to ensure that:


• the population sizes were right (10—15,000 per area) • includes an area with a significant Welsh-speaking population.


8. External Residential Care Costs 2014/15

(MARCH 2015) Purpose This report provides the panel with information on

external residential care rates.

Content The attached spreadsheet lists the different external residential placement categories that are available. It also shows the weekly cost of external residential care for each of the different placement categories. Information is also provided on the amount that the Local Health Board contributes to each placement category.

Councillors are being asked to

Use the information to: • gain a better understanding of how much different

residential placements cost the authority • influence the panel’s TASS scrutiny activities • determine if further reports on costs are

necessary

Lead Councillor(s)

Cllr J Harris, Cabinet Member for Services for Adults and Vulnerable People

Lead Officer(s) Carol Rea, Head of Adult Services Deborah Driffield, Chief Social Services Officer

Cover Report Author

Delyth Davies, Scrutiny Officer

Appendix provided by:

Carol Rea, Head of Adult Services

1 Introduction

1.1 At a previous meeting the panel agreed that it would like information

on costs of internal and external placement categories. The panel felt that it had a gap in its knowledge in this particular area and agreed that a breakdown of placement costs would benefit its TASS scrutiny activities.

2. External residential care categories and fee rates

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2.1 Information on the type of external care category placements, the weekly cost of each placement (2014/15) and the contribution from the Local Health Board is provided in appendix 1.

2.2 There are 10 different care category placements provided by external providers which the Local Authority uses, five of which have a nursing element which means that the Local Health Board makes a contribution to the cost.

2.3 Weekly fees for placements, paid by the local authority, range from £485 a week for an elderly residential care placement with no nursing element, to £538 a week for a care placement for physically disabled adults (£677 in total with the nursing element paid for by the Local Health Board).

3. Issues the panel may wish to consider

3.1 • How this information can be used within the panel’s overall work plan

• Whether the panel requires further information in this area • What is the total spend on external placements? How does this

compare with internally provided placements? • Are these placements considered value for money? • Are these fees likely to increase? • How is the nursing element arrived at? • What are the numbers requiring these placements and what

change in demand is expected?

4. Next steps

4.1 The panel’s findings, observations, recommendations for action arising from this session will be conveyed to the Cabinet Member in a Convener’s letter.

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8A External Residential Care Fee Rate 2014-15

Category PeriodWeekly Fee Rate Nursing element Total

Elderly Residential 06/04/2014 - 04/04/2015 £485 NIL £485Elderly Mentally Ill Res 06/04/2014 - 04/04/2015 £485 NIL £485

Elderly Nursing 06/04/2014 - 30/11/2014 £500 £138.61 £638.61Elderly Nursing 01/12/2/014 - 04/04/2015 £500 £139.61 £639.61Elderly Mentally Ill Nurs 06/04/2014 - 30/11/2014 £515 £138.61 £653.61Elderly Mentally Ill Nurs 01/12/2014 - 04/04/2015 £515 £139.61 £654.61

Learning Disability Res 06/04/2014 - 04/04/2015 £485 NIL £485Learning Disability Nurs 06/04/2014 -30/11/2014 £500 £138.61 £638.61Learning Disability Nurs 01/12/2014 - 04/04/2015 £500 £139.61 £639.61

Mentally Ill Residential 06/04/2014 - 04/04/2015 £479 NIL £479Mentally Ill Nursing 06/04/2014 - 30/11/2014 £500 £138.61 £638.61Mentally Ill Nursing 01/12/2014 - 04/04/2015 £500 £139.61 £639.61

Physical Disabled Res 06/04/2014 - 04/04/2015 £543 NIL £543Physical Disabled Nurs 06/04/2014 - 30/11/2014 £538 £138.61 £676.61Physical Disabled Nurs 01/12/2014 - 04/04/2015 £538 £139.61 £677.61

Please note - The nursing element of the charge is paid by the Local Health Board

9. LOCAL AREA COORDINATION IN SWANSEA: PROGRESS TO

DATE (APRIL 2015)

Purpose To provide a briefing requested by the Board about the

progress of Local Area Coordination.

Content This report includes: • A summary description of Local Area Coordination • Information about the recruitment process • Some learning points gathered from the work so far • An outline of the next steps for the work.

This report will be of interest to the Scrutiny panel, elected Members, officers of the Council and the general public. The report is designed to update the Committee on progress so far, facilitate discussion and encourage questions about the approach.


Use the report as an aide memoire to frame any further questions about Local Area Coordination.

Lead Councillor(s) Cllr Paxton Hood-Williams, Convener, Child & Family Services Scrutiny Performance Panel Cllr Mark Child, Cabinet Member for Well Being & Healthy City

Lead Officer(s) Chris Sivers, Director of People Deborah Driffield, Chief Social Services Officer Carol Rea, Head of Adult Services David Howes, Head of Child and Family Services.

Report Author Jane Tonks, Local Area Coordination Implementation Manager, Tel; 636645, [email protected]

1. Introduction Local Area Coordination is a long term, evidence based approach to supporting disabled people, people with mental health problems, older people and their families and carers to:

• Stay strong, safe and connected as contributing citizens • Build more welcoming, inclusive and supportive communities

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mailto:[email protected]

Research and evaluation studies show that where implemented correctly, Local Area Coordination supports:

• The building of community capacity and resilience • The prevention of, or reduced demand for costly services • Service reform and integration, leading to high quality services becoming a valued back

up to local solutions These outcomes reflect the direction of travel in the Social Services and Well-Being Act (Wales) 2014 and will support the City & County of Swansea to meet the requirements of the new legislation. 1.1. Funding Funding is available from the City and County of Swansea Prevention Fund to employ three Local Area Coordinators for one year in the first instance, and from Western Bay to employ a Local Area Coordination Implementation Manager. The Local Area Coordinators will be based in one of the three Health and Social Care Integrated Hubs: North, West and Central. Local Area Coordination is also being developed in Neath Port Talbot and Bridgend, though the three Authorities are at different stages of development. 1.2. How does Local Area Coordination work? Local Area Coordinators are based in communities of between 10—15,000 people and provide a local, accessible and single point of contact for individuals and families. They work with people with mental health problems, disabled people, older people, families and carers:

• who are not yet eligible for formal social services (helping them to stay strong and connected),

• who are at risk of requiring services/in crisis (sometimes in partnership with other services), and

• with people already dependent on services (in order to reduce that dependence through local non- service solutions, relationships etc.)

Sometimes formal services are complicated and difficult to navigate. Local Area Coordinators help with this by:

• Combining a range of traditionally separate roles to provide a single point of contact across service types and age groups, making things simpler and helping people to be in control.

• Becoming the new “front end” of the service system. Local Area Coordinators work on two levels;

• Most people will just need straightforward information or connection to other people, groups or agencies in order to solve their particular issue, and to stay strong and connected.

• For others, a more in- depth involvement is required. Local Area Coordinators will work with between 50 and 65 people in this situation. They take time to get to know the person, their strengths and gifts and ask “what is your vision for a good life and how can you get there?”

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1.2. What do Local Area Coordinators do? Local Area Coordinators support people to:

• Access information in a variety of ways that are useful • Be heard, stay in control and make choices • Identify their personal strengths, goals and needs • Find practical (non-service) ways of doing the things they want or need to do (thereby

reducing demand for formalised services). • Develop and use personal and local networks (thus reducing isolation). • Plan for the future. • Connect with, be part of and contribute to local community life. • Access support and services if required (services in the right place at the right time).

In addition, Local Area Coordinators work alongside the local community to:

• Understand, nurture and share the gifts, strengths and opportunities in the community. • Build partnerships to make communities more welcoming and inclusive. • Build a positive vision and action for our communities.

1.3. Where will the Local Area Coordinators be based? In the City & County of Swansea the funding available has allowed us to appoint three Local Area Coordinators in the first instance, working in these areas:

• Central: St Thomas (including Danygraig and Port Tennant, SA1 Waterfront, Pentrechwyth and Bonymaen)

• West: Sketty (including Sketty Park, Derwen Fawr and Tycoch) • North: Gorseinon (including Garden Village, Kingsbridge and Loughor)

The areas where they will be based were selected by the Local Area Coordination Leadership Group (elected Members, Social Services, Housing and Health and the Council for Voluntary Services) to ensure that:


• the population sizes were right (10—15,000 per area) • an area with a significant Welsh-speaking population is included • each integrated Community Hub (Central, North and West) will have a Local Area

Coordinator located within it. 2. Progress to date 2.1. Recruitment The three Local Area Coordinators have been recruited and will start in May 2015. The recruitment process was co-produced by community members in each area working alongside paid officers and the Leadership Group. Community members included local tenants of a supported housing project, a 6th former from the local comprehensive, members of several faith communities, a Vicar, local businessman, a retired health services manager, the Community Officer of a large supermarket chain (who also

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gave their premises free of charge to use as an interviewing venue), local mums, a primary school support staff member and a young jobseeker. All were recruited in their local communities and gave up a whole day of their time to help select the Local Area Coordinator for their area. Local Councillors supported this process by spreading the word in their communities and by being part of the recruitment days. This method of co-productive recruitment has proven to be an extremely important element in the success of Local Area Coordination; it ensures that individual communities have early knowledge and ownership of the approach and that the Local Area Coordinators ‘hit the ground running’. 2.2 Communication Presentations about Local Area Coordination have been made and information giving sessions have been provided to Social Services staff, Education colleagues, GP Networks, community members, Councillors and Cabinet Members. A two page spread about Local Area Coordination in Swansea has appeared in the Evening Post, progress has been tweeted on the Council’s Twitter account and on the Local Area Coordination Network Facebook page, a story appeared in SA4 magazine and there will be an article in the May edition of the Leader. Communications will be stepped up now that the Local Area Coordinators have been recruited and we approach the operational date. 2.3. Learning points The process we have undergone so far has provided the following initial learning points:

• There is a great deal of interest in communities about this approach and a good deal of willingness to be involved. This bodes well for future engagement.

• Recruiting, working with and preparing community members for the co-productive recruitment process is time consuming, but pays real dividends in terms of preparing the ground for the Local Area Coordinators when they come in to post. We have already built good, positive, local connections in the three communities.

3. Next steps 3.1. Start date The Local Area Coordinators will start in May 2015 and work for one full year from their start date. 3.2. Induction and training An induction and training package is in development ready for the Local Area Coordinators’ May start date. As a learning site we are part of the Local Area Coordination Network, which is made up of Local Authorities across the UK who are engaged in Local Area Coordination. This provides us with a ready-made group with which to share expertise and learning and enables us to access training opportunities that might otherwise be out of reach as a single Local Area Coordination site.

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As well as the City and County of Swansea’s and Social Services’ specific induction programmes, Local Area Coordinators will take time to get to know their local communities and the people in them. They will meet partners from relevant organisations and agencies and undertake a wide ranging training programme which is likely to include:

• Developing ‘first contact’ meeting skills and report writing appropriate to Local Area Coordination (provided by the Middlesbrough and Derby City Local Area Coordination learning sites.)

• The specifics of Local Area Coordination—what they do and don’t do. • Person centred planning/approaches. • Safeguarding • Mental health awareness • Dementia awareness • Disability equality • Asset based approaches to community development • Skills for joint working • Etc.

3.3. Evaluation Local Area Coordination in Swansea is being evaluated by the Institute of Life Sciences at Swansea University (see evaluation synopsis attached appendix 1). The evaluation will include a formative element and further summative reports as the work progresses. The formative research will ensure that the development stages, including the setting up of the Leadership Group and the recruitment process, are examined. First results are expected in September with further results in December 2015 and March 2016. 3.4. Planning for the future As we gather evidence, results and stories about the practice of Local Area Coordination in Swansea and we see the results of the formal evaluation, we will be able to assess the efficacy of the approach and the implications and feasibility of extending it beyond the first year, and across the City and County. As Local Area Coordinators work in populations of between 10---15,000, we estimate that a further 13 Local Area Coordinators will be needed to cover the whole of Swansea, bringing the total up to 16. Even if the results are favourable, expansion of this size will clearly take time. In other areas of the UK, funding for Local Area Coordinators has been secured by working in partnership with a range of organisations and agencies, for example the Fire Service and the NHS. These agencies have contributed funding to employ Local Area Coordinators as the approach has impacted positively on their areas of work. 3.5. Local Area Coordination in relation to other developments in the prevention and wellbeing work stream Local Area Coordination is one element in a spectrum of developments designed to promote prevention and wellbeing, including Adult Family Group Conferencing, Third Sector Brokerage and Circles of Support. Further development of Local Area Coordination will need to be evaluated in this context to ensure best fit and optimum use of resources.

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Background Papers: • Research evaluation synopsis, Institute of Life Sciences, Swansea University. • Local Area Coordination: what makes it different? Local Area Coordination

Network, 2015 (appendix 2) • Local Area Coordination Frequently Asked Questions, March 2015 (appendix 3)

Date: 23 April 2015

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Evaluation Aims Extensive evidence exists relating to the effectiveness of Local Area Coordination principles and its potential impact; this evaluation will give specific focus to the Western Bay Local Area Co-ordination Programme implementation. The following key deliverables and components have been built into the scope of the evaluation:

What the Research Team will deliver: • Evaluation report of Local Area Coordination in three areas: Swansea, Neath Port Talbot and

Bridgend • Delivery of an interim report - September 2015; an update report - December 2015 and Annual

report due March 2016. • Cross comparison of outcomes achieved in other independently evaluated Local Area

Coordination sites, as well as across the three Western Bay areas. • Strategy and recommendations for effective Local Area Coordination going forward.

What the research team will do: • Project design and implementation • Gather outcomes at level of individuals, families, community and system • Clarify identification of KPIs and research and compare benchmarking and achievements across

Local Area Coordination programmes • Conduct research, and gather and analyse a broad range of data from interviews, focus groups

and surveys to develop robust and in-depth case studies from a range of perspectives. • Regularly update stakeholders on progress • Produce three reports (Sept, Dec & March)

How the research team will do it: Build upon Good Practice: Recognising prior research and evaluations, an approach has been designed drawing upon good practice defined by HM Treasury applying mixed methods (interviews, focus groups, case studies and surveys) to appraise the implementation of Local Area Coordination. The HM Treasury guide will also form the basis of how the team will measure economic impact. The evaluation aims to identify how the implementation of Local Area Co-ordination manifests within Western Bay Local Area Co-ordination Programme. Gathering in-depth Data: Building upon good practice, a strong case study element will form part of the framework to provide in-depth and rich insight into initial activities. We will also use Focus Groups, interviewing and surveys to collect rich data, the regular analysis of which will help us develop and refine our lines of enquiry. The research team will also physically map the depth and breadth of Local Area Co-ordination interactions throughout the project. Sources of Data: We will engage with and gather data from a wide range of contributors across all three areas. This will include the Leadership Groups, Service providers, third sector organisations, the Local Area Co-ordinators, the citizens they support and their networks.

Appendix 1

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How is Local Area Coordination Different?

• The Local Area Coordinator takes time to get to know each person, their family, people important to them and their local community.

• The primary focus of a Local Area Coordinator is to support each person to identify, pursue and achieve their personal vision for a good life and provide support to enable a person to work towards this.

• Local Area Coordination operates a universal service to disabled people, people with mental health problems, older people, families and carers that is available without having to satisfy eligibility criteria based on need.

• Local Area Coordination offers support for as long as necessary at a level that suits the person's need at a particular point in time.

• Local Area Coordination provides different types of support, including very practical help.

• Being based in a local area, the Local Area Coordinator is able to build up detailed knowledge of local resources and direct people towards these.

• Local Area Coordination can operate flexibly and creatively because it is not bound by set referral and service criteria and does not fit people into a range of predetermined solutions.

Appendix 2

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• Local Area Coordination provides a ‘one-stop’ approach dealing with all aspects of a person's situation rather than having to focus on one particular area.

• Local Area Coordination works with people not yet known to services- to help build resilience and remain part of their community (staying strong – avoiding need for services), people at risk of becoming dependent on services- to remain strong in their own community diverting the need for more expensive ‘formal’ service responses, people already dependent on services- to become less so and more resilient in their own community.

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Local Area Coordination – Frequently Asked Questions 1. What is Local Area Coordination?

Local Area Coordination is a long term, evidence based approach to supporting people (children and adults) who may be isolated, excluded or vulnerable due to age, disability or mental health problems, and their families and carers to:

• Stay strong, safe and connected as contributing citizens • Build more welcoming, inclusive and supportive communities • Building partnerships with local people, communities, organisations and services

– nurturing and sharing the resources within our communities and ensuring that disabled people, people with mental health problems, older people families and carers are active, valued members.

2. How is it different?

People often talk about how the social care and health system is complicated to navigate--lots of people doing different things, it’s difficult to access and it is more likely to wait for a problem to become a crisis before acting. Local Area Coordinators are a single, accessible point of contact in your local community. They work alongside people (both children and adults who may be disabled, have mental health problems or be older, and their families and carers) in the local community. They are interested in people first and foremost. Service labels come second. Rather than waiting for situations to turn into crises, and then trying to fix them, Local Area Co-ordinators take time to get to know individuals and families, their local communities and service partners and help people to:

• Explore what’s important—an individual’s personal vision for a good life and ways of getting there.

• Identify, nurture and use/share their personal strengths, skills, experiences and those of their communities.

• Find practical solutions to problems wherever possible.

Appendix 3

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Local Area Coordination values, supports and aims to build on the great contribution, passion and resources that exist in our local communities, plus help all people (including disabled people, people with mental health problems and older people) to be part of it. It values and nurtures individual & family leadership – people are the experts in their own lives and it supports the contribution of ALL citizens. Local Area Coordination focusses on:

• the talents, skills and resources within our local communities • strengthening community capacity and less on funding • the importance of planning for/confidence in the future, personal networks

and community connections • supporting people to develop practical ways of reaching life aspirations –

choice & control • creating more welcoming, inclusive and accessible communities.

3. What have people said about Local Area Coordination in other places? “They don’t judge, assess or tell me what to do. It’s about me.” "It's really nice to be able to talk to the same person face to face". "The Local Area Coordinator has listened to all the issues affecting me, normally services want to pass me on to someone else; the Local Area Coordinator has helped me deal with all of it". “They take time to get to know us, our family, our community and our circumstances” “They support and challenge us to do things for ourselves – this has helped me build confidence, to solve more of my own problems and to need services less”.

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4. What does a Local Area Coordinator Do?

A Local Area Coordinator is based locally and is a single, accessible point of contact for people in their local community. They will take time to get to know individuals, families and communities well, building a more personal, positive, trusting relationship. They are a resource to anyone in the community for “light touch” information, advice or connections to local resources. They will support between 50-65 individuals (children and adults) and their families, who may benefit from longer term support, in a local area to

• Understand their needs and nurture their strengths, talents, skills, and experiences.

• Access accurate, relevant and timely information

• Build a positive vision and plan for the future

• Build and maintain valued, mutually supportive relationships

• Be part of, and actively contribute to, community life

• Be heard – self advocacy, advocating alongside people, advocating for people if no other options

• Find practical, non service solutions to issues and problems wherever possible

• Access, navigate and control supports and services, if these are required.

5. Where is Local Area Coordination starting? In Swansea, it is starting in

• Central area- St. Thomas (including Danygraig and Port Tennant, SA1

Waterfront, Pentrechwyth and Bonymaen),

• North area—Gorseinon (including Garden Village, Kingsbridge and Loughor)

• West area— Sketty (including Sketty Park, Derwen Fawr and Tycoch). 6. How would I contact a Local Area Coordinator?

You will be able to contact your Local Area Coordinator in a variety of ways including

• By dropping in to see them – we will let you know where they will be shortly!

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• Phone • Email • Through your local GP, social worker, housing officer, community

organisation, neighbour. 7. What sort of person becomes a Local Area Coordinator?

Local Area Coordinators are recruited by their local community, in partnership with services, and they:

• Need to be good listeners • Focus on helping people to stay strong, be in control and feel more confident

in the future • Value the talents, skills and contribution of all citizens, including disabled

people, people with mental health problems, older people and their families / carers.

• Have strong values about inclusion and communities • Have a focus on local solutions, helping people, families and communities

stay strong • Value relationships

Local Area Coordinators come from a range of backgrounds including:

• Community development • Social Work • Health • Housing • Youth work • Education etc.

8. How are they selected?

We are working with local people, including disabled people, people with mental health problems, older people, families/carers and the wider community, to find the right person – together. 9. How can people get involved and contribute to this?

We are keen to meet people who are interested in their local community and who would like to help us to find the first Local Area Coordinators.

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Please contact Jane Tonks for more information on 01792 636645, email [email protected] ) 10. What difference does Local Area Coordination make?

There have been many studies in different parts of the UK and internationally over the past 27 years. These have shown that, where it is done properly and there is strong leadership and real community contribution, Local Area Coordination leads to consistent positive outcomes. These include:

• People feeling safer and more confident in the future • Individuals having more friends and supportive relationships • Being able to find practical, local ways of solving problems or dealing with

crises • Having better access to information, so increasing choice and control • Being able to be part of and contributing to local communities • Having better knowledge of resources in local communities • Better access to services, if these are required • Families and carers able to continue their caring role • Good partnership working with community resources and services

Jane Tonks, City and County of Swansea March 2015

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J O B S P E C I F I C A T I O N

DIRECTORATE: People

DIVISION/SECTION/UNIT: Adult Social Services UNIT MANAGER: Carol Rea POST TITLE: Local Area Coordinator JOB FAMILY & ROLE PROFILE: POST NO: GRADE 8

SUMMARY OF ROLE

REPORTING TO:

PURPOSE OF THE POST:

1. To act as a single, local point of contact, supporting 50-65 people of all ages and across service types (who may be disabled, older or have mental health issues) and their families / carers to:

• determine and pursue their vision for a good life, • identify their own strengths and needs, • stay safe, strong, connected and contributing as valued

citizens • have a voice/self advocate • build resilience, • find local, practical, non service solutions to problems • access, coordinate and control the required

supports/services/resources, to the extent that they desire, to get there.

2. To support individuals and their families / carers to lead and contribute to the ongoing development of Local Area Co-ordination, including the monitoring of quality and outcomes. (Co productive approaches) 3. To build strong partnerships with communities, agencies and services to develop and increase their capacity to include and meet the needs of people-- who may be disabled, older or have mental health issues-- and their families / carers.

9A. LOCAL AREA CO-ORDINATOR JOB DESCROPTION

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Key Working Relationships This post will demand the development and maintenance of strong, positive working relationships with the following: External to the Social Services Directorate:

• Disabled people and people with mental health needs, older people, families and carers and their local communities.

• Third sector, community and faith groups, and organisations, the Council for Voluntary Service and independent service providers who work with and provide services and supports to local communities, disabled people, people with mental health needs, older people, families and carers.

• Other Council directorates / departments, e.g. Access to Services, Housing, Children and Family Services, Education, Economic Regeneration, Culture, tourism, sport and leisure, etc.

• Health colleagues and partners, including GP Networks, the ABMU Health Board and the Community Health Council.

• Elected members, including Community Councillors, County Councillors and other political representatives.

• Colleagues in other Authorities and relevant networks. • Key local community activists?

Internal to the Social Services Directorate:

• The Intake Team ( Single Point of Access) for Health and Social Care Teams.

• Social Work Teams and colleagues in Network Hubs. • Service providers • Senior Managers and Commissioners • Staff with policy, planning, contracting, information, data collection

monitoring, financial and funding responsibilities.

THE POST HOLDER IS RESPONSIBLE FOR THE FOLLOWING:

MAIN ACTIVITIES: Coordination (60%) 1. To get to know, build and maintain effective working

relationships with 50-65 individuals (children and adults who may be disabled, older or have mental health issues) and their families / carers and communities across a local area. (population area 10-15,000)

2. To assist people who may be disabled, older or have mental

health issues and their families /carers to clarify their goals, strengths and needs, and where appropriate enable them to develop a plan to pursue their life goals.

3. To support and promote opportunities for the involvement and

participation of people who may be disabled, older, have mental health issues and families and carers in a range of ways

11

including within community groups and cross-Council initiatives, and in influencing policy and decision-making at a variety of levels. (Co Production)

4. To support people who may be disabled, older or have mental

health issues and families and carers to access accurate, timely and relevant information and assist individuals, families and communities to access information through a variety of means.

5. To promote self-advocacy, provide advocacy support or

access to independent advocacy as required. 6. To assist individuals and families to develop and utilise

personal and local community networks to develop practical solutions to meet their goals and needs.

7. To assist individuals and families to access, navigate,

coordinate and control the support and resources they need to pursue their goals and needs, including access to funding as appropriate (Service coordination and navigation)

8. To build effective partnerships and working relationships with

community and statutory services, including Police, GPs, community organisations, Health, adult Social Care and children and family services. (Multi agency partnership working)

9. To build, maintain and develop effective working

partnerships and relationships with statutory services regarding early identification of and effective responses to safety and safeguarding.

Community Development and Capacity Building (20%) 10. To develop and maintain a clear understanding of local

community strengths, resources, connections, gaps and opportunities. (Social capital).

11. To develop partnerships with individuals, families, local organisations and the broader community to promote more opportunities for contribution and build a more inclusive community. (Inclusion)

12. To develop a sound understanding of the key issues in the local area for people who may be disabled, older or have mental health issues and families and carers in order to inform planning and policy development.

Administration and Information Management (15%) 13. To organise and maintain administrative records/data sharing

within Council protocols and contribute to the effective

12

operation of the local office.

14. To ensure proper records are maintained for all people supported in the local area through use of an endorsed data system, providing information and data for reporting purposes and responding to requests for information.

15. Administer all aspects of Local Area Coordination discretionary budget/funding in accordance with agreed policies and accountability benchmarks and signpost individuals and families to Direct Payments support processes.

16. To ensure that the concept and practice of Local Area Coordination is understood and communicated appropriately to disabled people, older people, people with mental health issues, families and carers, communities, colleagues and partners.

Professional Development and Supervision (5%) 17. To take delegated responsibility for specific projects,

developments and initiatives.

18. To participate in an approved supervision and performance development process and undertake training and development related to the position.

19. Ensure all work complies with standing orders, financial regulations and departmental instructions.

20. Participate in the induction training of new employees and trainees allocated to the section.

21. Participate in the introduction and development of new systems and procedures including those based on IT.

JOB WORKING CIRCUMSTANCES The post holder will be expected to:

SPECIAL CONDITIONS: The post-holder will be expected to be flexible at all times in duties undertaken to achieve workload. Considerations to be given to workloads and deadlines when booking leave. Will be required to work outside of office hours, including evenings and weekends. Will be required to work in a variety of geographical locations and situations.

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P E R S O N S P E C I F I C A T I O N

ROLE CRITERIA NO.1 EDUCATION, QUALIFICATIONS & TRAINING Essential

Relevant qualification in Community Development, Education, Health or Social Care – degree or post-graduate degree level or equivalent or 5 years experience in a similar role.

Desirable A minimum of three years post qualification experience.

Evidence All certificates to be provided at interview for validation. ROLE CRITERIA NO.2 SKILLS /TECHNICAL / PROFESSIONAL COMPETENCE

Essential 1. Understanding of and commitment to the principles of Local Area Co-ordination and to fairness and equity in our communities. 2. Able to set goals and manage a variety of tasks and competing priorities. 3. Capable of working with a degree of autonomy, analysing issues and reaching creative solutions. 4. Good communication and negotiation skills to build and nurture relationships and partnerships with a range of people and organisations at a personal, service and community level. 5. Able to constructively challenge existing processes and practice. 6. Able to identify opportunities and gaps in local communities and work to develop more welcoming and inclusive communities. 7. Demonstrate insight and astuteness, sensitivity and tact. 8. Skills and experience in influencing, managing and supporting change at the individual, family, community and systems levels. 9. Ability to record and present complex issues in a clear and

14

concise manner both verbally and written. 10. Able to identify and respond to potential safeguarding situations, maintaining effective longer term support. 11. Ability to effectively manage a local budget for non-recurrent, innovative responses. 12. A working knowledge of IT including word processing and email.

Desirable Knowledge of, and commitment to, the local area.

Evidence Valid certification and/or registration/CPD ROLE CRITERIA NO.3 EXPERIENCE

Essential 1. Experience of working alongside and supporting individuals and families from a variety of backgrounds and with varying needs. 2. An understanding of and practical experience in advocacy. 3. An understanding and experience of supporting people to plan for the future.

Desirable Experience of building partnerships with individuals, families, communities, organisations and agencies.

Evidence At interview, then in post ROLE CRITERIA NO.4 COMPETENCIES & ABILITIES

Essential Special Knowledge 1. Knowledge of the local and national policy context across services for disabled people, people with mental health issues, dementia, sensory impairments, older people, children and families and for carers.

Desirable Special Knowledge – Desirable

1. Knowledge of the Social Care and Wellbeing Act 2014. 2. Knowledge of Adult and Children Safeguarding legislation and practice 3. Knowledge of capacity issues and the Mental Capacity Act 2005 4. Knowledge of community resources that can help local children, adults and older people.

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Evidence At interview, then in post

ROLE CRITERIA NO.5 COMMITMENT TO EQUAL OPPORTUNITIES Essential Candidates will demonstrate that all activities are undertaken

in accordance with the Equalities Act 2010 and the City and County of Swansea’s Equal Opportunities Policy and Procedures.

Desirable Evidence At interview, then in post

ROLE CRITERIA NO.6 CURRENT DRIVING LICENCE Essential Desirable Evidence To be produced at interview and on request.

ROLE CRITERIA NO.7 OTHER REQUIREMENT (1) Essential Use of own car:

Should the post holder have a disability and/or be unable to drive, then they may seek alternative means of transport/assistance, which must be an effective and cost effective method of travelling

Desirable Evidence Evidence the post holder is appropriately insured for

business purposes to be provided annually

HEALTH SURVEILLANCE & MONITORING:

This post will require the post holder to take part in Health Surveillance and Monitoring procedures.

SAFEGUARDING: The Authority is committed to safeguarding and promoting

the welfare of children and young people and expects all staff and volunteers to share this commitment.

DISCLOSURE & BARRING SERVICE (DBS):

THIS POST REQUIRES THE POSTHOLDER TO HAVE THE LEVEL OF DBS DISCLOSURE AS INDICATED

BELOW: Standard DBS

Disclosure Application

Enhanced DBS Disclosure Application

No DBS Disclosure Application

Yes

REVIEW/ RIGHT TO VARY:

This Person Specification is as currently applies and will be reviewed regularly according to the Employee Performance Management Review Policy and the Performance Development Review and Appraisal process. The Job and Person Specification may be subject to other Variance within the remit of the Role Profile.

SIGN OFF LINE MANAGER: DATE: POST HOLDER: DATE:

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DISCLOSURE AND BARRING SERVICE (DBS) DISCLOSURE CHECKS

The Disclosure and Barring Service (DBS) has been introduced as a result of Part V of the Police Act, 1997 and will replace the current system of police checking (see attached notes). It should be noted that this post requires a Standard/Enhanced level of disclosure. Further information about the Disclosure Scheme is available at www.homeoffice.gov.uk/agencies-public-bodies/dbs/ or by contacting the Employee Vetting Team at the Guildhall, Swansea SA1 4PE. This service enables organisations in the public, private and voluntary sectors to make safer recruitment decisions by identifying candidates who may be unsuitable for certain work, especially that involve children or vulnerable adults. The DBS was established under Part V of the Police Act 1997 and was launched in March 2002. The DBS can issue 5 levels of Disclosure Certificates, depending on the position applied for, namely Standard, Enhanced, Enhanced with ISA check (children), Enhanced with ISA check (adults) and Enhanced with ISA check (children and adults) Prospective applicants should be aware that before any offer of appointment is confirmed the successful candidate will be required to complete an application for the appropriate level of disclosure; the Authority will provide the relevant DBS Application Forms. Proof of the successful candidate’s identity will also be required in the form of the following: Passport, Driving Licence, Birth Certificate and Utility Bills. The Authority actively promotes equality of opportunity for all existing employees and prospective applicants. Candidates are selected on the basis of skill, qualifications and experience, and their match against the Person Specification. A criminal record will not necessarily bar applicants from working with the Authority. It will depend on the nature of the position and the circumstances and background of the offence. The Authority has a written Policy on the Recruitment of Ex-offenders, which complies with the DBS Code of Practice, and undertakes to treat all applicants fairly. The DBS’s Code of Practice; the Authority’s Policy on the Security of Confidential Disclosure information and; information on the Rehabilitation of Offenders Act 1974 is available from the Employee Vetting Team, Room 214, The Guildhall, SWANSEA SA1 4PE; Telephone 01792 637795 Further information about the DBS can also be found at www.homeoffice.gov.uk/agencies-public-bodies/dbs/

17

http://www.homeoffice.gov.uk/agencies-public-bodies/dbs/



REQUIRED PERSONAL CHARACTERISTICS – LOCAL AREA COORDINATION

The list of examples below is provided as an aid in understanding what is meant by each criterion.

Applicants are encouraged to outline examples from their own life experiences to demonstrate they have the required personal characteristics.

General Description: Examples could include: Committed to enhancing the lives of all people and to fairness and equity in communities In making a positive difference, values and respects the diverse needs and contributions that each person makes in society and embraces social justice principles.

• Shows sensitivity, respect and empathy for the values and beliefs of others including those from culturally and linguistically diverse backgrounds.

• Acts to achieve outcomes which are fair and equitable. • Understands and makes efforts to address inequities

experienced by people including those from diverse backgrounds.

• Committed to empowering people to make their own decisions.

• Contributes to the development of positive relationships within families and communities.

• Promotes access, fairness and equity to address the needs of people from all cultural backgrounds.

• Embraces contemporary attitudes to disabled people, people with mental health issues, people with sensory impairments and older people.

Skills and experience in managing change Understands the importance that change can have on the lives of people and realises that people can react to change in different ways. Demonstrates an understanding of change management principles and processes.

• Recognises the positive dimensions of change within organisations and within people’s lives.

• Understands the potential impact of change, both positive and negative, on the lives of individuals.

• Committed to effective change management processes. • Actively promotes positive change to deal with

challenging issues and situations.

Values people, partnerships and teamwork Values and respects others and encourages diverse opinion. Works constructively with people and makes a positive contribution. Actively promotes, values and strives to work collaboratively with others to achieve a common goal.

• Has a non-judgemental approach and does not force opinions on others.

• Recognises and appreciates the diversity, skills and abilities of others.

• Fosters an environment of trust and actively encourages others to work as a team.

• Provides advice, guidance and support to others in varied situations.

• Actively communicates ideas, shares information and knowledge.

• Understands and takes account of differing community perceptions of disability.

• Works to empower individuals, families and communities

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9B CONVENERS LETTER COVERING RESIDNETIAL CARE COSTS

AND LOCAL AREA CO-ORDINATION


Transformation of Adult Social Services Scrutiny Panel, 30 March and 7th April 2015

The panel met on 39th March and 7th April. We agreed to deal with both meetings in one letter. What the panel requires from you in your response is detailed at the very end of the letter. 30th MARCH MEETING – COSTS OF LOCAL AUTHORITY RESIDENTIAL CARE The panel had a question and answer with Deborah Driffield and Mike Hawes regarding the production of information on the costs of authority provided residential care. The panel would like to thank the officers for attending. The panel was informed that there had been a number of difficulties in producing some of the costing information. As a result, APSE had been commissioned to review the data on care costs to ensure there is confidence and validity in the data and that the authority compared its costs against industry standards. APSE will facilitate all the workshops which will be carried out as part of the review process. Officers agreed to provide the data on costs as soon as it was available OTHER ISSUES HIGHLIGHTED Costs Difficulties were highlighted in comparing local authority provided services and services provided by the independent and private sectors because local authority residential care included respite, reablement and dementia services. Some of these services were not provided by the independent sector and



Scrutiny


e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf: TASS/008/09

Your Ref Eich Cyf:

Date Dyddiad: 20 April 2015



5

local authority reablement was not an income generating service. Officers were confident that over time need for standard residential care would reduce as more people chose to stay at home and purchase domiciliary care. The panel was concerned that the cheapest supplier of care was not always the best and was reassured that the Authority was not obliged to purchase from the cheapest supplier of care. The panel was assured that the contract sought to achieve best value through consideration and balance of price, quality, whether the supplier was local and other considerations such as the budget situation. Adult services along with the procurement service determined the balance within the contract. Care Homes The panel learned that each place was spot purchased rather than procured in a block of places because each person was entitled to choose their care home. Each placement was negotiated with the care home to ensure the care needs of the individual can be met. Each case was assessed on a case by case basis, there was no ceiling on costs and each decision had to be reasoned and defensible. Forecasting need The panel was keen to understand how Adult Services forecasted demand and used that information to plan for future services and levels of need. The authority managed demand and the market by being at the front end of provision so that it could understand the level of need. Providing services like reablement helped to manage the demand for placements in residential care. Officers felt that the number of care homes and places within these was a side issue and that getting the local authority model right helped to manage demand and shape the local market. Engaging non-Executive councillors in the Transformation of Adult Social Services process The panel was concerned that it was the only way that non-executive councillors were engaged in the Transformation of Adult Social Services process and it agreed to seek clarification on this from the Cabinet Member for Services for Adults and Vulnerable People. Changes to services Adult services knows that it will have less money this year, next year and the year after. There was a time lag between investment, savings and outcomes so some decisions on service change would be based on judgement not empirical evidence because of the time and budget constraints. The panel still felt that change was being driven by budgets rather than by service user needs. The panel remained unsure that the true cost and affordability of services was known. It felt that quantifying costs was important so that the authority can better understand what it can and can’t afford to provide. Services for older people



6

The panel agreed with officers that there needed to be a strategy for older people that pulled together all agencies involved in providing care and services to older people, eg housing, health, sheltered housing, local authority. The panel felt that more clarity was needed on housing for older people. APRIL 7th MEETING – LOCAL AREA CO-ORDINATION The panel learned the following about Local Area Co-ordination

• Each Local Area Co-ordinator will have 50-65 cases at any one time • Two Local Area Co-ordinators had been appointed and a 3rd

appointment was imminent. • A total of 6 Local Area Co-ordinators would be in place by the end of

the year and these will be funded by the Local Authority. • It was estimated that 15-16 Local Area Co-ordinators would be needed

to cover Swansea. It was an accepted standard from evidence and working practices in other areas that use Local Area Co-ordinators of 1 Local Area Co-ordinator to around 15,000 people.

• These additional posts would be funded from a pool of funds made up of contributions from other agencies.

• The current Local Area Co-ordinators were based in the Network Hub areas where services were integrated and intermediate services were delievered.

• The 5 GP hubs weredifferent to the Network Hubs and worked on different footprints

• The current Local Area Co-ordinators are employed by the Authority. Operationally, they will be responsible to Western Bay.

Panel was unsure about how the role of community connectors and Local Area Co-ordinators would be different. The panel suggested that Local Area Co-ordinators and Community Connectors should not work in isolation of each other. The panel was generally supportive of the Swansea University evaluation programme that will look at a number of different factors and outcomes. The panel requested more information on this. The panel felt that Local Area Co-ordinators should develop links with local community centre as they would be a useful resource to tap into for community groups and clubs. The panel had a number of concerns about Local Area Co-ordination:

• Whether the Local Area Co-ordinators would receive too many referrals from other organisations and how this would be managed

• That saving money should not be the driver for this project • Sustainability of funding of the project

AGREEMENTS



7

OFFICERS AGREED:

• To provide rateable value and rates paid by residential care homes – to be provided in advance of the full costings

• To provide clear stages with dates of the Commissioning workstream

PANEL AGREED:

• To seek clarification from the Cabinet Member for Services for Adults and Vulnerable People on how she intends to engage non-executive Cabinet Members in the Commissioning Workstream and the TASS programme overall.

• To re-schedule the cost analysis of local authority provided residential

care at a later date to ensure that there is confidence in the validity of the data

• To invite Martin Nicholls to a future meeting

• To re-start engagement with carers

• To invite Jane Tonks and Jan Worthing to the next panel meeting on

27th April CABINET MEMBER FOR WELL BEING & HEALTHY CITY AGREED TO PROVIDE:

• Job description and person specification for the Local Area Co-ordinator posts (this has been provided)

• Swansea University’s Local Area Co-ordination evaluation criteria

• Local Area Co-ordination reporting and management structure and

details of funding of the different posts Your Response - Cabinet Member for Services for Adults & Vulnerable People

• The panel would be grateful if you could clarify how you intend to engage non-executive Cabinet Members in the Commissioning Workstream and the TASS programme overall.

• We would welcome your views on the following concerns expressed by the panel:

o Whether the Local Area Co-ordinators would receive too many referrals from other organisations and how this would be managed



8

o That saving money should not be the driver for this project o Sustainability of funding of the project

Your Response – Cabinet Member for Healthy City and Well Being We would welcome your views on the following concerns expressed by the panel:

o Whether the Local Area Co-ordinators would receive too many referrals from other organisations and how this would be managed


Thank your for your recent attendance at panel meetings. We hope you find this letter useful and we would be grateful for your response by (date to be provided). Yours sincerely CLLR BOB CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]



9

10 Implementing the Social Services & Well Being Act Seminar with Minister for Health & Social Services, Mark Drakeford, AM (MAY 2015)

Purpose • To highlight the key points from the discussions

with the Minister on the implementation of the Social Services and Well Being Act.

Content This report:

• Includes the discussion themes and key points from the seminar

This report will be of interest to panel members, members of regional health consortia, the Council’s Head of Adult Services, the Chief Social Services Officer and the Cabinet Members for Adults & Vulnerable People; Children & Young People; Well Being & Healthy City.


• Give their views • Decide on a course of action

Lead Councillor(s)

Cllr Bob Clay, Convener of the Transformation of Adult Social Services Scrutiny Panel

Lead Officer(s) Report Author Delyth Davies, [email protected] 1. Introduction

1.1 The Transforming Adult Services Scrutiny Panel hosted a national seminar

on implementing the Social Services and Well Being Act with the Welsh Government Minister for Health and Social Services, Mark Drakeford AM. The panel invited officers from within the authority and representatives from the regional health consortia to take part in the seminar which was held on 14th May. The agenda and list of participants are detailed in appendix 1.

1.2 The aim of the seminar was to explore with the Minister the implications of the Social Services and Wellbeing Act as it related to adult social services. It followed a round table format and provided an opportunity to share views and ideas. Participants were asked in advance to highlight any issues that wanted to raise with the Minister.

2. Discussion points

2.1 A number of discussion points were suggested by participants: • The role of cooperatives and other social enterprises in the provision

3

of local authority care packages – the role of Welsh Government in support this

• The role of the private sector in providing social care for older people particularly in the context of doing ‘more for less’

• The role of the community in providing social care for older people and the degree to which this can be relied on – the different levels of resource and resilience that different communities have and how services taper support in response

• Balancing a universal service that provides for everyone with the need to target geographic communities

• The role of scrutiny in the regional consortia given limited resource • The opportunity to increase the democratic accountability of health

as in Manchester for example • The interface between health and social care and the cultural

challenges involved • The significance of isolation and loneliness in relation to care and

support for older people and the implication of this for support services

• Role of prevention and how we build it into council services – the role of Communities First in this regard

• Mental Health services for young adults

3. Key points from the seminar

• Diversification of the market in order to provide care for older people – care could be provided by organisations such as housing associations, unions and the voluntary sector.

• Innovation – small scale innovative models of community care

should be considered to help diversify the market (Powys example)

• Advice and guidance at the front door – there is evidence in local authorities that it is successfully preventing older people from entering residential care by providing them with advice and guidance and support needed to remain independent and in their own homes.

• Local authority provided domiciliary care is a positive element of the

domiciliary care market. It has more favourable pay and conditions for employees compared to privately provided domiciliary care as well as better levels of staff retention.

• There are a number of issues with privately provided domiciliary

care: o Difficulties of provision in rural areas particularly if a complex

package of care is required o Staff retention can be difficult because of terms and conditions

which means that private companies can incur costs associated with recruitment and training

4

• Local Authority scrutiny should be active in scrutinising health boards on issues that affect the area. This will provide a direct line of accountability from health to the public.

• Local scrutiny panels are encouraged to look at the interface between social services and health and to engage with health on that basis

• The vast majority of residential care homes are owned by individuals

rather than large companies.

• Prevention was considered by some seminar participants as the most important issue in social care.

• The Act is neutral in terms of sector – a mixed provision of service delivery is encouraged

4. Next Steps

4.1 The panel may wish to include the key points of the seminar in its final

report on Transforming Adult Services; to use the key points of the discussion to develop its work plan; to organise a follow-up seminar.

Background papers: None Report author: Delyth Davies, Scrutiny Officer Contact: [email protected]

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APPENDIX 1

Implementing the Social Services Act (2014): Invited National Seminar for Elected Members Hosted by Swansea’s Transforming Adult Social Services Scrutiny Panel 2.30 – 4.00, Thursday 14 May 2015, Committee Room 1, Swansea Civic Centre, Swansea, SA1 3SN Parking is available in the public west car park of the Civic Centre – places will be set aside for this seminar. Agenda 2.00 Tea and coffee

2.30 Welcome Councillor Mary Jones, Chair, Scrutiny Programme Committee, City and County of Swansea

2.35 Introduction to the Seminar Councillor Bob Clay, Convener, Transforming Adult Social Services Scrutiny Panel, City and County of Swansea

2.45 Implementing the Social Services Act (2014)

Mark Drakeford AM, Minister for Health and Social Services

2.55 Group Discussion An opportunity to share and hear views*

Chaired by Councillor Bob Clay

3.50 Concluding Remarks Mark Drakeford AM, Minister for Health and Social Services

4.00 Close

6

Participant List NAME ORGANISATION Cllr Sue Jones City & County of Swansea Cllr Chris Holly City & County of Swansea Cllr Erika Kirchner City & County of Swansea Cllr Jane Harris City & County of Swansea Cllr Mary jones City & County of Swansea Cllr Bob Clay City & County of Swansea Cllr Uta Clay City & County of Swansea Cllr Mark Child City & County of Swansea Cllr Paxton Hood-Williams City & County of Swansea Tony Beddow Co-opted member of the TASS panel Darren Williams Cardiff Council Jane Tuemlett Carmarthenshire County Council Phil White Bridgend County Borough Council Albert Heaney Welsh Government Andy Pithouse Welsh Government Sara Harvey Western Bay Programme Chris Sivers City & County of Swansea Arabella Owen Carmarthenshire County Council Rory Powell Welsh Government Rhodi Trehearne Vale of Glamorgan Council Darren Morgan Powys County Council

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11. DOMICILAIRY CARE COMMISSIONING REVIEW UPDATE

(JUNE 2015)

Summary

Purpose:

To update the TASS Scrutiny Panel on progress to date regarding the Domiciliary Care Commissioning Review process.

Policy Framework:

Sustainable Swansea Fit for the Future, Corporate Strategy

Reason for Decision:

For information only

Consultation:

Members, Unions, Providers, Officers

1.0 Introduction 1.1 The City and County of Swansea is undertaking an in depth review of

Domiciliary Care Services. APSE Solutions was initially asked to facilitate a workshop for Adult Social Care.

1.2 This report provides the detail of progress to date.

2.0 Main Body of Report 2.1 In March 2015 colleagues from across Adult Services, Service

Providers’, Chief Social Services Officer, Members and Trade Union representation were invited to a workshop aimed at initiating a review of domiciliary care, residential care and day care. A review scope was shared with the group.

The workshop was facilitated by Andy Mudd of APSE Solutions.

2.2 The focus of the workshop was to outline the purpose of the review, the

process to be undertaking and to clarify the roles that colleagues would have going forward.

2.3 Since this workshop a decision was taken by Executive Board to focus solely on a review of domiciliary care, given the pressures on the service. This review would cover internal and external domiciliary care and would help inform our next steps in the commissioning process.

2.4 An initial set up meeting took place on19th May where we discussed the scope of the review. A core group were invited to attend. The scope of the review was revised including identifying a Project Sponsor, Project lead and agreed membership of the group. (Appendix 1)

2.5 APSE will support the work required to complete Stage 1 & 2 of the review. A workshop is planned for July 10th which APSE will facilitate. APSE will then support the work required around stage 5&6 which will help us to identify the preferred model, make a decision and then prepare an implementation plan.(Appendix 2) 2.6 Institution of Public Care (IPC) - University of Oxford Brookes is an independent organisation which undertakes in depth evaluations of public services. They have a team of 40 staff working across the whole of UK ie England, Scotland and Wales. They come highly recommended having gained their reputation by the quality of work with the public, private and voluntary sectors. Established in 1987, they have a combination of relevant skills, expertise and experience to undertake this specific piece of work.

2.7 IPC’s role will be to conduct Stage 3 & 4 of the review . They have recently conducted an in depth review of Cardiff and Powys Domiciliary Care Services.. The intention for Swansea Council is for IPC to collate current national / regional / local policies , identify both best practise/ sustainable models’ of delivering domiciliary care and make comparisons between each of these options. . IPC will be a critical friend, will analyse data and conclude their work with an options appraisal.

2.8 APSE will then take the work forward, analysing the various models that

IPC have identified and potential way forward.

APSE will in conjunction with the Trade Unions, Members & Officers consider each model prior to reaching a preferred way forward.

2.9 A Joint Consultation Committee meeting took on the 17th June where

approval to use IPC was agreed 3.0 A further Trade Union meeting took place on the 19th June to provide

detail of the rationale behind using IPC. The purpose of this meeting was to share the rationale behind contracting with IPC and that it is fully supported by Members. APSE will be involved with Trade Unions undertaking the SWOT/Pestle analysis for each option identified ie stage 5 and 6.

3.1 The intention is to have the review completed by the 31st November 2015

4.0 Financial Implications

4.1 APSE has been paid from corporate funding whilst IPC have been paid from an historical underspend and regional collaborative fund. .

5.0 Legal Implications 5.1 There are no legal implications associated with this report.

6.0 Recommendations

6.1 It is recommended that we continue to undertake this review, meet the deadlines identified and engage with all key stakeholders as and when appropriate. Updates will be provided on a regular basis as the review gets underway.

Background Papers: None Contact Officer: Julie Burroughs Legal Officer:

Date of Report: 16.06.15

Stage 6

Assessments Implementation

July ovembe

Week 1

Week 2

Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week

10Week

11Week

12Week

13Week

14Week

15Week

16Week

17Week

18Week

19Week

20Week

21Week

22 Week 23

WC 5/7

WC 12/7

WC 19/7

WC 26/7 WC 2/8 WC 9/8 WC

16/8WC 23/8

WC 30/8 WC 6/9 WC

13/9WC 20/9

WC 27/9

WC 4/10

WC 11/10

WC 18/10 WC

25/10WC 1/11

WC 8/11

WC 15/11

WC 22/11

WC 29/11 WC 29/10

DMT Report16/6

workshoptbc

NovemberSeptember October

Complete: Week ending 20 Sept

Complete: Week ending 29 November

Complete: Week ending 23 August

Domiciliary Care - Commissioning Review 2015

Outcomes Comparisons Options AppraisalsDecision/Change

Plan/Benefits Realisation

Gat

eway

Gat

eway

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

August

Commissioning Review of Dom Care 24th June 15

Group Membership – To be confirmed Project Group: Bozena Allen – Sponsor Project Lead – Julie Burroughs Cabinet Member – Jane Harris Karen Gronert – Head of Integrated Community Services Fiona Broxton – Dom Care Contracting Officer Lee Morgan –Procurement Project Team Andrew Morgan – PO MH and LD Donna Kerslake – MH and LD Contracting Officer Lisa Banks – LD Planning Officer Anita Evans- Supporting People Jeanette Munn – OP Planning Officer Chris Francis – Child & Family Contracting Officer Mariann Pederson – Direct Payments Cathy Richards - Carers Ffion Larsen – North Hub Social Work Lead Anthony Porter – Central Hub Alison Ransome – West Hub Nursing Lead Helen St John - Community Services Hub OT Lead Project Support Business Change –Katie Kinevane Gareth Watkins Jane O’Connor Requested as required: Finance – Chris Davies Legal – Debbie Smith HR – Carolyn Thorne Commercial – Gemma Lelliott Procurement – Lee Morgan Performance & Information – John Grenfell/ Deb Reed Stakeholders (to be invited to Workshop) Union Reps (Unite, Unison and GMB),Providers, Service Users, Councillors, Staff

Stage 6

Assessments Implementation

July ovembe

Week 1

Week 2

Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week

10Week

11Week

12Week

13Week

14Week

15Week

16Week

17Week

18Week

19Week

20Week

21Week

22 Week 23

WC 5/7

WC 12/7

WC 19/7

WC 26/7 WC 2/8 WC 9/8 WC

16/8WC 23/8

WC 30/8 WC 6/9 WC

13/9WC 20/9

WC 27/9

WC 4/10

WC 11/10

WC 18/10 WC

25/10WC 1/11

WC 8/11

WC 15/11

WC 22/11

WC 29/11 WC 29/10

DMT Report16/6

workshoptbc

NovemberSeptember October

Complete: Week ending 20 Sept

Complete: Week ending 29 November

Complete: Week ending 23 August

Domiciliary Care - Commissioning Review 2015

Outcomes Comparisons Options AppraisalsDecision/Change

Plan/Benefits Realisation

Gat

eway

Gat

eway

Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

August

Commissioning Review of Dom Care 24th June 15

Group Membership – To be confirmed Project Group: Bozena Allen – Sponsor Project Lead – Julie Burroughs Cabinet Member – Jane Harris Karen Gronert – Head of Integrated Community Services Fiona Broxton – Dom Care Contracting Officer Lee Morgan –Procurement Project Team Andrew Morgan – PO MH and LD Donna Kerslake – MH and LD Contracting Officer Lisa Banks – LD Planning Officer Anita Evans- Supporting People Jeanette Munn – OP Planning Officer Chris Francis – Child & Family Contracting Officer Mariann Pederson – Direct Payments Cathy Richards - Carers Ffion Larsen – North Hub Social Work Lead Anthony Porter – Central Hub Alison Ransome – West Hub Nursing Lead Helen St John - Community Services Hub OT Lead Project Support Business Change –Katie Kinevane Gareth Watkins Jane O’Connor Requested as required: Finance – Chris Davies Legal – Debbie Smith HR – Carolyn Thorne Commercial – Gemma Lelliott Procurement – Lee Morgan Performance & Information – John Grenfell/ Deb Reed Stakeholders (to be invited to Workshop) Union Reps (Unite, Unison and GMB),Providers, Service Users, Councillors, Staff

12. CONVENER’S LETTER COVERING THE SESSION ON INTEGRATED

COMMUNITY SERVICES NETWORK HUBS


Transforming Adult Social Services Scrutiny Panel, 24 August 2015 The Panel met on 24 August to examine the establishment and operation of the 3 Network Hubs which are one element of the integration of health and adult social services. The panel was pleased to welcome officers from both health and social services and the authority’s new head of adult services, Alex Williams. The panel would like to extend its thanks to all those who attended the meeting. Network Hubs The panel supported the difference in staffing type and numbers across each hub area which reflected the demographics and need in the area. The panel also welcomed the work that Adult Services had done with Child & Family Services to look at how CFS changed its intake processes to ensure that referrals were appropriate. The panel had a number of concerns and these are detailed below.

