Wiltshire Independent Living Strategy 2022 to 2027

Our vision

This strategy aims to maximise the independence, choice, and control for people with a mental health condition, learning disability and/or autism spectrum condition (MH/LD/A) in Wiltshire by providing the right accommodation and support in the right place at the right time. This vision is underpinned by a need to ensure high quality and value for money.

Our focus in Wiltshire is to move away from residential care and ensure that we support people to live independently, with their own tenancy wherever possible. This means developing new supported accommodation and providing innovative and flexible care to enable people to live in the community.

The challenges we face

We currently face several challenges which stop us realising this vision:

• housing and care markets in Wiltshire provide limited quality and choice - we need a new approach to commissioning accommodation and support, including where appropriate intervening in the market, building new housing in the right places, providing support, and modelling good-practice
• there is a lack of focus on recovery - especially for people with mental health conditions. Through robust analysis of people's needs, we will develop business cases for new models of support which promote independence and recovery
• there is a lack of housing and care options in the right place - especially for people with learning disabilities and autism spectrum conditions. This leads to people sometimes having to move out of County, or to residential care, where a more independence-enhancing option closer to home might provide better outcomes. We will create more housing choices for people, including building where they are most needed
• housing and care provision is often not well aligned - through our commissioning functions, we will develop stronger relationships with and between housing and care providers. Internally, we will review our own processes to make sure these are clear and seamless
• the public do not always understand the options available - we will provide clear information to help people find accommodation and support which meet their needs.  Hearing from people with lived experience is at the heart of this strategy, and we will work with people and providers to co-produce new housing and support. We will also be clear about what is available and feasible and what is not, in order to manage expectations

The strategy identifies these challenges and sets out a plan of action as to how we can overcome them.

In the short-term (the next 12 months), we will:

• make sure our processes are clear to everybody, to ensure smooth pathways for housing and social care
• build on our needs analysis and agree new ways of delivering and commissioning the right housing and care
• establish arrangements for indemnifying housing providers if a person lacks capacity to sign a tenancy, to give housing market confidence
• explored the feasibility of deregistering residential care and be in the process of remodelling to supported living

In the medium-term (the next 2 to 3 years), we will have:

• recommissioned our framework of care and support providers (known as the Good Lives Alliance (GLA)
• fully implemented a dynamic system Provider Assessment and Market Management Solution (PAMMS) which will improve the collection and analysis of data
• implemented the South West Association of Directors of Adult Social Services (ADASS) framework for out-of-county residential care

In the longer-term (the next 4 to 5 years), we will:

• have developed a pipeline of accommodation schemes to meet needs, and be well on the way to delivering these
• be consistently measuring people's satisfaction and outcomes
• see strong joint working across Bath & North East Somerset (BSW) Integrated Care Board (ICB)

Our action plan

This action plan is organised around five key priorities:

1. we will change the way we commission accommodation and support
   • review GLA and use learning to re-commission new framework for accommodation and support
   • proactively manage and support the market to:
     • improve quality,
     • reduce placement breakdowns,
     • avoid spot-purchasing / off-framework commissioning
   • use data about supply and need to inform new models of care, support, and housing, and to generate service specifications
   • implement effective and consistent approach to performance management of care providers, with greater focus on outcomes
   • agree Brokerage dataset to assess provider engagement and performance
   • build key strategic partnerships with providers who perform well and demonstrate shared value base
   • work with BSW and South West (SW) England regional commissioners to grow local market providing specialist accommodation and support
   • facilitate partnerships between GLA and Homes4Wiltshire (H4W) providers
   • ensure commissioned staff are sufficiently skilled and experienced (for example, staff working with autistic people understand the different experiences of autistic people and are trained and competent in Positive Behavioural Support)
   • involve people who use services meaningfully in every aspect of the commissioning cycle
   • we will generally move away from commissioning residential care for adults of working age; we will use the SW ADASS framework when we commission out-of-county residential care
2. we will implement a recovery pathway which enables people with mental health needs to get the right support in the right place at the right time
   • analyse needs of people with mental health conditions, now and in the future
   • based on this analysis, develop five-year pipeline of new supported living projects to move away from our over-reliance on residential care - to include Care Support Plus model for people with more complex mental health needs
   • grow local market of effective supported living providers for people with mental health needs
   • work with BSW commissioners to develop short-term accommodation and/or support which effectively responds to crises, avoids the need for admission, supports people in an enabling way and supports them towards recovery
   • develop business case for Care Support Plus in Wiltshire (see Appendix 4)
   • we will ensure that pathways to recovery and independence include employment opportunities for people, and we will champion work placements, internships, and opportunities for work, as well as working with our commissioned providers to increase paid work for people with mental health needs, learning disabilities and/or autism spectrum conditions
3. we will create more housing choices for people, and this includes building new supported living in the places where they are most needed
   • review and further develop pipeline of new housing projects for people with learning disabilities and/or autism which are designed around the physical, mental, cognitive, and sensory needs of the individual
   • ensure people who use services are involved in design of new projects, and that all regulated services meet Care Quality Commission (CQC) standards for registration and are cost-effective and agreed in advance by Housing Benefit
   • ensure pipeline of people to move into each project - including care leavers with Special Educational Needs and Disabilities (SEND)
   • promote other alternatives to residential care - including Shared Lives, co-housing, use of Direct Payments, Individual Service Funds (ISF) etc
   • develop a range of tenure options in each geographical area; more respite provision; more tailored support around substance misuse.  We also need to manage expectations of families and individuals
   • explore feasibility of de-registering residential care to become supported living
   • ensure existing extra care offer meets the needs of older people with learning disabilities
4. we will review our ways of working, and where they are not clear or fit-for-purpose, we need to change them
   • start planning with people around their future transitions as early as possible (this includes understanding the profile of people currently living with parents, so that we can plan for when parents are unable to continue supporting
   • all new packages of care will be reviewed after 6 to 12 weeks, with an expectation that many packages can be reduced as people's needs change
   • develop pathways for people with learning disabilities who are ageing and / or may have dementia
   • clarify roles, responsibilities and pathways
   • agree and implement a consistent and shared dataset to capture activity and outcomes for people with MH/LD/A
   • clarify H4W allocations process, particularly around prioritisation of housing
   • explore inter-Authority arrangements with neighbouring Counties, especially Bath & North East Somerset (B&NES) and Swindon, where there are high numbers of Wiltshire people placed and vice versa (for example, high numbers of Swindon residents in Wiltshire)
5. we will provide clear information which helps people to find the accommodation and support which best meets their needs
   • manage expectations, particularly in the transition from children's to adults' services. Schools to support these discussions, setting expectations early, planning what a person's life looks like beyond their education, health and care plan (EHCP)
   • we will indemnify housing providers if a person lacks capacity to sign a tenancy; if things go wrong, we will indemnify the provider, as part of our duty of support
   • promote Your Care Your Support and H4W to publicise accommodation-based services - with clear service offer, specialisms (if any), inclusion/exclusion criteria, etc

Market disruption

To deliver these ambitions, we need a local market of providers with the right expertise and culture to provide excellent, enabling support to people; and we need suitable housing in the areas where people want or need to live. 

In reality, we know that the housing and care markets are challenged.  In some parts of Wiltshire, adults cannot live with friends or flatmates because housing providers will not accept multi-tenancies; we also have major challenges in supporting tenancies for people who may lack capacity to sign a tenancy, particularly where housing providers require Deputyships.

Likewise, the market is not always able to deliver the care and support that people need, particularly in certain areas of Wiltshire where labour supply is limited.

The Council will therefore take a more proactive role in developing housing and care solutions.  We will use data about the children, young people and adults we support to forecast and plan what housing we will need and where and will involve people in the design of future housing.  We will also explore building on the successes of our in-house Shared Lives and Intensive Enablement Service and, where there is a viable business case, we will lead the way in providing the kind of time-limited, enabling support that people need.

Adult Social Care Transformation Programme

The delivery of the strategy will be managed and monitored through Wiltshire Council's Adult Social Care Transformation programme.  An implementation group for the Independent Living Strategy will report to the Adult Social Care Transformation Operations Board.

The Independent Living Strategy project will influence and be influenced by a number of other projects within the programme, including:

• Technology Enabled Care strategy - creating a technology first culture for adult care delivery
• Practice development - ensuring all staff in Adult Social Care develop practice, knowledge and experience
• Mental Health Act reforms - the successful implementation of the new Mental Health Act Amendments
• Market Oversight - reducing the average cost of supporting working age adults and continuing to improve practice across service