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Adults’ Services Department Business Plan 2008/09

Version 15 1 Contents page

Message from the Director of Adults’ Services

1. Introduction and summary - Business planning in Westminster - Adults’ Services strategic vision - Summary of Key Priorities for 2008/09 2. Service profile – where are we now - Service accountability and scope - Adults’ Services – service users - Adults’ Services organisational chart - Review of performance in 2007/08 - Operating context 3. Priorities and objectives – where we want to be - Partnership priorities - Westminster City Partnership - Local Area Agreement - LARPs - Corporate priorities - One City - Worksmart - Equalities - Go Green - Adults’ Services priorities - Adults Transformation programme - Social care Services - Commissioning for health and care - Carers - Telecare - Adult Education - Workforce development 4. Action plan – how do we get there - Objectives, priorities and performance indicators - Managing Risk

Appendices  Appendix 1 –Financial schedules

Version 15 2 Message from the Director of Adult’s Services Last year was a very successful year for Adults services in Westminster. We achieved the highest rating in the country from the Commission for Social Care Inspection for our performance. More importantly we provided a wider range of services to more people in Westminster than ever before. The challenges that lie before us are even greater. We know we are facing unprecedented demand for services and that budgets are limited. We are going to have to make sure that we make best use of resources and also transfer control over those resources to the users of our services wherever possible. In order to do this we have established a Choice and Control Board chaired by a local disabled person who is a champion for individual budgets and direct payments. This board will establish the model for individual budgets in Westminster and ensure that the necessary support is in place for people who wish to manage their own care. We will also introduce self assessment on line for simple services to help people get help quickly and easily. We will have an increased emphasis on safeguarding vulnerable people this year and our training programmes will ensure all agencies are aware of their roles and responsibilities keeping people safe. We now have joint arrangements with the National Health Service for commissioning and public health and wellbeing. We want to make sure that this year we join up front line services wherever possible and look at how we can link up with GP practices to provide one stop services. We will work with rehabilitation services to make sure we are helping people to be as independent as possible. We have developed a partnership with Counsel and Care for the Elderly to ensure that older people who are funding their own care get the best information and advice when they are making these important decisions. We have launched our Housing with Care strategy which is an ambitious programme to make sure our housing for older people is fit for the future. We plan to make sure that there are increased opportunities for people with learning disabilities to live locally and as independently as possible. We have an efficiency programme which is part of the Council’s WorkSmart initiative. We are planning to introduce electronic monitoring of services wherever possible and electronic access for people who prefer this. Staff roles will need to change to reflect the new work for Adult Social Care and we will develop our workforce strategy with providers to make sure we have the right staff for the future. Our Every Older Person Matters programme has won national recognition and we plan to ensure that Council departments and partners continue to make their services respond to the needs and demands of older people. Westminster City Partnership will focus on reducing the health inequalities currently present in Westminster and our Adults’ Services Department will be assisting to co-ordinate the response to this. We will use the Joint Strategic Needs Assessment to identify priority areas for action in 2008 and inform future commissioning. I hope you enjoy reading our Business Plan and would welcome your comments on our proposals. Marian Harrington, Director of Adults’ Services Version 15 3 1. Introduction and summary

Business Planning in Westminster

The Business Plan is a key part of Adult Services overall performance management framework, providing a structure for discussion and scrutiny of performance at all levels of the organisation. The plan sets out the key strategic priorities for 2008/09, detailing the resources available to achieve them, activity to be undertaken and performance measures that will be used.

Our close partnership working with Westminster Primary Care Trust and continuing closer integration of services, is reflected in the alignment of priorities between this Plan and the PCT Operating and Business Plans for 2008/09. Business Planning is a key process which assists us to provide the best possible services for local people which meet their needs and continually improve performance. Across the Council there is a three-year financial planning process which is part of the annual Strategic Review which determines the resources available to support the delivery of priorities. The diagram below shows the key milestones in the annual business planning cycle.

Westminster’s Performance Management Process 2008-09

LAA Programme Business LAA agreed agreements signed off Plans 09/10 Review of completed 2007/08 April performance

Budget and Council Tax Closing of agreed Strategic accounts Review sets out Leader’s vision, Westminster February corporate aims Performance Plan and priorities Q3 Key Performance Estimates, Service Indicators & LAA Plans and review Changing Priorities Publication programme Annual Review and monitoring agreed assessment of existing of BVPP Quarterly Performance performance measured January Monitoring against key PI’s and Quarterly reporting of the new priorities Business service plans Planning CAA and reviews July 09/10 Use of Resources, started Risk assessment, Direction of Travel Q1 Key Performance statement Setting Budget Indicators & LAA RSG Options monitoring Growth and savings announced City Survey options agreed Consultation on new One City priorities

Management letter & Audit Audit of BVPP report and key Performance Star Chamber October Mid year Indicators proposals finalised review

The implementation of the business plan is closely monitored and reviewed through out the year. A quarterly performance information report is prepared for Health & Community Services Overview and Scrutiny Committee. Progress against priorities and performance indicators is reported to the Cabinet member, Senior Management Team and to Corporate Management Board on a monthly basis and there is regular reporting at an individual service level.

A new performance report will be produced for the Health and Care Network which will show progress against the new National Indicator set for health, well being and social care.

Version 15 4 Adults’ Services - Strategic Vision

Mission Statement

We will ensure that all adult residents of Westminster have the opportunity to achieve the best possible health and well being, are able to have as much choice and control in their lives as they wish, are able to make an active contribution to the community and are free from discrimination or harassment.

Key objectives

Improved health and emotional well being: We want people to enjoy good physical and mental health (including protection from abuse and exploitation), access to appropriate treatment and support in managing long-term conditions independently and opportunities for physical activity. Improved quality of life: We want to ensure access to leisure, social activities and life-long learning and to universal, public and commercial services for adults with social care needs. This includes security at home, access to transport and confidence in safety outside the home. Enable people to make a positive contribution: We want to encourage active participation in the community through employment or voluntary opportunities and involvement in policy development and decision-making. Enable people to exercise choice and control: We want people to have as much choice and control as they wish to help them achieve maximum independence. Enable freedom from discrimination or harassment: We want to ensure equality of access to, and experience of services for all groups and communities and that people are free from abuse and bullying. Improved economic well-being: We want to ensure the economic well being of people so that they have access to income and resources sufficient for a good diet, accommodation and participation in family and community life and are able to meet the costs arising from specific individual needs. Ensure people are able to live with personal dignity: We want to ensure that people are able to maintain self respect and enjoy a comfortable, healthy and safe environment. Ensure that we commission effectively: We will work with local and other providers to ensure that services available in the City and commissioned from outside, are designed to achieve improved outcomes, are of good quality and offer value for money; ensuring that existing needs are met and future needs of residents effectively planned for. Demonstrate effective leadership: The Council is committed to providing strong leadership to achieve consistent, sustainable and effective improvements in all services across the City to help achieve improved outcomes for adult residents. Workforce development: We are committed to working with our partners to develop a competent and confident workforce that will enable the achievement of improved outcomes for residents.

