ITEM BV12(a)
BEST VALUE COMMITTEE – 22 OCTOBER 2003
Best Value Review Specification
Name of review
Adult Learning Disability Services
Date of specification report and planned date of final report
Specification report
Scoping Report to Best Value Committee
October 22nd 2003
Final Report to Best Value Committee
January 23rd 2004
Review team members
Alan Sinclair (Review
Leader)
Operations Manager, Learning Disability
Janet Bolam
Performance and Review Unit, Resources Directorate
Cllr Lesley Legge
Martin Wilkinson
Co-opted Member of Best Value Committee
John Derham
Oxfordshire Learning Disability Trust (OLDT)
Helen Lewis
Oxfordshire Learning Disability Trust
Andy Martin
Oxfordshire Learning Disability Trust
Sara Livadeas
Learning Disability Services, Social & Health Care
Rob Finlayson
Central Planning Team, Social & Health Care
Colin Hobbs
North East Oxfordshire Primary Care Trust (NEPCT)
Steve Appleton
Thames Valley Strategic Health Authority (TVSHA)
Jackie Fletcher
New Support Options (service provider)
Jan Roast
Carer of Service user
Users of service will be part of the review team via separate meetings involving My Life My
Choice.
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Final
Executive summary
1.
This review of Adult Learning Disability Services aims to:
a. identify and evaluate the services provided for adults with learning disabilities in
Oxfordshire in terms of cost, quality and value for money.
b. identify what services are needed in the future and how they can best be provided.
c. inform a joint health and social care commissioning strategy
This differs from the review of Learning Disability Services undertaken in 2001 /02 which
focussed upon care management and commissioning.
The direction of this service is strongly driven by the government white paper-Valuing People
(2001). In line with this, there is a move towards greater independence for people, with a
shift away from institutionalised care towards independence and choice wherever possible.
Oxfordshire County Council Social & Health Care Directorate has lead responsibility for
ensuring the strategy is implemented and for commissioning services.
2.
Service Description
There are approximately 1700 people over age 18 with severe to moderate learning
disabilities known to OLDT and S&HC in Oxfordshire.
As well as providing a number of services in-house, Oxfordshire S&HC commissions
services via contracts with the Oxfordshire Learning Disability NHS Trust (OLDT), and with
private and voluntary sector providers. The North East Oxfordshire Primary Care Trust
commissions specialist health care from OLDT on behalf of the five Oxfordshire PCT’s and
the Thames Valley Strategic Health Authority (TVSHA).
The range of services provided includes day services, residential care, supported living,
respite services, support at home and employment services .
In addition, OLDT provides a range of specialist services which includes clinical services,
assertive outreach, short term assessment and treatment (STATT), inpatient services for
those with a Learning Disability combined with mental illness and/or behavioural
problems(John Sharich House and Evenlode), and a 3 bedded step-down unit to bridge the
gap between in-patient and community services.
There is a joint S&HC / OLDT community based Learning Disability Team that assesses
client needs and arrange for the appropriate services to meet them and also a
Commissioning and Contracting Team, formed to commission services, and establish and
monitor contracts.
3.
Finance
a. The gross funding for Learning Disability services in 2003/4 is £59m: This includes £47m
base budget and £12m income. At month 5, the predicted annual outturn is that the
service expenditure will break even.
b. Sources of funding are:

41% is from the health service ,

42% is from the County Council budget,

7% is from the Supporting People grant,

10% is levied as client charges.
b. As a result of commissioning:
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
OLDT receive 29% of the budget for social care,

S&HC use 19% to provide in house services,

41% of the budget is spent on contracts with the independent sector,
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Final

