Developing the Adult Safeguarding agenda

The Safeguarding Unit has had limited capacity to develop the work around Adult Safeguarding and this is a priority area over the next 12 months.

Implement the Signs of Safety Model across Case conference processes

The Safeguarding Unit is at the initial stages of the implementation of the SOS approach to Conference process. This is another practice area that work will be undertaken on over the next 12 months, across both Adults and Childrens case conferences.

Self Neglect / Hoarding

There have been two difficult cases this year that have highlighted to the service the need to develop our knowledge of and skills in working with people who self-neglect and hoard.

Getting a “When I Am Ready” (WIR) scheme set up by 1^st April 2016

Each Local Authority had to prepare a WIR scheme by the 1st April 2016. Significant regional and local work has been developed in order to prepare for this new duty.

Creating an Accommodation and Support Strategy for Leaving Care

We have insufficient suitable accommodation / support for some Care Leavers and we need to reduce the number of temporary Bed and Breakfast accommodation that we access for Care Leavers and build a portfolio of placements based on the revised needs analysis and Strategy.

Challenges within the integrated delivery of secondary mental health services.

Secondary mental health services in Conwy remain challenging around the interface with the Betsi Cadwaladr University Health Board.

This has been heightened during the period of special measures that the Health Board are subject to and their interim staff structures.

There are multiple issues regarding variance in access and management procedures – of differing models of Home Treatment Services and access to in-patient beds.

Recording and communication of patient records has also been an area of concern and the future integrated Health and Social Care IT system should help this. .

Significant work has been undertaken to ensure robust commissioning processes are now embedded in practice ensuring the Social Care budget sees a reduction in the current overspend going forward.

Social Care’s Vulnerable People’s service is working with the Continuing Health Care team within the Health Board to develop a Section 117 protocol which will determine the appropriate levels of funding to be apportioned mutually.

Following a spike in the number of suicides over the period leading up to 2015 a critical incident review highlighted serious concerns.

In response to the concerns a joint improvement meeting was established for managers within Health and Social Care which has produced positive changes in supervision and induction.

However fundamental and systemic issues remain a barrier to secondary mental health services working optimally currently.

Changes to reporting requirements

The new Act has introduced a major overhaul of the performance information we collect in social care.  We will now be required to report on 5 sections of information relating to adults social care:

• Performance measures that consider things like meeting statutory timescales
• Assessments – the number of people we asses at different stages
• Services
• Charges
• Safeguarding

There are 4 sections addressing social care for children:

• Performance Measures
• Care and Support
• Assessments
• Child Protection

The challenges this brings includes making sure we record all the information required to gather these data sets, writing new reports to extract the right information from our database, and testing, to ensure the data is robust.  Along with this, we are consulting with key stakeholders to ensure they know about and understand the changes.

We are also discussing with our colleagues which of the old measures we can leave behind, which ones we need to keep, and which of the new ones we’ll need to drill down for further information, to enrich our intelligence.

There is also a qualitative aspect to the information collected, which will require significant resource to coordinate.

Challenges over the coming year for Family Support & Intervention

With the implementation of the SSWBA, Family Support and Intervention service (FS&I) faces the significant challenge of mobilizing existing resources to comply with the principles of the ‘preventative agenda’.   Prevention in the first instance refers to the challenges presented in empowering families to make changes initially through Information, Advice and Assistance and whilst FS&I will not necessarily lead on these services there will be an important interface to develop with partner agencies, particularly Team around the Family (TAF), Youth Justice, Education and Health.

When families present with assessed needs requiring managed care, FS&I will be required to provide effective care and support packages with the aim to facilitate change and progression with clear outcome based results preventing an escalation through the services to ‘high end’ interventions through child protection and care proceedings.

When care proceedings present as inevitable FS&I are committed to explore every option to place children within a family environment first and foremost with family & friends and only when this is not possible through Foster Care and adoption.

In order to respond effectively to the changes in legislation and codes of practice the service will need to internally review existing resources and develop a skilled workforce to meet the challenge and promote the principles of prevention and empowerment.  Including in the service plan to deliver change:

• Develop simple and complex assessment processes locally and contribute to regional and national developments
• Care and Support packages are implemented according to assessed need
• Review current structure to ensure that workforce is deployed effectively to meet needs of the children and their families to maximise opportunities for positive change
• Upskill workforce to deliver effective interventions and work with families through outcome based and partnership approaches
• Develop participation tools to ensure that the customer voice is heard and responded to and can inform practice and service delivery
• Develop partnership forums with partner agencies in order to strengthen integrated working
• Continually evaluate and review effectiveness of the service and interventions

The most significant challenge for a social care workforce will inevitably be to make capacity to take the time out of every day work schedules, for reflection and consideration of new practice initiatives to respond to the needs of the service users within a changing landscape.  As an evolving service we need to assume a collective responsibility to ensure that this element of development can be facilitated through models of supervision, team days and service development opportunities.

All Frontline Disability Services

Recruitment of suitable staff is increasingly problematic for community support frontline posts, with very few applicants for advertised jobs.

