ITEM
PAGE 1
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
Email – Atierney@aberdeencity.gov.uk
Craig Stirrat
Head of Planning And Policy for Services to
Adults
Tel - (52)2860
Email - cstirrat@aberdeencity.gov.uk
Other Involvement1
: 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
1 See Appendix 7 ‘Communications Audit’ which includes responses to consultation.
ITEM
PAGE 2
Consultation undertaken with2 : 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
2 See Appendix 7 ‘Communications Audit’ which includes responses to consultation.
ITEM
PAGE 3
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.
ITEM
PAGE 4
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. ....................................................... 49
2nd. Remove medium eligibility criteria for all current and future service users -
this would be medium term policy decision for 2.5 years subject to annual
review (through to April 2010).................................................................. 50
3rd.
Agree revised eligibility criteria (see Appendix 4) for the services which
citizens can expect to receive depending on the outcome of the care
assessment.............................................................................................. 50
4th.
Introduce an annual review of all eligibility criteria, so that it can be
adjusted to meet changing needs and available resources. .................... 50
5th.
Instruct officers to assess current compliance with care assessment
standards in terms of regularity and quality and report findings to
Continuous Improvement Committee in March 2008. .............................. 50
6th.
Agree Policy to change the balance of supply from 75% residential care/
25% home care to 50%/50% by 2010/11, and reinvest a percentage of the
money saved to support citizens to live independently at home. ............. 50
7th.
Approve an annual capital investment in telecare projects of £500K 07/08
and £1.5m 08/09. ..................................................................................... 50
8th.
All care at home in the community to service users not living in Council
owned Sheltered or very Sheltered Housing to be provided by the private
and voluntary sector by March 2008. ....................................................... 52
9th.
Integrate the roles and tasks undertaken by Senior Home Carers and
Sheltered Housing Warden into the new role of Senior Personal Carer. . 52
10th. Reduce in the number of day care places to 135 over a 3-year period, with
the principle that 50% of the savings will be redirected into personalised
care.......................................................................................................... 53
11th. Instruct officers to complete Learning Disability Commissioning Strategy
and take recommendations to Commissioning Board in October 2007 and
for approval to Policy and Strategy in December 2007. ........................... 54
12th. Agree policy to shift the emphasis away from residential and day care
centres provision and into supported access to mainstream housing,
leisure, employment and adult education opportunities where appropriate.
................................................................................................................. 54
13th. Task officers to work with unpaid carer organisations to update the current
carers’ strategy and develop a three-year action plan. Bring proposals to
Policy and Strategy in February 2008 to cover the above solutions within
available resources. ................................................................................. 55
14th. Authorise officers to undertake thorough consultation with people with
sensory loss (or deprivation) and with providers to determine what service
will best meet their needs. ....................................................................... 55
15th. Thereafter to enter into discussion with NHS Grampian and service
ITEM
PAGE 5
providers on the commissioning of the most appropriate sensory service by
March 2008.............................................................................................. 55
16th. Agree a policy of not authorising funding for packages above the
Independent Living Fund limit of £200, if citizens have chosen not to take
this option. ............................................................................................... 56
17th. Adopt in principle the policy of self-directed support and task officers to
bring detailed report on the resource implications to Resources
Management Committee in December 2007. .......................................... 56
18th. Approve £8 million capital funding over the years 2008/09 and 2009/10 for
the site acquisition and development of a replacement Care home for Croft
House. ..................................................................................................... 57
19th. Authorise the development of East Woodcroft for Housing for Varying
needs / telecare (current estimated capital cost of £17 million) in
partnership with a Registered Social Landlord(s). ................................... 57
20th. Undertake process review of homelessness services (including thorough
benchmarking and any request for additional staff), and bring findings and
recommendations to Resources Management Committee in by February
2008......................................................................................................... 58
21st. Authorise the Scheme of Allocations Working Party to amend the Council
Allocations Policy to increase priority for Homelessness (with a priority on
families) and to increase the proportion of lets to homeless households to
25%. Submit a report to Policy and Strategy Committee in February 2008
for approval.............................................................................................. 58
22nd. Agree to increase the number of furnished temporary homeless flats by up
to 200 by 2010/11, (as required, e.g. draw down in increments of 10 at a
rate of 100 per annum). The first phase should be family units of two and
three bedrooms dispersed throughout the City. ....................................... 59
23rd. Task officers to review current protocols with Registered Social Landlords
to increase the proportion of lets to homeless households from 25% to 50%
in 2008/9. ................................................................................................. 59
24th. Review all homelessness related services funded by the Social Work
budget by December 2007 to ensure that Best Value is delivered - and
those national outcomes for Homeless Persons and Care in the
Community are achieved. ........................................................................ 59
25th. Introduce charges for Community Alarm at the same rate as Aberdeenshire
Council (£1.25 per week). ........................................................................ 60
26th. Work with internal audit to ensure strict adherence to current charging
policy and put in place simplified processes where processes are less than
efficient. ................................................................................................... 60
27th. Agree to the principle of a strengthened and better co-ordinated external
funding capacity within the Council and task officers to bring forward
detailed proposal to Resources Management Committee. ...................... 60
28th. Agree implementation of eligibility criteria for Adult Transport, and task
officers to bring proposal for eligibility criteria and an assessment process
ITEM
PAGE 6
to Policy and Strategy Committee for agreement in December 2007. ..... 61
29th. Agree to the concept of a corporate pool of escort drivers, and task officers
to bring detailed proposal to Resources Management by March 2008. ... 61
30th. To reaffirm previous policy decisions arising from the Social Work
Workforce Review.................................................................................... 61
31st. Task officers to develop, as part of the Corporate Asset Management
Strategy, an Asset Management Strategy for Adult Services, and bring
proposals to Resources Management Committee by April 2008. ............ 62
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
ITEM
PAGE 7
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.
ITEM
PAGE 8
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
ITEM
PAGE 9
assessment.
Human Rights/
: The completed strategy will include a Equalities
Equalities/Diversity
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
ITEM
PAGE 10
1.0
MAIN CONSIDERATIONS
Why a transformation strategy for services to adults.......................................10
2
Methodology.............................................................................................11
3
context - National legislative context ........................................................13
4
National Policy context .............................................................................16
5
Local policy context ..................................................................................20
6
overview of services provided in aberdeen...............................................23
7
Analysis of current Performance ..............................................................24
8
Current and Projected Service trends ......................................................32
9
Strategic Objectives and Recommendations............................................47
Appendices .........................................................................................................64
WHY A TRANSFORMATION STRATEGY FOR SERVICES TO ADULTS
1.1 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.
