Supporting adults with learning disabilities and/or autism to have better lives
The initial prioritisation process
Undertaking a full self-assessment covering all six domains in the Outcomes and Improvement framework is a significant task. To do it well will require a significant investment of time and other resources. Therefore, we recommend a phased approach is used. This involves identifying the domain(s) with the most improvement potential and working on it/them first. The Initial Prioritisation process to identify priority domains is a rapid and high-level process. It should be led by the director of adult social services and should including inputs from the senior management team, the learning disability service and key partner organisations. The Initial Prioritisation process involves looking at each of the six domains in turn and it has three steps:
Step 1: Review Outcomes and other performance indicators
The director of adult social services to review data on a small number of key outcome and other performance indicators for each of the six domains. In each case the director of adult social services should request that the performance team provide the data to show:
The trend in the last three years to assess the direction of travel,
How close performance is to local targets, and
Where available, a comparison of the council’s data with the same data from other councils considered comparable.
Step 2: Assess to what extent the main “enablers” of good outcomes and performance are in place
For most domains there are just two key enabler questions, but the “Enable the care and support system” domain has five key enablers. After steps 1 and 2 the director of adult social services should consider undertaking the full self-assessment process for any domain where (1) any enabler question cannot be answered with a confident “yes we do this all the time” or (2) where there is evidence that the associated outcomes are not being achieved” is a potential area for further investigation.
Step 3: Consider the findings from steps 1 and 2 and rank the six domains in order of the improvement potential
Rank the domains in priority order according to the potential to improve. The full self-evaluation resources can be found below:
Systems leadership, governance, and management arrangements
Understanding demand and using, prevention and early intervention (Incl. transitions support) approaches
Enabling the care and support system
Developing the local care and support workforce
Supporting people to keep themselves safe
Operating efficient and effective structures, systems, and business processes
Self evaluation questions
Are we getting the results we want?
Is the quality of life of adults with learning disabilities improving? See Adult Social Care Outcomes Framework Adult Social Care Outcomes Framework (1A) Social care-related quality of life for - Split out data for adults with learning disabilities from the full data set.
Is the health of adults with learning disabilities improving? See life expectancy data for adults with learning disabilities compared to life expectancy for the whole population in the council area.
Is the quality of care improving? See proportion of all local care and support services for adults with learning disabilities in the area rated “Outstanding” or “Good” by the Care Quality Commission.
Is our use of resources improving? See proportion of learning disabilities expenditure per head aged 18-64 on residential /other bed-based care including hospitals compared to percentage on community/other types of support.
Are the key enablers in place?
1. Do we offer systems leadership to shape a shared vision for how the whole system of care, support, health and housing supports people with learning disabilities to live a good life, be healthy and to fulfil their full personal potential?
This should include:
participation in system-wide planning and improvement initiatives
joint, work with partners to integrate or coordinated strategies, plans, and service delivery in line with the agreed vision.
2. Is there effective monitoring of performance and accountability across the social care and health system?
To be effective this requires performance management/governance systems, that involve people with lived experience and demonstrate value for money. Monitoring should include:
the extent to which people with learning disabilities have a good life experience
if costs of providing support are sustainable for the council and its partners.
Is urgent and responsive work minimised? See proportion of new learning disabilities care and support packages that are urgent/unplanned.
Is bed-based and out of area care being minimised? See proportion of new support packages (all and after transition) that are bed based (analysed between In/Out of Area) versus community based
Is the experience of people improving? See responses to the Making it Real “I” statements re: Having the information I need when I need it (See Part 12 - Annex 3).
Are the key enablers in place?
3. Is data about current and future demand used to ensure that the supply of affordable provision is sufficient to give people with learning disabilities choice and control over the support they receive?
To be effective the data used should include:
rolling forward projections of future accommodation needs based on bottom up data, for example, assessments, care and support plans, Education, Health and Care Plans, preparation for adulthood (transitions) plans and any other local plans that support people thought key life transitions.
top-down use of national data e.g. demographic/SEND/other data to predict longer term demand trends.
co-productive planning processes with the whole community so that plans reflect local people’s priorities.
analysis of data on the levels of inequality experienced by adults with learning disabilities living in the area.
