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Table of contents

Page

Demographics and activity in 2014/15 2

Welcome 3

Spend and money 4

Complaints and compliments 5

Adult Social Care Survey 6

Survey of Adult Carers 7

Devolution Manchester – preparation 8

Integration with health and ‘Living Longer, Living Better’ (LLLB) 9

The Care Act 2014 – what it means for citizens; how we prepared 10–11

Support to maintain Independence in the community 12

Citizens who need additional support 13–14

Disabled citizens 15–18

Substance misuse 19

Mental health and dementia 20

Keeping Citizens Safe – Safeguarding; Deprivation of liberties (DoLS) 21

Manchester Safeguarding Adults Board 22

Domestic violence 23

Social housing and homelessness 24

Personalisation; Freedom of Information 25

26 Sector-led improvement 26

Looking Forward 27–28

Contact 29

! Explanation boxes will help you understand some of the terms used in this document.

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Adult Social Care in Manchester A N N U A L L O C A L A C C O U N T

Demographics and activity in 2014/15

Population data from: Office for National Statistics, Population Estimates for UK, Mid-2014

182 Number of adult social care

complaints received

80 Number of adult social care

compliments received

1,763 Safeguarding investigations

that were completed

356,140 Population of Manchester

aged 18–64

49,354 Population of Manchester

aged 65 or older

28,176 Number of contacts from

new clients

6,230 Carers are known to adult

social care in Manchester

7,470 Citizens aged 18–64

received long-term

community-based services

4,604 Citizens aged 65+ received

long-term community-based

services

24,569 Pieces of equipment and/

or adaptations installed

100% Of citizens assessed or

reassessed were satisfied

with the assessment service (via customer satisfaction form)

455.15

per 100,000

Number of older citizens

permanently admitted to

residential or nursing care

3

ANNUAL LOCAL ACCOUNT

Welcome

Councillor Paul Andrews, Executive Member for Adult Health and Wellbeing

As the Executive Member for Health and Care, I am extremely pleased to publish this year’s Local Account.

Much of the work around adult social care is often hidden, and the way in which the national media

portrays social care activity can often be limited to just one or just areas. What this Local Account does,

therefore, is demonstrate the breadth of what we do and how we do it in Manchester. We are here to

serve and support older and disabled people in a variety of ways that both promote their independence

and allow them to have a good quality life. This relies on having an exceptional workforce, which we have

– one which works hard to deliver high-quality care to some of the most vulnerable people in this city.

I have found this report to be very useful and a great source of reference. I hope it is useful for you too.

Hazel Summers, Strategic Director (Adult Services)

For me, it is important that we continue to publish a Local Account and that our citizens and carers can read

about the important work we carry out. While the facts and figures are interesting, what really matters is

how we improve outcomes for Manchester citizens. Some of the short examples we have therefore included

describe the benefits of a particular service for a person – something that is really at the heart of adult

social care.

In addition, we are working towards a much bigger picture – we know we need to support people who are

eligible to receive care and support, but we need to do it in a way that helps the person become more

independent. The term sometimes used here is ‘enablement’ or ‘reablement’ and means helping people back

to independence. We think that this is the best way to help everyone do more for themselves, which leads to

a better quality of life. That aside, we have a central duty to safeguarding vulnerable adults, and that will

continue to receive the highest priority. I’d like to take this opportunity to thank everyone involved in adult

social care provision in the city – both within the Council and external providers/partners – for supporting us

to deliver adult social care to such a high standard.

4

Overview of the year

Spend and money

The total amount of money Manchester City Council spent on adult social care in 2014/15 is shown below.

Some breakdowns of expenditure

Breakdown by citizen group

Working-age adults

£61.1million

Older citizens

£43.1million

Breakdown by service provided

Residential care

£25.6million

Nursing care

£8.4million

Home care

£10.4million

Direct payments

£6.9million

Supported accommodation

£42.2million

Other

£4.7million

If we look forward to 2015/16, the budgetted expenditure for the same areas is:

Budgeted expenditure

Breakdown by citizen group

Working-age adults

£58.2million

Older citizens

£34.8million

Breakdown by service provided

Residential care

£23.1million

Nursing care

£8.6million

Home care

£10.7million

Direct payments

£6.4million

Supported accommodation

£34.1million

Other

£4.5million

As an overall Children and Families Directorate, budget cuts of £166million have been made between

2011/12 and 2015/16.

For 2015/16 the cut across the directorate is £39million, with the adult care budget being reduced by

£15million. The financial position across the directorate remains very challenging.

5

Complaints and compliments

As a result of complaints in 2014/15 we have taken the learning from the complaints and:

introduced annual peer case reviews and benefit checks on all Client Financial Services cases to

ensure that correct benefit claims are in place for our citizens

increased monitoring of Ordinary Residence Cases that occur in the Transitional Planning Team

increased contract monitoring of home care agencies where failings have occurred

provided one-to-one training for officers to improve their ability to engage with the public

staff members have attended dementia awareness and recording with care training

a new transport contract is in place to make sure that the vehicle management process is adequate

there has been a review of the training of drivers operating vehicles with tail lifts to ensure this covers

a wider variety of platform failures, paying particular attention to the operation of the manual

override in the event of a failure.

Some examples of compliments from 2014/15

“The assessment interview carried out … was done very well and made me feel very safe and confident. They had done a good job. Excellent staff.” “I just wanted to thank you for your help in getting me into detox. I know I still have a long way to go but I will get there thanks to the help and support that you have both given me. I can't thank you enough for another chance.”

“This is a brief note of thanks for all the kind assistance the team have given

me. My thanks go to them for their constant help given with so much concern.

… I feel confident now that because of their past help I can cope with life's

problems. My best wishes.”

Customer satisfaction forms – Adult Services had 523 customer satisfaction forms returned by customers who had had an assessment or reassessment.

100% rated the member of staff as Good or Excellent.

100% were Very Satisfied or Satisfied with the assessment service.

97% were Very Satisfied or Satisfied with the care and support service they received.