Version 15 5 Summary of Key Priorities for 2008/09 Adults Services contributes to a wide range of plans aimed at improving the health and well being residents. Our priorities are informed by these plans by the Council’s One City initiative; Westminster City Partnership priorities, the Westminster Primary Care Trust Operating and Business Plans; national priorities set by central Government; and importantly what local residents have told us. Our key priorities for 2008/09 are summarised: . Meet key targets in the Adults Services Transformation Programme to ensure services are redesigned to meet future needs and expectations of residents. . Place a stronger emphasis on prevention keeping people fit, healthy and well with earlier intervention where necessary with a focus on re enablement. . Enhance signposting, information and advice services to encourage residents to access services which can help support them, earlier. . Contribute to the delivery of the One City policy through delivering the next phase of the Every Older Person Matters initiative; with an increased emphasis on keeping older people fit and well and independent of health and care services. . Use the opportunities provided through the Westminster City Partnership and Local Area Agreement to reduce health inequalities. . Ensure greater personalisation of services with more choice and control for individuals. . Establish User led Choice and Control Board, introduce self assessment evaluate our individual budgets pilot and achieving a step change in the rates of people accessing self directed care. . Develop more integrated services with the PCT to support people with long term conditions. . Publish our initial Joint Strategic Needs Assessment with the PCT and develop the process to inform the development new commissioning priorities and evaluation of outcomes. . Develop a more flexible and responsive range of local services available to support increased personalisation. . Work with the voluntary sector to enhance their role in service provision to meet local needs. . Work more closely with the NHS partners to develop more integrated approaches and services, deliver greater efficiencies together; achieve shifts in resources into the community and preventive services and use buildings more effectively. . Achieve further increases in the rates of people with disabilities helped into employment and mainstream services. . Review safeguarding policies and continue to ensure that safeguarding is regarded as a high priority by all agencies in Westminster. . Continue contribution to WorkSmart through rolling out Electronic Social Care and flexible and mobile working to all adult services. . Modernise the adult education accommodation. . Contribute to the Families at Risk review particularly in relation to mental health services and substance misuse issues. . Deliver planned efficiencies through the Transformation Programme, WorkSmart, further integration with the PCT and effective commissioning. . Develop the local care workforce so that expert staff deliver more of what they’re qualified to do, with better use of IT, and work across departments and partner organisations. . Contribute to the City Council’s ‘Going Green’ initiative

Version 15 6 2. Service profile – where we are now

Service accountability and scope

Cllr Ian Adams is the Cabinet member with responsibility adults’ services and health and Marian Harrington is the Director of Adult’s Services. The Adults’ Services Department was established in 2006 to meet the statutory requirement to establish the post of Director of Adults’ Social Services (DASS) reporting to the Chief Executive, and to create a leadership structure that would enable the Council to deliver its ambitions to achieve further improvements in outcomes for residents and meet national priorities. The service is divided into four main parts in additional to cross cutting support services.

Social care services Zena Deayton is the Assistant Director, Adults Social Care. These services work with some of the most isolated, frail, disabled and vulnerable residents in the City. they provide assessment and care management for all adult care groups arranged in locality-based teams. Where the needs of people meet our eligibility criteria, (‘moderate’ or above Fair Access to Care criteria) the teams arrange services to support them and regularly review care to ensure that it continues to be appropriate. For people with lower levels of need information, advice and some preventive services are available to meet certain needs. The teams work in a person centred way, meeting performance targets and monitoring delivery by providers. Through their detailed local knowledge and case management, the teams have a role in influencing commissioning. Adult social care services for older people and adults with disabilities are organised to cover three localities, north west, north east and south. Each locality works in a generic way with designated specific workers for disability and HIV and mental health and older adults. There is also a Health Services team based at Imperial Hospital Trust which provides an assessment and care management service to people who are admitted to hospital which ensures that effective discharge planning and re enablement arrangements are made. A Housing with Care team, which includes Community Support Officers, providing a preventive service to older people with lower levels of need. Services to help keep people independent in their own homes include personal and home care, extra care housing, escorting and shopping, home bathing, equipment and adaptations, assistive technology services, such as alarms. These services work closely with community health services and in particular Westminster rehabilitation service managed by the PCT and joint funded with the City Council which focuses on re enablement. Westminster’s Community Mental Health Teams (CMHTs) arrange support to adults with serious and enduring mental health needs. The teams are fully integrated with Central North West London Mental Health Trust and are co-located and operate in three localities across the City. The teams are fully multidisciplinary with care co- ordinating staff, either specialist social workers or Community Psychiatric Nurses. The Approved Social Work service is provided through the CMHTs. Crisis resolution, assertive outreach and early intervention teams are also operate across the City. A Joint Homeless team provides a specialist outreach, assessment and care planning to vulnerable adults with mental health needs who are homeless.

Version 15 7 The Community Services team for people with a learning disability is an integrated, City wide team of health and social care staff who assess and arrange services to support people at home or in residential care. The team also offers a range of specialist health provision such as nursing, psychology, occupational therapy, physiotherapy, psychiatry and speech and language therapy. The Day, Specialist Residential, Employment & Short Break Service, covers services that the Council and Primary Care Trust directly provide for people with learning disabilities. There is a specialist care management team for people with substance misuse needs , which provides an assessment service leading to a range of treatment options for people with drug and alcohol related problems. The funding for the team and budgetary controls are governed through a Section 31 agreement creating a pooled budget. Following a review of current arrangements proposals are being developed to provide a specialist team working with other vulnerable adults, for example people with complex needs and those that do not easily fit into the eligibility criteria of existing services. Commissioning services Cath Attlee is the Assistant Director of Joint Commissioning Care & Health, a joint position with Westminster PCT. This section of the Department leads on strategic commissioning across all care groups, social inclusion, management of local markets and maintenance of local services, compliance with the Council’s Procurement Code, and the management of care contracts, service agreements with and grants to, the voluntary sector. It brings together commissioners for all adult care groups alongside the contracting and procurement functions and the management of relationships with corporate services. The section includes a number of joint, integrated commissioning teams with the PCT including; mental health, learning disability, Drug and Alcohol Action Team, older people and physical disabilities. We commission a wide range of services for adults which help promote their independence so that they can remain wherever possible in their own homes. These include home care and personal care services, a range of day opportunities including help for people to access employment, education, leisure services, and supported housing services. We also arrange services designed specifically to meet the needs of carers including a range of respite, sitting services and other forms of support and opportunities. Where people can no longer be supported at home we arrange residential and nursing home care for them. The Supporting People commissioning team is based within the Housing Department but works closely with the care group commissioning teams in managing contracts with housing with care providers and in the development of new services. Public Health & Well Being Tessa Lindfield is the Assistant Director for Health and Well Being, this is a joint post with Westminster PCT. This part of the Department leads on promoting the health and well being of the whole Westminster population in conjunction with the Director Public Health through community needs assessment, addressing health inequalities, and health promotion, prevention and protection. The section is responsible for delivering the health and well being agenda described in Our Health, Our Care, Our Say, health promotion, partnership working including health scrutiny, linking with planning, including the Local Area Agreements and the Version 15 8 Council’s responsibility for the psycho-social response to emergencies. The section has strong links into the Public Health Intelligence and leads on the development of needs assessment. Adult Education Service Barbara Holm is the Head Westminster Adult Education Service. The vision of of the service is to ‘inspire and develop our community through learning’. It is one of the largest, local authority adult education services in the country. It offers a very diverse curriculum range with over 1,000 courses delivered to 12,000 learners each year. WAES is a community focussed service delivering courses in over 80 venues across Westminster. A large part of the provision is aimed at the most disadvantaged individuals and communities. Around half of the service’s work is focussed on preparation for life programme in ESOL, literacy, numeracy and ICT. The Service is also now focussing on meeting the needs of local employers by providing training and skills development to people in work. There is an increasing demand for this as the skills needs of employers continue to rise. Support services Finance and accountancy support is provided through the Corporate Finance Department with a dedicated Assistant Director for adult services and housing and adult services accountancy team. The Workforce Development and Quality Assurance team works across both Adult’s and Children’s Services to shape and develop the workforce we need for the future and to collect customer feedback through the statutory Social Care Complaints function. The Strategy & Performance team provides support to the Director and Assistant Directors. It is responsible for the co-ordination of strategic performance management, management information, co-ordinating development of strategies, research and analysis to support the work of the Department.

