Agenda item

This report provides an update on the progress in respect of an aspect of the Adult Social Care Transformation programme-the modernising of day opportunities for people with learning disabilities.  It summarises the findings of assessed needs of learning disabilities day care service users.  The policy for implementing personalisation through the self directed support model is discussed within the context of providing choice and control for users. This includes the provision of personal budgets and/or direct payments and giving users a choice on how their budget allocation is spent.  The report provides an update on the proposal to re-provide services at Albert Road Day Centre on the John Bilham site in Preston.

Lance Douglas (Assistant Director – Quality and Support, Housing and Community Care) provided an update since the last report to the Committee in October 2009.  The report included details of assessments of users, which had involved self directed assessments of some 300 users and 96 carers, as requested by Members.  Lance Douglas advised that the process of servicing user’s support plans would be formalised and commence in March 2010 following feedback from both service users and carers to address earlier concerns. A personal budget for users would be provided and support would be offered through brokerage and advocacy to users and carers.  Lance Douglas highlighted the input made by Members through working with users, carers and officers and visiting day centres and he felt this was a good example of partnership working.

By April 2010, Lance Douglas advised that all users and their carers would be informed of the amount of money allocated to them for their personal budgets and they would have a choice on how this budget was spent.  He added that the personalisation arrangements would help improve the customer experience.  With regard to day centres, Lance Douglas advised that a joint planning application with the Gujarati Arya Association concerning the proposed John Billam Resource Centre would be considered at the Planning Committee meeting on 14 April 2010.  Nancie Alleyne (Special Projects Manager, Housing and Community Care) added that there had been positive feedback from local residents in respect of proposals for the John Billam Resource Centre.

Ms Anjna Manek, a carer, was invited to address the Committee.  She suggested that the support plans, though long on narrative, did not provide realistic financial support.  Members heard that carers had approached five private sector providers concerning costs, and Ms Manek estimated that the Council only provided approximately two-thirds of the money required to purchase their services.  Ms Manek stressed the large variation in each user’s needs, such as the level of capability and intellect and this would impact upon their ability to answer the questions in the assessments used to develop individual support plans.  She suggested that many support plans would not work for those users with less capability and she queried why users and carers were required to sign contracts.  Ms Manek felt that more transparency and empathy was required and she was mistrustful of the proposals, including some support plans that in her view included unrealistic objectives, such as users obtaining employment.  Members heard that it was a legal obligation of the Council to undertake both user and carer assessments simultaneously.  Ms Manek claimed that there was always a discrepancy in the numbers reported by officers and at this moment 30 users still had not been assessed, whilst only 96 of over 200 family carers had currently been assessed.  She felt that the existing support structure should be retained, whilst day centres should also continue to offer the option of support to carers and choice to users who clearly valued their centres.  Ms Manek stressed that in principle, carers did not have issues with trying new options, including employment, provided there was a safety net option of re-instating Day Centre support if the new option was not a success.  In addition, Ms Manek suggested that an independent body be created to monitor on-going developments in respect of the John Billam site and the Strathcona and Stonebridge Day Centres and to provide assurance that those users who were unsuccessful in employment as set out in their support plan would still have access to the day centres.

One carer added that it was not clear from the support plan for his brother what was being provided.  He doubted that his brother would be able to obtain employment, as had been included in the support plan because of communication limitations.  Concerns were also expressed about the budget provided and whether alternative day activities would be in place in time for April 2010.  Another carer added that she felt her brother had been coerced into opting for employment when her family know that the thought would not have ordinarily occurred to him; in any case his prospects were limited because of his capabilities.  This has led to issues of trust in the assessment process for her.

Councillor John was invited to address the Committee.  She highlighted concerns about the accuracy of assessments for users at Melrose House, adding that this issue had also been discussed at a meeting of the Forward Plan Select Committee which had passed recommendations to the Executive.  Although some assessments had been changed as a result of a review, concerns remained, including whether changes in service based assessments were secure.  Councillor John queried the use of the term ‘contract’ and suggested that an ‘understanding’ would be a more appropriate term.   She also sought details concerning the processes that would be put into place where carers had expressed dissatisfaction with assessments.

During Members’ discussion, Councillor Castle sought clarification as to why contracts needed to be signed with regard to support plans and views as to whether the financial support provided was sufficient to acquire the relevant services from the private sector and why costings had been provided.  He also questioned the accuracy of the assessments, stating that the carers and medical professionals would be best placed to offer the most meaningful and objective opinions.  Councillor Castle suggested that a working group be set up to scrutinise the processes of the assessments and the implementation of the support plans.  Councillor Mistry also enquired why costings details had been provided and commented that if funds were limited, then this would prevent users from having the choices that personalisation intended.  Councillor Clues suggested that the implementation of the support plans and their budgets should be simultaneous and enquired what about the implications if users and carers did not sign contracts. 

The Chair commented that there was a lack of trust amongst users and carers concerning the support plans, whilst some assessments were lacking in accuracy.  She also expressed concern about the support arrangements for carers and stated that users and carers should be provided with more information on how to make a complaint.

In reply to the issues raised, Lance Douglas acknowledged that the term ‘contract’ was not the most appropriate in agreeing the support plans, stating that the intention was to seek an agreement in principle between the user and the Council and for it to be overseen by the carer.  He advised the Committee that the Council was providing a contract for services it was statutorily obliged to provide and he did not feel that this entailed any legal obligation on the service user or carer.  However, he acknowledged that the term ‘agreement’ was more appropriate and this would replace the term ‘contract’.  Members heard that by allowing users to choose how they spent the money provided to them, that this offered users greater choice of services.  Lance Douglas continued that this may mean users choosing services from the private sector, although he acknowledged that there may be a lack of incentive in some cases for such organisations because of the costs involved.  However, by providing users with choices, it enabled them to consider services that may not be provided by the Council, although Lance Douglas added that the market for personalisation services was underdeveloped, but it was anticipated that it would expand.  Furthermore, the personalisation programme had only just begun and there would be changes to the programme over time, whilst a resource allocation system was being developed to simplify the process for users and their carers.  Members noted that guidance from the Government’s Department of Health required local authorities to identify budgets for the personalisation programme.

Lance Douglas advised that there would be follow-ups to assessments on individual users, including undertaking quality checks and discussions with users and carers, whilst surgeries would also be given to provide advice on assessments.  He encouraged users and carers to approach the assessors if there were any concerns about the accuracy of assessments and if there was still dissatisfaction, to contact Andy Lane who was responsible for the overall quality of the assessments.  Should there still be dissatisfaction, Lance Douglas advised that the Council’s formal complaints process could be activated.  Members heard that emphasis was placed on ensuring quality through thorough assessments and sound support plans.  In addition, the Council was working closely with the Care Quality Commission to produce an outline performance framework which would include processes to allow for regular feedback from users and carers.  Lance Douglas confirmed that support plans and personal budgets would all be determined by the end of March 2010 and that in order for these to be implemented, an agreement would need to be made between the user, carer and the Council. 

Members then agreed to the Chair’s request that this item be put on the Overview and Scrutiny Work Programme for 2010/11.

RESOLVED:-

(i)         that the Update Report on Day Opportunities for People Attending In-House Learning Disabilities Day Centres in Brent be noted; and

(ii)        that Day Opportunities for People Attending In-House Learning Disabilities Day Centres in Brent be included in the Overview and Scrutiny Work Programme for 2010/11.