A Strategy for Adult Care Services ‘Making Personalisation a Reality’ Autistic Spectrum Conditions 2008-11 DRAFT Joint Local Delivery Plan This 3 year plan describes the way in which Adult Social Care Services will carry forward it’s key aims and objectives as outlined in the Adult Plan (www.rbwm.gov.uk) for adults on the autistic spectrum. There are a total of 10 different plans similar to this one, covering all aspects of Adult Social Care. They are; Adult Mental Health Autistic Spectrum Disorder Carers Drugs & Alcohol Learning Disability Long Term Conditions Older People Older People’s Mental Health Physical Disability Sensory Impairment The plans recognise the inter-relatedness of the actions, and work required to successfully implement them for all service user groups. The 10 year Adult Plan identifies these 3 year delivery plans for commissioning activity particularly where there is: Need for urgent action, particularly regarding difficulty securing care Opportunities to test an approach to service delivery Partners seeking the chance to work together to achieve synergies Opportunities to test hypotheses that appear to have the potential to make a significant impact. The aims of the Adult Strategic Plan are: Putting people at the centre of everything we do-We will transform the way in which we work by placing people who need to use our services at the centre of everything we do. Promoting healthier communities-We will seek to form new and different types of relationships with our communities. Focusing on outcomes-We will concentrate of those things which people tell us makes a real difference to their lives. Making a difference-We will develop structures, processes and the way we use resources to ensure that everything we do adds value. Delivering better commissioning-We will work in partnership to better understand the needs of the whole population. There are eight broad and overarching objectives that will ensure that we are better able to deliver the vision for adult social care and meet the strategic aims outlined above and describes what we think is the right approach to delivering the Adult Plan. Promoting Independence and Preventing Dependency Dignity and Respect Joint Commissioning Choice and Control Effective Commissioning & Procurement Equality of Access Workforce Development Economic Well-being and Sustainability Some of these are a continuation of work already underway; some may be subject to evaluation and others are based on emerging national and local evidence. Each objective sets out what the overall outcome will be and what the commissioning implications are. There are a number of cross cutting themes identified within the Adult Plan that need to be addressed in each of the three year development plans. The following have been identified: Advocacy Assistive Technology / Telecare & telemedicine Care Breaks/Respite Day Opportunities Dignity in care End of Life Care Health & Well-Being Housing and Accommodation In-control – Individual Budgets Safeguarding Adults Single Assessment Process/Common Assessment Framework Transition Services (16-25 year olds) Population Needs-People on the Autistic Spectrum and those Adults with Aspergers Syndrome Autistic spectrum disorder is one of the many conditions that cross service boundaries. As a consequence adults with autism currently in the Royal Borough, receive services through the Community Team for People with a Learning Disability. Aspergers tends to be diagnosed as a higher I.Q functioning condition on the autistic spectrum. However in reality there are no sharp boundaries separating ‘typical’ autism from other autistic disorders, including Aspergers syndrome. National data on the numbers of people on the Autistic Spectrum is variable partly due to variations in diagnosis and also lack of national collection systems. Valuing People estimates there are 535,000 people in the UK with an ASD. There are no national prevalence rates as such for the adult ASD population according to some sources (Medical Research Council, Review 2001). However the National Autistic Society has done their own research and believe they can estimate prevalence. This underlies the importance of collecting local data to inform needs. Currently around 44 adults and young people on the autism spectrum are known to receive services through the Community Team. Few of these people will have a single diagnosis i.e. there will be a diagnosis of learning disability and /or challenging behaviour as well as autism Data from the transition database 15- 21 years tells us there are 29 young people in this category known to different agencies and who may well need social care services in the near future The majority of those 44 people known to learning disability services receive their support in residential care settings, many of which placements are commissioned out of borough due to the lack of local provision Nationally the numbers of children diagnosed with ASD is rising. Most reviews agree nationally that autistic spectrum disorders affect 60 per 10,000 children under the age of 8. In an audit of adults with an autistic spectrum disorder in Windsor and Maidenhead in 2007 by the Berkshire Autistic Society, 96 adults with an ASD identified themselves for the survey. Of this number 54 had some form of learning disability (LD), 8 had mental health issues (MH), and 4 had both LD and MH issues. 