4. Are key transitions throughout each person’s life anticipated and planned for?
This planning should ensure transitions are as smooth as possible, build on each individual person’s strengths and other assets, for example circles of support, and local community assets.
Is quality of life of people with support improving? See Adult Social Care Outcomes Framework (1J) Adjusted Social care-related quality of life regarding the impact of adult social care - Split out data for adults with learning disabilities from the full data set
Is quality of life of carers improving? See Adult Social Care Outcomes Framework (1D) Carer reported quality of life by carers – Split out data for adults with learning disabilities from the full data set
Is choice and control improving? See Adult Social Care Outcomes Framework (1B) Proportion of people who use services who have control over their daily life - Split out data for adults with learning disabilities from the full data set
Are more adults with learning disabilities in work? See Adult Social Care Outcomes Framework (1E) Proportion of adults with a primary support reason of learning disability support - In paid employment
Are people living where they choose? See Adult Social Care Outcomes Framework (1G) Proportion of adults with a primary support reason of learning disability support - Who live in their own home or with their family
Is the experience of people with support improving? See Adult Social Care Outcomes Framework 3A – Overall satisfaction of people with learning disabilities who use services
Is the experience of carers improving? See Adult Social Care Outcomes Framework 3B – Overall satisfaction of carers of people with learning disabilities who use services
Is expenditure on support for adults with learning disabilities value for money? Plot Adult Social Care Outcomes Framework 1A (Social care related quality of life) versus total current gross expenditure per head of population aged 18 to 64 on support for adults with learning disabilities and benchmark against comparable councils
Is use of resources improving? Use Adult Social Care Finance Return FR001 to calculate and benchmark with comparable councils, current gross expenditure on long-term support for adults with learning disabilities per
head of the adult population by service, for example, residential care, nursing care, supported accommodation, direct payment, home care, supported living, other
adult with learning disabilities with long term support by service, for example, residential care, nursing care, supported accommodation, direct payment, home care, supported living, other
unit of support by type of support, for example, residential care, nursing care, supported accommodation, direct payment, home care, supported living other
Are the key enablers in place?
5. Does the care and support system consistently deliver local, cost effective care and support to people with learning disabilities that allows them to achieve their potential?
This should include:
timely access to information, advice, and advocacy
short-term support when extra support is needed, for example, to help the person become more independent, or in response to a short-term crisis such as an illness/ bereavement or after a significant life transition
long-term support that addresses short and longer-term goals that reflect the aspirations of the person and supports them to safely maximise their independence and achieve wellbeing.
6. Is our professional practice always of a high standard consistently enables people to work towards their aspirations?
This includes:
first contact arrangements which start a strengths-based conversation with people with learning disabilities and/or their carers.
social work practice that is strengths based and personalised, assures people’s human rights and is integrated/co-ordinated with health and other support
always seeking to co-produce (with the person supported) support plans that are innovative and creative in relation to achieve the agreed outcomes.
7. Do we work effectively with partners to ensure that the wider system that affects the lives of people with learning disabilities is aligned to their needs and preferences and reasonable adjustments are made where appropriate?
This should include working in partnership to co-produce an inclusive, accessible and safe community. Key stakeholders include:
people with learning disabilities and carers
support providers, local businesses, and other public agencies
the wider community.
8. Do we fully explore every opportunity to ensure that people are involved in decision that affect their lives and, where possible, self-direct their support?
9. Are we delivering on the Transforming Care Partnership policy to minimise the use of residential and hospital (notably out of area) based care for adults with learning disabilities?
Is the quality of care improving? See percentage of local providers rated “Outstanding” or “Good” by the Care Quality Commission for the key lines of enquiry on being (1) caring and (2) responsive to people’s needs.
Is the experience of people improving? See responses to the Making it Real “I” statements regarding “The people who support me – Workforce (See Part 12 - Annex 3).