182

Number of adult social care

complaints received

12

Number of adult social care

ombudsman complaints

34% were resolved within 24

hours, and not formally

progressed

65 complaints were upheld or

partially upheld

7 ombudsman complaints were upheld or partially upheld

100% Of citizens assessed or reassessed were satisfied with the

assessment service

80 Number of adult

social care

compliments received

6

Adult Social Care Survey

The Adult Social Care Survey is carried out every year by all local authorities with a responsibility for adult

social services.

In February 2015 around two thousand Manchester residents aged 18 and over who receive community-

based or residential care funded, at least in part, by Manchester City Council were invited to participate. This

included citizens assessed by Manchester City Council, Manchester Mental Health and Social Care Trust, and

Manchester Learning Disability Partnership. The survey asked a number of questions regarding citizens’

experiences and opinions of the care they receive and how this affects their lives. Two different versions of

the questionnaire were produced, with one designed to allow citizens with a learning disability to participate.

Some of our results – percentage of citizens who:

39.6% Said they had as

much social contact

as they would like

74.5% Said it was easy to

find information

about services

63% Said they feel safe

as they want

84.4% Extremely, Very or Quite satisfied with care and support

59.2%

Said having help makes me feel

better about myself

72.9% Said they get

regular help from

family or friends

74.9% Said care and

support services help them feel safe

50.7% Are satisfied with

how the Council runs things

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Survey of Adult Carers

The Survey of Adult Carers is carried out every other year by all local authorities with a responsibility for

adult social services.

In October 2014 1,200 Manchester residents over the age of 18 who care for somebody over the age of 18

and have had a carer’s assessment or review in the last 12 months were invited to participate in the biennial

Survey of Adult Carers. This included citizens assessed by Manchester City Council, Manchester Mental Health

and Social Care Trust, and Manchester Learning Disability Partnership. The survey asked a number of

questions regarding citizens’ experiences and opinions of the care they, and the citizens they care for, receive

and how this affects their lives.

The survey asks 27 questions, including some local Manchester ones. Questions vary in structure, and some

have multiple answers while others require one answer only.

Not everybody who filled in the survey answered every question. Where this was the case we have given the

number of citizens who did not answer that particular question.

Some of our results – percentage of carers who:

* Of the 221 citizens who had tried to find information, and responded Very or Fairly easy **Of the 259 citizens who had received services, and responded Extremely, Very or Quite satisfied

41% Said they had as

much social contact

as they would like

73% Said it was easy to

find information about services*

84% Have no worries about personal

safety

75% Extremely, Very or Quite satisfied with care and support**

71.6%

Felt included in discussions about

cared-for person

33% Spend more than

100 hours caring per

week

41% Have been a carer

for ten years or longer

70% Have one or more health conditions

themselves

6,230 Carers are known to

adult social care in

Manchester

8

Devolution Manchester – preparation Devolution is the transfer of certain powers and responsibilities from the Government to a particular geographical region. Putting power into the hands of local decision-makers means they can better meet the needs of the people who live and work in their region. Greater Manchester is the first region in England to benefit from this transfer of power away from the Government to local decision-makers. In February 2015 the Association of Greater Manchester Authorities (AGMA) and the Association of Greater Manchester Clinical Commissioning Groups (CCGs) signed a memorandum of understanding with NHS England to create a framework for achieving the delegation and ultimate devolution of health and social care responsibilities to accountable and statutory bodies in Greater Manchester. The purpose of Manchester City Council and the other statutory health and social care organisations across Greater Manchester entering into the agreement was to:

improve the health and wellbeing of all of the residents of Greater Manchester, from early ages to older people, recognising that this will only be achieved with a focus on the prevention of ill health and the promotion of wellbeing

move from having some of the worst health outcomes to having some of the best

close the health inequalities gap within Greater Manchester and between Greater Manchester and the rest of the UK faster.

Across Greater Manchester, all localities – Manchester included – have been working to produce locality plans. These plans set out the programme of transformation and integration that will take place at a local level to ensure that health and social care services are clinically and financially sustainable. At a Greater Manchester level a Strategic Plan has been produced. This plan marries local-level work with the work required at a Greater Manchester level, to ensure that the region has a sustainable health and social care economy. The Manchester Locality Plan sets out the five-year vision for improving health and care outcomes across Manchester. It is a place-based plan that supports the growth of the city and identifies how sustainable change will be delivered.

The plan sets out the vision for health and care across Manchester to achieve a clinically and financially sustainable future.

The plan builds on the Manchester Strategy, which sets a long-term ten-year vision for Manchester’s future and how it will be achieved.

The Manchester Strategy is underpinned by the Joint Health and Wellbeing Strategy, the city’s plan for reducing health inequalities and improving health outcomes for Manchester residents.

The plan sets out how the transformation will be delivered.

The plan will be supported by growth, development of skills, education, early years, improved housing and employment.

Partners working across Manchester, in the public sector, in businesses, in the voluntary sector and communities all have a role to play in making Manchester the best it can be.

You can find the latest information here: gmhealthandsocialcaredevo.org.uk

AGMA members Bolton Bury

Manchester Oldham Rochdale Salford

Stockport Tameside Trafford

Wigan

! Memorandum of understanding – a formal agreement between two or more parties. Companies and

organisations can use these to establish official partnerships.

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Integration with health and ‘Living Longer, Living Better’ (LLLB)

Public sector reform requires the range of delivery programmes working within health and social care to work

in harmony. LLLB is the city’s integrated care programme, which is part of bringing health and social care

together. This work started in 2013, and currently has a plan running to 2020.

The LLLB programme is looking to help tackle the four main issues within the health and social care system:

Through 2014/15 the focus has been on:

development of New Delivery Models to provide better performance and management of investments of cost, to provide and how effective that support is for citizens.

financial processes developed to move budgets from hospitals to the community; better commissioning to provide more cost-effective services

designing a system which better understands the services available in the community, and the impact they have on citizens’ health and wellbeing.

Three citywide pilots with social care and health practitioners

working together have seen 8,000 citizens, and reduced unplanned hopital admissions by 15–20 per cent.

