Respite Care for Adults - Ministerial Response - 22 September 2015

Findings

Comments

1

There  is  no  cohesive information  regarding  the breadth  and  depth  of disability  in  Jersey. Information  is  held  within different agencies including the  Health  and  Social Services  Department, primary care providers and the  Social  Security Department, but there is a lack  of  concrete  data. Understanding  the  breadth and  depth  of  disability  in Jersey is a key element to developing  a  strategy; without it, services will not be tailored to meet people's needs and there will be an inability to plan for future demand.

The Social Policy Unit is currently conducting research  into  disability  in  Jersey,  which  will inform the development of a disability strategy in 2016.

There are 2 phases to the research:

1. August – October 2015:  In-house  qualitative research, to provide an insight into people's lives and what it is like to live in Jersey with a  disability,  impairment  or  long-term condition

2. September – December 2015:  A  UK-based social  research  agency  will  undertake  a Health and Life Opportunities survey in order to  provide  quantitative  data  on  disability, impairments  and  long-term  conditions  in Jersey. The survey will be sent to a random sample of a quarter of all households on the Island (c. 10,000).

This  will  provide  us  with  a  much  deeper understanding  of  the  breadth  and  depth  of disability in Jersey. Following these 2 elements of research, further qualitative work will be used to help shape the strategy in Q1 2016.

Findings

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2

There are 11 respite beds in the children's service and 5 (which  will  decrease  to  4 after  July  2015)  within adult  services.  There  is  a danger  that  users  of  the children's service will have insufficient  facilities  for overnight respite care when they reach 18 and enter into adult services. The disparity between  children's  and adult services may increase pressure  on  adult  services and lead to over-reliance on out-reach  and  in-reach services.

I  recognise  the  issue  regarding  the  disparity between Children's and Adults' residential short breaks availability.

Currently,  there  is  an  over-supply  of  beds  for children's  short  breaks,  and  an  increasing pressure  on  adult  residential  short  breaks capacity.  For  this  reason,  the  Commissioning Intentions  paper  proposes  re-purposing  4 beds into a dedicated facility for young adults (aged 14–21), so that there are:

• 8 beds  for  adults  at  Mourant  Lodge  and Maison  Allo  (for  c. 49  individuals  aged 14 and over)

• 7 beds for children aged under 14 (for c. 15 children aged 13 and under, plus 3 children aged 14–17 who access Oakwell).

The  out-reach  services  will  continue  to  be increased,  in  order  to  provide  choice  of  short breaks location.

3

Three  residential  beds  in adult  services  are  required to  meet  the  demand  for short  break  services  for wheelchair users. From the end  of  July  2015,  when Cheshire  Homes  will  no longer  provide  such  a respite bed, there will only be  one  respite  bed  which caters for wheelchair users.

Since Highlands ceased its short breaks in 2014, 2 beds have been available for adult wheelchair users.  The  bed  at Jersey  Cheshire  Homes  was fully utilised for longer-stay breaks, and the bed at Mourant Lodge was occupied on average for 100%  of  days.  Therefore,  it  is  assessed  that 2 beds are sufficient for current demand.

We are currently in discussion with Les Amis about adding an additional room at Maison Allo for  non-ambulant  users.  This  will  bring  the capacity back to 2. At the present time we are working with Silver Springs, which is assisting through the use of a non-ambulant bed within its facility.

4

Evidence suggests that the need  and  demand  by wheelchair users for respite will  increase  rather  than diminish,  with  3  more wheelchair  users  entering into  adult  services  within the next 3 years. The Panel understands  that  there  are several families waiting to access  the  wheelchair- friendly  room  at  Mourant Lodge. It is also noted that

Maison  Allo  will  include  one  room  for wheelchair users; this will be available for the young adults who will enter adult services, and for those students at Mont à L'Abbé School who are  eligible  for  short  breaks  and  require wheelchair accessible facilities.

