A Review of Adult Day Services in Fife January – October 2010 | Fife Social Work Service

JANUARY – OCTOBER 2010

Report by Day Service Review Steering Group

Lead Officer: Gail Crawford, Service Manager

Project Manager: Ian Wilson, Team Manager

November 2010

Appendix 1 - Day Services Review Steering Group Members

Appendix 2- Involving You in Shaping the Future of Day Services for Adults with a Disability in Fife - Consultation Questions

1. Introduction

"We have to put our trust in you for our loved ones" (parent carer, consultation event 21 September 2010)

In November 2009 Fife Council Social Work and Health Committee authorised a review of local authority day services in Fife for adults with a disability. We know from the Care Commission's inspections that our day services meet national standards and have very good or excellent results. We know from the involvement of our service users and their families in this review that our day services are highly valued. We need to make sure that our day services in the future are responsive to peoples needs, flexible and achieve good outcomes. People want to feel safe, have active and content lifestyles and improved health and well being.
Fife Council provides day support for adults with physical and / or learning disabilities from 7 social work day service facilities. These are:
Day services for people with a physical disability - Viewforth Centre, Kirkcaldy, The Grange, Dunfermline, The Forward Centre, Glenrothes
Day services for people with a learning disability - St. Clair Resource Centre, Kirkcaldy, Robert Gough, Leven, The Dalgairn Centre, Cupar, West Fife Community Support services (WFCSS)
Day services for people with younger onset dementia -The Forward Centre, Glenrothes.

1.3 The Same as You (SAY) report published in 2000 is one of the early policy drivers for modernising services for people with learning disabilities. This report focussed on the need to develop more opportunities for people with disability and draws on the principles of personalisation, inclusion and person centred approaches. The 21st Century Review Report (2006) also indicated that “more of the same won't do” and that services need to be modernised so that they provide a more flexible and inclusive support to the most vulnerable people.

1.4 The focus from the Scottish Government on Self Directed Support and the Personalisation Agenda all point to the need to do the following:-

Ensure that services are fit for purpose for the future.
Are flexible and responsive to the needs of people with disabilities.
Enable people to remain within their own community and spend time on meaningful activities and where possible employment.

1.5 This review recognised the developments in the agenda for self directed support and the independence and choices which adults with disabilities may benefit from in the future. A separate exercise has started to look at options for people who use day services and how they may benefit from self directed support. We will draw on the conclusions of that exercise in taking forward the proposals from this review. There is the likelihood that some adults may choose to opt out of traditional day services with a preference for alternative options such as purchasing independent and alternative forms of support.

1.6 The day service review report by the national SAY implementation group (2006) highlighted research in response to the question "Do day centres work?". Overall research on "day centres" does not give a good picture of the outcomes for people who use these services and "despite this, day services continue to be building based". The research suggests that services based in buildings become institutionalised. They are not good for social inclusion and should not only be for people with learning disabilities. We looked at this in the review and asked people their views about integrating services for people regardless of their type of disability. Most people from our analysis so far feel that day services should be integrated (see para.4.8). People need not be labelled in order to fully enjoy their daily lives and take an active part in their community. The challenge has been to consider day services deliveredin Fife and to propose how they may be developed for the future in a way that meets peoples" needs including the needs of family carers.

2. Principles

"Our young people deserve to lead a full life – they ask for nothing" (carer consultation)

2.1 Most people have said that they wish to see more flexible and responsive day services that they can access throughout the days, evenings and weekends. Younger people and their families have indicated that their vision for day services in the future is that they are "meaningful, stimulating, educational, desired and affordable". Others have told us that they wish to see day services continue to evolve in the way that they have over the last few years, that is more involvement in the community. People wish to have services that support them in community activities much the same as anyone else while keeping them feeling safe, supported and included.

2.2 Our day services will be based on the following principles:

Flexible and responsive -we will support people through the day, in the evenings and at weekends accordingto their different levels of need
Protection and safety - we will make sure people feel safe and supported in their day to day activities. We will develop a skilled workforce and will work in partnership with health and other services in the community to achieve this.
Local and accessible regardless of age and disability - we donot expect people to travel unacceptable distances or feel segregated because of their disability and we will make sure that those over 65 years of age receive opportunities that make sense to them.
Choice and opportunities - our staff will be skilled in supporting people with their choices and options and encourage individual development through community activities, employment, education and better health and well being.
Parents and families - we will listen and be guided by the needs of parents and carers.
Equitable and inclusive – our services will focus on the person first and their needs, regardless of disability.

2.3 These principles were developed from the first phase of the review where the staff from each day service or centre held focus groups, drop in sessions and surveys to gather the views of service users and carers. Staff's views were also taken into account from a development day held with staff earlier in the year. These principles are therefore based on what people have told us they value about day services. (See also paras. 7.3 and 9.3 which illustrates this further).

2.4 The more recent consultation feedback indicates unanimous support for these principles. Responses came with suggestions such as getting the balance right between protecting and keeping people safe without being risk averse.