Is recruitment/retention improving? See turnover, sickness, experience data from The Skills for Care Adult Social Care Workforce Dataset.
Are skill levels improving? See qualifications/training/skills data e.g. Qualifications by service type/sector from The Skills for Care Adult Social Care Workforce Dataset.
Are more adults with learning disabilities able to work? See Adult Social Care Outcomes Framework (1E) Population of adults with learning disabilities support in paid employment.
Are the key enablers in place?
10. Does the local care and support workforce for adults with learning disabilities have enough capacity, the right values, the necessary skills and competencies which enable people to live the best possible lives, make a contribution to society and achieve their aspirations?
11. Do procurement/contract management processes ensure provider fees are sustainable and require providers to pay staff a living wage and invest in skills development so they are able to:
manage risks positively and use the least restrictive options
enable the development of the skills of daily living in line with the outcomes in each person’s individual care support plan
work in an “outcome” rather than “input” focused way.
Overall, how safe do people feel? See Adult Social Care Outcomes Framework (4A) - Proportion of adults with learning disabilities who use services who feel safe.
Does our support help people to feel safer? See Adult Social Care Outcomes Framework (4B) - Proportion of adults with learning disabilities who use services who say those services have made them feel safe and secure.
Is the experience of people improving? See responses from people involved in safeguarding processes about their experiences re outcomes in Making Safeguarding Personal (2018).
Is expenditure on safeguarding affordable? Safeguarding expenditure per head of population aged 18 to 64 benchmarked against comparable councils
Is expenditure on safeguarding value for money? See safeguarding expenditure per adult with learning disabilities who use services benchmarked against comparable councils
Are the key enablers in place?
12. Do we support people with learning disabilitiesto keep safe from abuse, neglect, and crime (including hate crimes) always using the least restrictive ways that allow people to take managed risks that are consistent with the outcomes they want to achieve.
13. Are our safeguarding arrangements efficient and effective and do they involve the person experiencing or at risk of neglect/abuse in the process as fully as possible?
Specifically, do we ensure the:
Safeguarding Adults Board members have a clear understanding of their role.
Safeguarding Adults Board leads and co-ordinates the delivery of Adult Safeguarding policy and practice across all agencies.
Number/type of safeguarding alerts, enquiries etc. involving adults with learning disabilities and the outcomes and learning from them are monitored daily/weekly to inform day to day operations.
Regular reports (quarterly) on safeguarding are considered by the director of adult social services / senior management team.
Do our systems/process support timely interventions? See if the time lag between a referral being received and an assessment/or a review being is reducing year on year.
Is the experience of people improving? See proportion of adults with learning disabilities and their carers who report, when asked, having a positive experience when they deal with the council.
Are we easy to work with? See proportion of care/support suppliers who report, when asked, that arrangements to work with the council to support adults with learning disabilities easy/ efficient.
Are central overhead costs value for money? Benchmark Social Services Management and Support Services costs per Adult Social Care Financial Return on adults with learning disabilities : Per head of adult population, Per adult with learning disabilities with support, Per learning disabilities employee.
Are commissioning costs value for money? Split out gross current expenditure on learning disabilities social care activities in Adult Social Care Financial Return (ASC FR005) - Calculate and benchmark learning disabilities social care activities (1) expenditure per head of adult population, and (2) Per adult with learning disabilities supported by the council.
Are departmental overhead costs value for money? Benchmark overhead and other “on costs” as a percentage of overall expenditure on support for adults with learning disabilities.
Are the key enablers in place?
14. Are our systems/processes easy for people with learning disabilities, carers and our partners to understand and use and do they support our staff to work in a way that is efficient, strengths based, person centred, value people’s rights, enable relationship based social work and help us support people to stay safe and healthy.
15. Do we have effective communications processes:
within the council so support to adults with learning disabilities can be co-ordinated and feels joined up to the end user
bottom up so leaders hear and consider the views of front-line staff and top down so key information/ decisions etc. are disseminated in a timely manner
between the council and its partners/the local community to enable co-production.
