Promoting Independence in Devon: Adult Social Care Five-Year Plan (2018-2023), Schemes and Mind Maps of Nursing

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Promoting Independence in Devon

Our 5 Year Plan

for Adult Social Care

Introduction

Most people tell us that what matters to them is to stay living safely at home in their community, surrounded by their family and friends, where they can retain their independence for as long as possible. We aim to help adults in Devon find the solutions they need to achieve this. We have updated our vision for adult social care through conversations with the people who use our services and their carers, our staff and those of independent and voluntary sector providers, and colleagues in partner organisations and across the council. We are seeking to create conditions in which people can lead fulfilling lives as independently as they are able, through being informed, secure and connected:

• Independent – People who are ambitious about living lives they have choice in and control over.
• Informed – People who know how they can get the support they need, when they need it, to help with the things that matter most to them.
• Secure – People who feel safe and confident that they can make the choices they want about how they live.
• Connected – People who have rewarding relationships and involvement with their family, social networks, and communities rather than feeling lonely or isolated. We cannot do this alone and are working within the council and across the wider health and care system in developing and delivering our plan. This involves a long-term shift in the deployment of our limited resources to achieve these better outcomes in a sustainable way. We will continue to assess progress in our Annual Report. Jennie Stephens Chief Officer for Adult Care and Health Councillor Andrew Leadbetter Cabinet Member for Adult Care and Health

How this fits with our other strategies and plans

People sometimes tell us they want to engage with what we are trying to achieve, why and how but don’t understand how our various strategies and plans fit together. Several of these are statutory documents we have to produce, others are agreed locally, usually involving the people who use our services and their carers: Document Purpose Joint Strategic Needs Assessment This statutory document gathers together the main evidence that helps us understand the population of Devon and their needs. It is refreshed annually. Joint Health and Wellbeing Strategy This statutory document considers that evidence and sets the priorities and goals we want to achieve for the people of Devon. It is agreed by the Health and Wellbeing Board on a three year cycle. All organisational and partnership strategies and plans should refer to it. The wider Devon Sustainability and Transformation Plan This statutory document takes the health and wellbeing priorities for Devon, Plymouth and Torbay and determines how health and care services should be shaped to deliver those objectives. It informs the operating plans of each partner. This plan ‘Promoting Independence in Devon’ is the five year operating plan for adult social care in Devon and is refreshed annually. It includes a vision for the distinctive role social care has to play in the health and wellbeing system. Our Annual Report Our annual report assesses how well we are doing in delivering that plan and whether we are making a positive difference to people’s lives. It is published annually. Our Market Position Statement This statutory document considers the demand for and supply of social care services and is aimed at the market of service providers we commission from. Our service strategies and plans We also publish strategies and plans, jointly where appropriate, regarding specific services and how we intend to meet the needs of particular groups.

Social care affects us all

Many people don’t come into as regular contact with social care as they do with the NHS or other council services but it has an impact on all of our lives:

• It is estimated 25,000 people in Devon are employed in social care , 85% in the independent and voluntary sector, 10% self-employed and 5% by the local authority. They work for a range of commercial and voluntary sector organisations including almost 500 providers regulated by the Care Quality Commission.
• There are around 1,500 vacancies at any time, providing vital paid work opportunities in local communities, with starting wages often more than the national living wage and a range of training and development opportunities to progress as promoted by Proud to Care. Two-thirds of these are filled by people furthering their career in the health and care sector, with one-third by new recruits with opportunities to suit people in a variety of circumstances.
• Most of the money spent on social care by local authorities, NHS and individuals in Devon stays in Devon with more than half paid in wages to local residents. Half of social care is funded by the person who receives it or their family. Much of what the local authority spends is in the control of the individual through a direct payment enabling them to choose how they are best supported.
• The sector is one of the fastest growing in the economy , with the number of people employed increasing by more than 1% per annum as our population ages and people with disabilities and long-term conditions live longer.
• The local authority supports more than 17,000 people to live as independently as they can , meeting the needs of people with learning disabilities, physical disabilities, sensory impairments, dementia, frailty and loneliness a third of whom are under 65 and a third over 85.
• We also support four thousand carers each year as they support their loved ones and seek to keep as many carers and users of our services as we can in active and paid employment.