“By 2020, the LLLB programme will have radically transformed Manchester’s community-based care

system. This transformation will support citizens to live longer, healthier lives by ensuring a wide range of

high-quality health and social care services are easily accessible within communities, and are centred on

the individual and their specific health needs.” – LLLB vision

Statement

Citywide

Care Models

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The Care Act 2014 – what it means for citizens The Care Act came into effect on 1 April 2015, and brings the most significant change to social care in more than sixty years. The intention is to make care and support more uniform across England by putting the wellbeing of citizens at the centre of social care and health services. Many things that Manchester City Council was already doing have been made law through the Care Act, and

these include support for young citizens making the transition to adulthood, deferred payment agreements

and personal budgets.

The Care Act brings into law responsibilites for councils to:

undertake a free needs assessment for any citizen who believes they have care and support needs

ensure independent advocacy is provided if needed

make sure all citizens in their area have access to information and advice on their care and support

keep citizens safe from abuse and neglect through Safeguarding Adults Boards, the NHS and the police. This includes domestic abuse, modern slavery and self-neglect

assess anyone turning 18 (transition) if it considers there is ‘significant benefit’ to the individual in doing so, regardless of whether the individual currently receives any services

assess and support prisoners who believe they have care and support needs

assess anyone who cares for someone that otherwise wouldn’t be able to manage without their help

collaborate with other local authorities, the NHS and other services, to promote integration

assign a personal budget to all people who are eligible for support

offer deferred payment agreements.

The Department of Health has delayed the introduction of a cap on care costs until April 2020. This includes:

the setting-up of Care Accounts, and a proposed Care Cap of £72,000

changing the means-tested threshold from £23,250 to £118,000

the proposed appeals system.

! A deferred payment agreement is an option to delay paying fees for your care until after your death.

! Independent advocacy is about giving the person as much control as possible over their life. It helps them understand information, and say what they want and what they need. It is available to citizens who:

have substantial difficulty in being fully involved with their assessment, care and support planning, and review or safeguarding

do not have anyone appropriate and available to support and represent their wishes

cannot resolve issues through the normal discussion process.

! Transition – a child, young carer or an adult caring for a child is likely to have needs when they, or the

child they care for, turn 18.

! Personal budget – the amount of money needed to cover the cost of support for which a person is

eligible.

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The Care Act 2014 – how Manchester prepared

Work within Manchester on the Care Act commenced in summer 2014, in preparation for Care Act compliance from 1 April 2015. Some of our key areas of change have been as follows. Revised citizen and carer assessments New assessment forms have been designed to ensure that our new assessment processes are Care Act compliant. Nine wellbeing ‘factors’ from the Care Act have been made part of the assessment. These are:

Physical, mental health/emotional wellbeing

Personal dignity Social and economic wellbeing

Participation in work, education, training or recreation

Control over day-to-day life Suitability of living

accommodation

Domestic, family and personal relationships

Protection from abuse and neglect

The adult’s contribution to society

Connect to Support is an interactive IT system, upgraded to be Care Act compliant, which has been developed throughout 2014/15, and will host our new self-help pre-assessment questionnaire and a tailored statement of needs. It is a one-stop-shop portal designed to meet the Care Act requirements, which will provide information and advice to citizens encouraging independence, and the digital strategy, and help manage demand. It will go live in 2016. Fair Access to Care Services (FACS) We’ve updated our criteria for Fair Access to Care Services (FACS) to align with the new national criteria. This went live on 1 April 2015. Deferred Payment Scheme Manchester has had a discretionary scheme for a number of years, which was amended in March 2015 to reflect statutory requirements in the Care Act. Transition, and supporting people who move between local authority areas Manchester City Council staff have been issued with guidance to follow in these circumstances to ensure that we appropriately support people who move between areas, and to follow a national standard. Advocacy The Council has put in place a contract with the Gaddum Centre, which from 1 April 2015 will deliver the legal requirement to provide advocacy within a single service – known as the Manchester Advocacy Hub. Manchester Safeguarding Adults Board Manchester already had a safeguarding board, and it was reviewed to make sure it, and safeguarding activity in general, is Care Act compliant. Measuring progress of implementation – Care Act ‘stocktake’. Progress was measured through three national ‘stocktakes’ before the Care Act officially came into force on 1 April 2015. This was monitored by the Local Government Association (LGA), the Department of Health and the Association of Directors of Adult Social Services. You can read more about the Care Act on the Manchester City Council website: manchester.gov.uk/info/200048/health_and_wellbeing/6658/care_act_2014

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Support to maintain citizen independence in the community Care Closer to Home is a strategy for moving healthcare from hospitals to community-based settings. Local authorities are encouraged to find better ways to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better healthcare for patients, cutting the number of unplanned bed days in hospitals and reducing costs, and to enable people to stay at home rather than be admitted to a care home. In Manchester we apply this strategy, and others to support independence, in a number of ways.

Reablement helps patients with complex needs

to recover at home and live as independently as

possible after an illness or hospital admission, as

well as reducing ongoing social care costs,

through regular visits for up to six weeks.

Assistive technology helps to keep citizens safe

within their own home, and is monitored 24 hours a day, seven days a week by the Community Alarm Contact

Centre. This can include fire/smoke/carbon Monoxide detectors, a bogus caller alarm button, and a Lifeline

base unit (which the above detectors

communicate with).

Equipment and adaptations, which through

the provision of items helps to assist a citizen

live in their own home for longer. This includes

a wide variety of items such as handrails,

wider doors and stairlifts.

Extra Care housing is a form of retirement

housing with the addition of personal care

and 24-hour support available for those who

need it. It offers a self-contained ‘home of

your own’ in a block or estate where social

activities are easy to find.

The 91st Day is a measure of success of our rehabilitation

service. It looks at the proportion of older people (65 and

over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services.

Housing for an Age-Friendly Manchester is a strategy to help older people to be independent for longer, increasing their social participation and improving advice and guidance services for them. See more details of our plans on our website: manchester.gov.uk/downloads/download/6143/housing_for_an_age-friendly_manchester Strategies to improve access to primary care have been piloted in Manchester during 2014, including additional availability of primary care appointments to 8pm on weekdays and appointments during the day at weekends. There has been a fall in primary-care-related attendances to A&E at Central Manchester Foundation Trust.

