Mps 2012

Adult Social Care
Market Position Statement 2012

A new partnership approach to commissioning care services
Market position statement 2012 Adult social care
Contents
1. Preface 4
2. Introduction 6
3. The Changing Face of Adult Social Care 9
4. Supply and Demand 12
4.1 Older People 12
4.2 Adults with Learning Disabilities 27
4.3 People with Mental Health Issues 30
4.4 Carers 33
4.5 People with Visual Impairments 36
4.6 People who are deaf or hard of hearing 39
4.7 People with Physical Impairments 42
4.8 People with Autistic Spectrum Conditions 45
4.9 People with Substance Misuse Problems 48
5. The Likely Level of Future Resourcing 50
6. People Who Fund Their Own Care 54
7. Some Suggestions for Service Delivery Models in the Future 55
8. Useful Links 58
4
One. Preface
Last year we published our hrst Commissioning
Prospectus
1
in which we set out our programme
of activities for 2010 and highlighted our
plans for 2011. The Prospectus was aimed at
individuals and organisations providing care and
support services to people in Leeds. The key
message contained in the prospectus was that
successful commissioning depends on robust
partnerships, not only between commissioning
organisations, but also with those people and
organisations delivering services on our behalf.
To this end, the Prospectus aimed to inform and
support those organisations in their business
planning and business change programmes.
Information contained in the Prospectus
about our approach to commissioning and our
practical capacity to commission still remains
relevant.
This year we have decided to build on these
foundations with the hrst Market Position
Statement for Leeds Adult Social Care. This
document initially sets out the rationale for
this initiative and how it will help us and our
partners facilitate an Adult Social Care (ASC)
market for Leeds which delivers affordable
quality outcomes for our citizens. It then goes
on to describe the public policy context to
which the market will have to respond and
most notably, how ASC is set to change
radically in the coming years. Its main task,
however, is to present our best intelligence on
current and forecast supply and demand and is
meant to be a tool for decision-making, both for
commissioners and service providers. It then
provides a guide to the likely level of future
resourcing, followed by some suggestions
for future and creative, imaginative models
of service design and delivery to meet the
challenges of diminishing resources and
increasing demand. Finally, it describes a
new and emerging role for ASC commissioners
in the market for privately funded support
for people with personal care needs.
This statement has taken shape in the broader
context of the major changes taking place in
NHS Commissioning through the establishment
of Clinical Commissioning Groups (CCGs)
and associated new structures. Alongside
our colleagues in Childrens Services we
are currently engaged in transposing our
pre-existing strong commissioning relationships
with NHS Leeds onto the new CCGs. Hitherto
we have developed robust arrangements for
joint commissioning with the NHS and it is our
intention to take these to a new level with the
CCGs, particularly in the held of commissioning
for localities as well as for the whole city.
In addition and where appropriate, we are
gearing up to take the commissioning lead
on behalf of our NHS partners, when the Local
Authority is best placed so to do.
Much work needs to be done to bring together
the evidence for investment and change.
Each area of business will need to better
harness all the data available to us, both in
the Joint Strategic Needs Assessment (JSNA)
and in those bodies of evidence currently
hosted within all the different commissioning
organisations currently operating in the city.
The MPS will form the impetus for improved
knowledge management across the piece.
Finally, the MPS is produced at a time of great
change nationally and locally and against a
backcloth of signihcant hnancial challenges.
ASC services in the city have established a
programme of activity to address both the
1
Adult Social Care Commissioning Prospectus 2010 www.leeds.gov.uk
Market position statement 2012 Adult social care Market position statement 2012 Adult social care
5
policy and hnancial challenges to seek to ensure
that the people of Leeds are provided with the
best opportunity to enjoy Better Lives in the
future.
We regard the MPS as a work in progress
in its initial phase. We very much hope it
will become a vehicle to take forward our
partnership with providers and are looking
forward to their comments and contributions
as we move forward. To this end, we are
convening a Market Development Forum,
meeting regularly and comprised of key
representatives of market stakeholders.
But please dont delay your contribution
and contact us with your comments and
reactions at 0113 247 4258.
Finally, we are greatly indebted to the support
and scholarship afforded to us by the Institute
of Public Care at Oxford Brookes University in
the production of this document.
Dennis Holmes
Deputy Director, Strategic Commissioning
6
Two. Introduction
Why do we need a Market Position
Statement (MPS) in Leeds?
Leeds City Council has set the ambitious
and challenging target of making Leeds the
best city in Europe by 2030. From an ASC
perspective, to make this happen we need to
ensure that a range of the highest possible
quality services are available at an affordable
price, offering sufhcient choice to make truly
personalised services a reality. Facilitating and
developing the markets for these services is
now an important role for local authorities;
the MPS seeks to draw together all the factors
infuencing supply and demand, both now and
in the future.
Recent research
2
has indicated that local
authorities have considerable room for
improvement in how they use ASC resources.
We need to move away from a preoccupation
with expenditure, where spend on ASC services
is viewed largely as dead money, to a position
where expenditure is seen as investment,
principally in terms of outcomes for service
users but also as a contribution to wider
agendas, such as generating social capital and
tackling inequality.
The investment paradigm requires a much
more sophisticated understanding of the
market for social care and support alongside
those parts of the market that are most closely
related, notably health and housing. We are
eager to develop intelligence about how the
market responds to different stimuli and then
how best to infuence and support it to achieve
better outcomes and value. Along with our
commissioning and provider partners we need
to develop systems for the collation
and analysis of the evidence for cost,
quality and outcomes.
Finally, the increasing use of personal budgets
will mean signihcant change for social care,
support and related markets over the next
10 to 15 years. As local authorities increasingly
relinquish their role as providers of services,
they will assume greater responsibility to
ensure that a sufhcient range of options are
available to purchase by service users and
carers. The MPS aims to meet that challenge.
What does the MPS do?
The MPS brings together, into a single
document, material from the Joint Strategic
Needs Analysis (JSNA), commissioning
strategies and other market intelligence.
It presents the data and analysis the market
needs if it is to plan its future role and function.
The MPS also identihes the needs
and preferences of different service user
groups in the market, including privately
funded service users. It suggests the
necessary change and innovation required
to service design and delivery in the future.
Finally, it provides information on the likely
level of future resourcing.
The MPS is not an end in itself. Rather, it
represents the initiation of an evolving and
creative dialogue between Leeds City Council
and its private and voluntary sector providers.
It aims to cover the whole market and not just
that funded by ASC, thereby discharging an
emerging responsibility to ensure that those
who fund their own care can make informed
and effective choices.
2
Eg J Bolton The Use of Resources in Adult Social Care DH2010
7
The MPS must take into account the bigger
picture of publicly funded services in the city.
Most notably, the wider Council and the NHS,
but also social housing providers and other
bodies investing in communities. It should also
begin to engage with industry and commerce
more broadly in order to explore opportunities
for joint enterprise. Although many parts of
the local authority will be familiar with this
approach,
it represents another new challenge for ASC.
The quality of the MPS will be judged by the
robustness of the evidence it utilises, and the
analysis derived to inform decision-making.
It will also be judged by the clarity and
accessibility of its communication for all of the
interested stakeholders in the city and beyond.
How is it arranged?
In common with the 2010/11 Commissioning
Prospectus, this Market Position Statement
is organised into the principal user groupings
and commissioning categories used by ASC. It
is currently arranged in this way because it is
largely how all Local Authority ASC departments
account their business. In the past it has been
important to organise our work in this way to
enable national benchmarking of performance.
As this requirement declines in importance,
refecting national policy changes, so greater
emphasis will be in establishing categories more
closely refecting the shared agenda with Health
colleagues.
How will it help?
All stakeholders, commissioners, providers
and service users need a better understanding
of market intelligence if they are to optimise
their experience in the market for adult care
services. The MPS is our chosen vehicle for
broadcasting the current state of market
intelligence in Leeds. We aim to achieve a
shared perspective on supply and demand,
both current and forecast, and a consensus
on what works for whom in service delivery.
Such an approach should give the market a
shape and structure, where the outcomes
which commissioners require are agreed.
This shape and structure will be sufhciently
fexible to continuously adapt and change
according to need and demand, for example,
in the shift away from a reliance on residential
care towards housing with care options for
older people.
Alongside improving our approaches to sharing
market intelligence and infuencing market
structures, the MPS will make plain the kind of
interventions in the market that commissioners
will need to make, by way of the commissioning
cycle. This will make plain the kind of markets
that will be required for any given community.
How can stakeholders make a
contribution?
It is intended that the MPS will be a living
document, regularly updated by commissioning
staff and the product of an ongoing
dialogue between commissioners and other
stakeholders, particularly service providers. All
stakeholders will be encouraged to comment
8
on and challenge the form and content of the
Statement with the aim of developing common
ownership and continuous improvement.
The submission of market intelligence will be
actively sought, as well
as ideas on market structure and facilitation.
We have set up a market development
forum, comprising representative provider
organisations, which meets on a quarterly
basis and is chaired by the Deputy Director,
Strategic Commissioning. The group will act
as a sounding board for ASC market initiatives,
including the MPS. In addition, we intend
to hold events for the broader stakeholder
community to allow people to make a
contribution.
The overall aim is to make market development
a joint enterprise for investors, providers and
customers of services.
9
Three. The changing face of adult
social care: a new offer
Local Authority commissioning intentions and
behaviour are heavily infuenced by - and
closely aligned to - the developing public policy
agenda concerned with personalising the health
and social care received by adults and older
people. This policy is not only radically altering
the nature of care and how it is provided, but
it will also transform the role of Adult Social
Services in the coming years and decades.
Thus far, personalisation has been concerned
with enabling choice and control for service
users over the support and care they receive
as individuals, for example, through individual
budgets and self-directed support. However,
the balance of power in relation to decision-
making and the control of resources has
largely remained with the statutory authorities.
In order to move away from this, the
government has issued a raft of guidance
aimed at introducing engagement and
co-production as key elements in the process
of producing health and social care
3
.
These concepts have been variously dehned and
a useful dehnition appears in the Putting People
First Communication Toolkit:
Co-production is when you, as an individual,
infuence the support and services you receive,
or when groups of people get together to
infuence the way that services are designed,
commissioned and delivered.
The greater involvement and control of
individuals and communities in decision-
making will further devolve the power of all
public bodies and, in particular, Adult Social
Services departments, to control resource
allocation. This change will fundamentally alter
the traditional role of commissioners in parallel
with the way the increasing use of self-directed
support has begun to fundamentally shift the
scale of directly provided services. Similar
processes are under way in the NHS, Education
and Childrens services. Thus, the statutory
sector will need to develop its attributes as an
enabler and supporter of decision-making, and
commissioners will perform a key role in this
new offer from Local Authorities.
This revised role for ASC will be developed
in three domains:
- Firstly, rather than directly provide
services, ASC will co-ordinate the provision
of information and advice to people
and their carers about the care options
available to them, and what might produce
the best outcomes for them. It will also
fund directly or through third parties, the
costs of care services, wholly or in part,
where people are eligible for hnancial
support. This information and advisory role
will be extended to those who fund their
own care.
3
The NHS White Papers, Equity and Excellence: Liberating the NHS
A Vision for Adult Social Care; Capable Communities and Active Citizens;
Think Local, Act Personal
10
- Secondly, ASC commissioners will be
responsible for stimulating and shaping
the market for personal care, social care
and related housing support services. It
will forge new partnerships with health
care commissioners and service providers
in the voluntary and independent sectors
to ensure that a sufhcient range of quality
services are available at an affordable price
to enable real choice. It will also provide
intelligence and information to the markets
to assist their business planning processes.
The analysis and forecasting of demand
trends will lead to the creation of business
opportunities for enterprising, fexible and
creative providers.
- Finally, it will take the lead in ensuring
that citizens have better life opportunities
in terms of their health and wellbeing.
It will inspire and oversee care providers
in the delivery of better outcomes for
service users. Quality will be incentivised
and failure will be discouraged. If Leeds is
to become the best city to live in by 2030
then those most vulnerable citizens must
be allowed to beneht from the highest
quality services available to enable them
to live as fulhlling lives as possible.
The new face of ASC will have four priorities
in terms of improving outcomes for people:
Prevention
It will strive to prevent avoidable harm
to vulnerable people wherever possible.
For example, it is commonly acknowledged
that at least 30% of unplanned admissions
of older people to hospital are not necessary
and those admissions often lead to poor
outcomes, including admission to long-term
care. Services need to be re-aligned, therefore,
to face the front door of the hospital rather than
the back door.
Personalisation
In future, ASC will only invest in services
which can evidence personalised outcomes for
the service users they support, which are both
effective and affordable.
Partnerships
It is envisaged that, in future, all services
will be delivered via partnership arrangements.
Provider organisations, including those in the
statutory sectors of health and social care,
will be encouraged to develop formal and
informal collaborations and integrated services.
Evidence of co-production as integral to service
delivery will be incentivised. New service
models, including social enterprise and
co-operatives will be supported, and ways
of engaging business and commercial
enterprises will be explored.
Productivity
In the past, the production of care was seen
as an end in itself. The move away from a
focus on outputs to emphasising improved
outcomes for people has shifted commissioners
perspective from expenditure to investment.
Also to the kinds of return that can be realised,
for example in the form of increasing social
capital within communities, stimulating
enterprise in business and promoting
co-produced care and support. Organisations
and companies providing these services are
increasingly being encouraged to evidence
11
the benehts to the wider community of their
activities with individuals. This will directly
beneht local health and wellbeing agendas.
Traditionally, ASC has organised services for
individuals or whole communities. However,
the new public policy agenda promoting
localism will mean that some services will
be commissioned for neighbourhoods and
communities of interest, thereby creating
more opportunities to invest in community
cohesion and tackling health and social
inequalities. Thus, local interest groups will
need to be better and more strongly engaged
in commissioning processes.
This new agenda, combined with tight hnancial
constraints and ever-increasing demand for
services, exposes ASC to a range of service
challenges if it is to successfully deliver on its
responsibilities:
Firstly, ASC must act to reduce demand through
investment in prevention rather than cure.
Secondly, a signihcant amount of demand
needs to be diverted away from specialist
social care services into the mainstream by
means of better signposting and information
and by sponsoring the generation of social
capital and community infrastructures.
Thirdly, remaining demand needs to be better
managed by ensuring the use of evidence-
based interventions, the avoidance of
institutional options, more timely interventions
and smarter solutions, including maximising
the potential of new technologies to provide
answers to the care needs of citizens.
In general terms, ASC is challenged to provide
improved leadership with its health partners to
ensure the drive forward to create a successful
and diverse health and social care market
capable of meeting the care and support needs
of all the citizens of Leeds.
12
Four. Supply & demand
This section of the MPS sets out for each service
user group some detailed information about
our current knowledge of supply and demand.
It explains the salient demographic features,
the extent to which demand is expressed in
presenting needs, information on the current
supply of commissioned services to meet those
needs and a description of our commissioning
intentions for the future. Much more work
is required to build this intelligence base for
commissioning decision-making, by capturing
and bringing together knowledge, data and
analysis from all sections of the market. We aim
to do this on a step-by-step basis, building the
picture year on year.
As it grows and develops, the JSNA (now in
its third year of development and publication)
will form the hub of health and social care
data, information and analysis upon which
commissioning decisions will be taken. In
addition, in recent years we have built strong
relationships with a number
of academic institutions which have assisted
us in assembling and making sense of health
and social care factors prevailing in Leeds,
as well as evaluating our attempts to deploy
innovative services which meet prescribing
needs more effectively. These include the
University of Leeds, Leeds Metropolitan
University, the University of York, the University
of Kent, Birmingham University and Oxford
Brooks University.
We need to engage other market stakeholders,
particularly providers of health and social
care and support services, in this thinking
about the rationale for investment in
particular pathways, interventions or indeed,
localities. In 2010 we commissioned Cordis
Bright Ltd., an independent consultancy to
undertake a detailed analysis of supply and
demand in relation to residential care and
associated housing options for older people
in Leeds over the next 20 years. This piece
of work formed the foundation of our current
strategy for supported living for older people
over the same period, shifting the emphasis
towards extra care, supported housing and
assistive technology, and away from long-term
institutional care solutions.
The results of the 2011 census are set to be
published this year and will form a further key
resource for demographic, economic, social and
health data to inform commissioning decisions.
One area which requires signihcant
development is in relation to the markets for
people who wholly fund their own support and
care. We need to form a new partnership with
the existing and prospective providers of a
range of care and support services, in order
to collaborate on generating market intelligence
for this sector.
4.1 Older peoples services
Demographic Trends
The age prohle of the various populations in
Leeds is predicted to show signihcant change
in the next 20 years. In 2006 the University
of Leeds was commissioned to analyse the
demographics of the city by ward, particularly
focussing on predicting the prohle of the older
age population. The study also generated a
range of valuable intelligence in relation to,
for example, emerging trends among minority
ethnic groups and increasing rates of people
13
living alone. Although the wards that contain
a signihcantly higher proportion of older
people are almost entirely in the outer areas of
Leeds, there are smaller populations of more
vulnerable older people remaining in the inner
city wards. Currently there are relatively few
older people from ethnic minority communities.
However 70% of the ethnic minority population
live in only nine wards, the majority being in
the most deprived 10% Super Output Areas.
The JSNA conhrms that, as with national trends,
the population of Leeds will contain growing
numbers of people over the age of 85, although
this is not likely to impact noticeably until about
2020. Given the prevalence of dementia, other
illnesses and long term conditions among this
age group, we know that more people are likely
to require care and support to help them (and
their carers) to manage as independently as
possible.
Figures taken from The Projecting Older
Peoples Population Information (POPPI)
system during September 2010 estimate that
in Leeds there are 38,491 people over 65 who
are unable to undertake at least one self care
activity and 47,000 unable to complete at least
one domestic task.
Cordis Bright used information from POPPI
during 2009 to estimate the social care needs
of the over 65 population in Leeds. They found
that the proportion of older people identihed
as having a social care need was close to the
national average at 35%. They estimated
that this was the equivalent of 39,500 people
over 65 in Leeds with some level of need. Of
these they proposed that 3,300 of these were
potentially in need of high levels of statutory
social care with the remainder being supported
through less intense packages of care and
beyond that by informal support networks
and carers.
14
Projections from POPPI show that the numbers
of older people who are unable to perform
at least one domestic or self care task are
estimated to increase by around 2,500/3,000
over the next hve years and by around 17,000
to 20,000 over the next 20 years. The Cordis
Bright report urged the need to develop
alternatives to residential care, particularly
Extra Care, to ensure affordability in the future.
Once published, the 2011 census will give
us crucial current insights into the unfolding
picture of our ageing society, and its particular
characteristics for Leeds, as well as valuable
comparative data for other core cities.
Expressed Demand
ASC in Leeds collate two types of information
on people seeking assistance: those people
referred and then moving on to receive
a statutory social care service following
assessment and validation of eligibility via the
application of the Fair Access to Care (FACS)
criteria. Secondly in terms of those people
assessed and then signposted to use non-
statutory support services. (Table 1)
Demands are infuenced by:
- Increasing expectations and aspirations
of older people.
- Changes within the NHS system,
particularly within acute hospital settings
- The gradual increase in numbers of older
people, in particular older people with
long-term conditions, including dementia.
- The continuation of longstanding joint ASC/
NHS service responses at the intermediate
tier to support people to maintain
independence and prevent unnecessary
long-term admissions to care homes.
- The need to offer individuals greater choice
and control over how the resources and
support are used.
- Under occupancy in residential care homes
(as documented within the Cordis Bright
report).
- Growth in the cohort of the very old
i.e. over 85s
Table 1: New referrals received by ASC 2006/07 - 2010/11 by outcome
25000
20000
15000
10000
5000
0
2163
2163
13999
2006/07 2007/08 2008/09 2009/10 2010/11
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r
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s
2426
2416
14633
3628
3628
14264
3165
3165
12896
3034
3034
13185
Other Outcome
Sign Posting
Further Action
15
Current Supply
Overall
The table below (Table 2) shows the broad
trends in service provision. There has been a
reduction in the number of people receiving
traditional services, previously largely provided
by the Local Authority, such as day care, meals
and homecare. More recently however, the
numbers of people in receipt of equipment
including telecare and self directed support
have increased, with these kinds of services
largely provided by independent and third
sector providers (including directly employed
personal assistants). These trends are in line
with recent developments and national guidance
in relation to the promotion of preventative and
personalised ASC services.
Homecare/ Community Support/
Reablement
Leeds ASC currently provides or arranges
homecare (community support) to adults who
are assessed as eligible for assistance under
Fair Access to Care Services (FACS). Leeds
ASC has set the level of eligibility at either
substantial or critical levels of need in order for
people to be entitled to statutory support.
Prior to November 2010 homecare support
was provided by a relatively large in-house
service called the Community Support Service
alongside a block contract with six external
providers. In November 2010, in conjunction
with NHS colleagues, a Framework Agreement
was established with 36 independent sector
home care providers. The directly provided
Table 2: Numbers of people aged over 65 receiving community based service by type of service 2006/07 -08/09
Day Care
Direct
Payments
Equipment
and
adaptations
Home Care
Meals
Other
Overnight
respite, not
client home
Proffessional
Support
Short Term
residential not
respite
0 1000 2000 3000 4000 5000 6000 7000