Version 15 9 Adults’ Services in Westminster – service users

People supported at March 2008 People supported at home with care managed services 4,245 Older people 2,488 Physical disabilities 595 Mental health 830 Learning Disabilities 267 Substance Misuse 15 Other vulnerable adults 50

People supported in self directed care (DP, In Control, IB) 352 Older people 125 Physical disabilities 145 Mental health 13 Learning Disabilities 40 Other vulnerable adults 4 Carers 25

People supported in residential placements 788 Older people / physical disabilities 337 Mental health 246 Learning Disabilities 205

People supported in nursing home placements 324 Older people / physical disabilities 275 Mental health 40 Learning Disabilities 9

Older people / Physical disabilities 358 Mental health 40 Learning Disabilities 133 Voluntary sector support 323

People supported with preventive services in the community Older residents 1,348 Younger adults 1,118

People supported in housing with care services Older residents 2,184 Younger adults with disabilities or mental health problems 531 Single homeless & rough sleepers accommodation 809

Adults using Adult Education Services 9,000

Version 15 10 DIRECTOR OF ADULT SOCIAL SERVICES (DASS)

Director of Finance Support Officers x 3

Assistant Director Assistant Director Assistant Director Assistant Director Joint Finance, Adult Social Social Care Services Public Health, & Commissioning (Care & Care and Housing Health) Wellbeing Head of

Workforce

Adult Services Manager – North West Dev’t and Health and Wellbeing Commissioning Manager Policy Manager Quality Head of Adults Finance Older People & Phys Dis Assurance

Adult Services Manager – North East Public Health Co-ordinator Head of Joint Service Development (Mental Adult Services Manager – South Head of Financial Health) Services and Systems Adult Change Project Health Services Manager Manager Commissioning Manager Learning Disabilities

Vulnerable Adults’ Services Manager Emergency Commissioning Manager Planning Mental Health Services Manager DAAT/Subs Misuse Officer

Head of Head of Contracts and Vol Learn Dis Service Manager – Strategy, and Sector Partnerships Community Health and Care Mgt Performance, ICT Business Adult Services Relationship Westminster Adult CSI client and property Manager Education Service Learn Dis Service Manager – manager Day,

Housing with Care Manager Westminster Primary Care Trust

Version 15 11 Review of Performance in 2007/08 Westminster is recognised nationally as a high performing Council achieving an excellent rating in the Comprehensive Performance Assessment in 2008. Adult’s services have consistently achieved excellent external ratings. Our social care services were assessed by the Commission for Social Care Inspection against Our Health Our Care Our Say outcomes in 2006/07, we achieved the highest rating in the country, only equalled by two other authorities. The judgement and ratings for Westminster against each outcome are set out below:

Area of judgement Grade awarded Delivering outcomes Excellent

Improved health and well being Excellent Improved quality of life Excellent Making a positive contribution Excellent Increased choice and control Excellent Freedom from discrimination and harassment Excellent Economic well being Excellent Maintaining personal dignity and respect Good Capacity to improve (combined judgement) Excellent Leadership Commissioning and use of resources Star Rating 3 stars Other performance highlights in 2007/08 • Continued strong Corporate and political support for adult services. • Further established the new Adults’ Services Department, including more joint senior posts with health. • Successfully delivering the Council’s Every Older Person Matters initiative, with measurable action plans in place across key Council services achieving positives outcomes for older residents. • CSCI noted 54 key strategic strengths in how we were improving outcomes for adult residents; seven areas for further development (all now been addressed). • From a high baseline, demonstrated improved or maintained performance against all key national indicators used to evaluate adult services by CSCI. • Commenced our ambitious Adult’s Services Transformation Programme, a ‘gold star’ WorkSmart project, to radically redesign services to improve outcomes for residents, create more personalised services, meet the policy, demographic and financial challenges ahead. • Reorganised care management services creating a more generic service not based on age, whilst maintaining expert specialists. • Substantial increase in the rate of people on direct payments giving them more personalised services, choice and control. • Adult services priorities continued to feature in the Local Area Agreement and Neighbourhood Renewal Fund successfully used to develop our Healthy Futures initiative based on a deprived estate; expand our approach to prevention for older

Version 15 12 people, people with low level mental health needs, people with alcohol problems, people with diabetes and carers. • Published and commenced implementation of our joint strategy for older adults with mental health needs. • Continued to develop service level agreements with voluntary sector organisations, with specified outcomes to improve quality of life, health and emotional well being. • Helped more disabled adults achieve economic well being by helping them into employment, work like settings and use of ‘job carving’. • Achieving our ‘stretch’ target for supporting more carers with their own services. • Taking forward plans to develop the next phase in extra care housing for older people and develop older people’s ‘hubs’ providing improved access to services locally. • Further development of intermediate care and rehabilitation services with PCT partners reducing emergency admissions to acute care and the development of specialist services. • From a high base increased the number of people in receipt of telecare services in their own homes and developed a number of innovative projects for people with particular needs. • Continued good performance of the Westminster DAAT in meeting national targets and local needs of people who have problems with substance misuse. • Taken forward work to provide a new adult education unit as part of the Pimlico School rebuild. • Achieved an excellent outcome of the Audit Commission, Supporting People inspection; reflecting close working relationships between the Adults Services and Housing departments. • Again established Westminster as an Employer of Choice with excellent and consistent standards of management by maintaining our Investor In People (IIP) badge across Adults’ Services. Financial performance In 2007/2008 Adult’s Services effectively managed considerable demand from some services to achieve a projected outturn of within 0.7% of budget with a projected overspend of £607k. The table below shows the projected outturn by care group against the revised estimate. Service Area Budget Year End Variance £k Prediction £k £k Older People 39,862 40,237 375 Physical Disabilities 9,985 10,305 320 Learning Disabilities 16,623 16,433 -190 Mental Health 12,719 12,834 115 Failed Habitual Residents 1,076 1,063 -13 Service Strategy & Support 4,142 4,142 0 Services Westminster Adult 307 307 0 Education Services Total 84,714 85,321 607

The overspend (of 0.7%) was caused by a number of pressures including:

Version 15 13  impact of the single status agreement for staff in the City Council’s residential homes for Older People - £250k  increase in the number of referrals for occupational therapy and equipment to help people remain living at home independently - £360k  additional staffing costs arsing from the re-organisation of Adults Services covering teams for older and disabled people.  higher numbers than planned of people requiring support of mental health services

Operating context

National priorities and guidance

The 1998 White Paper, Modernising Social Services, set the direction for reform and aimed to ensure that adult social care services in England: • improved consistency and quality of provision; • integrated provision with health services and non-statutory provision; • improved access for both service users and carers; • introduced more personalised models of care.

In Independence, Well-being and Choice, the goals of the social care modernisation agenda were framed in terms of a clearer focus on the outcomes described, alongside continued concern with the protection of vulnerable adults, and the targeting of services in a resource-constrained environment.

Our Health, Our Care, Our Say The Government published the White Paper Our Health, Our Choice, Our Say; a new direction for community services in January 2006. The requirements set out in the paper form the blueprint for the future direction of adults social care and community health services, representing a significant shift in the focus of how services are commissioned and delivered. The Paper emphases the need to:

 improve outcomes for vulnerable adults  promote more choice and control, enabling greater independence and personalisation of services  promote well-being and prevent ill health  achieving a shift to a more preventive approach  supporting people with long term conditions effectively at home  achieving a shift from intensive social care and acute health services  enabling vulnerable people to access mainstream services  greater integration between health and care services, streamlining access and service delivery to improve  protect vulnerable adults;  change the culture of care;  modernise the workforce.

To achieve the ambitions of the White paper will require closer partnership and integration between local authority, health, providers and voluntary sector services. A more integrated, seamless future for health and social care services will require investment in

Version 15 14 health and social care workforce development and the development of more integrated frontline services delivered in more convenient ways for individuals.

Commissioning framework for health and well-being The commissioning framework for health and well-being provides commissioners of health, social care and well-being services with a framework for:  identifying current and future health needs;  jointly planning services;  engaging in a dialogue with local people and service users about the future development of services;  engaging with providers of services to ensure that services are appropriate, effective and outcome-focused.