1.2 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
ITEM
PAGE 11
context and the inter-relationships that exist with our partners in the City and
beyond.
1.3 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.
1.4 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).3 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.
1.5 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.4
1.6 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.
2 METHODOLOGY
2.1 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
3 GAE is the means by which the Scottish Executive distributes the total budget it has available
for Scotland’s local authorities. It is not and does not attempt to identify the level of expenditure
expected for each area of services.
4 A full copy of ‘Changing Lives: Report of the 21st Century Social Work Review’ can be found at
the following link: http://www.scotland.gov.uk/Publications/2006/02/02094408/0
ITEM
PAGE 12
has been finalised, progress and implications will be thoroughly monitored on
a quarterly basis and the strategy adjusted if required.
2.2 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.
2.3 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.
2.4 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
2.5 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.
ITEM
PAGE 13
2.6 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.
2.7 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.
2.8 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.
2.9 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.
2.10 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.
3 CONTEXT - NATIONAL LEGISLATIVE CONTEXT5
3.1 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
5 A comprehensive list of the legislative framework as it applies to Services to Adults can be
found in Appendix 1.
ITEM
PAGE 14
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.
3.2 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.
3.3 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.
3.4 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.
3.5 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:
ITEM
PAGE 15
• 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.
3.6 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.
3.7 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.)
3.8 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.
ITEM
PAGE 16
4 NATIONAL POLICY CONTEXT
4.1 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.
4.2 ‘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
ITEM
PAGE 17
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.
4.3 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
4.4 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.
4.5 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”
ITEM
PAGE 18
• 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.
4.6 The Executive launched "All Our Futures: Planning for a Scotland with an
Ageing Population" on March 2007.6 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.
4.7 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.
4.8 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
6 The full report can be accessed at the following link:
http://www.scotland.gov.uk/publications/2007/03/08125028/0
ITEM
PAGE 19
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
4.9 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.
4.10 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.
4.11 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.
4.12 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.
4.13 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
ITEM
PAGE 20
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.
4.14 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.
5 LOCAL POLICY CONTEXT
5.1 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.’
5.2 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.
5.3 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.
5.4 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.
5.5 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
ITEM
PAGE 21
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.
5.6 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.
5.7 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
ITEM
PAGE 22
referred to the Reporter on substance misuse grounds almost doubled, while
national figures dropped.7
5.8 ‘Ageing with Confidence – A Joint Strategy for Older People in Grampian’ –
outlines a range of ways to improve services to older people. The
recommendations include providing 24-hour/7 day-a-week access to
community based services. The joint strategy also calls for a greater emphasis
to be placed on delivering prompt, accessible and effective outpatient and
diagnostic services. Within the home care sector the strategy proposes that
greater provision should be made for people with dementia and functional
mental illness.
5.9 The aim of Aberdeen City Council’s Carers' Strategy is to provide appropriate
support for carers by keeping staff up to date with carers’ issues. This will be
done by publishing and actively distributing information on carers’ rights;
ensuring carers are fully involved in the implementation and monitoring of
consultation arrangements in relation to joint future; and increasing carers
training to meet the requirements of the National Expert Carer Programme.
5.10 The delivery of Services for Adults is taken forward jointly with NHS Grampian
through a Joint Future/Community Care Plan. The basic premises on which
the plan is founded are:
• That service planning should drive service commissioning, rather
than the other way round
• That ‘community care’ is the end towards which Aberdeen City
Council and NHS Grampian/Aberdeen City Community Health
Partnership [CHP] are striving, whereas ‘Joint Future’, as a way of
working together, is a means towards that end
• That the goal of community care is to move away, as far as is
possible and appropriate, from ‘institutional’ care, whether in
hospital or care home, to care delivered in or near a person’s home,
with the balance of funding and other resources adjusted
accordingly.
5.11 In this context, it is essential that the Council develops its social care planning
and commissioning activities, as outlined above, in collaboration with NHS
Grampian / Aberdeen City CHP. Furthermore that the changes brought about
by Joint Future further the goal of community care as a whole as set out in [3]
above.
7 One possible reason for this increase was the proactive referral to the Children’s Reporter by
the Grampian Police Youth Justice Management Unit (YJMU) of any offences where alcohol or
drugs are featured.
ITEM
PAGE 23
5.12 The Council has established a Community Planning Asset Management
Group, which includes representatives from Resources Management and NHS
Grampian. This group aims to ensure that we make effective use of joint
assets for the benefit of the whole City. The key priorities are to review existing
care home and day care provision and the development of an action plan,
designed to ensure that the accommodation is fit for purpose in the years
ahead.
5.13 Aberdeen City is home to a population of 206,880 and is a thriving
cosmopolitan city in the North East of Scotland. The city has a buoyant
modern economy, reflected in unemployment rates consistently under 2%.
Whilst traditional economies such as education, tourism, fishing and farming
still flourish, it is the energy industry that sets Aberdeen apart and which has
earned it the epithet of ‘The Energy Capital of Europe’.
5.14 The Transformation Strategy for Services to Adults will contribute to
addressing these local challenges through the modernisation of services and
the implementation of efficient government principles.
6 OVERVIEW OF SERVICES PROVIDED IN ABERDEEN
6.1 Services to Adults are planned, commissioned and delivered through six main
care groups:
• Older
People
• Learning
Disability
• Mental
Health
• Physical Disability (including Sensory Disability)
• Substance
Misuse
• Homelessness.
6.2 We also provide transport to adults in need, through a combination of in-house
fleet, contracted providers, and ad-hoc spot purchases.
6.3 Around 1860 people are employed by the Council in Adult Services social care
(1504 FTE posts). Services to Adults are delivered from the three area service
management teams, and within these teams through integrated
neighbourhood networks. This model of service delivery was agreed by the
Council in 2001. It is now becoming a reality via the disaggregation of budgets
or the provision of Service Level Agreements which will give Neighbourhood
Networks full control and accountability over all the services for which they are
responsible.
ITEM
PAGE 24
6.4 These services are provided in public offices, service users’ own homes, day
centres and residential establishments. Services may be provided directly or
through voluntary and private sector organisations. Over half (58%) of the
Adult Services’ budget is spent on external community care services.
6.5 The Office of the Chief Social Work Officer is responsible for quality
assurance, policy and procedures, professional supervision of the provision of
training for social work staff and social work commissioning.
