ADULT SOCIAL SERVICES PERFORMANCE ...moderngov.sthelens.gov.uk/documents/s2933/Annual...monitoring....

Adults' Social Services Performance Assessment Notebook Council: St. Helens

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ADULT SOCIAL SERVICES PERFORMANCE ASSESSMENT NOTEBOOK

Record of analysis

St. Helens

Contact Name Job Title

Ann Ford Area Manager

Derek Kershaw

Regional Intelligence & Evidence Officer

Agreed number of Routine business meetings as per engagement plan

2 plus Area Review Meeting

Routine business meeting dates

Themes discussed/ issues to raise

03-02-2009

Areas for development as outlined in PAN 2007-08 Outcome 1: Provision of bespoke services for people with long-term conditions; Alcohol-related admissions to hospital; services for people who misuse drugs Outcome 5: Level 4 of Local Government Equality Standard Outcome 6: Employment opportunities for people with learning disabilities in paid or voluntary work Leadership: Personalisation agenda Commissioning & Use of Resources: CRILL Council Update


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03-03-2009

Areas for development as outlined in PAN/CSR 2007-08: Outcome 2: Use of assistive technology for care and repair services Outcome 4: Acceptable waiting times for assessments; Provision of statements of need; Provision of advocacy services for people with a learning disability Outcome 6: Development of work opportunities for people with a physical/sensory disability. Leadership: Personalisation agenda Commissioning & Use of Resources: CRILL

Annual Review Meeting date

Themes discussed/ issues to raise

10-06-2009

Outcome 1: Long term conditions, alcohol services, services for drug misusers, end of life care Outcome 2: Extra care housing, telecare services, major adaptations Outcome3: Community engagement and cohesion strategy Outcome 4: Assessment and care management, direct payments, complaints Outcome 5: Local Government Equality Standard Outcome 6: Employment opportunities for people with a learning disability, physical or sensory disability Outcome 7: Safeguarding referrals, adult safeguarding training, Deprivation of Liberty Standards Leadership & Commissioning: Update on personalisation of social care and self-directed support

Contents

Outcome 1: Improving health and emotional well-being Go to > Start of section

Outcome 2: Improved quality of life Go to > Start of section

Outcome 3: Making a positive contribution Go to > Start of section


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Outcome 4: Increased choice and control Go to > Start of section

Outcome 5: Freedom from discrimination or harassment Go to > Start of section

Outcome 6: Economic well-being Go to > Start of section

Outcome 7: Maintaining personal dignity and respect Go to > Start of section

Leadership Go to > Start of section

Commissioning and use of resources Go to > Start of section

OUTCOME 1: Improving Health and Emotional Well-being

“People in the council area have good physical and mental health. Healthier and safer lifestyles help them lower their risk of illness, accidents, and long-term conditions. Fewer people need care or treatment in hospitals and care homes. People who have long-term needs and their carers are supported to live as independently as they choose, and have well timed, well-coordinated treatment and support”.

Areas for development

Area and issue Progress/judgement


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To continue exploring options for the provision of bespoke services for people with long-term conditions (2007-08 PAN, Page 12)

The council is seeking to adopt a coordinated position across all sectors and all funding streams in relation to long team conditions embedded within a Section 75 Partnership Agreement. The council has outlined progress in a number of areas relating to heart failure, Chronic Obstructive Pulmonary Disease, OPD, Diabetes Care, Community Matrons, Darzi review and stroke services. (RBM 03-02-2009) The council has made significant progress in agreeing joint commissioning arrangements to personalise services for people with long term conditions. There is good understanding of their GAP analysis and target groups. Outcomes are clearly defined, LAA targets are set, underpinned by Section 75 agreements and significant additional funding. Progress in this area of work remains subject to ongoing monitoring. (ARM 10-06-2009)

To reduce the high level of alcohol-related admissions to hospital (2007-08 PAN, Page 13)

The council is seeking a coordinated approach across health and social care, lead by the Deputy Director of Public Health. A recently commissioned Alcohol Strategy and confirmed investment by the PCT aims to enhance service infrastructure. In addition a successful Area Based Grant bid will significantly complement the PCT investment. The PCT are due to appoint a Programme Manager to take forward strategy implementation. (RBM 03-02-2009) The council, in partnership with the PCT, is making strong progress in reviewing and revising treatment interventions. There is a stronger emphasis on recovery and abstinence programmes and an extensive primary prevention programme is now in place. The impact of these changes will be come more evident in 2009-10. The improved outcomes in relation to alcohol related admissions to hospital will remain an area for ongoing development and monitoring. (ARM 10-06-2009)

To provide a single point of access to The council has undertaken a fundamental review of services for people


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services, shared assessments, and a broader range of pathway options for people who misuse drugs. (2007-08 PAN, Page 13)

who misuse drugs. This has resulted in a new service specification that is focused upon the regeneration of individuals and movement towards becoming drug free .The council reports current performance remains strong. (RBM 03-02-2009) The council and its partners now have a revised Service Level Agreement in place with providers and have improved links in relation to the Common Assessment Framework, prescribing, key worker support, drugs related offending behaviour and housing options. The proposed development of this service will further enhance abstinence and rehabilitation treatment options for people who misuse drugs. The impact of the revised approach will become more evident in 2009-10 and remains an area for ongoing development and monitoring. (ARM 10-06-2009)

Analysis of 08-09 performance against achieving outcomes

In 2007-08 the council was assessed as making an excellent contribution to health and wellbeing. (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to health and wellbeing. (Self Assessment (SA) 2008-09) The 2007-08 Performance Assessment Notebook (PAN) reported the council, in partnership with the PCT, had continued to provide well-evaluated healthy living programmes. These programmes provided a wide range of high quality information in a wide variety of formats and languages to both inform and encourage healthy living. (2007-08 PAN) In 2008 -09 the promotion of health and well being has remained a priority for the council and its strategic