HSSD has requested information on a number of occasions regarding the waiting-list for access to Mourant  Lodge  for  service  users,  but  has  not been  provided  with  this  information  as  yet. However, data from Les Amis does indicate that the Mourant Lodge non-ambulant room has no

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there  are  a  number  of students at Mont à L'Abbé School  who  need  physical support  or  have  other mobility  difficulties,  and therefore  are  likely  to require  ground  floor residential  respite  facilities when they enter into adult services.

spare capacity, which could be utilised by those eligible  for  the  service.  HSSD  is  currently providing  additional  capacity  for  non-ambulant adults through Silver Springs.

5

There is currently no spare capacity  to  cater  for emergency  cases.  If  a service user was to go into crisis, other users may have reduced  access  to residential  short  break services.

It  is  important  that  flexibility  to  respond  to emergency needs is included. This can at times be a challenge, and is managed by social workers, working with families as their needs change.

Data indicates that the existing beds are not being fully utilised – an average of 93% for Mourant Lodge and 42% for Maison Allo during Q2 2015. Therefore,  there  should  be  spare  capacity  for emergency short breaks within the existing bed numbers.

Should a family go into crisis then Les Amis can (and do) open The Lodge' to assist in addressing unplanned respite need.

It would not be value for money to hold beds empty in case of emergency short breaks needs; there will always be an element of operationally responding  to  needs  as  they  can  often  change quickly.

6

Some  families  and  carers have  been  left  confused about the Long-Term Care Scheme and what it would mean for them in terms of respite  care.  The  principle of  giving  people  more "buying  power"  may  lead to  inequalities  of distribution due to a lack of understanding  about  how the system works.

The  Long-Term  Care  Scheme  (LTCS)  was introduced in July 2014. It includes support for adults  living  at  home  with  some  of  their  care being  provided  by  a  friend  or  relative.  The support provided can include the cost of regular paid  support  and  the  cost  of  providing  short breaks for the unpaid carer. This is a major new scheme, and both HSSD and SSD are working closely with families so that they fully understand the new benefit and can make choices as to how to receive care, including short breaks.

At  present,  adults  access  short  breaks  through engaging  with  the  C&SS  Adult  Short  Break Co-ordinator or their assigned social worker (who will forward the request to the Adult Short Break Co-ordinator).

In the future, adults will access additional short breaks through the same process, choosing to use

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their  LTCS  budget  with  a  range  of  providers through the Approved Provider Framework. The Adult  Short  Break  Co-ordinator  will  help individuals access the right care within the right location at the right time.

7

The  Social  Security Department has set respite care at 6 weeks for the year in  relation  to  the  Long- Term  Care  Scheme. However, there may not be sufficient  overnight residential respite provision within  Health  and  Social Services  to  allow  for 6 weeks  of  respite  care. This  may  lead  to  families having no other choice but to  access  out-reach  and in-reach services.

SSD  outline  that  each  user  can  access  short breaks up to a maximum of 6 weeks per year. Not all users need or want this level of care, nor will all of them qualify for it. Based on all known service  users  accessing  the  maximum  6 weeks per year, capacity and demand for 2016 would be:

Adult  and  Young  Adult  beds –  2,880 days; demand  up to  2,058 days  (for  c. 42 adults  plus 7 individuals aged 14 and over);

Children's  beds –  2,500 days;  demand  up  to

756 days based on 15 children aged 13 and under, plus 3 children aged 14–17 who access Oakwell.

8

More services are available within  the  children's service  compared  to  adult services. For example, one of the respite homes within the children's service has a hydrotherapy pool facility.

Adults can access a wide range of services, from a  range  of  providers,  for  example,  Jersey Cheshire  Homes  provides  access  to  its hydrotherapy  suite  to  individuals  using  their LTCS funds.

9

No  audit  trail  has  been found  of  the  decision  to cancel  plans  for  a  new bespoke adult respite home. Evidence  gathered  during the review shows that there is and will continue to be a strong demand for this kind of respite care in Jersey.