6.6 Planning and Policy for Services to Adults is responsible for quality assurance
and performance management, strategic planning and policy development.
6.7 Resources Management has responsibility for contract monitoring, training
and development and asset management, finance, legal and democratic
services.
6.8 The Health and Social Care (Services To Adults) asset portfolio extends to
approximately 27 properties including a number of day centres for people with
learning disability, physical disability and older people, residential homes for
older people, people with mental health problems and people with learning
disability, plus office accommodation.
6.9 Continuous Improvement is responsible for CRM, change management,
Corporate Communications, and Performance Management
7 ANALYSIS OF CURRENT PERFORMANCE
7.1 Joint Performance and Information Assessment Framework
7.1.1 The performance of Joint Future Partnerships is assessed annually
by the Scottish Government using the Joint Performance and
Information Assessment Framework (JPIAF). The assessment of
Aberdeen for 2006/07 stated that ‘steady progress’ had been made
overall. The targets which were achieved were as follows:
• To increase the percentage of people receiving intensive*
home care - as a proportion of all the older people receiving
care at home - to 30% by 2008 (* = Over 10 hours)
• To increase the percentage of older people receiving care at
home compared to permanent NHS or Care Home care
• To reduce waiting times, for all users, for Health and Social
Care Occupational Therapy assessments
ITEM
PAGE 25
• To increase the number of people receiving a rapid response
service within 24 hrs of initial contact
• To reduce hospital patient delayed discharge numbers in line
with national targets in 2005-06
• To increase the number of people in receipt of Direct
Payments
• To increase the number of carers’ assessments, and self-
assessments
• To increase the number of carers accessing Care Home
respite
• To increase the number of hours of home-based respite care
for carers
7.1.2 The target that was not achieved according to the JPIAF
Assessment:
• To increase the number of service-user self-assessments.
7.1.3 Targets that were partially achieved or where the required
information was not available:
• To decrease the number of unplanned admissions to hospital
of people over 65
• To increase the percentage of Single Shared Assessments
with a service in place within 2 weeks and 4 weeks from
referral
• To increase service-user and carer satisfaction with service
provision by a service-user SSA survey carried out at yearly
intervals.
7.2 Statutory Performance Indicators8
7.2.1 Aberdeen’s performance is less successful when judged by the six
Statutory Performance Indicators (SPIs) currently used by the
Accounts Commission/ Audit Scotland to measure adult social care
and homelessness. Our performance on many of these SPIs has
improved over time; however, other Councils have also been
improving so we are not succeeding in closing the gap consistently
between ourselves and other Local Authorities.
8 A full list of our current performance as measured by Statutory Performance Indicators can be
found in Appendix 2.
ITEM
PAGE 26
7.2.2 The latest available comparative information for 2005-06 shows
areas of performance which are above the Scottish average:
• Percentage of residential care places occupied by older
people that are a single room
• Percentage of residential care places occupied by older
people that are en-suite
• Average time between presentation & discharge of
Homelessness duty
7.2.3 Areas where Aberdeen performs below the Scottish average are as
follows:
• Home Care, total number of hours per 1000 population
• Residential accommodation staff qualifications
• Home Care, percentage of home care clients receiving
personal care as a rate per 1000
• Home Care, percentage of home care clients receiving care
at weekends as a rate per 1000 population aged 65+
• Home Care, percentage of home care clients receiving care
in evening/overnight as a rate per 1000 population aged 65+.
• Percentage of cases reassessed as homeless or potentially
homeless within 12 months
7.3 Delayed
Discharge
7.3.1 Across Scotland, the issue of delayed hospital discharge has a high
public and political profile. Delayed discharge places strain on
hospital and community services, adding to waiting times for people
who need admission to hospital beds occupied by people waiting for
discharge.9
7.3.2 The Scottish Executive has set a national target for those patients
delayed over 6 weeks of zero by April 2008. This means that there
should be no one awaiting hospital discharge after 6 weeks.
Aberdeen City Council has set targets throughout the year aimed at
ensuring that we reach this target. As of 15th August 2007 the target
was 13 and the performance was 33 - which is the highest figure
since March 07. Figure 1 (from April 2007 ISD census) reveals a
similar performance trend to the national trends, showing that 22
people have been ready for discharge for over 6 weeks. This is 61%
9 Appendix 3 illustrates the various factors that may impact on each stage of a persons possible
journey , the aim being to shift the balance of care to the early stages of preventing admission to
hospital in the first instance
ITEM
PAGE 27
less than the number (57) at the January 2007 census and 54% less
than the number (48) at April 2006.
7.3.3 The number of patients outside the six week discharge planning
period who were waiting for a care home/specialist residential facility
placement has decreased considerably. There were 15 cases at the
April 2007 census, compared with 41 at the January 2007 census
(some of which is a reflection of seasonal trends), and 29 at the April
2006 census. Of the four cities, only Dundee had lower delayed
discharge numbers than the Council.
7.3.4 The number of patients outside the six week discharge planning
period in the Community Care Assessment reason category was
zero cases at the April 2007 census, compared with 8 at the January
2007 census, and 5 at the April 2006 census.
Figure 1 – Source ISD 2007
Delayed Discharges - OUTWITH 6 WEEK PLANNING PERIOD
Dundee City
Edinburgh City
Glasgow City
Fife
South Lanarkshire
North Lanarkshire
Perth & Kinross
Aberdeenshire
Falkirk
Aberdeen City
300
200
t
s
a
t
i
en
f
P
o
er
b
m
u
100
N
0
Sep Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July
2000 2001 2001 2001 2001 2002 2002 2002 2002 2003 2003 2003 2003 2004 2004 2004 2004 2005 2005 2005 2005 2006 2006 2006
Dundee City
69
100
76
73
75
60
76
102
75
68
68
68
68
39
38
29
27
29
22
22
30
40
20
37
Edinburgh City
136
163
140
178
190
201
212
236
198
147
160
188
200
184
129
153
163
169
78
68
72
79
45
62
Glasgow City
102
142
139
159
187
223
218
224
226
212
155
152
122
148
106
97
74
82
97
89
79
83
51
61
Fife
124
101
115
136
146
119
135
167
147
109
66
67
90
79
70
80
90
76
59
40
65
34
23
40
South Lanarkshire 102
59
41
68
61
71
51
64
51
38
40
37
36
42
42
54
40
28
22
23
24
20
8
12
North Lanarkshire
119
87
88
97
89
82
86
82
69
45
48
56
41
35
24
35
27
20
16
23
25
31
14
12
Perth & Kinross
67
67
69
81
77
58
29
45
51
33
8
16
22
36
28
41
22
19
16
27
15
14
4
10
Aberdeenshire
41
58
62
53
54
41
53
49
45
67
38
38
34
42
26
44
56
60
31
39
47
50
26
23
Falkirk
69
50
73
78
87
91
79
81
65
75
57
68
63
71
59
66
57
43
36
37
37
26
30
33
Aberdeen City
118
123
151
107
146
137
111
122
140
140
62
91
77
56
70
84
80
81
56
44
72
83
48
52
2000 - 2006
Figure 2 – Source Citistat ACC 2007
City Performance Targets
Over 6 week delay
Data as reported monthly to ISD
70
Target A
Actual
62
60
55
52
50
40
38
ITEM
PAGE 28
7.3.5 Figure 2 shows that since the commencement of Delayed Discharge
Citistat, there has been a concerted effort to reduce delayed
discharges to the April 2008 target. However, more recently the
performance has been going in the wrong direction.
