Agenda Meaningful Lives Matter Accommodation Strategy Supported Living Commercial Strategy EU Exit Preparation Progression and Outcomes Accommodation Standards Framework Procurement Meaningful Lives Matter Essex Learning Disabilities and Autism Transformation Programme ID: 775925
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Slide1
Supported Living Provider Forum 2019
Slide2Agenda
Meaningful Lives Matter
Accommodation Strategy
Supported Living Commercial Strategy
EU Exit Preparation
Progression and Outcomes
Accommodation Standards
Framework Procurement
Slide3Meaningful Lives Matter – Essex Learning Disabilities and Autism Transformation Programme
Supported Living Provider Forum
Jess Stewart – Head of Commissioning Robert Sier – Commissioning Manager
Slide4Meaningful Lives Matter Context
ECC spends net c£200m on about 4,000 adults with learning disabilities and/or autism. Demand is growing by c8% up to 2025 across LD and autism. Outcomes are not good enough yet ECC spends more than comparator authorities
The Vision
People with a learning disability and/or autism should thrive in their community, have a place to call home, someone to love and be loved
Slide5Ambition
To shape a stable and sustainable market that helps to deliver the employment, housing, health and progressive social care outcomes to meet the ambitions and expectations of service users and their families
.
Commissioning that enables people to be listened to and valued, have lifestyle opportunities, take risks, make their own choices and are integrated within and contributors to their community.
Improving health outcomes for people with LD/Autism by reducing health inequalities and improving access and working strategically with our health partners through championing the needs of those with a learning disability and developing integrated services. In addition to this, we will meet the ambitions of the NHS Long Term Plan.
A skilled front line social care workforce that is statutorily compliant and enables people, their carers and networks to live a meaningful life through excellent practice and a focus on early intervention, prevention, positive risk taking, progression, safeguarding and recovery.
Ensure that individuals are well supported across their whole life and that they experience a seamless and smooth transition across services and pathways. Ensure that Portfolios of work across ECC are strategically aligned.
MS&E
CML
H&I
TSC
WLP
Structure and Ambition
Meaningful Lives Matter Programme workstreams
Market Shaping and Engagement
Commissioning Meaningful Lives
Health & Integration
Transforming Social Care
Whole Life
Pathways
Slide6Following a small audit by
NDTi
of social work case notes, a targeted review was commissioned to understand more about the culture and practice changes needed to reach our vision and ambitions.
PeopleToo
worked closely with the social work teams including interviews, audits and workshops. The following 6 themes were identified as areas we need to focus on and an action plan and training plans are being developed to progress these.
KEY THEME 1: STRENGTHS BASED PRACTICE
KEY THEME 2: RISK ASSESSMENT AND POSITIVE RISK TAKING
KEY THEME 3: ENSURING COST EFFECTIVE SOLUTIONS AND BEST VALUE FOR MONEY
KEY THEME 4: PROPORTIONATE RESPONSE AND MAXIMISING USE OF RESOURCES
KEY THEME 5: AN ENABLEMENT APPROACH
KEY THEME 6: RECORDING, DOCUMENTATION, PROFESSIONAL PRACTICE AND LEGAL COMPLIANCE
Slide7Slide8A place to call home
Essex County Council Learning Disability and Autism Accommodation and Housing Strategy
2019 to 2021
Slide9What is important to adults
Co-Production is a process which involves adults who have a learning disability and/or autism being asked what is important to them and involving them in the development of strategies as equal partners with Essex County Council.
On the next slide are some of the things which adults have recently told us is important to them
Slide10To have helpful and supportive staff
Doing chores and maintaining their home
Wanting a place to call home
Helpful support staff who reassure them
To have a relationship and someone to love
Doing activities which they enjoy, outside of home
Wanting to find a job
Getting on well with people they live with
To feel connected to their community
To move to a home to live by themselves
Support to identify and achieve their goals
Choosing how their home looks inside
Slide11Slide12Housing Plan
Adults should be enabled to live as independently as possible, reducing their reliance on paid for support and lead a life which is meaningful to them.Essex County Council is intending over the next two years to:
1. Enable adults so they can continue to live in their own homes or with their families
Slide132. When an adult needs a higher level of support Shared Lives will initially be explored before other accommodation options.
3. Support adults to move on from Supported Living to general needs housing when their needs have decreased to a level where they no longer need to live in Supported Living accommodation.