• The level of unplanned need had not reduced since the hubs began operating

• The current availability of performance management data was limited. The panel felt that understanding and collecting performance data would be one of the keys to success of the hubs.



Scrutiny


e-Mail e-Bost:

[email protected]


Your Ref Eich Cyf:

Date Dyddiad: 30/09/2015

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 24th August 2015. It is about Network Hubs.



4

• The Common Access Point took between 3,000 and 4,000 calls a week. It was felt that with improved performance management data analysis could take place to ensure that the hubs dealt with appropriate business and signposted referrals where appropriate.

• The gap in dementia funding and the development of the support and stay service in the Western Bay

• The panel was keen ensure the continued involvement of scrutiny in the integration process

• The panel questioned the different terms and conditions and levels of pay for staff in the integrated hubs and were informed that no re-negotiation of these were planned at the current time.

• The panel learned that more and more people want reablement and respite in their own homes and there was concern about how health and social services would deliver these services in the way that people want them.

• Local Area Co-ordination: the panel remained concerned about the expectations of the local authority on local area co-ordination to deliver outcomes such as prevention and building resilience. The panel understood that a review of LAC was underway and it agreed to add the evaluation report to its workplan.

Agreed

• Panel members to visit the 3 network hubs, including intake team at the west hub

• Performance data from the network hubs to be provided to the panel. • To ensure continued involvement of scrutiny in the integration process

Alex Williams and Hilary Dover agreed to identify suitable items from the Integration forward work plan to bring to the panel.

• A note on respite and reablement be provided for the panel. • At the September meeting an update report on progress with

identifying costs for in-house adult services is provided to the panel. • An update on the Intermediate Business Case optimal model – RAG

status of key features Your Response In your response we would appreciate your comments on any of the issues raised in this letter. We would be grateful, however, if you could specifically refer to:

• The collection and availability of performance management data relating to the hubs

• The continued involvement of scrutiny in the integration process through identification of suitable items from the Integration forward work plan

We would be grateful if you could provide your response by 21 October 2015.



5

Yours sincerely BOB CLAY CONVENER, TRANSFORMING ADULT SERVICES PANEL

[email protected]



6

13. Evidence from site visits to West and North Hubs (SEPTEMBER 2015)

West Hub Visit Alison Ransom is the manager. Cllrs Uta Clay, Jeff Jones, Paxton Hood-Williams and Chris Holley attended.

• The West Hub will move when the Civic Centre is sold. If the hub moves to Singleton Hospital then there will be no rent

• 289 staff are based at the the hub – domiciliary care, nurses, social workers, therapists – usually around 120 staff are in the hub

• Social workers take referrals from the Intake Team which is also based in the Civic Centre.

• Intake operates Monday to Friday, 8.30am - 5pm • Health professionals use satellite hubs in Merton and Norton and there is

public access at these clinics. These are used as bases to reduce unnecessary travel time.

• The local authority and health both report into Western Bay • Social workers and the integrated domiciliary care team use PARIS • Alison Ransom meets with GP practices once a month and this enable good

information sharing with GPs. • There is no IT recording system for district nurses • The hub contains the 5 groups of care – domiciliary care, nurses,

Occupational Health, Physiotherapists and Social Workers - and is the operating centre;all duty teams are located there

o District nurses – 28 FTE o Social Workers- 15 o Occupational therapists – 15 o Physiotherapists – 8 o Chronic Condition Nurses (respiratory conditions, dementia, falls, heart

failures – 12 o Integrated Domiciliary Care Nurse – 1 o Home Care Carers – 150 (includes managers and senior carers)

• Intake team is not staffed by qualified social workers • Western Bay requires monthly data on the following: new packages of

domiciliary care, number of rapid responses, closed cases, numbers with reduced needs, types of care packages

• At the time of the visit the IT systems used by health and social care were not joined up. But for clients, the services were provided as one integrated service. The data reporting, at the time, was being worked on.

• Domiciliary Care provides all sorts of care – reablement, end of life and acute • The OT data is shared on PARIS. • At the time there was no performance framework for integrated care. Alison

told the councillors that the next piece of work would be on integrated performance data.

• No current systems interfaced with GPs or hospitals and there was no interface between any of the IT systems in use.

• Benefits of working in this integrated way: o One referral system o One department with one budget

o Reduces duplicationo Communication between professionals has improved

• Externally commissioned carers are managed by Social Services, they don’treport into the hub

• 80% of care is commissioned• The Domiciliary Care Commissioning Review was looking at the lack of care

in the sector• The Integrated Domiciliary Care Team are carers from Health and the Local

Authority and they deal with reablement• Example: -

o A social worker carries out an assessment of an older person inhospital who has had a stroke

o The assessment sits within the duty desko The social workers and nurse think the older person needs support at

homeo The social worker sends a request to the duty desk of the Hub via

PARISo A multi-disciplinary triage team will look at all requests for care that are

submitted, this is carried out twice a week (Mon & Thurs). They willlook at the notes on PARIS to formulate a care package.

o The older person fits the reablement model and an estimated date ofdischarge is given

o A senior carer from Home Care carries out an assessment of the homeo The older person is discharged and transferred into the care of the hub.o The team will carry out reablement or whatever is needed. There is no

need to do any referrals to other agencies because the hub co-locatesall the relevant agencies.

o The hub does not get notified until the hospital deems that discharge isappropriate.

Another example:- o Someone is struggling at home but wants to remain at home. Some care

is needed and has been referred by the son. o This goes through the intake team who collect information and pass it onto

the Duty desk. These are the types of people who may not be known to any service

o The Multi-Disciplinary Team can go out, carry out the assessment and putin pace a package of care.

o This is a rapid response which helps prevent people from needing to beadmitted to hospital

o There is also an Emergency Duty Team.• If a hub care package doesn’t work and an ongoing package of care is needed

then the person will leave the care of the hub (the assessment will go with them)and they will be passed onto the brokerage service.

• Brokerage is a central social services function in the Commissioning Team. Thepackage of care is brokered out to a 3rd party provider.

• The Social Work team reviews the package of care• Private sector provides 80% of this type of commissioned care

• The private providers cost around half of the cost of local authority care but this is because the private providers select the packages of care that are the most cost effective

INTAKE TEAM

• A team of 20 – 1 x manager (qualified Social Worker), 2x assistant managers, 1x brokerage officer and the remainder are Intake Assistants.

• At the time of the visit a review of the Intake Team was underway. The review was considering whether the Intake Team would benefit from having qualified social work staff in the team or putting intake team staff into the hubs. Health favoured the latter.

• Data on the number calls in a month is in section 13B • The Intake Assistants are experienced, they complete inquiries before

passing the referral onto the hub, they are able to signpost many callers to other services

• The Intake Team does prevent many calls escalating to referrals to hubs • Some clients and service users bypass the intake team and go straight to the

hubs • Since Andrea started there has been a reduction in the number of calls. In

2024/15 around 35k calls were taken • Intake team now deals with around 1,000/month, calls go to the different

teams. • Around 20% of all referrals go directly to the hubs rather than going through

the Intake Team. The Manager felt that this was a good thing because they are contacting social workers directly.

North Hub Visit Helen St. John is the manager. Cllrs Uta Clay and Paxton Hood-Williams attended.

• The North hub is located in Gorseinon Hospital and covers Clyndach, Morriston, Llansamlet, Gorseinon, Gowerton, Pontaddulais and as far down as Penclawdd.

• Its has between 70-80K population and covers 2 of the GP networks • The hub contains:

o Physiotherapists, occupational therapists and support o Social Workers o Community and district nursing o Domiciliary care

• The manager is also responsible for the Community Resource Service which is covers the whole of Swansea and includes services such as:

o Community equipment o ABMU continence services o Speech and language therapy o Dietetics o Therapists for specialist care, eg dementia

The North Hub is comparable with other hubs with regards to staff but it has lots of small offices rather than an open plan approach of the other 2 hubs. The accommodation may not have been ideal but the hub is geographically close to the local population and the GP clusters and it will be able to develop a relationship with the Multi Disciplinary Team. The Hubs bring together the different health and LA occupational health teams. There is a £5k salary difference between the two roles which isn’t good for integration. Long term it could result in recruitment issues if you have vacancies in health occupational health which LA occupational therapists will apply for. A possible solution to this would be to transfer all OTs to the Health Board but the discussions were in very early stages at the time of the visit Across Swansea and the 3 hubs there are 26 occupational therapists, 12 health and 14 LA. The North hub has around 200 staff and includes

• 120 care staff • 6 Physios • 43 Social Workers • There are duty professionals on duty rota each day

Referrals

• Referrals come from the Intake Team and then this goes into PARIS • Intake screens the referral to identify the type of service or whether to refer

elsewhere • An inquiry is created in PARIS which goes to the duty desk professional who

looks at the kind of response needed and then the Duty Team allocates the referral

Intake team • Not qualified staff • Within the model at the time of the visit, the intake team had a set of

questions which had been developed by the different professional teams. • The Intake Team model was under review and was considering whether to

have qualified staff in the team • Integrated Care Fund monies – Swansea decided to have a larger Intake

Team but unqualified • NPT & BCBC had a smaller team but qualified staff (this model is more

inline with Western Bay) • The Intake Team is learning lessons from CFS on their front door model.

Lots of parallels being drawn from between CFS and Adults Domiciliary Care

• All requests for domiciliary care come straight to the hubs • The system used to manage requests is the Board Round concept – this is

reviewed twice weekly and maintains a focus on patient flow. It encourages people to take responsibility and All requests for domiciliary care come straight to the hubs

• The system used to manage requests is the Board Round concept – this is reviewed twice weekly and maintains a focus on patient flow. It encourages people to take responsibility and more patients are able to be handled through the system

• Twice a week the Domiciliary Care Manager and other professionals go though all requests and discuss the service users. Intake would have carried out a broad overview assessment of the service user

• The in-house Domiciliary Care service picks up people who have the potential for reablement which maximises their ability to look after themselves and keep them out of services. The Dom Care service will look at other support the individual has

• This approach reframes the way services are used • The individuals that the service takes in are those who can be rehabilitated so

that when they l;eave the service they have a smaller package of care • The only individuals that remain in-house are those with complex care needs,

eg dementia, behaviour issues • The service is providing care for more people with complex care needs Linking with other services

• The North hub is developing links with Community Connectors and works closely with the Local Area-Cordinators

Co-location and integration

• Positives: peer support, use of the Board Round, encourages conversations between professionals, improved communication, less bureaucratic, duplication has reduced, service users tell their story once and all staff have access to PARIS

• Areas for improvement: lack of space and staff accommodation at the north hub, need to move health professions to electronic records

13A. INTEGRATED NETWORK HUBS – INTAKE TEAM ENQUIRIES TAKEN (SEPTEMBER 2015)

Reason AD/INF ARRANGE ASSESS CARERS CRS

CONTINENCE CRS

Exercise CRS OT

CRS MED MAN

CRS PHYSIO CRS S&L

CRS TISSUE

CRS WAST DFG

Team AS Dom Care Brokerage 1 Care Home Quality Team 8 Care Management (LD) CMHT 2 CMHT 3 CRS IT North 5 50 27 CRS IT West 1 1 3 63 31 CRS IT Central 1 4 46 29 CRS Specialist 101 3 4 23 32 DCAS 2 9 DOLS EMI 8 Gower 2 1 HOSPITALS SW TEAM 1 Hub Central 1 34 9 Hub North 33 13 Hub West 29 15 INTAKE 93 2 1 2 1 7 Sensory Services 1 Totals 98 1 127 37 101 15 160 4 87 25 32 1 7

13B. SITE VISITS TO INTEGRATED NETWORK HUBS INTEGRATED COMMUNITY OCCUPATIONAL THERAPY SERVICES BRIEFING (SEPTEMBER 2015)

The Local Authority OT Service and the Therapy component of the former Swansea Community Resource Team were co located in January 2014 in Gorseinon Hospital. This was the initial phase of integrating the two OT services into a single community OT service. Although the two services are being integrated this is in the context of staff remaining with their original employer and retaining their original terms and conditions – this does bring challenges.

Historically, the type of work carried out by OTs from Health and Social Services has tended to differ. The Health staff has generally been involved with a greater degree of rehabilitation and patients with a more acute level of health need whilst the Social services staff caseload has tended to be patients with more chronic conditions requiring compensatory interventions. This is a generalisation intended to give an overall picture of the varied experience of the staff from the two organisations however the impact of this for the client was often the need to be referred on to a further therapist should their assessed needs be outside the scope of experience of the OT involved. The most common example of this duplication would be where a Health OT was involved with a patient and the need for adaptation to the property identified – prior to integration this situation would have resulted in a referral to the Social Services OT

Since the physical joining of the services a number of pieces of work have been started to bring the working practices of the staff together to reduce duplication and improve efficiency of service to the client.

• Common referral route through Intake for Health and Social Care established in September 2014

• Adoption of a common IT system (PARIS) in September 2014

• Development of common paperwork

• Joint rotas for rapid response work

• In house training and mentorship to share the wealth of skills within the previous teams across the integrated team.

• Development of shared performance information

In April 2015 the OT staff were relocated to the Network hubs. The staff structure is set out in the table below which indicates numbers of whole time equivalents by employing organisation. ( Green – Social Services, Blue – Health)

SWANSEA NETWORK HUBS – OT Staff.

North Hub wte West Hub wte Central Hub wte

Glynis Griffiths Occupational Therapy Lead

1.0 Sue Palmer Occupational Therapy Lead

1.0 Amanda Archibald Occupational Therapy Lead

1.0

Francesca Ormeno

OT

1.0 Sarah Edwards

OT

1.0 Julian Smith

OT

1.0

Ruth Brickell

OT

1.0 Rhian Peacock

OT

0.45 Jamie Maund-Daly

OT

1.0

Jason Harris

OT

1.0 Vacancy

OT

0.6 Emma Nelson

OT

0.9

Jenny Graves

OT

1.0 Alison Fleming

OT

1.0 Rachel Gillett

OT

0.8

Sheila Stroud

OT

1.0 Claire Riley

OT

0.6 Stephanie Morris

OT

1.0

Gail Rankin

OT

1.0 Jenny Congdon

OT

0.8 Leanne Morgan

OT

0.9

Nicole Kuhne

OT Band 5

1.0 Amanda Forman

OT

0.45 Kath Cardy

OT Band 5

1.0

Kim Watkins

OT

0.9 Tracy Price

OT

1.0 Karen Mahood

OT Band 5

1.0

Denise Perry

OT

0.5

Vacancy Band 5 1.0

Each of the three network hubs is operationally managed by an Occupational Therapy Lead with the Community Resource Service Manager ( Helen St John, employed by Social Services) providing the strategic lead for community therapy services.

Referrals are received into the service via the Intake team (with the exception of requests for assessments in respect of Disabled Facilities Grants which originate in the Housing Department and are e mailed on to the OT service for assessment ). Every referral is triaged in detail by the relevant OT Lead who will make the following decisions based on the information in the referral

Appropriate staff grade to perform assessment – the teams contain a mixture of Health and Social Services staff and also staff of different grades and experience. Additionally there are non registered support staff in each hub who can perform non complex assessments. Wherever possible we undertake to provide consistency of therapist for those re-presenting to the service that have been known to us previously.

Priority response required – cases are considered to be of a higher priority where a client may be at risk of admission to hospital or placement or where there has been a rapid decline in functional ability which poses a risk to the client and or carers. Such cases are allocated straight out to a therapist for rapid response. Routine referrals are placed onto a waiting list

Whether there is a need for further information to inform the prioritisation decision

In addition to providing cover on the rapid response duty rota, all OTs will receive an allocation of work from the waiting list. This work is allocated by the OT Leads and levels of allocation are influenced by planned absence, numbers of working days in the month and the caseload monitoring that is integral to the regular staff supervision sessions that are carried out.

Numbers of referrals

Prior to the integration of the two OT services the figures for referral numbers were recorded on two separate systems however, since the move to a single point of access and shared recording system in September 2014 we are able to produce

OT

improved performance information – this is ongoing work. It would therefore be of little value to produce referral figures for 2014 and 2015 to date as this period of time spans two different recording methods.

In the 12 months since September 2014 we have received 4128 referrals for OT assessment.

In this same period 2683 Occupational Therapy assessments have been completed ( this figure represents assessments with the status ‘closed` on the PARIS system and does not include ongoing assessments)

The DFG figures are still recorded in the same manner so it is possible to give figures for 2014 and 2015 to date in respect of the number of sets of recommendations provided to Housing by this service following assessment.

2014 – 897

2015 to end July – 564 (this figure exceeds performance at this point last year.)

Of the 2683 assessments completed since September 2014, 872 have resulted in recommendations for housing adaptations.

Staffing issues.

During 2015 there have been 6 full time staff on maternity leave at various points in the year. At present there are 4 staff remaining on Maternity leave, 3 of these are not due to return until mid 2016.Staff returning from mat leave are entitled to reduce their hours of work so the full impact on the service remains to be seen.

A number of staff took sick leave in February 2015 – one with a broken ankle returned in July 2015, a second remains on sick leave receiving treatment for breast cancer. The management of sickness absence policy is followed for all absences.

A further member of staff has been sick since March 2014 and has actually resigned from her post this week – this vacancy will be filled.

Waiting lists

The combination of demand and staff absence has led to an increase in the waiting times for routine referrals. We are currently performing a waiting list review which entails the staff on rapid response duty making contact with those awaiting assessment. They will then screen the referral to identify those who no longer require assessment, those whose needs have changed and require a more priority response and also those who may fall outside the FACS eligibility criteria for statutory provision. Staff will also provide signposting for clients where this is appropriate and possible.

Prepared by Helen StJohn CRS Manager/Community Therapy Lead

26/08/2015.

14. Unit Costing within the Council’s Residential Care and Domiciliary Care Services (SEPTEMBER 2015)

Purpose To provide information requested by the Scrutiny Panel

on the costs of providing the Council’s Domiciliary Care and Residential Care services.

Content Analysis of the direct costs in providing each service during the 2014/15 financial year.


Consider the reports as part of their wider review of Adult Services

Lead Councillor(s)

Cllr Harris, Cabinet Member for Services for Adults and Vulnerable People

Lead Officer(s) Alex Williams – Head of Adult Services Report Author Christopher Davies

Principal Accountant (Social Services) 01792 636058 [email protected]

1. Introduction 1.1 These reports have been requested by the Panel to contribute to the financial visibility within these areas. 1.2 The aim of the appended reports is to establish the following

• A weekly unit cost for each of the six Council Operated Residential Care Homes for Older Persons

• An hourly unit cost for the provision of internal domiciliary care 1.3 The Panel also requested similar information on Day Services. This information is currently being worked on and will be presented to a future Panel. 1.4 Due to commercial sensitivity surrounding the information contained in the appended reports, the reports themselves will be presented in closed session. Background Papers:

1. Unit Costing Report – Residential Care Homes 2. Unit Costing Report – Domiciliary Care

Date: 15th September 2015.

7

Legal Officer: Finance Officer: Chris Davies

8

a

Residential Care Homes Unit Costing for Older People’s Homes 2014/15

September 2015

This report is intended to establish the weekly cost to the authority of a placement at each of its six residential homes for older people.

Contents Terms of Reference ...................................................................................................................................... 2

Method ......................................................................................................................................................... 2

Results ......................................................................................................................................................... 2

In House Residential Care Costs – 2014/15 .............................................................................................. 3

Unit Costing .............................................................................................................................................. 4

2014/15 ................................................................................................................................................. 4

Additional Staffing.................................................................................................................................. 4

Room Remodelling ................................................................................................................................ 5

Cost of External Provision ............................................................................................................................ 5

Conclusions .................................................................................................................................................. 5

Appendices ................................................................................................................................................... 6

1

Terms of Reference The aim of this exercise is to establish a weekly unit cost for the following care homes operated by City and County of Swansea

• Rose Cross • St Johns • The Hollies • Parkway • Bonymaen House • Ty Waunarlwydd

Method This work is based on the 2014/15 financial year. Financial reports have been produced from the ISIS system and the Sustainable Swansea full cost recovery methodology has been used to establish the total cost to the Council of each home. Occupancy statistics have been provided by Social Services staff based upon the Vacancy Master Sheet completed by the homes. The following cost centres have been used within the calculations Home Cost Centre Cost Centre Narrative

Rose Cross 53921 Rose Cross House APH St Johns 59292 St Johns House APH The Hollies 53293 The Hollies House APH Parkway 53288 Parkway HFA Bonymaen House 53286

53155 Bonymaen House HFA Hub Seven – Bonymaen RCAS Teams

Ty Waunarlwydd 53294 53162

Ty Waunarlwydd HFA RCAS Dementia Team

Abertawe Bro Morgannwg University Health Board also incurs costs in respect of Ty Waunarlwydd and Bonymaen House. Their costs have not been included in this analysis.

Results The table overleaf uses 2014/15 financial data to calculate the net direct cost of the six residential homes. The figures reflects the initial impact of Single Status implementation.

2

In House Residential Care Costs – 2014/15

Rose Cross St Johns The Hollies Parkway Bonymaen Ty Waun

Employees

909,945 853,874 702,325 681,060 1,452,506 1,866,028

PLUS Premises excluding Asset Rents

36,923 40,492 23,753 35,433 32,880 37,804 PLUS Transport

25 498 867 272 30,553 21,667

PLUS Supplies and Services

89,288 75,768 68,377 90,180 76,219 141,158 PLUS Third Party Payments

- - - - - -

PLUS Transfer Payments (if any)

- - - - - - PLUS Internal Debits

184,889 9,172 68,397 40,894 18,975 122,942

MINUS Internal Credits

- 18,300 - - 30,200 - - - 26,500

EQUALS Net Direct Cost of Service

1,202,770 979,804 833,519 847,839 1,611,133 2,163,099

Notes All figures aside from asset rentals taken from the Adj115 period. This is to the 31st of March 2015 The above reflects additional costs of single status implementation No income included as the exercise is to establish costings.

3

Unit Costing As a response to the Winter Beds Crisis within local hospitals, the Council assisted the Health board by admitting residents that they ordinarily would not have from the Hospitals concerned. These residents were not included in the occupancy statistics as they were not considered ‘true’ admissions to the homes. For this reason, unit costs based upon statistical occupancy and full occupancy are reported.

These have been considered for the following circumstances

• 2014/15 capacity and occupancy • Additional staffing requirements • The remodelling of homes without ensuite facilities to provide them. This would result in a 33%

reduction in rooms. All unit costs are provided on a per bed per week basis.

2014/15 Rose Cross

St Johns Hollies Parkway Bonymaen Ty Waun

Total Costs 1,202,770 979,804 833,519 847,839 1,611,133 2,163,099 Capacity 33 29 23 36 29 48 2014/15 Bed Weeks Available* 1,721 1,512 1,199 1,877 1,512 2,503 2014/15 Bed Weeks Vacant* 66 246 316 303 55 61 2014/15 Occupancy 96.2% 83.7% 73.7% 83.9% 96.4% 97.6% Unit Cost at 2014/15 Actual Usage £ 727 £ 774 £ 944 £ 538 £ 1,106 £ 886 Unit Cost at 2014/15 Full Occupancy £ 699 £ 648 £ 695 £ 452 £ 1,066 £ 864

Additional Staffing Rose Cross


2014/15 Costs 1,202,770 979,804 833,519 847,839 1,611,133 2,163,099 Capacity 33 29 23 36 29 48 Annual Bed Weeks Available 1,721 1,512 1,199 1,877 1,512 2,503 2014/15 Annual Bed Weeks Used* 1,655 1,266 883 1,574 1,457 2,442 2014/15 Occupancy 96.2% 83.7% 73.7% 83.9% 96.4% 97.6% Additional Residential Care Officer Requirements

94,319 94,319 183,832 94,319 - -

Additional Night Care Domestic 62,528 62,528 62,528 62,528 - - Additional Senior RCCO 115,458 115,458 115,458 115,458 - - Additional Administrative Capacity 4,610 5,187 5,187 3,458 - - Total of Additional Costs 276,915 277,491 367,004 275,762 - -

Revised Estimated Costs 1,479,685 1,257,295 1,200,523 1,123,601 1,611,133 2,163,099 Estimated Unit Cost @ 2014/15 Occupancy

£894 £993 £1,359 £714 £1,106 £886

Estimated Unit Cost @ 100% Occupancy

£860 £832 £1,001 £599 £1,066 £864

4

Room Remodelling1 Rose Cross


Current Capacity 33 29 23 36 29 48 Estimated Future Capacity 33 19 15 24 19 32 Annual Bed Weeks Available 1,721 991 782 1,251 991 1,668 Unit Costs Based on Reduced Beds at 100% Occupancy £ 860 £ 1,269 £ 1,535 £ 898 £ 1,626 £ 1,296

Cost of External Provision The Council pays a fixed fee to external providers for the provision of a place at their home. In 2014/15 these were as follows

Category 2014/15 Weekly Fee

Residential Care £485 Nursing Care £500 Dementia Nursing Care £515

The recent Westminster Government announcement around the increased minimum wage/national living wage is likely to significantly affect the future costs of external providers. Additional work to quantify the potential impact of this has been requested and is ongoing.

Conclusions It is recognised that the Council’s Care Homes provide an important service to their residents and the wider community. How well they do this is reflected in a number of recent CSSIW reports and this is to the credit of the staff involved. This report has used financial and occupancy data to establish the cost of the service. From this we have established that the Council’s homes are costing more than private provision, with our costs likely to increase in future years. Staff costs have increased due to the implementation of Single Status and will increase further as staff who gained pay on implementation progress through their pay scale. Costs will increase further due to additional staffing requirements and building adaptations. The decorative state of the homes has already been noted in CSSIW reports and is likely to become a more significant issue in the future. This report is not intended to make judgement on the future of any Council provision but it is hoped that this report will contribute to wider financial visibility in this area. For this reason, no recommendations have been made.

1 Includes additional staffing costs as per previous table. 5

Appendices Appendix One

COMPARISON OF PROVISION ACROSS LOCAL AUTHORITY AND PRIVATE SECTOR CARE HOMES BASED ON ACTUAL EXPENDITURE FOR 2013/14

Parkway 36 beds

Hollies 24 beds

St Johns 29 beds

RCH 33 (respite)

Private Sector 36

Manager 1 F/T = 37hrs £31-35K

1 F/T = 37hrs £31-35K

1 F/T = 37hrs £31-35K

1 F/T = 37hrs £31-35K

1 F/T = 40 hrs £33K

Deputy Manager

1 F/T = 37 hrs £27-30K

1 F/T = 37 hrs £27-30K

1 F/T = 37 hrs £27-30K

1 F/T = 37 hrs £27-30K

1 F/T = 30 hrs £26K

Carers Day time staff ratio

1:12 1:8 1:9 1:5.5 1:7

Carers Night time staff ratio

1:12 1:8 1:10 1:11 1:11.5

Hourly rates of pay for care staff excluding on costs

£10.57 based on mid-point and assuming 37 hrs




£6.50 3% above minimum wage.

Activities coordinator

Nil Nil Nil Nil 16.5hrs pw

Admin support 16hrs 8hrs 16hrs 17hrs + 15 respite admin =32

30hrs

Staff costs as proportion of total costs (including internal charges management and on costs)

69.66% 77.15% 75.47% 71.55% 61.48% (does not include finance and HR costs)

6

Appendix Two

Fees breakdown – Rate agreed for 2013/14 Per person per week and 3% increase for 2014/15

Staff Costs calculated for 36 bed care home operating at 92% occupancy. Non staff costs based on typical costs per person per week.

Cost Type Swansea

% Change Comments/Assumptions re Swansea Costs 3.00%

STAFF Manager £19.32 £19.90

£33.4k per annum. Slightly over median. Covers costs at 7 of 12 homes £16 ph x 40 hrs divided by 33.12

Deputy £11.32 £11.66 £26k per annum (pro rata). Assumes 30 hrs per wk. Covers costs at 5 of 9 homes. £12.50 ph x 30 divided by 33.12

Admin / recep £6.58 £6.78 equates to 15.1K per annum (pro rata) but assuming 30 hour week)

(top of typical range – covers costs at 5 of 9 homes)

Total £37.22 £38.34

Care Staff - day Senior Carer £21.00 £21.63 Assumes ratio of 1:7 with 75% of care

provided by carers at £6.50 per hr and 25% of care provided by senior carers at £7.00 per hr. Total 397.4 hrs

Care Assistant £58.50 £60.26

Care staff – night Senior Carer £12.78 £13.16 Assumes ratio of 1:11.5 with 75% of

care provided by carers at 6.50 per hr and 25% of care provided by senior carers at £7.00 per hr. Total 242 hrs

Care Assistant £35.60 £36.67

Activities Coordinator £5.00 £5.15 Top of mean avg of typical range. Equates to 16.56 hrs assuming £7.50 per hr at 36 beds with 92% occupancy. This equals 30 mins pp pwk

Total £132.88 £136.87

Laundry £8.86 £9.13 Mean avg of typical range is 9.83. Adjusted to covers costs at 5 out of 8 homes Bottom end of typical range. Covers costs at 7 of 13 providers

Cleaning (H+D) £15.91 £16.39 Kitchen £22.79 £23.47 Above typical range. Adjusted to cover

costs at 8 of 14 providers Total £47.56 £48.99

Handyman & Gardening £5.27 £5.43 Towards top of typical range. Covers costs at 7 of 13 providers

Subtotal staff costs £222.93 £229.62

On costs £35.67 £36.74 Assumes 16% for agency, a/l, training, sickness, recruitment, induction + insurance– top end of typical range but covers costs at 7 out of 11 homes

7

Tax / NI £17.83 £18.36 Assumes 8% for employers’ contribution

to tax and NI. Total

£276.43 £284.72

PROPERTY Repairs & Maintenance £14.15 £14.57 Mean avg of typical range. Covers costs

at 7 out of 13 providers

Grounds Maintenance £0.00 £0.00 Included under handyman and gardening

Rent / Mortgage (inc. capital costs) £60.00 £61.80

6 providers pay commercial rent. 7 providers pay mortgage. Towards top of typical range (mean is £54). This covers costs at 9 of 13 Providers

Utilities & water £19.59 £20.18 Mean avg of typical range. Covers costs at 8 out 14 homes

Council Tax £1.91 £1.97 Mean avg of homes in typical range is 1.31. adjusted to cover costs at 7 of 11 homes

Insurance £1.87 £1.93 Mean avg of typical range. Covers cots at 7 out of 12 providers

Total £97.52 £100.45

TRANSPORT Leased / hire and other £3.49 £3.59 Mean avg of typical range. Covers costs at 8 out of 14 providers.

Total £3.49 £3.59

SUPPLIES & SERVICES Medical & Incontinence £3.38 £3.48 No info that enables a cost to be

determined. Using costs within L+B

Furniture £0 £0.00 Only 5 providers gave cost info. Insufficient data

Equipment, aids & adaptations £6.08 £6.26 Includes purchase and maintenance. Only 8 providers gave cost info. Mean avg. Covers cost at 6 out of 8 providers

Food £25.84 £26.62 Mean of typical range. Covers costs at 9 of 14 homes

Staff Clothing £0.65 £0.67 Mean avg of typical range. Covers costs at 5 out of 8 providers

Laundry (non staff costs) £4.30 £4.43 Top of typical range. Covers costs at 5 of 9 homes

Cleaning (non staff costs) £0.00 £0.00 Only 5 homes gave cost info. Insufficient data

Stationary £0.99 £1.02 Top of typical range. Covers costs at 6 of 11 homes

Advertising £0.65 £0.67 Towards top of typical range. Adjusted to cover costs at 5 of 9 homes

Licences, CRB and reg £0.55 £0.57 Top of typical range. Covers costs at 5 of 9 homes

Domestic & Clinical Waste £2.64 £2.72 Top of typical range. Covers costs at 6 of 11 homes

Telephones £1.41 £1.45 Top of typical range. Covers costs at 8 of 14 homes

Postage £0.50 £0.52 Towards top of typical range. Covers costs at 5 of 8 homes

IT £0.50 £0.52 Mean avg of typical range. Covers costs at 6 of 9 homes

Prof & Legal fees £4.55 £4.69 Mean of typical range is £4.55. Covers costs at 7 of 13 homes

Equipment Hire £0.00 £0.00 Insufficient info

8

Total £52.04 £53.60

CENTRAL MANAGEMENT R. I. £13.07 £13.46

Covers costs at 4of 7 homes. Equates to 22.6 k per year for RI at 36 bed home with 92% occupancy.

Finance £0.00 £0.00 Only 5 providers gave cost info. Insufficient info

Human Resources £0.00 £0.00 Only four providers gave cost info. Insufficient info.

Total £13.07 £13.46

DEPRECIATION Inc Fixtures & Fittings, motor vehicles and office equipment £9.14 £9.41 Mean avg of typical range. Covers costs

at 5 of 9 homes

SUMMARY OF SUB TOTALS

Swansea

Staff Costs £276.43 £284.72 Property costs £97.52 £100.45 Transport costs £3.49 £3.59 Supplies & Services £52.04 £53.60 Central Management £13.07 £13.46 Depreciation £9.14 £9.41 sub total £451.69 £465.24 Margin @ 4% £18.07 £18.61

FINAL TOTAL £469.76 £483.85

9

a

Domiciliary Care Unit Costing - 2014/15

September 2015

This report is intended to establish an average hourly rate for the cost of both internal and external domiciliary care.

Contents Terms of Reference ...................................................................................................................................... 3

Method ......................................................................................................................................................... 3

Results ......................................................................................................................................................... 3

In House Domiciliary Care ........................................................................................................................ 3

External Domiciliary Care .......................................................................................................................... 4

Summary ...................................................................................................................................................... 5

Conclusions .................................................................................................................................................. 5

Terms of Reference The aim of this exercise is to establish an hourly unit cost for internal and external domiciliary care.

Method The work is based on the 2014/15 financial year. For internal services, financial reports have been produced from the ISIS system. External costs have been calculated by analysing payment data. Usage statistics have been provided by Social Services staff. The following cost centres have been used within the in house calculations Cost Centre Cost Centre Narrative

53155 Hub One - Long Term Service North 53117 Hub Two - Long Term Service Central 53119 Hub Three - Long Term Service West 53127 Home Care O P 53130 Homecare Night Service 53140 Homecare Weekend Cover 53148 Hub Four - DCAS North 53150 Hub Five - DCAS Central 53152 Hub Six - DCAS West 53161 Hub Eight - Gower Teams

Results The below calculates the direct cost to the Council of providing services for both the DCAS and long term homecare services. As this is based upon the 2014/15 financial year, it reflects the initial impact of Single Status implementation.

In House Domiciliary Care

Employees

5,778,849

PLUS Premises excluding Asset Rents

59 PLUS Transport

312,348

PLUS Supplies and Services

97,978 PLUS Third Party Payments

-

PLUS Transfer Payments (if any)

- PLUS Internal Debits

50,000

MINUS Internal Credits

- 995,500

EQUALS Net Direct Cost of Service

5,243,734

Notes All figures taken from the Adj115 period. This is to the 31st of March 2015 The above reflects additional costs of single status implementation No income included as the exercise is to establish the cost of the service Only direct costs have been included in the above. The internal service provided 201,234 hours of care across the long term and DCAS services in 2014/15. Based on the above, this equates to a unit cost of £ 26.06 per hour of care.

External Domiciliary Care

Provider Apr-14 Oct-14 Mar-15 Total

Planned Hours Actual Cost

Hourly Rate


Hourly Rate


Hourly Rate


Hourly Rate

1 645.89 9,274.94 14.36 612.21 8,791.77 14.36 620.06 8,904.79 14.36 1,878.16 26,971.50 14.36 2 745.44 10,734.35 14.40 773.88 11,132.30 14.39 674.83 10,099.15 14.97 2,194.15 31,965.80 14.57 3 1,764.14 25,584.07 14.50 1,784.24 25,831.40 14.48 1,690.83 24,517.19 14.50 5,239.21 75,932.66 14.49 4 1,488.62 21,585.48 14.50 1,314.89 19,038.44 14.48 1,426.62 20,661.81 14.48 4,230.13 61,285.73 14.49 5 756.47 10,893.60 14.40 729.50 10,504.85 14.40 579.58 8,608.65 14.85 2,065.55 30,007.10 14.53 6 405.58 6,416.29 15.82 493.24 7,803.11 15.82 490.41 7,758.34 15.82 1,389.23 21,977.74 15.82 7 2,322.41 34,043.54 14.66 2,409.77 35,327.14 14.66 2,258.19 33,105.05 14.66 6,990.37 102,475.73 14.66 8 189.25 2,640.05 13.95 - - - - - - 189.25 2,640.05 13.95 9 10.50 141.75 13.50 10.50 141.75 13.50 10.50 141.75 13.50 31.50 425.25 13.50 10 26.70 394.76 14.79 33.49 490.85 14.66 33.00 572.30 17.34 93.19 1,457.91 15.64 11 - - - - - - 131.82 1,924.57 14.60 131.82 1,924.57 14.60 12 96.00 1,305.61 13.60 96.00 1,402.56 14.61 - - - 192.00 2,708.17 14.11 13 14.50 275.77 19.02 48.00 570.56 11.89 - - - 62.50 846.33 13.54 14 - - - - - - 5.00 70.00 14.00 5.00 70.00 14.00 15 - - - 38.00 639.10 16.82 70.00 1,165.88 16.66 108.00 1,804.98 16.71 16 216.25 3,548.89 16.41 75.00 1,213.71 16.18 - - - 291.25 4,762.60 16.35 17 - - - 466.33 6,505.33 13.95 758.76 11,381.40 15.00 1,225.09 17,886.73 14.60 18 - - - - - - 10.00 130.00 13.00 10.00 130.00 13.00 19 11.64 150.74 12.95 11.14 144.26 12.95 4.32 55.94 12.95 27.10 350.94 12.95 20 - - - 38.75 558.00 14.40 33.50 482.40 14.40 72.25 1,040.40 14.40 21 350.19 5,077.81 14.50 449.11 6,512.16 14.50 519.03 7,525.97 14.50 1,318.33 19,115.94 14.50 22 315.92 4,352.75 13.78 410.31 5,662.60 13.80 439.89 6,070.85 13.80 1,166.12 16,086.20 13.79 23 2,746.78 40,259.11 14.66 2,828.13 41,460.36 14.66 2,568.39 37,652.57 14.66 8,143.30 119,372.04 14.66

Total 12,106.28 176,679.51 14.59 12,622.49 183,730.25 14.56 12,324.73 180,828.61 14.67 37,053.50 541,238.37 14.61 The above table shows the costs for three sample weeks during the year. These were selected to be at the start, middle and end of the year and are believed to be representative of the period As only direct costs have been considered in the calculation of in-house figures, the above require no amendment to be considered comparable.

Summary The overall comparison between internal and external costs is as follows Internal External Hours Planned 201,234 643,990 Base Costs 5,243,734 9,406,723

Hourly Rate 26.06 14.61

The recent Westminster Government announcement around the increased minimum wage/national living wage is likely to significantly affect the future costs of our external providers. Additional work to quantify the potential impact of this has been requested and is ongoing.

Conclusions It is recognised that the Council’s Domiciliary Care Teams provide an important service which is well regarded by service users and their families. This report has used financial and usage data to establish the cost of the service. From this we have established that the Council’s services cost more than private sector alternatives. Staff costs have increased due to the implementation of Single Status and will increase further as staff who gained pay on implementation progress through their new pay scale. This report is not intended to make judgement on the future of any Council provision but it is hoped that this report will contribute to wider financial visibility in this area. For this reason, no recommendations have been made.

15. INTEGRATED SERVICES & INTERMEDIATE CARE PROVIDED UNDER S33 AGREEMENT: PERFORMANCE DATA

(DECEMBER 2015)

Purpose To provide the Panel with updated data relating to the evolving integration of adult social care and NHS community provision under the terms of a Section 33 agreement.

Content The report includes relevant performance data related to a range of service arrangements under the terms of the S33 agreement (in development). Data relates to:- Common Access Point / Intake. Performance of re-ablement services. Performance of assessment beds service.

The data in this report relates to Q2 2015/16 and updates a previous report provided relating to Q1.


Consider the content of the report

Lead Councillor(s)

Cllr Jane Harris, Cabinet Member for Vulnerable People and Adult Services

Lead Officer(s)

Alex Williams, Head of Adult Services

Report Author John Grenfell, Performance & Information Manager, 01792 636767, [email protected]


1. Introduction 1.1. The City and County of Swansea is in the final stages of ratifying a

Section 33 agreement between adult social care services and the community health services of Abertawe Bro Morgannwg University Health Board (ABMUHB).

1.2. We are seeking to continue to evolve a comprehensive and integrated service model for intermediate care. The S33 agreement is intended to support better integration of services between the NHS and adult social care.

1.3. We have already established a range of joint working arrangements in advance of the formal completion of the agreement.

2. Summary Performance Quarter 2 2015/16 2.1. The following table presents performance data set out as requirements

to manage the performance of services delivered under the draft Section 33 agreement. It follows the format set with the previous reporting of Q1.

2.2. Data collection takes place monthly and we intend to continue reporting to the Board monthly figures on a quarterly basis.

Qtr 1 Qtr 2 Monthly Jul-15 Aug-15 Sep-15 Monthly Quarterly Average Average Total REABLEMENT DCAS Caseload (snapshot @ end of month) 290 273 280 290 281 DCAS/RCAS New Starters 140 112 107 110 110 329 DCAS/RCAS Discharges 113 133 107 115 118 355 INTAKE (CENTRAL ACCESS POINT) Number of calls received 3,244 3,007 2,787 2,606 2,800 8,400 Number of calls answered 2,889 2,731 2,546 2,341 2,539 7,618 Number of calls outbound 3,269 2,896 2,289 1,805 2,330 6,990 Number of calls abandoned 13 8 15 10 11 33 RESIDENTIAL REABLEMENT Average Monthly Bed Occupancy 23 24 23 22 23 69 Total New Admissions to RR 19 14 20 13 16 47 Total No. of Admissions to RR from Hospital (subset) 8 4 3 5 4 12 Total No. Discharges 22 19 17 15 17 51 Total No. Discharge to long term placement (subset) 9 8 2 5 5 15 Total No. Discharge to hospital (subset) 3 0 4 1 2 5 Total No. Discharge deceased (subset) 1 0 0 0 - 0 Total No. Discharges own home (subset) 9 11 11 8 10 30

Qtr 1 Qtr 2 Monthly Jul-15 Aug-15 Sep-15 Monthly Quarterly Average Average Total LONG TERM RESIDENTAL ADMISSIONS Total number of admissions 24 30 23 32 28 85 ACUTE TEAM - NURSE PRAC SERVICE Hospital Admission avoidance 7 6 7 11 8 24 Estimated Bed Days saved (IV at Home service) 105 44 64 66 58 174 MEDICINES MANAGEMENT TEAM Caseload 26 19 19 34 24 New Starters 23 38 30 23 30 91 Warfarin cases (hospital admission avoidance) 6 8 11 17 12 36 Number of Care Workers trained to use MAR charts 72 37 54 74 55 165

2.3. The references to ‘Caseload’ indicate numbers at a point in time and we therefore do not add them together to create a quarterly total.

2.4. There are ongoing reviews around the methods of data collection within Swansea Locality, with the view to further automate, regulate and quality-assure the data captured and this will be reflected in future reports.

3. Common Access Point (CAP) 3.1. The CAP (locally known as Intake) is currently under review in order to

move to a point where multi-disciplinary triage occurs at the earliest opportunity.

3.2. Given the volume of contacts, this is being worked through cautiously so that professionals are only utilised after effective screening and handling has taken place.

3.3. The following table provides a summary of the volume of calls put through to the Common Access Point in Q2:-

Qtr 1 Qtr 2

Monthly Jul-15 Aug-15 Sep-15 Month Quarter

Average Average Total Number of calls received 3,244 3,007 2,787 2,606 2,800 8,400 Number of calls answered 2,889 2,731 2,546 2,341 2,539 7,618 Number of calls outbound 3,269 2,896 2,289 1,805 2,330 6,990 Number of calls abandoned 13 8 15 10 11 33

3.4. Some revision of working processes has already taken place to streamline contact with community nursing which has reduced total number of calls to the CAP (-17.8%).

3.5. Of the 7,618 calls answered in Q2, 6,239 (81.9%) resulted in a recorded referral or integrated assessment. Of the 6,239, 1,717 (27.5%) were passed to the Hubs or the specialist community health services.

3.6. The following graph shows the amount of calls being handled and also the referrals that have been passed specifically to the Hubs and CRS specialist teams.

4. Integrated Hub Activity 4.1. The CRS figures (part of red) in the above graph can be further broken

down. Looking specifically at CRS activity, referrals to specialist elements of the CRT are as follows:-

Requests for CRS Speciality

Apr 15

May 2015

June 2015

July 2015

Aug-15

Sep-15

Total for Specialty

Average per

month

Dietician 1 2 1 10 1 15 2.5

OT 202 160 157 146 151 170 986 164.3

Physiotherapy 106 85 101 93 82 107 574 95.7

Exercise class 19 16 16 13 13 11 88 14.7

Continence 28 23 68 44 39 52 254 42.3

Continence products 67 44 33 44 57 37 282 47.0 Medicines management 4 4 4 10 3 1 26 4.3

Speech & language 31 23 28 31 24 24 161 26.8

Tissue viability nurs 21 15 30 30 31 28 155 25.8

WAST 6 4 1 11 1.8 ALL Requests for CRS Specialty 485 376 438 421 401 431 2552 425.3

4.2. In Q2 there has been a small reduction (-3.5%) in the number of referrals for the CRS specialisms from the CAP compared to Q1.

4.3. The Integrated Health and Social Care Network Hubs include the following staff:-

• Chronic Condition Nurses • District Nurses • Social Workers • Occupational Therapists • Physiotherapists • Domiciliary Care Teams consisting of –

Reablement and Complex End of Life Health and social care workers Community Care Assistants

• Business support/Admin • Hub Manager

5. Assessment Beds at Ty Waunarlwydd and Bonymaen House

5.1. The tables and graphs below show the admissions and discharges at Bonymaen House and Ty Waurnarlwydd.

5.2. Both saw a fall in numbers admitted and discharged in Q2, as illustrated in the respective charts. We expected this as we have sought to admit only clients with potential for reablement. As a result, considerably higher proportions of leavers in Q2 are now returning home rather than being discharged into residential / hospital care compared to Q1.

Bonymaen House 2014-15 2015-16

Q1 Q2 Q3 Q4 Q1 Q2

Admissions 35 32 42 43 37 31 Discharges 33 35 37 40 43 35

Ty Waunarlwydd 2014-15 2015-16

Q1 Q2 Q3 Q4 Q1 Q2

Admissions 13 17 15 22 23 17 Discharges 12 17 17 19 23 16

6. Key Metrics Relating to Intermediate Care 6.1. The following table shows the history of some key measures over the

last 4 full quarters.

Care Home admissions

New homecare starts

Reablement starts

Q1 2014/15

Apr 30 62 159 May 24 66 145 Jun 14 57 169

Q2 2014/15

Jul 32 60 128 Aug 24 63 151 Sep 26 49 190

Q3 2014/15

Oct 26 50 168 Nov 21 65 137 Dec 23 39 145

Q4 2014/15

Jan 25 53 172 Feb 31 34 163 Mar 39 52 128

Q1 2015/16

Apr 32 42 194 May 25 37 186 Jun 29 68 199

Q2 2015/16

Jul 30 63 176 Aug 23 62 174 Sept 32 56 153

6.2. The figures for reablement in this table include DCAS, the Integrated Gower Team and the Assessment Beds, as well as an assumed average for the CRS services.

6.3. Care home admissions refers to new admissions of elderly people to residential or nursing care.

6.4. New homecare starts refers to all new packages of care for individuals, whether they are provided by the in-house service or by external providers.

6.5. The same data for the last 4 quarters is presented here as a graph:

168

137

145

172

163

128

194

186

199

176

174

153

26

21

23

25

31

39

32

25

29

30

23

32

50

65

39

53

34

52

42

37

68

63

62

56

0 50 100 150 200 250 300 350

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Q3

2014

/15

Q4

2014

/15

Q1

2015

/16

Q2

2015

/16

Admissions to Re-ablement, Residential / Nursing & Long-Term Home Care October 2014-September 2015

Care Home admissions New homecare starts Reablement starts

6.6. There has been a continued focus on keeping new residential placements in check but the trend since April 2015 has been upwards.

6.7. We continue to see increases in the numbers of people continuing to receive care at home and while we have had some success in bringing down the numbers who start to receive a service, the trend since summer 2015 is notably upwards.

6.8. There appears to have been a slowing down in the increase of people starting a new package of reablement. However the trend is strongly upwards compared to the beginning of 2014/15.

6.9. From October, we will be able to use the Paris system to report on the numbers of Rapid Response interventions undertaken by the NHS community health specialists. This will increase the number of reablement interventions we can report.

7. Background Papers: None.

Date: 4 December 2015 Legal Officer: Approved Finance Officer: Chris Davies

16. Older People’s Services Income Generation (DECEMBER 2015)

Purpose To provide information requested by the Scrutiny Panel on the

income achieved through older persons day, domiciliary and residential care.

Content Analysis of the income achieved through each service in 2014/15



Lead Councillor(s)

Cllr Harris, Cabinet Member for Services for Adults and Vulnerable People

Lead Officer(s) Alex Williams – Head of Adult Services Report Author Christopher Davies

Principal Accountant (Social Services) 01792 636058 [email protected]

1. Introduction 1.1. Unit costing reports were provided to the September meeting for both

Domiciliary and Residential Care. During this meeting, additional questions were raised. These were responded to during the October session.

1.2. Additional information around the income generated through services was requested during the October meeting, and the following is intended to respond.

2. Adult Services Income and Expenditure Analysis for 2014/15

2.1. We have been asked to produce an analysis comparing the income and expenditure for Day, Residential and Domiciliary Care. This has been split between that attributable to our internal services and that which is in respect of externally commissioned provision.

2.2. All figures are for the 2014/15 financial year and unlike the figures produced for the unit costing exercises have not been adjusted to account for additional costs such as corporate management, finance, human resources, etc. in any way.

Category Internal/ External

Gross Exp Gross Inc Net Exp

1

Day Services

External 358,816 (95,253) 263,563 Internal 672,166 (45,611) 626,554 Total 1,030,982 (140,864) 890,117

Domiciliary Care

External 9,512,360 (1,422,590) 8,089,770 Internal 6,365,592 (861,421) 5,504,170 Total 15,877,952 (2,284,011) 13,593,940

Residential Care

External 23,501,785 (10,760,076) 12,741,710 Internal 6,654,629 (2,285,683) 4,368,945 Total 30,156,414 (13,045,759) 17,110,655

Grand Total 47,065,348 (15,470,634) 31,594,712

3. Day Services

3.1. Income in respect of external provision was made up as follows

Contributions from Individuals £16,453 Miscellaneous £78,800 Total £95,253

3.2. Miscellaneous income is contributions from the Supporting People grant

scheme.

3.3. Income from the internal services was primarily sales income.

Rental Income £ 360 Sales Income £45,251 Total £45,611

4. Domiciliary Care

4.1. Income for this service is substantially affected by Welsh Government rules

that prohibited us from charging more than £55 per week in 2014/15. In the current financial year, this maximum charge has been raised to £60.

4.2. External Income

Contributions from Individuals £1,422,590

4.3. Internal Income

Contributions from Individuals £356,537 Grants (WG) £504,884 Total £861,421

5. Residential Care

5.1. Within this sector, some income is in respect of ongoing care paid by those

who are of means and have assets above the capital limit. In cases where individuals are above the capital limit but do not have significant cash available they may defer their contributions until after their death. This is

2

referred to as windfall. Significant recharge income is received from ABMU in respect of the nursing care element of residential care.

5.2. External Income

Contributions from Individuals £ 6,533,574 Recharges to Health £ 3,005,041 Miscellaneous (Windfall) £ 1,221,461 Total £10,760,076

5.3. Internal Income

Contributions from Individuals £1,776,930 Contributions from Health £ 147,000 Contributions from other LAs £ 34,530 Miscellaneous (Windfall) £ 105,382 Grants (WG) £ 221,841 Total £2,285,683

Date: 8th December 2015 Legal Officer: Tracey Meredith Finance Officer: Mike Hawes

3

17. LOCAL AREA COORDINATION: FORMATIVE EVALUATION (DECEMBER 2015)

Purpose To inform the Scrutiny Panel of the outcome of the first

stage (formative) evaluation of Local Area Coordination in order to provide an update on progress so far.