The framework is an important new tool for the further alignment and integration of commissioning for health and care into a coordinated framework, focused on outcomes, tailored to meet local needs. Particular implications for implementation locally will include:

 Support the move from a medicalised view of health and well-being, to considering the social, economic and environmental determinants of ill-health  Agreeing a definition of well-being to support commissioners in commissioning services to achieve it  Considering how empowering GPs to commission social care will work in practice  Decommissioning of services. The framework sets out an expectation of evidence based decommissioning of services to generate resources to support the commissioning of preventative services.

Putting People First Putting People First was launched by the Government in 2007, it sets out a shared vision for the transformation of adult social care, and establishing a collaborative approach between central and local Government, the sector’s professional leadership, providers and the regulator.

The aim is to ensure that people, regardless of illness or disability, are supported to  live independently  stay health and recover quickly from illness  exercise maximum control over their own life and where appropriate the lives of their family members  sustain a family unit which avoids children being required to undertake inappropriate caring roles  participate as active and equal citizens both economically and socially  have the best possible quality of life irrespective of illness or disability  retain maximum dignity and respect

Local authority leadership is to be accompanied by partnership working with the NHS, other statutory agencies, third and private sector providers, users and carers and the wider local community to create a high quality care system which is fair, accessible and responsive to the individual needs of service users and their carers.

Version 15 15 Social Care Green Paper In the Comprehensive Spending Review in 2007 the Government signalled their intention to publish a new Green Paper on the future of Social Care, this is expected in late 2008 and will contain proposals for the future funding and shape of adult care services.

Changing demography There are currently 210,000 residents aged 18 and over in Westminster, 195,200 are aged 20-64 years and over 25,100 are aged 65 or over, with 8,900 aged between 75 to 84 years and over 3,000 aged over 85 years. Population projections show that Westminster’s population will continue to grow in the coming years with the adult population aged over 20 years increasing to 247,000 by 2011. Within this overall increase there are expected to be between 1,900 and 2,000 more older residents and 24,300 adults aged 20-64 years. Currently 0.22% of resident adults aged 18-64 years, 6.8% of older people aged 65 to 74, 16.1% of those aged between 75 and 84, and 43% of those aged 85 and over are supported with a social care service and receive care management. The changing size and make up of the local population is in itself a challenge. The Wanless Social Care Review ‘Securing Good Care for Older People’ demonstrated that over the next decade and beyond, current funding arrangements for social care services are unsustainable, by 2010/11 in Westminster we estimate that an additional c.480 – 500 adults will require support, placing increased pressure on services designed to help people stay independent.

High levels of migration from and to other London boroughs, the rest of the UK and the world is particularly significant. Westminster has the highest volume of international migration per 1,000 population of any LA in the UK with over 9% either arriving from or leaving to go to another country between 2001 and 2006. Overall annual population churn is around 25%. (ONS Ad-hoc migration Paper, 2007). The resident population is highly mobile and there are significant cross-border flows in relation to the use of health, care, employment, education and leisure services, which represent particular challenges to improving the health and well being or residents and planning health and social care services.

There are significant health inequalities in the City reflected in significant difference in mortality rates for different social classes and genders in different parts of the City. The recent Index of Deprivation shows that Westminster is ranked 69th most deprived out of 354 districts in England (now 7th most deprived London borough on the ‘rank of local concentration’).

As the population is set to grow, we expect the proportion of older and younger adults with specific care needs to grow also. Currently there are approximately 1,800 older residents suffering with severe dementia (likely to grow to x,xxx by 2011) and about 11,250 who are physically frail, these numbers are expected to grow to x,xxx and x,xxx respectively by 2011. Numbers of people with a limiting long term illness are likely to rise from 32,000 residents to around xx,xxx, with similar rises in the number of people registered with GPs in the City who suffer from a long term condition e.g. coronary heart disease from 5,000 to x,xxx; diabetes 6,200 to x,xxx, and asthma 7,900 to x,xxx.

Version 15 16 Locally there are over 500 adults known to services who have a learning disability. At present around 9,000 residents have a severe disability with 6,500 people of working age in receipt of the Disability Living Allowance. Currently there is a high level of people with disabilities on incapacity benefit; a key challenge is to help more people with disabilities back into work.

At any one time between 16 - 25% of the general population are likely to have a common mental health problem and about 800 people are likely to be suffering from a psychotic illness such as schizophrenia or manic depression. Local Community Mental Health Teams typically work with around 3,000 people who are subject to the Care Programme Approach, of whom around 850 are likely to be on enhanced CPA. The high incidence of mental health problems locally creates particular cost pressures on budgets.

Over a 1,000 residents are diagnosed as having HIV and the latest estimates suggest that around 1 in 30 people aged 15-49 years have problems associated with their use of drugs.

Westminster is characterised by a high proportion (nearly 50%) of single person households, so there is high potential for increased social isolation for some residents. However, there are a significant number (around 12,000) unpaid carers who provide valuable support to help others stay independent at home; as many as 3,500 provide 20 hours or more of support per week . A key challenge is to provide effective support to this group to enable them to continue to undertake their caring roles and enjoy a fulfilling life.

Consultation, engagement and involvement User and carer involvement is at the centre of our approach to planning and delivering services. We use a comprehensive range of mechanisms to ensure effective user and carer consultation and feedback to measure satisfaction and outcomes we are achieving.

Within the Health & Care Network, each care group specific partnership board includes user and carer representation and participation, with links to wider reference groups. During the coming year we will be establishing a Local Involvement Network. We make use of the corporate processes such as the City Survey, Area Forums and LARPS to gain feedback from adult residents about their concerns. A range of user surveys were undertaken during the year which focused on what outcomes different interventions and support are achieving.

In 2007/08 we undertook survey of older residents the results of which have been used to inform the next phase of Every Older Person Matters, supported the Helping Older Peoples Empowerment study and undertook a survey of the outcomes people achieved by the use of equipment.

We have well developed quality assurance systems in place as part of contract monitoring, these are used to make sure concerns about service quality are acted upon and resolved. The annual complaints report demonstrates how issues raised through the complaints process are addressed and taken into account when developing services.

In order to fully engage different groups of vulnerable adults we continue to developed specific approaches to involvement and consultation, these include multi media work with people with learning disabilities through to user focused monitoring of services for people with mental health needs.

Version 15 17 Financial challenges There have been several significant changes to the funding for Adults’ Services announced as part of the Governments Comprehensive Spending Review and grant settlement in 2007, which will influence the funding available for 2008/2009 and the following two years.

The first is the full implementation of new distribution formulae for adults and children’s social care which has had the effect of reducing London’s underlying social care funding by £420m. The reduction for Westminster is equivalent to £25m in grant terms before the application of overall floor damping or 40% per resident child (for children’s services) and 25% (£8m in monetary terms) per 18-64 year old for younger adults’ services. This reduction has had the effect of putting Westminster at the floor for grant increases in 2008/09.

The current indicator used in the low income adjustment element of the older person’s formula is the proportion of older people living in rented accommodation. From the 2008/09 settlement onwards, this will be based on the proportion of older people receiving income support or pension credits. Westminster has a low benefit take up rate in general so this option is disadvantageous and has reduced Westminster’s underlying grant by around £1m.

The revised 2004 based Sub-National Population Projections have been used for the 2008/09 to 2010/11 settlements. No allowance has been made for short-term migrants or other population pressures faced by London boroughs including Westminster. This has resulted in a reduction of the estimated adult population aged 18-64 years and has, along with the full implementation of the new distribution formulae above, resulted in the Council receiving less adults and specific grant income than it otherwise would have done.

There have been significant changes to the grants received for Adult Services. Both the Access and Systems Capacity and Delayed Discharges grants have been subsumed within the formula grant from 2008/2009 and will add £3.6m to the base budget. A further seven specific grants totalling £4.1m will be subsumed within a new non ring fenced general grant known as the Area Based Grant (ABG). The ABG comprises most of the grants currently paid through the local area agreement pooled grant which will no longer exist next year plus the vast majority of the Council’s funding for youth services, adults and children’s social care. It is completely un-ring fenced and the entire sum can, in principle, be spent on anything the Council wishes. It is therefore for the Council to decide corporately how this money is spent to meet local and national priorities including Local Area Agreement targets.