30 people had neither LD nor MH issues. Given the sampling this figure is atypical and reflects under reporting The National Autistic Society (NAS) despite the lack of consensus nationally re any prevalence rates have estimated 91 per 10,000 for all autistic spectrum disorders including Aspergers Syndrome Aspergers Syndrome Aspergers Syndrome is a condition within the Autistic Spectrum and is the term most commonly used to describe people with autism who have average or above average intelligence. It affects four times more males than females. Adults in the Royal Borough with Aspergers Syndrome currently receive their services through The Community Mental Health Team. Many adults with an Autistic Spectrum Disorder (ASD), particularly those at the more able end of the autistic spectrum (i.e. having Aspergers Syndrome (AS) or High Functioning Autism), do not receive appropriate support services because they do not meet the Council’s eligibility criteria which would enable them to qualify for care management services – even though their lives may be severely affected by their condition. Within the Royal Borough almost 30% of all adults identified do not therefore, qualify for support services. It is intended that the new recently formed specialist team for people with Autism will be able to offer a service to those non eligible individuals through other approaches e.g. group work. A survey was initiated to determine the number of adults affected and identify gaps in provision. Of the adults interviewed so far in the project: 90% of adults interviewed live in the family home with their parents 90% said that they did not have friends and found it difficult to make friends 25% worked, but only part time 25% stayed at home all day and it was felt that at least 75% of these, without intervention, were more likely to have health problems in the near future The adults interviewed clearly had needs in the areas of: Advocacy, Social Groups, Employment and Housing. Prevalence Rates Recent figures circulated by the National Autistic Society estimate that the prevalence of all autistic spectrum disorders is 91 per 10,000. For people with average or higher ability (IQ>70) the rate is 71 per 10,000, and of these 36 per 10,000 have Aspergers Syndrome and 35 per 10,000 have other spectrum disorders (Ehlers and Gillberg, 1993). The table below illustrates the effect of the estimated prevalence on UK populations. People with IQ under 70 Kanner Syndrome Other spectrum disorders People with above IQ over 70 Aspergers Syndrome Other spectrum disorders Total estimated prevalence rate all autistic spectrum disorders per 10,000 all age population Rates per 10,000 5 15 36 35 91 Using this NAS estimate 91 per 10,000 (all ages) illustrates the following: Estimated prevalence all people with ASD in RBWM 2006 pop 138,800 1,263 2020 pop 148,500 1, 351 Source: NAS website ( Ehlers and Gillberg 1993) This increase represents an estimated increase in the ASD population of 7% within the Royal Borough. Policy Implications Focus on a supported living model so as to maximise independence and choice with a particular emphasis on home ownership and tenancies. Examine the whole of the local residential provision in terms of planning for future needs and efficiency to live within our means. Increase local provision for those people with complex, often challenging needs on the Autistic Spectrum who meet eligibility criteria Continuous health improvement by ensuring through effective partnerships that the NHS provides full and equal access to good quality healthcare. Personalisation of services in order that people having real choice and control over their lives and services Ensure social inclusion with day opportunities enabling people to be properly included in their communities, with a particular focus on paid work Implement the ‘Independence and Choice’ agenda by pursuing a policy of offering Individual Budgets and Self Directed Care as part of choice option Ensure equality of access to services and be responsive to local needs for service creation for all communities in the Royal Borough including BME communities. Please find below the Joint Local Delivery Plan for Adults on the Autistic Spectrum, with the actions separated by the strategic objectives identified in the Adult Plan. For information, the progress of the actions is recorded as Red (Not commenced or stalled), Amber (proceeding but some slippage on progress) or Green (On target as planned). Outcome 1: Promoting Independence and Preventing Dependency for Adults on the Autistic Spectrum Promote a healthy, safe and sustainable locality that