East Dunbartonshire Adult Learning Disability Strategy 2024-29

The Learning Disability Strategy is strategically linked to East Dunbartonshire Health and Social Care Partnership’s (HSCP) vision for people with learning disabilities, ‘Working together to deliver better outcomes for people with learning disabilities, and their families and carers’.

The focus of the strategy is on improving the quality of life, choices, and personal outcomes for people with learning disabilities and in doing so, improving the quality of life for the people who care for them.

People’s expectations and aspirations have increased for better services, support, choice and control, equality of opportunity and human rights. This has happened during a period when the number of people with complex support needs has increased, and available
resources have been under severe pressure. To ensure that we set realistic expectations we must consider current and future challenges and the resources and finance available to make changes happen.

The Learning Disability Strategy 2024-29 takes account of the needs of people with a learning disability aged 18 years and older, that live in East Dunbartonshire or for whom East Dunbartonshire Council is responsible.

Throughout this strategy there are references to families and carers. It is acknowledged they are vital to the success of the delivery of this strategy, whether it be giving feedback, co-production or supporting the cared for person to navigate new ways that services are delivered.

The Learning Disability Strategy 2024-29 is a continuation of East Dunbartonshire’s HSCP’s last Learning Disability Strategy launched in 2018. The 2018-23 Strategy included a number of priorities to be actioned during the term of the Strategy.

The Strategy set the context for a planned review and redesign of Learning Disability Services and wider service development and modernisation. The redesign focused on four priority areas:

1. To develop a Fair Access to Community Care (Adults) Policy
   and updated Eligibility Criteria.
2. To improve transition arrangements for young people moving to
   adult services.
3. To develop redesigned day services and accommodation-based
   support services for people with learning disabilities
4. To work in partnership with other HSCPs across the Greater
   Glasgow and Clyde Health Board area to take forward.
   Improvement.

Development of a Fair Access to Community Care (Adults) Policy and updated
Eligibility Criteria

The HSCP consulted widely on the development of a new Fair Access Policy prior to its implementation in June 2019. In practice, the policy where applied, has supported the implementation of personal budgets that are calculated fairly and consistently and have proven to maximise personal independence whilst meeting eligible needs. The Policy is underpinned by systems and processes that measure risk and determine eligibility. In essence, where applied, the policy has enabled different service types to be accessed, in addition to promoting the use of Self Directed Support that promotes personal choice.

A subsequent review of policy implementation has highlighted that the Fair Access to Community Care (Adults) Policy and updated Eligibility Criteria has not been fully applied across the Learning Disability care group and there remains variations in the levels of care packages provided. Retrospective application of the Policy will ensure consistency and fairness in how resources are allocated. Implementation of the Policy and updated Eligibility Criteria will remain a priority in the 2024-25 Strategy.

In addition, all resource application policies and frameworks will be prioritised for consistent application during the term of the refreshed strategy to ensure fair and equitable allocation of available resources.

Progress has been made with transitions during the previous term of the strategy, although we recognise that there is still further work to be done. A collaborative approach to transitions was established in 2019 with the development of a Transition Panel, bringing together children and adult multi-disciplinary professionals and strategic commissioners. The panel seeks to secure positive destination pathways for young people in transition, retaining oversight during the
planning and delivery of adult services.

A Transitions booklet was developed in 2022. It provides information on assessment, eligibility, support services, welfare benefits and continuing care.  It includes guidance in relation to Self Directed Support (Direct Payments and other SDS options) and Adults with Incapacity (Welfare and Financial Guardianship). There are also links to East Dunbartonshire Council policies.

We want to continue work to improve the transition process from child to adult services for young people and their carers. We will take into account pending changes to legislation and procedures, such as the expected implementation of the Disabled Children and Young People
(Transition to Adulthood) (Scotland) Bill which will place new responsibilities on local authorities in relation to transitions. Effective transitions will remain a priority within the 2024-25 Strategy.

In addition, within the refreshed priorities 2024-29 we are keen to improve the transition process from adult to older people services, when frailty and ill-health become the predominant factor in delivering appropriate support.

