To review the transfer out from the Council of two accommodation services for adults with learning disabilities (Shared Lives and the Community Living Service) to external providers at the end of  year one of the contract. 

Providers and service users will attend the meeting and a report is attached.

The Chairman particularly welcomed Managers, Carers and service users from Midland Heart and Positive Steps, the Community Living and Shared Lives services.

The Head of Social Care, Efficiency and Improvement introduced the report before Members (a copy is attached to the signed minutes) and explained that these two accommodation services for adults with learning disabilities had previously been Council provided services.  The Community Living Service transferred to Midland Heart and Shared Lives service to Positive Steps during summer 2014. 

Community Living Service – Midland Heart

Members heard that Midland Heart customers received levels of support from a few hours a day, to overnight or up to 24 hour support.  Services were currently focused on Shrewsbury and Oswestry based in supported accommodation. It had established an Excellence Panel and individuals had been helped to access a range of community activities.  A designated Community Fund had been established to help support people on limited funds to achieve some of their aims, ambitions and aspirations.

Emma Main, Operations Manager, outlined the ‘Mythbreaker’ holidays which were open to all Midland Heart customers.  The holidays provided groups of people who historically had not had contact with each other to meet and participate in adventure based activities.   One of Midland Heart’s customers present at the meeting reported how much he had enjoyed the holiday and had experienced horse riding, abseiling and a zip wire.

Another Midland Heart customer talked about how well his voluntary work was progressing and his carer reported on dramatic progress in his independence skills.  His previous 15 hours of care had now dropped to just 5. 

Members were pleased to hear such positive feedback directly from service users and carers.  They went on to ask a number of questions including:   

-        If the service was likely to grow beyond Shrewsbury and Oswestry for Shropshire residents;

-        how long it generally took for someone who had been used to day centre care used to independent activities; 

-        Whether there were targets within the Council for future delivery;

-        Whether a physical building was needed to work from;

-        How Midland Heart could increase its offer in Shropshire;

-        Were there any issues accessing physiotherapists or occupation health services.

The Head of Social Care Efficiency and Improvement explained that Community Living service was based on where people lived in supported accommodation, of which there was a limited amount available in rural areas.  She also explained that there were no targets set as the service had transferred as a whole in 2014 and the Council was responsible for commissioning services where they were required. Any future developments would be subject to a procurement process and Midland Heart did participate in that but it was a very competitive market. 

The Operations Manager explained the market was competitive because a shared property could provide a care base which was easier to grow from.  110 hours of care made a good care base and would offer more efficiencies if a staff team were based in one location.

In response to a question from a Member for a particularly rural electoral division, she also explained that Midland Heart did not offer traditional domiciliary services.  Visits would never be shorter than one hour which meant that lack of premises was not such an issue as for other services.   However, having to travel long distances did impact on costs and time.  The aim was to  develop services which met people’s needs and kept costs down.  The Member for Cleobury Mortimer reported that a new medical centre had spare capacity in her electoral division.

Members noted that it could take up to eight weeks to access a physiotherapist, and there was often a long wait before a referral was even acknowledged.  There could also be long waits for occupational health services and equipment.    The Committee suggested that this was a potential area of attention for the Committee and the Director of Adult Social Care referred to acute shortages of physiotherapists which would need to be followed up in the first instance with the Community Trust and Clinical Commissioning Group.

Positive Steps - Shared Lives

A carer working for Positive Steps explained how he and his family had shared their home with two adults with learning difficulties for eight years.  The transfer from the Council to Positive Steps had been fairly seamless, excellent support was always available by telephone or in person, and there were good working relationships.   He congratulated the council on having faith in the local community, and the excellent support offered by Positive Steps.

He also stated that social workers now seemed less accessible and there were now restrictions on taking on additional service users for respite periods, as short term day services at the Mayfair Centre in Church Stretton were no longer available. 

The Head of Social Care, Efficiency and Improvement, explained that there had been a significant number of recent changes to day care in the county.  She confirmed that from October, the Mayfair Centre would be able to offer a temporary service again.  The Director of Adult Social Care acknowledged the comment with regard to social workers and referred to work undertaken in considering how best to use them. 

A member representing a particularly rural electoral division expressed her support for Shared Lives and Positive Steps.  She referred to a service user in her electoral division who had been able to obtain a secure home in a community she was used to and become more active than she ever had been. 

The Committee expressed admiration for the carers, and emphasised the need to recruit more.  They asked what was being done about increasing capacity for future years and asked it if it would be possible to see a map of care provided across the county.  They also congratulated Positive Steps on using carers who had been frustrated that they were not being used before the handover.   

Members were pleased to hear endorsement of the services from those who used them and wondered why there was little provision in the Shrewsbury area.  Two carers had been taken on in the Shrewsbury area since the transfer and it was intended to actively recruit in the Shrewsbury area as well as Market Drayton and Whitchurch.  Members noted that the matching process was very detailed, and if the match did not appear to be right, then a pairing would not be made, even if the carer was located in the right geographical area for a service user.

Alison Glover and Diane Phillips from Positive Steps reported on intended promotional activity.  Leaflets were to be circulated via GP Surgeries, Radio Shropshire was to be utilised as well as talks given at Business events and WI groups.   A Member pointed out that many Shropshire patients were registered at Welsh GP surgeries close to the border and asked that leaflet distribution covered these practices.  

A member asked about financial and contractual arrangements around the service and noted that

the procurement exercise included evaluation criteria with weightings for both quality and price.  Bids were competitive and the evaluation process was detailed.  The contract period was five years with a possibility to extend for another two years. 

Members also asked about demand and whether Council finances were constraining the service.  The Director of Adult Social Care explained that both Positive Steps and Midland Heart provided good examples of better outcomes whilst spending less money than would be required by some of the traditional models of adult social care such as residential care.  The law did not allow the council to turn anyone down if their needs met the eligibility criteria and Shared Lives offered a good quality, cost effective model.  

In response to questions the Director referred to the significant overspend in Adult Social Care in the last year and Quarter 1 pressure from three areas: service users known to the Council but needing a change to care packages; self funders who were now at the threshold; and those coming out of hospital following an accident or illness with complex needs and who were new to the service.

It was hoped that expansion of Shared Lives would involve supporting more older people in local communities in addition to those with learning disabilities.  However, older people tended to have a higher level of need and could be harder to place as some accommodation was not suitable and downstairs rooms with ensuite facilities were usually needed.

Shared Lives carers applauded the plans for expansion.  However there had been just a 1% pay rise over the last 8 years and it would be important to bear this in mind for future expansion plans and not push good will too far as the cost of living changed over time.   

In conclusion, the Committee felt that:

·       the developments had been very successful in terms of outcomes for service users and were well placed to progress and expand.  This would be essential to meet increasing demand on social care.

·       It would be important to continue to monitor and track progress on a regular basis.

·       It would be useful to gain greater understanding of geographic areas of provision through visual presentation using maps.

·        it wished to encourage expansion of services to also cover mental health and older service users  

·       Recruitment of new Shared Lives Carers could be promoted to Parish and Town Councils through the Shropshire Association of Local Councils and also through the Local Joint Committees 

The Committee expressed its appreciation to the Positive Steps and Midland Heart managers, service users, customers and carers for attending the meeting and sharing their views and experiences.