Review report and action plans

Service area under review	Joint Commissioning Learning Disability Service	
Service budget	£34million	
Core review team membership	Review leader: 	Alan Sinclair	
PPRU officer: 	Neil Lawrence
Designated member: 	Cllr Brian Law 
Independent members: 	Stephen Cotterill 
		Amanda Grosvenor 
		James  Bond
		(Service user representatives) 
Supported by:	Chris Locke. 

Carer Representatives:	Robin Seymour 
		Ben Brown

Other team members: 	Zaidie Orr
		Sara Livadeas
	                     	Neil Bradley –Finance rep
		Chris Cosgrave – Finance rep	
Terms of reference (taken from the Baseline Questionnaire)	1.	Getting into the Service: Improving access to services for people with learning disabilities and carers, including providing information in an easily understandable format.
2.	Care Planning and Reviewing: Undertaking, providing and reviewing care plans to ensure users, carers and providers can work together in the most effective way.
3.	Meeting Needs: An analysis of how services are purchased, commissioned and monitored and how well these services meet peoples needs. 
4.	How well does the care management and commissioning service work?: Managing the performance of the service, to include financial and workforce planning, client information systems and the performance targets and indicators.
5.	Consultation with others: Consulting people with a learning disability, carers, service providers, user groups, voluntary organisations and staff to ensure that all are involved in the planning and delivery of the service. 
Each of these areas will be examined in light of the structure, strategy and business processes and budget of the service. The review will also undertake an analysis and comparison with other local authorities regarded as good performers.	

Sections of report
1.	Executive Summary
Background
The gross expenditure budget for Social Services for learning disability for 2001/2 is £34 million. This includes £13m section 28a health transfer to this service area, £1m charging income and grants and £7m social services internal services. 63 contracts are in place with a total estimated value of £18.63m. There are approximately 1700 people with a learning disability receiving services from Social Services.

A number of factors are influencing how services for people with a learning disability are managed;
•	The Government have published ‘Valuing People – A New Strategy for Learning Disability for the 21st Century’, which has given the lead for learning disability to the Local Authority and requested that each sets up a Learning Disability Partnership Board to ensure the objectives of the strategy are met (Board established in Oxfordshire Sept 2001). The Strategy encourages rationalisation of separate resources, providing seamless services between agencies, partnership working involving users and carers, and the introduction of person centred planning
•	A Valuing People requirement is to review the use of Community Teams for People with Learning Disability by Autumn 2002.
•	The forthcoming Fair Access to Care Services guidance looks to introduce a single assessment process, common eligibility criteria between health and social services
•	Restructuring of the health service within Oxfordshire has taken place, with the development of 5 new Primary Care Trusts from April 2001 and the new Strategic Health Authority coming into effect in April 2002. One of these PCTs now represents all five as the lead for health on learning disability in Oxfordshire. This means there will need to be a different partnership arrangement between Health and Social Services  for the management of funding for learning disabilities in Oxfordshire

As a result of these changes work has been commissioned on behalf of the Learning Disability Partnership Board to examine the feasibility of future options for the structure of learning disability services in Oxfordshire. Social Services Committee, at its meeting on 2 October 2001, considered a report on the reconfiguration of Services for people with a learning disability, and agreed that further work take place into evaluating the options. This will also look at models for commissioning responsibilities and use of the Health Act Flexibilities (in particular Lead Commissioning and Pooled Budgets), and establishing a Care Trust.

Strengths and Weaknesses
Strengths that the service has in meeting the challenges outlined above are;
•	Oxfordshire has a history of good joint working, and a reputation for innovation and good quality services
•	Its joint commissioning approach has been in place since 1995, and other authorities are now looking to follow this model
•	There is a track record of success in delivering on strategic objectives, particularly the elimination of long stay hospital beds, the development of employment services, the development of services to meet the needs of people with complex & mental health needs, and the development of supported living
•	It is a leader in the provision of direct payments 
•	It has a dedicated learning disability care management and commissioning team, and service users are satisfied with the work they do

Weaknesses found from the review include;
•	Problems in accessing services due to the current ‘front door’ arrangements with CTPLD, which can be confusing, time consuming and inefficient due to multiple assessments, separate eligibility criteria and a lack of shared standards
•	Problems with performance management, including uncertainty over client records, limited contract monitoring, low numbers of completed care plans on file and no systematic care plan review system.
•	Budgetary control is unsatisfactory due to inadequate financial systems and client activity systems
•	A need to improve consultation arrangements at all stages to be more inclusive and remove perceptions of decisions made ‘behind closed doors’

Recommendations for Action
It is recommended that a new structure for Learning Disabilities in Oxfordshire be pursued that will;
•	Offer a single point of access for all services with care managers joining with community teams
•	Meet the objectives of ‘Valuing People’
•	Pool current budgets
•	Result in shared information systems
•	Have a common eligibility criteria and assessment and review procedures
•	Enable person-centred planning rather than have separate person centred plans for each organisation
•	Manage within its existing budget
•	Provide better workforce planning
•	Monitor commissioned services to ensure for quality and value for money
And that the Learning Disability Partnership Board ensure this structure is decided upon and implemented as soon as possible.

However, in order to facilitate this there is a need for action to be taken first in the following areas;
•	Address the inadequacies in client data and financial information to ensure that service activity matches available budget
•	Ensure that agreed care plans are in place for all service users, and that a system for reviewing these is set up. Introduce standards of service for assessments, care plans and reviews (including timescales)
•	Strengthen the commissioning and contracting arrangements to ensure purchasing is placed with only accredited or approved care providers, and that all contracts receive an annual review. 
•	Improve consultation and involvement of services users and carers in the planning and development of services. Devise and introduce an appropriate consultation mechanism to help achieve this.

2.	
Reports on areas of research
Area of work (1)	Getting into the service	
Description of research

	The objective of the research was to recommend options on how to improve access to services for people with learning disabilities and carers. To inform this, the research aimed to identify;
•	How do people find out where they can get help, and what help they can get?
•	What happens when they get there? Specifically when they speak to
•	The CTPLD (Community Team for People with a Learning Disability)
•	A GP
•	A Care Manager
•	The Adult Assessment Team
•	Who decides what type of assessment people get, and how do they decide this?
•	Who is involved in the assessment? What do they use to help them carry out the assessment?
•	Does this all happen the same way across the county?
•	What is said in “Fair Access to Care Services” and in “Valuing People” and does this mean we need to change how assessments are done? 
•	How does the level of funding available affect how people gain access to the service

A ‘mystery shopping’ exercise was carried out by two service users with support. Using an agreed scenario, the group contacted the South and Vale Community Team, the Social Services Customer Services Unit, Social Services Offices (Oxford City & Banbury), CTPLD (Oxford City & Banbury), South Community Learning Disability Team (Bishopswood), Blackbird Leys Surgery and the My Life My Choice Association office.
Other information was collected from the three CTPLD teams, Social Services Care Managers and Unit Managers, the Joint Commissioner within the Joint Commissioning Team, and Carers’ Centres. The implications of the consultation paper “Fair Access to Care Services” was also examined. 	
Key findings	Organisation
•	CTPLD are contracted by Social Services to act as a ‘front door’ for access to all learning disability services in Oxfordshire. This includes providing information about services, giving access to primary care services and referring cases to the Care Management Teams. A review of CTPLD is required by the DoH to take place by October 2002 as part of the ‘Valuing People’ learning disability strategy.
•	The intention is that all requests for information and services are received in the first instance by the CTPLD teams. Findings from the research show that this is not necessarily the case.