A review of learning disability services commenced in 2018. Phase 1 of the review focused on a redesign of day services. The aim of the redesign was to modernise day care provision by aligning services with people’s needs and increasing the ability to deliver support to people
with the most complex care needs, within local facilities. It was anticipated that by developing inhouse specialist day care provision, people whose needs were currently being met out with the authority, far from home, could now be supported locally.

Day service transformation has progressed significantly over the term of the previous strategy. The Allander Resource centre, a new state of the art facility, has opened its doors and is successfully supporting an increasing number of young adults with complex support needs coming through transitions. In addition, four customers previously supported out of area have now successfully returned to the Allander Centre. Community support provision has grown and is delivering improved outcomes in education, employment and volunteering.

Work does not stop there for our day services. We are continuing to work in collaboration with people who use our services, their carers and communities to provide local services wherever possible and develop new and innovative opportunities within the financial framework available.

The review and modernisation of accommodation-based support services will continue to be a priority over the course of the 2024-29 Learning Disability Strategy. In addition, we are keen to include respite services in the refreshed priorities.

Health Board area to take forward Improvement and service development. A number of legislative frameworks affecting people with a learning disability have been jointly implemented across GGC during the term of the strategy, such as the introduction of a ‘Dynamic Support Register’. Established in response to the Coming Home Report 2018, several NHS Greater Glasgow and Clyde wide multi-agency working groups have supported a cohesive approach to reducing delayed discharge and providing care closer to home for people with learning disabilities and complex needs across GGC.

Collaboration with HSCPs across the Greater Glasgow and Clyde (GGC) Health Board area and participation in board wide programmes and initiatives relating to services and support for people with a learning disability, such as the roll out of annual health checks detailed later in
the document, will continue to deliver improvement in the future.

Health and Social Care Partnerships (HSCPs) were introduced in 2015 to bring together a range of community health and social care services. The responsibility for organising these services previously lay with Councils and Health Boards, but now sit with HSCP Boards (sometimes called Integration Joint Boards). The idea behind creating these HSCPs was to integrate health and social care services much more closely under a single manager, with a single combined budget, delivering a single plan to meet a single set of national outcomes in a
way that best meets local needs.

East Dunbartonshire HSCP works in partnership with East Dunbartonshire Council and NHS Greater Glasgow and Clyde within a number of strategic planning groups, to jointly plan health and social care services along with a range of stakeholder representatives, including service users and carers.

The East Dunbartonshire Learning Disability Strategy sits under the overarching umbrella of the HSCP Strategic Plan. The Strategic Plan 2022-25 sets out the HSCP’s vision and values, its strategic priorities and enablers and its programme of action over the period of the Strategy. 

Shaped by the Scottish Government’s ambition for all citizens and aligned with East Dunbartonshire Health and Social Care Partnerships Strategic Vision to ‘care together to make a difference’, the HSCP’s vision for people with learning disabilities is simple but is at the heart of its ethos.

In practice this means working together to ensure that:

• People with learning disabilities in East Dunbartonshire have access to housing, transport and the wider environment to enable them to participate as full and equal citizens.
• People with learning disabilities in East Dunbartonshire learn to reach their full potential and participate in an inclusive economy.
• People with learning disabilities in East Dunbartonshire live healthy and active lives.
• People with learning disabilities are able to participate in all aspects of community and society.

Since our last Learning Disability Strategy in 2018 there have been a number of important policy updates which have sought to further empower and develop choice for people with learning disabilities.

The Scottish Government sets out their ambition for people with learning disabilities in the revised Keys to Life Implementation Framework 2019. It builds on what has been done since the previous framework was published in 2015 and reflects the broader priorities of the Scottish Government, local authorities, NHS Boards and integration authorities. For the Scottish Government, this includes a commitment to equality through the Fairer Scotland Disability Delivery Plan – to halving the disability employment gap, getting it right for every child and tackling the impact of social isolation, and recognising the capacity that self-directed support can offer people with learning disabilities to have greater choice and control in their lives.

In March 2021, the Scottish Government published ‘Towards Transformation’, a two year plan for learning/intellectual disabilities and autism in Scotland. The plan sets out to ensure that progress is made in transforming Scotland for autistic people and people with learning/intellectual disabilities. To shape supports, services and attitudes to ensure that the human rights of autistic people and people with learning/intellectual disabilities are respected and protected and that they are empowered to live their lives in the same manner as everyone else.

