Community Support and Supported Living Light Touch Dynamic Purchasing System (DPS) for people with Health & Adult Social Care needs
Summary of the engagement with people who use services and carers.
|
Action |
|
|
People with ABI receiving community support want consistency and to work with someone they know and get on with well. They also want face-to-face support as well as or instead of telephone/virtual support. Carers generally view paid carers as efficient, courteous, respectful and friendly. Feedback to ASC Operations Manager from clients of ABI community support service and their carers (2020) |
Staff cover to provide consistent service included in draft specification.
To include the positive characteristics/values in key principles section of spec. |
|
Mental health community support service is good at giving time to explain any difficulties, listening to any requests and making plans, with the support good at respecting background, culture, and religious beliefs. Mental Health Services in Brighton and Hove – experiences of service users and professionals, Healthwatch (2022) [Individual case study] |
Specification to emphasise importance of person-centred support. |
|
I would like support to get out and about to connect with the community. User Survey 2022 |
Links to community services section in draft specification.
|
|
I would like opportunities to work or volunteer. User Survey 2022 |
Activities, life skills, education and work section in draft specification. |
|
It’s important to have company & activities in care settings. User Survey 2022 |
Social contact and activities to be considered/reviewed by commissioners when specifications are developed for new contracts. Review the requirements to provide activities in care settings and to support people to participate & engage. |
|
I would like support to maintain friendships & relationships. User Survey 2022 |
Social connections section included in draft specification. |
|
I would like support maintain autonomy and independence. User Survey 2022 |
Draft specification includes maximising and enhancing independence and control. |
|
I would like support to take part in physical exercise. User Survey 2022 |
Reference to physical activity in health and wellbeing section of spec. |
|
Quality of food is important to people – Having access to healthy food makes a big difference to my wellbeing. User Survey 2022 |
Reference to healthy food noted in health and wellbeing section of draft specification. |
|
Services need to be more proactive checking in and also not giving up and leaving the person alone when there is a lack of social engagement. Carers’ Centre engagement feedback 2020 |
Make it clear in the specification the requirements when someone is not engaging. |
|
Carers and social workers have highlighted difficulties when not being able to contact a community support provider. Feedback to ASC Operations Manager from carers of community support service clients (2020) and feedback to HASC Commissioning directly from social workers. |
Communication section of draft specification includes service users and carers being clear on how to contact the service. |
|
With a community support service, the person’s carer wanted more communication between the two support workers supporting their relative and also highlighted the impact of the support workers’ lack of organisation with their relative’s appointments, leisure activities, shopping and food. Feedback to ASC Operations Manager from carer of a community support service client (2020) |
Staff cover to provide consistent service included in draft specification. |
|
Another carer raised an issue with a community support provider not providing housing-related support their relative needed. Feedback to ASC Operations Manager from carer of ABI community support service client (2020) |
Ensure the specification refers to tenancy related support. |
|
Recommendation for mandatory training for staff to ensure that the disabled person is recognised as the expert in their own care. Care Assessment for Physical, Sensory or Neurological Impairment Report, The Carers Centre for Brighton and Hove (January 2020) |
Specification refers to person-centred and strengths-based approaches, and ‘lots’ will have specific training requirements. |
|
Recommendations have been made for:
· Mandatory training around culture, race, sexuality, gender and lifestyle for all care agency and council employees. · Social workers and care workers to continue to develop their understanding of the cultural differences between ethnic minority groups and communities, through peer-to-peer exchanges and platforms and supplemented by relevant race awareness training. Adult Care Assessment, Consultation with Black, Asian & Minority Ethnic (BAME) Adult Care Service Users, Trust for Developing Communities, May 2020 |
The specification includes: The Service Provider will be personalised ensuring that individual needs are met, and that staff are skilled in supporting cultural needs and the needs of all communities of interest. Also to include how this is monitored. |
|
Carers frequently describe having to research information themselves and find information on services hard to find. Information should not just be online but also be available in multiple formats and easy to locate. Care Assessment for Physical, Sensory or Neurological Impairment Report, The Carers Centre for Brighton and Hove (January 2020) |
Providers fed back that they are unlikely to share the specification with those using services or their carers so have included providing service information for service users and carers in appropriate format and not just online. |
|
“Sourcing small packages of social care community outreach support for people, to enable them to live independently and maintain a tenancy, is virtually impossible.” Mental Health Services in Brighton and Hove – experiences of service users and professionals, Healthwatch (2022) [Quote from professional] |
Goal of framework is to increase the number of providers that could provide outreach support. |
|