OLDT use 11% of the budget on specialist care services ( commissioned by the NE
PCT directly).
c. Supported living services account for the largest part of the budget (over £19m), followed
by residential care (over £17m).
4.
Planning and performance
The most recent joint strategy between Oxfordshire Health and OCC was published in 1995.
Work is underway to produce a S&HC Commissioning Strategy for 2003 and this review will
inform the learning disability part of this strategy.
There is a hierarchy of plans with aims and objectives that has clear links between the
different levels of service , so “front-line” plans link to the Learning Disability Service Plan,
that, in turn, links into the overall plan for S&HC.
The annual Delivery and Improvement Statement (DIS) to the SSI has 11 performance
indicators relevant to LD. Although this information is not currently benchmarked, the SSI is
due to release a full set of results from all Authorities in October 2003. This will be used to
provide a basis for a comparative analysis as part of the work of the review.
d.
Consultation strategy and arrangements for consultation
Valuing Our People (2001) strongly emphasises the need for consultation with users and
carers when planning and delivering services. The Oxfordshire Learning Disability
Partnership Board is currently working on a strategy for consultation.
6.
Issues facing Learning Disabilities are identified as:

Compliance with Valuing People

Development of the Partnership Board

Recruitment and retention

Implementation of the previous Best Value Review of Learning Disability on care
management and commissioning services.
As a result of SWOT and PEST analyses, a further set of issues were identified:
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
More robust, user friendly information needed about the service, including finance
and demographics.

The overspend must be addressed

The Thames Valley Strategic Health Authority (TVSHA) has expressed a wish to
dissolve the OLDT and to reprovide specialist health services else where.

There is a need to strengthen the framework in which services are provided, which
means a clear joint health and social care commissioning strategy leading to a review
of current contracts and improved planning for the future.
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Final
1.
Introduction
This review of Adult Learning Disability Services aims to:
1.
identify and evaluate the services provided for adults with learning disabilities in
Oxfordshire in terms of cost, quality and value for money.
2.
identify what services are needed in the future and how they can best be provided.
3.
inform a joint health and social care commissioning strategy
This differs from the review of Learning Disability Services undertaken in 2001 /02 which
focussed upon care management and commissioning The changes to service that have resulted
from this work are being implemented, and it is not anticipated that the current review will affect
this.
2.
Description of Services Provided
a.
OVERALL DESCRIPTION
An individual is classified as having a Learning Disability (LD) if there is:

a significantly reduced ability to understand new or complex information, to learn new skills
(impaired intelligence), with;

a reduced ability to cope independently (impaired social functioning);