The Scottish Government commissioned Coming Home Report 2018 highlighted the significant number of people with learning disabilities who are delayed in hospitals in Scotland, sometimes for many years, despite being clinically assessed as ready for discharge into community settings. The Coming Home Implementation Framework has been set out to support people with learning disabilities and complex support needs who are placed in unsuitable out-of-area placements, or who are inappropriately admitted to hospital, due to breakdown in their community-based support.

The Strategic Plan 2022-25 sets out the strategic direction for 2022-25 and the key priorities it will focus on. The vision remains unchanged, and our refreshed strategic priorities continue to reflect and support delivery of the National Health and Wellbeing Outcomes. The Strategic Plan has aspirations set against the realities of the pressures being faced in the health and social care sectors and building towards a fair, equitable, sustainable, modern and efficient approach to service delivery.

The lists below set out what we consider to be the key policy drivers that inform the 2024-29 Learning Disability Strategy:

• Adult Support and Protection (Scotland) Act 2007
• Adults with Incapacity (Scotland) Act 2000
• Audit Scotland Health and Social Care Integration report 2015
• Christie Commission on the Future Delivery of Public Services
• Coming Home: Complex Care Needs and out of Area Placements 2018
• Equality Act 2010
• A Fairer Scotland for Disabled People - Scotland’s Disability Delivery Plan 2016
• Carers (Scotland) Act 2016
• Health Inequalities Policy Review 2014
• Health and Social Care Standards: My Support, My Life
• Human Rights Act 2000
• Independent Living Fund Scotland (ILF Scotland)
• Independent Review of Adult Social Care in Scotland (March 2021)
• Keys to Life Strategy 2013
• Keys to life: implementation framework and priorities 2019-2021
• Mental Health (Care and Treatment) (Scotland) Act 2003
• A National Clinical Strategy for Scotland
• National Health and Wellbeing Outcomes
• The National Care Service Bill 2022
• The Public Bodies (Joint Working) (Scotland) Act 2014
• Public Health Priorities for Scotland
• Realising Realistic Medicine
• Scotland Act 2016
• Scotland’s National Action Plan for Human Rights (SNAP)
• Scotland’s third national Dementia Strategy, 2016-19
• Scottish Government Framework for Community Health and Social Care Integrated Services (Nov 2019)
• Scottish Government’s 2020 Vision
• Scottish Strategy for Autism
• See Hear: A strategic framework for meeting the needs of people with a sensory impairment in Scotland (2014)
• Scottish Mental Health Strategy 2017- 2027
• Social Care (Self Directed Support) (Scotland) Act 2013
• The Promise 2016
• Welfare Reform Act 2012.

• East Dunbartonshire HSCP Strategic Plan 2022-25
• The East Dunbartonshire Local Outcome Improvement Plan (2017-27)
• NHSGG&C Health and Social Care Strategy: Moving Forward Together (July 2019)
• Turning the Tide through Prevention: NHSGG&C Public Health Strategy 2018-28
• Fair Access to Community Care (Adults) Policy (March 2019
• NHSGG&C and East Dunbartonshire Council Covid-19 Recovery and Remobilisation Plans
• East Dunbartonshire HSCP Recovery and Transition Plan
• NHSGG&C Board-wide strategies
• Mental Health, Learning Disability, Unscheduled Care, Health Visiting, School Nursing, District Nursing, Rehabilitation
• Joint Inspection of HSCP Adult Services in East Dunbartonshire (July 2019).

The National Care Service and The Learning Disability, Autism and Neurodiversity Bills are developing agendas at the time of preparing this strategy. We will be closely monitoring their development for any new or changing priorities and will review the Learning Disability Strategy as these arise .

The 2018 based population projections published by National Records of Scotland predicts that by 2028, the population of East Dunbartonshire will increase 3.8% from 108,330 in 2018 to 112,008 in 2028. Between the 2011 Census and the 2022 Census, the total
population of East Dunbartonshire increased by 3,900 people (+3.7%) to 109,000.

Demand for health and social care services is predicted to increase 25% by 2031.