Citizens who need additional support

1,712 – Number of new citizens receiving

reablement

52.9% – Percentage of new citizens not needing

additional support following reablement

99.2% – Equipment and adaptations

delivered/installed within seven working days of

assessment

24,569 – Pieces of equipment and adaptations installed

6 Extra Care housing schemes for people aged 55+

297 apartments, studios or bungalows available

1,092 housing units across 12 schemes by 2020

64.3% Hospital discharges where

person was still at home 91 days later

! Primary care is the day-to-day healthcare given by a healthcare provider, usually your GP, who acts as

the first contact and principal point of continuing care for patients within a healthcare system.

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A delayed transfer of care (DTOC) is the term used to describe when a hospital inpatient is medically fit to leave hospital but their timely discharge is prevented. This delay could be due to a number of reasons, such as waiting for a care package or an assessment. The average number of people delayed discharges from hospital per month was 41, and of those an average of 20 per month were attributable to adult social care. Not only have we missed our targets for these figures, but they are both worse than those in 2013/14. DTOCS are a major challenge for the health and social care partnership, and

current performance is a reflection of the increased number of patients and

pressure in the local hospital systems as whole.

Hospital discharge is critically linked to the availability of community services and

resources for recovery, reablement and care, and currently the market is unable

to provide enough capacity to support this.

There are several reasons our performance has struggled, which include:

within the city, Manchester City Council has to deal with three health sectors, each dealing with

DTOCS independently

pressure on available local government funding

the NHS has established 24/7 working, but this is not yet standard for much of the social care sector

(though the Care Act 2014 requires its introduction), leading to gaps in joint working, typically out-of-

hours and at weekends

management of hospital discharge in the three health sectors tends to be reactive, ad hoc and

improvised, but the Council and the local CCGs co-operate closely to limit the effects of this on DTOC

performance, but this is not sustainable in the long term.

We recognise the system is undesirable for patients and inefficient for the participant organisations, and

requires a different approach. Among other things, partnerships need to be strengthened, alongside a clear

set of aims and outcomes for consistent, uninterrupted service delivery, and stronger performance.

Residential and nursing care

The Council is developing services that better meet people’s needs in the community, and fewer adults and older people choose to go into residential or nursing care in Manchester compared to similar local authorities. As mentioned on the previous page, we are working hard to enable people to

remain in their own homes through the extension of Extra Care housing schemes

and more preventative support, rather than using admissions into residential or

nursing care as default option.

The 2014/15 results show that we put around 200 (per 100,000 population) fewer adults aged 65+ into permanent residential or nursing care than the England average, which ranks us in the top 20 English councils for this result.

432 Citizens admitted

permanently to

residential or nursing

care

41 Average number of

people delayed discharges from

hospital per month

20 Number of citizens whose delays were

attributable to social

care

87.5% Of citizens admitted

permanently to

residential or nursing

are aged 65+

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Citizens who need additional support Short breaks service (respite care for Learning Disabled Adults) Respite care is provided from three locations across the city, offering 20 beds a night, and supports both emergency and planned placements. The service supports families and carers to stay at home in the communities of their choice and reduces the need for long-term residential support. The service currently offers support to over 120 families. Daytime Support Daytime Support is offered from three key locations, providing a range of meaningful activities both on-site and from a range of asset-based locations across the city, to people who are assessed as requiring high levels of support. An average of 200 people a day use this provision. This service provides essential daytime support to families and enables vulnerable citizens to stay at home with their families. Ross Place provided Home to Daytime Support in central Manchester, and initially was a temporary location to support the 70 disabled and older people a day who used the Minehead Resources Centre before it was destroyed by fire in December 2014. The relocation has proved to be a tremendous success and saw the dedicated staff who work there win the Manchester City Council Team of the Year Award. Ross Place is due to undergo major refurbishment in 2016 and will remain the key hub for day services in central Manchester. Help and Support Manchester: manchester.fsd.org.uk/kb5/manchester/directory/home.page Disability Supported Accommodation Service Providing accommodation based support, this service promotes the independence and wellbeing of 181 people across the city from 39 locations, including Marillac House. During the autumn of 2014 Marillac House underwent extensive refurbishment and renovations, including the installation of a lift, the refit of all kitchens and bathrooms, installation of a new heating system, landscaping to gardens, re-carpeting, refurbishment and total redecoration. Individual properties (where appropriate) are fitted with state-of-the-art assistive technology tailored to an individual’s needs to ensure dignity in a safe and independent living environment. All renovation works have been undertaken to specifically meet the needs of people with a learning disability, to ensure a high-quality housing offer in a safe and supported residential development. The property is surrounded by gardens set in a quiet residential area, and comprises 13 self-contained flats and studio apartments with communal facilities on site. Built around a private central courtyard, Marillac House will provide 24-hour staff-supported accommodation to all tenants within their own flat or studio apartment.

Daytime Support

North – Heathfields Central – Ross Place

South – Hall Lane

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Disabled citizens All-Age Disability Strategy co-production Manchester City Council wants to work together with all disabled residents (ie. not just those people receiving social care support), carers and public sector partners (eg. the NHS, police, other services in the city) to co-design a new Manchester All-Age Disability Strategy. We want to work together as we believe that’s the best way to achieve the transformation in disabled people’s life chances that we all seek. Using workshops we targeted established disability customer groups, in order to seek a range of experiences, views and issues, which would help us to understand ‘what’s working well’, and ‘what’s not working well’. To do this we used eight themes that have been chosen to cover the main aspects/issues affecting disabled peoples lives. They are:

Health and wellbeing Independence in your

home Advocacy Choice and control

Getting off to a good start

Community opportunities

Involvement Staying safe

What’s working well? The top three areas citizens say we do well at:

community opportunities – accessible public and community transport (eg. Stagecoach, travel passes)

advocacy – knowledge and confidence to self-advocate with services

community opportunities – promoting services and signposting people via different methods, eg. multi-agency events, partnership boards, local third sector providers, radio, family information service.