3. How our day services will look in the future

"Our day service at Dalgairn already integrates employment services and helps people into work where possible and desired"(staff consultation)

3.1 Firstly,what we mean by a "day service" is a service that will support individuals regardless of their disability to live meaningful lives and access community activities at times that suit them. This may be during the day, in the evenings and at the weekend. For some, it may be a combination of all. Our day services currently cost £7.6m to deliver. We have a responsibility to make sure it is spent wisely and effectively in a climate that asks for "more with less". We will deliver a flexible day service within the financial resources we already have and by making the necessary workforce changes that we need to deliver by targeting our resources more efficiently. This is based on the consistent views throughout this review from service users, carers and staff that they wish to see more flexible and responsive day services.

3.2 Secondly, we recognise that there is a range of need and that people may require different levels of support. Our day service will reflect this and respond to a range of abilities from those who may need only advice and information and who are able to determine their own support (e.g. self directed support) as a first option, to those needing higher levels of support because they have greater needs. Great care will be taken to provide the level of personal and social care needed ensuring that the right facilities are available especially for those with the highest levels of need (e.g. those with profound, multiple and complex needs). Our health and safety measures and staff skills will match the care and support needs people have.

3.3 We know from people we spoke to during the review and from the written questionnaires that most people hold the view that people with the most complex needs should have the same opportunities as anyone else and at the same time be confident that their personal care and safety needs will be met. We received feedback which told us that some individuals who have the ability may prefer to direct for themselves how they choose to spend their days. This could be through the self directed support route.

3.4 Thirdly, we need to have facilities across communities in Fife that are fit for purpose for meeting all levels of need. We already do have a range of facilities in the form of our existing day centres and the range of localities used by WFCSS. While the table at 16.2 shows the current range in costs associated with improvements needed much of this can be met from existing budgets. In addition there is already an identified sum for improvements in next year's capital budget. We need to make sure that improvements we make are consistent with the range of need and ability people have so that capacity within and out with the centres is developed and used effectively.

3.5 People who have learning or physical disabilities (including sensory impairment and/or ASD) can expect to receive a day service in their area. This is based on the views collated from families who would like to see local and accessible services which mean people with disabilities do not have to travel too far a distance. We will develop stronger connections therefore across services, including community services, to ensure local facilities are available. We will make sure that people regardless of their type of disability do not have to travel unnecessary distances.

3.6 This review proposes people will be regarded as individuals first regardless of the type and label of disability they may have. We asked people their views: "should our services be more integrated providing improved local access for all adults with a disability". In response to this question the majority supported day services that do not distinguish between disabilities. Others expressed concern about staff skills and some people with a physical disability themselves are concerned about being associated as having a learning disability. We therefore need to be sensitive to this and manage any change in this area carefully and with the full involvement of service users and their families. At the Forward Centre we already provide a service for people with physical disabilities and for people with younger onset dementia. People have indicated to us that this works well. Service users" needs will be fully assessed as they are supported to access activities, including educational and employment opportunities, according to their needs and abilities. Day services will be personalised and available over seven days a week based on person centred approaches which people have told us they highly value.

3.7 Ouraim therefore will be to support people in their own localities while recognising that for some travelling may be necessary to access college or employment. This is true for most of us. We will do further partnership work in our communities to make sure people with disabilities feel accepted and can make the fullest contribution. We will work towards making sure that community facilities are accessible to all regardless of the level of disability they may have and from the principle that the person comes first and that their disability is one part only, of the whole person (albeit a most significant part).

3.8 Day services in the future will be geared to making sure that people are supported safely and with a focus on safe staffing levels at the front line. In order to do this we will make sure we have a highly skilled and trained workforce. Managers will have a leadership and developmental role within their locality identifying other amenities and hubs from which services could be delivered. Focus will shift from managing day services in only buildings to managing support and care in a range of settings in the community. There was unanimous support through the consultation exercise for using day centre buildings in different ways. Ideas included community cafés, advice and information and other resources to be available. We could be open to sharing facilities with other groups where that makes sense for example with health staff which makes health in the community more accessible or, community development staff which will help foster greater access and integration for people in the community.

3.9 The facilities we currently have are: the Dalgairn Centre, Cupar; the Forward Centre, Glenrothes; the Robert Gough Centre, Leven; the St Clair Centre, Kirkcaldy; the Viewforth Centre, Kirkcaldy; the Grange Centre, Cowdenbeath and West Fife Community Support Services ( WFCSS) in Dunfermline. If we are going to develop day services that are flexible, accessible and integrated for all and buildings that are fit for purpose it does not make sense from the findings of this review to have two buildings in Kirkaldy. This would result in a) an under use of facilities and, b) inefficiency in terms of unnecessary costs for improvements for two buildings where only one is needed. We know from previous discussions with service users that there is a lack of kitchen facilities and catering choices at Viewforth. Further from the comparison of properties (see table at para.16.2.) it would make economic sense for the St Clair Centre to be used rather than Viewforth which is a much older building and less fit for purpose. In making this shift we would make sure day opportunities are available for people who currently attend Viewforth in the same way as for those attending other centres (see table at 6.1).

3.10 Employment opportunities – we will build in to our day services for people strong and meaningful employment opportunities and links. We already do this in different ways across our day services which we will strengthen and develop consistently. There was unanimous support from our consultation for integrating our supported employment service into day services. Comments such as " I think this has been a success where it is already in place" indicate how we need to progress in this area.

