Living well

Introduction

We live in challenging times. People with disabilities or mental health needs (or both), along with their families and carers, have been impacted more than most. First, because of the COVID-19 pandemic and the restrictions we lived through, with some services provided differently or not at all. And now through the cost-of-living crisis, where pressures on private and public finances mean that we are having to think very hard about getting best value and good outcomes by doing what matters most.

This strategy is for adults of working age who receive or may receive adult social care support during their lives to sustain or maximise (or both) their capacity for independent living. This includes autistic people, people with a learning disability, mental health need and/or physical or sensory disability.

Across Devon, we want more people to live independently in their own homes in the community, to benefit from support that builds on their strengths and to live the life that is right for them and those who support them.

We want to create fairer, healthier, more inclusive and caring communities where people feel safe and connected within their community, and able to help themselves and each other.

We want adults with disabilities and/or mental health needs to have choice, control and support to live independent lives, and when needed, to access outstanding quality care and support.

For most people, most of the time that will be in their own home and for some people this will be in hospital or a specialist setting where we will work to get them home as soon as it is safe to do so.

Adult Social Care works with people at all stages of their lives, including young people developing independent living skills as they approach adulthood. The things that adults with disabilities or mental health needs or both would like to support them to live independently will change over time.

Our Strategy

Our aims are to:

• encourage you to stay well and support you to help yourself
• work with you when you need help through personalised, strength-based support to keep you connected to your community

Early intervention and prevention are vital to supporting people’s health and wellbeing. We will focus on supporting people early with targeted information and advice, alongside community, employment and reablement support, to prevent or delay the need for longer term care.

We will work in partnership to support people to be active in their community, to connect with others and to stay well. We will recognise and support the growing contribution and needs of voluntary, community and social enterprise organisations to improving the health and wellbeing of people and achieving different solutions, alongside the continuing development of services.

Voluntary, community and social enterprise organisations are involved and trusted within communities across Devon. It is important that adult social care works alongside these groups to support their crucial role in preventing the escalation of need and developing solutions together.

Encouraging you to stay well and supporting you to help yourself

• We help you to remain fit and well, or to improve or maintain your current abilities for longer by making informed choices.
• We encourage you to do as much as you can with support from your family, friends and community networks.
• We promote the use of technology and digital solutions where it can play a role in helping to maintain or improve your independence.
• We work with other organisations to ensure you can access advice and find out about local support and other services to help you look after yourself in your community.
• We contribute to making your local places, healthy and safe places. We will work with partners, in particular the NHS, GPs and the Voluntary Sector, to achieve this.
• Where you have specific care needs, we help you to find support that increases your ability to manage them.
• We work with you so that preparing for adulthood is a positive experience where you can achieve your full potential and live independently as an adult.

Everything described is underpinned by a way of working that builds on people’s strengths. Strengths-based working is a collaboration between service professionals, you and your family and community, which draws on your skills, abilities and networks.

This approach maximises what you are able to achieve – it supports you to remain happier and independent for longer or progress towards independence and recovery whilst staying socially connected.

Where direct adult social care support is needed, we will make sure that the care and support is personalised and strength-based and supports people to be connected to their communities.

Working with you when you need help through personalised, strength-based support to keep you connected to your community

• When you are in need of direct support, we ensure you have timely access to social care services that meet your needs and are affordable for the County Council.
• If you are referred to Adult Social Care, we ensure that we understand what you really need to support you in the short and longer term to live as independently as you can.
• The support you have focuses on achievement of goals, digital or equipment needs, existing or new community and family connections.
• We support you by commissioning housing and support that promotes and maintains your independence for as long as possible, by developing more modern settings and offering more short-term and goal-focused opportunities.
• We ensure that you are safeguarded from harm in ways that meet their desired outcomes.

Our vision and aims for adults with disabilities or mental health needs or both across Devon provide the framework for the outcomes we want to achieve with people and the priority areas we will focus on.