Information on obtaining services
•	People find out how to get help from a wide range of sources, including; Local Social Services Offices, their GP, Central County Council services or its helpline, voluntary sector organisations, specialist learning disability services (health or social services), and the CTPLD. Evidence is that people rarely go directly to CTPLD to ask for a service, which results in people being referred between organisations a number of times before they receive a service.
•	Many of these organisations contacted as part of the mystery shopping exercise were not sure about how to access a Community Care Assessment from Social Services, or gave different answers about how this would happen. Printed material requested from them was not always sent, and when it was it was often in an inappropriate format for people with a learning disability.
•	The CTPLD appear to be able to better assist people when they have previously received services from them. It could be more difficult for people who previously did not know about the service to find the help they needed.
•	Service users found asking for help confusing and complicated, and some would need to rely on someone supporting them. There was a lot of jargon used by the people contacted, although they were friendly and helpful.
•	Most information on obtaining services is not in an appropriate format, and so not easily accessible for people with a learning disability.
Assessment Process
•	The term ‘assessment’ is used to describe a variety of things. Sometimes it is a process, at other times an outcome. There are a variety of different assessments, each carried out by different people and sometimes using different sources of information. This can be confusing for the person being assessed. Some may want one type of assessment but actually receive another. 
•	The type of assessment people receive is decided in the first instance by CTPLD. They carry out an initial assessment into a person’s immediate needs, which may take around four weeks to complete. They will use information from the person being assessed, their carer and others with specific knowledge about the person. 
•	This initial assessment can classify someone unknown to the service as having a learning disability, but the judgement on the level of this learning disability can be made only by a psychologist as part of a separate assessment.
•	CTPLD may carry out a health specific assessment (e.g. speech/language, dietary, physiotherapy, psychology), or look at social circumstances, lifestyle, current and future life choices (e.g. training, employment, occupational needs, practical skills development, personal and social skills development). These detailed assessments rely on the professional knowledge and skills of the assessor, and input from his/her supervisor.
•	These assessments can lead to direct support being provided by CTPLD itself, referral to other support services to respond to particular needs (e.g. counselling and support following bereavement) or referral to Social Services Care Management teams for a Community Care Assessment.
•	Care Managers carry out Community Care Assessments using specialist information provided by other professionals (e.g. CTPLD, their GP, current support providers) who may be involved, as well as information from the person themselves. Unit Managers discuss assessments with Care Managers and offer guidance on certain aspects. There is no set format used for these assessments.
•	Community Care Assessments are carried out according to the urgency of the person’s circumstances and needs by using a ‘priority matrix’, which is linked to the availability of service resources. Therefore, the length of time to complete the process can vary widely.
Consistency
•	Timescales and processes for initial assessments by the CTPLD are broadly similar across the county. The practice of allocating cases to Care Managers within Social Services has varied in the past. 
•	CTPLD and Social Services each work to their own eligibility criteria. This leads to further confusion and inconsistent decision making across agencies.
Fair Access to Care Services
•	“Fair Access to Care Services”, currently at consultation stage, aims to provides councils with a framework for determining eligibility for adult social care services. It includes guidance on how to carry out reviews, and support individuals through these processes. 
•	The aims are that Councils will;
-	Provide or commission resources to meet assessed needs, within available resources 
-	Prioritise needs according to risks to the persons independence both in the short and long term
-	Ensure people receive broadly similar services to similar outcomes regardless of where they live (without requiring Councils to make identical decisions about eligibility)
•	Its General Principles for Assessment, also at consultation stage, aim to;
-	Provide clarity for service users about the process and decisions made in assessments
-	Introduce a single assessment process across all agencies
-	Involve service users more in the process, and ensure they are ‘person centred’
-	Ensure the assessment is recorded and agreed
-	Review the outcomes of care plans	
Conclusions

	•	The current arrangements offer a confused picture both for those inside and outside of the service, particularly people with a learning disability.
•	Organisations that may be approached by people with a learning disability for assistance are generally poorly informed about the assessment process, and are not necessarily trained to deal with them properly. 
•	Information and its distribution needs to be improved on how the service operates and what people can expect.
•	The principle of a ‘front door’ service provided by a separate organisation does not produce real efficiencies as multiple assessments by different organisations are often required, and these combined can be time consuming. 
•	‘Fair Access to Care Services’ will require the Service to address many issues, the need for which have been highlighted by the research during the review. Not least of these are the need for a single assessment process across all agencies, and for common eligibility criteria to be used.	
Ref to fuller document (where appropriate)	•	‘Getting into the Service – a telephone survey’, Nov 2001
•	‘Fair Access to Care Services’ – DoH consultation report
•	Review Area report, Nov 2001	

Area of work (2)	Care Planning and Reviewing	
Description of research

	The objective of the research was to recommend options on how to improve the way care plans are drawn up, the way they provide services and how they are reviewed to make sure that everyone works together in the best way. To inform this, the research aimed to identify;
•	How do people go from having an assessment to having a care plan?
•	Who decides what goes into a care plan?
•	What makes a good care plan, and what makes a poor care plan?
•	How is it decided on the best way to meet a person’s care needs?
•	How long does it all take, and how long should it take?
•	How does this work change with how much money is in the ‘pot’?
•	Are people always getting a copy of their care plan? Are they easy to understand?
•	If people are not happy with their care plan what do they do about it? What would they like to see happen?
•	What are care plan reviews for? Does this need to change?
•	How do care plan reviews happen? Are all the decisions made in the open?
•	How do we make sure care plans and services are meeting peoples’ needs?