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partners. There is strong evidence of targeted interventions for people living in the most deprived areas and for diverse community groups. (SA 2008-09 Page 29) Initiatives such as Heart Smart, lifestyle referral schemes, Men’s Health programmes and the target Wellbeing Portfolio have supported and encouraged a wide range of people including carers to adopt and enjoy healthier lifestyles and meaningful leisure activities. (SA 2008-09 Pages 3-4) The council’s Social Inclusion Team actively promotes healthy living for people with mental health problems. Adult mental health teams have robust links to a service accessed through General Practitioners (G.P’s) surgeries that provides physical health checks for people using mental health services. (SA 2008 -09 Page 5) Individual support is available for people if required and uptake of the healthy living programmes is actively encouraged. (SA 2008 –09 Pages 4-5) In addition the council has enhanced health and well being by assisting 671 households that were “fuel poor”. A wide range of good quality information that is publicly available and systematically provided in a variety of events, venues and improved council access points supports this approach. (SA 2008 -09 Page 5, RBM 03-03-09) This targeted activity is contributing to the council’s steady progress in reducing health inequalities and improving life expectancy in the borough. The council has adopted a coordinated position through a Section 75 agreement to progress commissioning across all sectors that will include long-term conditions. (RBM 03.03.2009) Progress has been made in a number of areas including Chronic Obstructive Pulmonary Disease (COPD), Diabetes Care and Stroke Services. (RBM 03.03.2009) The council has made significant progress in agreeing joint commissioning arrangements to personalise services for people with long term conditions. This area of work remains subject to ongoing development and monitoring. (ARM 10-06-2009) The council’s performance in relation to delayed discharges was judged a strength in the 2007-08 PAN. The council in partnership with the PCT had maintained well-developed, effective arrangements for the provision of intermediate care increasing the numbers of people receiving intermediate care in both residential and non-


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residential settings to facilitate timely hospital discharge/effective rehabilitation. The Older Peoples Inspection (2006) also found there was a wide and increasing range of rehabilitation services that were delivering positive outcomes. (2007-08 PAN) The council has continued to perform strongly in this important area of work. There is mature, effective joint working in the provision of Intermediate Care, Intensive Home Care, rapid response and reablement services to reduce hospital admissions and facilitate timely discharge. (ARM 10-06-2009) As a result delayed discharges from hospital remain low and there has been an increase in the numbers of people still living at home 6 weeks after receiving a reablement or rehabilitation service. The council had reached its target of 75%. (SA 2008 -09 Page 10, SA 1_AAD-AAF, NI125) There has been an increase in the number of people receiving intermediate care in a residential setting to facilitate timely hospital discharge / effective rehabilitation with an increase from 21 in 2007-08 to 31 in 2008-09. The number has decreased in non-residential settings from 326 in 2007-08 to 313 in 2008-09. There has been an increase in the number of people receiving intermediate care to prevent hospital admission in both residential settings from 228 in 2007-08 to 252 in 2008-09 and non-residential settings from 822 in 2007-08 to 830 in 2008-09.Intermediate care provision for older people aged 65+ per 10,000 population in St Helens has slightly improved during 2008-09 to 486.8, from 482.3in 2007-08, (SA 2008-09 10P001-1_AGG, NI125)

In Mental Health, the Early Intervention and Psychosis Team continues to work closely with younger adults (aged 14 -35) experiencing a first episode of psychosis to promote positive outcomes and good recovery rates. Support is also provided to their families to reduce pressures at home and facilitate timely discharge and reduce the need for hospital admissions. (SA 2008 -09 Page 10) The specialised domiciliary care service for people with dementia is also effective in supporting people within the community in terms of continued independence and reduced hospital admissions. The council is aware that there is a high level of alcohol-related admissions to hospital relating to both acute periods and chronic alcohol-related conditions. The council and its partners are currently reviewing the Alcohol Harm Reduction Strategy and are conducting a review of all alcohol-related services. A number of other


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initiatives continue to have a positive impact. However the council and its partners recognise the major impact that alcohol consumption causes and this supports the Alcohol Strategy development and significant resource allocations. It is envisaged that as a result of this investment there will be a reduction in the number of alcohol related admissions to hospital. The council and its partners have continued to invest into alcohol related services. A recently commissioned Alcohol Strategy and the appointment of a programme manager (by the Primary Care Trust) augers well for service improvement (RBM 03.03.2009). The council, in partnership with the PCT, is making strong progress in reviewing and revising treatment interventions. There is a stronger emphasis on recovery and abstinence programmes and an extensive primary prevention programme is now in place. The impact of these changes will be come more evident in 2009-10. The improved outcomes in relation to alcohol related admissions to hospital will remain an area for ongoing development and monitoring. (ARM 10-06-2009) In relation to services for people who misuse drugs the council reported there is a potential multi-area approach to services across Halton, Warrington and St Helens. This would aim to pool resources, to re-engineer the market, and shift emphasis towards rehabilitation against a backdrop of safe practice. The council’s review of services for people who misuse drugs has resulted in a new service specification focussed on people becoming drug free and adopting active citizenship. (RBM 03.03.2009). The council and its partners now have a revised Service Level Agreement in place with providers and have improved links in relation to the common assessment framework, prescribing, key worker support, drugs related offending behaviour and housing options. The proposed development of this service will further enhance abstinence and rehabilitation treatment options for people who misuse drugs. The impact of the revised approach will become more evident in 2009-10 and remains an area for ongoing development and monitoring. (ARM 10-06-2009) The council promotes the provision of good quality; nutritious meals through its contractual requirements with care home providers. There is also an expectation that individual dietary needs and requirements are identified and met in a person’s care plan. (SA 2008-09) This approach is having a positive impact on the quality of meals served in regulated services as the majority of care homes within the borough are rated as good or excellent by the Care Quality Commissions in relation to the National Minimum Standards (N.M.S.). (CRILL 2008 -09).


