Legislation Committee No. 5

Additional evidence from WLGA

• The WLGA represents the interests of local government and promotes local democracy in Wales.  It represents the 22 local authorities; the 4 police authorities, 3 fire and rescue and 3 national parks authorities are associate members.  

• The WLGA’s primary purposes are to promote better local government and its reputation and to support authorities in the development of policies and priorities which will improve public services and democracy.

• The Association of Directors of Social Services Cymru is the professional organisation in Wales.

Context:

The WLGA and the ADSS gave evidence to the committee on 24thof September 2009 and have approved the transcripts of our oral evidence. You have subsequently asked for further information from us regarding the cessation of the Joint Special Working Grant in 2012.  

Headline Messages

We have consulted in a very short time scale with all our councils and this response is based on replies from 14 out of the twenty two councils. We offer the following as the headline messages.

• The WLGA has consistently argued that this is a vital element of funding and that the grant process, not the grant should end and the money transferred into the RSG and monitored through joint outcomes and the HSCWB strategies. This remains our view.

• Many of the schemes have been robustly evaluated and demonstrate positive outcomes against their stated aims. These outcomes and benefits will peak for many schemes at the time when they are to be lost or seriously diminished.

• The primary impact will lie with service users, with a reduction in the opportunity to be as self managing as possible. Promoting independence is at the heart of Assembly Government policy, but the ability of local agencies to meet such objectives will be severely curtailed if the proposals to cease grant provision are implemented. A domino effect will happen as impact is shifted to other parts of the service or agencies to respond with pressure op services increasing, at a time of the most severe financial restraint on public sector budgets.

• The detrimental impact is not only to service users, but also staff who have in many cased developed significant expertise and secured enormous recognition for their work. These skills will be lost in many cases and the infrastructure that has been build eroded or lost.

• The purpose of the grant is to promote joint working and formal partnership schemes between councils, (education and social service departments), the NHS and the third sector. A loss or diminution of the funds will impact not just on councils but also on all other agencies. The vast majority of schemes contribute to service delivery or are stand alone and involve a wide range of professionals and the voluntary sector

• The whole ethos of the grant is to underpin and promote stronger partnership working and to build bridges between the statutory agencies so that users and carers receive a more seamless service. At a time when these partnership arrangements are being tested due to NHS reform, these schemes are vital to retaining joint working. This is fully acknowledged by all parties and the Welsh Assembly Government This proposal is counter to the overwhelming shared policy direction in Wales.

• It is a condition of the grant, that the schemes reflect key aims of national strategies including the ten year strategy for social services, Fulfilled lives Supportive Communities and also the broad aims of preventing independence, early prevention and minimising adverse and unnecessary stays in hospitals. The NHS reforms and the overall direction of policy is to enhance and strengthen this activity.

• The Grant will cease in 2012 which is the year that financial forecasts show a deepening reduction of overall public spending levels and significant impact to both the NHS and councils. At the same time we envisage that the effects of recession and cut backs and demographic change will be placing unprecedented levels of need onto public services, and the most vulnerable will inevitably look to social services. The NHS demands on in patient care will be significant and partners will be working hard to maximise schemes that diminish entry into hospital, build community cohesion and intervene earlier.

• The grant conditions clearly set out the terms by which the funds are to be used. Councils complete monitoring forms to WAG within the specified time scales and are judged to be compliant.

• For 2009 the grant conditions set out that exit strategies must be developed for when the grant ends. They should be realistically based on, continuation of grant at current level, at a reduced level, grant money being subsumed into RSG and discontinuation of the funding.

• Councils for the 2009 monitoring process are considering these four options for cessation of grant in 2012. This initial trawl for evidence from councils highlights that they are all of the opinion that if the funding is lost or diminished this will dramatically impact on direct services and partnership working.

• £2.2million of the grant is ring fenced at £100k per council who in partnership with the NHS must develop and implement HSCW strategies. All partners are aware that as a result of the NHS reforms, extra investment in maintaining and developing new partnership arrangements is needed if the bed rock of HSCWB activity across the agencies is protected. The imminent strategy - Healthy Futures which is the flag ship public health strategy for Wales and the creation of Public Health Wales NHS Trust are symbols of the commitment to HSCWB strategies and greater synergy between local government and the NHS to prevent and reduce inequalities. They will have implementation time scales that will co incide with the cessation of this grant.

Specific comments

The fourteen councils who were able to provide information to meet the committee’s request all report that the schemes fund early intervention and partnership schemes. The following is a selection of these schemes

Reablement and Intermediate care services

Many Councils are operating reablement and intermediate care schemes which are designed to prevent older people regain independence and return to community living earlier and for longer.  If the money is lost, there will be an increase in dependency requiring ongoing home care treatment (which ironically may have to be funded if it goes beyond the £50 limit) further admissions to hospital and expensive care packages. Many schemes are part of wider reconfiguration plans involving several councils and the voluntary sector and the newly configured NHS. A case study submitted as part of the monitoring process is attached. It is a typical case study.

