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					          Transforming Adult Day Services in Birmingham
 Birmingham City Council Consultation with the Third Sector Assembly
                         BVSC, Birmingham
                          23 October 2007

                             Executive Summary

Introduction and Policy Context

The fundamental driver for this consultation is a shift in Government policy on
the way public services are provided. Within the area of adult institutional day
care, this shift translates to a more diverse and person centred approach.
Instead of the local authority acting as main provider of services for adults in
need of day care, in future there will be a mixed economy of service providers,
giving the third sector a greater role in both the policy and commissioning
process as well as increased scope for expanding their existing services.
Although this raises expectations of the third sector, it also opens up an
exciting range of opportunities for third sector engagement and influence over
policy and service delivery.

We acknowledge there may be fundamental arguments against this closer
working relationship between statutory agencies and the third sector, but this
debate is outside the scope of this report. We hope to find the best solutions
for local people within the given political and policy environment.

There is a strong willingness from Birmingham City Council and the wider
partnership to actively work with Birmingham’s third sector to find the best
shared solutions to individual care needs, including direct and expanded care
provision provided by third sector organisations, as well as statutory partners.
The Third sector Assembly for Birmingham, established in July 2007, provides
an effective and timely mechanism for statutory partners to engage and work
with the third sector on this developing agenda and programme for
Birmingham.

What are the priority messages or themes emerging from the Assembly
event discussions?

An ongoing dialogue

Both Birmingham City Council and BVSC hope this event signals the start of
an ongoing dialogue between the City Council and the third sector to secure
the best adult care solutions for the people of Birmingham. Communications
opportunities will be explored further as part of City Council planning and
Third Sector Assembly thematic activity.




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Clear opportunities to build capacity, skills and contributions of the
Third Sector

      Expanding existing third sector services
      Providing new services, and for new clients
      New ways of joint working
      New and productive relationships
      What support mechanisms are required for these processes to work
       effectively?

Careful management of information flows and relationships

      Between the third sector and statutory partners
      Between third sector organisations and existing clients, through new
       approaches to care
      Between third sector organisations and new clients, providing new
       opportunities for expansion and diversification
      Structure of agreements and legal issues can be explored further
      Joint planning, budgets and staffing opportunities e.g. sharing of skills
       across and between sectors, such as more use of secondments.

Keeping a focus on the needs of the service user and carer

Some important issues to consider:

      How will vulnerable clients cope with the changes proposed?
      How do we plan for this?
      How is trust established and maintained?
      What are the specific needs of carers? Carers support services have
       become more focussed and effective in recent years. How can we build
       on this?

Conclusion to Executive Summary

The time is right for new relationships to be explored and developed but we
must always remember the complex needs of those people affected by these
fundamental changes. If we build this in to our planning and delivery through
communications and understanding we have more than a good chance of
success.




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                                The Approach

This consultation day with the third sector in Birmingham is part of an on-
going series of consultation events that will be taking place until April 2008
relating to Transforming Day Services in Birmingham. Consultation with
service users, staff and service providers will help to develop a new approach
to the provision of community activities for service users currently accessing
traditional day care services.

This is part of a City Council wide approach to transforming they way it
supports and interacts with its own community, providing high quality services,
making the most of technological advances and improving the quality of life if
its residents.

The event was developed in partnership with Birmingham Voluntary Service
Council (BVSC) which used its local knowledge and expertise across the
sector to develop a meaningful programme of engagement with the Third
Sector across Birmingham. Promotion of the event happened via articles in
Update magazine (the magazine of Birmingham’s third sector), a leaflet insert
in Update magazine, leaflets distributed at the Assembly launch, adverts on
the BVSC website and the Birmingham City Council website, in the BVSC e-
bulletin, and in the City Council’s External Funding Support Unit’s alert email
and via a targetted email invitation campaign. Delegates registering to attend
the all day event, which ran at full capacity (102 people). Some service users
also attended the event.




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                           Outcomes from the day
The event was Birmingham City Council’s first consultation directly with the
new Third Sector Assembly on its new vision for transforming day services
across the city. The move away from buildings-based services to offering a
wide range of community based, meaningful and user led activities is most
likely to impact colleagues working in the Third Sector.

This event focused on the background to the overarching transformation
programme, explaining in more detail the concept of this new vision for day
services in order to set the scene for further discussions during workshops
being run throughout the day. The workshops were themed in order to be
able to explore strategic alignment of this vision with that of the sector, and to
begin to identify opportunities, challenges and practical issues that the sector
is in the ideal position to identify with the City Council.