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The target Well Being portfolio includes a healthy carer’s project that provides support, advice and encouragement to carers to improve their diet and adopt healthy eating. (SA 2008 -09 Page4). The council’s 3 resource centres for older people have implemented the nutrition programme, “Nutmeg” to ensure that people using the service enjoy a nutritious and balanced diet (SA 2008 -09 Page 4). In addition, the Meals on Wheels service provide nutritious meals that meet health and cultural requirements. Providers are contractually obliged to deliver nutritious meals that are ethnically sensitive. User Surveys are very positive about the Meals on Wheels service with 92% of respondees indicating that they were very satisfied or satisfied with the meals provided. (SA 2008 -09 Page 8). The council and its partners have adopted a multi – disciplinary approach to support a highly individualized Care package for people requiring end of life care. People are well supported at home by a key worker and a range of specialised nursing and medical support. The aims of this approach are to meet the physical, emotional, spiritual and mental health needs of the person being cared for as well as provide support and respite to their families and carers. This approach to end of life care has resulted in a significant number of people remaining in their preferred place of care and reducing the number of people receiving end of life care in a hospital or residential care settings. The council has exceeded its set target in relation to NI129 – end of life care. (Target Set 20% - outturn 28%). (SA 2008 -09 Page 10, ARM 10-06-09).

Key strengths

• Progress in reducing health inequalities and increasing life expectancy through health living initiatives • Strong focus on health improvement supported by good quality information • Expanded self-assessment options • Effective rapid response and reablement services • Reduced admissions to long term care • An expanding range of services for people at the end of life • Very strong performance in the number of clients receiving a review


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Key areas for improvement

• The council acknowledge the need to continue to reduce the numbers of alcohol related admissions to

hospital • The council should continue to implement its robust and detailed plans to expand the range of treatment

options for people who misuse drugs • The council and its partners are aware of the need to continue their joint approach to enhance

individualised services for people with long term conditions

Areas to explore

Area and issues Progress/judgement

OUTCOME 2: Improved Quality of Life

“People who use services and their carers enjoy the best possible quality of life. Support is given at an early stage, and helps people to stay independent. Families are supported so that children do not have to take on inappropriate caring roles. Carers are able to balance caring with a life of their own. People feel safe when they are supported at home, in care homes, and in the neighborhood. They are able to have a social life and to use


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leisure, learning and other local services.”



Increase the use of assistive technology for care and repair services. (2007-08 PAN, Box 5)

The council has made progress in this area. It anticipates that recent developments will have a wider impact during 2009-10. However, the development of information technology and care and repair services will see an improvement in performance during the next financial year. (RBM 03-03-2009). Although the council has made progress in this area, it envisages that developments will have a wider impact on outcomes for people using services in 2009 –10. (ARM 10-06-2009) This area of work remains subject to ongoing development, monitoring and review.


In 2007-08 the council was assessed as making an excellent contribution to improved quality of life (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to improved quality of life (Self Assessment Survey (SA) 2008-09).


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The majority of people seeking support from the council are assisted in a helpful and timely way. Acceptable waiting times for assessment for older people have improved from 75.7% in 2007-08 to 83.25% in 2008-09. The provision of statements of need has improved from 88.5% in 2007-08 to 93.5% in 2008-09. (ARM 10-06-2009) See analysis Outcome 4 The 2007-08 PAN reported the council was providing equipment to promote independence and minor and major adaptations in a timely manner. The council’s integrated falls service had improved and coupled with the provision of assistive technology this had reduced the number of emergency admissions to hospital due to injuries sustained by falls. The O.P. Inspection also found the council provided an increasing range of preventative services that were improving older people’s independence and safety. (2007-08 PAN). The council’s work with its partners to promote independent living and develop effective preventative services was judged to be a strength in the 2007–08 PAN. In 2008–09 the council and its partners have continued to work collaboratively across health, housing, leisure, community safety and children’s services. There is also a good range of co–ordinated activity with partners in the independent and voluntary sectors. Services to promote independence include strong and positive performance in the provision of Intermediate Care and Intensive Home Care Services. (See outcome 1) In addition the council has improved the waiting times for minor and major adaptations. Revisions in the council’s assessment and funding processes have resulted in the average waiting time for major adaptations being reduced from 14.6 weeks in 2007-08 to 11 weeks in 2009-10. Similarly the average length of time waiting for minor adaptations from the time of assessment to work beginning has decreased from 2.3 weeks to 1.0 week (SA2PD014.0, 2PD016.0, SA2PD015.0, 2PD107.0, ARM 10-06-2009) These services contribute to maintaining people’s independence in their own homes and reducing the numbers of admissions to hospital (See outcome 1) and are instrumental in maintaining low numbers of people being admitted to long term care facilities. In addition the council and its partners provide an integrated falls service that complies fully with the National Institute for Clinical Excellence (N.I.C.E.) guidelines. The service also has links with the Home Improvement Agency. (H.I.A.). The agency supports falls prevention by fitting appropriate safety equipment that is having a


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positive effect in maintaining people’s safety at home. (SA 2008-09) The council also provides a wide range of services that seek to socially include and value people who use services. Examples are the Active Care Service, the St. Helen’s Library Home Delivery Service, a befriending service (using volunteers) and a specialist transport service for people with a disability. (RBM 03-03-09, S.A. 2008 –09). The council makes effective use of assistive technology. The council has increased its expenditure on telecare infrastructure and has plans to expand this service further in 2009-10. (SA2OP009.0-2OP13.0, ARM 10-06-2009) Carers are well supported through a broad range of services. Carers initiatives are underpinned by training or development opportunities coupled with a flexible approach to care options that enable the carer to maintain their own quality of life outside their caring commitments. (RBM 03-03-09, SA 2008 –09) The council’s ambitious plans to develop 180 extra care housing units during 2009-10 are making excellent progress and are nearing completion, the council has well developed allocation systems to enable people to access the properties on a fair and equitable basis and is offering support to people wishing to purchase extra care housing in their own right. (SA2OP007.0, ARM 10-06-2009) This comprehensive approach has resulted in a range of provision that supports the very good performance in N.I. 136 (people supported to live independently through social services). The council has exceeded its set target for this indicator achieving an outturn figure of 3167 people helped to live independently. In addition, the numbers of people admitted to residential and nursing care settings have continued to reduce. The 2007-08 PAN reported the council had continued to improve the range and nature of the information it provided for all groups of people. This activity, coupled with improved access points within the community had improved people’s access to all council services. (2007-08 PAN) The council’s approach to the personalisation and transformation of social care services, in accordance with the principles of “putting people first”, includes improved accessibility to universal services. The council has remained active and responsible in improving its transport, housing, leisure and education