There is a strong demand for both residential and out-reach short breaks, and it is important that safe, affordable services are available to meet this demand  both  now  and  into  the  future.  The Commissioning  Intentions  demonstrated  that there  is  sufficient  capacity  within  the  current services, and that existing providers are willing to continue  providing  services.  Therefore,  the significant cost of building a new facility can be avoided.

10

Home-based  respite services (out-reach and in- reach)  have  developed more  readily  in  recent years,  whilst  residential- based respite services have contracted.  The  Panel believes that these types of respite  services  should  be additional  for  families

It  is  important  that  we  provide  choice  for individuals,  so  both  residential  and  out-reach services must be available. The States must meet the needs of individuals, but must be clear about eligibility for services and the amount of services that individuals can expect, in order to manage public  finances.  The  Long-Term  Care  Scheme provides funding for eligible individuals, based on their assessed needs for paid care, unpaid care and short breaks. The individual will then choose

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rather  than  a  replacement for  residential-based respite.

the  package  of  care  that  they  need  and  want, within their individual budget.

11

The  previous  Panel highlighted  significant issues  with  the  transition process in 2012. It appears that  the  process  is  still variable,  and  families  and carers  are  still  being  left confused  when  their  child reaches the age of 18. The Panel has been told that in order  to  provide  an effective transition service, 2 additional  social  worker posts are required.

The 2 social worker posts have been included in the bid for funding for 2016 as part of MTFP 2. The  service  provision  within  Community  and Social Services is currently being reviewed under the leadership of the newly appointed Managing Director,  and  the  transitional  needs  of  young people are a high priority.

12

The  Le Geyt  Centre  is  no longer fit for purpose as a day  centre  and  does  not have  adequate  facilities  to meet the long-term needs of the  service  users.  Plans have  been  developed  for smaller  bespoke  premises to  be  provided  around  the Island  with  the  Le Geyt Centre  building  becoming an autism centre.

Through LTCS, individuals will choose their own care package and services, tailored to their needs. The vision of Day Services is to move away from a traditional building-based service to one which provides  improved  daytime,  community-based care  as  part  of  an  individual's  package. Community  and  Social  Services  and  Jersey Property  Holdings  are  working  in  partnership with Jersey Autism with the aim of developing an autism centre.

13

The  transport  provision  to take  service  users  to  and from Le Geyt Centre is not working properly. Many of those  most  severely disabled spend a lot of time on the bus collecting other service  users.  Financial constraints have meant that there  are  no  funds  to replace the current vehicle which is in its ninth year in service.

Patient  transport  is  currently  being  reviewed, with  the  aims  of  improving  the  service  and reducing the length of time service users are on the  bus.  The  current  vehicle  is  listed  for replacement within the next 12 months.

14

The  States  of  Jersey  does not  have  any  statutory obligations  to  fund  respite care for adults. As a result, services  could  be  an  easy

Whilst  the  States  has  not  adopted  specific legislation in respect of short breaks, the recent introduction of the LTCS has had a similar effect. The Long-Term Care Law provides a statutory entitlement  to  financial  support  for  long-term

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target  for  funding  cuts, particularly  in  the  current economic climate.

care  costs  for  eligible  adults –  including  short breaks where applicable.

Benefit levels within the LTCS are dependent on the level of long-term care contributions collected from local residents and an annual grant provided from  the  Consolidated  Fund.  The  level  of  the annual  grant  is  set  in  legislation  and  is automatically uprated each year.

Ongoing decisions as to the level of contributions and benefits will need to be taken by successive States Assemblies.

15

The  Health  and  Social Services  Department  has proposed  repurposing Maison  Allo,  currently  a respite  home  which  sits within  the  children's service, to a young person's facility for ages 14–21. Not only  might  this disadvantage children aged under 14,  it  also  fails  to address  the  residential- based  respite  needs  for adults aged over 21.

The  plan  is  to  repurpose  Maison  Allo  into  a young  adults'  residential  short  breaks  facility, which will provide continuity of care for those individuals  who  currently  access  this  facility, who are aged 14–18, and who will soon transition into adulthood.

Mourant Lodge will remain the residential short breaks facility for adults aged 18 and over.