What’s not working well and what do we have planned so we can work better? Citizens suggested a range of ideas that will inform and improve our strategy. These include:

health and wellbeing – staff knowledge, training and attitudes in relation to disabled people; integration of services, and better planning and support for progressive conditions

staying safe – police and partners advising on how to keep safe, educating schools, and public sector promoting positive images; transport/road safety: more CCTV, driver training, more ramps and dropped kerbs, scooter training, and more flexible Ring and Ride

getting off to a good start – improved transition support in education; improved information and communication, plain English, large print

choice and control – improving flexibility and process around individual budgets; improving support for deaf people, especially with British Sign Language

independence in your own home – accessibility and range and type of property; support for independent living

community opportunities – accessible Information, voluntary organisations, socialisation; employment/volunteering, including more employer flexibility; accessible Leisure and community services

involvement – local networks and groups, and voluntary section collaboration; design and improvement of services and getting disabled citizens involved; an access guide.

! Primary support reason – this relates to the needs of a citizen at the point of each contact. These reasons

can change throughout the year, and may not necessarily relate to a citizen’s main condition.

16

Disabled citizens Learning disability Using the health conditions that have been captured throughout the year, a snapshot from 31 March 2015 shows 4 per cent of citizens in receipt of a long-term service suffer from autism or Asperger syndrome. The number of learning-disabled clients in paid employment has fallen slightly to 1.23 per cent. It has been a challenge in the current economic climate to support learning-disabled citizens into work, but we are working with partners and citizens to support and improve these figures. Autism Autism is well recognised to be a special element of learning disability. The latest studies indicate that 1.1 per cent of the UK population may have autism. The National Autistic Society (NAS) is the UK's leading charity for people affected by autism. It provides a wide range of personalised support services for people on the autism spectrum and their families and carers in Manchester. We have continued to work with the NAS and colleagues in education to ensure that people with autism have their needs met through the new Education, Health and Care plan (Children and Families Act 2014 – similar to the Care Act). We have developed an autism-specific Joint Strategic Needs Assessment (JSNA). Key actions for 2014/15

Include the JSNA actions and align to the new autism national strategy to produce a comprehensive autism action plan for Manchester.

Ensure the Autism Strategy Group, reporting into the Learning Disability Joint Commissioning Board, effectively oversees progress and reports any challenges to the board.

Work with the NAS at Greater Manchester level to ensure that the Greater Manchester training plan addresses the need to train advocates on autism.

Ensure that the developing housing strategy includes people with a disability and also those with autism/learning disability, and sets out the accommodation offer for adults.

Implement reforms to ensure that the single Education, Health and Care Plan meets the needs of young people with needs, particularly those with autism, to support the strategic priorities of the Health and Wellbeing Board.

Further investigate the recommendations from the NAS on ‘Growing Older with Autism’ and take account of best practice through older people’s commissioning practice.

Report ongoing annual progress to Manchester’s Health Scrutiny Committee.

86.9% Of citizens with

learning disabilities living in settled

accommodation

1.2% Of citizens with

learning disabilities

are in paid

employment

188 Diagnosed citizens

aged 18+ accessing

National Autistic

Society services

17

Disabled citizens

Sensory JSNA – co-production

The JSNA working group was created to inform an in-depth report on sight loss. The group was made up of

professionals from the services that currently provide support to the people of Manchester with sight loss.

•2,196 people registered as blind (severe sight impaired).

•1,972 registered as partially sighted (sight impaired).

•1,481 people registered blind are over 65 years old.

•1,317 people registered as partially sighted (sight impaired) are over 65 years old.

Further information on the numbers of people with sight loss living in Manchester are held by Lancasterian

Sensory Support Service and Henshaws Society for Blind People.

The group identified gaps in services, and produced a strategy that could address these issues.

These fell into three categories:

everyone in the UK looks after their eyes and their sight

everyone with an eye condition receives timely treatment and, if permanent sight loss occurs, early

and appropriate services and support are available and accessible to all

a society in which people with sight loss can fully participate.

There are more details of what we need to do next in section 6 of the JSNA.

manchester.gov.uk/info/500230/joint_strategic_needs_assessment/6216/sight_loss

Physical disability Disability Supported Employment Service Manchester City Council has worked with a local disabled people’s organisation to provide a supported employment service to disabled people in Manchester. The service is unique locally in that it is the only provision that is based on the ‘Social Model of Disability’ and the ‘Pillars of Independent Living’ and takes a holistic approach, enabling and supporting people to identify their personal barriers, and working with them and other relevant agencies, providers and employers to remove barriers and ensure that opportunities are accessible to disabled people. For more information, visit: disabilityrightsuk.org

72 Citizens supported

by the service

100% Participated in some

sort of voluntary

work placement or

work trial

20% Achieved paid

employment, versus

10% on

Government scheme

18

Disabled citizens

The Physical Disability Partnership Board Manchester City Council commissioned Breakthrough UK to conduct a detailed review of the Physical Disability Partnership Board. This entailed:

establishing the views of board stakeholders as to the role and purpose of the board

exploring the current and potential links between this board and others, in particular the Learning Disability Partnership Board, the Sensory Impairment Steering Group, Valuing Older People Group (Now Age-Friendly Manchester) and the Health and Wellbeing Board

seeking out best practice on engagement structures with disabled people from elsewhere

exploring the opportunities provided by digital/social media channels

setting out clear recommendations for the future of the board

supporting the development of an overall approach to co-Production and how it can operate in a sustainable way in the future.