A selection of 33 care plans were examined at random from each of the three social service area offices to examine;
•	Length of time between date of referral, date of care plan and commencement of services
•	The amount of information contained within care plans, if they are based on needs with outcomes or statements of service, and if they are signed
•	The procedure for reviewing the cases, and what change resulted
10 cases were looked at in depth for evidence of user involvement, carer involvement, and how far the services provided match those outlined in the care plan. This involved interviews with service users, their carers and the care managers involved.
In addition, three care managers were interviewed, and also a selection of external care providers. The level of complaints about the service was also investigated. 	
Key findings	From the 33 case files examined at random the following evidence was revealed;
•	The length of time it takes from referral to date of care plan varies and is dependant on circumstances. For the case files examined, 50% were dealt with within 1 month, the next 20% within 2 months and the next 30% within 3 months. 1 assessment took 6 months to deal with.
•	60% of the cases examined were for people already in receipt of services, 40% were school leavers with one person unknown to the service prior to referral.
•	 Only 30% of the files examined had care plans written following the referral (some had care plans pre-dating the referral), and of these 70% were not signed. This means that 80% of people receiving services have no evidence that they have been involved in decisions affecting their care. Failure to complete a statement of needs is a breach of statutory duty.
•	The format of care plans is varied. The most detailed plans are for people receiving direct payments. There was no consistency in the recording of support which is not directly purchased or provided by the care management team.
•	Only 30% of cases had been reviewed, which is a failure to meet with the statutory responsibility to review all cases. For half of the cases reviewed, this review had been undertaken by the care provider (as part of agreed procedures).
•	There was no consistency in the format of recording reviews, which made it difficult to judge the time between services starting and the review taking place.
•	Of the 30% of cases reviewed, 2 people had a change of service as a result
From the 10 cases examined in depth;
•	Only two people had a care plan.
•	Most of those interviewed did not understand the care management process and only one knew how to make a complaint. This lack of clarity about the process was echoed by care managers and also in how agencies work together. 
•	The majority of people were satisfied they had been treated with courtesy by the care manager. 8 were satisfied with the outcome of the care management process although most had outstanding issues that had not been addressed in the care plan. Service users commented that they were uncertain when the care planning process had been completed due to a lack of feedback.
From the Care Managers interviewed;
•	All thought the client’s view was most important in deciding on the services needed, although the carers view was also important.
•	None had received training in how to carry out the care planning process as applied within Oxfordshire. 
•	The care plan itself is seen by care managers as formalising the assessment process and stating what services will be provided, rather than being a statement of what the service user needs. Significantly, the care plan is viewed by care managers as duplicating the assessment process
•	Obstacles to writing care plans were given as a shortage of time, lack of administrative support and little access to PCs. 
From the complaints examined;
•	Between April 2000 and April 2001 there were 6 complaints from carers, which were registered and investigated under stage 2 of the Council’s complaint system. There were no complaints from service users.
•	Of these, 2 related to charges for services, 1 was for an incomplete care plan, 1 related to direct payments and 2 expressed a general dissatisfaction with the service.
•	There is a system for recording informal complaints about the service, but this information is not used within the team
From the interviews with 5 Care Providers;
•	All claim reviews are carried out on an annual basis. Providers take responsibility for ‘calling’ reviews, with the service user having the main say on whom is invited.
•	Care managers are not generally invited. Minutes of the reviews are not routinely sent to them, although they are notified if the reviews result in a request for a change to service.
•	Each provider documents reviews in different formats. Where they use specific forms the wording and guidance of these is unclear and difficult to explain to service users	
Conclusions

	•	An agreed care plan is central to the care management process, yet the Council is not ensuring that every service user receives one, understands it fully and has it reviewed it regularly. In addition, there appears to be a lack of clarity by staff of the purpose of the care plan.
•	A lack of training has led to inconsistencies by staff in their approach to and understanding of the care management process.
•	No standards of service exist for the time to complete a care plan, what it will contain, and what service users can do if they are dissatisfied with the outcome of the process.
•	Performance management is unsatisfactory, with insufficient controls over the signing off of care plans and a lack of involvement in, and control over, the reviewing process. Documentation used is poor.
•	There is a reliance on care providers to organise and complete the reviewing process, which takes management control away from the authority responsible for ensuring they take place and lacks impartiality. In addition, this approach fails to ensure the service meets its statutory responsibilities for reviewing cases.	
Ref to fuller document (where appropriate)	•	Survey of users of care management, Chris Locke, Nov 2001
•	Review area report, Nov 2001	

Area of work (3)	Commissioning and Monitoring	
Description of research

	The objective of this research was to recommend ways to improve how services are bought, commissioned and monitored to make sure they meet peoples’ needs. To inform this, the research aimed to identify;
•	How do we commission a service? Is this the best way to do it?
•	How do we decide on what any new service should do and how it is provided?
•	How do we monitor the services we commission, and make sure that they are meeting peoples’ needs?
•	How do we make sure we are paying the right amount of money? 
•	How do we decide when a new service is needed? 
•	Does this all happen the same way across the county?

A survey was undertaken with care providers currently working with the County Council (and other authorities), and another with carers involved in commissioning reference groups. A number of interviews were held with key stakeholders.
Research was undertaken into the different models of commissioning in operation in other parts of the country.	
Key findings	The Commissioning Process
Joint Commissioning
•	Oxfordshire has used a joint commissioning model since 1994, based on the NHS and Community Care Act 1990 principle that agencies working together can more effectively meet peoples’ needs. The main objectives are;
-	Bringing together the relevant sources of finance
-	Establishing clear lines of responsibility and accountability
•	Commissioning takes place within the context of a joint strategic plan, where resources are allocated to specific goals, priorities set for improvements and progress reviewed regularly. 
•	It also takes place at individual care manager level to meet the needs in individual care plans. This is not common in other client groups, and is viewed as a positive idea that encourages person-centred planning
•	Commissioning services accounts for £34m of gross expenditure of the Learning Disability budget, of which £7m is for internal services. 
New Services
•	Decisions on when new services are needed are made in response to information on unmet needs in a locality, the outcome of consultation with users or carers, and from the numbers and levels of need of young people coming through transition.
•	The types of services to be commissioned and how they are provided is decided by the joint local strategy and Joint Investment Plan. Formerly, these decisions were made at a national level and then interpreted locally.
•	Within the current framework, the types of services commissioned include accommodation services (including residential services), supported living, support to live at home, day services, drop-in services, advocacy, employment and respite.
Strengths and weaknesses
•	Nationally, a number of reviews have taken place into joint commissioning models, which have highlighted the following strengths of the approach;
-	A stable, experienced workforce
-	Good budget control and monitoring
-	A commitment to users and carers
-	The development of sound partnerships
-	A track record of service change and innovation
-	More cost effective services through competition
-	Effective needs analysis
•	Areas identified for development locally include;
-	Changing eligibility criteria with changes in resources
-	Information systems
-	Measurement of outcomes
-	Monitoring 
•	A small survey of carers involved in project reference groups revealed that there was frustration that managers responsible for decision making did not always attend reference group meetings. In addition, these meetings were infrequent, were held at inconvenient times, had insufficient advocacy services available and did not necessarily ensure equitable representation.
•	A survey of care providers revealed that the majority rate the commissioning process as either fair or good, and consider it impartial. Suggested improvements to the feedback should include service users and their support, more constructive information on the reasons for rejected tenders and more regular meetings are needed as part of the feedback process.

