Report to:

Lead Member for Adult Social Care and Health

 

Date of meeting:

 

21st September 2021

By:

Director of Adult Social Care

 

Title:

Service Model for Directly Provided Learning Disability Day Services

 

Purpose:

To seek Lead Member agreement to make permanent changes to the service model for the Council’s Directly Provided Learning Disability Day Services, following a comprehensive consultation process.

RECOMMENDATIONS

Lead Member is recommended to:

1.  Agree to the permanent change to Service Model for Directly Provided Learning Disability Day Services with effect from 18th October 2021, specifically to provide:

•       the service across three sessions per day, rather than as whole days.

•       the service in ‘support bubbles’ of up to 15 clients.

•       sessions based in the community that are independent of the building-based service;

2.  Delegate authority to the Director of Adult Social Care to take all necessary actions to give effect to the implementation of the revised model of delivery;

3. note the summary of the outcome of the staff consultation (Appendix 1);

4. note the summary of the stakeholder consultation (Appendix 2);

5. note the report by POhWER, an independent advocacy service, as part of the consultation process (Appendix 3); and

6. note the summary of the Equality Impact Assessment (Appendix 4).

1          Background

1.1       Throughout the COVID-19 pandemic East Sussex County Council’s  Directly Provided Learning Disability (LD) Day Services remained open to support the small number of vulnerable adults and their families who were dependent on the service.  Throughout the first six months of the pandemic attendance at Day Services fluctuated, initially being low as clients and families ‘locked down’ and increasing as restrictions were lifted.

1.2       The Directly Provided LD Day Services are located at Beeching Park in Bexhill-on Sea,  Linden Court in Eastbourne, St Nicholas Centre in Lewes and Hookstead in Crowborough.

1.3       During this period, work was undertaken to deliver a ‘Covid secure’ service with increasing numbers while managing social distancing and the associated restriction on the capacity of the day service buildings. The service model evolved alongside changing national guidance, with the key elements including:

·         A reduction in the occupied capacity of Day Service buildings.

·         Extending opening hours and delivering day services as three sessions per day to increase use of the building and mitigate against the capacity restrictions.

·         The delivery of day service sessions in ‘support bubbles’ of no more than 15 clients.

·         Delivering community-based sessions to start and end in the community, therefore not being affected by the limited building capacity

·         Restricting numbers on the Day Service transport to aid social distancing.

·         Staff use of PPE, temperature testing and COVID-19 testing.

1.4       In August and September 2020 clients, parent carers and staff were formally asked to support this model to assist delivery through the pandemic.  At the time it was envisaged that this service model may have to be in place until Easter 2021.  All parties were understanding and supportive of the approach.

1.5       In January 2021 Covid restrictions were introduced and it was apparent that Day Services would not return to pre-pandemic delivery in time for Easter 2021.  There was also emerging evidence that some of the changes were having a positive impact on the way services were delivered and outcomes for clients.  As such, a six month extension to the temporary model was agreed to ensure a ‘Covid secure’ service could be maintained and allow time to better explore any potential benefits of making elements of the temporary model permanent.

1.6       Consultation was undertaken with Clients and Parent carers alongside a staff consultation with a view to making permanent:

·         Day Services across three sessions a day, a morning, afternoon, and twilight session

·         Day Service sessions in support bubbles up to 15 clients

·         Community sessions that start and end at the community venue

1.7       Having delivered this model for ten months, and taking formal and informal feedback throughout the period, it is believed that these changes do, and would continue to:

·         Provide a more person-centred service to clients through smaller groups

·         Provide a broader range of options as the twilight sessions have added a more social element to Day Services

·         Offer improved opportunities for being within the community

1.8       This model of delivery would also ensure that the Day Services are well positioned to respond to further Covid restrictions or the potential impact of a new pandemic in the future.

2          Supporting information

2.1       Staff Consultation was carried out from 14th June 2021 to 6th August 2021. This focussed on a change to their working hours as staff would be required to permanently work until 7.30pm on some days.  The general response to this has been positive with some colleagues having specific concerns about caring responsibilities and health requirements which would be addressed on an individual basis.  A summary of the outcome of the staff consultation is contained in Appendix 1.

