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Business Case (incorporating Community Impact Assessment)

1. Project Information

Project Title: Independent Futures

Version v.17 Project Number

SLT Sponsor: Eric Robinson, Deputy Chief Executive and Director for People

Cabinet Members Liz Staples, Cabinet Member for Adult Wellbeing Mike Lawrence, Cabinet Member for Children’s’ Wellbeing

2. Purpose of the Project – Sponsor’s Statement Description – Outline items below:

Please explain how the proposal began; a change in legislation? An exploration of innovation? An identification of need? The projects aims & objectives

Why we need the project?

Continuing to deliver assessment and brokerage support for people with disabilities in its current form is not sustainable; people are not consistently able to achieve the outcomes that they want and need and the overall resource base available to provide support is not used effectively or efficiently. Regardless of the delivery mechanism, major transformation is required if outcomes for individuals, the experience that people have and value for money are to be improved to the level required. These three outcome areas are the focus for Independent Futures. This is not only a reflection of local issues, but of significant society-wide challenge and a way of working that is in the process of transformation, led by the concepts of personalisation and self-directed support, seeking to recast users away from being passive recipients of services towards being active citizens with a right to control and shape their own support. The first stage of the project proposes to establish a single management structure for assessment and brokerage support for children and adults with disabilities, new ways of working and additional capacity and expertise that will start to improve outcomes from April 2013 onwards. A second stage of the project will consider the delivery options for Independent Futures, producing a further business case for consideration during 2013/14. Aligned with the Staffordshire vision and priority outcomes and the People ‘Putting People First’ strategy and vision, Independent Futures aims to create a seamless, holistic, all-age assessment and brokerage service to work with people with disabilities in Staffordshire, enabling resilience, independent living and personalised choice and control; in short, enabling and empowering people to live the life that they want to. It will do this through:

• Holistic assessment of need • Identifying outcomes • Person-centred planning • Brokerage

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• Promotion of personal budgets • Key working • Ensuring appropriate access to specialist support

It will deliver against the requirements of Staffordshire’s Strategy for Disabled People of All Ages, ‘Living my Life My Way’ (2012), the overarching priorities of which are:-

• The Best Start in Life • Lifelong Learning • Choice and Control • Community Opportunities • Good Health • A Strong Voice for Disabled People & Their Families • Staying Safe

A Service Level Agreement with a service specification and performance framework for Independent Futures has also been developed. Current arrangements reflect a way of working that is focused on eligibility criteria, services, professional boundaries and capacity. Policy documents and legislation over the last 5-6 years through both the former Labour and now the Coalition government have looked to address these issues being consistent in their support for:

• Person-centred and personalised approaches, with choice and control in the hand of the user;

• An outcomes-based focus; • Localised and community-based delivery; • Social capital development; • Co-production and user / carer ownership;

Nationally, assessment and brokerage services for people with disabilities, whether in social care, health, education or housing are often reactive, disjointed and largely isolated from each other, resulting in:

• Less than optimum transition between services and between childhood and adulthood;

• Duplication and an ineffective use of resources; • Failure to maximise outcomes for the individual and their family; • Personalisation and transformation through this, being patchy in implementation

and with a pace that is less than desired. • An experience felt by individuals that confuses rather than clarifies.

In addition to the above, the complexity of support and systems that have to be navigated by many people with disabilities is challenging and can also be confusing and difficult. These include health care, social care (adults and children), the benefits system, tax and tax credits and education / schooling. This array of systems means that many individuals and families struggle with their entitlement and professionals struggle to keep abreast with accurate, timely and integrated information to aid effective support. Independent Futures aims to meet requirements and address issues with a focus on ‘Real Wealth’ (Duffy, Murray and Crosby, 2010) which offers a framework for thinking about the capabilities that are needed to build a fairer society and the real factors that underpin people’s lives. It also reflects the writings of key thinkers from the disability community and

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should underpin the work of Independent Futures as it develops. Appendix 1 provides further detail. Independent Futures has been developed so that a disabled person will:

• Experience a smooth, person centred assessment which will consider all areas of support – health, housing and education for example. This will particularly benefit young people with a lifelong disability who currently experience separate assessments in children’s and adult’s services.

• Be central to the development of a life-long plan of support that’s right for them and enables them to achieve their goals.

• Have increased choice and control with regards to the support they receive and a personal budget will back up their choices.

It will achieve this through a greater user-led focus and collaboration, improving customer insight, developing new ways of working, joining up systems and support, helping to shape and influence the market and providing for a skill base, capacity and culture that is better aligned with the needs of the population.

How will the projects meet one or more of the county’s priorities? Sk

illed E

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Prosperin

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Free from

Crim

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Vuln. Pe

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Indep

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Lives

C&YP

Make a

Po

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Contrb

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Peop

le: long

er &

Healthie

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s

Safely &

Easily

Ac

cess Fa

cilities

Access form

al an

d inform

al lea

rning

Influe

nce o

ver

Decis

ion M

aking

Clima

te Ch

ange

Score: 0 - None, 1 - Low, 2 - Medium, 3 - High

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3

3

3

3

2

3

3

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Based on the 2012-17 Strategic Plan and People Strategy and the linkages created between Independent Futures and outcomes through the work PSLT have undertaken on outcomes chains, the following outcomes are deemed those impacted on at a High level by the Independent Futures project. Many of the project outcomes identified have multiple linkages to service area and County Council outcomes; these have been mapped via the development of Outcome Chains that provide a more complete view than the summary table below. County Council Outcome

People’s Service Area Outcome

Project Outcomes Staffordshire is a place where people can live safely - increasingly free from crime, the causes of crime and the fear of crime

Safe - People understand and avoid risks that will do harm to themselves or others

SO2: People are well informed and advised so that they can avoid harm to themselves and their family. SO3: People are safeguarded, protected and cared for.

In Staffordshire's Healthy and Well – SO6: People are enabled to make

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communities people are able to live independent and safe lives, supported where this is required

People live long and fulfilling lives, being able to address the health and wellbeing issues that affect them

choices and take control, directly managing the care and support that they need to live independently SO7: The care and support that people need to live independently is accessible, available and flexible enough to meet needs in the way that people want. SO8: People are supported to access wider support that improves health, such as decent housing, education, jobs and things to do

Staffordshire is a place where people live longer, healthier and fulfilling lives

Independent – People manage their own life, make their own choices, deal with issues their own way

SO7: The care and support that people need to live independently is accessible, available and flexible enough to meet needs in the way that people want. SO8: People are supported to access wider support that improves health, such as decent housing, education, jobs and things to do SO9: People are supported to manage their own health and wellbeing.

Staffordshire's children and young people can get the best start in life and receive a good education, so they can make a positive contribution to their communities

Responsible - People feel empowered as individuals, families and communities, to be responsible for their lives and their futures

SO8: People are supported to access wider support that improves health, such as decent housing, education, jobs and things to do SO9: People are supported to manage their own health and wellbeing SO10: People are helped to live healthy lifestyles and make healthy choices SO11: People can access targeted services that can help manage a problem SO17: People are encouraged and supported when needed in meeting their ambitions and aspirations

Staffordshire's communities can access, enjoy and

Educated – People can access high quality education that supports

SO20: People can acquire the right qualifications and skills to meet the needs of current and future

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benefit from a range of learning, recreational and cultural activities;

them to achieve their ambitions. Informed – People have the information they need to make good decisions for themselves and their family.

employers. SO21: Learners achieve their potential and progress through education and learning to live full and independent lives. SO13: People can access good quality information to base their decisions on. SO14: People can get hold of information quickly and easily when they need it.