seeks to maximise the impact on the health and well being for all adults living within the borough through developing services that respect a person’s independence. Proposed Action 1) To plan and commission suitable accessible housing for eligible adults on the autism spectrum who need accommodation with support to enable them to remain independent and local to the area 2) Telecare and Tele-Health (Medical) care – Increase access to & use of Telecare/Tele Health systems / Ensure that assistive technology is taken into consideration during an assessment and review 3) Producing a range of formats and accessible information on healthy lifestyles for service users, self funders and other adults. Proposed Partner(s) Joint RBWM and Housing Associations Joint BE PCT and RBWM Joint RBWM & BE PCT Proposed Lead Joint Locality Managers/Joint Commissioning Manager and ASD Team Manager Lead Sen. OT and ASD Team Manager Joint Locality Managers and ASD Team Manager Target date Proposed Outcome A wider range of housing options to support a variety of peoples needs Service users have access to Telecare and Tele health equipment and systems maximising independence Routine consideration is given to telecare during the assessments actively promoting independence Each provider service commissioned by PCT to publish an accessible guide to services Comments Outcome 1: Promoting Independence and Preventing Dependency for Adults on the Autistic Spectrum Promote a healthy, safe and sustainable locality that seeks to maximise the impact on the health and well being for all adults living within the borough through developing services that respect a person’s independence. Proposed Action Proposed Partner(s) 4) Provide services that promote health & well-being for all adults in the Borough and provide a range of specific services for those adults on the autism spectrum requiring additional support Joint RBWM and BE PCT 5) Commission community based services promoting independence and lowering dependency on services. RBWM Proposed Lead Joint LD Locality Managers and Joint Commissioning Manager and ASD Team Manager Joint LD Locality Managers and Joint Commissioning Manager Target date Proposed Outcome Increase ability for self help for Users Increased numbers of people with better health outcomes People are assisted to promote their own individual well being These opportunities are community based throughout the Borough and enable choice and control Comments Outcome 1: Promoting Independence and Preventing Dependency for Adults on the Autistic Spectrum Promote a healthy, safe and sustainable locality that seeks to maximise the impact on the health and well being for all adults living within the borough through developing services that respect a person’s independence. Proposed Action 6) Enhance personal mobility and transport choices. Increase awareness to transport partners of those with additional needs Proposed Partner(s) RBWM Proposed Lead Joint RBWM Transport Policy Officer and LDPB transport sub group Target date Proposed Outcome Improved outcomes for individuals using public transport and taxis Reduced social isolation 7) People have improved quality of life, health and well-being and are enabled to be more independent through the promotion of healthy life styles 8) People are supported and enabled to self care and have an active involvement in decisions about their care and support through integrated service planning. Joint RBWM and Public Health Dev. Group Joint RBWM and BE PCT Ongoing Joint Locality Managers and Direct Payments Manager improved quality of life, health, well-being and levels of independence Increase in Direct Payments / Individual budgets take up Self Assessment Comments Outcome 1: Promoting Independence and Preventing Dependency for Adults on the Autistic Spectrum Promote a healthy, safe and sustainable locality that seeks to maximise the impact on the health and well being for all adults living within the borough through developing services that respect a person’s independence. Proposed Action Proposed Partner(s) Proposed Lead Target date Proposed Outcome system in place Person-centred and integrated support planning in place (Self Directed Care) Access to self care tools monitoring equipment & assistive technologies Access to self care tools monitoring equipment & assistive technologies 9)To focus on the supported living strategy so as to maximise independence and choice RBWM and Housing Associations Joint Locality Managers and ASD Team manager Increase opportunities for living independently 10). Support people to access a range of day opportunities that support their RBWM Joint Locality Managers and Increased number day opportunities as part Comments Outcome 1: Promoting Independence and Preventing Dependency for Adults on the Autistic Spectrum Promote a healthy, safe and sustainable locality that seeks to maximise the impact on the health and well being for all adults living within the borough through developing services that respect a