These are set out in the infographic below and are developed further throughout this strategy.

The outcomes and priority areas of focus are informed by what people have told us and what we know about the current context in Devon. We will keep these under regular review.

What people have told us

Residents, carers and partners are at the heart of our work and are involved at all stages of planning and delivering care. We will continue to make sure that people’s views and experiences are heard, taken into account and influence how we achieve the best possible support for people.

The detail below sets out the key issues that people have told us about through our conversations with them.

Support to be part of the community

• There is a lack of accessible information, advice and guidance to enable me to have a choice and to plan.
• I want to have a job, but I find it hard to get one.
• I have to tell you more than once.
• I have problems getting bus passes without reasonable adjustments.
• There is a lack of understanding of my disability in the community and this causes me to feel discriminated against.

Housing opportunities in the community

• I want more options in communities to help me to live with people my own age and/or be supported by my family and friends.
• I want information to help me and my family to plan for the future. 
• There is a need to separate accommodation from care and support offered so that I have choice and control.
• Housing for people with more complex needs is hard to find.
• Policies can be unhelpful – I may accept a property that isn’t right for me.
• Young people in need of housing support have a lack of viable housing options to support their needs.
• Young people often want to live with people their own age.

Professional practice (care and support)  

• I do not have timely conversations with professionals about my care.
• There is not enough training for families, professionals or communities to understand autism and how to make reasonable adjustments.
• Transitions to adulthood are a challenging and uncertain time for me.
• Fixed ages within transitions to adulthood are unhelpful and don’t help me to have choice and control.
• I want to feel safe and take positive risks with support.
• Professionals are not confident in behaviour management and shared risks.
• More support is needed for people with severe/profound needs.
• There are not enough replacement care options.
• I often have to convince ‘gatekeepers’ of the support I need and experience barriers with eligibility criteria – this can lead to me experiencing crisis.
• I want short-term flexible support when I need it.

Alongside this feedback, Adult Social Care staff tell us that they do not always feel safe at work and experience racism. The Council is committed to being an anti-racist (Anti-racism at Devon County Council) and inclusive council that is intolerant to prejudice and discrimination.

We want our staff, providers and communities to feel empowered to challenge the inequalities they may see or face and contribute towards the actions in our strategy.

*Whilst this strategy focuses on transforming Adult Social Care in Devon, it will be achieved as part of the wider health and care system. This strategy will help organisations that support the health and wellbeing of people with disabilities or mental health needs or both to focus on the things that matter most to people in their local communities.

This includes GPs and other health service providers, organisations providing housing, leisure facilities, transport and those who help make sure that our communities are safe.

Where we are now

Devon’s population is ageing and growing. More adults have complex health needs and are living with them for longer. As a result, many people increasingly require support to self-manage their care and live independently. The table below sets out the population projections in Devon by age group through to 2040.

Vital Statistics tool – Devon Health and Wellbeing

In Devon, Adult Social Care supports more people aged 18-64 years, both in the community and in residential care, than in other comparable areas (especially people with a learning disability). Demand for adult social care support is mainly through:

• increasing numbers of young people requiring adult social care support as they become adults, most of whom are autistic, especially with complex and costly care needs
• people with learning disabilities who survive their parent or carers often being unprepared for independent living and requiring more dependent and costly support

We need to have more timely and proactive conversations with people about how best to support them to develop and maintain independence. This includes changing the culture and practice of social work in Devon to have conversations with people that focus on the achievement of goals, the home environment, equipment needs, and existing or new community and family connections.

We must improve the frequency and number of strength-based reviews of the support people need to live as independently as possible and increase the use of digital solutions and technology enabled care and support (TECS).

There are significant workforce challenges in Devon. We need to continue to grow the social care workforce and ensure that new ways of working are adopted, including digital and TECS solutions.

Skills for Care estimates that the staff turnover rate for the independent provider market in Devon was 39.9% in 2021; higher than the region average of 32.0% and England at 29.5%.