The Government has agreed the need to explore options for the long term funding of the care system to ensure that it is fair, sustainable and unambiguous about responsibilities of the state, family and individual and has announced the intention to produce a Green Paper setting out the key issues and options for reform later this year.

The Government is also currently consulting on policy changes for learning disabilities and one of proposals is that funding and commissioning responsibility for learning disability social care services transfers from the NHS to local government.

Version 15 18 Financial resources for 2008/09 The net Adults’ Services budget for 2008/2009 is £95.5m and includes:

£45.4m on services for older people £11.1m on services for adults with a physical disability £18.9m on services for adults with a learning disability £12.5m on services for adults with mental health needs £1.6m on services for adults with substance misuse needs

This includes planned growth of £1.9m covering the increased number of people we aim to support with self directed care, the increasing demand for and cost of residential and nursing home placements, for older people, people with a physical disability, people with HIV, people with a learning disability and people with a mental health needs. There is additional new investment of £125k to develop a social network and self support service for older people. To cover increased workforce costs associated with the ‘single status’ agreement and legislative changes to the statutory minimum holiday entitlement for staff there is some further growth.

Savings and efficiencies of £1.4m are planned in 2008/2009 and these will be achieved by increasing our collection of income and from efficiencies from the WorkSmart and Adults’ Transformation programme.

In order to support the transformation of adult social care the Government has made available a new ring fenced Social Care Reform Grant to help Councils to redesign and reshape their systems over the next three years. The grant allocation for Westminster is £508k in 2008/2009, £1.2m in 2009/2010 and £1.5m in 2010/2011.

Version 15 19 3. Priorities and objectives – where we want to be

Partnership priorities

Westminster City Partnership One of the key ways in which we will achieve improved outcomes for adult residents is by using our strong local partnership networks to assist with the delivery of our objectives. This means effectively influencing the priorities of these strategic networks to address the health and care needs of adult residents.

The Westminster City Plan is our Community Strategy and aims to improve the quality of life and well being of Westminster residents, visitors and businesses. The plan is the responsibility of the Westminster City Partnership (WCP). The partnership brings together representatives from Westminster City Council, other public sector agencies and the voluntary and community sectors, local businesses, regeneration partnerships and residents’ groups. The 2006-2016 Plan was published following extensive consultation with stakeholders and residents, it sets out a vision for :

• an improving environment; • better life chances; • strong, united and engaged communities; • customer tailored services.

The partnership priorities of the Health & Care Network feed directly into the City Plan. All adult services strategic commissioning priorities are reported to the Network and contribute towards delivering the Programme for a Healthier Westminster.

Within the Westminster City Partnership, the Adult Services Department directly works through the Health & Care Network, but also works closely with other thematic networks particularly the Housing, Liveability, LEN and Safer Westminster networks on areas of interest for delivering improved outcomes for adult residents.

Adults Services play a significant role in supporting community cohesion. Westminster Adult Education Service provides a comprehensive range of ESOL provision and the Contracts and Voluntary Sector Partnerships team lead on supporting a range of community groups and organisations in the voluntary sector which reach a wide range of the diverse communities within the City, including BME communities and local lesbian, gay and transsexual residents.

Local Area Agreement (LAA) 2008 - 2011 Local Area Agreements are one of the key mechanisms enabling a more effective partnership approach to addressing local issues. They provide the opportunity for local priorities to be addressed across networks, agencies and services and enable the pooling of resources. They aim to change the relationship between the local authority, its partners, and central government and develop new ways to deliver better outcomes for residents.

Westminster’s first LAA ran from April 2006, this has been updated into a new Agreement to run from 2008-11. There are nineteen locally agreed priorities in the Agreement and we

Version 15 20 have been particularly successful in securing a high profile for health, well being and social care. Specific priorities aligned to the work of Adults’ Services include:

• enabling people to live longer and healthier lives.

The LAA is the mechanism for the whole of the Westminster City Partnership to address the health inequalities agenda and we are undertaking a wider range of initiatives which will result in improved health and improvements in overall mortality. In 2008/09 we will be rolling out the findings from of Healthy Futures project in Queens Park, again be giving a high priority to smoking cessation and improving signposting into healthy lifestyles.

• tackling anti-social behaviour and reduce the number of people who feel it is a problem in their area, including alcohol and drug misuse;

A key focus is on improving the effectiveness of brief interventions following attendances at A&E for incidents which have involved alcohol use, and training staff to support this.

• enabling people with long term conditions and their carers to achieve the best health possible, with increased control and choice of their health and care.

With a focus on improving the assessment, review of carers and the provision of support services to them including advice and information; we will continue to prioritise achieving our ‘stretch’ target to support more carers, we will also be developing more training and development for carers using the ‘expert carers model’. We will strengthen the ‘carer voice’ in our strategic planning through Carers Action and improve the identification of carers, focusing on those at risk of damage through their caring role.

Acknowledging the role which the wider City Partnership has in enabling more choice and control to be enjoyed by people who use adult services, we have included a target in the LAA.

• enabling older residents to live independently and enjoy a good quality of life.

We have made falls a theme of the new LAA. Falls are frequently the most significant factor in an older person loosing their independence. Partnership working is important in delivering an effective falls prevention service involving health, care, housing and safer Westminster services. Responding to Help The Aged recommendations on Pensioner Poverty, we will also look at developing local indicators to measure improved take up of benefits in Westminster.

We are continuing our work with voluntary sector organizations designed to ensure the services they offer make a measurable difference to peoples’ reported sense of health, well being and quality of life. Our Quality of Life Survey undertaken in 2006, will be followed up in 2009, and expect to be able to demonstrate that our approach over the last three years has improved outcomes for older people.

The replacement of the Neighbourhood Renewal Fund with the Working Neighbourhoods Fund has disadvantaged Central London in particular, with a significant reduction of resources available to Westminster over the next three years. However, the Health & Care Network are committed to continue a number of initiatives designed to support improved

Version 15 21 outcomes for particular groups of excluded residents and the PCT will pick up some of the funding to enable this:

• Healthy Futures project, this aims to develop new approaches to assessing the needs of, and engaging individuals with local services to help achieve real improvements in health and well being for some of the most disadvantaged residents. Focusing on two estates initially, we aim to roll out learning from this project to other estates in the future. • assistance for people with common mental health needs seen in primary care to access employment opportunities.  assistance to carers in accessing services to help them achieve more fulfilling lives outside their caring responsibilities  helping people with long term conditions stay healthy  various healthy eating and healthy lifestyle initiatives

Local Area Renewal Partnerships Since 2003, Westminster City Partnership has supported the creation of Local Area Renewal Partnerships (LARPs) to improve the quality of life of people who live and work in Westminster’s most disadvantaged areas:

- Church Street - Queen’s Park - Harrow Road - Westbourne - Various areas across South Westminster

There is also a sixth LARP function in the West End to reflect the particular challenges posed by the unique characteristics of the area to the quality of life of residents, businesses and visitors. LARPs receive funding through the Local Area Agreement (LAA) to coordinate partnership working at a neighbourhood level and to deliver programmes to reduce deprivation. They bring together service providers (including the Council, Police, the Primary Care Trust, the voluntary sector) and residents, to identify and address key local issues across a range of areas (crime, health, housing, education, employment, environment). Adults Services are represented on each LARP and help shape local priorities.

Corporate priorities

One City One City is an initiative that sets out the Council's vision for the City. It has four main themes, Order, Opportunity, Enterprise and Renewal as well as its four Cross Cutting priorities:

 Neighbourhood Focus  A tolerant City  Active Citizenship  Customer Focus

Version 15 22 The programme for 2008/09 has a strong focus on strengthening communities through public respect and personal responsibility. The new Neighbourhoods agenda is central to the goal of building strong communities. This is a ground breaking initiative designed to strengthen the community leadership role of elected members and deliver better, targeted services. One City also maintains a focus on improving the health and well being of residents and the underpinning principles will help provide the context within which we deliver improved outcomes for adults.