Staffordshire's people are involved in shaping the delivery of public services

Independent – People manage their own life, make their own choices, deal with issues their own way Responsible - People feel empowered as individuals, families and communities, to be responsible for their lives and their futures

SO6: People are enabled to make choices and take control, directly managing the care and support that they need to live independently. People with disabilities are empowered and enabled to directly influence and shape the way that support and services are developed to meet their wants and needs.

What analysis has been undertaken to inform the development of the proposal? e.g. local knowledge, Census data, feedback from previous consultation exercises, place survey etc. The analysis must take account of protected groups/characteristics; disability, race, gender, sexual orientation, age, religion/belief, gender reassignment - what is it telling us? What are the determinants to health telling us? Does the evidence/data indicate any differential impact on any group or groups? Are there significant information gaps?

Issue being addressed

Independent Futures is for those people with disabilities having an eligible social care need:

• People with learning disability of all ages and their families • People with autistic spectrum disorder of all ages and their families • People with physical disability up to the age of 18 and their families • People with sensory impairment up to the age of 18 and their families

People over the age of 18 with a physical disability, sensory impairment or an adaptations or equipment need, will receive appropriate services from Staffordshire and Stoke on Trent Partnership Trust (SSOTPT) under current contractual arrangements. Independent Futures is working with SSOTPT colleagues to ensure a smooth transition between services and ensure that it reflects the Independent Futures values and principles for people. Based on numbers of people currently accessing disabilities social care teams it is estimated that approximately 4,100 people will access Independent Futures, based on the following breakdown.

• Number of individuals typically being supported by children's disability social care

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teams - 660 • Number of individuals typically being supported by children's occupational therapy-

180 • Number of individuals typically being supported by adult’s learning disability social

care teams – 2,720 • Number of individuals with Adult Protection referrals, but who are not in receipt of

services or support - 260 • Number of individuals or carers assessed, who are not in receipt of services or

support - 290 People are supported in a number of different ways; typically people are either supported to live independently through social care services (supported living, day care, domiciliary care, respite care, professional support, personal budget / direct payment) or receive 24 hour residential / placement support. Whilst there are excellent examples of more holistic support packages that are in place, these are the exception rather than the rule. Total expenditure on services and support for these 4,100 people equates to approximately £90 million per annum and of this, it is estimated that around £51 million will be managed directly by Independent Futures at it’s formation stage, with this number steadily increasing towards the larger number as block contracts and in-house services decrease in number and size, Historically, there has been a cohort of people who access social care support but who do not meet eligibility criteria. One of Independent Futures aims will be to work with commissioners and this group of people to identify appropriate community support or universal services to meet need, ultimately allowing the focus to be applied to those people meeting eligibility criteria. Population Projections The number of people predicted to have moderate or severe learning disabilities in Staffordshire shows an increase in the number of people aged 18-64 of 3.5% between 2012 and 2030, from around 2,780 to 2,880. The number of people aged 65 and over with learning disabilities will increase from 474 to 650, an increase of 37%. In total, across the whole adult population, the numbers will increase by just over 8%, from around 3,250 in 2012 to 3,530 in 2030. Source: POPPI and PANSI using ONS data In addition, it is stated that there is likely to be a reduction in the informal care networks that provide care as a result of:

• Increases in lone parent families • Increasing rates of maternal employment • Increases in the percentage of older people with learning disabilities (whose

parents are likely to have died or be very frail) • Changing expectations among families regarding the person’s right to an

independent life Source: Estimating Future Need for Adult Social Care Services for People with Learning Disabilities in England, Emerson and Hatton, Centre for Disability Research, Lancaster University, 2008 Data shows that the number of people aged 18-64 with a physical disability in Staffordshire will slightly decrease (-0.3%) from around 54,200 in 2012 to 54,000 in 2030. Conversely the number of people with a physical disability over the age of 65 will increase by 86% from around 17,000 in 2012 to 31,600 in 2030. This is due to the greater numbers of people who will be that age in 2030.

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Engagement Our local research, consultation and analysis supports the need to address these key issues. A wide range of people including service users, families, carers, social care staff, professional colleagues in health and education, partners, service providers and independent / voluntary organisations have been involved in shaping the services and support they wish to be available in the future. Further detail is provided below. Extensive engagement with disabled children, young people and their families as part of our Aiming High Sufficiency Statement work has emphasised the importance that they place, not upon ‘services’ but upon being supported to learn, make friends and enjoy their lives. They told us about the importance of:

• Activities that enable children and young people to make friends, be part of group activities and to do things together as a family

• Being supported to live an ordinary life, playing and learning alongside friends within their communities.

• Weekly clubs, especially for children and young people who like to have routine, activities during the school holidays, and that clubs that also enable siblings to attend helps children and young people to feel more confident.

• Disabled children and their families told us about the importance when growing up, of having a smooth transition to adult life, including activities for those who need them

Parents told us that:

• They value activities where they are able to do things with other families with disabled children, such as the one-off family days.

• They appreciate the opportunity to access short breaks and some families told us that they rely on them.

We also know that parents who have been offered a personalised approach to their child’s care are delighted with outcomes giving them (Murray 2009):

• Choice and flexibility for the whole family • A voice • A sense of being valued • A positive view of their disabled child • Opportunities to make connections with their communities • Opportunities for children and young people to make friends • Simple solutions • adult time with their partner • opportunities to carry on or return to work • ability to respond to the fluctuating needs of illness and impairment • transparency and greater understanding of what services and support cost • time with their other children • opportunities for children to develop self confidence and self esteem • opportunities to try things out to see what works best • control over how the money allocated to them is spent.

Adults with learning disabilities and their carers told us about the importance of:

• Accessible and timely information in the preferred format. • The option to try equipment before you buy is essential.

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• The need for a fully integrated equipment service across health and social care. • Appropriate assessment before discharge from hospital. • Getting discharge from hospital right the first time by making sure the right support

is in place when disabled people return home. • More active work in physiotherapy in hospital and the community setting. • Not writing older disabled people off in terms of employment. • More planning with older carers: “what happens next”?

Furthermore the Youth Action Kouncil Manifesto 2010 identifies that all children and young people in Staffordshire have the following priorities:

• Affordable and reliable transport • Education and advice on sex and relationships • Affordable and positive activities • Feeling safe and free from the fear of bullying • Portraying young people positively in the media

We have met with groups including SPAN (Staffordshire Parents Action Network) SUN groups (Staffordshire Umbrella Network), Learning Disability Partnership Boards and have published articles in parents and learning disability newsletters. We have met with carers, health colleagues and education colleagues to discuss proposals for Independent Futures. All the feedback received has been overwhelmingly positive, people have supported our aim to join children’s and adults assessment, brokerage and support planning services and to facilitate outcome focused, holistic support plans A dedicated team has been working both with historical data and current cases to identify where barriers existed in the current system and design a system that will enable professionals to work with individuals who need support in a holistic and outcome focused way. To improve outcomes for individuals and their families Individual services focus on those needs that are presented as considered against their own service or eligibility criteria. This means that there is often a failure to take a holistic ‘Real Wealth’ view resulting in:

• Repeat referrals as individuals try to get the support they feel they need until their needs escalate / they fall into crisis and services are put in place e.g. 40% of referrals into the children’s disability teams which did not receive an assessment came back as a re-referral (analysis of a sample of data, confirmed anecdotally).

• Needs not being met. In depth analysis of 17 cases from children and adult social care services found that in 77% of these cases, families did not get all the support they needed at the right time for them and that needs escalated in 46% of cases.

• Inappropriate services being delivered as the solution. There are individuals in services that they do not need or want e.g. an analysis of individuals in in-house day services carried out as part of the modernisation programme estimates that 45% could access other universal opportunities with little or no support.

