Verbal update by Anne Marie Lubanski, Strategic Director, Adult Care and Housing
Minutes:
AnneMarie Lubanski, Strategic Director of Adult Care and Housing, provided a verbal update on the work to transform Learning Disability Services.
In July a report on Learning Disability and the recommendations within the report were agreed at Cabinet and a number of consultations were now being planned and would be commencing in early September. No decisions had been taken yet with regard to closure of any centres.
The Directorate had been working with carers of people with learning disabilities to keep them well involved. This included two events where officers talked through the report with the carers as soon as it had been published.
Based on feedback from the earlier consultation, it had been agreed that carers would be involved in designing the consultation, alongside SpeakUp, together with another organisation the Service hoped to procure to provide additional support to people with learning disability through the consultations.
Consideration was also being given to the on-line questionnaires and how these could be done differently, although there had been over 900 responses through the various means. The consultation materials could be shared with the Commission.
It was stressed that this was not just the in-house Learning Disability offer but modernisation of the wider learning disability offer for everyone, although this message was sometimes being lost.
Out of 780 people on Service, across internal and external commissioning, there were around 20 people with complex needs whose packages costed between £160,000 to £250,000 p.a. There was a need to start doing things differently for such packages such as trying and testing the use of technology as a substitute for direct care.
Other challenges in undergoing this transformation and service modernisation, both for Adult Social Care and for families, were highlighted, including:
- people with learning disabilities perhaps wanting something different to what their families wanted for them
- the need for sophisticated conversations and being very clear about the Mental Capacity Act and who made the decision
- difficult conversations with families
- difficulties for families when someone with learning disability or autism reached 18 and had the right to choose and the family member was no longer their next of kin
- as much as carers had parity of esteem through the Care Act the central focus was what the person wanted
- how new high cost support packages as people come into service may increase budget pressures in Adult Social Care
These were reasons why it was so important that the learning disability offer was widely understood. Our money was locked into very traditional services and it needed to be reiterated that this was not a quick journey but would happen over two to three years.
· Clearly improving the quality of provision and driving up standards was important but the other side was the economics, so was cost a driver as well given that in the future there will always be people with complex need and high cost support packages? – The premise of personalisation was about putting the person at the centre. Absolutely there would always be people with very complex needs, whether through learning disability, brain injury, or drug or alcohol related physical complexities and that would be there. What was needed as we worked in a different way was to maximise the people who did not need those high end services, regardless of the cost of those services. This was why it was about getting the front door right and getting reablement right so in the end the service was working with the people with the complex high end needs, whether safeguarding, physical, mental, emotional or psychological. In Rotherham there was a legacy of responding to complexity through using residential care and that had resulted in too many people aged under 65 in residential care across all groups, especially mental health. Costs did come into it but it was about maximising the use of the personal budget if a person needed one, getting the right information at the right time and starting to use technology as a positive.
Councillor Roche reiterated his concerns regarding national cutbacks on Adult Social Care but highlighted that many of the changes were positive and we would have wanted to make them irrespective of the period of austerity. Case studies of people using direct payments showed positive outcomes. Examples from other local authorities such as Wigan had shown it was possible to reduce costs and provide a better service.
· Consultation needed to involve people with autism as well as people with learning disability and some people had found the previous questionnaire difficult so more easy read questions and better explanation would be helpful - One of the challenges in Rotherham was that people with autism and people with learning disability tended to be lumped together and sometimes that was right but it had also led to some services not being designed for people with autism. The Strategic Director would be chairing the first Autism Partnership Board meeting on 20th July, 2017. Initial work would focus on increasing awareness of autism system-wide as overall it was agreed there was a lack of confidence in working with people with autism.
Resolved:- That the Health Select Commission receive further updates as the work progresses.
With regard to wider work on Learning Disability Services Vicky Farnsworth provided a brief update on the work of the Transforming Care Partnership across the sub-region. SpeakUp was closely involved as both Vicky and Robert Parkin sat on the panel as experts by experience. A lot of good work had been carried out although there was still more to be done in relation to people with learning disability or autism moving out of hospital and back into the community.