The outputs from the day will be used to inform the on-going development of
the new vision for community based activities, and the findings from the event
will contribute to joint Birmingham City Council and Third Sector Assembly
implementation planning. A report on this event and wider developments in
the transformation of health and social care services will be presented to the
Birmingham City Council Cabinet on 26th November 2007




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Process
The day was a mix of presentations, workshop activities focusing on
discussions, examples of best practice taking place across the City,
networking opportunities and showcasing of relevant current activities of a
number of service providers working in this field. A Programme of the day is
attached as Appendix I.

Presentations giving an insight into the Transformation Project were given by
Birmingham City Councillor Sue Anderson, Cabinet Lead for Adults and
Communities and Third Sector Champion, Simon Jones on behalf of Berkley
Broomes, Director of Transformation, Adults and Communities, Birmingham
City Council, Peter Davis, Project Director, Day Services Modernisation,
Birmingham City Council. Copies of all presentations are attached as
Appendix II.

This was followed by a Question and Answer session during which a number
of points around contracting, timescales, support for small third sector
organisations and the numbers of service users affected by the transformation
programme. A full list of questions and answers raised is attached as
Appendix III.

Following the coffee break, two presentations were made showcasing existing
activities that support the community activity approach already being delivered
by third sector organisations. Copies of these presentations are in Appendix
II.




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Workshop Themes
Delegates had the opportunity of participating in two of the four workshops
being run throughout the day as follows:

Workshop A – Promoting Community Cohesion and Citizenship through
community activity.

Workshop B- Individualised Budgets

Workshop C – Developing the Market

Workshop D – Multiple client needs

Each workshop was assigned a facilitator and was set a series of questions
as the basis of the one hour discussion. Delegates were asked to break into
groups of 2/3 to discuss certain questions, and then reconvened to identify
and agree the two or three key points they wished to feed back to the final
session and the wider audience.




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Workshop feedback

Group A – Promoting Community Cohesion and Citizenship through
community activity
   1. This is a golden opportunity for BCC to cement relationships with the
      Third Sector and it is hoped that continuing issues around access and
      disability will also be addressed through this process.
   2. Feedback from this consultation is anticipated, as well as a coordinated
      approach to capacity building opportunities within the sector.
   3. There will inevitably be risks that will need to be managed and a robust
      legal framework will need to be established.
   4. This new agenda is a real challenge for the sector for both service
      delivery and the promotion and market of services to current and
      potential users.



Group B- Individualised Budgets
   1. Information needs to be in a range of accessible formats, in order for
      individuals to be able to make informed choices that respond to their
      own needs.
   2. The role of advocate, broker or mentor needs to be acknowledged and
      developed as part of the modernisation agenda.
   3. Information will need to be jargon free and kept up to date and offered
      in a range of formats.
   4. Service users will need to understand the process of how to either
      change or complain about the services that they receive.
   5. Providers will need to have a clear understanding of the quantifiable
      unit costs of services, as will service users.


Group C - Developing the Market
   1. The sector would welcome more visits from BCC for it to better and
      more fully understand the work they do. Perhaps shadowing
      opportunities could be developed.
   2. There is a need to develop jointly agreed outcomes across the sectors.
   3. The need to consult with carers should be prioritised.
   4. Services should be developed organically not prescriptively
   5. The sector feels able to offer diverse, specialist services, is able to pool
      resources and develop hubs. However they are also concerned about
      loss of individual organisational identity and the reluctance or fear of
      working together.




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   Group D – Multiple client needs
   1. It is good that A&C is reducing its silo thinking approach.
   2. It would be desirable for the third sector to be funded to provide
      services that deal with the whole person’s needs, rather than have
      clients having to access services from different agencies if they have
      multiple needs.


