Priorities for change at a local level 1. Whole system change for working age and lifelong disabled adults based on their specific needs, not based on an older adults’ model Unlike many other areas within health and social care, working age and lifelong disabled adults are typically less described and perceived as a whole-system responsibility. Attention is often focussed on very specific individual needs, and whilst this is vital at a personalisation and support level, this can miss the opportunity to recognise themes for system roles and reform. The cohorting analysis undertaken for this programme shows clear common themes in programme argued that the current delivery model for working age and lifelong disabled adults is out of date and needs redesigning, in close conjunction with individuals with lived experience and with a wide range of system partners. They agreed that this must continue to be a social model of care and support, not a medical model, and be more strengths-based. different groups across the country. Stakeholders engaged through this
Despite the progress made in models of care over the last 100 years, the new model required for the future will inevitably be more multi- faceted and will require government support to help embed it nationally. The fragmentation of current referral routes, eligibility criteria, and funding streams creates issues for individuals and their families trying to navigate a very complex system, whilst also forcing additional strain and conflict between organisations with no benefit to the individual. Clarifying shared and measurable objectives across partners will help to improve alignment and reduce fragmentation. The role of local partners should be prioritised, for example taking a stronger community strengths-based approach to support and maximising the role of education partners. Nationally, DWP is an example of a partner who could play a different role by supporting better employment outcomes for working age and lifelong disabled adults. Stakeholders were also strongly of the view that this new model needs to be more imaginative and ambitious in what support is provided. It should look at wider constraints, such as opportunities for more diverse work experience, recruitment, and employment. It should also consider how people can be better supported flexibly in their communities, day to day, without setting them up with inflexible levels of support based on their largest need area. 2. A more effective approach to influencing and managing the market, ensuring that commissioning best practice is implemented and working with providers to develop a jointly beneficial arrangement Providers play a crucial role in delivering quality support to individuals and are an important part of any future reform.
Amongst stakeholders engaged for this programme, there was a recognition that support providers will often find working with working age and lifelong disabled adults with complex needs less commercially attractive. There are greater potential reputational risks if they struggle with managing quality with complexity, and different profit opportunities compared to largely self-funded older adult provision. This is resulting in several authorities needing to increase their use of more expensive out of area placements to meet local needs or feeling ‘at the mercy’ of the provider market. In addition, there is potential for commissioning best practice to be shared and implemented more widely across adult social care nationally, so that local authorities are managing their local providers and markets to best effect. For example, through more long- term, strategic planning; more rigorous use of local population data to inform commissioning decisions; working with and responding to variation in local provider set-ups; and a more rigorous and consistent approach to managing local markets. 3. An approach which places maximising individuals’ independence at its heart, including long-term planning with providers and with families, to ensure that over- innovation and investment is needed to take a more forward-looking, preventative approach and improve longer-term outcomes. For example, many young people are reaching adult services without the ‘life skills’ to get into employment, and intervention from social care earlier to influence an individuals’ later life would be beneficial. provision of support is minimised Stakeholders engaged through this programme emphasised that further
When they showed me how to cook, it was amazing! Being allowed to cook for myself after that made such a difference, I felt like I was really independent at last.” Keisha, 27 Such an approach requires more effective transition planning from an earlier stage, as well as more joined up working with a wider range of partners, in particular schools. An in-depth understanding of different cohorts’ needs (as illustrated in this report) will also be important for effective targeting of appropriate preventative interventions, for example identifying key points in people’s life journeys where timely and appropriate support can prevent needs from escalating. The involvement of individuals with lived experience will be crucial in this analysis and identification. This opportunity for more preventative thinking applies both to support staff in local authorities and in provider organisations (e.g. thinking for every individual – how can we help maximise their independence?) as well as for parents (e.g. helping them understand the likely journey for their disabled child and make decisions early that will maximise their later independence, such as location of the family home). Working age and lifelong disabled adults should be enabled to have better and more equitable access to the right education, employment, and housing opportunities from the earliest opportunity. In addition, they should be supported to develop the skills to more actively participate and contribute to their local community at every stage of their lives, through work, volunteering, and education. This is something that individuals with lived experience consistently highlighted as important to them, as it is for their non- disabled peers.
70 HOME
HOME
71
Made with FlippingBook - Online catalogs