Introduction

1. Who is the Plan for?

1.1 This Plan is intended for anyone who is interested in understanding the broad picture of how community care is organised in Northumberland and what changes to it are planned. This is likely to include organisations and individuals involved in providing or arranging community care services, as well as some people who use services, or care for users, and some people with a more general interest.

1.2 The Plan is also a working document for managers in the Community Care Authorities, and a means by which the Department of Health, through the regional offices of the National Health Service and the Social Services Inspectorate, can monitor the implementation of the community care reforms. These “bureaucratic” objectives affect the contents and organisation of the Plan, but we have tried so far as possible to make it accessible to all those likely to be interested in information at this broad level.

2. What other information is available?

2.1 For people who want more specific information about the community care services available for individuals, we publish a range of other information materials. Detailed information about the standards which we aim to achieve in community care services is included in the Northumberland Community Care Charter. Contact points for these materials are listed in Appendix 8.

2.2 There are also a number of more detailed documents, primarily intended for professionals, which give further details of policies and procedures. Advice about these documents and their availability can be obtained from the same contact points.

3. Whose Plan is this?

3.1 The signatories to this Plan are the County Council and Northumberland Health Authority (NHA). The County Council discharges its community care responsibilities through its Social Services Department (SSD).

3.2 The two signatory Authorities are referred to in the Plan as the Community Care Authorities. However other key stakeholders have been closely involved in the discussions which have led to the preparation of the Plan:

a) GP fundholders are responsible for purchasing many of the community health services which are covered by this Plan for those patients on their lists. They have indicated that they are willing to accept the joint strategy for community care agreed by the two Authorities;

b) the County has two total funds – an extended form of GP fundholding in which GP practices are responsible for purchasing all health services for the people on their lists, including those which elsewhere are arranged by Northumberland Health Authority. They are the Tynedale Total Fund and the Lintonville Practice in Ashington. These total fundholders are particularly important partners in joint arrangements;

c) other GPs do not have the same contractual role under current arrangements, but the Authorities will continue to involve them equally closely in the development of community care (as well as working towards the proposed new arrangements in which all GPs will be formally involved in commissioning health services);

d) the NHS Trusts serving the County's residents have a crucial role in developing this Plan and implementing the Authorities’ community care strategy. The Trusts employ health service care managers and provide some of the care and support services which care managers secure for people;

e)housing authorities are involved in continuing discussions about community care with officers representing the Authorities;

f)independent providers have been involved in a variety of ways, including formal consultation, negotiation over specific service and contractual issues and participation in other discussions about aspects of community care;

g)users and carers have influenced the development of the Authorities’ plans in many different ways, including a series of meetings held in all parts of the County during the winter of 1997/8.

4. How the Plan is arranged

4.1 The Plan is in four parts:

Part A: Summary of existing policy. This brings together policies set out in preceding community care plans which remain part of the framework of the Authorities’ approach to community care.

Part B: Developments in 1998-2001. This sets out new or modified policies, actions to be taken by the Authorities during the year 1998/9 or the subsequent two years (many of which are further developments to implement existing policies) and one and three year targets.

Part C: Consultation on the Plan. This explains the consultation process which has taken place to help us prepare this Plan;

Part D: Background information. This provides statistical and descriptive information about needs and services in Northumberland.

Part A: Summary of existing policy

A1. Overview

A1.1 The Community Care Authorities in Northumberland have agreed an approach to community care based on two key aims:

a) a fundamental shift away from “top-down” planning to arrangements in which the development of services will be driven by individual care planning with users and carers;

b) the development of much closer joint working relationships at all levels between health and social services.

A1.2 In outline, the agreed approach is as follows:

a) any adult who may need care and support because of disabilities or special needs is offered a care manager, who considers with the person and anyone who cares for them all the problems which they wish to bring to care management, and seeks to arrange solutions to them;

b) care managers come from both health and social services. They operate to a common framework, and work together as closely as possible, with joint teams where appropriate;

c) the Authorities have created and are continuing to develop a pooled budget for care and support services for adults with disabilities or special needs. This budget is used to purchase whatever services will best resolve individual problems and meet individual preferences, whether provided through the health service, social services or independent bodies;

d) in deciding how resources from this pooled budget should be allocated, the Authorities are guided by a common set of Community Care Standards, with the first call on the budget being to resolve the most severe problems which people bring to care management, irrespective of the reasons for those problems.

A2. Objectives

Accessibility

A2.1 It is the aim of the Authorities to move towards a manner of organising services which enables individual people with disabilities or special needs, and family members or friends who are caring for them, to:

a) find out simply and quickly what kinds of care and support may be available and how their entitlement to help will be assessed;

b)assure themselves that their voices have been heard and all relevant circumstances have been considered when decisions are taken about the level of publicly-funded care and support which can be offered them;

c) have easy and timely access to a single service which can make arrangements for care and support of any kind that is practicable within the resources available, unconstrained by the boundaries between professions or agencies.

Choice and control

A2.2 Individuals should so far as possible have control over their own lives. Most people who need community care will also need some professional help and guidance to enable them to make informed and realistic choices. Sometimes, in their own best interest, it will be necessary to limit the options available to people who are not capable of making considered decisions. But the Authorities believe that in normal circumstances people in need of community care services should have the right to:

a)make their own decisions about which of their problems are most urgent;

b)make their own decisions about how the available resources should be used to provide them with care and support;

c)choose where to live from as wide as possible a range of alternatives, and get help with their problems in the setting which they prefer.

A2.3 The Authorities will aim to ensure that people in need of community care services are able if they wish to receive them in an ordinary home, or a setting as like an ordinary home as possible. However they will not seek to force this option on people who do not wish to accept it. It is the intention of the Authorities that people’s choice as to where to live should be restricted only by the feasibility of providing care and support to them, and if resources are limited the cost of doing so.

Fairness and priorities

A2.4 The Authorities will aim to ensure that access to appropriate community care services is equally open to all, depending only on the severity of people’s problems. In particular they aim to ensure that access to appropriate services is not denied to people because of their age, ethnic origins, religious or ethical beliefs, gender, sexual orientation or disability.

Carers

A2.5 The Authorities will aim to ensure that people who have chosen to care for someone with a disability or special need are given consideration in their own right, and are offered help with the problems which they themselves may have as a result of caring. Where carers wish to draw boundaries round their responsibilities, they should be able to do so.

A3. Care management

A3.1 The Authorities have developed a joint care management system as the driving force for developing community care services.

A3.2 Care management in Northumberland is a service in which a single professional, who may work for social services or the health service, assesses with people all the problems which they bring, and seeks to arrange co-ordinated solutions to them, obtaining further specialist advice and bringing together the assessments of other professionals as necessary.

A3.3 The Authorities offer a care management service to any adult with disabilities or special needs who has problems which may call for care and support. Care management is also offered to all those people with mental health problems for whom the Authorities are required to maintain a “care programme”.

A3.4 All care managers, whether from social services or the health service, and whatever their profession, follow a common approach to assessing people’s problems, agreeing individual care plans, and monitoring and reviewing these care plans. This approach is set out in detail in the Authorities’ Care Managers’ Handbook.

A3.5 The Authorities aim to ensure that an assessment carried out by any care manager is accepted as a sufficient basis to allocate any kind of care or support service which does not require specialist expertise to determine that it is appropriate. Where such expertise is necessary, they aim to ensure that all care managers are able to access it to support assessments.

A3.6 In particular, the SSD is committed to ensuring that assessments carried out or co-ordinated by any approved care manager are treated in the same way in allocating resources from the pooled community care purchase budget which it holds on behalf of the two Authorities.

A3.7 Standards for the care management process are set out in the Authorities' Community Care Charter.

A3.8 Basic information about all care management clients is recorded on a single database, maintained by the SSD. The same database now holds the information about people with enduring mental health problems required by the “care programme” approach. Users’ agreement is sought to this information being made available as appropriate to all the health and social services professionals working with them.