The review also reconsiders the positioning of the board so that it does not sit exclusively under the Directorate for Children and Families. Aligning to the All-Age Disability Strategy will ensure the contribution to the Council’s wider equality agenda and to the priorities of the Manchester Community Strategy. Brokerage and support planning Cash individual budget (IB) customers currently receive support with the management of their budget from both internal and external providers. This support includes:

support planning from In-house brokers and care managers

recruitment, retention of personal assistants, and budget advice from the in-house Brokerage Team

payroll service from an accountancy firm

managed bank accounts from external providers. The Brokerage Support team led the implementation of the direct payments and individual budgets. The team of brokers are experienced and skilled in supporting individuals to:

identify alternative and additional funding sources

cost budgets and calculate employee salary costs

recruit staff and deal with employment issues and arrange insurance

give advice, and signpost and support customers to use community resources

navigate through Council procedures involved in the delivery of a cash IB

support colleagues, advising on cash IB processes and actively promoting them within locality teams

support customers and colleagues with audit processes

support customers and colleagues with complex cash IB packages and safeguarding issues

facilitate the DBS checking process for staff employed by cash IB customers. A broker is based in each locality and offers services to physically disabled customers and older people as a matter of course. We have also tested a different approach to brokerage and support planning by using locally recruited peer brokers to support customers with developing their own support plan. This approach is being evaluated with the provider, and will use the findings to inform our future approach. Find out more by visiting: mysupportbroker.com/healthandsocialcareagencies

19

Substance misuse Drugs and alcohol – substance misuse Support for citizens with substance abuse is short term, and designed to maximise independence. During the year 167 citizens contacted us for social care support for alcohol or drug misuse (adults seen by the alcohol and drug social work teams for residential rehab access and other social care support), and 4,797 citizens received alcohol or drug treatment from services commissioned by Manchester City Council. The rate of admission for alcohol-related hospital admissions (broad measure) is 3,309 per 100,000. The alcohol-related hospital admission rate in Manchester is 9.1 per cent higher than it was five years ago. Manchester’s Troubled Familes programme identified in October 2014 that, of the families in the programme, almost 67 per cent of these also present with alcohol misuse, and 77 per cent with substance misuse that needs to be supported. The Manchester Alcohol Strategy 2012–15 aims to reduce alcohol-related harm to individuals, families and communities by:

promoting and supporting change in attitudes and behaviours

improving access to alcohol early intervention and treatment

ensuring alcohol is sold responsibly

protecting children and families from alcohol-related harm

reducing alcohol-related crime, disorder and antisocial behaviour.

You can find out more information about our alcohol strategy by visiting:

manchester.gov.uk/downloads/download/5091/manchester_alcohol_strategy_2012-15

Of citizens with long-term conditions, reason for contact:

Learning Disability – 8.1%

Physical Disability – 28.1%

Mental Health – 60.2%

Memory and Cognition – 2.2%

Sensory (Sight/Hearing) – 1.0%

Social Support – 0.4%

(Including Substance Misuse)

4,797 Citizens received alcohol or drug

treatment

20

Mental health and dementia

Mental health The total number of mental health clients in paid employment has increased to 3.9 per cent. We have already done good work with Manchester Mental Health and Social Care Trust to help these figures continue to increase, and support citizens to increase these figures. In April to September 2014, 180 local people attended training for local communities, including the Boost programme to improve mental health and emotional resilience (6- to 8-week sessions) and 68 people attended mental wellbeing drop-in sessions. Specific courses are also delivered for people with long-term conditions (Living Life to the Full and Reclaim Your Life). Dementia The most recent available figures suggest there are currently 1,760 citizens with dementia known to Manchester City Council, of whom 1,319 have an open care package of support. The most recent JSNA dementia section was refreshed in February 2014, and there are a number of developments that have taken place through the last year. Some are below.

Improve dementia care through the Living Longer, Living Better care model development – to improve health and care provision in the community for frail older adults and adults with dementia.

Explore and maximise the use of dementia research and academic insight to inform the Dementia Strategy.

An evaluation of care delivered by nursing and residential care homes – commissioned and overseen by the Joint Quality Board across health and social care.

An evaluation of memory assessment services – with a view to improvements to waiting times – in line with the Mental Health Improvement Plan.

Promote further development of community dementia initiatives.

Explore the potential for further contributions from the Age-Friendly Manchester team to further improve the care and dignity of people with dementia across all pathways, guided by academic insight

You can read more of the complete JSNA for Manchester here: manchester.gov.uk/jsna

3.9% Of citizens in contact with mental health services in paid

employment

69.5% Of citizens in contact with mental health

services living independently

1,319 Citizens supported with a dementia-specific support

package

21

Keeping citizens safe

Safeguarding

While more than one type of abuse can be reported in each referral, the nature

of abuse reported for this year has proportionally been:

physical 25.2%

sexual 6.7%

psychological and emotional 17%

financial and material 21.5%

neglect and omissions 25.1%

discriminatory 1.4%

institutional 3%

Deprivation of liberties (DoLS)

In March 2014, a Supreme Court judgment meant that DoLS applications could now

include those from people in domestic settings with social care support, not just

hospitals and residential and nursing care homes.

This had a huge impact on the number of DoLS applications received, and is the

same for every local authority.

To cope with this we:

moved data recording to a single electronic system

moved support documentation to a single electronic system

improved reporting to identify where further improvements and efficiencies

can be made, and where there are training gaps

work with local trusts to reduce the number of inappropriate applications

aim to have an additional 50 assessors trained.

! Safeguarding – this relates to preventing abuse and minimising risk without taking control away from

individuals, and responding if abuse or neglect has occurred.

! Deprivation of liberties (DoLS) – If a citizen is lacking mental capacity, such as understanding information

given to them, a care home or hospital can apply to use restrictions to keep the citizen safe.

1,763 Completed

safeguarding referrals

50% Of abuse is committed in

citizens’ own homes

527% Rise in DoLS applications

267 DoLS applications

granted

50% Reported as

occurring in hospitals

22

Manchester Safeguarding Adults Board Manchester has both a Manchester Safeguarding Children Board and Manchester Safeguarding Adults Board, who expect all providers and commissioners of services for adults at risk and children in Manchester to adhere to this safeguarding standard. Under the Care Act, the board now has statutory guidance about membership. The Manchester Safeguarding Adults Board is committed to working with the six principles of safeguarding:

Empowerment Partnership Proportionality

Personalisation and the presumption of person-led decisions and

informed consent

Local solutions through services working with their

local communities

Proportionate and least-intrusive response appropriate to the risk

Prevention Protection Accountability

It is better to take action before harm occurs

Support and representation for those in greatest need

Accountability and transparency in delivering safeguarding

Here are just some of the things we’ve done to develop and strengthen our safeguarding partnerships:

every GP in Manchester has a Safeguarding Link Nurse identified for their GP practice

University Hospital of South Manchester is working with Safeguarding teams to update training, processes, Mental Capacity, confidentiality, etc

