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Attachment to FOI request 'Completed strategy + on Adult Health & Care 2007-2010' (HTML version)

ABERDEEN CITY COUNCIL

Name of Committee

:

Council

Date of Meeting

:

1 October 2007

Title of Report

:

A Strategy for Transforming Adults Services - Health and Care for 2007 to 2010

Lead Officer

:

Abigail Tierney

Corporate Director of Strategic Leadership

Author of Report

:

Abigail Tierney

Corporate Director of Strategic Leadership

Tel - 523797

Craig Stirrat

Head of Planning And Policy for Services to Adults

Tel - (52)2860

Email - xxxxxxxx@xxxxxxxxxxxx.xxx.xx

Other Involvement

:

Matt Bailey, Modernisation and Innovation Manager

Alison Wiles, Change Manager

Claire Hunter, Change Manager

Friederike Debus, Development Officer Integrated Children's Transport

Craig Stirrat, Head of Service

Alistair Baird, Strategist (Planning and Policy, Services to Adults)

Graeme Stuart, Strategist (Policy & Planning - Housing)

Heather Stadames, Joint Future Service Manager

Consultation undertaken with

:

Stakeholder events took place during August and September. Participants included front line staff, community planning partners, unions, and Elected Members. Before the strategy was completed, there was an opportunity for formal consultation on a consultative draft. The views of service users are central to the process. Service providers in the voluntary and private sectors were also involved.

All Elected Members

Corporate Management Team

Extended Corporate Management Team

Service Managers working across Health and Care

Staff working across Health and Care and Housing

Strategists, Strategic Leadership

Resources Management - HR, Finance, Legal

Continuous Improvement - CRM, Service Design and Development

Trade Unions

The Aberdeen City Alliance

The Voluntary Sector Liaison Group

Service Users

Aberdeenshire Corporate Management Team

Aberdeen Community Health Partnership

Summary of Report

Aberdeen City Council has set the bold and aspirational vision to be recognised as a leading Council in Northern Europe by 2010. To achieve this vision the Council has to deliver the best possible outcomes for the citizens of Aberdeen.

The Transformation Strategy will provide direction for the considerable amount of work still required within Services to Adults over the next two years in relation to work arising from the national change programmes.

The purpose of the Transforming Strategy for Services to Adults is therefore:

To provide strategic direction and priority to ensure available resources are aligned to the need of citizens

Provide area teams with strategic leadership to assist in the delivery of modern, effective, and efficient services that link available resources to outcomes

Provide Elected Members with an evidenced based, strategic picture that will support them in taking bold and sometimes difficult decisions

Build capability within Strategic Leadership for strategic analysis, planning and monitoring.

Build capability in operational teams for delivering high performing, integrated, citizen focused services through a culture of continuous improvement.

It is possible to draw three main conclusions to summarise the findings in the report. Firstly, whilst we have some high performing services, overall the services to Adults are not consistently performing amongst the best in Scotland. We have many good services, but we have set the vision in the Community Plan and the Council to deliver high performing services and be recognised as a leading Council in Northern Europe by 2010. We still have a long way to go if we are to achieve this vision across the majority of our services. Secondly, the analysis also indicates that the current structure of the services are not consistently citizen focused, and there are significant areas where we are not targeting resources to meet demand and we therefore need to look for ways of adjusting our resource mix. For example, we are potentially over providing in residential care, and under providing services that enable Adult's to live independent lives. The third main conclusion is that the analysis of budgets demonstrates that we are currently consuming far more resources than are justified or available in the current environment.

In order to successfully confront these significant challenges in a collegiate and collaborative manner, we need to continue to foster a culture of continuous improvement throughout the Council. Critically, this does not yet exist as the dominant culture throughout the Council. Continuous improvement assumes that employees are the best people to identify room for improvement, since they see the processes in action all the time. In order to support this culture, we therefore need to continue to find ways to encourage and reward employees for their contribution to the process. While this transformation strategy may have identified some radical changes that need to take place, the key to success will be the ongoing identification of many small changes. All employees should therefore continually be seeking ways to improve their own performance. Managers in return need to encourage workers to take ownership for their work, and thereby improve worker motivation and morale.

Recommendations

1st. Remove low eligibility criteria for all current and future service users. This would be a long-term policy decision for at least 3.5 years (through to April 2011), and subject to annual review.

