Wales Audit Office – Strategic Commissioning of Learning Disabilities and Review of first point of contact and assessments under the SSWBA PLEASE PRINT HANDOUTS IN BLACK AND WHITE

The Auditor General for Wales and the Wales Audit Office The Auditor General for Wales is the statutory auditor of: Welsh Government and its sponsored bodies. Health service bodies in Wales. Local government bodies in Wales. Total annual value of expenditure audited > €27,000 million. Legal basis for Auditor General’s work: Duty to audit accounts (provide opinion on them). Powers to examine and report on economy, efficiency and effectiveness (“value for money” or “VfM”) and to make recommendations for improving VfM. Statutory discretion in the way powers and duties are exercised. Is not directed by government — can, for example, pursue issues raised by the public.

Legal basis for Auditor General’s Local Government Studies work The basis for local government studies is derived from the Public Audit Wales Act 2004. Studies are designed to enable the Auditor General for Wales to make recommendations for improving economy, efficiency and effectiveness. review the discharge of the functions and/or services of local government bodies in Wales. report on the impact of the operation of any statutory provisions, or any directions or guidance given by the Assembly (whether or not under a statutory provision). Reports can make recommendations to Welsh Government, local authorities and other public bodies. Focus on good practice and improvement. Can be reported to Public Accounts Committee and followed up by Assembly Committees.

LG Studies – current programme of work How local government provides services to rural communities – publish 2018-19. Use of data in local government – publish 2018-19. Implementation of the Violence Against Women Domestic Abuse and Sex Exploitation Act – fieldwork and research 2018-19. The impact of local authority planning services on wellbeing – fieldwork and research 2018-19. First point of contact and assessments for adults by local authorities under the Social Services and Well-being Act - – fieldwork and research 2018-19. Future programme of work Will consult this year to set 3 year programme 2019-20 to 2021-22. Welcome thoughts and suggestions on what we should audit.

Strategic Commissioning of Learning Disabilities Review has focussed on assessing if local authorities have effective approaches to commissioning accommodation for adults with learning disabilities (those aged over 16). Focuses on: Demand for services Future costs Effectiveness of commissioning

The ‘Commissioning’ cycle

Part 1 - The approach to commissioning accommodation for people with learning disabilities is potentially unsustainable Around 20% of the estimated total adult population of 58,300 people with learning disabilities are provided with LA social care services. The number has increased by just over 900 people since 2008-09 – currently stands at roughly 12,000. Local authorities are keeping pace with demand. But proportionally, provision for younger people is falling and the number of people with learning disabilities aged 65 and over in receipt of social care services is increasing. Daffodil (Welsh Government) projections highlight significant challenges in the future: The number of people with learning disabilities will increase by 4,806 by 2035. 20 authorities will see the number rise and five significantly. Those aged over 65 with learning disabilities will rise from 12,986 to 17,996, a 38.5% increase.

The number of people with learning disabilities assisted by local authorities 2008-09 to 2015-16

Change proportionally in the number of people with learning disabilities assisted by local authorities 2008-09 to 2015-16

Part 1 - The approach to commissioning accommodation for people with learning disabilities is potentially unsustainable At a Wales level, gross expenditure for people with learning disabilities (adults under 65) has risen by 16.5% from £336.3 million in 2008-09 to £398.5 million in 2015-16. In real terms, considering inflation, this equates to an all Wales increase of 6.8% over the period. Welsh Government does not collate and report on the cost by authority of the different types of social care accommodation Therefore not possible to compare expenditure for the different forms of accommodation to determine economy in service provision. To determine ‘Value for Money’ we modelled: High cost/high usage analysis. Regional variations on health board footprints. authorities by geographical and socio economic type. variations by service model – community or residential services.

Change in number of learning disabilities accommodation placements for adults under 65 against change in gross expenditure (real terms) between 2008-09 and 2015-16

Average spend per learning disabilities accommodation placement for adults aged 16-65 in 2015-16 by local authority grouped on Health Board footprint

Average spend per learning disabilities accommodation placement for adults aged 16 – 65 grouped by local authority geographical and socio-economic characteristics

Comparison of the three authorities with lowest and highest average cost per accommodation placement Type of placement Ranking of the three authorities with the lowest average level of expenditure per client Ranking of the three authorities with the highest average level of expenditure per client Authority A – average spend of £22,120 per placement Authority B – average spend of £25,367 per placement Authority C – average spend of £26,343 per placement Authority D – average spend of £49,966 per placement Authority E – average spend of £55,298 per placement Authority F – average spend of £70,822 per placement Own home 1 11 4 22 21 7 Living with parents or family 17 8 5 3 Foster home 13 =21 10 Lodgings / supported living 18 16 Health service accommodation 20 19 Local authority care homes 2 Private or voluntary care homes 6 Other accommodation =16 14

Part 1 - The approach to commissioning accommodation for people with learning disabilities is potentially unsustainable Our research shows no discernible pattern or rationale that helps explain or justify variations in expenditure. Consequently, we consider cost driven by other factors, in particular: the effectiveness and approach of authority commissioning teams, especially ability to negotiate, challenge and set costs; the number and range of staff employed and their engagement with and management of external care providers; the availability of providers within the market and how effective local authorities are at increasing provider capacity; the link between corporate procurement and social care commissioning; the robustness of needs assessments and strategic planning; & the strength of scrutiny and oversight of the commissioning system to determine what is working and what needs to improve.