We draw evidence from the Joint Strategic Needs Assessment in considering the challenges we face in Devon:

• An ageing population which is also growing faster than the national average;
• A sparse and predominantly rural population with patterns of deprivation marked by isolated pockets and hidden need;
• Significant inequalities in healthy life expectancy between the most and least deprived parts of the county that can only be impacted on by changing social, environmental and behavioural factors determining health;
• The extending life expectancy of people with learning and physical disabilities;
• The growing number of people with often multiple unpaid caring responsibilities ;
• The growing number of people with long-term conditions , sensory impairment, dementia, cancer and other health problems;
• Growing levels of severe frailty in the population with increasing early onset;
• High levels of social isolation resulting in loneliness with mental health needs increasingly pressing in all age groups;
• Improvements in health-related behaviours in younger age groups not mirrored by the middle-aged and elderly;
• A disparity between the quality of indoor and outdoor environments in Devon with housing both unaffordable and of variable quality and incomes lower than the national average;
• Changes in the benefits syst em having unforeseen consequences;
• A working age population that is not growing at the same rate as the non-working population with recruitment and retention challenges in our workforce escalating;
• A complex organisational geography with multiple NHS partners.

The challenges we face in Devon

How we are performing

As part of the government’s sector-led approach to improving social care, we make statutory returns which enable comparative performance to be analysed through the Adult Social Care Outcomes Framework and associated publications in our Annual Report:

• Our ‘promoting independence’ approach has brought the number of people dependent on our support to comparator levels, and the rate of placements into care homes is relatively low, but we support significantly more working age adults than is typical, in particular in community settings.
• Although our short-term services aimed at restoring people’s independence are effective, we know we can extend their reach in partnership with the NHS.
• We are comparatively good at preventing unplanned admissions into hospital but despite recent improvements have more to do to avoid delayed transfers of care into the community.
• Our expenditure on adult social care relative to our population is in line with comparators and we are currently delivering within budget.
• Our unit costs are in line with the regional average.
• Our support to carers is consistently delivered through direct payments giving them choice and control.
• People with learning disabilities or with mental health needs are more likely to be in paid employment and living independently than is typical elsewhere and we aspire to do even better.
• The quality of adult social care service providers is rated significantly higher in Devon than the national average and our overall satisfaction ratings are in line with comparators.
• Our level of safeguarding concerns and enquiries is well below the comparator average, and our Safeguarding Adults Board is raising awareness and changing practice accordingly.
• We have convened focus groups of service users and carers to understand our less positive survey results , seeking to improve people’s perceptions of safety and reduce social isolation.
• Our social care workforce turnover is reducing and vacancy rates are less high than many comparators but we have more to do to ensure sufficient, high quality, affordable services into the future.

Living life well

Health and care services only contribute 10% to the determinants of people’s health and wellbeing. For most of us the choices we make are more important than the treatment we receive in impacting our health. All public services can influence people’s behaviour in making healthier choices, not just public health, and all of us have a responsibility to consider the consequences of our actions for ourselves and those around us. The county council and its partners are key in shaping the places which people inhabit – the social and environmental context in which we live our lives according to what matters to us including the house where we live, the community in which it is situated, and the learning and working opportunities available to us. Our shared objectives for the people of Devon are articulated in the Devon Joint Health and Wellbeing Strategy.

Doing what matters

In Devon we aim to support people to keep their life in balance and live well. In adult social care we are focussed on keeping people as safe, healthy and independent as they can be by being informed, secure and connected. In changing our services, we are working with and listening to people to better understand what matters to them and redefining our purpose and how we measure success on that basis. We start with the assumption that the more independent people are, the better outcomes they will achieve and at lower cost. Once someone is receiving adult care support they risk their needs escalating unless we work with them, and the people who care for them, to keep them as independent as possible in the place most appropriate to their needs at that time. For most people most of the time that will be in their own home which is where people tell us they want to be. For some people some of the time this will be in hospital or specialist settings where we will work to get them home whenever it is safe to do so.

The outcomes we want to achieve

Working together with colleagues from across the wider Devon health and care system we have put ‘Promoting Independence’ at the heart of our shared strategy:

Prevention

Theme Initiative Impact Prevention: enabling more people to be and stay healthy. Life Chances: taking a social prescribing approach to linking people to voluntary sector support. More people connected to opportunities that reduce social isolation and improve well- being with a consequent reduction in demand for adult social care. Stimulating the voluntary sector: through targeted seed-funding and community development. A self-sustaining voluntary sector with the capacity and capability to support people to live independently in their communities. Making every contact count: a training initiative for professionals across the health and care system. More people changing their behaviours in ways that have a positive effect on their health and wellbeing encouraged through the many interactions our health and care staff have with them. Falls prevention: working across the health and care system to reduce the incidence of falls. A reduced incidence of falls that lead to unnecessary hospital admissions and the premature loss of independence. One small step: working with Public Health to promote better lifestyle choices. More people reducing their risk of developing conditions that lead to dependence on health and care services through a tailored service for people in Devon who want to quit smoking, lose weight, become more active or reduce alcohol intake.