2008-09
2007-08
2006-07
16
Community Support Service is now being
restructured into a short term homecare
reablement service called the SkILs (Skills for
Independent Living) Team and a much smaller
long term service.
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
2006 2007 2008 2009 2010 2011

7934
19215
9502
18376
13778
14320
21224
128842
23984
8024
Ind Sector LA
6351
23479
Table 3: Home Care Hours Attributable to LA / Independent Sector
Table 4: Proportion of Home Care Hours Attributable to LA / Independent Sector
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2006 2007 2008 2009 2010 2011
Ind Sector % LA%
21.3%
78.7%
29.%
70.8%
34.1%
65.9%
49.0%
51.0%
62.3%
37.7%
74.9%
25.1%
The balance of hours has shifted signihcantly
over the last hve years from the Local Authority
to the independent sector as depicted in the
two graphs below (measured in September
of each year). (Tables 3 and 4)
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The total numbers of service users receiving
home care is illustrated here, and shows a
decline in numbers of over 25% from 4063
to 3025. (Table 5)
4500
4000
3500
3000
2500
2000
1500
1000
500
0
2006 2007 2008 2009 2010 2011
Table 5: Home Care Service Users 2006-2011
Table 6: Black Minority Ethnic Home care users 2007-2009
9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
2.0%
1.0%
0%
2007 2008 2009
4.2%
6.2%
7.8%
4.4%
6.0%
7.8%
5.4%
6.6%
7.8%
BME as % Users
BME as % Hours
BME as % Population
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18
The proportion of homecare users from BME
groups has increased year on year, however
this still represents an under-representation in
relation to the makeup of the population. (Table
6)
Providers on the Framework Agreement will
produce the majority of long term homecare
support in the future. As the Local Authority
continues to reduce the size of its workforce
in this area, and to increasingly specialise in
providing reablement support alongside NHS
intermediate care services, remaining demand
for long term homecare support will be provided
by independent sector contractors, either on
the framework arrangement or retained directly
by people using individual budgets to purchase
their care.
The advantages of the Framework
Agreement are:
- The Community Homecare Framework
has greatly extended customer choice in
relation to homecare providers, with 36
providers now offering more personalised
services for customers.
has increased capacity and is enabling
ASC to better meet increased demand for
homecare provision.
Service Specihcation is outcome focused,
ensuring that customers needs are met
more effectively.
- The success of the Framework can be
seen by the fact that 3000 Hours of
homecare support have transferred from
the Community Support Service (CSS)
to the framework providers in the hrst
3 months of 2011.
- The Community Homecare Framework has
achieved affordable prices for homecare
provision and is contributing to efhciencies
for ASC.
- The Community Homecare framework
agreement is a good example of
partnership commissioning as it has
been jointly commissioned by Adult
Social Care and NHS Leeds.
A growing number of adults are electing to
receive their Individual Budget as a Direct
Payment, a cash payment which they can
use to purchase their own services. In this
way, more people are choosing to meet their
domiciliary care needs through contracting
with homecare agencies themselves or
employing their own personal assistants.
In August 2010 407 people were identihed
as using an individual budget to purchase
their own support through an agency; by
August 2011 this had risen to 485. Including
those who were identihed as employing a
personal assistant the hgures rise to 757 in
August 2010 and 1083 by August 2011.
(Table 7)
19
ASC is developing a reablement service which
includes the Homecare Reablement Service
(SkILs Team), an Outreach Service and
Assistive Technology. The reablement service
compliments the work of the Intermediate
care services provided by health colleagues.
The intention is to establish a fully integrated
Intermediate Care Team (ICT) and Homecare
Reablement Service.
The SkILs Team provides short term
interventions for people with poor physical
or mental health to help them cope with their
illness by learning or re-learning the skills
necessary for daily living.
After a local pilot in 2010, from April 2011
the service was offered city-wide to new
customers and people being discharged from
Leeds hospitals who were likely to beneht
from reablement. From November 2011, the
service expanded further so that it is now also
offered to existing customers of Adult Services;
meaning that the service is now a fully
operational in-take and discharge service.
Gains demonstrated thus far include:
- The Reablement Service is bringing
customers required hours of care down,
with an average reduction of care hours of
62% over the programme of reablement.
- The Reablement Service is helping people
to live independently in their own homes,
with 70% of reablement customers not
requiring an ongoing package of care once
their reablement programme has come to
an end.
- The Reablement Service is saving the local
authority money, with an average saving
per head for reablement customers of
2,020 per year.
- The Reablement Service is seeing tangible
improvements in terms of customer
perceptions of the outcomes they are
achieving from the service.
With the service at full capacity, in 2012/13
we aim to provide homecare reablement to
approximately 2000 customers per year;
equating to the provision of 144,781 hours
of homecare reablement delivered by 150.50
whole time equivalent workers.
Looking forward, on the reablement outcomes
evidenced above, we can now say with
conhdence that with the service at full capacity,
the delivery of reablement city-wide will
contribute to a reduction in the long-term needs
of the customers who use the service.
1200
1000
800
600
400
200
0
2010 2011
Personal Assistant Home Care Agency
Table 7: Service Users using Individual Budgets
(IB) to Directed Purchase Support
N
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f