4. Continue to minimise the use of Residential Homes as a place for adults to live
Slide145. Ensure there is enough housing options for adults with complex support needs.
6. Support targeted growth of additional Supported Living schemes in specific areas were they are required
7. Develop accommodation standards and minimise void levels in existing Supported Living schemes
8. Ensure commissioned services represent best value, both for individual adults and as a sector
Slide159. Develop closer working links with the borough, city and district councils in Essex
10. Reviewing adults living in residential and supported living services outside of Essex to ensure they are living in the right accommodation
11. Needs assessment for older people with learning disabilities who have developed dementia and frailty
Slide16Supported Living Category Strategy
Key Points from ECC’s Supported Living Category Strategy
Slide17The market for supported living is varied and spend is spread across a lot of support providers. Support is delivered at sites owned by a large number of different landlords. Support providers often work with a range of different landlordsECC commits an estimated £70m pa to the placement of adults with disabilities into supported livingECC (like other authorities) is moving away from traditional residential care towards supported livingECC has experienced severe financial restraints that have meant there were packages paid below the actual cost of care in the market – hence recent agreements to pay uplifts
.
Background
Slide18There are a growing number of supported living placements, with providers continuing to open new sites across the county and a waiting list of individuals looking for places to live.Places are considered on an individual basis with little forecasting of needs, as a result some areas experience over or under supplySupported living is viewed as the ideal type of accommodation to help people to become more independent over time – so we need to get it rightOne of our big challenges is making sure that provision matches our requirements, so we need to find a way of making sure that we supply useful data to the market
.
Background and Purpose
Slide19AWD Supported Living Services – Key Information
Slide20Packages by Age Group - AWD
Data shows two clear spikes in need – younger people aged 18-25 coming through the transitions service, and people aged 50-60 who perhaps experience a mid-life change in circumstances
Slide21Placements by Budget Quadrant - AWD
This shows the number of placements by the originating quadrant; North clearly showing the highest number
This shows the weekly spend by quadrant; of note is that
Mid’s proportion of the spend is smaller than their proportion of placements made.
SO: North makes the greatest number of placements, and has the highest spend. The size of the market in that part of the county has implications that will require careful management, for
eg
the capacity of the local workforce to actually deliver to these volumes appears to be peaking.
Slide2222
Transitions and Residential SchoolsEssex currently have placements at 54 different residential schools. The majority of these schools are out of county.There are 108 individual placements within these residential schools with ages ranging between 5 and 20 years old.96 of these people are aged above 13 years old and could come through adult services in the next 5 year period.Planning for these people needs to commence as soon as possible to ensure that the market is geared up for their needs and there is sufficient provision at reasonable rates in order to avoid expensive placements out of county or into residential care.
Demand Analysis - Transitions
Slide23Demand Analysis - Waiting Lists
LocalityNo. on waiting ListOf Which have no current optionsNorth479South2914West247Mid259
The Specialist Accommodation Leads (SALs) work with operational teams to maintain a list of individuals who are currently seeking accommodation options. Within each waiting list there are a number of individuals who will not be suitable for any of the current options, whilst the rest will be in the process of exploring suitable properties.
The waiting list can be broken down by user groups as follows:
Locality
LD/Autism
Complex
PI
North
40
4
3
South
22
6
1
West
22
1
1
Mid
20
4
1
Slide24Demand Analysis - Waiting Lists
The concentration of services and service users varies across localities, and the turnover of service users and vacant placements can vary according to a wide variety of factors. The SALs maintain information on how long individuals have been on the waiting list over the last 12 months, which can indicate gaps in local provision
According to the SALs, three factors can lead to individuals spending longer on the waiting list:Having a primary need related to Physical ImpairmentHaving complex needs related to LD and autismIndividuals and/or families expressing very particular needs around the property or the area they wish to live in.Waiting list numbers are reported as fairly consistent, although the list is not maintained in a way that allows for analysis of historic records.
Locality
Average Time on Waiting List
North
34 weeks
South
34 weeks
West
62 weeks
Mid
64 weeks
Slide25Demand Analysis - Waiting Lists
The SALs also maintain information about the vacant tenancies (voids) within each locality. There are several factors that feed into the number of voids:
a room may not have been onboarded yet;
the scheme may provide specialist services which take longer to place;
the scheme may not be ideally placed;
the building may not be appealing;
there may be issues with compatibility with current residents
there may be oversupply of that type of accommodation in an area
there may just be more service users in that area, so more turnover
there could be a number of new schemes recently onboarded but not filled
Slide26Demand Analysis - Waiting Lists
The number of vacant tenancies should feed into future coordination of scheme development.
