9. Support in the Home and to Access the Community
People live in their communities in different types of settings: in homes they own or rent, in purpose built housing schemes where support is on hand (i.e. Supported Living), in prisons and in other settings. People may also live in ExtraCare housing schemes or in residential care homes but these are different in their support arrangements and are covered separately in later sections of the document. This section focuses on the statutory level of support the Council is required to provide under the Care Act to anyone who is eligible to receive care and support under the Care and Support (Eligibility Criteria) Regulations 2014. This range of statutory services is provided to support people to live as independently as possible in their own accommodation and in South Gloucestershire we group these services together under the heading Community Based Support.
In South Gloucestershire our aim is for people to have the same access to the same quality of care services, whatever their support need and wherever they live. However, we recognise that there are particular geographic areas and communities of interest within South Gloucestershire where it is more challenging to meet individual expectations and offer appropriate choice and control. For example, we recognise that diagnosis to referral to services for people with autistic spectrum disorders is a particular challenge for service users. We are keen to work with partners to explore more innovative and creative ways of responding to the challenge of providing support in those communities and are particularly keen to explore the potential for supporting the development of micro-enterprises. The areas presenting the greatest challenge tend to be the less populous rural areas, especially along the Severn estuary and the outlying rural villages on the eastern border of South Gloucestershire. It can often also be more challenging to identify support to meet needs of individuals from minority groups, particularly when a request for support in a particular language other than English.
In South Gloucestershire we have implemented a reablement approach, which means that for the majority of people who are identified as requiring support this will initially be through the Promoting Independence reablement service, a multidisciplinary approach designed to work with the individual to support them to make progress on shared goals designed to improve confidence and regain or retain a level of independence. We have established two Promoting Independence (reablement) teams, one focused on supporting timely discharge from hospital and the other working across the community, both are supported by reablement practitioners commissioned from an independent sector partner. Building on earlier pilots this approach has been fully rolled out across South Gloucestershire since February 2014.
One of the aims of the reablement approach is to increase peoples’ independence and reduce the need for ongoing support however where it is recognised that there will be a need for longer term support the reablement team will work with that individual and their family (when appropriate) to agree longer term outcomes and explore how they can best be achieved within an identified personal budget.
The further development of self-directed support is a priority in South Gloucestershire – this means a different way of thinking across the whole system including the way providers operate and engage with the people they support. We want to increase substantially the uptake of Direct Payments and will explore whether there are benefits to be gained by investigating the use of Individual Service Funds (ISF’s). The aim is to ensure that there is greater choice, control and flexibility for users of our services and that we support people to live the lives they choose. We will continue to develop our relationship with the Direct Payment Support Providers and refine the use of the Direct Payment Card system, introduced in 2014.
South Gloucestershire recognises that central to our aim to increasing the use of direct payments is to ensure that there is an innovative and dynamic market able to work with direct payment recipients as ‘micro commissioners’. This increasing flexibility and responsiveness is also vital to supporting the continued growth in the number of people who fund their own care. A support provider was commissioned in 2015 to provide support to Personal Assistants and to increase the number of personal assistants working in South Gloucestershire. An online register called ‘PA Finder’ is now available with details of Personal Assistants available for work and of people who are looking for a Personal Assistant.
South Gloucestershire recognises, however, that even with a renewed emphasis on direct payments there will always be a need for local authority purchased support and this continues to be purchased via a framework agreement. South Gloucestershire’s new Community based Support Framework was introduced in February 2014. This is an open framework agreement and we have welcomed new providers onto the framework periodically via an accreditation process. In line with our reablement approach the current framework places a greater emphasis on ‘doing things with’ people who require support rather than ‘doing things for’ than the previous arrangement.
The following chart shows the number of current overall homecare or domiciliary care referrals placed by the Council with our framework providers over a 12 month period, with a line showing the trend over the previous 12 month period;
The current framework agreement has nearly 50 service providers delivering home care support and community based support across South Gloucestershire for approximately 940 service users at any one time. The current framework expires in March 2018 and is already not delivering the scale of capacity that the Council requires. The Council has considered alternative approaches to both strengthen the market and align it to the 6 locality health clusters as set out in South Gloucestershire’s Better Care Fund Plan to facilitate a system that can better coordinate health and social care services around an individual. As a result, during 2016 a new service model will be developed in partnership with providers with the intention of re-commissioning services ahead of the expiry of the current framework agreement. See the tables on p 33 for volumes of commissioned home care hours in January 2016.
Another cost effective alternative to residential and community based care provision is the current in-house Shared Lives service, where service users either live permanently, have short breaks or regular hours staying in a trained Shared Lives Carer’s home. We recognise that the ‘Shared Lives’ model fits closely with our approach to promoting independence and personalisation. The Council has recently agreed to externalise the existing small ‘in-house’ Shared Lives scheme and will be commissioning this through a tender process during 2016. It is recognised that currently the highly valued existing scheme works predominantly with people with learning disabilities and a smaller number of people with dementia. However, we know that the scheme could be of benefit to a wider population, including people requiring support with other medium and long term conditions such as mental health, dementia and Huntington’s and any new provider appointed will be commissioned to develop and expand the capacity of the current service in this respect.
The following chart identifies the current level of purchasing activity by the local authority in an indicative sample week across the six GP Cluster Groups in January 2016;