7.4 Direct
Payments
7.4.1 Direct Payments enable eligible people to purchase and manage for
themselves some or all of the care they have been assessed as
needing. This is right at the heart of national and local policy to
personalise services, as Direct Payments are one way of increasing
the flexibility, choice, and control people have over the care they
receive.
7.4.2 Direct Payments have been available to people aged 18-64 with
community care needs since April 1997, and to people aged 65 and
over since July 2000. Since 21 December 2001 they have also been
available to disabled 16 and 17 year olds and disabled parents for
children's services. From 1 June 2003, it became a duty for local
authorities to offer Direct Payments in place of providing services to
all eligible disabled people aged 16 and over and to parents (or those
with parental responsibility) for disabled children aged 15 and under.
Table 1 – Direct Payments in 2005-2006 – Number of Client per 1000
population10
Number
Rates per 1,000
Average payment
Payments per
of
population
per client (£’000s)
head of
Clients
population
No.
Rate
Rank
£’000
Rank
£
Rank
Aberdeen
56
2.8
20
9.2
17
2.6
21
Dundee
33
2.3
22
10.6
15
2.5
11
Edinburgh 152
3.3
14
16.6
2
5.5
9
Glasgow
124
2.1
25
11.4
13
2.4
25
Scotland
1829
3.6
9.8
3.5
4 City
365
2.6
13.2
3.5
7.4.3 Table 1 shows that Aberdeen’s Direct Payment recipients (per 1,000
total of the population) are below the Scottish average, and lower
10 Scottish Executive Statistics Release: Direct Payments Scotland 2006 Note: Client counts
include child-related payments, not separated in these SE statistics, but believed to be small in
relation to community care.
ITEM
PAGE 29
than Edinburgh.11 Our average payments per recipient are ranked
17th in Scotland making it comparable with the Scottish average.
Overall, Aberdeen accounts for only 3% of the Scottish spend on
Direct Payments, ranking at 21st highest in terms Direct Payments
(£) per head of population. Our own data collection suggests that we
will improve significantly in terms of take up in 2006, with 10
additional citizens choosing Direct Payments since April.
7.4.4 On average in Scotland, twice as many people with physical
disabilities receive direct payments than people with learning
disabilities. In Aberdeen slightly more people with learning disabilities
than people with physical disabilities receive direct payments.
7.4.5 Areas identified for focused improvement are transition services,
where no referrals have been received this year for the Independent
Living Fund. For other authorities this is the largest groups of
applicants, and once an award has been made it remains in place for
the lifetime of the applicant. A second area for focus is older people,
where there have been no referrals for independent living. The age
for eligible applicants will be reduced from 66 to 64 from the 1st April
2008. We therefore need to be planning in advance, with a particular
focus on care packages of approximately £200 per week.
7.5 Learning
Disabilities
7.5.1 ‘The same as you?’ review of services for people with learning
disabilities was published in May 2000.12 The review set out a
programme for change to develop learning disability services over a
10-year period. As we near the end of the programme, the Council
has demonstrated significant achievement in a number of key areas,
but there are important areas where performance needs to improve.
7.5.2 One of the recommendations of ‘the same as you?’ was that local
authorities and health boards should put in place local area
coordinators to get to know people with learning disabilities and their
families, assist them to identify their needs and assist meeting their
needs. An estimated 179 adults received the services of a local area
co-ordinator in Aberdeen. This equates to 21% of all adults with
learning disabilities known in Aberdeen. Table 2 shows that
Aberdeen ranked above Dundee, Edinburgh and Glasgow in terms of
performance in this area in 2006.
11 These figures are indicative only as they mask some complexity around population sizes and
approach to managing and measuring direct payments.
12 A full copy of the review can be found at the following link:
http://www.scotland.gov.uk/ldsr/docs/tsay-00.asp
ITEM
PAGE 30
Table 213
Local Area Coordination
Estimate of Adults as % of Known
2006
Rank
Aberdeen
21
9th
Dundee
1
28th
Edinburgh
1
28th
Glasgow
4
20th
Scotland
7
7.5.3 In Aberdeen, 235 adults with learning disabilities were living in their
own tenancies or were owner occupiers. This is an increase of 10
people from the 2005 level. The figure represents 28% of all adults
with learning disabilities in Aberdeen. Table 3 shows that Aberdeen
ranked 20th in Scotland for this performance indicator, which reflects
the extent to which we encourage citizens with Learning Disabilities
to live independent lives.
Table 314
Adults Living in their own tenancies
Estimate of Adults as % of Known
2006
Rank
Aberdeen
28
20th
Dundee
15
28th
Edinburgh
18
28th
Glasgow
32
17th
Scotland
28
7.5.4 A Personal Life Plan (PLP) is a process for continual listening and
learning which, in alliance with a person’s family and friends, focuses
and acts upon what is important to someone now and in the future.
The Council has had significant success (see Table 4) in delivering
the recommendation that everyone with a learning disability who
wants a PLP should be able to have one. We out perform other
Scottish Cities and we are also above the Scottish average.