person’s independence. Proposed Action needs Proposed Partner(s) Proposed Lead ASD Team manager and Day Opportunities Manager Target date Proposed Outcome of ordinary community activity Individual outcomes for people show improved lives Comments Outcome 2: Dignity and Respect for Adults on the Autistic Spectrum Support & Care will be provided that ensures dignity and respect are at the heart of services for everyone, so people are free from discrimination or prejudice and are safe from harm. Proposed Action Proposed Partner(s) RBWM 1) Joined up planning with service users, carers, partners and stakeholder for effective outcomes and services Proposed Lead Joint Locality Managers and ASD Team Manager RBWM 2) To develop easily accessible, independent advocacy services for people of working age on ASD spectrum 3) Continued development and implementation of the Mental Capacity Act Joint RBWM/BHFT/BE PCT Mental Health Locality Manager / service managers RBWM MH Target date Proposed Outcome Efficient use of resources. Clarity for Users and Carers. Reduction in time in assessment which will reduce stress for users and carers Increase in availability and uptake of advocacy People are supported to express their own views Mental Capacity Act is fully embedded into daily practice and procedures Comments Outcome 2: Dignity and Respect for Adults on the Autistic Spectrum Support & Care will be provided that ensures dignity and respect are at the heart of services for everyone, so people are free from discrimination or prejudice and are safe from harm. Proposed Action 4) Ensure Independent Mental Capacity Advocacy (IMCA) services are meeting the needs as defined in the Mental Capacity Act Proposed Partner(s) RBWM and BE PCT Joint RBWM/ Thames Valley Police 5) Provision of advice & support to help people feel safe & secure from crime and anti social behaviour and its affects Proposed Lead Promotion Officer Joint Mental Health Locality Manager and Berks MCA Implementation Team RBWM Community Safety team and Thames Valley Police Target date Ongoing Ongoing Proposed Outcome Representation for those individuals who lack capacity and have no natural support. Offered to all who meet criteria People feel safe at home and in their community. Homes have security- alarms and other safety support aids. All people managed by the ASD team are given advice and support regarding personal safety . Comments Outcome 2: Dignity and Respect for Adults on the Autistic Spectrum Support & Care will be provided that ensures dignity and respect are at the heart of services for everyone, so people are free from discrimination or prejudice and are safe from harm. Proposed Action 6) Provision of advice and support regarding the use of assistive technology to support daily living. Proposed Partner(s) RBWM Joint RBWM/BE PCT Proposed Lead Sen OT/ MDHA Telecare officer and working group Joint Locality Managers and Contracting Manager Target date 7) Ensure that dignity & respect are an integral part of service commissioning: including planning, delivery, quality assurance, monitoring and review 8) Access to better information and support so that people can navigate health & social care systems RBWM and BE PCT Joint Locality Manager and Joint Commissioning Ongoing Proposed Outcome Advice and information and support readily available Self Directed Care (SDC) Review system in place QA contract monitoring system (SDC) Service users report good outcomes from providers Commissioned providers are of high quality meeting the diversity needs of individuals Single point of access re information for all Comments Outcome 2: Dignity and Respect for Adults on the Autistic Spectrum Support & Care will be provided that ensures dignity and respect are at the heart of services for everyone, so people are free from discrimination or prejudice and are safe from harm. Proposed Action Proposed Partner(s) Proposed Lead Manager 9) Work with RBFRS to reduce health inequalities in the form of home fire risk checks Royal Berks Fire and Rescue Service Safe At Home Working Group 10) Facilitate those within the eligibility criteria to access Supporting People services where appropriate RBWM ASD Team Manager Supporting People Manager 11) Palliative care arrangements shall be based on personal choice with support available for those bereaved. Joint RBWM and BE PCT District nurses Target date Pilot Oct 08 ongoing Proposed Outcome Planned pathways health and social care Service users are aware of risks and are helped to prevent fires from occurring People are enabled to have support services to live independently Promoting services that reduce need for high level intervention Service user choices respected Support for bereaved Comments Outcome 2: Dignity and Respect for Adults on the Autistic Spectrum Support & Care will be provided that ensures dignity and respect are at the heart of services for everyone, so people are free from discrimination or prejudice and are safe from harm. Proposed Action 12) Support & protect all adults from abuse and neglect through pro-active multi agency working. 