Day Care Service Review
Summary Report of the Day Care Service Review
Why we carried out a Day Service Review
The way we deliver day services and the type of day service we have has not really changed since around 1995. In the years since then, there have been a lot of new laws and advice on how to work with people who use services. The way we deliver our day services just now, does not account for some of the new laws and modern ways of working.
The population of both adults and older people who use day services has changed and the people who use day services need different things now than back in 1995. People are living much longer even when they have poor health or serious disability. The number of people who are very old in South Lanarkshire is growing and the number of people aged under 64 is falling.
When people need more help because of age or disability, the numbers of people who can come to the day service is smaller because the staff need to spend more time with each individual.
There are 19 day service buildings in South Lanarkshire and many of these are not fully used. This is because people need different kinds of support and the numbers who attend the buildings has to be kept low so that there is enough staff to give people the right support. Some of the buildings are not suitable to keep using because they cannot be fitted with modern equipment like hoists, to assist with personal care.
How we carried out the Day Service Review
- We looked carefully at all elements of our day services and produced a profile of each part of the service
- We involved people who use services, families, employees and people from other partnership groups by talking to them about what was good about services and what could be improved
- During the time we were reviewing day services, the COVID-19 pandemic started and we also looked at what the COVID-19 situation had taught us about providing support to people during the day
- We looked at a lot of research and guidance about best practice in providing day support which advised on what works well and what doesn’t work well
The profile of day services told us that there were:
- 667 people (294 adults and 373 older people) using the buildings
- 209 people were supported in the community
- 21 other organisations provided day services
- All the different services were graded as either good, very good or excellent by the Care Inspectorate
- 62% of the people attending older people day services were older than 80 years of age
- One fifth of the people attending older people day services were younger than 60 years of age
- Only 41 people attending the adult day services were aged 25 or younger
- A large proportion of adults have attended day services for more than 20 years without the opportunity to choose a different type of individual support
There are almost 200 employees working in the service and most (175) of them are women. More than half the staff are aged over 50 years and are very experienced care staff. A small number of the staff (10) are aged less than 25 years.
Cost of day services:
The council-provided day services cost £11.5 million each year and other organisations’ day services cost £1.5 million each year to buy.
More than one fifth (£2.4 million) of the day service budget is spent on fleet transport; these are the buses used to take people to and from the buildings. For each person using the bus, it costs the council just over £4,000 per year. Many adults who use the council transport also receive a mobility payment from the Department of Works and Pensions.
The review found that the fleet transport model presented some challenges. Due to the bus availability working alongside school transport for education resources, this limited the flexibility options for day service hours. Some people who live in rural areas spend a lot of time on the bus and not so much time in the building. At times, the support for people on the transport is reliant on the goodwill of staff who volunteer to either start before their working hours or finish after their working hours. There is a concern that the current model of transport contributes adversely to the council’s carbon reduction plan.
The council subsidises the cost of day services and on average each placement costs between £72 and £108 per day depending on how many people use the service at each location. Where there are more people with higher support needs, not all of the places can be used. Where people using the service have very high support needs, the real cost ranges between £580 and £866 per day for each person.
Older people pay a contribution towards their day service costs whereas most adults do not pay any contribution yet. The council’s charging policy which aims to provide a fair and consistent framework for charging, includes charging for day care services. Just over half (52%) of all people using day services have a Self-Directed Support (SDS) assessment, support plan and subsequent financial assessment. This means that a large number of people using services will need to be assessed in the near future.
Consulting with people about the Day Service Review:
We held 136 events to consult with people about the review. 27 of these events were for carers of people who use services and 89 events were for the people who use services.
We used an appreciative inquiry model to consult with people during the review. The model is known as a 5-D approach and considers these things:-
- Define (to decide what questions to ask in the consultation)
- Discover (to identify what matters to people and what is good about current day services)
- Dream (to find out what people would wish for in the future of day services)
- Design (to plan what a new service model could look like)
- Deliver (to build and deliver the redesigned model of day services)
The first consultation covered all the points up to the Dream stage, and the information from this review report so far will be included in the next stage of consultation during the summer of 2021 in order to design and plan the revised service model.
438 people who use services were involved in the consultation (265 adults and 173 older people). In summary, people felt that day services;
- Had good staff who were knowledgeable, caring and well trained.
- Allowed people to meet with friends and do interesting activities during the day. Activities mentioned were; the gym, football, trampoline, going to the pub, Zumba, swimming, sensory room, quizzes, singing, art and pottery.