Not all turnover leads to staff leaving the sector, but this churn can impact on service and provider quality (continuity of care and training or development) and efficiency (indirect spend to recruitment and agency staff).

In Devon, the pandemic has highlighted the limitations of building-based day services and short break/replacement care models. Many adults, particularly younger adults, access outreach support in the community. We need to invest in a more diverse set of opportunities for enabling and independence in communities that are short-term and goal focused.

Devon used the UK Community Renewal Fund (2021/22) to improve employment opportunities for people with disabilities and/or mental health needs within the county. We need to build on the learning from this project to support more people to have a paid job.

Pressures on housing affordability have increased, with Devon now at 10.35 times the average salary in 2021; 20% higher than the rest of the UK. Private rent stock levels across Devon fell by 50% between 2019 and 2021. Devon had 11,100 second homes registered during 2021, a 2% increase since 2019. These figures underestimate the number of homes used for, for example, Airbnb.

Fuel poverty and poor housing conditions, particularly in the private rented sector, are a major issue, especially in rural parts of North and West Devon, which impacts on health and wellbeing. Homelessness is increasing, with more than 15,000 families on the housing register in 2022 and average house prices more than 9 times annual earnings (compared to 7 times nationally).

The supported housing available to adults of working age in Devon is limited and housing options are often focused on age rather than need, which limits choice. For example, extra care housing is currently exclusively for older people and supported living is mainly for people with disabilities and/or mental health needs. We need more of these housing models across Devon.

The supported living market in Devon is fragile and characterised by an outdated model of shared houses in remote areas where people cannot connect with their communities or easily get to work.

Supported living services need to be redesigned so that support is shaped around people and we increase their choice and control over how and where they live. We want to ensure some consistency in the type of support provided and ensure quality of tenancies.

Care at home in Devon is usually commissioned by the amount of time needed to do a particular task (‘time and task’) and can result in inflexible blocks of time that do not empower providers to adjust a care plan in partnership with people or their family.

The life expectancy of people with a learning disability is 65.1 years for women and 65.4 years for men, compared to 83.1 years and 79.4 years respectively for those without. We need to do more with our partners to make healthcare and health improvement services more accessible, including access and support for screening and immunisation programmes.

Poor mental health and wellbeing has a considerable impact on quality of life and is a major contributor to premature death. Loneliness is often a precursor for mental health needs and is seen across the life course. Many Devon communities have a high risk of loneliness. Younger renters with little sense of belonging to their area, unmarried middle-agers with long-term conditions are at increased risk.

Forthcoming changes to the Mental Health Act are intended to maximise people’s choice, address racial inequalities and end the inappropriate long-term detention of people with learning disabilities and autistic people under the Act. We need to work in partnership to prepare for and deliver these changes.

How we will achieve our vision

The priority areas that we will focus on over the next five years are set within the context of our vision, aims and outcomes for adults with disabilities and/or mental health needs across Devon. The actions that we will take over the next five years to achieve our vision are described below.

AIM: Encourage you to stay well and support you to help yourself

1. Early intervention and prevention

People want better access to information about services (in a way that suits them) and tell us that they do not have enough accessible information, advice and guidance to enable them to have choice and to plan for the transitions in their lives.

An increased focus on prevention and early intervention will promote better outcomes for people and will lead to a longer-term financial sustainability for the Council and our partners.

We will improve timely access to information and advice, increasingly taking a digital approach and:

• Review our current information offer to identify where a digital approach will improve access for people, alongside accessible formats where people have communication needs. This includes health improvement, screening and immunisation programmes.
• Provide accessible information about housing choices so that people (including young people) can make informed decisions about where and how they live throughout their lives.
• Share co-produced housing standards for autistic people setting out the reasonable adjustments for homes to support sensory differences. Consider producing for other needs.