s
e
r
v
i
c
e

u
s
e
r
s

u
s
i
n
g

I
B
20
However, to work effectively, the Council will
continue to require adequate independent
sector home care capacity at the end of a
programme of reablement to enable the smooth
transfer of individuals into homecare services,
thereby facilitating a constant fow of people
through the service. Further work is required
to estimate with conhdence precisely the
aggregated hours required of the independent
sector to meet this requirement.
Accommodation options including
residential and nursing care
Leeds currently commissions around 3000
permanent residential and nursing placements
with around 2500 of these being for people over
the age of 65. The vast majority of the total are
commissioned in Leeds with around 500 being
commissioned in out of area placements.
In June 2011, ASC undertook a signihcant
consultation on the future of its current stock
of residential care facilities, in September the
Executive Board of the Council determined that
six of the homes should be de-commissioned
and a further two homes re-commissioned
as specialist intermediate care facilities to be
provided in partnership with the NHS Leeds
Community Healthcare Trust (LCHT).
In three localities Rothwell, Morley and
Otley, it was agreed that the decommissioning
process would actively begin once appropriate
independent sector local alternative provision
was on stream. In Rothwell this also includes
the potential for a local community group to
take over the existing establishment and to
run it as a community owned facility. In the
coming years ASC will wish to continue to
promote this approach wherever possible, to
stimulate the re-provision of residential stock
in the localities of Leeds nearing the end of
their useful life with modern, ht for purpose
alternatives.
ASC is developing Extra Care Housing schemes,
in partnership with independent sector housing
and social care providers, as part of a range
of alternatives to care homes. In addition to
the cost effectiveness of such schemes, they
promote independence, increase choice and
control and enable the use of self directed
support.
21
Social care policy in recent years has aimed
to reduce the need for residential and nursing
care through the commissioning of preventive
services and community based support. Whilst
there have been fuctuations in residential
and nursing care hgures in Leeds the overall
trend has been downwards in placements and
admissions. This has been against a background
of demographic changes which includes an
increasing aging population. (Tables 8 and 9)
1600
1400
1200
1000
800
600
400
200
0
129
1277
101
1299
94
1073
58
1071
64
949
80
909
70
943
69
783
70
912
33
838
96
911
N
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b
e
r

o
f

A
d
d
i
m
i
s
s
i
o
n
s
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Adults Aged 18-64
Elderly People
Table 8: Admissions to Permanent Placements 2000/01 - 2010/11
Table 9: People supported to live in permanent residential/nursing placements at 31st March 2006/07 - 2010/11
4000
3500
3000
2500
2000
1500
1000
500
0
1607
1202
564
2006/07 2007/08 2008/09 2009/10 2010/11

N
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o
f

P
e
o
p
l
e
1505
1131
488
1409
1054
502
1434
1044
539
1458
1066
538
Aged 85+
Aged 65-84
Aged 18-64
NB: ASC CAR hgures adjusted to incorporate data anomalies
22
Individual Budgets / Direct Payments
A recent development has been the introduction
and promotion of self directed support which
includes a range of options for people to wholly
or partly organise their own support by being
provided with a cash payment.
Direct Payments were hrst introduced in 2006
and personal budgets in 2008. In the hrst year
228 people received payments including 83
who were over 65. By August 2010, this hgure
had risen to 1279 including 704 over-65s.
An analysis was undertaken of older people
receiving direct payments using information
which had been recorded relating to the
intended use of payments. From a total of
715 recorded uses of direct payments, it was
found that at least 60% were intended for
homecare type services employed as a private
arrangement or through an agency. (Table 10)
Use of Self Controlled Total
Personal Budgets*
Personal Assistant 116
Agency Support 284
Respite 130
Practical 57
Meals 9
Social/Leisure 7
Transport 13
Insurance/Stationery 39
Equipment 12
Other 48
*(Count of services recorded, not people)
Grand Total 715
Table 10:
Although this represents signihcant progress,
the potential for using personal budgets and
self directed support remains largely untapped
and it is set to become increasingly infuential
in the coming years. (See Map 1 for distribution
by wards across Leeds)
Telecare
Leeds City Council provides people with
a range of telecare services which aim to
support people alone or in combination with
other services to continue to live independently
in the community.
23
The Care Ring emergency alarm call service
involves a pendant-style monitor connected
to a response centre. When activated the
alarm alerts staff in the response centre that
help is needed. The use of this service have
increased in recent years from around 1,300
in 2008/09 to over 2,000 new service users
in 2010/11. Telecare builds upon the existing
Care Ring pendant alarm system to offer added
security at home by providing equipment
such as movement sensors and medication
reminders, and extends this service to people
who suffer from cognitive difhculties or
confusion. The number of new people provided
with telecare each year is around 1,200 with
an aim to increase this to 2160 in 2012/13.
(Tables 11 and 12)
Initially the programme focused on older
and disabled people but in 2010 the remit
of the programme was broadened to include
all social care client groups, bringing it in line
with the personalisation agenda and Putting
People First.
Map 1:
24
Early Support Services
ASC also commissions a substantial range of
community based services for older people
delivered largely by third sector organisations
whose aims include: the reduction of isolation;
increased participation and involvement of
older people in the communities in which they
live; choice and control over their own lives;
and enhanced wellbeing and healthier life
choices. These include both generic services
for older people and specihc services, such
as services for people with dementia.
This commissioning activity includes jointly
funding, with NHS Leeds, 37 Neighbourhood
Networks with coverage across the city who
between them work with 16,000 older people and
harness a volunteering workforce of 6,000 people.
An example of work to support the
personalisation agenda ASC funds Keeping
House. This has been running since 2005
and aims to help people to continue to live
independently. The programme has three key
strands of activity:
- A directory of quality assured services
(http://leedsdirectory.org), so that people
can make informed choices about which
services to buy.
- Business support and investment to set
up new socially enterprising services which
support independence.
- Ongoing research to understand and
stimulate the development of the market
for independent living services.
New Installations Upgrades Overall Activity
200
180
160
140
120
100
80
60
40
20
0
97
141 140
161
133 122
128 128
144
116
128
115
158
166
139
153
157
161
158
79 76
102
102
102
92 93
127
113
130
118
105
118
128
96 98
88
44
61
57
59
26
30
40
38
31
36
22
31 26
36
35
52
43
30
I
n
s
t
a
l
l
a
t
i
o
n
s
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
10 10 10 10 10 10 11 11 11 11 11 11 11 11 11 11 11 11
Table 11: Leeds Telecare Service Activity
25
Future commissioning priorities
Commissioning activity is to be supported in
four distinct areas;
- To ensure that overall investment in health
and wellbeing opportunities for older people
and their carers is sustained, providing
information people need to gain easier
access to a full range of local services and
a broad range of early intervention and
preventative services.
- To ensure that a greater range of
enterprising care and support services are
stimulated in local communities, generating
volunteer and employment opportunities
for local people, stimulating development
opportunities in care and support
occupations and encouraging the creative
use of Individual Budgets to support this
process.
- To work with health partners to reshape
services at the intermediate tier and
provide a service that is responsive and
2,500
2,000
1,500
1,000
500
0
2007/08 2008/09 2009/10 2010/11 20011/12 2012/13