13). Deprivation of Liberty Safeguards (DOLS) - Ensure training for statutory, voluntary and other stakeholder organisations. Proposed Partner(s) RBWM Joint RBWM and BE PCT Proposed Lead Safeguarding Board and Safeguarding Coordinator Joint Locality Manager MH and Berks MCA Imp. Team Target date Proposed Outcome Staff maintain skills level through training Safeguarding Board has annual plan and action plan Joint needs assessment completed to identify provision required Training and delivery embedded including Best Interest Assessor training Comments Outcome 3: Joint Commissioning for Adults on the Autistic Spectrum Where this will deliver better outcomes for individuals and cost-efficiencies for purchasing partners, we will engage in joint planning and commissioning of services. Proposed Action 1) Continuity of care between social care and health care to provide holistic services and reduce the number of duplicate contacts to different organisations 2) Work in partnership with local agencies and stakeholders to ensure effective delivery of national strategies / frameworks and local priorities relating to ASD. 3) Embed into health and social care an integrated and systematic approach to the case management of people on the ASD spectrum Proposed Partner(s) Joint RBWM and BE PCT RBWM Joint RBWM and BE PCT Proposed Lead Target date Joint Locality Manager and Joint Commissioning Manager Ongoing Locality Manager and ASD Team Manager Ongoing Joint Locality Manager and ASD Team manager Ongoing Proposed Outcome Transparency in service delivery . Efficiencies in services. One lead person for individuals with ASD for information regarding ASD services Ensure services reflect national and local priorities for adults on the autism spectrum Raise awareness of ASD to ensure appropriate interventions. Ensure that all health professionals have access to information about ASD Comments Outcome 3: Joint Commissioning for Adults on the Autistic Spectrum Where this will deliver better outcomes for individuals and cost-efficiencies for purchasing partners, we will engage in joint planning and commissioning of services. Proposed Action 4) Jointly increase the use and support of third sector and social enterprise service providers who are able to offer required specific support to those on the autistic spectrum 5) Effectively engage in transition planning for young people coming through childrens services and identified through mainstream education Proposed Partner(s) Proposed Lead RBWM Joint Commissioning Manager Joint RBWM with lead partner agencies Joint Transition Planning lead and Disabled Childrens Team Manager Target date Proposed Outcome Increased effective provider market through joint working with private and voluntary sector Pathways, person centred transition plans are monitored effectively and information from reviews used to make improvements People contribute to their reviews and are positive about service provision Comments Outcome 4: Choice and Control for Adults on the Autistic Spectrum We will ensure that all adults living within the borough have significantly increased choice and control over the way they have their support and care needs met and are able to make informed choices relating to the way their services are provided. Proposed Action Proposed Partner(s) Proposed Lead Target date Proposed Outcome 1) Encourage the take up of personalised / individualised budgets and direct payments through a supported process to enable people to make informed choices. RBWM Head of Adult Social Care and Project Manager, Total Transformation 2011 Personal budgets offered to all people eligible for a service. Take up targets to be determined 2) Work with partners to incorporate assistive technology in housing developments to support the needs of people with ASD RBWM and Housing Associations Locality Manager ongoing Increased use of AT in 3) Empower people with ongoing health and social care needs through greater choice and control over their care through a wide range of initiatives. Individual choices are supported through a positive risk management process RBWM and BE PCT Locality Manager LD Supported Living leading to an increased sense of independence Reduction in need for domiciliary support for some Targets Review of IBs and to be set risk assessment in 2009 evidence that decision making is shared with citizen More people supported to have more choices All service users known to ASD team are risk managed Comments Outcome 5: Effective Commissioning and Procurement for Adults on the Autistic Spectrum We will commission services to clear standards of both quality and cost, by the most effective, economic and efficient means available. This will enable us to increase capacity into the future by commissioning and procuring social care differently so as to meet the growing and changing need for a range of services. Proposed Action Proposed Partner(s) RBWM 1) To encourage a local market