Links to the Community Plan and to a Vibrant, Dynamic and Forward Looking Council

This Report relates to the delivery of the Council's priorities contained in the Policy Statement, “Vibrant, Dynamic and Forward Looking Council”, our corporate objectives to integrate services and to deliver our Community Planning Challenges for Health & Care.

Implementation

On approval of the recommended options, Continuous Improvement will work with Strategic Leadership, the Area Teams and other services to produce and implement action plans within agreed timescales.

Once implemented, the process for monitoring the strategy will be via the corporate performance management system, including supervisory meetings, ECMT Performance Board; CMT Quarterly Review; Citistat; Area Committees, and ultimately the Performance and Standards Committee. Where solutions are not delivering the required results, we will scrutinise the reasons and adjust our approach accordingly.

Resource Implications

People

:

The strategy includes a work-force strategy that will have significant people implications. The success of the strategy will also be dependent on fostering a culture that is motivated by the opportunities provided by the drive to transform public services.

Finance

:

Estimated costs for capital investment and net revenue savings arising from the strategic options outlined are detailed in Appendix 6 for the periods 2007/08 to 2011/2012.

These elements of the Transforming Adults Services strategy will contribute significant net annual revenue savings, (£11.388 million by 2011/2012) and bring projected spend closer to GAE levels.

Notwithstanding the above it is important given the continuing pressures on the Council's current year and future years budget that the transformation programme delivers on these strategic options with implementation, as soon as practicable, and others are also explored as vigorously to ensure that the services delivered can be accommodated within the resources available to the Council on a sustainable basis. This will mean, inevitably, a change in service delivery.

There is currently a significant forecast overspend in 2007/08 which includes expected commitment and pressures on Social Work services (c£8 million) and the revised timelines for the implementation of Equal Pay and Modernisation - Terms and Conditions (£6.3 million)

Whilst the Council has the ability to use its uncommitted funds and balances to support the non-achievement of budget savings and demand pressures this should only be on a limited and preferably on a one off basis.

It is in effect comparable to meeting your day to expenses from your savings and it is not prudent or good financial management to significantly reduce them below acceptable levels or worse to completely deplete them without plans to address on-going annual operating costs.

It should be noted that if balances were completely depleted there is a legal requirement to budget for the restoration of balances in the following financial year. It is not therefore an option to do nothing.

The current levels of spend cannot be sustained on a continuing basis and urgent action is required to reduce the Councils recurring levels of expenditure.

Taking account of these factors It is essential that the strategic options for Adults Services are implemented. The continuation of services at current levels are not sustainable based on the current and future levels of funding.

Although the outcomes of the Spending Review 2007 are not yet known and Council tax levels are expected to be frozen in 2008/09 there is not expected, at this stage, to be any significant increases to the core local government settlement in 2008/09 and future years.

In light of this the Council must carry on and continue to significantly transform these services, and all other services, which make up a significant share of our net costs.

Systems & Technology

:

The strategy does include links to telecare and telemedicine, which will have a major benefit in delaying the requirement for high cost supplementary services for people with complex needs, including dementia.

Property

:

The strategy includes links to the estates strategy, therefore there will be property implications.

Other Equipment

:

The strategy includes links to the provision of equipment to disabled persons, so there will be other equipment implications.

Other

:

None arising from this report.

Other Implications

Health & Safety

:

The strategy will help tackle workload issues by ensuring resources are in the right place to deliver the services citizens needs and expect. The hope is that the strategy will provide focus and direction, and this will have a positive impact on the health and safety of staff, as well as raising staff morale.

Risk Management

:

The strategy will include a comprehensive risk assessment.

Human Rights/

Equalities/Diversity

:

The completed strategy will include a Equalities Impact Assessment

Sustainability

:

The completed strategy will include a Strategic Environmental Assessment. This strategy is sustainable, by providing opportunities for all children, young people and their families to be included in the life of the City.

Environmental

:

The strategy will ensure that all potential physical improvements will meet the highest environmental standards. The integrated nature of the strategy is also in recognition of the potential positive (or negative impact) that the physical environment can have on the quality of Citizens in Aberdeen.