Table 12: Actual and Planned New Telecare Service Users 2007-2013
prevents older people needing to access
more intensive care and support services.
The aim is to support people to leave
hospital earlier where it is medically
appropriate.
- To increase the entire range of long term
housing, care and support options.
These overall imperatives will be supported
by resources redirected from traditional,
directly provided care and support models,
such as day care and residential care and by
generating better value and more effective
use of those remaining directly provided and
mass commissioned services. For example, in
future, resources will be directed increasingly
towards Telecare and Telehealth, improved
housing (including more extra care housing)
and a continued reduction in the use of all types
of residential and nursing care. Commissioning
will be done as a joint enterprise with the NHS
whenever it is appropriate.
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Examples of commissioning activity to support
this will include:
- Neighbourhood Network Schemes
to encourage greater enterprise and
innovation within the networks which
support older people to diversify in the
scale of their offer and plan for the future
needs of people in their locality.
- Keeping House (KH) Support the
Keeping House programme to develop the
Leeds Directory as the premier source of
information which enables older people
to make informed choices on services
they may want or need, as part of the
development of a regional E-Market
Place. Using the KH vehicle to maintain
investment in local social enterprise
organisations and to encourage market
development of activities and services
that support older people to remain
independent.
- Residential and nursing care framework
contracts with independent providers -
the use of block specialist provision will
be reduced due to a fall in demand and in
recognition that older people wish to exert
greater choice and control over where they
live. There will be a joint approach with
health to purchase care at the intermediate
tier for people with continuing health care
needs. Commissioning framework contracts
will emphasise the respective roles in
improving safeguarding and dignity
- Home care a jointly commissioned
framework contract for homecare will
advertise an approved list of providers
of care and support to direct payment
recipients and to ensure that service
recipients wishing to exercise choice and
control over their care arrangements are
able to access a wider range of potential
care providers.
- Day services consolidating work within
centres and introduce more personalised
services targeted on greatest need. This
follows the national direction of travel for
day services and the move away from
buildings accommodated day services.
- Supported housing developments
to commission additional extra care
housing facilities learning from the recent
partnership approach of the Hunslet Model.
To extend the range of sheltered housing
and housing outreach support available to
older people and disabled people within the
city.
- Dementia services future commissioning
plans will refect the National Dementia
Strategy and the local Living Well with
Dementia and wider Older Peoples Mental
Health strategies. This will include day
opportunities, home care, intermediate
care, information, support and guidance.
We intend to enter into discussions with our
partner commissioners and providers on the
following long term solutions:
- A reduction in investment in residential
care by two-thirds over the next 20 years.
- A corresponding increase in investment in
a diverse range of housing with support,
reablement and assistive technologies.
27
- The introduction of a fair price for
residential care linked to a quality
framework, raising the overall quality
of care in a diminishing market.
- The Local Authority provider services will
shrink and occupy vital specialist areas of
the market.
- Enterprise partnerships and co-production
in service delivery will be a favoured model
for investment.
- An additional 1000 units of extra care
housing available by 2020.
- Service providers will be increasingly
required to produce evidence of the
generation of social capital in their
enterprises.
- Resource centres to support dementia and
older peoples mental health and delivery of
specialist short term care options.
- Changes in commissioning patterns
towards shorter stay bed usage
(intermediate care, respite) and reduction
in long stay beds.
4.2 Adults with learning disabilities
Demographic trends
The number of adults with learning disabilities
in Leeds is increasing year on year, this is in line
with national demographics. More young people
with severe and complex disabilities survive
into adulthood with a lifelong need for care and
support. Improved healthcare means that there
is a signihcant increase in the number of learning
disabled people in the 60 plus age group.
The estimated total adult population with a
learning disability is 15,582, with a predicted
hgure of 17,350 for 2020 and 19,014 for 2030
(an increase of 22%). For people with moderate
or severe learning disability (and those likely
to be eligible for services) the estimated 2010
hgure was 3,264 with an anticipated rise to
4,125 in 2030, an increase of 26%. Further
detailed information is available in the JSNA.
In Leeds in 2005, 35 young people with
moderate to severe learning disabilities left
school at 19 and by 2009 this had risen to 89.
Expressed demand
Consultation with stakeholders, including
carers and service users, in developing the
Learning Disability Strategy and through the
Leeds Learning Disability Partnership Board has
identihed the need for:
- More opportunities to be available for
learning disabled people in mainstream
services e.g. leisure, education and
employment.
- More choice and easier access to housing.
- A skilled workforce able to meet a diverse
range of need in the community and at
home.
- Innovative ways of meeting the needs
of individuals within shared support
environments.
- Specialist services to support individuals
with very complex needs in Leeds and
prevent them from being sent out of area.
28
Current Supply
In Leeds, services and support for adults with
learning disabilities are funded by ASC, NHS
Leeds and Supporting People.
ASC directly provides some services,
predominately day care, care management
and accommodation. NHS Leeds directly
contracts with Leeds Partnership Foundation
Trust for specialist health services which
includes in patient beds, respite and some
day opportunities.
ASC provides a range of services for people
with learning disabilities. These include:
- Social work support and care management
- Learning disability housing support
- Supported living accommodation
- Respite care
- Learning disabilities day services
Over recent years the in-house services have
transformed the way they support people with
learning disabilities and this work will continue
in coming years.
The priority in Leeds is to support people
in their own tenancies. Where appropriate,
a number of people have been given the
opportunity to move back to Leeds from
out of area residential placements to newly
commissioned supported living services.
The Independent Living Project began in
2008 with the ambition of moving people
with learning disabilities out of the 13 hostel
sites across the city into more stable housing
where individuals had more choice and control
over where they live. Over 230 people with a
learning disability are now supported in a range
of housing options, including home ownership
and individual tenancies.
The day services transformation has seen
the closure of Moorend, a large segregated
day service, and investment into smaller
community-based services and support
provided by the voluntary sector.
This transformation of services will continue
through disinvestment in in-house services to
fund organisations to develop and deliver new
services and support for people with learning
disabilities. Thirteen community based projects
have been newly commissioned to offer people
with learning disabilities opportunities to access
a more personalised service. People will have a
choice about the types of things they do during
the day, and be able to do this close to where
they live.
Together with the grant funded services, the
Council will also develop small community
bases. This will ensure that all customers
will be able to have their needs met in
services in their local community. Both
Horsforth and West Ardsley Fulhlling Lives
Centres will close in 2012 and 2013. The
new grant funded projects will start running
between November 2011 and April 2012.
The Learning Disability Pooled Budget is made
up of contributions from Leeds City Council
and NHS Leeds. Payments from the Pooled
fund are made to providers in the independent
sector who deliver a wide range of services and
support to adults with learning disabilities.
29
72% of learning disability spend is in
the independent sector.
In 2009/10 there were approximately 700
people with moderate to severe learning
disabilities in Leeds supported to live in their
own tenancies. A further 390 people lived
in residential accommodation. A signihcant
number of these people live in specialist
provision outside the Leeds area. A considerable
number of people continued to live in the family
home and of these it is estimated that 280
people lived with family carers over the age
of 65.
When making new placements, Leeds strives
to achieve good value for money by using the
National Care Funding Calculator (CFC) tool
with providers. This is a tool that was developed
by the Regional Improvement and Efhciency
Partnerships (RIEPs) to support commissioners
in ensuring improved outcomes for service
users and the best use of resources. The tool
works by assessing and identifying in detail
the level of staff support required to meet an
individuals needs and agreeing a price based
on relevant market knowledge for that and
other elements of the package, such as non
stafhng related costs. Leeds uses the CFC
with providers in order to fully understand
their costs of providing accommodation based
care for each individual.
Future Commissioning Activity
To meet the challenge of demographic trends
we will need to develop innovative and fexible
ways of supporting individuals with highly
complex needs in order to ensure that they can
continue to live in Leeds. ASC and NHS Leeds
are currently working in partnership to develop
a plan for how best to meet the needs of this
group of individuals.
There is a range of respite services available
provided by ASC, Leeds Partnerships Foundation
Trust, an independent sector provider and a
shared lives scheme. A full review of these
services will be undertaken to ensure that
they can meet the demands of the future
demography.
In Leeds we spend less than the national
average on care homes and we expect
this to further decrease as commissioners
work with current residential care providers
(predominantly small group living situations)
to de-register their provision.
Take up of individual budgets has been slow,
although it is increasing. The implementation
of the learning disability supported living
framework will support individuals and care
managers to respond to the need for local
solutions.
There will be a continued move away from
segregated specialist building-based services
in favour of more personalised, community
based services and support.
We intend to begin a dialogue with our
commissioning and provider partners
on the development of an investment
plan based on evidence of need and
effectiveness of outcomes. We will also
explore the opportunities afforded by
enterprise development partnerships with
the Independent and Voluntary Sectors
for the delivery of new services.
30
4.3 People with mental health issues
Mental Health Services for working
age adults (16-65)
Demographic Trends
Mental ill health is the single largest cause of
disability in the UK, contributing up to 22.8%
of the total costs, compared to 15.9% for
cancer and 16.2% for cardiovascular disease.
The wider economic costs of mental ill health
in England have been estimated at 105.2
billion each year. This includes direct costs
of services, lost productivity at work and
reduced quality of life. Of the 2.6 million people
on long term health related benehts, 43%
have a mental or behavioural disorder as their
primary condition. At least one in four people
will experience a mental health problem at
some point in their life and almost half of all
adults will experience at least one episode of
depression during their lifetime.
The Leeds Mental Health JSNA, published in
2011, concludes that the patterns of mental
health in Leeds broadly refect the national
picture, however there are inequalities in
mental health outcomes within the population of
Leeds. Higher levels of poor mental health and
wellbeing are linked to deprivation and one in
hve people in Leeds live in neighbourhoods that
are amongst the 10% most deprived in England.
Some mental health problems are becoming
more prevalent in Leeds, refected in data around
depression and the signihcantly higher levels of
psychotic disorders reported in Leeds compared
to the national picture. It is estimated that there
are 86,337 people, aged between 18 and 64
years, living in Leeds with a common mental
disorder (such as depression or anxiety). This
hgure is projected to rise to 94,773 by 2020 and
101,690 by 2030 ( an increase of 18% on 2010).
The number of people with a psychotic disorder
(such as schizophrenia or bi-polar disorder)
was estimated to be 2,145 in 2010 and this
number is projected to rise to 2,523 by 2030.
An estimated 38,648 people in Leeds have 2
or more psychiatric disorders. These numbers
represent 5.9% of the 18 to 64 year old
population in the city and this is predicted
to rise to 45,891 by 2030.
Expressed demand
In March 2011 there were a total of 726 service
users accessing services provided by Leeds
City Council ASC across the city. The spread of
service users across the city using each centre
is represented in the diagram below. (Fig. 1)
Community Alternatives Team
The Vale
Lovell Park
Stocks Hill
290
177
130
129
Fig. 1: ASC Day Services: Number of service users as of
March 2011
31
Lovell Park day centre is located in the Inner
North East of the city, having relocated to newly
refurbished premises from Roundhay Road last
year; Stocks Hill is in the West of the city in
Armley; and The Vale is in the South of the city
on the Hunslet/Middleton border. These bases
serve the approximate geographical areas in
which they are based.
At any one time during 2010/2011, on average
1964 individuals were using the services
commissioned by ASC across the city. Over the
same period, an average of 1130 service users
were being supported by the services that are
jointly commissioned by ASC and NHS Leeds,
although systems are not in place to identify
if service users are accessing more than one
service.
The Leeds Mental Health JSNA indicates that the
relationship between ethnicity and deprivation
is signihcant in relation to local mental health
and wellbeing needs. A signihcant number
of BME communities live in the deprived
neighbourhoods of Leeds. For example, 50%
of the Asian-British/Asian-Pakistani residents
live in the 10% most deprived areas of Leeds.
Ethnic population projections suggest that non-
white groups in Leeds are likely to increase in
size signihcantly faster than the total average
growth across the city and providers will need
to ensure that they are able to respond to
the growing culturally diverse makeup of the
population of Leeds.
Current Supply
ASC provides a wide range of in-house mental
health services. These include the following:
- social work support and care management