Content This report provides a summary of the content of the formative evaluation of Local Area Coordination in Swansea. It includes initial findings and recommendations. The evaluation was completed in September 2015. It is the first report of three which are anticipated over an 18 month period; the process for how the remaining parts of the evaluation will be commissioned are still to be determined. The report examines the developmental months of Local Area Coordination when the foundations were being laid, plus the first three months the Local Area Coordinators were in post (from June 1st 2015). The Institute of Life Sciences (ILS) at Swansea University undertook the first stage of the evaluation.



Lead Councillor(s) Cllr. Mark Child, Cabinet Member for Wellbeing and Healthy City

Lead Officer(s) Alex Williams, Head of Adult Services

Report Author Alex Williams: [email protected] Tel: 636245

1. Introduction

1.1 Local Area Coordination is a long-term evidenced based approach to supporting disabled people, people with mental health problems, older people, families and carers to stay safe, strong and connected as contributing citizens.

1.2 The approach is being trialled in three areas of Swansea as part of

Social Services’ and the wider Council’s prevention agenda, and the implementation of the Social Services and Wellbeing (Wales) Act 2014.

1.3. The purpose of the evaluation is to gauge how well the approach is

working and support decision making about the further development of Local Area Coordination in Swansea.


Tel:636245

Tel:636245

1.4. This report provides an overview report into the first three months of operation of Local Area Coordination in Swansea.

2. LOCAL AREA COORDINATION EVALUATION (INITIATION) REPORT 2.1 Three Local Area Coordinators were employed in Swansea from June

1st 2015 via the Sustainable Swansea Prevention Fund. They act as a single point of contact for local people in three areas: Sketty, St Thomas & Bonymaen, and Gorseinon & Loughor.

2.2. A Leadership Group of representatives from Social Services, Housing,

ABMU, voluntary sector and elected Members provides a steering and coordination function. An Implementation Manager is responsible for delivery of the service.

2.3. The three Coordinators were co-productively recruited by members of

the public from the three local communities. They worked alongside Council officers, ABMU staff and the voluntary sector to select and appoint the Coordinators. Co-productive recruitment ensures Coordinators have a ready-made group of people to help them get started in the local area, and that they are known and ‘owned’ by communities from day one.

2.4. Coordinators’ initial activities include community engagement,

identifying community assets and identifying individuals for support. A mapping tool to measure the strength and range of connections made indicates this is progressing well with rapid and rich growth over the first three months.

2.7. Additionally, the Coordinators are engaging with groups and agencies

who might introduce them to people who need support. This is critical in order to foster understanding of Local Area Coordination and its role in helping people and communities.

2.8. Each Coordinator is developing a ‘caseload’ of people they will work

intensively with over longer periods of time. Introductions have come from all adult Social Services Teams, a Child and Family Team, Housing’s Tenancy Support Unit, the voluntary sector, Jobcentre Plus, GPs, District Nurses, Occupational Therapists, local Hairdresser, a post mistress, from food banks and local people.

2.9. Key findings to date: The Local Area Coordination model complements existing support

services, though must be clearly understood as a medium-long term community resilience effort.

2.10. Initiation has progressed well, and the Coordinators are making good

progress within their respective communities.

2.11. Local Area Coordination has the potential to make a valuable contribution to Swansea’s communities, with benefits already emerging from these very early stages of delivery.

2.12. Recommendations after the first three months of delivery:

• Continued commitment to the approach is important to optimise shorter and longer-term impact, building trust and meaningful engagement for what is a long-term aim rather than a ‘quick-fix’.

• The Leadership Group, though working well, could be strengthened with expanded membership, including relevant emergency services, and community members.

• Enhanced engagement of the third sector at Leadership Group level will complement the strong links already being forged by Coordinators on the ground.

2.13. The Leadership Group has already responded to these initial

recommendations; a Summit meeting in November has resulted in emergency services and ‘not for profit’ sector representatives being engaged and willing to support Local Area Coordination by, for example, joining the Leadership Group.

2.14. The Leadership Group meets more regularly and continues to be

instrumental in promoting, supporting, and directing the development of Local Area Coordination.

2.15. The Summit identified and engaged a wide range of agencies and

partners who want to develop a collaborative forum alongside the University and industry partners.

2.16. Its purpose is to develop a corporate responsibility compact to ensure

that the people of Swansea benefit from the expertise and resources available from inward investment. This wider benefit of the development of Local Area Coordination (better resourced communities), is an outcome evidenced in other Local Area Coordination sites.

Background Papers: Formative Evaluation Report 2015, Local Area Coordination in the Western Bay Area: Initiation Review. Pilot Site Study: Swansea Authors: Sian Roderick, Gareth Davies, Jayne Daniels & Jennifer

Gregory. Date: 8th December 2015 Legal Officer: Approved Finance Officer: Chris Davies

Formative Evaluation Report 2015

Local Area Coordination in the

Western Bay Area: Initiation Review

Pilot Site Study: Swansea

Researchers: Sian Roderick, Gareth Davies , Jayne Daniels & Jennifer Gregory

Swansea University, Institute of Life Science, Scientia Research.

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Contents

Foreword................................................................................................................................................. 4

Executive Summary................................................................................................................................. 5

1. Introduction .................................................................................................................................... 6

1.1 The Challenge Faced ..................................................................................................................... 6

1.2 The Social Services and Wellbeing (Wales) Act 2014.................................................................... 7

1.3 The emphasis on Co-production ................................................................................................... 8

1.4 The Act in Western Bay................................................................................................................. 8

2. Local Area Coordination...................................................................................................................... 9

2.1 Development and Context ............................................................................................................ 9

2.2 Local Area Co-ordination Aims, Ethos and Attributes ................................................................ 10

2.3 The Role of the Local Area Coordinator...................................................................................... 13

2.4 LAC Evidence Base ...................................................................................................................... 15

3. The Inception of Local Area Co-ordination for Swansea .................................................................. 19

3.1 Local Area Co-ordination as an Approach for Swansea .............................................................. 19

3.2 Swansea Pilot Areas .................................................................................................................... 22

4. The Formative Evaluation Framework .............................................................................................. 24

4.1 Framework Development and Aims ........................................................................................... 24

4.2 Framework Elements .................................................................................................................. 26

4.3 Evaluation Framework Summary ................................................................................................ 28

5. The Leadership Group ....................................................................................................................... 30

5.1 Group Role and Membership...................................................................................................... 31

5.2 Group LAC Ambitions .................................................................................................................. 31

5.3 Implementation Management.................................................................................................... 33

5.4 Local Area Co-ordinators: Recruitment and Training ................................................................. 38

5.5 Initial Delivery ............................................................................................................................. 39

5.6 Network & Relationship Science Approach ................................................................................ 56

5.7 Emerging Network & Relationship Highlights............................................................................. 57

5.8 Financial Perspective................................................................................................................... 59

6. The Findings ...................................................................................................................................... 61

7. References ........................................................................................................................................ 63

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Foreword

The Western Bay Local Area Co-ordination (LAC) Pilot programme is an implementation of an

approach, novel to the region, supporting communities with focus upon local relationships and

assistance rather than use of statutory services. To support this work, and inform key stakeholders

of progress and early outcomes a formative evaluation is being undertaken. This report provides the

first formal feedback from this evaluation process), with focus upon the setup activities and initial

activities (Initiation) of the Local Area Co-ordinators within the Swansea area.

Further reports will develop the evaluation further as data are collected from the Pilot delivery

phase, giving focus to outcomes and networks established within LAC communities. Update reports

at December 2015 and March 2016 will assess progress in delivery and towards outcomes

anticipated from this stage of the review. The formative evaluation will be completed with an 18

month report drawing together review of the Pilot phase.

Combined with reports for Local Area Coordination in Neath Port Talbot and Local Community

Coordination (LCC) in Bridgend, ongoing monitoring and longer-term summative evaluation, this

work is intended to support both practitioners in optimising delivery, and policy makers in potential

future use of LAC and LCC in the Western Bay region and beyond.

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Executive Summary

• Increasing demand due to demographic changes and funding pressures upon Health and

Social Care are requiring stakeholders to re-examine approaches to achieving goals of

supporting individuals and communities to lead full, active, healthy and engaged lives.

• Local Area Coordination (LAC), a concept pioneered in Western Australia in 1988 and

delivered recently across the UK is a person-centric approach aligned with the ethos of co-

production to help individuals lead a ‘good life’.

• Previous implementations and subsequent evaluations of LAC, including within the UK, have

validated the effectiveness of the approach for individuals and communities, together with

potential short and longer-term financial benefits for stakeholders.

• Western Bay is coordinating a Pilot implementation of LAC and similar approaches across

the region with activity underway in the three local authorities.

• Formative evaluation of the implementation is being undertaken by Swansea University,

commissioned by Western Bay to support Pilot delivery and inform stakeholders of progress

and implementation.

• The formative evaluation is being undertaken over a period of 18 months, with reporting

update points at months 3, 6, and 9 of delivery, and a full report to be provided at the end.

• This Initiation Review report provides the first formal insight from the recruitment and initial

delivery activities of the Swansea LAC Coordinators.

• The areas of St Thomas, Gorseinon and Sketty have been used as LAC Pilot areas, with three

Coordinators recruited with involvement of their respective communities. The new

Coordinators started on 1st

June 2015

• A Leadership Group is providing a steering and coordinating function, with a dedicated Local

Authority Implementation Manager responsible for delivery.

• Initial activity undertaken over the past two months has been progressing well, including

community engagement identifying community assets and individuals for support.

• A case load is starting to develop with each of the Coordinators taking on cases which clearly

fit with the nature of engagement suited to LAC.

• Initial key findings to date are;

o The LAC model complements existing support services, though must be clearly

understood as a medium-long term community resilience effort rather than risk

being perceived as rebranding of social services.

o The initiation of the project has progressed well, with a team of Coordinators

making good progress within their respective communities.

o LAC has the potential to make a valuable contribution to WB communities, with

benefits already emerging from these very early stages of delivery.

• Initial recommendations to date are;

o Continued commitment to the approach is important to optimise its shorter and

longer-term impact, building trust and meaningful engagement for what is a long-

term aim rather than a quick-fix.

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o Strengthening of the role of the LAC Leadership Group through regular attendance

and with expanded membership. This should include relevant emergency services

and community members.

o Enhanced engagement of the third sector at the Leadership Group level to

complement the strong links being forged by Coordinators at the operational front.

1. Introduction

1.1 The Challenge Faced

Traditional approaches to health and social care across the UK and Wales are struggling to address

growing demand, exacerbated by the challenges of an ageing population, chronic disease and

economic hardship, all set within a context of public sector austerity. The Western Bay region faces

some acute manifestations of this challenge, particularly in its Communities First Clusters where

socio-economic deprivation is greatest.

The continued pressure upon public services makes it a challenge to embrace opportunities to adopt

new practice, especially while maintaining quality and safeguarding obligations for services upon

which users are highly dependent. This apparent paradox makes innovation most intriguing,

particularly where further resource is unavailable, demand is growing, and change difficult.

These challenges, and efforts to address them are not unique to Wales or the Western Bay region,

and Welsh Government through the Social Services and Wellbeing (Wales) Act 2014 sets new

obligations upon organisations to work collaboratively in supporting individuals. The identification,

appraisal, tailoring and adoption of relevant effective approaches to collaboration is itself a

challenge for organisations balancing concurrent priorities.

The following sections describe key aspects of this challenge, set in the context of the Act and

Western Bay region.

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1.2 The Social Services and Wellbeing (Wales) Act 2014

The publication of the Government white paper Sustainable Services for Wales: A Framework for

Action (2011) highlighted a number of challenges faced by public services in Wales.

The White Paper called for greater freedom for individuals to decide which services they need while

offering consistent, high-quality services across the country. However, it acknowledged that Social

Services are not always in a position to help people live independent lives. Furthermore, it suggested

that change would need to take place in a shifting demographic landscape, amongst increased

expectations from those who access care and support; and against continuing hard economic

realities.

Building upon the challenges highlighted in the White Paper, The Social Services and Wellbeing

(Wales) Act 2014 received royal assent in May 2014 and is expected to be fully implemented by April

2016. The intention of the Act is to transform services on a multilevel basis across Local Authorities

and the NHS to meet individual wellbeing needs. This legislation encourages a greater focus on ‘co-

production’ and the need for systems change without additional resource. It places emphasis on

building community and individual resilience through person-centred approaches.

The implementation of this Act is a challenge to many Local Authorities across Wales, especially at a

time of unprecedented budgetary cuts. Therefore, the ability to find innovative and impactful ways

of working on a multi-agency level, underpin joint working and shared outcomes which are key

components to systems change. Despite complexities around the alignment of policies, priorities and

delivery, such partnerships make a valuable contribution. In addition, the role of service users must

become the priority in the operation, quality and governance of agencies and the nature of their

provision.

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1.3 The emphasis on Co-production

Co-production has been defined as ‘a particular approach to partnership between people who rely

on services and the people and agencies providing those services’ (Hunter and Richie, 2007). It is a

person-centred approach enabling a greater sense of autonomy, dignity and agency.

During the last two decades, partnership has become a continual theme across social policy, with an

emphasis on formal and frequent long-term multi-agency partnerships. Such partnerships utilise the

service provision of more than one agency and may cover mental health, community safety, housing

providers and environmental sustainability.

Welsh Government has embraced co-production as a central tenet of its philosophy, giving new

focus to the role and responsibilities of individuals for their own health and wellbeing1.

1.4 The Act in Western Bay

The Western Bay Programme (WBP) was first established in 2012 with the aim of bringing cohesion

and integration to health and social care services more effectively for the benefit of its service users

and carers. Services and partners working in silos is no longer a sustainable option as identified by

WBP. Therefore, the programme examines use of innovative approaches of supporting services

which operate amongst changing demographics, in a challenging climate and face increasing

demand.

WBP covers the local areas of Bridgend, Neath Port Talbot and Swansea and operates as a

collaborative in the area of health and social care. Together with independent partners and third

sector organisations it progresses this agenda in the context of the aforementioned Social Services

and Well-being (Wales) Act (2014). With its implementation taking place in April 2016, the Act will

have a profound effect on the way health and social care services operate in Wales. It places

particular emphasis on collaborative approaches to the delivery of health and social care services

with a view to reducing the escalation of people’s needs for care and support. It also encourages

person-centred approaches which give service users a stronger voice and greater control over the

care that they receive2. The Western Bay response to these duties involves emphasis on increased

resilience and self-determination, supporting individuals to become healthy active participants in

their communities.

1 Social Services and Well-being (Wales) Bill, Approach to Implementation, Welsh Government, 2014

2 The Social Care and Well-being (Wales) Act 2014, legislation.gov.uk/anaw/2014/4/contents , 2014

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2. Local Area Coordination

2.1 Development and Context

Developed 27 years ago in Australia, Local Area Coordination (LAC) was formed in response to the

urgent need to find new and innovative approaches for supporting people with learning disabilities

and their families. Given the large rural expanse of Australia, supporting people to remain with their

families and in their communities was for many integral to their vision of ‘good life’. Since then Local

Area Coordination has been adopted by areas of New Zealand and the UK. To date, (September

2015) UK Local Area Coordination has been implemented in England, Scotland, and Wales. In Wales

and England, there are four sites operating (Derby City 2012, Thurrock 2013, Swansea 2015 and Isle

of Wight 2015), three sites partly developed (Gloucestershire 2013, Cumbria 2009/10 and

Leicestershire 2015), and three sites about to recruit (Derbyshire, Suffolk and Neath Port Talbot).

Middlesbrough was the first area to start in England, but despite strong evaluation and

recommendations to expand across the area, stopped in 2014 following a change in senior

leadership. Local Area Coordination continues in Scotland, although with tailoring in design provided

by the Scottish Government3.

These sites have implemented Local Area Coordination to address not only the needs of people with

learning disabilities and their families, but people facing challenges in a multitude of ways. The

approach involves a strong person-centred value base and operates as a single point of contact for

those individuals and their families in the community. It has a ‘slow-build’ approach, investing in

forging strong relationships with individuals, families, community and networks of stakeholders. It

works to develop and enhance the capacity of communities for inclusion and resilience. It draws

support from the community with the aim of enabling people to live a good life with increased

choice and control. Furthermore, Local Area Coordination is attempting to drive system reform using

‘small scale levers to create large scale change’ (Hunter and Ritchie, 2007. p.20).

Local Area Coordination has an established evidence base of successful case studies and benefit/cost

ratios from a number of different areas. All have different demographics, geographies, community

dynamics, case-loads and leadership. However, the model thus far is able to demonstrate its

comprehensive value to those Councils willing to engage with it. Section 2,2. presents an overview

of LAC’s core aims and principles of operation.

3

National Guidance on the Implementation of Local Area Coordination, Scottish Government, 2008

10

Having been subject to numerous evaluations and reviews, the evidence base stemming from these

implementations indicates that LAC can achieve significant impact for the individuals, families and

communities engaged. Further discussion of these reviews is included in section 2.4.

2.2 Local Area Co-ordination Aims, Ethos and Attributes

A useful summary of LAC, in the form used for the Pilot, is provided by Ralph Broad through the

Centre for Welfare Reform publication, Local Area Coordination: From Service Users to Citizens4.

Based upon seven core principles presented below, LAC aims to develop an inherent capacity within

communities for individuals to support themselves, with formal services serving as backup rather

than first order support.

LAC Principles

Citizenship – with all its responsibilities and opportunities

Relationships – the importance of personal networks and families

Information – supporting decision making

Gifts – all that individuals, families and communities bring

Expertise – the knowledge held by people and their families

Leadership – the right to plan, choose and control your own life and support

Services – as a backup to natural support

Local Area Co-ordination is multi-faceted and aims to achieve many different outcomes for the

individual, their support network and the community. The ways in which LAC aims to achieve this is

through ‘Coordinators’ charged with the following;

4 Local Area Coordination: From Service Users to Citizens, R Broad, Centre for Welfare Reform, 2012

11

Develop practical and local responses to needs

Support people to build and pursue their vision

for a good life - imagining a better future

Enhance social inclusion

and contribution

To understand, nurture and utilise the links and

resources within communities

Support people to be heard, have a voice and

make decisions

Identify resources and

gaps in local communities - work with local

communities to develop local responses

Enable individuals to have

control of the support they receive

Support accurate and timely access of

information in a range of ways that meet individual

needs and preferences

Simplification of the system making it easier

for users to navigage and access support

Contribute to building more personal. local,

flexible and accountable services as a back up to

local solutions

The Ethos of the Model

The ethos of Local Area Co-ordination for the individual

Local Area Coordination postulates that every person should be able to lead their version of a ‘good

life’, to make their own decisions and take their own risks.

Individuals can gain control over their lives when they have access to timely and accurate

information which is accessible to them and their individual needs. Individuals have a greater sense

of control and security when they are directly involved in decisions about their lives. Having a

physical or mental disability should not prevent an individual visualising a good life and achieving it.

The model stipulates that individuals and their families are the most appropriate to review

challenges, changing needs and goals.

The ethos of Local Area Co-ordination for families and personal networks

Local Area Co-ordination determines that families are the most integral and consistent support

system for the individual facing challenges. Such positive relationships often provide a basis for

individuals to become an active part of family life, friendship groups and the community. Families

often want what is best for the individual and therefore offer advocacy, positive leadership and

safeguarding. Whilst services may be needed, families often have their own resources to help

individuals pursue their vision for a good life. The model is predicated the belief that if people are

supported to stay strong through the development of practical local solutions then both personal,

family and community resilience grows.

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The ethos of Local Area Co-ordination for the Community

Society is enriched and enhanced when people are given the opportunity to contribute their

knowledge, creativity, skills and opinions. Every person has a contribution to make and there should

be an awareness of people’s talents and skills in order to maximise such opportunities. Community

connectedness is essential for a good life. Having individuals and their families join the community

not only provides additional support, but provides further opportunities for people to contribute.

Services may offer additional support but they should complement the natural resources available to

the individual.

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Attributes of the Model

Local Area Co-ordination has the ability to drive positive outcomes across three key areas:

Individuals and families; communities; and services and systems. Local Area Coordination

encompasses the following components which makes the model different to other social and

community-based initiatives. These are defined across the three key areas:

Creating, developing and maintaining social networks

and informal support

Promoting better use of

mainstream services

Utilisation of local resources and networks, not dependent on budgets and allocation of

funds

Consideration of the needs of the family and the social

context

Inclusive of all ages and disabilities

Focuses on the skills, resources and competencies of the community and the

individuals

Clear values and a set of principles underpinning all

decisions and actions

Impact across individuals, families, communities, sytems

reform and systems change

Very Localised, offering a 'light touch' to inform, advise and connect people, places

and services

Takes time to build trusting long-term relationships with

individuals, families and communities

Helps individuals build a vision

for their version of a 'good life' and support them to find

practical solutions

Focus on resilence across individuals, familues and the

community

Focus on non-service

solutions wherever possible

A combination of traditionally seperate roles, delivered in

the community alongside local people in partnership with

community

Embedded in both the

community and the system

A focus and expectation to drive reform, systems change

and potentially cultural change with joint working

However, despite its focus on helping people and communities to build self-sustaining solutions and

high levels of resilience, Local Area Co-ordination takes the position that all partners are highly

valued and joint working leads to a shift in the way services and organisations work together to

achieve shared outcomes. Third sector partners are particularly valued as well as such initiatives as

Time banks, faith groups, organically occurring groups and associations, micro enterprises, statutory

partners and local companies.

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2.3 The Role of the Local Area Coordinator

According to the Centre for Welfare Reform publication, People, Places and Possibilities

5, the role of

the Coordinator is essentially an integration of ’a range of roles that have often been kept separate,

and it delivers these alongside local people in their local community. The Local Area Coordinator is

based locally and acts as a single, accessible, point of contact for people in their local community,

irrespective of age or service label’.

Underpinning the ‘Slow-build’ approach is the gradual development of trusting relationships with

individuals, families and communities. There are no pre-determined responses or timelines to adhere

to. The number of people they support will usually be in the region of 50-65 and may involve

long-term support through to a ‘light touch’ encounter. Many of these tend to be people not known

to services, at risk of becoming dependent on services or wishing to reduce service use and gain

independence. This is not to say that services do not play an important role and aren’t a necessity

but for some, indeed Local Area Coordinators are encouraged to work alongside existing services,

specialist services and external organisations to navigate the best path for the individual. Local Area

Coordinators support others by helping them to:

� Understand and nurture their gifts, skills, experiences and needs

� Access accurate , relevant and timely information

� Build a positive vision and plan for the future

� Build and maintain valued, mutually supportive relationships

� Be part of, and actively contribute to community life

� Help people be heard – encouraging self advocacy, advocating alongside people or

advocating for people if there are no other options

� Find practical, non-service solutions to issues and problems wherever possible

� Access, navigate and control supports and services, if these are required

People, Places and Possibilities (2015)

Through the work of the Coordinator, individuals and their families are encouraged to:- reflect on

what their vision of a ‘good life’ might look like; to explore ways of progressing; consider their own

attributes and those of their support network and community; and to see themselves as part of a

wider community.

The ethos of LAC and role of the Coordinator demonstrate that the approach is distinct and

complementary to existing support services. Rather than a rebranding of existing efforts, it is

important for LAC to be understood as a distinct complementary approach.

5

People, Places, Possibilities; Progress on Local Area Coordination in England and Wales, The Centre for

Welfare Reform, 2015

15

Finding

The LAC model complements existing support services, though must be clearly understood as a

medium-long term community resilience effort rather than risk being perceived as rebranding of

social services

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2.4 LAC Evidence Base

Since its inception in Western Australia in 1988 and more recent application in the United Kingdom,

LAC has been subject to numerous evaluations and reviews. Increasing pressure on public services in

the face of resource pressures have led to greater interest in innovative community-based

approaches to reducing service demand. This section presents considerations from recent relevant

reviews which are helpful in informing this evaluation process.

Recent evaluations of LAC implementation in Middlesbrough6

and Thurrock7

have found LAC to be

effective in engaging with individuals and communities, and effecting positive change. Both studies

present a rich portfolio of stories demonstrating real improvement in people’s lives while also

identifying positive impacts in avoided resource requirements for public services.

Implementation of LAC in Scotland, another devolved nation, provides useful insight, where

extensive delivery (some 58 Coordinators working in 24 of 32 local authority areas during 2008) has

provided particularly useful insight. Evaluation8

findings included validation of key LAC aims of;

- Enabling Greater Choice

- Increased Family Capacity

- Increased Community Capacity

- Individuals and families, through networks established by the Local Area Coordinator,

mutually supporting each other

The ‘spend to save’ benefits identified in implementation of LAC in Scotland demonstrate how

preventative action leads to reduced longer-term costs. Although this suggests increased initial

expenditure, this insight also found the approach to be cost-effective, with each coordinator able to

work with meaningful numbers (~60) of individuals in their communities.

A clear theme emerging from all of the above is that LAC is not an immediate panacea. While it can

rapidly deliver benefits to individuals and families, it is the longer-term impact which is of most

interest. The relationships developed by Coordinators must be allowed to embed and become

community resilience which develops to the sustainable ‘mutual support’ identified in Scotland. This

underlines the importance of strong leadership providing the patience and long-term commitment

required to see implementation through the potential whims and turbulence of political and

planning cycles.

6 Evaluation of Local Area Co-ordination in Middlesbrough: Final Report, Peter Fletcher Associates, 2011

7 Local Area Coordination, Fourteen month evaluation report, Thurrock Council, Inclusive Neighbourhoods,

2014 8

National Guidance on the Implementation of Local Area Coordination, Scottish Government, 2008

17

The above evidence base provides an important reference point for the WB Pilot, demonstrating

that effective implementation can bring real benefit.

Recommendation

Continued commitment to the approach is important to optimise its shorter and longer-term

impact, building trust and meaningful engagement for what is a long-term aim rather than a

quick-fix

18

A broader Rapid Evidence Assessment was undertaken of the evidence base with a

summary of findings tabled below, with a breakdown and referencing of reports utilised

presented as an Appendix.

Recurrent positive themes identified in evaluations and reviews of UK LAC

implementations include clear ambitions for;

1. A personal service that helps individuals build new relationships, overcoming

isolation,

2. Finding non-service solutions which are sustainable, low cost or at no cost to

resolve identified issues and target achievements,

3. Providing practical solutions to problems, assisting people to use local and

personal networks,

4. Helping people speak up, be heard and be in control of their lives by being their

advocate,

5. Providing timely advice and information,

6. A collaborative approach identifying local community resources non service

solutions,

7. Reversing the current system from being crisis led to individually led with clients

identifying what is their vision for a ‘good life’ thereby giving an individualised

approach to their identified needs,

8. Advantageous to community and other support sectors by sharing resources,

learning, knowledge and skills.

Challenges, including operational issues identified in LAC implementation in Scotland

included;

1. Difficulties in the implementation, operation and expectations of LACs in Scotland

acknowledging that the issues identified in the Short Life Working Group on LAC

(SLWG, 2002) do not appear to have been completely addressed,

2. The need for standardised pay scales for LACs,

3. LAC should be extended to include all age groups and people with all types of

impairment and or mental health issues,

4. The findings also suggest the need for the Scottish Executive to issue updated

guidance on the implementation of LAC in Scotland.

Examination of LAC implementation in Middlesbrough provided the following

considerations, suggesting that LAC should be;

1. Funded on a long term basis

2. Extended across Middlesbrough

3. Part of the front end for adult and children ‘s social care service

4. LAC and personalisation / self-directed support

5. There ought to be a greater emphasis on building community capital

6. Funded for building community and individual capacity

7. Building better links with the NHS

8. Providing information and advocacy

9. Increasing the capacity of the service

10. Developing new ways of working across the council.

19

Also, Glasby, Miller and Lynch 2013, (Turning the welfare state upside down?

Developing a new adult social care offer, provide the following useful considerations for

the future of LAC;

1. Work with current staff to ensure that they focus on social capital and

community resources rather than deficits and limitations.

2. Changes to social work education and workforce development so that future

practitioners are trained in new ways with a more explicit community focus.

3. Pay attention to the practical impact of new models so that they are not only

intellectually coherent but work in practice.

4. Viewing social care spending as a form of social and economic investment.

5. Linking social care to economic development and encouraging new providers to

pioneer asset-based approaches.

6. Investing time and money in understanding local communities and how best to

engage them.

7. If necessary, reversing previous changes that have centralised support or taken

resources away from working with local communities.

8. Working with NHS partners to explore joint funding arrangements and to

develop new approaches to identifying and supporting people with complex

needs at risk of hospital admissions.

9. Mindful of the emerging national settlement while contributing new local

approaches to national debates.

Evaluation of LAC activity in Thurrock identified the following effects and future work;

1. Individuals reported reduced calls and visits to Accident and Emergency

Departments and General Practitioner practices as individuals felt supported and

felt ‘stronger’ (pg. 17).

2. LACs attended multidisciplinary team meetings at General Practitioner practices’

offering alternative solutions to help people manage their own health care needs.

3. Supporting individuals to organise meetings to coordinate the support they are

receiving, helping then to help themselves.

4. Financial benefits have been reported in relation to LACs working in the

community.

5. Early input response for people with mental health needs

6. Supporting people who have declined conventional services.

Future work following on from this report includes:

1. Funding for longer term implementation

2. Joint working with other partners with the model being strength based and not

deficit based.

3. National evaluation of LAC

4. Expanding the service to all citizens irrespective of age.

5. Linking in with development in the community and asset mapping.

6. Whether the LACs roles can prevent crisis by working with other health

professionals

7. Micro-enterprises viewed both as a prospect for people working with LACs and the

wider community.

20

3. The Inception of Local Area Co-ordination for Swansea

Western Bay’s mission is to progress social care and health integration and encourages collaboration

where there is value to be added. It aims to identify programmes of change, priorities for the sector

and opportunities for joint working. It currently has three key areas it oversees:-

• Services for older people

• Prevention and wellbeing

• Contracting and procurement

Western Bay identifies service improvements, better outcomes as a result of Collaborations across

Social care and health agendas.

3.1 Local Area Co-ordination as an Approach for Swansea

The prevention and wellbeing agenda was already identified as a priority for Western Bay as well as

services for older people with complex needs. It was evident there needed to be early intervention

across these areas before individuals reached crisis point. This was further reinforced by the

emergence of the new Social Services and Wellbeing (Wales) Act 2014 which placed a lens on

prevention and highlighted co-production and community resilience as a solution.

Local Area co-ordination (LAC) was an approach which fitted with the prevention and wellbeing

agenda and had come to the attention of the Local Authority after staff members attended a

conference which discussed the LAC model and its impact. Swansea Council proposed the adoption

of the model to the Western Bay Programme and subsequently secured funding for the approach to

be piloted across the three Western Bay areas.

Currently, there are two different sources of funding for the LAC programme in Swansea. Sustainable

Swansea funds the Co-ordinators through their Prevention Fund and as part of the Council’s

strategic programme. Western Bay use Welsh Government funding allocated to the Regional

Collaboration Fund (2014/15) and the Delivering Transformation Grant (2015/16) to fund the

Implementation Managers post and an expert advisor from Inclusive Neighbourhoods. Through

interview, the following challenges and opportunities were identified:

21

Challenges for this approach identified by Western Bay staff include:

• The Model not only requires support and commitment at a senior level but also at a

grassroots community level. The message of Local Area Co-ordination needs time to

permeate both

• Funding – Local Area Co-ordination is a long-term solution whilst grant funding cycles remain

relatively short. The benefits of the model will take time to cultivate and quantify.

• Interpretations of the Model vary making it difficult to compare and contrast for evaluative

purposes.

• The life cycle of Leadership change can be a detrimental to sustainability. With every

change, buy-in and understanding of Local Area Co-ordination is required.

• Perception and Misperception - The response from some who believe that Local Area Co-

ordination is no different to other social care and wellbeing initiatives or alternatively, see it

as a threat to their future employment.

• It is evident that some do not fully understand the model but this may be because it has not

had time to gain significant visibility.

It is important to acknowledge that the design of this approach takes time to become

embedded and build a sustainable presence.

Opportunities for Local Area Co-ordination identified by Western Bay staff

• The development of case studies and further evidence base

• Tangible benefits

• Political Champions

• Finding the fit and relevance for other facets of the Western Bay agenda such as Services for

Older People and with Local Area Co-ordination at the front end with other service delivery

• Engagement with the local health and wellbeing Hubs, complementing their remit

• A strong Leadership group who can unlock barriers and get things moving, be politically

engaged and push for strategic direction and identify funding streams

22

The City and County of Swansea Context

Swansea is the second largest city in Wales and has a population of 241,0009, projected to grow to

270,000 by 2036 with a disproportionate increase in the number of individuals aged 65 & over10

. It is

also a diverse city with growing student and ethnic populations. The population of the neighbouring

WB local authority area of Bridgend is also projected to grow strongly, while that of Neath Port

Talbot is projected to remain relatively level over the same period.

While life expectancy by local authority may present a broad averages of 75-80 years11

, the quality of

life and life expectancy vary greatly from area to area within the city region with up to 23 years

difference in healthy life expectancy between most and least deprived areas12

. The combination of

health and socio-economic challenges within deprived areas have made them the focus for

interventions including Communities First13

.

Services within the city are subject to ever growing demand. Last year saw 10,000 individuals

including approximately500 adults receiving support commissioned or directly provided by Swansea

Council14

. However, the ability to identify and reach all those with existing or (particularly in the case

of preventative interventions) emerging needs is limited. At a UK level it is estimated that amongst

older people there would be an additional 26 percent more service users if ‘moderate’ needs were

used as an eligibility threshold15

. This estimate was established at a time before eligibility criteria

were tightened, further exacerbating the challenge of increasing need outside of council provision.

This scale of delivery underlines the challenge faced within the region, and the importance of

preventative actions that preserve valuable resources for those with greatest need.

9 Mid-Year Estimate 2014, www.swansea.gov.uk

10 Population and Household Projections, Briefing Note, Welsh Government, 2011

11 Life expectancy by local authority and gender, StatsWales, Welsh Government, 2015

12 Measuring Inequality, Trends in mortality and life expectancy in Swansea, Public Health Wales Observatory,

2015 13

Communities First Clusters and Communities, City and County of Swansea,

www.swansea.gov.uk/communitiesfirst 14

Annual Report 2014, Director of Social Services, City & County of Swansea 15

PSSRU 2010 research cited, Care in Crisis 2014, Age UK, 2014

23

3.2 Swansea Pilot Areas

The original criteria for selecting the areas were as follows:

• The areas should be socio-economically and culturally different.

• The population in each needs to be between 10—15,000 as per the LAC model.

• There must be a learning area in each of the three network hubs (North, West and Central).

• There should not be any other major developments taking place in the area as this might

cause difficulty in evidencing the effects of Local Area Coordination.

• There should be an awareness of the Welsh speaking population.

In practice this was a complex task. For example, ideas vary about which communities are naturally

aligned; these may be based purely on geography rather than Ward boundaries and so the areas

may straddle these, making statistical information difficult to aggregate.

Another complication is that it is difficult to completely avoid major developments, such as

Communities First areas, when drawing up the learning areas since these programmes often operate

in parts of the very socio-economic and culturally diverse communities that the local authority

wished to include. The role of the Leadership Group is important as it will draw on its own

knowledge about the make-up of various communities to inform decision making and further

expansion of the programme.

Three areas were agreed upon were as presented below and overleaf;

Gorseinon (Swansea East)

Local Area Co-ordination in the Gorseinon area,

also covers the communities of Loughor,

Kingsbridge and Garden Village.

This area has a population of 15,420

Demographics: Communities with a Welsh

speaking population

24

St. Thomas and Bonymaen (Swansea East and a Communities First area)

Local Area Co-ordination in the St. Thomas and

Bonymaen area also covers Port Tennant,

Danygraig, Pentrechwyth, and SA1 Waterfront.


Demographics: Communities First East Cluster

in St. Thomas, Port Tennant, Bonymaen

Sketty (Swansea West)

Local Area Co-ordination in the Sketty area

covers Sketty Park, Derwen Fawr and Tycoch.


Demographics: Communities First (South

Cluster) in Sketty Park

25

4. The Formative Evaluation Framework

4.1 Framework Development and Aims

As described in Section 2, LAC as an approach to personalisation, capacity building and social care

reform has been studied and evaluated significantly since its inception in Western Australia in 1988.

Evaluation of LAC has followed its transfer of the approach to a UK context both at national/regional

level in evaluation of its implementation in Scotland16,

together with more recent reviews of pilot

implementation in English local authorities of Thurrock17

and Middlesbrough18.

Rather than revisiting the principles of LAC, this evaluation focuses on the effectiveness of its

implementation in the pilot areas and seeks to use a novel research approach in understanding its

deployment and operation.

The WB LAC Pilot Evaluation has been developed as a partnership between Western Bay, Swansea

University’s College of Medicine, and the Local Authority partners delivering the activity. This

partnership approach has been adopted to embed research, monitoring and evaluation into the LAC

activity thereby allowing deep insight into the work whilst also making effective use of resources.

The formative evaluation key components and aims are assessment of;

- Project design and implementation

- Outcomes at the level of individuals, families, community and system

- Benchmarking processes and achievements

- Recommendations for future development and expansion

As the LAC pilot is at an early stage, this formative evaluation is intended to support the

development and implementation of the activity, and to lay a foundation for ongoing evaluation as

intended benefits are pursued. The remainder of this section outlines the context, aims and

approach adopted for the evaluation.

The formative evaluation framework, presented on the following pages was drafted in December

2014 by the University as a result of discussions with Western Bay partners to support its

stakeholders in assessing effectiveness of LAC rollout across the region. The Institute of Life Science

16 Evaluation of the Implementation of Local Area Co-ordination in Scotland, Scottish Executive, 2007

17 Local Area Coordination: Fourteen month evaluation report, Thurrock Council, 2014

18 Evaluation of Local Area Co-ordination in Middlesbrough, Peter Fletcher Associates, 2011

26

(ILS) Scientia research group was engaged to undertake the research and evaluation work in

February 2015.

It was agreed that the first stage of the evaluation be completed and submitted by early September

2015 in line with the Local Authority planning cycle. The LAC Pilot study commenced on 1st

April

2015 and continues to date (September 2015). This interim report presents findings for the period

to until August 2015 with update reports at 6 and 9 months which will assess progress in delivery

and towards outcomes anticipated from this stage of the review. The formative evaluation will be

completed with an 18 month report drawing together review of the Pilot phase in each of the three

Western Bay Local Authority areas.

27

4.2 Framework Elements

The WB LAC Pilot Evaluation involves a number of elements which build up over time to provide the

overall Evaluation. Each element of this mixed method approach contributes to developing this

picture throughout the stages of the evaluation, as presented in the next section. The remainder of

this section outlines each of the elements, describing its contribution and the activity involved.

Expert Panel

Development and implementation of LAC since its inception in 1988 had created a wealth of

expertise and experience amongst practitioners and researchers, not least in Ralph Broad of

Inclusive Neighbourhoods who is supporting the WB LAC Pilot in Swansea and Neath Port Talbot.

The evaluation aims to make use of this expertise to assess effectiveness of delivery at key stages

through interview and review drawing upon data collected through each of the research elements.

Stakeholder Interviews and Focus Group

The effective engagement of key stakeholders during development and initial delivery is important

for the successful delivery of the LAC approach. The review will interview each stakeholder at key

stages to assess their expectations and involvement in the Pilot, together with a mapping of

relationships with other actors (see also Network Mapping below).

Network Mapping

Effectiveness of co-ordination is dependent upon the successful engagement and tangible activity

driven through individuals and organisations involved in delivering personalised support. A Network

and Relationship Science approach will map the development and activity of LAC across the network

of individuals and organisations in working together towards common objectives. The development

of this LAC-involved network across the region in terms of linkages, activity and sustainability will be

important in realising the LAC approach.

Beneficiary/360/Community Interviews & Case Studies

As LAC interventions are personalised and therefore have scope for significant variation, the context,

requirements, activity and outcomes of a sample will be followed through with in-depth interviews

with beneficiaries and those around them. These will be used to develop case studies from which

impacts can be assessed. These will be initiated through emerging stories prepared from case notes

of the individual coordinators.

28

Quantitative Outcomes Review

As LAC is intended to make more effective and efficient use of pressured resources, the insight

gained from the previous research elements will be used to identify and quantify benefits. Using

baseline data for costs avoided/incurred, the evaluation will aim to determine impacts for the case

studies. Working with key stakeholders and the Expert Panel, scenarios will be considered as to how

they may extrapolated across the wider community. This will be established over time, with early

stages of the evaluation process working to identify potential benefits, with the final report

providing a combined picture of the financial impact achieved.

The following table presents how these methods are combined to deliver against the aims and

provides a framework for both Formative and Summative evaluation.

29

4.3 Evaluation Framework Summary

Formative Evaluation Phase Summative Evaluation Phase

Evaluation Theme Pre-Deployment Deployment Ex-ante Ex-post

Process / Design Objective: Appraise plan/design against

LAC principles

Method:

Review local and published

international practice

Objective:

Review deployment of LAC

in pilot areas

Method:

Expert Panel Review using

Network Mapping data

(Delphi)

Objective:

Review delivery of LAC approach

in pilot areas

Method:

Stakeholder Interviews including

target beneficiaries and LAC and

Expert Panel Review using Case

Study Vignettes

Objective:

Review LAC implementation

and effectiveness

Method:

Expert Panel Review of

combined data

Outcome Aim: Define KPIs and Assess

Expectations

Method:

Review Leading Practice

Stakeholder Interviews

Aim:

Review activities against

potential for KPI progress

Method:

Stakeholder Interviews

Aim:

Review progress with KPIs for

pilot areas and

Method:

Stakeholder Interviews including

target beneficiaries and LAC and


Study Vignettes

Aim:

Review achievement against

KPIs

Method:

Case Study vignettes with

quantitative evidence and

Expert Panel Review

Individuals Objective: Capture

Requirements/Expectations

Method:

Semi-structured Interviews

Objective:

Measure engagement

Method:

Semi-structured Interviews

or survey

Objective:

Measure support

Method

Case Study vignettes from

follow-up interview

Objective:

Measure outcomes

Method:


quantitative evidence

30

Families Objective: Capture

Requirements/Expectations

Method:

Interviews by Coordinators

Objective:

Measure engagement

Method:

Interviews by Coordinators

Objective:

Measure support

Method:

360 style interview case studies

Objective:

Measure outcomes

Method:


quantitative evidence

Community Objective: Measure LAC Absorptive

Capacity

Method:

Local Network Mapping

(Density)

Objective:

Measure LAC engagement

Method:


(Density) developed

through survey

Objective:

Measure LAC activity

Method:


(Activity) developed from survey

and case study data

Objective:

Identify LAC structural

impact

Method: Local Network

Mapping (Density,

Connectivity and Activity)

changes

System Objective: Define LAC Ecosystem

Method:


(Connectivity)

Objective:

Measure LAC Ecosystem

Engagement

Method:


(Connectivity)

Objective:

Measure System LAC

Involvement

Method:


(Activity) developed from survey

and case study data

Objective:

Identify LAC structural

impact

Method: Local Network

Mapping (Density,

Connectivity and Activity)

changes

Benchmarking Objective: Identify leading/good practice Method:

Review of Leading

Practices/Practitioners

Objective:

Measure LAC Ecosystem

Engagement

Method:


(Connectivity)

Objective:

Review support performance

against expectations

Method:


Study Vignettes

Objective:

Review impact of LAC pilot

activities

Method:

Expert Panel Review of

combined data

31

5. The Leadership Group

5.1 Group Role and Membership

Previous evaluations and the LAC model have shown the role of the leadership group to be integral

to the successful sustainable progress of LAC (Scotland, 2007; Derby City, 2012; Middlesbrough 2012;

Thurrock, 2013). The Swansea Pilot has established this group including the following

representation:

- Councillors and Cabinet Members providing community perspective

- Implementation Manager for LAC in Swansea

- Projects Manager for Western Bay

- Assistant Director Swansea Council for Voluntary Services (SCVS)

- Representative from the ABMU Health Board

- Disability Development Officer (SCVS)

- Local Authority Housing Services

- Local Authority Adult Social services

- Local Authority Poverty and Prevention

- Local Authority Child and Family Social Services

Through interviews and a facilitated workshop, the evaluation work has drawn upon the Group to

define expectations, opportunities and challenges, and anticipated activities of the LAC

Coordinators.

The Group clearly identified LAC as being an opportunity for more productive and collaborative local

working within communities. The scarcity of resources was seen as a major challenge and threat.

Communication across the third sector was also regarded as a further issue in ensuring efficient use

of resources and avoidance of duplication of effort.

“We’re not evaluating the concept, we know it works. For me it’s about the Leadership driving

reform through Local Area Coordination, a strong functioning group driving the future. All colleagues,

all connected makes us stronger”

Ralph Broad, Inclusive Neighbourhoods

addressing the Swansea Leadership Group, July (2015)

32

5.2 Group LAC Ambitions

The Group was engaged to identify their short (first year), medium (18-24 months) and longer-term

(year 3 onwards) ambitions for the LAC Pilot activities in Swansea. The following sections outline

these objectives and activities with reference where appropriate to insight from this current and

subsequent stages of the evaluation.

Short-Term

Initial expectations for the LAC Pilot are familiarisation and engagement with their respective

communities. Alongside the establishment of administration such as record keeping systems, it

is also anticipated that a case load would start to develop as engagement leads to immediate

demand and activity. The importance for initial activities to identify and highlight success

stories to build momentum was emphasised, with improved quality of life outcomes the key

consideration.

Subsequent sections will show that good progress is already being achieved against all of the

above, with community assets being engaged and participant stories already evolving.

Medium-Term

Building on some quick wins in the medium term to catalyse further progress was identified as a

way of increasing momentum. By the medium-term, it is hoped that Coordinators will be well-

established within their communities, drawing on increasingly dense networks. Developing co-

production as the default approach to addressing challenges was perceived as the focus for

activities through to the medium-term, with Coordinators drawing upon a deep understanding of

individual and community needs.

The pooling of resources and creation of solutions within communities should be clearly

established as the modus operandi by this point with a changing though steady level of case-

load.

Longer-Term

Capacity building within communities to provide mutual support amongst individuals and

families was a core LAC ambition of the group for the longer-term. The ability of communities to

have greater internal engagement, preventing and addressing issues through local assets as a

norm, rather than through public services is the ultimate collective aim. Achieving a culture shift

from paternalistic statutory services towards more self-sufficient communities was anticipated

as the focus of Coordinator efforts through into the longer-term.

This perspective is particularly encouraging, as it clearly shows LAC being perceived by all as a

longer-term transformation rather than simply immediate additionality for social services. The

network mapping element in further stages of this evaluation will give particular focus to

whether this capacity is being developed and utilised.

33

In light of these ambitions, the feedback from wider stakeholders, and the review of prior LAC

implementations, it is clear that the strength and engagement of this Leadership Group is critical for

success. Therefore maximising this engagement at the earliest possible stage will help build the most

effective partnerships.

Recommendation

Strengthening of the role of the LAC Leadership Group through frequent attendance and

commitment to regular meetings, with expanded membership potentially including relevant

emergency services and community members.

Recommendation

Enhanced engagement of the third sector at the Leadership Group level to complement the

strong links being forged by Coordinators at the operational front

34

5.3 Implementation Management

Critical to the programme is the role of the Implementation Manager to establish and oversee the

start-up, recruitment, training and ongoing development of the programme and to play a key role in

the engagement with stakeholders, external and internal services, agencies and organisations.

The Implementation Manager, drawn from CCS Social Services was recruited into the role in

November 2014 to begin the set-up of the programme in Swansea. From interview undertaken in

this review, it is clear that the individual involved has a clear understanding and commitment to the

LAC ethos and approach. The manager has been responsible for overseeing recruitment of the

Coordinators and initial delivery activities.

This section presents insight gained from the UK Implementation Managers’ Forum, together with

findings from in-depth interviews with the Swansea Pilot Manager.

35

Recurring themes around implementation as discussed by Local Area Co-ordinator managers from

across the UK (May, 2015).

The managers from across the UK convened in May 2015 to share the successes and challenge they

had encountered during the implementation and scale out of Local Area Co-ordination. Many

themes were shared amongst several or all managers:

External Partners

• Boundaries remain vague or confused at times amongst Coordinators and other agencies

• Third sector have taken time to engage but are extremely valuable partners once on board

• Fire and police services also proven important partners for Local Area Co-ordination

• 'Professional friends' are a constant and significant challenge

• Great support from faith groups

Funding

• Funding an issue across local authorities, strong evidence base is a must.

• Funding cuts have raised concerns about the scope of LAC and whether it might put other

teams in danger of redundancy

• Constant pressure of budget constraints

• Salary is important for attracting the right people to the Coordinator’s role and retaining

them. A high staff turnover would be detrimental to the success and growth of LAC

Leadership

• Steering group/Leadership groups integral to success and sustainability of LAC

• The programme needs understanding and buy-in from those at a senior level

• Important for the Leadership group to convey the model to colleagues, areas of their work

and seniors.

Communication

• Difficulties with language, terminology, labels - these are a constant challenge

• Many in the councils now understand and appreciate what Local Area Co-ordination is but it

has taken some time and repeating of the message.

Scaling the Model

• The new Social Services and Wellbeing Act has had a positive impact to date

• Model certainly works but how do you expand it rapidly

An interview was conducted with the Swansea Implementation Manager for Local Area Coordination

in September (2015) to review how the implementation process was progressing. The responses are

redacted, however the salient points are presented with additional comments from the researcher

after cross-comparisons with interview data from Western Bay and the new co-ordinators

36

Question Implementation Manager Researcher Comments

Inception of LAC for

Swansea

Background and relation

to LAC

Challenges for

Implementation

We already had Community Connectors but knew we wanted to do more around

prevention. Several models were researched and LAC was favoured. It had a

structure, it seemed solid, it moved us away from the usual way we’d been doing

things and supports reclaiming the social work agenda.

I currently manage the Community Connectors. I started doing work on Co-

production and working with people is the bit I loved. LAC is what I thought Social

Work would be. I also knew how to project manage and set up. It was an

opportunity to get away from theory and do the practical. The ultimate driver for

me is knowing you can make a difference.

Changes at senior management level and then trying to demonstrate to the next

people that this is a good thing. Without senior level buy-in it goes nowhere. It’s a

big challenge.

Recruitment – Going through HR especially when it’s a different format of

recruitment. It was also a lot of work to get the community members together to be

on the interview panels. SCVS were brilliant because the organisational elements

were difficult.

Getting the Leadership Group to do the work, to share LAC with their networks and

raise the profile.

Getting into the Hubs to build the message.

Recording data of who we are engaging with – questions around is it really

representative?

The Community Connectors

initiative has paved the way for

LAC and highlighted the need

for greater coverage

Both Coordinators and

Implementation Manager

mention the return to

interfacing significantly with

people as a primary objective

and appeal of the role.

Furthermore, the opportunity

to make a positive impact is

also echoed by both parties.

Change at Senior Management

level is also an issue mentioned

by previous evaluations and

Western Bay. Raising the

profile of LAC is also a key issue

for buy-in, engagement and

sustainability. Accurate and

effective data recording is

recurring theme mentioned in

the Coordinator responses.

37


Early responses to LAC It varies from really positive responses, for example some of the Councillors who

really get it and champion it through to ‘seen it all before’ and ‘how is this going to

work?’ from some colleagues. The public get it (the model) straight away. Some

professionals do seem suspicious of it and it has been described as a ‘cult’ - it has

its own language etc.

Additional support for LAC Community members have been incredible, Councillors on the whole have been

brilliant and many connecting us up. Some GP’s but it’s a work in progress, the

libraries, Child and Family Team and Supporting People have been great with

practical support.

Perceptions of LAC That it’s like every other community and social working initiative out there, that it

has restrictions around age and client group, that it’s just like what they do.

Once again Councillors are

mentioned as a key support for

the model. The mention of LAC

being a ‘cult’ like entity is also

reflected by Coordinator ‘A’ .

There are themes around

communicating and

understanding the model for

colleagues, services and some

external entities.

GP’s and particularly Practice

Manager’s have been cited as a

useful asset for LAC. As

mentioned by all 3

Coordinators, the libraries are a

key source of support

This sentiment is echoed by the

Coordinators and in an

interview with Western Bay

Role of the Leadership

Group

Training - what was

effective?

To shape what we do but critically, to promote LAC in their own forums. They must

have a strong understanding of LAC to do this. They are also there to question it and

provide contacts to progress and support funding efforts. They are there to provide

their knowledge and expertise to enable us to do it well.

Ralph was integral. Going to meet other Managers from LAC sites in the UK was also

very useful.

Emphasis on the importance of

having a strong and committed

Leadership Group

As with all 3 Coordinators,

Ralph’s support and

contribution at this stage is

viewed as critical to the

training period.

38


Training needs There’s something missing about the practical side, but we are learning on the job.

It’s missing ‘lone working’, maybe some more ‘safeguarding’ but we don’t want to

be completely risk adverse and ‘bereavement’.

Coordinator ‘B’ also mentions

‘Safeguarding’ . Coordinators

‘A’ and ‘B’ both have Tier 2

cases with bereavement at

their core.

Helping LAC in the Short

term

Having stories of success but it’s only been three months.

Having publicity and getting the right message across

Having and maintaining buy-in from senior management

Having representation from health on the Leadership Group as well as Police and

the Fire Service.

Stories- The value and impact

of stories is integral to the

evidence base for LAC in

Swansea.