A3.9 The Authorities encourage care managers to take full account of the risk that vulnerable adults in any of the groups they work with may be abused by people they live with or by others.

A4. The pooled budget

A4.1 The Authorities have established a pooled budget for the purchase of care and support services for adults with disabilities or special needs. This budget is held by the County Council and managed by the SSD. The aim is that this budget should be available to fund whatever forms of care and support people need, without the constraint of artificial distinctions.

A4.2 Care and support services include all the services which the SSD is responsible for providing or purchasing. They include too a range of non-treatment services historically funded by NHA as part of the NHS – for instance residential care for people currently or formerly living in long-stay hospitals, and some of the non-treatment services traditionally provided by auxiliary nurses in the community. In broad terms, care and support services are those services best arranged for people by care managers, as opposed to health treatment services, which are best arranged by doctors or other health professionals outside care management.

A4.3 The Authorities have not prepared a firm list of which health services fall in which category, though the principles which will be applied in some of the most significant service categories are set out in the Health Authority’s published eligibility criteria for NHS continuing care (see Appendix 8). In other cases, they will make practical decisions on specific services as they move forward.

A4.4 The Authorities have adopted a detailed General Memorandum of Agreement about the pooled budget which sets out in detail how it operates. Only the key features of this agreement are reflected in this Plan.

A4.5 The pooled budget held by the County Council includes:

a) all County Council budgets for the provision or purchase of care and support services for adults under social services legislation (but not the costs of care management staffing);

b)sums transferred by Northumberland Health Authority.

A4.6 All services funded through the pooled budget are provided or purchased under one of the social services functions of the County Council. In general, they are allocated to individuals on the basis of assessment by a care manager.

A4.7 Northumberland Health Authority aims progressively to transfer to the pooled budget all health service funding for community care services providing care and support for adults with disabilities or special needs (this does not include health treatment). It is transferring blocks of funding incrementally. Each transfer of funding is associated with a transfer of responsibility for securing services. In deciding the sequence of future transfers, priority will be given to those areas of service in which the benefits of pooled budgets for users and carers are likely to be greatest.

A4.8 Where it is desirable for services to include a component of health treatment alongside care and support services, the Health Authority will ensure that this is covered by a health service contract, separate from but co-ordinated with arrangements made from the pooled budget.

A4.9 Transfers of health service funding to the pooled budget are recurring, and are made from the revenue allocation of Northumberland Health Authority. However in some cases the Health Authority is able to recover temporary “bridging” funding from the joint finance budget to meet transitional costs of new arrangements (subject to the agreement of the Joint Consultative Committee).

A4.10 While each transfer of funding is accompanied by a transfer of responsibility, transferred funding is not tied to expenditure associated with that responsibility, but forms part of the overall pooled budget for one or more client groups. The aim is to combine clarity about funding responsibilities with flexibility in responding to the overall pattern of needs.

A4.11 Neither Authority can foresee all future circumstances that may arise, and their agreements about the pooled budget cannot bind them rigidly. However as a general principle, both Northumberland Health Authority and the County Council intend at least to maintain in real terms their contributions to the pooled budget, unless either Authority faces general financial constraints that requires it to reduce its budgets across the board. If an Authority has to make such across-the-board budget reductions, it will aim not to reduce its contribution to the pooled budget by more than the proportion by which it is reducing other expenditure.

A4.12 While the Health Authority retains the ultimate right to terminate transfers of funding, it does not intend to do so unless as a result of a major change in the national legislation affecting the allocation of responsibilities between health and social services authorities.

A4.13 The County Council will continue to add to the pooled budget each year the funding transferred from the Department of Social Security to reflect the disappearance of higher rates of income support for residential and nursing homes.

A4.14 In the period before all care and support costs are included in the pooled budget, each Authority will endeavour to take decisions on the basis of the overall costs to health and social services budgets rather than the costs to its own budgets alone. If either of the Authorities proposes to take a decision which might have a significant impact on the budgets of the other, it will aim to do so by agreement.

Coverage of the pooled budget

A4.15 The Authorities have already agreed that the pooled budget should incorporate the following elements of health service funding:

a) all transfers of funding made since 1992/3 to pay for care and support services for residents resettled from the County’s two learning disability hospitals and all future transfers for this purpose;

b)funding for the two projects managed by the SSD in Morpeth and Rothbury which were established as part of an earlier phase of resettlement from Northgate;

c) all future transfers of funding to pay for care and support services for people with mental health problems re-provided from St George’s Hospital;

d)funding for those residential and nursing homes previously supported by Northumberland Health Authority in an earlier stage of the programme of re-provision of services from St George’s;

e) a health service contribution to the costs of disability equipment supplied by the Joint Equipment Loans Service, which are allocated through the care management process.

A4.16 The Authorities anticipate that funding for other care and support services will be added to this list over time.

The allocation of the pooled budget

A4.17 The overall allocation of the pooled budget will be discussed each year between the SSD and Northumberland Health Authority (and the Tynedale Total Fund Project, as appropriate), as part of the community care planning cycle.

A4.18 Wherever reasonably possible, it is the aim of the Authorities that the funding available to pay for community care services should be directed into particular services as a result of individual care plans prepared with individual users and carers. Where decisions need to be taken on the basis of aggregated information about potential service users, the Authorities aim to ensure that they are taken at a level as close as reasonably possible to that at which individual care planning is being carried out.

A4.19 The objective where possible is payment according to usage, with the overall funding of a service depending on the level of takeup resulting from individual care plans. However in practice some services will need to be guaranteed funding before individual users have been identified.

A4.20 Currently the services purchased from the pooled budget for which funding has been devolved to local budget holders include:

a)home care services (local authority and independent);

b)most publicly-funded independent sector residential and nursing home care;

c)some independent sector day care;

d)disability equipment (other than a list of standard items which can be requisitioned by appropriate professionals outside care management);

e) a variety of other forms of support arranged to meet individual needs.

A5. The care managers

A5.1 The Authorities are moving towards a position in which all health and social services professionals are able to act as care managers if their role naturally involves directly arranging care and support for adults with disabilities or special needs. However it is their working assumption that doctors, whether GPs or consultants, do not wish to act in person as care managers and take on direct responsibility for arranging care and support, though they do wish to have ready access to care management for their patients and to have their views taken into account in assessments.

A5.2 The Authorities believe that it is appropriate for many of the professionals who act as care managers also to provide treatment or therapy for care management clients and others. However they believe that, to achieve the full benefits of care management, care managers should where sensibly possible have a degree of independence from the provision of other care and support services which they arrange for people.

A5.3 This principle applies to all the organisations which both employ care managers and provide services arranged through care management. A number of steps have so far been taken to further this separation of roles:

a) the SSD has separated at a high level management responsibility for care management and service management. When it makes arrangements with voluntary organisations, it generally does so on the basis that assessments of the need of individuals for SSD-funded services will be carried out through care management rather than by provider organisations;

b) the Northgate and Prudhoe NHS Trust has separated the management of community nurses, who act as care managers, from that of the community services operated by the Trust.

c) care managers working for the Northumberland Mental Health NHS Trust are now managed through an SSD Commissioning Manager, and are therefore organisationally separate from the Trust’s provider services.

A5.4 All staff working with clients in the SSD’s Care Management Division are able to act as care managers, including social workers, occupational therapists and unqualified care managers responsible for users who need simpler packages of support.

A5.5 In the health service, professionals able to act as care managers include:

a)every district nurse with a caseload of patients

b) all community psychiatric nurses on appropriate grades, and other appropriate mental health professionals

c) all community learning disability nurses, and other appropriate professionals specialising in learning disability

A5.6 All care managers undertake a common foundation training programme before taking on the role.