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services during 2008-09. (SA 2008 –09) Through the council’s self assessment pathway people are able to request and receive information and support regarding a range of low level services, community activities and opportunities to be involved. (SA 2008 –09) The council has also continued to improve its access and information points. (See Outcome 1). (RBM 03-03-2009, SA 2008 –09) There is strong evidence to support the view that the council takes seriously people’s concerns about their neighbourhood and environment. There are neighbourhood management arrangements to address anti–social behaviour, crime and vandalism with good effect. As a result, people express high levels of satisfaction regarding the quality of their homes and neighbourhoods. The equipment and adaptations survey and N.I. 138 found that 83.2% of respondees were satisfied with their homes and neighbourhoods. (SA 2008-09) The 2007–08 PAN reported that individuals with highly complex needs benefited from strong partnership working that resulted in people receiving a joint assessment, review and funding options. In 2008–09 the council has continued to build these strong foundations and has (with its partners) adopted a co –ordinated approach to housing options for people with a learning disability and/or a sensory disability. A review of supported living services has resulted in an outcome focussed service specification aimed at maximising independence that has already increased the numbers of people who live independently and are supported in a person centred way. Similarly there has been a revised approach for services for people with an Autistic Spectrum Disorder. The PCT has secured funding for a joint service that aims to provide highly individualised support to people and families within a community setting. This specialised service will begin in 2009-10. (SA 2008-09)

Key strengths

• A broad range of preventative and assistive services that enables high numbers of people to live

independently • Strong partnership working to provide improved housing, leisure and social opportunities • The provision of extra care housing • Reduced waiting times for minor and major adaptations • Strong and growing support for carers


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• Improved access to services for people with complex needs


None

Areas to explore


OUTCOME 3: Making a Positive Contribution

“People who use services and carers are supported to take part in community life. They contribute their views on services and this helps to shape improvements. Voluntary organisations are thriving and accessible. Organisations for people who use services and carers are well supported”.



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There were no areas for development for this outcome identified in the PAN 2007-08


In 2007-08 the council was assessed as making an excellent contribution to making a positive contribution (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to making a positive contribution. (Self Assessment Survey (SA) 2008-09). The council has continued to perform well in providing widespread opportunities and support for participation in community life. In mental health services, the newly developed Heath Park Lodge Centre accommodates the Social Inclusion Team, MIND, Coalition for Disabled People and Making Space. These organisations are led by or employ people who use services and they are active in influencing and contributing to service design and delivery. (SA 2008-09 Page 17) The new LINKs service is becoming well established with regular meetings with adult health and social care managers. A key specification for the LINKs Service Level Agreement is to ensure that all marketing activity promotes inclusive membership with particular reference to including socially excluded groups such as carers, travellers, homeless people and migrant workers. (SA 2008-09 Page 19) Additionally, there are growing numbers of people included in the partnerships boards; membership has enabled people who use services to influence and shape transport, housing, leisure and cultural services. (RBM03.03.2009, SA 2008 -09 page 20).


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During 2007-08 the council introduced a new volunteering policy that recognised and reflected the framework adopted by the Council for Voluntary Services for managing volunteers. There was clear commitment to providing volunteers with quality opportunities, providing appropriate task supervision, support and training, and a commitment to provide a robust induction programme with volunteers located within a safe working environment. The council regularly recruited volunteers to the Healthy Living programme and provided opportunities for volunteers within a number of its services. (2007-08 PAN) The council’s successful promotion of volunteering opportunities and increased access to volunteer based services has continued in 2008 -09. The council has a well established volunteer network with volunteers across citizens, carers and people who use services. Activities include a home delivery service to people who are housebound, luncheon clubs and fund raising activities for local and national community projects. (SA 2008-09 page 19). There is successful and ongoing active recruitment for the Age Concern befriending service that is resulting in increased volunteers providing an important social link for adults in vulnerable circumstances. (SA 2008-09 Page 19) The council has recently created a volunteer co-ordinator within the Healthy Living Service to work with people and the families of carers of people who have suffered a stroke. (SA 2008-09 Page 19) The 2007-08 PAN demonstrates that the council had effectively consulted with all people who use services and their carers. The O.P. inspection found that feedback was valued and was used to shape planning, service delivery and improvement activity. Furthermore the Auditor reported that the council’s consultation processes were effectively planned and coordinated. (2007-08 PAN) The council commissioned a consultant to carry out a consultation exercise to gather the views of people with physical and sensory disabilities in a bid to improve their quality of life. This is being used to better understand the experience of living as a disabled person in the Borough. People’s views are being used to help shape a strategy and to help set priorities and make plans. The scope of the consultation was to ascertain views about what is positive and successful along with what could be done to improve the physical and mental health of individuals and to ensure that they have the same life chances as other people. It covered a wide range of issues including home life, health, social inclusion, employment and travel. (St Helens council website - A


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consultant has been commissioned to gather the views of disabled people in a bid to improve their quality of life (7th January 2009) In terms of strategic development all of the council’s key developmental activities undertaken in 2008 -09 have involved well targeted and comprehensive consultation with people who use services and their carers. The Adult Support Foundation Plan is the council’s over–arching strategic document for all vulnerable adult across the borough. People using services, carers and voluntary groups provide a valuable contribution to the plan and have influenced the council’s future priorities. There are positive examples of service re-design and configuration in response to expressed need and preferences. (SA 2008-09 Pages 20-21, ARM 10-06-2009). In a wider sense, the council and its partners actively engage with local residents in shaping their plans. They use a range of methods to gather community views tailored to the needs of specific target groups and communities. These include a Senior Voice Forum, People’s Panels and the Coalition for Disabled People and Business Forums. (SA 2008-09 Page 17). At the neighborhood level, local people are encouraged through Ward Committees. Partners have improved engagement with black and racial minority communities through making sustained efforts to contact residents. As a result they now have multi-agency meetings with Eastern European residents aimed at giving advice and information. Improved links have also been made with the Kerala and Chinese communities in the borough. Good engagement enables partners to understand local people’s priorities and concerns and make an effective response. (Audit Commission 2008.).