The facilitators from each group fed back the above outcomes from their two
workshop sessions. However, all discussion points and individual comments
were captured on post it notes and a full list is attached as Appendix IV.
Conclusion
The event was a successful first step in the engagement of the Third Sector
Assembly with Birmingham City Council’s proposals to transform its current
adult day services provision. A great deal of insightful observations,
comments and issues were raised by delegates representing the sector, all of
which will be used to further develop the City Council’s approach to its
transformation programme.
It is clear that there will be issues for the Third Sector around contracting,
capacity building, training, financial security and support and guidance, to
enable it to be able to be in a position to work effectively with the new agenda.
Birmingham City Council needs to provide effective and timely information,
guidance, advocacy and protection for service users as the programme
develops.
Next steps for the Third Sector Assembly
The Assembly thematic activity plans, initially based on the four Local Area
Agreement blocks, and below this policy themes or topics, form the framework
for moving forward with specific areas of Assembly activity. This will include
further thinking, planning and dialogue with Birmingham City Council on the
adult care services agenda. Some issues and links have already been
explored between Peter Davis, Project Director and the BVSC Policy and
Communications Team.
Next steps for Birmingham City Council
This report will form part of a wider report on health and social care reforms to
the Birmingham City Council Cabinet on 26th November which outlines the
progress to date, and ongoing plans to work with the Third Sector Assembly
on this transformation agenda.




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APPENDIX I

                           Programme of the Day
                               APPENDIX II

                              Presentations [x4]
                                APPENDIX III

                      Question and Answer Session
Q1 – How many people are involved in this re-provision of Service.
A - 30,000 individuals in total.

Q2 – What are the timescales for these aspirations to be realised.
A – The first phase of change relates to Older Adults and is currently
scheduled for April/May 2008. The total transformation programme will
inevitably take a number of years to transform.

Q3 – It is important consultation takes place with users who want to take
charge of their own services. (From a PPI representative)
A - Consultation is already underway with all service users affected by this
transformation programme.

Q4 – Why hasn’t the publication ‘Our health, our care, our say’ been updated.
A – This is a government White Paper and this transformation programme is
in direct response to the directives within that document.

Q5 – Why are more modern buildings built in the 80’s being closed and not
renovated.
A –The closure of buildings is because they all now need to meet minimum
quality standards and it is not cost effective to repair them. Birmingham City
Council has been inspected by the Commission for Social Care Inspection
and its inspection report requires it to replace buildings based day services
with more meaningful community activities.

Q5 – Can you give more clarification on the Third Sector Prospectus that has
been published.
 A –There is £9 million available and the requirement of a robust
commissioning approach, the use of Service Level Agreements and the
identification of agreed outcomes for service users.

Q6 –How would you support smaller groups with this new process.
A - We are moving away from block contracting provision with a limited
number of providers to working with a more varied range of organisations.
We will be providing organisations with a diagnostic tool to help them identify
their own capacity to respond to the requirements outlined in the Prospectus.

Q7 – What if service users have an idea for their own support, how do they
communicate this and work within the requirements of the Prospectus.




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A - This is an issue that we still need to work on. Support work is already in
place but not yet city wide. It would be more effective for service users to use
the 3rd sector as their champion and the BVSC would be able to signpost you
to appropriate organisations.




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Q8 – There are always very short timescales for applying for budget and quite
often applications have to be re-done.
A – The Prospectus now extends funding to a 3 year model.

Q9 – I am from a small volunteer group. How would I design a model for
setting up groups to respond to this transformation process.
A – This is a learning process for both your sector and us. This is the sort of
feedback we need from you in order to develop a model that is workable for
all of us. We will not have all the answers at this stage and will need to go
through an agreed procurement process which will be developed.




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                                  APPENDIX IV

             BVSC Third Sector Consultation Event – 23.10.07
            Comments captured on flip charts and post it notes

Delegates were encouraged throughout the day to make use of both flip
charts and post it notes to express their own personal views, issues, concerns
and suggestions, which are captured and grouped under headings below.

Issues for service provider organisations
    Service providers will eventually be competitors due to individual
      budgets – this could push high quality smaller providers out of the
      marketplace.
      The sector needs to have access to a named officer in BCC to whom
       they can go to for support and advice re. capacity building, advising on
       suitable premises (business relationship officer?)
      Shared training opportunities should be developed to enhance
       understanding across the sectors
      3 year funding is not long enough for planning services
      Some basic training for small groups around data management, setting
       up processes and procedures etc is needed.
      Need flexibility in service level agreements
      Need more clarity of new third sector prospectus
      Time is needed to build trust across and between organisations
      Quality training for all staff involved in support individuals
      Support needs to be given to community groups to migrate from
       ‘traditional’ service models to this new agenda.
      The council has good intentions and we have finally found a place
       where we fit!
      Mixed messages about small groups, how will contracts be managed?
      Are we being given false promises/expectations?
      Current core plans are not dynamic enough
      Smaller local organisations need to be recognised and supported
      3rd sector organisations need confidence that funds will be available to
       cover their costs for the 3 years of a contract. Any additional funds via
       individual budgets could be used to top up and expand the service as
       necessary. Funding solely reliant on user choice is a risk as users
       have the right to vary their activities from one week to another.