Adults with learning disabilities tell us they want: · To be respected and listened to · To have support to talk about mental health, and to access services · To develop and maintain friendships, and support to talk about relationships, sexuality and personal safety · Information and support to access activities in the community, including work and volunteering opportunities · Support to stay physically healthy · To develop their independence and life skills · Support to access the internet and technology · Support with life changes/ transitions · Choice about where to live and who with · Have good, reliable and consistent staff support · Have enough staff support to help to be independent Families and advocates tell us that their key priorities are: · Employment, Education, Training and Volunteering opportunities · Access to financial and benefit support · Improved access and support from wellbeing and mental health services · Improved relationships with GP services and access to quality healthcare · Information on services, what’s available and how to access them · Increased availability of easy read documents · Availability of a range of activities and support to access them · Training for staff to be able to communicate with people with learning disabilities and Autism and awareness of disabilities · More information on planning for transitions, support and housing options · Consistent support of a good standard · Greater support for parents with a learning disability Brighton & Hove Adult Learning Disability Strategy: The Big Plan 2021-2026 (https://www.brighton-hove.gov.uk/brighton-and-hove-adult-learning-disability-strategy-big-plan-2021-2026) |
The specification will include this (many of these have also been highlighted by other groups here and underline the importance for all services). |
Summary of the engagement with stakeholders
|
Session with Assessment Team 08/02/23 |
|
|
Action |
|
|
There is a gap in services for autistic men in their 40s who struggle to engage with services and people. |
Specification includes expectations of providers when people don’t engage with services. |
|
There is a gap in provision for hoarders who are provided with cleaning services but no specialist support around what has led to the hoarding and how to prevent it. |
Consider how we provide and fund specialist support to fill this gap. |
|
All staff need a basic awareness of communicating with hard of hearing people (including while not wearing a hearing aid). Also need to consider people with dual sensory impairment. |
Largely included in specification but will add more. |
|
Only 1 provider for BSL users so no choice. The specification needs to be clear on the level of BSL. |
To add to physical disability and sensory needs appendix in the specification. |
|
ABI: need support with:
Signposting is needed for support with money and finances |
Include in the ABI appendix in specification. |
|
Gaps in support for people with substance misuse over and above the Changing Futures criteria.
Lack of services for people who are still using particularly around their environment and behaviours eg providers won’t enter somewhere with needles or other paraphernalia
Issue with services not accepting people with active substance misuse. |
Add sub-lots for substance misuse. |
|
Gaps for small packages of community support and in areas like Saltdean and Rottingdean |
The DPS will help to identify clusters of support to make them more attractive to providers. |
|
Need for providers to carry out specialist health tasks eg PEG feeding as well as support other needs. Diabetes also raised specifically and need for blood tests and insulin injections. |
Consider adding to the Physical Disability appendix to the specification and discuss with Home Care Commissioner. |
|
|
|
|
Session with user and carer representatives 08/02/23
|
|
|
Feedback/recommendation |
Action |
|
Ensure the specification includes information about the person’s home and environment and that person has the right to have choice over their environment. |
Add to the specification. |
|
Ensure wellbeing is listed as distinct from health. |
Add to the specification. |
|
Include the requirement for providers to work positively with independent advocates/ support people’s right to advocacy in the specification.
And also ensure that is included in the home care and care home specifications. |
Advocacy already included in spec but added to (section 4.1)
Check with commissioners of home care and care homes. |
|
Check if there is anything in the Terms & Conditions regarding pandemics/lockdowns |
Discuss with Legal. |
|
Ensure that carers and their needs are featured and that referrals for carer support take place. |
Add to specification about supporting carers with referrals to carer support and also have specific carer information in specification (now section 4.11) |
|
Quality assurance – is there any reference to quality checking and particularly independent quality checking by experts by experience (and highlighted the value of external, independent experts by experience rather than just those engaged directly be a service) |
Discuss with Quality Monitoring colleagues. |
|
Ensure due diligence and conflicts of interest are included. |
This is checked at the qualification stage. |
|
Would like to know the outcome of the feedback given at session.
|
This information will be shared with contributors. |
Summary of gap and needs analysis and Equalities Impact Assessments
1. Mental Health needs
1.1 Brighton & Hove City Council currently has no framework in place for procuring community support and support living placements for individuals with mental health support needs. Placements are currently being made via the learning disability framework. Recent analysis of mental health placements has identified the need for more supporting living placements within the city, 9% of those currently placed in residential care would be better placed in a supported living service if one was available. Of those currently placed in supported living services 44% have been placed out of area with the average waiting time for a placement being 2 to 3 months.
