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Hertfordshire County Council

Overview of service


The Adult Disabilities Service (ADS) supports 4,600 people in Hertfordshire. While Covid19 has had a significant impact on many individuals and services over the last 18 months, much of the sector has also been very stable through this challenging time. The hard work, dedication and commitment of our colleagues, in all organisations, in supporting the health and wellbeing of adults with disabilities in Hertfordshire, continues to be remarkable.

During the pandemic period we have seen innovation and flexibility in many places, including effective use of technology, and it will be critical to ensure this is acknowledged, built upon and expanded as appropriate. Covid19 will undoubtedly continue to provide an extra challenge in how we support people with a range of disabilities, but by learning from what we did at the height of the pandemic, it is now critical that we get back to enabling individuals to build supportive networks in their own communities and live fulfilling lives.

In order to achieve this vision it will be essential to work in partnership, to plan services that meet the needs of our communities, and this will include the individuals that use our services as well as their families and carers, care provider organisations and our wider partners in the health and social care sector.

Alongside the wider Adult Disability service Hertfordshire County Council has developed, in partnership with Health colleagues, the Big Plan specifically for Adults with Learning Disabilities.

The Big Plan outlines three key priorities for this group of people and aligns with the wider ambitions of ACS, with an action plan that is regularly refreshed.

•    Living a healthy life - with initiatives in health, social care and community services to reduce health inequalities and improve access to services, enabling people to live longer and healthier lives.

•    Living locally – a commitment to reducing the number of out of area social care and hospital placements

•    Being connected in the community which is a commitment to the Connected Lives approach

 

Current Position

There are over 600 people in just under 100 Residential Care services in Hertfordshire purchased by ADS.  There is a higher concentration of older people in these settings; more than 70% are over 50 and over 25% are over 65 years. Most ADS provision is small (4-8 people), often with shared facilities and provide homely environments.  

Supported Living services are provided to 1400 people with disabilities in Hertfordshire and is delivered by over 80 charitable or independent provider organisations and in-house by HCC.

The Supported Living Framework, launched in 2019, aimed to improve choice and control for people requiring support and develop new services for identified gaps in the market. There are 64 providers on the Framework and in its first year (Sept 2019 to Sept 2020) there were 233 referrals for Supported Living and 199 referrals for Community Support (broken down by District in the Table below). 

Table 1: The Supported Living Framework

Table 1: Services we commission from the voluntary and community service sector

Borough or DistrictSupported Living - TotalCommunity Support - Total
Broxbourne 20 8
Dacorum 23 15
East Herts    
Hertsmere    
North Herts    
St Albans    
Stevenage    
Three Rivers 18 14
Watford 17 16
Welwyn / Hatfield 21 11
Supported Living Data ADS 2021

While the majority of these referrals had good outcomes we know there is a demand for more placements and in particular we are aware of the need to increase placements for people with autism, complex needs and behaviours that can challenge. We also need to work with a wider group of providers for people with mental health needs and we need to more effectively to support people in crisis.

Over 1000 people with disabilities are supported by HCC in-house day services and over 850 people receive support from over 40 charitable or independent commissioned day opportunity providers.  While all day services across Hertfordshire have re-opened since the worst days of the pandemic, regular attendance has reduced and there is therefore a need to consider alternative models of support, such as online and outreach services.

 

Commissioning intentions

Residential


The residential offer for adults with disabilities has met demand and has remained relatively stable during the pandemic but there are increased vacancies in some services and longer term challenges mean this market may see some closures in the future. Some providers have offered flexible support during the day and this is something we are looking at in the longer term for some individuals.

Our future intentions for this market are:

Continue to embed the Connected Lives approach in service and support models.

Residential services should be effectively connected with their communities, supporting the people who live in them to have relationships and engage with the wider population.

Provide flexibility in current services

We would like to see services consider offering short term respite, assessment or temporary stays, alongside long-term placements, and we are working with older peoples services to develop pathways for people with physical and learning disabilities.