Publicity -The use of Social

media as mentioned by all 3

Coordinators may assist getting

the message out there

Buy-in - Western Bay also

recognise the importance of

senior level buy-in

Leadership – Widening the

membership of the Leadership

group to include important

services such as Fire and Police

have previously been

evidenced by other pilot sites

Additional Comments I feel fortunate in that I’ve been given the space to project manage and implement

LAC in the way it was designed. We’ve been allowed to get on with it.

Being given autonomy to

develop in the role was also

touched upon by all 3

Coordinators. Coordinator A

also felt that remaining true to

the original model design was

important.

39

5.4 Local Area Co-ordinators: Recruitment and Training

The Swansea implementation embraced the ‘citizen-centred’ recruitment approach which involves

members of Pilot area communities. This provides immediate engagement and supports rapid

development of both trust and progress.

Job adverts for Local Area co-ordinators were posted on 30th

January 2015 on the Guardian Website,

Jobcentre Plus website, City and County of Swansea internet and intranet websites. It also went out

to the voluntary sector via Swansea Council for Voluntary Service (SCVS). The closing date was 13th

February 2015 and Swansea City Council received 60 applications in total, 12 were shortlisted and 11

interviewed (one person dropped out on the morning of the interviews).

During this time, a member of Swansea Council for Voluntary Services was integral in convening

community representatives to act as interview panel members for each of the chosen areas. This is

an important and effective component of the model as these representatives are connected to the

local context and will arguably have greatest appreciation of their community needs, assets and

challenges as well as an understanding of the candidature who might be the best ‘fit’ for their areas.

Furthermore, the representatives act as a ‘springboard’ for new co-ordinators and are key in plugging

them into existing community networks.

Local Area Co-ordinator interviews took place in April and were held at the national pool for the

Sketty appointment, the local Community centre in Port Tennant for the St. Thomas and Bonymaen

appointment and in the local Asda Community room for the Gorseinon appointment. The Gorseinon

group could not reach a majority agreement on a candidate and therefore a second interview took

place. In total three candidates were selected, one for each area and commenced training on 1st

June 2015. Two candidates had previous experience in social care and the other as a community

leader.

40

5.5 Initial Delivery

The recruited Coordinators completed a month long training programme (June, 2015) which has

provided them with the skills and understanding to deliver LAC activities. They commenced work on

a full-time basis at the start of July 2015 and have therefore been active for just over two months at

the writing of this report. During the period to date, the three Coordinators have engaged with

community assets, and worked in support of individuals and their families.

As LAC is a person-centric approach, the crux of the delivery is the individual interactions. The

remainder of this section provides feedback from Coordinator interviews together with a digest of

example interactions demonstrating the nature of the interactions undertaken by the coordinators

to examine alignment with LAC principles. To maintain privacy of those involved, these stories have

been anonymised, and the section will be further redacted in versions of this document intended for

wider dissemination.

41

Question LAC ‘A’ LAC ‘B’ LAC ‘C’ Researcher Comments

Background and relation

to LAC

Social Worker for Adults with

learning difficulties then

became a housing case co-

ordinator

I had facilitated a peer

advocacy group for adults with

learning difficulties giving

them a voice. I’d been a

teaching assistant before that

which taught me patience!

Been a community leader,

previously a community

Policeman. Community and

Race Relations – LGBT, faith

groups etc. Then went to work

for the Church

Two Coordinators had

previous social care

backgrounds working with

Adults with learning

difficulties. The other had

substantial experience of

community work.

Awareness of the role I found out about the role

through the Swansea City

Council Bulletin

Third sector jobs website Family member saw it

advertised and notified me.

Awareness of role accessed

by various methods.

Appeal of the role It was the reason why I

became a Social Worker,

working face to face with

people

It sounded perfect; it was

trying to address everything I

was worried about and

countering it. It was also about

doing the small things that

make the big changes.

I get to carry on doing the sort

of things I’ve done previously

and make an impact on the

community where I live.

Interviews revealed the

appeal of working with

people and saw LAC as the

opportunity to make a

positive change for

individuals and the

community

Understanding of LAC I got the ethos straight away,

it fitted with my previous

experience and knew it

required a certain type of

person – empathic,

relatable, sociable and saw

that Community is stronger

together

When I read about LAC it

came across clearly. I read

around it and took time to

look at it. There was nothing

muddy or murky about it.

It did take some work. I’d

never heard of it. I did a lot of

reading and went to visit two

LACs working in England which

helped. I can understand you

either get it or you don’t. It’s

very different to Services. For

me it’s connected to having

that social awareness and

passion for community.

Two of the Coordinators felt

LAC required some reading

to fully understand the

model.

42


Importance of community

leaders during/after

interview

Very important, I met with I engaged with some of the Yes, very beneficial. Two were

some members very early on group but not as much as I’d away but I visited all of them.

and they introduced me to liked to have because one fell The Curate at the Church has

faith groups, Schools, the ill. I’ve been linked to the been key in connecting and

Foodbank, community hospital gardening project, building the Community

centres and sports clubs ‘Time to meet’ and the local Orchard. I also met with

Institute even got me a room Mandy who runs the winter

as a part-time base homeless project, that was

good to start with the

leadership in the community.

It was good to start

conversations saying you’ve

been chosen by the

community.

All felt the interview panel

members played an

important and valuable role

in getting them started in

their prospective

communities. Community

leaders were able to link

them into networks quickly

and effectively.

Getting started in the

community

I went to the local library

very early on which was a

huge source of information

and they were very

knowledgeable about what

was going on in the

community

As well as introductions from

the community leaders, a

mixture of arranged formal

meetings with community

teams, drop-ins at the

community centre and the

local pub. I’ve started a

Facebook page and uploaded

a Google map which shows

where things are happing in

the local community

The library has been key as

has a sheltered

accommodation place, a

coffee shop, shops, post

offices and hairdressers. The

local community centre as

well. Jane has taken us to

loads of group meetings with

key organisations – housing

associations, SCVS, Council

groups and Community

Connectors.

All of the Coordinators

mention the library as a key

centre of community

activity (Coordinator B

mentions this in some of the

stories he’s shared).

Hairdressers are mentioned

by Coordinator C but also by

Coordinator A in one of the

stories. Formal group

meetings arranged by the

Implementation manager

with other community

teams have also been

43

beneficial for others

understanding LAC.


Challenges and barriers so

far

People (services)

understanding what LAC is

about, they don’t see the

blurred lines where we can

work together. I guess

they’re still sizing us up.

Nothing major, some GP’s

surgeries haven’t responded

to emails and the Youth

Workers have been very

reluctant to respond and meet

up.

It’s about getting us known, to

be high up on the list of

resources for people – that’s

the biggest barrier. Being a

face people know. Part of that

is our responsibility to keep

pushing the message, the

other is the Implementation

Manager’s to push senior

management to see the value.

They need to be encouraging

other teams to use us.

Challenges include visibility,

communicating ‘the

message’ of LAC;

understanding the

boundaries and a

willingness by external

groups to respond and

engage with the

Coordinators.

Early responses to LAC I’ve had connections from The frequent thing people say I met with local Councillors

Councillors, hairdressers, is ‘Oh that’s what we do’. very early on and they were

and newsagents. I’ve made Once they understand more very encouraging. Some

64 connections since mid they can see the value and haven’t managed to ‘get it’ as

July. SCVS, Mental Health scale of what we do. Others much as we’d hoped.

Co-ordinators, Libraries, say ‘Why has no one been

Swansea Park’s Network doing this?’ and ‘What can we

have all been great. do to help?’ They’re not

getting paid, they’re just

happy someone’s taking an

interest.

Early responses to LAC are

on the whole positive. There

is support from many of the

local Councillors,

community businesses,

organisations and local

groups. However, there is

the need to get the message

of what LAC does across in

order to clarify that it is not

the same as existing social

and community activity.

44

Question LAC ‘A’ LAC ‘B’ LAC ‘C’ Researcher Comment

Perceptions of LAC Some in Services have said

LAC is like a ‘cult’, it has a

model, it’s separate, has its

own terminology, even

Guru’s, it’s competition etc.

until you tell them a story

and then they understand

It’s been 99% positive from the

people in the community.

People love someone who can

listen and who takes an

interest.

Some have said ‘what you’re

doing in the community is like

40 years ago’ building strength

and people looking out for

one another – I’ve heard that

several times now. On the

other hand I’ve also had

‘that’s what we do’ from OT’s

and Community teams. I’ve

also had a Social Worker say

‘That’s what we should be

doing’.

The comparison of a ‘cult’

was also supported by the

Implementation Manager

during interview. The issue

of terminology is also

echoed by the

Implementation and UK

Managers as a challenge. All

verify a positive response

from the community.

Recording your work I’ve been putting everything

down in a spreadsheet.

Trying to keep on top of it. I

make short stories of

everything but I have more

success using spreadsheets

and the Google map.

It’s manageable at the

moment but do need a

system. I’ve got a spreadsheet

with all the contacts but I’d

love to find some good

software. I use EverNote as

well because you can tag

keywords.

At present it appears that a

spreadsheet database is the

most favourable until

something more ‘fit for

purpose’ is developed. UK

Managers are currently

investigating suitable

alternatives.

Training - what was

effective?

Ralph Broad was integral to

my training, his sessions

were excellent and well

worth attending

First 2 days very inspiring,

definitely the best. Jane and

Ralph were inspiring. Met the

other Co-ordinators and we all

Ralph has been good and very

useful, he embodies the ethos

and values. Those training

days were great. Giving us

Ralph Broad was integral to

the training process. This

response was also

45

brought our previous time to chat in the team was

experiences. also very useful.

supported by the

Implementation Manager.


Training – What was not? One external workshop was On reflection one session My frustration is with the

too risk adverse and flew in wasn’t inspiring but I guess it database and forms. We still

the face of what LAC was defined the middle ground not sure what we’re using.

about. It didn’t feel like I between Ralph enthusiasm

could have natural and the other trainer’s

conversations if I followed measured approach.

her method

Feedback given expressing

what each felt was missing

from the training session or

what did not inspire them in

their roles

Training needs Not that I can think of Safeguarding training earlier

on might have been beneficial.

Maybe add Mindfulness

training?

It would have been useful to

have the database and forms

up and running at the start.

No phone and no laptop until

a month after I started.

Safeguarding as a training

need mentioned by

Implementation manager

and LAC ‘B’

Role of social media in LAC Very important for LAC but Once we receive approval for I’ve helped to write a business

the Council are sceptical. official work Facebook and case for us to have Facebook

We’ve had to put a business twitter accounts it will be a and Twitter. It’s important

case together to use it. I’ve vital resource to make links because there are no

got 37 groups on my with individuals, groups and Foodbanks or Job centres

Facebook account and get organisations as well as being where you know there are

instant updates. a central place where we can people in need here. It’s not a

share information regarding conversation they’re used to

where we will be, things that having.

are happening in the

community, resources people

can access, groups that they

can attend. As soon as the

All of the Coordinators feel

that social media plays a key

role in supporting what they

do. This maybe particularly

useful in more rural and

middleclass areas where

many are not used to

accessing support. It

appears to be

46

Google map went public on

Facebook I received messages.


The most difficult part of

LAC

The ability to pull in services Walking into a group for the At the moment -it is already

established in first time, particularly without introducing myself and the

Swansea and retain the having arranged anything role and being proactive in all

ethos of LAC without beforehand. I’ve had to have the conversations with

compromise. Most have the confidence to introduce shopkeepers, community

wanted part of LAC without myself to a whole host of contacts etc. In my area

committing to the model people and tailor the LAC people seem to be more

wholly or they have claimed message for people from all private and the area is new to

they are already doing the walks of life, career paths and me. This isn’t unexpected, just

role in their service. needs. hard work, as we are building

the bases of relationships.

Also because the role is new

other council colleagues have

not yet seen the benefit of it,

or experienced it, so it takes

energy and time to explain.

For two of the Coordinators

it’s becoming comfortable

with introductions,

conversations and

understanding. It is still

early and LAC is very new to

the area.

The best part of LAC When people ‘get it’ and

they are inspired, as we are

as workers, by it. People

finding their feet and

methods of sustainable

support and help is joyful in

a way that focus upon

problems, issues and needs

of support are not. People

often take a little but want

I have been surprised with the

amount of people who’ve not

only been receptive to LAC but

who’ve said straight away

“What can I do to help”. I’ve

been privileged to have had

people share details about

their lives with me. It takes a

lot to invite a stranger into

your home and talk about

Best part is working within the

LAC values and principles

especially not being time-

driven, not having to meet

short term targets, and having

different attitudes in the way

we approach our work.

Both Coordinators mention

the willingness of people

asking how they can help,

this is a core component of

the model and contributes

to building self-sustaining

solutions and community

resilience. The autonomy of

47

to give more back your mental health,

disabilities, losses that you

have suffered, as well as

exploring your hopes and

dreams.

the model but also the

autonomy allowed by

management is key to

developing the way

Coordinators work and build

relationships.

Question LAC ‘A’ LAC ‘B’ LAC ‘C’ Insight

Additional Comments Having IT support ready and

aware of the demands of the

role would be beneficial

rather than spending weeks

on bureaucratic processes

which keep LACs from their

locality.

Having a database sorted on

which to record and map out

day to day other than the

story template currently

used.

The continuing cooperation of

other organisations and

agencies is important to our

success. For them to believe in

LAC as much as we do. Most

of the early work has been

networking, resource

mapping, information

gathering, etc. This is all the

ground work that must be

laid, to build on in the future

and ensure a good knowledge

base and support network.

This will plateau and most of

our time will be devoted to

one to one support. The

continued promotion of the

project to ensure we never

stay still and we are

continually learning and

developing will also be

essential. The great

management structure that is

LAC would benefit from a

higher profile – both in council

publications and local

newspapers etc. Also it will

need overt support from

senior management for it to

succeed.

LAC ‘A’ and LAC ‘C’

(identified in training needs)

that IT support and a ‘fit

for purpose’ database was

not available to them at the

outset.

The role of senior

management is also echoed

in interviews with Western

Bay and the Implementation

Manager.

48

already in place must also

continue. I’m imagining a stage

in the future where walking

down the street is like walking

into the bar in Cheers, where

everybody knows your name.

Local Area Co-ordination - Swansea

Emerging Stories

Formative 3 month Evaluation

June-August 2015

STRICTLY CONFIDENTIAL

These stories are not to be circulated or distributed, these contacts are still developing and

their stories emerging as the Local Area Co-ordinators build relationships and gain further

insight into the individual’s vision for a ‘good life’.

Names have been changed to protect the identity of the individuals

49

50

Nigel’s Story

“I want to do more with my

life before I go”

Source of Initial Contact:

Introduced to the Local Area

Co- ordinator by the

Community Mental Health

Team

I

Introduction

Nigel is a 70 year old gentleman living independently in the

local community. The Community Mental Health Team

(CHMT) had been supporting Nigel for several years

following a breakdown and had helped him to move to

sheltered accommodation. He was about to be discharged

from the team, who felt that he would benefit from LAC

help in socialising and meeting new people.

Nigel’s

Situation

The Local Area Coordinator met with Nigel and took time to get to know him. They talked

about his past, his current situation and what was important to him and what a good life looked

like to him. He is in a stage of reappraising his life, and said “I want to do more with my life

before I go”. He was planning to start taking up exercise again. He takes long walks regularly

and has reduced his visits to the local pub. N i g e l also wants to stop smoking. He is keen to

meet more people, and maybe go on trips.

What Happened?

The Local Area Coordinator took time to find out Nigel’s interests which included doing some

voluntary work. The CMHT worker had identified an opportunity working at the local woods

which he was pursuing.

Nigel and the Coordinator also discussed computer training, although Nigel recounted that he

had had a negative experience of being taught in a large group. The Coordinator also suggested

getting out to a coffee morning where Nigel could talk to more people. It was suggested that

as Nigel has a car, he may be able to collect another person that the Coordinator is already

supporting, who is visually impaired and finds it hard to get out. Nigel was agreeable to this.

Follow up and next steps

The Coordinator has connected Nigel with a member of a local church who also has an interest

in cooking and who will visit Nigel regularly. The Coordinator is researching one-to-one

computer training for Nigel, which would provide another connection, and an opportunity to

learn new skills. In addition the Coordinator has connected Nigel with an older lady living nearby,

who needs support after a fall. Nigel will visit and accompany her to the shops to help her grow

confidence to go outside independently.

51

Gwen’s Story

“I’m not much of a joiner”


Local Area Coordinator met

Gwen at the local community

centre and discovered she was

visually impaired and

looking for activities.

Introduction

Gwen is a woman in her 80s who is vision impaired and

has recently lost her husband. She lives on her own in the

same house she has occupied for nearly fifty years. She has a

daughter locally who visits once a week. Gwen would like

more things to do, but isn’t keen on joining groups.

Gwen’s

Situation

The Local Area Coordinator met Gwen at the Community centre when she attended with her

companion from RNIB. They were looking for activities at the centre but there was nothing

going on at the time of their visit. As they were inspecting the notice board, the Coordinator

asked them what they were looking for and was able to explain about local area coordination.

As a result of that conversation, the Coordinator was able to meet with Gwen a few days later to

discuss Local Area Coordination and how it may help her, and Gwen felt that a

further conversation would be useful.

When the Coordinator visited Gwen at home, he asked her about her life currently; Gwen gets

help from the companions from RNIB, but would enjoy talking to other people. G w e n has a

good relationship with her neighbour who is great but works and so isn’t around very much. She

used to love sewing and knitting but finds this impossible now her eyesight has deteriorated. She

also has a gardener to cut the grass, but is concerned that the bushes in the garden are growing

too high and obscuring her view of the road outside, and contributing to her feeling isolated. She

describes herself as ‘not much of a joiner’, having been an only child, and so is less interested in

joining groups, especially those that are just for other vision-impaired people.

What Happened?

The Coordinator visited Gwen again, where he got to know her further and she was happy to talk

about her life, her past but also what she would like to do in the future. A visit from Swansea

Vale Resources Centre staff to help her be more confident about going out and using buses etc.,

was planned but unfortunately she was not up to it. She indicated that she may be up to learning

braille and also finding some way to be involved in knitting/sewing - that could be with

someone else who she could teach or help and use her vast experience and skill to pass on to

another


The Coordinator is finding out about local knitting/sewing possibilities and also about braille

lessons. He will be connecting her with the sensory services team and RNIB for this, and he has

made a couple of other local connections who would be interested in meeting up with her for

coffee. One of these other connections can drive, so may be able to provide transport so she

can get there.

52

Eira’s Story


This introduction came from a

Social Worker who the Local

Area Co-ordinator met in one

of the Local Hubs where he

goes to complete his

paperwork

Introduction

Eira has a history of cancer and has recently been diagnosed

with Parkinson’s disease. She is also on medication for

depression and complains of constant pain. Her health

problems have been exacerbated by issues with a

neighbour. This has left her anxious about being in her

home alone and she has lost confidence in going out.

Eira’s

Situation

Eira has overcome serious illness in the past and unfortunately has recently been diagnosed with

Parkinson’s disease. There have also been complications with previous surgeries which have left

her in constant pain.

Last March Eira experienced a serious physical attack which left her fragile and nervous. Eira

now feels anxious about staying at home alone but has lost confidence in going out.

Eira’s social worker felt that she wasn’t in need of physical services, but she is in need of

emotional support and reassurance. The social worker also felt that Eira may benefit from

activities she could participate in to help her get out of the house and reduce her feeling of

isolation

What Happened?

To date, the Local Area Co-ordinator has met with Eira on several occasions. He took time to get

to know her and listen to her story and the things she was concerned about. Eira lacks

confidence and has been very nervous but appreciated the visits. The Co-ordinator has been

able to help Eira be less anxious by dealing with some utility paperwork that she was confused

about and continues to help with letters she receives. He has also liaised with the tenancy

support unit to whom Eira was referred.


The Coordinator will be working alongside Eira and the partner organisation to identify a new

flat for her to move into. She currently feels too scared to stay in her home since the incident

with the neighbour. This will also involve helping her with accessing benefits. When she feels

well enough the Coordinator will introduce her to a coffee morning in a local park which is run

by volunteers. This will connect her with others as well as supporting a local community run

project

53

Emma’s

Story

“I don’t want to talk to

anyone, they’ll take my

kids away”


Manager of a local corner

shop

Introduction

Emma is a young mother with three young children. She is

recently bereaved, isolated and struggling to cope. She is

not sleeping or eating properly, her children are also

grieving and she lacks familial support. E m m a and her

partner signed a new tenancy agreement just before he

unexpectedly passed away and she is concerned about how

she will manage alone with the property. Emma wants to

help her children with their grief, resolve her housing issues

and gain control once again.

Emma’s Situation

The manager of the local corner shop suggested Emma would benefit from a visit from the

Local Area Coordinator as the family would be reluctant to be approached by a ‘service type’

person fearing this might lead to the family being split up. The Coordinator took the time to

explain their role and they agreed to meet at her home.

Emma explained that she had lost her partner suddenly a month ago. Since then, she has moved

in with her mother and describes their relationship as ‘up and down’. Emma is not eating or

sleeping much, she feels drained and numb. Emma and her partner recently signed a tenancy

agreement for a new property. It has no heating, flooring and is unfurnished, it feels empty and

cold. A friend has told her if she seeks help from Social Services they will remove the children

and people will see she cannot cope. E m m a became very emotional when talking about her

children who she thinks may have autism or ADHD. Emma feels she and her children need help

dealing with the loss of her partner. She went to the local library to borrow some books on grief

but someone asked her how she was and she burst into tears and left. She also is worried about

her new tenancy and the property.

What Happened?

The Coordinator went to the library and collected 3 books for Emma. The library was able to

offer support through a ‘Mums and Toddler’ Group held there which Emma signed up for. The

books have helped her children start to talk through their toys about their feelings and ask

questions. The Coordinator put her in touch with her local housing officer to get the remedial

work done on the house and found information on benefits and entitlements. Emma was

encouraged to visit her GP to talk about her and her children’s situation.


Emma is on a waiting list for Counselling with Cruse Bereavement and has discussed the idea of

an assessment for her children for Autism and ADHD. She is grateful to have the Coordinator to

talk to and doesn’t feel judged or pressurised. The Coordinator has also agreed to accompany

Emma and her children to the Mums and Toddler group on their first day

54

5.6 Network & Relationship Science Approach

Network science uses the relational linkages between individuals, organisations, and other actors to

inform methodology and research across a wide spectrum of fields including the understanding of

social interconnectedness

Swansea University’s Network/Relationship Science Analytics programme is a partner with IBM's

Network Science Research Centre (NSRC). IBM’s NSRC is collaboration among scholars and

researchers from IBM, Swansea University, MIT, Harvard University, Brown University, Columbia

University, and other organisations, and it provides access to practitioners and subject matter

experts as well as pertinent information regarding information technology that can be applied to

advancing several societal missions such as advancing environmental sustainability, promoting

global security and stability, and to transform the way we live and work as well as to improve the

human condition – one person, one city, one nation at a time.

With this in mind, the researchers incorporated some of the principles of relationship science into

the evaluation methodology in order to assess the effect of LAC upon community networking and

potential resilience. By identifying the eco-system of assistance accessed by individuals at the start

of the project and mapping the interactions and their effectiveness created by LAC (or lack thereof)

the researchers hope it will provide a clear picture of its impact across the region.

The approach identifies assets and individuals, charting the relationships established between them.

This is recorded by the Coordinators in field notes and case studies. A simple characterisation and

hierarchy of relationships is used to chart their development, as shown below;

1. Initial Engagement (red)

2. Sharing of basic information (purple)

3. Collaboration in achieving a goal (green)

4. Successful co-production outcome (gold)

The networks and relationships are presented graphically with maps19

using points to represent

assets/individuals and lines between them of different colours to represent the hierarchy of

relationships.

19

At this early stage, non-geographic maps are used to maintain anonymity of individuals engaged due to the

relatively low numbers involved

55

5.7 Emerging Network & Relationship Highlights

The Pre-Deployment phase use of the network and relationship science approach has focused on

establishment of connectivity between the LAC Co-ordinators and local assets. Despite the relatively

early stage of deployment, it can be clearly seen that all areas have seen not only a growth of both

asset and supported individual networks, but also evolving relationships demonstrating activity

across these networks.

The following network map presents progress in establishment and activity across community

networks in one of the three Pilot areas (the remaining two are in preparation). The ‘Initial’

position presents an outline of identified community assets, with the ‘Current’ map showing

the level of connectivity achieved to date.

Area 1 – Initial Area 1 – Current

56

The above network map demonstrates a clear progression, with the Coordinator engaging effectively

with community assets in the Pilot area (i.e. number of lines and connected nodes). It is most

encouraging also that even at this early stage there is tangible activity underway as well as

connectivity being established. There is a high level of centrality around the Coordinator as data

collected is relatively limited, though case studies will be able to inform in future whether density

increases over time.

Finding

The initiation of the project has progressed well, with a team of Coordinators making good

progress within their respective communities

Update reviews and the final report will examine how this network has developed both in terms of

connectivity and activity. This will establish whether LAC is not only engaging across the targeted

community but also making effective use of assets therein.

57

5.8 Financial Perspective

As described in earlier sections, many of the anticipated LAC benefits, and in turn their financial

impacts, are ultimately a complex aggregate of savings achieved through prevention of issues

developing into need for resource-intensive services. Establishing additionality is also challenging as

each interaction is unique and working out what would have happened without intervention risks

being mere guesswork.

Furthermore, significant targeted benefits are intended as longer term and indirect. For example,

interventions supporting vulnerable individuals into work run straight into the proven links between

poverty, employment and health. The result of such positive outcomes is benefit through both

reduced welfare expenditure and future health service costs - in addition of course to the personal

and social benefit. Therefore, only professional insight and personal/family/peer reflection on a case

by case basis to assess the counterfactual missed prognosis for a supported individual can help

establish what costs may have been avoided.

Available service unit costs from Government20

and academic21

research, or other appropriate

benchmarks for avoided service requirements, together with further quantifiable benefits allow a

level of assessment of individual cases which can be aggregated or appropriately extrapolated.

The early stage of interactions makes it challenging to quantify benefits as insufficient data are

available. However, the case studies developing around individual interactions allow the nature of

services use already avoided through LAC interventions, and their planned outcomes to be

identified. Encouragingly these already demonstrate both emerging and planned benefits for

individuals, together with interventions targeting entire groups within communities.

The following table lists those identified as already happening (Emerging) and those targeted by

existing engagements (Anticipated and Potential).

Emerging Benefits

- Avoided calls upon Social Worker support (Adult Services)

- Avoided General Practitioner Visits

- Avoided calls upon mental health services

Anticipated Potential Benefits

- Potential employment (with associated benefits to UK central government)

- Avoided Community Nurse visits

- Avoided/Delayed transition into residential care or nursing home

20

Personal Social Services: Expenditure and Unit Costs, England, 2013-14, Health & Social Care Information

Centre, 2014 21

Unit Costs of Health & Social Care 2013, Personal Social Services Research Unit, The University of Kent, 2013

58

- Avoided Home Care Visits

Encouragingly, the albeit limited delivery undertaken to date has already resulted in both Emerging

an Anticipated Potential benefits mapping well against those hoped for by key stakeholders.

There is of course the perspective that LAC may introduce individuals to use of service which would

not have occurred otherwise, resulting in new costs. However, on the basis that earlier interventions

provide more effective and cost-effective resolution of issues this would be more likely to provide net

benefit than simply being regarded as additional cost.

Further stages of this evaluation will draw further upon experienced Social Worker and case review

to assess benefits achieved, avoiding any optimism bias during the quantification of benefits. The

update reviews will provide a compendium of stories with 360o

interviews to assess additionality.

These will be used to identify whether the Anticipated Potential Benefits have been achieved and

quantify their value. The final report will then use these combined data to provide a perspective for

the wider LAC Pilot impact.

In terms of cost, the Swansea LAC Pilot Implementation is approximately 200k for twelve months,

inclusive of Co-ordinator and other management costs. This is comparable with other benchmarks

for delivery and will be tracked against the scale up of delivery and benefits achieved during the

further stages of this evaluation.

Finding

LAC has the potential to make a valuable contribution to communities in Swansea, with benefits

already emerging from these very early stages of delivery

59

6. The Findings

This early stage report provides a high-level initiation review which will be used to build up the

evaluation over coming months as the LAC Pilot is delivered. However, as detailed in earlier sections,

a number of emerging observations and recommendations have been identified and formulated.

These are as presented in the tables below’

Finding

The LAC model complements existing support services, though must be clearly understood as a

medium-long term community resilience effort rather than risk being perceived as rebranding of

social services

Finding

The initiation of the project has progressed well, with a team of Coordinators making good

progress within their respective communities

Finding

LAC has the potential to make a valuable contribution to communities in Swansea with benefits

already emerging from these very early stages of delivery

Recommendation

Continued commitment to the approach would support the approach building trust and

meaningful engagement for what is a long-term ambition rather than quick-fix

Recommendation

Strengthening of the role of the LAC Leadership group through regular attendance at meetings,

with expanded membership potentially including relevant emergency services and community

members.

Recommendation

Enhanced engagement of the third sector at the Leadership Group level to complement the

strong links being forged by Coordinators at the operational front

60

Further findings drawn from triangulation of the datasets collected include;

• Many of the themes raised by the UK Managers have since been echoed in interviews with

Swansea’s new Coordinators and Western Bay. A comprehensive understanding of Local

Area Coordination would further assist in clarifying boundaries, building partnerships and

encouraging joint working as potentially exploiting additional funding streams.

• Whilst some members of the third sector in across the Western Bay region have been a

significant support, a wider affiliation is a work in progress. A small number of third sector

colleagues have been hesitant or even reluctant to engage - a theme echoed across UK

Managers and throughout the data we have gathered. Further research needs to be

undertaken to understand the causes underpinning this finding.

• Increasing pressure on resources and availability of funding has increased the need for a

convincing evidence base. However, as this model’s ‘slow-build’ approach is integral to its

ethos, significant evidence will take time to gather.

• Increasing pressure on resources and availability of funding has also put constrains on other

community and social initiatives supported by the local authority. This has contributed to

some of the negative perceptions of LAC, in that it has been viewed with suspicion or seen as

a repetition of existing initiatives

• The role of the Leadership group is widely viewed as integral to the success and

sustainability of LAC. Its ability to influence and convey the message of LAC into its nuanced

networks and forums along with its ability to unlock barriers and progress the programme is

key for Western Bay, UK Managers and the Swansea LAC team.

• Senior leadership and buy-in is also related to systems change and service reform and the

encouragement of joint working and greater co-production.

• Language and terminology has been raised as an issue. The model does indeed have its own

terminology which for some sets it apart from the mainstream.

• Centres of community activity or those entities that are passing on referrals to the

Coordinators e.g. the local libraries may add an additional level of insight to the Leadership

Group.

• Whilst the membership for the Leadership Group covers a broad range of areas, regular

attendance and commitment is imperative to maintain momentum.

• The need for a clear and cohesive method of recording data is required not only in Swansea

but this was an issue expressed by the UK Manager’s.

• LAC is a ‘slow-build’ model therefore short-term funding will not give it the time to develop

and fulfil significant potential. This approach requires longer-term investment to appreciate

its potential.

• Understanding and communicating the model is essential for it realise its aim of becoming

a front end service. Social media has an important role to play as well as the leadership

group communicating LAC in their individual fora.

61

8. References

1. Social Services and Well-being (Wales) Bill, Approach to Implementation. Welsh Government, 2014.

2. The Social Care and Well-being (Wales) Act 2014, legislation.gov.uk/anaw/2014/4/contents, 2014

3. National Guidance on the Implementation of Local Area Coordination, Scottish Government, 2008.

4. Local Area Coordination: From Service Users to Citizens. R.Broad, Centre for Welfare Reform, 2012.

5. People, Places, Possibilities; Progress on Local Area Coordination in England and Wales. The Centre for

Welfare Reform, 2015.

6. Evaluation of Local Area Coordination in Middlesbrough: Final report. Peter Fletcher Associates, 2011.

7. Local Area Coordination, Fourteen month evaluation report. Thurrock Council, Inclusive

neighbourhoods, 2014.

8. National Guidance on the Implementation of Local Area Coordination, Scottish Government, 2008.

9. Mid-Year Estimate 2014, www.swansea.gov.uk

10. Population and Household Projections, Briefing Note, Welsh Government, 2011.

11. Life expectancy by local authority and gender, StatsWales, Welsh Government, 2015.

12. Measuring Inequality, Trends in mortality and life expectancy in Swansea, Public Health Wales

Observatory, 2015.

13. Communities First Clusters and Communities, City and County of Swansea,

www.swansea.gov.uk/communitiesfirst

14. Annual Report 2014, Director of Social Services, City & County of Swansea

15. PSSRU 2010 research cited, Care in Crisis 2014, Age UK, 2014

16. Evaluation of the Implementation of Local Area Co-ordination in Scotland, Scottish Executive, 2007.

17. Local Area Coordination: Fourteen month evaluation report, Thurrock Council, 2014.

18. Evaluation of Local Area Co-ordination in Middlesbrough, Peter Fletcher Associates, 2011.

19. Personal Social Services: Expenditure and Unit Costs, England, 2013-14, Health & Social Care

Information Centre, 2014.

20. Unit Costs of Health & Social Care 2013, Personal Social Services Research Unit, The University of

Kent, 2013

18. PRE-DECISION SCRUTINY OF CABINET REPORT – REVIEW OF ABERGELLI & THE BEECHES ALTERNATIVE DAY SERVICES (JANUARY 2016)

Purpose This report provides guidance on pre-decision scrutiny

ahead of consideration of the Cabinet report on the “Review of Abergelli and the Beeches alternative day services”

Content This report is focussed on the role of the committee in undertaking pre-decision scrutiny.


• consider the Cabinet report and proposals • agree any views on the proposed decision that are to

be submitted to Cabinet

Lead Councillor Councillor Uta Clay, Convener, Transforming Adult Services Scrutiny

Lead Cabinet Member / Officer(s)

• Councillor Jane Harris – Cabinet Member for Services for Adults and Vulnerable People

• Alex Williams, Head of Adult Services and Dave Howes, Chief Social Services Officer

Report Author Delyth Davies, Scrutiny Officer

Telephone: 01792 637491 [email protected]

1. Introduction

1.1 Following a review of future cabinet business at a recent meeting

the panel requested to undertake pre-decision scrutiny of the Cabinet report on the ‘Review of Abergelli and the Beeches alternative day services’. The report is due to be considered by Cabinet on 21 January.

2. Role of the Panel

2.1 Pre-decision scrutiny provides the opportunity for consultation with non-Executive Members on fully developed proposals, where a clear recommendation exists, before decisions are taken by the Executive.

2.2 This meeting will enable the panel to gain information and develop an understanding of this matter, and, acting as a ‘critical friend’, to ask questions and comment on the report. This gives scrutiny a valuable opportunity to inform and influence decision-making


through debate and challenge.

2.3 Councillor Jane Harris, Cabinet Member, Services for Adults and Vulnerable People, will attend the meeting to present the report and answer questions, along with relevant officer(s) involved in the development of the report who will assist the committee and provide appropriate advice.

2.4 In terms of key questions, the panel may want to consider: • the rationale for the report • robustness of the proposed decision and process • potential impact and implications (including policy /

performance / budget issues) and risks • how different options have been considered • the extent of consultation undertaken

3.5 In sharing its views with cabinet this may include giving support, providing other suggestions on the way forward, or flagging up any concerns.

3.6 The panel (through the convener) will have the opportunity to present its views, conclusions and recommendations about the report to Cabinet on 21 January. These views are required to be formally considered by Cabinet before it makes the decision and feedback should be given to the committee including explanation for any rejection of views expressed.

4. Legal Implications

4.1

In accordance with the Council’s Constitution “pre-decision scrutiny gives scrutiny the opportunity to influence Cabinet decision making as a critical friend”. “The views of the scrutiny committee are formally presented (either in a written report or verbally by the scrutiny Chair) to the Cabinet meeting for the Cabinet to consider and inform its decision making”.

5. Financial Implications

5.1 There are no specific financial implications raised by this report. Financial implications of the actual cabinet report are contained within that report which is appended.

19. Commissioning Review - Scoping Template

(JANUARY 2016)

Review/Service Area: Social Services (Learning Disability, Mental Health and Physical Disability Services) Budget Savings anticipated : £ 20% savings from 2017/18 onwards

Complexity (H, M, S) High

Scope of Service Review Rationale? Key Issues/Constraints/Interdependencies

Allocated Resources (agreed) (Service Area, BC, Corporate Services etc)

In-Scope: (Please list service specific areas)

Any Learning Disability, Mental Health or Physical Disability day opportunity or accommodation/accommodation related service which is either commissioned or internally provided. Out of Scope: (reason why) Day Services for Older People, Residential Care and extra care for Older People. Domiciliary Care (excluding 24 hour provision) across all client groups, including

The Commissioning Review of Learning Disability, Mental Health and Physical Disability Services will seek to ensure that we are able to deliver the right services for our service users and their carers, improving outcomes for citizens whilst achieving a 20% saving from 2017/18 onwards by transforming the services we currently provide. It will support us to answer the question ‘why do we do what we do?’, ‘can we do it in a different way?’ and ‘how can we provide models of care that support people to lead a good life?’. The review will also seek to align service delivery with the Social Services and Well Being (Wales) Act 2014 and corporate priorities.

• The Commissioning Reviews

taking place already within Adult Social Services – timescales need to align

• The current remodelling of our Supported Living model in Learning Disability Services

• Gaps in our knowledge of demand, supply and gap analysis (including prevention and demand management and reshaping of services to achieve these objectives)

• Views of current service users, potential service users, carers, staff and service providers

• Requirements under the Social Services and Wellbeing (Wales) Act 2014, including our responsibilities to carers.

• Previous reviews that support this area of work

• A review / creation of eligibility criteria

Service Area Andrew Morgan Lisa Banks BC Phil John Vicky Thomas IPC (cost to be calculated and decision required on who will support stage 3-4) Likely cost to be in the region of £20K

learning disability, mental health and physical disability. Any services to children. Advisory or information services within learning disability, mental health and physical disability services.

Older Peoples Residential Care, Older People’s Day Services and Adult Services Domiciliary Care are already the focus of a Commissioning Review. Therefore, to have a whole systems approach to Adult Services, it is imperative that this review is undertaken at the same time. Our focus is on services that sit within ‘managed care’ and are accessed through the Assessment and Care Management process.

• The role of Local Area Co-ordinators, the third sector and universal services

• The role of Direct Payments • Quality of services for service

users including quality of physical environment and fit for purpose considerations

• Transport issues and development of Integrated Transport Unit

• Financial situation and the current costs of services and opportunities to achieve 20% efficiency savings

• Suitability of existing contractual arrangements

• Market analysis/shaping

Sign off Director Lead Cabinet Member Review Lead

Signature Chris Sivers Cllr Jane Harris (pending approval of this document, but scope already agreed) Alex Williams

Date 8th December 2015 7th December 2015

20. DRAFT BUDGET PROPOSALS – PANEL’S VIEWS AND COMMENTS SUBMITTED TO CABINET (FEBRUARY 2016)

• The TASS Panel heard from Councillor Jane Harris, Cabinet Member and Dave Howes, Chief Social Services Officer, about the budget position and proposals for adult services

• The Panel wishes to thank the Chief Social Services Officer for his clear

presentation of the issues – the Panel found this very helpful.

• The panel notes that there is a proposed increase in the adult services budget and no additional savings proposals. The emphasis currently is on ensuring that services are excellent, citizens are safe and arrangements are as cost effective as they can be. The assumption is that, by ensuring services meet people needs effectively, costs will reduce over time. This was the experience in child and family services.

• The Panel further notes that the expected overspend in Adult Services will be

balanced by an equivalent underspend in child and family services. This is a reversal of the position in the past.

• The panel is concerned about the financial risk associated with the

transformation programme. Previous savings targets associated with programmes such as TASS have not been delivered and it is not clear that lessons have been learnt. The Panel urges the Cabinet Member to ensure that monitoring of these savings is robust.

21. PERFORMANCE APPRAISAL & OBJECTIVE SETTING

(FEBRUARY 2016)

Purpose To provide a briefing requested by the Board in respect of the process of performance appraisal and objective setting for senior officers.

Content This report includes a summary of the process for performance appraisal and objective setting for senior officers.


Note the information provided.

Lead Councillor(s) Clive Lloyd, Cabinet Member for Performance & Transformation

Lead Officer(s) Steve Rees, Head of HR&OD Report Author Steve Rees, Ext. 6067

1. Introduction

1.1 The TASS Scrutiny Panel at its meeting on 11th January 2016 requested the

performance objectives of key officers as they relate to and their involvement in transforming adult social services - Chief Executive, Director of People, Chief Social Services Officer, Head of Adult Services and Head of Finance.

1.2 It is not appropriate to share the individual objectives of senior officers of the Council

as they are set and monitored in the confidential environment of the performance management appraisal between the officer and the immediate line manager.

1.3 This Briefing Note therefore sets out the process by which performance objectives

are set and monitored for senior officers.

2. Corporate Planning & Improvement Framework

2.1 The Council’s corporate planning and improvement framework is set out in the diagram below.

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2.2 The Council undertook a review of its performance improvement arrangements in 2014/15 with the aim of making it ‘simpler, easier and better’. This was in the context of helping the Council to meet the considerable financial challenges posed by austerity while ensuring that the Council’s key priorities are delivered on the ground. The goal of the review was to be achieved through two principal and related means:

a) As part of the Sustainable Swansea – Fit for the Future Strategy, the

identification of a smaller number of corporate priorities to be expressed within a new Corporate Plan.

b) The introduction of the ‘Balanced Scorecard’ as the framework for the Council’s new performance improvement framework

2.3 Taken together, Sustainable Swansea and the Corporate Plan represent the

Council’s strategic framework for delivery. The Council’s model for the Balanced Scorecard is as a strategic delivery system that aims to translate the Council’s vision and strategy into tangible objectives and measures. This will see the Balanced Scorecard being used to cascade the corporate strategy down through the directorate, service and team levels and even into individual employee objectives through staff appraisals.

3. Performance Appraisals 3.1 The Council’s corporate priorities and improvement plans provide the strategic

framework for corporate and service objectives as outlined in the business plan, sometimes referred to as the ‘Golden Thread’ when it comes to Appraisals.

3.2 Managers are responsible for interpreting the Council’s priorities for their staff by setting appropriate targets and objectives during review meetings and one-to-ones. Guidance is issued to Directors/Heads of Service/Senior Managers to ensure a whole Council approach to this. It is the employee’s responsibility to deliver on those objectives with appropriate support from their manager.

3.3 The aims of the appraisal should include;

i) To identify and clarify the key objectives, priorities and targets of the

Council and appropriate timescales for their achievement over the next year.

Page | 2

ii) To review progress against targets previously set and future targets for the service which should be set in order to provide the employee with a clear understanding of what is expected of them over the coming year.

iii) The appraisal should be undertaken in the context of the Council’s

objectives, priorities and targets as expressed in the Corporate Plan. Appraisal targets when taken as a whole should be related to agreed targets for the Council as a whole.

Steve Rees Head of HR&OD 29th January 2016

Page | 3

22. PANELS VIEWS & CONCERNS EXPRESSED IN CONVENER’S LETTERS & CABINET MEMBER’S RESPONSES

DATE PANEL’S VIEWS & CONCERNS PANEL’S RECOMMENDATIONS/ACTIONS/AGREEMENTS

CABINET MEMBER’S RESPONSE

Oct 2014 Importance of ensuring that the report on the Independent review on the commissioning and provision of social services to older people was made available as soon as possible to the group

Developed ideas to provide challenge, assurance and scrutiny engagement in the TASS process. Panel agreed to explore the following:

• Understand why the transformation was necessary, the drivers of change

• Understanding the user need and perspective, how to establish what local needs are

• Identify areas to focus the scrutiny work on and tailor the work to the TASS cabinet timetable.

Suggested areas that the work plan should focus on:

• Independent Review • Western Bay work • Strategic integration • Network hubs and health • Joint commissioning of services and

pooling funding • Costs • Transport • Housing • Different service areas such as

Learning disabilities, Mental health • Local area co-ordination and

community development, drawing on the approach in Scotland and Australia

• Safeguarding & risks • Signposting

Agreed with the panels engagement in the TASS process and the areas of work upon which to focus. Suggested that the panel also consider some underlying principles of what is care, access to services, efficiencies and dependency. Suggested that the work plan could include monitoring outcomes, collecting users views, delivery of integrated services, how any resource saved would be used for new services and staff training, outcomes and expectations.

DATE PANEL’S VIEWS & CONCERNS PANEL’S RECOMMENDATIONS/ACTIONS/AGREEMENTS

CABINET MEMBER’S RESPONSE

Dec 14 The panel met to discuss the independent review report: • The budget had become more of a

priority than expected. • Importance of ensuring that the Council

targeted scarce resources at the right people in the right places.

• Concern over how Local Area Co-ordination would be measured and evaluated

• Choice of locations for the network hubs • Governance and scrutiny arrangements

of the Western Bay • Vulnerability of the Council to the private

care market

• Further scrutiny of the Independent Review Report

• Engagement with health with regards to the integrated network hubs

• Further detail required on the short term actions of adult services

Jan 2015 The panel met to discuss the Social Services & Well Being Act and its work plan. • Concern that change to ensure the

Council was ready for the implementation of the Act was not based on sound understanding of unit costs for domiciliary and residential care. Officers agreed that this was unknown and assured the panel that this was a piece of work that needed to be done.

• Long term future for adult and child & family services

• Uncertainty over who was responsible for young people and women from Swansea who were in detention outside of Swansea

• Panel to hold a session on unit costs which looked at the whole financial aspect of domiciliary and residential care

• Panel to be provided with the consultation documents for the draft regulations and code of practice

• Provide panel with the Western Bay regional implementation plan.

•

Not required

• Need to understand what kind of community resources were available

• Whether implementation of the Act would in fact be cost neutral as Welsh Government intended

• Need to understand what the Act means when it refers to social enterprises and cooperatives

The panel agreed that for each topic to be scrutinised it would consider it against 5 broad lines of inquiry: a) Cost b) The impact of Western Bay c) Interface and joint working with health partners d) Local area co-ordination e) Implications of the independent review of older people’s services f) Implications of Sustainable Swansea – fit for the future The panel took the long list of proposed changes in the TASS programme timeline that was presented to the panel in December and prioritised 5 topics. • Support to Carers • Volunteering and Befriending • Implement Local Area Coordination • Swansea Integration Plan – Network

Hubs • Procurement Review

Mar 2015 • Concerned that costs information received was a schedule of what the Council pays for accommodation in Private Residential Homes for older

Difficulties in producing some of the costing information. As a result, APSE had been commissioned to review the

people, not the cost of the authority’s own residential care homes.

• Panel also wanted similar information relating to Day Care and Domiciliary care to enable the panel to make a considered contribution to TASS.

data on care costs to ensure there is confidence and validity in the data and that the authority compared its costs against industry standards. APSE will facilitate all the workshops which will be carried out as part of the review process. Costs data to be provided as soon as it became available

Mar 2015 Question and answer session with Chief Social Services Officer on residential care. Key concerns: • Costs: difficult to compare private and

Council provided provision because the Council picks up all the higher need users like dementia, reablememt, respite

• Costs: Concerned that the cheapest supplier of care was not always the best and was reassured that the Authority was not obliged to purchase from the cheapest supplier of care.

• Forecasting need and planning future services

• Engagement of non-Executive councillors in TASS

• change was driven by budgets rather than need

• True costs of in-house provision still unknown

• Strategy for older people needed

• Rateable value and rates paid by residential care homes to be provided

• To provide clear stages and headings with dates of the Commissioning workstream

• Clarification from the Cabinet Member on intentions to engage non-executive Cabinet Members in the Commissioning Workstream and the TASS programme overall.

• To re-schedule the cost analysis of local authority provided residential care at an early date to ensure that there is confidence in the validity of the data and the rate of progress being made

•

Involving non-executive Cabinet Members in the Commissioning Workstream and TASS programme • the first of the

commissioning workstreams (domiciliary care) is in the process of being established and we have asked Officers to involve Councillors with responsibility in the CAC's and with responsibility for championing issues.

• Officers will establish a project group to take forward plans to remodel day services for learning disabilities in the first place. We have asked that Councillors be involved in that work.

Apr 2015 Local Area Co-ordination • Panel was unsure about how the role

of community connectors and Local Area Co-ordinators would differ.

• The panel suggested that Local Area Co-ordinators and Community Connectors should not work in isolation of each other.

• The panel felt that Local Area Co-ordinators should develop links with local community centre as they would be a useful resource to tap into for community groups and clubs.


• That saving money should not be the driver for this project

• Sustainability of funding of the project

The panel requested more information on the Local Area Co-ordination Evaluation methodology and timescales for the report The panel requested further information:

• Job description and person specification for the Local Area Co-ordinator posts

• Swansea University’s Local Area Co-ordination evaluation criteria and methodology

• Local Area Co-ordination reporting and management structure and details of funding of the different posts

Local Area Co -ordinators (LAC) and volume of referrals research into the experience in other areas that have adopted the approach indicates that detailed support will need to be provided for between 50 and 65 individuals or families at any given time. Should demand exceed that level then boundaries between areas would need to be revisited. The driver for Local Area Coordination is to improve outcomes for citizens through taking a prevention and well being approach to promoting safer independence. This is a necessary part of ensuring that Swansea has safe and financially sustainable adult services going forward. Financing Local Area Coordination and Sustainability Local area co-ordination is a part of the agreed Western Bay approach to ensuring coordinated, integrated health and social care arrangements for older people that promotes

their health and well being. The Welsh Government have provided additional funding to support more effective coordinated and integrated services to be established. It is anticipated that these services will reduce cost pressures elsewhere in the health and social care system as part of the transformation to more financially sustainable arrangements. As funding is released from elsewhere in the system a proportion will need to be reinvested in LAC coordination and other prevention and well being approaches.

May 2015

Social Services & Well Being Act Seminar with the Minister for Health & Social Services, Mark Drakeford, A.M Discussion points suggested by participants

• The role of cooperatives and other social enterprises in the provision of local authority care packages – the role of Welsh Government in support this

• The role of the private sector in providing social care for older people particularly in the context of doing ‘more for less’

• The role of the community in providing

N/A N/A

social care for older people and the degree to which this can be relied on – the different levels of resource and resilience that different communities have and how services taper support in response

• Balancing a universal service that provides for everyone with the need to target geographic communities

• The role of scrutiny in the regional consortia given limited resource

• The opportunity to increase the democratic accountability of health as in Manchester for example

• The interface between health and social care and the cultural challenges involved

• The significance of isolation and loneliness in relation to care and support for older people and the implication of this for support services

• Role of prevention and how we build it into council services – the role of Communities First in this regard

• Mental Health services for young adults Key points raised in the seminar • Diversification of the market in order to

provide care for older people – care could be provided by organisations such as housing associations, unions and the voluntary sector

• Innovation – small scale innovative models of community care should be considered to help diversify the market (Powys example)

• Advice and guidance at the front door – there is evidence in local authorities that it is successfully preventing older people from entering residential care by providing them with advice and guidance and support needed to remain independent and in their own homes.

• Local authority provided domiciliary care is a positive element of the domiciliary care market. It has more favourable pay and conditions for employees compared to privately provided domiciliary care as well as better levels of staff retention.

• There are a number of issues with privately provided domiciliary care:

o Difficulties of provision in rural areas particularly if a complex package of care is required

o Staff retention can be difficult because of terms and conditions which means that private companies can incur costs associated with recruitment and training

• Local Authority scrutiny should be active in scrutinising health boards on issues that affect the area. This will provide a direct line of accountability from health to the public.

• Local scrutiny panels are encouraged to look at the interface between social services and health and to engage with health on that basis

• The vast majority of residential care homes are owned by individuals rather

than large companies. • Prevention was considered by some

seminar participants as the most important issue in social care.

• The Act is neutral in terms of sector – a mixed provision of service delivery is encouraged

June 2015 (1)

Concerns: • The lack of availability of information to

the panel on the domiciliary care commissioning review

• The importance of scrutiny councillor involvement in commissioning reviews

• Duplication between the work of scrutiny and the CACs

• Alpha Care situation in Neath Port Talbot • The need to see the original Independent

Review Report

Agreed • To include details of outstanding issues from

previous letters, and request that these are responded to in the Cabinet Member’s response to this letter

• Panel to provide comments on the note on the Social Services & Well Being Act seminar

• Panel agreed the broad questions to ask carers; to use a number of different methods to gather evidence; to engage carers as well as carers organisations; to provide comments on the revised carers consultation proposal

• To use the next meeting (29th June) to examine the domiciliary care commissioning review, the domiciliary care costs and the cabinet member response to the social care at home inquiry.

Cabinet Member sought clarification from officers whether there was a substantively different report to that which was received last year. The recommendations from the University's Independent review will be taken forward as part of the Council's commissioning review. In relation to worries about duplication of the work of scrutiny and CACs, I am aware that the Leader is taking this forward. Carers consultation proposal has been sent to the relevant officer. Officers will prioritise establishing performance management arrangements within Adult Services that

deliver far more transparent and readily available information Alpha Care, the Chief Social Services Officer will explore whether there are financial or legal impediments to the Council adopting a similar approach to that apparently taken by NPTCBC. Panel to clarify what it is asking the Cabinet Member to provide views on with regards to housing and older people

June 2015 (2)

The panel discussed the Domiciliary Care Commissioning Review: update report Concerns:

• panel involvement in the Domiciliary Care Commissioning Review

• Ability of panel to influence Domiciliary Care Commissioning Review workshop

• Unsure whether the local authority had a true sense of the population projections and therefore the type of social care settings and models of delivery that will be needed to meet the needs of the older population.