1.2 There is a need to increase the provision of Community Support in the city following the departure of provider from the market, the majority of current Community Support placements in the city are with one support provider and we would be looking to create a wider market of providers via the DPS to make the costs for support packages more competitive and ensure the best outcomes for service users.
1.3 An EIA for mental health identified both gaps in data and feedback in relation to individuals with mental health needs and certain protected characteristics. Consultation has taken place with users of mental health services, their families and carers around access to services and gaps in provision. This consultation was carried out by Healthwatch and feedback from this and other consultation exercises is being fed into the development of the service specification. This includes the need for provision for those with mental health and substance misuse needs, mental health and autism and the need to ensure that services are sensitive to the needs of individuals with protected characteristics.
2. Learning disabilities
2.1 There are currently 9 community support providers in the city for adults with learning disabilities. Due to cost pressures and recruitment and retention issues the market is struggling to meet the current demand. One provider served notice on their community support contract at the beginning of 2022 requiring a tender process to be completed at pace to source support for 56 individuals (across FCL and HASC). One provider has made the strategic decision not to expand their provision and others are unable to take on additional packages of support due to lack of staff. The result is delays in support needs being met often with an increased pressure on families and very expensive specialist agencies being used by providers with the local authority picking up the additional cost. In addition full time placements are also being considered as an alternative, again at at increased cost and resulting in the over provision of care.
2.2 There are currently 15 packages out on the current DPS system waiting for responses from community support providers. A recent market engagement event was undertaken and prior information notice published to try to stimulate the community support market. We have been successful in signing up one additional provider onto DPS, but this in no way meets the current/future demand.
3. Acquired brain injury (ABI).
3.1 There is currently only 1 Community Support provider for people with Acquired Brain Injuries (ABI) and they have not been able to take on new cases for the past year. This has led to a blockage in the move-on from, and an increase in the need for, the 10 supported living placements that are in the city. Consequently more people need to be placed in residential care as there are no vacancies in supported living. The average cost of ABI residential care is £1,657 per week, compared to £735 for supported living and £86 for community support so there are considerable savings to be made by increasing provision of community support and supported living.
4. Physical disability and sensory need
4.1 People with physical disabilities, acquired brain injury or other conditions under 65 are significantly impacted by the lack of appropriate supported living options in the city, leading to people being placed out-of-area or in inappropriate residential placements. There are no specific supported living options for younger people under 25. The lack of effective transitions planning could mean young people’s care and support is delayed.
4.2 There is a lack of choice of community support providers for people with acquired brain injury or d/Deaf people, and no specialist community support provider for people with sight loss.
4.3 Care and support services, from home care through to nursing care that are not specialist for people with sight and/or hearing loss, may not be adequately equipped to support people with a sensory loss. Services also need to show awareness and understanding of LGBTQ issues and the cultural, behavioural and attitudinal differences across ethnic minority communities.
5. Autism and neurodiversity
5.1 There is a large cohort of autistic, and otherwise neurodivergent, adults who do not have a learning disability but have adult social care needs. However, there are currently no specialist service providers within the city. In particular, there is significant demand for community support and this is currently met by learning disability or mental health providers who often do not have capacity to support new service users.
6. Multiple compound need
6.1 Brighton & Hove has a significant number of people who have multiple support needs, these support needs can include mental health, learning disability, substance misuse, homelessness, physical health needs and offending behaviour. The city ranks 61 out of 151 in terms of highest numbers of adults engaged with substance misuse, homelessness and offending services. 20 in every thousand people in Brighton & Hove are estimated to have needs in three or more support areas.
6.2 There is no framework for Community Support or Supporting Living for individuals with multiple and compound need and various pieces of work including the Mental Health and Housing Plan 2021 have identified significant gaps in services within the city for people with mental health combined with other needs including substance misuse. People with multiple needs experience longer waiting times for placements and are more likely to be placed in services outside of the city.