C – Improving Social Care and Support for Vulnerable People
6.1 Our commitments and key functions
High quality health and social care services are important to the quality of life of the people and communities of Leicestershire. We are committed to promoting people's physical, social and mental wellbeing. We will work with the National Health Service, other statutory, voluntary and private agencies and, most importantly of all, our users and carers to ensure they receive effective and responsive services.
This will be done by:
- Assisting older people and people with disabilities to live as independently as possible by continuing to develop preventative, rehabilitation and home care services;
- Commissioning and providing high quality residential care and supported living for those who need it and choose it;
- Protecting and safeguarding vulnerable children and adults;
- Ensuring people who need services are provided with information about what is available and can access those services easily;
- Improving the life chances of children and young people we look after and bringing stability to their lives by being good 'Corporate Parents';
- Co-ordinating our services to ensure they work together and with our partners to improve the general health of the community;
- Continually reviewing our effectiveness and developing improvements to our services.
- Consulting on a regular basis with service users, carers and other stakeholders about our services and about proposed developments.
In 2002 the Department of Health introduced a system of star rating of all Social Services Authorities. Leicestershire is one of only 11 out of 150 authorities to have been awarded the top rating of three stars. It was judged, in the case of both children's and adult services, to be serving most people well with excellent prospects for improvement.
Leicestershire County Council receives the lowest Formula Spending Share (FSS) per capita of all English counties for social services. Although the County Council has demonstrated its commitment to social services by significantly increasing its budget in 2003/04, resources are limited and need to be very well managed to ensure that eligible needs are appropriately met and that quality services are fairly distributed.
6.2 Our Priorities
Our main priorities for further improvements to these services can be summarised as:
- Redeveloping community homes for young people;
- Improving the quality and range of fostering and adoption services;
- Developing home care, preventative and rehabilitation services for older and disabled people;
- Improving learning disability services;
- Improving the employment opportunities of people with disabilities;
- Developing "Supporting People" housing related support services;
- Pursuing further integration with NHS services, initially by delivering an integrated mental health service.
This section of the Performance Plan assesses our progress against these priorities and sets out our commitments for further developments in the future. It also refers to other developments to services which will support the achievement of our objectives.
It is important for children looked after by the Council to be provided with care in a stable, good quality environment. As Corporate Parents we want, wherever possible, to provide care in a family setting that best meets their needs.
Priority – To redevelop community homes for young people.
Priority – To improve the quality and range of adoption and fostering provision.
6.3 Current Issues
In February 2003 a full inspection of our services to Children and Families was undertaken by the Social Services Inspectorate. The report of the inspection will be formally presented to the Council in June 2003 and an action plan will be established to respond to its recommendations. The outcome of the Inspection will be included in the final version of this Plan.
In common with all social services departments our child protection procedures are being reviewed in the light of the Laming Inquiry into the death of Victoria Climbié.
Children in Need
6.4 Progress to Date
In 2001/02, we were in the best 25% of comparable authorities for:
- The low number (11%) of re-registrations on the child protection register;
- The low number (7%) of children on the child protection register for 2 years or more;
- The proportion (30%) of spend on children in need but not looked after by the Council.
In 2001/02 we achieved average performance for 97% of children on the Child Protection Register whose cases should have been reviewed that were reviewed, and in 2002/03 we met our 100% target for this.
- Maintained the Child Behaviour Intervention Initiative, securing funding from the Children's Fund to ensure that the service can be extended across the county;
- Developed a multi-agency parenting work strategy. Group work is offered to parents of vulnerable young people and young offenders. Children's Fund and other money will enable us to increase the scope of this work in 2003/04;
- Appointed a Child and Adolescent Mental Health Service (CAMHS) Strategy Manager who took up post in February 2003. The Joint Steering Group for the mental health strategy for children in Leicester, Leicestershire and Rutland aims to draft a new three year development strategy by September 2003 to replace the current three year strategy.
- Implemented the Teenage Pregnancy Strategy. A Co-ordinator has been appointed to work with young people on sex and relationship education in educational and youth settings. Since April 2003 the County Council is the lead agency for this Strategy, guided by a multi-agency steering group.
