building the road to independence · 4 building the road to independence 1. introduction doncaster...

Building the Road to IndependenceA Strategy for Modernising Adult Social Care and Support in Doncaster

Foreword ..................................................................................3

1. Introduction ..........................................................................4

2. Vision and Values ................................................................4

2.2 Our Values .............................................................................. 4

2.3 Delivery ................................................................................... 5

2.4 Scope and Equality Impact .................................................... 5

3. Why do we need to Change? ..............................................6

3.1 Adult Social Care and Support – The Current System ........... 6

3.2 Understanding Demand ........................................................ 6

3.3 Commissioning ...................................................................... 7

3.4 Health and Wellbeing ............................................................. 7

3.5 The Economic Climate ........................................................... 7

3.6 Summary ................................................................................ 7

4. Our Plans for Moving forward .............................................9

4.1 Commissioning ....................................................................... 9

4.2 Building Strong and Resilient Communities........................... 9

4.3 Prevention and Early Intervention ......................................... 10

4.4 Assessment and Eligibility for Support ................................ 10

4.5 Meeting Needs ..................................................................... 12

4.5.1 Personal Budgets ......................................................... 12

4.5.2 Specialist Accommodation .......................................... 12

4.6 Partnerships ......................................................................... 13

4.7 Workforce and Culture .......................................................... 14

5. Making it Real in Doncaster – How will we know if we’re getting it right? ................................................14

6. Bibliography .......................................................................15

7. References .........................................................................15

8. Local Plans and Strategies ...............................................16

Appendices

Appendix 1: Making it Real I Statements ................................... 17

Appendix 2: Glossary ................................................................ 18

Contents

Building the Road to Independence

A Strategy for Modernising Adult Social Care and Support in Doncaster 3

Most of us want to stay healthy and live our lives independently, in a place we can call home, with people we know and care about around us. We want to live in a supportive community we are familiar with and that feels safe. We like to be in control of our own lives choosing how we live according to our own values, wishes and interests and sometimes we want to make choices or take risks that others don’t necessarily agree with.

We want to be able to do everyday things for ourselves like go to work, visit friends and family, get the groceries, have our hair done, sort our money out and pursue our interests. Many of us want to have a sense of community, be connected to those around us and be able to make a positive contribution through volunteering for example. We also like to be valued and treated with dignity and respect.

In order for this to happen at some point we may need to make use of some or all of the following resources:• Personal resources – our own knowledge, skills and talents • Support networks – family, friends and neighbours • Community resources – schools, colleges, pubs, clubs, parks, leisure centres, health

centres, libraries, churches, community centres.

Sometimes some of us need a little help to maintain our wellbeing and independence. Some people need additional help due to impairments they are born with or develop; or a mental health condition developed during childhood or later on in life.

Adult social care and support is provided to help those who need it to manage the activities of day-to-day living that many of us take for granted. It covers different types of help including financial, practical and emotional.

With council budgets being squeezed, alongside an increasing older population and new government policy, the way adult social care and support is delivered needs to change.

We would like to use this document to have an honest conversation with you about what needs to change. We know some of what we need to do may be difficult to accept but our hope is that together we can make sure that in the future adult social care works more fairly and supports people more effectively.

It is important that you have an opportunity to contribute your views about this strategy. To help focus your feedback there are a number of questions embedded within the document. As the changes begin to take place, there will be further opportunities to share your views in specific areas.

You can let us know what you think through the Council website, by completing a questionnaire or by attending and participating at listening events during November and December. We look forward to hearing what you have to say.

Joan Beck, Director for Adults and Communities & Councillor Pat Knight, Cabinet Member for Health and Adult Social Care

Foreword

Building the Road to Independence4

1. Introduction

Doncaster Council’s purpose is to ensure Doncaster and its people thrive and that effective, value for money services are at the heart of everything that we do.’

Supporting a better life for people and helping to build strong and resilient communities, so that everyone can reach their potential and live a good life is what local government is about.

In future the Council’s role needs to change from being primarily a provider of service to providing the infrastructure support to empower local communities, build social capital (the skills and resources within a community) and ensure value for money through effective commissioning. This will be underpinned by a ‘core offer’ of services provided directly by the council only where there is a clear rationale for continuing to do so.

It is with this in mind that our plans for developing a modern system of adult social care and support in Doncaster have been developed.

The strategy ‘Building the Road to Independence’ describes the vision, values and foundations of a modern care and support system in Doncaster, outlines why we need to change, what we are already doing and what we plan to do next.

This document does not sit in isolation. It follows on from the recently published document ‘Doncaster 2017 – A council looking to the future – The Budget Conversation’ and sits within a number of borough wide and specific adult social care strategies and plans. Reference to these can be found on page 16.

2. Vision and Values

2.1 Our Vision We have chosen to adapt the following vision

developed by National Voices, a national coalition of health and social care charities, because it is based upon the experience of patients, service users, carers and their charities and echoes what we have heard locally.

‘Person centred, outcome focussed, coordinated care and support’

“I can plan my care and support with people who work together to understand me and my carer(s), who enable me to take control over my life, and who help me to bring together the resources I need to achieve the outcomes that are important to me.”

2.2 Our Values It is important to us that all Doncaster citizens feel

respected, are treated fairly and are recognised and valued for their different gifts and talents. When it comes to care and support Doncaster should be a place where people are:

Valued and Respected • People are free from discrimination, treated with

dignity and respect and recognised and valued for the vital contribution they make

• People are supported by a workforce that is also valued for the vital contribution that it makes.