3.11 Education opportunities – during the day service review it was evident that we have stronger links with specialist schools relating to younger children and those in transition. However, partnerships with colleges and further education could be a lot stronger. We aim to build stronger partnerships with colleges and develop strategies which support people with disabilities into college opportunities. Our day services will promote further integration of people with disabilities into education as well as employment opportunities.

3.12 This review has highlighted the need to make sure we have the right resources for people with disabilities as they are getting older and for those who have or who may develop dementia at a younger age. We looked at the age range of people using our day services (see para. 5.4) there are 34 people between the ages 65 – 79. This is an area worthy of closer review to make sure we are meeting the needs of older adults effectively. We need to work in partnership with older peoples" services and the voluntary sector who tell us that we "need to do more planning for service users reaching 65" (see para. 17.0).

3.13 We looked at what we currently do in relation to transport (see section 15) and asked peoples" views about independent travel, our view is that further work in this area is required. We propose to work more closely with Transportation Services with a view to developing a corporate approach to transport issues. There were mixed views in the consultation exercise about service users and their families being expected to provide or pay for transport. While there were many people who were in favour of some sort of charging policy there were a significant proportion who either did not agree with this at all or were unsure.

4. How we have carried out the review (methodology, process and consultation)

"I think the way it is the now is fine. I wouldn't like to change it "(service user)

4.1 We wanted to make sure that the day service review process was as robust as possible, open and transparent so that everyone's views would be heard. We achieved this firstly by having a steering group with representatives from as many parties as possible including service users, carers, staff and colleagues from other organisations who work with and have an interest in people with disabilities. We included the following who progressed the first phase of the day service review between January and July 2010. A full list of contributors can be found at appendix 1.

Service users and parents/carers
People First ( Self Advocacy)
PAMIS
Enable
Day services staff (social work)
Assessment and care management (social work)
Education
Health
Local and community services
Autism Spectrum Disorder (ASD) Coordinator (social work)
In addition there was input from Equalities and consultation with the Disabilities Access Coordinator.

4.2 The review group met on seven occasions between January and July to oversee the process of the review. An action plan was agreed at the outset which set out the service review areas and work streams (themes). The action plan formed the working tool for the group and was updated at each meeting with progress reports from the lead officers of the working groups. The action plan and groups focussed on the demographics of the day service population, learning disability, physical disabilities, PMLD and complex needs, younger onset dementia, autism spectrum disorder, employment, alternative models of day care, transport, workforce development, communication, engagement and involvement, properties and health and safety, catering. Through our communication, engagement and involvement strategy we aimed to engage with and involve as many people as possible in the review.

4.3 The levels of engagement involved:

service users and carers – through the work and involvement of staff in individual day centres and working groups
staff – through staff awareness days, involvement in day service events and working groups
voluntary sector – focus group with voluntary day service providers
other Fife Council services : Education, Local and Communities, Development Services – as part of the review group and working groups
NHS Fife – as part of the review group and working groups
Consultation events with service users and carers – Dean Park Hotel 21 September 2010 – both day and evening sessions
Individual meetings and discussions with parent representatives e.g. Robert Gough, St. Clair Centre, Dalgairn and Viewforth.

4.4 We communicated regularly with information about the review and its process through letters, news bulletins and briefings for service users, families, staff and elected members. In addition the review group referred to an independent external reference group with members from St Andrew's University, Fife Independent Disability Network and Fife Carers" Centre. The external reference group is overseeing the evaluation of the review for the future.

4.5 The following Day Services were visited by a combination of managers, staff, service users and carers:

Edinburgh City -provides four day centres for integrated groups of adults with disabilities including Autism. The also have a network of bases located in community facilities throughout the Council. A team of local area co-ordinators has been established to provide support to service users who want to find alternative sources of support.

South Lanarkshire - Harry Smith Complex is a purpose built 75 place day centre for adults with learning disabilities located within a complex that includes the local G.P. surgery and Sports Centre. The centre is also available for use by the wider community at evenings and weekends.

Aveyron Day Centre is a purpose built centre for adult with Profound and Multiple learning disabilities. The service is funded by North Lanarkshire Council but run by Sense Scotland. The centre currently supports 18 people a day with a total number of 24 people being supported per week.

West Lothian - The Ability Centre . This is 12 place service located in a purpose built resource centre for adults with a physical disability. Service users attend the Ability centre for an initial period of six month during which a support package is agreed. Service users then either move onto one of the 11 outreach groups located throughout West Lothian or are supported to access other services according to their needs identified in their support plans.

Glasgow City Council – Aim to develop "self directed support" policiesas a key feature for day opportunities. They have closed 3 of their 10 day centres for adults with learning disability. They have worked closely with leisure and recreation, arts and culture and other community organisations to develop an infrastructure of services to support the move to community based services. They have also worked with accommodation provider agencies to agree a funding rate to enable them to take over responsibility for providing day care for the people they currently support.

The shape of day services for Fife may involve some of the above elements. Developments are based on the needs and wishes of the people who use or may use day services in Fife in the future.

4.6 Consultation - We consulted with over 300 staff on 9 September and held a consultation event on 21 September 2010 with service users and carers. We shared our initial findings from the review and checked back with participants what they had told us during the review. An evening event on 21st was also held for those could not make it earlier. At the same time a draft report had been made available a week before the event with consultation questions. We received over 300 fully completed questionnaires (of which over 50 are pictorial) expressing broad and specific views in response to key questions that the review had raised for us (see appendix 2).

