External Review into Day Services undertaken by Jan Lawry

Summary

The requester asked for the 2023 external review of day services for adults with learning disabilities and the resulting actions, which Manx Care fully disclosed by providing the report and a summary table of findings and progress.

Key Facts

• The external review was conducted by Jan Lawry between May and July 2023.
• Manx Care is designing a strengths-based care model to promote positive risk-taking and independence.
• A transitions working group has been established to coordinate future day service requirements across multiple departments.
• Supported employment initiatives are adopting European practice frameworks and linking with the Disability Employment Service.
• Manx Care is considering commissioning third-sector partners to deliver community-based activities and social enterprises.

Data Disclosed

• 2023
• May 2023
• July 2023
• 2 May 2024
• 22 May 2024
• 3838797
• 6 pages
• 1 document

Original Request

Dear Sirs, Please provide a copy of the commissioned external review into day services for those with learning disabilities in 2023 alongside its findings and actions taken to date. Many thanks

Data Tables (5)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 3838797 22 May 2024

Dear ###

We write further to your request, received 2 May 2024, which states:

"Dear Sirs,

Please provide a copy of the commissioned external review into day services for those with learning disabilities in 2023 alongside its findings and actions taken to date.

Many thanks"

I have detailed below the information that is being released to you:

Please see enclosed copy of the report produced following the review of Day Service Provision for Older Adults and Adults with a Learning Disability, carried out between May and July 2023.

In order to provide further advice and assistance, the table below summarises the findings and the actions taken to date, along with planned actions.

Findings / Recommendations Actions to date The overarching day services provision should be viewed as part of the preventative model of care for older people and those with a learning disability

…and as a catalyst for service users to be part of their community

• Adult Learning Disability Services (ALDS) is designing a strengths-based care and support practice model to specifically deliver the preventative aims of the Day Services Mandate; promoting positive risk taking, development of self-confidence, social skills and independence. • The ALDS Day Service offer has been reformulated to offer a dedicated community inclusion and participation pathway (subject to funding), as well as a clear route to paid supported employment.

There is a clear and urgent need to focus on:

• Transport • Future planning • Transport is in the process of returning to Manx Care from the Department of Infrastructure (DOI), which presents an opportunity to review and adapt service arrangements.

• Early identification of those who could go onto paid employment

Consideration should be given to expanding this highly specialised area [supported employment] working in collaboration with the college, Tall Trees and Greenfield facilities

• A transitions working group to better co-ordinate and future forecast Day Service requirements has been established involving ALDS, Department of Education, Sport & Culture (DESC), Children With Disabilities and the Adult Social Work Teams. • ALDS Supported Employment is:- o adopting European SE practice framework
o linking with Disability Employment Service to identify suitable employment opportunities
o investigating NVQ awards as part of the training pathway o exploring employment opportunities within Manx Care and
o developing closer curriculum co- ordination with DESC • ALDS are planning to link with DESC ‘Vulnerable on Transition’ employability strategy to support early identification and planning for those of compulsory school age with LD who could go into paid employment.

There should be a formal progression to a cradle to grave service, using a multidisciplinary approach, where service users and their families are supported from birth. This should encompass a strengths based approach to care with age appropriate valued activities

• This is the broad direction of travel following the actions described earlier in the table.
• Discussions with regards to formalising service delivery frameworks and clarifying statutory duties/powers are being held within Adult Social Care, Manx Care.
Collaborative working with the Third Sector…to develop, strengthen and embed this relationship

• Manx Care is considering arrangements and responsibilities for commissioning of third sector LD provision. • Manx Care is considering opportunities for partners to provide further community based inclusion and participation day service activities, subject to funding. • Manx Care is considering whether partners are better placed to deliver Greenfield Park Café and shop as social enterprises.