through commissioning and support for a range of services so that service users accessing an individual budget / direct payments can have a wide range of service providers Proposed Lead Joint Commissioning Manager, Contracts Manager Target date Proposed Outcome To be Evidence of a wide set 2009 ranging menu of services from local providers Reduction in block contracting A varied local provider market and responsive to individual support needs Comments Outcome 6: Equality of Access for Adults on the Autistic Spectrum Services will be accessible, responsive, non-discriminatory, and provided in line with the Fair Access to Care standards. We will work with partners to ensure universal services are developed to which all adults can have access (e.g. sports, leisure, cultural, educational, training, transport and employment services). Proposed Action 1) Training for employers in Borough in AS awareness and strategies for employment 2) Ensure that services are culturally appropriate/sensitive to the needs of service users 3) Improve the social networks of those on the autism spectrum to reduce social isolation and improve community integration 4) Consult with stakeholders and partners when developing services for people with a LD go ensure services are outcome focused Proposed Partner(s) Joint BAS and RBWM partnership Joint RBWM and BE PCT RBWM RBWM Proposed Lead ASD subgroup ASD Team Manager Locality Manager and ASD Team Manager ASD team and BAS social groups Service manager and ASD team manager Target date Proposed Outcome Increased awareness for employers about Autism Services reflect diversity of need in Borough ongoing User satisfaction surveys report services being appropriate Reduction in social isolation ongoing Opportunities for involvement are encouraged Clarity for Users and Carers feeling fully consulted ongoing Services are proven to be of benefit to service users Comments Outcome 7: Workforce Development for Adults on the Autistic Spectrum With partners we will develop a workforce capable of delivering the vision of our strategic priorities Proposed Action 1) Encourage staff innovation and new ways of working in order to optimise capacity of resources Proposed Partner(s) Joint RBWM and BE PCT Proposed Lead Workforce Development Manager Members of ASD team Target date Ongoing Proposed Outcome A Workforce Development plan reviews how the skills of the workforce can be deployed to benefit service delivery Staff supported to explore new ways of working All Users will be in receipt of a personalised service as evidenced on care plans. 2) Develop shared approaches to service development and training to disseminate best practice across partner agencies 3) Extending voluntary work opportunities through the day Joint RBWM and BE PCT - Joint RBWM/ WMVA Workforce Development Manager Day Opportunities Ongoing Ongoing Efficient use of resources and shared expertise Protocol for ASD service will reflect this. Increased numbers of people who currently Comments Outcome 7: Workforce Development for Adults on the Autistic Spectrum With partners we will develop a workforce capable of delivering the vision of our strategic priorities Proposed Action Proposed Partner(s) opportunities service Proposed Lead Target date Manager 4) Workforce development plan aligned with changes to need arising from development of individual budgets and self directed care RBWM 5) Increase capability to ensure people working in Social Care have the skills and support they need to deliver services Joint RBWM and BE PCT Joint commissioning manager & Workforce Dev. manager Joint commissioning manager & Workforce Dev. manager Ongoing Proposed Outcome attend day services offered work experience Workforce plan operational and new developments requiring change can be incorporated Positive response in User Satisfaction surveys Continuous professional development is encouraged beyond minimum standards Staff are supported and utilise training 6) Support continuous professional development of staff in the health & Social Care sector through shared training opportunities Joint RBWM BE PCT Workforce Dev. Manager and Locality Manager Highly skilled and knowledgeable workforce Comments Outcome 8: Economic Well-being and Sustainability We will work in partnership to ensure that the residents of the borough have access to economic opportunities such as income and resources for a good diet and feel able to participate in family and community life. Proposed Action Proposed Partner(s) Proposed Lead Work with the Welfare Benefit / Revenue & Benefits teams and partner agencies to proactively distribute benefit information and advice RBWM Manager Welfare Benefits Encourage people on AS spectrum to use Ways into Work job coaches RBWM WIW Manager Target date Proposed Outcome Service users are able to access all benefits that they are entitled to Included in general LAA target More adults with learning disabilities have paid employment Comments
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