Integrated Impact Assessments – Disability Services – Review people using day support who live with care providers to move to a single service
Disability Services – Review people using day support who live with care providers to move to a single service.
Service provision for adults with learning disabilities accessing day support who also have an alternative Care at Home provider in place, will be reviewed with a view to providing a single service by the Care at Home provider. This will be reviewed for anyone whom the Partnership is directly organising and arranging care for via Option 3 of Self Directed Support.
There has been no public involvement to date as this does not impact general members of the public. Involvement will be very specific to the individuals and families it will impact.
5 March 2020 reviewed 20 February 2021.
| Name | Job Title | Date of IIA training | |
|---|---|---|---|
| Mark Grierson | Service and Strategy Manager, Disabilities Lead Officer | Mark.grierson@edinburgh.gov.uk | |
| Linda Dodgson | Care and Support Manager, Partnership Representative | Linda.dodgson@edinburgh.gov.uk | |
| Emma Pemberton | Care and Support Manager , Facilitator, Report Writer | 25/4/2018 | Emma.pemberton@edinburgh.gov.uk |
| Robert Smith | Care and Support Manager, Partnership representative | R.smith@edinburgh.gov.uk |
| Evidence | Available? | Comments: what does the evidence tell you? |
|---|---|---|
| Data on populations in need | Within Outline Strategic commissioning Plan – Pathway for Life. | Over the next 5 to 10 years the increasing demand for day support is potentially 300 – 700 people. |
| Data on service uptake/access | Within Outline Strategic commissioning Plan – Pathway for Life. | Turnover in services is relatively low, leading us to a position that services are regularly at capacity and unable to provide services without growth investment. There is a legal duty on the Partnership to provide day opportunities for people with learning disabilities. |
| Data on equality outcomes | N/A | |
| Research/ literature evidence | Keys to Life | Published in 2013, ‘Keys to Life’ sets out the Scottish Government’s ten year strategy for improving the quality of life for people with learning disabilities. The implementation framework for the Keys to Life has four strategic outcomes which relate to the United Nations Convention on the Rights of People with Disabilities:
|
| Public/patient/ client experience information | From those previously involved in similar transition.
From those at point of IIA review who have already or are in the process of transitioning. 3rd sector provider organisations |
People have reported positively to the transfer of their support hours and receive a more individualised and flexible support package. Many people continue to be actively involved with the same networks, friends and community groups as well as adding to it.
Covid-19 and the associated restrictions has altered the direction of this change. Most people who receive paid support from CAH providers have remained at home since March 20, unless an identified critical need to attend day support provision. At point of review there has been approx. 50% uptake on transitioning to CAH provider. Of this 50% this has ensured appropriate support has been able to be provided throughout the lockdown and tiered approach phases. There were mixed responses to this and where this wasn’t opted for, there was a choice not to progress. For most who opted not to transition they remain at home awaiting further guidance in relation to restrictions. There has been a mixed response from provider organisations. Most CAH providers are keen to take on this support for individuals and view this as a positive direction. Day support provider views are mixed. Whilst some view this as a positive direction, others do not support this approach. |
| Evidence of inclusive engagement of service users and involvement findings | This will be provided throughout consultation and implementation.
Ongoing consultation |
Wider consultation was carried out in relation to the Outline Strategic Commissioning Plan for Learning Disabilities with the publication of an easy read information document and an easy read questionnaire – ‘Tell us What you Think’
All individuals and/ or family representatives have been consulted with during this process and further referrals have been made for a Social Worker to carry out the transition process to engage further with people and/or family representative. Concern was raised by provider organisations regarding advocacy and this was addressed with appropriate connections being made where this was requested and has been offered to be available in the future. |
| Evidence of unmet need | Yes | Due to turnover in services being low and regularly at capacity, this has left some individuals in a position where they cannot access appropriate services at the right time.
Covid-19 and the associated restrictions have resulted in reduced capacity within building based day services and also reduced accessibility of community resources. This has led to individuals receiving a lesser volume of support than previously and for some no support – either through choice to remain at home, shielding or from the direction of the Scottish Government and Partnership. |
| Good practice guidelines | EHSCP Framework agreement for housing support (with care at home) services for people with learning disabilities. (Currently in process)
Health and Social Care Standards – My Life, My Support. Scottish Social Services Council (SSSC) |
This Framework will introduce a single service specification for all housing support service models which reflects current national ‘best practice’ guidance and the outcome of local co-production activity as well as using standard Framework Agreement Terms and Conditions and monitoring arrangements.
All health and Social Care providers are governed by these standards and inspected by the Care Inspectorate. The standards provide clarity on what should be expected when using health, social care or social work services in Scotland. They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld. The SSSC is the regulator for the social service work force in Scotland. Their work means the people of Scotland can count on social services being provided by a trusted, skilled and confident workforce. They protect the public by registering social service workers, setting standards for their practice, conduct, training and education and by supporting their professional development. Where people fall below the standards of practice and conduct they can investigate and take action. For all Care at Home providers their staff are required to be on the register. |
| Environmental data | No | |
| Risk from cumulative impacts | No | |
| Other (please specify) | N/A | |
| Additional evidence required? | No |
Equality, Health and Wellbeing and Human Rights
Positive
The changes will provide a more consistent approach in the services being delivered and ensure equity of support for people with learning Disabilities within Edinburgh, creating opportunity to enhance access to appropriate social care – more capacity within day services for people who currently have no access or other formal paid support.