Involved and Included • People are enabled to remain active and included

within their community for as long as possible • People’s views and experiences are central to our

work – working together to develop and provide services.

Placed at the heart of everything we do through Person Centred Approaches

Irrespective of how their care is funded people are: • Supported to find their own solutions, to

take control over their own wellbeing and independence and to use the resources available to them to prevent and postpone the need for more intensive care and support

• Enabled to make informed choices through a range of information sources and to access innovative, flexible and high quality care and support

• Supported to strike a good balance when making choices about risk


Safeguarded • People feel safe and are safeguarded from abuse.

Confident that services are well organised and represent value for money

• Services are secured on the basis of delivering good social and financial return on investment and the outcomes that are important to individuals.

2.3 Delivery Delivery of our Vision and Values in Doncaster will

mean: Taking a commissioning-led approach by: • Making better use of local intelligence to ensure

care and support is targeted towards people who need it, when and how they need it ensuring that there is a of range innovative, flexible and high quality care and support options which are not too heavily reliant on services provided by the Council

• Having a greater focus on outcomes for people – i.e. focussing more on the effect social care and support has on a person’s life rather than on the process and method of delivery

• Assuring quality so people can stay safe, remain well and live their life independently

• Clearly demonstrating cost effectiveness and the economic and social value of services

• Building capacity within communities and fostering a culture of co-production. This means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours and seeking to shift the balance of power, responsibility and resource to Doncaster people helping to maximise their contribution as citizens

• Making the strategic shift towards prevention and early intervention more quickly, prioritising the development of information advice and placing these at the forefront of the new system of care and support as a mechanism for avoiding crisis

• Increasing choice and control to ensure that care and support responds to need and delivers the outcomes people want

• Building upon well established relationships with partners to ensure services are better integrated and quality is assured through a workforce and culture that:

• champions person centred, self-directed and individualised care and support

• always treats people with dignity and respect and is able to respond to the diverse needs of the community

• supports people to strike the right balance between freedom of choice and protection from abuse and neglect

• helps to keep people safe by taking responsibility for what happens to them both within and across organisational boundaries

• Taking and implementing difficult decisions

about the future of services without unnecessary delay so people remain healthier and independent for longer. This will mean stopping or decommissioning services that are less popular and or less effective so that resources can be released to develop more modern and personalised services.

2.4 Scope and Equality Impact This strategy is intended to apply to all adults

aged 18 and over in need of care and support. We recognise however that some of the changes proposed will affect particular groups of people and some will require further consultation. In all cases we will ensure that the impact of the proposals on particular groups is fully assessed and more detailed consultation will take place.


3. Why do we need to Change?

3.1 Adult Social Care and Support – The Current System

During 2011, in preparation for its White Paper; ‘Caring for our future: reforming care and support,’ the Government engaged with thousands of people who used or worked in adult social care and support. Many reported how high-quality care and support had transformed the way they live their lives. This, however, was not the case for everyone.

What the Government heard was that: • Too often the system only reacts to a crisis • Society is not making the most of the skills and

talents that communities have to offer • People do not have access to good information

and advice • Access to care varies across the country and is

confusing • Carers have no clear entitlement to support • Not all care is good. The quality of care is variable

and inconsistent • People often feel ‘bounced around’ and have to

fight the system to have the joined-up health, care and support they need; and

• Our growing and ageing population will increase the pressures on the current system. (DH 2012)

These findings mirror what we know locally. People tell us that the system can be complicated and unnecessary bureaucracy causes confusion, creates delays and can disempower the people it is there to support.

Many say they have difficulty finding out what they want to know and not enough people are aware of what is available to help them.

People and communities are often identified in terms of their problems rather than their assets which can result in over provision, over dependency and an over reliance on formal care and support services. Sometimes support is provided indefinitely when it could be reduced or even stopped, and people can find themselves being admitted to residential care before they really need or want to be.

While it is right that those who need support are able to access it, there can be an expectation that care and support should be provided by the council when often, people could be supported to find their own solutions.

We need to make sure that people’s needs are identified properly and formal care and support services are not provided inappropriately.

We are already changing social care in Doncaster to reduce dependence and ensure access to support is more equitable and centred on the individual. This is a system-wide change and will need to take account of major changes from the Care and Support Bill 2012 currently going through Parliament. The Bill will place new duties and responsibilities on the council for promoting independence and wellbeing, and will also change significantly the way social care is funded.

3.2 Understanding Demand One of the main concerns for adult social care in

Doncaster is the rise, in line with national trends, in the older population. The following figures give a feel for the key likely impacts on demand for social care.

• Currently there are estimated to be 50,000 people over the age of 64 in Doncaster. By 2020, this will have increased to around 61,200. Three-quarters of people aged over 65 are likely to need care and support in their later years1.

• The number of people aged 65 and over with dementia is currently estimated to be 3,573 of which around 32 per cent and 13 per cent have moderate and severe dementia respectively. This number is likely to increase to 4,332 by 20202

• The number of unpaid carers in Doncaster had increased from 31,944 in 2001 to 33,364 in 20113

• The number of people aged 18-64 with a mental health problem is currently estimated to be 13,310 and is likely to decrease slightly over the next few years

• The number of people aged 18–64 with a learning disability is currently estimated to be 4,496 and again is likely to decrease slightly

• The number of people aged 18–64 with a severe physical disability is currently estimated to be 4,346 and is likely to increase slightly 4

• The number of people aged 18–64 with a serious visual impairment or profound hearing impairment is currently estimated at 186 and is likely to decrease slightly.