Table 4 15
Personal Life Plans
Estimate of Adults as % of Known
2006
Rank
13 Figures taken from ‘The Same as You Survey 2006’
14 Figures taken from ‘The Same as You Survey 2006’
15 Figures taken from ‘The Same as You Survey 2006’
PAGE 1
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
Email – Atierney@aberdeencity.gov.uk
Craig Stirrat
Head of Planning And Policy for Services to
Adults
Tel - (52)2860
Email - cstirrat@aberdeencity.gov.uk
Other Involvement1
: 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
1 See Appendix 7 ‘Communications Audit’ which includes responses to consultation.
ITEM
PAGE 2
Consultation undertaken with2 : 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
2 See Appendix 7 ‘Communications Audit’ which includes responses to consultation.
ITEM
PAGE 3
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.
ITEM
PAGE 4
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. ....................................................... 49
2nd. Remove medium eligibility criteria for all current and future service users -
this would be medium term policy decision for 2.5 years subject to annual
review (through to April 2010).................................................................. 50
3rd.
Agree revised eligibility criteria (see Appendix 4) for the services which
citizens can expect to receive depending on the outcome of the care
assessment.............................................................................................. 50
4th.
Introduce an annual review of all eligibility criteria, so that it can be
adjusted to meet changing needs and available resources. .................... 50
5th.
Instruct officers to assess current compliance with care assessment
standards in terms of regularity and quality and report findings to
Continuous Improvement Committee in March 2008. .............................. 50
6th.
Agree Policy to change the balance of supply from 75% residential care/
25% home care to 50%/50% by 2010/11, and reinvest a percentage of the
money saved to support citizens to live independently at home. ............. 50
7th.
Approve an annual capital investment in telecare projects of £500K 07/08
and £1.5m 08/09. ..................................................................................... 50
8th.
All care at home in the community to service users not living in Council
owned Sheltered or very Sheltered Housing to be provided by the private
and voluntary sector by March 2008. ....................................................... 52
9th.
Integrate the roles and tasks undertaken by Senior Home Carers and
Sheltered Housing Warden into the new role of Senior Personal Carer. . 52
10th. Reduce in the number of day care places to 135 over a 3-year period, with
the principle that 50% of the savings will be redirected into personalised
care.......................................................................................................... 53
11th. Instruct officers to complete Learning Disability Commissioning Strategy
and take recommendations to Commissioning Board in October 2007 and
for approval to Policy and Strategy in December 2007. ........................... 54
12th. Agree policy to shift the emphasis away from residential and day care
centres provision and into supported access to mainstream housing,
leisure, employment and adult education opportunities where appropriate.
................................................................................................................. 54
13th. Task officers to work with unpaid carer organisations to update the current
carers’ strategy and develop a three-year action plan. Bring proposals to
Policy and Strategy in February 2008 to cover the above solutions within
available resources. ................................................................................. 55
14th. Authorise officers to undertake thorough consultation with people with
sensory loss (or deprivation) and with providers to determine what service
will best meet their needs. ....................................................................... 55
15th. Thereafter to enter into discussion with NHS Grampian and service
ITEM
PAGE 5
providers on the commissioning of the most appropriate sensory service by
March 2008.............................................................................................. 55
16th. Agree a policy of not authorising funding for packages above the
Independent Living Fund limit of £200, if citizens have chosen not to take
this option. ............................................................................................... 56
17th. Adopt in principle the policy of self-directed support and task officers to
bring detailed report on the resource implications to Resources
Management Committee in December 2007. .......................................... 56
18th. Approve £8 million capital funding over the years 2008/09 and 2009/10 for
the site acquisition and development of a replacement Care home for Croft
House. ..................................................................................................... 57
19th. Authorise the development of East Woodcroft for Housing for Varying
needs / telecare (current estimated capital cost of £17 million) in
partnership with a Registered Social Landlord(s). ................................... 57
20th. Undertake process review of homelessness services (including thorough
benchmarking and any request for additional staff), and bring findings and
recommendations to Resources Management Committee in by February
2008......................................................................................................... 58
21st. Authorise the Scheme of Allocations Working Party to amend the Council
Allocations Policy to increase priority for Homelessness (with a priority on
families) and to increase the proportion of lets to homeless households to
25%. Submit a report to Policy and Strategy Committee in February 2008
for approval.............................................................................................. 58
22nd. Agree to increase the number of furnished temporary homeless flats by up
to 200 by 2010/11, (as required, e.g. draw down in increments of 10 at a
rate of 100 per annum). The first phase should be family units of two and
three bedrooms dispersed throughout the City. ....................................... 59
23rd. Task officers to review current protocols with Registered Social Landlords
to increase the proportion of lets to homeless households from 25% to 50%
in 2008/9. ................................................................................................. 59
24th. Review all homelessness related services funded by the Social Work
budget by December 2007 to ensure that Best Value is delivered - and
those national outcomes for Homeless Persons and Care in the
Community are achieved. ........................................................................ 59
25th. Introduce charges for Community Alarm at the same rate as Aberdeenshire
Council (£1.25 per week). ........................................................................ 60
26th. Work with internal audit to ensure strict adherence to current charging
policy and put in place simplified processes where processes are less than
efficient. ................................................................................................... 60
27th. Agree to the principle of a strengthened and better co-ordinated external
funding capacity within the Council and task officers to bring forward
detailed proposal to Resources Management Committee. ...................... 60
28th. Agree implementation of eligibility criteria for Adult Transport, and task
officers to bring proposal for eligibility criteria and an assessment process
ITEM
PAGE 6
to Policy and Strategy Committee for agreement in December 2007. ..... 61
29th. Agree to the concept of a corporate pool of escort drivers, and task officers
to bring detailed proposal to Resources Management by March 2008. ... 61
30th. To reaffirm previous policy decisions arising from the Social Work
Workforce Review.................................................................................... 61
31st. Task officers to develop, as part of the Corporate Asset Management
Strategy, an Asset Management Strategy for Adult Services, and bring
proposals to Resources Management Committee by April 2008. ............ 62
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
ITEM
PAGE 7
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.
ITEM
PAGE 8
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
ITEM
PAGE 9
assessment.
Human Rights/
: The completed strategy will include a Equalities
Equalities/Diversity
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
ITEM
PAGE 10
1.0
MAIN CONSIDERATIONS
Why a transformation strategy for services to adults.......................................10
2
Methodology.............................................................................................11
3
context - National legislative context ........................................................13
4
National Policy context .............................................................................16
5
Local policy context ..................................................................................20
6
overview of services provided in aberdeen...............................................23
7
Analysis of current Performance ..............................................................24
8
Current and Projected Service trends ......................................................32
9
Strategic Objectives and Recommendations............................................47
Appendices .........................................................................................................64
WHY A TRANSFORMATION STRATEGY FOR SERVICES TO ADULTS
1.1 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.