A5.7 The Authorities aim to establish the closest working relationships between care managers from different agencies which can be achieved without damaging other key professional relationships. To further this aim, care management budgets and SSD care managers are organised according to three broad groupings of needs designed to correspond with the main organisational groupings in community health services.

a)Physical disability and illness, including physical frailty associated with ageing, sensory impairment and most kinds of chronic or terminal illness

b)Mental health, including dementia and other mental health problems of older people, and problems arising from misuse of drugs, alcohol or other substances

c)Learning disability.

A5.8 In mental health and in learning disability, care management is provided through joint teams of health and social services care managers, with a single manager responsible for a devolved budget and for all operational matters, who may come from a health or social services background. The team manager also authorises access to resources purchased from the centrally held element of the community care purchase budget held by the SSD (and is responsible for monitoring the costs of these resources).

A5.9 The Authorities jointly fund the two commissioning manager posts within the SSD which have overall responsibility for the care management service for mental health and for learning disability.

A5.10 Care management for people with a physical disability or illness is provided through a different form of joint arrangement, which aims to link it as closely as practically possible with primary health care.

A5.11 SSD care managers working with this grouping are managed in small groups linked to clusters of GP practices (with on average two practices to each cluster, though some larger practices constitute a cluster on their own). Budget and day-to-day management responsibilities are devolved to lead care managers, each responsible for one cluster, with four team managers covering broader geographical areas taking responsibility for the overall use of resources. Where suitable opportunities arise, SSD care managers are moving into GP practice premises. These arrangements are designed to facilitate close joint working both with district nurses who act as care managers and with other members of primary health care teams.

A5.12 Care management for hospital patients is provided by the geographically-based care management teams, though a few care managers are still based on hospital premises for convenience. Special arrangements have been agreed to ensure effective care management for people who require services on discharge from hospital.

A5.13 Other special care management arrangements for specific groups include:

a) a community substance misuse team serving the South East of the County and supporting mental health care managers in other areas. This team includes health and SSD staff, some of whom act as care managers. There is also a special “fast track” arrangement to give rapid approval if necessary for the funding of people from Northumberland who urgently need residential care in other parts of the Country;

b) a head injuries care management scheme, which has a budget to purchase health services as well as being able to access general care management budgets;

c) an arrangement under which members of the SSD’s disability team for children can access care management budgets to support school leavers;

d) a locally-based care management service for people with sensory impairments provided by selecting and training one worker in each PDI team to specialise in each of the two groups of sensory impairments (visual impairment and hearing impairment), supported by contracts with voluntary organisations who provide specialist assessment expertise when required;

e)special arrangements for people with HIV/AIDS who need support designed to ensure a particularly high degree of confidentiality. A specialist care manager based in the Community Substance Misuse Team provides care management across most of the County for people who are HIV+ or have AIDS.

A6. Empowering users and carers

A6.1 The Authorities endeavour to ensure that the voices of users and carers are heard at all levels in the planning, purchasing and management of community care services.

A6.2 The SSD aims to ensure that all those who need residential care have the choice of either a public sector or an independent sector place, if they wish to consider both these options. Wherever possible, people who need residential care will be offered the opportunity to visit a number of homes before making a decision, including both public sector and independent homes (there are no public sector nursing homes). People will also have as wide a choice as can be achieved as to the locality of the home – including the choice of independent homes outside the boundaries of the County.

A6.3 When any person moves from hospital to an independent nursing home, it will be made quite clear to her/him in writing before the transfer whether or not the health authority will pay the fees under a contractual arrangement. (This decision is taken on the basis of NHA's published eligibility criteria for continuing care – see Appendix 8).

A6.4 The Authorities will on request provide users with an estimate of the overall cost to social services and health of the services which are being provided or purchased for them, unless there are reasons to believe that this information would worry or confuse a particular user. Users and carers will be encouraged to make proposals if they feel that alternative forms of support closer to their preferences could be obtained for the same cost.

A6.5 More generally, the Authorities aim to ensure that appropriate information is available to clients and carers to enable them to play a full part at each stage of the care management process, and they have produced leaflets (also available in other media) providing the information people need at each key stage.

A6.6 The Authorities aim to ensure that whenever new or revised information materials are produced in social services or any part of the local health service the case for producing them jointly is considered.

A6.7 The Authorities accept that people have the right to choose to take risks, provided that they are able to make this choice with full understanding. Where people prefer as an informed choice to receive support in a manner which involves greater risks to them than an available alternative, the Authorities will support care managers who arrange services which meet users’ preferences.

A6.8 The Authorities support a number of advocacy schemes, offering support both to people affected by the transfer to the community of services formerly provided by long-stay hospitals and to other groups of users of services arranged through care management.

A7. Strengthening collaboration

A7.1 The Authorities have developed particularly close collaborative arrangements between themselves and with the three NHS Trusts which provide community services. However they recognise that collaboration over community care needs to extend further than this.

A7.2 The Authorities will plan community care in close collaboration with GPs, taking account of the additional responsibilities of fundholding practices and the Tynedale Total Purchasing Project. They will seek to involve GP representatives wherever sensible and possible in groups considering community care developments.

A7.3 The Authorities have agreed with housing authorities a number of key areas in which collaboration is required:

a)strategic planning of housing;

b)adaptations to properties;

c)medical points systems;

d)sheltered housing;

e)central alarm systems;

f)wheelchair accommodation;

g)single persons’ accommodation.

A8. Developing services: General policies

A8.1 The Authorities will continue to develop their relationships with independent providers of care. Whenever a new service is to be developed, they will balance the quality and cost of independent sector options against those of a directly-provided service. Service developments in the voluntary sector which are consistent with the Authorities’ priorities will be particularly encouraged.

Residential and nursing homes

A8.2 All funding for the care and support of new residents in residential or nursing homes is allocated from the pooled budget managed by the SSD, except for terminal care in hospices and care in nursing homes which is provided under the supervision of a consultant or of a designated GP.

A8.3 To maximise flexibility and choice, places in independent residential and nursing homes are purchased through care management on the basis of separate payment for each person actually supported, unless there are special circumstances which make it necessary or advantageous to commit funding in advance of individual placements. Most placements are made within “option to place” contracts negotiated with homes in advance. Pricing schedules for homes for older people are set through a mixture of tendering and collective negotiation with home owners' representatives ; arrangements with homes for other groups vary.

A8.4 The Authorities aim to ensure that assessments which might lead to long-term admission to a residential or nursing home consider all alternative options, and enable users and carers to make fundamental decisions about their future with a full understanding of the implications.

A8.5 Before any person is placed in a nursing home following an assessment, medical confirmation of the appropriateness of this step is required from a hospital consultant or GP. If such confirmation has been obtained, the consent of the NHA to the placement is deemed to have been given. In an emergency, a placement may be agreed without a full assessment or a medical opinion, but in such a case these are sought as soon as practicable after admission.

A8.6 The Authorities have adopted the aim of bring about a progressive improvement in the standard of the service offered by care homes in the County towards a new set of “target standards” higher than the minimum standards required for registration purposes. They will aim to set target standards in a manner which takes account of all the aspects of the service which matter most to residents (balancing this goal against the need for standards to be objectively measurable).

A8.7 One starting point for these target standards is the recommendations of the 1996 publication from the Centre for Policy on Ageing, A Better Home Life – but the standards may in some areas need to be more specific than that publication and in others to be varied in detail. Staffing levels, the way in which care is organised and the standards of the premises in which it is provided are all likely to be covered in target standards, but it may be possible to recognise separately the achievement of high standards in one area (for instance staff skills) in homes which in other areas cannot readily achieve target standards (for instance where older premises cannot readily be brought up to the standards which are now coming to be expected).

Home care

A8.8 The SSD has taken steps to stimulate the development of home care services in the private and voluntary sector and will make use of these services whenever they offer the best option for particular users/carers. It no longer funds separate “carer support” schemes, but care managers are expected to make use of home care services as a means of supporting carers wherever appropriate.