- mental health housing related support
- accommodation with support
- respite care
- mental health community support
and day services.
The directly provided mental health day
services are building based, one in each wedge
of the city. In recent years they have moved
towards providing more community located
activity, whilst continuing to offer buildings
based groupwork and drop in sessions. In
addition, centre staff provide one to one
support for service users, helping users access
other services, activity groups in community
venues and peer support in a variety of
formats. Each Centre has a community day
where all activity is undertaken off site.
The Community Alternatives Team is a city-
wide service, supporting service users to access
mainstream activities and resources within their
own communities.
Ten mental health organisations are currently
commissioned by Leeds ASC and these provide
14 services throughout the city. Eight of these
are jointly funded with NHS Leeds. Each of the
services fall into the following groups:
- Community services. These include two
generic mental health services and two
BME specihc services, an outreach service,
an employment service and a carers
support service.
32
- Residential support. This provides 24-hour
support in a residential setting.
- Crisis service. One service can be directly
accessed by users and the service is able
to provide one to one support. The other
service offers a telephone helpline.
- Information and advice. Three services are
commissioned to ensure that service users
are able to receive information and advice,
to allow them to make informed choices.
The services are offered at a variety of
locations across the city.
- Advocacy support. This service provides
independent advocacy advice for people
experiencing mental distress and dementia.
- Counselling. One service provides
counselling and therapy for women
with moderate to severe mental health
problems, and the other provides a more
generic counselling service.
Future commissioning activity
The commissioned organisations were reviewed
between April 2008 and August 2010. The
reviews very clearly demonstrated the diversity
and quality of the work carried out within each
of the services. However, despite the quality of
what was provided, the reviews highlighted a
number of areas that needed to be addressed.
These included unequal citywide access to
services and gaps and duplication in provision.
Building upon these reviews and other sources
of information, including the i3 Project
research, the report The Future of Mental
Health Day and Accommodation Services made
recommendations about changes to the way
in which services are delivered across the city.
This report was approved by Executive Board
and consultation with service users is currently
taking place regarding the proposed model.
Recommendations include the reorganisation of
in-house mental health day services, reducing
the reliance on building-based services and a
commissioning exercise to procure a new and
comprehensive day services system.
The new model of support will:
- promote the independence and recovery of
the service user and ensure that services
which promote inclusion are available
citywide.
- be fexible and focus on delivering
outcomes that can be demonstrated
- ensure service user involvement in the
organisation and delivery of the services.
It is proposed that the following elements will
make up the new service:
- Recovery and Wellbeing Service: This
service will operate in the community,
providing individual tailored support to
overcome barriers service users may
experience and will focus upon their
recovery and inclusion.
- Information and Access Service: This
will assist service users in engaging with
mainstream opportunities and provide
33
advice and information about staying well
and healthy.
- Employment Support: To support service
users to access and sustain economic
independence through training, education
and employment.
- Creative Solutions Service: This will offer
fulhlling opportunities to aid the recovery
process. These skills-based, time-limited
group and individual activities, such as
gardening and cookery, will equip service
users with the resources to improve their
daily living skills and prevent relapse.
- BME Support Service: BME service users
remain over-represented in the most
restrictive parts of the mental health system
whilst, at the same time being least likely
to beneht from supportive and enabling
services. The BME day service will continue
to address issues associated with stigma
and exclusion. It will strive to provide a
culturally sensitive service that meets the
varied and complex mental health needs of
BME communities in the city.
It is also intended that grants will be available
to service users who wish to run initiatives such
as drop ins and peer support groups within the
community.
The existing in-house Mental Health Reablement
Service is currently being aligned with the
generic reablement service in Leeds to ensure
that all service users receive the same level
and quality of service and that they receive the
most appropriate service to meet their needs.
This should also ensure that those who require
ongoing support, transfer from reablement to
other services in a smooth and timely manner.
We intend to explore the opportunities for
enterprise partnerships between the Local
Authority and Voluntary Sector for the delivery
of these services.
4.4 Carers
Demographic Trends
According to the 2011 Census there are 70,500
carers in Leeds. This has changed very little
since the 2001 Census (70,446).
Detailed analysis of the latest Census is not yet
available so the breakdown of the hgures below
is taken from the 2001 Census analysis:
- Twenty percent were providing 50+ hours
per week, eleven percent were providing
20-49 hours, sixty nine percent were
providing 20+ hours per week.
- In Leeds 6.29% of carers were from a
black or ethnic minority community. This
hgure is lower than the population as a
whole which may indicate that people
from BME communities do not identify
themselves as carers.
- Among carers in the age groups 75+ and
85+, over half were providing 50+ hours of
care per week.
34
Expressed Demand
Carers and service users in Leeds who were
involved in refreshing the National Carers Strategy
in September 2010 expressed their need for:
- Better support from their GP through
greater understanding of the impact of
caring; systems to record carers in patient
records; provision of information on
conditions and treatments; prescription
of gym membership or complementary
therapy sessions to relieve stress and
improve mental wellbeing of carers
- Carers to be treated and respected
as fellow professionals by GPs, health
professionals and social workers
- A wider range of opportunities for carers to
take breaks
- Easier access to breaks, services and
information generally
- Provision of services and support to carers
that help sustain them in their caring role,
thereby preventing carer breakdown
- Greater carers involvement in care
planning for the cared-for person,
particularly for hospital discharges
- For health and social care professionals
to be more proactive in offering support
to carers and not assuming that they can
cope with the caring situation they are in
they should review the carer as well as the
care plan
- More social and support activities that both
carer and cared-for person can attend
together
- Continued availability of daytime services
for the cared-for person, enabling the carer
to have their own life
Current Supply
A wide range of carers services are
commissioned by Leeds City Council and the
Leeds Primary Care Trust:
- There is a city-wide generic carers advice,
information and support service which
operates from a city centre venue. It
publishes bi-monthly newsletters to 7,000
carers, and facilitates carers groups,
training and social activities.
- There are four specialist carers support
agencies in Leeds: a young carers support
service; a support service for carers over
age 65 who care for an adult with learning
disabilities; a mental health carer support
service; and a dementia carers support
service.
- A range of home based respite services
are commissioned from internal and
independent sector agencies, providing up
to eight hours of support per week to the
cared-for person in their own home, in all
parts of the city. This includes a specialist
service for BME carers who require a care-
worker of a particular cultural background.
Approximately 700 carers are supported
each year to have a regular break in this
way.
- Residential and nursing care respite is
provided in a number of local authority and
independent residential settings for older
people, and younger adults with learning
disabilities, physical disability or mental
health needs.
35
- A carers grant scheme provides a 200
grant to up to 400 carers for a single break
opportunity or holiday for themselves.
- Carers assessments are provided by ASC
for approximately 2,700 carers of adults
who use their services
- In addition to carers groups run by the
commissioned services, a small grant is
provided to 20 self-managed carers peer
support groups across the city.
- Leeds City Council produces and distributes
a range of information in printed form and
on our carers website, www.leeds.gov.uk/
caringinleeds
- A carers emergency plan scheme is
commissioned by ASC and supports 1,400
carers. This service is due to be re-
commissioned in 2012.
ASC can expect that awareness of the
needs of carers will continue to develop
as a result of the national governments
focus on their importance, and health and
social care services will need to adjust
and change accordingly, to ensure carers
can maintain a decent quality of life.
One of the priorities of the National Carers
Strategy is to raise the prohle of carers and
their needs. This is likely to mean an increase
in the number of people identifying themselves
as carers and ultimately lead to an increase in
demand for support.
It is anticipated by Care UK that demographic
change, coupled with the direction of
community care policy, will see a 60% rise in
the number of unpaid carers needed by 2037
an extra 3.4 million carers nationally.
Based on the 2001 Census data, in Leeds there
were 12,634 carers over age 65 years in 2010
and this is projected to rise to 13,792 in 2015,
14,416 in 2020 and 16,683 in 2030.
4
As self directed support is now in place to meet
the needs of individuals with care or support
needs in the community, carers are becoming
aware of the possibility of receiving personal
budgets for their own needs and ASC will be
responding to this. It is likely that growing
numbers of individual carers will be looking to
purchase respite care services for themselves,
or on behalf of the person they care for.
A signihcant amount of new funding for
carers breaks is being provided in 2011/12
to NHS Leeds to pool with the Local Authority
to provide carers breaks, through Direct
Payments. This funding will continue for three
further years. A joint plan between the Local
Authority and the NHS for respite services is in
preparation.
A review of the overall pattern of investment
and effectiveness of carers services will
be conducted in partnership with provider
organisations.
4
Figures provided by POPPI projected from the Census 2001. In 2001 womens retirement age was still 60
years but this projection excludes women aged 60-64 years.
36
4.5 People with visual impairments
Demographic Trends
The Royal National Institute of Blind People
(RNIB) estimates that there are approximately
2 million people in the UK with sight loss that
is severe enough to affect everyday life and
around 1 million people have serious sight loss
that are eligible to register as blind or partially
sighted. It is estimated that among people aged
over 65 in the UK around 300,000 have sight
loss that meets the registration criteria and a
further 800,000 have sight loss, which seriously
affects their everyday life.
The Leeds Vision Strategy 2009-2014 identihed
approximately 5,200 people registered in Leeds
as blind or partially sighted; 2,760 people
are registered as blind and 2500 people are
registered as partially sighted. Of those people
registered, approximately 632 people are in
receipt of social care services such as day care,
home care and residential care.
BME communities comprised of less than 4% of
the total population. However, national and local
evidence identihes a higher prevalence of visual
impairment in some BME groups. For example,
people of African Caribbean descent are up to
eight times more likely to suffer from Glaucoma
than the general population and it tends to
appear 10-15 years earlier than in other ethnic
groups and South Asian people have a higher
prevalence of diabetic retinopathy.
The majority of registered people are over 65
years of age. The Leeds population aged over 65
is expected to increase by over 25% by 2030,
from 109,900 in 2005 to 137,768 in 2030.
People with sensory impairment in comparison
to non disabled people are more likely to be
in receipt of a lower income; be employed in a
low level occupation; have fewer educational
qualihcations; be at risk of social isolation, and
live in a home that may not meet their social
care and support needs.
A Rapid Ophthalmic Assessment was under
taken in Leeds in 2004 to estimate the number
of people with each of the major eye diseases
across the city. The assessment estimated the
number of people affected by cataract, age
related macular degeneration, glaucoma and
diabetes and made appropriate adjustments for
age, genetic mix and gender. (Table 13)
The hndings of the ROA provided a target to
plan future service provision in reaching those
who are at risk or affected by eye disease and
a guide to how many people can be expected
from each area of Leeds.
Expressed Demand
Following a service review and extensive
consultation with approximately 450 sensory
impaired people through out 2009/2010,
vision impaired individuals and service users
supported the following key elements of the
service specihcation:
- An accessible city centre based location
- A service that used outcome focussed
support plans and person centred
approaches
- Access to appropriate IT and employment
opportunities
37
- Flexible and responsive service provision,
available in the evening and weekends
- Development of locality based services
- Benehts/housing information sessions
- Employment advice and information
- Advocacy services
- Wider availability of support and increased
access to social networks.
Current Supply
In 2011, Leeds Vision Consortium (LVC) which
comprises of Action for Blind People, SENSE
and the Wilberforce Trust was awarded a hve-
year contract to provide and develop blind and
partially sighted services for Adults. Action
for Blind People is a national charity providing
practical help and support to blind and partially
sighted people of all ages. The Wilberforce
Trust is a regional organisation for visual
impairment that provides a range of services
that include emotional support for the newly
diagnosed, assistive technology, communication
guide, domiciliary care, housing, benehts and
hnancial advice. SENSE is a leading national
charity supporting children and adults who are
deafblind.
ASC commission LVC to provide assessment
and support planning, casework, advocacy, sign
posting, information and support to enables
service users to maximise their independence,
reduce social isolation, and maintain their
individual dignity, privacy and freedom of
Table 13:
Estimates of cases of the major 4 UK blinding conditions across Leeds
Leeds Area
North West
North East
East
South
West
Total
Area
Populations
185,372
149,709
149,128
145,067
110,189
739,465
Cataract
No (%)
12,516 (6.7%)
11,939 (8.0%)
11,959 (8.0%)
10,627 (7.3%)
