CSCI Inspection of Services for People with Learning Disabilities

Inspection of Services for People with Learning Disabilities 6 th -17 th February 2006

Inspection Team Sandra Miller (Lead Inspector-CSCI) Jean Hanson (CSCI) Michelle Mansfield (Learning Disability Assessor-Speaking Up!)

CSCI Role Promote improvement in social care. Inspect all social care- for adults & children in the public, private and voluntary sectors. Register and inspect services against national standards.

Methodology Two inspectors and a learning disabled assessor on site in Southend on Sea for 8 days. Focus on collecting evidence relating to practice and the outcomes achieved. Aim to collate pre-inspection information systematically and raise questions to explore in fieldwork. An interim collation is included in the fieldwork process. Questionnaires are sent to carers and fieldwork staff, using appropriate reminders and prompts to the liaison officer to increase the response rate. Focus on the view of users and carers about their experience of receiving services and the outcomes achieved. Examine liaison with other agencies, particularly the outputs of joint work and planning arrangements eg joint commissioning, pooled budgets, new services.

Summary of Inspection Findings Overall we judged that some people were being served well. From a slow start in delivering on the Valuing People agenda, Southend on Sea Borough Council and partners had made some positive progress over the last two years. The range of available services for people with learning disabilities had increased and this had led to more choice for some people. The Southend Learning Disability Partnership Board was established in The board had been reinvigorated and relaunched over the last year with the assistance of the regional Valuing People team. The Partnership Board was well attended by a range of key partners and competently co-chaired by a service user, but it was recognised that despite improvements, the board was still in the early stages of engaging service users and carers in a meaningful way. The service user sub-group of the Partnership Board was slowly beginning to engage small numbers of people with learning disabilities to contribute to planning and service development.

Councillors had used the Borough’s Scrutiny function to undertake a comprehensive review of Southend’s learning disability service and this had led to the Partnership Board developing and publishing a range of strategies that responded to national priorities and strategic objectives within the Valuing People framework in The council’s processes for consulting and informing service users, carers and some staff about major modernisation plans had not been inclusive and had generated some mistrust. Positively, relationships with services users and carers were in the process of being repaired. The council was increasingly working effectively with relevant council-wide and external partners to ensure that key strategies had improved access to housing, employment and meaningful day opportunities for people with learning disabilities. The council and its partners were committed to moving away from reliance on traditional patterns of service for people with learning disabilities. There were some early signs of good service initiatives in respect of day opportunities that promoted independence for instance, but managers recognised there was much scope for further improvement.

Mapping of service provision by ethnicity had been undertaken and managers were committed to improving the service response to all diverse communities. Expenditure had shifted in line with service modernisation and the council’s performance compared to its comparator group in helping people to live at home for the period was very good. The numbers of people being supported to live independently were increasing steadily. A reducing number of people with learning disabilities were being admitted to residential care and the range of available housing options was increasing. There was still a need to ensure that people placed outside of the borough in costly placements were appropriately placed within Southend. The council had ensured that Direct Payments were steadily increasing. Despite this progress, the scheme was not being promoted robustly, information about the scheme was not available in accessible formats, and the leaflet did not take account of the needs of carers. There was recognition by managers of the need to improve the transitions process for young people with learning disabilities and plans were in place to do so.

Case files and interviews with services users and carers showed some good social work practice overall. Adult protection arrangements were robust and effective and plans were in place to ensure improvements in data collection and analysis. Assessments that we saw were of a good quality and written in the first person. However, most assessments required updating and care plans needed sharper focus on objectives and intended outcomes. There were significant delays in conducting reviews. Most service users and carers said that they were treated with respect by staff and we heard some very positive comments about the commitment and responsiveness of some social work and provider service staff. A Person Centred Planning approach was evident but few Person Centred Plans had actually been completed. A number of Health Action Plans had been sent out to service users, but evidence of action plans playing a role in improving the health of people with learning disabilities was not seen. There was no overarching adult service quality framework or quality officer and this had resulted in a somewhat fragmented approach to the monitoring of quality.

Over all we judged that capacity for improvement was promising The council and its partners had a clear vision and strategic direction for modernising learning disability services. Managers recognised the need to ensure that staff and partners understood more fully the council’s corporate priorities and their respective roles in achieving these. This in turn would lead to better linkage between the needs of people with learning disabilities and the corporate agenda. Council members recognised their collective responsibility for improving outcomes for people with learning disabilities and were committed to creating opportunities for meaningful and outcome-focussed involvement with service users and carers in addition to the Partnership Board. Overall the council faced significant financial pressures and it was anticipated that learning disability services would contribute £875,000 in efficiency savings for the period Given that this is a service going though a considerable amount of modernisation it was difficult to see how such radical modernisation would create efficiencies.

The council had developed a range of local strategies based on Valuing People goals and these in turn had led to demonstrable improvements. Performance management and quality assurance systems were not well developed, and the council was only just beginning to include service user and carer views in emerging performance and quality systems. The Care First Information system had not yet been fully exploited to offer a single solution to support commissioning, budget, performance and planning processes. Despite her capacity being stretched, the acting Head of learning disability services had provided clear and effective leadership for the past year to a service that previously had not benefited from such clarity. Some other key positions within learning disability services faced further change. The Community Team for People with Learning Disabilities (CTPLD) did not have single line management and with the exception of nursing staff was not co- located. The function and joint arrangements of the team were under review at the time of the inspection, and it was anticipated that the outcome of the review would include improved, more integrated processes and functions.

Staff were appropriately supervised and felt well supported by managers, and many staff showed creativity in their approach to increasing choice and independence for people with learning disabilities. Annual appraisals of staff had not been well embedded as a means of managing performance or achieving the council’s priorities, and workforce development was very poorly planned. The direction of travel for learning disability services was in line with Valuing People although the pace of change to date had been slow. Some of the key challenges for the council and its partners will be to further accelerate the pace of change, ensure that the capacity of both management and staff is sufficient to arrange and deliver modernised services for people with learning disabilities and their carers, implement the identified service improvement priorities and to effectively respond to the diverse needs of service users and carers in a consistently collaborative way. These key areas will need to be closely risk- managed.

Judgement Matrix

Thank You users/carers senior officers operational staff key stakeholders