We will review and reshape the front door to adult social care with increased use of technology, community equipment and personalised care to help people to be as independent as possible and:

• Enable more people to take more control of their support through digital communications with the Council via web chat, online self-assessment and financial self-assessment.
• Help people to live independently in their own home for as long as possible through increased use of and information about Technology Enabled Care and Support, so that they can keep doing things for themselves.
• Proactively identify areas for digital and technological improvement and share best practice across the health and care system.
• Work with partners to address the technology challenges of our rural communities.
• Plan for adulthood early and ensure expertise remains around the young person for transition.
• Improve timely understanding of needs and aspirations of young people to inform planning.
• Support adults who live at home with elderly or frail carers to develop independent living skills and plan for older life whilst also supporting their carers.
• Work with partners to prevent and support recovery from substance misuse and mental health issues, along with promoting general health and wellbeing (for example, the importance of vaccinations).

A case study

Olivia is 20 years old. She lives at home with her Mum, Dad and Grandad and attends a local FE college.

Olivia now “doesn’t have to ask Mum all the time and can carry on and do it herself”. It has positively impacted on the family dynamics.

Olivia is autistic and struggles with social interactions. She can get very anxious in unfamiliar environments. Her goals were to cook independently and gain full-time employment after her apprenticeship.

Olivia is working towards NVQ level 2 and by creating a partnership with her Tutors there has been consistency throughout her transitions.

AutonoMe worked with Olivia and her FE College to create digital support tailored to the academic programme and within the home as part of a holistic approach.

Her social work team are thrilled with the outcomes for Olivia. It has created a system that means Olivia has continuous support to live independently as an adult and to achieve her goals. The programme has taken the pressure off their resources

2. Community

Independence and a good quality of life should be less about services and more about increasing capacity for early intervention and enabling life experiences.

We will build on the innovative ways that people were supported during the pandemic by developing a more diverse set of enabling support in communities that is short-term and goal focused. We will:

• Consider new technologies and buildings as hubs/pods to increase the availability of outreach for people at all stages of their lives, preventing escalation of need and/or carer breakdown.
• Develop support of volunteers to achieve different solutions for adults with disabilities and/or mental health needs. This includes improving access/pathways into voluntary support and developing volunteering as a pathway into employment.
• Support community and providers to have a shared knowledge of local support needed and enable community groups, who are trusted, established and connected in communities, to directly design and deliver support.
• Work with independent providers to agree personalised outcomes and monitor progress.
• Consider whether place-based budgets which pool resources between separate services would be more capable of aligning the risk and reward of investment in early intervention.
• Build more opportunities for people to use Direct Payments to access care and support opportunities local to them. Direct Payments provide people with more choice and control over how they meet their care and support needs.
• Recognise that for some people a traditional day service may currently be the right support to meet their needs and those of their families/carers. Where this is the case, we will provide this support for people as part of a strength-based approach to developing independence.  
• Ensure enabling opportunities for people are available outside of working hours, to support people to have a job.
• Build on resources developed across the Council to support more people into employment. This includes the Be Ready Employer Hub (hosted by Learn Devon) which provides training to increase Disability Confident support to employers.

3. Housing

Good quality supported housing is vital. It provides a safe, stable and supportive place to live and opens up opportunities for people to live the independent life that is right for them. People with disabilities or mental health needs or both want to be able to access safe and good quality housing at the right time, which support positive outcomes and value for money.

Extra care housing and supported living, with care delivered on site, gives people greater independence and a choice over the care that is provided for them in their own property. People living in this accommodation have a tenancy or can buy their flat outright. Adult social care is only responsible for funding the care and support costs, and not the housing costs.

Shared lives schemes support people (from age 16) to be introduced to higher levels of independence, whilst remaining in a safe and protective family environment.

Many people would rather be in a family home than a care environment and Shared lives schemes give people the opportunity to be part of family life within the community and to develop independent living skills so that they can live in their own home independently.