Business Drivers

To improve individuals’ and their families experience of services A large number of professionals currently work with people with disabilities and their families / friends. Professional and organisational boundaries often mean that the experience people have is poor. A core working group of managers and frontline workers analysed 34 social care cases in April 2012 by reviewing files, speaking to professionals & parents/carers (where possible) and visiting schools. This analysis found that on average 17 professionals are involved in any one case, although this could typically be as many as

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37 across health, education and social care services. This results in:

• Individuals having to retell their story and having to be available for multiple visits, appointments and assessments

• Hand-offs causing delays and errors e.g. multiple inputs / forms to set up direct payments, errors in starting new support arrangements.

• Needs being identified through professional lenses with the focus on individual needs and outcomes being lost e.g. no further action decisions being taken because an individual did not meet a specific service criteria.

• Conflicting advice from different professionals and confusion e.g. between school and social worker or social worker and Benefits Agency.

• Increased family stress and uncertainty as young people transition from children’s to adult’s services.

To improve efficiency and value for money Current social care and wider People based demographics in Staffordshire reflect the national position; needs and their associated costs are increasing steadily whilst overall funding is reducing. It is recognised that nationally there will be growth in the number of people with learning disabilities in England over the next two decades for three key reasons, these being (1) an the increase in proportion of younger British adults who belong to Bangladeshi and Pakistani South Asian minority ethnic communities (among whom evidence suggests there may be a two to three fold increase in the prevalence of more severe learning disability in children and young adults); (2) increased survival rates among young people with severe and complex disabilities; (3) reduced mortality among older adults with learning disabilities. Modelling shows an average increase of around 1% per annum is expected over the two decades 2001 – 2021 on a base number of 65,000 children and 145,000 English adults with severe or profound learning disabilities, and 1.2 million with mild or moderate learning disabilities (Valuing People 2008). Our own analysis tells us that there are over 19,000 school age children who are supported with their Special Educational Needs with some 2353 – 5715 having a learning disability. There are approximately 18,000 adults with some level of learning disability, of whom approximately 3,300 have moderate to severe learning disabilities. Staffordshire, when compared to national comparators spends a higher proportion of gross expenditure on adults with learning disabilities (aged 18-64) living in nursing and residential care homes and a lower proportion on day and domiciliary care support, as shown in the charts below. Source: NASCIS 2011/12 Nursing and Residential Care: Proportion of Gross Current Expenditure 2011-12 Staffordshire – Learning Disability

Comparator Average 42.7%, Comparator Max 65.0%, Comparator Min 16.4%, Comparator Ranking: 7 of 32

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g High Low Ranking Source Day and Domiciliary Care: Proportion of Gross Current Expenditure 2011-12 Staffordshire – Learning Disability

Comparator Average 52.0% Comparator Max 81.2% Comparator Min 26.5% Comparator Ranking: 26 of 32 This suggests that there is room for improvement in developing independent living for the largest cohort of people that Independent Futures will support. On its own and without considering the financial impact of other efficiency savings, if Staffordshire operated at comparator averages in its use of resources (aged 18-64), savings of over £2 million per annum should be achievable. Other efficiency savings could be expected to arise from reducing the reliance on in-house care provision, particularly residential and day services and reducing the number of people requiring social care support (without allowing for demographic change). The impact of population change together with inefficiency in the systems, structures and processes used results in:

• Insufficient capacity in current teams to respond to current demands and undertake timely review of services e.g. annual reviews that should occur for all do not always take place, alternative community based support is not promoted.

• Professionally narrow assessment and review arrangements, with insufficient resource being available to provide the holistic and lifelong support that will result in improved outcomes for the individual and improved value for money.

• Transition arrangements that support planning for adulthood and assist young people to achieve their ambitions are not effective, with some individuals not gaining support until their needs escalate / they fall into crisis.

• Higher placement and other support costs because people are not supported holistically to achieve their ambitions and / or the community based support that they might want or need (as oppose to a service).

• Independent living not being promoted and developed to the level that could be achieved, together with the other opportunities that come with this e.g. employment, involvement in communities, health and wellbeing etc.

Summary of Key Benefits

Improved Outcomes • Greater opportunities for enablement and independent living with a consequent

reduction in dependence. • A maximising of ability and responsibility for the individual, so that they are able to

live the life they want. • Greater choice and control through an extension of personal budgets to those that

have not yet had access to these. • Opportunities for greater levels of inclusion in local communities, benefiting people

with disabilities and local providers e.g. community and voluntary sector organisations.

• Avoidance of crisis management through people feeling well supported and able to obtain support when needed.

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• Improved safeguarding through balancing more effectively risk and empowerment. As measured by:

- number of people in settled accommodation - number of people of working age in paid employment - number of people in education, employment or training - number of people accessing self-directed support - number of people receiving a personal budget - number of people accessing specialist services - proportion of people supported in residential or nursing care - proportion of people supported to live independently in their own home - number of people accessing local authority day services - number of people accessing local authority residential care - number of adult protection referrals - proportion of adult protection referrals that are repeat referrals

Improved Experience

• Improving satisfaction with IF services as a result of:

- reducing unnecessary delays - reducing family confusion and anxiety by working towards creating one version

of the truth for families and reducing families having to retell their story - improved relationships between workers and individuals and their families

through collaborative, holistic approach - improved choice and control of individuals in deciding the right options to help

them achieve their outcomes

• Improving understanding of needs and outcomes, being guided by what is important to individuals and their families, without being constrained by current role boundaries.

• Improving staff morale (job satisfaction in enabling individuals to achieve outcomes and seeing the impact of this). As expressed by one member of the early implementation team “this way of working allows us to deliver a service to people we work with in a way that I know we all want to do, without duplication and constraint, but with accountability and guidance with the individual and their families at the heart of it.”

• Improving quality of service providers as they widen their focus to develop individual independence and achievement of outcomes – for specialist providers this means moving away from a ‘caring only’ focus and for universal providers this means being able to adapt to customers that may have different wants and needs.

As measured by:

- feedback from individuals and their families to measure and enable further improvements:

o satisfaction with IF service o having choice and control o reduction in family confusion and anxiety, particularly around transition from

childhood to adulthood o reduction in families having to retell their story

- timeliness and completeness of:

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o assessment following referral o person centred planning, transition plan, housing option plan and other

appropriate plans following referral o implementation of support arrangements following assessment and person

centred planning o carer assessment, planning and implementation of support arrangements o reviews

- satisfaction levels amongst staff group - improved quality of service providers

Improved Efficiency and Value for Money

• Directing and aligning the right resource (skills and capacity) to the specific needs of individuals e.g. undertaking timely reviews, whole-life and person-centred planning.

• Developing the key worker role so that all individuals have a single named contact providing lifelong support that will enable them to meet their wants and needs and be capable of drawing in any specific expertise needed. This role will also ensure that maximisation of universal support and services takes place avoiding direction into specialist services that are not required and / or create dependence.

• Supporting delivery of modernisation to re-provide in-house residential and day opportunities placements at a community level.

• Reducing unnecessary delays in the support that people require through enhanced capacity.

• Reducing the numbers of individuals needing to access services in the future due to increased independence and prevention of needs escalating

• Increasing individuals in the right employment or training to enhance their independence and control over their own lives.

As measured by:

- Reduced cost of support packages - Number of people being supported and support by service type e.g. residential

care, day care, home care etc. - Reduction in whole life costs spent on individuals - Achievement of MTFS savings - Referrals resulting in care and support packages - Referrals resulting in universal support

The key benefits can be best expressed in totality by making reference to case studies. Two case studies that have arisen during the design of Independent Futures are attached as Appendix A to the Business Case. A summary of the first of those is detailed below. Case study 1: Sian A holistic, family approach freed from constraints of current role boundaries

• Sian is a 13 month old child with a working diagnosis of cerebral palsy. Existing Approach

- Referral to social care would have resulted in an initial assessment of social care needs and then closed as not meeting criteria. As a low priority case the referral to Occupational Therapy would have remained on waiting list until allocated, with then

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a longer delay to order and make available specialist equipment. - Further referral to social care would likely have resulted in delays, the support that

the family will have needed in respect of welfare benefits and debt management would not have been provided at the time required and housing needs would have been directed towards the housing association involved with the family.

