Reducing Presentations to Social Care Presented by Phil Stevens Director of Wales Council for the Blind

“A brief exploration of facts, ideas, problems and potential solutions” Or….. “troublesome truths, speculative thoughts, wild ideas and controversial suggestions…”

Reducing Presentations to Social Care ….. 1) A factual statement 2) A desire to reduce demand on social care 3) A potential benefit for clients

Part One.. The facts

Reducing Presentations……. as a fact. Benchmarking Key Performance Indicators covering 2010/11 show: - 9 out of 22 Local Authorities record fewer presentations to VI teams than 2008/9 - 7 had more - 5 didn’t record them/submit them Source: VI Benchmarking Returns, WCB 2010/11

Substantial reduction where reported 2 LAs report a reduction by 25% or less 1 LA reports 35% or less Source: VI Benchmarking Returns, WCB 2010/11

Visual Impairment Registrations 2005 : 20, : 19, : 17, : 18, : 16,081 Source: Welsh Government figures

Yes… we know… Registration is not the same as presenting to social care

Sample analysis of 3 Local Authorities LA 1 June 2010: 34 clients awaiting assessment, 57 awaiting rehab delivery. June 2011: 24 Clients awaiting assessment, 8 awaiting rehab

LA 2 April 2010: 23 clients awaiting assessment, 25 awaiting rehab delivery. June 2011: 4 Clients awaiting assessment, 6 awaiting rehab

LA 3 April 2010: 56 clients awaiting assessment, 29 awaiting rehab delivery. June 2011: 32 Clients awaiting assessment, 0 awaiting rehab

LA 1 had same levels of staffing LA 2 and LA 3 had less …..miracle of efficiency and streamlining?

Reducing Presentations……. as a desire Key policies/work strands seek to reduce dependency on social care: - Sustainable Social Services for Wales: A Framework for Action - The Strategy for Older People in Wales Phase 2 - Social Care Improvement Fund and ‘invest to save’ initiatives - ‘regionalisation’ agenda - specific work programmes such as Gwent Frailty Team

Emphasis on partnership and ‘societal support’ - work on single eligibility criteria framework for Wales - move to maximise third sector support - growing interest in social enterprise - client directed support

Capacity in Teams greatly reduced: 15 LAs out of 22 seen posts removed LA4 seen Sensory team reduced from 9 to 2 LA5 completely removed

Part Two.. The problems

Right reductions? Growing evidence that VI clients are being failed - Far too high eligibility criteria - Contact centres that don’t respond to VI needs - Failure to appropriately refer on to other help - Massive care package cuts

Eligibility criteria - Increase in clients having care removed after re-assessment. 2009: 3 appeals 2010: 2 appeals 2011: 34 appeals to June* - Reassessment appears financially driven - Growing failure to recognise VI complexity around - Co-morbidity - Depression - Isolation *Source: WCB Referrals by clients

Eligibility criteria “Approximately 70% of people who accessed the Low Vision Service did not meet the visual acuity guideline criteria for registration (6/60).” Thomas Pocklington: All Wales Visual Impairment Database (AWVID), 2010

‘Single point’ Access Centres 18 Local Authorities now use ‘one-stop’ contact centre* Of 56 VI clients interviewed, 41 said they received limited understanding on contacting them Several questions used appear to ‘screen out’ clients Worrying trends of service withdrawal – ‘don’t promote, and withdraw when not used’. *Sources: WCB Regional Benchmarking 2011, Pan Wales VI Roadshow Interviews

Combine VI clients with others VI increasingly being seen as Occupational Therapy, ‘Reablement’ or ‘Frailty’. Future service may entail discreet, intensive, time limited intervention (the ‘OT model’ ) Worrying trend of service withdrawal – ‘don’t promote, and withdraw when not used’. Evidence on effectiveness?? *Sources: WCB Regional Benchmarking 2011, Pan Wales VI Roadshow Interviews

Part Three.. The possibilities

“Magic 8 Ball says…” - End of VI Rehab as a specialist profession? - Most clients not entitled to statutory care? - End of commissioner/provider split? - Client directed support excusing no statutory provision?

Rehab - VI Rehab needs national discussion - Is cost of rehab appropriate for foundation degree course? - Evidence needed that ‘OT model’ works - Splitting mobility from independent living skills.

Entitlement to statutory care - Already seeing many clients not getting services from statutory sector - If so, are we spending resources on assessing where not necessary? - Devolve responsibility for entire provision to third sector? - Clarity over what is needed for charitable service provision to those who fall through net

Commissioning - Tradition model is specification  tender  contract - Limited understanding of complex sensory services - Intelligent or ‘co-design’ not used in Wales - Move to spot purchase reduces sustainable work force

Service pathways - Tradition model for 3 rd Sector is grant or: specification  tender/award  contract - Limited understanding of complex sensory services - Intelligent or ‘co-design’ not used in Wales - Charitable services will blur boundaries between statutory and voluntary sector provision

Thanks for listening Views, comments and cakes welcome…