Scotland’s Census 2011 reported that 26,349 people in Scotland have learning disabilities. Of these, 21,115 people are aged over 16 years, which equates to 0.5% of Scotland’s population.

Scotland’s Census 2011 reported that 458 people in East Dunbartonshire have learning disabilities. Of these, 357 people are aged over 16 years, which equates to 0.4% of the East Dunbartonshire population. From our own strategic analysis set out below, we understand this number to be significantly higher and believe that our prevalence of adult learning disability is the same as the Scottish average, at 0.5% of the population. Scotland’s 2022 Census information relating to disability was not available at the time of preparing the strategy.

During September to November 2023, we undertook a Strategic Needs Analysis to support us with the planning and delivery of services during the term of the new strategy. A number of local data sources were used to inform the analysis including:

• Learning Disability Budgets / Expenditure – Finance
• Care First System – Joint Learning Disability Team (JLDT)
• EEMIS – Children with Disability Team
• Care First System – Carer Data
• Service Data – Planning and Commissioning.

Our analysis identified that 504 people with a learning disability aged over 17 years, were known to social work services and receiving support, ranging from low-level advice to extremely intensive round-the-clock care with specialist health input.

Below show a breakdown of customers by gender and age range;

Breakdown of customers by gender

• Male 309
• Female 195
• Other 0

Breakdown of customers by age

• 17-34 50%
• 35-64 41%
• 65+ 9%

Our analysis identified that East Dunbartonshire HSCP are delivering around 730 formal support services to customers including respite, supported living and day care. It is not possible to measure how many customers these benefit as some individuals will access more than one type of service. Of those services, 79 customers (16%), are receiving formal support out of area.

The Strategic Needs Analysis predicts that by 2028/29:

• The number of customers aged 65 years+ will rise from 44 to around 72
• At least 57 young people will transition to adult services
• An estimated additional 1,118 extra respite nights per annum will be required to support transitions and ageing carers
• At least 40 young people will require day care
• At least 14 people will require supported accommodation

The Strategic Needs Analysis forecasts that by 2028/29 demand for services will far exceed what is available locally. In addition to known customers, many more individuals will not be in regular contact with specialist health or social care services and will live largely independently or be supported by family.

The increasing demands and pressures on services result from a combination of factors such as;

• Adults with a learning disability are increasingly living longer with previously life-limiting medical conditions (such as Down’s Syndrome) and are benefiting from continuing support. The associated costs of maintaining someone into old age can increase as their support needs change
• The substantial rise in the number of young people in ‘transition’ from school to adult services, many of whom are now being diagnosed with Autistic Spectrum Disorder as well as having a learning disability
• The breakdown of longstanding arrangements with parents or other family carers as a result of the advancing age and reducing capacity of these carers (many of whom are in the 70-90+ age group) and/or the increasingly complex and challenging behaviours exhibited by their son or daughter.

The total budget for adult Learning Disability Services in East Dunbartonshire in 2023-24 was just over £18 million. This equates to an average spend of approximately £36,409 per person we support, per annum. Chart 3 below shows the breakdown of how the £18 million for 2023- 24 was allocated. This does not include central management costs, contribution towards third sector support services or other common overheads.

Breakdown

• Assistive Technology £11,989
• Residential £2,631,660
• Day care £2,065,142
• Home care £256,674
• Transport £655,323
• Supported Living £5,750,064
• Supported Accommodation £6,979,491.

The HSCP is operating within an increasingly challenging financial framework. Over the lifetime of the strategy, it is likely that the overall financial envelope for the HSCP will decrease in real terms, and additional funding directed to supporting staffing costs associated with the Scottish Living Wage. This means that subject to annual funding reviews, Learning Disability Services and those across all other care groups will be required to achieve sustained efficiencies. It is important therefore, that any aspirations set out within the Learning Disability Strategy reflect current and future financial challenges.

Occasionally, Health and Social Care Partnerships across Scotland receive non-recurring funding to support particular policy or best practice initiatives. Two such programs that are currently progressing are:

• Coming Home Implementation Framework 2022
  Restricted funding has been made available to HSCPs to redesign the way services are provided for people with complex needs, to prevent admissions to hospitals and repatriate those people inappropriately placed outside of their own authority
• Annual Health Checks
  Limited funding has been made available to HSCPs to support the roll out of health checks for people with a learning disability and approaches are being developed to deliver a consistent approach across NHS Greater Glasgow and Clyde.

