Darlington Council Learning Disability Services

Darlington is an example of a council that demonstrates good practice across all six domains of this outcomes and improvement framework and achieves excellent outcomes for people with a learning disability. It has also consistently realised significant efficiency savings.

Supporting adults with learning disabilities to have better lives outcomes and improvement framework

For example, in the 18 to 64 age group these are as follows:

*Includes joint funding additional income, ending or reduced packages and direct payment reclaims **The in-year figure includes savings to temporary packages and direct payment reclaims too which further inflates the in-year figure but does not necessarily equate to full year effects.

The Darlington approach is characterised by a strong focus on outcomes, a determination to fully understand the needs of children and adults, a commitment to personalised services and co-production. By focussing on outcomes and supporting people to achieve their best independence using The “Progression” model, and also investing wisely in service modernisation and market development, the authority is achieving outstanding efficiency and a highly cost effective service model. Data is used effectively to support effective planning and to monitor performance.

In Darlington, the Life Stages Service (0-25 and 26+) supports disabled children, young people and adults with a learning disability. The authority moved away from the traditional system of transferring young adults to another team at 18 because they recognised that young adults, and their families, value consistency and stability during a time in their life where there is considerable change. In Darlington, this usually means that the allocated social worker remains with the young adult as they transition into adulthood.

Darlington was an early adopter of the “Progression” approach, using this as the basis for professional practice and commissioning in its Life Stages Service. This means that when working with individuals and their families the aim is to build on the individual’s strengths, skills and support networks so as to promote their independence throughout their life. The strengths-based approach is essential to this.

Investment in training and has enabled Social Workers in the Life Stages Service to develop their skills and knowledge to ensure they can assist young adults during this phase of their lives

System leaders have successfully created and sustained a strong culture that builds on the strengths of integration, uses the advantages of effective partnerships, both internal and external, and where staff are supported and encouraged to be adventurous in their practice.

The key aspects of Darlington’s approach in the six domains are detailed below:

Senior managers are highly visible in Darlington and, as a matter of routine, proactively engage with staff at all organisational levels. This has helped to create a strong sense of shared vision and allows for joint problem solving. Managers are very clear about the culture they wish to encourage and invest of their time in, “Knowing Ourselves, Knowing our Outcomes, Knowing our Children, Knowing our Adults”.

• Social Care staff meet regularly with members of the leadership team through staff forums and carousels where there is an opportunity to discuss and together agree priorities and plan the actions to achieve these.
• Workloads are carefully managed by forward planning to ensure that reviews are allocated evenly throughout the year and that the relevant resources are available.
• Leaders have created a culture that encourages high challenge and good support. There is recognition of the importance of good staff support mechanisms (see also section below “Enabling the local care and support workforce. There has been investment to encourage and enhance person centred and positive enablement, including supervision, a practitioner forum and the validation process (see also below – “Implementing the Care and Support System).

Darlington’s managers and planners are very proactive in developing the systems that generate data which can be used to inform strategy and planning processes. These may involve working with both internal council and external organisational partners. There has been investment in the use of ICT to support date collection, and analysis. Better understanding of the data, combined with new access arrangements, has helped to enable a shift to earlier intervention and prevention.   Developments include:

• Investment in mechanisms to improve demand forecasting to ensure that appropriate services and interventions will be available at the right time for the individual. Importantly this includes collection of housing needs information at the point of assessment using a ‘Housing Matrix’ (current development is to collect future housing demand from transitional assessment onwards) and using the ‘Transition to Adult Social Care Forum” (TASC) for transitional planning for young people to establish likely need.
• Where appropriate, the assessment process incorporates the use of a proprietary activity monitoring system to better understand need. It helps to show people’s day-to-day capabilities and when support is needed.  It is used to help adults with learning disabilities and/or autism to extend their independence, and receive just the right level of support.
• Ensuring that there is close partnership working, for example between the 0 – 25 and 26+ Life Stages teams. This includes a daily video conference “huddle” and a four weekly Learning Disability Leadership meeting at Head of Service level. Social Services staff meet weekly with NHS CCG staff at a Health Validation Forum.

• The “Progression” model underpins all professional practice and commissioning activity. Practice principles are embedded into the commissioning processes
• There is a close working relationship between commissioning and Life Stages staff
• A new social services data base has been introduced and continues to be developed with input from a user group, which allows staff to actively suggest and lead on system evolution and development. It is allowing better quality assurance and management oversight. The database enables:
  • Relevant data to be collected and reported, including the housing matrix.
  • Customised reports and dashboards to be readily available and used for all management levels.
• ‘Validation’ forums are used to ensure that interventions are the best they can be and offer cost effective. The Council forum is for cases fully funded by Adult Social Care and a joint Health validation forum which includes cases jointly funded including S117 and CHC. Each care package is routinely examined to ensure that where possible the most appropriate funding (CHC/s. 117) is claimed
• There has been investment in developing the local Assistive Technology (AT) offer to support maximisation of independence. The use of AT support is routinely considered to ensure the cost effectiveness of support
• Darlington is a net gainer of people with high cost / risk packages because of a concentration of private hospitals (5 within the borough). In order to manage the risk, the social service’s department:
  • Monitors detentions and where people are coming from.
  • Gathers relevant information on cases coming to attention.
  • Convenes a regular (six weekly) meetings with legal and commissioning staff to monitor S117/ Ordinary Residence cases.