Commissioning Models
•	Of eight authorities contacted during the research phase, three had joint commissioning arrangements in place and one was looking to move toward this model. 
•	The research has identified three other methods of commissioning
-	A consortia model, where a group of commissioners agree jointly on an area and service to be commissioned
-	A lead commissioning model, where a single agency is chosen to commission a range of services, and all partners agree on which functions are transferred to the lead.
-	A virtual commissioning model, where a web-based tool is used to propose and agree on areas for commissioning. This is primarily used to commission research and development projects.
•	A preferred provider list was also looked into. While not an alternative to joint commissioning, it does enable countywide and individual commissioning to be better linked. It involves creating an assessed shortlist of interested providers by use of a tender and accreditation process, and then commissioning projects from this list rather than repeatedly approaching the market for each new project. This enhancement to the current commissioning model is seen to offer advantages in terms of financial risk, business planning and opportunities for time saving.
Monitoring
Financial
•	Oxfordshire’s performance on cost is explored as part of the Performance of the Service area of research, as is the adequacy of current contract monitoring arrangements
•	It was intended to carry out a cost-benefit audit to explore if the relatively high level of expenditure offered any significant benefits in terms of quality. This work was also to consider the management of risk in the current commissioning strategy.
•	However, difficulties were exposed as to the adequacy of data and how it is collected, variations in the cost of care packages and service users accessing a range of services at any one time, and the audit has not been undertaken.
•	It is accepted that work needs to be done here to more accurately reflect and record what is included in our contracts, whether they reflect costs adequately, and if benchmarking can be introduced against which to measure existing services and new proposals
•	Care providers have called for a move to an ‘open book’ policy, where both sides provide clear financial information. Greater transparency would assist a move toward benchmarking services, and would reflect procurement practice in other sectors where open partnership arrangements of this sort can lead to greater efficiencies.
Quality
•	Ensuring the needs of service users and carers are met is a key factor in commissioning services. There is evidence of good practice of service users being involved in planning, monitoring and auditing services.
•	A quality monitoring system has been established to ensure that the different needs, interests and aspirations of all stakeholders are met. This involves a Quality Monitoring Summary Sheet used to collect data as part of the annual service review. Weaknesses with the approach are that quality tends to be measured in terms of inputs (level of staffing etc) rather than outcomes.
•	Another, more inclusive method of monitoring quality is a Quality Network. This employs a simple method to evaluate service quality by asking for volunteers to spend time with people who use services, finding out what happens in their everyday lives.
•	Quality Circle Groups are also used, involving key stakeholders (housing, carers,social services and service providers).
Consistency
•	Within the Joint Commissioning team, the process of commissioning takes place in the same way and format. Links have been developed with the Social Services Contracts Unit, and other commissioning teams across other care groups (eg mental health, older people)
•	As some services are commissioned at an individual care manager level, there are questions as to the consistency of this approach.	
Conclusions

	•	The Joint Commissioning approach has proved a successful model and one that a number of other authorities have since followed. 
•	A clear need exists to improve systems for gathering information on service performance, and for benchmarking to better assess the costs of existing and new services.
•	In general, the process of commissioning is seen as fair and robust, and involves key stakeholders. Further work is needed to build on this and make the decision making process more accessible, and standards should be set to help achieve this.
•	Inconsistencies in individual commissioning need to be addressed by providing guidance and training for care managers.
•	The concept of a preferred provider list, while having some disadvantages in terms of flexibility and allowing new suppliers into the market, can be incorporated within current arrangements to allow for a better planned and more cost effective service.	
Ref to fuller document (where appropriate)	•	‘Adults with a Learning Disability – A Joint Strategy’  1995
•	Review area report, Nov 2001

Area of work (4)	Performance of the Service	
Description of research

	The objective of this research was to recommend ways to improve the performance of the Learning Disability Care Management and Commissioning service. To inform this, the research aimed to identify;