Panel discussed matters arising from the Cabinet Member’s response to the previous letter and its views are detailed below: • The panel felt that by seeing a copy of the

original report from Cardiff it could contribute and comment fully on the domiciliary care commissioning review.

• The panel wanted to draw your attention to the delay in producing a response to the Social Care at Home scrutiny inquiry. The social care at home review and recommendations demonstrably feed into the current domiciliary care commissioning review.

• At your suggestion, the panel discussed ways that it could be involved in the domiciliary care commissioning review. We suggested that 3

A copy of the draft independent review report by Cardiff University was provided with the Cabinet Member’s response. Cabinet Member noted that the final report included some minor grammatical and factual corrections. Cabinet Members response to the Social Care at home review is scheduled to be considered by Cabinet on the 20 August 2015.

members of the panel join the project group. We would welcome your views on this.

• We welcomed the priority that will be given to establishing a robust performance management reporting framework in Adult services

• Housing for older people: Cabinet Member views on the character and type of housing stock that will be required in Swansea in 5,10 & 15 years from now and providing your department’s population forecasts to relevant housing bodies to help inform their future planning and strategies.

Officers have been asked to include Scrutiny Members in the workshops and gateway ·meetings planned for the Domiciliary Care-review. These arrangements to include Scrutiny Members mirror those that are in place for all the planned council commissioning reviews. Officers were asked to prepare a chronology setting out how the transition from Alpha Care to other providers has been managed. I will then make arrangements for this to be shared with Scrutiny. Cabinet Member asked officers to share the current needs and population assessment that has informed the commissioning strategies for Adult Services to date. These will be reviewed and updated as part of the new commissioning reviews for domiciliary care and residential and day care services. The residential and day care

commissioning review is about to be scoped and the intention is to invite the Housing department to be involved in that review in order that the strategy for meeting future housing needs can be best informed by and coordinated with the strategy for developing future residential and day services .

Jul & Aug 2015

The panel discussed the Health & Social Care Integrated Hubs and the Domiciliary Care Commissioning Review. Hubs: Concerns • The panel still has reservations about the

need for 3 network hubs in 3 separate locations and the costs associated with this in terms of rent and management costs.

• There appeared to be several pressures on the hubs, including reablement, domiciliary care, applications under the Deprivation of Liberties safeguards and caseload numbers.

• Separate budgets of health and social services in an integrated health and social care setting.

• The impact on caseload volumes if anyone can make a referral to the

Domiciliary Care Commissioning Review. Agreed: • The panel agreed that it should be

engaged at the Gateway stages of the review in order to exert influence and provide its opinion. This will ensure that executive decisions and scrutiny activity are discrete and separate That a “family tree” structure chart for the network hubs is provided to the panel

• That the panel receive Gateway reports at the end of stage 4 of the review

• The Cabinet Member will look at how scrutiny has been involved in other commissioning reviews

Not required

network hubs.

Sept 2015

VISITS TO NETWORK HUBS – NORTH AND WEST – SEE SECTION 13



Sept 2015

The panel discussed the cost of providing the Council’s Domiciliary Care and Residential Care services. Residential Care: Concerns • That comparative costs may be

underestimated. Officers explained that the approach used to arrive at the figures in the report is a process that is consistently applied across the Council

• Remodelling of homes to provide ensuite facilities The panel learned that some homes without would result in a 33% reduction in rooms. This would be taken up in the Residential Care Commissioning Review

• If vacancy rates were as a result of respite provision

• Staff ratios in privately provided residential care homes

• Impact of the Living Wage on the private sector and its desire to bid for contracts

Residential Care: Views • Supported the use of Bonymaen as a re-

ablement unit and that those admitted had the capacity to be re-abled

Domiciliary care costs: Concerns • The panel was unable to identify what

Residential Care The following was agreed to be provided: at the next meeting: • Reasons for vacant bed weeks at the different

care homes and whether respite is a factor in this.

• Additional staffing costs for Bonymaen and Ty Waunarlwydd which were not in the unit costing report as.

• A revised set of costs which took into account: potential reductions in residents arising from refurbishment and increased staff costs arising from wage increases.

• Net costs to include management costs Domiciliary Care The following was agreed to be provided: at the next meeting:

Not required until all the data has been shared with the panel

proportion of the spend was on Gower • Impact of the increase in the minimum

wage on future costs

• Budgeted staff costs for 2015/16 for the Gower Team

• Spend on direct payments to be provided • Updated summary of Dom Care costs to take

account of 1) Gower Team costs being taken out 2) Travel taken out 3) Forecast costs to include minimum wage 4) breakdown across hubs.

• Summary to include net costs which include management costs.

Oct 2015 The Panel discussed the cost of providing the Council’s Domiciliary Care and Residential Care services Residential Care Concerns: • overall impact on the total number of

beds if the ensuite remodelling is carried out.

• financial information on Ty Cila was not included

• how in-house respite is managed and delivered, including requests for emergency respite beds and how the Council uses external providers

Domiciliary Care Concerns: • adequacy of the local market to provide

appropriate care (Commissioning Review will consider how the Council can stimulate and develop the local care market)

The additional information requested at the previous meeting was provided and can be found in section 14. Agreed: • That the panel’s views on the focus of in-

house domiciliary care and all other matters raised in this and the September letter be conveyed to the Commissioning Review Team.

• Adult Services performance management

framework be brought to the panel at the earliest opportunity

• Officers to provide existing information on

levels of income from residential care homes and if possible, that the data is trended.

Cabinet Member’s Response: The TASS scrutiny panels views on the focus of in-house domiciliary care and all other matters have been communicated to the Commissioning Review team for inclusion in the process. The views were: • Following the provision of

costing re the historic plans to remodel in house residential care and therefore provide services to fewer clients, the scrutiny panel would seek verification during the commissioning review of residential care, of the proposed staffing saving anticipated if en-suite

The panel’s view:

In-house domiciliary care should be focussed on

re-ablement, complex needs and market

development. The panel would like its views,

on this and all other matters raised in this letter,

conveyed to the Commissioning Review Team.

provision led to a reduction in clients.

• The panel wishes that the commissioning review will consider and offer guidance on how the service monitors and communicates that clients admitted to Bonymaen have the capacity to be re-abled and returned successfully to their home.

• The panel wished that the commissioning review would evaluate occupancy and vacancy rates across in house care homes and consider how problems experienced can be managed more successfully in future service delivery .

• The panel wished that the commissioning review would identify the service specifications that are required from which to evaluate staff ratios and skills that the Council staff needed to provide and I or evaluate present and future good quality care for clients with a range of strengths and dependencies in care

home settings both in house and private.

• The panel agreed that for a quality service there was a need for a stable workforce and required this to be addressed as part of the commissioning review.

• The panel agreed that there is a need for accurate castings to underpin future service development.

Details of the Adult Services performance management framework will be available shortly and communicated to the scrutiny panel. As part of the residential care homes review the overall impact on the total number of in house beds if the ensuite remodelling is carried out will be considered if appropriate.

Nov 2015 Review of work plan Views: • importance of jointly developing

performance management indicators and measures and welcomed the aim of one

Panel agreed to • Recommend to you that cabinet

responsibility for the integrated hubs should fall under a single cabinet portfolio.

No response required

suite of performance measures for the hubs that cut across health and social care.

• The panel felt it needed a greater understanding of how resources were allocated amongst health and social care and prevention

• Invite Councillor Mark Child to the next meeting to present the Local Area Co-ordination evaluation report to the panel

Dec 2015 The panel discussed initial performance data for the health and social care integrated services, income generation from older peoples services and the Local Co-ordination Evaluation report Integrated health and social care hubs performance data report

The panel was pleased with: • Assessment beds were performing

as intended and only people who were capable of being re-abled were placed in these beds

• More older people return home after a hospital stay than enter an institutional care

• Locally relevant performance and qualitative measures will be developed

• The review of the intake team to ensure better challenge at the first point of contact and an effective triage system

Concerns:

The panel agreed: • To undertake pre-decision scrutiny at its

meeting in January on the Cabinet report on the “Review of Abergelli and the Beeches alternative day services”

• Given the development of a new framework for performance and delivery in Adult Services, the panel becomes an Adult Services Scrutiny Performance Panel

• Further information on gas and electricity usage in local authority care homes and day centres to be would be circulated via email.

• Local Area Co-ordination KPIs circulated to the panel along with the population splits across the different LAC areas in Swansea

• That the second evaluation report should include an analysis of the type of network that LAC was.

• That the second evaluation report is presented to the panel for consideration

The Cabinet member: • Supported the pre-

decision • Agreed that the new

performance management framework should inform the panels new work plan

• Circulated the additional information on gas and electricity

• LAC PIs were circulated

• Agreed that the 2nd LAC Evaluation wold include analysis of the type of network local area co-ordinators were developing

• Joint working amongst agencies will help to build resilience in the LAC projects

• Sometimes privately provided packages of care could not be assembled quickly enough because of capacity in the private sector. The lack of capacity in the private sector and the risk this presents to the authority continues to concern to the panel.

• The panel raised the number of calls that were shown to be abandoned

Older People’s Services Income Generation Panel’s views: • Report provided clarity to questions it

had raised recently. • Pleased to learn that since income

collection had been moved to the Finance department, income this year was higher at this point than last year.

• Supported the inclusion of the viability of charging for day services was included in the commissioning review.

• supported the robust processes in place to recover income from deferred payments of care users in order to maximise the potential for income.

• The panel recognised that windfall income was difficult to predict and control as it was contingent on deaths of older people in residential care homes.

• Supportive of the success of debt recovery and any write off above £10,000 had to be approved by the Head of Service

Local Area Co-ordination: Formative

Evaluation – Panel’s Views • A cautious welcome to the success to

date of the Coordinators in beginning to develop and build community networks

• A risk exists to the resilience of the project if Coordinators leave their posts

• Supportive of the full suite of KPIs that had been developed and the data that was now being collected to establish a database of performance information.

• The panel felt that the second evaluation report should identify the type of network that local the area co-ordination initiative was and that the KPIs should reflect that.

• That the second evaluation report is presented to the panel for consideration

Jan 2016 The panel discussed the review of Abergelli

and the Beeches (pre-decision), the Social Services and Well Being Act and the Mental Health and Learning Disability Commissioning Review Scope Our concerns and views on the pre-decision report were submitted to the Cabinet Member for consideration with the Cabinet Report: In summary these were: • Panel agreed with the review of the

current service and the need to deal with the under capacity that had been identified.

• Panel supported the proposed remodelling of Abergelli and the Beaches

The panel agreed: • That we submit our views on the Review of

Abergelli and the Beeches to you for consideration alongside your cabinet report.

• The performance framework for the Social Services & Well Being Act to be presented to the panel in about 12 months time.

• Our views on the Commissioning Review Scope are considered during the review process.

• The Chief Social Services Officer’s report on the revised performance management framework for Adult Services will be discussed at the panel’s March meeting.

• A report on the performance objectives of key

Not required

by consolidating the 2 services, using the Abergelli building and the creation of additional capacity at Abergelli

• Panel’s concern: that service users who withdrew from the day services at the Beeches and Abergelli had a follow-up assessment to ensure that their decision remained right for them. A further review at 6 months should be undertaken to ensure that the service user continued to be comfortable with the choice they made.

• Two known cases were highlighted of service users who were unhappy with the move to Abergelli. The panel the Head of Adult Services to look at these.

• Related to this the panel wanted its views taken into account in relation to personal development and safeguarding:

• Personal development: this should be undertaken by a professional

• Safeguarding: need to stipulate under the new arrangements who will be responsible for this

Mental Health and Learning Disability Commissioning Review Scope – Panel’s views: • each of the three service areas covered

by the commissioning review should be dealt with separately within the review and have equal weighting and consideration.

• Supported the proposed workshop structure which divided up stakeholders

senior officers as they relate to the delivery of change in adult services is presented to the panel’s February meeting.

• The Convener and Head of Adult Services have an initial meeting to discuss the development of a new work plan which aligns with the revised performance management framework for Adult Services.

into the specific services to ensure that service specific views were discussed and heard.

Feb 2016 The panel discussed the objective setting and performance appraisal process for senior officers and the draft Adult Services Budget report. Panel’s views: Performance/Appraisal Report Keen to understand the content of the objectives as well as the overall process Budget Report •The panel notes that there is a proposed increase in the adult services budget and no additional savings proposals. The emphasis currently is on ensuring that services are excellent, citizens are safe and arrangements are as cost effective as they can be. The assumption is that, by ensuring services meet people needs effectively, costs will reduce over time. This was the experience in child and family services. •The Panel further notes that the expected overspend in Adult Services will be balanced by an equivalent underspend in child and family services. This is a reversal of the position in the past. •The panel is concerned about the financial

Agreed: • further evidence to be sought to allow the

panel to understand whether TASS objectives have been translated into service delivery. Specifically in respect of Director of People, Chief Social Services Officer, Head of Adult Services, Head of Finance.

• Provide views on the budget to the Service Improvement and Finance Performance Panel to be included in the Convener’s report to the Cabinet

risk associated with the transformation programme. Previous savings targets associated with programmes such as TASS have not been delivered and it is not clear that lessons have been learnt. The Panel urges the Cabinet Member to ensure that monitoring of these savings is robust.

SECTION C

APPENDICES

1

IndependentReviewontheCommissioningandProvisionofSocialServicestoOlderPeopleintheCity&CountyofSwansea

Dr.RodHickandDr.ShaneDoheny

September2014

2

Acknowledgments

WethankSiônJonesforsterlingresearchassistanceandtostaffatthelocalauthority,and in particular Paul Littlewood, Julie Burroughs and Simon Jones, for providing uswithinformationandrespondingtoournumerousquestionsandrequests.Mostofall,we thank the stakeholders – and in particularly the older people themselves – whoattendedoureventsandsharedtheirexpertiseandexperienceswithus.

3

EXECUTIVESUMMARY

1. In June 2014, we were commissioned by the City and County of Swansea toundertakeanIndependentReviewontheCommissioningandProvisionofSocialServicestoOlderPeopleintheCity&CountyofSwansea.

2. Thenumberofolderpeople isexpected to rise sharply in thecomingdecades.StatsWalesestimatesthatthenumberofover‐65slivinginSwanseawillriseby44%by2036,andthatthenumberofover‐80s–theageofmanyexistingserviceusers–willriseby84%overthesameperiod.Atthesametime,UKGovernmentcutsmeanthattheCouncil’sbudgetarypositionisextremelydifficultintheshortterm and, unless theUKGovernmentmakes changes to the financing of socialcare, there is, even in the longer‐term, little prospect of any rise in resourcesmatching the anticipated rise in need. The challenge of ensuring thesustainabilityofolderpeople’sservicesisthusveryreal.

3. Throughout the period of this Independent Review, we have been impressed

withtheforwardplanningwhichisongoingwithintheAuthorityinordertoputsocialservicesonalong‐termsustainablefooting,especiallyundertheWesternBayandTransformationofAdultSocialServices(TASS)programmes.Thepolicydirection in Swansea broadly comprises a rebalancing provision away fromresidential care and towards domiciliary care, enabling people to remainindependentandlivingintheirownhomesforlonger,jointworkingtoimproveoutcomes forolderpeopleandcommunity initiatives topromotewellbeing forolder people in Swansea. Broadly speaking,we view these initiatives as beingdesirable and necessary and believe that the policy direction which has beenadoptedistherightone.

4. On the rebalancing of provision specifically, while supporting people to liveindependentlyintheirownhomescanmeetbothindividualwellbeingandcostcontainment objectives for some older people, we believe care needs to beexercised in identifying the ‘tipping point’ beyond which living in one’s ownhome,evenifcontributingtocostcontainmentobjectives,nolongercontributestoindividualwellbeing.

5. Making specific decisions regarding policy alternatives – such as the idealbalance between in‐house and externally provided provision – requires gooddataontheunitcostsofsuchprovision.Estimatingunitcostscanbeadifficulttask, butwebelieve that further efforts are required to improve thequalityofunitcostestimatesinordertofacilitatebetterdecisionmaking.

6. Wehaveidentifiedfivebroad,strategic‘levers’whichtheCouncilmightutilisein

seekingtoensurethesustainabilityofsocialservicesforolderpeople.Theseare:

4

i. Rationcareonthosemostinneed;ii. Rationcareonthoseonlowincomesorraisecharges;iii. Invest inpreventionandreablementservices,andpromote independent

living;iv. Reduceunitcostsofcare;v. Supportpolicieswhichseektoboostprivateincomes.

7. Wedonotviewthesestrategicoptionsasbeingmutuallyexclusive:rather, the

questioniswhatbalanceshouldbestruckbetweenthem.Furthermore,wenotethat the Council’s ability to utilise lever 2 is tightly circumscribed by WelshGovernmentlegislationandweviewpoliciespursuedunderlever5asbeingabletocontributeonlymarginallytoensuringthesustainabilityofsocialservicesinSwansea.

8. Ourpreferredapproachwouldbeastrategywherethepredominantfocusison

preventionandreablement(lever3).Suchastrategycouldcomprisearangeofinitiatives, includingthosecurrentlybeingpursuedaspartofWesternBayandtheTransformingAdultSocialServicesprogramme.Inourview,notonlyisthisapproach consistentwith the recent Social Services andWellbeingAct (2014),but itperhapsoffers thebesthopeofbalancing theneedsof tomorrow’solderpeoplewiththeresourceswhichare likelytobeavailable,withoutresortingtoincreasingeligibilitycriteria(lever1).

9. We note that early‐stage evaluations of the assessment beds/reablementinitiative inBonymaenHousehavebeenpositive,with approx. 60%of serviceusersreturninghomeattheendoftheshortsix‐weekintervention.This figurefallstoabout50%afterasixweekfollow‐upperiod.Thesefiguresdemonstratethatthereablementinitiativeissucceeding.

10. Nonetheless, we are mindful that existing data relate primarily to short‐termoutcomes.Inordertomaintainaconstantneedforresidentialformsofcareovertime, something in the region of a 45% reduction in entry into residential ornursingcareacrossthewholelifespanby2036wouldberequired.

11. We recommend continuedmonitoring of longer‐term outcomes of reablementservicesandmonitoringoftheeffectivenessof integratedcare.Werecommendmonitoring of efforts to rebalance provision towards domiciliary care, takingaccountoftrendsinthebalancebetweenlocalauthorityandindependentsectorprovisionandthebalancebetweennursingandresidentialcare.

12. Whileourpreferredwayforwardcomprisesaprimaryfocusonpreventionandreablement, it is possible that this will need to be combined with a modest

5

contribution in termsofefforts to reduceunit costsover themedium‐ to long‐term, increases in charges, tax rises and, finally, as a last resort, concentratingresourcesonthosemostinneed.

13. We aremindful that this Independent Review has been conducted against the

backdropofproposalstoclosethreelocalauthoritycarehomesandremodeldayservice provision. While the focus of this Independent Review has sought toadoptamedium‐term,strategicfocusonthesustainabilityofsocialservices,theinformation, testimony and evidencewe have considered also relates to thesemoreimmediatedecisions.

14. WhileweagreewiththebroadpolicydirectionbeingundertakeninSwansea,wearelesspersuadedbytherationalesfortheseimmediateproposals.Inourview,therearestrongerandweakerreasonsfortheproposaltoclosethreeresidentialcarehomes.Thestrongestrationale,webelieve,isthatthebuiltenvironmentinsome homes renders existing homes unfit‐for‐purpose in terms of a futureservicemodel.However,wearenot clear that this judgementwouldextend tothreeofthelocalauthorityhomes,northatitrequiresimmediateaction.Anotherjustification which has been put to us is that the prevention initiatives andrebalancing of provisionmight reduce demand for residential care sufficientlythatthesehomeswouldnotberequired.Giventhescaleof increasedlongevitywhichisforecast,wearenotpersuadedbythisrationale.

15. Webelievethatamoresustainableapproachwouldbetowaitandseewhetherthe demand and need for residential care falls sharply and whether, givenpopulationprojections, the residential beds are unlikely to be required, ratherthantoassumethiswillbethecase. Insum,wewouldnotprioritiseclosureoflocalauthorityresidentialcarehomesatthistime.

16. In terms of proposals regarding day services, we do not make a concrete

recommendationdue to the time‐limitednature and focus of this IndependentReview.Whilewecanseethatdayopportunitiesareinlinethelocalauthority’sresponsibilitiesundertheSocialServicesandWellbeing(Wales)ActandwouldimposealowercostburdenontheCouncil,webelievethatcautionneedstobeexercisedindirectingolderpeoplewhohavesubstantiallevelsofneedtowardsdayopportunities,wheretheseneedsmaynotbemet.

17. Ensuring the sustainability of older people’s services is a significant challenge,andoneofimmenseimportance.Considerableworkhasbeenundertakenbythelocal authority to date to ensure the sustainability of social services for olderpeopleinSwansea.Theseservicesmeettheneedsofmanyolderpeopleandwillcontinuetodoso,wehope,formanyyearstocome.

6

IndependentReviewontheCommissioningandProvisionofSocialServicestoOlderPeopleintheCity&CountyofSwansea

THETERMSOFREFERENCEOFTHEINDEPENDENTREVIEW

18. In June 2014, we were commissioned by the City and County of Swansea toundertakeanIndependentReviewontheCommissioningandProvisionofSocialServicestoOlderPeopleintheCity&CountyofSwansea.

19. ThetermsofreferenceforthisIndependentReviewwere‘toleadon,andcarryout an independent review of the current range of services available to olderpeopleinSwansea,andtorecommendafuturemodelbasedonprojectionsandtrends of the resources available and the likely demand for social care that isexpected’.1

20. Thecontractcomprisedoftwostages:

i. Stage1:Tocarryoutthereview,and,aspartofthisdeliveronacommunicationplantoengagewithanagreedgroupofstakeholders.

ii. Stage 2: To deliver a report to Cabinet which outlines a strategy for older

peoplesservicesintheCityandCountyofSwansea.ThiswillthenformthebasisofourcommissioningplanforOlderPeople.

21. Bytheendofthereview:

i. ‘[A] final product is expected to weigh up the advantages and

disadvantages of a small number of strategic approaches to sustainablesocialcare,whicharepotentiallyavailablefortheCabinettoconsider.’

ii. ‘Thereportistoconcludewithaclearsetofproposalswhicharedrawnfromthepreferredwayforward,whichreflecttheoutcomesfromtheengagementevents,withatimetableforimplementationovertheshort,mediumandlongerterm.’

22. TheIndependentReviewcommencedon30thJuneandwastobedeliveredtotheCouncilby5thSeptember.Therelativelyshortreviewperiodwasacknowledgedat the outset by both the Council and the Independent Review team, but wasnecessitated to by the need for the Review to inform decisions about theforthcomingyear’sbudgetinlateSeptember.

1 Invitation to tender, p. 7.

7

THECONTEXT:OVERVIEWOFPROVISION,DEMOGRAPHICCHANGE,BUDGETARYPRESSURESANDTHEPOLICYCONTEXT

OverviewofprovisionofsocialservicestoolderpeopleinSwansea

23. In2013/14, therewere44,377peopleover theageof65 living inSwansea. InMarch2013/14,SocialServiceswereprovidingservicesto4,216,or9.5%ofthetotalpopulationofolderpeople,whoweresupportedeitherinthecommunityorincarehomes.

24. Of the 4,216 people in in receipt of services from Social Services in March2013/14,23%(954olderpeople)werelivinginacarehome.

25. Ofthe4,216olderpeople inreceiptofservices in2013/14,44%wereaged85andover,37%werebetween75and84,withtheremaining19%agedbetween65 and 74. Service provision is thus concentrated on older people of moreadvancedyears.

26. Ofthe954peoplebeingsupported inresidentialcareservices,54%wereaged85orover, 34%wereagedbetween75and84,with the remaining12%agedbetween65 and74.Residential care support is, to a greater extent thanotherservicesupport,concentratedonolderserviceusers.

Demographicchange

27. There is widespread recognition that society is ageing and that policymakersmust plan now in order manage the challenges which arise from populationageing.

28. Stats Wales provides local area population forecasts as far into the future as2036 and we have analysed these as part of this Independent Review. Theseforecastsshowthat,between2011and2036,thenumberofolderpeople(aged65andabove)isexpectedtoriseby44%.

29. Thisisundoubtedlyasignificantriseinthenumberofolderpeopleintheperiodof twenty‐five years. However, the sharpest population rises are amongst theolderold.StatsWalesforecastsestimatethatthenumberofpeopleaged80andover in Swanseawill rise by 84% over the same period, while the number ofolderpeopleaged90andoverwillriseby197%.

30. These projections clearly point to a demographic transition. However, thistransitionisnotuniquetoSwanseaand,indeed,islessrapidinSwanseathaninWalesoverall.Thatis,theproportionateincreaseinthenumberofolderpeopleaged65+and90+ inSwansea isestimatedbyStatsWales tobe lower than forWalesasawhole.

31. Of course, the expansion of life expectancy is substantial societal achievementand should be celebrated. However, greater longevitywill create pressures interms of the financing and provision of social care and health services. Webelieve that the population ageing should be thought of as a demographic

8

transitionratherthanconstitutingapopulation ‘timebomb’,as it issometimesdescribedinthemedia.Nonetheless,thechallengesposedbypopulationageingarerealandmustbeaddressedbypolicymakers.Ifnewservicemodelsarenotimplemented,thestatusquowillimposerisingcostsovertime.

32. Theextenttowhichincreasinglongevityresultsinrisingdemandforsocialcareis particularly difficult to forecast as it relies on assumptions about whetheradditional years of life are spent in periods of independence and/or health orwithhighlevelsofneedand/orinill‐health.

33. Overall, then, the number of older people is expected to rise significantlybetween2011and2016,byaround44%.Thenumbersofover80sandover90sare expected to rise evenmore rapidly than the numbers of older people as awhole, by 84% and 197% respectively over the same period. This mattersbecause, as we have seen, current service support is concentrated to asubstantial extent onolderpeople at thesemore advanced ages.All elsebeingequal,wecanthusexpectasubstantialriseindemandforsocialcareservicesinthedecadestocome.

Budgetarypressures

34. Incontrast to thesignificantrise in theneed forsocialcareover timewhich isanticipatedtofollowfrompopulationageing,theCouncil’simmediatebudgetaryposition is difficult. The Council’s Medium Term Financial Plan 2014/15 –2016/17notestheextenttowhichtheUKGovernment’sdecisionstocutpublicspendingwillimpactonCouncilfinances.

35. As the Plan notes, ‘prospects for 2015/16 and 2016/17 are poor’ (p. 56),anticipatingareal terms3.2%reduction in theRevenueSupportGrant inboth2015/16and2016/17.ThePlannotesthat‘Goingforward,theabilityofCouncilsto provide comprehensive Adult Services will be heavily impacted by fundingdecisions of theUKGovernment. As such, the promotion of independence, selfhelpand thedevelopmentof a strong third sector is likely tobe inevitable’ (p.57).

36. This is broadly supported and recognised in Welsh Government policydocuments. Fulfilled Lives, Supportive Communities (2007: 29) notes that ‘theneed for greater efficiency and getting greater value for theWelsh poundwillintensify. Remodelling services and achieving efficiencies through bettercommissioningwillbecomeevenmoreimportant[overtime].’

37. These economic estimates are of a rather shorter‐term nature than thedemographic estimates discussed above. Nonetheless, in the short term thebudgetarypositionisextremelydifficultand,unlessthereistobeamajorshiftinthefinancingofsocialcarebytheUKGovernment,itisexpectedthattheriseinneed associatedwith increased longevitywill substantially outstrip any rise inresourcesoverthemedium‐tolonger‐term.

9

ThePolicyContext

PolicyBackground

38. The NHS and Community Care Act (1990) provides a useful starting point interms of considering the policy context in this area. TheAct focused statutorycare provision on the flexible delivery of care to an older person. The level ofcareprovidedwastobedeterminedusingthe“UnifiedAssessment”.Accordingto theAct, each local authorityhas aduty to carryout aneedsassessment foranybodywho“maybeinneed[...]ofcommunitycareservices”(section47)andprovides local authorities with the power to inspect any premises “in whichcommunitycareservicesareorareproposedtobeprovidedbyalocalauthority”(1990,section48).

39. Since devolution, the Government ofWales have drawn on a distinctive set ofsocialpolicyprincipleswhichseparatepolicyimplementationinWalesfromtheway it is implemented in England. Perhaps the main principle guiding thisdistinctiveapproachisthecommitmenttoputthecitizenatthecentre(‘MakingtheConnections’(2004)).

40. Thecitizenshipapproach“relieson ‘voice’ todrive improvement togetherwith

thedesign,management,regulationanddeliveryofservices,alloperatingintheinterests of the citizen, with the potential to build up trust and a long‐termrelationshipbetweenthecitizenandpublicservices”.2Thus,publicservicesaresupposed to be delivered in a way that supports collaboration and citizenengagement.3Central to this is the ideaof ‘co‐production’,or theway inwhichsocial care is simultaneously consumed and produced4 through negotiationbetweenproviders,usersandpolicymakers.5

StrategyforOlderPeople

41. Theoverarchingpolicynarrativeonolderpeople inWaleshasbeenshapedby

the Strategy for Older People inWales. The first Strategy for Older People inWales (2003‐2008) identified structures and policies which needed to beintroducedtomakepublicpolicy inWalesmoresensitivetotheneedsofolderpeople. The Strategy sought to challenge negative stereotypes of older peopleand celebrated the contribution made by older people, emphasising theengagement,participationandempowermentofolderpeople.ItnotedtheneedtoimproveservicesforolderpeopleinWales.

42. The second Strategy for Older People in Wales 2008 – 2013, Living Longer,Living Better (WG, 2008) shifted the focus from raising awareness of olderpeopletomainstreamingthisawareness(2008:13).Thissecondstrategysought

2 Birrell, D. (2009), The Impact of Devolution on Social Policy, Bristol: Policy Press. 148). 3 Martin, S. and Webb, A. (2009), ‘Citizen‐centred’ public services: contestability without consumer‐driven competition? Public Money & Management, 29, 2: 123–30. 4 Baldock, J. (1999) “Social care in old age: more than a funding problem”, Social Policy and Administration, 31(1): 73‐99 5 Needham (2007) "Realising Potential of Co‐production: Negotiating Improvements in Public Services", Social Policy and Society: 7(2): 221‐231

10

topromotepositiveimagesofageing,tosupportpolicieswhichwouldincreasetheabilityofolderpeopletomakeanactivecontributiontosocietyforaslongastheywereabletodoso,toensurethatolderpeopledidnotliveinpoverty,andtoensure that people could live ‘as actively and independently as possible in asuitableandsafeenvironmentoftheirchoice’(WG,2008:4,seealso25).6

43. TheThirdStrategyforOlderPeopleinWales(2013‐2023)7assumesthatmuchofthisworkhasbeenachieved,andshiftsfocusinthedirectionofavision–“tomakeWalesagreatplacetogrowold”.Thus“Itisnotenoughtonullifydisablingconditions;wemustalsocreateconditionsinwhichallolderpeoplecanflourish”(2013: 1). This third strategy seeks to improve outcomes in terms of socialparticipation,diversity,accesstoinformation,learningandactivitiesandhealthyageing.

44. The principle mechanisms for embedding these three strategies have been

National Service Framework forOlderPeople inWales, and theCommissionerforOlderPeople(Wales)Act.ThesesetouthowtheGovernmentwouldaddressdiscrimination,promotehealthyageing,introducedthesystemofolderpeople’schampionsandolderpeople’scoordinatorsandsoon.Theirmainthemeswerearound enabling older people to live a full life, preventing ill health andpromotingwellbeing, challenging dependency and developing an intermediatecareinfrastructure.

Shapingthedevelopmentofsocialservices

45. Inthe2007FulfilledLives,SupportiveCommunities–AstrategyforSocialServices

inWalesoverthenextdecade,theWelshGovernmentsetoutpreventionaspartof the core function of social services. Here social services were to “provideservices which help people to prevent or delay the need for more intensiveservices”(2007:15).

46. FulfilledLives,SupportiveCommunitiespositionedsocialservicesclosetofamiliesandcommunitieswheretheseserviceswere“strong,accessible,andaccountable,in tune with citizens’ and communities’ needs and promote social inclusion,citizens’ rights and good values” (2007: 2). This document also expressed theviewthat“Whatevertheirdifficultyorimpairment,peopleshouldbesupportedto have control over the life they wish to live. People have a right to expectservices,whichhelpthemtomakefulluseoftheirpotential,protectthemfromharmandoffer a choice abouthow they are supported” (2007:3, emphasis inoriginal).

47. SustainableSocialServices forWales:AFramework forAction (2011) notes thebackdrop of demographic changes and budget constraint, and articulates achoiceforthefutureofsocialservices:retrenchmentorrenewal.

48. The path of retrenchment ‘would see fewer people receiving services, greaterexpectationsthatpeoplefindtheirownsolutions,increasedburdensoninformal

6 Welsh Government (2008), The Strategy for Older People in Wales, 2008 – 2013: Living Longer, Living Better. 7 http://wales.gov.uk/docs/dhss/publications/130521olderpeoplestrategyen.pdf

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carersandagrowingnumberofdisputesbetweenservicessuchastheNHSandsocialcareaboutwho isresponsible forservices’.8Ontheotherhand, ‘renewalmeans focussing clearly on delivery; it means continuing to innovate; and itmeanscreatingsustainable services’.9This is thepreferredway forwardof theWelshGovernment.

49. The Framework emphasises the importance of joined‐up working and sharedlearning, avoiding duplication of services, giving service users and carers astronger voice and greater control of services, and prioritising professionaljudgement.10 It stresses the importance of the local authority leading a wholecommunityresponsetopromotingwell‐being,prioritisingre‐ablementservicesandusingnewtechnologiestoensureefficientuseofresourcesandasameansofpromotingindependence.

Recentpolicydevelopments

50. The recent Social Services and Well‐being (Wales) Act 2014 transformspreventionintoadutyshoulderedbyLocalAuthorities.Thespecificduty is“toseektopromotethewell‐beingof(a)peoplewhoneedcareandsupportand(b)carers who need support” (para 4), and this duty directs local authorities toensure the “a range and level of service” that it “considers” as “contributingtowardspreventingordelayingthedevelopmentofpeople'sneedsforcareandsupport”andwhichreducecareneedsofthosewhodohavesuchneeds(para6,section2).

51. The Act changes the assessment process from an administrative to a morecommunicativeprocess.Under thisnewAct, social services stillhaveaduty tocarryoutassessments to identifyneed forcareandsupportregardlessof theircurrentneedsandtheirfinancialsituation.Inparticular:

(4)Incarryingoutaneedsassessmentunderthissection,thelocalauthoritymust—(a)seektoidentifytheoutcomesthattheadultwishestoachieveinday‐to‐daylife,and(b) assesswhether, and towhat extent, the provision of care and supportcouldcontributetotheachievementofthoseoutcomes.

52. TheActdoesnotstipulatelevelsofneed,andeligibilitycriteriaarethesubjectof

anongoingconsultation.11Thepreferredproposalatthispointisthateligibilitymustconsiderwhattheindividualswantstoachieve,whatkindoflifetheywanttolive,andhowservicescanbeprovidedtohelpachievethisobjective.Thus,theActprovidesamechanismthroughwhichsocialservicescanengagewitholderserviceusersinawaythatisconsistentwiththelatestStrategyforOlderPeopleinWales.

8 WG (2011) , p. 6 9 WG (2011) , p. 6 10 WG (2011), p.7 11 http://wales.gov.uk/topics/health/socialcare/act/journey/eligibility/?lang=en

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53. The Social Services and Well‐being (Wales) Act 2014 Act requires localauthoritiestopromotethedevelopmentofsocialenterprisestoprovidecareandsupport and preventative services, and to promote the involvement of serviceusersinthedesignandrunningoftheseservices.12

54. ThemeasurescontainedintheActwillneedtobe implementedbyApril2016.Aswouldbeexpected,considerationofthechangeswhichneedtotakeplaceinorder to comply with the new Act feature inmany of the internal documentswhichwehaveseenaspartofthisIndependentReview.

SOCIALSERVICESFOROLDERPEOPLEINSWANSEA

55. In this section,weprovide anoutlineof existing serviceprovision in Swansea.Before a person can receive support and help from Social Services, theymustmakeareferralorbereferredbysomeoneelse.Onceareferral ismade,SocialServiceswill carryoutanassessmentof theneedsof theperson forwhomtheservices has been requested. The assessment allows Social Services to decidewhat support would bemost helpful and to determinewhether the person iseligibleforsupport.13

56. Therearefourdifferentbandswithintheeligibilitycriteria:Critical,Substantial,ModerateandLow.Likemost localauthorities,SocialServicesprovidesupportonly for thosewhohave critical or substantialneeds.Apersonwith critical orsubstantialneedsisconsideredeitherunableto“managetodoessentialthings”oris“strugglingtomanage”.The“person’slifemaybeatrisk”andtherehasbeenortheymaybeabuseorneglectifthereisnoaction.14

57. Once the eligibility needs of the person have been determined, the Social

ServicesDepartmentwill thenwrite a SupportPlan for theperson, settingouthow certain services and support will work with them towards a specificoutcome. The Support Plan is reviewed on a regular basis to verify whetherneedsarebeingmetandtocheckifneedshavechanged.15

DirectPayments

58. InadditiontothetraditionalapproachtosocialcareprovisionwheretheSocialServices controls themoneyandprovisionof social careor they candecide tomanagetheirownsocialcaresupportthroughDirectPayments.Thismoneycanbeusedtoemployapersonalassistant,buycarefromaprivateregisteredcareagencyortheycanmaketheirownarrangementsinsteadofusinglocalauthorityDayCentresandRespiteCentres.ItispossibleforanindividualtochooseamixofDirectPaymentsandthetraditionalapproachofsocialcareprovisionthroughtheSocialServices.

12 Clements (2014), The Social Services and Well‐being (Wales) Act 2014 – An Overview. P.3 13 http://www.swansea.gov.uk/index.cfm?articleid=48629 14 http://www.swansea.gov.uk/index.cfm?articleid=49997 15 http://www.swansea.gov.uk/index.cfm?articleid=49997

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59. Wenote that, asofMarch2013/14, therewere77olderpeople inreceiptofadirectpayment.

ResidentialandNursingCareHomes

60. TherearecurrentlysixresidentialcarehomesforolderpeoplemanagedbytheLocal Authority. The Local Authority commissions services from approx. 40independentsectorresidentialandnursingcarehomesintheSwanseaareaandapprox.50otherindependentsectorandLocalAuthoritycarehomesaroundthecountry.16Wenotethatthelocalauthoritycanonlyprovideresidentialcareandare prevented by legislation from providing nursing care, while independentsectorproviderscanprovidealltypesofresidentialandnursingcare.

61. An assessment from a social worker on the needs of the person is aimed athelpingthepersonchoosethemostappropriatecarehomefortheperson.17Theperson can choose to go to any care home as long as it meets their assessedneedsanditsatisfiesthestandardssetbythegovernment.18

62. A financial assessment is carried out to see whether a person moving into aresidentialornursingcarehomeiseligibletoreceivemoneytocontributetothecostoftheircare.Apersoniseligibletoreceivemoneytocoversomeofthecostofresidentialornursingcareiftheyhavelessthan£24,000insavingsorotherassetsandthatSocialServicesthroughaCommunityCareAssessmentconcludethat moving into residential or nursing care is the best way of meeting theirneeds.Ifapersonhasmorethan£24,000savingsorotherassets,theymustpayforalloftheircare,thoughtheymaybeeligibleforanumberofotherpayments.

63. If aperson fallsunder the thresholdof£24,000 in savingsoranyotherassets,they are eligible to receivemoney from the Social Service to cover the cost ofcare.ThemoneygivenbytheSocialServicesismeanstestedanddependentonthe person’s financial circumstances. In 2015/2016, Social Services willcontributeamaximumof£485.00perweek towards those inResidential care,£500.00perweektowardsGeneralNursingCareand£515.00perweektothoseinDementianursingcare.19

64. If apersonwho is apermanent residentof a residential ornursing carehomeownstheirownproperty,SocialServicesmaytakeintoaccountthevalueoftheirhomewhenmakingafinancialassessment.Incertaincircumstancesuchasifanelderlyordisabledrelativestilllivesinthehome,SocialServiceswillignorethevalue of the person’s home. The person who is the permanent resident of aresidentialornursingcarehomeisexpectedtoselltheirhomeafter12weeksofmoving. For the first12weeks, the Social Serviceswill ignore the valueof theperson’shome.Thisiscalledthe12weekpropertydisregard.

16 Review of Residential care homes, p. 5. 17 http://www.swansea.gov.uk/index.cfm?articleid=50538 18 http://www.swansea.gov.uk/index.cfm?articleid=50969 19 http://www.swansea.gov.uk/index.cfm?articleid=50969

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65. ThepersoninquestionmaybeabletoapplyforaDeferredPaymentScheme.20Thismeansthatapersondeferspartof thepaymentfortheircareuntila laterdate,possiblyafter theirdeath.Duringthis time, theCouncilhasa legalchargeovertheirpropertyandSocialServicescoverthecostsfortheperson’scare.Anindividualmusthavelessthan£24,000insavingsorotherassetsandtheremustbe littleornooutstandingmortgageon theproperty inorder tobeeligible forthescheme.

66. ApersoncangotoahomewhichismoreexpensivethanSocialServiceswould

normallypayfor.However,theymustfindanotherpersontopaythedifferenceontheirbehalf.Thisisknownasa‘ThirdPartyAgreement’.21

67. Of the 954 people supported by the Local Authority in care homes at March2014, 15% (145) were in Local Authority residential care homes, with theremaining 85% receiving in residential or nursing care homes in theindependentsector.22Theaveragelengthofstayinanindependentresidentialornursing home was estimated in 2013 to be 2 years and 6 months. In a localauthorityresidentialcarehomeitwas3yearsand11months.23

Othertypesofhousingavailableforolderpeople

68. Inadditiontoresidentialandnursingcarehomes,thereareretirementhousing,shelteredhousingandextra‐carehousingschemesinSwansea.

69. Retirement housing consists of a group of houses or apartments which arespecificallydesignedtomeettheneedsofolderpeople.Residentsnormallypayan annual service charge to cover maintenance issues. In certain complexes,residentscanalsopayforaddedsupportservices.24

70. ShelteredHousingschemesconsistofproperties forolderpeoplewhichhavea

wardenonsite.ShelteredHousingcanberented(throughtheCouncilorHousingAssociation) or can be bought (through a private company). To apply forshelteredhousing, a personmust apply for shelteredhousing through theCityandCountyofSwanseaCouncil’sAccommodationService.25

71. Extra‐carehousingconsistsofapartmentsorhouseswherecareisprovidedon‐

site for peoplewho are unable to live independently but do not need24‐hourcomplex,medical supervision.26 By 2013/14, note that the local authoritywasworkingwiththreeagenciesandonein‐houseproviderinextracaresettings.

20 http://www.swansea.gov.uk/index.cfm?articleid=53665 21 http://www.swansea.gov.uk/index.cfm?articleid=50970 22 Performance Management returns 2013/14 23 Improving Outcomes for Older People ‐ initial business case: 13 24 http://www.swansea.gov.uk/index.cfm?articleid=49200 25 http://www.swansea.gov.uk/index.cfm?articleid=1161 26 http://www.swansea.gov.uk/index.cfm?articleid=49202

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HomeCareServices(DomiciliaryCare)

72. Care services are also provided within a person’s home. Home care servicesprovidespractical support in carryingoutpersonalorhousehold taskssuchaswashing,dressing,usingthetoilethelpwithpreparingmealsandwitheating.27For the first six weeks, the older person will receive a service from City andCountyofSwansea'sDomiciliaryCareAssessmentService.28Afterthesixweeks,a person will receive support either by a staff employed directly by SocialServicesorbyaprivatecareagencyundercontracttoSocialServices.29

73. In 2013/14, the authoritywas commissioning eight accredited and four othercontractedindependentsectoragenciestoprovidelong‐termdomiciliarycare.Inaddition, the authoritywasworkingwith three agencies providingdomiciliaryrespitecareforcarers.

74. As with residential care, a financial assessment is carried out to decide howmuchapersonwillpayforhomecareservices.30Inthefinancialassessment,anindividual’sincomefrompensionsandbenefitsandtheirsavingsaretakenintoaccount.Expensesfromrent,mortgagepaymentsandCouncilTaxpaymentsaresubtracted from an individual’s income and savings. If a person’s savings aremore than £24,000, they will have to pay the full amount allowable underchargingguidanceunlesstheycanprovethatsomeoftheirassetsmaybeclassedas income. If a person’s savings are less than£24,000 and theyhave aweeklyamountwhichislessthan£215.11(forolderpeopleover60yearsold),theywillnot have to pay anything towards home care. If it is above this threshold, apersonwillbeexpectedtopayupto£10anhouror£2.50perquarterhourforhomecare.Nooneisexpectedtopayabove£55perweek(fromApril2014).Ifaperson has savings in a joint account, the Financial Assessment Officer onlycountshalf themoney.Couplescaneitherbe financiallyassessedseparatelyortogether. If a person finds it difficult to pay for home care, they are asked tocontacttheFinancialAssessmentOfficerorsocialworker.

75. A Rapid Response Service, which aims to prevent emergency admissions to

residentialcare, isrunbySocialServices'DomiciliaryCareAssessmentService,alongwith CareManagement staff andDistrictNurses from theAbertaweBroMorgannwg (ABMU) Health Board Community Resource Team.31 A person orsomeoneontheirbehalfmustcontacttheAdultServicesIntakeTeamtoreceivethisservice.Oncetheyarereferred,thepersonwillreceiveavisitfromtheRapidResponseTeamwithintwohours.TheRapidResponseServiceisavailableforupto72hours.Ameetingwillbeheldwithinthefirst72hoursameetingtodiscusshowthecareneedsofthepersonwillbebestmet.

27 http://www.swansea.gov.uk/index.cfm?articleid=50001 28 http://www.swansea.gov.uk/index.cfm?articleid=49841 29 http://www.swansea.gov.uk/index.cfm?articleid=50004 30 http://www.swansea.gov.uk/index.cfm?articleid=50126 31 http://www.swansea.gov.uk/index.cfm?articleid=51070

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76. 1,807 older people received home care services atMarch 2014, a rise of 17%fromtheMarch2013figure.32Approximately15%ofhomecareprovisionisin‐house,withtheremaining85%beingprovidedexternally.33

TheIntegratedGowerCareTeam

77. SinceOctober2013,theSwanseaCouncil'sSocialServicesandtheAbertaweandBro Morgannwg University Health Board have been running a joint pilotinitiativecalledtheIntegratedGowerCareTeam,34whichprovidesawiderangeof health and social care support such as reablement support, long‐termdomiciliarycareandanemergencyresponseservicetopeoplelivinginthemidandwestareasofGower,includingLlanrhidian,Llangennith,PortEynon,ThreeCrossesandBishopston.TheinitiativehasbeensetupastheGowerisasparselypopulated rural area and it is therefore difficult to provide an effective careservicetoeveryonewhoneedsit. Peopletendtoreceiveashort‐termsixweekAssessmentservice,wheretheperson’sneedsareassessed.Afterthesixweeks,theTeamreviewtheneedsofthepersonandworkoutiftheyrequirelong‐termcareandsupportservices.Theneedsofthepersonwillbereviewedfromtimetotime.ApersonmaybereferredtotheteambyaGP,socialworkerorahospitalstaff. Additionally, a person or someone on their behalf is able to request toreceivetheservice.Thereisnochargefortheshort‐term,sixweekAssessmentservice.However,apersonwillbechargedforanylong‐termcareandsupport.

DayServices

78. Socialservicesrunfivedaycentres forolderpeople inSwanseawhohavehighlevels of needs. Day care services can only be provided to those who havereceived an assessment of their needs by the Social Services.35 Day centresprovidedaycareforolderpeople,anopportunitytosocialisewithothersandtobeinvolvedinanumberofdifferentactivities.

79. Duetothelimitednumberofplacesavailable,individualswhoareeligiblefortheschememayhavetowaitbeforetheyareallowedtostartgoingtothedaycentre.Users of day care service usually attend once a week. There is no charge forattending a day centre if an individual is a resident of the City and County ofSwansea. However, individuals will be charged for refreshments or any craftmaterialsusedforaparticularactivity.

80. Day opportunities are groups which meet regularly and which provide olderpeoplewithasocialoutlet,butdonotprovidethemoreintensivesupportwhichexistsatadaycentre.CityandCountyofSwanseaCouncilhas fiveCommunityConnectors who help older people to become involved with groups, activitiesandorganisationswithinthelocalarea.36Anyoneovertheageof50canattendthesedayopportunities.

32 Performance Management returns 2013/14 33 Commissioning Plan Older People’s Services 2011 – 2014 (Current year 2013/14), p. 19. 34 http://www.swansea.gov.uk/index.cfm?articleid=56891 35 http://www.swansea.gov.uk/index.cfm?articleid=50987 36 http://www.swansea.gov.uk/index.cfm?articleid=56712

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Supporttohelpolderpeopleregainindependence

81. SocialServiceandotherpartnersprovidesupportandarangeofservicetohelppeoplewhohavehadaperiodof illhealthtoregaintheir independence.Aswediscuss in greater detail below, as part of a recent reablement initiative, theAssessmentUnitatBonymaenHousesupportspeoplewhohaveexperiencedaperiodof illhealthorhavebeen inhospital,whorequireadditional support torecover before they return home to live independently. The service is “shortterm, time limited and goal orientated” and a person usually spends up to sixweeksintheAssessmentUnit,37aftertheyhavebeenreferred.Aftertheirstay,apersonmayreturnhomeiftheyareabletomanageormaymovetoacarehomeiffurtherorlong‐termresidentialornursingcareisneeded.

82. There is also aDementiaAssessmentUnit a TyWaunarlwydd,which providessupportforpeoplewithdementiatocontinuetoliveathome.38

83. Ifapersonhasover£24,000insavings,thefullcostofthestayintheAssessment

Unitmustbepaid.Iftheyhavelessthan£24,000insavings,thecostiscurrentlybetween £123 and £169 perweek depending onwhether the person receivesanybenefits.

Leavinghospitalandreablementinthecommunity

84. SocialworkteamsarebasedinSingletonandMorristonhospital,whichprovide

an assessment care management service to certain patients whomay requiresupportwiththehospitaldischargeprocess.39Ifapersonaimstoreturnhome,Social Serviceswill provide a package of support for them. Information aboutsupportprovidedbyanumberofthirdsectororganisationsforolderpeoplewholeavehospitalisprovidedbytheLocalAuthority.

85. Followingastay inhospital,anolderpersonmayreceiveaperiodof specialist

reablement, short‐term support to help a person to manage livingindependently.40 This may include the Community Occupational TherapyServicesprovidingthemwithtechniquesorequipmenttodocertaintasks.Itmayinvolve a Community Connector providing information regarding groups andactivitieswithinthelocalarea.

SupportforCarers

86. TheCouncilalsoprovidessupportandhelpforpeoplewhoactascarers.CarershavetherighttoaCarer’sNeedsAssessment,carriedoutbytheSocialServices.41Theassessment focusesontheneedsof thecarerandnot thepersonthattheylookafter.Thereisalsoaself‐assessmentquestionnaireforacarertocomplete,

37 http://www.swansea.gov.uk/index.cfm?articleid=50547 38 http://www.swansea.gov.uk/index.cfm?articleid=50546 39 http://www.swansea.gov.uk/index.cfm?articleid=50809 40 http://www.swansea.gov.uk/index.cfm?articleid=49764 41 http://www.swansea.gov.uk/index.cfm?articleid=50067

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whichprovidesthemtheopportunitytothinkabouttheircaringroleandotherissuestheymightliketodiscusswiththepractitionerintheassessment.

87. Therearealsoopportunitiesforcarerstohaveabreakfromcaringforafriendorrelative. Social Services can provide advice and can direct carers towards theappropriateservices.42Respiteservicescanbeprovidedathome,atasupportedliving flatwithin theHazelCourt complex in Sketty, or in LocalAuthority carehomes such as Rose Cross House. Costs and entitlement criteria for theseschemesvary.

Provisionofinformation

88. In addition to serviceswhich are directly commissioned or provided, the localauthority also provides information to older people about a range ofopportunities,activitiesandservices inthe localarea includingSeniorCitizens’Pavilions, lifelong learning opportunities, volunteering opportunities, leisurecentres,befriendingservicesrunbyarangeofthirdsectororganisations,andsoforth.Therearediscountedratesatsportandleisurecentresforolderpeopleinreceipt of the Pension Credit. The Local Authority also provides informationabout services and support for carers provided by local third sectororganisations,andaboutentitlementtoCarer’sAllowance.

THEPOLICYDIRECTION

89. Policyisnotstatic,however.Inordertomeetthechallengesposedbypopulationageing, the Local Authority have introduced a number of initiatives which,together, aim to guarantee the long‐term sustainability of social services forolder people in Swansea, and which ensure policy is in line with WelshGovernmentlegislation.

90. Broadlyspeaking,theseinitiativesamounttoeffortstointroduceanewservicemodel of social care. This model seeks to move beyond what is sometimesviewed the ‘deficit’model of the past, whereby needs are assessed, and thosewith eligible needs have services allocated to meet these needs, within theavailable resource constraints,43 and towards a preventative, universal socialcaremodel.

91. In this new model, promoting wellbeing is viewed as being “everybody’sbusiness”; the Local Authority will have a role and responsibility for leadingcommunity services, promoting community wellbeing and strengthening andsupportingcommunities’owncommitmenttosupportcitizens.Thismodelwill,toagreaterextentthaninthepast,focusonpreventionratherthanonmeetingneeds,andwillseektoenableindividualstoremainasindependentaspossibleforaslongaspossible.