which will have started before adulthood, with a lasting effect on development.
This definition includes people who have autism and a learning disability, but not those who have
an average or above level of intelligence coupled with autism, nor people who have learning
difficulties as defined in education legislation. (Valuing People 2001)
There are approximately 1700 people over age 18 with severe to moderate learning disabilities
known to OLDT and S&HC in Oxfordshire. Accurate figures are not available because there is
no comprehensive Learning Disability database in the county.
In response to the government white paper-Valuing People (2001), Oxfordshire County Council
Social & Health Care directorate is charged with lead responsibility for ensuring the strategy is
implemented.
As well as providing a number of services in-house, S&HC commissions services via contracts
with the Oxfordshire Learning Disability NHS Trust (OLDT), and with private and voluntary sector
providers. The North East Oxfordshire Primary Care Trust commissions specialist health care
from OLDT on behalf of the five Oxfordshire PCT’s and the Thames Valley Strategic Health
Authority (TVSHA).
b.
STRUCTURE OF SERVICES
See appendix 1 for structure of services for S&HC and OLDT
c.
SERVICE PROVISION
In line with Valuing People, there has been a considerable shift of services from a registered
residential base to more independent, supported living. This is a trend that will continue. The
table below shows the size of the shift so far.
2002/3
2003/4
Clients in registered residential care
484
322
Clients in supported living
343
415
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Final
i
Day services
Day services aim to promote independence and social inclusion, and to provide respite to family
carers. They are provided primarily to people living at home with family carers and to people
living alone in the community. Day services are also provided to those living in registered care
and supported living.
In recent years, these services have been developed led by the New Directions Strategy to
provide more individualised support, moving provision away from large centres with set times
activities towards a more flexible provision.
Day service provision
Type of provision
Clients
Costs
Comment
S&HC Inhouse
446
£3.8m
21 centres based in 8
localities
OLDT contract (Vision)
185
£582.5k
Community based centreless service
OLDT contract (Centres)
42
£293.6k
3 bases in N Oxfordshire
Other contracts with the
independent sector
90
£458.3k
Seven contracts
Individual placements*
13
£70.3k
Total
776
£5.2 m
* does not include packages purchased by the CMPB
ii.
Employment services
Approximately 10% of those with a learning disability have employment gained through OES or
Right Employment
To address this, S&HC provide a supported employment service (for all disabled people) which is
part government funded and Right Employment- previously run by OLDT are services that aim
to get clients with a learning disability into paid employment.
Clients “on
books”
Number in
employment
Number seeking
employment
Cost
OES (S&HC)
80
57
23
£79.5k
Right Employment
Contract
175
118
57
£168k
Total
255
175
80
£247.5k
iii
Residential Care (including nursing care)
Residential care is provided in registered homes in Oxfordshire and outside the county. Most
people live in small homes that provide 24 hour support, accommodation and board. In some
circumstances, the residential care provided includes nursing care. This is particularly true of the
some of the high dependency spot placements.
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Final
Registered Residential Care
Type of provision
Clients
Cost
Comment
Block Contracts with
independent sector
80
£3.87m
6 contracts
OLDT
27
£1.81m
Spot placement Oxfordshire
75
£2.25m
Spot placement Out of county
116
£4.31m
S&HC internal provision
24
£0.71m
Total
322
£12.95m
iv.
Stowford Hostel
Supported Living
This is a form of supported accommodation, which enables the person to live in their own home
usually as a tenant, occasionally as an owner occupier - with care support provided to them
according to their individual needs. The housing is provided by a Housing Provider, with whom
Social & Health Care has a Housing Management Contract. The care support is provided by a
separate Care Provider paid for either through a contract with Social & Health Care or as an
individual 'spot' purchase. Clients are charged towards the costs of their service through
Community Care Charging. They may also be entitled to Independent Living Fund (ILF), which
they then pay towards the cost of their care (approximately £15,000 per annum).
For some supported living schemes Housing Related support is commissioned and paid for by
Supporting People (a joint commissioning body funded by the ODPM) and can be a significant
proportion of the total support package.
Supported Living could be as little as 2 or 3 hours of care per week up to 24 hour continuous
care
Supported living
Type of provision
Clients
Gross Cost
7 block contracts with
independent providers
126
£1.8m
OLDT contract
188
£8.6m
Individual placements
32
£1.2m
S&HC Internal
provision
85
£3.0m
Total
415
£14.6m
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Comment
These placements are also funded by
grants from Supporting People,
Independent Living Fund and a
Support Housing Management Grant.
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Final
v.
Respite services
This is a service that enables those who live with their carers to spend an agreed number of
nights away from home so that carers (and often the users) can have a break.
Type of provision
Clients
Adult Family Placement
75
Cost
£0.52m
(In house provision )
Comment
Range of nights pa 2 –190.
72% of clients receive between 25-45
nights pa.