4.7 Analysisof the questionnaireswe have receivedhas been carried out on two basic levels. Firstly, the themes emerging from reading the responses gave an indication of peoples" views and informed the development of proposals in this report. Secondly, a brief analysis of a random sample of 100 questionnaires highlighted the level of views in response to the questions asked and which can be seen from the table below. A third and more systematic analysis is being undertaken as further evidence in support of the proposals and direction in this review.

4.8 Random sample of 100 questionnaires from over 300 received

Question	general support	against	unsure
1. Do you agree with the principles (in the draft report) and do you have any others to include?	92%	14%	15%
2. Should our services be integrated providing improved local access for all adults with a disability?	68%	14%	15%
3. Should we have a "centre of excellence" for people with profound, multiple and complex disabilities or should we provide a dispersed service across Fife?	28%	55%	7%
4. Should we integrate our supported employment service into our future day service?	83%	4%	5%
5. Should people with specific mobility or motability benefits be expected to use these to pay or provide their transport to day services? To what extent (if any) should transport be provided e.g. to those with pmld / those with no mobility and wheelchair dependent?	57%	26%	8%
6. How might the current buildings be used to their fullest potential in the future?	68% (in favour of using differently)	3%	15%

Note – where the %ages do not add up to 100% it is because some questions were left blank.

4.9 St Andrew's University as part of the external reference group is assisting us for an evaluation of the proposed changes in this review. A base line has been taken from evaluation questionnaires at the consultation event which will give a comparison of views of how people value our day services now and in the coming years.

5. Who attends our day services and how many? (Demographics)

"Doing more of the same won't work. Increasing demand, greater complexity and rising expectations mean that the current situation is not sustainable"

(Changing Lives 21st Century Social Work review" 2006)

5.1 In our day services across Fife we currently support 555 adults with a disability. Of these 398 have a learning disability and 157 have a physical disability (of which 11 have younger onset dementia (YOD)). The Charts below gives a picture of age ranges.

5.2 Service users across our day services have a range of dependency levels from around 99 people with lower level needs and abilities requiring a ratio of 1:8 staff support to 197 people needing a ratio of 1:5 or 1:4 staff ratios to 152 people needing ratios of 1:3 or 1:2 staff support and 75 people needing 1:1 while 32 people each need 2 staff to support them. Our day services in the future need to take account of the differing levels of needs people have.

5.3 We know from population projections that more children with disabilities are living longer with better health care and that there will be increased demand over the next few years from young people with profound and multiple learning disabilities with a greater number and range of people on the autism spectrum disorder (ASD). In terms of the numbers of younger adults aged between16-25 attending specific day services, most attend WFCSS (around 30) with 19 younger adults attending Robert Gough compared with relatively few or no younger people attending the other day centres. This gives some indication about the choices younger people are making. It appears from the absence of younger people in some centres that either they are already choosing to opt out of traditional day services or there are fewer younger people needing day services which, is unlikely because of the demographic trends described above. We know from the partnerships built up between WFCSS and special schools and colleges and the focus on younger people with partnerships such as "Fairways Fife" and the John Muir Trust initiatives that there appear to be better outcomes for younger people leading them and their families to choose the type of day service that offers wider community opportunities and involvement.

5.4 We have around 123 adults between the age range 56-65 and around 34 who are between the ages of 65 – 79. There is a need to review the extent to which our older service users" needs are being met and to address transition issues for the older adult population coming up in the next 5 – 10 years. This also suggests that we need to work in partnership with older peoples" services to develop the most effective supports for their day time activity which is likely to differ from the younger generation who have different expectations and demands.

5.5 Most individuals attending our day services either live at home with their families (334) or in 24 hour staffed supported accommodation (117) with 104 who live in their own tenancy with a level of support. We need to make sure that we are deploying all our staff efficiently and minimising duplication. In this way the involvement of social care workers in accommodation services e.g. group homes facilitating day opportunities for service users is worthy of further exploration.

6. What do people do in our day services?

"I have fun, lots of friends and am more confident"(service user)

6.1 The Table below shows the levels of community and centre based activities across all of our day services.

Day Service	% Centre based activities	% Community based activities
Dalgairn - Cupar	48%	52%
Robert Gough - Leven	50.8%	49.2%
St Clair - Kirkaldy	55%	45%
WFCSS – West Fife	0	100%
The Grange-Dunfermline	55%	40%
Viewforth - Kirkaldy	88.1%	11.9%
Forward Centre - Glenrothes	60%	40%
Younger Onset Dementia – Forward Centre	45%	55%

6.2 The above table shows that all of the service users with learning disabilities in West Fife spend all of their day time activities 100% engaged in the community with no time spent in a centre. This, compared with only 11.9% of community activities experienced by people with who attend the Viewforth Centre compared with 88.1% of time spent on centre based activities. There is a wide variation in the opportunities which adults with disabilities may access in the community through our day services suggesting disadvantages for some. We need to develop and standardise day services which provide equitable access and opportunities for all adults with a disability.