But demand is not just about numbers. Understanding demand also requires a good understanding of the communities in which people live and about what works for people and their different needs. This will require a more robust and informed approach to commissioning.


3.3 Commissioning Commissioning is defined by the Cabinet Office

in Partnership with Public Services (2006) as “the cycle of assessing the needs of people in an area, designing and then securing appropriate service.”

Doncaster has historically focussed on the end stages of the commissioning cycle – procuring the service and managing and monitoring service providers. In some cases contracts have been ‘rolled over’ rather than services being re-commissioned. Furthermore activity has been largely focussed on purchasing services that respond to more intensive care needs.

Insufficient emphasis has been placed on data analysis including data broken down by individual groups of people. This is needed to help us better understand how well services are performing, and future demand from the perspective of different individuals and groups who do or could benefit from support. Furthermore some services provided directly by the council have not been formally commissioned in the same way as contracted services.

This means that commissioning has not been based on a full understanding of the needs of individuals and the local community.

Good commissioning is fundamental to developing a modern system of care and support.

3.4 Health and Wellbeing Many of us look after ourselves physically and

mentally by eating healthily, exercising and living active lives. Health and wellbeing is improving in Doncaster for both men and women but not as fast as across the rest of the country.

Heart disease, strokes, cancer and alcohol are still major causes of death, with death rates from alcohol in Doncaster being twice the national average. Some parts of Doncaster have larger than average numbers of older people living on low incomes and many communities experience difficulty in accessing health provision, good housing, learning and employment opportunities, public transport, local shops and natural environments. This can undermine people’s health and wellbeing.

Where and how people live has a significant impact on their health and wellbeing their capacity to flourish and their resilience. This in turn impacts on the level of care and support they will need.

3.5 The Economic Climate In the 2012/13 financial year Doncaster Council spent

more than £112m on adult social care services.

The challenges we face financially are significant. Total Council spending needs to reduce by £109m by 2016/17.

We need to accept there is less money to do things and therefore be honest about what level of service the council will be able to fund. If there is an expectation that the council provide above this level then a way of funding this will need to be found.

3.6 Summary The need to have a modern adult social care and

support system in Doncaster has never been more relevant or pressing.

The existing approach has been widely criticised for making people more dependent on the system and leaving people feeling that choice, control and judgements about quality, lie in the hands of professionals rather than themselves.

Personalisation, the process by which services can be adapted to suit individuals, is the way the Government wants to develop a modern care and support system. Giving people more choice over how they are cared for and when, will make the care system more flexible and manageable financially in the future.

Over time adult social care in Doncaster has changed in response to national policy and local demand. If left alone however, the current system, faced with increasing demand and financial pressure, will not be affordable in the longer term and more needs to be done to prevent people entering the formal care system in the first place.

1 Source: Projecting Older People Population Information System www.poppi.org.uk

2 Source: Doncaster Data Observatory Dementia Health Needs Assessments July 2013

3 Source: Office for National Statistics Census 2011

4 Source: Projecting Adult Needs and Service Information website www.pansi.org.uk


Figure 1 compares the current system with the new system. It is based on the idea that:

• The current system does not offer enough support until people reach a crisis point

• The new system will promote wellbeing and independence at all stages to reduce the risk of people reaching a crisis point, and so improve their lives.

Figure 1

Current System New System

Living Well Living Well

Better info, advice & connections

Planning ahead to prevent care needs

More support in communities, better housing options & support for carersCrisis avoidance

Reablement & crisis response

Regaining Independence

Low-level Needs Low-level Needs

Crisis Crisis

Need for Intensive Care & Support

Need for Intensive Care & Support


What we will do next: • Agree the way in which the council will gather,

process and present data and management information for future strategic commissioning, decision making and performance management

• Take out of service (decommission) out-dated provision and models of care to modernise the provision of care and support.

4.2 Building Strong and Resilient Communities Doncaster has its own unique culture. It has some

very vibrant communities with people actively involved in volunteering, supporting community projects and looking out for their neighbours.

We want to encourage and enable people and communities to support themselves, ensure people feel safe and further build upon the distinctive qualities of residents and communities by putting people at the heart of everything we do. We aim to create a system which recognises everybody’s responsibility for and contribution to delivering lasting change.

What we are doing now: • Embedding the principles of working together

(co-production) and improving community participation and volunteering in a wide range of local activities including sport, culture, community self-help, and shaping and delivering local services

• Supporting improvement priorities through early intervention and prevention work within neighbourhoods and by building capacity and resilience in communities

• Progressing work to establish Doncaster as a Dementia Friendly Community

• Reducing anti-social behaviour and ensuring support to vulnerable victims

• Improving the response to domestic violence and reducing incidents

4. Our Plans for Moving Forward

The programme of change is broad and is requiring us to rewrite the whole system of care and support. The following sections outline the main proposals designed to modernise care and support in Doncaster and will involve some significant changes.

4.1 Commissioning In future we will take a commissioning-led approach

so the council can invest more in solutions that deliver real outcomes for individuals and communities and make best use of the resources available.

Decisions about use of resources will be much more firmly based on evidence from local people across all equality groups, about what is needed and what will enable them to achieve the outcomes they want. Information about the care and support market and levels of demand will also be gathered and used more routinely.

With a strong commitment to deliver choice and increase quality, flexibility and responsiveness without compromising safety, the council’s approach will transform traditional models of care into more modern and personalised community and home-based support.

We will also look at the additional social, economic and environmental benefits there might be in the services we commission.

