1. Public Value Review of services for people with learning disabilities Andrew Price, PLD Commissioning, Adult Social Care September 13th 2011

2. 2 Updates on the 11 workstreams 1. Accommodation 2. Complex Needs 3. Dayservices 4. Short Term Breaks 5. Review RAS arrangements 6. PLD Placement Review (incorporating High Cost Placements and Strategic Provider initiatives) 7. Integrated services with Health, Districts and Boroughs and VCFS 8. Commissioning Strategy 9. Finance 10. Transition 11. Engagement

3. 3 Workstream One – Accommodation – initial recommendations Surrey County Council support 1,500 people in residential care homes, 600 of whom live outside the county. We operate 5 homes with capacity for 102 people. There are an estimated 540 people living in residential care in Surrey funded by other local authorities.  Recognised need for more focused resource to work with providers to enable the move from residential care to supported living and to review the placements of young adults still in residential care out of county (£11m)  Confirm strategic direction away from commissioning residential care  Ensuring all new supported living services are within target hourly rate level  Ensuring existing supported living rates reduced to target level  Improved monitoring of supported living vacancies  Supporting People contracts, ensuring ASC and SP rates aligned, standardise the range of SP contracts, ensure services across county consistent, hours delivered per person capped at a level TBC, new specification for floating support  Development of relationships with neighbouring commissioners; regular review of out of county in corresponding areas

4. 4 Workstream Two – Complex Needs – initial recommendations There are 91 people in residential care services that cost over £2k per week, totalling £11m each year. A high number of these (47) are located out of county, of which 38 are awaiting Continuing Healthcare determinations. We are exploring whether the definition actually exists and whether we should continue to use it to understand the support needs of individuals with severe and/or multiple needs We are identifying key features of services that support this cohort of individuals, including accommodation/physical environments, appropriate staff training, and multi-agency input to assessments and support planning We are examining continuing health care referrals in more detail to facilitate the progression of CHC determinations for these individuals, in partnership with health colleagues in Surrey and other areas We will conduct a review of our most complex individual cases to establish a portrait of needs, clear outcomes for those individuals, and review current placements in and out of county

5. 5 Workstream Three – Dayservices – initial recommendations Surrey County Council still operate seven daycentres attended by 710 people  We are reviewing our current “offer” and the way in which meaningful day activities are delivered  Working towards a menu of activities for all day activities, detailing full costs of services  We will propose that all individuals accessing day services go through supported self assessment and have personal budgets  Review the delivery of meaningful day activities as part of work to move services from residential care to supported living  Clear policy on supporting individuals with higher needs; link to Continuing Healthcare work  Its broader than County Council services! We are working with other day services providers

6. 6 Workstream Four – Short Term Breaks – initial recommendations Surrey County Council either provide or purchase a residential model of respite provision. We purchase or provide approx 7,500 overnight stays each year, of which 50% are from the NHS.  Proposals for creation of a new range of options for people to access short breaks, to meet needs and within Individual Budgets  Utilise other capacity (e.g. Hotels and leisure providers) to deliver new individualised options; continued move away from buildings based respite  New respite services required in East of county (6 beds)  Stop and decommission respite services at selected locations to ensure there is an equitable provision across Surrey offering value for money  Review respite as part of work to move services from residential care to supported living

7. 7 Workstream Five – Review RAS arrangements – initial recommendations There has been a slow roll out of SDS and resource allocation to individuals with learning disabilities. There are challenges around the process. Issues around the length of time to approve packages of support. Issues around recording certain costs.  Internal processes are being reviewed and improved and the PVR is making initial recommendations to support this e.g. prompt fields in data system to ensure comprehensive recording  Very small sample to date: we know we need to find a way to advance the personalisation agenda for people with learning disabilities  Not enough cases with valid RAS points to justify a review of current RAS levels at the present time

8. 8 Workstream Six – PLD Placement Review – initial recommendations Phase Two of the Strategic Provider review has started. Clear information given to providers before the start of the process. Lessons learned from Phase one.  Phase One – successful renegotiation of terms with 17 providers  Phase Two – 23 providers contacted to arrange meeting  Quick turnaround expected following initial meeting  Relationship Manager allocated to each Strategic Provider from the Commissioning team

9. 9 Workstream Seven – Integrated Services – initial recommendations NHS Surrey, SABFT NHS Trust and District and Borough councils involved in the review to date.  Closer working relationship developing with NHS Surrey post transfer and pre roll out of GP Consortia across the county to establish joint commissioning initiatives  Establishing how individuals placed out of county by NHS can be supported to return to Surrey  Updates to NHS Surrey on progress and developing relationships with Strategic Providers  Working with NHS Surrey over promotion of healthy eating and leisure activity initiatives  Linking with District and Borough councils re Telecare initiatives, ensuring this is considered on conversion of properties to supported living  Development of Cobham model re dayservices across county  Website for housing under development, linking with partnership agencies and district councils  Expert by experience ‘mystery shopper’ review of D&B services offered and provider services

10. 10 Workstream Eight – Commissioning Strategy – initial recommendations Surrey County Council has not published a comprehensive learning disability strategy.  Market position statement required for clearer direction  Clearer commissioning direction emerging from PVR process  Final SCA workshop to discuss how this is finalised  Short summary document planned; Strategic Providers to benefit from more detailed data and research

11. 11 Workstream Nine – PLD Finance – initial recommendations The Surrey County Council Medium Term Financial Plan requires ongoing savings to be achieved, with 45% of ASC budget savings from PLD services  Further efficiencies to be established following PVR

12. 12 Workstream Ten – Transition – initial recommendations Young Adult’s transition team has already been restructured with additional resource allocated. Problems with length of time finding accommodation for some individuals and associated practice issues  Looking to utilise block contract beds and current provision for older people. Currently trialling support provided from a OP rather than PLD focused service  Pathways for young people to be reviewed for effectiveness  Transition team to work with YP from age 14  Comprehensive database of individuals to enable commissioning ie detail of needs and locations, specific requirements, current costings and availability of supported living

13. 13 Workstream Eleven – Engagement – initial recommendations PVR discussed widely with a range of organisations. Monthly Partnership Board update, four dedicated provider workshops, local Valuing People Groups attended, open day at Dorking Halls, Councillor and provider challenge.  Four further engagement events to be planned for October, to be held across county  Partnership Board update in November dedicated to PVR  Select Committee next week 21/9