6.3 The West Fife Community Support Service is distinct from the traditional day centres in that it is dispersed across a number of localities or meeting points located in Rosyth, Dell Farquharson, Touch, Townhill, Crossgates, Cowdenbeath and Lochgelly. It is flexible and responsive to peoples" needs with a focus on young people through the "Youth Team" and the "Pace Team" which supports people who are frail and limited by age or personal circumstances. Staff are contracted to work flexibly in the evenings and at weekends providing a range of opportunities across 7 days.

6.4 The Table at 6.1 shows a trend towards the community approach across most of our day services which have evolved steadily over the last ten years. Service users and carers have told us that they support this development and that they enjoy and benefit from the wider range of community opportunities and involvement that this approach brings.

7. People with a physical disability

"It"s important for you to have a break from your family /carers" (services user)

7.1 The Grange Centre, Dunfermline, Viewforth Centre in Kirkcaldy and the Forward Centre in Glenrothes between them support 146 adults with a physical disability. These are divided as The Grange 39, Viewforth 42 and 67 at the Forward Centre. The needs and dependency levels of individuals in each of these centres varies ranging from those who need support by two staff 2:1 or 1:1 to those with low level dependency requiring a staff to service user ratio of 1:8.

7.2 We need to do more work:

To establish needs and wishes for daytime, evening and weekend day services
To assess the needs of individuals over the age of 65 and determine how these can best be met
Jointly work with older peoples" services to meet the needs of those over 65, specifically older adults.

The diagram overleaf illustrates what we heard people with a physical disability say.

7.3 "What we heard you say"

BEING ABLE TO MEET FRIENDS IS IMPORTANT

YOU WOULD STILL LIKE A BUILDING

YOU WOULD LIKE TO HAVE THE CHANCE TO HAVE MORE ACTIVITIES AND OPPORTUNITIES

YOU NEED STAFF TO SUPPORTYOU

YOU WOULD LIKE A SERVICE THATIS FLEXIBLE

IT"S IMPORTANT FOR FAMILIES/CARERS TO CONTINUE TO HAVE SHORT BREAKS

YOU WOULD LIKE TO KEEP TRANSPORT

8. People with a profound and multiple learning disability (PMLD)

"When out and about people with PMLD could access any day centre if needed"

(Staff member)

8.1 We are supporting 28 adults with PMLD across our day services including our community support service in West Fife.

8.2 We asked our services users, carers and staff what they thought was good about the current day service and also what they view to be important about the service now and in the future. The following is an extract of their feedback and views on care needs, activities, social benefits, facilities, structures, staffing, culture.

meeting health and social care needs including personal, nutritional needs and specialist care
having good care standards and good communication ,
having a Keyworker and co-worker making sure my needs are met,
care plans that make sure needs are met,
participation in the community,
increased self help skills, confidence from the centre helping him to be more confident in the community with more people,
one to one staffing, good personal care facilities,
having fun, matching gender preferences

9. People with a learning disability

"I would like the existing service" (service user)

9.1 The Dalgairn Centre, Robert Gough, St Clair and West Fife Community Support Service (WFCSS) between them support 398 adults with a learning disability. These are divided as The Dalgairn Centre (Cupar) supports 108 adults, Robert Gough (Leven) supports 88 adults, St Clair (Kirkcaldy) supports 80 people and WFCSS supports 122 people. The needs and dependency levels of individuals in each of these centres varies.

9.2 The themes people with a learning disability value are:

flexible and responsive transport
keeping the buildings
friendships
flexible service
work experience
service development
good staffing
person centred service

9.3 The following pictorial is an example of what is important for people with a learning disability and their carers in any future service development. We were told that they thought their current service "was ideal" and that they liked to "keep seeing my friends". Flexibility, variety of transport options, opportunities for growth and development, being out and about as well as having a base were key features. Family carers told us that they wished for evening and weekend opportunities for their sons and daughters.

9.10 This is one example of the different ways our staff communicated with people to gather their views. These boards have been on display at day centres over the last few months.

10. People with younger onset dementia

"I still work and the service gives me peace of mind" (carer)

10.1 There are around 71,000 people with dementia in Scotland with 2,300 affected by younger onset dementia (Scottish Government National Dementia Strategy) October 2010). These numbers are expected to double over the next 25 years. The prevalence of dementia increases with age with 1.5% of the age group 65 – 69 affected. In addition we know that adults with a learning disability and some people with acquired brain injury may also develop dementia at an earlier age.

10.2 The Fife Strategy on Dementia (March 2010)projects that the total number of people with dementia in Fife is expected to increase from 5748 in 2008 to 9372 in 2025with the numbers for females being almost twice as much as that for males. We need to be prepared in our adult day services to meet the demand in the future for the increasing numbers of adults who are likely develop dementia.

10.3 We provide a day service for 14 people who have been diagnosed with younger onset dementia. Of these 8 people attend the specialist dementia unit hosted within the Forward Centre. This service had been provided at the Viewforth Centre and in 2008 relocated to the Forward Centre with 9 service users now increased to 11. 3 people with physical disabilities are in the mainstream Forward Centre, 1 attends St Clair and 2 attend Robert Gough. The ages of service users in our day centres with early onset dementia ranges from 34 – 72.

10.4 We asked service users and their families about how they viewed the service they received. Their comments ranged from:

"getting out and doing things instead of sitting in the house doing nothing"
" lack of care (days) for under 65s, needs to be resolved"
" needs to be more quieter at times" to
" before day care, I felt no one was listening to me, at day centre, staff listen and act on what I say".