6.5 Priorities for 2003/04 and beyond
- Implement the recommendations of the Laming Inquiry into the death of Victoria Climbié. The initial self-audit was completed by April 2003 as required by the Department of Health; our Area Child Protection Committee procedures are being reviewed in the light of the recommendations and discussions about improving procedures have been initiated with police and health services. We are looking in particular at arrangements in place with Leicester City Council regarding hospital social work;
- With Leicester City and Rutland Councils develop our Identification, Referral and Tracking (IRT) initiative for vulnerable children. We have 'trailblazer' status to develop this initiative. There are ten trailblazer sites nationwide which should have an 'exemplary system' in place by September 2003 to assist other authorities in developing their systems;
- Implement a Local Preventative Strategy. This aims to promote positive outcomes both in childhood and in later life for children and young people at risk. The IRT initiative and various strands of youth crime prevention link closely with this. Youth crime prevention work includes the Action Plan following the Best Value Review of Community Safety, a youth crime prevention working group which will be a sub group of CYPSL (see Partnerships below) and the 25% of the Children's Fund which must be spent on prevention initiatives.
6.6 Progress to date
In 2001/02, we were in the best 25% of comparable authorities for:
- 99% of children under 10 looked after in family placements;
- High proportion (55%) of looked-after children in foster placement for at least 2 years (through performance in 2002/03 of 55%, fell slightly short of our 58% target).
We also achieved better than average performance for:
- Health of children looked after and
- Adoptions of children looked after (9%) in 2001/02, though our performance in 2002/03 fell to 5%, which was below our target of 7% (see Appendix 5 for explanation).
In 2001/02 our costs of children’s residential care were higher than average but the reconfiguring of this service will improve future performance.
- Implemented an earlier review of our residential services for children and young people;
- Continued to extend the range and quality of foster placements and increased the rate of adoption of children who cannot return to their families in line with our policy of providing less care in institutional settings;
- Maintained a consistent number of foster placements. Although we had a net loss over the year of four places we have been successful in recruiting foster carers for sibling groups and children with special needs. In order to enhance the quality of foster care we encourage foster carers to register for NVQ level 3, aiming for ten per year. We are developing our kinship care services, by the appointment of a specialist worker, so that, where appropriate, children who need foster care can receive this care from a member of their extended family. We have also identified specialist foster carers to provide for young people remanded by the courts into the care of the local authority.
- Awarded a new contract to an independent provider in August 2002 to provide a more responsive respite care service for disabled children across the County in residential facilities in Melton Mowbray and Glenfield. These complement the link family fostering project for respite care of disabled children;
- Strengthened the Leaving Care Team to ensure a consistent service for care leavers up to the age of 21. Additional posts include social workers, an accommodation officer and a seconded post from the Connexions Service to support young people as they leave care and move into independence;
- Implemented a joint accommodation strategy for 16/17 year olds in partnership with the Youth Offending Service, the Leaving Care Team and the district councils;
- Reduced offending by looked after children (from 13% to 8%), though numbers are small. The aim is to bring the level of offending by looked after children down to the level of offending by the general 10 -17 population (approximately 2%).
6.7 Priorities for 2003/04
- Complete the closure of Blaby Children's Home and its replacement with alternative provision. A new contractual arrangement has been entered into with an independent provider to replace Blaby Children's Home with three two-bedded units in different parts of the County. In addition a four-bedded in-house unit will be provided in Market Harborough. The new units will be operational by October 2003. There will always be a small number of children for whom residential care provides the most appropriate or only option;
- Improve the percentage occupancy of residential homes for children and young people.
|PI||PI Description||Actual 01/02||Actual 02/03||Targets 03/04||Targets 04/05||Targets 05/06|
|LC5||Percentage occupancy of in-house and block-purchased residential places for children looked after.||82%||80%||85%||85%|
|B9||Unit cost of in-house and block-purchased residential care for children looked after.||£3008||£2,350||£2,686||£2,756||£2,824|
- Bring increased stability to the lives of looked after children, particularly those who remain in our care for a long time by reducing the numbers of children who experience frequent placement changes;
- Work with the Education Department to improve the educational achievements of looked after children (see Section 5.6 of this Plan). We aim to:
- Reduce the number of secondary age children who miss more than 25% of schooling a year to 9%;
- Raise the performance of looked after children at key stage 2, including those with a statement of special educational needs;
- Increase the percentage of young people looked after at age 16 engaged in education, training or employment by age 19 to 80% by 2005/06.
- Building on completed research, improve the health care of looked after children. Where children are looked after for at least 12 months we will increase the percentage of children who receive an annual health and dental check and whose immunisations are up-to-date;
- Develop housing support for care leavers and other vulnerable young people.