Working Differently

- A Key Worker listened to the family’s story without being constrained by traditional role boundaries, considering all needs and shifting the focus away from whether to provide option of short breaks / direct payments which was implied solution on social care referrals.

- The worker identified family tensions and made time to talk to and positively involve dad who was at work during initial visits. Kept in touch regarding second referral by a phone call to mum who explained that she had had a bad week. Also ensured that a faster and more effective provision of equipment took place e.g. a bath seat was provided and liaison with the Physio to set up the chair took place (set up within 1 week of delivery).

- Tailored risk assessments for the family to help focus on what to do when using equipment rather than what not to do through colourful, bullet point versions, in line with other documents in the home (design of the documents determined taking into account parental dyslexia)

- Key Worker collaborated with other professionals including welfare benefits officer and housing association to help them understand Sian’s future needs. Visited properties to provide advice on future suitability and liaised with housing to stress the importance of making minor alterations to a new house (to remove cupboard at top of the stairs).

- Supported mum in not being pressured by housing association into making a decision on a potential house before dad had been able to visit the property.

Benefits The benefits of the approach taken were significant. The total cost of support provided is estimated at £3,800, as compared to an estimated cost of an alternative (respite care and direct payments) of £7,800. Although these costs are relatively low, the multi-agency future costs avoided across Staffordshire from the improved outcomes detailed below are likely to be significant. • Safe outdoors

- Parents had tried a range of prams but none of them were suitable and mum was anxious about Sian’s health when outside. Provision of new, tailor-made pram will reduce risk of aspiration and should reduce mum’s anxieties.

• Comfortable arm, hand and leg position - Sian has now had splints fitted which will support her future development, although

ideally these will not be needed in the future - Portage are supporting Sian to relax her hands and build muscles

• Attend right nursery - Mum has been supporting Sian’s development through messy play etc. In addition,

Sian is now receiving support from Portage, Physio and Speech and Language. Parents need further information to enable them to make the best decision about which nursery would be best for Sian.

• Walking down aisle at parents’ wedding - Provision of equipment (chair, bath seat, standing frame, pram) and Portage input

is helping development of posture and muscle tone • Talking more

- On first visits, Sian was not talking at all. She is now babbling and laughing more

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(is being given a muscle relaxant and equipment enables more interaction with the world)

• Sleeping through the night - This is being facilitated by muscle relaxant, sleep system and tilting bed. Parents

initially very anxious about Sian’s breathing and check her repeatedly during the night.

• Safe, comfortable and independent in the bath - Sian was initially safe in the bath but both parents were needed to bath her, with

one parent sitting in the bath to support her - The bath seat now means Sian is safe and independent, she no longer needs one

parent in the bath, and a flannel is used to prevent the bath seat strap causing a red mark

• Suitable housing - The family want to move as there are steps to their current property which mean

Sian has to be lifted up in her pram, causing potential injury to parents. There is mould in Sian’s bedroom which will not be helping with her breathing difficulties and they can smell their neighbours’ smoking

- More suitable house has been offered by housing association where parents want to live, although it is not a perfect house

• Financial security - Family were in debt (rent and council tax) but did not understand why/how to repay

debts effectively. Welfare Benefits assessor helped them produce a repayment plan which they are implementing and housing association are happy for them to move given current repayment levels.

• Parental confidence and wellbeing - On first visit, mum reported being “at breaking point” and family tensions were

evident. Now parents are talking more positively and they have set a date for their wedding. Provision of equipment reduces risk of injury to parents through lifting and has given parents more time as they are not both needed to bath Sian.

Case study 2: Peter Improving future planning by focusing on outcomes not just presenting needs

• Peter is a 17 year old looked after child with autism currently living in a children’s residential home.

Existing Approach

- Primary assessment focus would have been on responding to presenting need which is to find somewhere to live. Peter’s current skill levels and potential for independence may not have been understood (differing views on current capabilities expressed by school and children’s residential home) so independent living options would have been constrained, with a likely outcome of institutional care.

- Current assessment processes result in 3 social care professionals (a transition worker and social workers from both the children’s disability team and from the adults LD team) would be involved in planning Peter’s move, although capacity issues mean this is not always the case e.g. transition support lacking.

- Timing is not ideal as social care work is undertaken a year before the career advice support is available, with issues of mental capacity proving difficult to manage.

- Potential issues with services as there are delays is being able to agree budgets available to support Peter and provision that is available.

Working Differently

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- The assessment focus is on presenting need and on outcomes and understanding Peter’s potential for independence: skill levels, potential for achieving outcomes, managing day to day in an independent environment e.g. through observation knowing that Peter is not being able to make a sandwich.

- Triangulating information from different sources and sharing knowledge and expertise between social care staff, SYPS career’s advisor, Peter’s school, care home and parents.

- Specific and realistic outcomes are being identified for Peter in relation to his personal care skills, medication, ability to effectively manage his own anxiety, independent living skills and understanding and behaving within appropriate sexual boundaries.

- Key working approach provides the family with someone to contact if needs change/issues arise. Parents were very anxious when the IF Early Implementation Team first became involved and through the team’s approach, this anxiety has significantly reduced. Having key workers that the family trust will improve their experience of services in the future and facilitate improved outcomes for Peter. The family will not need to wait for a review; if they have concerns they know who to contact.

- Working across traditional boundaries of children and adult services means workers are in a better position to advise and prepare parents on how their role will change and what involvement they will have in decision making once their son turns 18 (workers able to share their understanding of the differences in legislation from childhood to adulthood)

- Closer and earlier working between social care and SYPS career’s advisor with the information necessary for a 139a assessment gathered and analysed without the need for a separate assessment.

- Holistic approach enables review of whether it is best for Peter to remain in school until age 19 which helps inform where he needs to live (i.e. location in relation to current school).

Benefits The benefits of the revised approach are significant financially. The net saving as a result of Peter being able to live independently is a minimum of £33,000 per annum, this being the difference between a residential care option and the assessed supported living arrangement. This saving will increase further as Peter adapts to independent living and one to one support is reduced; the provider is aware of this expectation and has experience of managing similar issues in the past.

• Focus for new home will be on developing independence and achieving outcomes, rather than institutionalisation

• Expectations set with parents and new provider before Peter moves in that focus will be on developing future independence with a view to achieving supported living

• Parents have built up trust in IF workers as they have gained a thorough understanding of Peter. Parents are therefore more likely to take on board any future advice they may receive from IF (e.g. regarding what Peter could do when he leaves school)

• Parents able to focus on Peter’s strengths and skills, rather than just worrying about the “crisis” of needing to find somewhere for him to live and implement a smooth transition

• Maintaining continuity of worker from childhood to adulthood will improve experience of transition and prevent the need for separate assessments

• Involvement of social care expertise in helping Peter and his family consider the best options for when Peter leaves school means Peter’s mental capacity will be assessed in relation to his capacity to make this decision, rather than necessarily

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relying on parents to make this decision on his behalf • Reduced need for separate assessments and prevented potential conflicting views

across social care and SYPS • More accurate understanding of current abilities and potential means parental and

professional perception that an independent specialist placement will be needed on leaving school is less likely

• Parents now proactively looking at potential colleges for Peter, enabling them to plan in a less anxious way

• Early identification of issues prevents delay later in process (i.e. resolving cost issues when receive detailed costs from potential providers)

What does the End State look like?