Social

:

This strategy provides opportunities for improving the social aspects for all citizens in Aberdeen City. For example, the focus on self-directed support will ensure citizens are given the support they need to reach their full potential and contribute positively to the life of their communities and to Aberdeen City.

Economic

:

This Strategy supports the Council Policy to develop a City that becomes an even more attractive place in which to do business and so ensure that high quality employment opportunities exist for citizens. It will achieve this by ensuring all Adult's in Aberdeen reach their full potential and have the opportunity to contribute to the economic prosperity of the City. Also, by improving the quality of life for citizens who live in the City, Aberdeen will become an even more attractive place for families to live.

Construction

:

All future capital investment will adhere to the highest standards of modernised construction methods

Signature

:

Corporate Director of Strategic Leadership

1.0 MAIN CONSIDERATIONS

Why a transformation strategy for services to adults

Why a transformation strategy for services to adults

    1. The past decade has seen major changes in the organisation and operation of Public Sector services in Scotland. Following the move to unitary authorities in April 1996, the new UK government in 1997 suspended the statutory requirement for Compulsory Competitive Tendering (CCT) and replaced it with an expectation of the achievement of Best Value (BV) which was and remains far more demanding than CCT had proven to be. With the implementation of the Local Government (Scotland) Act 2003 came the formalisation of BV as a statutory requirement and an increased drive towards modernisation and efficiency against the background of decreasing funds. Alongside this, the implementation of the National Agreement of Single Status and Equal Pay is taking place and creating further financial demands on local authorities as well as a need to modernise terms and conditions. Since its inception Aberdeen City Council has embraced the transformation agenda, and this determination was explicit in the very first policy statement in 1996, which included a commitment to streamline (modernize) service delivery.

    2. The Transformation Strategy for Services to Adults has been developed to set out an evidenced based picture of the choices facing Aberdeen City Council in planning and improving its services to Adults over the next 3-5 years. By planning 3 years ahead, this Strategy will help to ensure that the Council is ahead of the curve when it comes to responding to and implementing emerging policies. The strategy follows relevant Scottish guidance and seeks to ensure that the Council keeps pace with emerging and established local and regional policy as well as the City's Community Plan Aberdeenfutures. It is our intention through the successful delivery of this strategy to meet and preferably exceed all minimum legislative requirements. Overall, this strategy focuses on issues specific to Aberdeen, whilst also being aware of the wider context and the inter-relationships that exist with our partners in the City and beyond.

    3. We have set the bold and aspirational vision to be recognised as a leading Council in Northern Europe by 2010. To achieve this vision we have to deliver the best possible outcomes for the citizens of Aberdeen and ensure we have the internal capacity to deliver against ever rising citizen expectations. We also need to provide all staff with strategic leadership to enable them to deliver modern, effective and efficient services that link available resources to outcomes. We will do this by implementing a transformation strategy that aims to close (and then exceed) the gap between our performance and the performance of our comparator authorities by 2010.

    4. Benchmarking illustrates that in Health and Care we are investing more money than our comparator authorities but not always delivering superior performance. Certain areas of the service are significantly overspent in comparison to Grant Aided Expenditure (GAE). This strategy aims to reduce budget spend where necessary, taking account of GAE whilst increasing performance. It is a strategy that seeks to deliver better outcomes while bringing the various strands of the budget into line with GAE and ensuring that spend remains within agreed budget limits.

    5. If agreed, the strategy will provide direction for the considerable amount of work still required within Adult's Services over the next three years in relation to work arising from the National Changing Lives Agenda, and the changes required to move to full neighbourhood service delivery.

    6. The strategy will also provide a `road map' for operational teams in terms of policy direction. However, the road map alone will not be sufficient to ensure success. The modernisation that the strategy is demanding is monumental, and will require significant capacity building in change management and continuous improvement amongst and with the operational teams.

    7. Methodology

      1. In preparing the Transformation Strategy for Services to Adults we have balanced the need for consultation and analysis with the need for speed and pragmatism to tackle the critical challenges Aberdeen faces. Once the strategy has been finalised, progress and implications will be thoroughly monitored on a quarterly basis and the strategy adjusted if required.