•	How well does the service do when you compare it to other councils?
•	Is there the right number of people doing the work? 
•	Are we doing all the things that we say we will do? How well are we doing them? Look at what we say we will do in
-	Our policies
-	Our service plan objectives
-	Our Joint Investment Plan objectives
•	How we set ‘goals’ for parts of the service to make sure it keeps improving. What should these be?
•	If the service knows enough about how well it does at the moment. What else does it need to know?
•	Are there other people that can do the care management and commissioning work that Social Services do at the moment?
Interviews took place with key personnel involved in the management and monitoring of the service. In addition, relevant reports, plans and monitoring documents were examined.	
Key findings	Service Objectives and Targets
•	The objectives of the service, as outlined in the 1995 Joint Strategy, were subject to a Strategy Review Conference in 1996. The report from this conference does not document progress against the 29 individual projects forming the Strategy, although evidence collected separately as part of the review would confirm that the large majority of these have been successfully pursued. These include;
-	Developing supported living
-	Developing employment services
-	Eliminating long-stay hospital beds
-	Developing an external market for care provision
•	Areas that were not successfully completed were improvements to planned provision for school leavers, improved advocacy services and better information from care providers on services they provide.
•	Since April 2001, the specific objectives for learning disability services across all agencies have been embodied in the Oxfordshire Learning Disability Joint Investment Plan 2001-2004. Amongst broader policy objectives, the Plan does contain specific measurable targets for performance. However, a systematic process is needed to evaluate progress against the objectives and targets in this Plan.
•	The future objectives for Social Services have, more recently, been embodied in the draft ‘Learning Disability Care Management Team Plan 2002-2003’. This has been developed as part of the Planning Into Action work in association with SSRADU.
•	The action plan contained within the Team Plan contains specific targets with identified performance measures and monitoring arrangements. This Plan includes targets for improved budget monitoring.
Staffing Levels
•	There has been a 39% increase in staff over the past 3 years, with the ratio of managers to care managers kept broadly the same (1:4). The largest single change in staffing resulted from a restructuring exercise in 1999 creating 6 new posts. 
•	This increase was funded from special grants arising from the ‘Modernising Social Services’ White Paper, and was intended to support projects arising as part of the modernisation agenda. However, guidance given to local authorities at the time suggested that any increases to establishment should be on a short-term basis (1-3 years) to reflect the duration of the ‘start-up’ funding the grants provided. These are permanent additions to the establishment. Funding for these posts has been provisionally agreed for a further 12 months, but it is unclear how they will be funded in future years.
Client Numbers
•	The SWIFT Client Information System is designed to retain all information on service users, but is only implemented at present to hold basic client information. However, even this is poorly utilised because;
-	Care managers do not find it useful and not all elements of the system are yet in place. Limited training took place upon its introduction.
-	The North Learning Disability Team is not on the IT network so does not have access to the Departments intranet or SWIFT and  there is limited access to PCs at the other two area offices.
•	The most recent information on the number of service users is for DoH PAF returns for March 2001;
No. of people helped to live at home:    	1024
No. people in residential care			  395
					Total		1419
•	This figure excludes service users aged 65 and over helped to live at home as they are counted in returns for older people and cannot be easily separated out, but an estimate for these additional service users brings the total to approximately 1700.
•	It has not been possible to look at trends in client numbers from using these returns as;
-	There were serious discrepancies with data collected in 1999/2000, leading to a figure of just 369 people helped to live at home, which is clearly incorrect
-	The method of data collection prior to 1999/2000 was different, which would produce inconsistencies
•	Other figures available are on outpatient attendance from the Oxfordshire Learning Disability NHS Trust, which suggest a reduction in the number of clients by 11% over the last 3 years. However, this only considers the number of people getting a service from OLDT.  
•	The Joint Commissioning model itself produces some confusion over who are our clients. An assumption made that anyone receiving less than 100% Health funding is a Social Services client. This is due to the guidance given by the DoH for how to collate client information, and there is debate nationally amongst Social Services Departments about this issue. 
•	The lack of management information in this area means that an evaluation of workloads has not been possible, and so no reliable conclusions can be made as to the appropriateness of staffing levels
Joint Commissioning Contracts
•	As at January 2002 there were 63 jointly commissioned contracts and service agreements running, with an estimated total value of £18.63m, ranging in value from £500 to £8.4m. The Learning Disability service took the decision some years ago to manage its own contracts and not use the Social Services Contracts Unit within the Community Care Division.
•	These contracts were formerly monitored by a 1 FTE Service Manager, who also has departmental responsibilities for project development and service planning, meaning that approximately 20% of this time was available for contract work. This is now enhanced by the addition of a full-time temporary (12 month) Unit Manager post (previously with the Social Service’s own Contracts Unit).
•	For services under £20,000 in value, a service agreement is used. For services over £20,000 in value, a more formal contract is used. Exceptions may be made to this where a service is only short-term or needs to be introduced quickly, and there are thought to be some historical anomalies still in place.
•	The specification is sent out to likely providers, and written proposals returned on how they would propose to meet the specification. A shortlist is drawn up, then providers are invited to carry out presentation (even if only one provider is involved). Contracts are awarded on a cost/quality balance. There may be further negotiation based on the costs of providing similar services elsewhere. However, no unit rates are used as a guide to costing, or for the process of negotiating prices although current and projected costs are taken into account.
•	Some poor practice has resulted from this approach. There are examples of care packages purchased through employment agencies, which then employ ‘self employed’ care workers without any checks on their credentials. In the view of the new Unit Manager, current contracts do not provide sufficient protection to the authority, or to the individual care manager that has commissioned them. 
•	Individual commissioning takes place often at Care Manager level. This is not common with practice in other client groups within Social Services. There is no formal training in contracting or contract supervision. 
•	An annual review is meant to be carried out, and a service development plan written, but this does not always happen, and staff are often too busy to chase. As at January 2002, only 10 (16%) of the contracts on file had any valid review or renewal dates against them (other dates either being expired or left blank)
•	The approval process for care providers is not the same as the accreditation process as is common in other client groups within Social Services, particularly Domicillary Care, which may lead to questions on assurances of quality of care providers. 
•	There are also a number of services purchased individually (“spot purchases”) provided by agencies that are neither approved or accredited by Oxfordshire County Council.
Performance Indicators
The two indicators directly relevant to this service are PAF B14 and PAF C30
PAF B14 – Unit Cost of Residential and Nursing Care for Adults with a Learning Disability (£/week)
1998/99 	£555
1999/00	£569	(2.5% increase)	6th most expensive of 35 councils
2000/01	£692	(21.6% increase)	8th most expensive of 33 councils 

•	Oxfordshire continues to be judged by the DoH as a low performer for this indicator, with calls to investigate this urgently. This is the third successive year the authority has received this rating.  This high cost is reflected in other care groups in Oxfordshire. 
•	Costs for 2000/01 have, on average, risen by 33% nationally, or by 31% amongst shire counties. Oxfordshire’s rise of 21.6% is only the 22nd highest amongst shire counties. However, a year-on-year comparison of this figure is not considered relevant as the definitions underlying the calculations are radically different. For instance, client contributions are now included. Despite this, the unit cost for 2000/01 is 43.5% higher than the top performing 25% of shire councils. 
•	The indicator is  based on the total cost divided by the number of weeks residential care was provided. This covers not only in-house provision but the external placement of clients. The 1999/2000 return for the PSS estimates for Social Services spending gave no figures for the split between the two, as financial reports only show the net cost to the authority rather than the full cost of the packages. It has therefore not been possible to make a comparison between the two and draw a conclusion as to the cost effectiveness of each. 

PAF C30 – Adults aged 18-64 with Learning Disabilities Helped to Live at Home per 1,000 population
1998/99 	3.0 
1999/00	0.9 (70% reduction)
2000/01	2.6 (174% increase over 1 year, 13% reduction over 2 years)

•	Oxfordshire is regarded as a good performer, although with a low indicator. Its 2000/01 indicator is the joint 13th highest amongst the shire counties. 
•	On face value the 2000/01 indicator represents the 4th highest increase amongst the shire counties over 1999/2000. However, the 1999/2000 indicator must be regarded as an anomaly since there have been no radical changes in policy to affect such an improvement.  It is highly likely that incorrect client figures given as part of this exercise lead to the very poor performance indicator here. 
•	There are significant difficulties in monitoring this indicator due to the lack of a comprehensive client index system. Experience shows that much of the performance management information required within the division resides either within the heads or the diaries of care management staff.
•	In establishing the return for the PAF C30 indicator, it is necessary for the Social Services Performance Information Unit to carry out an extensive manual check involving speaking to/chasing individual Unit Managers and care providers. For the 2000/01 return this process took from February 2001 until August 2001. 
•	This is for a single indicator amongst the 50 PAF indicators that need to be collected by Social Services every year. It should be highlighted that LD are not unique amongst Social Services for problems in this area of performance management.
Budget Monitoring
•	Problems in identifying specific financial information have been a problem throughout this research, and it is acknowledged by the finance section that they are unable to produce good information due to the systems and processes currently used by the service.
•	Routine financial information is currently provided to managers on a monthly basis. The SMT Budget Monitoring Report for the end of November 2001 shows a predicted overspend of £262,400. This is despite predictions earlier in the year that the budget would balance.
•	The most significant variations to the budget are the Care Managers Purchasing Budget (£537,900 or 32% overspend), Agency Residential Care costs (£248,400 or 3.6% overspend) and the Supported Living budget (£434,200 or 19.7% underspend)
•	There is a saving target of £250,000 built into the budget, although not identified against any individual budget heads.
•	Currently there is no clear financial information between clients and the cost of care packages. It is intended to introduce a Costed Packages of Care module into the SWIFT system which should allow;
-	Client details to be stored alongside coding details and other financial information to provide information on activity spend against budget
-	Payments identified against different budget heads
-	Direct payments calculations to be made from the system
 However, the pilot programme has been put back due to resourcing problems.
•	Orders for care packages are generated by Care Managers and authorised by Unit Managers. Before payment is made on an invoice an authorisation must be seen. A 5% variation is allowed on the cost of regular orders to cope with small changes in a client’s routine. For anything more significant, a variation order should be agreed by the Unit Manager. In practice, this process is ‘sidestepped’ and the care provider is often contacted directly by the finance section for information on this variation.	
Conclusions