What we are doing now: • Using the adult social care commissioning

strategy to modernise care and support in Doncaster

• Continuing work to encourage the development of the right mix of services in Doncaster through delivery of a Market Position Statement across the region and supporting market development in Doncaster

• Improving the use of data, information and intelligence to better support our commissioning decisions and ensure our staff are suitably trained to make the most of it

• Incorporating care and support services directly provided by the council into the commissioning process.


• Ensuring people have timely access to good information and advice which promotes choice and control and supports people to commission and independently fund their own care and support where appropriate

• Further improving the provision of equipment, adaptations and telecare

• Further improving the efficiency and effectiveness of rehabilitation and reablement capacity through continued service redesign.

What we will do next: • Consult on changes to day services to move

from directly provided services in favour of more community based, innovative, flexible and personalised solutions

• Invest in locally based solutions designed to prevent crisis, improve choice and control and promote independence.

4.4 Assessment and Eligibility for Support Fair Access to Care Services (FACS) criteria

currently determines who is eligible for support following a community care assessment. Four categories are used to determine the risk to a person’s independence and autonomy after considering their existing support networks. Councils are currently free to determine the threshold for people to ask for council help. The categories are:

• Low • Moderate • Substantial • Critical

The threshold in Doncaster is currently set at Moderate and above.

In 2010 Department of Health guidance – Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care asked local councils with social services responsibilities to review their eligibility criteria. Councils were encouraged to ensure that eligibility criteria was applied within the context of providing personalised care and support that extended beyond formal care services and helped people to remain independent.

The Government is due to set a new national eligibility framework in April 2015. A minimum threshold will be set for all Councils to comply with. Indications are that the national threshold will be set at a higher level than is currently in place in

• Supporting the reduction of health inequalities and promoting active citizenship through contributing to the following five areas of focus within Doncaster’s Health and Wellbeing Strategy:

• Alcohol • Mental Health and Dementia • Obesity • Family • Developing Personal Responsibility.

What we will do next: • Agree what support we can provide to help

communities to help themselves in order that people can remain in their own homes and communities for as long as possible.

4.3 Prevention and Early Intervention Research shows that if people receive a little

help early on, they have more chance of living in their own home for longer. Building strong and resilient communities and developing effective solutions to avoid crisis are vital to making sure that the formal care and support system can cope with future demand.

We aim to ensure that all adults in Doncaster who receive care or who may do so in the future continue to have access to a range of opportunities such as telecare (technology that helps people with daily living) and reablement (support to help people relearn and regain daily living skills lost as a result of an illness or accident) to prevent crisis and support them to live independently.

We will also seek to ensure that carers in Doncaster are properly valued for the significant contribution they make, are better supported in their caring role and are able to have a life outside of caring.

Ultimately we want to make sure that the offer of support at this level is modern, cost effective and flexible enough to meet changing demand and prevent crisis.

What we are doing now: • Completing and implementing both the

Independence and Wellbeing Strategy and Carers Strategy. This will involve setting up a network of locally based services designed to prevent crisis, improve quality of life and maximise independence within communities

• Considering more flexible and appropriate day opportunities to support independence and wellbeing


Doncaster. This means fewer people will be entitled to ask Doncaster Council to meet their eligible needs than can do so now. By taking the approach described in the 2010 guidance however, we hope to establish a framework of support that goes beyond a reliance on formal services.

Working in this way will mean that the council’s limited resources are targeted towards those who need it most whilst others will be supported to find solutions from their own and wider community networks.

Figure 2 Demonstrates how people with eligible needs will be supported above and below the threshold in the future.

Universal Services and Short-term Support People helped to help themselves

Community capacity building Targeted prevention

Reablement

Support for people whose needs do not meet the threshold

Support for people whose needs meet or are over the threshold

Ongoing SupportPersonal Budgets

Specialist accommodation including residential care

Eligibility Threshold


What we are doing now: • Progressing work to encourage community

solutions, enable people to take more personal responsibility and develop early support to reduce the reliance on specialist adult social care services

• Completing a review of eligibility policies for providing social care ahead of the national minimum threshold in 2015

• Improving the current application of FACS criteria to ensure specialist support is targeted towards those most in need.

What we will do next: • Raise the FACS threshold to the national minimum

threshold in April 2015.

4.5 Meeting Needs

4.5.1 Personal Budgets People who are eligible for on-going support are

now able to access that support via a Personal Budget. Evidence suggests that when people have a Personal Budget, particularly when taken as a Direct Payment, they spend the money much more efficiently and achieve better outcomes than through more traditional forms of support.

Personal Budgets were introduced in Doncaster just over three years ago. This has largely been a positive step. However the system needs modernising to allow people the freedom to spend the money they are entitled to on the things they know will make the most difference to their lives. The differing levels at which subsidies are set in Doncaster could be affecting take up of direct payments.

We want to improve access to Personal Budgets, increase take up of Direct Payments and develop a more person-centred approach where services are co-produced with people who could or do use them.

What we are doing now: • Redesigning processes so that getting a Personal

Budget is quicker, more straightforward and positively encourages people to take up the offer of a Direct Payment so that they can have maximum choice and control over their care. This will include support to help people manage their Personal Budget

• Continuing to work with all staff and organisations to ensure personalised care and support is available in all care settings.

What we will do next: • Review policies to encourage a higher take up

of Direct Payments for example by revisiting subsidy levels.

4.5.2 Specialist Accommodation Whilst our aim is to do everything we can to support

people to remain in their own home for as long as possible, for some people a move to more specialist accommodation may be needed.