OLDT
78
£0.43m
9 beds
2 independent sector
contracts
75
£0.43m
10 beds
Total
228
£1.38m
vi
Support at home
This is a range of services available to clients who live with their families, carers, or alone.
Services such as domiciliary care, transport, direct payments are arranged through care
managers, using their purchasing budget.
Number clients
Costs
Receiving care packages
159
£1.43m
Receiving direct payment
27
£0.82m
Total
197
£2.25m
vii
Learning Disability Teams
As a result of the Best Value Review on Care Management and Commissioning of LD services,
it was agreed that the community based care management team in S&HC and the community
teams in OLDT are combined so that they work together to provide a coordinated service with a
single point of access, common eligibility criteria, shared information and a pooled budget.
These changes are currently underway.
The team assesses client needs and arrange for the appropriate services to meet the agreed
assessed needs under Fair Access to Care. OLDT staff also provide direct intervention and
provision.
Budget £2.3m
viii
Commissioning and Contracting Team
As a result of the Best Value Review this newly established team is responsible for both the
commissioning and decommissioning of services, establishing contracts and monitoring service
quality. It works closely with the Learning Disability Teams to link care plans with arrangements
for services.
Budget £0.3m
ix
Specialist Services provided by OLDT
OLDT currently provide specialist health services. These include:
Clinical Services
Consultant psychiatrists, other doctors and clinical psychologists all work on a session-basis
across the community teams and in-patient services. Speech and language therapy,
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physiotherapy and dietetics services are bought-in from a countywide service. These also work
across health services.
Budget £1.97m
Assertive Outreach Team
Assertive Outreach within learning disabilities is a way of working with a discrete identified group
of people who have a learning disability and enduring mental health problems and/or challenging
behaviour and do not effectively engage with either health or social care services. The team
supports an individual through a consistent and long term therapeutic relationship, working in a
needs-focused way. The overall intention is to significantly reduce admissions to inpatient
services, and provide intensive support to the person and their networks in their familiar
environment and community.
Budget £114k
Number patients 2002/3 = 12
Short Term Assessment and Treatment Team (STATT)
STATT is located on the Slade site, Headington, Oxford and provides 6 in-patient beds and an
outreach service. Referrals to the STATT service are via the community teams, and STATT
provides for people who have a learning disability and a superimposed mental health disorder
and/or challenging behaviour. The main function of the service is to identify issues affecting a
person’s mental health through comprehensive assessment and to design and deliver treatment
to alleviate or dramatically reduce this problem for the individual. Expected length of stay is up to
6 months.
Budget £770k
Number patients 2002/3 = 16+ outreach patients
John Sharich House
John Sharich House is located on the Slade site, Headington, Oxford and is designated as a
medium term rehabilitation service and low secure service providing 6 beds. John Sharich House
provides for people who have a learning disability and a superimposed mental health disorder
and/or challenging behaviour. Referrals may be received from other in-patient services,
community teams or out of county placements. The main function of the service is to identify
issues affecting a person’s mental health through comprehensive assessment and to design and
deliver treatment to alleviate or dramatically reduce this problem for the individual. Expected
length of stay is up to 2 years.
Budget £780k
Number patients 2002/3 = 10
Evenlode
Evenlode is located at the Littlemore Health Centre and is a part of the Oxford Clinic. Evenlode is
a purpose built service providing 10 beds (5 for Oxfordshire and 5 for Berkshire) with medium
secure services for forensic patients. Evenlode provides for people who have a learning disability
and a superimposed mental health disorder and or severe challenging behaviour or offending
behaviour. Referrals may be received from other in-patient services, community teams, out of
county placements, or via the criminal justice system. The main function of the service is to
identify issues affecting a person’s mental health or reasons causing offending behaviours
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BV12(a) – page 9
through comprehensive assessment and to design and deliver treatments to alleviate or
dramatically reduce these problems. Expected length of stay average 2 years. .
Budget £770k
Number patients 2002/3 = 8
Step Down
Step down is located on the Slade site, Headington, Oxford and provides 3 beds and is designed
as a service which will bridge the gap between in-patient and community services. Step Down
provides for people who have a learning disability and a superimposed mental health disorder
and or challenging behaviour, who have completed their treatment within in-patient services but
are proving difficult to place in the community. Referrals may be received from other in-patient
services, community teams or out of county placements. The main function of the service is to
prepare an individual for a move to supported living within the community. Expected length of
stay is up to 2 years.
Budget £350k
Number patients 2002/3 = 6
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Final
3.
Financial Information
Learning disability services funding streams are from