In November 2023 the HSCP Board approved the commencement of a period of consultation on the Learning Disability Strategy 2024-29, supported by a Communication, Engagement and Participation Plan.

Engagement channels included representative consultees that either live or operate in East Dunbartonshire such as people who use health and/or social care services, carers of people who use health and/or social care services, third sector bodies carrying out activities related to health or social care, the local authority and Health Board and social
care and health professionals. A website notice and social media campaign provided opportunities for members of the public to share their views on the strategy.

Engagement mechanisms included formal and informal meetings, social networks and an accessible survey.

Set out below is a summary of the key themes that were identified during the consultation:

• The commitment to our shared vision
• The high regard for the opportunities provided at day services
• The need for improved transition from childhood to adulthood
• The importance of regular contact with social work services
• The need for improved information on the services and supports available and how to plan your own support (self directed support), reinforcing choice and control for individuals
• The consequences of changing needs and the critical importance of future planning around living arrangements and accommodation, from adulthood to old age
• The impact when support packages change and the importance of open and honest communication with people at the earliest opportunity
• The need for regular respite provision for people with a learning disability and their unpaid carers, in maintaining good health and wellbeing
• The importance of accessible health care and the negative impact of the pandemic, including the prevalence of poorer oral health in adults with learning disabilities compared to the general population.

The consultation exercise concluded in January 2024. The general consensus indicated support with the areas identified for priority development in the consultation document, with very strong agreement on some priorities. These have been preserved within the finalised strategy.

Throughout the development of the 2024-29 Learning Disability Strategy our primary focus has been on improving the quality of life, choices and personal outcomes for people with learning disabilities and in doing so, improving the quality of life for the people who care
for them. We have examined Local and National Policy developments and presented and responded to a number of suggestions for improvement and development during the public consultation.

We have reflected on the progress of our previous Learning Disability Strategy 2018-23 and identified any priorities that require further work and therefore should be included within the refreshed 2024-29 Strategy.

Our Strategic Needs Analysis highlighted a significant increase in demand on resources during the term of the strategy. In addition, we clarified that the financial framework that will underpin any developments will not be increased, meaning that any improvement or
development must be delivered within the current or lesser financial envelope. We have stressed the importance of ensuring that our limited resources are allocated fairly and equitably.

We believe that the priorities set out below portray the important areas for development highlighted during the planning process. Improvements will be within the context of review and effectiveness, ensuring the best outcomes are being achieved within the resources available.

• To apply all resource allocation policies such as the Fair Access
  to Community Care (Adults) Policy, extensively and consistently
  to ensure fairness and equity of service provision across all care
  groups and individuals
• To review transitional arrangements for young people moving to adult services and adults moving to older people services to ensure early and effective engagement, information and planning
• To redesign accommodation-based and respite support services for people with learning disabilities to ensure high quality, cost effective and sustainable support provision
• To maximise the use of technology enabled care (TEC) for people
  with a learning disability as a means of delivering support (when and where it is appropriate) and maintaining independence and control
• To develop a programme of health checks with partners across NHS Greater Glasgow and Clyde for people with a learning disability, using the additional funding made available by Scottish Government for this purpose
• To embed a collaborative commissioning approach across the third sector with a view to building alliances that support the development of increased informal and formal support networks and opportunities within existing resources.

The priorities for improvement and development set out above will provide the strategic framework for developing learning disability support services over the next five years. Cognisance will be taken each year to overarching Scottish Government policy and financial
frameworks.

A Commissioning and Delivery Plan will be developed as a consequence of this strategy, based on the Strategic Priorities set out above and linked to the Strategic Priorities set out in the Partnership’s overarching Strategic Plan.

This delivery plan will be consulted upon and directed by the Strategic Learning Disability Review Group. Headline progress will be reported and monitored through the Health and Social Care Partnership Board, which comprises representation by service users, carers, the Third and Independent Sectors and staff.