      2. It is vital to note that given the pace of change required, we have focused initially in this strategy on the Health and Care elements of Services to Adults. We need to do further work on a strategy for transforming our Housing service and how we tackle community safety, and in particular substance misuse. This work is ongoing, and the substance misuse strategy, being led by the Chief Executive, will be brought to Committee in December 2007 and will be integrated into the overall transformation Strategy for Services to Adults. Within the health and care strategy, officers recognise that the analysis and proposals around Mental Health is currently weak, and must therefore be a focus moving forward. Integrated proposals will be brought to Policy and Strategy in January 2008.

      3. For the first time, we are working collaboratively to develop a truly integrated transformation strategy for Services to Adults. Continuous Improvement is project managing and co-ordinating the process from end-to-end. Strategic Leadership has led the strategic analysis, with input from Resources Management, Continuous Improvement and drawing on specific expertise from the 3 area teams.

      4. Consultation has included workshops with the following interested parties to gather views on current problems and what we should aim to do about them:

    • workshops with staff

    • 2 workshops with elected members

    • 1 workshop with partners and service users

      1. A rich source for consultation and performance assessment is the input from service users and their unpaid carers. Whilst service users and carers were invited to participate in a workshop, the arrangements for gathering individual service user and carer satisfaction with services are less well developed. The main vehicle for obtaining this information is the Single Shared Assessment annual survey, which provides some indication of our performance. However, user and carer involvement in service planning is a significant area where we need to improve as a Council. The Joint Improvement Team (JIT) has been funding and supporting a national project to look at including service user and carer experience into performance management and service planning and delivery. An interview tool has been developed - the User Defined Service Evaluation Tool (UDSET) - and it is anticipated that this approach will be developed nationally.

      2. We have reviewed the context within which Services to Adults in Aberdeen need to contribute to the economic, social and environmental well being of the city and the wider region.

      3. We have undertaken a thorough review of the progress made in delivering performance outcomes, and identified the gap between current performance and where we need to be by 2010. We have also analysed this performance in light of key demographic and budget trends.

      4. The strategic context, performance gap and key trends lead to a succinct articulation of the key problems that need to be addressed by the strategy. The final section proposes a number of potential solutions including estimated budget implications over a 3 year period. These integrated solutions and include a strategy for workforce, assets, ICT, and shared services.

      5. As well as these major issues and policy decisions that are recommended below, many operational improvements were also identified during the strategy formulation process. Once this strategy is approved, the operational improvements, any previously agreed actions and recommendations (sources would include recent inspection reports, previous Committee Reports, the Corporate Transformation Programme) will be brought together into one improvement plan for Adult Services that will be monitored and updated on a quarterly basis. As additional elements of the strategy are formulated (e.g. improvements identified through Social Work Inspection and forthcoming Child Protection Inspection) these will be added to the improvement plan.

      6. Once implemented, the success of the strategy will be closely managed and monitored through the corporate performance management system, including supervisory meetings, appraisals, the Area Committees, the Performance and Standards Committee and Citistat. Where solutions are not delivering the required results, we will scrutinise the reasons and adjust our approach accordingly.

      7. context - National legislative context

        1. At the highest level, the strategy seeks to ensure that the services the Council delivers fit with the requirements of the Local Government in Scotland Act (2003). This Act gave community planning a legislative basis; established the power to advance community well being & partnership working; & secured a duty of best value including having regard to economy, efficiency and effectiveness. In order to ensure we meet our statutory duty under The Local Government Act to deliver best value, this strategy for Services to Adults will further strengthen the Council's approach to integrated neighbourhood delivery which places the citizen at the heart of the services we deliver. We also recognise that all employees and stakeholders must be empowered to contribute to delivering high performing services. We already have examples of dedication, innovation and energy throughout the Council. We are now developing a culture where the best can help support and raise the performance of the rest. The Local Government Act also places a duty on Council's to deliver best value in a way which contributes to the achievement of sustainable development (including physical, economic and social aspects). This strategy has been developed within this context, and aims to support and promote sustainable development within Aberdeen City and the wider region.

        2. The Community Care and Health (Scotland) Act 2002 provides powers to local authorities and health boards to devolve responsibilities to each other to enable integrated working. It also makes it possible to pool budgets, align staff and share premises in the interests of more effective joint working. The Act also introduced a `ladder of intervention' which provides a basis for the Executive to direct local partnerships where sufficient progress is deemed not to have been achieved.