Key strengths

• The Community Cohesion Strategy “St Helens Together” was finalised in March 2009 • Comprehensive involvement and consultation with people using services and their carers


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• The mental health social inclusion team supports people in people led organisations • Developing relationships with LINKs. • Strong evidence that local people are influencing and shaping service design and delivery • Varied use of volunteers in community projects and initiatives


None

Areas to explore



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OUTCOME 4: Increased Choice and Control

“People who use services and their carers are supported in exercising control of personal support. People can choose from a wide range of local support”.



To improve performance on acceptable waiting times for assessments and the provision of statements of need. (2007-08 PAN, Page 51)

The council has made progress in this area and anticipates it will exceed its targets for both assessments for older people and the provision of statement of needs by the end of the year. (RBM 03-03-2009) An area for improvement is to build on positive progress in addressing acceptable waiting times for older people and extend this across all client groups (ARM 10-06-2009)

To improve performance on the provision of advocacy services for people with a learning disability. (2007-08 PAN, Box 9)

The council has continued to progress this area submitting an application for an Area Based Grant for the development of an improved range of advocacy services available to all. A specification is currently being written and is being consulted on as part of a project plan over the next few weeks. Details will be presented to relevant Partnership Boards. Following approval / consultation the council will then submit it for tendering and commissioning. RBM 03-03-2009) The outcomes for people as a result of this work will need to be explored further with the council during 2009-10.


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In 2007-08 the council was assessed as making a good contribution to increased choice and control. (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to increased choice and control. (SA 2009-10) The council has continued to improve the range, quality, consistency and accessibility of its public information. Advice and information is comprehensive, detailed and personalised for people who use services and their carers. The sources of information are varied including face to face interviews, publications that are well circulated, by telephone and through the council’s user friendly website. The information provides a full directory of the services provided by the statutory, private and voluntary sectors. This has resulted in an increase in the numbers of people accessing both assistive and supportive services across a wide range of needs (See Outcomes 1 and 5). (SA 2009-10 Pages 24 - 25) The 2007-08 PAN reported the council had maintained its good performance in undertaking reviews of people’s individual needs. The Single Assessment Process (SAP) was well established within the local health and social care economy. Social Care Teams, PCT and acute trust staff use a generic SAP Tool Kit (EASYcare) and there was a high level of integration across agencies for effective joint assessment. (PAN 2007-08) The council has made excellent progress in the areas identified for improvement in 2007-08, namely in speeding up contact and referral times and to improve performance on the statement of need. Due to the successful introduction of the Access and Information Team in 2008, acceptable waiting times for assessment for older people has exceeded its target and achieved an outturn of 83.25% in 2008-09 up from 75.7% in 2007-08. Performance on statements of need has improved from 88.5% in 2007-08 to 93.5% in 2008-09. (ARM 10-06-2009) The new National Indicators NI132 (Timeliness of social care assessments for all adults) and NI133 (Timeliness of social care packages following assessment) have both not achieved their challenging target this year. As these indicators include vulnerable adults in the definition, the council is expecting that the roll out of the Access and Information Team to vulnerable adults in 2009-10 will improve performance in these indicators. (NI132, NI133)


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Person Centred assessments and support plans for young people in transition to adult services are holistically focussed. Support plans are clear about desired outcomes and include health action plans. All new referrals to the transition support services are encouraged to explore options for self directed support and here has been an increase in the numbers of young people and their families using an Individualized Budget (I.B.) to meet their needs. (SA 2008 -09 - 4LD023.0.). The council has developed a new specification for an improved range of advocacy services available to all. The proposals have been subject to consultation. The implementation of this new service will be monitored during 2009-10. In the interim, advocacy support is being provided through a range of agencies and the St. Helen’s People’s Choice Forum. (RBM 03-03-2009, 4LD024.0, ARM 10-06-2009)

The 2007-08 PAN reported there was an increasing range of preventative and assistive services to meet people’s needs and preferences and high levels of satisfaction with the services provided. There was evidence of the council providing a range of services to meet the diverse needs of the borough’s population. The council had a ratified self-directed support policy with arrangements in place to assist its implementation. This included draft procedures for self assessment, resource allocation systems and a risk Project Initiation Document. The council had identified 50 people to pilot the policy’s implementation. (2007-08 PAN) A report was presented to Executive on 4th February 2009 regarding the remodelling of day care services. It was proposed that locally based community services be provided flexibly 7 days a week including evenings with services being provided at a time that suits the service users’ and carers’ needs. The new service will provide a wide range of services including intensive support, support with health and wellbeing issues, provision of employment, volunteering opportunities, provision of training and a wide range of leisure and cultural activity. (RBM 02-03-2009 /Report to Executive 4th February 2009 - Principles for the Development of Adults Social Care Day Opportunities). There is strong evidence that the council and its partners are working effectively to transform and personalise services in accordance with “putting people first” requirements. There has been a significant increase in the number of people using Direct Payments/Individualised Budgets. The council reported it has exceeded its target in relation to direct payments that are included as stretch targets


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for the next two years in the LAA. (RBM 03-02-2009) 204 people receiving direct payments during 2008-09 did not have a direct payment in any previous years. This is an increase from 87 during 2007-08. (SA4GN027.0-4GN030.0) Of those who received one or more direct payments during 2008-09, the majority had gross direct payment expenditure amounting to £5,000+. (SAGN034.0-4GN040.0) There is strong support for people using direct payments and individualised budgets. The council provides assistance to people so they may meet their financial obligations, wage payments, recruitment of personal assistants and financial monitoring in relation to payments over £5,000. This activity has enabled significant numbers of people to meet their own needs in a self-determining and confident way. (ARM 10-06-2009) The full implementation of the Single Assessment process (S.A.P.) and the Electronic Single Assessment Process (E.S.A.P.) are supporting the development of outcome focussed care planning systems and individualized support. The council remains confident that through a range of key work streams overseen by a self directed support programme manager, its challenging targets for the transformation of services will be met in 2009 -10. (SA 2008 -09) There has been an expansion of support services during 2008 -09, including the previously reported increase in day care service, assistive technology, supported living options, intermediate care, rehabilitation and reablement services. The council acknowledges that the continued development of preventative services coupled with the transformation and modernisation agenda need to remain a key priority for 2009 -10. The Older People’s Service Inspection found that the council effectively managed complaints and undertook robust monitoring to ensure matters were appropriately resolved. There were good examples where the outcome of complaints investigations have led to revised and improved practice, better information sharing across agencies and improved clarity for information provided on the council’s website. The Auditor reported that the council had improved access to services and assessment. (2007-08 PAN) The council’s management and learning from complaints were reported as strengths in the 2007-08 PAN The council has a robust complaints process that is subject to strong management scrutiny and review. The council identified that the number of complaints from people with a mental health problem was disproportionately low. Targeted awareness raising activity and amendments to the councils recording systems have resulted in the