An Integrated Holistic Assessment and Brokerage Service The proposed service will integrate the children’s and adults assessment, care management and brokerage services into one streamlined service. The remit of workers will be changed and expanded beyond the traditional boundaries of social care to encompass a holistic, whole life view that will include education, employment, housing, health and leisure, transport and other universal / specialist support. There will be a need to not only continue to work in partnership with key stakeholders and build on the solid work and relationships already in place, but to also support partners to work differently and within the principles of Independent Futures in order for wider strategic benefits to be realised. The service will facilitate the development of a person centred plan, which will enable the individual to achieve his /her goals, and access the whole range of universal, preventative, and where necessary, more specialist support. As such, the new service will be responsible for securing availability of a range of enabling support to include community support, supported living, residential and educational placements and managing the budgets associated with these services. The service will not directly provide any such services but secure access as part of the individuals support plan. New Roles, Ways of Working and Increased Frontline Capacity New frontline roles are created within Independent Futures, in particular a Key Worker role that will:

• Collaborate with individuals and their families to gain a holistic understanding of needs and desired outcomes, considering all aspects of an individuals life

• Bring in other professionals when required, undertaking joint visits when appropriate to gain a shared and full understanding of the individual and their family

• Triangulate and analyse information from different sources, including different professional viewpoints to gain an accurate understanding of an individual’s needs and outcomes, identifying and challenging assumptions where appropriate

• Co-produce one holistic, person centred life plan with the individual and their family • Provide consistency and a key point of contact who knows an individual and their

family • Co-ordinate the commencement of options, keeping track of what is happening for

the individual and their family, rather than seeing a referral to another professional as the option being put in place

• Ensure timely reviews are carried out in line with statutory requirements and when needs are expected to change to help ensure a proactive, rather than reactive approach (e.g. to schedule a review of equipment when the child is likely to have grown out of what has been provided, to review provision when it is expected that specific outcomes will have been achieved e.g. being able to make a hot drink independently)

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• Help individuals and their families plan for future needs and changing circumstances in a less anxious way, with a focus on the outcomes they want to achieve, not just immediately presenting needs

• Provide advice and guidance and help build individual and family resilience A direct comparison of existing frontline posts i.e. excluding senior management and administrative staff shows an increase from 133 FTE to 162 FTE equivalents (+ 29 FTE). Of the 162 FTE staff group proposed, 84 FTE’s are Key or Family Workers. New Partnerships The service will work in partnership with a number of key partners to include:

• People with a Disability, Carers and Advocates including representative organisations

• Learning Disability Partnership Board • Learning Disability Carers Group • County Council and NHS Commissioners • Families First • The Multi-Agency Safeguarding Hub (MASH) • Schools, Colleges and SEN Services • Autism Outreach Services • Educational Psychology • Community LD Health Teams & Community Paediatric Services, GPs, community

and specialist health services • Assessment & Social Work Services for adults with physical disabilities (currently

provided by SSOTP) • NHS Provider Trusts • Education Support Services • JobCentre+ • Department of Work and Pensions • Voluntary & Independent Sector Providers • Local Employers • IAG Services • Other or additional partners, as directed by the commissioner, reflecting changing

market or service delivery arrangements The relationship with service users and carers will see significant change. Independent Futures, through its governance processes will develop to be more directly influenced by users and carers and potentially in the future to be user-led. New Leadership and Governance Independent Futures in the form of a new and innovative organisation with significant operational and financial responsibilities (190 FTE, £90 million annual budget) will challenge existing and develop new ways of working, address cultural norms, create real user-led arrangements and ensure efficient management of resources, all of which will require strong and effective leadership, expertise and capacity. The future consideration of delivery options means that these requirements must be present with an excellent understanding of the service area e.g. disability, the mechanics of delivering organisational change e.g. finance, legal, HR and OD, procurement etc and the opportunity e.g. government, delivery, business. The proposed structural arrangements for Independent Futures makes provision for the

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leadership, expertise and capacity required, by making provision for three key senior posts that will head up the organisation and take change forward. These are:

• Head of Independent Futures (Grade 528) • Strategic Lead – Operations (Grade G16) • Strategic Lead – Business Development (Grade G16)

Given the organisational responsibilities, the complexity of the management issues faced, the development required and the potential for transformational change, all three posts are considered essential; they allow for the right skill mix, capacity and leadership to develop Independent Futures from April 2013 and then to take this to the next stage. Learning from the development of Families First, its senior structure (Head of FF plus 4 x G16 posts) and its structural changes has helped to arrive at these plans. The delivery vehicle options appraisal will ultimately determine the specific focus of these roles but regardless of this, the organisational and business change required to achieve the outcomes set out requires the capability and capacity that is provided through these roles. The change agenda that requires support in establishing and developing Independent Futures requires support to:

• Strategic leadership and vision; • Business leadership, set-up and launch; • Business and improvement planning; • Business and workflow design; • Change management; • Reorganisation and restructuring; • Organisational development and workforce planning; • Performance management framework; • Governance development; • Engagement and involvement activity; • Communications; • Partnership development and networking; • Options development and appraisal; • Options implementation.

Whilst support will be available through the County Council to undertake the above activities, the ownership, leadership, capability, knowledge and expertise to ensure that it is delivered will need to be owned within the service It is intended that the service development will be overseen by a Project Board that will ensure that the legal, financial, operational and ongoing development and implementation of Independent Futures takes place effectively. If at a future point, a decision is made to externalise the functions of Independent Futures, then new Board structures will be developed. Service user and carer involvement will be promoted and developed within the governance framework so that development is reflective of true user / carer led principles.

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3. Critical Success Factors Factors/measures by which the Sponsor/Key Stakeholders will deem the project as being successful

• Independent Futures is established in line with design principles. • Key posts in the new operational structure are established and recruited to. • Delivery of MTFS efficiencies and improved value for money. • A robust workforce development and OD plan to embed the new way of working across the

workforce is in place, ensuring people in all roles have the necessary mindset, skills and knowledge and that they understand how to put this into practice to improve people’s experience of services and deliver personalisation

• There is a willingness from all professionals and other stakeholders to work effectively with Independent Futures (e.g. joint visits, sharing information, combing paperwork for families, being open to challenge and different viewpoints)

• The frontline workforce is given permission to think creatively and to innovate with individuals and their families and develop solutions that meet individual needs and wants, whilst also meeting organisational requirements.

• Service procedures, performance and financial frameworks enable the culture of and use of professional judgement and autonomy

• There is a planned capacity review once new way of working is embedded • Future exploration of linkages, gaps and overlaps with other services takes place to further

develop the Independent Futures vehicle (e.g. Health OTs and Physios)

4. Timescales & Key Deliverables

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Proposed Start date: 1st February 2013 Approximate duration in months: 15 months Independent Futures has been supported through a design and development stage leading to the production of this business case. There is now a need to implement the changes required to address issues highlighted and deliver key benefits. The project will be split into the following stages and produce the following deliverables: Stage Deliverable Stage 1: Initiation

February 2013 – April 2013 • Approval of business case • Senior management structure recruited to • Independent Futures structure approved and recruited to • Service design completed • Independent Futures budget agreed and in place • Implementation plan in place • Develop partnership working and interfaces (on-going) • Communication and engagement all stakeholders (on-going)