- People said that they felt happy, safe, excited and stimulated at day services
People who use services also told us what they thought we could do better:
- Better menu choices and bigger portions
- To get out more often to do different activities
- Plan to have people with similar abilities in groups
- Change choices of activities depending on whether it is summer or winter
92 carers and family members took part in the consultation (57 from adults and 35 from older people). In summary, carers and family members placed value on,
- That buildings provide a safe environment
- Day services provide structure for the person they care for
- Day services support friendships and prevent isolation
- There are good bonds with staff
Carers and family members thought that day services in the future could be improved in the following areas;
- More flexibility in the hours to accommodate carer needs such as work and looking after their own well being
- Easier access to day services when needed rather than waiting a long time for an assessment
- Faster assessments to get carers budgets
- A menu of opportunities that people could pick and choose
- Services to develop especially in rural locations to give a sense of community
- Continue to have building based support available
Staff and other professionals who took part in the consultation felt that day services were good at:
- Supporting people to stay involved in their communities
- Assisting people to stay as independent as they could
- Involving people who use services and their families
- Spotting changes in the health and wellbeing of people who use day services
About the future, staff and other professionals said:
- People who use services should have the same opportunities in life as everyone else
- For people to be receptive to new ideas
- More than one type of service should be developed to meet different needs and outcomes
- Services should be fair and equitable and not based on age
Learning from the COVID-19 pandemic:
An Outreach Service was developed at the beginning of the pandemic when day service buildings had to temporarily close. People who used day services previously could choose to have an individual service within their own home or to get support individually within their own community.
Not everyone chose to use this service, but feedback from those who did, told us that this was a lifeline during the pandemic. Some people want to continue with this and others would prefer a mixture of this as well as traditional services as we recover from the pandemic.
The Outreach Service faced challenges because of lockdown restrictions where people were not allowed to meet up with other household and most community activities were closed down. At each step of reducing lockdown, there have been more opportunities for the Outreach Service to develop and we are working towards a time when groups of friends will be able to be supported in the future to undertake activities of interest together, and not just individually.
The Outreach Service has taught us that we depended too much on having only one type of day service model in the past.
Research and best practice guidance:
During the review, we gained a lot of knowledge from researching into best practice about how to provide day services. The findings are summarised below.
- Social care support should fit around the person, support personal outcomes and focus on assets instead of problems and needs
- Assessment for support should be co-produced with those who use support and their carers acknowledging that both parties will have different outcomes
- Change is needed at scale and at pace, but not so fast that it costs more to fix problems that could have been avoided
- We should prioritise prevention and support people to maintain independence
Evidence from the research showed that there was no single best way to deliver day services, but that we should work to end the separation of people who use services from their communities by being less dependent on segregated buildings.
The research pointed to a three level model of support:
- Individualised tailored support
- A focus on reablement
- Intensive support for those with the most complex needs
What the Day Service Review has told us so far:
Evidence from the review suggests that there are key principles which need to be taken into account as part of the service redesign and modernisation. These are:
- Fairness and equity
- Access to services based on priority need
- Robust assessment, support planning and review
- Flexibility and choice
- Enabling and asset based
- Tailored support/reablement focus/intensive support
Next stage of the Day Service Review
Now that we have all the information from the initial review, we want to go back to people who use services, their carers, staff and other partners to discuss ideas about designing the service in the future.
A new model of service needs to take account of the intentions of the Integration Joint Board (IJB) plan and its priorities. We think that the following areas need to be discussed more:
- A local approach to how we develop the day service resources
- How we develop a reablement, rehabilitation and crisis intervention model as well as a support model
- We will need to redirect resources to strengthen community assets
- We intend to continue with the Outreach model
- Everyone needs to have an SDS assessment and we need to make sure that the service is prioritised to those who need it most
- We need to revise how we provide transport
- We need to identify where the service budget priorities should be so that we can redirect resources and offer choices to people
What comes next?
Due to COVID, it is still difficult to have groups of people from different households meeting together at the same time and so we need to consult with people in different ways.
There will be some online consultation as well as separate small focus groups of carers, service users and staff. We will also make sure that there will be a paper copy of the consultation for people to use if they cannot access it online. If people who use services need support to take part in the consultation, this will be able to be arranged and advocacy services will be available.
This information is a Summary of the initial Review. You can access the full Report.
The extended Consultation closed on Friday 10 September, however, we are continuing to consult with small focus groups and hope to report the findings of the Consultation in the near future.
- Day Care Service Review
- Summary Report of the Day Care Service Review