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number of complaints increasing from this particular group of people. The council is positive about the increase and is confident that it is in response to awareness raising and support. (See Outcome 7) (SA4GN041.0-4GN047.0, ARM 10-06-2009) There is good evidence of the council applying the learning from complaints, into service design and care practice (SA 2008 -09.).

Key strengths

• Timely assessments for older people and provision of services through the newly established Access and

Information Team • Increased take up of Direct Payments and Individual Budgets (Exceeding LAA targets) • Strong progress in providing services for carers and exceeding LAA targets • Outcome focused service specifications • Robust complaints management and scrutiny


• The council acknowledge the need to expand advocacy services and have plans to implement a universal

service in 2009-10 • To build on positive progress in addressing acceptable waiting times for older people and extend this across

all client groups


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Areas to explore


OUTCOME 5: Freedom from Discrimination and Harassment

“People who use services and their carers have fair access to services. Their entitlements to health and care services are upheld. They are free from discrimination or harassment in their living environments and neighborhoods”.



To continue to work towards achieving Level 4 of Local Government Equality Standard. (2007-08 PAN, Page 56 2007-08)

The council reported good progress has been made in working towards achieving Level 4 Standard. The council has just two more areas of evidence (community engagement and accountability) to provide before seeking accreditation at Level 4. (RBM 03-02-2009) The council is confident that it is now achieving Level 4 of the Local Government Equality Standard. Although not mandatory the council is seeking external validation in September 2009. (ARM 10-06-2009)


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In 2007-08 the council was assessed as making a good contribution to freedom from discrimination and harassment. (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to freedom from discrimination and harassment. (Self Assessment (SA) 2008-09) The council’s eligibility criteria are set to meet moderate, substantial and critical levels of need. There is ongoing political and corporate support to maintain criteria at these levels for the foreseeable future. The council has achieved level 4 of the local government equality standard. (Awaiting external validation) (ARM 10-06-2009) The council remain active in providing a range of services that may be directly accessed as well as publishing information in appropriate formats for migrant workers and the travelling communities as well as ethnic minority groups. In addition there are clear equality objectives and performance is regularly monitored. Standards of good practice in promoting equality, diversity and easy access are established in staff training and supervision. Feedback from people who have sought assistance from the council is positive in terms of information provided, support given and service quality. (RBM 03-03-2009, SA 2008 -09) All adult social care and health services that monitor service access have built in equality profiles (disability, race and gender). The data collated is used to continuously improve service access and provision. A Care First Performance Management System records the ethnicity of service users and carers and supports equality of access and service uptake. As a result the council is able to demonstrate high standards of prevention of discrimination. (SA 2008 -09) In terms of community safety a strong multi –agency approach is having a positive effect on reducing crime. Overall crime in St. Helens is below the most similar group average. Racially or religiously aggravated crime and


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violent crime are all below average for similar areas. The council is also tackling neighbourhood related crimes such as anti – social behaviour and vandalism. Good performance in crime reduction coupled with a neighbourhood approach are giving people who live in the borough increased feelings if safety and security. (SA 2008 –09, Audit Commission 2008)

Key strengths

• Achieving Level 4 of the Local Government Equality Standard • The Access and Information Team providing people with universal advice and information • Strong performance across ethnicity indicators • A proactive approach to meeting the needs of travelling communities and immigrant workers • Reducing crime and improving community safety • Effective use of Fair Access to Care criteria


None

Areas to explore



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OUTCOME 6: Economic Well-being

“People who use services and their carers have income to meet living and support costs. They are supported in finding or maintaining employment”.



To increase opportunities for people with learning disabilities in paid or voluntary work. (2007-08 PAN, Box 3)

The council reported that further work opportunities have been identified and that progress is being made in increasing the numbers of people in paid and voluntary work. (RBM 03-02-2009) The council is making steady progress however this area of work will remain subject to ongoing monitoring and review (ARM 10-06-2009)

Further development of work opportunities for people with a physical/sensory disability. (2007-08 PAN, Box 4)

The council has continued to progress this area and is looking to develop one of its services into an Independent Living Centre. The council also reported on a number of other initiatives that it intends to develop to further promote work opportunities for people with a physical/sensory disability. Outcomes from this work will need to be explored further with the council during 2009-10. (RBM 03-03-2009) The council is making steady progress however this area of work will remain subject to ongoing monitoring and review (ARM 10-06-2009)


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In 2007-08 the council was assessed as making a good contribution to economic well being. (APA Summary Report 2007-08) In 2008-09 the council assessed itself as good in its contribution to economic well-being. (SA 2008-09) The council has been instrumental in the development of the local economy and the regeneration of the borough working closely with partners to attract inward investment. Targets have been exceeded in relation to new companies moving into the area and the number of jobs created. This has enabled substantial numbers of local people to move into paid work. The council is shaping sustainable communities and tackling poor housing. As a result of increased employment and improved housing the local economy and environment have improved. However addressing worklessness remains a priority for the council. (SA 2008-09) The council. in partnership with a range of agencies, provides accessible, comprehensive support and advice to assist people to maximise their income. There is specialist support available for people with a learning disability or mental health problems. The council is also active and responsible in it support of people who fund their own care and provide assessment, signposting and review services. The Home Improvement Agency provides advice and support for carers and people using services in relation to adaptations and the use of direct payments and individual budgets. (See Outcome 4) There is also a Fuel Debt Relief Scheme to assist people falling behind with utility payments enabling debts to be repaid and services maintained. (SA 2008-09) The council’s performance in supporting people with employment with a learning disability, sensory or physical disability was reported as an area for development in the 2007-08 PAN. In 2008-09 the council has implemented plans to develop Windle Pilkington House into an Independent Living Centre (based on the Stephenson model for people with learning disabilities) The centre will provide a range of services including – visual impairment services, carer’s services with an opportunity to see and use aids and adaptations based on a retail model. Employment opportunities are being provided by a developing café and reception area. The Directorate has been successful in receiving two Area Based Grants. These will enable the council to further develop the existing Supporting Employment Service for Disabled People that is being delivered in partnership with the St Helens Coalition for Disabled People. (ARM 10-06-2009)