1.2 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
ITEM
PAGE 11
context and the inter-relationships that exist with our partners in the City and
beyond.
1.3 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.
1.4 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).3 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.
1.5 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.4
1.6 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.
2 METHODOLOGY
2.1 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
3 GAE is the means by which the Scottish Executive distributes the total budget it has available
for Scotland’s local authorities. It is not and does not attempt to identify the level of expenditure
expected for each area of services.
4 A full copy of ‘Changing Lives: Report of the 21st Century Social Work Review’ can be found at
the following link: http://www.scotland.gov.uk/Publications/2006/02/02094408/0
ITEM
PAGE 12
has been finalised, progress and implications will be thoroughly monitored on
a quarterly basis and the strategy adjusted if required.
2.2 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.
2.3 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.
2.4 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
2.5 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.
ITEM
PAGE 13
2.6 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.
2.7 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.
2.8 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.
2.9 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.
2.10 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.
3 CONTEXT - NATIONAL LEGISLATIVE CONTEXT5
3.1 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
5 A comprehensive list of the legislative framework as it applies to Services to Adults can be
found in Appendix 1.
ITEM
PAGE 14
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.
3.2 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.
3.3 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.
3.4 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.
3.5 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:
ITEM
PAGE 15
• 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.
3.6 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.
3.7 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.)
3.8 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.
ITEM
PAGE 16
4 NATIONAL POLICY CONTEXT
4.1 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.
4.2 ‘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
ITEM
PAGE 17
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.
4.3 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
4.4 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.
4.5 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”
ITEM
PAGE 18
• 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.
4.6 The Executive launched "All Our Futures: Planning for a Scotland with an
Ageing Population" on March 2007.6 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.
4.7 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.
4.8 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
6 The full report can be accessed at the following link:
http://www.scotland.gov.uk/publications/2007/03/08125028/0
ITEM
PAGE 19
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
4.9 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.
4.10 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.
4.11 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.
4.12 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.
4.13 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
ITEM
PAGE 20
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.
4.14 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.
5 LOCAL POLICY CONTEXT
5.1 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.’
5.2 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.
5.3 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.
5.4 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.
5.5 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
ITEM
PAGE 21
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.
5.6 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.
5.7 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
ITEM
PAGE 22
referred to the Reporter on substance misuse grounds almost doubled, while
national figures dropped.7
5.8 ‘Ageing with Confidence – A Joint Strategy for Older People in Grampian’ –
outlines a range of ways to improve services to older people. The
recommendations include providing 24-hour/7 day-a-week access to
community based services. The joint strategy also calls for a greater emphasis
to be placed on delivering prompt, accessible and effective outpatient and
diagnostic services. Within the home care sector the strategy proposes that
greater provision should be made for people with dementia and functional
mental illness.
5.9 The aim of Aberdeen City Council’s Carers' Strategy is to provide appropriate
support for carers by keeping staff up to date with carers’ issues. This will be
done by publishing and actively distributing information on carers’ rights;
ensuring carers are fully involved in the implementation and monitoring of
consultation arrangements in relation to joint future; and increasing carers
training to meet the requirements of the National Expert Carer Programme.
5.10 The delivery of Services for Adults is taken forward jointly with NHS Grampian
through a Joint Future/Community Care Plan. The basic premises on which
the plan is founded are:
• That service planning should drive service commissioning, rather
than the other way round
• That ‘community care’ is the end towards which Aberdeen City
Council and NHS Grampian/Aberdeen City Community Health
Partnership [CHP] are striving, whereas ‘Joint Future’, as a way of
working together, is a means towards that end
• That the goal of community care is to move away, as far as is
possible and appropriate, from ‘institutional’ care, whether in
hospital or care home, to care delivered in or near a person’s home,
with the balance of funding and other resources adjusted
accordingly.
5.11 In this context, it is essential that the Council develops its social care planning
and commissioning activities, as outlined above, in collaboration with NHS
Grampian / Aberdeen City CHP. Furthermore that the changes brought about
by Joint Future further the goal of community care as a whole as set out in [3]
above.
7 One possible reason for this increase was the proactive referral to the Children’s Reporter by
the Grampian Police Youth Justice Management Unit (YJMU) of any offences where alcohol or
drugs are featured.
ITEM
PAGE 23
5.12 The Council has established a Community Planning Asset Management
Group, which includes representatives from Resources Management and NHS
Grampian. This group aims to ensure that we make effective use of joint
assets for the benefit of the whole City. The key priorities are to review existing
care home and day care provision and the development of an action plan,
designed to ensure that the accommodation is fit for purpose in the years
ahead.
5.13 Aberdeen City is home to a population of 206,880 and is a thriving
cosmopolitan city in the North East of Scotland. The city has a buoyant
modern economy, reflected in unemployment rates consistently under 2%.
Whilst traditional economies such as education, tourism, fishing and farming
still flourish, it is the energy industry that sets Aberdeen apart and which has
earned it the epithet of ‘The Energy Capital of Europe’.
5.14 The Transformation Strategy for Services to Adults will contribute to
addressing these local challenges through the modernisation of services and
the implementation of efficient government principles.
6 OVERVIEW OF SERVICES PROVIDED IN ABERDEEN
6.1 Services to Adults are planned, commissioned and delivered through six main
care groups:
• Older
People
• Learning
Disability
• Mental
Health
• Physical Disability (including Sensory Disability)
• Substance
Misuse
• Homelessness.
6.2 We also provide transport to adults in need, through a combination of in-house
fleet, contracted providers, and ad-hoc spot purchases.
6.3 Around 1860 people are employed by the Council in Adult Services social care
(1504 FTE posts). Services to Adults are delivered from the three area service
management teams, and within these teams through integrated
neighbourhood networks. This model of service delivery was agreed by the
Council in 2001. It is now becoming a reality via the disaggregation of budgets
or the provision of Service Level Agreements which will give Neighbourhood
Networks full control and accountability over all the services for which they are
responsible.
ITEM
PAGE 24
6.4 These services are provided in public offices, service users’ own homes, day
centres and residential establishments. Services may be provided directly or
through voluntary and private sector organisations. Over half (58%) of the
Adult Services’ budget is spent on external community care services.
6.5 The Office of the Chief Social Work Officer is responsible for quality
assurance, policy and procedures, professional supervision of the provision of
training for social work staff and social work commissioning.