        3. The NHS Reform (Scotland) Act 2004 established Community Health Partnerships (CHPs) from April 2005. CHPs provide the opportunity to connect all parts of health and social care systems together with community and voluntary sector interests and link into wider Community Planning Partnerships. CHPs provide the scope for more integrated and flexible working across service boundaries, to better meet the needs of patients and service users and carers. In Aberdeen, this is being achieved through aligning health and local authority resources; through linking health and council staff into unified teams; and through more effective engagement with users and carers.

        4. The Mental Health (Care and Treatment) Scotland Act 2003 came into effect in October 2005 and covers four main areas:

      • When a service user can be given treatment against their will

      • When a service user can be taken into hospital against their will

      • What a service users rights are, and

      • What the safeguards are to make sure that service user rights are protected.

        1. National policy on mental health aims to maintain mental well-being of the people in Scotland and to improve the situation of those with mental ill-health by working with others to:

      • Promote attitudes and behaviour in the general public which lead to mental well-being

      • Ensure that good quality mental health services are available for everyone that needs them at all levels of need.

      • Ensure people with mental health problems can receive effective care and treatment.

        1. A number of initiatives have been introduced with the objective of enhancing the safety of vulnerable groups and clarifying the circumstances in which they can be the subject of legal interventions. The Adults with Incapacity Act 2002, the Mental Health (Care and Treatment) (Scotland) Act 2003 and the upcoming Vulnerable Adults Bill clarify definitions of vulnerable people and introduce clear principles to underpin any intervention.

        2. The Housing (Scotland) Acts 2001 and 2003 introduced legislative changes regarding homelessness:

      • A duty to provide temporary accommodation for all homeless households, irrespective of whether they are in priority need

      • A stated intention to remove priority need by 2012 so that councils have a duty to provide permanent accommodation to all homeless households

      • Standards of temporary accommodation have also been introduced in the best interests of children

      • A responsibility on Registered Social Landlords to help councils deliver these responsibilities. (Given the scale of homelessness, these changes are expected to mean that a growing proportion of the lets will be made to homeless people, with knock on implications for other groups.)

        1. As well as legislation specifically related to Children and Young People, there are a number of general pieces of legislation that have an impact on the way we deliver services. These include the Health & Safety at Work Act (1974); Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (1995); Management of Health & Safety at Work Regulations (1999); Workplace (Health, Safety and Welfare) Regulations (1992); Disability Discrimination Act (1995); and the Race Relations Amendment Act (2000); and the Equal Pay Act (1970) which gives an individual a right to the same contractual pay and benefits as a person of the opposite sex in the same employment.

        2. National Policy context

          1. On May 3rd 2007 the Scottish National Party were elected to government with the following ambitions for Scotland:

          • Our nation can be healthier. The SNP will keep vital health services local and there will be a presumption against centralisation of core hospital services to protect local access to healthcare.

          • Families in Scotland can be wealthier. The SNP government will remove the burden of business rates from 120,000 small businesses, freeing them to grow and create more and better paid jobs. Small businesses sit at the heart of local economies and with the right support they will flourish.

          • Local communities can be safer. The SNP government will put more police on our streets to detect and deter crime. And we will come down hard on those who sell alcohol to underage Scots and fuel anti-social behaviour.

          • Local taxes can be fairer. The SNP will scrap the Council Tax and introduce a fairer system based on ability to pay. Families and individuals on low and middle incomes will on average be between £260 and £350 a year better off. Nine out of ten pensioners will pay less local tax.

          • Life should be easier for young families. The SNP will increase by 50% the amount of free nursery education available for 3 and 4 year olds.

          • Scotland can be greener. The SNP government will not give the go ahead for new nuclear power stations. We will invest instead in developing Scotland's extensive renewable energy potential.

          • Scotland can be smarter. It's time for more opportunities for young Scots with smaller class sizes and it's time to dump student debt.

          1. `Transforming Public Services: The Next Phase of Reform' was published in June 2006. The report called for public services to be more responsive and effective. The conclusion was that we must accelerate the pace of modernisation and reform in order to face up to a number of long-term challenges over the next 20 years, including:

          • We have a more diverse and individualistic society with different aspirations and expectations. People are better equipped to make assessments of service quality and to judge service quality against the best elsewhere, and they expect services tailored to their needs.