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In addition the council is a ‘two ticks’ employer and it has been proactive in recruiting 23 people that have a disability. The council has also implemented a range of support programmes to enable people with a disability to remain in long term employment .The ‘New Ventures’ programme employed 4 new people with a learning disability and supported a variety of vocational and training activities. The council intends to build on this work in 2009-10 with a view to increasing paid and voluntary work opportunities. (NI146, ARM 10-06-2009) The 2007-08 PAN reported that the council was active and responsible in offering support to carers to seek and maintain paid work. The council has continued to strengthen its performance in this regard and carers benefit from training, pre – employment preparation and flexible care options. There is strong support for carers in maximising their income and reducing financial hardship. The council acts as an exemplary employer and seeks to support carers well in balancing their working life and caring responsibilities. A flexible and supportive approach is evident across the council’s workforce. (ARM 10-06-2009)

Key strengths

• Increased opportunities for voluntary and paid work for people with disabilities • Targets have been exceeded in relation to new companies moving into the area and the number of jobs

created • The council, in partnership with a range of agencies, provides accessible, comprehensive support and

advice to assist people in maximising their income • The development of an Independent Living Centre • Support for self-funders


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• To continue to increase the range and number of voluntary and paid work opportunities for people with a

learning disability or a physical or sensory disability. • To continue to provide increased opportunities for training for people with a learning disability or a physical

or sensory disability.

Areas to explore


OUTCOME 7: Maintaining Dignity and Respect


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“People who use services and their carers are safeguarded from all forms of abuse. Personal care maintains their human rights, preserving dignity and respect, helps them to be comfortable in their environment, and supports family and social life”.





In 2007-08 the council was assessed as making an excellent contribution to maintaining dignity and respect. (APA Summary Report 2007-08) In 2008-09 the council assessed itself as performing excellently in its contribution to maintaining dignity and respect. (Self Assessment (SA) 2008-09) There is a dedicated resource for Adult Safeguarding within the council. The safeguarding unit has strong links with the Police Family Support Unit, with joint working arrangements, hot desks and co-location facilities. The Safeguarding team works well with local partners and there is a strong commitment to single safeguarding policies and procedures. There is clarity of each agency’s roles and responsibilities. Safeguarding activity is supported by a range of appropriate training across the wider social care workforce and the council continues to include a range of care providers in raising awareness and training opportunities. The council has plans to increase the percentage of staff trained across the social care workforce in relation to safeguarding adults during 2009-10.


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There is evidence of safeguarding referrals across agencies and there is a strong number of referrals from the public. The numbers, range and nature of referrals support high levels of awareness across both professional and lay groups. In under-represented groups (e.g. mental health) the council has taken a proactive approach and has implemented targeted awareness raising and support for people using services to raise concerns, complaints or allegations of abuse. This activity has resulted in an increased number of people contacting the Safeguarding Team for advice, support and referral. There are formal links across safeguarding, contract monitoring, commissioning and health functions. These robust links enable partners to take a structured approach to promote and monitor a high level of protection and personal care across services Regular and effective contact is sought and maintained with care regulators where appropriate. Safeguarding information is strongly monitored and evaluated. There is a high level of scrutiny in relation to investigations and outcomes. Performance information is used to inform and enhance practice. The adult safeguarding board is providing good leadership in this regard. The council is currently conducting a self audit of its strategic and operational safeguarding approach across adult and children’s services. Recommendations from the Audit will be considered by chief officers and subject to detailed action planning to address any identified shortfalls and to facilitate continuous improvement. (SA7GN057-7GN063.0, SA7GN073.0, SA7GN074.0, ARM 10-06-2009, SA 2008 -09) The council has remained active in developing practice guidance for interpersonal relationships for people in vulnerable circumstances and has adopted a multi-faceted approach based on best practice for guidance and training. The practice guidance is included within the Adults Safeguarding Board to improve joint working with Health colleagues and other partners and has identified and agreed components of the practice guidance. There has been a revision of the Halton LA/PCT policy and practice to include St Helens and facilitate a co-ordinated approach across the councils. In addition staff are being trained about adult safeguarding and the Mental Capacity Act as well as specific NVQ competencies relating to supporting personal and sexual relationships. Envisaged outcomes are a knowledgeable and competent workforce that is able to support positive interpersonal relationships for people in vulnerable circumstances. (St Helens Safeguarding Adults Board – Annual Report 2007-08/Update on Adult Safeguarding)


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The council continues to promote dignity and respect in personal care through its focus on personal dignity in its policies, procedures and contracting arrangements. There is a high level of personal involvement in developing and reviewing personal care plans. There is strong evidence that people who use services are integral to the decision making processes and due regard is paid to their personal aspirations, views, needs and preferences. Customer satisfaction surveys support a high level of satisfaction and people are positive about their interactions with council staff in terms of respect and dignity. In addition the council has robust arrangements relating to personal information and data security contained within the Corporate Information Management Policy. The council operates a cross departmental governance statement and the information sharing protocol adopted by the local strategic partnership demonstrates an agreed framework for the monitoring and review of data quality across agencies. There is strong evidence of internal audit and information risk management. (ARM 10-06-2009) There have been no breaches of data security and people who use services benefit from high levels of confidentiality in relation to their personal details, circumstances and related information. (ARM 10-06-2009) Overall, the council makes effective use of the good quality regulated services. The council remains vigilant in monitoring the quality of provision and takes timely action in addressing required improvements where service shortfalls are identified. Contract monitoring and suspension are proportionally applied to good effect. (CRILL 2008, RBM 03-03-2009, S.A. 2008 -09) The council continues to support and value the role of carers and families in meeting the needs of people who use services. In addition to the support carers receive to manage their caring responsibilities, the council works closely with the Carers Centre to deliver a range of joint training programmes to social care staff and carers. As part of the council’s work in the personalisation of social care services, there has been a range of events for social care staff that have included carers so social care staff are given insight into the aspirations and needs of this group of people. Carers and carer needs are included within the Equality and Diversity training. Carer’s awareness training is also delivered to front line staff so staff are able to knowledgeably advise and