Issues for Users
    Users will need to be supported to manage their own budgets and
      understand the concept of budgeting over a 12 month period.


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      Complexity of Direct Payments has resulted in few older adults taking
       up this approach
      This programme does not meet the needs of non-eligible clients who
       still have needs that are not being met
      The ideas of choice and options for service users need to be stretched.
      There is a risk that the carer/advocate can be more articulate than the
       service user herself.
      Service Users who are alcoholic/drug users will abuse the individual
       budget system
      Need to keep service users close to their own local communities via
       accessing locally based community based activities
      More travel training and associated support will be required for LD
       users
      Safeguards need to be put in place to protect vulnerable service users
       from abuse or exploitation
      Carers need to have peace of mind in relation to this new model
      Some of the suggested activities would be difficult for older people or
       those who are frail, confused or with poor mobility and strength.
       Therefore need to find a happy medium for those who may or may not
       want to participate.
      Service users may be reluctant to employ individuals because of the
       necessary legal requirements
      All of us are likely to be potential service users at some time
      Need to continue to develop peer group support arrangements



Issues around communication/promotion
      Penderels are currently putting together a database of service
       providers for their clients (Direct Payments)
      High quality information needs to be made available to all stakeholders,
       i.e. users, potential users, organisations, support workers and
       advocates
      More organisations need to be included in this consultation process,
       e.g. Travel West Midlands
      Re. Hard to Reach Groups – this was a big clumsy meeting with big
       agendas, lack of dialogue, lack of clarity and unrealistic timescales.
      Need to build networks of referral, influence market forces and
       encourage competition
      Need to have widespread marketing of across the city aimed not just at
       service users but at local citizens


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      Need to think about how we promote the marketplace of services that
       are/will be developed. Do we use an electronic directory, paper based,
       catalogue?
      Any policy changes taking place should be communicated to the Third
       Sector in a timely manner
      There has been a long consultation lead in for the 3rd sector
      More inspired by good practice examples from voluntary agencies than
       by the council
      Culturally appropriate methods of communication relating to the new
       service model and range of services available needs to be considered
      Need more promotion of individual budgets as this will be key to this
       new approach


Issues around joined up thinking and working
      Need to be more linked in with NHS service providers
      Need to get Housing and Leisure on board


Issues around the new Service Model
      Need to look at existing service provision and offering additional
       support
      Will need to develop more ring and ride, taxi and community transport
       type services to meet the multiple transport needs of users no longer
       using centre based services
      Need to develop highly skilled support workers
      You can visit Martineau Gardens for only £15 per group! A good
       example of a costs effective and enjoyable community activity.
      .Some mental health services users need a building based refuge that
       offers a retreat that they have not got in their life. Therefore,
       community can also be about a ‘place’ for some service users.
      Performance management and quality framework will need to be
       developed
      Having centres that offer support and advice would be useful
      A seamless approach to commissioning across health, leisure, training,
       employment would be ideal
      We will need more than (currently) one organisation to support clients
       taking up Individual Budgets and Direct Payments.
      Commissioners need to properly segment the market to help support
       service providers in planning future services
      Combat the ‘white coat’ syndrome



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      Need more examples of best practice in order to be able to develop
       new ideas for community activities
      Buildings used for community activities need to be owned by the
       community with a pick and mix type of approach
      Community outreach needs to take place to draw people in to access
       facilities
      .Need to ensure that practice is capable if fitting the theory model and
       risks are appropriately managed
      Concerns over timescales and the effect they may have on staff and
       service users. More clarity and reassurance required.
      Need for less bureaucracy
      Ensure that both physical wellbeing and social support is being offered
       to service users.
      Feels like passing the buck
      Too much focus on independence could cause additional isolation
      Special Care Centres seem like a good model to develop
      BCC appears to be too controlling
      The desire for single faith/race groups to provide services is against the
       ideas and principles of cohesion
      Too much top down. Where is commissioning in the process.
      Independent body should hold the purse strings.




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Description: Day Services Modernisation Project