We want to enable older and disabled people to live independently at home, or be supported in the community for as long as possible, participating fully in society. Where this is not possible we want to provide appropriate high quality residential care in partnership with other agencies.
Priority – To develop home care, preventative and rehabilitation services for older and disabled people.
6.8 Progress to Date
In 2001/02, we were in the best 25% of comparable authorities for:
- the proportion of over 65s receiving intensive home care (though we fell slightly short of our target in 2002/03);
- costs of intensive social care for adults;
- costs of home care;
- costs of residential and nursing care (older people, learning disabilities, physical disabilities, and mental illness);
- reduction in emergency re-admissions for older people.
Our performance was below average in 2001/02 for the number of assessments of over 65s carried out and fell a little short of our target in 2002/03. But we achieved average performance in 2001/02 for the proportion of over 65s helped to live at home, and we exceeded our target for this in 2002/03.
|PI||Description||Average 01/02||Leicestershire Actual 01/02||Leicestershire Actual 02/03||Leicestershire Targets 03/04||Leicestershire Targets 04/05||Leicestershire Targets 05/06|
|BV54||Older people aged 65 or over helped to live at home per 1,000.||73||73||76||77||
- Put in place an Action Plan with the NHS to implement service changes required by the National Service Framework for Older People including the Single Assessment Process;
- In partnership with the NHS begun to develop intermediate care schemes and the Home Assessment and Rehabilitation Teams to provide rehabilitative services for older people discharged from hospital or to prevent avoidable admission to hospital or residential care;
- Carried out extensive consultation with residents of our fourteen in-house Elderly Persons' Homes (EPHs), their families and other stakeholders. Cabinet has approved recommendations identifying seven homes for potential transfer to external providers;
- Following the review of home care services in 2001 carried out a full tendering exercise and contracts were awarded to independent home care providers in November 2002. We continue to offer an in house service focussing on specialist needs and re-ablement. We continue to monitor the quality closely whether provided in-house or by independent providers.
- Transferred the community meals service to an external provider. The new service offers service users more choice of menus, better quality meals, greater flexibility with regard to meal times and better coverage across the county.
6.9 Priorities for 2003/04 and beyond
- Transfer seven EPHs to external providers in line with the decision detailed above. Security of provision for existing residents and compliance with Care Standards and other quality issues will be key factors informing the transfer process. The focus of services in homes retained by the Council will be on respite, rehabilitation and intermediate care. The key priority in all residential homes whether in-house or in the independent sector is to ensure a quality service;
- Continue to develop the Single Assessment Process. This will bring the assessments of different agencies, notably the NHS and Social Services, into one system, leading to easier information sharing and greater consistency. Most importantly it will make it much easier for older people to participate in their own assessment;
- Expand intermediate care schemes. In house older people's homes and home care will increasingly focus on re-ablement work. We intend, by 2006, to have increased the number of people benefiting from these services by 700 in partnership with the NHS;
- Ensure compliance with the Community Care (Delayed Discharges) Bill hospital social work teams will concentrate on short-term assessments while a number of 'step-down' beds will be commissioned where more detailed assessments can take place outside hospital;
- Review and increase the number of extra care schemes available, in partnership with District Councils;
- Undertake a project to examine provision of day services for older people, reporting in November 2003. We will look at the needs that this service is meeting and how it can respond to changing patterns of care need in the future.
Priority – To improve the work and occupation related opportunities of people with disabilities.
6.10 Priority for 2003/04
In 2001/02 we were in the best 25% of comparable authorities for the high proportion of disabled employees in the workforce. We have agreed targets to improve the employment prospects of people with disabilities in our Public Service Agreement with the Government. As shown below these involve significant increases on current levels.
Employees declaring that they meet the Disability Discrimination Act disability definition as a percentage of the total workforce.
Number of people with disabilities assisted into paid work.
Numbers of people with disabilities assisted into permitted paid work.
Numbers of people with disabilities assisted to engage in voluntary work.
People with Learning Disabilities
Priority – Modernisation of residential, day and respite services in Melton, Oadby and Wigston and Blaby by 2005, and start work in the remainder of the County by 2006.
6.11 Current Issues
In-house day services have traditionally been located in large units, often away from centres of population. The facilities and activities no longer meet the needs of many service users, many of whom wish and are able to participate in mainstream community activity. We have carried out a Best Value review examining the options for modernising these services and making them more responsive to the individual needs of clients. Considerable progress has already been made in making the services more flexible and in providing greater access to community education and leisure provision.