8,463 (7.6%)
55,503 (7.5%)
Age Related
Macular
Degeneration
No (%)
1,223 (0.6%)
1,152 (0.7%)
1,090 (0.7%)
964 (0.9%)
773 (0.7%)
5,204 (0.7%)
Glaucoma
No (%)
1,140 (0.6%)
1,093 (0.7%)
1090 (0.7%)
964 (0.7%)
770 (0.7%)
5,057 (0.7%)
Diabetes
No. (%)
5,561 (3%)
4,491 (3%)
4,473 (3%)
4,352 (3%)
3,305 (3%)
22,183 (3%)
38
choice. LVC services focus on the principles of
maximising and sustaining choice, involvement
and inclusion through the use of support plans
and quality person centred approaches that
facilitate opportunities for people who are blind,
partially sighted or deafblind to live meaningful
and fulhlled lives. Their service is inclusive to
adults aged 18+ whose sight loss affects their
ability to live a fulhlling life and impacting their
potential to live independently.
This includes people who are registered as well
as those who are not, whether sight loss is
permanent or temporary and whether it co-
exists with other impairments.
Current services available at LVC include:
- A service for older people with dual sensory
loss SENSE delivers specialised services
for people who have both hearing and
visual impairment.
- Transition coordinators primarily
working with young people aged 17-25
in their transition from school to college,
university, employment or training. The
service encourages independence and
the development of physical skills in a
supportive environment.
- Assistive technology - provides advice
and practical support to enable individuals
wishing to use technology to communicate
more effectively and to interact with others
at home and in the workplace.
- Eye care liaison ofhcer (ECLO) - the service
is based at St Jamess Hospital and liaises
with clinical staff and ASC in providing
information and advice for people who have
been diagnosed with an eye condition.
The ECLO supported approximately 899
individuals during 2010/11.
- Independent living coordinator (ILCO) -
offers information, advice and support with
day-to-day living, welfare rights, housing
issues and managing personal budgets.
ILCOs provide tailored support
in all aspects of life after sight loss enabling
service users to make informed choices
and be in control of the way individuals
maintain independence.
- Employment service provides help in
developing skills, providing career advice,
hnding a job or starting up a business or
staying in employment when faced with
sight loss.
- Locality based satellite support groups
in line with the move away from
traditional building based activities, support
services are being developed in local
neighbourhoods across the city.
- Outreach activities focus on prevention
initiatives and increased uptake of
registration amongst diverse BME
communities.
- Health and wellbeing service provides
self care management programmes and
information to help newly registered
adults to take control of their emotional
and physical well being and improve their
quality of life.
39
- Leeds City Council rehabilitation services
provide specialist assessment, early
intervention, practical training, counselling
therapeutic skills, information and
independent living skills to enable blind
and newly registered individuals to remain
independent
The development of future services within LVCs
contract will be shaped and consolidated by the
following:
- Developing a variety of approaches that
encourage uptake and access to eye care
prevention and support services particularly
amongst BME communities and people with
learning disabilities.
- To increase access to self directed support
for adults with a visual impairment or dual
sensory loss.
We intend to improve the quality of the
evidence base for investment decisions in the
coming year, drawing together the JSNA with
data systems held by the NHS and the City
Council, and those being developed by our new
providers of services.
4.6 People who are deaf
or hard of hearing
Demographic Trends
The Royal National Institute for the Deaf (RNID)
estimates that there are over nine million
people in the United Kingdom who are deaf or
hard of hearing, 28% of affected individuals
are aged between 16-60 years, with 72%
over the age of 60 years. The severity of the
impairment appears to increase with age, with
38% of those over the age of 70 years having a
mild impairment, and 10% severe impairment,
compared with 52% of those aged of 50 years
having mild hearing impairment and 7% severe
impairment.
The NHS Information Centre for Health and
Social Care recorded at 31 March 2010 56,400
people on the deaf register and 156,500 people
on the hard of hearing register for England.
As of 31st March 2008, 88,500 people were
registered as blind or partially sighted with an
addition disability and of these, 25,300 (29%)
were recorded as having a hearing impairment
(Deafblind) as their additional disability.
The register of Deaf and hard of hearing is
not compulsory so the statistics recorded
with Councils with Adult Social Services
Responsibilities (CASSRs) and submitted to the
NHS Information Centre for health and social
care, will not provide a complete picture of the
number of people in England who are deaf or
hard of hearing.
40
There are between 50,000-70,000 British Sign
Language (BSL) users in the UK and only one
fully qualihed interpreter to every 275 sign-
language users. An estimated 2 million people
in the UK use a hearing aid and there are more
than 1500 hearing dogs for the deaf.
Leeds has a population of approximately
770,000 (2009) and there are an estimated
107,000 people (one in seven) affected by
hearing loss. Age, genetics and noise pollution
are the main factors leading to hearing loss.
The most common type of hearing loss in the
UK is amongst people who are gradually losing
their hearing as part of the ageing process.
Of the 2,035 people registered Deaf or Hard
of Hearing in Leeds, 58% (1,100) of the total
number of people affected by hearing loss are
aged 65 and over. (Table 14)
Expressed Demand
Following a service review and extensive
consultations with approximately 450 sensory
impaired people through out 2009/2010 service
users supported the following key elements of
the service specihcation:
- Information, Advice and Guidance
- A service that uses support plan and
person centre approaches
- Flexible and responsive service provision,
available in the evening and weekends
- Development of locality based services
- Benehts/housing information sessions
- Specialist Social Work team with BSL
interpreters
Table 14:
Leeds Data: Breakdown of individuals who are deaf or hard of hearing
Category
Deaf and Hard
of Hearing
Current number
of Deafblind
accessing
commissioned
services
Total
Under 65s
375
5
380
Over 65s
1,660
42
1,702
Total
2,035
47
2,082
41
- Locality based social groups for deaf and
hearing impaired
- Employment advice and information
- Advocacy services
- Equipment assistance
- Day service provision for people with Deaf,
hard of hearing and Deafblind people with
learning disabilities.
Current Supply
In 2011, Birmingham Institute for Deaf (BID)
Services, in partnership with SENSE and
Signhealth was awarded a hve year contract
to provide and develop a city wide service for
adults with hearing loss. SENSE is a leading
national charity supporting children and adults
who are deaf blind and Signhealth supports the
mental health and well being of deaf people.
The Leeds service, called Deaf Across Leeds
Enablement Service (DALES) provides a variety
of services that focus on the principles of
maximising and sustaining choice, involvement
and inclusion through the use of support plans
and quality person centred approaches that
facilitate opportunities for people who are
deaf or hard of hearing to live meaningful and
fulhlled lives.
The service is inclusive to adults aged 18+
whose hearing loss affects their ability to
live a fulhlling life and impacts their potential
to live independently. This includes adults
who are registered as well as those who
are not, whether deafness is permanent or
temporary and whether it co-exists with other
impairments.
Current services available
at DALES include:
Single Point of Access (SPA) this is a drop-in
facility for individuals without an appointment
who have a benehts query or want to be
assessed for support services. The SPA service
is staffed by a full time worker and is available
Monday -Thursday (9-5pm) and Friday (9-
4.30pm)
Assistive Technology and Equipment DALES
provides assistive technology equipment,
assessments and home installation for adults
and young people aged 17+ in transition.
During 2010/11 over 1500 people used the
service to access resources such as doorbells,
alarms and room monitors as well as more
sophisticated products to ensure independence,
safety, enhance quality of life and keeping
people in their own homes.
Specialist Social Work Team DALES is currently
recruiting two specialist social workers with BSL
qualihcations to provide a community based
assessment and care management service for
adults who are deaf or hard of hearing.
Employment Information and support DALES
provides advocacy, information and support
to assist deaf people to gain employment and
access voluntary opportunities.
Day Services for deaf/hearing impaired adults
with learning disabilities Over 90 individuals
who attend DALES day service each week
have recently undertaken an assessment to
understand their aspirations and meet their
changing needs and expectations. Daytime
42
activities are no longer facilitated around
traditional building based day services,
interventions are focused on improving
learning, communication skills, accessing
leisure activities and gaining independent
living skills.
The development of future services within the
DALES contract will be shaped and consolidated
by the following:
- Developing partnerships with NHS Airedale,
Bradford and Leeds audiology services
as well as other statutory and voluntary
organisations to minimise the waiting
time between diagnosis and receiving
community based support services.
- Increasing the awareness of self directed
support and encourage greater uptake .
- Developing a variety of approaches that
encourage uptake of services amongst
working age adults, BME communities and
people with learning disabilities.
- Embed and consolidate the social work
function within DALES service.
We intend to review and improve the evidence
base for investment decisions in the coming
year, by drawing together the JSNA with data
held by the NHS, the city council and that of our
new service providers.
4.7 People with physical
impairments
Demographic Trends
In 2010, Protecting Adult Needs and Service
Information (PANSI) predicted the numbers
of people aged between 18 and 64 in Leeds
considered to have a moderate physical
impairments to be 37,362, and this number is
expected to rise by 19% by 2030 to 44,377.
The number of people with a physical impairments
and receiving an ASC service during 2010/11
totalled 8,603. It is estimated the number of
people accessing ASC with a serious physical
impairments will rise to approximately 12,348
by 2030.
The Health and Deprivation domain of the Index
of Multiple Deprivation 2010 indicates that
the areas with the highest concentration of ill
health are located towards the inner east and
south areas of Leeds, two of the most deprived
Super Output Areas. With increasing numbers
of affected ethnic populations and an ageing
population, it can be anticipated that there
will be an increase in the number of people
reporting a long-term illness in future years.
Expressed Demand
The Leeds Centre for Integrated Living (LCIL)
and University of Leeds User Dehned Outcomes
consultation research (2007), and more
recent consultation with people with physical
impairments, identihed the need for:
- Improved access and outcomes from
mainstream and universal services and
opportunities, including employment
43
- Greater fexibility and access to leisure
activities
- Greater choice and control; the
development of short-term support
arrangements
- Support services to be fexible enough
to accommodate the varying lifestyles,
routines and personal care requirements
of people (including cultural and linguistic
diversity)
- More inter-agency working between social
care and health
- Increased access to equipment service
and low/high technology to provide
possible solutions to enable people to live
independently
- Residential care as a temporary measure
rather than long-term solution
Current Supply
There is a wide range of service provision within
Leeds however, there are limited numbers of
providers who offer services exclusively for
people with physical impairments.
LCIL
In April 2011, LCIL became a user-led,
independent organisation and is established as a
Social Enterprise. LCIL has established a brokerage
service (provided by an Independent Living Guide)
for people who have chosen to receive a personal
budget to meet their needs. The LCIL service
provides support for all aspects of recruiting,
paying and managing personal support assistants
and is used by people in receipt of direct payments
(DP), personal budgets (PB) and the Independent
Living Fund (ILF) who choose to use some of their
funding to employ personal assistants.
Leeds Community Equipment Service
(LCES), Telecare and Care Ring Services
LCES is funded by ASC, Continuing Care,
Children & Young Peoples Social Care and
Health and is accessed by both adults and
children. The service is often the hrst and only
contact people with physical impairments have
with social care and provides an important
element in the prevention of further disability
by ensuring people can live at home safely and
assisting those who have difhculty with daily
living with aids and adaptations.
Telecare uses simple monitors to help people
feel safer in their home. It includes a range
of equipment linked to a social alarm or to a
carer in the same property. An alert is sent
to a response centre and the centre assists
accordingly. The telecare service also provides
equipment for continuing care Care Ring
which provides hrst and second generation
of assisted technology. Telecare provides the
second generation of assisted technology and
provides the third generation which is used
outside the home.
Domiciliary home care Skills for
Independent Living Service (SkILs)
Before November 2010 demand for domiciliary
home care services outstipped supply. In
November 2010, a framework agreement was
established in partnership with NHS Leeds to
meet the increasing need for long-term care
and support services for people with personal
and complex needs living in their own home.
44
A service specihcation has been developed
to ensure that services provided are person
centred, fexible and outcome focused to meet
the individuals own aspirations and chosen life
style; and to ensure there is added value in the
delivery of services for disabled people.
The in house Community Support Service has
been restructured into a short-term homecare
reablement service called the SkILs Team,
which is a specialist service providing short-
term interventions and support for adults to
help them regain independence.
A separate outreach team provides short-term
intervention for people outside of their home
helping people to access community services
and social activities. SkILs has now been
running for over eighteen months in the North
West area and one year in the rest of Leeds.
Some of the benehts are:
- 83% of customers referred to reablement
are successfully diverted away from
unsuitable long-term services to
support which helps them to live more
independently
- People need an average of 62% less care
hours after a six-week programme of
reablement.
- 75% of customers do not need ongoing
care after reablement.
Providers of long-term support under the
Framework Agreement must work to ensure
that the gains in independent living skills made