Some people with a learning disability may be looking to move from more institutionalised settings to accommodation which is more suited to independent living such as supported living.

We will be providing more supported living options for people with a learning disability, including group homes and extra care as an alternative to residential care.

For some people residential or nursing care is the right choice and when this is the case, people should expect to receive good quality, safe and personalised care.

There is currently an oversupply of residential care for older people and a rise in vacancies in both the independent sector and council provided service. At the same time there is an under-supply of alternative provision.

Despite a modernisation programme in the early 1990s a review of in-house residential care services has confirmed that many of the Council’s eight residential care homes for older people do not meet the minimum environmental standards and the service is generally more costly than that provided by the independent sector.

By comparison to other similar councils, permanent admissions of older people into residential care appear high in Doncaster and the Council directly provides a comparatively high proportion of that care [230 of 1,110 (20.7 per cent) people are supported by the Council in council owned residential care homes – the second highest in the region]

This coupled with our aim to support people to live independently in their own homes for as long as possible, means that a reduction in conventional residential care beds is needed in favour of specialist short-term rehabilitation and assessment beds, extra care housing and residential and nursing beds for people with dementia.

What we are doing now: • Looking at ways in which we can reduce reliance

on residential care and the numbers of people admitted to care homes, and reduce the number of council owned residential care homes


What we are doing now: • Establishing a clearer picture about how we can

work even better together to improve outcomes for people who use services

• Progressing work to establish an approach to joint commissioning in Doncaster

• Supporting the Health and Wellbeing Board priorities particularly developing personal responsibility.

What we will do next: • Develop with partners a five year strategic

plan for further integration as a way of achieving more person-centred, outcome-focussed, coordinated care and deliver efficiencies across the whole system.

4.7 Workforce and Culture It is vitally important that everyone involved in

modernising adult social care in Doncaster is clear about what it is that we are trying to achieve and that the right culture is developed to support that.

Whilst much has been done to modernise adult social care there is more work to be done. One of the challenges lies in developing a culture across all geographical, specific interest and organisational communities that can truly embrace the principles of personalisation and shift the balance of power, responsibility and resource back to the people of Doncaster.

To respond to the challenges, we need to strike the right balance between state and individual responsibility and develop a workforce that can provide responsive, flexible and safe services.

We want to develop a better understanding across all stakeholders of what it is we are trying to achieve regarding adult social care and support and what that means for Doncaster.

What we are doing now: • Working in partnership with a range of

stakeholders including elected Members to help them understand the changes we need to make

• Working with staff within communities, adult social care and across key partner agencies to help them understand the changes needed and embed person centred and more co-ordinated ways of working.

What we will do next: • Agree and implement Doncaster’s Adult Social

Care Workforce strategy 2013 – 2018

• Continuing to develop more flexible housing options including extra care and supported living

• Working with providers to ensure care is more personalised in residential settings.

What we will do next: • Consult on the future of council owned residential

care homes for older people to enable further development of specialist short term rehabilitation and assessment beds and residential/nursing beds for people with dementia.

4.6 Partnerships In the face of greatly reduced resources but rising

public expectation and demand, all partners will have to think creatively about how services can be delivered in the future.

In Doncaster we believe we can secure better outcomes by working in partnership with individuals, communities and across organisations than we can hope to achieve by working in isolation.

Doncaster’s health and social care community has a strong history of partnership working and has developed a range of approaches to deliver more co-ordinated care and support.

• The rollout of One Team Working – a partnership between Doncaster Council and RDASH (Rotherham, Doncaster and South Humber NHS Foundation Trust) to provide integrated community health and social care services

• Doncaster’s stronger families initiative, which seeks to establish a more co-ordinated, collaborative and persistent approach to working with families with multiple needs

• The involvement of the voluntary and community sector in service development and delivery

• Work to establish joint health and social care commissioning arrangements.

The challenge to organisations is to recognise that individuals and communities have a contribution to make in achieving our ambitions and must do more to engage them as genuine partners rather that passive recipients of service.

We want to continue to demonstrate our commitment to working better together to improve outcomes for people, and ensure we are doing everything we can to maximise the use of resources and deliver efficiency savings.


5. Making it Real in Doncaster – How will we know if we’re getting it right?

Arranged by an organisation called ‘Think Local Act Personal’ – people who use adult social care services up and down the country got together and described what success would look and feel like.

A set of ‘I’ statements were developed which represent what people will say if things are done well. The statements are grouped in six areas:

1) Information and Advice: having the information I need, when I need it

2) Active and supportive communities: keeping friends, family and place

3) Flexible integrated care and support: my support, my own way

4) Workforce: my support staff 5) Risk enablement: feeling in control and safe 6) Personal budgets and self-funding: my money

These statements are attached as Appendix 1 and again mirror what people have told us locally. We will use these statements as a way of measuring and monitoring performance locally and will use our Local Account to demonstrate progress to the people of Doncaster.