We want to greatly increase this type of housing across Devon to support people in the community. This will be accompanied by an increased emphasis in reablement and short-term practice and culture change in adult social care. We will:

• Work collaboratively with partners to assess local need and demand for supported housing in communities, to jointly plan and inform development of the market and increase supply.
• Implement a new Supported Living contract to increase people’s choice and control and ensure quality of tenancies through the separation of housing and support, alongside clear pricing.
• Redesign Supported Living and increase the supply of alternatives to shared houses to meet demand. This includes individual self-contained units within a core and cluster model.
• Develop Shared Lives schemes to support people with high levels of needs as short-term replacement care and alternative to residential care, or to develop independent living skills.
• Develop more Extra Care Homes schemes in Devon for people with disabilities, including people with disabilities and dementia, to benefit from community-based support as they get older.
• Use Extra Care schemes more effectively; move away from block contracts and improve usage.
• Develop short-term crisis support for people with complex needs to prevent hospital admission and unplanned moves to other areas.
• Whilst our aim is for people to live in their own homes, there will always be a need for quality residential and nursing care for people with the most complex health and care needs.
• Set out with the independent provider market the strategic objectives that we are working to achieve in Devon, including quality provision, sustainability and the training/skills required.

AIM: Work with you when you need help through personalised, strength-based support to keep you connected to your community

4. Strength-based and personalised practice that is goal focused

People tell us that they want more personalised and timely support to promote their independence, and that they want the transitions in their lives to be better managed. We will:

• Change the culture and practice of social work that focuses on achievement of goals and includes a wider conversation with people about their home environment, equipment needs, existing or new community and family connections.
• Improve the frequency and number of strength-based reviews of the support people need to live as independently as possible.
• Ensure strength-based assessments are directed by people and support personal choice and control in how assessed eligible needs are met, including the use of personal budgets.
• Set out our core values for social work practice, that aligns to this vision and supports the transformation of how we work with people and their families/carers. These are set out below.

• Increase the use of digital solutions and Technology Enabled Care and Support for people.
• Consider use of the Disabled Facilities Grant for technology solutions, including investigation of handyperson schemes focusing on ‘low-tech’ as well as ‘high-tech’ solutions.
• Develop our commissioned offer for digital solutions and technology enabled care and support, including awareness raising and increasing diversity of prescribers.
• Collaborate with health and other partners to ensure people who use our services and their carers experience joined up working and good quality service which meets their needs.
• Work with children and young people’s services to improve the transition period through earlier conversations and joint planning. Share timely information with commissioners to support the planning of housing and employment options.
• Consider how we commission care and support in people’s homes to promote achievement of outcomes and empower care providers to deliver positive outcomes for people with flexibility over how and when they do this.

TSA – the voice of TEC (tsa-voice.org.uk)

TSA – the voice of TEC (tsa-voice.org.uk)

5. Safeguard adults at risk from harm

Keeping people safe and helping them to stay safe is a key priority for us all. We need to ensure that staff are well trained to support prompt responses to any allegation of abuse and that the public, unpaid carers, volunteers and professionals have a good understanding of safeguarding. We will:

• Listen to people and their families/carers about what matters to them.
• Support individuals to speak out, with the help of trained advocates if required.
• Make sure that all services we provide or commission are up to date in safeguarding training of their staff and in respect of the Mental Capacity Act Deprivation of Liberty Safeguards.
• Commission services that deliver kind and compassionate care that helps to keep people safe through contract management of quality of provision.
• Monitor where Making Safeguarding Personal questions have been asked, and also monitor all our safeguarding activity to ensure a timely and proportionate approach.

6. Be an anti-racist council

A number of actions are being taken forward across Devon County Council to support our intent to be an anti-racist organisation. We will:

• Support staff to feel safe, including listening and providing support to staff and managers.
• Improve data on equalities and ethnicity, including in the independent provider market.
• Improve representation in our engagement forums.
• Include a clause in our social care contracts with acceptable standards that are monitored.
• Consider race equality as part of all commissioning strategies.