10.5 Broadly the following issues highlighted include:

Lack of information on available resources.
Lack of services across Scotland for people with YOD including day and respite services.
Lack of opportunities for carers to get a break
Shortage of skilled staff
Inflexibility of current services.

10.6 This is an underdeveloped service area in Fife worthy of closer review. We will work in partnership with older peoples' services and the voluntary sector to make sure we are meeting the needs of this very vulnerable group.

11. Younger people with a disability

"Opportunity to be educated appropriately" (a younger person)

11.1 We have met with younger people and parents of children with a learning disability to find out what they are looking for from future services. This has included focus groups through ENABLE Scotland"s "Big Plan" process, Fife Children"s Right"s Strategy focus groups, Speak 4 yourself groups and youth groups and a self advocacy consultation event. A questionnaire was also distributed via CVS. Young people tell us that they like a variety of activities including being with friends and family and having fun. They like going places, having work experience and learning new skills. We know they don"t like "big gaps" between school and college.

11.2 Some parents have told us that they were not aware of what was offered by way of a day service. They felt that no-one had been able to tell them what a day service was. Some parents had the image of "dingy building with lots of people aimlessly wandering about". This tells us that we need to promote our day services more and make information available about what we do and how we involve people in community activities.

11.3 Most parents were interested in the idea of direct payments or self directed support. Others" experience of this had not been positive. Some parents felt they could have been better advised. Other parents highlighted inflexibility associated with how money could be used resulting in excessive amounts building up. Parents raised issues about transition not knowing what plans were in place despite some young people reaching 16 years of age. Parents were clear that they looked for person centred approaches and community based opportunities.

12. People on the Autism Spectrum Disorder (ASD)

"Opportunities to meet people with common interests" (person with ASD)

12.1 Autism is a lifelong developmental disorder that affects an estimated 1% of the population, approximately 3,280 people (adults & children) in Fife. It is described as a spectrum of disorders, ranging from those affected with a learning disability to those apparently more able and high-functioning, with many adults remaining undiagnosed. Demonstrating problems in social skills, social language and communication, and rigidity of thought and behaviour, Autism, without timely and appropriate interventions, hinders the ability of those affected to understand the world around them.

12.2 Knowledge and understanding of Autism, and the impact on the individual and family members, is imperative. The following is an extract of what people affected by ASD told us what their ideal day services and opportunities for the future would look like:

A Service that people can dip in and out of and that would develop social and life skills.
Practical skills i.e. filling in forms, to be educational and fun.
Learning new things and becoming skilled in them.
Learning how to be confidence in oneself, trusting and knowing own abilities.
Opportunities to make a difference in the life of the person who is using the service.
Something that is progressive and "outcome" focused.
Services that are meaningful and purposeful – increasing capacity.
A chance to meet new friends, short term "snapshot" input to skill for long term life experience.

13. What "People First" who are a self advocacy group told us

"Respect from others; not only those involved in our lives but the whole community"

13.1 We involved "people first" in this review as a self advocacy group. They told us that they had spoken to their members across Fife about the review. They told us that "we did not think Day Centres were a good idea in the first place. It stopped people from engaging in all the risks, satisfactions and disappointments of everyday adult life". Some of the views from the members across Fife are:

I want to stay at the day Centre. I like it. I have been here for 25 years.

I would like a job that is not short term and that I get paid for.

I want a place of my own in the future and I would like to handle some of my own money and have a bank card.

I want to stay with my mum or family members and I want to go to college to do art but can"t because of lack of transport. I also want to keep in touch with the friends I made there.

I would just like people to behave decently.

I want to live in the community with other people, where there are no walls between us and we can all get on and enjoy being together.

I want to get out of hospital and live in my own place.

Better education that prepares us for paid employment and not “voluntary” work.

Lives that are independent and person centred not service centred

Recognition from service providers and families that we are “adults” and have the right to enjoy adult relationships and not be treated like children.

Stop bullying. We are bullied and harassed far too often and it makes us frightened to go out.

14. Supported Employment

"I want to work in a hotel and get some qualifications from college"

14.1 Many people with disabilities want to work. Our consultation demonstrated that most people would like to see supported employment an integral part of day services. The recent review of the health of Britain's working age population “Working for a Healthier Tomorrow” (2008) confirmed that being in employment is generally good for physical and mental wellbeing. Work can be therapeutic and overall, the beneficial effects outweigh the risks of work for the majority of people, including many people with disabilities and long-term health conditions.