Oxfordshire County Council - a direct budget for social care

NHS to OLDT directly for specialist health care

Section 28a money ie funds within the health service designated for social care is joint
between health and S&HC. This money flows from North East Oxfordshire Primary Care
Trust (which has overall responsibility for health LD issues).to S&HC as the main
commissioner of services.

Other sources include direct government grants, some income generated from charging and
some from the European social fund.
The current year financial position is tabled below:
S&HC
NE PCT
Other Health
TOTAL
£22.9m
£22.1m
£2.2m
£47.2m
Forecasted Net Spend £23.0m
£22.8m
£2.2m
£48.0m
Variation
£00.1m
£00.7m
£00.0m
£00.8m
% Variation
0.56%
3.39%
0.00%
1.69%
Net Budget 2003-04
This information shows that LD funders are managing their respective finances closely.
Providers of Learning Disabilities Services and their clients have access to wide range of funding
sources. In Oxfordshire the true value of Learning Disability Services extends beyond that dealt
with in this review, as external providers are funded by grants which we do not come into contact
with. The gross funding however, for Learning Disabilities in Oxfordshire, where we have
influence or decision making control is £59 million.
For clarity, it essential to reconcile the gross £59m just identified, with the net funding £47m
tabled above. For ease it is important to understand the following formula and definitions below.
NET FUNDING + INCOME = GROSS FUNDING
£47M
+ £12M
= £59M

Net Funding – the net or base budget position of the organisation, which excludes any
income or grants, from clients and external organisations.