6. Bibliography

Boyle D, Harris M (2009), THE CHALLENGE OF CO-PRODUCTION How equal partnerships between professionals and the public are crucial to improving public services. Nesta, London

Broad R, With contributions from Simon Duffy, Alex Fox, Brian Frisby, Patrick Graham, Carol Taylor and Neil Woodhead (2012) Local Area Coordination FROM SERVICE USERS TO CITIZENS, The Centre for Welfare reform

DH (2010), Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care Guidance on Eligibility Criteria for Adult Social Care, DH, London

Healthy Communities Programme (2010), The role of Local Government in Promoting wellbeing, Local Government Improvement and Development, London

7. References

DH, (2012) Caring for our future: reforming care and support, DH, London


8. Local Plan and Strategies

Borough wide plans and strategies • A Plan for Doncaster – Doncaster’s Borough

Strategy 2010-2015 • Doncaster’s Health and Wellbeing Strategy • The Council Plan • The Council’s Commissioning and Procurement

Strategy • Better Homes Better Places – Doncaster Housing

Strategy 2011-214 • The Doncaster Safeguarding Adults Partnership

Board Strategic Aims 2013 -2016 • The Community Involvement Strategy • Building equality considerations into decision

making- A Three Point Plan

Adult social care plans and strategies • Doncaster’s Adult Social Care Commissioning

Strategy – Building the road towards person centred commissioning,

• Towards Independence and Wellbeing – A Strategy for Prevention and Early Intervention in Doncaster,

• Anyone Anytime – Doncaster’s Carer Strategy (still in development)

• Doncaster’s Integrated Adult Social Care Workforce Strategy 2013 – 2018 (still in development)


Appendix 1

Think Local Act Personal Making It Real Markers For Progress

1) Information and Advice: having the information I need, when I need it

“ I have the information and support I need in order to remain as independent as possible.”

“ I have access to easy-to-understand information

about care and support which is consistent, accurate, accessible and up to date.”

“ I can speak to people who know something about care and support and can make things happen.”

“ I have help to make informed choices if I need

and want it.” “ I know where to get information about what is going

on in my community.”

2) Active and supportive communities: keeping friends, family and place

“ I have access to a range of support that helps me to live the life I want and remain a contributing member of my community.”

“ I have a network of people who support me – carers, family, friends, community and if needed paid support staff.”

“ I have opportunities to train, study, work or engage

in activities that match my interests, skills, abilities.”

“ I feel welcomed and included in my local community.”

“ I feel valued for the contribution that I can make to my community.”

3) Flexible integrated care and support: my support, my own way

“ I am in control of planning my care and support.”

“ I have care and support that is directed by me and responsive to my needs.”

“ My support is coordinated, co-operative and works well together and I know who to contact to get things changed.”

“ I have a clear line of communication, action and follow up.”

4) Workforce: my support staff “ I have good information and advice on the range

of options for choosing my support staff.” “ I have considerate support delivered by

competent people.”

“ I have access to a pool of people, advice on how to employ them and the opportunity to get advice from my peers.”

“ I am supported by people who help me to make links in my local community.”

5) Risk enablement: feeling in control and safe “ I can plan ahead and keep control in a crisis.”

“ I feel safe, I can live the life I want and I am supported to manage any risks.”

“ I feel that my community is a safe place to live and local people look out for me and each other.”

“ I have systems in place so that I can get help at an early stage to avoid a crisis.”

6) Personal budgets and self-funding: my money “ I can decide the kind of support I need and when,

where and how to receive it”. “ I know the amount of money available to me for

care and support needs, and I can determine how this is used (whether it’s my own money, direct payment, or a council managed personal budget).”

“ I can get access to the money quickly without having

to go through over-complicated procedures.”

“ I am able to get skilled advice to plan my care and support, and also be given help to understand costs and make best use of the money involved where I want and need this.”


Common Social Care Terms

Term Definition

Abuse Harm that is caused by anyone who has power over another person, which may include family members, friends, unpaid carers and health or social care workers. It can take various forms, including physical harm or neglect, and verbal, emotional or sexual abuse. Adults at risk can also be the victim of financial abuse from people they trust. Abuse may be carried out by individuals or by the organisation that employs them.

Adult social care Care and support for adults who need extra help to manage their lives and be independent – including older people, people with a disability or long-term illness, people with mental health problems, and carers. Adult social care includes assessment of people’s needs, provision of services or allocation of funds to enable you to purchase your own care and support. It includes residential care, home care, personal assistants, day services, the provision of aids and adaptations and personal budgets.

Advocacy Help to enable you to get the care and support you need that is independent of your local council. An advocate can help you express your needs and wishes, and weigh up and take decisions about the options available to you. They can help you find services, make sure correct procedures are followed and challenge decisions made by councils or other organisations. The advocate is there to represent your interests, which they can do by supporting you to speak, or by speaking on your behalf. They do not speak for the council or any other organisation. If you wish to speak up for yourself to make your needs and wishes heard, this is known as self-advocacy.

Aids and adaptations Help to make things easier for you around the home. If you are struggling or disabled, you may need special equipment to enable you to live more comfortably and independently. You may also need changes to your home to make it easier and safer to get around. Aids and adaptations include things like grab rails, ramps, walk-in showers and stair-lifts.

Assessment See also: Pre-assessmentSelf-assessment

The process of working out what your needs are. A community care assessment looks at how you are managing everyday activities such as looking after yourself, household tasks and getting out and about. You are entitled to an assessment if you have social care needs, and your views are central to this process.

Benefits Payments from the Government that you may receive because of your age, disability, income or caring responsibilities. Some benefits are universal – paid to everyone regardless of their income. Others are paid to people who have particular types of needs, regardless of their income. And others are means-tested – only paid to people whose income or savings fall below a certain level. Benefits in England are paid by the Department of Work and Pensions, not your local council.

Broker (also called ‘care navigator’)See also:AdvocacySignposting

Someone whose job it is to provide you with advice and information about what services are available in your area, so that you can choose to purchase the care and support that best meets your needs. They can also help you think about different ways that you can get support, for example by making arrangements with friends and family. A broker can help you think about what you need, find services and work out the cost. Brokerage can be provided by local councils, voluntary organisations or private companies.