	•	The Service is developing some clear objectives with clear performance indicators as part of the Planning Into Action process. 
•	The lack of a performance management culture, and any systems to support this, may ultimately frustrate the ambitions set out in the draft Team Plan, as the service cannot be managed effectively without a clear picture of current demands and predicted future demands. Poor client and financial information systems are the main problems.  
•	Staffing levels have grown disproportionately to the number of clients in order to support modernisation projects. Decisions taken in 1999 to increase the establishment using short-term grants leave the service at risk to being under-resourced. 
•	Poor contract practice may expose the service to risk, its clients to poor quality service, and may mean the service is paying higher prices than it needs to. The current work to address this is to be commended and supported. Better negotiation of contracts is likely to realise improved costs and a key area for investigation/improvement is the cost of residential care.	
Ref to fuller document (where appropriate)	•	Review area report, Dec 2001
•	Oxfordshire Learning Disability Joint Investment Plan 2001-04
•	Learning Disability Care Management Team Plan 2002-2003 (draft 31 Dec 2001)
•	‘Getting Together’ – Strategic Review Conference Report 10/9/96
•	DoH PAF statistics 1998/99 – 2000/01
•	PUI PAF Audit trail documentation
•	Personal Social Services Statistics 1999-2000 (estimates)
•	Joint Commissioning Contracts Lists - January 2002
•	DoH Outpatient Attendance statistics 1998/99 – 2000/01
•	Learning disability establishment lists 15/9/98 – 25/9/01
•	Background Comparative information (PPRU)	

Area of work (5)	Consultation	
Description of research

	The objective of the research was to recommend ways to make sure that everyone that needs to be is consulted and involved in planning and delivering the service. To inform this, the research aimed to identify;
•	How good are we at talking and listening to people? How can we do better?
•	How do we find out what people feel about the services we provide? How well does this work?
•	Do we give people information that is easy to understand?
•	How do we change the way we do things when people tell us they are not right? 
•	How do we make sure meetings don’t take place ‘behind closed doors’?
•	How are Social Services staff involved in making decisions about how the service works?
The research looked at good practice nationally and locally and compared this to methods of consultation currently used. A workshop was held with My Life, My Choice to look at how service users can be included in service planning and development. Other information was gathered from Carers’ Centres	
Key findings	•	The types of consultation carried out currently are;
-	Individual; as part of the assessment and care planning process
-	Local; to determine local needs within a defined geographical area
-	Project specific; using reference groups to refine planning for specific projects being commissioned by the Service
-	Countywide; to determine needs across the County
-	Ad Hoc; In response to Government or best practice initiatives being introduced, or as part of the Joint Investment Planning

Information from service users told us the following;
•	There is a perception that service managers do not have enough contact with service users, nor do they have the time available to carry out effective consultation.
•	In order to ensure that service users play as effective a part in the process as possible, and to avoid perceptions of tokenism, the consultation process must be well planned, with meetings held at convenient times and in accessible, friendly/comfortable locations with plenty of support.
•	Consultation needs to include a wide range of service users to avoid using the same people each time, which is unrepresentative, puts pressure on the few to come up with ‘right answers’ for everyone else and risks alienating them from the process.
•	There is a perception of some decisions being made ‘behind closed doors’

Information from Carers told us the following;
•	Consultation on specific projects, e.g. reference groups, is generally more successful than for general subjects, which is perceived as ‘difficult’ 
•	Problems with inclusiveness and equity may arise from those who are more confident about making their views known dominating the discussions.
•	Workshop events, such as those used for the Joint Investment Plan and the Joint Strategy, were considered useful, productive and appreciated.

Information from Joint Commissioning Team members told us the following;
•	Staff felt that consultation was positive, open and genuine.
•	Feedback on services could be better used, and should come from service users more than carers. Success is often judged on service outcomes rather than how service users feel. 
•	There is felt to be a shortage of the time, skills and resources needed to make consultation more successful.
•	Service users on out of county placements are often excluded from the process, as are people without a care manager. People with a high priority for services may be ‘listened’ to more
•	Consultation within the service, particularly where changes are made to working practice, is seen to be poor

Consultation mechanisms
•	Other authorities have adopted a ‘citizens panel’ model as a consultation mechanism to allow a wide range of people to be approached according to the scale and scope of the particular consultation exercise
•	Another model is a learning disability parliament, where participants are voted on by their peers to represent them in consultation exercises. This is used successfully in Cambridgeshire.
•	A report has been commissioned by the Learning Disability Partnership Board to look into the best way for consultation to take place in relation to the board and the objectives of ‘Valuing People’ in working in partnerships with people with a learning disability and carers.	
Conclusions

	•	A good deal of consultation work currently takes place, and for the most part this is well conducted. There is a need to improve on this further to ensure it is more inclusive. However, without sufficient training and resources dedicated to this staff are unlikely to have the time and skills necessary to achieve this
•	The consultation base needs to be broadened in order to ensure that the same people are not consulted each time, which may lead to tokenism or consultation fatigue. A wider consultation group needs to be established for the Service, possibly using a mechanism similar to a citizens’ panel or a Learning Disability Parliament. 
•	The recommendations of the LDPB report on consultation should be adopted as far as possible within Social Services	
Ref to fuller document 	•	Review area report, January 2002	