Gross Funding – is the total funding available to the funders to purchase LD services. It
includes grants and income from clients and other sources to replicate where we can the
FULL COST of LD services.
Reconciliation Statement
Net Funding Position
£’M Notes
47
Add back Client Income
6 Income collected from S&HC clients
Add back Other income
1
Add back Supporting People Grant Income
4 Provider SP income for S&HC and
OLDT (not the full value of SP in the
system)
Add back other grant income
1
Gross Funding Position
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Final
The pie chart below illustrates the proportion of gross funding from each main source.
Funding the Learning Disabilities Service 2003-04
Health
41%
Supporting People
7%
Client Charges
10%
S&HC
42%
Although funding sources for Learning Disability services is split as above, the actual
commissioning of services is largely the responsibility of S&HC. The chart below shows that 82%
of the gross funding is commissioned by S&HC and 12% by the PCT’s. The value in the chart for
the teams represents the funding available for commissioning and contracting within S&HC and
OLDT (£3.3m or 6% of the total).
Commissioning of LD Services 2003-04
PCT's
12%
S&HC
82%
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Comm. Teams
6%
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Final
Expanding further we can analyse this information to establish the main providers of Learning
Disability Services. Presently the 2 main named providers are Social & Health Care and
Oxfordshire Learning Disabilities Trust, the latter providing social as well as specialist health care
services.
The NE PCT funds both specialist health and general social services through arrangements
under Section 28a which allow funding to both OLDT and S&HC.
Note that these percentages are based on the gross funding of £56m, after taking off the funding
for the commissioning and contract teams.
The gross funding for Learning Disabilities is illustrated below by service type.
LD Service Type Budget Analysis 2003-04
Supported Living
Residential Care
Day /Respite Services
Specialist Services
Care / Management
Home Support
Clinicil Services
Employment Services
Adult Family Placements
Client Packages
Other Initiatives (NHS)
£0
£2,000
£4,000
£6,000
Base Budget
£8,000
£10,000
Other Income
£12,000
SP
£14,000
£16,000
£18,000
£20,000
Client Income
In order to reconcile with the service section (which shows the net cost of the service) we have
tried to illustrate the funding of the service above showing the base budget (in dark bold) and
additions to it through income to illustrate the gross funding for the service.
The chart above shows that the bulk of service provision, over £30m, is delivered through
supported living and residential care. A further £6 m is spent on day services. Changes to service
delivery already mentioned above will mean that the amount spent on residential care will reduce
and the amount on supported living will increase.
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Final
4. How well is this area performing against targets and compared to
others?
a.
Strategic Planning
The most recent joint strategy between Oxfordshire Health and OCC was published in 1995. It is
recognised that this now needs revision and some work was undertaken in 2002 to develop a
new one. This has not yet been agreed. Work is underway to produce a S&HC Commissioning
Strategy for 2003. This review will inform the learning disability part of this strategy.
b.
Service Planning
S&HC have a service wide planning initiative, Planning into Action which provides a structure
and process for all the directorate service plans. Learning Disability Services have a main plan
into which service specific plans feed. For 2003/4, the service has 3 overall objectives:
i.
To deliver services within budget
ii
To develop a new Joint Health and S&HC Learning Disability Commissioning
Strategy/Plan for 2004-2007 by Oct 2003
iii
To establish and develop integrated learning disability teams working to shared objectives
within an agreed performance framework by Sept 2003
Social & Health Care are also required to submit a Delivery and Improvement Statement (DIS)
to the Social Services Inspectorate (SSI) twice yearly.
OLDT service plans cover a three year period and focus on:
i
Coherence-aligning the goals of individuals, teams and the organisation together
ii
Infrastructure- a framework that enables services to deliver
iii
Managing risk
iv
Culture
v
Quality methods-a plan to incorporate quality into all areas of service
vi
Managing performance
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c. Performance measurement
The DIS statement includes information about our performance using a basket of performance
indicators (PIs) relevant to Learning Disabilities. Since every Local Authority with Learning
Disability responsibilities are now required to provide this information, a good basis for
comparison/ benchmarking will be established. This information will be available during the
review period. The PIs being used and the information to date is:
Description of indicator
02/03
Plan*
Percentage of adults with learning disabilities receiving community
based services who are receiving direct payments
2.9%
3.5%
Percentage of adults with learning disabilities receiving community
based services who are receiving short term breaks
25%
25%
Gross expenditure on day care as a percentage of expenditure on
all non-residential services
56%
50%
Proportion of expenditure on day and domiciliary services for
people with learning disabilities to expenditure on residential
provision for people with learning disabilities
50%
50%
Unit Cost of residential and nursing care for adults with learning
disabilities (£/client)
824
735
Adults with LD helped to live at home ( per 1000 population)
2.2
2.5
NB The SSI are due to circulate all the information gathered for the DIS for all counties in
October. This will provide a basis for comprehensive comparison across all UK Local Authorities.
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Final
5.
Client satisfaction and Consultation
Consultation strategy and arrangements for consultation
Valuing People (2001) strongly emphasises the need for consultation with users and carers
when planning and delivering services. The local Partnership Board includes users and carers in
its membership which provides a way of ensuring that users and carers are central to decisions
affecting service delivery. The Board is currently working on a strategy for consultation.
The approach to consultation and communication to date has been to look at individual needs
with the person concerned and their families. Where it is appropriate, reference groups have
been formed to develop and commission services. In addition, an annual conference with
stakeholders is held to check on progress and future direction. The last event was held in
November 2002, and was hosted by the Partnership Board.
A consultation exercise was undertaken in Oct/Nov 2002 with a range of stakeholders, staff in
learning disability services and people with a learning disability and their carers on the
development of services for the future – these included:

Development of Joint Teams

A pooled budget

A new joint health and social care strategy and decision making structure.
Feedback from this exercise has been very positive with responses supporting these
developments with some concerns raised over the time-scale for implementation and ensuring
that all the relevant stakeholders are informed and consulted at each stage of the
developments.
To support these developments and manage the strategic direction of learning disability
services an Integrated Commissioning Team has been established between the Social and
Health Care Directorate, the NE Oxon PCT (representing all 5 Oxfordshire PCT’s) and the
Oxfordshire Learning Disability NHS Trust.
6.
Current issues affecting Learning Disability services
a. The Government white paper entitled "Valuing People: A new strategy for Learning
Disability for the 21st Century" was published in March 2001. This paper has had a
profound influence on the approach taken to plan and deliver services. The main proposals
aim to improve the rights, independence, choices, inclusion and opportunities available for
people with learning disabilities. To do this, there is now a prevailing emphasis on
stakeholder involvement in planning and delivering services coupled with a person -centred
planning process (rather than one that is dictated by the services available). The implications
are that Learning Disability services must become more flexible so that it is better geared to
meet individual needs.
b. In response to this paper, a Partnership Board has been established. This is chaired by a
member of the OCC Executive, and includes users, carers, service workers, senior managers
from S&HC and OLDT and representation from the independent sector. The way that this
Board will work is still developing, and it is anticipated to be a major influence on the
direction of local action plans.
c. The New Directions project was a local initiative that set out ways to improve service
planning and delivery for day services, so that they better meet the needs of the individual.
The strategy aims to enable greater community inclusion and participation and to empower
people to take greater control of their own lives. The outcomes are a more client centred
approach to planning and service delivery
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Final
As a result, day services are provided nearer to town centres, shops and community centres.
This enables people to access local services and amenities helping to promote inclusion and
independence.
This change in provision has resulted in less clients staying in day centres and far more being
out in local communities acquiring skills and experience. As a result many of the buildings
used by the day services are now overly large and do not represent an appropriate use of
County Council resources. As a result of a review of these services, there are proposals to
dispose of some of these properties.
d. Recruitment and retention
Within Oxfordshire, a county with a high cost of living and high employment, there are issues
about recruitment and retention of public sector workers.
Within Learning Disability Services, S&HC employs 240 FTEs including in-house services,
with a 10.6% vacancy rate and a turnover of 12.46%. OLDT has 763 FTEs, a vacancy rate of
13% and a staff turnover rate of 16.5%.
e. A Best Value Review of Learning Disability Care Management and Commissioning was
carried out in 2001-2002. The main findings from this review were to:

Improve access to services by combining the S&HC care management service with the
community teams in the Learning Disability Trust

improve contract monitoring by enlarging the team

improve management of the budget

improve the communication and consultation with people with a learning disability
These areas for development have been picked up by the action plan from the review,
Learning Disability service plans and in joint planning with health.
The recommendations are currently being implemented.
7.
Issues identified from PEST analysis
a. Political issues that have an impact on this review

‘Valuing People’ provides a clear political and strategic direction at a national level.

There is a greater accountability at national levels for public service performance than
there has been in the past, and the number of Performance Indicators that apply to
services has increased. This may enable easier ways to compare services- although the
caveat to this is that you must ensure you are comparing “apples with apples”.

The Oxfordshire NHS is restructuring, and the NE PCT, which has lead health
responsibility for LD is likely to merge with the other north PCT, which may have an
impact on joint working. The future PCT lead for Learning Disability is therefore uncertain.

Thames Valley Strategic Health Authority , a co-partner in this review- do not anticipate
the continuation of the Oxfordshire Learning Disability Trust

The NHS “Agenda for change” initiative
b. Economic Issues

Changes to the funding arrangements for Oxfordshire County Council overall may impact
on the funds available for Learning Disabilities, as has been the case in the last 2 years.

The cost of living in Oxfordshire is high, which impacts particularly on housing and
staffing

The increasing costs of service delivery are not matched by increased funding
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c. Sociological

Expectations of users and carers are changing with people speaking up for themselves
and their rights

The longevity for those with Learning Disabilities is increasing

The emphasis on community living has changed the nature of LD services

There are issues about the transition from children to adults services, especially in the
provision of education

Recruitment and retention remains an issue in Oxfordshire due to the high cost of living
and low unemployment.
d. Technological

Improved technology improves longevity and also the number of people who survive with
complex needs.