Consistency will offer better health and wellbeing outcomes through flexibility and personalisation in line with Self Directed Support (SDS). The underlying principles of SDS is all about giving people a better life. It is about supporting people to think how they could lead their lives and giving them the chance to control that.
Individuals may be able to continue within their existing day service funding it through SDS option 1 or 2, if this is determined appropriate in line with the Partnerships 3 conversations approach. Both options encourage and enable people to have more control over their support and decisions. This will increase peoples understanding of their rights and participation within decisions about their support and enables people to discuss, understand and access the right support at the right time.
Due to the impacts and restrictions presented as a result of Covid-19, individuals have been offered the option to remain with the day support provider within the existing contract rather than seeking to change this to option 1 or 2.
Regardless of any additional protective characteristics all service users have access to the same level of support in line with the assessed level of need. It is not foreseen that any individual will be affected due to any other protected characteristic.
Negative
Some individuals may feel that their right to choose a day support service choose to attend a day support service under option 3 of SDS is inhibited and believe a change to a single provider will have an adverse effect on them.
Any change to option 1 or 2 may be viewed as putting people at a disadvantage because they can be viewed as time consuming and complex for individuals. At point of review this has not progressed and if individuals opt to remain with their day support provider, this remains on the existing contract at this time.
Individuals may feel that they are losing friendships or connections which are important to them.
Affected populations
Primarily people with learning disabilities, some may have additional protective characteristics such as age, gender and race.
Environment and Sustainability
Positive
There would be a reduction in corporate transportation as well as general taxi use in providing transport for people travelling to their day service from home. It would be expected that any forms of travel in and around the city will be utilising public transport and where available motobility vehicles.
The Framework Agreement sets out key performance indicators to ensure sustainability for the providers who sign up to the agreement. This includes a commitment from providers to ensure specific training and completion of an annual monitoring form which is audited by contracts team.
Negative
No negative impacts in relation to Environment or Sustainability are anticipated in relation to disability or any protected characteristics. It is not foreseen that any individual will be affected due to any other protected characteristic.
Affected populations
Primarily people with learning disabilities . Some may have additional protected characteristics such as gender and race.
Economic
Positive
There will be a continued need for access to day opportunities as populations and demand increases. This change will improve access to day opportunities for those who do not have any other formal support arrangement in place.
Growth will be enabled in voluntary and private sector organisations. Single provider enhances employability for Care at Home Organisations and may encourage longer term sustainability.
Negative
Covid-19 and the associated restrictions have resulted in reduced capacity within building based day services and also reduced accessibility of community resources. This has led to individuals receiving a lesser volume of support than previously and for some no support – either through choice to remain at home, shielding or from the direction of the Scottish Government and Partnership.
Affected populations
Primarily people with learning disabilities . Some may have additional protected characteristics such as gender and race.
Services will be provided by voluntary and/or private sector organisations, some of which are already known to service users. All equality, human rights, environmental and sustainability issues are covered by the Framework Agreements, good practice guidance or the contracted terms and conditions. Children’s rights are not applicable within the scope of this IIA.
It will not be necessary to communicate with children and young people within this change, however a large proportion of service users will require additional communication tools in order to understand the change. Some parents and carers may also need additional tools to support their understanding.
Communication will be carried out on an individual basis and as is appropriate. Examples may include use of picture symbols, talking mats, large type, discussion with someone known by the service user, language interpretation, sign language and social stories.
If yes, an SEA should be completed, and the impacts identified in the IIA should be included in this.
No.
Ensure appropriate communication plan is in place and where required made accessible for people with additional support needs.
Monitor and respond to individual circumstances and requests as required.
| Specific actions (as a result of the IIA which may include financial implications, mitigating actions and risks of cumulative impacts) | Who will take them forward (name and contact details) | Deadline for progressing | Review date |
|---|---|---|---|
| Monitor and respond to individual circumstances and requests as required | Emma Pemberton
Mark Grierson Jayne Kemp |
Ongoing | |
| Develop appropriate communication plan and where required ensure accessible formats for people with additional support needs. | Emma Pemberton | Complete April 2020 |
The EHSCP Framework agreement for housing support (with care at home) services for people with learning disabilities. (Currently in process) will provide a framework for quality assurance and key performance indicators. The annual audit within the framework will allow for routine monitoring of service delivery and service user outcomes, including those with protected characteristics.
Ongoing conversations, briefings and feedback gathering, with all stakeholders will be continually reviewed and any impacts actioned.
Mark Grierson
5 March 2020 / reviewed 20 February 2021