Locality
Number of vacant tenancies
North
60
South
14
West
17
Mid
22
Out of County
4 (in schemes that are used by Essex)
Slide27Business Requirements – LD and Autism
The population of people with learning disabilities is relatively stable, but does account for a significant proportion of adult social care expenditure. Demand is variable by age group. In the period to 2030, it is forecast that:
Slide28Business Requirements – LD and Autism
Slide2929
Some of our current business requirements include:
Business Needs
Slide3030
This slide shows the geographical spread of Supported Living schemes across Essex based on existing data.As expected, the bulk of Supported Living provision is within North Essex which mirrors the position with other accommodation based services.There is a lack of provision within West Essex and the Maldon district.Provision is concentrated around population centres as most schemes make use of existing properties or are developed on brownfield sites.
Market Analysis – AWD Supported Living
SO: Different areas of Essex have very different markets for Supported Living. Parts of North are reaching the limits of what the job market can support; parts of West and Mid have very little provision forcing people to move. We need to take a locality focussed approach to managing the market.
Slide31Inflation Pressure : National Living Wages, Pension Increase and RPI increasesProviders’ wage bill for care staff is circa 75%-85% within Supported Living and circa 65% to 75% within Residential, and a further 8-10% accounted to management structure of their total cost structure. This is an unavoidable cost pressure on the business, unless you can reduce the number of staff, which is extremely difficult in small supported living settings whilst maintaining the required hours of care in accordance with the ECC Care Act assessment. Providers are also required under the terms of their CQC registration to maintain a safe service.
Market pressures
Note 2019/20 uplift to £15.16/£17.04 rather than a % uplift.
Slide32Market pressures
Person-Centred Approach
Services bought on a person-centred, case by case basis, making it difficult to forecast need with accuracy. This leads to oversupply in some areas with providers selling property, and undersupply in others leading to procurements
Diverse Local Markets
Some areas have a lot of providers operating in a small area, leading to competition for staff and difficulties engaging with other services e.g. NHS or community services
Competition
Recent procurements have shown there is interest in working in Essex. Providers are competing for business which could drive quality and variety of services
Slide33Key Actions
Demand Forecasting:
We need to develop a model based on past placements and pipelines of need, to create a more reliable forecasting model to share with providers
Develop specialist PSI services in Essex
: We need to forecast the need for specialist PSI services to meet suspected hidden need; this will be shared with providers and work carried out to develop specialist schemes in Essex.
Outcomes Focus:
We need providers to be able to work towards, record and analyse the outcomes they have achieved with service users. We will support providers to develop awareness of outcomes, skills to develop users outcomes, and the tools to record and analyse those outcomes.
Slide34Key Actions
Assistive Technology:
We need to ensure that there is appropriate support for providers to understand and implement assistive technology across the market, working closely with operational colleagues
.
Framework Procurement:
We need to ensure that we have a fair, open and transparent method for securing supported living placements. We will carry out a procurement to secure a framework of providers who meet our quality standards.
Slide35EU Exit
Is your BCP up to date ?
Slide36Have to plan or deadline of 31st October Thoughts to consider contingency plans for key areas:
EU Exit Planning
Slide37Food
Consider your planning and support for those with dietary requirements, those solely dependent on your service for food shopping.
Travel Disruption
Consider how staff will get to work, how they will travel to and between sites, how they will support Adults to necessary appointments, e.g. medical appointments, respite, education, do you deliver services in areas where there is a transport pressure point such as a port which may impact the road and public transport network
Short Term Fuel Issues
In the unlikelihood of a fuel issue , consider how all staff will travel to and from work, to and from sites, can staff car pool or use alternative transport (cycle) , how can they support transporting Adults to necessary appointments
Slide38Necessary Equipment
e.g. cleaning products, personal protective equipment, continence pads etc. Consider how you can ensure that you have enough equipment, how staff can access it, how strong your supply chain is
Staff Availability
Consider how staff availability may be impacted, e.g. are any staff parents and schools may close for similar issues, can staff work remotely, do shift patterns need to be amended, do you use agency staff and are your arrangements with these agents robust and can meet your requirements, do you employ other companies to deliver key services to your organisation and can they meet your requirements, e.g. catering, transport
Slide39Testing Business Continuity
Consider testing your plan to ensure it is up to date, e.g. do you have the correct contact numbers for all staff, have you tested your phone tree, do all staff who can work remotely have the correct equipment in working order to do so, do all staff know who to contact if a problem arises.