An important aspect of Darlington’s performance is based on delivering knowledge and skills development, staff support and investment in systems to enable staff to work efficiently and effectively. The highlights of this are:

• Investment in technology (tablets, iPhones and video call capability) to help staff to be efficient and effective
• There has been significant investment in training and development. The Darlington Academy is a CPD, Training and Staff progression model that spans the professional career of a staff member. An employee at any level of the organisation can enter into the process seamlessly and progress, train and develop at a pace that suits themselves and the local authority. It comprises a 5 Tier “live model” that evolves with needs of workforce

• Tier 1 – Pre qualification
• Tier 2 – Newly qualified support
• Tier 3 – Experienced staff support
• Tier 4 – Middle manager support and progression
• Tier 5 – Supporting strategic direction

Key elements of the development programme are:

• Person Centred practice
• Support planning training
• The “Progression” model
• Care Act 2014
• The PICKS (Process, Information, Competency, Knowledge and Skills) programme - a 15 week training programme developed by the Life Stage Service. Its aim is to develop the skills of the workforce to enable them to implement the “Progression” model across the service. The model supports the team to embed a positive enablement approach and capacity building for individuals, which in turn leads to cost efficiency and future planned efficiencies for the organisation.
• Autism
• MINDSPACE - a behavioural science technique used to support strength based conversations.
• Relational Practice
• Providing training and tools to enable positive risk enablement including assistive technology.

Darlington is strongly committed to supporting people with a learning disability to enjoy active citizenship rather than just being present in the community. In order to achieve this, there has been a recognition of the importance of putting in place a number of enablers that are helping to realise this ambition. Supporting people to be safe is essential to the goal and, important in its own right. Key elements of Darlington’s approach are:

• Positive risk management – a key part of the “Progression” model, with its emphasis on supporting people’s aspirations to be as independent as possible, underpins active citizenship. Positive risk management in Darlington is characterised by:
  • A person centred enablement approach to risk – rather than risk aversion
  • A shared multi-agency approach to risk.
  • Use of evidence is assessing and managing risk (for example sharing the results of technology based monitoring with allied professionals and family. For example, a proprietary system is routinely used to assess night time risks and requirements for night care arrangements. This has shown over provision in this area and also demonstrated how unnecessary staff actions can unwittingly create the conditions that justify their presence.
• Darlington has also used a pilot project to demonstrate how telecare and assistive technology may be deployed to manage risks. For example, a technology product is used to support a person to manage their actions when they become anxious. Previously this would result in them displaying behaviours that can challenge others.  Another individual uses a GPS/falls alert system to help in the management of pseudo seizures. This allows them to spend time unsupported at home, and in due course will be used it to build up their confidence to travel and take part in activities outside her home.
• Darlington Council, in partnership with the Community Safety Partnership, the Police and Crime Commissioner and Darlington Safeguarding Partnership and has implemented a “Safe Places” scheme (see https://www.safeplaces.org.uk)
• A positive risk enablement approach is embedded in professional practice and work is shared with providers to encourage and help their management of risks. Families are supported to understand the positive risk enablement approach. This includes:
  •  Use of strengths-based conversations
  • Routinely sharing with families, the data from a proprietary technology based monitoring system to help them understand the evidence base.
  • Proactively discussing a person’s long-term future and what will happen when current family care arrangements may not be possible
• Darlington’s approach to safeguarding is to use staff who know the individual who is subject to the concern
• The Hub (Darlington Association on Disability) provides advocacy support and have the young inspector project encouraging quality and co-production in local services.

Structures and systems have been an important enabler of change in Darlington. The Life Stages model has led to very effective management of child to adult transitions, which is itself a one of the most important determinants of outcomes and cost effectiveness in adult social care. By embracing the “Progression” model and using it inform all aspects of the service, Darlington has achieved a congruence of the different elements that contributes to the delivery of great outcomes and highly cost effective services. Notable structure, systems and business process improvements include:

• The Life Stages 0-25 and 26+ team structure
• Use of a new social services database for data collection reporting and analysis
• Creation of a Transition to Adult Social Care Forum (TASC), which aims to support early identification of needs and co-ordinated planning
• Recognition the importance of modernised, “Progression” focussed services that provide support to those who need it. For example, in-house day opportunities have been modernised and the home care contract has been retendered with the “Progression” approach embedded in the service specification.
• A very close working relationship between the Commissioning Manager, who meets regularly with staff and attends operational meetings that help to her to develop a better understanding of service demand that can be used to shape future markets. Marketplace development is recognised as a key enabler of the services ambitions and acknowledged to be an area for further improvement
• A commitment to work co-productively.
  • This has achieved, for example, a genuinely co-produced “Preparing for Adulthood (PfA)” vision statement and action plan which is owned by young people and parent-carers. It has helped to increase confidence, raise aspirations and created a determination to work together. The key elements of the process were:
    • A successful “Preparing for the Future” event co-produced by representatives of Young Leaders, Parents Forum, and Darlington Association on Disability and consisting of a number of workshops that young people and parents contributed to. The theme of raising aspirations was introduced by 2 young people describing their life journeys at the beginning of the event. The event was and facilitated by staff from adult social care and the PfA regional advisor and attended by 45 young people and parent/carer delegates, with the Head of Education in attendance for the whole day. 
    • A subsequent event, attended by 30 young people and parent carers, was arranged when it became apparent that the information gathered at the previous event required further input to enable the development of the action plan, particularly in relation to the section on friends, relationships and communities. The event generated a lot of interesting discussion and provided valuable information enabling completion of the population of the action plan. People attending the event agreed the vision statement. A task and finish group then developed an action plan using outputs from the co-production process.
    • The vision statement was then shared at the Darlington Parent-Carer Conference in November 2019.