Services provided by the SSD

A8.9 Residential and day care services provided directly by the SSD are funded on the basis of a service agreement, renegotiated in advance of each financial year, which guarantees in advance that their costs will be fully funded. Any overall changes to services which are identified as desirable through care management are discussed in the course of renegotiation of the service agreement.

A8.10 When resources permit, the SSD will be funded to complete its programme of replacing or upgrading residential accommodation which fails to meet contemporary standards.

NHS continuing care

A8.11 The Authorities have agreed the criteria which determine eligibility for continuing health care provided through the NHS. They are committed to monitoring closely the application of these criteria and any changes in the balance between the services funded by the two Authorities. The Health Authority has when appropriate made transfers of funding to the local authority and to community health services to reflect reductions in the level of NHS continuing care revealed by this joint monitoring.

A9. Developing services: PDI

A9.1 The Authorities monitor regularly the level of long-term care and respite care for older people provided in acute and community hospitals. Northumberland Health Authority will aim to ensure that any reduction from the agreed baseline in the level of long-term or respite care provided in hospital is matched by a transfer of resources from hospital to community services.

A9.2 The Authorities aim to collaborate closely to provide a comprehensive palliative care service for people who require help with the management of pain and distressing symptoms rather than curative treatment . This will include as necessary care and support arranged through care management and health care. They recognise the particular importance of having clear and reliable arrangements for supporting people who are terminally ill.

A10. Developing services: mental health

A10.1 Mental health services currently provided on the St. George’s site are being reprovided in a locally accessible and responsive manner. The objective of doing so is to retain, and if possible improve the existing high standard of service while making services more accessible to those in need. Services on the St George’s site will not be withdrawn until replacements have been properly established in the community.

A10.2 For the purposes of this reprovision process a distinction is being drawn between the reprovision of assessment and treatment services and the reprovision of care and support services.

A10.3 Assessment and treatment services will be reprovided as NHS services under contract with Northumberland Health Authority. Care and support services are being purchased from the pooled care management budget on the basis of individual care management assessments. Their reprovision will thus be driven by the care management process, with services secured under Social Services contracts.

A10.4 It is agreed to be essential to the achievement of integrated mental health services that contracting for assessment and treatment services and the reprovision of care and support services are properly co-ordinated.

A10.5 The following services are generally being reprovided through care management: residential services, continuing care for the elderly mentally ill (except where it falls within the eligibility criteria for NHS continuing care), respite care, day care and employment training.

A10.6 However, some people currently cared for in both the residential and elderly sectors at St. George’s have been assessed as requiring continuing health care because of the nature of their illness, taking account of the published eligibility criteria for NHS continuing care.

A10.7 A small group of older people (initially 12 people) who do not fall within the NHS continuing care criteria will continue to be accommodated in St George's Hospital to honour commitments made at the time of their admission. However no new residents in this category will be admitted.

A10.8 Assessments for resettlement have been conducted in line with a programme for ward closures which is agreed by NHA, the SSD and the Northumberland Mental Health Trust.

A11. Developing services: learning disability

Hospital resettlement

A11.1 The Authorities have now completed the programme of resettlement for residents of Northgate and Prudhoe hospitals, providing alternative accommodation for all those inappropriately living in hospital.

A11.2 Northumberland Health Authority will continue to secure psychiatric treatment services for people who have both learning disabilities and challenging behaviour, and hospital services for offenders with learning disabilities.

A11.3 Funding for care and support, which is the largest part of the cost of resettlement schemes, has been transferred to pooled care management budgets. Funding for health services, in particular support from occupational therapists, physiotherapists and speech therapists, continues to flow through NHS contracts.

Day activities

A11.4 The Authorities will continue to develop wherever possible more individualised and less segregated day activities for people with learning disabilities than can be provided in traditional adult training centres (ATCs). In the course of these developments, it will seek to retain those features of the traditional service which are valued.

A12. Fairness and priorities

A12.1 To ensure that the resources available for care and support are allocated in an open, equitable and consistent manner, the Authorities have adopted and published a set of Community Care Standards as a guide to budget holders and others making decisions about priorities. These standards are included in the Community Care Charter, and in the Care Managers’ Handbook.

A12.2 The Standards cover most of the kinds of problem which care management may be able to resolve. They give guidance which the SSD will use in determining what kinds of problem may give rise to a “need” in the legal sense in which the term is used in the statutes within which social services authorities must operate. Where a “need” in this sense is recognised by the SSD, it is required by the legislation to provide services to meet it.

A12.3 The Standards also give guidance about the priorities that will be given to other kinds of problem which, while they will not formally be recognised as giving rise to “needs”, will wherever possible be resolved by care managers, using public funding where necessary. The underlying principle is that the most basic standards should be resolved first, up to the limit of the budget available. Standards are defined in terms of the outcomes for people’s lives, not in terms of specific health conditions or disabilities.

A12.4 The same Community Care Standards apply to all the categories of people who may ask for community care services, whatever the disability or special need which causes them to require help and whatever their other circumstances.

A12.5 Care managers are expected to record in a format comparable with the Standards information about the problems brought to care management which it has not proved possible to resolve, either because no suitable service is available or because funding cannot be justified within the budget available. The SSD monitors this information through the management process and the occasional collection of statistical data, and uses it in developing and auditing services.

A13. Access to services

A13.1 The Authorities recognise that the limited availability of suitable transport impairs the quality of life of many people with disabilities or special needs.

A13.2 Where access to a service depends on special transport arrangements, the SSD will generally contract with the service provider on the basis that transport will be included in the cost of the service. However in cases where special transport arrangements are needed to achieve the best solution to someone’s problems and cannot be covered within the contract for another service, funding will be allocated from the community care purchase budget, if the problems to be resolved have sufficient priority for the cost to be met within the funds available.

A13.3 The Authorities anticipate that in due course it will be desirable to review the contribution to community care of patient transport services. They expect the scope for such a review to become clearer when current changes affecting the service have had time to take effect.

A13.4 The Authorities will seek to use their influence to encourage all relevant bodies in the County to ensure that disabled people are able to gain easy access to buildings. They are working to build a more comprehensive picture of the accessibility of social services and health service premises to people with disabilities, and will seek, as resources become available, to remedy identified problems.

A14. Monitoring quality

A14.1 The Authorities operate a joint inspection unit to carry out their responsibilities for registering residential and nursing homes under the Registered Care Homes Act 1984, with harmonised guidelines for registration. (Registration and inspection of residential homes is legally the responsibility of the SSD; for nursing homes it is the responsibility of the health authority).

A14.2 The Authorities have not currently taken any steps to integrate their complaints procedures to handle joint community care services, but will keep the matter under review.

A14.3 The Authorities have agreed a joint charter for users of mental health services, and expect to develop further joint charters over time.

Part B: New Developments in 1998/2001

1. Strengthening collaboration

1.1 Person-centred care in a Health Action Zone

Policy: The Authorities will make the development of integrated person-centred care a central plank in the development of a Health Action Zone for Northumberland.

1.1.1 Action: The Authorities will establish appropriate mechanisms within the overall management and accountability arrangements of the Health Action Zone to ensure that their community care strategy forms an integral part of a wider move towards better services through partnership.

Target: Zone management arrangements established by October 1998.

1.2 Developing localities

Policy: The Authorities will aim to develop the closest attainable integration of health and social services commissioning activities at locality level.

1.2.1 Action: The Authorities will ensure that the areas covered by Primary Care Groups coincide with the key geographical boundaries for joint and SSD care management teams.

Target: Primary care groups established at the appropriate level March 1999.

1.3 Geographical equity

Policy: The Authorities will seek to arrive at a shared view about equity between localities in the allocation of total funding for health and social care, and to alter funding patterns as necessary to achieve overall equity.