Every Older Person matters In 2008/09 there are 30 new One City initiatives being launched, these include the expansion of the nationally acclaimed Every Older Person matters programme.

The programme is comprehensive and covers health and care, leisure, community protection, libraries, housing and other council services has been put in place for the coming year and incorporated into service and departmental Business Plans for 2008/09. The overall aim of our approach is to keep older people fit and well so that they are less likely to require health and social care services. Key priorities have been informed by booth the recent Older Peoples Survey undertaken by the Council and its partners, and the Helping Older People’s Empowerment study undertaken by the local voluntary sector.

. Improve information for older people including an A-Z of services via the Council’s website, enhance the Senior Passport, including better signposting information for callers and a new proactive service to monitor vulnerable residents linked to housing estate teams; publish the popular Westminster Plus quarterly . . Work with Counsel and Care (a national charity) on a groundbreaking project to provide better information for older people funding their own care. . Providing further free events such a ‘Silver Sunday’, using sponsorship, following the successful Tea Dance last year . Providing a Fuel Switching Service so that older residents get the best deal on their fuel bills . Delivering a renewed focus on opportunities for older people to take part in paid employment . Improving opportunities for older people to volunteer, with a particular emphasis on intergenerational initiatives . Maintaining the most Taxicard scheme in London, and successfully transferring Freedom Passes. . Introduce parking concessions for carers and people visiting older relatives . Increasing the number of step-free and dropped crossing points to make the City more accessible for older people . Expanding on the network of activities available for older residents in libraries, including book clubs and classes . Delivering a Seniors Online project to reduce the digital divide which will see over 280 older people trained to use the internet by March 2009 . Delivering new initiatives to tackle the number of older people who fall on Westminster’s pavements . Using the Home Improvement Agency to provide a proactive service for potentially vulnerable older people, involving housing condition, security and other issues. . Working in partnership with the PCT on new public health initiatives . Working with Participle (a social enterprise) to deliver innovative solutions in service delivery (e.g. expansion of the community hubs for older residents)

Version 15 23 . Investing an extra £50k in exercise opportunities for older people - in leisure centres and the wider community . Delivering the Council’s wider WayFinding project to make it easier for older people to navigate around the City by foot . Providing more support to carers through the Local Area Agreement and, to raise the profile of this important work, launching an annual Caring for Older Neighbours award. . Expanding the Exercise Referral Scheme by working with practice based commissioners (GPs) in the South of the City . Improving the proactive handyman service which provides support with light jobs around the house, which is currently oversubscribed . Increasing older residents’ awareness of the Go Green programme and participation in ‘green’ initiatives

Worksmart WorkSmart is a major Council-wide initiative that aims to modernize the way we work, deliver greater efficiency and more cost-effective business processes across all services, and improve the services provided to residents. WorkSmart and making better use of the opportunities presented by IT is at the heart of the Adults Services Transformation programme. It will help change the way teams operate so that care are able to focus deliver more on work with service users and carers.

The Adult Services Department is at the forefront of delivering the two key themes of the initiative;

 Flexible, location and independent working, and  Electronic Social Care Record

The Department has already made significant progress against both projects, with a lead implementation for ESCR already started, and successful application of FLOW to a wide range of teams. During 2008/09, both initiatives will be fully rolled out to all teams.

Equalities The Council is committed to achieving Level 4 of the Equality Standard for Local Government by October 2008. A key part of this is ensuring that we have robust monitoring systems are in place and that information is used effectively to plan new policies and procedures to increase equality of opportunity for service users and staff. Targets for sexual orientation, age, religion and belief also need to be in place in March 2008, and progress made against them by 2009.

During 2008-09 we will ensure that all Adults’ Services are in line to meet level four in terms of leadership, service delivery, consultation and employment and training, and each service contributed to a detailed Departmental action plan monitored regularly by the Senior Management Team and Health and Care Network.

Go Green Westminster’s Go Green programme sets out the ways in which the City Council intends to lead in creating a more sustainable city. The programme’s aim is to re-establish Westminster as an exemplar ‘green’ authority. It will contribute towards making London a greener, more liveable city. ‘Go Green’ will deliver a wide-ranging programme of environmental schemes and projects, and maps out a challenging agenda for the future.

Version 15 24 Adults’ Services will contribute to the initiative and is working in partnership with the PCT to undertake an audit of activities using a dedicated NHS tool.

Adults’ Service priorities

Transforming Adults Services To meet the challenges of delivering on local and national aspirations with the reducing financial resources available, in 2007/08 we commenced an ambitious phased transformation programme. This will affect our policy, priorities, use of resources, relationship with traditional users and providers of services and partner agencies, and organisational culture and the skills and competencies required of its staff.

The programme is designed to:  Meet the national agenda and government policy shifting the balance of power and control to users of our services;  Address the Council’s ambitions to exploit new technologies and ways of working to create efficiencies and to free up resources through Worksmart;  Enable future projected demand for services to be meet arising from the changing population, within the context of with potentially fewer resources;  Meet the ambition of the Department to achieve continuous improvement, beyond our current 3 star status.

Social Care Services The key priorities of Social Care Services are informed by the transformation programme.

Redesign of first contact Our vision is, that as close to the point of first contact as possible, people can identify their own needs utilising self assessment and establish the outcomes they want. Where appropriate, they will be signposted to other services which will help them, or they will be given the information they require to make informed choices about how their needs can be met.

Where appropriate, services up to an agreed level will be arranged at this first point of contact, ensuring a quick response to identified needs.

Focusing future role of care managers We want to target the role of the care manager to those people who have more complex needs. Where it is required professionals would visit to undertake a more thorough assessment with the service user or their carer to agree the outcomes they want and a care plan. This assessment process would continue to be multidisciplinary in nature, subject to the agreement of the person being assessed.

Re-ablement as a way of working We want to shift the whole basis of our approach to focus on re ablement of individuals. There will be a strong focus on ensuring people’s capacity for independent living is restored and maintained as much as possible. Whilst re ablement is at the core of all assessment work, we also aim to develop more resources to provide intensive short term interventions.

Version 15 25 Extending choice and control To help strategically drive forward this agenda we will establish a user led Choice and Control Board. Building on progress we have made in increasing the numbers of people on direct payments we now want to achieve a step change in the extent of choice and control people who need our support and care can exercise. By the end of 2010/11 we are aiming to support 80% of adults who require support on individual budgets or direct payments. In 2008/09 we will extend and evaluate our Individual Budgets pilot and achieve further significant increases in take up of DP across all care groups.

We want to broaden out the scope of our approach to self directed care and with be discussing with the PCT how best to include the local Expert Patient Programme in this work.

We aim to simplify and streamline the processes associated with direct payments to make them more attractive to service users. To do this we will introduce preloaded payment cards that will provide an alternative to a standard bank account and will reduce administration and bureaucracy for both service users and the Council. The introduction of Smart Payments will help our service users by giving them access to simple bank accounts and simplify our accounting procedures.

Recognising that individuals and their carers are experts in their own rights we aim to introduce a self assessment tool for Westminster. We are exploring potential partners for the development of this. We will compliment this with the provision of different levels of assistance for residents of different abilities.

Financial costs and assessment. We will introduce systems to ensure that the costs of services are clear at the point of assessment. The financial assessment of individuals will be brought forward and undertaken y a visiting officer shortly after the care assessment is completed.

Safeguarding As we work to introduce more choice and control for service users and their families, we will continue to give a high priority to minimising the risk of abuse and protecting vulnerable adults from harm. We will review and strengthen procedures and management arrangements, ensuring that all staff in the Council, NHS, police, ambulance and fire services, voluntary sector and members of the public are made aware of their roles and responsibilities in relation to adult protection. Training for staff and managers will continue to be rolled out.