Support at Home

Theme Initiative Impact Support at home: integrating and improving community services and care in people’s homes. Living Well at Home: developing our personal care framework to maintain capacity and improve outcomes. Personal care delivered in a way that encourages the recipient to be as independent as they can be. Supporting Independence: individualised support to assist independent living. People with disabilities supported to develop their independent living skills to do what they want to do. Short-term services: developing an integrated reablement, rehabilitation and recovery offer. Unnecessary hospital admissions avoided and recovery through rehabilitation after hospital discharge promoted by integrating social care reablement and NHS rapid response services. Enabling: targeted short-term support to people with disabilities to develop their independent living skills. Adults with disabilities developing the skills they need to lead more independent and fulfilling lives, enabled by targeted short-term intensive support. Day opportunities: purposeful and interactive group-based activities. People participating together in activities meaningful to them in appropriate centre and community-based settings. Supported living: ensuring the right balance of group and individual support in supported living settings. People who live in supported living settings supported to live more independently in the best value and most effective way.

Specialist care

Theme Initiative Impact Specialist care: delivering modern, safe, sustainable services. Accommodation with care: improving the range of accommodation with care options in Devon An improved range of accommodation with care options that meet the changing needs of Devon’s population, working in partnership with district councils. In-house services review: ensuring our in-house residential and respite services are fit for purpose Our in-house provision kept under review, to ensure we maintain the right balance of council and commissioned services. New residential and nursing care framework: implementing a new contract for older people A more sustainable care market with providers funded using an assessment of care needs that ensure fees are proportionate to care hours required and accommodation costs are met at a consistently good quality. Regional commissioning: taking a more regional approach to commissioning specialist bed-based care Improved sufficiency, quality and value for money of specialist residential services for people with disabilities by working across the south-west region. Quality assurance: maintaining the comparatively high-quality care in Devon by investing in quality assurance and contract management. Improved quality and sustainability of regulated and unregulated care and support services, preventing whole service safeguarding services.

What this means for older people

Themes Aims Prevention: enabling more people to be and stay healthy.

• Take preventive approaches to avoid, delay and reduce the need for ongoing support by working across the council and wider Devon health and care system.
• Further develop and more widely implement a social prescribing model that targets individuals according to an assessment of their risk of losing independence. Empowerment: enhancing self-care and community resilience.
• Ensure that when vulnerable older people first approach social care and partner agencies they receive information, advice and support that takes a strength-based approach, with a default offer of a reablement-focused short-term service.
• Increase the use of technology enabled care and support to maximise independence will be considered at every point of contact.
• Improve the community equipment service to aid people to live independently in their own home.
• Improve support services to people with dementia, ensuring they have a named support worker, and a care and support plan developed with them and their families. Support at home: integrating and improving community services and care in people’s homes.
• Develop and extend the short term services offer with NHS partners to improve pathways, triage and the range of options available to help people recover their independence, especially on discharge from hospital.
• Further the implementation of our Living Well at Home framework for the provision of personal care to ensure sufficiency, improve quality and take an outcomes-based approach that encourages people to regain their independence. Specialist care: delivering modern, safe, sustainable services.
• Increase the choice and availability of accommodation with support for older people.
• Maintain progress in reducing the number of admissions into residential/nursing care relative to our population by always considering alternative accommodation with support and only admitting in a planned way rather than at a point of crisis.
• Support the development of strategically located care homes with nursing.

What this means for people with disabilities

Themes Aims Prevention: enabling more people to be and stay healthy.

• Work alongside local communities to support people with disabilities to access the same opportunities as everyone else.
• Make information available in formats appropriate to people with learning disabilities, sensory impairments and other communication challenges. Empowerment: enhancing self-care and community resilience.
• Work with children and families in transition to enable them to live as independently as they can as adults.
• Promote the aspiration to be employed and the value that people with disabilities can bring to businesses and to the local community working with partners to increase the educational and employment opportunities available.
• Ensure that people with disabilities have appropriate and equal access to health services to prevent avoidable mortality. Support at home: integrating and improving community services and care in people’s homes.
• Consider how Technology Enabled Care and Support can complement support that people receive to live as independently as possible in their communities.
• Develop Positive Behavioural Support services so that people who need them get the right psychological support to help manage crises without having to go to hospital.
• Involve families and carers in the health and care support for people with disabilities, including for when they are no longer able to offer care and support.
• Focus enabling services and the use of direct payments on maximising independence. Specialist care: delivering modern, safe, sustainable services.
• Meet people’s needs in settings other than residential care such as adapted social housing, supported living, shared lives and extra care housing wherever possible maximising their independence and development of independent living skills.
• Where specialist residential care is required only maintain it while it is therapeutically necessary and in Devon as close to home as possible.