1.3.1 Action: The Authorities will carry out a review with the aim of defining all relevant funding and mapping its allocation by locality.

Target: Review of current resource utilisation completed by September 1998.

Some complex technical issues about differences between health and local authority budgets will need to be discussed before it is possible to develop a common formula. Prospects for progress towards the policy goal may hinge on what freedoms from national NHS rules on funding allocation can be agreed as a result of Health Action Zone status.

1.4 General practitioners

1.4.1 Action: The SSD, in partnership with the Northumberland Mental Health NHS Trust, will seek to conclude written agreements with individual GP practices, based on a standard model, setting out how the relationship between practices and the integrated care management service is expected to operate.

Target: March 1999.

The aim of these agreements will be to clarify questions such as the way in which referrals will be allocated between professionals in a joint team and the information which practices can expect to receive about the service provided to people on their lists. Without agreements on these issues there is a danger that flexibility within joint teams will be impaired by the different contractual bases on which health and social services care managers operate.

1.4.2 Action: The SSD will build on the experience of preparing these agreements about mental health care management by developing further forms of agreement for learning disability and PDI care management.

Target: March 1999.

1.5 Housing providers

1.5.1 Action: The Authorities will continue their discussions with housing authorities in the County how to progress the recommendations of the joint review of arrangements for adapting housing for disabled people which reported during 1996. These discussions will cover radical options such as the pooling of budgets for adaptations as well as continuing the process of clarifying smaller technical and process issues.

Target: Discussions on consistent approach to adaptations completed by May 1998.

2. Care management

2.1 Physical disability and illness

2.1.1 Action: The SSD will shortly move PDI care managers into at least two further GP practices – Seaton Hirst and Broomhill, and will pursue any additional opportunities which arise.

Target: July 1998.

Following these moves, five clusters of SSD care managers will be based in GP practices (in Hexham, Morpeth and Guide Post), with a further two clusters having moved to more local premises near a GP surgery (in Ponteland and Newbiggin) during the past year. Discussions are in progress about shared use of primary care premises in Wooler and Corbridge.

Policy: The Authorities will pursue the objective of an integrated management structure for all health and social services professionals working in PDI networks.

2.1.2 Action: The Authorities will review the options available for achieving this goal within the proposed new structure of Primary Care Groups and Primary Care Trusts, in partnership with GPs and the Northumbria Health Care NHS Trust.

Target: Proposed way forward and timetable agreed in time for incorporation in Community Care Plan 1999/2002.

Policy: The Authorities will review the scope for integration of occupational therapists (OTs) working in acute and community hospitals with OTs working for the SSD.

2.1.3 Action: The Authorities will examine any opportunity that arises to test an integrated arrangement.

Target: If a suitable opportunity arises, pilot arrangement in place by March 1999.

Policy: The Authorities will consider whether any special arrangements should be made to provide care management for adults of working age with complex physical disabilities.

2.1.4 Action: The Authorities will carry out a review building on discussions with the same group of service users about direct payments (see subsection 3.1).

Target: July 1998

2.2 Mental health

2.2.1 Action: The Authorities will monitor the first year of operation of the fully integrated mental health care management service, and consider whether any fine tuning of arrangements is necessary.

Target: Any need for fine-tuning identified by March 1999.

2.3 Learning disability

Policy: The Authorities, in partnership with the Northgate and Prudhoe NHS Trust, will integrate fully the management of learning disability care managers.

Joint teams of SSD and NHS care managers have been in operation in this field for a number of years, but staff have retained separate management lines for some purposes. It is now intended to move to full management integration, on broadly the same basis as has been agreed for mental health care managers.

2.3.1 Action: The SSD will complete negotiations on an agreement with the Trust and move rapidly to implement it.

Target: May 1998.

2.4 Risk

2.4.1 Action: The SSD and the Northumberland Mental Health NHS Trust will issue guidance to care managers and others about the management of risk in mental health cases.

Target: Guidance issued by March 1999.

2.4.2 Action: The Authorities will consider how far this guidance can usefully be generalised for professionals working with other groups.

Target: Decision on guidance by March 1999.

2.5 Protecting vulnerable people from abuse

2.5.1 Action: The Authorities will issue a guidance document for care managers about situations where there is reason to suspect that a vulnerable adult may be being abused. They will aim to do so in partnership with all the NHS Trusts working with people in the community.

Target: Guidance issued by December 1998.

A consultation draft of a guidance document has already been circulated to professionals for comment.

2.6 Monitoring the quality of the care management service

Policy: The Authorities will seek to improve their information about the quality of the care management service.

2.6.1 Action: The SSD will introduce a new audit arrangement, including examining a selection of client files to monitor whether the letter and spirit of the Authorities’ approach to care management is being effectively implemented.

Target: First audit report available by October 1998.

3. Empowering users and carers

3.1 User/carer control of services

Policy: The SSD will offer the option of direct payments as an alternative to services where exceptional circumstances mean that this is clearly the best way to ensure that a service user receives an efficient and effective support package.

An example is where direct payments would enable a user to integrate support from more than one public body by amalgamating all the funding available. Consultations suggest that there is not currently demand in Northumberland for a more wide-ranging direct payments scheme.

3.1.1 Action: The SSD will prepare a guidance document setting out the steps which need to be taken when a direct payments arrangement is agreed.

Target: Guidance issued by September 1998.

Policy: The SSD will experiment on a small scale with the use of vouchers for services, initially in arrangements for respite care, and will consider in the light of experience whether such arrangements should be introduced more widely.

3.1.2 Action: The SSD will pilot vouchers for respite care in learning disability services.

Target: Pilot scheme in operation by April 1999.

3.2 Monitoring user satisfaction

3.2.1 Action: The Authorities will continue their programme of user surveys by arranging surveys of users of Adult Training Centres and their carers and of residents in resettlement schemes set up for people previously living in learning disability hospitals.

Target: Surveys complete by March 1999.

3.3 Other steps to gather users’ and carers’ views

3.3.1 Action: The Authorities will again consult users and carers about general issues through a series of local meetings in the Autumn/Winter, to assist in rolling forward this Plan for the following year.

3.4 Information for users and carers

3.4.1 Action: The Authorities will review with users of mental health services the information available about the roles and responsibilities of agencies.

Target: Review completed by May 1998.

3.4.2 Action: An additional leaflet will be produced, in partnership with district councils, explaining arrangements for adaptations to properties.

Target: May 1998.

3.4.3 Action: The Authorities will explore the potential of the Internet as an additional means of making community care information available.

Target: Pilot information available by March 1999.

3.4.4 Action: The Authorities will review their arrangements for getting information to specific groups of ill or disabled people about the specialist services relevant to their particular needs.

This is in part a response to comments made during consultations on this year’s Plan. Currently, the Authorities’ community care information materials mostly provide general information relevant to all care management clients or to users of major services such as home care and residential care.

Target: Pilot new information materials issued by March 1999.

4. Developing services: general themes

4.1 Raising the standard of care homes

4.1.1 Action: The Authorities will finalise a set of “target standards” for care homes, set at a level above the minimum standards required for registration.

Target: December 1998.

4.1.2 Action: The SSD will introduce a new contract with care homes, which provides for a link between the achievement of quality standards and the level of fee payable. In 1998/9, it will use this contract to differentiate the fees paid for a “standard” room (a single room which meets all the standards which would be required for registration of a new home) and a “basic” room which falls below these standards (for instance because it is a double room, or because its size or access arrangements would not be acceptable if the home were newly seeking registration).

Target: New contract in effect from April 1998.

It is anticipated that in future years, a further differential may be introduced to recognise the achievement of “target” standards.

4.1.3 Action: NHA working with total funds as appropriate will consider the scope for incorporating target standards into the specifications which it uses in contracting for NHS continuing care services, and the Authorities will explore the potential to a joint approach to monitoring for quality.