Medication
Consider how you will manage access to medicines, how you will monitor medicine level, including incontinence pads , pegs feeds etc
Prioritising your service
Consider how you will determine the priority status of Adults in the service, and priority calls if the normal services cannot be delivered. This may mean considering a number of potential issues at once, such as transport problems and reduced staff availability for a longer than usual period of time.
Slide40Staff who are EU nationals
Consider how many of your staff are EU nationals, if they have applied for settled status and what level of status they have received (settled or pre-settled)
Not all issues will apply to all providers
Not all issues will have an obvious solution – but there may be things you can do to mitigate or lessen the impact
EG if you usually obtain all your medication from a particular pharmacy, have conversations with some local alternatives
Slide41Reflections
Are there particular issues that are worrying you or that you think would particularly affect your service(s)?
Have you already put any mitigations in place that you would be willing to share with the rest of the table?
Are there one or two good ideas that you think would be worth sharing with the rest of the room?
Slide42Outcomes and Progression
Enhanced Social Care Support Teams for Learning disability and/or Autism
Outreach and
Inreach
Positive Behaviour Support (PBS)
10 staff members embedded in social care rather than health, with a strong ECC commitment to the PBS model
Qualified in Intellectual and Developmental Disabilities (Tizard)/ PBS
Use the principles of Positive Behaviour Support and Applied Behaviour Analysis in role
Core work - behaviour assessments, service specifications, review support levels , working alongside social workers toward the best outcomes with a whole life pathway approach.
PBS is now in guidance (NICE/ DOH)
Slide44Positive Behaviour Support, progression and outcomes
How do you use Positive Behaviour Support (PBS) in your provision?
How does use of PBS feed in to progression and outcomes for the individuals you support?
How are you assessing, improving and monitoring skills of the individuals you support?
Slide45How positive behavioural support feeds into progression and outcomes
Identifying the function of behaviour can guide skills building
Identifying triggers can indicate changes in support which enable meaningful engagement
Using a PBS approach can reduce restrictive practises, e.g. high staffing levels, physical intervention, environmental restrictions
Reducing challenging behaviour can increase Quality of Life and vice versa
A PBS plan should reflect how skills building is supported
Slide46Team Examples of PBS/ Skills building
Skills assessment tools , e.g. communication, daily living skills, community access.
Monitoring tools- keeping track, person centred specific recording tools
Person centred goal setting
Person centred active support approach to engagement; every moment has potential, graded assistance, maximising choice and control, little and often)
Task analysis recommendation; breaking a task down and using forward/ backward chaining
Recording systems are important to monitor behaviour, skills, e.g. engagement in activity. Without recording and analysing, can’t see patterns/ increases/ decreases
Slide47On-boarding and Accommodation Requirements
Essex County Council
October 2019
Slide48‘Having a home guarantees a place in the community and is part of how people are accepted as equal citizens. People with learning disabilities are one of the most socially excluded groups in our society and this is primarily a result of an historical segregation of services that unintentionally deny people their own home, choice and control and a decent income; factors which ultimately deny citizenship and social inclusion.’ https://www.ndti.org.uk/uploads/files/Supported_Living_-_Making_the_Move,_May_2010.pdf
Slide49Why has on-boarding been introduced
To ensure good quality and stable Schemes are available, as well as to support partner organisations to develop new Supported Living services to meet present and anticipate future demand.
Prior to the introduction of basic on-boarding checks and processes, there were:
Several evictions of vulnerable Adults from Supported Living
Some concerns about the condition of Supported Living accommodation.
No co-ordinated approach to deregistration of previous residential properties.
Concerns about quality and sustainability of accommodation has led to the development of the on-boarding process which makes clear, standards expected in Essex.
This approach started in April 2017 for new schemes and pre existing Schemes will also go through the same process when a void tenancy arises.