The current challenge of duplication of services (more prevalent in the Learning Disabilities offer than the Older Persons offer) should be the initial focus • Manx Care is considering the extent to which services are indeed duplicated, or a) an extension / continuation of a service offer for the same profile of needs (e.g. complex needs day services), or b) providing different delivery models with the same aim (e.g. supported employment) or c) providing different cohorts of service users with the same service.

It is suggested that 2 working groups are formed (one for Older Persons and one for Learning Disabilities) comprising representation from all relevant providers, staff (at all levels) the third sector and service users and their families/carers • Regular discussions are taking place with third sector partners representing the LD community about service developments. • Commissioned partners are involved in a newly formed Day Services transitions working group. • A co-production plan is under consideration to provide stakeholders a wider forum to develop services.
• Third sector partner arranging family/carers meetings with ALDS.

Day Services management teams liaise with the Wellbeing Partnerships and Primary Care to ensure that all service users have access to annual health checks, a GP and/or nurse with special interest in older persons needs and learning disability needs. • An LD Liaison Nurse has been appointed (starting July/August 2024), with annual health checks a high priority. • Further discussions are in progress to establish a wider Health and Social Care LD Liaison Group to encompass therapies, psychology and Positive Behaviour Support.
• ALDS, LD Social Work and Mental Health Services are exploring possibilities to establish a dedicated LD Psychologist role.

Day Services work with an external provider to provide specialist training for LD staff and collaborate on awareness and engagement for LD island wide.

• An external provider has recently (Spring 2024) delivered LD specific autism communication training.
Educational sessions should extend to schools, public services and emergency services and Service • No specific actions to date.

User parents/guardians/carers.

Efforts should be made for more robust KPIs across the system which will greatly aid in predicting services, early resolution of problems • ALDS-wide LD Service User register has been established to profile needs and service user service access
• Day Services managers are developing an enhanced employability data set (in terms of skills/work readiness) • Adult Social Care / ALDS will have more access to corporate business planning and project management capacity from autumn 2024. • Existing systems and tools are being explored (e.g. use of Microsoft Teams) to better develop, maintain and report management information.

illiIt is recommended that the service investigates opportunities to rent out the space [workshop/rooms/weaving rooms] in the evenings and weekends to commercial ventures. • No actions are planned as yet. As a potential development of the café, extended opening hours should be considered.

• This is under consideration as part of the employment pathway developments. Staffing Structure should include 2 Team Leaders with specialist knowledge.

• No actions are planned as yet. It is recommended that [specialist autism training] becomes a commissioned service not just for the public but more importantly for those that have direct one to one contact with people with autism. • New Island-wide autism strategy in effect, includes dedicated autism training actions • ALDS / Manx Care offering advisory support to deliver the autism strategy. Consider the potential for a split of service offers to those with profound and complex needs, generic needs and those who are identified as progressing on to independent living/employment/volunteering.

• ALDS is already broadly structured this way between Tall Trees (complex) and Greenfield Park (mild/moderate) • New ALDS day services pathways identify specific cohorts of service users with a view to developing outcome focussed strength-based plans.

Work towards a better relationship with the College • New ALDS senior management has utilised extensive links with DESC to bring professionals together to develop assessment and transition guidance.

• A multi-agency working group is developing a ‘transition hub’ to better plan transitions with UCIOM.

Consider adopting an existing (by external provider) model of managing staff teams across operational services thus supporting and achieving consistency to cover periods of sickness absence, staff training and annual leave.

• No actions are planned as yet. Learning Disability Services will only accept individuals with a diagnosis. The diagnostic process is long and protracted…consider whether this is necessary for lower-level services where the real emphasis is arguably about a combination of community access and relevant building based activities.

• The multi-agency DESC/ALDS/Social Work working group has agreed to move away from diagnostic criteria to functional assessments for all LD, with an assessment schema already drafted and in effect. Regular communication with government officials/ministers to help them gain an understanding of decision making within Day Services particularly at transition.
• Development of actions described within the table supports cross- government communication.

Please quote the reference number 3838797 in any future communications.

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