One council stated "the loss of the JSWG and the independence grant would completely shut down our intermediate care service and reablement service. This is part of our medium term strategy for controlling the demographic increase in demand for long term care. This would be a double whammy as not only would the level of demand for long term home care grow more quickly but the relative costs of providing care will also increase because the net costs of providing the service would also increase more due to the £50 charging cap.

Mental Health

There are several schemes for both children and adult funded within this grant. Innovative early intervention is the core aim and there are examples of a home treatment team for older people with mental health problems. The funding allows for extension of core operating times and to provide on call services.

Dementia sufferers and their carers would loose critical outreach services that are helping to maintain people at home. Age Concern is commissioned to provide the service.

The Occupational Therapy flexibilities team contributes to reducing the long term patient stays on the rehabilitation wards and the acute wards. This scheme has already been highlighted at serious risk and the partner agencies raising concerns about the loss of this scheme

Many councils are using this grant to bolster the under funded and resources Child and Adolescent Mental Health services. Recent and imminent reports will again state that considerable improvements in services across Wales will be needed.  Many of these projects involve education, social services, the NHS and voluntary sector. In one area the schemes straddles two councils, and the extended NHS and is linked to a redevelopment of a childrens centre.

Children services

Schemes Specialist Health Visitor for early intervention and prevention enable reductions in crisis and children escalating into the children in need and looked after categories

There are several examples of schemes that are integrating and improving services for children with disabilities.

Conclusion

The recent WLGA report to the Expenditure sub group highlighted in the social services chapter

"The Welsh Assembly Government could rationalise initiative, policies and grant schemes that put unnecessary obstacles and demands on staff and inevitably divert resources from the frontline. It should build on pilot schemes and provide mainstream funding for activities that have evidence it works. Similarly there should be a transfer of specific grants into non hypothecated funding and certainty over future funding levels would enable authorities to plan more effectively and to respond to local demands with greater agility.”

We understand the pressure on the public purse and wish to work constructively with the Assembly Government to make best use of the diminishing resources. It seems counter intuitive to be moving towards a scenario where we are closing down or diminishing services that will need to be at the heart of a modernised health and social care service.

If this funding ceases in 2012, the impact on service uses, partnerships and locality based early intervention schemes would be catastrophic. It is also ironic that a separate strand of WAG funding under the banner of continuing health care will be seeking bids for funding that in many cases will be funding the exact schemes that are currently funded under the JSW grant. We believe that if the schemes were aligned and in some cases rationalised within a clear strategic framework for service modernisation, then future strands of funding could be harnessed to greater effect.

Appendix A -

Case Study

Case Study 1

Mr. A had a major stroke in January 2009 whilst staying with his daughter in England. He spent some months in hospital and a further period of Re-ablement in his daughters home where he was confined to first floor level.

In order to facilitate his return to Wales, he was admitted to a Joint Care Bed (JCB) in Aberaeron with a planned discharge date, of 2 weeks, to his own home. On assessment from the Ceredigion Re-ablement Service he needed assistance with Personal Care, was mobilising with a quad stick and assistance of one person mainly due to a right sided hemiparesis. Goals were agreed with Mr. A to enable him to return to his own home by working on daily living skills.

During his time in the JCB he was seen by various members of the team (Occupational Therapist, Physiotherapist and Generic Re-ablement Assistants) and supported by the Residential Home staff.

A Home Visit was carried out by the Re-ablement Service with Mr. A to establish the level of support required once discharged from the JCB. On discharge to his own home he was managing most of his Personal Care independently including changing colostomy bags, but had some residual difficulty managing shoes and socks. His mobility had improved but he remained under confident mobilising alone.

The Re-ablement Service escorted Mr. A home after two weeks, ensuring that all essential equipment was in situ. A joint care package was set up to included Re-ablement, mornings and lunchtimes Monday to Friday and Domiciliary Care, afternoons and evenings with four daily calls from them at weekends.

Over a period of 8 weeks of ongoing rehabilitation at home Mr. A achieved the following:

Personal Care

1. Completely independent in daily washing and dressing without aids.

2. Assistance required for showering twice a week provided by Domiciliary Care.

3. Able to negotiate the stairs and steps independently and safely in his split level house.

4. Independently mobile indoors using a quad stick. Quad stick and slight assistance of one person outdoors.

5. Independently able to make own hot drinks and breakfast, wash up and clear away.

6. Managing own medication from dosette box.

7. Able to regenerate frozen meal, but preferred fresh food.

8. Needed ongoing assistance with domestic tasks.

9. Mr. A had started going to the Day Centre once a week.

Summary

Mr. A regained a huge amount of independence partly due to the services he received and his own determination. He was discharged from Re-ablement having two calls daily from Domiciliary Care (lunch time and evening) plus a check call daily mid morning.