by individuals through use of the reablement
service are maintained.
Terry Yorath House (TYH) is a 12 bed residential
care home catering for the needs of adults with
physical impairments. Ten of the places are
available for long term residential care and two
beds are available for respite. TYH provides
residential care but there is an increasing focus
on developing the independent living skills of
residents and 30 respite users who access the
service and who may want to further explore
supported living options and exercise more
choice and control over their lives.
Resource Centre for Disabled People
The Mariners and Osmondthorpe resource
centres are primarily used by people with
physical impairments. Both provide a
combination of in-house activities based on
developing daily living skills/conhdence and
outside activities aimed at helping disabled
people to access community facilities.
The current level of day services for disabled
people will be maintained for the time being,
but they will need to diversify to adapt to the
developing needs of service users and carers.
Care & Repair
Care & Repair Leeds is a home improvement
service for older people, adults and children
with disabilities and people on low incomes. It
provides a wide range of cost effective, efhcient
services, which are fexible and can be adapted
to meet changing needs.
Future commissioning activity will focus on
reduced dependence on acute hospital and
long term care through prevention and early
intervention:
45
- Reablement Consolidating ASC
reablement service, which includes
homecare (SkILs) to assist people to
hnd the support they need to avoid
dependency and enable them to regain
skills for independent living. Service
targets for 2012/13 is to support at least
3,000 customers. Leeds ASC is working
closely with health partners to develop
a clear commissioning vision so that
services are joined up and responses are
consistent, this will be in place from 2013.
- Personalisation - During 2010/11 around
4,550 people received their social care
through a directly controlled or council
controlled personal budget. Further work
will be undertaken to ensure information
and advice regarding self directed support
are improved and more widely available to
the public.
- Day services consolidating work within
centres and introducing more personalised
services targeted on greatest need. This
follows the national guidance for day
services and the move away from buildings
accommodated day services.
- Supported housing developments to
commission additional extra care housing
facilities learning from the recent partnership
approach of the Hunslet Model. To extend
the range of sheltered housing and housing
outreach support available to older people
and disabled people within the city.
- Telecare and Assistive Technology - The
service aims to signihcantly expand the
Telecare Service so that more people can
beneht from advances in technology. We
want to develop an assistive technology
Hub, linking different services together
to ensure a more seamless service
and to implement the LCES Options
Appraisal recommendations. This will
include considering how AT services can
demonstrate greater fexibility to cater for
those that are FACs eligible or that are self-
funders.
In the coming year we intend to review and
analyse the current and projected pattern of
investment in physical impairment services
and develop a detailed 5 year plan for
future investment in telecare and assistive
technologies.
4.8 People with autistic spectrum
conditions
Demographic Trends
People with autism can have a wide variety
of support needs and any one individual with
autism can have areas where they function well
and other areas where they may need support.
The term autistic spectrum is used to refect
this variation.
Estimates of the prevalence of Autistic Spectrum
Condition (AuSC) in the UK differ depending
on the source and have varied over time as
diagnostic categories have changed. The current
estimate, from both the National Autistic Society
and the psychiatric morbidity survey is that
around 1 in a 100 people are on the spectrum.
For Leeds this would mean a current hgure
of 6,450 adults with AuSC (based on an adult
population of 645,314 in July 2009).
46
Projections for the numbers of people with
AuSC in Leeds are 5,793 in 2015, 6,090 in
2020 and 6,641 in 2030. It is not yet clear
what proportion of this number of people might
be eligible for social care support but at present
less that 20% of this number of people are
receiving social care support for AuSC.
People with autism have a very wide range
and type of support needs; they are also more
likely than not to have a co-occurring condition
these include epilepsy, and a full range of
common mental health problems. A number
of people with AuSC also have a learning
disability (dehned as an IQ less than 70) and
it is anticipated that there will be a steady rise
in the increase in the number of people with
this type of disorder as life expectancy rises.
Projections are that in 2015 there will be 695
people in Leeds with both AuSC and a learning
disability, rising to 730 in 2020 and 797 in
2030. These people with both autism and
learning disabilities are likely to have very high
level needs.
Expressed Demand
Local hgures suggest that the majority of
people on the autistic spectrum are not
currently using services. The task of supporting
these people, if they need or want support, will
fall to a number of agencies and organisations
within and outside of the Council. Much of this
work will be to provide reasonable adjustments
to enable people on the autistic spectrum to use
universal services.
There may be some need for further social
care support arising from either new diagnosis
for adults or from a clearer recognition of the
FACS eligible needs of people who are already
diagnosed. We anticipate that the numbers here
will be relatively small but this will be monitored
over the next few years.
The implication of the high level of co-occurring
conditions is that people with autism will be
using a range of existing services and, in many
cases, it will be appropriate for those services
to meet their needs. The task in this case is
to support these services, provide appropriate
training and to specify and monitor the quality
of their support for people on the autistic
spectrum.
Early indications are that there will be a growing
demand for accommodation and day support,
particularly from young people with learning
disabilities as well as autism. There will also be
a need for lower level support for people on the
spectrum, either post-diagnosis or intermittently
throughout their lives. Only a proportion of
people on the autistic spectrum will be eligible
for social care support and we anticipate a need
for preventative work ie low level open access
supports which could beneht both FACS eligible
people and those who are not FACS eligible.
There will also be a need for partnership work
with employers and education providers to help
them meet the needs of people on the spectrum.
People with autism were particularly concerned
to have support and advice around obtaining and
retaining work.
Autism is a relatively newly identihed need
and because of this health and social care
services, are not yet well designed to meet
47
peoples needs. There have been some national
developments in response to the needs of
people with autism and the failure of systems to
support them:
- The Autism Act passed in 2009
- The National Autism Strategy ` Fulhlling
and Rewarding Lives published in 2010
- The Autism statutory guidance published
in December 2010 requires Health and
Social Care to:
- improve training for staff
(both awareness raising and specialist)
- put in place a pathway for diagnosis
and assessment of autism in adults
- improve all transitions from child services
to adult services
- Ensure planning of services for people
with autism and local leadership
A city-wide Adult Autism Strategy has been
developed. This is a high level strategy which
touches on all the areas which can support
adults with autism and this will be followed by
a commissioning plan. Further developments
will be overseen by an autism partnership board
from February 2012. Information will be made
available on www.leeds.gov.uk
Current Supply
Specialist Autism Services provides specihcally
designed AuSC learning programmes with
approximately 80 places for people with autism
and Aspergers. This involves employment
support, an outreach service, AuSC awareness
and training provision.
Day services support is provided for 30 service
users by Leeds Autism Services at Mabgate.
Some people with autism receive personal
budgets or direct payments which they can
choose to spend on accommodation, day
support or outreach support either through a
provider or by recruiting their own personal
assistant(s).
Five care and support providers have been
quality assured to provide supported living for
people on the spectrum. Care managers or
individuals with personal budgets can use the
Autism Supported Living framework to source
support. (All FACS eligible)
The providers are:
- Creative Support
- Dimensions
- Home Farm Trust
- Real Life Options
- UBU
In addition three dedicated schemes are
available at Brandling Court, Potternewton Road
and Westerton Road with a capacity of 29 units
of independant living. Residential care is also
provided at Ashlar House an 8 bedroom house
and at The Thicket a 4 bedroom house.
48
Outside Leeds
Twenty six people with autism and learning
disabilities are supported out of area in
specialist residential services, some of
which also provide education. Six people
are supported in hospitals.
A commissioning priority will be to improve
the needs assessment information.
The range of needs of people on the autistic
spectrum means that, in some cases, commissioning
activity will be undertaken in partnership with
other disability groups in particular with
learning disabilities and mental health.
There is a shared overall aim with NHS Leeds to
reduce the number of out of area placements
whether these are driven by accommodation
needs or education needs.
We will help the use of personal budgets by
ensuring that there is a range of providers
in place. Only a proportion of people on the
autistic spectrum will be eligible for social
care support and we anticipate a need for
preventative work ie low level open access
support which could beneht both FACS eligible
people and those who arent FACS eligible. We
will work in partnership where we can.
The existing autism supported living framework
will be reviewed in September 2012 to ensure
it is ht for purpose in the light of current
information. A new 5 year investment plan in
line with the local strategy will be developed.
4.9 People with substance
misuse problems
Demographic Trends
Prevalence estimates of problematic drug users
resident in Leeds have been produced covering a
5 year period from 2004/05 to 2008/09. Recent
estimates based on 2008/09 data show there
are an estimated 6,055 resident in Leeds. This is
a prevalence rate of 11.11 per 1000 population
aged 15-64. Over the hve year period the
number has gone down from 6,473 in 2004/05.
Prevalence estimates by age have also been
produced and the most recent estimates show
that in Leeds there are an estimated 1,107 users
aged 15-24, 2,846 are aged 25-34 and 2,101
are aged 35-64.
An examination of service users who use
opiates or crack cocaine accessing services
between 2008/09 and 2009/10 shows 2,443
individuals were in contact with specialist drug
agencies on the 31st March 2010.
Also in the last two years 3,771 problematic
drug users resident in Leeds have received
treatment through a specialist treatment
provider.
Whilst the full extent of problematic alcohol use can
only be estimated the demand for specialist detox
and rehabilitation grow steadily year on year.
49
Expressed demand
During 2010/11 forty seven individuals
accessed out of area residential drug
rehabilitation at a cost of 363,991. Out of
those forty seven adults twenty hve successfully
completed the full programme. A further
hfteen adults spent on average seven weeks
in residential rehabilitation. Seven remained in
treatment at the end of March 2010.
Current supply
ASC currently invests in a 13 bed alcohol
residential rehabilitation service which is
provided by St Annes. The contract for this
service will expire on 31 March 2014. It will be
subject to a competitive procurement exercise.
During 2010/11 St Annes alcohol rehabilitation
service admitted 72 adults of which 40
successfully completed the programme.
ASC currently invests 350,000 in out of
area residential rehabilitation treatment
services for adults with problematic drug and
or alcohol problems. Leeds has developed
a residential rehabilitation protocol which
nationally is deemed to be a model of best
practice. ASC contracts out its community
care assessments for out of area placements
to two organisations one for drugs and
the other for alcohol. They provide a full
assessment and rehabilitation preparation
service for these groups of service users.
The National Drug Strategy launched in
December 2010 sets out a new direction for
drug treatment which is recovery oriented
and outcome focussed. It focuses on helping
individuals leave treatment with a support
structure in place around them. It also wants us
to help people hnd work.
Finally, improvements need to be made to the
Safer Leeds Treatment and Recovery Service.
To fully understand this a consultation process
is being undertaken to gather views information
and advice from across a wide range of
stakeholders.
ASC will continue to commit resources to residential
treatment as part of Leeds recovery model.
In the coming year we will review and analyse
current patterns of investment in substance
misuse services, and draft a new medium term
investment plan.
50
Five. The likely level of future
resourcing
The amount we commission
Leeds City Council recognises that it is not
the only provider and that the independent
and voluntary sectors also provide quality
care for service users. The Authority has,
over a number of years, increased the
amount of funding that is allocated to such
organisations. The chart below shows that
in 2011/12 the Authority will commission
110.1m across a range of services. (Fig. 2)
Leeds City Council Funding Constraints
The Council now operates within the context of
public sector cuts and demographic pressures,
particularly amongst older people and people
with a learning disability. Table 15 shows the
impact upon its work. ASC wants to work with
independent and voluntary sector providers to
meet needs and maintain quality whilst being
cost efhcient.
Table 16 also illustrates the funding pressures
that need to be considered over the coming
years by Leeds City Council.
It should be noted that these hgures do not
account for infationary pressures or pay
awards, and that these will need to be met
from within a smaller funding base.
Domiciliary Care hours (historic)
The Council now uses the independant sector a
lot more than it used to, as seen in Table 15.
In terms of actual hours provided, provision by
the independent sector has almost doubled over
a period of 3 years. (Table 16)
Changed Pattern of Investment
The table below shows where the Council is
investing in a more personalised and preventive
way of providing services Delivering these
services has involved a much closer working
relationship between the council and the
independent and voluntary sectors, as well as
closer relationships with other public bodies.
Fig. 2: Leeds ASC Commissioning Budget 2011/12
Learning Disability
Older People Residential and Nursing
Domicilary Care
Services Commissioned with VCFS
Physical Impairment Residential and Nursing
Mental Health
41.5M
33.3M
14.5M
11.5M
5.0M
4.3M
51