14.2 People with learning disabilities who receive support from day services are likely to claim for benefits that indicate that they are not fit for work. These benefits include incapacity benefit, employment and support allowance and disability living allowance. In addition and in some instances their carers will be in receipt of benefits associated with the care of that person. People indicating they are unfit for work may be perceived as being in the “benefits trap”. Fife Employability Team (FET) within social work links with day services and currently supports a number of adults into employment:

St Clair Centre	Employment options identified at 6 monthly reviews and in weekly discussion with staff. Suitable unpaid placements and voluntary work options then sourced and individuals undertake preparatory work within the centre environment. Currently 7 people in paid work and 14 people on placements
Forward Centre	Service users identified through review process. They are then referred to FACET, FET or college
Robert Gough Centre	Employment is a focus within the service review for service users. Service users ask staff about employment. Service users are offered in-house and external placements all sourced by staff of Robert Gough. Currently 2 people in paid work and 44 in placement in-house and in the community
Grange Centre	Service users have high support and personal care needs. Employment was explored in the past but there was not a great uptake and it was not easily sustained.
Viewforth Centre	No in-house provision for offering employment opportunities for service users.
Dalgairn Centre	Dalgairn has a history of supporting service users to source employment opportunities. Service users can approach staff to discuss employment options and this is also identified at service reviews. Currently 3 people in voluntary work, 9 people in preparation for work and 7 people in paid work.
West Fife Community Support Service	WFCSS employ 1 FTE Disability Employment Co-ordinator matrix managed by FET. Currently 11 people in paid work, 20 people in unpaid placements, 5 people undertaking “Prepare for Work” course, 10 people undertaking vocational training

14.3 We need to build on these strengths and develop closer working links between our day services and the Fife Employability Team.

15. Transport

"Public transport helps people develop self esteem, meet other people".

15.1 The review has highlighted a number of issues relating to transport.We spend about £1m on the provision of transport which is used fully throughout the day i.e. 9-4. You can see from the table below the number of people who use their own transport or means of travel and those who rely on transport being provided for them. This review has highlighted issues as to whether those with specific motability or mobility allowances and benefits should be expected to fund their transport arrangements? When we posed this question during the review there were mixed views with around 50% ( out of a random sample of 100) indicating support for people either paying or providing their own transport. Highland Council introduced a charge for transport and other authorities are considering this. In Fife there may be benefits from taking a corporate approach involving the Council"s Transportation Services with a view to developing more efficient and cost effective arrangements.

15.2 "People First" conducted a survey in Fife in May 2007 which gathered views from members about their experience of using public transport. This told us that our public transport services could be more effective and that staff and bus drivers" attitudes were helpful a significant number of individuals had experienced an unhelpful attitude. There are issues about how safe people with disabilities feel travelling on a bus and how difficult bus timetables and other information about travel is to understand.

16. Properties including catering and cleaning

16.1 All buildings require financial investment of varying degrees. All have issues which will require to be addressed whether it is upgrading the facilities, investing in the fabric of the building or taking steps to reduce carbon emissions. The reduction in O2 emissions is one of the Council"s big 8 priorities .Currently Adult Day Service buildings are accounting for approx 10% of the councils overall Co2 emissions.

16.2 The following table gives technical details of comparative property related information, for each part of the service.

No. of service users	Property related Costs	Improvement Works Cost	Safety Rating 1= poor condition 5= exceeds current standard	CO2 Emissions Tonnes/m2
Major	Minor
Dalgairn	108	£48,136	£109,000	£9,700	3.26	0.07
Robert Gough	88	£46,524	£45,000	£12,080	2.44	0.11
St Clair	80	£59,672	£26,000	£26,200	3.44	0.18
West Fife Community Support Service	122	£78,226 (for dispersed rents)	£0	£5,000	3.69	0.12
Please note that these figures only relate to the core base.
Grange	39	£7,831	£34,500	£19,042	3.67	0.07
Forward	67	£37,667	£22,000	£0	3.11	0.05
Viewforth	42	£17,828	£53,000	£17,000	1.78	0.11

16.3 All of the above factors will need to be considered when deciding if a property is fit for purpose. The information on improvement work were derived from surveys carried out by Elders Consulting Engineers in 2005 on the Life Safety Systems in our Day Centres and their compatibility with legislation, a condition survey report carried out by Property Services in 2007 and information gathered by Property Services as part of this review. These costs should only be used as a rough guide until more up to date costs can be provided, however the work identified is still relevant. The minor works showing in the table could be covered from existing resources and an amount of £150k has been built in to the capital budget for adult day centres in 2011/12.

16.4 A review was carried out by Fife Catering and Cleaning Services across day services. Each day services manager was asked to document their current catering and cleaning provision. The following table shows that lunches are provided in 4 out of 7 day service facilities. We will review the catering facilities required for the future.

Type of Catering Provision
Full Provision	Self cater and vending	Self cater
Forward Centre	?
Grange Centre	?
Viewforth Centre	?
Robert Gough Centre	?
Dalgairn Centre	?
St Clair Centre	?
West Fife Community Support Service	?

16.5 In our consultation we asked the question: How might the current buildings be used to their fullest potential? Suggestions included opening up buildings to the community and other groups. Sharing facilities in the evenings and at weekends with drop in sessions were some of the ideas put forward.