          • The unparalleled growth in expenditure on public services in recent years is not likely to continue indefinitely, particularly when our economy faces increasing competition from Eastern Europe, India and China.

          • We are experiencing unprecedented technological change - with opportunities to deliver services in new ways, but also risks of increased inequality.

          • The proportion of people of working age in the population is shrinking.

          • There is declining engagement with the political process and generally with the public sphere. This could fuel a loss of trust in public services unless we can demonstrate that they are valuable and efficient, and match the best that can be found elsewhere.

          • Our determination to improve economic opportunity is informed by the social disadvantage that is still experienced by too many in our country.

          1. Against this broad context of ambitious transformation, the 21st Century Review of Social Work report (Changing Lives), issued in February 2006, recommended:

        • Building capacity for personalised services

        • Building the capacity of the workforce

        • Building capacity for sustainable change

          1. The review has now been followed by a Scottish Executive Implementation Plan, which outlines the process required to build capacity for change across social work services in Scotland. Five national change programmes have been identified:

        • A clearly defined role for social workers and the social work profession

        • Improvements in the organisation and delivery of social work services

        • A strong improvement framework and culture, supported by robust inspection

        • Strengthened leadership and management of social work services

        • A competent and confident workforce.

          1. The Transformation strategy will enable the Council to provide direction for the considerable amount of work still required within Services to Adults over the next two years in relation to work arising from the five national change programmes and linked to the following issues identified in the review:

        • People should be able to influence how their services are planned and delivered and receive “personalised care”

        • Other agencies and Council functions should play a more substantial part in supporting people traditionally steered towards social work services

        • Individual social workers should be enabled to operate with greater professional autonomy and qualified staff skills should be used to better effect

        • Social Work should remain a single, generic profession

        • The specific functions of qualified social workers should be defined and set out in guidance and regulations

        • Professional leadership should be strengthened. Councils should have one Chief Social Work Officer, reporting to the Chief Executive

        • There should be investment in leadership and management of the profession.

          1. The Executive launched "All Our Futures: Planning for a Scotland with an Ageing Population" on March 2007. This strategy sets the vision for Scotland's future - a Scotland that will value and benefit from the talents and experience of its older people; a Scotland that welcomes its ageing population. The report examines ways to ensure the right infrastructure is in place for an aging population including housing, transport, life-long learning, and planning progressively to meet the needs of all ages.

          2. The National Outcomes for Community Care is a package of national measures and targets aimed at improving services for users and carers with a focus on feeling safe, satisfaction with care packages and opportunities for social interaction. The outcomes seek to:

        • Change the balance of care with a focus on increased personal care at home and intensive home care when required as opposed to inappropriate care in a care home

        • Provide support for carers and thus increase the number who feel supported and able to continue in their caring role

        • Reduce the number of unplanned hospital admissions and Delayed Discharges over 6 weeks

        • Reduce the waiting time for completion of assessment of needs and the delivery of community care services.

          1. The final report of the Joint Future Group (2000) has been the driver of many of the recent changes in the social care and health sectors. It required health and social work to work together more effectively in providing joint services in the community. Key developments in Aberdeen have included:

        • Promotion of the Single Shared Assessment

        • Improving equipment and adaptations services

        • Addressing delays in discharge from hospital

        • Establish, through health and social care teams alignments and integrated services at GP practices

          1. In 2004, Scottish Ministers launched their “Closing the Opportunity Gap objectives and targets”. These targets focus on where the Executive can make the biggest difference within its devolved powers. They require the Scottish Government, and its agencies such as Communities Scotland, to work across all departments and engage with local authorities to:

        • Prevent individuals or families from falling into poverty

        • Provide routes out of poverty for individuals and families

        • Sustain individuals or families in a lifestyle free from poverty.

          1. The detailed targets for `Closing the Gap' are ambitious and make the connections between different aspects of community life from employment to debt to health to education. The policy context explicitly sets out the need for organisations to work together across these issues with a joined up approach to improving the quality of life for our most vulnerable communities and groups.

          2. In July 2004, the Minister for Communities announced the establishment of a new £104 million Community Regeneration Fund (CRF). Funding is allocated on the basis of regeneration outcome agreements (ROAs) and information about the most deprived communities. The Scottish Executive encourages social landlords to promote economic and social regeneration through the wider action programme. Examples of “wider action” in this regard include employment and training schemes, provision of community facilities and workspaces, childcare and youth projects and money and energy advice.