42 http://www.swansea.gov.uk/index.cfm?articleid=56273 43 City and County of Swansea (2014), ‘Sustainable Swansea – fit for the future: A safe prevention strategy – Supporting Older People to Live Independently, p. 11.

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92. Thepolicydirectionseekstoachievearebalancingofcareprovisionawayfromresidential forms of care and towards lower levels of support within thecommunity. Three beliefs underpin this strategy. The first is thatmost peopleprefer to live at home rather than in residential care. The second is that byinvesting in prevention and reablement, people can be enabled to liveindependently inthecommunity for longer.Thethird is thatolderpeoplewithlower levels of careneedswhomightpreviouslyhave entered residential carecanhavetheseneedsmetequallywellbydomiciliarycare.

93. Thebelief thatmostpeopleprefer toremain intheirownhomewhentheyareabletodosoimpliesthatbyhelpingpeopletoremainintheirhomestheLocalAuthoritycontributesinapositivesensetopeople’swellbeing.Fromafinancialpointofview,helpingpeopletoremainindependenceforlonger,requiringeithernoorrelativelylowlevelsofdomiciliarycaresupportalsohelpstomoderatethefinancialdemandsontheCouncil’sbudget.

94. Thisisnotastraight‐forwardquestforeconomy.Providingsupportforpeopleatlower cost levels means that a greater number of older people can receivesupportatanygivenlevelofresources.

95. Itisinstructivetothinkoflevelsofprevention.Shapingcareservicestofocusonhelpingpeopletolivewellinthecommunitymightinvolve:

“Preventingthepersonfrombecomingillorfrailinthefirstplace(Primaryprevention)Helping someone manage a condition as well as possible (Secondaryprevention)Preventingadeteriorationinanexistingcondition(s)(Tertiaryprevention)Providing active support to help someone regain as much autonomy andindependenceaspossible(Rehabilitation)”44

96. Swansea Local Authority have developed a number of initiatives that address

variousformsofprevention.TheWesternBayprogrammefocusesverymuchonsecondaryand tertiary formsofprevention,while theTransformationofAdultSocialServicesfocusesonrehabilitation.

97. In terms of local authority‐provided care, the policy direction entails a shifttowardsprovidinganicheservice, focussingonthosewithcomplexcareneedsand/orwhohavedementia.

WesternBay

98. TheWesternBayProgrammewasestablishedtodeliverintegratedcaremodels

acrossolderpeople,mentalhealthandlearningdisabilityservicesintheregioncovered by ABMU.45 The Western Bay Programme Board was established in

44 Allen, K., and Glasby, J. (2010) "‘The billion dollar question’: embedding prevention in older people’s services ‐ 10 ‘high impact’ changes", Health Services Management Centre, policy paper 8, p. 3 45 Western Bay, Delivering Integrated Health and Social Care for Older People with Complex Needs across Western Bay, Statement of Intent, March 2014

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January2012andcomprisestheChiefExecutivesforBridgendCountyBoroughCouncil, Neath & Port Talbot County Borough Council, City and County ofSwanseaandAbertaweBroMorgannwgHealthBoard.46

99. The aim of the Western Bay Programme, as set out in the Memorandum ofUnderstandingbetween itsmembers, is to ‘to establish a regional approach todeveloping sustainable and effective health and social care services’.47 Todevelop this regional approach, the participating counties have “identified aconsistent model for an integrated intermediate tier of services which willprovideanumberof functions, focusedon time limited support topeople thathelps themtorecover their independenceeitheratapointofcrisisorafteranincidentthatmayhaveledtoahospitaladmission”.48

100. The Western Bay Programme has been focusing on components ofintermediatecareprovisionsuitedtointegration.Theseinclude: aCommonAccessPoint; acomprehensiveRapidResponseservice; arangeofcommunityreablementservicesavailabletoensurethat

individualscanremainasindependentaspossiblewithintheirownhomes; ‘stepup’and‘stepdown’facilitiestoassessandre‐ableindividualswho

cannotinitiallybenefitfromreablementfacilitiesinthecommunity; thirdsectorbrokeragetoensurethewealthofvoluntarysectorsupportcan

beefficientlyaccessedandappropriatelyutilisedbyindividualsorprofessionalsontheirbehalf;

Investmentinanddevelopmentofotherthirdsectorserviceswhichwillenhancetheresponsivenessofservices;

moreeffectiveuseofTelecareandothertechnologiestocomplementandenhanceotherservicesandtomaketheworkofthoseprovidingservicesmoreefficientandeffective;

Expandedmedicalworkforcetobettersupportpeopleinthecommunity.49

101. AsofJanuary2014,£8.2mwasbeingspentonintermediatecareservicesacrosstheregion.However,inmappingoutandexploringthepotentialoftheseservices,thebusinesscaseproposed“thatapproximately£14.5mwillbeneededby2016/17 to transform theservicesanddeliverongoingsavingsby reducingother long termsupportneedsand/ordependencyonhospital care forpeoplewhoseneedscanbemetbetterelsewhere.”50

102. Western Bay work programmes currently employs 252 Whole TimeEquivalents across the region. The Western Bay programme anticipatesincreasingthisworkforcebyanother138WholeTimeEquivalents.51

46 Western Bay Health & Social Care Launch Event, 2 July 2013. 47 Memorandum of Understanding between Western Bay partners, Oct 2013, p.1 48 Report of the Cabinet Member for Wellbeing Cabinet ‐ 3 June 2014 WESTERN BAY HEALTH AND SOCIAL CARE PROGRAMME INTERMEDIATE CARE FUND 2.24 49 City & County of Swansea/ABMU Health Board, Swansea Locality Statement of Intent on Integration of services 50 Transforming care through investment in the intermediate tier, 3 year business case 27th, January 2014 51 Transforming care through investment in the intermediate tier, 3 year business case 27th, January 2014

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103. Western Bay has received funding from the Welsh Government

Intermediate Care Investment Fund of £2.601m capital and £5.203m revenue.Formalnotificationoffundingwasgivenonthe2ndofApril2014forthefundingallocationwhichcannotbeextendedbeyond1stofApril2015.52TheProgrammefaces issuessurroundingspending thegrant in the limited timeavailable53andbridgingafundinggapof£3.9min2015/16.54

104. Work to date has largely focused on the governance and aims of theProgrammeusingaWholeSystemsPartnershipapproach. It isanticipated thatworkinthecomingyear(s)willfocusmoreonserviceusers.55

105. TheProgrammehasadoptedahubmodeltoorganisework.TheseHubsgatherprofessionalsfromdifferentservicestogetherintoanetworkhub.Theseteamswouldbemanagedbyanintegratedhubmanagermanagingasocialworklead,nurselead,therapyleadandservicelead;theotherserviceshubwouldbemanaged by a Community Resource Manager, managing LA/Locality‐wideservices, Specialist Services, CareHomes Quality Team, andHospital in‐Reach.Thishubapproachintegratesprofessionalsatthefrontlinebutfromavarietyofservices,andsoincreasesthepossibilitythattheWesternBaymodelwillachievethepositiveoutcomessuggestedabove.

106. TheWesternBayprogrammeintegrateshealthandsocialcareservicesbydevelopingonexistingarrangements.Thishas involveddevelopingCommunityResourceTeams,CommunityMentalHealthTeamsandCommunityNetworkstoincorporate more integrated working practices. Work is underway to furtherdevelop on existing joint working arrangements in Community Mental HealthTeams,andtodeveloptheroleofcommunitynetworks.56

107. TheWesternBayProgrammeinitiativeis,inourview,consistentwiththeSustainable Services forWalesFramework,whichnotes that ‘we expect to seepositive examples of the planning of services on a regional or, where moreappropriate,nationalbasis’(WG,2011:11).

TheTransformingAdultSocialServices(TASS)agenda

108. A second initiative is Transforming Adult Social Services (TASS),which

beganin2010.TASSaimstoguaranteethesustainabilityofsocialservicesand,morerecently, isdesignedtosupporttheimplementationoftheSocialServicesandWell‐being (Wales)Act. TASS is comprised of three strands: Prevention&Wellbeing,DevelopingaNewOperatingModel;andReshapingandRemodelling.

52 Report of the Cabinet Member for Wellbeing Cabinet ‐ 3 June 2014 WESTERN BAY HEALTH AND SOCIAL CARE PROGRAMME INTERMEDIATE CARE FUND, section 1.5 53 Report of the Cabinet Member for Wellbeing Cabinet ‐ 3 June 2014 WESTERN BAY HEALTH AND SOCIAL CARE PROGRAMME INTERMEDIATE CARE FUND 5.7 54 Transforming care through investment in the intermediate tier, 3 year business case 27th, January 2014 55 Western Bay Health and Social Care Programme, Memorandum of Understanding, October 2013 56 Western Bay, Delivering Integrated Health and Social Care for Older People with Complex Needs across Western Bay, Statement of Intent, March 2014

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109. The firststrand isprevention&wellbeing.Themainaimsof thisstrand

are: To develop and build community capacity to provide natural support

services tominimiseuseof commissionedserviceswhichsupport thosewithacriticalorsubstantialneed;

Tobuild communities inwhich people can take ownership, control andresponsibility of decisions that affect their lives which will developpersonalisationwithinthisparticularcommunity;

Enhancingandsupportingwellbeing; Preventingoravertinglongtermdependenceonservices; Toensure that safeguarding iseverybody’sbusinessand the focus ison

prevention.

110. We note that this strand is consistent with the local authoritiesresponsibilities in terms of ‘encouraging a whole community response topromotingwell‐being’.57

111. The second strand seeks to change how the local authority works,

includingeffortsto: Place the emphasis on outcomes and achievements and not needs and

requirements; Supportculturalchange; Improveclientjourney; Focusteamstoshiftrelationsbetweenprofessionalandcitizen; Improvesupportplanningtoachieve&demonstrateagreedoutcomesvia

asinglerighttoassessmentforpeopleinneed,child,adultandcarers.

112. This second strand focuses on how the local authority can do thingsdifferently. Key themes within this pillar include ensuring assessmentprocedures are person‐centred and that service users are provided withsufficient information in order tomake decisions about the care they receive;transparency in terms of operation, greater co‐ordination between social careand health providers, between the local authority and other partners, andgreaterregionalorjointcommissionworkinginanattempttoimproveoutcomesandgenerateefficiencies.

113. Thethirdstrandisreshapingandremodelling.Thefocusofthisstrandis‘to develop a comprehensive range of services which will support people athome’,includingto:

Ensure that commissioning for such services is outcome‐based, flexibleandpersoncentred;

Ensurethatforpeoplewhorequirealeveloflongertermsupportthiswillbe provided flexibly and collaboratively using in‐house and externalservicesasappropriate;

57 Welsh Government (2011) Sustainable Social Services for Wales: A framework for action. p.7

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Ensure that a range of other sustainable services (such as Telecare,equipment services, etc.) are developed, reviewed and revised tocomplementtheseaims;

ToconsiderhowtodevelopfuturemodelsofExtraCareincludingSocialEnterpriseprovisionwhichwill aim tooffera sustainablealternative toCare Home/Day Service admission and will complement care at homedevelopments.

114. Perhapstheoverarchingvisionforthispillaristopromoteindependence

and toenablepeople tobe independentand in theirownhomes foras longaspossible. Essentially, this strand seeks to ‘do different things’. Theway this isenvisagedtobeachievedisthroughaninvestmentinreablementservicesaswellas assistive technology, which, it is hoped, will promote independence andwellbeingandwillreducedemandformoreintensivecarealternatives.

115. Together, the three strands of TASS support the broad policy directionconsisting of greater preventive work, to promote wellbeing, integrated workbetween social care and health services, efforts to support communities tosupporteachother.

116. Thepolicydevelopmentsthatthelocalauthorityhasengageduponreflecttheworkofanactiveandforwardlookinglocalauthority.Thelocalauthorityhasclearlyengagedinaprocessoftacklingtheservicepressuresthatwillarisefromchanging population demographics by incorporating ideas around promotingindependenceandhelpingolderpeopletoliveathomeforlongerintoitswork.The policies reviewed here present clear evidence that the local authority hassought to develop initiatives that connect professionals, managers, carers andcommunitiesaroundthecareneedsofolderpeople.Oneunderlyingthemeinthelocalauthoritydocuments isaroundthecommitmenttosustainingservices forolderpeople.ThepolicyinitiativesonintegratedcareandthetransformationofadultsocialservicesalsoreflectpolicydebatestakingplaceelsewhereinWalesand the UK and form part of a wide range of initiatives that aim to developpreventativeservicesasawayofmanaginganticipateddemandforservices.

SPECIFICISSUESANDAREASOFPROVISION

Onprevention,reablementandindependentliving

117. At first glance, the preventative agenda in general, and re‐ablement inparticular,seemstoofferapanaceatotheproblemofprovidingcaretoanageingpopulation.Itseemstomarryindividualgoalsforindependenceandwell‐beingwithfinancialgoalsofcost‐containment.

118. Onecrucialquestion,asweseeit,ishowsuccessfulsuchpreventativeandreablement activities are likely to be in terms of reducing need for social careovertheentirelifecourse.AsFrancis,FisherandRutternote,‘Akeyquestioniswhether investment in reablement services can fulfil the imperative to reduce

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demandforlong‐termsupport,achievingsavingstothepublicpurseandatthesametimeimprovingpeople’squalityoflife’.58

119. The existing literature on the efficacy of re‐ablement strategies isrelatively sparse, with a small number of studies, themselves often relying onrelativelysmallsamplesizes.Whatliteraturedoesexist,however,inmanycasessuggests the potential of re‐ablement services to promote independence andwell‐being,atleastintheshort‐tomedium‐term.

120. Ryburn,WellsandForemannotethat‘Overallasmallbutgrowingbodyofevidence suggests that time‐limited multicomponent interventions result in areduction in the ongoing use of home and community care services incomparison towhatwouldhavebeenanticipatedwith theprovisionof “usual”homeandcommunitycareservices’.59

121. While studies point to the potential positive outcomes which can arisefrom re‐ablement services, what is less clear is the extent to which theseoutcomesaredependentofspecifickindsofre‐ablementactivities,orthescaleofthesavingthismightgenerateforthelocalauthorityintermsofreducedratesofadmissiontoresidentialcarehomes.

122. Thus, Rabiee and Glendinning note that ‘Although existing researchshowed a reduction in the use of home‐care services for re‐ablement serviceusers…likelytoresultinlonger‐termcostsavings…,itstillremainsunclearhowlonganyreductionsinserviceusecanlastandwhatelementsofaserviceworkbest, for which groups of people and at what costs’.60 Similarly, Allen andGlasby61suggestthat‘re‐ablementappearsapositivemodel–butevidenceaboutthepotentiallonger‐termimplicationsisstillemerging’.

123. Giventhevariednatureofreablementactivitiesandthecircumstancesofserviceusers,itisimportanttonotethatnotallactivitiesmaydeliverthedesiredindividualgoals,evenifthegoalofcost‐containmentisachieved.ThoughFrancisetal.aregenerallypositiveaboutthepotentialofreablementactivities,theynotethat‘itisconceivable,particularlyforisolatedindividuals,thatareductionintheamountofcareworkervisitsmight lowertheirsenseofwellbeing.Reablementusers livingaloneare reported tohaveexperienced the servicedifferentlyandmorenegativelyintheSPRU/PSSRUstudy’.62

124. To some extent, the relatively sparse evidence base combinedwith thevaried nature of reablement activities and contexts means that the research

58 Francis, J., Fisher, M. and Rutter, D. (2014),‘Reablement:acost‐effectiveroutetobetteroutcomes’,Social

CareInstituteofExcellenceResearchBriefingNo.36 59 Ryburn, B., Wells, Y. and Foreman, P. (2009),Enablingindependence:restorativeapproachestohomecareprovisionforfrailadults’,HealthandSocialCareintheCommunity,17,3,pp.224–234. 60 Rabiee, P. and Glendinning, C. (2011),‘Organisationanddeliveryofhomecarere‐ablement:whatmakesadifference?’,HealthandSocialCareintheCommunity,195,pp.495‐503.p496. 61 Allen, K. and Glasby, J. (2010),‘”Thebilliondollarquestion”:Embeddingpreventioninolderpeople’sservices–10“highimpact”changes’,HealthServicesManagementCentrePolicyPaper8,UniversityofBirmingham.p.12.nihn 62 (2010/2014:6)

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literature is unlikely to provide a good guide to the savings which may beexpectedfromthereablementinitiativeinSwansea.

125. Theconsequence,asAllenandGlasby(2010:15)noteisthattheprospectof‘evidence‐basedpolicy’inthisarea‐thatis,offindingtheevidencepriortothepolicydecision, is likely tobe limited.Rather, theynote that there is scope for‘practice‐based evidence’ – that is, to implement a re‐ablementmodel, and tomonitortheevidenceofitsefficacy,perhapsmakingadjustmentstothismodelifthisbecomesnecessaryovertime.

EvidenceofsuccessofreablementactivitiesinSwansea

126. Assessmentbeds,forthepurposesofreablement,werepilotedinitiallyin

St. John’s Residential Care Home. An evaluation of the assessment bedprogramme at St. John’s found that, of the 32 service users who had beenadmittedtosuchbeds,themostrecentplaceofresidencefor19(almost60%)oftheseservicesuserswasathome.63Ofthese,three‐quartersrequiredanincreaseintheircarepackage,butthecostofthisprovisionwasnotedtobesubstantiallylowerthanthecostofresidentialcare.

127. AsaresultoftheperceivedsuccessofthispilotinSt.John’s,thenumberof beds designated as assessment beds, for the purposes of reablement, wasincreased, with these beds concentrated in Bonymaen House and, to a lesserextent,TyWaunarlwydd.Atthetimeofwriting,therewere14assessmentbedsin Bonymaen House (1/2 of total provision) and 8 assessment beds at TyWaunarlwydd.

128. An early evaluation of assessment beds provision at Bonymaen Housefound that, between November 2012 and August 2013, 60% of the 53 olderpeople who had been discharged from the service returned to their ownhomes.64Of thosewho returned home, one‐third required an increase in theirpackageofcare(11/32).65Ofthe19olderpeoplewhocouldbetracedsixweekslater, almost 80% (15)were still at home. If such figureswere representative,thiswouldsuggestabout50%ofusersofreablementserviceswerestilllivingathomeafteraperiodof6weeks.

129. Assessment beds have more recently been introduced in TyWaunarlwydd. Early data from this service have suggested a lower rate ofserviceusersreturninghome,butwenotethattheAssessmentbedsinitiativeisatanearlierstageatthishomeandthatthefiguresmaychange.

130. Broadly speaking, the results from these initiatives provide grounds foroptimism. Nonetheless, we are mindful that these user outcomes reflectrelatively short‐termoutcomes,whereas in order for reablement to contribute

63 City and County of Swansea (2012), Short‐term convalescent care at St. John’s Residential Home, Cwmbwrla: An Evaluation. P.7. 64 City and County of Swansea (2013), An Evaluation of the Assessment Bed Service, August 2013. 65 City and County of Swansea (2013), An Evaluation of the Assessment Bed Service, August 2013. P. 9.

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substantially to ensuring the sustainability of social services in Swansea,independenceoverthelonger‐termforsuchserviceuserswouldberequired.

Integratedcare

131. InreflectingonSwanseaLocalAuthority’scommitmenttodevelopingtheWestern Bay programme, we take into account the findings of the researchliteratureontheeffectivenessofintegratedhealthandsocialcaresystems,interprofessional working arrangements, and the use of joint commissioningpractices.

Integratedcareandoutcomesforserviceusers

132. Researchersfocusingontheeffectofserviceintegrationonoutcomesforolder service users have argued that integration may actually negativelycompromise outcomes for users. That is, service integration focuses onorganisational factors and risks overlooking older people’s priorities “forsupport and services which can help avoid ill health and disability, maintainindependence and maximise the quality of life” (Glendinning, Coleman andRummery, 2002: 186). The concerns of Glendinning, Coleman and Rummery(2002) are that the focus of intermediate care on step down or rehabilitativeservices are too narrow, suggesting that intermediate care not be seen as asubstitute for specialist services, and that the rehabilitative focusmay reduceattentionpaidtotheneedsofthoseatriskofadmissiontohospital.

133. Rummery (2009: 1798) reports a systematic review which aims to“examinetheinternationalevidencebaseforimprovedpatient/useroutcomesasaresultofpublicpartnerships(particularlyhealthandsocialcarepartnerships,and those partnerships involving the private and/or voluntary sector andpatients/usersthemselves),andtodiscusstheissuesraisedforuseroutcomesand user involvement in the context of increasing policy pressure towardscollaborativegovernanceofhealthandsocialcare”.Thisisinstructiveasitgoestowards the importance of the co‐production of outcomes between providersand users of services and involves the voluntary or private sector. Twenty‐sixpercent of papers included in Rummery’s review were concerned with olderpeople (2009: 1799). Commenting on how intermediate care services relievesthe pressures of older people on secondary care, or ‘bed blocking’, Rummeryargues that: "If the policy objective is to move users to cheaper parts of thehealthandsocial caresystemthen theseschemescanbe judgedashavinghadsuccessfuloutcomes.However,thereisverylittleevidencethat linkstheuseofsuchserviceswithwhatmightbetermedrealandsustainedoutcomesforusers:nodemonstrableormeasurableimprovementsinsocialorcognitivefunctioning,independence or quality of life. Indeed, users, and their families,may prefer alonger stay in hospital to recover from an illness or injury [...]" (2009: 1802).ThusoverallRummery(2009:1802)arguesthatthereis“limited”evidencethatpartnershipwork leads to the priorities of users “being taken seriously in theplanninganddeliveryofwelfare”.

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134. Otherevidencewereviewedfoundthatthattheelementsofpartnershipworkingofmostvaluetoserviceuserswerearoundholisticoutcomes,improvedprocess outcomes and the feeling of being responded to, and thereforehighlighted the importance of effective integration of a wide range of localservices at the frontline.66 Taken together, these documents highlight thechallengethathealthandsocialcareintegrationfacesinachievingthebroadsetofoutcomesvaluedbyolderserviceusers.

Theeffectivenessofdifferentmodelsofintegratedcare135. Herewemoveon fromconsideringresearchontheoutcomesofservice

integration valued by older service users, to outcomes that demonstrateeffectiveness for health and social care systems. One systematic review ofintegratedcaresoughttoidentifythemodelsofinterprofessionalworkthathadthe strongest evidence base for practice with older people living in thecommunity67.Theauthorsofthisreviewidentifythreemodelsofintegration–acare management model (where a key worker assumes a leadership rolecoordinating care and reporting back to professionals), a collaboration model(differentprofessionals,usuallyfromdifferentorganisations,worktogetheronapatientbypatientbasis,usingestablishedmethodsofworkingtogether)andanintegrated team model (where most professionals came from the sameorganisations, the model makes use of an acknowledged team who workedalmostexclusivelywithoneanotherdedicatedtoaparticularfunctionandjointcare planning). Although it remains in development, the Western Bay modelappearstousasanexampleoftheintegratedteammodelidentifiedabove.Thatis, theWesternBayprogrammemakesuseofaclearlyacknowledged team(orhub) composed of professionals drawn largely from ABMU, where teammemberstaketheleadonparticularareasofwork.

136. While “[o]verall, the proportion of studies demonstrating improvedoutcomesissimilaracrossthethreemainIPWmodels”(2013:124),Trivedietal(2013)arguethattheir“reviewdemonstratestheimportanceofunderstandingthe detail and organisation of IPW within different models of working thatinitially appear to have similar approaches and names” (2013: 124), thusunderscoringtheneedtoexaminetheparticularwayinwhichtheWesternBaymodelworksinpractice.

137. In2013,Cameronetal. conducteda reviewof research that focusedonwhether joint working between health and social care in the UK hadmet theobjectivesofpolicymakers.68Thiswasareviewofresearchon integratedcarethat focused first on the models of joint working, and evidence for the

66 Petch, A., Cook, A., and Miller, E. (2013). “Partnership working and outcomes: do health and social care partnerships deliver for users and carers?” Health and Social Care in the Community, 21(6): 623‐633 67 Trivedi, D., Goodman, C., Gage, H., Baron, N., Scheibi, F., Lliffe, S., Manthorpe, J., Bunn, F., and V. Drennan, (2013) ”The effectiveness of inter‐professional working for older people living in the community: a systematic review”, Health and Social Care in the Community, 21(2): 113‐128. 68 Cameron, A., Lart, R., Bostock,L. and Coomber, C. (2013) ”Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature”, Health and Social Care in the Community, doi: 10.1111/hac.12057, 1‐9

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effectiveness of these models, before considering “the factors promoting orhindering joint working” (2013: 3). This review found that there has been amove to better document outcomes for service users, but that finding data onintegrated care remained challenging. Indeed, Cameron et al. (2013) echoRummery (2009) in pointing out that the evidence base “largely report small‐scale evaluations of local initiatives and few are comparative in design, sodifferencesbetween‘usualcare’andintegratedcarearenotassessed,makingitdifficult to draw conclusions about the effectiveness of integrated services”(2013:7).

138. In relation to the effectiveness of integrated working, Cameron et al(2013) found weak evidence that integrated care delivered improved clinicaloutcomes;goodevidencethatintegratedcarereducedinappropriateadmissionsto acute or residential care; and evidence that integrated care does not itselfimprove the likelihood that older people will remain in the community forlonger.Issueswithdataandthemeasurementofcost‐effectivenessledCameronet al (2013) to focuson resourceutilisation instead.TheevidencegatheredbyCameron et al (2013: 4) suggested that the resource utilisation costs ofintegratedversusstandardcarewere‘identical’.

139. Finally,Cameronetal(2013)payspecialattentiontoadetailedanalysisof the impact of service organisation and service user type on the costs ofintegratedcarebySchneideretal.69Thiswasastudyofhealthcarecostsoffourdistricts,comparingtwowherementalhealthtrustsworkedcloselywithsocialservices, and twowhere theyworked independently. In terms of service usertype,twodealtwitharangeofmentalhealthproblems,andtwofocusedservicesonthosemost inneed.Thisstudyfoundthat integratedserviceswerenomorecostlythannon‐integratedservices,but“therewereindicationsthatwhentakinghealth and social care costs together, integrated districts may be less costly”(Cameronetal.,2013:4).

140. Overall, Cameron et al. (2013: 7) find that the evidence “demonstratesthat jointworking can lead to improvements in health andwell‐being, reduceinappropriateadmissionstoacutecareorresidentialcareandthatintermediatecarecansavecosts”.Thekeytermhereis‘can’.Cameronetal.(2013:7)remainunconvinced by the research evidence base underpinning joint working. Inaddition,Cameronetal.(2013:8)raiseconcernsbytheconsistentreportingof“a lack of understanding of the aims of integration and concern that thecontributionofcommunityhealthandsocialcareservicesmightbemarginalisedbytheinterestsoftheacutesector”.

Politicalissuessurroundingintegratedcare

69 Schneider J., Wooff D., Carpenter J., Brandon T. & McNiven F. (2002) ”Community mental healthcare in England: associations between service organisation and quality of life”. Health & Social Care in the Community 10 (6), 423– 434.

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141. Incarryingoutthisreview,wehavealsobeenstruckbytherecentHouseof Lords Select Committee on Ageing report70 which drew on evidence thatintegratedcareneedstobeincentivisedfurther,foundsome‘excellent’examplesofintegratedcare,butfoundabroaderproblemintheneedtorebalancethecaresystem.ThereportquotesMikeFarrarsayingthat“whatwereallyneedtodoishaveacareservicewithamedicaladjunctratherthanamedicalservicewithacare adjunct” (2013: 69). The Select Committee report goes on to argue thatsome of the resources directed to acute and accident and emergency hospitalservices “could be better invested in supporting older people to livewell andindependently in the community” (2013:70).Thisobviously involves reducingthecapacityofsecondarycareprovidersandindeed,theCommitteereports“weheard fromProfessorMayhew thatwhena care co‐ordination service inBrentachieved substantial reductions in days in hospital, the rate of hospitaladmissions stayed level because ‘theHealth Servicewas just admitting peopleintothebedsthatwerevacated’”(2013:70).Theimplicationhereisthattotheextentthatintermediatecareservicesaresuccessful,theresultmayimplyaneedforgreaterresourcestobedirectedbothtocommunitybasedintermediatecare,butalsotosocialcareservices,andawayfromsecondarycareproviders.

142. Overall, the research evidence in support of integrated care is ratherweak.Ontheonehand,thereislimitedevidencethatintegratedcaredeliverstheoutcomes prioritised by service users. On the other hand, evidence of theorganizational effectiveness of integrated care working remains unconvincing.Whilst there certainly are examples of successes, these have either not beendocumented in the research literature, or have been presented as small scaleevaluationsorwithouttheuseofcomparativedata.

143. Thesuspicionsofearlierresearchersthatintegrationisprimarilydrivenbymanagerialthinkingandresultsinusersbeingmovedtocheaperpartsofthecare system may be correct. However, even if this is true, so long as thosecheaperpartsofthesystemprovidegoodqualitycare,thenthereshouldnotbeadifficulty as a matter of principle. In addition, the evidence suggests that theparticularmodelusedintheABMUareaisaslikelytohavebeneficialeffectsaseitheroftheothertwomodelsconsideredbyTrivedietal.(2013).ThereforewewouldsupportthecontinueddevelopmentoftheWesternBayprogramme,butwe find little systematicor clearevidence thatwouldsuggest that cost savingsshouldbeanticipated.WewouldsuggestthattheoutcomesoftheWesternBayprogrammebecloselymonitoredforbenefitsandcostreductions.Inmanyways,thework of theWestern Bay programme spearheads the transfer of resourcefromsecondarytoprimarycare71.Thebenefitsandsavingsthatmayaccruefromthis transfer may be neither obvious nor forthcoming until the health careinfrastructurebasedinthecommunityisdevelopedfurther.

70 House of Lords Select Committee on Public Service and Demographic Change, (2013) Ready for Ageing? HL Paper 140. London: HMSO.p 67, 68 71 House of Lords Select Committee on Public Service and Demographic Change, (2013) Ready for Ageing? HL Paper 140. London: HMSO.p 67, 68

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Thebalanceofcare:absoluteandrelativenumbers

144. Aswe have noted, one of the key priorities of the local authority is tochange the ‘balance of care’ from residential care to domiciliary care, and thatthis is in line with what older people themselves want. It is envisaged thatthrough a combination of preventative and reablement initiatives and arebalancingofcareinfavourofdomiciliarycare,peoplewill livebeableto liveindependentlyforlonger.

145. We are broadly persuaded that, so long as independence is genuine, itwould be the preferred option of most people.We can also see that it wouldallowforsavingstobemadeor,putanotherway,foragivenamountofmoneytosupportmoreolderpeopleinmeetingtheirneeds.

146. However, we have heard it expressed that one justification for theproposedclosureofthethreelocalauthoritycarehomes(not,wenote,themainjustification) is that they might not be required since ongoing preventioninitiativesandtherebalancingofcaretowardsdomiciliarycaremightmeanthatfewerolderpeoplewouldrequireresidentialcareinthefuture.

147. Webelieveitisimportanttodistinguishbetweentherelativeproportionand the absolute numbers of older people in residential accommodation. Wehave noted the very substantial rise in the numbers of older people, andespeciallyintheover‐80swhomakeupasizeableproportionofresidentialcarehomeserviceusers,whichisanticipatedinthecomingdecades.

148. It is therefore entirely possible that even if the provision of care isrebalanced,eventoasignificantextent,thattheabsolutedemandforresidentialandnursingcarehomebedswillcontinuetorise.

149. If theneedforresidential formsofcarerises in linewiththenumberofover65sinSwansea,thenweestimatethata30%reductionintheproportionofolderpeople requiring such carewouldbeneededby2036 simply in order tomaintaina fixednumberofolderpeople in residential formsof careover time(i.e.tooffsettheriseinthenumberofolderpeoplebythatpoint).

150. If, as seemsmore likely given the ageprofile of residential care serviceusers, the demand for residential and nursing care increases in line with thenumberofover80s, thentheproportionwhorequiresuchcarewouldneedtoreduceby45%by2036inordertoholdabsolutedemandconstant.

151. Analternativesuggestionhasbeenthat,eveniftheabsolutedemandforresidential forms of care rises of time, this will be concentrated in terms ofnursingcare,withresidentialcareplayinganincreasinglyresidualrole,sothat,ineffect, theabsolutedemandforresidentialcaremight fall.Wecanseethat ifthecurrentpolicydirectionisimplemented,itislikelytomeanthattheneedsofolderpeopleenteringresidentialformsofcarearelikelytobehigherthanthoseofrecentcohorts,withagreaterproportionrequiringnursingcare.Nonetheless,given the uncertainty surrounding the care needs associated with further

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increases in longevity and the success of efforts to rebalance provision andpromote preventative approaches, we do not see that the need for residentialcarewillnecessarilyfall.

Residentialcare

152. Wehave, throughout theperiodofconducting this IndependentReview,

beenconsciousthatthereareproposalstoclosethreelocalauthoritycarehomesandthatdisquietsurroundingthisproposalwasoneofthefactorswhichledtothecommissioningofthisIndependentReview.

153. Aswehaveidentifiedattheoutset,ourTermsofReferencerequireustoadopt a medium‐term, strategic approach to considering how to achieve asustainablemodelof care.Wehavebeenclearduring theperiodofconductingthis Independent Review that we did not intend to make recommendationsabout the future of any specific residential care homes. Nonetheless, in thecourseofconductingthisIndependentReview,wehavedealtwithevidenceandinformation which may be considered relevant to the decision as regards thefutureofthesecarehomes.

154. By way of context, we note that while the desired trend is towards areductioninthenumberresidentialandnursinghomeplacements,thetrendinrecentyearsindicatesanincreasingnumberofserviceusers,withthisincreaseconcentrated in the independent sector. Between 2009/10 and 2012/13, thetotal number of residential and nursing care home placements funded by thelocalauthorityrosefrom845to971(anincreaseof15%).72Thisrisehasbeenconcentratedintheindependentsector–duringthisperiod,thenumbersinlocalauthorityresidentialcarehomeshasfallenfrom205to171.

155. Weareawarethatthereareconcernsregardingthebuiltenvironmentatsomeofthelocalauthorityhomeswhichoffersonereasonwhytheyarenotfitfor purpose for delivering the kind of care model which is likely to be inincreasingdemand–namely,providingcareforolderpeoplewithmorecomplexcareneedsand/orwithdementia.

156. We are also aware that, evenwhere refurbishment and/or retro‐fittingthe buildingsmight be an option, the cost of this would be prohibitive to theCouncil. The most recent survey of all local authority care homes, which wascarriedoutin2010,foundthatapprox.£3.68mofrepairswererequiredinordertobringexistinghomesuptorequiredmaintenancestandards.Wearecognisantthatthisfigure,nowfouryearsoutofdate,islikelytobeanunder‐estimate.

157. Wehavealsohadtheviewexpressedtousthat,giventheinvestmentinreablement, and the fact that care is being rebalanced away from residentialformsofprovisionandtowardsgreaterindependentlivinginthecommunity,theneedfortheresidentialbedsatthesethreehomeswouldbenotbemanifest,orthatitwouldbesubstantiallyreduced.

72 Commissioning Plan, Older People’s Services 2011 – 2014 (Current year 2013/14).

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158. One internal document ‘comes to the conclusion that there will be

reduceddemandonmainstreaminhouseresidentialcareandsuggeststhatthisoffersanopportunityofdivestingin3localauthoritycarehomesandreinvestinginLocalAuthorityDomiciliaryCareandAssistiveTechnologytosupportpeopletoremainintheirownhomesforlonger’.

159. A strategic review of residential care serviceswas conducted internallyandconsidered10options.Thisreviewrecommendedthat theLocalAuthorityshould keep some, but not all, of its residential care provision, with theremaining provision focussed on meeting short‐term respite and reablementneeds,aswellascomplexneedsandwithaspecialismindementiacare.

160. InJanuary2014,therewasaprotestorganisedbyUNISONopposingthe

closureofsomecarehomes.Apressreleasenotedthat‘undertheproposals,thecouncil will close three care homes, as yet unnamed, ahead of the ultimateclosureofall six’.Basedon the internaldocumentationwehaveseen, that thisdoesnotreflectthepolicyofthelocalauthority.

161. Onefactorwhichdoesnotfeatureprominentlyininternaldocumentationbutwhichmayhaveabearingonanyfinaldecision,inourview,istheknock‐oneffectoftheproposedclosureofthreehomesonthemarketforresidentialcaremorebroadly.Wherethelocalauthorityhasadutytoensurepeople’sneedsaremet, but (increasingly)doesnotprovide services itself, it becomes crucial thatthere is adequate regulation of existing provision and vigilance as regards thefragilityoftheexternalmarketofresidentialcare.CSSIWhaveaveryimportantrole to play here and we are aware that the LA also monitor standards inindependentsectorresidentialcarehomes.

162. The operation of the external market for residential care and thatconcentration of that market have been the subject of considerable academicscrutiny and concern. Scourfield73 coins the term ‘caretelization’ to articulatethisconcernwiththeconcentrationofownershipofcarehomes“inthehandsofthefew”coupledwiththewayinwhich“providershavedemonstratedthattheyarebothpreparedandabletoshapethetermsofthemarket”.

163. Furthermore,PlayerandPollock74havevoicedconcernsthattheprivate

sector’sinterestinsecuringprofitfromresidentialcarehomes“dependsheavilyon the use of casualized, non‐union labour, with its corollaries of low wages,minimum guaranteed hours and the absence of sick pay or trainingopportunities” and that this labour force enjoyed “poor or non‐existentemployment benefits” leading to “affect the quality and conditions of care,promotinghighstaffturnover,indifferenceofcarestafftowardstheiremployersandresultantambiguitytowardstheircharges”.

73Scourfield,P.(2005),‘Aretherereasonstobeworriedaboutthe“caretelisation”ofresidentialcare?,CriticalSocialPolicy,27,pp.155–180.P.165 74Player,S.,&Pollock,A.M.(2001).‘Long‐termcare:frompublicresponsibilitytoprivategood’.CriticalSocialPolicy,21(2),231‐255.P.250.

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164. Wearemindfulthatwhilemostindependentsectorresidentialhomesin

Swansea are owned by individuals who own only one care home, a relativelyhighproportionof residential carehomebedsare concentratedwithina smallnumberofthelargerindependentsectorresidentialhomes.

165. We view the concentration of ownership of residential care homes andtheoperationoftheresidentialcarehomemarkettobeimportantconcerns.Tothis end, we would prefer discussion regarding divestment of specific carehomes not to be taken to automatically imply a reduction in local authorityprovision. To the extent that there is an independent rationale for the localauthorityreducingitsprovisionofresidentialcare,wewouldpreferforthistobearticulatedexplicitly.

166. Finally,wenotethat thesavingswhichwouldaccrue fromclosing these

threehomes,while non‐trivial, are nonethelessmodest.Based on a number ofassumptionswhicharesogenerousastobeunrealistic,weestimatetheclosureof these three homes to equate to the cost of about four years of populationageing. A more realistic set of assumptions may put the figure somewherebetweenasavingof1–3yearsofthecostsofageing.

167. Overall,itwouldseemtousthattherearestrongerandweakerrationalesfor the currentproposals to close three local authority carehomes. If thebuiltenvironment is not fit‐for‐purpose and cannot be renovated andmade fit‐for‐purpose,thenitisquestionablewhetherthesespecifichomescouldcontributetosustainable social services in the future. We would view this as being thestrongest of the existing rationales, but we are unclear from internaldocumentationandCSSIWinspectionreportsthatthiswouldbeapplicableinthecaseofthreeofthelocalauthoritycarehomes.

168. If existing homes can be renovated but this proves prohibitivelyexpensive,thisprovidesanalternative,butinourviewweaker, justificationfordivesting local authorityprovision.Weunderstand fromdiscussionswith localauthoritystaffthatindependentsectorcarehomessimilarlyrequirerenovationinordertobefittodelivercareforaserviceuserbasewithmorecomplexneeds.To theextent that these investmentsmustbemade, theyare likely to increasefeedemandsintheindependentsector.

169. The third rationale for divesting someprovision is that the demand forsuch places will be reduced due to the preventative work which is beingundertaken and the strategic rebalancing towards domiciliary which isenvisaged. Our view is that given the scale of population ageing, one cannotassume that preventative initiatives and the rebalancing of care provisionwillresult in an absolute reduction in the number of residential care homeplacements.Thisdependson thesuccessofpreventative initiatives inenablingindependence over the longer‐term, and the ability to keep domiciliary careneeds below certain limits (see below), both of which introduce importantuncertainties.

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170. Furthermore,giventhattheresultsofreablementandintegratedcarearelikelytobeknowninaperiodof,perhaps,2to3years,andearlydataregardingthe extent of rebalancing care provision towards domiciliary care might beknown over a similar time‐frame, both subject to appropriate monitoring, itwould seem preferable to first see that these initiatives reduce the need forresidentialcarebeforedivestingprovision.

171. We would, in addition, like to see greater consideration about whatimpact divesting provision would have on the residential care home marketitself. We are aware that the independent sector has secured fee increases inrecentyearswhich,iftheyweretocontinue,wouldbeentirelyunsustainable.Wearealsoaware that there isamoderateconcentrationofresidentialcarehomebedswithinasmallnumberofindependentsectorhomes.

172. While barriers of entry to the market appear low, and this is to bewelcomed, we would like to see greater consideration of the fragility of theresidential care homemarket, aswe findwhen it comes to that of domiciliarycare(seebelow).Suchapositionwouldbeconsistent,inourview,withthatsetoutinFulfilledlives,SupportiveCommunities(2007:27),whichmakesclearthatlocal authorities ‘need to take a much more active role individually andcollectivelyinhelpingtoshapethemixedmarketofprivate,publicandvoluntarycare’.

173. Finally,weregardtheongoingstress,worryandconcernofolderpeoplewhoare currently resident in local authority carehomeswhich–potentially –face closure as being regrettable. While we are not persuaded that any onecohortofresidentsshouldbeableto‘veto’proposalswhichmightputSwansea’ssocial services on a more sustainable footing, if the decision is made to closethesecarehomes,webelievethatmoreneedstobedonetolimittheuncertaintyandworryforthoseserviceusersaffected.

Domiciliarycare

174. Thefinancialrationaleforrebalancingprovisiontowardsdomiciliarycare

arises because of the greater numbers of older people who can be supportedfrom a finite resource base. Internal documents estimate that 80 older peoplemightbesupportedtoliveathome,withsupport,atthesamecostofproviding30peoplewithresidentialcare.Nonetheless,internaldocumentsalsonotethat,beyond about 20 hours of care per week, domiciliary care may be moreexpensivethancareprovidedinaresidentialhome.Thus,agreaterrelianceondomiciliarycareislikelytoreducethecosttothelocalauthorityaslongascareneedsarebelowacertainthreshold.

175. Intermsofthedomiciliarycaremarketitself,concernhasbeenexpressedat the perceived fragility of the care market. There are 8 domiciliary careproviders, two ofwhomhave about a 60%of the external domiciliarymarketshare.Therehasbeensomeconcernthatthismarketsharemightbetoo large;that, in general, the externalmarket isperhapsnotoperating as it should, andthat, given the size of the local authority’s remaining share of this market, it

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wouldnotbeabletostepinguaranteeprovisionifone(ormore)providersweretoexitthemarketplaceatrelativelyshortnotice.

176. We regard the concern at the fragility of the external domiciliary caremarket as demonstrating caution and prudence.We concurwith the StrategicReviewofResidentialCareServices,whichnotedthatthescenarioofanexternalproviderexiting‘needstobebalancedagainsttherelativelikelihoodofsuchanevent occurring’ (p. 19).We can see that increasing the provision of in‐housedomiciliary care servicesmayhelp inmitigating the risk of unmet need in theevent that one or more providers exits the market. Indeed, we have arguedabove that similar concern may also extend to the external residential caremarket (see above). Nonetheless, we do not view a marked expansion of in‐housedomiciliarycareprovisionasbeingtheonly,orevennecessarilythemostdesirable, response, unless it is believed that the domiciliary care externalmarketisextremelyfragileandthattheprobabilityofthecollapseorexitofoneprovider is high. Other possible actions which would limit the risk of oneproviderexitingmightincludelimitingthemarketsharewhichanyoneprovidercouldacquireortosupportnewentrantsintothemarket(seebelow).

CommissioningandcontractingcareforolderpeopleinSwansea

177. Contractsformsthecentralleverwithwhichcommissionersinfluencethe

waycareisdelivered.LocalAuthoritiesmaydrawuponthreedifferenttypesofcontracts – spot, block or relational contracts. The primary issue forcommissioningstrategiesisabouthowabalanceisachievedbetweenmanagingcostsofcarewhilesafeguardingquality.SwanseaLocalAuthoritymakesuseofanumberofstrategiesinthisregard.

178. First, Swansea Local Authority commissions certain mission criticalservices in‐house.These include thepurposive commissioningof services suchas a Rapid Response Service and a short term Reablement and EnablementDomiciliary Service (delivering 1010 hours of care per week, 2011/12). Inaddition,SwanseaLocalAuthoritycontinuestocommissionacertainamountofits domiciliary care hours (2177 hours per week in 2011/12) and care homeplacements(189 fundedplaces in2011/12) internally.Thecomparativelyhighwages,lowstaffturnoverandbetterqualityofcareprovidedin‐housedrivesthevalueattachedtothismethodofprovidingservices.

179. Second, Swansea Local Authority continues to use essentially blockcontracts to procure care home beds from independent sector providers (710beds in 2011/12) at agreed prices that themselves have been subject toincreasesoverthepastnumberofyears.Blockcontractshavebeencriticisedasfailing to reward providers for improving quality as they focus on price pervolume. However, the increases in fees paid by the Local Authority toindependent sector providers may be expected to secure or improve qualitystandards.

180. Third, Swansea Local Authority’s Social Services Department usespredominantlyspotcontractsinitscommissioningofdomiciliarycare,providing

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9798 hours of care per week in 2011/12. These discrete contracts withindependentsectorprovidersarenestedwithinnationalregulatoryframeworkswhich set out the required quality specifications. Spot contracts have beencriticisedfortheirhightransactioncosts.

181. Fourth, the Local Authority has sought to incorporate relational normsintospotcontracts.Relationalcontractsemphasise the importanceofadjustingthe termsof an agreement over time.The idea of co‐production that has beendevelopedbytheLocalAuthorityfocusesonrecognisingpeopleasactiveagentsinthedeliveryofservices,understandingtheworkofdeliveringservicesasaco‐operativeprocess,incentivisingreciprocalandco‐productiveworkbetweenuserand professional; and "developing new networks and sustaining existing onesthatsupportchangeinhowpeopleaccessopportunities"(C1,3.2,section3).TheLocal Authority’s focus has been on describing desired outcomes for serviceusers, andassessing the “the suitabilityofpotentialproviders towork ina co‐producedway".Co‐production therefore enables certain relational elements tobeincorporatedintospotcontracts.

182. Themovefromtheuseofspotcontracts,tocontractsthathaveastrongerrelational element is supported by the development of outcomes‐orientatedsupportplans,themovetoaminimumcalltimeof20minuteswithinbudget,thesimplification of the way domiciliary care providers invoice and charge forservices,connectingcontractmonitoringwithworkforcedevelopmentandcaremanagement, and developing the capacity of independent sector providers tofocusonoutcomesforserviceusers.

183. Fifth,thetransferofcommissioningpowertoserviceusersthroughdirectpayments has created the opportunity for the Local Authority to support thedevelopment of bespoke services for older people by supporting micro‐enterprises.Suchservicesmaybesupportedbyamemberofthecommissioningteam whose role may be to link individuals with micro‐enterprises, and toencourageandsupportmembersofthecommunitytodevelopsuchenterprises.

184. Sixth,SwanseaLocalAuthoritytogetherwithABMUhavedevelopedjointcommissioning arrangements whereby commissioning ‘hubs’ may be formedwithadelegatedauthoritytocommissionservicesusingpooledLocalAuthorityandHealthBoardmoniesthroughtheWesternBayprogramme.In2011/12,250care home beds were supported by Continuing Health Care. Whereas healthconcernshavetendedtodominatejointcommissioning,75themoveinSwanseais towards allowing the LocalAuthority to retain overarching responsibility toensureequityandconsistency.76

185. ThusSwanseaLocalAuthoritysocialcarecommissioningusesamixofin‐house commissioning ofmission critical aswell as domiciliary and residentialcare,alongsidetheuseofblockcontractsinrelationtoresidentialcareandspot

75 Glendinning, C. Coleman, A. and Rummery, K. (2002). “Partnerships, performance and primary care: developing integrated services for older people in England”. Ageing and Society, 22, p. 204 76 City and County of Swansea/ABMU Health Board, Swansea Locality, Statement of Intent on Integration of Services

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contracts with domiciliary care providers. The main moves are fromcommissioning no specialised or mission critical services, towardscommissioning a range of mission critical services internally; fromcommissioning some residential care internally to commissioning fewer or noresidential care bed internally; from using spot contracts to commissiondomiciliary care towards incorporating relational norms into these contracts;fromcommissioning in‐housedayandsocialcentrestowardsdecommissioningsocialcentresandcommissioningdayopportunities;fromcommissioningsocialcare separately from health care towards developing joint commissioningarrangementswithABMUHealthBoard.

PotentialstrategicdevelopmentofcommissioningandcontractinginSwansea

186. Researchers have suggested that Local Authority Social Services

departments may take one of three main commissioning postures – a costminimiser, partnership or mixed approach77. Swansea Local Authority’s socialservices commissioning strategy falls into the partnership category. The LA iscommitted to containing the growth in the costs of providing services to agrowingpopulationbytransferringresourcesintoalternativestocarehomesintheexpectationthatthiswillreducedemandforcarehomes.However,itseekstoachieve this by working in partnership with home care organisations,domiciliary care providers, the third sector and the Local Health Board. Feeshavebeenupratedataboveinflationrates,andcareprovidersreceivesupportinrelation toHRconcernsalthoughtheLAtends torelyonCCSIWevaluations tomonitorqualityofcareprovided.

187. SwanseaLocalAuthoritycouldchangeitsoverallstrategytofocusonlyonprice. This strategy could involve pushing down fees paid for care, requiringmoreolderpeople to topup their care fees,monitoringqualitybut refusing topay higher fees for better quality. Focusing only on the cost of providing caremayentailclosingallin‐houseresidential,dayanddomiciliaryservices.Missioncritical re‐enablement and rapid response services may continue to becommissioned internally as these provide services that constrain demand forcare homeplaces by retaining people in the community served by domiciliarycare. The Local Authority would expand the support offered to micro‐enterprises, its joint commissioning work with ABMU and other forms ofpreventionforsimilarreasons.TheLocalAuthoritycouldextenditsuseofblockcontractswithresidentialcareproviders,keepqualitymonitoringataminimumand push down fees to a relatively low level with the risk of increasing staffturnoverandreducingthequalityofcare.TheLocalAuthoritycouldalsoreduceitsemphasisonrelationalformsofcontracting/outcomesbasedcommissioningofdomiciliarycare,andreturntoadifferentiatedsetoftariffsforcareprovisionso that outcomes for older people were reflected in the pricing schedule.However,arguably,noneofthiswouldachievevalueformoney

77 Rubery, J., Grimshaw, D., Hebson, G. (2013) "Exploring the limits to local authority social care commissioning: competing pressures, variable practices, and unresponsive providers", Public Administration, 91(2): 419‐437.

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188. SwanseaLocalAuthoritycouldchangeitsstrategytocreatemoreofamixbetweencostminimisingandpartnershiporientations.Thismayentailcurtailingcare fees at a low to moderate level with greater scope for top‐ups with theoption for paying a premium for quality. It may also involve maintaining theresilience of thewhole system by deciding to sustain in‐house residential andhome care at current market shares. However, given the recent efforts toincrease the technical efficiency of service provision, further efficiencies areunlikelytoproducemorethanmarginalsavings.

Furtherareasforconsideration

189. Providingdomiciliarycareforolderpeopleacrossacomplexgeographic

area using a single tariffwithin an outcomesbased commissioning frameworkmayprovechallenging.Oneissuethatmayarisehastodowiththetimeneededto travel to older people’s places of residence. The Rhondda Cynon Taff LocalAuthority has made use of a combination of framework agreements and spotcontracts tocommissionproviders inspecificgeographicareas.Thus, theLocalAuthoritycouldagreeframeworkcontractswithasmallnumberofprovidersindefinedareas,andprovidetheresidentsofthatareawiththeoptionofsourcingtheir care from the agreed providers. Indeed, to some extent, the use offrameworkdocumentsgrantscertainproviderspreferredstatusandcouldtaketheformofessentiallyblockcontractssothatprovidersareguaranteedavolumeof work in return for which they provide the service to an agreed qualityspecification and may receive additional support from the Local Authority.Geographically‐focused frameworkdocumentsmayalsobring theadvantageofsupportingsmallandvoluntarysectordomiciliarycareprovidersbyfocusingondeliveringservicesingeographicareasforanagreedpriceandqualitystandard.

190. Low level services have been shown to be of particular value for olderpeople.78 Themove towards supporting the development ofmicro‐enterprisesthat focusonprovidingbespokeservices forolderpeoplemaybeofparticularinteresttoprivateandvoluntarysectororganisations.TheLAcouldexplorehowthis role could foster the development of micro‐enterprises by for instanceproviding small sums of money that help with start‐up costs and providingadvertisingspaceforsuchorganisationsandsignpostingtheseorganisationsaspartoftheassessmentprocess.