Stage 2: Development

Phase Two: April 2013 – April 2014 • OD programme to engender culture change being implemented • Strategy, business and improvement planning developed • Business and workflow design • Service model and structure in place • Commissioning intentions agreed and being delivered • Governance structure embedded • Complete research into delivery vehicle options • Present Business Case to SLT / Cabinet evaluating the benefits of delivery vehicle

for Independent Futures and make recommendations

Stage 3: Consolidation

Phase Three April 2014 - ongoing • Embed Independent Futures culture • Benefits realisations articulated, agreed and being delivered • Organisation review and evaluation in light of options appraisal • Options implementation

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Approximate duration 2012/13 2013/14 2014/15 2015

Named Deliverable 3rd Qtr

4th Qtr

1st Qtr 2nd

Qtr 3rd Qtr

4th Qtr

1st & 2nd Qtr

3rd & 4th Qtr

Business case agreed � Structure, process and governance agreed

� Recruitment to senior management roles

� Implementation Plan � Staff recruitment � � Service Launch � Organisational Development � � � Service Specification agreed with Commissioner

� Business Plan developed and implemented

� � New service delivery arrangements developed, refined and embedded

� � � �

Service delivery models explored and recommendations arrived at

� � � �

Presentation of business case and agreement to implement **

� �

New organisational arrangements implemented **

� � � �

** Dates subject to further clarification

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5. Summary of Financial Costs & Benefits The establishment of the new Independent Futures delivery model is key, either directly or indirectly to delivering the substantial savings for adult learning disability services that are identified in the County Council’s medium-term financial strategy (MTFS). These are identified in the table below.

Medium-Term Financial Strategy Adult Learning Disability

2013/14 £000

2014/15 £000

2015/16 £000

2016/17 £000

2017/18 £000

4,916 6,310 7,701 8,209 8,209 The gross budgets available from which these savings will be made total approximately £86 million per annum. At present these are planned to be managed through three different arrangements although all involve the Commissioner for Disabled People: • Independent Futures – responsible for and managing all externally commissioned placements (as with

SSOTPT for older people). • In-House Services – responsible for and managing in-house residential and day opportunity provision. • Other Block and External Contracts – managed directly by the Commissioner. The intention is that as in-house services and block contracts reduce in size as they will through the assessment and brokerage support provided by Independent Futures, with more people in receipt of direct payments, most of the £86 million budget will rest with Independent Futures. In 2013/14, it is estimated that £51.4 million will be directly controlled through the new function. Other than staffing costs of approximately £6.2 million, these budgets are utilised to provide care and support for individuals including residential care, day opportunities, supported living and care at home, as well as personal budgets / direct payments. The proposed staff complement of Independent Futures is as set out in the table below. Staffing Description FTE Senior and Service Management 7.00 Locality Management 14.00 Social Work 57.00 Occupational Therapy 6.00 Key and Family Worker 84.00 Support Staff 22.66 Total 191.66

The funding of Independent Futures at a level that enables it to develop in line with the intentions set out in this business case relies upon MTFS pressures being funded as set out in the Council’s Budget Report due to be presented in February 2013. This provides for a ‘correction’ of the overall LD Services base budget to reflect the current reported 2012/13 outturn position and an investment of £350,000 in additional staffing capacity to support the escalation of care assessments. The additional cost implications of establishing Independent Futures are included in the table below; these include redundancy and pay protection cost estimates and estimated additional operating costs including for ICT and premises. The ICT and premises costs identified arise as a result of the increased staff numbers that are allowed for in the Independent Futures model. There is no specific funding set aside to meet these costs; however, the opportunity to achieve additional savings and / or reduce the need for demographic growth suggests that these can costs can be funded. As a result of capital costs funded by revenue resources in 2013/14 there is a shortfall of resources in this year. Options to manage this position will be explored further. The table below shows that assuming MTFS savings are achieved, a breakeven position can be achieved in future years, with a small shortfall in 2013/14. This also assumes that the funding available from within

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the base budget to meet demographic growth and other pressures is sufficient. Given the intention to reduce rather than increase the number of people supported, this should also be achievable. However, it is prudent given the challenge in establishing the new Independent Futures arrangements and the savings requirements, particularly in 2013/14 to keep this under review and reassess the position regularly. The front loading of savings into 2013/14 has been identified as a key risk area within the MTFS.

Financials & Savings 2013/14 (£000)

2014/15 (£000)

2015/16 (£000)

2016/17 (£000)

2017/18 (£000)

Capital Total Capital Costs 520 Less: Capital funding identified Less: Funded from revenue 520 Capital Shortfall/(Headroom) 0 Revenue Revenue Costs - Employees 6,369 6,344 6,344 6,270 6,270 - Net Placement Costs 35,136 35,136 35,136 35,136 35,136 - Net External Contracts 325 606 806 806 806 - In-House services - Capital financing (over xyrs) - Other costs (ICT / Accommodation) 2,271 1,751 1,751 1,751 1,751 - MTFS Cost Reductions (4,116) (5,410) (6,801) (7,309) (7,309) - Resources Available for Demographic Change / Pressures

0 905 1,870 2,864 3,824

Total Revenue Costs 39,985 39,332 39,106 39,518 40,478 Base Revenue Funding - Existing resources / budgets 39,279 39,279 39,279 39,279 39,279 - New grant / external income - Revenue funding approved (MTFS Pre 2013/14)

1,518 2,558 3,698 4,598 5,538 - Revenue funding to be approved (MTFS 2013/14)

2,880 2,905 2,930 2,950 2,970

Total Base Revenue Funding 43,677 44,742 45,907 46,827 47,787 MTFS Savings Commitment (4,116) (5,410) (6,801) (7,309) (7,309) Total Net Available Funding 39,561 39,332 39,106 39,518 40,478 Revenue Shortfall / (Headroom) 424 0 0 0 0

Overall Confidence Levels in Financials: Medium

Cost Estimates

Will be subject to change as progress to develop alternative ways of working take place. The most significant risk is increased care costs as a result of demography.

Savings Estimates

Overall savings are dependent on making significant changes to existing service provision, including in-house services. High level dependency therefore, on political support for specific proposals and on embedding new ways of working within the staff group.

Additional Financial Commentary or Context Future savings will be delivered through:

• Continued modernisation of in-house residential and day services, with appropriate alternative provision developed that meets the choices made by people in achieving better outcomes.

• People that have low or moderate needs accessing universal support that enhances independence, rather than care services that create dependence.

• People being supported into employment, volunteering or training that enhances independence.

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• People utilising personal budgets and direct payments to make different choices about care and support that are better joined with other life choices.

• People requiring more intensive care and support being able to access lower cost and local alternatives.

• Market efficiencies, decommissioning block contract arrangements and developing new services that reflect wants and needs.

The expectation is that Independent Futures will reduce the number of people requiring support through the council, despite the demographic pressures that exist. The 4,100 people referred to in section 2 of the report include people that are supported as a result of ‘the way things have been done’ rather than through a more balanced view of the appropriate level of support required by the individual and the ability to ensure such support is available. On the realistic assumption that those people requiring less or no support in the future will be those people that have support arrangements that have a cost at the low end of the cost range, success in supporting people to gain their support in different ways will still have significant financial benefits. A 5% reduction in numbers, which based on assessment information for only those people accessing local authority day care is a reasonable and prudent view, when costed at current unit costs (Source: NASCIS 2011/12) suggests a saving of approximately £4 million could be achieved.

Non-Financial Benefits Benefit Description Mechanism to measure realisation of benefits Benefits realised by

See Key Benefits Section of Business Case.