Neonatal survival rates are increasing

Improved technology can help with the provision of care

SMART houses can improve living conditions for those with LD

Improved IT will improve services and our knowledge about services

New drugs
8.
Issues Identified from SWOT analysis
a.
Strengths

A county wide, whole system approach to services

Service providers who are well informed, creative, and forward thinking

A well developed partnership approach that includes users and carers

There are few out of county “health” placements

Flexible services that can respond to change

There are no large institutions/hospitals as part of the service

Actions identified in the last LD BVR have been implemented
b.
Weaknesses

Lack of robust information about the services, particularly about quality and outcomes

Gaps in consultation and communications with users and carers (no strategy)

There is a lack of affordable placements for people with complex needs within
Oxfordshire, which results in a high number of people in expensive out of county
placements

Financial information is not in a user friendly form

Contract monitoring needs further development

The infrastructure for decision making is not strong enough, leading to ad hoc purchasing
and other decisions

The Partnership Board is not yet effective

Substantial overspends have been sustained
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Final

There are issues about the transition from children to adults services, especially in the
provision of education

Planning for future services is not extensive enough (ie taking into account housing,
staffing and demographic issues)
c.
Opportunities

‘Valuing People’ provides a clear way forward for the service

The Best Value Review is an opportunity to improve services
 New ways of working that include NHS, LA and independent sector staff may improve the
critical mass of staff working in LD and improve services.
 Improved information about services and the demographic profile of clients improve our
ability to manage the service
 The potential to further improve partnership working with private and voluntary sector
 Achievement of a pooled budget will improve purchasing processes and decisions
 An improved service could potentially affect the SSI star rating and the CPA assessment.
d.
Threats

Growing bureaucracy and regulations

Can we meet changes in demand due to changing demographics?

Recruitment and retention of staff in a high employment / high cost county

Increased expectations from the services provided by users and carers

Increasing costs not met by increasing budgets leading to savings / cuts
9.
Key issues identified from the PEST and SWOT analyses
a. More robust, user friendly information needed about the service, including finance and
demographics. This includes better information about those in transition from children to
adult services.
b. The overspend must be addressed.
c. The Thames Valley Strategic Health Authority (TVSHA) has expressed a wish to dissolve
the OLDT and to reprovide specialist health services else where.
d. There is a need to strengthen the framework in which services are provided, which means
a clear joint health and social care commissioning strategy leading to a review of current
contracts and improved planning for the future.
e. Measures of quality of service should be developed and applied.
f.
The role of the Partnership Board is still developing.
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Final
10.
Project brief
The aims of the review are to:
1.
identify and evaluate the services provided for adults with learning disabilities in
Oxfordshire in terms of cost, quality and value for money.
2.
identify what services are needed in the future and how they can best be provided.
3.
inform a joint health and social care commissioning strategy
In order to meet these, a 4 stage programme of work is planned.
Stage 1
to gain a clear picture of the current service in terms of services provided, finance
and demographics.
Stage 2
to develop a vision of the way services could be delivered in the future
Stage 3
to match the service aspirations to practical ways of delivering the service
Stage 4
to generate options for service delivery in the future and to undertake an option
appraisal to select a favoured option.
Glossary
CMPB
Care Managers Purchasing Budget
DIS
Delivery and Improvement Statement
DoH
Department of Health
FTE
Full Time Equivalent
LD
Learning Disability
NE PCT
North East Oxfordshire Primary Care NHS Trust
OCC
Oxfordshire County Council
OES
Oxford Employment Services
OLDT
Oxford Learning Disability NHS Trust
PCT
Primary Care NHS Trust
PEST
Analysis of Political, Economic, Sociological and Technological issues.
SH&C
Social and Health Care
STATT
Short Term Assessment and Treatment Team
SWOT
Analysis of Strengths, Weaknesses, Opportunities and Threats
TVSHA
Thames Valley Strategic Health Authority
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