16

The  Health  and  Social Services  Department  plan to  introduce  eligibility criteria for those wanting to access  adult  respite services.  Although eligibility  criteria  could ensure  a  transparent  and consistent  approach  to allocating  services,  it should not mean that fewer families  receive  residential respite  care,  as  the  Panel considers  residential-based respite care to be a crucial component  in  the  service offered to families.

Short breaks are essential in ensuring individuals are able to live at home, providing a valuable break  for  the  carers  and  the  individuals  alike. Both residential and out-reach short breaks will continue to be available.

Eligibility  criteria  are  needed  for  all  States- funded services, in order to provide clarity about what  individuals  can  expect  to  be  publicly funded. These need to be set robustly, ensuring that the needs of individuals are supported.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

By  the  end  of  2015,  a framework  for  collecting and  collating  data  and monitoring  and  developing performance  within  both children's  and  adults' services  should  be developed.  This  should  be developed  using  data obtained from the Disability Strategy and in accordance with  an  information management  system  which complements  collecting information  from  other Departments.

HSS

Accept (but with revised timescale)

Integrated  reporting  is incorporated  as  part  of  the HSSD  Informatics  Strategy. Where  available,  disability indicators  can  be  included  as relevant and appropriate.

The  Informatics  Strategy  also includes a plan to work across the Island to ensure that systems are  in  place  and  reports  are produced  appropriately.  This will be discussed in the Island- wide  Health  and  Social  Care Informatics Forum.

The  Social  Policy  Unit  is currently  undertaking  research work  in  the  period  to  31st December 2015. Any disability reporting  framework  will  need to take account of the outcomes of  this  research,  and  of  the strategy which the Social Policy Unit is planning to develop from Q2 2016.

31.12.2016

2

The Minister for Health and Social  Services  should ensure  that  overnight residential  respite  will continue  to  be  provided  to families and carers without having a negative impact on other services. In particular, the  Minister  should  ensure that  wheelchair  users  have sufficient  facilities  which the  Panel  considers  should include  3 accessible  beds. The  Department  should work  in  partnership  with organisations  such  as  Les Amis, who have offered to develop what is needed for families.

HSS

Accept

Analysis has demonstrated that 2 wheelchair accessible beds for adult residential short breaks are required.

Discussions are well underway with  Les  Amis  regarding  this provision,  and  the  Department will  continue  to  work  in partnership  with  Les  Amis.  In the  meantime,  one  bed  is available at Mourant Lodge, and one bed at Silver Springs.

31.12.2015 for Maison Allo re- purposing and 2 non- ambulant beds at Les Amis

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

3

The  Panel  was  told  that resources  must  be  secured through  the  Medium  Term Financial  Plan  2016 – 2019 for  2  additional  social worker posts if an efficient and  effective  transition service  is  to  be  provided. The  Health  and  Social Services Department should develop new and innovative ways of working in order to provide  an  effective transition  service  within existing  resources  and  not solely  rely  on  securing funding for additional staff.

HSS

Accept

Funding  for  2  Social  Workers has  been  included  within  the MTFP 2  bid  for  Children's Services.

We  are  also  redesigning  the Adult and Older Adult Services, with  a  view  to  improving services and value for money.

31.12.2015

4

By  the  end  of  2015,  the Minister  for  Health  and Social  Services  should publish  an  update  on  the Carers'  Strategy  2013 – 2016.  This  should  include what  progress  has  been made since it was drafted in 2013.

HSS

Accept

This work is underway, working with  the  Carers'  Partnership Group.

31.12.2015

5

The Chief Minister, through his Assistant Chief Minister, should engage more closely with  the  Service  User Forum  and  use  it  as  an opportunity  to  develop policy, as it brings together people  who  have  personal experience  of  multiple  and complex  problems.  The Chief  Minister's Department  should  publish formal  records  of  the Service  User  Forum's meetings,  which  include specific actions to be taken forward.