Table 15: Leeds City Council Funding Constraints
Leeds City Council Adult
Social Care
2011/12
2012/13
2013/14
2014/15
Base
Reduction
in Funding
m
50.0
27.0
8.1
20.9
Demographic
Pressures
m
27.5
17.1
24.4
31.7
Net Funding
Gap
m
77.5
44.1
32.5
52.6
Cumulative
m
77.5
121.6
154.1
206.7
Net Managed
Budget
m
178.5
180.5
181.6
177.0

Table 16: Local Authority and Independant Home Care Investment 2008-2012
Weekly Hours

2011/12
2010/11
2009/10
2008/09
LCC Provided
Hours
570,205
840,110
875,940
1,162,475
%
21%
33%
36%
52%
Hours
2,115,541
1,693,796
1,559,116
1,083,165
%
79%
67%
64%
48%
Total Hours
2,685,746
2,533,906
2,435,056
2,245,640
Independent Sector Provided
52

Table 17: Shifting Patterns of Investment
Net Managed Budget 11/12
Reablement 3,588,006
Telecare - Revenue 433,570
Telecare - Capital 1,000,000
Neighbourhood Networks 1,929,202
Direct Payments and Personal Budgets 7,932,070
These areas of service provision are expected
to be ones that will continue to be invested in
signihcantly over the coming years. (Table 17)
The ASC Directorates key priorities are aimed
at making Leeds a place where people can be
supported to have better lives than they have
now. Over the next three years it is intended
to achieve this through a powerful mixture of
enterprise and integration, where the council
increasingly integrates with health and other
service providers to create an adult social care
sector that is diverse, pluralistic, accessible
and ht for purpose for all individuals. It will
mean that people with social care needs are
empowered through their use of personal
budgets, are in control, have choice, and are
safe. We will ensure that all people know how
and where to get services appropriate to their
needs or circumstances, when they need them.
Public funding will move towards enabling
individuals to pay for the care they want, and
away from directly provided services. This means
the Council will become a catalyst for providing
more for less, for the people of Leeds.
Three priorities are key to helping achieve this
over the next three years:
Better lives through enterprise
Building on work already undertaken, ASC will
encourage existing and new kinds of enterprise
to develop in the Leeds care market. This will
include private enterprise, social enterprise, co-
operatives, user-led services, staff buyout and
a vibrant voluntary and faith sector. All of these
will work in local areas and communities to
provide older and disabled adults with a choice
and variety of services, able to respond to their
specihc needs. This approach will release social
capital and civic entrepreneurship ensuring that
the beneht of public money spent by people in
meeting their social care needs is maximised
within their local areas and communities.
53
Better lives through housing, care and
support
Complementing the hrst priority, ASC will
work with other council directorates, private
house-builders and developers, social housing
providers and community, voluntary, faith
and enterprise organisations. We will create a
mosaic of types of housing (including residential
and extra care), with care and support suited
to, and adaptable for, peoples varying needs.
With new housing options will come care and
support as necessary, to maintain people living
at home independently, safely and with dignity
for as long as possible. Each option will be
tailored not only to the needs of individuals but
to the local areas and communities in which
people live.
Better lives through integrated services
Adult social care and health services will
become more closely integrated so that peoples
experience of the support they receive in older
age, illness or disability will be more positive.
People will be treated as whole people and
without fragmentation in how their needs are
met. People will be encouraged to take control
and have their treatment, care and support
combined in a single package, which they will
be able to direct. When a persons circumstance
changes, resulting in increased vulnerability,
services will be there
to protect them and relieve the anxieties that
are associated with older or disabled life.
NHS Income
The Authority works very closely with the NHS,
including the more local NHS Leeds, Leeds
Partnership Foundation Trust and the Leeds
Teaching Hospital Trust. Figure 3 below
shows the level of funding the Authority will
receive in 2011/12 to help deliver services or
to work in partnership to deliver services for
vulnerable adults.
Income From PCTs
Grants Department of Health
Income from Other NHS Bodies
19.0M
10.1M
1.1M
Fig. 3: Income from the NHS 2011/12
54
Six. People who fund their own care
Because of the relative affuence of large parts
of Leeds around three quarters of the adult
population own their own homes - a signihcant
proportion of those with eligible needs fund
all or part of the costs of their personal care.
Those with assets of more than 23,250 must
pay the full cost of their care. Furthermore,
the tightening of eligibility criteria by ASC in
recent years, has reduced the number of those
receiving publicly funded and organised social
care services. This feature of the social care
market is particularly signihcant for older people.
And yet most Local Authorities know little about
the nature and extent of this market. A recent
survey in Which? Magazine
5
found that more
than 50% of Councils, including Leeds, did not
keep records of self-funders who pay the total
cost of their long-term care. Until recently, ASC
directorates did not see this as central to their
business, until self-funders ran out of money and
required state assistance with their care costs.
In addition, many providers regard information
about their private customers as commercially
sensitive. Also, signihcant numbers of older
people are wary of sharing information about
their personal and hnancial circumstances with
the local authority. Those factors have led to the
lack of data available to commissioners.
However, a number of things have changed.
Firstly, the development of safeguarding services
for vulnerable adults has led to a huge rise in
interventions in care settings. Secondly, the
changing role of the Care Quality Commission
has meant that local authorities are increasingly
performing a regulatory role once more, albeit
informal. Thirdly, it is increasingly recognised
that an unregulated market does not always
lead to the best choices and outcomes for
service users. Fourthly, the range of options as
alternatives to traditional care delivery, from
housing with support to Telecare, are developing
at pace and commissioners need advice and
support to make the right choices. Finally, and
perhaps most signihcantly, current arrangements
for funding long-term care have now been seen
by successive governments as increasingly
unaffordable and unfair. In July 2011, the
government published the Dilnot Commission
Report on Social Care. Its recommendations
seek to put in place sustainable long-term
solutions to those challenges. Amongst these
is a new statutory duty on local authorities to
provide advice and information to inform the
choices of self-funders and help people plan for
their long-term care needs well in advance of
when they are needed.
Clearly, as the local authority gradually
withdraws from its role as care provider,
new responsibilities are opening up to better
understand private care markets, support the
market to deliver choice and quality, intervene
where necessary to protect the vulnerable, and
develop a role in advising and guiding service
users in planning and choosing the care which
delivers the best outcomes for them.
As commissioners, we will be developing these
skills and interventions over the coming years
and forging a new partnerships with service
providers, to enable a thriving market for all
concerned.
5
Paying for Long Term Care Which? November 2011
55
Seven. Some suggestions for future
service delivery models
In future, the social care market will need to
be more creative and innovative in its design
and delivery of services if it is to successfully
meet the twin challenges of hnancial constraints
and personalised outcomes. Furthermore,
commissioners will increasingly be looking
for return on investment in much broader
terms than the production of outputs,
described earlier as the dead money model
of investment in social care. For example,
evidence of the production of social capital as a
result of investment.
This section sets out an early agenda, for
discussion with stakeholders, of concepts and
service delivery models which are likely to
feature strongly in future markets. It is hoped
that this will initiate a partnership approach
to stimulating the market where promoting
independence and choice are a reality. The list
is not exhaustive, rather it is indicative of the
direction of travel of commissioners intentions.
Care Advisor
Trip Advisor has proved hugely successful as a
tool to help consumers decide on their travel
arrangements. Could we commission a service
which, by harnessing new technology, provide
up to date information and feedback from
service users on their experiences of receiving
care and support? This would have appeal
equally for local authority-funded and self-
funded users.
Co-Production
Described earlier in this statement, co-
production is a powerful concept which helps
service users to be full partners in the process.
Service providers will, in future, be encouraged
to consider how they might build co-production
into their business models. The Care Advisor
service referred to above would clearly lend
itself to this approach. Also, current successful
user-led initiatives, such as Leeds Centre for
Integrated Living, have already set a precedent
to be developed further.
Extra Care Housing
Sometimes referred to as housing with support,
extra care is identihed as the main alternative
to residential care over the next 15 years in
Leeds. It is predicted that the city will require
the development of at least 1,000 additional
units of extra care during this period if the
residential care market continues to contract
at the current rate to one third of its capacity
by 2025. Although this forecast refects the
aging population, the issues are the same for
other service user groups. In the absence of
available public funding for such developments,
commissioners will explore options for
partnerships with property developers in order
to stimulate initiatives where opportunities
arise. This approach needs to grow signihcantly
in the coming years. Similarly, discussions
are underway with current residential care
providers on options for market repositioning to
respond to this trend.
56
Commissioners are also initiating discussions
with private sector retirement developers to
ensure that this market offers sufhcient choice
and quality for customers.
Telecare
Opportunities exist for service providers to
build in extra capacity and effectiveness
into their business models through the
innovative use of new technologies, such
as Telecare. With the continuous need to
increase productivity while driving down
costs, it is clear that those providers who
are able to exploit these opportunities will
thrive in the market. A strategic plan for
technologies in personal care will be drawn up
in partnership with service users and providers,
to include a new assistive technology hub.
Volunteering, befriending and building
social capital
As the public sector withdraws from areas of
direct provision, and new technology assumes
some of the roles traditionally performed by
care staff, attention will be needed to ensure
that service users are not left socially isolated.
In addition a new emphasis, derived from a
rich vein of evidence, is required in improving
the links between generating social capital,
community cohesion and healthy communities
in the broadest sense. For example, study
of the Italian-American community in Roseto,
Pennsylvania between 1855-65 where mortality
from heart attacks was at least 50% less than
all other local communities, found the most
important factor to be traditionally cohesive
family and community relationships. Thus, the
production of social capital was demonstrated
to translate into signihcant material health
benehts as well as the social benehts accrued.
This striking hnding was followed up with
a longitudinal study over the following 25
years. However, as the community became
increasingly Americanised with those
relationships being progressively eroded
the death rate from heart attacks steadily
increased. But in 1985 Italian-American
death rates were the same as other local
communities.
The new responsibilities for local authorities
in public health gives us an
opportunity to tackle inequalities.
A new partnership needs to be devised between
commissioners, providers and community
groups to explore how voluntary action,
befriending and peer support can deliver
the social capital which will enable people
to become more resilient and self-reliant.
Combining personalisation and community
engagement
The Combining Personal and Community
Engagement (CPCE) project in Leeds seeks
to further develop the Neighbourhood
Networks and extend the range of services
currently provided from being social activities/
signposting service to become skilled brokers,
commissioning services from and for the
local community to achieve earlier, less costly
interventions. This will be achieved by using
an increased range of social and community
57
capital, which will make it possible to extend
the use and effectiveness of scarce public
funds. This will make it possible to release
resources in the form of a community dividend
that can be shared by the local authority,
local communities and local people.
Enterprise partnerships
Leeds can boast a successful track record
in promoting partnerships to deliver health
and social care outcomes. However, the
changing role of the local authority means that
there will be a new emphasis on alternative
delivery mechanisms. These will blur the
boundaries between the statutory, voluntary
and independent sectors. There will be more
scope for local, rather than city-wide, solutions
which should enhance the community cohesion
referred to above. Social enterprises and co-
operatives will be encouraged, which will be
built on volunteering opportunities private
enterprise and the vision and values of the
statutory sector. Thus, collaboration will be
encouraged when business opportunities arise.
Through the discourse between partners, a new
language and culture for social enterprise will
be developed in Leeds.
Individual service funds (ISFs)
Up to now the personalisation agenda has
been driven by individualised budgets, but it
is clear that the responsibility for managing
such budgets is not appropriate for all service
users or their carers. In addition, the lack of
clarity about funding streams is challenging for
both voluntary sector and independent sector
providers. ISFs allow groups of service users
to give their personal budget allocations to a
chosen provider to manage on their behalf.
This allows them to retain control of their
resources whilst not having the additional
responsibility of budgetary management. They
may also beneht from economies of scale and
other solutions. At the same time, service
providers have a greater degree of hnancial
security than would otherwise be the case.
Currently ISFs are not widely used in Leeds,
but some forms of personal care, for example
housing with support, may lend themselves
to this type of delivery mechanism. Further
exploration and consideration is required.
58
Eight. Useful links
If you would like more information about
local social care needs and how the Council is
responding to them, you may hnd the following
documents helpful.
City Priority Plan 2011/2015 This document
describes what the Council and its partners are
doing to make Leeds the best city in the UK
http://www.leeds.gov.uk/Council_Publications/
Vision_for_Leeds/City_Priority_Plan.aspx
Leeds City Council Business Plan
2011/2015 This document outlines what
the Council want to change and improve over
the next four years and how they intend to
go about it) http://www.leeds.gov.uk/hles/
Internet2007/2011/42/council%20business%20
plan%20lraw.pdf
State of the City Report This sets out key
facts about Leeds, the challenges it faces and
how we, along with the NHS and other public
and third sector partners, will be working to
secure the best possible prospects for the city.
It provides a high level account of what is going
on in the city and is for anyone wanting to know
more about Leeds http://www.leeds.gov.uk/
hles/Internet2007/2011/50/sotc%20vr(1).pdf
Joint Strategic Needs Analysis This
document identihes the currently unmet
and future health, social care and wellbeing
needs of the local population. It provides a
comprehensive prohle of Leeds across a number
of areas crucial to the health and wellbeing of
the population http://www.leedsinitiative.org/
JSNA/
Local Account (Living Life Your Own
Way) 2010/2012 This document provides
an account for local citizens of the Councils
achievements and improvement priorities for
social care in Leeds www.leedsinitiaitve.org.
uk
The Leeds Safeguarding Adult Partnership
Board Annual Report 2010/11 This report
details the improvements in safeguards for
vulnerable citizens in Leeds that the Board have
achieved over the last 12 months http://www.
leedssafeguardingadults.org.uk/documents/
annual_reports/lsap_annual_report_2010-11.
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