6.6 Planning and Policy for Services to Adults is responsible for quality assurance
and performance management, strategic planning and policy development.
6.7 Resources Management has responsibility for contract monitoring, training
and development and asset management, finance, legal and democratic
services.
6.8 The Health and Social Care (Services To Adults) asset portfolio extends to
approximately 27 properties including a number of day centres for people with
learning disability, physical disability and older people, residential homes for
older people, people with mental health problems and people with learning
disability, plus office accommodation.
6.9 Continuous Improvement is responsible for CRM, change management,
Corporate Communications, and Performance Management
7 ANALYSIS OF CURRENT PERFORMANCE
7.1 Joint Performance and Information Assessment Framework
7.1.1 The performance of Joint Future Partnerships is assessed annually
by the Scottish Government using the Joint Performance and
Information Assessment Framework (JPIAF). The assessment of
Aberdeen for 2006/07 stated that ‘steady progress’ had been made
overall. The targets which were achieved were as follows:
• To increase the percentage of people receiving intensive*
home care - as a proportion of all the older people receiving
care at home - to 30% by 2008 (* = Over 10 hours)
• To increase the percentage of older people receiving care at
home compared to permanent NHS or Care Home care
• To reduce waiting times, for all users, for Health and Social
Care Occupational Therapy assessments
ITEM
PAGE 25
• To increase the number of people receiving a rapid response
service within 24 hrs of initial contact
• To reduce hospital patient delayed discharge numbers in line
with national targets in 2005-06
• To increase the number of people in receipt of Direct
Payments
• To increase the number of carers’ assessments, and self-
assessments
• To increase the number of carers accessing Care Home
respite
• To increase the number of hours of home-based respite care
for carers
7.1.2 The target that was not achieved according to the JPIAF
Assessment:
• To increase the number of service-user self-assessments.
7.1.3 Targets that were partially achieved or where the required
information was not available:
• To decrease the number of unplanned admissions to hospital
of people over 65
• To increase the percentage of Single Shared Assessments
with a service in place within 2 weeks and 4 weeks from
referral
• To increase service-user and carer satisfaction with service
provision by a service-user SSA survey carried out at yearly
intervals.
7.2 Statutory Performance Indicators8
7.2.1 Aberdeen’s performance is less successful when judged by the six
Statutory Performance Indicators (SPIs) currently used by the
Accounts Commission/ Audit Scotland to measure adult social care
and homelessness. Our performance on many of these SPIs has
improved over time; however, other Councils have also been
improving so we are not succeeding in closing the gap consistently
between ourselves and other Local Authorities.
8 A full list of our current performance as measured by Statutory Performance Indicators can be
found in Appendix 2.
ITEM
PAGE 26
7.2.2 The latest available comparative information for 2005-06 shows
areas of performance which are above the Scottish average:
• Percentage of residential care places occupied by older
people that are a single room
• Percentage of residential care places occupied by older
people that are en-suite
• Average time between presentation & discharge of
Homelessness duty
7.2.3 Areas where Aberdeen performs below the Scottish average are as
follows:
• Home Care, total number of hours per 1000 population
• Residential accommodation staff qualifications
• Home Care, percentage of home care clients receiving
personal care as a rate per 1000
• Home Care, percentage of home care clients receiving care
at weekends as a rate per 1000 population aged 65+
• Home Care, percentage of home care clients receiving care
in evening/overnight as a rate per 1000 population aged 65+.
• Percentage of cases reassessed as homeless or potentially
homeless within 12 months
7.3 Delayed
Discharge
7.3.1 Across Scotland, the issue of delayed hospital discharge has a high
public and political profile. Delayed discharge places strain on
hospital and community services, adding to waiting times for people
who need admission to hospital beds occupied by people waiting for
discharge.9
7.3.2 The Scottish Executive has set a national target for those patients
delayed over 6 weeks of zero by April 2008. This means that there
should be no one awaiting hospital discharge after 6 weeks.
Aberdeen City Council has set targets throughout the year aimed at
ensuring that we reach this target. As of 15th August 2007 the target
was 13 and the performance was 33 - which is the highest figure
since March 07. Figure 1 (from April 2007 ISD census) reveals a
similar performance trend to the national trends, showing that 22
people have been ready for discharge for over 6 weeks. This is 61%
9 Appendix 3 illustrates the various factors that may impact on each stage of a persons possible
journey , the aim being to shift the balance of care to the early stages of preventing admission to
hospital in the first instance
ITEM
PAGE 27
less than the number (57) at the January 2007 census and 54% less
than the number (48) at April 2006.
7.3.3 The number of patients outside the six week discharge planning
period who were waiting for a care home/specialist residential facility
placement has decreased considerably. There were 15 cases at the
April 2007 census, compared with 41 at the January 2007 census
(some of which is a reflection of seasonal trends), and 29 at the April
2006 census. Of the four cities, only Dundee had lower delayed
discharge numbers than the Council.
7.3.4 The number of patients outside the six week discharge planning
period in the Community Care Assessment reason category was
zero cases at the April 2007 census, compared with 8 at the January
2007 census, and 5 at the April 2006 census.
Figure 1 – Source ISD 2007
Delayed Discharges - OUTWITH 6 WEEK PLANNING PERIOD
Dundee City
Edinburgh City
Glasgow City
Fife
South Lanarkshire
North Lanarkshire
Perth & Kinross
Aberdeenshire
Falkirk
Aberdeen City
300
200
t
s
a
t
i
en
f
P
o
er
b
m
u
100
N
0
Sep Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July Oct Jan Apr July
2000 2001 2001 2001 2001 2002 2002 2002 2002 2003 2003 2003 2003 2004 2004 2004 2004 2005 2005 2005 2005 2006 2006 2006
Dundee City
69
100
76
73
75
60
76
102
75
68
68
68
68
39
38
29
27
29
22
22
30
40
20
37
Edinburgh City
136
163
140
178
190
201
212
236
198
147
160
188
200
184
129
153
163
169
78
68
72
79
45
62
Glasgow City
102
142
139
159
187
223
218
224
226
212
155
152
122
148
106
97
74
82
97
89
79
83
51
61
Fife
124
101
115
136
146
119
135
167
147
109
66
67
90
79
70
80
90
76
59
40
65
34
23
40
South Lanarkshire 102
59
41
68
61
71
51
64
51
38
40
37
36
42
42
54
40
28
22
23
24
20
8
12
North Lanarkshire
119
87
88
97
89
82
86
82
69
45
48
56
41
35
24
35
27
20
16
23
25
31
14
12
Perth & Kinross
67
67
69
81
77
58
29
45
51
33
8
16
22
36
28
41
22
19
16
27
15
14
4
10
Aberdeenshire
41
58
62
53
54
41
53
49
45
67
38
38
34
42
26
44
56
60
31
39
47
50
26
23
Falkirk
69
50
73
78
87
91
79
81
65
75
57
68
63
71
59
66
57
43
36
37
37
26
30
33
Aberdeen City
118
123
151
107
146
137
111
122
140
140
62
91
77
56
70
84
80
81
56
44
72
83
48
52
2000 - 2006
Figure 2 – Source Citistat ACC 2007
City Performance Targets
Over 6 week delay
Data as reported monthly to ISD
70
Target A
Actual
62
60
55
52
50
40
38
ITEM
PAGE 28
7.3.5 Figure 2 shows that since the commencement of Delayed Discharge
Citistat, there has been a concerted effort to reduce delayed
discharges to the April 2008 target. However, more recently the
performance has been going in the wrong direction.