DayServices

191. One of the immediate budget proposals is to remodel day services for

older people. The proposals for day services are that they adopt a tieredapproach providing for different levels of need. It is clear from internaldocumentation that there is concern regarding the sustainability of existingprovisionasthenumbersofolderpeopleincreases.79

78 Dwyer, P., Hardill, I., (2010), Promoting social inclusion? The impact of village services on the lives of older people living in rural England, Ageing and Society, 31, 2: 243‐64. Windle, K., Francis, J. and Coomber, C. (2011) “Preventing Loneliness and Social Isolation: Interventions and Outcomes”, Social Care Institute for Excellence, Briefing Paper 39. 79 Day Services Strategic Intent and Action Plan – November 2010. p. 2

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192. TheCommissioningFrameworkforAdultSocialServicesdocumentnotes

the importance of ‘The continued reconfiguring of this provision into a widervarietyof services thataregrounded in facilitatingaccess toanduseofwider,moreindependentuseofothercommunityopportunitiesisnecessary.’

193. Essentially, current remodelling proposals entail a division between

community‐baseddayopportunitiesforolderpeoplewithlowerlevelsofneedsorwithnoeligibleneedsanda smallernumberofdaycentres forpeoplewithmorecomplexneeds.Thesecentreswouldalsoprovidereablementandrespitecare.

194. Intermofdaycentres,theaimisthatthesewillfocustoagreaterextent

onolderpeoplewithhigherneedsthanpreviously,andthatthesecentreswillbemore closely alignedwith other priorities in terms of specialising on disabledolder people with complex needs, reablement and with people living withdementia.Fromourdiscussions, itseemsthattheeligibilitythresholdtoaccesstheseserviceswillbehigherthanhaspreviouslybeenthecaseand,indeed,thatthisprocesshasalreadybegun.

195. Theconsequenceofthisisthatolderpeoplewithlowerlevelsofneedwillbe directed to day opportunities,which anyone over the age of 50 can attend.Theseopportunitieswillnotprovidetheintensivecareandsupportprovidedata day centre but instead are community‐run groups which meet at variouslocations in the community such as coffee shops, and so forth. They may besupported by a Community Connector, who may help to direct people to thegroupsinthefirstplaceandmayhelpthegroupssustainthemselvesovertime.As thereareenvisaged tobemanygroups supportedbyanyoneCommunityConnector,thesedayopportunitiesareintendedtooperateonalowcost/nocostbasis.80

196. We note that there were previously 11 Social Centres run by the localauthority, which provided services to older people with less extensive careneeds, andwhichhavebeenclosed in recentyears.Wenote further that therehavealreadybeensomereductionsandamalgamations in termsofdayserviceprovision.TheJune2013TASSreportnotedthat:

‘BusinesscasefortheHolliesDayServiceandRoseCrossDayServicepresentedtoTASSBoardapprovalgiventoreducetheHolliesDayServiceto4daysperweekincorporatingaDementia “Remember Me” 1 day per week – to be reviewed in 6 months with thepossibilityofreducingto3daysperweekifundercapacity.RoseCrossDayServicetobedevelopedinordertoprovidereablementdayservice1dayperweek.’

197. FiguresprovidedtoCabinetsuggestedthatthecostofDayCentreswasin

2013/14was£1morapprox.2.5%ofthebudgetforolderpeople’sservices. Inaddition to services provided in‐house, some day service provision iscommissionedexternally.IfthebudgetfiguresintheCommissioningFramework

80 Day Services Strategic Intent and Action Plan – November 2010. p.4

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for Adult Services are comparable, then actual spend per in‐house day centreplaceisapproximatelyhalfofthatprovidedbyexternalproviders.

198. IntheyeartoMarch2014,584peopleweresupportedindayservices,a13%reductioninthepreviousyear.Thebudgetfordayserviceswas£1.02m,81orapprox.£1,740perdayserviceuser.Wenote that thisbudget isunchangedfrom2012/13despite therebeingfewerserviceusers. If serviceuserswere toattendthedayserviceanaverageof40timesperyear,thiswouldimplyacostof£43peruserperday.

Carers

199. One cross‐cutting issuewhich relates to current proposals surrounding

residentialcareanddaycentresistheprovisionofsupportforcarers,includingrespite care. This, we have noted, becomes increasingly important given thestrategic direction towards enabling people to live in their own homes,independently, foras longaspossible.TheStrategicReviewofResidentialCareServicesmakesclearthat ‘supporttocarersisvitaltohelpingpeopletoremainathome’(p.6).

200. We note that the overwhelming majority of residential respite care isprovidedinLocalAuthoritycarehomes[performancedata]andthatthenumberofnightsof respite careprovidedunderAdultServices ingeneralwas9977 in2012/13,areductionofalmostone‐thirdfromthe2009/10figure.82

201. Werecommendthatdecisionsregardingthefateofthethreeresidentialcare homes and day service provision take on board the likely increase indemand for respite provision given the strategy to support independence andenablingpeopletoliveathome.

Unitcostcomparisons

202. In considering the desirable balance between in‐house and externally

provided provision, the ability to understand cost implications of differentchoicesisimportant.Specifically,whatareneededareestimatesoftheunitcostsof various forms of provision (i.e. costs of service provision per service user).Oneareawhichwewouldrecommendfurtherworktobedoneisintheareaofgenerating life‐for‐like unit cost estimates of in‐house and externally providedcare.

203. Existingfiguresoftherelativecostofin‐houseandexternalprovision,forexample those provided in the Commissioning Framework for Adult SocialServices, are provided on the basis of actual costs of in‐house and externallyprovidedservices.Thesefiguresarenotalwaysdirectlycomparable,forexampleintermsoftheserviceswhichareprovided,thelevelofneedoftheserviceuserswhoreceivesuchservices,andsoforth.

81 Adult Services Business Plan 2012/15 Appendix 1. 82 Adult Services Business Plan 2012/15.

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204. Furthermore, in some areas – for example, domiciliary care, differentinternaldocuments showquitea rangeof relativeunit costsbetween in‐houseandexternalprovision.

205. Making like‐for‐like comparisons canbedifficult given themany factorsinvolved–geographicaldifferencesintermsofprovisionofhomecare,extentofneed,andsoforth.Nonetheless,wheretherearedecisionstobemaderegardingthebalanceof in‐house and external provision, it is important tohave reliabledata on the cost savings which can reasonably be expected to accrue from agreater(orlesser)relianceononesectorratherthantheother.Webelievethatsuchdecisionswouldbeaidedby thesupplementationofestimatesof like‐for‐like unit costs in addition to comparisons of actual costs, and that generatingbetterdatarelatingtotheseunitcostsshouldbeprioritised.

Engagement,consultationandequality

206. Wenotethatthelocalauthorityhasengagedwithserviceusersandother

stakeholders on a number of occasions where policy changes were made orproposed. In our view, the authority clearly recognises the importance ofconsultingwitholderpeoplebeforemakingdecisionswitheffecttheircare.

207. Of particular importance, and recognised by the Second Older People’sStrategyforWales,istheimportanceofensuringthatanyengagementincludestheviewsofgroupswhoseviewsarenotalwaysheard(2008:47).

208. Furthermore, Sustainable Lives, Supportive Communities (2007: 20)notes that ‘it is important that the principles of quality, responsiveness andequalitywillbecomecorefeaturesofsocialcareinWales.Intailoringservicestotheneedsofindividualsandtheircarers,socialservicesneedtotakeaccountofreligious, cultural, and ethnic needs as well as age, gender and sexualorientation’.

209. It goes on to say that ‘theWelsh language is an essential part ofWelsh

culture and life. It must be reflected in developing effective local social carestrategies as well as in planning, delivering and improving services forindividualswhoselanguageofpreferenceisWelsh’.(2007:20).

210. Inthecommentsfromoureventswhichfollow,weidentifyoneinstancewhereonestakeholderfelt itwasimportanttoensuretheavailabilityofWelshlanguage provision in terms of reablement services, and that the currentconcentrationoftheassessmentbedinitiativelimitedthisavailability.

SUSTAINABLESERVICESFOROLDERPEOPLEINSWANSEA–FIVEPOLICYLEVERS

211. In our view,within any given resources envelope, there are five broad,strategicleverswhichcanbeusedtosetsocialservicesonasustainablefootingin the medium‐ to long‐term, given the context of rising needs and tightresources.Wepresent these leversasbroadstrategies,eachofwhichmightbeputintopracticeusinganumberofdifferentpolicies.

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212. While there are, aswe see it, five leverswhich can be used in order toensurethesustainabilityofsocialserviceswithinanygivenresourceenvelope,itgoeswithout saying that oneway to help to ensure the sustainability of olderpeople’s serviceswithout relyingon these five leverswouldbe to increase theresource envelope itself. This might be achieved by re‐directing a greaterproportion of total resources to older people’s services, or it may involveincreasingcouncil tax.Thismightbe considered tobea “LeverZero” in that itframes the contributionwhich needs to bemade by the remaining five policylevers.

213. Oftheremaining fiveoptions, therearetwo leverswhicharedirectly inthecontrolofthelocalauthoritythemselves(levers1and2,thoughwenotethatthe authority’s capacity to exercise lever 2 is tightly circumscribed) aswell asthree background conditions which, while not wholly within the authority’scontrol,theauthoritymighttrynonethelesstoinfluence(levers3,4and5).

Lever1:Rationcareonthosemostinneed

214. Utilisinglever1wouldimplythat,withintheconstraintsoftheresourceenvelope, the Local Authority simply concentrates resources on thosemost inneed.Thisisequivalenttoa‘donothing’option.

215. ThisapproachwouldmakeuseoftheeligibilitycriteriasetoutintheNHSandCommunityCareAct1990byallocatingresourcestothoseinsubstantialandcritical need and then, as the population of older people expands, to those incriticalneedonly.

216. One advantage of this approach is that it does not require any serviceclosuresatthispoint.Anotheradvantageisthat,whileserviceswouldhavetoberationedtoagreaterextentinthefuture,thosemostinneedwouldcontinuetoreceivesocialservices.

217. Nonetheless, the disadvantages of this strategy are substantial. First,giventherapidriseintheforecastnumbersofolderpeople,thiswouldrequireeligibilitycriteriarulingoutsubstantialnumbersofpeoplewhoatlevelsofneedwhichwould receive social services –perhaps in the regionof40%of currenteligiblecasesbyourestimates.Thiswouldmeanaverysubstantialriseinunmetneed.Relyingentirelyon lever1wouldalsomeanthe localauthoritywouldbefailingtomeetitsdutyundertheSocialServicesandWellbeingAct(Wales)2014topromotewellbeingandtoengageinpreventionofmorecomplexneeds.

218. Eveniflever1werefeasible,itishighlyquestionablewhetheritwouldbedesirable. Indeed, a strategy structured around lever 1 might legitimately beviewedas failingtoplansufficiently for thedemographic transitionof thenexttwoorthreedecades.

Lever2:Rationcareonthoseonlowerincomesorraisecharges

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219. Using Lever 2 means that the costs of care might be rebalanced byprovidingservicestofewerpeopleasaresultofmeans‐testing,orbyincreasingcharges.Thus,whilelever1rationscaretoasmallerproportionofolderpeoplebasedontheirlevelofneed,lever2rationscarebasedontheirresources–oritimposesgreaterchargesonthosewhoreceiveservices.

220. The local authority has quite awide range of discretion in termsof the

typeofchargesitmayimpose.AsarecentLEWalesreportnotes, ‘Accordingtonationalregulationstheonlyservicestheyneedtoprovidefreeofchargeare:

o Transport toand fromaday centre,where this formspartof their careneedassessment

o AftercareservicesprovidedunderSection117ofthe1983MentalHealthAct

o ServicesprovidedtosufferersofCreuzfeldtJacobDiseaseo Intermediatecareservices(reablementservices)for6weeksfollowinga

stayinhospital’.83

221. The recent Social Services andWellbeing Act (Wales) 2014 introducesnewpowers to levy “a charge forprovidingor arranging theprovisionof careandsupport tomeetanadult’sneeds,or forputting inplace thearrangementsforthatcareandsupport”(Section44,subsection2).Thesepowersaresubjectto regulation. LAs may make ‘brokerage’ charges “to people with resourcesabove the charging threshold who seek help from the local authority, anddeferred payment agreements, currently applicable only to residential care,wouldbeextendedtoallservicesundersections21‐29.”84

222. The Act also introduces a system of ‘deferred payments’ under whichpeoplewhowillneedtopayfortheircarecanenterintoanagreementwiththeLA (Section 53). Under this scheme, the adult can agree “to give the localauthority a charge over the person’s interest in his or her home to securepaymentoftheperson’srequiredamount”(Section53,subsection3b).

223. Nonetheless,wearemindfulthatthelocalauthority’sabilitytochargeis

keptwithinlimitssetbyWelshGovernment.Atpresentnon‐residentialchargesmustnotexceed£55perweek,whichisduetoriseto£60perweekfromApril2016.85Furthermore,themeans‐testingregimeforresidentialcareisalsokeptwithintightboundariesdeterminedbyWelshGovernment.

224. WeareawarethattheWelshGovernmenthasindicatedthatitwillreformthesystemofpaying for social carebefore2016,86 so theremaybechanges inthisregimeinfuture.Nonetheless,forthetimebeingatleast,thereislittleroomformanoeuverintermsofrelyingontightermeans‐testingorincreasingchargesas a means of bridging the gap between rising needs and tight – or, indeed,reduced,resources,thoughtheremightbesomescopeforraisingcharges–for

83 LE Wales (2014), Future of Paying for Social Care in Wales: First Report to the Welsh Government. p.42 84 (National Assembly for Wales, Health and Social Care Committee, Social Serivces and Wellbeing Bill, Stage 1 Committee Report, July 2013, page 78, 79 – section 54 of the Act). 85 http://wales.gov.uk/about/cabinet/cabinetstatements/2014/payingforsocialcare/?lang=en 86 Clements, L. (2014), ‘The Social Services and Well‐being (Wales) Act 2014, p. 1

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example, in termsofdayserviceprovisionforserviceuserswhofallbelowtheweeklyceiling.

Lever3:Investinpreventionandreablementservices,andpromoteindependentliving

225. Thethirdleverentailsadoptingapreventativeapproach,tryingtoensurethat as many people are able to live independently for as long as possible. Itwould also include efforts to try to ensure that fewer people require moreintensive residential care provision, with more people who have care needssupportedinthecommunity.

226. We have noted that the levels of ill‐health and/or disability whichaccompanies increased longevity is difficult to predict, but adopting strategiesbased on lever 3, in essence,wouldmean trying to reduce ill‐health, disabilityandfrailtyamongstolderpeople.

227. Lever 3 thus potentially includes a relatively wide range of policy

initiatives including promotion of healthy living, efforts to create and sustainvibrantcommunitieswhocansupporteachother intimesofneed, investing intechnology to provide appropriate support to enable older people to liveindependently. It would also, more specifically, include the programme ofreablementwhich has been ongoingwithin Swansea over the past number ofyears.

228. One important advantage of this approach is that, as long as

independence is genuine and needs are not unmet, this optionwould seem tocontribute to older people’swellbeing. Itwould also concentrate resources onthosewhoneedthemmostnotbydenyingsupporttoanincreasingproportionof olderpeoplebut because substantial unmetneedswouldnot emerge in thefirstplace.

229. Preventative strategies in general, and a focus on reablement, inparticular,wouldalsobe consistentwith the local authority’sdutiesunder theSocialServicesandWellbeing(Wales)Act2014.

230. Onedisadvantageoflever3isthatsomeofthesocietaltrendswhichsuchstrategies seek to influence (e.g. promoting healthy living, or fostering greatercommunity or familial support) might be difficult to influence through policy.The success of such efforts might also be related to issues of poverty anddeprivation and thusmay bemore successful in areas of greater financial andsocialcapital.

231. Another disadvantage is that investments in preventative services andinitiativesmay reduce the resourceswhich can be allocated to other forms ofservice provision. The greater use of assessment bed provision within localauthorityresidentialcarehomes,forexample,reducesthenumberofbedswhichcan be made available for long‐term residents within the sector. Whilepreventative initiatives require up‐front and concrete investments, they maydeliver more or less uncertain gains. Furthermore, in a period of budgetaryconstraint, prioritising preventative services may mean reducing service

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provision for users with higher levels of need. This is, we note, an importantlimitationofpreventativestrategies,especiallywheretheup‐frontcostsarehigh,andthebenefitsuncertain.

Lever4:Reduceunitcostsofcare

232. Lever4entailsamedium‐tolong‐termefforttoreduceunitcostsofcare.Employing a strategy based on lever 4 would first entail renewed efforts toestimate the unit costs of care in the local authority and independent sectorresidentialcaresectors,ensuringthattheseestimateswerebasedonlike‐for‐likecomparisons in termsof the servicesprovidedand the levelofneedof serviceusers.Subsequently, itwouldentailassessmentofwhetherhigherunitcostsofcarewere justified in terms of quality of care and value formoney criteria. Ifnecessary, it wouldmeanwithdrawing provision where unit cost differentialscouldnotbejustifiedintermsofqualityofcareandwhereeffortstoreduceunitcosts directly had failed. Lever 4 is likely to involve some form of pay/feerestraint.

233. Atpresent,andwithadmittedlynon‐idealdata,thecostsoflocalauthorityprovidedcareappearhighcomparedwithexternally‐providedresidential care.However,since85%oflocalauthority‐supportedprovisionisintheindependentsector, the fees paid to independent sector care home providers will play agreaterroleindeterminingtheoverallresidentialcarebudget.

234. An alternative approach which might be adopted as part of this leverwouldbetotryandachieveeconomiesofscaleintermsoftheprovisionofcare.We note that while existing local authority care homes are relatively small(approx.30beds)thereareanumberofhomesintheindependentsectorwithapprox.100beds.Largerresidentialcarehomes,inboththelocalauthorityandindependent sector,mightenablegreatereconomiesof scaleand thus reducedunit costs of care. Seeking economies of scale as a means of ensuringsustainability is recognised in the Review of Residential Care Homes (p. 5) asbeing one option for away forward in terms of ensuring the sustainability ofservices.

235. Finally, one might seek to identify efficiency savings. This cannot beentirelyneglectedasawayforward,butsuchsavingsareunlikely,wesuggest,tomakeamajorcontributiontowardsbalancingrisingneeds,ontheonehand,withconstrainedresources,ontheother.

236. Oneadvantageoflever4isthat,ifpay/feerestraintcouldbeachieved,or

if economies of scale could be achieved by shifting to larger residential carehomes(inboththelocalauthorityandindependentsectors),thiswouldallowagreaternumberofolderpeopletoreceiveservicesfromafixedpoolofresources.

237. Thereareimportantdisadvantagesto lever4,however.First,someholdtheviewthatthatpay/feerestraintmayresultinthedeteriorationinthequalityofcareprovided.Asimilarconcernmightbelevelledatthequalityofcarewhichcouldbeprovidedinlargerresidentialcarehomes.Thereisadangerthatafocuson‘valueformoney’couldeasilybecomeafocuson‘cheap’care.

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238. This concern is particularly pertinent given that salaries in the care

professionsarenothighand there is alreadya concern thatmanypaid carers,especiallythoseworkingintheindependentsector,arenotpaidalivingwage.

Lever5:Supportpolicieswhichseektoboostprivateincomes

239. Thefinalpolicyleverwouldentaileffortstoboostolderpeople’sincomesso that they could themselves purchase a greater proportion of the servicesrequiredtomeettheircareneeds.Initiativeswhichfallunderthisheadingmightinclude attempting to improve social security take‐up or to encourage peopleapproaching retirement age who remained active and independent to worklonger.

240. The Welsh Government have, in recent years, been making efforts to

encourage people to take up their social security entitlements. The SecondStrategy for Older People noted that in 2006‐7, £1.5m was provided to localauthoritiestofundworktoimprovethetake‐upofCouncilTaxBenefit.87

241. Alternatively, the localauthoritymightprovide informationandsupporttoolderpeople inorder toallow themtoconsiderworking into later life.ThiswouldbeconsistentwiththeSecondStrategyforOlderPeopleofWales,whichnotesasastrategicobjectiveto‘supporttherecruitmentandretentionofolderworkersandincreaseeconomicactivitybyimprovingaccesstojobsfortheover50s’.88

242. Beyondpotentialpolicyinitiatives,itispossiblethat,overtime,acohorteffect will be observed whereby new cohorts of older people have greaterresources than thosewhopreceded themandwould thusbemore likely tobeabletomeetthecostsof theirowncareneeds.TheUKNationalEqualityPanelfoundthat,ofthoseaged65andabove,averagecurrentincomesfellconsistentlyasageincreased(infiveyearlybrackets).89

243. Furthermore, data show that, in linewith other parts of theUK, owneroccupationhasriseninWalesfrom56%in1971to70%in2013.Homeownersmaybeabletousetheequitybuiltupintheirhousestopayfortheirowncare.Againstthisgeneralrise,wenoteaslightlylowerpercentageofthepopulationofSwansea are in non‐local authority rented accommodation than the Welshaverage(80%vs83%).

244. Weviewthislever5asbeingnotentirelywithoutmerit, inparticularintermsofprovisionofadviceaboutsocialsecurityentitlements,wherethiscanbedone at little cost to the authority. However, it seems unlikely that policies

87 Welsh Government (2008) The Strategy for Older People in Wales 2008 – 2013, Living Longer. Living Better’. p. 32. 88 Welsh Government (2008) The Strategy for Older People in Wales 2008 – 2013, Living Longer. Living Better’. p. 26. 89 NationalEqualityPanel(2010),AnanatomyofEconomicInequalityintheUK:ReportoftheNationalEqualityPanel.London,CASEreport60.p.192,200.

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pursued under this lever canmake amajor contribution to helping to balancerisingneedandfiniteandconstrainedresources.

STAKEHOLDEREVENTS

245. Aspartof this IndependentReview,weheld twostakeholdereventson14th and 15th August. In addition, we held a meeting with a smaller group ofstakeholderson8th Julyandheld interviewswithanumberofmembersof thelocalauthorityduringtheperiodofthisIndependentReview.

246. About60peopleattendedtheeventsonthe14thand15thofAugust.ThelistofparticipantswhosignedourattendancelistispresentedintheAppendix.

247. We divided these stakeholder events into two sessions. In the firstsession,wediscussedthegoals,valuesandprioritieswhichshouldunderpinandinform the commissioning and provision of social services for older people. Inthesecond,afternoonsession,weoutlinedthefivepolicyleversdiscussedabove,and sought stakeholders’ responses as regards the advantages anddisadvantagesoftheseandwhattheysawasthemostdesirablewayforward.

Morningsession:Goals,valuesandpriorities

248. Webegan themorningsessionbydiscussing thepolicygoalofenablingpeopletoliveintheirownhomesforaslongastheycan.Aswehavediscussed,this can be found throughout the policy documentation as well in as theacademicliteratureasacentralgoalofpolicyinthisarea.

249. Onthefirstmorning,discussiontendedtowardsexploringwhetherthereare limits to the desirability of this aim. One stakeholder noted that wewhatpeoplewantandwhattheyneedmaynotbethesamething.Forexample,oneofthe stakeholdersdiscussedhowher elderlymotherwanted to stay inherownhome, but that because of her complex needs, residential care was a betteroption.

250. Safety was another concern in regards to policy of promotingindependentlivingwithinthecommunity,particularlyinrelationtoolderpeoplewith dementia. The daughter of awomanwith dementia discussed how therewasariskthathermothermightletpeopleintoherhomewithoutknowingwhotheywere.

251. Furthermore, while it was generally agreed that policy should respectolder people’s desire to stay at home where this exists, some stakeholdersemphasised the need to acknowledge that staying at home can be an isolatingexperience for some older people. Some stakeholders suggested that thatisolationandlonelinesscouldacceleratetheonsetofdementia.

252. Asonestakeholderput it,enablingpeople to live independently in theirownhomesisonlyadesirablepolicygoaliftheycancope.

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253. However,anothercontributorsuggested thatolderpeople’sexperiencesandpreferencesdifferandnotedthatsomeolderpeoplebecomedepressedoncetheymoveintoaresidentialcarehome,orotherwisefindthetransitiondifficult.

254. Onestakeholderexpressedtheviewthatreablementisnotsufficientanddid not work for everyone. This stakeholder told us how they had heard of apersonwhowassentbackhomethreetimesfromhospital,beforefinallybeingmovedtoaresidentialcarehome.

255. Anotherstakeholderwasconcernedwiththeconcentrationofreablementservices in certain residential care homes and thus in particular areas ofSwansea. She discussed how her elderlymotherwould feelmore comfortablereceiving services through themediumofWelsh in her local area ‐ an area ofSwansea with relatively higher proportion of Welsh speakers. When askedwhether this should be a priority to which resources should be allocated, ifnecessary,shesaidshebelieveditshould.

256. In terms of priorities, a number of stakeholders eloquently expressedtheirviewasregardstheimportanceofdaycentres.Indeed,thesestakeholdersemphasisedtheroleofexistingdaycentresasapreventativetoolwhichmeantthatolderpeople could continue to live independently.Thesestakeholders feltthat day centres helped to alleviate the isolationwhich somewere concernedwouldbetheresultofapolicywhichemphasisedindependence.

257. Asecond themewhichemergedduring thesediscussionswasabout theimportanceofrespiteservices,whichwouldbeincreasinglyindemandifpeoplewere going to remain independent, at home for longer.One stakeholdernotedthe importance of local authority respite provision because the independentsectorcouldnotguaranteerespiteplaces inadvance, thuspreventingher fromplanninginadvancetotakeaholiday.

258. Therewerealsoanumberofconcernsexpressedaboutproposalstoclosethree local authority residential care homes in Swansea. One stakeholderreported that the uncertainty about whether his mothers’ residential homewould close had caused her stress and worry. Other stakeholders – andparticularlyolderpeoplethemselves–spokehighlyoftheservicestheyreceivedinthelocalauthorityresidentialhomeswheretheylived.

259. One local authority staff member expressed the view that the builtenvironment at some local authority care homes was inadequate, with somehomeslackingensuitefacilitiesandwithroomstoosmalltofitahoist.

260. CertainstakeholdersspokehighlyofTelecareandbelievedthatitworkedwellinhelpingstafftooverseeclientsandtoensurethattheyaresafeandwell.Stakeholders also felt that thereneeds to be further investment inTelecare tosupportpeople,particularlywithlowerlevelneeds,toenablethemtolivewithinthecommunity.

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261. A spokesperson for Unison stated thatwe should not dismiss in‐house,publicsectorcareprovision.Hearguedthatthereislesscontroloverqualityandstaffarenotpaidenoughwithinprivatesectorprovision.Publicsectorprovisiongivespeoplethedemocraticrighttoshapeolderpeople’sservices,hesuggested.

262. Specialist residential and day care services were regarded as anotherpriority among stakeholders. Therewas praise for the ‘RememberMe’ Club, asocialactivitygroupforpeopleinthemidstagesofdementiawhocannolongerparticipateinregulardayservices.90

263. Certainstakeholdersalsobelievedthatwhenthinkingaboutthefutureofsocial care for older people’s services, we should give carers greaterconsiderationastheysavethelocalauthoritymoney.Onestakeholdersuggestedthatweshouldlookatco‐productionandlookatwaysofrewardingolderpeoplefortheirworksuchasthroughsomeformofcommunityvouchers.

264. Onestakeholderfeltthatitwaseasiertowithdrawprovisionofdaycarecentres compared tocrisispreventionprovision.Despite this, theyargued thatdaycareprovisionwasstillimportant.

265. Some stakeholders felt that older people should be given moreinformationasregardsthe fullrangeofhousingoptionsavailable to them.Onestakeholder suggested that another post should be set up, similar to aCommunity Connector,whowould help older people specificallywith housingadvice.

266. In addition, it was suggested that efforts should be made to buildcommunitynetworksandincreasesocialcontactamongneighbourhoods.Manyrespondentsdiscussed thatdue to factorssuchasgeographical isolation,manyelderlypeoplemayhaveno familymemberswho livenearby.Stakeholders feltthatneighboursshouldbeencouraged to lookout forandhelpolderpeople inorderforthemtohavesomeonebeyondcareworkersthattheycanrelyon.

267. However, building community networks was also regarded as being autopian vision and other stakeholders discussed how it may be difficult forpeople to look after elderly people as theymay have other priorities such asworkandfamily.

268. There were concerns among stakeholders that there is limited careprovision available for older people during thenight andweekend.One of thestakeholdersdiscussedhowpeoplewithdementiamaysleepduringtheday,butmaybeactiveduring theevening. Anotherstakeholdernoted that this typeofprovisionwasbeinglookedatbythelocalauthority.

269. Other stakeholders suggested that a helpline should be set up, whicholderpeople can contact if theyhave anydifficulty. Stakeholdersbelieved thatbothSocialServicesandtheHealthServiceshouldbeinvolvedinoperatingthis

90 http://www.swansea.gov.uk/index.cfm?articleid=50444

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helpline.Othersuggestedthatonesinglehelplinemaypreventolderpeoplefromhavingtorepeattheirproblemstodifferentpractitioners.

270. Community Connectors were regarded as being important in relievingsocial isolation among elderly people and stakeholders felt that this schemeshouldbeexpanded.

271. The Intermediate Care Fund was considered to be helpful, with aspokesperson fromCareandRepairnoting that ithasenabled themtocontactelderlypeopletoseeiftheyrequirehelp.

272. Stakeholders also discussed how schemesmay gain different responsesfromolderpeoplefromdifferentareas.Anumberofstakeholdersdiscussedhowtherewasatendencyforolderpeopleindeprivedareastobemorereluctanttogetinvolvedinschemesastheymaybescepticalofthesocialservices.

273. Furthermore,aCommunityConnectordiscussedhowthesuccessratesofcommunity groups vary across different areas of Swansea. The CommunityConnector noted how certain community groups in affluent areas are able tosustain numbers as elderly people in these areas may have the financialresources to pay for transport to attend meetings. Community groups indeprived areas of Swanseamay find it more difficult to maintain numbers aselderlypeopleintheseareasmaynotbeabletoaffordtransportandothercostsinvolved.

Afternoonsession:Policyleversandalternativepolicyfutures

274. In the afternoon session, we presented the five policy levers discussedabove and sought stakeholders’ views as regards the advantages anddisadvantages of these options, and asked them to identify a preferred wayforward.

275. Concentratingresourcesonthosemostinneedwasconsideredtobeoneof the least desirable levers. Certain stakeholders expressed concern that thisleverwouldresultinanincreaseinunmetneed.OthersnotedthatchangingtheeligibilitycriteriamayplaceastrainontheNHSandtheHealthServicesastheymayhavetodealwithincreasingnumberofelderlypeopleenteringhospitalastheirneedsmaynotbemetbysocialservices.

276. Certainstakeholdersreportedthattheywouldbehappytopaymoreforday centres, and would prefer to pay for these services than to lose themaltogether.Anotherstakeholdersuggestedthatcertainservicesforpeoplewithlowerlevelneedscouldbechangedintosocialenterprises,meaningthatelderlypeoplewouldhavetocontributefinanciallytoreceivetheseservices.

277. Intermsoflever3(prevention),stakeholdersfeltthatthelocalauthorityshould not only target promoting active ageing and healthier living for olderpeople, but also to the younger generation to combat thepotential increase inobesityanddiabetesratesinthefuture.

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278. Promotinghealthier livingwasregardedassomethingwhich isnotonlytheresponsibilityofSocialService,butalsootherdepartmentswithinthe localauthority.StakeholdersfeltthePassportforLeisurescheme,CityandCountyofSwansea’s discount scheme for sport and leisure centres should be promotedfurther. Itwasalsomentioned that librariesandvoluntaryorganisations couldmake more of an effort in holding social activities and that private sectorcompanies such as gyms could also be encouraged to provide discounts forelderlypeople.

279. Somestakeholdersalsoindicatedthateducatingpeopleaboutthebenefitsof reablement was important. Care workers working in assessment unitsdiscussed how many family members are risk‐averse and are worried whenpractitioners decide to send their elderly relative back to their own home.Stakeholders also felt that there was a need to educate consultants about theethos of reablement as there is a tendency formedical consultants andGPs toadviseanelderlypersontomovetoaresidentialhomewhilethey’reinhospital.

280. It was agreed that the outcomes of reablement needs to be closelymonitored and that research is needed to look at what happens once olderpeoplefinishreceivingreablementsupport.

281. Providing older people with adequate equipment to support them wasregardedasmakinganimportantdifferencetothelivesofolderpeople.Certainstakeholders noted that there was a surplus of equipment to support olderpeople in Swansea. Some suggested that individuals should pay a deposit forequipment and give their name and address to ensure that equipment isreturned.

282. Somestakeholderswereconcernedthatcreatingeconomiesofscaleandhavinglessstafflookingaftermoreelderlypeoplewouldresultinstaffburn‐out.

283. Reducingtheunitcostsofcarewasregardedasoneoftheleastdesirableleverstouseastherewereconcernsthatthiswouldinevitablyleadtoadecreaseinquality.

284. AlthoughstakeholderswerefavourabletowardstheWelshGovernment’s

pushtoincreasethetakeupofbenefitsamongolderpeople,certainstakeholdersfeltthatagreaterinvestmentshouldbemadebythelocalauthorityinordertohelpmaximiseolderpeople’sbenefits.

285. One stakeholder noted that increasing private incomes would result insomeolderpeopleearningjustabovethethreshold.Thestakeholderfeltthatthelocal authority should look at creating a sliding scale threshold, which mayreplace thecurrent systemwheresomeoneeitherhas topay foreverythingorpaysnothing.

Summary

286. Overall,stakeholderscouldseethat formanypeople, living intheirownhomeforaslongaspossiblewasadesirablepolicygoal.Nonetheless,theywere

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also able to identify a range of circumstances where this was not desirable –whereaperson’sneedsbecametoogreat;whereitwasnolongersafetoliveintheir own; in some cases where they were isolated and lonely and withinsufficient family or community support.What emerged fromour discussionswasthe importanceofbeingsensitivetothe ‘tippingpoint’where independentlivingmay not continue to contribute to individual well‐being, even if it doescontributetocost‐containment.

287. Secondly, in terms of the policy levers which we identified, there wassomeagreementthatthebeststrategywouldbetoseekabalancebetweentheselevers, rather than rely on just one or two. At least in our second stakeholdergroup, there was a reasonable consensus that lever 3 was themost desirableoptionandthatapreventativestrategywasmoredesirablethantheremainingfour options. There was some support for this in the first group, though thissupportwasgenerallyweaker. Stakeholders recognised that eachof the leverspresenteddifficultchoicesandthat,totheextentthatthesustainabilityofsocialservices could not be achieved by preventative efforts alone, this left moredifficultoptions– likely tocentreonconcentrating resourceson thosemost inneed(lever1)andreducingunitcostsofcare(lever4).

OURPREFERREDWAYFORWARD

288. The five policy levers we have identified above are not, of course,mutuallyexclusive.Thelikely–andindeedthemostdesirable–courseforpolicyislikelytobesomecombinationofthefive.

289. Our proposed policy levers reflect the primary strategieswhich can beadopted irrespective of the exact resource envelope. We note that, as societyages,onestrategywhichmayhelptoensurethesustainabilityofsocialservicesforolderpeopleistoincreasetheresourceenvelopeitself,perhapsthroughtaxrisesorbydevotingagreaterproportionoftheCouncil’sbudgettoservicesforolderpeople.Whilewedonotviewtheseoptionsasbeingtheprimarysolutionsto ensuring sustainability, over the longer‐term they could make somecontributiontowardsensuringthesustainabilityofservices.

290. At theoutset,wemustnote thatweviewLever2 andLever5 asbeingabletomakearelativelymarginalcontributiontoensuringthesustainabilityofprovision.Theremaybescope for increasingcharges for certainservices– forexample, fordaycentres–within the limitssetbyWG.Theremayalsobe lowcosteffortswhichcanbemadetotieinwiththeWelshGovernment’sinitiativetoimprovethetake‐upofsocialsecurityentitlements.Nonetheless,weviewtheseleversasbeingcapableofmakingonlyamarginalcontributiontoensuringthesustainabilityofsocialservicesforolderpeople.

291. In terms of the policy levers we have identified, our preferred optionwouldbetofocussubstantiallyonLever3(prevention&reablement).NotonlyisthisrequiredbyWGlegislation,itperhapsoffersthebesthopeofbalancingtheneeds of tomorrow’s older people with the resources which are likely to be

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available,withoutresortingto increasingeligibilitycriteria.Tothisend, ifsuchinitiativeswere not already in place in Swansea, wewould be recommendingthem.

292. However, as we have discussed, we do not view it as self‐evident thatreablementinparticular,orpreventioningeneral,willbesufficienttoensurethesustainability of services on its own. To that end, some contribution theremaininglevers,andespeciallyfromLever1(concentratingresourcesonthosemost in need) and Lever 4 (reducing the unit costs of care) might well berequired. It should be possible in a reasonably short period of time – perhapsbetween1and3years–togetmoreinformationaboutthelonger‐termsuccessofthereablementandintegratedcareinitiativesandthusfromthecontributionwhicharerequiredofthem.

293. Intermsoftheseremaininglevers,whereunitcostscanbereducedina

way which does not compromise quality of care, such options should beconsidered(Lever4).Asnotedabove,weviewtheestimationoflike‐for‐likeunitcosts of in‐house and external service provision as being necessary to informdecisionsasregardshowtoreduceunitcostsofprovision.Optionstoreduceunitcostsbyincreasingeconomiesofscaleshouldbeexplored,eveniftheimmediateeconomic climate makes such proposals difficult to implement. As unit costsappeartobehigh intermsof in‐houseprovision,withdrawalof thismaymakesomereductionintermsofunitcosts.Aswehavenoted,however,thisexplainsarelatively small fraction of the savings which will need to be found over themedium‐ to long‐term sowe recommend that alternative approaches are alsoconsidered.

294. Finally, where services must be withheld from some older people, werecommendthateligibilitycriteriaensuresthatthisaffectsthosewithrelativelylowlevelsofneedwiththosewithhigherneedscontinuingtoreceiveprovision(lever1).Webelievethisoptionshouldbetreatedasalastresort.

295. Overall, our preferred way forward comprises a primary focus on

preventionandreablement,withcontinuedinnovationintermsofprovisionandmonitoringofoutcomes,combinedwithamodestcontributionintermsofeffortsto reduce unit costs over themedium‐ to long‐term, increases in charges, taxrisesand,finally,asalastresort,concentratingresourcesonthosemostinneed.

CONCLUSIONSANDRECOMMENDATIONS

296. Given the increases in longevitywhichare forecastanda tight resource

environment, the challenge of ensuring the sustainability of older people’sservices very real. If current provision is unchanged, not only will the localauthority be failing in its responsibilities under the recent Social Services andWellbeing (Wales) Act 2014, but a substantial proportion of tomorrow’s olderpeople,whotodaywouldbeeligibletoreceiveservices,willhavethemdeniedaseligibility criteriawouldneed tobe tightened considerably inorder tobalanceneedandresources(Lever1,discussedabove).The‘donothing’option–failing

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toensure thesustainabilityofservices–will result inarise inunmetneed fortomorrow’solderpeople.

297. Throughout the period of this Independent Review, we have beenimpressedwith the forwardplanningwhich isongoingwithin theAuthority inordertoputsocialservicesonalong‐termsustainablefooting,especiallyunderthe Western Bay and Transformation of Adult Social Services (TASS)programmes.ThisplanningisnotonlyconcernedwithensuringcompliancewithWGlegislation–itisseekingtolearnlessonsofwhatworksinotherpartsofthecountry, introducing new initiatives such as reablement and – importantly –monitoringthesuccessoftheseinitiatives.ThisworkisbasedonforecastsofthenumberofolderpeoplewhoareanticipatedtobelivinginSwanseaintheyearsanddecadestocome.

298. Wearepersuadedthatenablingpeopletoremain independent, living in

their own homes, can meet both individual well‐being as well as cost‐containmentobjectivesforsomeolderpeople.Nonetheless,wearemindfulthatindependentlivingisnotlikelytobedesirableforeveryoneandbelievethatcareneeds to be taken in identifying that ‘tipping point’where living in one’s ownhome – perhaps on one’s own – may continue to meet cost containmentobjectives,evenifitisdetrimentaltoindividualwellbeing.

299. Giventhecostpressureswhicharelikelytootherwiseemergeasaresultof a substantially greater number of older people, and the cost differentials ofcommissioning and providing domiciliary as compared to residential careprovision,we can see that there is a good argument for rebalancing provisionawayfromresidentialcareandtowardsdomiciliarycare,asthisenablescaretobeprovidedtoagreaternumberofolderpeoplewithafixedbudget.

300. WecommendthereablementeffortswhichareongoingwithintheCity&County of Swansea and note that the emerging data from this initiative arepositive,even if theyareconfinedtoshort‐termoutcomes.Werecommendthecontinuedmonitoring of thosewho have received reablement services so thatthelonger‐termeffectsoftheinitiativecanbecomeknown.

301. Incarryingoutthisreview,wehavebeenimpressedbythewayinwhich

the challenge of developing an integrated care model that recognises localcultures in the context of a large regional organization like ABMU has beenhandled.Inreflectingonhowintegratedcareserviceshavebeendeveloped,andcontinue tobedeveloped,wearemindful that thesedevelopmentsconsciouslyadoptawholesystemsapproach,onethatisendorsedintheresearchliterature.Inaddition,thedevelopmentofbothstepdownandstepupassessmentservicesreflectgoodpracticeidentifiedelsewhere.

302. Nevertheless, the research literature is of limited usewhen consideringhow intermediate care may develop, providing mixed messages on theeffectivenessofthiskindofservice.Whilethereisscepticismamongresearchersontheeffectivenessofthismodelofcare,thereisnonethelessrecognitionthatattheveryleastintegratedcaremeansbettertargetingofresourcesonactualcare

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needsandsomovingolderpeopletomoreappropriate,andpotentiallycheaper,partofthecaresystem.

303. Giventhecostpressuresthatarelikelytoariseinthesocialcareofolderpeople,anddespitethelackofevidenceonthecosteffectivenessofintermediatecare,webelievetherearegoodargumentsforcontinuingtobuildalargerhealthcare infrastructureat the levelof thecommunity.Aswith reablement services,werecommendthecontinuedmonitoringofserviceuserstoestablishthelongertermeffectsofthisinitiative.However,totheextentthattheeffectsofintegratedcaremayincludeshorterhospitalstaysandfewerinappropriatere/admissions,then the success of intermediate caremay create additional burdens on socialcare, underscoring the need to further develop joint commissioningarrangements.

304. It is important to bear in mind that a rebalancing of provision from

residentialtodomiciliarycare–whichimpliestherelativeproportionsbetweenthe two – does not, when the numbers of older people are expected to risesharply, imply anabsolute reduction in aggregateprovisionof residential care.Indeed,asubstantialrebalancingwouldberequiredsimplyinordertokeepthenumberofserviceusersinresidentialformsofcareconstant,allelsebeingequal,over the comingdecades.Whilewe agree thepolicy approachwhichhas beenadoptedwouldbeconsistentwithagreaterproportionof futureservicesusersrequiringnursingcarethanatisthecaseatpresent,weremainoftheviewthat,unlessinducedbypolicy,itisdifficulttosaywithanycertaintythattheneedforresidential care will fall. In general, we believe that the distinction betweenrelativebalanceorproportionandabsoluteoraggregatedemandshouldfeaturetoagreaterextentinlocalauthorityconsiderationofsustainabilityofprovision.

305. Tothisextent,ithasbecomeclearduringtheperiodofthisIndependentReview that we are rather less optimistic about the reductions of absolutedemand for residential carewhich are likely to result from the current policydirection.

306. While outcomes from reablement initiatives are positive, they aremeasuredoverareasonablyshorttimehorizon(weeksormonths).Inorderforreablement, in itself, to reducedemand for residential care,without relyingonincreasedeligibilitycriteria(Lever1)wewouldneedtoseeabroadlyequivalentlevelofoutcomesoverthewholelifecourse,andforlaterentryforthosewhodorequire residential care so that the period spent in residential care does notincrease.

307. Ifcareistoberebalancedtowardsdomiciliarycare,thisrequiresfurtherinitiatives in terms of Telecare and other assistive technologies, as ourstakeholders made clear. Greater reliance on domiciliary care is also likely toimplyagreaterrelianceoncarers,sorespiteopportunitiesarecrucial.Thelatterbecomes an important consideration in terms of consideration of the currentproposals surrounding residential care home closures and remodelling of dayservicesgiventhat theasignificantproportionofrespiteservicesareprovidedbythelocalauthority.

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308. Makingdecisionsaboutalternativepolicytrajectories–suchastheideal

balance between in‐house and externally provided provision – requires gooddataontheunitcostsofsuchprovision.Estimatingunitcostscanbeadifficulttask, butwebelieve that further efforts are required to improve thequalityofunit cost estimates in order to facilitate decision making regarding thesustainabilityofsocialservicesinthefuture.

309. Broadly speaking, then, we are persuaded that the strategic directionwhich isbeingpursuedby the localauthority is therightoneand isconsistentwithourlever3whichisthepriorityinourproposedwayforward.

310. We are rather less persuaded by rationales for the immediate budget

proposals regarding closure of residential care homes and remodelling of dayservices.Aswehave already indicated,webelieve that there are stronger andweakerrationalesfortheproposedclosureofthreeresidentialcarehomes.Wearesympathetictotheclaimthatthebuiltenvironmentmightactasabarriertoensuring the sustainability of provision. However, we are not clear that suchconcerns extend to three of the residential care homes currently under localauthoritycontrolnorthatitrequiresimmediateaction.

311. Webelievethattheanticipatedreductionindemandforresidentialcareoffersaratherweakerrationaleforclosureofthethreehomes.Giventhescaleofpopulationageingoverthemediumtolong‐term,andtheuncertaintyinvolvedinterms of the success of prevention initiatives and intentions to rebalanceprovision towards domiciliary care, we believe a “wait and see” approach toobservingwhetherthereductionindemanddoes,infact,occur,wouldamountofamoresustainableapproachtothisissue.

312. If some existing care homes are to close, this will create significantdisruptiontothelivesofexistingserviceusers.Whilesuchdisruptioncannotberuled out and does not provide a sufficient reason for not moving to a moresustainableformofprovision,webelievethattheconcernsandanxietiesofthoseserviceusersaffectedbysuchamoveareanimportantconcern.Webelievethatplans for where these older people would be located should be given a highpriority, decided upon prior to the announcement of residential care homeclosures,andthatthisshouldbecommunicatedtothoseserviceusersaffectedina clear and timely manner. To this end, while a period of engagement andconsultationmayberequiredbeforeprecisearrangementsareput inplace,webelievethatcertainguaranteesshouldbemadetotheolderpeople inquestionprior to this period of consultation. We believe that re‐assessment of olderpeople affected should be avoided and that they should, unless stating analternativepreference, be relocated, collectively,wherepossible, to other localauthorityorindependentsectorresidentialcarehomeproviders.

313. In general, we would prefer if proposals around the closure of local

authorityresidentialcarehomeswerenottakentoimplythedivestmentofonehalfofcurrentlocalauthorityresidentialcarehomeprovision.Totheextentthatthe latter is in itself desirable,wewouldprefer to see an explicit rationale for

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this. To the extent that it is not, wewould prefer to see options for the localauthorityretainingitsshareofthemarketbeingconsideredtoagreaterextent,evenifthismeansbuildingnewresidentialcarehomes–perhapswithagreaternumberofbeds,whichwouldenableeconomiesofscaleandthusreducedunitcosts.While the current economic climatemakes such considerations difficult,sustainability – and, in particular, a sustainability strategy built aroundprevention–requiresinvestment.

314. Despite concerns surrounding the built environment of some existingcare homes, given the as yet unknown long‐term success of prevention andreablement initiatives and uncertainty surrounding the rebalancing of careprovision,giventhescaleofageingwhichisforecast,giventherelativeabsenceof consideration of the impact of the divestment of one‐half of local authorityresidential care provision on the market for residential care, and given therelativelymodest contribution of such divestment in terms of themeeting thecosts of population ageing, we would not prioritise closure of local authorityresidentialcarehomesatthistime.

315. Given the time limitednatureand focusof this IndependentReview,we

finditmoredifficulttomakeaconcreterecommendationasregardsproposalstoremodel day services. On the one hand, we can see that in‐house day centreprovisionismoderatelycostlyandthatdayopportunitiesarelikelytoimposealower cost burden on the Council.We can also see that they contribute to thelocalauthority’sresponsibilitiesundertheSocialServicesandWellbeing(Wales)Act. On the other, we are mindful of the importance which a number ofstakeholders who attended our events placed on day centres and that suchservices might become more important as care is rebalanced towardsdomiciliarycare,whichislikelytoincreasedemandsonunpaidcarersandfamilymembers.Wearealsomindfulthat11SocialCentreshavebeenclosedinrecentyears.Overall,webelieve that cautionneeds tobe exercised indirectingolderpeople who have substantial levels of need towards day opportunities, wherethese needs may not be met, and we would prefer to see the possibility ofincreasing charges explored before any decision to substantially reduceprovision.

316. Whilewe endorse a prevention‐led approach to ensuring sustainability,prevention can raise a conundrum. To the extent that prevention requires aninvestmentwhichmustbeoffsetelsewhereintheolderpeople’sservicesbudget,there isa risk that resourcesaredivertedaway fromolderpeoplewithhigherneedsanddivertedtothosewithloweror,indeed,noeligibleneeds.Webelieveitisimportanttobesensitivetothispossibilityandtoensure,totheextentthatis possible, services for people with relatively higher levels of need arepreserved.

317. Theauthorityhavemadeaclearstrategicdecisionthatin‐houseprovisionshouldbespecialisedandshouldconcentrateonreablement,complexcareanddementia services, where it is felt that service provision in the independentsectormightnotexistormightbeprovidedonamoreexpensivebasis.Wearepersuadedbythejustificationforthisspecialisationandcommendtheplanning

58

whichisongoinginordertoprepareforasharpincreaseinthenumbersofolderpeoplewhowilldevelopdementiainthefuture.

318. Considerableworkhasbeenundertakenbythelocalauthorityinordertoputsocialservicesforolderpeopleonasustainablefooting.Reservationsaboutimmediate proposals notwithstanding, we believe that the longer‐term policytrajectory,inadoptingapreventativeapproach,enablingpeopletoliveathomewhen they are able to do so and when it contributes to their wellbeing, inofferinghigh‐qualityspecialistprovisionwhichbothmeetsolderpeople’sneeds,andsetsamarkerofthestandardofcarewhichcanexpected,istherightone.

319. Ensuring the sustainability of older people’s services is a significant

challenge, and one of immense importance.We thank all of thosewho sharedtheirexperiencesandtheirexpertisewithus,andespeciallytotheolderpeoplewhocurrentlyreceiveserviceswhotoldus–ofteninquitemovingterms–howimportant the services they received were for their wellbeing.We hope suchservicescontinuetomeettheirneedsand,indeed,intime,theirchildren’sneeds.

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MeetingsandtelephoneinterviewswithLocalAuthoritystaffandCouncillors

PaulLittlewoodJulieBurroughsSimonJonesCarolReaDeborahDriffieldDebbyHobbyPeterFieldCllrMarkChildCllrChrisHolley

WrittenSubmissions

PaulLittlewoodRowlandJenkinsAnonaBlackwellKayDrewsonInitialStakeholder’sEvent–8thJuly2014

CllrJanCurticeShirleyBowenJackieGriffithsSimonJonesJulieBurroughsPaulLittlewoodCarolHarrisRowland Jenkins

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StakeholderEventAttendanceList–14thAugust2014

CathyBoyleMaryPitsonKarenGronertJulieBurroughsTonyKlugeShirleyBowenCarolHarriesJoanneFordCllrJanCurticeTraceyGriffithsRowlandJenkinsKirstyRoderickHelenHuelinAndrewThomasGayleBrownSharonGriffithsDianeBirminghamSusanAdamsDawnsWilliamsEmmaPhillipsCarolConwayJaniceMylesIrisDixonIraHopkins‐JonesLouiseRowlandsLindaKerswellJaneThomasPamSpenceNicolaEdwards

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StakeholderEventAttendanceList–15thAugust2014

LynCurtisMarilynEvansAmy‐MeredithDaviesMaggieBerryJulieBurroughsJeanetteMunnLyndaRoachLaurenThomasJackyMatthewsDebbyHobbyMarkChildVWArthurJackieGriffithsJuneRenziWendyGoffCathyRichardsJaneTonksNormaSteadDavidTristhamLynnetteSmithMeganTristhamDonnaSouthardLindaWhiteleyBeverleyRichardsIanLawsonAnnaLloydLeighThorneDavidPhillipsHelenBarryAliWilliamsHelenHunter

Conveners Letters and

Cabinet Member

Responses 2015 - 2016

C I T Y A N D C O U N T Y O F S W A N S E A

———————————————————————————————————————————————



Transforming Adult Social Services Scrutiny Panel, 1 June 2015 The Panel met on 1 June to consider the outcomes of the Social Services and Well Being Act seminar, the consultation with carers that the panel has agreed to carry out and to revisit the workplan. The panel would like to thank you and officers for attending the meeting. Convener’s letters and Cabinet Member responses The panel agreed to consult with you and officers to provide a definitive list of the letters that have been sent, responses received and those that remain outstanding. Many of the issues and concerns raised in the outstanding letters have been overtaken by work plan developments, evidence gathering sessions and subsequent convener’s letters and your responses. One issue however, remains outstanding and this is in regard to the Independent Review on the Commissioning and Provision of Social Services to Older People. The panel agreed at its December meeting to hold a second session with you and officers on the report and to request that you provide us with the original version of the report that was provided to the Authority for its comment. The panel will liaise with you to find a suitable date for a second meeting on the



Scrutiny


e-Mail e-Bost:

[email protected]


Your Ref Eich Cyf:

Date Dyddiad: 12/06/15

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 1st June 2015. It is about the Social Services and Well Being Act seminar, the carers consultation and the workplan.