Area of work (6)	Comparison with other authorities	
Description of research

	The objective of the research was to compare aspects of Oxfordshire’s learning disability services with other authorities to establish if there were significant differences in structure, strategy, business process and budget
Three authorities were from within Oxfordshire’s SSI comparator group, and are considered ‘good performers’ in different areas;
•	Gloucestershire – good performer on PAF C30
•	Hampshire – high number of people receiving direct payments
•	Suffolk – has an integrated service with Health
In addition, informal discussions were undertaken with Northamptonshire, Kent, Somerset, Norfolk and Warwickshire	
Key findings	Comparisons between authorities in terms of their performance against aims and objectives has been difficult due to a lack of a common format for Joint Investment Plans. A new common format for 2002/03 has been introduced by the DoH as part of the Valuing People strategy 
Structure
•	There is a strong preference for specialist teams for learning disability services. Those authorities currently operating generic services are considering, or in the process of moving to this structure. 
•	There is no single preferred model for commissioning amongst authorities
•	Suffolk’s current integrated service does not involve joint care teams or joint working at care manager level.
Funding/Expenditure
•	Gloucestershire and Suffolk are experiencing similar problems with budget overspends and, like Oxfordshire, have used revised eligibility criteria to address this.
•	Direct comparisons with other authorities have proved difficult. For the CIPFA Personal Social Services estimates 2000/01, Oxfordshire did not enter a return. Problems with financial systems have been a significant factor.
•	Oxfordshire is regarded as a high spending authority for residential and nursing care by the DoH. Hampshire’s average cost was previously much lower than Oxfordshire last year but is now nearly 10% higher. No in-depth analysis has been carried out into these costs
•	A rough comparison of gross expenditure on learning disability services with the number of people with a learning disability supported by Social Services shows Oxfordshire spending approximately £20,000 per person compared to £18,666 in Gloucestershire and £16,814 in Hampshire. Suffolk spends approximately £30,000 per person
•	Oxfordshire spends more per head of population on learning disability services than other authorities interviewed, at £54.83 per capita compared to £49.50 for Gloucestershire, £44.77 for Suffolk and £34.63 for Hampshire.
Care Management Arrangements
•	Similar problems with reviewing care plans were identified in the other authorities. Both Hampshire and Gloucestershire use provider-led reviews. Suffolk has a generic reviewing team with workers seconded from other teams, but not everyone has had a recent review.
•	It is not common practice for clients to have named care managers
•	A standard or generic eligibility criteria is used in other authorities 
Joint Arrangements/Planning/Strategies
•	Suffolk is the only authority to have pooled budgets in place at present.
•	Strategic planning and joint working arrangements differ across the authorities with no single, preferred model being used
Client/Care Provision
•	Suffolk has the lowest number of people in residential accommodation at just 15% of the total number of people supported. This compares with Oxfordshire at 23%, and Hampshire at 35%.
•	Oxfordshire has more people with a learning disability receiving direct payments. 
•	Gloucestershire is quite far behind on developed supported living schemes, and has a large number in long stay hospitals or continuing care beds compared to others	
Conclusions

	•	Oxfordshire’s approach in having a specialist learning disability service is in step with current structures in other authorities. Other comparisons are difficult due to the variety of commissioning and joint working arrangements in operation. There is no single model that can be identified as being more successful.
•	Other authorities experience similar problems in delivering services in terms of budgetary control and care plan reviewing
•	Although Oxfordshire performs well, it spends comparatively more on learning disability services than other authorities. This needs to be explored in greater depth than has been possible in this Review
•	Greater use of comparative information should be made using the revised Joint Investment Plans of other authorities	
Ref to fuller document (where appropriate)	•	Review area report, Dec 2001	

3.	
Service Improvements

Key Service improvements
	
High priority for implementation	
1
	Restructure the service to have one service providing front door access to information, screening, assessment and access to services.

This will lead to –
•	Less confusion for users and carers. 
•	Clearer responsibilities with one service with one line management.
•	Common eligibility criteria and use of the criteria for accessing assessments and services. 
•	Better information to users and carers and other organisations in accessible formats.
•	Better client information and therefore improved planning and better statistical returns to the Department of Health and for own planning purposes. 
•	Cost savings of at least £35,000 through reduced management. 	
2
	Introduce standards of service for learning disability services

This will lead to 
•	A reduction in the time people wait for an assessment for services
•	All service users having a signed care plan that is understood and agreed. 
•	Assessments, re-assessments and care planning being undertaken within current eligibility criteria.
•	Care plans being reviewed annually and being led by the Learning Disability Service and not led by the service provider.
•	The requirements of the Fair Access to Care Guidance being met
•	Person centred planning being central to care planning.	
3
	Improve Commissioning and Contracting Practice

This will lead to -
•	The current commissioning process and responsibilities being clearer to all involved.
•	A monitoring system being set up that will lead to 50% of contracts reviewed in 2002/3 and 100% reviewed annually by March 2004.
•	Improved contract negotiation 
•	A provider accreditation process being introduced with the potential to move to preferred purchaser arrangements	

4
	Strengthen Client and Financial Systems 

This will lead to –
•	Targeting areas of spend to service priorities
•	Budgetary control targets being set for all aspects of the service
•	Decision making by managers based on up to date client activity and budget information.
•	Activity that matches the budget agreed before the beginning of the financial year and monitored throughout the year.
•	Better client information and therefore improved planning and better statistical returns to the Department of Health and for own planning purposes. 
•	An investigation into the high cost of residential and nursing care PAF B14.	
5 
	Improved consultation with and involvement of service users and carers in planning and development of services

This will lead to – 
•	Services being planned to meet peoples needs
•	An improved mechanism for better representation of people with a learning disability and carers.
•	Decisions not happening behind closed doors	
	
Other Service improvements	
	
Not a high priority for implementation	
1
	Accessible complaints and raising concerns information and process.

This development area will be dealt with as part of the work on care planning and reviewing and also improved consultation 	

4.	Action Plan

Service improvement 1	Getting into the Service
	
Description	Restructure to have one service providing front door access to information, screening, assessment and access to services.	
Objective

	•	To have a more efficient and better-understood way of getting into the service.
•	To provide clear information about the service
•	To meet the requirements of ‘Fair Access to Care Services’	
	Proposed service improvement targets
	Completed by	
1	An agreed joint eligibility criteria in use	Oct 2002	
2	Publish information about the new combined service in accessible formats	Feb 2003	
3	Combine the current front door access to the service provided by the CTPLD and the care management service	April 2003	
4	A single assessment process implemented	April 2003	
5
	Realise savings in management costs to Social Services of at least £35,000	April 2003	
Costs
Project management or management time
Publications to promote new service	
Risk assessment
Of carrying out the proposed improvements;
•	Staff morale; the desire for them to ‘buy in’ to the new structure
•	Requirement for agreement with partner agencies
•	A lack of consistency with other adult care groups

Of failing to carry out proposed improvements;
•	Retaining current confusion amongst users, carers and organisations. 
•	Inefficiencies across the system 
•	People working to different eligibility criteria.
	
Issues to consider – areas that will be affected by implementation
•	This recommendation for improvement will be passed to the working group from the OLDPB who are currently looking at the future structure for Learning Disability Services in Oxfordshire. 
•	The requirement to review the use of CTPLD by Autumn 2002
•	The future structure of Social Services – the need for generic adult service or specialist services
•	Accommodation and IT costs will need careful consideration in any joint venture	
Implementation plan
To be developed by: 
May 2002	

Service improvement 2	Care Planning and Reviewing
	
Description	Introduce standards of service for care planning and reviewing/re-assessments.	
Objective

	•	To ensure all people in receipt of a service have a care plan that they understand and agree. 
•	To ensure that all people in receipt of a service have a review/re-assessment of their care plan at least once a year 
•	To reduce the time people have to wait for assessment for services
•	To meet the requirements of 'Fair Access to Care Services'	
	Proposed service improvement targets
	Completed by	
1	Standards of service for assessments, care plans and reviews introduced, to include timescales for each stage	
July 2002	
2	All care managers trained on care planning and reviewing, and in new standards of service	
Oct 2002	
3	Accessible care plans developed	March 2003	
4	Care Plans in place for all people who have a service
 - 70% of service users
 - 100% of service users	
March 2003
Oct 2003	
5	70% of care managers current caseload reviewed and re-assessed	
March 2003	
6	Reviewing service in place and all people in receipt having an annual review of their care plan	
March 2004	
Costs
Training costs met from within existing training budget
	