7.4 Direct
Payments
7.4.1 Direct Payments enable eligible people to purchase and manage for
themselves some or all of the care they have been assessed as
needing. This is right at the heart of national and local policy to
personalise services, as Direct Payments are one way of increasing
the flexibility, choice, and control people have over the care they
receive.
7.4.2 Direct Payments have been available to people aged 18-64 with
community care needs since April 1997, and to people aged 65 and
over since July 2000. Since 21 December 2001 they have also been
available to disabled 16 and 17 year olds and disabled parents for
children's services. From 1 June 2003, it became a duty for local
authorities to offer Direct Payments in place of providing services to
all eligible disabled people aged 16 and over and to parents (or those
with parental responsibility) for disabled children aged 15 and under.
Table 1 – Direct Payments in 2005-2006 – Number of Client per 1000
population10
Number
Rates per 1,000
Average payment
Payments per
of
population
per client (£’000s)
head of
Clients
population
No.
Rate
Rank
£’000
Rank
£
Rank
Aberdeen
56
2.8
20
9.2
17
2.6
21
Dundee
33
2.3
22
10.6
15
2.5
11
Edinburgh 152
3.3
14
16.6
2
5.5
9
Glasgow
124
2.1
25
11.4
13
2.4
25
Scotland
1829
3.6
9.8
3.5
4 City
365
2.6
13.2
3.5
7.4.3 Table 1 shows that Aberdeen’s Direct Payment recipients (per 1,000
total of the population) are below the Scottish average, and lower
10 Scottish Executive Statistics Release: Direct Payments Scotland 2006 Note: Client counts
include child-related payments, not separated in these SE statistics, but believed to be small in
relation to community care.
ITEM
PAGE 29
than Edinburgh.11 Our average payments per recipient are ranked
17th in Scotland making it comparable with the Scottish average.
Overall, Aberdeen accounts for only 3% of the Scottish spend on
Direct Payments, ranking at 21st highest in terms Direct Payments
(£) per head of population. Our own data collection suggests that we
will improve significantly in terms of take up in 2006, with 10
additional citizens choosing Direct Payments since April.
7.4.4 On average in Scotland, twice as many people with physical
disabilities receive direct payments than people with learning
disabilities. In Aberdeen slightly more people with learning disabilities
than people with physical disabilities receive direct payments.
7.4.5 Areas identified for focused improvement are transition services,
where no referrals have been received this year for the Independent
Living Fund. For other authorities this is the largest groups of
applicants, and once an award has been made it remains in place for
the lifetime of the applicant. A second area for focus is older people,
where there have been no referrals for independent living. The age
for eligible applicants will be reduced from 66 to 64 from the 1st April
2008. We therefore need to be planning in advance, with a particular
focus on care packages of approximately £200 per week.
7.5 Learning
Disabilities
7.5.1 ‘The same as you?’ review of services for people with learning
disabilities was published in May 2000.12 The review set out a
programme for change to develop learning disability services over a
10-year period. As we near the end of the programme, the Council
has demonstrated significant achievement in a number of key areas,
but there are important areas where performance needs to improve.
7.5.2 One of the recommendations of ‘the same as you?’ was that local
authorities and health boards should put in place local area
coordinators to get to know people with learning disabilities and their
families, assist them to identify their needs and assist meeting their
needs. An estimated 179 adults received the services of a local area
co-ordinator in Aberdeen. This equates to 21% of all adults with
learning disabilities known in Aberdeen. Table 2 shows that
Aberdeen ranked above Dundee, Edinburgh and Glasgow in terms of
performance in this area in 2006.
11 These figures are indicative only as they mask some complexity around population sizes and
approach to managing and measuring direct payments.
12 A full copy of the review can be found at the following link:
http://www.scotland.gov.uk/ldsr/docs/tsay-00.asp
ITEM
PAGE 30
Table 213
Local Area Coordination
Estimate of Adults as % of Known
2006
Rank
Aberdeen
21
9th
Dundee
1
28th
Edinburgh
1
28th
Glasgow
4
20th
Scotland
7
7.5.3 In Aberdeen, 235 adults with learning disabilities were living in their
own tenancies or were owner occupiers. This is an increase of 10
people from the 2005 level. The figure represents 28% of all adults
with learning disabilities in Aberdeen. Table 3 shows that Aberdeen
ranked 20th in Scotland for this performance indicator, which reflects
the extent to which we encourage citizens with Learning Disabilities
to live independent lives.
Table 314
Adults Living in their own tenancies
Estimate of Adults as % of Known
2006
Rank
Aberdeen
28
20th
Dundee
15
28th
Edinburgh
18
28th
Glasgow
32
17th
Scotland
28
7.5.4 A Personal Life Plan (PLP) is a process for continual listening and
learning which, in alliance with a person’s family and friends, focuses
and acts upon what is important to someone now and in the future.
The Council has had significant success (see Table 4) in delivering
the recommendation that everyone with a learning disability who
wants a PLP should be able to have one. We out perform other
Scottish Cities and we are also above the Scottish average.
Table 4 15
Personal Life Plans
Estimate of Adults as % of Known
2006
Rank
13 Figures taken from ‘The Same as You Survey 2006’
14 Figures taken from ‘The Same as You Survey 2006’
15 Figures taken from ‘The Same as You Survey 2006’