Part 1 - The approach to commissioning accommodation for people with learning disabilities is potentially unsustainable Modelling future demand and expenditure. Our analysis highlights that: 9 local authorities need to increase the provision of social care accommodation services to address a demand by 2035. 7 authorities past performance broadly matches predicted growth in accommodation. 6 authorities have a potential over supply of accommodation. In addition, our modelling suggests that local authorities need to: increase expenditure by £365 million by 2035. Increase the rate of investment at a significantly higher level than past investment - £150 million more than by 2035. Our modelling is not exact but it does provide an indication of likely demand and cost based on past performance.

Modelling of current performance against the predicted change in numbers potentially requiring accommodation services by 2035 Demand increasing at levels broadly in line with performance Past performance is higher than the predicted increase in demand

Modelling of projected increase in expenditure of social care accommodation services for adults with learning disabilities by 2035

Part 2 - Local authorities generally do not have effective arrangements to commission accommodation services for people with learning disabilities Not all local authorities have developed strategic commissioning options in line with Welsh Government guidance and the introduction of the Social Services and Wellbeing Act Commissioning strategies are not always resulting in cost effective service options that meet the needs of people with learning disabilities Regional joint working between local authorities is steadily developing, but engagement with Health Boards is variable Local authority engagement is not always responding to the needs of people with learning disabilities and their carers Resources to support planning and commissioning of services vary widely

Part 2 - Local authorities generally do not have effective arrangements to commission accommodation services for people with learning disabilities Range Commissioning Manager Operational staff Support officer Other Staff Minimum 0 in six LAs 0 in five LAs 0 in ten LAs Maximum Four in one LA 13 in one LA 15 in one LA 16 in One LA Wales total 33 89 74 44

Part 3 - Ineffective evaluation of outcomes means local authorities are not always able to demonstrate the positive impact of their accommodation commissioning choices Many local authorities have not set clear outcome measures to judge the impact of their commissioning activity Variable oversight and scrutiny of performance hinders evaluation

Part 3 - Ineffective evaluation of outcomes means local authorities are not always able to demonstrate the positive impact of their accommodation commissioning choices Report published 24th May 2018. Makes six recommendations for local government. Provided a good practice checklist to support elected member scrutiny of services. Also published a one sheet infographic capturing key facts. Referred to Public Accounts Committee. Plan to follow up-progress on addressing recommendations as part of our local audit work.

Social Services and Well-being (Wales) Act 2014: First point of contact assessments Background and purpose Part of the Auditor General’s local government studies programme for 2018-19 Call for evidence conducted and published in July 2017 – this has shaped the scope of the study Provide independent assurance on whether authorities are improving in line with legislative changes, national requirements, local and individual needs, and within the resources available.

Why is this issue important? Social services supports the safety and welfare of some of the most vulnerable people in our society A significant amount of public money goes towards social services Local authority expenditure rose by 12.5% between 2012-13 and 2016-17 Around 5% of the Welsh population in receipt of social services Some authorities have seen the demand for social services more than triple since 2012-13 New legislative framework in place since April 2016 Carers assessments New emphasis on prevention and shared ownership of solutions

What are the potential benefits of this review? Considerable variation of the care and support needs of service users means that there is no single one-size-fits-all approach to ensure equitable outcomes for citizens Using ‘value and failure’ demand management principles, our fieldwork is designed to assess the effectiveness and efficiency of assessments – for both the authority and the individual Evaluate the early impact of the Act and highlight areas for improvement Operating environment conducive to innovation We will share good practice Provide assurance that authorities are delivering value for money: Efficient Effective Economic

Focus of the review Focus on adults “Are local authority first point of contact assessment and processes better meeting the needs of service users and carers in line with the commitments of the Act?” the comprehensiveness of the assessments whether the assessment is person-centred including ease of access whether the assessment process is leading to a shift towards prevention in social care and non-social care services; and the impact of assessments on people’s wellbeing and interaction with the requirement of the Wellbeing of Future Generations Act 2015.

Methods A telephone survey of carers to identify the level of care and support they receive and to determine whether they feel the Act has supported improvement An online survey of third sector provider organisations Working with the Public Services Ombudsman for Wales to analyse complaint patterns relating to social services (pre and post SSWB Act) Review a sample of documents from each of the 22 unitary authorities Review of published performance data

Methods (continued) Detailed fieldwork in five local authorities Interviews and focus groups with a range of officers, Elected Members and local partners Walk through of council’s end to end process Interviews with national organisations

Outputs National report published in late 2019

Engagement with third sector partners Method: An online survey of third sector provider organisations We welcome engagement from you as partners Please find sheets on your tables giving you an opportunity to provide comments and tell us whether you would be willing to contribute further

Further Information E-Bost: nick.selwyn@archwilio.cymru euros.lake@archwilio.cymru E-Mail: nick.selwyn@audit.wales euros.lake@audit.wales Web: www.archwilio.cymru / www.audit.wales