Risk assessment
Of carrying out the proposed improvements
•	Capacity issue with level of current staff resources available to review approx 1700 cases

Of failing to carry out the proposed improvements
•	Services may not meet needs 
•	Statutory duties will not be met
	
Issues to consider – 
•	Numbers of people receiving a review but not by the care manager is not known –and therefore there is a capacity issue. 
•	Meeting the standards contained in ‘Better Care, Higher Standards’
•	The objective of ‘Valuing People’ to have person centred planning in place by 2004	
Implementation plan
To be developed by: 
May 2002	

Service improvement 3	Commissioning and contracting
	
Description	Commissioning and Contracting Improved
	
Objective

	•	To ensure commissioning meets needs identified in learning disability plans
•	To ensure purchased services meet the needs of service users
•	To ensure that contracts offer good value for money
•	To ensure commissioning and contracting is carried out in a consistent manner and to best practice guidance
	
	Proposed service improvement targets
	Completed by	
1

	All purchasing and commissioning to be placed with accredited or approved care providers	July 2002	
2	Commissioning and contracting standards and guidelines in place	Oct 2002	
3	Revised contracts monitoring process implemented	Oct 2002	
4
	90% of contracts over £250k in value reviewed
50% of contracts below £250k in value reviewed
All contracts with annual review	March 2003
March 2003
March 2004	
Cost
Additional contract monitoring officer time required – to use savings identified in access to the service changes to increase this service area by 2FTE approx. £50k 
	
Risk assessment
Of carrying out the proposed improvements
•	Care providers withdrawing services leading to a shortage as a result of pursuing efficiency targets

Of failing to carry out the proposed improvements
•	Capacity to undertake reviews and monitoring with only 1FTE dedicated staff 
•	Service users, the County Council and individual care managers exposed to risk through poor contracts
	
Issues to consider – 
Monitoring of service contracts in future organisational structure – internal services/care trust services and external market.
	
Implementation plan
To be developed by: 
May 2002	

Service improvement 4	Client information and  Financial management
	
Description	Client and Financial Systems Strengthened
	
Objective

	•	Costs of Service Activity to balance available budget
•	Target areas of spend to service priorities
•	Effective performance management of the Service	
	Proposed service improvement targets
	Completed by	
1	All people with a learning disability receiving a service from Social Services recorded on the SWIFT system	
 April 2002	
2	Information available to managers on client activity and costs that is up to date and accurate to enable managers to make informed decisions.	
April 2002	
3	All client activity and financial data on SWIFT with costed packages of care recorded on the SWIFT system	April 2003 (subject to funding)	
4	Accurate information for planning and performance management for learning disability plans and Department of Health returns.	April 2003 (subject to funding)	
5	Delegation of budget and decision making  to Unit managers	April 2002	
6	Review of purchasing of services compared with costs (to include costs of residential care) completed and ways to achieve cost savings identified	March 2003	
Costs
IT and additional infrastructure costs to implement SWIFT system
	
Risk assessment
Of failing to carry out the proposed improvements
•	Continuation of the existing poor data and information on current activity – 
•	Staff time spent in completing DoH returns. 
•	Decisions taken on spend based on inaccurate and not up to date budget information.
•	Failure to achieve value for money
	
Issues to consider – 
•	Future Pooled Budgets under Section 31 Health Act Flexibility’s
•	Future structure for Learning Disability services in Oxon
•	Means to share data between health and social care	
Implementation plan
To be developed by: 
March 2002	

Service improvement 5	Consultation with users and carers
	
Description	Improved consultation with and involvement of service users and carers in planning and developing of services. 
	
Objective

	•	Services planned to meet peoples needs
•	The planning and development of services in Oxfordshire is more inclusive 
•	Improved representation of people with learning disabilities and carers
•	Information produced by Social Services to be in accessible formats
•	Meeting the objectives of ‘Valuing People’ 	
	Proposed service improvement targets
	Completed by	
1	Information in accessible format
- reach agreement with service users and carers as to which information needs to be included
- Provide agreed information in accessible format	

Dec 2002 
March 2003	
2	Improved mechanism for consultation
- reach agreement with service users and carers on structure
 - Implement new mechanism	

Dec 2002
March 2003	
3	100% of commissioning and contract monitoring involves service user and carer representatives	
March 2004	
Costs
Training for service users and carers – bid to LD modernisation funding for training for Board members and for effective user involvement and cost of putting information into accessible formats & publishing it	
Risk assessment
Of carrying out the proposed improvements
•	Raised expectations of service user and carers beyond what can be provided
•	Staff time and skills to carry out consultation work

Of failing to carry out the proposed improvements
•	Services not meeting peoples needs, and therefore a potential for inappropriate use of resources
•	Perceptions of tokenism surrounding consultation exercises
•	Failing to meet ‘Valuing People’ objectives	
Issues to consider – 
Future structure of the service	
Implementation plan
To be developed by: 
May 2002	

2.	
Glossary

Commissioning	“A strategic activity of assessing needs, resources and current services and developing a strategy of how to make best use of available resource to meet needs” (DoH, 1995). This includes a range of services, such as residential services, supported living, day services, leisure/drop-in services, advocacy, employment and respite.	
CTPLD	Community Teams for People with a Learning Disability  - operated by the NHS Learning Disability Trust, and acts as the ‘front door’ for access to services	
DoH	Department of Health	
JIP	Joint Investment Plan; a joint strategic plan to set out the health and social care objectives for the service	
Learning Disability	A term to describe a person including the presence of a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence) with a reduced ability to cope independently (impaired social functioning) which will have started before adulthood, with a lasting affect on development.	
MLMC	“My Life, My Choice” - An independent advocacy organisation run by people with a learning disability	
OHA	Oxfordshire Health Authority	
OLDPB	Oxfordshire Learning Disability Partnership Board	
OLDT	Oxfordshire Learning Disability (NHS) Trust	
PAF	Performance Assessment Framework: The Department of Health’s version of Best Value Performance Indicators	
PCT	Primary Care Trust	
PIU	Performance Information Unit of Social Services, responsible for collecting performance data across the Department	
S28A Funding	Refers to Section 28A of the National Health Service Act 1977, The amount of funding provided by the Health Service to pay for health care related services provided by other agencies.	
SMT	Senior Management Team (Social Services)	
SSI	Social Services Inspectorate	
SSRADU	Social Service Research and Development Unit	
Transition	Moving into the Adult client group from being a younger person	
Valuing People	“Valuing People – A New Strategy for Learning Disability for the 21st Century”, published by the Department of Health in March 2001