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Independent Review report and in the meantime we would be grateful if you could make available to us the original report. The panel also agreed to add to the agenda of its next meeting, your response to the letter which covered the meetings held on 30th March and 7th April and examined Local Area Co-ordination so it can assure itself that all issues raised in the letter were covered in the reply. Social Services and Well Being Act Seminar The panel reflected on the seminar which Assembly Member Mark Drakeford, Minster for Health and Social Services, attended and agreed to circulate the note of the seminar so that members could add further key points. The panel was pleased that the Director of People attended the seminar but expressed disappointment that other officers from social services were unable to attend. Carers Consultation The panel has put together a consultation proposal and it is keen to gather views of carers directly and not just organisations representing carers. The panel noted that Carers Week could provide an opportunity to seek views of carers informally. The panel was concerned about how young carers who did not identify themselves as carers would be consulted with and how their views would be used. The panel agreed that the purpose of engagement with carers was to capture carers’ perceptions of their current circumstances and their hopes; evidence gathering would be achieved through a number of methods including writing to organisations, consultation sessions and panel meetings. The panel’s questions will be broad and along the lines of identifying barriers to improving their lives, what would improve your life as a carer and what sorts of things provide help and support to your current caring role. Our final report will be used to inform the panel’s scrutiny of future cabinet proposals on support for carers. Work Plan The panel agreed to consult with you and officers on its work plan to ensure that its work added value to the transformation of adult services; to use the next meeting (29th June) to examine the domiciliary care commissioning review, the domiciliary care costs and the cabinet member response to the social care at home inquiry. Concerns The panel had a number of concerns which it wished to bring to your attention:

• The lack of availability of information to the panel on the domiciliary care commissioning review



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• The importance of scrutiny councillor involvement in commissioning reviews

• Duplication between the work of scrutiny and the CACs • Difficulties regarding responses to the panel’s requests for information • Alpha Care situation in Neath Port Talbot

Agreed

• To include details of outstanding issues from previous letters, and request that these are responded to in the Cabinet Member’s response to this letter

• Panel to provide comments on the note on the Social Services & Well Being Act seminar

• Panel agreed the broad questions to ask carers; to use a number of different methods to gather evidence; to engage carers as well as carers organisations; to provide comments on the revised carers consultation proposal

• To use the next meeting (29th June) to examine the domiciliary care commissioning review, the domiciliary care costs and the cabinet member response to the social care at home inquiry.

• Your Response In your response we would appreciate your comments on any of the issues raised in this letter. We would be grateful, however, if you could specifically refer to:

• The outstanding issues from previous convener’s letters raised in the letters section on page one of this letter

• The panel’s request to examine the domiciliary care commissioning review, the domiciliary care costs analysis and your response to the social care at home inquiry at its meeting on 29th June.

• In our letter dated 30th March & 7th April (to which you have responded), the panel felt that more clarity was needed on housing for older people. Could you please provide your views on this matter please.

We would be grateful if you could provide your response by Friday 3rd July. Yours sincerely BOB CLAY CONVENER, TRANSFORMING ADULT SERVICES PANEL

[email protected]



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Transforming Adult Social Services Scrutiny Panel, 29 June 2015

The Panel met on 29 June to consider the Sustainable Swansea: domiciliary care commissioning review and your response to its last letter which covered the meeting held on 1st June.

There were a number of matters arising from your response and these are detailed below.

• The panel felt that by seeing a copy of the original report from Cardiff itcould contribute and comment fully on the domiciliary care commissioning review.

• The panel wanted to draw your attention to the delay in producing aresponse to the Social Care at Home scrutiny inquiry. The panel is keen to stress that the social care at home review and recommendations demonstrably feed into the current domiciliary care commissioning review.

• At your suggestion in your response, the panel discussed ways that itcould be involved in the domiciliary care commissioning review. We suggested that 3 members of the panel join the project group. We would welcome your views on this.




Scrutiny Direct Line: Llinell Uniongyrochol: 01792 637491 e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf: TASS/03 Your Ref Eich Cyf: Date Dyddiad: 13/07/15

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 29th June 2015. It is about matters arising from your previous letter and the domiciliary care commissioning review.

ITEM 2



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• We welcomed the priority that will be given to establishing a robustperformance management reporting framework in Adult services andwe were pleased that the lessons learned in Child & Family Serviceswill be used to make improvements to the availability of thisinformation.

• With regards to housing for older people, the panel seeks your viewson the character and type of housing stock that will be required inSwansea in 5,10 & 15 years from now; providing your department’spopulation forecasts to relevant housing bodies to help inform theirfuture planning and strategies.

Domiciliary Care Commissioning Review: update report

The panel learned that the change in priority which had prompted this commissioning review was a result of a number of problems within the delivery of domiciliary care, for example, capacity of both in-house and external providers, pressure on beds, use and delivery of reablement.

The panel was keen that it be involved in the Domiciliary Care Commissioning Review and, as detailed above, put forward a suggestion to officers. We would very much welcome your views on our suggestion that 3 panel members (2 labour members and 1 opposition member) join the project group.

We were informed by officers that a workshop will take place on 17th July to identify the desired outcomes for the Domiciliary Care Commissioning Review and that the panel would be able to influence this session. We would welcome your views on this.

The panel was unsure whether the local authority had a true sense of the population projections and therefore the type of social care settings and models of delivery that will be needed to meet the needs of the older population. It would welcome further information on the population and epidemiological projections upon which service development will be based.

Agreed • That the original Independent Review Report is provided to the panel

as soon as possible • That a report on the implications of the demise of Alpha Care be

brought to the panel • That officers discuss with you, the panel’s suggestion to nominate 3

panel members to be part of the commissioning review project group • That your response to the Social Care at Home Inquiry is prepared

immediately and presented to Cabinet at the earliest opportunity

Your Response In your response we would appreciate your comments on any of the issues raised in this letter. We would be grateful, however, if you could specifically refer to:



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• the panel’s suggestion to nominate 3 panel members to be part of thecommissioning review project group

• your views on the character and type of housing stock that will berequired in Swansea in 5,10 & 15 years from now; providing yourdepartment’s population forecasts to relevant housing bodies to helpinform their future planning and strategies.

• The timetable for your response to the social care at home scrutinyinquiry

We would be grateful if you could provide your response by Monday 3rd August.

Yours sincerely

BOB CLAY CONVENER, TRANSFORMING ADULT SERVICES PANEL

[email protected]



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Transforming Adult Social Services Scrutiny Panel, 24 August 2015

The Panel met on 24 August to examine the establishment and operation of the 3 Network Hubs which are one element of the integration of health and adult social services. The panel was pleased to welcome officers from both health and social services and the authority’s new head of adult services, Alex Williams. The panel would like to extend its thanks to all those who attended the meeting.

Network Hubs The panel supported the difference in staffing type and numbers across each hub area which reflected the demographics and need in the area. The panel also welcomed the work that Adult Services had done with Child & Family Services to look at how CFS changed its intake processes to ensure that referrals were appropriate.

The panel had a number of concerns and these are detailed below. • The level of unplanned need had not reduced since the hubs began

operating




Overview & Scrutiny


01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/05

Your Ref Eich Cyf:

Date Dyddiad:

30/09/2015

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 24th August 2015. It is about Network Hubs.



5

• The current availability of performance management data was limited.The panel felt that understanding and collecting performance datawould be one of the keys to success of the hubs.

• The Common Access Point took between 3,000 and 4,000 calls aweek. It was felt that with improved performance management dataanalysis could take place to ensure that the hubs dealt with appropriatebusiness and signposted referrals where appropriate.

• The gap in dementia funding and the development of the support andstay service in the Western Bay

• The panel was keen ensure the continued involvement of scrutiny inthe integration process

• The panel questioned the different terms and conditions and levels ofpay for staff in the integrated hubs and were informed that no re-negotiation of these were planned at the current time.

• The panel learned that more and more people want reablement andrespite in their own homes and there was concern about how healthand social services would deliver these services in the way that peoplewant them.

• Local Area Co-ordination: the panel remained concerned about theexpectations of the local authority on local area co-ordination to deliveroutcomes such as prevention and building resilience. The panelunderstood that a review of LAC was underway and it agreed to addthe evaluation report to its workplan.

Agreed • Panel members to visit the 3 network hubs, including intake team at the

west hub • Performance data from the network hubs to be provided to the panel.• To ensure continued involvement of scrutiny in the integration process

Alex Williams and Hilary Dover agreed to identify suitable items fromthe Integration forward work plan to bring to the panel.

• A note on respite and reablement be provided for the panel.• At the September meeting an update report on progress with

identifying costs for in-house adult services is provided to the panel.• An update on the Intermediate Business Case optimal model – RAG

status of key features

Your Response In your response we would appreciate your comments on any of the issues raised in this letter. We would be grateful, however, if you could specifically refer to:

• The collection and availability of performance management datarelating to the hubs

• The continued involvement of scrutiny in the integration processthrough identification of suitable items from the Integration forward work plan



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We would be grateful if you could provide your response by 21 October 2015.

Yours sincerely


BOB [email protected]



1




Transforming Adult Social Services Scrutiny Panel, 21 September 2015

The Panel met on 21 September to consider the costs of providing the Council’s domiciliary care and residential care services. Due to the commercially sensitive nature of the information the meeting was held in closed session.

The panel would like to thank your officers for providing us with this vital information on domiciliary care and residential care services provided by the Council.

Our concerns and the discussion about each are detailed below.

RESIDENTIAL CARE HOMES Confidence in the robustness of the data The panel was concerned that comparative costs may be underestimated and it sought assurances from officers that this was not the case. Officers explained that the approach used to arrive at the figures in the report is a process that is consistently applied across the Council.




Overview & Scrutiny


01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/06

Your Ref Eich Cyf:

Date Dyddiad:

05/10/2015

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 21 September 2015. It is about the cost of providing the Council’s Domiciliary Care and Residential Care services



2

Remodelling of homes to provide ensuite facilities The panel learned that some homes without ensuite facilities could be remodelled to provide this facility but that this would result in a 33% reduction in rooms. The panel questioned whether a reduction in beds would mean a reduction in staff costs, but were informed that due to the complexity of some cases, a reduction in beds did not necessarily mean a reduction in staff costs. Officers informed the panel that like the domiciliary care commissioning review, there will be a residential care commissioning review which will address issues such as re-modelling, refurbishment and meeting current and future needs.

Reablement and the use of Bonymaen Over time it became apparent that Bonymaen was not being used for its intended purpose of re-ablement; older people were placed in Bonymean that may not have had the capacity to be re-abled. The panel was pleased to learn that the criteria had been changed to ensure that those admitted to Bonymaen had the capacity to be re-abled.

Residential care homes – occupancy The panel wanted to understand more about the reasons for occupancy and vacancy rates across care homes because vacant bed weeks and under occupancy in the Council’s care homes pushes up the cost of each bed. The panel also wanted to know whether these rates were affected by respite beds in the care homes. It was reported to the panel that the residential care commissioning review would pick up this issue. However, officers were unable to confirm whether the vacancy rates were affected by respite beds. The panel asked that officers provide more detail at the next meeting on the reasons for vacant bed weeks which would also consider the impact of respite beds.

Staff ratios The panel understood that staff ratios were no longer mandated by CSSIW but that current levels were a legacy of this. Each care home had its own arrangements for staffing levels. The panel learned that it was a challenge for care homes to retain appropriately skilled staff. The panel agreed that understanding the skills that the Council needed to provide good quality current and future care in care home settings was important. The panel was informed that this would be considered as part of the residential care commissioning review; the panel welcomed this.

The panel was concerned about staff ratios in privately provided residential care homes given that there were no mandated levels set by CSSIW or the local authority. The panel asked officers explain how staff ratio levels in the private sector were monitored. The panel was told that the contract management process monitored the delivery of services from private providers, CSSIW undertook inspections of these establishments and the authority had safeguarding procedures in place. However, the panel remained unclear about how staffing levels were set. Officers stated that



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improvements needed to be made in the service specifications and that issue would be considered as part of the residential care commissioning review.

Additional staffing costs The panel learned that additional staffing costs were required to cover things like sickness, to ensure quality of care, increasing complex needs when older people are placed in care homes. Data for additional staffing costs was not provided for Binyamin and Ty Waunarlwydd; officers agreed to provide this.

Job evaluation had a big impact on staff costs and the panel learned that the living wage will also have an impact on costs. The panel was concerned about the potential impact the living wage could have on private sector tendering for contracts; it was important that the potential impact of this was understood if the Council was to continue to provide sustainable services.

Agreed Following our discussions on residential care, this is a list of what we agreed would be provided at the next meeting:

• Reasons for vacant bed weeks at the different care homes andwhether respite is a factor in this.

• Additional staffing costs for Bonymaen and Ty Waunarlwydd whichwere not in the unit costing report as.

• A revised set of costs which took into account: potential reductions inresidents arising from refurbishment and increased staff costs arising from wage increases.

• Net costs to include management costs.

DOMICILIARY CARE

Domiciliary care costs From the unit cost data provided, the panel was unable to identify what proportion of the spend was on Gower. The panel was also concerned about the impact of the increase in the minimum wage on future costs. Officers agreed to provide an updated summary of domiciliary care costs which disaggregated Gower costs and which also took into account travel, forecasts for the increase in minimum wage and a breakdown across each hub area.

This is a list of what we agreed following our discussions on domiciliary care • That the following be included in the report for the next meeting:

o Budgeted staff costs for 2015/16 for the Gower Teamo Spend on direct payments to be providedo Updated summary of Dom Care costs to take account of 1)

Gower Team costs being taken out 2) Travel taken out 3)Forecast costs to include minimum wage 4) breakdown acrosshubs.

o Summary to include net costs which include management costs.

The panel made a number of other agreements and these are listed below



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• Day services financial analysis to be brought to panel at a later date• The report on unit costs in October will include the net cost per bed for

residential care and per unit of domiciliary care• At the last meeting the panel requested hub performance data. This

was provided but it was agreed that a separate session on theSwansea Locality performance data would take place at the Novembermeeting; John Grenville and Karen Gronhurt will be invited to thepanel.

• That the local area co-ordination evaluation report be added to thepanel’s work plan for October

• It was agreed that an update would be provided on the DomiciliaryCare Commissioning Review at the next meeting

Your Response In your response we would appreciate your comments on any of the issues raised in this letter however a response is not required at this time as the panel will wait until it has received the updated reports and data detailed above before requesting a response from you.

Yours sincerely


BOB [email protected]



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Transforming Adult Social Services Scrutiny Panel, 19 October 2015

The Panel met on 19 October to consider an additional report on the cost of providing Council run domiciliary care and residential care services. This was a follow up to the report on the same subject that was discussed at the September meeting. Due to the commercially sensitive nature of the information the meeting was held in closed session.

Here is a summary of the additional information we asked to be provided: Residential Care

• Reasons for vacant bed weeks at the different care homes andwhether respite is a factor in this.

• Additional staffing costs for Bonymaen and Ty Waunarlwydd whichwere not in the original unit costing report

• A revised set of costs which took into account: potential reductions inresidents arising from refurbishment and increased staff costs arising from wage increases.

• Net costs to include management costs.




Overview & Scrutiny


01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/07

Your Ref Eich Cyf:

Date Dyddiad:

10/11/2015

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 19 October 2015. It is about the cost of providing the Council’s Domiciliary Care and Residential Care services



2

Domiciliary Care • Budgeted staff costs for 2015/16 for the Gower Team• Spend on direct payments to be provided• Updated summary of Dom Care costs to take account of 1) Gower

Team costs being taken out 2) Travel taken out 3) Forecast costs toinclude minimum wage 4) breakdown across hubs.

• Summary to include net costs which include management costs.

The panel would like to thank your officers for providing us with the further information on domiciliary care and residential care services provided by the Council.

Our concerns and the discussion are detailed below.

RESIDENTIAL CARE HOMES Remodelling of homes to provide ensuite facilities The panel learned that some homes without ensuite facilities could be remodelled to provide this facility but that this would result in a 33% reduction in rooms. The panel would like to know the overall impact on the total number of beds if the ensuite remodelling is carried out.

Ty Cila The panel noted that financial information on Ty Cila was not included in either of the reports. It would like to see the financial information relating to costs for Ty Cila.

VACANT BEDS It was unclear to the Panel how respite provision was managed in the Council’s residential care homes in terms of whether the “booking of beds” was possible and if so, what effect this had on occupancy rates . The panel would like clarification on how in-house respite is managed and delivered, including requests for emergency respite beds and how the Council uses external providers. The panel welcomed the general agreement between itself and the cabinet member that services needed to be operating near capacity in order to achieve value for money for services.

Additional staffing costs In the previous report presented in September data for additional staffing costs was not provided for Bonymaen and Ty Waunarlwydd. We learned from the additional information provided this time that Bonymaen and Ty Waunarlwydd already dealt with complex needs and as such no additional costs were incurred as existing staffing levels met the demands of the services provided at these 2 care homes.

Net costs At its last meeting the panel asked for further information on net costs which included management costs. The additional information report informed us that management costs, set using the Sustainable Swansea costing method,



3

accounted for 6.8% of net operating costs. The panel suggested at the meeting that the management costs might be underestimated. We would welcome your views on this.

DOMICILIARY CARE The panel learned that all packages of in-house domiciliary care had been reviewed to enable the Council to make better use of its resources for those with complex needs. In practice this meant that those assessed with lower end needs would be transferred to an external domiciliary care provider; the Council would retain complex needs cases. However, if there was not a private provider who could meet the needs of an assessed case then the Council would continue to provide care until an appropriate provider became available. The panel was concerned about the adequacy of the local market to provide appropriate care and it was informed that the Commissioning Review will consider how the Council can stimulate and develop the local care market. The panel learned that although the Council took the decision that in-house domiciliary care would focus on re-ablement and support for those with complex needs, it was not outside of the scope of the Commissioning Review.

The panel’s view is that in-house domiciliary care should be focussed on re-ablement, complex needs and market development. The panel also felt that in house services would thus be catering for a different client base and hence in house and external costs would not be strictly comparable. The panel would like its views, on this and all other matters raised in this letter, conveyed to the Commissioning Review Team.

Unit costs – hubs and integrated Gower team The panel learned that this was not currently available but it will be developed. One possibility is that cost data could be developed as a subset of Adult Services performance management. The panel agreed that once the PIs and performance management framework for Adult Services had been developed it is brought to the panel.

Direct Payments The panel learned that if use of Direct Payments was extended for less complex packages of domiciliary care it could contribute to a more sustainable model of care, provided the Direct Payment package was less than the domiciliary care package.

Residential care income The panel requested existing information on income from residential care homes and if possible to have the data and information trended.

Agreed Following our discussions on residential care, this is a list of what we agreed.

• That the panel’s views on the focus of in-house domiciliary care and allother matters raised in this and the September letter be conveyed to the Commissioning Review Team.



4

• Adult Services performance management framework be brought to thepanel at the earliest opportunity

• Officers to provide existing information on levels of income fromresidential care homes and if possible, that the data is trended.

Your Response In your response we would appreciate your comments on any of the issues raised however we would particularly welcome your views on the following:

• the overall impact on the total number of beds if the ensuiteremodelling is carried out

• Your confidence in the level at which managerial and support costs areset when applied to care homes

• Clarification on the management and delivery of respite, includingemergency

• The panel suggested at the meeting that the management costs mightbe underestimated. We would welcome your views on this.

• Officers were unable to clarify at the meeting whether residents wereonly in Council residential care homes for four days and then eitherreturned to the community or “passed” over to the Private Sector.

Yours sincerely

ERIKA KIRCHNER TEMPORARY CONVENER, TRANSFORMING ADULT SERVICES PANEL

[email protected]




Transforming Adult Social Services Scrutiny Panel, 16 November 2015

The Panel met on 16 November to review its current work plan and work to date on the TASS programme. We would like to thank you for attending the panel meeting and taking part in our discussions.

Here is a summary of our discussions as they relate to items on the agenda:

• Cabinet Member’s response to 24 August Convener’s letterWe recognised the importance of jointly developing performancemanagement indicators and measures and welcomed the aim of onesuite of performance measures for the hubs that cut across health andsocial care.

• The panel felt that it needed a greater understanding of how resourceswere allocated amongst health and social care and prevention

Here is what we agreed: • That we recommend to you that cabinet responsibility for the integrated

hubs should fall under a single cabinet portfolio.





[email protected]

Our Ref Ein Cyf: TASS/08 Your Ref Eich Cyf: Date Dyddiad: 16/11/15

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 16 November 2015. It is about the work plan



1

• To invite Councillor Mark Child to the next meeting to present the LocalArea Co-ordination evaluation report to the panel

Your Response We would appreciate your comments on any of the issues raised however we do not require a formal response at this time.

Yours sincerely

ERIKA KIRCHNER TEMPORARY CONVENER, TRANSFORMING ADULT SERVICES PANEL

[email protected]



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Transforming Adult Social Services Scrutiny Panel, 14 December 2015

The Panel met on 14 December to consider performance in the integrated health and social care hubs, income generation in older people’s services and Swansea University’s evaluation report of Local Area Co-ordination. We would like to thank officers for attending the panel meeting. Here is a summary of our discussions.

Before we began to examine the reports on the agenda a number of issues were raised. Details are given below of what the panel agreed in relation to these issues.

1. We discussed the upcoming report to Cabinet on the review ofAbergelli and the Beeches and agreed to undertake pre-decision scrutiny on this at our next meeting.

2. The Head of Adult Services informed us that the Chief Social ServicesOfficer was developing a new performance and delivery framework forAdult Services. We agreed that it would therefore be appropriate tochange and widen the remit of the panel to focus on the performance




Overview & Scrutiny


01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/09

Your Ref Eich Cyf:

Date Dyddiad:

15/01/2016

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 14 December 2015. It is about performance in the integrated health and social care teams and the initial evaluation of Local Area Co-ordination

ITEM 2



of Adult Services and develop a new work plan which is aligned with the department’s strategic priorities

3. Alex Williams verbally briefed the panel on respite capacity across thedifferent residential care homes. Respite provision will be consideredas part of the residential care commissioning review.

Integrated health and social care hubs performance data report The panel welcomed the performance data report and agreed that it was a positive step to see the data. The panel was pleased with the following:

• Assessment beds were performing as intended and only people whowere capable of being re-abled were placed in these beds

• More older people return home after a hospital stay than enter aninstitutional care

• Locally relevant performance and qualitative measures will bedeveloped

• The review of the intake team to ensure better challenge at the firstpoint of contact and an effective triage system

The panel was concerned to hear that sometimes privately provided packages of care could not be assembled quickly enough because of capacity in the private sector. So to meet the challenge of moving people out of hospital and back home the authority used its in-house service as an interim arrangement until the long term provider was able to provide the care. The lack of capacity in the private sector and the risk this presents to the authority continues to concern to the panel.

The panel raised the number of calls that were shown to be abandoned and asked officers about the standards that were in place. The panel was informed that there was still some uncertainty about the most appropriate things to measure.

Older people’s income generation report The panel welcomed this report and agreed it provided clarity to questions it had raised recently. The panel was pleased to learn that since income collection had been moved to the Finance department, income this year was higher at this point than last year. The panel learned that the viability of charging for day services was included in the commissioning review.

The panel was supportive of the robust processes in place to recover income from deferred payments of care users in order to maximise the potential for income. The panel recognised that this windfall income was difficult to predict and control as it was contingent on deaths of older people in residential care homes.

The panel was pleased to learn that the authority did not “write off” large amounts of debt and anything above £10,000 had to be approved by the Head of Finance.



The panel requested some further information on gas and electricity usage in local authority care homes and day centres and it was agreed that this would be circulated via email.

Local Area Co-ordination: Formative Evaluation The panel examined Swansea University’s evaluation report which looked at the first three months of Local Area Co-ordination in Swansea. The evaluation was carried out for free and discussions were ongoing for the second evaluation.

The panel cautiously welcomed the key findings and the success to date of the Co-ordinators in beginning to develop and build community networks. Although we discussed and identified a potential risk and we would welcome your views on this in your response. We were concerned about what would happen to the community networks which had been developed by a Local Area Co-ordinator if that Co-ordinator left the job. We were interested in how much resilience was there was within the project to deal with this type of situation.

The panel was informed that a full suite of KPIs had been developed and that data was now being collected to establish a database of performance information. Officers agreed to circulate these KPIs to the panel via email along with the population splits across the different local area co-ordinator areas in Swansea.

Officers informed the panel that the second evaluation report would consider the social return on investment and how people were prevented from progressing to specialist services. We would like to add our views on what the second evaluation report should consider. The panel felt that the second report should identify the type of network that local the area co-ordination initiative was and that the KPIs should reflect that.

Finally, we agreed that the second evaluation report should be reported to Scrutiny when it becomes available.

Here is what we agreed: • The panel undertake pre-decision scrutiny at its meeting in January on

the Cabinet report on the “Review of Abergelli and the Beeches alternative day services”

• Given the development of a new framework for performance anddelivery in Adult Services, the panel becomes an Adult Services Scrutiny Performance Panel

• further information on gas and electricity usage in local authority carehomes and day centres and it was agreed that this would be circulated via email.

• Local Area Co-ordination KPIs circulated to the panel along with thepopulation splits across the different LAC areas in Swansea

• That the second evaluation report should include an analysis of thetype of network that LAC was.



• The second evaluation report should be reported to Scrutiny when itbecomes available

Your Response In your response we would appreciate your comments on any of the issues raised however we would particularly welcome your views on the following:

• The resilience that exists within Local Area Co-ordination to continue tomaintain and develop community networks should a local area co-ordinator leave their post.

• Changing the remit of the panel to reflect the new framework forperformance and delivery in Adult Services which is currently under development; developing a new work plan which is aligned to the department’s strategic priorities.

We would be grateful to receive your response by Friday 5 February 2016.

Yours sincerely








Transforming Adult Social Services Scrutiny Panel, 11 January 2016

The Panel met on 11 January to consider the review of Abergelli and the Beeches, the Social Services and Well Being Act and how it will impact on carers and the Mental Health and Learning Disability Commissioning Review Scope. The report on Abergelli and the Beeches was pre-decision scrutiny. The panel would like to thank you and your officers for attending the meeting and answering our questions.

Pre-decision – Review of Abergelli and the Beeches Alternative Day Services The panel has submitted the following views to you for consideration alongside your report that will be presented to Cabinet on 21 January; the Convener will attend the Cabinet meeting.

• The panel understands the need for the review of the current serviceand the need to deal with the under capacity that was identified waspart of the review.




Overview & Scrutiny


01792 637491

e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf:

TASS/10

Your Ref Eich Cyf:

Date Dyddiad:

27/01/2016

Summary: This is a letter from the Transforming Adult Social Services Scrutiny Panel to The Cabinet Member for Services for Adults and Vulnerable People following the meeting of the Panel on the 11 January 2016. It is about the review of Abergelli and the Beeches, the Social Services and Well Being Act and the Mental Health and Learning Disability Commissioning Review Scope



• The panel is broadly supportive of the proposed remodelling ofAbergelli and the Beaches alternative day services by consolidating the2 services, using the Abergelli building as the premises and it supportsthe creation of additional capacity which will be created at Abergelli.

• The panel’s main concern is that service users, who as a result of theirindividual reviews, decided to withdraw from the day services at theBeeches and Abergelli, had a follow-up assessment to ensure that theirdecision remained right for them. The panel also felt that a furtherreview at 6 months should be undertaken to ascertain that the serviceuser continues to be comfortable with the choice they made.

• Two known cases were highlighted of service users who were unhappywith the move to Abergelli. The panel requested that, subject to thecarers being in agreement, these cases would be referred to the Headof Adult Services.

Furthermore, the panel raised concerns regarding safeguarding and personal development . While these were not specifically related to the recommendations contained in the Cabinet Member’s report – Review of Abergelli and the Beeches Alternative Day Services, they related to the delivery of day services

1. Personal development : the key workers in day centres did significantwork with service users in helping them to realise their aspirations anddevelop their potential. This is highly skilled work which needs insights,training and expertise. Who will do this aspect in future? This taskshould be carried out by a professionally trained person, not throughinformal arrangements taking a group to a café in the community.

2. Safeguarding : given the key role day centre workers played overrecognising signs that a service user might be subjected to forms ofabuse, including financial exploitation, it is necessary to stipulate whowill be tasked under the new arrangements to fulfil this responsibilityand what training they will they will receive in order to discharge thisresponsibility.

The Social Services and Well Being Act – impact on carers

The panel requested a briefing on the Social Services and Well Being Act and how it will impact on carers. The panel sought clarification on a number of issues which are detailed below.

Resettlement of prisoners who are carers The panel learned that funding for this was not defined within the funding for implementation and delivery of the Act. While there will not be large numbers of prisoners who would become cares upon release, officers had been worked



with the prison to identify those who would become carers and put appropriate arrangements in place and to ensure such things as the portability of assessments.

Defining a carer The panel was unsure how the Act applied and whether it differentiated between professional carers and unpaid carers. The panel was informed that that the Act did not apply to professional carers. However, a carer providing care under a direct payment was considered a carer under the Act.

Eligible needs of carers A carer’s needs become as important as the cared for person under the Act. The carer will be assessed so that their needs can be understood and met. Carers' needs will be assessed using a national eligibility tool which is a framework rather than a set of eligibility criteria.

Young carers The panel learned that assessments for young carers would have to consider their development needs and how their caring responsibilities impact on their life experiences.

Mental Health and Learning Disability Commissioning Review Scope The panel welcomed the opportunity to provide its comments and views on the mental health and learning disability commissioning review scope. Our views are detailed below.

The panel was of the view that each of the three service areas covered by the commissioning review scope – Learning Disabilities, Mental Health, Physical Disability – should be dealt with separately within the review and have equal weighting and consideration. The panel supported the proposed workshop structure which divided up stakeholders into the specific services to ensure that service specific views were discussed and heard.

The panel queried the anticipated budget savings of 20% and was informed that was set a number of years ago and applied across the whole of adult services, not just Learning Disabilities, Mental Health, and Physical Disability.

The panel was unsure what was meant by the key issue/constraint in the scope which stated “a review/creation of eligibility criteria”. This meant there was a need to ensure that a set of eligibility criteria existed which were applied consistently and by everybody.

Here is what we agreed: • That we submit our views on the Review of Abergelli and the Beeches

to you for consideration alongside your cabinet report. • The performance framework for the Social Services & Well Being Act

to be presented to the panel in about 12 months time.



• Our views on the Commissioning Review Scope are considered duringthe review process.

• The Chief Social Services Officer’s report on the revised performancemanagement framework for Adult Services will be discussed at thepanel’s March meeting.

• A report on the performance objectives of key senior officers as theyrelate to the delivery of change in adult services is presented to thepanel’s February meeting.

• The Convener and Head of Adult Services have an initial meeting todiscuss the development of a new work plan which aligns with therevised performance management framework for Adult Services.

Your Response We would appreciate your comments on any of the issues raised however a formal response is not required to this letter.

Yours sincerely



Conveners Letters and

Cabinet Member

Responses 2014 - 2015




Transformation of Adult Social Services Working Group, 13 October 2014

The working group met on 13th October to consider the best way for scrutiny to engage with the Transformation of Adult Social Services programme. I would like to thank you and officers for attending the panel.

The working group discussed at length with you the importance of ensuring that the report on the Independent review on the commissioning and provision of social services to older people was made available as soon as possible to the group. The working group understood that the report was received by Social Services at the beginning of September but was being withheld. The group expressed in very uncertain terms, its frustration about such an unacceptable delay and also pointed out that panel members need time to study its findings. Therefore, in order to do justice to this responsibility the report needed to be released to scrutiny members without delay. The working group welcomed your agreement to circulate the report as soon as possible.

Ed Hammond from the Centre for Public Scrutiny attended the meeting to discuss and help the group develop its ideas on how best to provide challenge, assurance and scrutiny engagement in the TASS process. With regards to this, the panel agreed to explore the following:

• Understand why the transformation was necessary, the drivers ofchange

• Understanding the user need and perspective, how to establish whatlocal needs are




[email protected]

Our Ref Ein Cyf: TASS/01 Your Ref Eich Cyf: Date Dyddiad: 6 November 2014

Overview & Scrutiny / Trosolwg a chraffu City and County of Swansea / Dinas a Sir Abertawe

Civic Centre, Swansea, SA1 3SN / Canolfan Ddinesig, Abertawe, SA1 3SN

• Identify areas to focus the scrutiny work on and tailor the work to theTASS cabinet timetable.

As part of our discussions we came up with the following list of possible area on which we could focus our scrutiny work:

• Independent Review• Western Bay work• Strategic integration• Network hubs and health• Joint commissioning of services and pooling funding• Costs• Transport• Housing• Different service areas such as Learning disabilities, Mental health• Local area co-ordination and community development, drawing on

the approach in Scotland and Australia• Safeguarding & risks• Signposting

The next step for the working group is to identify a set of dates so that a timetable of work can be drafted and agreed.

I hope you find this letter useful and informative.

Yours sincerely

CLLR UTA CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]







The working group met on 8th December to achieve the following: Understand the driver for the TASS programme and the timetable for decision making Discuss the likely impact of the Independent Review Discuss and agree where and how our working group can add value to the TASS programme Agree our main lines of inquiry Discuss and agree how to engage service users during our work Consider the need to co-opt a member onto the group to provide expertise

The working group was unable to achieve all that it set out to do for the following reasons: We had to start our meeting later than usual so that officers could attend which in turn meant that we had to conclude our meeting early so that 2 members could attend another meeting Representatives from the CfPS were unable to make the working group meeting.

The working group did discuss a number of related issues which are detailed below.

The working group remains dissatisfied with the timeliness in which the independent review report was provided to us and we asked that your officers clarify the date that the report was provided to the authority and when it was




[email protected]

Our Ref Ein Cyf: TASS/02 Your Ref Eich Cyf: Date Dyddiad: 10 December 2014

ITEM 2



presented to the Cabinet Away Day. This information has since been received and we are grateful for the timeliness of the response. However, we would also like further detail on what happened to the report from the time it was received by officers to the time it was received by the cabinet member.

The working group agreed to make additional space in the work plan to examine separately, the service areas of learning disabilities, mental health and respite ahead of the mainstream elderly services.

The working group agreed to hold more than one meeting a month where necessary.

The working group agreed to have a briefing and presentation on the Social Services and Well Being Act at its meeting on January 5th.

The working group remained concerned about the budget decisions taken last year to reduce day centre services for people with learning disabilities. We agreed that you should contact carers organisations to provide them with information on the TASS programme regarding services and decisions relevant to them.

As the working group did not get through its agenda for this meeting, we agreed to hold an additional meeting, which you have been invited to attend, on Wednesday 17th December. This meeting will deal with the Independent Review Report. It would benefit the working group if you were able to attend the meeting as I am sure your contribution would enhance our discussions. Officers also agreed to provide a more detailed timeline of TASS implementation as the one supplied for this meeting was inadequate.

In the meantime I will draft a work plan and add this, along with the other agenda items that we did not discuss, to the agenda for our meeting on 17th December.

I hope you find this letter useful and informative and I look forward to your response by Friday 2nd January 2015

Yours sincerely


[email protected]







The working group met on 17th December to discuss the independent review report

Independent Review Report The panel was concerned that the consultation meeting about services for people with learning difficulties was cancelled and asked officers to explain this. Officers informed the panel that the decision, taken previously by cabinet, was under review and that consultation had therefore been suspended.

Officers stated that the overall direction of travel of Adult Social Services had been endorsed however some caution was expressed about some assumptions particularly in terms of the rebalancing of services between community and residential care.

The panel engaged in the following discussion points and would like to bring the following comments to your attention:

Budget The influence of the budget has accelerated and this has become more of a priority than expected. The panel expressed how important it was to ensure the Council targeted its scarce resources at the right people in the right places.




[email protected]

Our Ref Ein Cyf: TASS/02 Your Ref Eich Cyf: Date Dyddiad: 22 December 2014

ITEM 2



Local Area Coordinators There needed to be more people helping other people in the community. Local Area Coordinators are a step up from community connectors and the evidence has shown that that this approach works once it gets going. There will be investment in the systems to support it. Jane Tonks has been appointed to lead this and Adult Services will be employing people for each of the three hubs and shifting posts into this structure as they become available. The panel learned that Jane Tonk’s post will be funded for 1 year by a Western Bay Prevention Fund bid. The Intention will then be to seek other sources of funding from partners, other departments.

The panel felt that CCS was some way behind other councils in terms of this approach and we would like to know how you intend to evaluate the success of this approach.

Community Hubs The panel learned that there were 3 community hubs located in the civic centre, SA1 and Gorseinon hospital. The panel was unhappy with the choices of locations for the community hubs and we will make arrangements to consult with Jan Worthing about this matter.

Western Bay The Panel had concerns about the scrutiny of the Western Bay and the balance of risk between the Council and Health partners. We noted that an event will be held in the new year by Western Bay to explore this and that the chair and vice chair of the Scrutiny Programme Committee had been invited. The panel will request feedback from the SPC on this event.

Private Sector Concern was expressed about the vulnerability of the council to the collapse of private health and social care providers or other market failures. Officers reported that the independent review report questioned whether the Council’s policy of taking more services in house will reduce this risk – it suggested that council unit costs are not sustainable in the long term.

Health You expressed the need scrutiny of interfaces between council and health and perhaps this is something that can be explored further when we discuss our work plan on 9th January.

Agreed • Further meeting needed to discuss report with you and officers• The panel needs to be provided with more detail on short term actions• Invite Jan Worthing to future meeting

Letter from 8th December



We agreed to make the following amendment to the previous letter and it will be re-sent to you with this letter. Paragraph 4… “we asked that your officers clarify the date that the report was provided to the authority and when it was presented to the Cabinet Away Day. This information has since been received and we are grateful for the timeliness of the response. However, we would also like further detail on what happened to the report from the time it was received by officers to the time it was received by the cabinet member.

I hope you find this letter useful and informative and I look forward to your response by Monday 19th January 2015

Yours sincerely


[email protected]




D I N A S A S I R A B E R T A W E

Councillor Uta Clay Convenor Transforming Adult Services Scrutiny Panel


Councillor Jane Harris Direct Line: Llinell Uniongyrochol:

(01792) 636926

E-Mail / E-Bost: [email protected] Our Ref / Ein Cyf: JH/CM Your Ref / Eich Cyf: Date / Dyddiad: 5th February 2016

If you require this or any other information in another format e.g. Braille, audio tape or a different language, please contact me

Dear Councillor Clay

Re: Transforming Adult Social Services Scrutiny Panel, 14 December 2015

Thank you for your letter dated 15th January 2016. In response to the specific points raised, I can respond as follows.

1) The panel undertake pre-decision scrutiny at its meeting in January on the Cabinet report on the ”Review of Abergeli and the Beeches alternative day services”. This has been actioned, response on concerns raised is being sought and a formal report was provided to Cabinet.

2) Given the development of a new framework for performance and delivery in Adult Services the panel becomes an Adult Services Scrutiny Performance Panel Once the performance framework has been agreed the lead for Adult services will work with the Chair of the Scrutiny panel to devise a forward work programme.

3) Further information on gas and electricity usage in local authority care homes and day centres and it was agreed that this would be circulated via e mail This was provided by the lead for Adult services via e mail on 18th December 2015.

COUNCILLOR/Y CYNGHORYDD JANE HARRIS

CABINET MEMBER FOR SERVICES FOR ADULTS & PEOPLE / AELOD Y CABINET GWASANAETHAU OEDOLION A PHOBL DDIAMDDIFFYN

CABINET OFFICE, THE GUILDHALL, SWANSEA, SA1 4PE SWYDDFA’R CABINET, NEUADD Y DDINAS, ABERTAWE, SA1 4PE

(01792) 636926 [email protected] www.swansea.gov.uk


C I T Y A N D C O U N T Y O F S W A N S E A ———————————————————————————————————————————————

D I N A S A S I R A B E R T A W E 4) Local Area KPIs circulated to the panel along with the population splits across the different LAC areas in Swansea. This was provided by the lead for Adult services via e mail on 28th January 2016. 5) That the second evaluation report should include an analysis of the type of network that LAC was This will be incorporated into the second evaluation. 6) The second evaluation report should be reported to Scrutiny when it becomes available. This will be provided when agreed by the Local Area Coordination Leadership Group and the Western Bay Prevention and Wellbeing Board and is anticipated by April/May 2016. 7) The resilience that exists within Local Area Co-ordination to continue to maintain and develop community networks should a local area coordinator leave their post. Whilst there is always the possibility that community initiatives will be affected by changes in personnel there is a great deal of joint working across the 3 coordinators within this development that should avoid potential difficulties. In addition it would be anticipated that this community process that has resilience built in to practice through the development of individuals and community groups would have enough synergy to accommodate to change. 8) Changing the remit of the panel to reflect the new framework for performance and delivery in Adult services which is currently under development; developing a new work plan which is aligned to the department’s strategic priorities. There is a clear need for a performance and delivery framework for all adults that will address the priorities of the constituents as well as meeting the requirements of the present and future legislation. The framework being developed will have to continue to address what is required for older adults as well as all other adults such as those with: emotional and mental health disorders; learning disabilities; physical disabilities; substance misuse problems; a range of vulnerabilities; the potential homeless. The need for scrutiny of the performance and delivery of adult services will have to be





C I T Y A N D C O U N T Y O F S W A N S E A ———————————————————————————————————————————————

D I N A S A S I R A B E R T A W E referenced to issues of isolation; carers, integration with health; partnerships; regional implications associated with ABMU and other networks. Yours sincerely COUNCILLOR JANE HARRIS CABINET MEMBER FOR SERVICES FOR ADULTS & VULNERABLE PEOPLE






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Transformation of Adult Social Services Working Group, 5th & 9th January 2015

The working group met twice at the start of January – 5th & 9th. The aim of the first meeting was to gain an understanding of the Social Services and Well Being Act – its aims and objectives, intended impacts and what it means in terms of operational practice for the authority. The second meeting dealt with work planning and was facilitated by Ed Hammond from the CfPS. Panel meeting held on January 5th - Social Services and Well Being Act The panel had a number of concerns which are detailed below and we would welcome your views on each one.

• The panel was concerned that the change taking place to ensure the

Council was ready for the implementation of the Act in 2016 was not based on a sound understanding of the authority’s unit costs for domiciliary care and residential care. Officers agreed that this was unknown and assured the panel that this was a piece of work that needed to be done. It was agreed that the panel would hold a session on unit costs which looked at the whole financial aspect of domiciliary care and residential care.

• The panel briefly touched on the long term future for adult and child & family services. The panel understood that some work had been done in some areas to look at combining the services but the panel was concerned about this.



Scrutiny


e-Mail e-Bost:

[email protected]


Your Ref Eich Cyf:

Date Dyddiad: 12 January 2015



• There was some uncertainty over who was responsible for young people and women from Swansea who were in detention outside of Swansea. Officers agreed to report this back to the panel.

• Community resources – the panel agreed that the sooner this list of resources was available the better. However, approaching community groups to provide services/support would need to be managed carefully as some groups may not want or have the capacity to provide more services or support to users.

• Implications for practice – the panel understood that WG expects the implementation of the Act to be cost neutral and met within existing resources. Are you confident that this will be the case?

• We wish to understand what the Act means when it refers to social enterprises, co-operatives, etc.

Agreed

• To invite you, the Chief Social Services Officer and relevant finance officers to the panel to detail the authority’s unit costs for domiciliary care and residential care.

• Officers to provide the panel with the consultation documents for the draft regulations and code of practice and bring the authority’s consultation response to the panel for comment before the end of February.

• That the panel be provided with the Western Bay regional implementation plan.

Panel meeting held on January 9th – work planning with Ed Hammnd, CfPS Detailed below is the panel’s draft work plan. The next step in the process will be for you and me to meet, along with relevant officers, to discuss the topics that the panel prioritised and to construct a timetable of scrutiny activity based on cabinet report dates and other relevant departmental dates. The panel agreed that for each topic to be scrutinised it would consider it against 5 broad lines of inquiry: a) Cost b) The impact of Western Bay c) Interface and joint working with health partners d) Local area co-ordination e) Implications of the independent review of older people’s services f) Implications of Sustainable Swansea – fit for the future The panel took the long list of proposed changes in the TASS programme timeline that was presented to the panel in December and prioritised 5 topics. 1. Support to Carers 2. Volunteering and Befriending 3. Implement Local Area Coordination 4. Swansea Integration Plan – Network Hubs 5. Procurement Review



The panel agreed that prior to the start of scrutiny work of Network Hubs it would require a briefing to provide a background and an overview of the role and workings of the hubs. The panel also agreed that it would need a briefing on the Western Bay – what it is, its role, details of its work and planned projects, governance, accountability and how it works with partners. The panel is keen to undertake some community engagement during its TASS work; it agreed that the Support to Carers would lend itself well to user engagement. Thank you for meeting with me on Monday 26th January to discuss the work plan outlined above. I hope you find this letter useful and informative. Given our discussions at the meeting a response is not required to this letter. Yours sincerely CLLR BOB CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]




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Transformation of Adult Social Services Scrutiny Panel, 2 March 2015 The TASS Scrutiny Panel met on March 2nd. We were very disappointed that the only “Costs” information that we received was a schedule of what the Council pays for accommodation in Private Residential Homes for the elderly. We had expected, at the very least, an analysis of the comparative costs for our own homes. We also want to study similar information relating to Day Care, Domiciliary care and various other related costs, and the timescale for this is very tight if the Panel is going to be able to make any considered contribution to the TASS review. It was unfortunate that there was no social services senior management attendance at the meeting. I will liaise with officers on this matter to ensure that the panel’s questions during meetings on the reports and evidence provided can be responded to accurately and promptly. It is important that we have a positive and productive working relationship so that the TASS process benefits from the involvement of Scrutiny Now that we have a separate panel to scrutinise adult services, specifically TASS, we are able to devote an entire meeting to service and policy issues and provide you and the department with our views and recommendations.



Scrutiny


e-Mail e-Bost:

[email protected]


Your Ref Eich Cyf:

Date Dyddiad: 9 March 2015



We also remind you that this Panel is the only opportunity that elected members outside the Executive have to participate in a process that will probably lead to very major changes in a vital service that is of great concern to many thousands of those who elect us.

I think we all agree that establishing this panel was a positive step and it is an important element of the decision-making process. Now that we have a clear scrutiny work plan we can ensure that we have the information we need at meetings to add value to the TASS process.

Although there has been widespread debate about the future of Adult Services for a number of years which has had a national dimension the urgent work in Swansea arises from the 2013/14 Budget process, the “Sustainable Swansea” work and some controversial proposals for certain savings.

The Panel feel that there is still a worrying shortage of evidence on which the “pace of travel” if not the “direction of travel” that the department wish to pursue has been based.

Finally, I must remind you that I am still waiting for a response to my Chair’s Letter of February 6th which was due on Monday 9th March. The Panel hopes that you can now give that some priority.

Yours sincerely

CLLR BOB CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]




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Transformation of Adult Social Services Scrutiny Panel, 30 March and 7th April 2015

The panel met on 39th March and 7th April. We agreed to deal with both meetings in one letter. What the panel requires from you in your response is detailed at the very end of the letter. 30th MARCH MEETING – COSTS OF DIFFERENT ELEMENTS OF LOCAL AUTHORITY RESIDENTIAL CARE The panel had a question and answer with Deborah Driffield and Mike Hawes regarding the production of cost information for authority-provided residential care. The panel would like to thank the officers for attending. The panel was informed that there had been a number of difficulties in producing some of the costing information. As a result, APSE had been commissioned to review the data on care costs to ensure there is confidence and validity in the data and that the authority compared its costs against industry standards. APSE will facilitate all the workshops which will be carried out as part of the review process. Officers agreed to provide the data on costs as soon as it was available OTHER ISSUES HIGHLIGHTED Costs



Scrutiny


e-Mail e-Bost:

[email protected]

Our Ref Ein Cyf: TASS/008/09

Your Ref Eich Cyf:

Date Dyddiad: 30 April 2015



Difficulties were said to arise when comparing local authority provided services and services provided by the independent and private sectors because local authority residential care included respite, reablement and dementia services – which are expected to require higher levels of care. Some of these services were not provided by the independent sector and local authority reablement was not an income generating service. Officers were confident that over time the need for "standard" residential care would reduce as more people chose to stay at home and purchase domiciliary care. If true, this would be likely to increase in-house costs even further when compared with services offered by the (less intensive) private sector. The panel was concerned that the cheapest supplier of care was not always the best and was reassured that the Authority was not obliged to purchase from the cheapest supplier of care. The panel was assured that contracts sought to achieve best value through consideration and balance of price, quality, whether the supplier was local and other considerations such as the budget situation. Adult services along with the procurement service determined the balance within the contract. Care Homes The panel learned that each place was spot purchased rather than procured in a block of places because each person was entitled to choose their care home. Each placement was negotiated with the care home to ensure the care needs of the individual can be met. Each case was assessed on a case by case basis, there was no ceiling on costs and each decision had to be reasoned and defensible. Forecasting need The panel was keen to understand how Adult Services forecasted demand and used that information to plan for future services and levels of need. The authority managed demand and the market by being at the front end of provision so that it could understand the level of need. Providing services like reablement helped to manage the demand for placements in residential care. Officers felt that the number of care homes and places within these was a side issue and that getting the local authority model right helped to manage demand and shape the local market. Engaging non-Executive councillors in the Transformation of Adult Social Services process The panel was concerned that its work was the only way that non-executive councillors were engaged in the Transformation of Adult Social Services process and it agreed to seek clarification on this from the Cabinet Member for Services for Adults and Vulnerable People. Changes to services Adult services knows that it will have less money this year, next year and the year after. There was a time lag between investment, savings and outcomes so some decisions on service change would be based on judgement not empirical evidence because of the time and budget constraints.



The panel still felt that change was being driven by budgets rather than by service user needs. The panel remained unsure that the true cost and affordability of services was known. It felt that quantifying costs was important so that the authority can better understand what it can and can’t afford to provide. It was also considered that a more refined approach to in-house costing would be helpful - for example in costing different levels of dependency, respite care as opposed to longer stay care, and care offered to clients with different underlying needs ( for example people with learning difficulties or mental illness). Services for older people The panel agreed with officers that there needed to be a strategy for older people that pulled together all agencies involved in providing care and services to older people, eg housing, health, sheltered housing, local authority. The panel felt that more clarity was needed on housing for older people. APRIL 7th MEETING – LOCAL AREA CO-ORDINATION The panel learned the following about Local Area Co-ordination

• Each Local Area Co-ordinator will have 50-65 cases at any one time • Two Local Area Co-ordinators had been appointed and a 3rd

appointment was imminent. • A total of 6 Local Area Co-ordinators would be in place by the end of

the year and these will be funded by the Local Authority. • It was estimated that 15-16 Local Area Co-ordinators would be needed

to cover Swansea. It was an accepted standard from evidence and working practices in other areas that use Local Area Co-ordinators of 1 Local Area Co-ordinator to around 15,000 people.

• These additional posts were intended to be funded from a pool of funds made up of contributions from other agencies.

• The current Local Area Co-ordinators were based in the Network Hub areas where services were integrated and intermediate services were delievered.

• The 5 GP hubs were different to the Network Hubs and worked on different footprints

• The current Local Area Co-ordinators are employed by the Authority. Operationally, they will be responsible to Western Bay.

Panel was unsure about how the role of community connectors and Local Area Co-ordinators would differ. The panel suggested that Local Area Co-ordinators and Community Connectors should not work in isolation of each other. The panel was reassured to learn that Swansea University was conducting the evaluation of the programme that will look at a number of different factors



and outcomes. The panel requested more information on the methodology and timescales for the report. The panel felt that Local Area Co-ordinators should develop links with local community centre as they would be a useful resource to tap into for community groups and clubs. The panel had a number of concerns about Local Area Co-ordination:


• That saving money should not be the driver for this project • Sustainability of funding of the project

AGREEMENTS OFFICERS AGREED:

• To provide rateable value and rates paid by residential care homes – to be provided in advance of the full costings

• To provide clear stages and headings with dates of the Commissioning

workstream PANEL AGREED:

• To seek clarification from the Cabinet Member for Services for Adults and Vulnerable People on how she intends to engage non-executive Cabinet Members in the Commissioning Workstream and the TASS programme overall.

• To re-schedule the cost analysis of local authority provided residential

care at an early date to ensure that there is confidence in the validity of the data and the rate of progress being made

• To invite Martin Nicholls to a future meeting

• To re-start engagement with carers

• To invite Jane Tonks and Jan Worthing to the next panel meeting on

27th April

• To receive an outline of the approach to the evaluation being conducted by Swansea University



Your Response - Cabinet Member for Services for Adults & Vulnerable People

• The panel would be grateful if you could clarify how you intend to engage non-executive Cabinet Members in the Commissioning Workstream and the TASS programme overall.

• We would welcome your views on the following concerns expressed by

the panel: o Whether the Local Area Co-ordinators would receive too many

referrals from other organisations and how this would be managed


For your information only and therefore not requiring a response, the Cabinet Member for Well Being and Healthy City agreed to provide the following:

• Job description and person specification for the Local Area Co-ordinator posts (this has been provided)

• Swansea University’s Local Area Co-ordination evaluation criteria and

methodology (this has been provided)

• Local Area Co-ordination reporting and management structure and details of funding of the different posts

Thank your for your recent attendance at panel meetings. We hope you find this letter useful and we would be grateful for your response by 22 May. Yours sincerely CLLR BOB CLAY CONVENER OF THE TRANSFORMATION OF ADULT SOCIAL SERVICES WORKING GROUP

[email protected]



transformation of adult social services panel: letter to cabinet member 11 may 2016

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