          3. Supporting People (SP) was introduced in April 2003, and created a significant new policy and funding system to provide low level, preventative services to support independent living. Reduced SP allocations were announced in 2004 and whilst some councils have been awarded additional funding many, like Aberdeen City Council, face reductions.

          4. Telecare (also known as Smart/Assistive or Preventative Technology) is a term that covers devices installed in people's homes that can trigger a pre-determined, escalating chain of responses from a call centre. National policy developments in this field are being taken forward as part of the National Telecare Programme. Typically, potential services range from a reassuring phone call to the person, to alerting a local carer, neighbour, staff or emergency services. When used as part of a holistic package of services, Telecare can contribute to independent living and can improve a person's quality of life by helping to maintain independence, increase safety and confidence, and provide support for carers.

          5. Scotland has seen developments in the recognition of the vital role undertaken by carers. A strategy for carers in Scotland was published in November 1999, and the Community Care and Health (Scotland) Act 2002 extends carers' rights to assessments and to information about assessments.

          6. Local policy context

            1. In 2001 the Community Planning Partnership in Aberdeen agreed a vision for a `City that is vibrant, dynamic, forward-looking - an even better place to live & work - where people can expect high quality services that meet their needs.'

            2. Underpinning the development and implementation of the Community Plan in Aberdeen is our aim to ensure sustainability and social inclusion to include being better informed about local services and opportunities and through active citizenship and community involvement. Success is dependent on breaking down the barriers by tackling inequality, discrimination and exclusion and promoting social justice and inclusion to ensure that individuals and communities achieve their potential.

            3. In order to deliver higher quality services, the Council has to be fit for purpose, and has therefore set the bold and aspirational vision of `being recognised within the City and more widely as a leading Council in Northern Europe by 2010'. This vision will be achieved through high performing, citizen focused, integrated service delivery.

            4. For Services to Adults the Council is committed to supporting the most vulnerable and excluded people; protecting those at risk of harm from themselves and others; and working with partners and citizens to close the opportunity gap.

            5. At the heart of these inter-dependent visions is the desire to transform our communities, and ensure citizens benefit from improved outcomes through the delivery of integrated services. Alongside integration, neighbourhood service delivery is the foundation of service delivery throughout the Council, and is therefore a core principle of the Transformation Strategy. Furthermore, the strategic objectives will not be achieved without a culture of continuous improvement filtering throughout the Council. This strategy is just the beginning. We need to continually seek ways to deliver improved services with increasingly restricted resources.

            6. The 2007-2011 Council Policy Statement “Vibrant, Dynamic & Forward Looking” lays out the local priorities on which this strategy will be based, including:

          • Improving joint working with the NHS, especially in relation to the delivery of services in mental health and wellbeing, learning disability, care of older people, and delayed discharge

          • Developing advocacy for appropriate client group and ensuring that the advocacy provisions of Mental Health (Care and Treatment) Scotland Act 2003 are implemented.

          • Providing appropriate respite and rehabilitation services

          • Adopting and implementing strategies to involve and support service users and unpaid carers in developing appropriate service provision

          • Adopting and implementing strategies to support independent living for people with special needs

          • Supporting income maximisation measures to help people with disabilities and carers claim all the benefits to which they are entitled.

            1. Another key driver of local policy for both services to Adults and Children is the urgent need to tackle substance misuse in the City. During 2005-06, Aberdeen reported to the Scottish Drug Misuse Database (SDMD) there were 516 new people seeking care and treatment. This figure was a decrease on figures for the four previous years. However, the City had seen a year-on-year increase in the number of people seeking specialist addiction intervention. The numbers of people accessing shared care methadone had increased by more than 10% a year for the previous three years and numbered approximately 1200 in May 2007. A report in 2003 indicated that Aberdeen had a prevalence rate of opiate and benzodiazepine use of 2.03%, while the Scottish average was 1.84%. It also had the highest rate of injecting and a higher incidence of psychostimulant use than elsewhere in the country. It is harder to obtain reliable data on people accessing help for alcohol misuse than for drug misuse. The figures for under-age drinking exceeded the national average on a number of key measures. Between 2003 and 2005 the number of children referred to the Reporter on substance misuse