Target: December 1998.

4.1.4 Action: The Authorities will consider how best to publicise findings about homes' achievement of target standards as an aid to potential residents choosing a home.

Target: Information about homes’ achievement of target standards readily available by the end of 1999.

4.1.5 Action: The Authorities will collaborate in revising the Notes of Guidance issued through their joint inspection unit to current and prospective proprietors of residential and nursing homes, to ensure that the minimum standard required for registration is clear and appropriate.

Target: June 1998.

Policy: The SSD will develop a strategy to ensure that all the homes which it operates directly meet both minimum registration standards and target standards.

4.1.6 Action: The SSD will cease to operate directly Bell View in Belford and will conclude its consultations about the proposal to cease to operate Greenholme in Haltwhistle and Cowpen House in Blyth. In all three cases, it will consider any expressions of interest in taking over and refurbishing the homes, and in the cases of Belford and Haltwhistle expressions of interest in providing a continuing service in the same locality, before making any final decision to close the homes.

These three homes fall well below current minimum registration standards. Bell View and Greenholme are former workhouses. A review of the options for achieving minimum and target standards in other homes is currently under way.

Target: Final decisions on the future of the homes by the end of April 1998.

4.2 Meals in people's homes

4.2.1 Action: The SSD will continue its review of arrangements for providing meals in people’s homes, and will pilot some new forms of service.

Target: Pilot arrangements underway by September 1998.

4.3 Services for older people

The developments listed in this section will benefit both frail older people and those who are mentally infirm. Plans relevant to only one of these groups are included under PDI developments or mental health developments as appropriate.

4.3.1 Action: The Authorities will keep under review the scope for achieving greater integration between health and social care services for older people in Coquetdale as part of the reprovision of the day care and inpatient services offered by Coquetdale Community Hospital.

Target: [The timetable for this scheme is subject to resolution of current planning issues about the Wansbeck Hospital element of the Private Finance Initiative scheme.

5. Developing services: PDI

5.1 Rehabilitation and recuperation

5.1.1 Action: The Authorities will review current recuperation and rehabilitation services for older people, taking account of local needs and concerns.

Target: Terms of reference for a review established by May 1998. Review completed by February 1999.

5.2 Personal hygiene

5.2.1 Action: The Authorities will continue the pilot scheme in Tynedale for the provision of improved personal hygiene services funded through the pooled care management budget, and will consider in the light of further experience how similar improvements can be achieved across the County.

The Tynedale pilot scheme involves an increased assessment/care management role for district nurses, with personal hygiene services funded through the pooled budget except where users have specific medical needs. Initial experience of the pilot scheme has demonstrated real potential benefits, but has left some issues about roles and responsibilities unclear.

Target: Decision about roll-out to other areas by July 1998.

5.3 Palliative care

5.3.1 Action: The Authorities will evaluate the recently-commenced South East Northumberland Community Hospice project.

This is a scheme which provides support to palliative care patients linked, initially, to three medical practices in Wansbeck and Blyth Valley.

Target: Project evaluated by December 1998.

6. Developing services: mental health

6.1 Mental health strategy

6.1.1 Action: The Authorities will evaluate the progress made in developing a tiered approach to mental health care, in close cooperation with primary care teams and the Northumberland Mental Health NHS Trust.

Target: Evaluation completed by May 1998.

6.1.2 Action: The Health Authority will review its action plan aimed at reducing the number of suicides and raising awareness.

Target: Review of progress completed by June 1998.

6.1.3 Action: The Health Authority will increase its funding for the User Voice network which supports mental health service users and carers, and will seek in collaboration with the SSD and the Mental Health Trust to extend the role of this network.

Target: Terms of reference of User Voice revised by May 1998.

6.1.4 Action: The Authorities will review current out of hours response arrangements and follow-up care for individuals with mental health problems in the Wansbeck area.

Target: Review completed by August 1998.

6.2 Reprovision of hospital accommodation

6.2.1 Action: The Authorities will commission supported accommodation in the community to complete the replacement of accommodation in St George’s hospital used by adults who do not require NHS continuing inpatient care.

Target: A scheme for 13 Northumberland and 3 North Tyneside residents (Easter Field Court) will be provided in the Morpeth area by August 1998.

6.2.2 Action: Services for the remaining adults in residential wards, and for users of rehabilitation wards will be reconfigured on the St George's Hospital site as an interim stage in the development of new NHS services.

Target: Services reconfigured by October 1998.

6.2.3 Action: The Authorities will agree a framework for user participation in the design of new residential mental health care in hospital, ensuring high standards of provision, including patient privacy and dignity.

Target: Framework in place by July 1998.

6.2.4 Action: The Health Authority will aim to improve services for elderly mentally infirm people in the North of the County, to reduce the current reliance on hospital beds at St George’s Hospital, which will continue to provide a service for South East Northumberland residents.

Target: Service changes in place by March 2000.

6.3 Day care

6.3.1 Action: The day care for younger adults with enduring mental health problems funded through the care management budget but currently provided in the Wensleydale Unit on the St George's campus and at the Harbour Day Unit in Blyth will be transferred to a new service in Blyth.

Target: January 1999, subject to resolution of current problems about meeting the timetable required to meet the conditions for Department of Health grant.

6.3.2 Action: The SSD will commission, making use of funding transferred from the Health Authority, an eight-place day care service in Tynedale for older people with a mental illness.

Target: Service in place by September 1998.

6.3.3 Action: The Authorities, in collaboration with the Mental Health NHS Trust, will examine the scope for improved access to health and social care day facilities in the County.

Target: March 1999.

6.4 Residential care for people of working age

6.4.1 Action: The Authority will conclude a review of the types and level of residential care for under-65s with a mental illness across the County, following the completion of the current hospital reprovision programme (Easter Field Court)

Target: September 1998.

6.5 Drugs and alcohol

Policy: The Authorities will continue to develop drug misuse services in line with the joint strategy agreed by the County's joint Drug Action Team.

6.5.1 Action: The Health Authority aims to extend the supervised methadone administration service currently available in Blyth to a further 10 pharmacies in the County.

Target: Extended service available by October 1998.

6.5.2 Action: So far as available resources permit, the Health Authority will give high priority to the development in Wansbeck and the North of the County of community substance misuse services to support the existing work of GPs.

Target: Decision about what developments can be funded by September 1998.

6.5.3 Action: Subject to the success of a current bid for housing corporation funding, the SSD will part-fund the development of an outreach service to people with substance misuse problems living in local authority and housing association accommodation in Blyth Valley.

Target: Service operational by July 1998 (subject to funding approval).

7. Developing services: learning disability

7.1 Resettlement from hospitals

7.1.1 Action: The Authorities will keep under review through the care management process the needs of patients in learning disability hospitals beyond the residential sector.

Following the completion of the resettlement programme, there are now no people from Northumberland in residential wards in learning disability hospitals. However some other patients who have been in hospital for a considerable time might at some time in the future potentially benefit from community-based care.

7.2 Hospital services

7.2.1 Action: The Authorities will contribute to a review, led by Gateshead and South Tyneside Health Authority, of the services provided on the Prudhoe Hospital site, following the completion of the resettlement programme from the residential sector of the hospital.

Target: Review completed by August 1998.

7.3 Reprovision of SSD hostels

Policy: The SSD will aim to replace its existing learning disability hostels by smaller-scale schemes broadly similar to those developed for people resettled from Northgate and Prudhoe hospitals.

The County Council believes it to be likely that independent providers will be best placed to develop such schemes, rather than its own in-house service.

7.3.1 Action: The County Council will start this process by arranging alternative services for current residents of Haining Croft in Hexham, and will then aim to do the same for residents on Lyndon Walk in Blyth.

Target: Haining Croft reprovision completed by March 1999; Lyndon Walk by March 2000.