Appendix 2


Care plan See also: Support plan

A written plan after you have had an assessment, setting out what your care and support needs are, how they will be met (including what you or anyone who cares for you will do) and what services you will receive. You should have the opportunity to be fully involved in the plan and to say what your own priorities are. If you are in a care home or attend a day service, the plan for your daily care may also be called a care plan.

Carer A person who provides unpaid support to a partner, family member, friend or neighbour who is ill, struggling or disabled and could not manage without this help. This is distinct from a care worker, who is paid to support people.

Care Worker A person who is paid to support someone who is ill, struggling or disabled and could not manage without this help.

Client contribution See also: Self-funding

The amount you may need to pay towards the cost of the social care services you receive. Whether you need to pay, and the amount you need to pay, depends on your local council’s charging policy, although residential care charges are set nationally. Councils receive guidance from the Government on how much they can charge.

Client group A group of people with social care needs who fit within a broad single category. Client groups include older people, people with physical disability, people with learning disability, people with mental health problems, and so on.

Commissioner A person or organisation that plans the services that are needed by the people who live in the area the organisation covers, and ensures that services are available. Sometimes the commissioner will pay for services, but not always. Your local council is the commissioner for adult social care. NHS care is commissioned separately by local clinical commissioning groups. In many areas health and social care commissioners’ work together to make sure that the right services are in place for the local population.

Community care services Social care services that can help you live a full, independent life and to remain in your own home for as long as possible.

Community health services Health services that are provided outside hospitals, such as district nursing.

Continuing health care Ongoing care outside hospital for someone who is ill or disabled, arranged and funded by the NHS. This type of care can be provided anywhere, and can include the full cost of a place in a nursing home. It is provided when your need for day to day support is mostly due to your need for health care, rather than social care. The Government has issued guidance to the NHS on how people should be assessed for continuing health care, and who is entitled to receive it.

Co-production When you as an individual are involved as an equal partner in designing the support and services you receive. Co-production recognises that people who use social care services (and their families) have knowledge and experience that can be used to help make services better, not only for themselves but for other people who need social care.

Core service offer A clear statement by the council outlining what people can expect regarding the provision of either support or services from the council.

Direct paymentsSee also:Personal budget

Money that is paid to you (or someone acting on your behalf) on a regular basis by your local council so you can arrange your own support, instead of receiving social care services arranged by the council. Direct payments are available to people who have been assessed as being eligible for council-funded social care. They are not yet available for residential care. This is one type of personal budget.


Eligibility When your needs meet your council’s criteria for council-funded care and support. Your local council decides who should get support, based on your level of need and the resources available in your area. The eligibility threshold is the level at which your needs reach the point that your council will provide funding. If the council assesses your needs and decides they are below this threshold, you will not qualify for council-funded care.

Home care Care provided in your own home by paid care workers to help you with your daily life. It is also known as domiciliary care. Home care workers are usually employed by an independent agency, and the service may be arranged by your local council or by you (or someone acting on your behalf).

Independent living The right to choose the way you live your life. It does not necessarily mean living by yourself or doing everything for yourself. It means the right to receive the assistance and support you need so you can participate in your community and live the life you want.

Integrated Care Joined up, coordinated health and social care that is planned and organised around the needs and preferences of the individual, their carer and family. This may also involve integration with other services for example housing.

Occupational therapist A professional with specialist training in working with people with different types of disability or mental health needs. An OT can help you learn new skills or regain lost skills, and can arrange for aids and adaptations you need in your home. Occupational therapists are employed both by the NHS and by local councils.

Older people Older people are the largest group of people who use adult social care services. Many councils define people over the age of 50 as ‘older’, but social care services for older people are usually for people over the age of 65 – unless you have particular needs that make you eligible before this age.

Outcomes In social care, an ‘outcome’ refers to an aim or objective you would like to achieve or need to happen – for example, continuing to live in your own home, or being able to go out and about. You should be able to say which outcomes are the most important to you, and receive support to achieve them.

Personal assistant Someone you choose and employ to provide the support you need, in the way that suits you best. This may include cooking, cleaning, help with personal care such as washing and dressing, and other things such as getting out and about in your community. Your personal assistant can be paid through direct payments or a personal budget.

Personal budget Money that is allocated to you by your local council to pay for care or support to meet your assessed needs. The money comes solely from adult social care. You can take your personal budget as a direct payment, or choose to leave the council to arrange services (sometimes known as a managed budget) – or a combination of the two. An alternative is an individual service fund, which is a personal budget that a care provider manages on your behalf. A personal health budget may also be available: it is a plan for your health care that you develop and control, knowing how much NHS money is available.

Personalisation/Person Centred

A way of thinking about care and support services that puts you at the centre of the process of working out what your needs are, choosing what support you need and having control over your life. It is about you as an individual, not about groups of people whose needs are assumed to be similar, or about the needs of organisations.

Pre-assessment The point at which you make contact with your local council and a decision is made about whether a full assessment is necessary. This is based on the information given by you or the person who refers you to adult social care. It is often conducted over the phone.


Preventive/early intervention services

Services you may receive to prevent more serious problems developing. These include things like reablement, telecare, befriending schemes and falls prevention services. The aim is to help you stay independent and maintain your quality of life, as well as to save money in the long term and avoid admissions to hospital or residential care.

Primary care The part of the NHS that is the first point of contact for patients. This includes GPs, community nurses, pharmacists and dentists.