Older Adults with Mental Health needs Jointly with CNWL Foundation Trust we will take forward the next phase improving joint working arrangements to support older adults with mental health needs. This will include having dedicated workers with the new generic Adults Social Care services teams specialising in older adults with mental health needs.

Community Mental Health Teams In October 2008 we plan to enter into a new partnership agreement with CNWL for the future provision of CMHT services to younger adults, subject to the national review of the

Version 15 26 Care Programme Approach, expected in the Autumn, which is likely to focus the work of secondary mental health services more exclusively on people on ‘enhanced’ CPA. A key focus is to more clearly define how local services work to improve a broad range of outcomes for Westminster residents with serious and enduring mental health needs.

People with long term conditions People with particular long term conditions often have a range of complex health and social care needs requiring co-ordinated support to improve outcomes for them. We are working closely with the PCT to develop options for improved case coo-ordination and virtual team working between care management and community matron services.

Telecare To promote good health and well being and foster a greater sense of safety in vulnerable adults we offer telecare to all people supported at home, and include this in all care management reviews. We already support a higher than average number of people with alarms and our approach will increase the use of telecare as a preventive service further.

We have made a bid to the Assisted Innovation Living Platform with BT and Design London. Westminster’s Pathways to Well being project is designed to address the needs of older people with long term conditions at risk of emergency admission. Other projects in development this year include, older people with dementia in a residential home, joint work with community matrons service to support people with long term conditions; tele medicines and tele health projects with the PCT and CNWL; implementing proactive caller, where people who have activated their alrm are checked, this approach will be lined to the community support officer role.

Commissioning for health and care The key aims of the Adults Transformation programme related to commissioning are:

- to ensure that our plans for each care group address the need to develop a wider range of services available to local people, and - to ensure a greater amount of personal adviser/advocacy to support individual budget management.

From a contracting perspective we will be exploring the development of different contract models and evaluating their impact on cost, quality and access. We shall be working closely with both contractors and in-house service providers to take this work forward.

The transformation themes will also underpin our approach to the development of new commissioning strategies for different groups.

Joint Strategic Needs Assessment Westminster’s Joint Strategic Needs Assessment is being designed as an ongoing development tool which will help prioritise the review of existing commissioning and partnership plans, inform the development of new commissioning priorities and help to evaluate the outcomes our actions achieve. It is utilising the Corporate CoWStat project to draw together a wide range of information, including community intelligence, with the aim of being able to analyse this by neighbourhood, community, equalities strands etc. Our initial assessment will be made available from April 2008.

Version 15 27 Home care services To meet the need for greater flexibility in provision during 2008/09 we will commence work on redesigning home care contracts and look for what short term adaptations of existing contracts can be made to allow more flexible use. We will also consider tendering a contract for a preferred provider list for a new personal care contract

Residential and nursing home provision for older people During the Summer 2008 we will undertake a review of review of residential and nursing provision for older people to ensure that local services will be able to meet the projected changes to Westminster’s population, national and local policy drivers and latest market developments. We want to ensure that local provision meets the needs of all communities, is of high quality and offers improved value for money.

During the year we will be implementing our strategy for older adults with mental health needs designed to improve both the quality and range of provision, deliver earlier identification, rehabilitation and intervention.

Promoting independence of people in residential care In response to issues raised in Valuing People Now, we aim to achieve a measurable increase in numbers of people with learning disabilities living independently or in supported housing who were previously in institutional care. To achieve this we have revised our Learning Disabilities Strategy for Independent Living.

For people with severe and enduring mental health problems who require support, we want to ensure that their independence is maximised, and aim to achieve ‘move on’ to achieve this. We have set ourselves a target to achieve increases in the numbers of people with living independently or in supported housing

Substance misuse services We are undertaking a major re-letting exercise for our substance misuse services in the year with the aim of fundamentally transforming the model of service. The new model providing a one stop solution across drugs and alcohol to meet the needs of different local communities.

Help into employment Increasing access to employment for adults with a learning or physical disability or mental health need is a key priority in order that they might achieve greater health and economic well being. We have a number of schemes and initiatives in place across different service groups. We are seeking to extend our collaboration with other agencies to enable vulnerable adults to move from volunteering and supported employment to formal employment and/or to keep people in work

Voluntary sector The voluntary sector have a key role to play in assisting with the delivery of improved outcomes for adults. We are committed to giving them a higher profile in Westminster. To achieve this we will be monitoring the effectiveness of longer term funding and commissioning arrangements as part of the annual grants programme. We will be exploring opportunities for voluntary sector services to deliver further services, building on the work undertaken to health improve the quality of life of older residents as part of the

Version 15 28 LAA. During the year we will also be revising the Voluntary Sector Compact agreement and developing a new strategic view of future work with the third sector in Westminster.

Community engagement Building on existing involvement and engagement initiatives, we will be establishing a community intelligence work stream as part of our approach to the development of the Joint Strategic Needs Assessment. The aim is to ensure that information collected through consultations and other mechanisms is better co-ordinated and more directly influences strategic planning. During 2008/09 we will also be establishing a Local Involvement Network.

Adult education A key priority for Westminster Adult Education Service in 2008/09 is to develop modernised accommodation. Our aim is to deliver a hub and spoke model, with a new purpose built centre in Marylebone and 3 satellite centres in Pimlico, Soho and Queen’s Park. We have secured approval and substantial funding to deliver the project.

Workforce Development In support of the delivery of the Adults’ Services transformation programme we will be working closely with partner agencies in developing a new comprehensive workforce strategy for all Adults’ Services in Westminster.

Priorities for this year are:  to support the development of new ways of working that promote re-enablement, the personalisation of services, and increased choice and control by service users, supported by improved use of technology through the WorkSmart programme;  to encourage and enable registered services in Westminster to meet National Minimum Standards workforce requirements for qualifications and staff management and to prepare for social care workforce registration and NMDS-SC;  to ensure that our services are safe through the continued roll-out of Safeguarding POVA, “Safer Recruitment”, Mental Capacity Act, Deprivation of Liberty (DoL) and managing challenging behaviour training;  to contribute to building pathways into employment for local people;  to support access to qualifications for unqualified staff and to foster access to the Degree in Social Work to ensure a supply of qualified social workers;  to maintain access to Continuous Professional Development and Post-Registration Training and Learning for all professional groups to improve the quality of our workforce;  to build our managers’ and leaders’ skills in working in multi-disciplinary teams and in leading change in all our settings;  to support the diversity of our workforce and the achievement of level 4 of the Equality Standard.  To encourage and enable our provider services to develop new ways of working and new skills to meet the changing needs and aspirations of service users.

In order to deliver these priorities, we will work with our partner agencies in the statutory, private, independent and voluntary sectors to align our resources for workforce development within Westminster to achieve efficiency, effectiveness and equity of access.

Version 15 29 4. Action plan – how do we get there

Objectives, priorities and performance indicators This section of the Plan sets out in more detail how we will measure progress in delivering our priorities and what outcomes we are achieving.