The on-boarding process
Slide51New schemes
Developers making tentative enquires as to demand for services in a particular area,A Provider/Landlord may have a property they are thinking of purchasing,A Provider wishing to deregister a former or current residential care home for development into a Supported Living Scheme, Provider and/or Landlord have a property that they wish to have on-boarded as a Supported Living Scheme,Developers, Landlords or Providers have plans for a new build for a Supported Living Scheme
Pre-existing
Void in a pre-existing property that has not already been on-boarded
Procurement Services will confirm when the on-boarding process starts. Sometimes there will be a meeting initially for all parties to look at what is proposed/needed
Slide52The process:
Specialist Accommodation lead (SAL) checks current demand in area
SALs send covering standard letter via email with Accommodation Planning Board (APB) form for completion by Landlord and/or Provider
SALs to confirm if the Scheme is needing a letter of support or looking to on-board. If only a letter of support is required, SALs to gain as much of the requested information that is currently available
Checks to be made:
SALs to checks the Landlord for any Regulatory Judgements
SALs to check Care Quality Commission website for current/proposed Provider rating. If rating is not ‘Good’ or above, or if the service has yet to be inspected, the process should be paused until it is confirmed the Provider has received at minimum a ‘Good’ rating
Procurement Services to confirm with SALs that an hourly rate for care has been agreed with the Provider and that it is in line with the framework
SALs to check the tenancy to ensure there is not link between the Landlord and Provider
SALs check rent breakdown
Slide53Property visit
SALs arrange a site visit. Attendance representation requirement as follows:
New Scheme
– SAL, Operational Team manager, Commercial Manager as minimum. Commissioning Team to be informed of visit and invitation extended.
New Scheme, proposed client group includes Complex
needs*
– SAL, Complex Team Manager, Commercial Manager, Behavioural Advisor as minimum. Commissioning Team to be informed of visit and invitation extended.
New Scheme, proposed client group includes people with additional physical requirements –
SAL, Operational Team Manager, Commercial Manager, Occupational Therapist as minimum. Commissioning Team to be informed of visit and invitation extended.
Pre-existing void –
SAL, Operational Team Manager as minimum. Commercial Manager and Commissioning Team to be informed of visit and invitation extended.
Slide54Property standards
Slide55Information being collected
Property Inspection checklist – Self-contained Accommodation:
https://www.livingwellessex.org/media/679985/Property-Inspection-checklist2.docx
Property Inspection checklist – Shared House
https://www.livingwellessex.org/media/679731/Property-Inspection-checklist-Shared-House-002-.docx
Please see draft accommodation requirements hand out
Slide56How decisions are made
Slide57The Accommodational Planning Board meets Monthly. Its purpose is:To agree to on-board new Supported Living Schemes, which have been through the Scheme Approval Process, to ensure the Scheme fits ECC’s quality and best value criteria. To decide if pre-existing Supported Living Schemes which have been through the Scheme Approval Process fit ECC’s quality and best value criteria. To act as a forum for proposed Supported Living developments to be discussed, and if appropriate to be given a letter of support. A forum for the discussion of any Supported Living issues within the County and to share information among colleagues. To act as a reference group to support the development of the ECC Accommodation Strategy, ensuring the Board is working to ECC’s strategic intentions.
Accommodation planning board:
Slide58Discussion
Slide59Table top discussion – 15 min
Initial thoughts on accommodation requirements
Anything we missed/could improve?
What should we do with pre-existing voids that do not meet these proposed requirements?
Group feedback
Slide60Supported Living Framework
Market Engagement Slides
Procurement Services
Realising Essex's potential through our suppliers
Slide61Background and Purpose
Slide62Key Points
Slide63Proposed Call Off Process
The call off process is led by the Specialist Accommodation Leads (SALs) who receive the Accommodation Needs Assessment for the adult from the social worker and are responsible for matching the adult to supported living accommodation
The choice of the adult is paramount in this process and they will have the ultimate choice about where they will live
Slide64Bidding Process
The framework procurement will be open to all providers, whether delivering in Essex currently or not.
Providers will be required to provide the following documents in response to the invitation to tender:
The framework will be re-opened on a regular basis (at least annually) in order to attract new provision so any provider that has been unable to secure a place in the first instance will be given the opportunity to bid again in future.
Providers do not have to have supported living property within Essex may still bid for a place on the framework.
The procurement process will be run through ECC’s e-procurement portal and details will be shared closer to the time of tender release.
Slide65Timescales – Framework Procurement
This timescale is indicative and may be subject to change.
Slide66Closing
Slide67Feedback sheets available – we would like your ideas for topics and issues to cover at future events
Slides and materials from today will be available on the ECC provider hub at:
https://www.livingwellessex.org/care-provider-information-hub/
Thanks for coming!