7.4 Reprovision of SSD day care

Policy: The SSD will aim to move away from Adult Training Centres on the current model towards a range of day services more closely tailored to individuals’ needs.

The balance between public sector and independent sector provision of these new day services will be determined case by case on the basis of quality and value for money.

7.4.1 Action: The SSD will review opportunities for change.

Target: Timing of potential developments reconsidered in preparing next Plan. Likely to depend on the County Council’s budgetary position.

7.5 NHS care for people requiring treatment

7.5.1 Action: The Authorities will produce guidance for practitioners about the elements of care for people with severe and complex needs which should be funded through NHS budgets and those which should be funded through the pooled care management budget.

Target: Guidance issued by September 1998.

7.6 Development of pooled budgets

7.6.1 Action: The Authorities will seek to agree the transfer to the pooled budget of funding for schemes developed in earlier phases of resettlement which are managed by a voluntary organisation

Target: Transfer completed by September 1998.

7.6.2 Action: The Authorities will agree with the Northgate and Prudhoe NHS Trust the transfer to the pooled budget of funding for day care provided by the Trust for people not resident in hospital.

Target: Transfer completed by September 1998.

7.7 People with complex disabilities

7.7.1 Action: The SSD will commission a residential service within the County for people with complex disabilities including challenging behaviour.

Target: March 1999

8. Developing services: carers

Policy: The Authorities will support carers in carrying out tasks required by their role.

8.0.1 Action: The SSD will contract with the Northumbria Health Care Trust for the services of a specialist able to carry out assessments in cases where lifting and moving a user may present particular difficulties and risks, and will arrange for two occupational therapists to develop additional expertise in this area.

Target: Specialist in post by April 1998.

9. Funding

Appendices 1 to 3 set out the budgetary position of the Authorities for 1998/9. This section sets out the main changes from 1997/8.

9.1 County Council budget changes

The County Council has had to make significant budget cuts to stay within Government limits on local authority spending; those which particularly affect community care services are listed here. Despite budget pressures, however, the County Council has been able to provide additional funding to meet some of the major new pressures on community care services.

Because the County Council’s budget settlement for 1998/9 includes a sharp fall in the amount which central government estimates that the County needs to spend on social services for adults (because of a change in formula), cuts in social services budgets are greater than those in the County Council as a whole. This is contrary to the general principles about budget reductions included in the pooled budget agreement, but is accepted by the Health Authority as necessary and reasonable in the circumstances.

9.1.1 Action: The County Council will make the following reductions in community care budgets in 1998/9:

- closure of three homes for older people (subject to consultation), with a net saving of £410,600 in 1998/9 and £547,000 in a full year

- a reduction of £825,800 in spending on home care. This cut will be made wholly in the County Council’s directly-provided service since independent services now appear to be of similar quality and have lower unit costs

- management savings in direct services totalling £53,800

- an increase in the standard charge for home help from £10 to £12 (raising £201,500) and in the administration charge for disability equipment from £10 to £15 (raising £18,400)

- ending a scheme under which the County Council provided automatic top‑ups on a sliding scale when people needing adaptations to their houses were assessed by a district council as eligible for Disabled Facilities Grant at less than 100% of the cost (saving of £20,000)

9.1.2 Action: The County Council will provide additional funding in 1998/9 to meet new costs arising from:

- increased numbers of older people, particularly in the oldest age groups (£165,000);

- further young adults with severe and multiple disabilities leaving the education system (£135,000)

9.2 Health contributions to the pooled budget

9.2.1 Action: Northumberland Health Authority will make the following new transfers to the pooled budget starting in 1998/9 (figures are estimates, and in some cases are subject to further detailed agreement. All sums of money are full-year amounts; the transfers in 1998/9 itself will in most cases be lower):

- £777,200 associated with the transfer of responsibility for a learning disability resettlement scheme managed by a voluntary organisation

- £222,400 associated with residential care for people formerly in residential sector of St George’s hospital

- £54,700 associated with day care for elderly mentally ill people in Tynedale

- £20,000 as a contribution to the integrated management arrangements for mental health care managers

It is estimated that the overall effect of these changes will be to increase the total Northumberland Health contribution to the pooled budget and care management staffing budgets to £7.1m in a full year.

9.3 Special Transitional Grant

9.3.1 Action: The SSD will allocate the Special Transitional Grant for Community Care for 1997/8 to fund:

- an increase of £1.76m in delegated funding for the purchase of services

- staffing cover in directly-provided learning disability services (£60K)

- enhancements to services for people with a visual impairment provided by the Northumberland Association for Visual Handicap (£30K)

- work on improved programmes of care for older people in local authority care homes, particularly those with dementia (£25K)

- outreach mental health day care services in Berwick (£15K)

- four care managers to specialise in supporting adults of working age with severe physical disabilities, and associated costs (£115K)

- other administrative and professional support services (£70K)

9.4 Other special Government grants

Policy: The Authorities will continue to make use of special grants from the Government or the European Union to strengthen their ability to achieve their overall community care strategy.

9.4.1 Action: The SSD will make use of Training Support Grant from the Department of Health to fund:

- training to support developments in care management, including the establishment of joint mental health care management teams, the development of practice-linked PDI care management and the further development of joint learning disability teams;

- continuation of the joint care management foundation training programme, which all care managers are expected to undertake on taking on the role;

- a programme of awareness training for professionals outside care management but with close contact with it – particularly ward staff in hospitals;

- training for front line care staff in direct services focused on the goal of an NVQ-trained workforce;

- training for managers of direct services focused on the goal that all managers should have professional qualifications, with BTEC/HNC management/social care qualifications the preferred option for those not already qualified;

- training for SSD direct services staff involved in joint developments with health service agencies;

- training about sensory impairment.

9.4.2 Action: The SSD, with agreement from NHA, will continue to use Mental Illness Specific Grant (MISG) to fund:

- three posts to support the reprovision of services from St George's Hospital – two specialising in day care and occupational services (now extended indefinitely), one in residential services (to continue until the opening of Easter Field Court, expected in August 1998);

- five community-based care management posts: a team manager and three care managers (one temporary until September 1998) in the North of the County, and a care manager in the community substance misuse team;

- a contribution to delegated purchase budgets for mental health teams

- day care and outreach developments in Alnwick district (supported by the MISG target fund)

- a day care centre in Blyth for under-65s with enduring mental health problems (whose capital costs are expected to be supported through an MISG-related supplementary credit approval)

9.4.3 Action: The SSD will continue to use the specific grant funding available for HIV/AIDS to fund:

- work with people who are HIV positive or have AIDS by the voluntary organisations ACET, ACT and Body Positive North East

- a post in a Community Mental Health Team focused on the links between drugs, mental health and HIV

9.4.4 Action: The SSD will continue to use specific grant for alcohol and drug problems as a contribution to the day care scheme for problem drug takers in Blyth (also supported by the County Council, NHA and the Probation Service).

Following the ending of European Union funding for a training project for people with learning disabilities, there are currently no projects funded in this way.

9.5 Joint finance

Joint finance is a part of the budget of Northumberland Health Authority set aside to fund jointly-agreed schemes which will further health objectives. It is largely used to support community care priorities, though some funding has also recently been allocated to support the joint planning of services for children in need.

9.5.1 Action: Joint finance will continue to be used to support the objectives of this Plan by:

- supporting the continuing bridging costs of resettlement from learning disability hospitals and the reprovision of inappropriate mental health services provided at St George’s hospital.

- supporting the development of joint care management and pooled budgets.

- funding time-limited expenditure by voluntary organisations which will contribute to the achievement of community care priorities (a fund of £50,000 a year has been set aside).

Part C: Consultation on the Plan

C1. How consultation was carried out.