2.2       Client and parent carer consultation was carried out from 21st June 2021 to 6th August 2021. This was delivered in two phases, initially to ascertain stakeholders’ general views of the concept followed by a second phase of consultation which focussed on the specific detail of the proposal i.e., the timing of the sessions.  Appendix 2contains a summary of both phases of the stakeholder consultation and Appendix 3contains a report prepared by POhWER, an independent advocacy service, as part of the consultation process

2.3       The consultation process was undertaken using Microsoft (MS) Teams meetings, face to face meetings in day services, individual meetings where people couldn’t access MS Teams either face to face or by telephone, online and paper questionnaires.  The responses to the question ‘How happy are you with our plans for learning disability day services?’ are summarised in the table below:

 

 

Number of responses

Very Happy/Happy

Unhappy/Very Unhappy

Neither Happy nor unhappy

Did not answer

Clients

128

65%

8%

17%

9%

Parent/Carer

4

100%

0%

0%

0%

Other

2

50%

0%

50%

0%

(Note: This question was asked in phase 1 of the consultation. There was a higher number of responses to the more specific questions in phase 2 with 68 parent/carers and 8 stakeholders)

2.4       The positive responses cited clients thriving being in smaller groups, enjoying different sessions the increased flexibility of the timing.

2.5       The negative responses tended to be from clients and parent carers not liking the twilight sessions as they clashed with mealtimes or evening routines; clients struggling with change and the restrictions of the bubbles (although these will be eased when they aren’t fulfilling an infection control function).

2.6       Access to day service transport was restricted during the pandemic and has been focussed on ensuring that clients with no other means to get to a building-based day service have been able to attend.

2.7       The community sessions in the new model are designed to enable most people accessing Day Services to have access to their community and some of the activities that are not available in the Day Service Building.  This model does, however, create some challenges including:

·         Accessing community-based sessions that are not accessible on public transport. 

·         Supporting clients living in rural areas to access community-based sessions.

·         Supporting clients without transport and unable to access public transport to access community-based sessions.

·         Ensuring clients who only access building-based services can still access the community.

 

2.8       To address these transport challenges, the following solutions will be implemented from the existing service budget:

·         Enhance existing day service transport runs to include drop off points at some community based sessions.

·         Review the fleet of day service vehicles to include a wider range of vehicles that support staff are able to drive, offering additional flexibility.  

·         Provide driver training to support staff to enable them to drive the larger 16-seater buses that are unused between core transport runs.

·         Increase dedicated driver provision by 0.8fte driver across to provide transport to community activities for clients who only access building-based services, using existing day service vehicles on their closed days therefore maximising the use of an existing resource.

2.9       An Equality Impact Assessment was undertaken for the temporary delivery of this service model at the start of the pandemic and has been updated as part of the consultation process.  It identified ‘No major barriers to implementing this new service model”.  A summary of the Equality Impact Assessment is contained within Appendix 4 and an action plan has been developed to address the small number of concerns that were identified.

3.         Conclusion and reasons for recommendations

3.1       Making the current changes to the service model for the councils Directly Provided  Learning Disability Day Services permanent will improve the service offered to clients and parent carers by providing a broader range of options, hours of delivery and locations.  Whilst the vast majority of clients, parent carers and staff are supportive of the service model which has effectively been in place for over a year, support will be provided to those who find this change challenging.

3.2       If agreed, the proposed service changes will be made permanent from 18th October 2021.

 

MARK STAINTON

Director of Adult Social Care

 

Contact Officer: Richard Lewis, Head of Learning Disability Services
Tel. No. 01273 337765       Email: Richard.LewisASC@eastsussex.gov.uk

 

Background Documents

Equality Impact Assessment and Consultation responses

Local Members

Cllr Hollidge, Cllr Tutt, Cllr Maples and Cllr Lunn