6. Option Appraisal Outcome (Optional) Description of options considered Brief explanation justifying options exclusion Further development work is required to fully explore the future delivery options for Independent Futures; this business case does not consider that further work other than in broad terms. The further consideration of delivery options is timetabled to take place over the first 12 months of Independent Futures life; this aligns with the national consideration of legal issues. The changes implemented in establishing Independent Futures in the first instance are significant and will improve outcomes, experience and value for money as set out earlier in this document. Over the last ten or more years however, there has been a growing interest in alternative organisational forms of health and social care service delivery that initially focused on direct service provision and are now expanding to include assessment, care management and brokerage services. There are many examples of successful delivery models for direct service provision, but to date progress on assessment services has been slower, although examples exist. There are several inter-linked reasons for the interest and development which has occurred, including: • The continued pressure to reduce costs of service delivery, reduce bureaucracy and improve efficiency. • The desire to create organisations that foster an entrepreneurial approach to public services, which

stimulate innovation and more flexible responses to meeting need. • The opportunity to be more inclusive through co-production, with users more able to shape and

influence the development of the organisation. • A means of creating more diverse markets, allowing greater consumer choice and control. • Some evidence that staff working in such organisations are likely to be more highly motivated and

empowered, leading to higher productivity with less absenteeism, which in turn improves outcomes for people using services.

With the development of Independent Futures all of these reasons can be seen to be applicable; there is a compelling case for approaching assessment, care management and brokerage support for people with disabilities within a new paradigm, being closer to service users, carers and advocates so that co-production can be a reality and being able to develop innovative and flexible responses that reflect the

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benefits that can be delivered for the individual within the economic constraints that apply. The interest in alternatives to direct service provision has been an element of the health and social care reforms pursued by both the previous and current governments, with numerous references to social enterprise development in its broadest form, in policy and guidance documents and through existing pilots in both children’s and adult care. Assistance has been provided through the Cabinet Office Mutuals Programme to consider future options and further involvement and support through the programme is being secured. The right option for Independent Futures will only be determined through having regard to the outcomes that aim to be delivered, political consideration and maximising viability. The further development of Independent Futures over the next year will therefore explore the alternative delivery models through a separate business case, based on the experience of service delivery and outcomes that are gained, best practice, financial and legal issues and a full evaluation of options. These options will include the consideration of continuing to deliver through the local authority as the provider of assessment and brokerage services, social enterprise models, partnership models and other independent / arms length options. Broadly and in advance of a full consideration of options the potential benefits and costs that may arise from three alternatives are summarised in the table below; 1) maintaining adult and children’s services as now, 2) creating and maintaining Independent Futures as an in-house function and 3) developing Independent Futures to be an external organisation (accepting that options are extensive).

1) Maintain existing arrangements

2) Create and maintain IF as a local authority in-house function

3) Develop IF to be an external organisation

Benefits • Service stability with limited

change to existing delivery arrangements and staffing.

• Avoidance of the costs of change.

• Provides for incremental change and improvement.

Benefits • Matching of assessment and

brokerage support to needs in a consistent way.

• ‘Whole-life’, lifelong planning and person centred approaches are the default.

• Choice and control for individuals and families is consistently the default.

• Outcomes for individuals can be improved through improved support achieved by redesigned roles, capacity and expertise.

• Commissioning expectations are deliverable.

• MTFS savings are more likely to be achieved.

Benefits • As 2) with additional benefits: • Perceived to be a natural

progression from an in-house function.

• An entrepreneurial approach, more likely to take managed risks.

• Commercial opportunities both within and outside of Staffordshire are more easily accessed.

• Funding streams not open to local authorities can be accessed.

• Organisational shape and change can occur quickly and flexibly. Ability to become more user-led and adopt principles of co-production.

• Efficiency of operation.

Costs • Current service is not able to

meet needs, which will continue to be the case.

• Continued fragmentation of services that do best use capacity and expertise.

• ‘Whole-life’ ways of working and other aspects of cultural change are not deliverable.

• Commissioning requirements

Costs • Major change is required with

some disruption and difficulties likely.

• Increased financial and non-financial costs in the short-term.

• Leadership and support capacity to achieve change required is substantial – impact therefore on other

Costs • As 2) with additional costs: • Further organisational

change with implications for all stakeholders.

• Complex stakeholder management with expected challenge to proposals from some.

• Leadership and support

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7. Key Risks (Identify key risks to deliver the project and mitigating actions) Risk Description Risk Mitigation A Risk Register has been developed for the project. Risks highlighted as Red rated are identified below. MTFS savings directly or indirectly relating to IF not achieved. High level of savings in 2013/14.

• Strategic agreement around budget decision making across partners and IF financial responsibilities.

• Outcome focussed micro-commissioning processes for managed or autonomous personalised budgets.

• Proposed IF structure creates capacity to undertake assessments of individuals in current provision to identify outcomes and alternative options to achieve these.

Lack of effective operational interfaces between IF and other key services and partners.

• Further design work to include development of partnership interfaces with relevant partners and key stakeholders.

• Commissioning framework for Staffordshire County Council. Role of IF commissioner.

Building on staff consultation, creating the new staffing structure at pace, reducing staff morale and TU / staff support for change in skills mix.

• Continued testing of skill mix required through design work

• Involving managers in design testing and culture change

• OD plan • Workforce development plan

Negative customer perception and expectations regarding the implementation of IF.

• Continuation of design approach that is focussed on achieving outcomes for individuals and their families

• Individuals and their families are engaged with the design process, workforce development and evaluation of services

• Comprehensive communication and engagement plan with current user and carer led organisations

The timescale for service design has been developed based on untested assumptions, because much of what is proposed is ‘new’ on both a local and national basis. This could result in delays to the project

• Regular progress updates • Continued design input. • Robust project management. • Corporate support in further development. • External support and guidance e.g. Cabinet Office

Engagement of wider workforce to influence and shape the service design

Lack of clarity relating to practical application of the new service model could delay implementation

• Protocols for delivery of service ensuring adherence to IF cultural changes

Challenging timescale to identify appropriate • Phase implementation of new service

are not deliverable. • Outcomes and experience for

individuals are not maximised.

• MTFS savings are at high risk of non-delivery.

priorities.

capacity to achieve and manage change effectively is greater – impact therefore on other priorities.

• Skills and expertise to make change may not be available from within the Council – buy in of support necessary.

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accommodation and facilitate business infrastructure requirements could delay implementation of new service

• Robust project management. • Corporate support in further development.

Resource demand on support services from ESS may result in delays to the establishment of the service

• Phase implementation of new service • Robust project management. • Consideration by Resources Group.

Release of commissioning service specification following IF service design may result in non-alignment of service and require rebuild.

• Involvement of both key officers from commissioning and service in design, with future development planning continuing this arrangement.

• Continued design input. • Robust project management.

8. Detailed Project Information

Project Type Transformation Portfolio Area Adult and Children’s Wellbeing

Executive Sponsor/ Budget Holder

Eric Robinson Project Lead / Senior

Officer Responsible Wendy Angus-Bovell Portfolio Manager Richard Battams Project Manager Linda Salmon Finance Lead John Broad Business Case Author Glynn Dixon 9. Staff Resources Required Project Board Responsible for providing direction for the Project; approves the Business Case and ensures resources allocated to the Project Name Responsibility Wendy Angus-Bovell Project Lead and Chair Richard Hancock Strategic Lead for Families First Anna Halliday Commissioner Representative Julie Forrest-Davis Commissioner Representative Denise Tolson Commissioner Representative Ian Benson Commissioner Representative Karen Webb Independent Futures Operations Alan Percox Human Resources Lead John Broad Finance Lead Jamie MacDonald Property and Assets Lead Janice Smith ICT Lead Anna Whitehead TSU Lead Linda Salmon TSU Project Manager Jean Evans Legal Lead Paul Masterman Communications lead

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Resources calculated by service areas in number of days required (please note 20 days = 1 FTE with the exception of ICT)

Please note: Resources have been estimated to undertake the re-organisation and the option appraisal – period used Jan to July 2013 Type

Jan

Feb

Mar

Apr May June July

Project Management (TSU) 20 20 20 20 20 20 20 Design & Change (TSU) 40 40 40 40 20 20 20 HR 12 12 12 12 12 12 12 Finance tba ICT 110 60 Legal 1 1 1 1 1 1 1 Procurement 5 Organisational Development 7 6 6 4 4 4 4 Communications 4 4 4 4 4 4 4 Strategic Property 4 4 4 4 4 4 4 Policy and Performance 5 Shared Service 3 5 5 Other: 10. Commissioning / Procurement / Contract Strategy (Optional) If applicable, what process or strategy will be followed to ensure compliance and value for money Commissioning Strategy for People with Disabilities of All Ages has within it a clear specification and performance framework that will ensure that the service delivers to expected standards and outcomes. 11. Key Dependencies Inbound: this project is dependent on the delivery of these project(s) or activities Project/Activity What is the dependency (include key timings) Approval of the 2013/14 Medium Term Financial Strategy

The proposed MTFS provides for a secure financial baseline on which the development of Independent Futures relies. Final approval in Feb 2013.