The National Health Service needs to arrange more suitable accommodation for existing residents of Gorse Hill Hospital by April 2004. These residents will become our responsibility and we will work with the NHS to provide appropriate support and accommodation.
6.12 Progress to Date
In 2001/02, at 2.5 per 1,000 population, we achieved better than average performance for the proportion of adults with learning disabilities helped to live at home. We maintained this level of performance in 2002/03.
- Started to implement the Action Plan drawn up following our Best Value review and the Social Services Inspectorate review of services for people with learning disabilities and the proposals set out in the national strategy Valuing People;
- Carried out very extensive consultation with service users and carers regarding the future shape of services for people with learning disabilities;
- In partnership with the NHS reassessed all residents of Gorse Hill hospital who are to be resettled in more appropriate community based facilities.
6.13 Priorities for 2003/04 and beyond
- Progress plans for the modernisation of both accommodation and day services in the selected priority areas of Melton, Oadby, Wigston and Blaby aiming to complete this of the work phase in 2005. Services users and carers will be fully consulted at every stage of the programme;
- Facilitate the closure of Gorse Hill hospital by ensuring that suitable alternative accommodation is provided for current residents.
|PI||PI Description||Actual 02/03||Targets 03/04||Targets 04/05||Targets 05/06|
|LC4||Number of people with learning disabilities in open employment.||3||8||10||10|
|LC7||Number of admissions of people with learning disabilities to long term residential/nursing care per 10,000.||1.0||0.7||0.6||0.5|
|LC8||Percentage of day service activity for people with learning disabilities which is community based.||40%||45%||
Priority – To deliver integrated mental health services
6.14 Progress to Date
- Signed an Integrated Mental Health Agreement with the NHS. This key document will ensure a co-ordinated approach from health and Social Services to meeting the needs of those with mental ill-health.
6.15 Priorities for 2003/04
Consolidate the integrated health and social care approach with a view to moving towards a pooled budget;
- Introduce Assertive Outreach Teams into the County by December 2003.
6.16 Progress to Date
In 2001/02 we achieved average performance with 94% of items of equipment costing less than £1,000 delivered within three weeks. We increased this to 98% in 2002/03, exceeding our target of 94%.
- Reduced the time that disabled people wait for assessments for major adaptations to their home and made improvements to the arrangements for the provision of equipment to support daily living;
- Agreed a new strategy for services for people with physical disability. The key aims are to provide services which promote independence, are responsive to the individual needs of service users, are readily accessible, and fully involve service users and carers in decision making.
6.17 In 2003/04 we will:
- Implement a strategy specifically for people with sensory impairment.
- Work with Primary Care Trusts on the care needs of people with brain injury and neurological conditions.
6.18 Progress to Date
- Revised our eligibility criteria for community care services and provided appropriate training for staff in response to the government's guidance Fairer Access to Care Services;
- Relaunched the Direct Payments Scheme, trained staff and improved information to the general public and service users;
- Implemented new arrangements for charging for non-residential care in line with the government's Fairer Charging guidance after extensive consultation with service users, carers and stakeholders;
- Increased budget provision for independent providers of residential, nursing and home care services to support quality improvements in community care services.
6.19 In 2003/04 we will:
- Encourage increased take up of Direct Payments provision and of the Independent Living Fund in appropriate cases.
Priority – Develop "Supporting People" housing related support services.
The Supporting People programme offers housing support services to vulnerable people to provide a stable environment, improve their quality of life and encourage greater independence.
6.20 Progress to Date
- Completed successfully our preparations for the Supporting People initiative, which was introduced on 1st April 2003. A number of funding streams for supported housing were pooled and will be administered locally. Housing and support providers will be paid the costs of the support they provide to service users through a Supporting People contract.
6.21 Priorities for 2003/04 and beyond
- Ensure a smooth transition of the funding and associated service provision, in particular ensuring that neither service users nor providers are disrupted as a result of the transfer of responsibilities;
- Through the Supporting People Team begin reviewing all the services being funded. All the reviews have to be completed by March 2006;
- Begin work on a five-year Strategy for Supporting People to plan ahead for meeting needs across the County. Stakeholder Groups will all be consulted about the Strategy.
We recognise the important role that carers play in helping people remain in their local communities. We want to support them as much as possible in this.