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support carers in their rights and entitlements. This training and raised awareness is instrumental in supporting carers being integral to the partnership approach to meeting the individual needs of people using services. (SA 2008-09) In relation to Deprivation of Liberty Safeguards (DOLS) an MCA Co-ordinator post has been sent up collaboratively between the council, Halton council and the PCT. A nominated signatory and deputy signatory had been identified and authorized within the council. Inter agency policies and procedures have been agreed and implemented by the local implementation group. 8 Best Interest Assessors have been trained and are available to carry out the assessments. A Mental Capacity Act coordinator is available to provide specialist advice and support. This work is being well supported by training across the health and social care workforce including the independent sector. (ARM 10-06-2009)

Key strengths

• The continued focus on strengthening adult safeguarding across partnerships and agencies • Dedicated adult safeguarding resources • An established safeguarding board that is providing leadership and scrutiny • The ongoing commitment to raising awareness and appropriate representation • Robust information management • The implementation of appropriate Deprivation of Liberty Safeguards


• To continue to provide adult safeguarding awareness and training opportunities across the social care

workforce


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Areas to explore


Leadership

“People from all communities are engaged in planning with councilors and senior managers. Councilors and senior managers have a clear vision for social care. They lead people in transforming services to achieve better outcomes for people. They agree priorities with their partners, secure resources, and develop the capabilities of people in the workforce”.





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“The Adult Support Foundation” plan is the partnership’s wide-ranging and over-arching vision for Adult Health and Social Care. The plan was finalised in summer 2008 after well-targeted and meaningful consultation with all major stakeholders. (ARM 10-06-2009) Commissioning strategies that support and deliver the councils vision have been developed in the context of the issues identified in the Joint Strategic Needs Assessment. (J.S.N.A.). Key priorities have been tested against and linked to the priorities identified within the Sustainable Communities Strategy and the Local Strategic Partnerships Local Area Agreement (L.A.A.). Similarly, the council has clear strategies and plans for the transformation of social care services and self-directed support. Good progress has been made in direct payments, self assessment, enablement services, personalised planning and in defining positive outcomes. In addition the council is effectively managing a number of key work streams to further this agenda and making effective use of the Social Care Reform Grant to support transformation. The council has an annual departmental plan for adult health and social care that sets out explicit aims and objectives for the performance year. Performance is managed and evaluated systematically against identified objectives. (RBM 03-03-2009, SA 2008 –09, ARM 10-06-2009) The council continues to invest in its workforce in terms of ongoing professional development and the personalisation of social care services. There is improved attendance at work and reductions in sickness and absence as a result of effective management and workforce support. There is ongoing work in relation to equality and diversity, good practice in the recruitment and support to volunteers and a flexible approach to staff with caring responsibilities or a disability. The council continues to make good progress in the pay and grading review. In addition there is good performance in re-location and re–deployment of staff as services are realigned to meet the demands of the transformation and personalisation agendas. (SA 2008 –09, SA8GN079.0, SA8GN080.0, SA8GN081.0, ARM 10-06-2009) Performance management arrangements were reported as being effective in the 2007 -08 PAN. In 2008-09 the council has consistently improved its performance across a range of indicators and addressed the


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areas identified as requiring improvement in 2007 -08. Key LAA priorities and targets in many areas have been exceeded and very good progress made in helping people to live independently as well as access self-directed support. The council continues to make strong progress in this important area of work. The management of performance information is systematic and robust. There is a high level of scrutiny and timely remedial action were performance falls short of expectations. (SA 2008 –09, ARM 10-06-2009)

Key strengths

• Strong progress in the transformation and personalisation of social care services • Strong leadership, clear strategic direction and effective resource management • Workforce planning and development is actively managed • Mature and effective partnerships • An informed understanding of local and national priorities • Robust scrutiny arrangements


• To continue with the transformation and personalisation of social care services

Areas to explore



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Commissioning and use of resources

“People who use services and their carers are able to commission the support they need. Commissioners engage with people who use services, carers, partners and service providers, and shape the market to improve outcomes and good value”.





The council and its partners promote effective engagement regarding its commissioning intentions through a wide range of partner organisations within the voluntary and community sectors. This includes the community groups to ensure wide ranges of views are able to influence the commissioning of services. To reach those people who might not be heard the council has established mechanisms to include BME residents, migrant workers and people from the lesbian, gay and bisexual communities. The views of carers and disabled people also feature strongly in influencing commissioning activity. (RBM 03-03-2009, SA 2008 -09, Audit Commission November 2008.).


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The council’s priorities are firmly based on a sound understanding of the needs and views of local people. Priorities reflect local circumstances, challenges and opportunities translated in to detailed action planning and outcome based targets. Partnership working in strong, mature and effective in identifying and meeting needs. Service quality is high and provides good value for money. (RBM 03-03-2009, SA 2008 -09, Audit Commission November 2008.).

Key strengths

• Effective use of the JSNA reflected in commissioning intentions • High quality and good value for money services • Highly effective use of resources and balanced budget • Risk management processes strongly embedded in the business planning framework


None

Areas to explore


ADULT SOCIAL SERVICES PERFORMANCE ...moderngov.sthelens.gov.uk/documents/s2933/Annual...monitoring....

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Transcript of ADULT SOCIAL SERVICES PERFORMANCE ...moderngov.sthelens.gov.uk/documents/s2933/Annual...monitoring....