More services for specific groups

While we expect generic residential services to reduce slightly we need more specialist services that can support larger people, people with higher levels of need and people with complex health and profound and multiple disabilities.
We need to develop services for younger people in transition with complex needs to help them build independent living skills and link with educational resources in preparation for adulthood and independent living.

Transformation

Some parts of the residential market need significant change. We will support some services to de-register into supported living settings to maximise independence and citizenship, but other services may need to close or be significantly redeveloped, often due to the age or inappropriateness of current properties.

Supported Living

The Supported Living offer has remained stable during the pandemic but outreach support to access the community has understandably reduced because of social mobility restrictions. This needs to return to ensure people remain connected to their communities, friends and family.

Our future intentions for this market are:

Continue to embed the Connected Lives approach in service and support models.

Enabling individuals to be connected to their communities is a crucial aspect of successful supported living schemes and all providers should be considering how to support individuals to live completely independently where they can.

Continued expansion

There is still a need for more Supported Living placements, in a variety of individual, self-contained or small shared environments across Hertfordshire, with suitably trained staff.

There is a particular gap in supported living provision for people with physical disabilities, autism, mental health issues, Acquired Brain injury, and behaviours that may challenge.

We need to develop services for younger people in transition with complex needs to help them build independent living skills and link with educational resources in preparation for adulthood and independent living.

Improvements to the Framework

We will identify how referrals on the portal can be clustered to make new services/schemes more viable and we will continue to respond to feedback from individuals, families and providers about how to increase the number of successful placements.

Property and Accommodation development

We recognise the need for more appropriate properties for Supported living across Hertfordshire and are working with corporate and District council colleagues, developers and Housing Associations to build, redevelop and refurbish accommodation suitable for people with a range of disabilities.    

Community Opportunities & Day Services

Community based opportunities were significant impacted by the pandemic but have now re-opened and need to consider how to support more people effectively.

Our future intentions for this market are:

Continue to embed the Connected Lives approach in service and support models

All services should be firmly based around peoples own communities and the enablement of long-term relationships and friendships.

Meaningful activity or employment is a crucial aspect of life and this should be a focus for all community based services, making the right links with educational and employment services.

Development of Innovative models to support people during the day

Models that were developed during the pandemic, including on-line activities and outreach services, should now be part of the wider offer individuals can access and we would like to see increased flexibility of services, for example in evenings and weekends.

We have seen a wide range of organisations engage in our recent tender activity in this area and thisi s something we are hoping to develop further.

Short Breaks

The number of people choosing to access overnight short breaks understandably reduced during the pandemic but is now returning to normal. Where short break services adapted their offer to be more flexible we are hoping to see that continue.

Our future intentions for this market are:

Continue to embed the Connected Lives approach in service and support models

Short breaks services should be effectively connected with their communities, offering individuals a ‘home from home’ experience but also developing independent living skills.

Expansion of services

We need a wider range of overnight short breaks in Hertfordshire for adults with disabilities but we would also like to develop specific provision for:

•    larger people and people with physical disabilities

•    people with mental health issues or acquired brain injuries

•    individuals with behaviours that can challenge services

•    people with profound and multiple learning disabilities

We are also looking for community based short break services that can support younger people, people with autism and we need services to think about how they can accept emergency admissions or provide a crash-pad option.

Complexity

Focused on adults with a learning disability and/or autism who display behaviours that challenge, including those with a mental health condition, we want to improve the support we provide to some of our most complex individuals.

Our future intentions for this market are:

To reduce out of area hospital placements

By developing appropriate community provision to support people with complex metal health needs, behavioural support needs and/or forensic histories, which often need to be tailored/bespoke services. 

Preventing Admission

Health and community based social care services need to support complex individuals with long term planning to prevent hospital admission and manage crisis situations. Developments in this area include the need for more housing, flexible support options and specific services for those people returning to Hertfordshire from an out of area residential school placement.

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