6.22 Progress to Date
- Launched the Carers' Plan which includes an Action Plan for 2002 - 2005. This acknowledges the contribution made by informal carers in enabling vulnerable people to continue living in their communities and confirms the Department's commitment to increasing support to carers;
- Trained 110 staff in carer's needs;
- Increased the number of carers' assessments;
- Identified existing support and improved publicity and information about
- the Carers’ Plan;
- Funded six Carer Development Posts to co-ordinate and support work with carers county-wide;
- Given grants to a number of voluntary organisations involved in carer support.
6.23 In 2003/04 and beyond we will:
- develop a co-ordinated approach to information provision with other County Council departments, the NHS, District Councils and the independent sector;
- complete a joint strategy with the NHS and Education for the identification and support of young carers.
In most areas of our work we can only succeed by working in close partnership with other organisations. The more significant of these partnerships are mentioned below.
Priority – Pursue further integration with NHS services
6.24 Progress to Date
- Improved linkages with the four Primary Care Trusts (PCTs) now established in the County;
- Restructured the Social Services Department, a key objective being to position us better in terms of partnership working with the PCTs;
- Established the Mental Health Integration Service. This provides mental health and social care services for those with mental ill health on an integrated basis under a partnership agreement;
- Begun to develop intermediate care and delayed discharge initiatives.
6.25 Priorities for 2003/04
- Develop joint approaches to falls, strokes and older people's mental health;
- Continue to develop the Single Assessment Process.
Other Significant Partnerships
Learning Disabilities Partnership Board
As required by Valuing People, this has been set up to guide and oversee policy and planning at local level, particularly in the field of workforce planning and housing strategy. People with learning disabilities and carers, as well as local statutory and voluntary agencies are represented.
Leicestershire Children and Young People's Strategic Partnership
This partnership oversees the strategic agenda for the planning of Children's Services. IRT and the Local Preventative Strategy will feed into the Children's Services Plan.
Vulnerable Adults Strategy
A multi-agency policy and procedure has been developed jointly with Leicester City, Rutland, Leicestershire Police, Health and voluntary and private sectors to ensure that agencies can assist and protect vulnerable adults. A jointly funded co-ordinator has been appointed to develop a training strategy and to standardise investigations.
Sports Development Strategy
In partnership with Rutland and Leicester City and professional and voluntary sector sports groups, this strategy aims at improving sports provision and opportunities for all people to participate in sport complemented by a prioritised action plan for disability sport.
Sport offers many opportunities for the promotion of good health and wellbeing and for social inclusion. The County Council is particularly keen to encourage the participation of disabled people and other excluded groups in sport and encourages this in partnership with the Youth and Community Education service, Sport England and District Councils. The current main disability sport initiatives are club development work (building the skills of existing clubs and creating new ones) and coach development work (training existing coaches to work with disabled people and helping disabled sportspeople to become coaches).
Tobacco Control Strategy
This is a partnership between the County Council, Leicester City Council, Rutland County Council, Health, Leicestershire Police and various voluntary organisations with the aim of:
- Reducing smoking uptake (particularly among young people);
- Reducing tobacco consumption;
- Promoting smoking cessation;
- Protecting non-smokers from environmental tobacco smoke;
- Ensuring retailers comply with the law on sales of tobacco products, especially with regard to underage sales.
Food standards enforcement
This is a responsibility of the Trading Standards Service working closely with District Councils which have a responsibility for food hygiene.
- Nearly 1,000 premises are inspected annually;
- The service concentrates on foods where there is a particular problem or where disadvantaged groups are disproportionately affected;
- The Trading Standards Service also publishes advisory leaflets for both businesses and consumers, a quarterly consumer magazine and 'Business Matters', an e-mail publication for traders.
The 2001 census has confirmed a growing minority ethnic population in Leicestershire. We are conscious of the need to ensure that service users are offered culturally appropriate services.
6.26 Progress to Date
- Established Panels to review the quality and appropriateness of the services we provide to individuals and families from minority ethnic communities;
- Developed culturally appropriate domiciliary and older people's day care services, both in house and voluntary sector. These are able to meet the needs of older people particularly from the Asian community;
- Put in place an Equalities Action Plan. This will ensure regard for all aspects of equality, both within the department in respect of staff and externally with regard to service users and the public.
6.27 In 2003/04 we will:
Further develop culturally appropriate services for minority ethnic service users and other minority groups;
Aim to recruit and support more black and minority ethnic staff;
Train staff to recognise and challenge discriminatory attitudes and practices
Page Last Updated: 30 June 2003