Reducing Presentations to Social Care

Presented by Phil Stevens

Director of Wales Council for the Blind

“A brief exploration of facts, ideas, problems and potential solutions”

Or…..

“troublesome truths, speculative thoughts, wild ideas and controversial suggestions…”

Reducing Presentations to Social Care …..

1) A factual statement

2) A desire to reduce demand on social care

3) A potential benefit for clients

Part One..

The facts

Reducing Presentations……. as a fact.

Benchmarking Key Performance Indicators covering 2010/11 show:

- 9 out of 22 Local Authorities record fewer presentations to VI teams than 2008/9

- 7 had more

- 5 didn’t record them/submit them

Source: VI Benchmarking Returns, WCB 2010/11

Substantial reduction where reported

2 LAs report a reduction by 25% or less

1 LA reports 35% or less

Source: VI Benchmarking Returns, WCB 2010/11

Visual Impairment Registrations

2005 : 20,656

2006 : 19,965

2007 : 17,814

2008 : 18,075

2009 : 16,081 15000

16000

17000

18000

19000

20000

21000

2005 2006 2007 2008 2009

Source: Welsh Government figures

Yes… we know…

Registration is not the same as presenting to social care

Sample analysis of 3 Local Authorities

LA 1

June 2010: 34 clients awaiting assessment, 57 awaiting rehab delivery.

June 2011: 24 Clients awaiting assessment, 8 awaiting rehab

LA 2

April 2010: 23 clients awaiting assessment, 25 awaiting rehab delivery.

June 2011: 4 Clients awaiting assessment, 6 awaiting rehab

LA 3

April 2010: 56 clients awaiting assessment, 29 awaiting rehab delivery.

June 2011: 32 Clients awaiting assessment, 0 awaiting rehab

LA 1 had same levels of staffing

LA 2 and LA 3 had less

…..miracle of efficiency and streamlining?

Reducing Presentations……. as a desire

Key policies/work strands seek to reduce dependency on social care:

- Sustainable Social Services for Wales: A Framework for Action

- The Strategy for Older People in Wales Phase 2

- Social Care Improvement Fund and ‘invest to save’ initiatives

- ‘regionalisation’ agenda

- specific work programmes such as Gwent Frailty Team

Emphasis on partnership and ‘societal support’

- work on single eligibility criteria framework for Wales

- move to maximise third sector support

- growing interest in social enterprise

- client directed support

Capacity in Teams greatly reduced:

15 LAs out of 22 seen posts removed

LA4 seen Sensory team reduced from 9 to 2

LA5 completely removed

Part Two..

The problems

Right reductions?

Growing evidence that VI clients are being failed

- Far too high eligibility criteria

- Contact centres that don’t respond to VI needs

- Failure to appropriately refer on to other help

- Massive care package cuts

Eligibility criteria - Increase in clients having care removed after re-assessment.

2009: 3 appeals 2010: 2 appeals 2011: 34 appeals to June*

- Reassessment appears financially driven

- Growing failure to recognise VI complexity around

- Co-morbidity- Depression- Isolation

*Source: WCB Referrals by clients

Eligibility criteria

“Approximately 70% of people who accessed the Low Vision Service did not meet the visual acuity guideline criteria for registration (6/60).”

Thomas Pocklington: All Wales Visual Impairment Database (AWVID), 2010

‘Single point’ Access Centres

18 Local Authorities now use ‘one-stop’ contact centre*

Of 56 VI clients interviewed, 41 said they received limited understanding on contacting them

Several questions used appear to ‘screen out’ clients

Worrying trends of service withdrawal – ‘don’t promote, and withdraw when not used’.

*Sources: WCB Regional Benchmarking 2011, Pan Wales VI Roadshow Interviews

Combine VI clients with others

VI increasingly being seen as Occupational Therapy, ‘Reablement’ or ‘Frailty’.

Future service may entail discreet, intensive, time limited intervention (the ‘OT model’ )

Worrying trend of service withdrawal – ‘don’t promote, and withdraw when not used’.

Evidence on effectiveness??

*Sources: WCB Regional Benchmarking 2011, Pan Wales VI Roadshow Interviews

Part Three..

The possibilities

“Magic 8 Ball says…”

- End of VI Rehab as a specialist profession?

- Most clients not entitled to statutory care?

- End of commissioner/provider split?

- Client directed support excusing no statutory provision?

Rehab

- VI Rehab needs national discussion

- Is cost of rehab appropriate for foundation degree course?

- Evidence needed that ‘OT model’ works

- Splitting mobility from independent living skills.

Entitlement to statutory care

- Already seeing many clients not getting services from statutory sector

- If so, are we spending resources on assessing where not necessary?

- Devolve responsibility for entire provision to third sector?

- Clarity over what is needed for charitable service provision to those who fall through net

Commissioning

- Tradition model is specification tender contract

- Limited understanding of complex sensory services

- Intelligent or ‘co-design’ not used in Wales

- Move to spot purchase reduces sustainable work force

Service pathways

- Tradition model for 3rd Sector is grant or: specification tender/award contract

- Limited understanding of complex sensory services

- Intelligent or ‘co-design’ not used in Wales

- Charitable services will blur boundaries between statutory and voluntary sector provision

Thanks for listening

Views, comments and cakes welcome…