C1.1 This year, as in previous years, the Authorities consulted widely in preparation of the Community Care Plan. The range of methods used was broader than in any previous year, including:

a)Discussion meetings with groups of service users and carers and representatives of voluntary organisations in localities across the County, invited through local care management teams or networks as in previous years.

b)Informal meetings with established groups of service users and carers to look at specific aspects of Community Care relating to their special needs.

c)Semi-structured interviews conducted by care managers with service users, carers and care staff to discuss specific services, namely; respite care services for people with learning disabilities and very sheltered housing provided in one specific local facility.

d)Targeted interviews with potential users of a specific service (direct payments).

e)Questionnaire surveys of users of specific services, i.e. the equipment loans service.

f)Written invitation to comment sent to as many people as possible known to have an interest in the planning of community care services.

C1.2 Participants were asked for their views on services that affect themselves or the service users they relate to. In the general meetings and written consultation there were no specific service areas identified for discussion but the focus was on:

a)access to services,

b)quality of service provision and

c)locality needs.

C1.3 Officers from both the Social Services Department and the Health Authority were actively involved throughout the consultation exercise although the Health Authority took the lead in consultation on mental health issues, with Social Services leading on the work on direct payments, services for Deaf people and equipment services. Care managers from both agencies carried out the consultation on respite care for people with learning disabilities and the review of very sheltered housing.

Discussions with users and carers

C1.4 Fifteen meetings were organised with groups of service users, carers and representatives of voluntary organisations involving more than 200 people across a range of group sizes and interests. A further 260 people gave their views through individual interviews or questionnaire responses. These related to direct payments, respite care equipment loans and very sheltered housing.

Written consultations

C1.5 In addition a range of individuals and organisations were consulted by letter requesting their comments on the 1997-2000 Community Care Plan and suggestions for inclusion in this current update. Participants were asked to consider local needs and those issues that would most affect themselves or the people they represented.

C1.6 The written consultation included:

a) care managers

b)NHS Trusts

c) GP practices

d) the District Housing Authorities

e)around 300 voluntary organisations

f)Parish Councils

g) the Community Health Council

C1.7 As might be expected, these written invitations to comment do not now generate the level of response produced in the early days of the Community Care Plan. Interest now tends to focus more on specific issues and organisations and individuals are involved with planning with the Authorities in other ways outside the formal written process, for example in contract discussions or in consultation about specific service developments.

C1.8 There were 13 formal written responses to the consultation letter. However the Authorities also take into account the full range of views expressed in informal consultation with organisations and individuals throughout the year in planning the details of services.

C2. Services for deaf people

C2.1 Deaf people were invited to meeting in four locations across the county. These were facilitated by the Newcastle and Hexham Deaf Service, with British Sign Language translation. An additional meeting was held at Newcastle College for students from Northumberland.

Priorities Identified

C2.2 Although a wide range of issues were identified at each meeting, principal concerns centred around similar priorities. Concern was expressed that Deaf people feel marginalised and isolated and hence social contact and access to information are important. Provision of a 'drop-in' centre at clearly identified times each week was suggested to allow deaf people to meet together to organise activities, training and support. It was also suggested that if staffed at set times by a communications trained social worker, the problem of access to information could be improved and waiting times for basic support could be reduced.

C2.3 It was suggested that difficulties in using transport and the costs involved increased problems of isolation for deaf people in Northumberland because of the distances involved in accessing services and meeting socially. It was felt that bus pass allocation would reduce the communication problems and expense that deter Deaf people from using public transport. Access to a minibus was also suggested as a possible improvement.

C2.4 Some of those present suggested that deaf people find accessing services difficult and daunting. It was suggested that someone in each Social Services office with communication skills would be helpful. In addition, 'deaf awareness' training for front line staff in both Health and Social Services was seen as important.

Other issues raised

C2.5 Concerns were raised about access to communications support. Students felt that portable minicom equipment would help them be more independent. It was suggested that this would also help reduce feelings of isolation by improving communication with friends. Other groups suggested that more specialist social worker support was needed to ease demand on services for deaf people. Some felt that access to interpreters would also help for non-specialist support.

C2.6 Whilst all group members felt that some type of 'club' or drop-in centre would be a valuable service, the student group felt that it was important that they had some separate provision as their needs and interests were different. Access to computer equipment in the centre for training and information was suggested.

C2.7 Although it was suggested that consultation with deaf people was a positive move, concern was expressed that representatives from the deaf community along with a range of other service users should be able to provide more input into service planning.

C3. Respite care for people with learning disabilities

C3.1 Using a pre-piloted interview schedule, 24 care managers consulted with 42 people who access learning disability services and their associated carers about provision of respite care services. The people consulted included users of respite care services at 14 different facilities across the county along with people who currently do not use respite care, but may do in the future.

C3.2 Although when asked what was good about current services, one person said 'things can only get better', many service users felt that the services they did get were good. Less than half those consulted said they felt they needed more respite care but many felt that the services available should be more flexible and responsive.

C3.3 Respite care was seen as an opportunity for social contact for service users and a much needed break from the responsibilities of caring for carers.

C3.4 Suggested changes to current services included providing respite in smaller, 'more homely' units closer to family homes, with organised activities, particularly outings and with respect for the service user's normal routines and needs. Some carers said they would prefer respite care in their own home to minimise disruption to routine or financial support to give more scope. The introduction of vouchers discussed in last year's consultation was raised, although it was felt that they would not be helpful where service availability is limited.

C3.5 User and carer ideas of what constituted a quality respite care service identified the same basic issues but with different priorities. Service users stressed the importance of care and comfort whereas carer priorities were safety and support. Both groups stressed the care and facilities provided over where the service was situated, however, it was stressed that 'tacking' respite care for young people onto nursing homes for the elderly was unsuitable. The wide range of priorities coincided with a range of abilities of the people consulted and it was suggested that the Agencies need to be more creative about the scope of services provided.

C3.6 Service users and carers perceptions of a 'quality' respite care service was of one that is flexible and responsive, particularly to emergencies. Facilities should be small and 'homely' and not attached to care homes. Care should respect the individual needs of service users and provide stimulating activities that will help individual development. Links between users and carers, care managers and unit staff should be developed and it was suggested that direct access would help produce a more rapid response.

C3.7 Carers expressed concerns about the levels of staff in some facilities and the 'suitability' of some staff. Some carers felt that more experienced staff with proper training was important for a quality service with service users stressing the need for empathy, kindness and reassurance from staff. Some users and carers felt that it was important for them to have the opportunity to comment on the range of service quality issues on a regular basis.

C4. Developments from the Mental Health Strategy

C4.1 Following on from the consultations carried out in early 1997 to develop 'From Needs To a Strategy, common themes that had been identified were followed up. Three consultation meetings were facilitated by User Voice to look at three key issues.

Welfare Rights

C4.2 Concerns were raised at all three consultation meetings about how few places there were to go to get information and advice on welfare rights issues. Citizens Advice Bureau was seen as offering good support around housing and debt management but care managers were frequently used to help complete benefits application forms. Concern was expressed that information on benefits entitlement was most difficult to access as DSS staff are not allowed to give it and other organisations may not be up to date on what is available.

C4.3 A trained welfare rights worker offering support and advice on a regular basis at an identified site along the lines of the sessions offered by Blyth Valley Disabled Forum was suggested at specified centres across Northumberland. It was felt that this service could be made available within existing units or centres for ease of access.

After Hours Support

C4.4 The need for evening, weekend and holiday support was identified as an issue in last years consultation. However, when discussed this year, the details of what was needed were difficult to pin down. Outreach support with an extension of current service provision to evening and holiday opening of centres was suggested, although it was felt that possible transportation problems associated with this would need to be addressed in some parts of the County.

C4.5 Co-ordination of volunteers to provide a befriending service was also suggested.

C4.6 A central, well publicised contact point was thought to be important for people who could not attend a unit, underlining the need for some form of telephone helpline.

Telephone Helplines