Reablement A way of helping you remain independent, by giving you the opportunity to relearn or regain some of the skills for daily living that may have been lost as a result of illness, accident or disability. It is similar to rehabilitation, which helps people recover from physical or mental illness. Your council may offer a reablement service for a limited period in your own home that includes personal care, help with activities of daily living, and practical tasks around the home.

Referral A request for an assessment of a person’s needs, or for support from a social care organisation. A referral to adult social care may be made by your GP, another health professional or anyone else who supports you. You can also refer yourself, or a member of your family, by contacting the adult social care department at your local council.

Residential care Care in a care home, with or without nursing, for older people or people with disabilities who require 24-hour care. Care homes offer trained staff and an adapted environment suitable for the needs of ill, frail or disabled people.

Resource Allocation System The system some councils use to decide how much money people get for their support. There are clear rules, so everyone can see that money is given out fairly. Once your needs have been assessed, you will be allocated an indicative budget – so that you know how much money you have to spend on care and support. The purpose of an indicative budget is to help you plan the care and support that will help you meet your assessed needs – it might not be the final amount that you get, as you may find that it is not enough (or is more than enough) to meet those needs.

Respite care A service giving carers a break, by providing short-term care for the person with care needs in their own home or in a residential setting. It can mean a few hours during the day or evening, ‘night sitting’, or a longer-term break. It can also benefit the person with care needs by giving them the chance to try new activities and meet new people.

Review When you receive a re-assessment of your needs and you and the people in your life look at whether the services you are receiving are meeting your needs and helping you achieve your chosen outcomes. Changes can then be made if necessary.

Rights What you are entitled to receive, and how you should be treated, as a citizen. If you have a disability or mental health problem, are an older person or act as a carer for someone else, you have the right to have your needs assessed by your local council. You have a right to a service or direct payment if your assessment puts you above the eligibility threshold your council is using. You and your carers have a right to be consulted about your assessment and about any changes in the services you receive.

Risk assessment An assessment of your health, safety, wellbeing and ability to manage your essential daily routines. You might also hear the term risk enablement, which means finding a way of managing any risks effectively so that you can still do the things you want to do.


Safeguarding The process of ensuring that adults at risk are not being abused, neglected or exploited, and ensuring that people who are deemed ‘unsuitable’ do not work with them. If you believe that you or someone you know is being abused, you should let the adult social care department at your local council know. They should carry out an investigation and put a protection plan in place if abuse is happening. Councils have a duty to work with other organisations to protect adults from abuse and neglect. They do this through local safeguarding boards.

Self-assessmentSee also:Pre-assessment

A form or questionnaire that you complete yourself, either on paper or online, explaining your circumstances and why you need support. A social care worker or advocate can help you do this. If your council asks you to complete a self-assessment form, it will use this information to decide if you are eligible for social care services or if you need a full assessment by a social worker.

Self-directed supportSee also:Personalisation

An approach to social care that puts you at the centre of the support planning process, so that you can make choices about the services you receive. It should help you feel in control of your care, so that it meets your needs as an individual.

Self-funding When you arrange and pay for your own care services and do not receive financial help from the council.

People who use services Anyone who uses care services, whether you are in your own home, in residential care or in hospital. The NHS is likely to describe you as a ‘patient’, while the council and other care providers may also describe you as a ‘client’ or ‘service user’. You may also be described as a ‘cared-for person’, in relation to your carer.

Signposting See also: Broker

Pointing people in the direction of information that they should find useful. Your local council should signpost you towards information about social care and benefits through its helpline or call centre (if it has one), website and through local services such as libraries and health centres.

Single assessment process An attempt to coordinate assessment and care planning across the NHS and councils, so that procedures aren’t repeated and information is shared appropriately. It was introduced because people sometimes have a wide range of needs and can end up being assessed more often than necessary, and information can end up getting lost. The single assessment process is widely used for older people, and increasingly for other adults with care needs.

Social worker A registered professional who works with individual people and families to help improve their lives by arranging to put in place the things they need. This includes helping to protect adults and children from harm or abuse, and supporting people to live independently. Social workers support people and help them find the services they need. They may have a role as a care manager, arranging care for service users. Many are employed by councils in adult social care teams; others work in the NHS or independent organisations.

Support plan A plan you develop that says how you will spend your personal budget to get the life you want. You need to map out your week, define the outcomes you hope to achieve, and show how the money will be used to make these happen. Your local council must agree the plan before it makes money available to you.

Telecare Technology that enables you to remain independent and safe in your own home, by linking your home with a monitoring centre that can respond to problems. Examples are pendant alarms that you wear round your neck, automatic pill dispensers, and sensors placed in your home to detect if you have fallen or to recognise risks such as smoke, floods or gas-leaks. The monitoring centre is staffed by trained operators who can arrange for someone to come to your home or contact your family, doctor or emergency services.


Universal services Services such as transport, leisure, health and education that should be available to everyone in a local area and are not dependent on assessment or eligibility.

Voluntary organisations Organisations that are independent of the Government and local councils. Their job is to benefit the people they serve, not to make a profit. The people who work for voluntary organisations are not necessarily volunteers – many will be paid for the work they do. Social care services are often provided by local voluntary organisations, by arrangement with the council or with you as an individual. Some are user-led organisations, which means they are run by and for the people the organisation is designed to benefit – e.g. disabled people.

Wellbeing Being in a position where you have good physical and mental health, control over your day-to-day life, good relationships, enough money, and the opportunity to take part in the activities that interest you.

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