Recruitment to leadership posts within the proposed structure.

Pending approval of the business case, the transformation planned will require dedicated capacity and capability. Recruitment planned for early 2013.

Consideration of safeguarding activity for children and young people

Whilst not an absolute dependency, the final shape of the proposal will be determined by consideration of how safeguarding activity is managed; this will be concluded during January 2013.

Staff consultation Staff consultation activity is underway; consideration of feedback on proposals may impact on final proposals.

Commissioning The development of a market place that meets people’s wants and needs will be developed through the implementation of the Disability Commissioning Strategy from 2013/14.

One Council and other support Support being available to assist in the development of the IF service and future delivery options; to include TSU, Customer Insight, Finance, HR, OD, Communications, Policy and Performance etc.

Outbound: other project(s) or activities will not deliver if this project is not completed Project/Activity What is the dependency (include key timings) Learning Disability modernisation programme (residential and day)

The project relies on holistic assessment and brokerage support being available (capacity and capability) if positive outcomes are to be achieved by individuals.

MTFS savings The MTFS relies on holistic assessment and brokerage support being available (capacity and capability) if VFM is to be achieved and savings secured.

Personalisation A truly personalised approach for people that receive support through IF will assist the Council in delivering its strategic intentions.

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12. Key Stakeholders Finding out what people need What consultation has taken place with the stakeholders/potential stakeholders in respect of the proposal to check out what local people need to meet the issues? Are the consultation activities you have carried out/are planning to carry out representative of the groups who will be impacted upon and are they inclusive and accessible? How will you act upon the findings of the consultation? How will you feedback to the consultees? Stakeholders who may be impacted by the project: Stakeholder Impact the project may have on stakeholder Service users and their families, carers. Positive – the feedback received from service users and carers in respect of

the new model of service should help the individual achieve better outcomes and provide more appropriate support.

Social care and other staff / Trade Unions

Formal consultation is taking place with the staff group affected by the proposals. Feedback will influence the final design

Professional colleagues / partners Different ways of working within IF will impact on professional colleagues and other organisations. Extensive involvement and engagement activity has taken place to ensure that the service design has been influenced by colleague and partner views.

Service providers Providers will through commissioning activity be expected to respond to personalised need. IF will help to identify this need and work with commissioners to ensure that capacity is available.

Commissioners See below Stakeholders who may have an impact on the project’s ability to deliver: Stakeholder Impact the stakeholder may have on the project Commissioners A service specification will set out delivery expectations for IF and identify

how through a performance framework these will be measured and managed.

Professional colleagues / partners Professional colleagues, partners and other organisations will influence the projects ability to deliver. Extensive involvement and engagement activity has taken place to ensure that the service design has been influenced by colleague and partner views.

Members Future delivery mechanisms will be established through Member approval. Service users and their families, carers. Using co-production the feedback received from service users and carers in

respect of the new model of service will influence and shape development. 13. The impact of your proposal on the Public Sector Equality Duty & Health a) In relation to protected groups/characteristics how will your proposal eliminate discrimination, advance equalities and foster good relations?

• The first stage of the project will be to complete consultation to ensure that the competitive dialogue process considers all protected groups.

• Design of the centres will take account of disabled access • The centres to cater for the needs of all elderly, people including marginalised groups.

b) From 2013 the County Council takes on the statutory responsibility for Public Health and reducing health inequalities across the County. We therefore need to know if the proposal is going to have an effect on health inequalities. The project will support the reduction of health inequalities in relation to provision of dementia care. Providers will be expected to complete a Community Impact Assessment, prior to operation to ensure compliance with equalities legislation. 14. Climate change implications All significant policies, services and project should be assessed for their significance with respect to climate change. To make this as simple as possible you are asked to assess your proposal by is impact on the key drivers of carbon emission within the council. To help you do this follows the checklist below; Will your proposal result in an increase or decrease in

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Question Answer 1 Business mileage by officer or; No change 2 Mileage of our badged fleet or; No change 3 Mileage under contract (eg taxis or: No change 4 Fuel use in our building or other

infrastructure (eg street lighting) or; No change

5 Fuel use in the building or on the sites of private sector contractors delivering a service on our behalf or;

No change

6 Waste generated in the workplace No change 7. other No change

15. Governance Mandatory Sign-offs Stakeholder Required Sign-off By Date Cabinet Member Mandatory SLT Sponsor Mandatory Project Sponsor / Budget Holder (if not SLT) Mandatory Transformation Support Unit – TOM Alignment Mandatory S151 Officer or Deputy (New / additional funding) Mandatory Project specific where includes elements below Legal (Monitoring Officer) Mandatory HR (HR Business Partner) Mandatory Property (Head of Strategic Property) Mandatory ICT (Head of ICT) Mandatory Contracts / Procurement (Staffordshire Purchasing) Mandatory [Need to consider list?] Mandatory Consulted Stakeholders Applicable? Stakeholder Name Date TSU Resourcing (Transformation projects only) Yes / No Data Security Yes / No Business Continuity Yes / No Internal Audit Yes / No [Need to consider list?] Yes / No

Supplementary Document(s) Available Document Title Short Description only (do not embed documents) Community Impact Assessment Attached

Document History Date Version Decision Made

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Appendix 1 Concept of ‘Real Wealth’ Independent Futures aims to meet requirements and address issues with a focus on ‘Real Wealth’ (Duffy, Murray and Crosby, 2010) which offers a framework for thinking about the capabilities that are needed to build a fairer society and the real factors that underpin people’s lives. It also reflects the writings of key thinkers from the disability community and should underpin the work of Independent Futures as it develops. This offers a framework for thinking about the capabilities that are needed to build a fairer society and the real factors that underpin people’s lives. It also reflects the writings of key thinkers from the disability community and should underpin the work of Independent Futures as it develops. The diagram below shows the concept of ‘Real Wealth’ that has influenced the design of an assessment and brokerage service that looks, feels and operates differently to that which currently exists.

Relationships - the ability to bond and to connect with others at the basic level; individuals and families can only thrive if they are connected to, valued by and have a sense of belonging within their local communities. Community - in order to make connections and develop relationships, people need to feel welcomed in their communities. They need to be able to access community activities and buildings, they need information that is welcoming and inclusive and more importantly access to relationships, opportunities and a wide human experience. Strengths - in order to make the most of their life people need opportunities to develop natural strengths, interests and talents and it is important that these are recognised by those that provide support. Control - personalisation provides people with the possibility to shape their own lives and develop their autonomy. With this control, they can learn about or exercise their inherent citizenship. Resilience - the experience of these four supporting elements impacts on people’s natural resilience, ultimately shaping their ability to take responsibility for the way they respond to life.