Version 15 30 Version 15 31 Improve the health and emotional well being of adult residents Priorities Link to: Performance indicators lead Timescales

Reduce health inequalities LAA 12; NI Reduce all-age all cause TL March 2009 and enable people to live 120 mortality rate. longer and healthier lives LAA Achieve local smoking cessation TL March 2009 target

NI Place Residents perceptions of their TL March 2009 Survey health and well being; LAA 14 Increased take up of the falls CA March 2009 prevention service

Reduce drug and alcohol NI 40 NTA Increase the proportion of drug CA March 2009 use and the contribution to users in effective treatment anti social behaviour. LAA Increase the number of TL March 2009 attenders at A&E for alcohol related incidents who take up brief interventions. Provide effective approach Local All hospital discharge cases to ZD Ongoing to re ablement be reviewed at 2 week and 4 week intervals to maximise re ablement potential NI 131 Maintain or reduce rate of ZD Ongoing delayed transfers of care from hospitals NI 125 Effectiveness of intermediate CA/ZD From Sept care and rehabilitation services. 2008

NI 134 Reduce the number of ZD/CA March 2009 emergency bed days per head of weighted population Local Reduce rate of acute psychiatric ZD/CA March 2009 admissions

Local; NIS Maintain low level of delayed ZD Ongoing transfers of care

Provide effective service to Local Respond to all requests for ZD Ongoing people in crisis assessment under the Mental Health Act in 2 hours. Local Record all requests for ZD Ongoing assessment under the Mental Health Act

Version 15 32 Improved quality of life of adult residents Priorities Link to City Performance indicators lead Timescales Plan, LAA improvement priorities Support more people with Local Increase number of older CA March 2009 preventive services and people supported through reduce demand for preventive services intensive interventions NI 136 Maintain rates of people ZD /CA Ongoing supported to live independently through social services Local Increase take up and ZD/CA March 2009 effectiveness of signposting services Increase the proportion of LAA 9, NI 145 Increase the rate of people with ZD/CA March 2009 adults with disabilities who learning disabilities in settled live independently. accommodation Local Increase in numbers of people ZD/CA March 2009 with learning disabilities living independently or in supported housing who were previously in institutional care. NI 150 Increase the rate of people with ZD/CA March 2009 mental health needs to be in settled accommodation Local Increase the rate of people with ZD/CA March 2009 mental health needs supported in their own homes, compared to residential/nursing home care. NI 141 & NI Increase number of vulnerable ZD/CA March 2009 142 people achieving independent living (through housing with care services) and stability of placements To enable people with long LAA 13, NI 135 Ensure all known carers are ZD / TL March 2009 term conditions and their offered an assessment / review carers to achieve the best in the year health possible, with NI 135 Increase the rate of carers ZD/TL March 2009 increased control and receiving carers services or choice of their health and advice and information. care

Version 15 33 Enable adult residents to make a positive contribution Priorities Link to : Performance indicators lead Timescales

Enable vulnerable residents LAA Increase the number of older TL/CA March 2009 participation in volunteering residents participating in and community action volunteering Ensure adults with Local Increase numbers of disabled CA / ZD March 2009 disabilities have access to adults receiving social services education accessing learning opportunities.

Further develop consultation Local Working with the community CA Summer 2008 and involvement establish a Westminster LINKS opportunities Local Implement community TL Spring 2008 intelligence workstream of the Joint Strategic Needs Assessment.

Local Service user and carer ZD/CA Ongoing involvement in service redesign and evaluation Local Develop action plan arising from TL/CA June 2008 HOPE and Older Residents survey NI, User Achieve improved satisfaction CA Feb 2009 Survey rating with home care services Ensure carers are supported Local Increase carers take up of TL Ongoing to have lives outside their opportunities outside their caring roles caring roles Promote community Local Maintain and increase take up BH Ongoing cohesion of ESOL classes

Version 15 34 Enable people to exercise more choice and control over their care Priorities Link to: Performance indicators lead Timescales

Achieve a step change in LAA 13, NI Increase the rate of people ZD March 2011 choice and control enjoyed supported at home using self by adults who need social directed care to 80% by care 2010/11, setting milestones targets for each care group LAA 13 10 people with learning ZD September disabilities on individual budget 2009 pilot.

Local Extend IB pilot to other care ZD March 2009 groups and achieve numbers from other care groups on IB WorkSmart Implement pre loaded payment PF September cards achieve 50 users on 2008 cards for pilot WorkSmart Reduce petty cash use by PF October 2008 setting up simple bank accounts for 40 service users. NI 124 Place Improve the rate of people with ZD tbc Survey long term conditions who report that they are supported to manage their condition

Local Increase the number of carers ZD / Ongoing using self directed care, TL including for short breaks and holidays Provide a responsive Local Introduce model of self ZD March 2009 person centred assessment assessment options NI 132 Complete 91% of assessments ZD Ongoing for social care within 4 weeks of referral NI 133 For 91% of care packages to be ZD Ongoing fully in place within 4 weeks of assessment Local Ensure all people who are ZD Ongoing supported with social care for 12 months or more are reviewed at least annually. Ensure there is an effective Local Exceed 3,000 users per annum ZD / March 2009 signposting service for of the Senior Passport CA people to arrange their own care

Version 15 35 Ensure that freedom from discrimination and harassment Priorities Link to: Performance indicators lead Timescales

Meet requirements of ESLG Achieve Equality Standard for MH October 2008 Equalities Standard for Local Local Government level 4 Government and Single ESLG Review and update MH June 2008 Equalities Scheme Departmental Action Plan to comply with Single Equalities Scheme Local Ethnic details recorded for 95% ZD Ongoing of social care staff Local Ethnic details recorded for 97% ZD / CA Ongoing of adults - assessed or reviewed in the year - provided with a service in the year Local Full equalities details to be ZD / CA September recorded for 95% of adults 2009 - assessed or reviewed in the year - provided with a service in the year

Ensure new service ESLG Review programme of EQIAs ZD/CA April 2008 developments are non and update programme taking discriminatory and meet all account of Transformation communities needs projects Work to ensure the economic well being of adults with care needs Priorities Link to : Performance indicators lead Timescales Improve the proportion of LAA 14 NI Increase the % of people with ZD March 2009 disabled service users learning disabilities who are in helped off benefits and into employment. employment. LAA 14 NI Increase the rate of people ZD/PR March 2009 using secondary mental health services in employment to 15% of those known.

LAA 14 Increase the % of people with ZD March 2009 learning disabilities who are in employment.

Ensure timely financial Local Complete 95% of financial PF April 2008 assessment take place to assessments for people maximise independence and receiving home care within 7 income days of completion of the care assessment Maximise the income of Local Ensure all adults who receive a ZD/CA April 2009 service users social care service get a benefits check Local Increase number of new claims CA Summer 2008 generated for benefit and the extra amount of benefit generated

Version 15 36 Enable people to maintain self respect, and enjoy a comfortable, healthy and safe environment Priorities Link to : Performance indicators lead Timescales

Ensure vulnerable adults Local Undertake review of safeguarding HB Summer 2008 are effectively protected procedures and processes from abuse Local All POVA alerts to be captured ZD April 2008 and recorded

Local Hold a strategy ZD Ongoing meeting/discussion for 100% of cases where an adult protection enquiry is required within 5 working days of the decision to proceed. Provide a responsive Local Complaints achieve stage 1 target PB Ongoing complaints service Statutory Complaints achieve stages 2 & 3 PB Ongoing target

Version 15 37 Risk management

Risk management enables us to identify and manage key obstacles to the achievement of our objectives. It is a strategic tool that is an integral part of effective and efficient management and planning. Risks to Adult Services achieving our objectives in the 2008/09 financial year are summarized below:

Version 15 38 ADULT SERVICES RISK REGISTER 2008/09 Summary

t r e s o f d c e r u o o N a t n o

o p a n c k w t h o s i S m i l i S O I t Short Description e R c k G k i e s i A r L i R R D l e v a r 1 MH High Critical 15 R ↑ T Effective implementation of new technology

2 MH High Critical 12 A ↑ Managing increased demands within existing resources

3 CA / Signific Critical 12 A ↑ Achieve shift in emphasis to more self directed care ZD ant 4 ZD Signific Critical 12 A ↓ Failed Habitual Residents / Failed Asylum Seekers ant 5 CA/ZD Signific Critical 12 A → Effective Management of cost pressures ant 6 ZD/CA High Critical 12 A ↓ Implementation of NHS continuing care criteria

7 ZD High Critical 12 A ↓ Quality of some commissioned services

8 CA / TL High Marginal 10 A → Balancing investment in prevention and maintaining investment in intensive care

9 CA High Marginal 10 A → Young people in transition to adult services

10 MH High Marginal 8 A ↓ Recruitment and retention of care staff - competition for care staff in highly competitive London market 11 MH High Marginal 8 A ↑ Data security and data sharing with the NHS

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