Realignment of the Disability Service

Realignment of the teams, managing change, uncertainty for staff, accounting for staff preferences and striving to achieve this for them fairly across the service.

Ensuring the workforce is trained to deliver the Act

The capacity of trainers on the national training framework to train the workforce in Conwy.

Regional Learning & Development

Welsh Government are seeking to achieve one Learning and Development plan for the whole North Wales region, via the Social Care Workforce Development Partnership (SCWDP).

DOLs

Deprivation of Liberty Safeguards became law on the 1st April 2009. The Supreme Court Judgement of the 19th March 2014 has clarified the DoLS threshold. The criteria has been greatly reduced, which has impacted on Conwy’s ability to meet its statutory legal requirements. The impact of the judgement is that there is now a waiting list of 337 people awaiting DoLS assessments. The number of people estimated to need a DoLS assessment is expected to increase gradually year on year in line with demographic trends.

Conwy has responded by training twelve Social Work/Occupational Therapy professionals in total to carry out assessments. Each assessor has to carry out one assessment per month, this is additional of their usual case load and consists of six separate assessments per service user. There are also three permanent Best Interest Assessors all undergoing training in Chester University. (Graduation May 2016).These Assessors are dedicated to DOL’s service.

The legal requirements of the new case law cannot be met in the short term due to a lack of resources and this leaves the department open to litigation challenge from families and from people who have been deprived of their liberty without the legal safeguards being applied.

Social Services & Wellbeing Act

Under the new Act, it will be a challenge to ensure an equitable and fair approach to those people who have been in receipt of services for some time, and in addition, those who will become new service users after April.

Reduction in Families First grant AND LAP Grant for Flying Start

There has been an 11.7% reduction in grant for 2016-17 which is resulting in some loss of services (Participation Officer under consultation) plus a reduction in grant under SLA’s for external delivery. These are challenging times for Let’s Get Working / Rural Families First.

The cut in LAP (Language and Play grant) is resulting in the loss of a great teacher who currently undertakes this role for Flying Start.

Equitable Services

Having realigned teams to create a Disability Service the inequitable allocation of resources remains a challenge in particularly between people with Physical Disabilities and/or sensory impairment and people with Learning Disabilities.

Managing Resources

The Social Care budget is facing unprecedented challenges. There is increased demand across all service areas which resulted in an overspend at the close of accounts for 2015/16 in excess of £1 million.

There are a range of factors that have caused this, many of which were reported through the political process in 2015/16. However a range of additional costs further affected the overall outturn for 2015/16. The department had in the latter months of 2015/16 predicted the increase overspend and the opportunity to use the reserves was a solution.

The 2016/ 17 budget is under further pressure as it has had to agree additional funding for the Residential, Domiciliary and Supported Living (24/7) care sector to the sum of £0.75m, over and above the funding made available through business cases.  The supported living projects (24/7) are further affected by the introduction of the National Living Wage (NLW). It is clear that the policy decision taken nationally to introduce the NLW has had significant financial consequences locally. This is however not unique to Conwy.

In addition there has been an increased demand for independent placements for Looked After Children (LAC), with the independent sector seeking an uplift in fees as a result of the National Living Wage.  Both of these factors are creating additional budget pressures and a projected overspend.

In respect of LAC, pressures are due to the lack of availability of foster placements within the county and within independent providers across the region. Due to this lack of placement choice, it is sometimes necessary for some young people to be placed in higher cost residential settings, particularly where behaviours escalate and Foster carers cannot meet their needs. It’s is accepted that the introduction of the National Living Wage will hopefully address some recruitment and retention issues within the sector and make it a more attractive sector to work within. In turn, this will hopefully assist with the drive for improved quality and sustainability. However the disparity between the business cases agreed and the funding required for National Living Wage alone has resulted in a deficit.

The department has benefited from additional funding via the business cases route to the sum of £6.2m over the last 5 years and has achieved £9.4m efficiencies as part of the councils efficiency drive over the same period.

As of the 1st of April 2016 the £1.436m value of the efficiencies that were approved by Council for 2016/17 have been removed from the budget. A failure to achieve any of these initiatives will only further increase the departments overspend.

The position in 2017/18 will worsen with further increases and demand expected within the service. The worse -case scenario of the NLW is that it raises to £9.00 per hour in April 2017 which would place additional demands of £2.3m for Residential/Nursing, £1.05m for Domiciliary Care and £1.2m for Supported Living. This is on top of the potential resource shortfall for 2016/17 and that will roll forward and further pressures experienced by the care sector as a result of other council initiatives.

The Social Services and Wellbeing (Wales) Act 2014 continues to be the major driver of change. Our transformation programme successfully redefined our service structures to be better aligned to meet the needs of the Act, and we’re now at a point where established services are seeking to optimise or balance their resources against the demand, and new services are developing effective models of working, that are appropriate to people’s needs.

Our current challenges can be grouped into four categories:

• Financial challenges vs new demand
• Staffing – deployment of existing resources
• New practice initiatives
• Policy development