CMD

Accept

The  Assistant  Chief  Minister has  recently  commenced  a review  of  the  Service  User Forum, including an assessment of  its  purpose,  function  and membership.

As  part  of  the  review, consideration  will  be  given  to record-keeping and the potential publication  of  meeting  notes. Any decision on whether or not to  publish  would  be  taken  in consultation  with  members  of the  Forum  (this  includes individual  service  users  who may  or  may  not  have reservations about publication).

November 2016

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

6

The Minister for Health and Social  Services  should ensure  plans  for  the  future of  the  Le  Geyt  Centre  are fully  costed  before  June 2016 when the second part of  the  Medium  Term Financial  Plan  2016 – 2019 will  be  lodged.  The  Panel also  recommends  that  key decisions  regarding  this development  are  formally recorded  and  published  so that service users are able to track its progress.

HSS

Accept

At  present,  Community  and Social Services is reviewing day services  and  the  future  of  the Le Geyt Centre. Providers such as  Autism  Jersey  are  being consulted, and once future plans are  fully  formed  these  will  be consulted upon. The outcome of the  consultation  and  any  final decision  will  be  formally recorded and published.

June 2016

7

The  Health  and  Social Services Department should investigate  ways  of providing a better transport service  for  users  of  day services, including working with  the  Voluntary  and Community Sector.

HSS

Accept

Patient  transport  services  are under  review  with  the  aim  of improving  service  user experience.

June 2016

8

The Minister for Health and Social  Services  should introduce a Social Services Law  with  Regulations  and guidance  to  accompany the Law,  to  include  a requirement  to  provide  a break  for  carers  and  for individuals with disabilities in  order  to  improve  the quality of their lives.

HSS

Accept

The current draft list regarding amendments  to  legislation involving  children  includes Carers' Rights.

Respite  legislation  could  be considered  within  the development  of  the  disability strategy,  which  is  being developed by the Social Policy Unit in 2016.

31.12.2016

9

A "Care Navigator" will be employed for a short period by  the  Health  and  Social Services  Department  to work with carers to identify unmet needs and choose the most  appropriate  respite  to meet all of their needs. The Panel's  evidence  suggests that  support  for  carers  in

HSS

Accept

Two Social Worker posts have been  included  in  the  bid  for funding  for  2016  as  part  of MTFP 2. The service provision within  Community  and  Social Services  is  currently  being reviewed under the leadership of the newly appointed Managing Director,  and  the  transitional needs  of  young  people  are  a

March 2016

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

both the children's and adult services is required, and not just for a short period.

high priority.

10

In  order  to  ensure  re- purposing  Maison  Allo  is the  right  approach,  the issues  identified  by  the Special  Needs  Advisory Panel  (SNAP)  should  be fully  addressed  and answered  in  writing  before plans  for  the  facility  are implemented.  This  formal response  to  SNAP's concerns  should  also  be circulated  to  all  service users of Maison Allo.

HSS

Accept

Members  of  SNAP  have  met both the Director of Children's Services  and  the   Deputy Directors  of  System  Redesign. SNAP  has  been  asked  to contribute  to  the  redesign  of respite  care  delivery  to  ensure that the voice of the service user is heard.

30.09.2015

11

The  Health  and  Social Services Department should ensure  that  the  eligibility criteria  for  accessing  adult respite services are fair and consistent. Before finalising the criteria, the Health and Social Services Department should consult fully with the Special  Needs  Advisory Panel  and  other stakeholders.

HSS

Accept

Eligibility criteria are needed for all  States-funded  services,  in order  to  provide  clarity  about what individuals can expect to be publicly funded. These need to be set robustly, ensuring that the  needs  of  individuals  are supported.

The  eligibility  criteria  for HSSD-funded adult short breaks services  will  be  developed during  the  Autumn,  and meetings  will  be  held  with stakeholders.

Eligibility  criteria  are  not needed  for  services  for  which individuals  receive  Long-Term Care Benefit, as the individuals decide  which  services  they access,  using  their  individual budgets. The individual budgets are based on need, following a robust assessment.

31.12.2015