Central Manchester Hospitals Foundation Trust has recruited over one hundred Safeguarding Adults Champions across the organisation to be a voice for vulnerable adults

Pennine Acute Hospitals Trust has been promoting awareness, including learning disability, the Mental Capacity Act, capacity assessment and female genital mutilation

Manchester Mental Health and Social Care Trust has a key focus to ensure that training is provided that enables staff to understand their responsibilities to safeguard adults at risk, through three different levels

Channel is a multi-agency-based process to identify and provide support to individuals who are at risk of being drawn into terrorism. Safeguarding people who are vulnerable to being drawn into terrorism is delivered as part of Manchester’s multi-agency safeguarding arrangements for children and vulnerable adults

health professionals are working with Local Authority Safeguarding Co-ordinators to deliver a co-operative approach

Greater Manchester Police inspectors oversee all incidents reported to the police and determine that the most appropriate specially trained staff are made available to support individuals

HMP Manchester has engaged with Manchester City Council to identify and assess those in custody who may be vulnerable, ensuring they have any additional support they require

The Clinical Commissioning Group Safeguarding Team continue to work collaboratively and in partnership with all organisations across the NHS, local authority, police, GPs and the voluntary sector to ensure there is a co-ordinated approach to keeping adults safe from harm.

1,763 Referrals – full

safeguarding

investigation

undertaken

4,195 Alerts – concern

for the safeness of an individual

23

Domestic violence

Domestic violence

Manchester has a new strategy for 2015–20 that will build on the success of our

work to date, while acknowledging more needs to be done. The refreshed strategy

will strongly align with the refreshed Early Help Strategy, the Community Safety

Partnership Strategy and the Public Service Reform programme.

Manchester has several services it uses to support individuals in reporting domestic

violence, which offer support, information and practical advice to victims of

domestic violence:

Manchester Women’s Aid

Manchester Women’s Domestic Abuse Helpline

National Domestic Violence Helpline

The Respect Phoneline

The Men’s Advice Line.

Manchester’s Troubled Familes programme identified in October 2014 that, of the families in the programme,

83 per cent have a presenting domestic violence and abuse need that needs to be supported

Victims told us things we need to change:

we do not help them enough to recover and move forward once the violence and/or abuse stops

they want better support for emotional recovery

they want to work and retrain

financial independence is a vital component of their recovery

some people stayed in a violent relationship as they did not know where they could move to

victims/survivors in refuge accommodation were surprised how long they were there before rehousing.

Perpetrators told us:

they want community-based programmes to help them understand and change their behaviour

some had asked for help from GPs and advice bureaus and had received none, which led to their

abusive behaviours escalating in severity

they were also strongly motivated to change by both access to their children and what their children

perceived the issues to be.

To make these changes, some of the things we need are:

much better risk assessment tools to understand the different types of perpetrators

simple, clear, integrated routes of support for those affected by domestic violence and abuse

better ways of reporting it, including GPs, health visitors, midwives and schools

sharing learning of people who have died as a result of domestic violence and abuse

better use of public money to challenge domestic violence and abuse

revisit the times we can provide support, including more out of hours

* violent breakdown of relationship involving associated persons, which includes domestic violence other than that committed by a partner.

298 Homeless

applications due to domestic abuse by a

partner or other*

35 Average number of

assaults before a

person calls 999 for

help

24

Social housing and homelessness

Housing

People we support include those with mental ill health, older people, survivors of

domestic abuse, single homeless people, homeless families, people with learning

disabilities, offenders, vulnerable young people (including 16- and 17-year-olds),

care leavers, young single parents and people with substance-abuse issues.

Things we’ve done or are in progress:

recognised the importance of providing suitable accommodation for older residents of the city, with a new older people’s housing strategy, Housing for an Age-Friendly Manchester

renovated, in partnership, three vacant 12-storey residential tower blocks in Ancoats, to provide an additional 192 apartments for rent

in Gorton, four hundred poor-quality social rented properties demolished, and 212 high-quality replacement social rented homes provided

Matrix Homes Ltd is developing 121 affordable homes across five sites in Chorlton Park, Northern Moor, Brooklands, Ardwick and Gorton North

a new house building programme called ‘Manchester Life’ was announced. Phease One of the programme will deliver more than eight hundred and thirty homes (predominantly private rented) in Ancoats and New Islington

the Brunswick PFI scheme is a project to refurbish more than eight hundred and fifty social housing properties and construct more than two hundred new social housing properties.

develop a Market Rental Strategy, whose objectives are:

promote good practice in the sector through greater self-regulation

target and focus intervention to improve the worst properties and neighbourhoods, with pro-active enforcement on landlords and agents

enhance the role of professional bodies

improve communications in the sector. Homelessness Manchester has seen an increase in citizens presenting as homeless, and incidents of begging. There were 786 households accepted to receive support from our homelessness service. Rough sleeper figures are recorded once a quarter, and our target is that no more than 24 citizens should be identified as sleeping rough. In March 2015 (the last quarter of the year), on the day chosen to record the number of people, there were 43 rough sleepers identified, meaning we missed our target. We reopened three shared houses, accommodating 168 places, and we have also developed overnight accommodation by re-purposing some buildings.

786 Households

accepted to receive

support from our

homelessness service

14,750 People supported

by housing-related

funding

195 ‘Affordable homes’

built

50,000

The number of

citizens who reside

in the city centre

and fringe

792

Households

accepted as being

homeless and in

priority need

43 Number of rough-

sleepers identified

on one night

25

Personalisation

Personalisation aims to ensure that the care and support each person gets is matched to their needs and

wishes. It also makes sure that everyone who needs information and advice about social care gets it,

regardless of their wealth or eligibility for services.

Self-directed support helps a citizen to self-direct their care or support in a number of different ways:

a personal budget is money that is available to someone who needs support, and the money is provided by Manchester City Council directly to the eligible citizen

an individual budget is money for support that could come from several places – including social services, the Independent Living Fund and Supporting People

a direct payment is money that is paid directly to you so you can arrange your own support.