17.0. Voluntary Sector Day Services

"Not enough planning for Service Users reaching 65"

17.1 We met with representatives from the voluntary sector which was facilitated by ARC, a National Voluntary Organisation to hear their views and experiences about day services. In addition to the numbers of adults receiving a local authority day service there are 47 people attending day services in the voluntary sector. An extract of some of the views they have are that:

There should be more flexibility when services user become ill at their Day Centre
There is no effective notice regarding closure of Day Services ( when people need to attend voluntary day services)
Not all agencies are invited to joint meetings.
There could be more resources for personalized approaches
There could be better communication between service providers as to what's available
Criteria for attendance needs to be more flexible
Preparation for transition into services from school
Lack of flexibility and training to meeting changing needs of service users.
Lack of flexibility in service (7 day support)
User/parent/carer control of services offered
Awareness of possible sight problems (80%) affects independence
Over reliance and dependence on day centre rather than a move to independence –current services are institutional
Meaningful access to community activities – avoid tokenism

18. Conclusion

18.1 This day service review has looked into current service provision and the needs people have for the future. We currently provide a service to 555 people with disabilities across 7 day service facilities at a current cost of £7.6m. Our day services are evolving in the right direction when compared nationally and according to the views of our service users and their carers and our staff. The service in the future will match the aspirations of service users and their parents and families. We need to ensure those with the most complex needs and people with profound and multiple disabilities are supported competently and safely. We also need to take account of changing need and demand as a result of increasing life expectancy for people with all ranges of disabilities including those with younger onset dementia, ASD and sensory impairment. We need to pay close attention to the needs of older adults ensuring that services are fit for purpose for them as well as for the middle and younger population.

18.2 There is strong support for day services that are flexible and responsive to a range of need. Services that are local and accessible are important features and should be open to people regardless of disability. There is support for integrated services where people should not be segregated because of the type of disability they may have. People have said they want better education and employment opportunities and to feel valued as a citizen in their own right.

18.3 The key principles underpinning future development are outlined at the start followed by a proposed way forward in Section 3.0. They are based on the modernisation agenda both nationally and locally to develop services that are more flexible. They focus on people"s ability to be independent and recognise the range of different expectations and views people have of day services. This is particularly true for those younger people and their families who may be looking to use our services in the future. We therefore need to develop a workforce fit for the future that is flexible in meeting peoples" needs. This report is a snapshot of current provision, highlights examples elsewhere in Scotland and forms the basis of a strategy for the development of day services over the next 5-10 years.

19.0 Recommendations

Develop Day Services for adults with a disability underpinned by the principles in Section 2.0 and proposed service outline in Section 3.0 of this report.
Develop flexible day services in the evenings and at weekends.
Make sure we have buildings where personal care and support can be provided safely for those who need it particularly for those with PMLD and more complex needs.
Make self directed support available for those who choose this as an alternative option to day services.
Develop integrated day services for people regardless of the type of disability they may have with equitable access to increased community activities and involvement.
Develop partnership strategies with other agencies e. g. Health, Local and Community Services, Education and Employment Services to provide further integration into the community including Transportation Services in respect of transport issues.
Develop proposals for better use of facilities e.g. sharing with other community services and groups, developing community cafes?
Develop a more consistent and joined up approach between FET and day services.
Work in partnership with older peoples" services and the voluntary sector to develop effective day services for adults over the age of 65 and those with younger onset dementia.
The External Reference Group to continue developing the evaluation programme so that the success of the development of day services in the future can be measured.

Thank you to the Review Steering Group, External reference Group and to all the service users, parents, carers and staff who have given full support to this review from the outset. Your comments and views have been invaluable for shaping the development of day services for adults in the future.

Appendix 1 Day Services Review Steering Group Members

Gail Crawford	Service Manager, Adult Resources (Chair)
Ian Wilson	Project Manager
Frank Robinson	Service Improvement
Peter Hibberd	Parent/Carer
Anne Brown	Parent/Carer
James McNab	People First
Kate Milligan	People First
Janice Laird	Community Services
Alistair Haldane	Education
Mhairi Stewart	Social Work Resources
Mahri Lascelles	Social Work Resources
Angela Lindsay	Social Work Resources
Anna Capon	WFCSS
Ronnie Ritchie	Human Resources
Yvonne Jeffrey	Day Centre Manager
Susan Brown	Day Centre Manager
Janice MacCrimmon	Team Manager – Adults Central
Angela Hamilton	Team Manager – Fife Employability Team
Stella Macdonald	ASD Coordinator
Rhona McCallum	Direct Payments
Willie Christie	Service User
Jim Meldrum	Service User
Jessie Roberts	PAMIS
Shona Grant	Catering and Cleaning
Angus Thomson	Catering and Cleaning
Claire McCulloch	Health
Linda Erskine	Unison
Colm Wilson	Policy Officer (Equalities)
Gordon Somerville	Parent/Carer
Ricky Jannetta	Parent/Carer

External Reference Group

Martin Campbell St Andrews University
Mary Stewart, Fife Carers Centre
Michael Tonks, Fie Independent Disability Network

Appendix 2

Involving You in Shaping the Future of Day Services for Adults with a Disability in Fife

Consultation Questions

Question 1: Do you agree with these principles and do you have any others to include?
Question 2: Should our services be more integrated providing improved local access for all adults with a disability?
Question 3: Should we have a "centre of excellence" for people with profound, multiple and complex disabilities or should we provide a dispersed service across Fife?
Question 4
: Should we integrate our supported employment service into our future day service?
Question 5: Should people with specific mobility or motability benefits be expected to use these to pay or provide their transport to day services? To what extent (if any) should transport be provided e.g. to those with PMLD / those with no mobility and wheelchair dependent?
Question 6: How might the current buildings be used to their fullest potential in the future?

Please return to Carolyn Borthwick, Clerical Assistant, Social work Offices, South St. Glenrothes, Fife, KY7 5NL or email carolyn.borthwick@fife.gov.uk

Fife Social Work Service - Adult Services Resources

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