*Excludes Mental Health, who manage this differently

Freedom of information

Between April 2014 and March 2015, Manchester City Council received 490 freedom of information (FOI) or environmental information regulations (EIR) requests. Of these, 162 were related to adult social care. FOI requests cover a range of reasons, from safeguarding to care home provision, and there is guidance in place to ensure that requests are responded to in a standardised and timely way – within 20 working days from receipt (excluding postal time). FOIs are often complicated and can take a lot of time and effort to fully respond to a request, which means that we are not always able to achieve our timescales for response, but we are always looking to improve. You can find out more about FOIs and EIRs by visiting the Information Commissioner’s Office website: ico.org.uk/for-organisations/guidance-index/freedom-of-information-and-environmental-information-regulations

92%

Proportion of carers who use services who receive self-directed

support

99% Proportion of citizens

who use services*

who receive self-

directed support

162

FOIs or EIRs received, related to

adult social care

26

Sector-led improvement

Peer review The peer review was commissioned to provide an independent assessment of how well the Council is delivering adult social care to identify recommendations to make service delivery more consistent. The peer review process was carried out by the Association of Directors of Adult Social Services North West and involved the director from Salford Council and a team of people to support the review. The process involved Manchester completing a self-assessment activity which was used to establish where adult social care is currently at. This was followed by a site visit in March 2015. This model of adults peer challenge intends to help local government to help itself to respond to the changing agenda in adult social care. The peer challenge process is both constructive and supportive, and aims to help a council and its partners assess its current achievements, and identify those areas where it could improve. It is delivered from the position of a ‘critical friend’ to promote sector-led improvement. The focus of the peer review was on three main areas, and we identified the following areas for improvement, and will be reporting in the 2015/16 Local Account on our progress. 1. End-to-end delivery

The need to develop a more outcomes-based approach.

The assessment process needs streamlining.

Change management was not supported by implementation plans, which made them difficult to follow and effectively evaluate.

Support plans need to be more innovative, and we should use more data analysis to support service improvement.

2. Safeguarding

The need for more ‘citizen voices’ in the delivery of adult safeguarding.

The need to develop an improvement cycle linked to an analysis of data and citizen outcomes.

Address under resourcing of the adult safeguarding process.

The Adults Safeguarding Board had previously not been functioning appropriately so that there is “no connection between strategy and operations”.

3. Social work practice

There is a need to develop a consistent case recording system as recording is considered to be inconsistent.

There should be enhanced management oversight for the case recording process, particularly with recording of Best Interest Assessments and the Mental Capacity Act.

The citizen pathway is unclear and there are multiple hand-offs.

! A critical friend is someone who agrees to speak truthfully, but constructively, about weaknesses,

problems, and emotionally charged issues.

27

Looking forward There will continue to be significant change across the health and social care system, as new arrangements are set up to implement the devolution deal. Manchester’s Health and Wellbeing Board will need to be at the forefront of these changes and developments, and to ensure that Manchester has the focus and capacity to drive forward health and social care integration in Manchester as part of the wider Greater Manchester context. It will also be important that the refreshed Health and Wellbeing Strategy is closely aligned to the devolution work streams, and in particular that there is a strong focus on financial sustainability. Manchester is already progressing health and social care integration through the Living Longer, Living Better (LLLB) programme, which is a key element of the city’s Health and Wellbeing Strategy. LLLB is working towards a ‘One Team’ place-based care model that outlines the transformation needed to enable the delivery of a new community-based care system by 2020. The One Team model will see existing social care services, community primary and secondary health care services, and community mental health services integrate on a neighbourhood place level, working towards shared-outcome goals. Place is defined geographically, and the intention is to have 12 local teams within the city, each covering a population of approximately 40,000–50,000. It may not be practical to deliver some aspects of the model at such a local level – for example, where services require highly specialist infrastructure and/or staff. For this reason, some services will be established at the CCG level (three teams) and some at the city level (one citywide team). The intention is to provide service at the most local level possible. Where services are delivered on a larger scale they will be geared towards supporting local teams. More broadly, there will continue to be a major shift in the focus of services towards prevention of problems and intervening early to prevent existing problems getting worse across the whole life course. This will:

maximise the city’s available resources through a clear prevention and early-intervention strategy and supporting investment plan

place progressive universal services and early help at the heart of strategic planning for education and skills across the city

look at developing further peer support and support networks to provide opportunities for people to live in their own community, and provide opportunities to learn new skills and gain confidence

research the development of support pathways based in communities to complement statutory services and allow access for individuals to move on to independence

develop new investment and delivery models that will improve outcomes for citizens, including people with learning disabilities, troubled families, and families needing support to enable them to be more independent in the future.

28

Looking forward Extra Care housing We want to significantly increase provision of Extra Care housing, to keep people independent in their homes for as long as possible, and prevent admissions to residential and nursing homes. We’ve commisioned further building and are moving from 297 units across six schemes to 1,042 units across 12 schemes by 2020. Housing Options for Older People (HOOP) We commissioned this service from Northwards Housing from April 2015, part-funded from Manchester City Council and North Manchester Clinical Commissioning Group. HOOP is a technique for appraising housing options, and includes two main elements:

a comprehensive assessment of a citizen’s current housing

identification of any information they may need about possible solutions or alternatives. It is a questionnaire which asks citizens to focus on different aspects of their home situation, including size, condition, comfort, location, managing and costs. It is designed for use by older people themselves, or working with an advisor. We want to evaluate the pilot and consider rolling it out across the city. Find out more at: hoopmanchester.eac.org.uk State of the City You may wish to read more about the broader aspects of activity within Manchester City Council, and the city’s progress towards our vision for a world-class city, as set out in the refreshed Community Strategy. This is available in our annual State of the City report. manchester.gov.uk/downloads/download/6359/state_of_the_city_2015_complete_document

29

Contact The Local Account is published every year.

If you would like a copy of this report, please contact one of the following, quoting ‘Local Account of Adult

Social Care, 2014/15’:

By post:

Manchester City Council

Manchester Town Hall

Albert Square

Manchester

M60 2TA

In person:

The Customer Service Centre

Manchester Town Hall Extension

Mount Street

Manchester

Monday to Friday, 8am–5pm

By phone:

0161 234 5000

Monday to Friday, 8am–5pm

Via our website:

manchester.gov.uk/contactus