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Wiltshire Independent Living Strategy 2022 to 2027

National and local context

In November 2021, the Government published its White Paper on adult social care reforms. The White Paper identifies that too many people live in unsuitable homes that do not provide a safe environment for care and support to be effective. It states that older and disabled people are more likely to be digitally excluded, and many care home staff cannot access the Internet and lack digital skills. It adds that there is insufficient innovation of new models nationally that have the potential to transform the ways care and support are provided. It makes national commitments of:

  • £500m for social care workforce training and qualifications
  • £300m to integrate housing into local health and social care strategies
  • £150m to adopt new technologies and digitisation
  • a new support service to make repairs and changes to people's homes
  • £25m to unpaid carer support
  • £30m innovation fund

The White Paper follows other policy documents in recent years:

  • building the right home1 highlights the need for personalised housing for adults with learning disabilities and/or autism spectrum conditions, with security of tenure/ownership and housing rights, a separation of landlord and care provision, design adjustments and flexible support which minimises restrictions for the person
  • building the right support2 aims to shift resources from acute or institutional settings to the community. It argues the case for re-designing pathways and provides commissioners with a National Service Model, so that people with a learning disability (LD) and/or autism spectrum condition (ASC) who have been in hospital for a long time can move into the community. This is part of the Learning Disabilities and Autism Programme (formerly known as the Transforming Care Programme), which emphasises the need for commissioners to take a positive and enabling approach to risk
  • right support, right care, right culture3 emphasises the leadership and staff ethos, values, attitudes, and behaviours that are needed to ensure that people who use services lead confident, inclusive and empowered lives. This document, which supports the regulation of registered providers, places good-quality care and support within a framework of human rights and citizenship
  • the NHS Long Term Plan4 aims to improve community-based support so that people can lead lives of their choosing in homes, further reducing reliance on specialist hospitals
  • Out of sight - who cares?5 states that successful outcomes come from treating difference with dignity and respect, and that the built environment and the right support can promote this. The report finds that too often difference is dealt with through restraint, seclusion, and segregation - this is especially the case in hospital settings, but sometimes in the community too. The report recommends timely diagnosis, earlier intervention, better training (for example, around de-escalation, communication tools such as Picture Exchange Communication System (PECS) and Makaton), review of psychotropic medication (which should only be used as a last resort), and a culture of openness whereby providers routinely tell commissioners/regulators about incidents of restraint and seclusion
  • the recovery model has been central to mental healthcare for over a decade.  It is a strengths-based approach that emphasises resilience and control over life's challenges. Research suggests that important factors on the road to recovery include good relationships, satisfying work, personal growth, and the right living environment. This strategy describes how we will embed pathways to recovery within our care and support model in Wiltshire

In December 2021, NHS England and Improvement published the independent review into the death of Clive Treacey, a man with learning disabilities who tragically died at the age of 47 in January 2017. An independent review found that a lifetime in institutional settings had seriously impaired his quality of life and safety, and that he was failed by a system that did not work together to make sure he lived independently with good quality care and treatment. The review found that these failings placed Clive at a higher risk of sudden death. There are a range of recommendations for practitioners and commissioners to ensure that this tragedy does not happen again, and to support people to live in psychologically safe spaces that they can call home, with support flexing as their needs change.

In September 2021, Norfolk Safeguarding Adults Board also published a Safeguarding Adults Review (SAR) into the avoidable deaths of three young adults: Joanna, "Jon" and Ben (all in their 30s), all of whom had learning disabilities and had been patients at Cawston Park Hospital6. One key recommendation in the SAR is that Clinical Commissioning Groups complete an in-depth review for all individuals (all age) with a Learning Disability and/or Autism in a mental health hospital7, including anyone on s.17 leave. BSW Integrated Care Board has (as of 31 January 2022) completed these reviews, and once an Executive panel has provided assurance, oversight and challenge, an Action Improvement Plan will be developed in response to lessons learned.

Local vision, challenges, and opportunities

Wiltshire Council's vision is to create strong communities where people can fulfil their potential, be actively involved, and included in their communities, make informed decisions, have control over their lives, and be valued and included within society.  In Wiltshire, we start from people's strengths, talents, and assets - this means looking beyond their diagnosis or needs, however important these may be. This vision reflects what people in Wiltshire have told us they want to live well.

In 2021, Wiltshire Council published its first market position statement (MPS) for whole life commissioning8. This will influence our local care and support provider market, so that it provides an excellent service to people in Wiltshire. The MPS notes several challenges that currently prevent us realising this vision of excellence, including:

  • too many people move outside of Wiltshire to get the support they need. We are over-reliant on residential, and around half of placements outside of Wiltshire occur because our local market could not provide an appropriate service to that person. Around two thirds of these placements are for residential care, so we must enhance supported living in Wiltshire to meet demand
  • there is not enough early intervention, prevention and enablement support provided to people with mental health conditions, learning disabilities and/or autism spectrum conditions. We must ensure that people are offered the least restrictive option to meet their needs - this means expanding our Shared Lives provision and Intensive Enablement Service and re-specifying supported living so that it is the default option for people with complex needs, giving them tenancy rights and housing security. We will also 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
  • there is not enough support for autistic people.  Our emerging joint all-age autism strategy will be published in 2022. One of its key aims is to make Wiltshire a more inclusive place for autistic people to live, learn and work. This means that universal services must be accessible for autistic children, young people and adults, from mainstream education and libraries to housing and social care
  • transitions sometimes feel like falling off a cliff-edge. We need to support people earlier and ensure that children, young people and families are supported on a pathway to adulthood - our Growing up and moving on guide is the framework for this work9
  • people and their families don't always know what is available. We will ensure that the information we produce is accessible, useful and kept up to date. We will signpost people towards the most relevant information

We need to make a fundamental shift away from residential care by commissioning the right amount of high-quality, responsive supported living and transitional step-down services. Nursing and residential care will be needed for small numbers of people with particularly complex needs, but we would expect most people to have their own tenancy (or ownership), their own front-door and sharing with others or living alone if this is appropriate.

As we commission and develop more supported living options, we will expect the providers we commission to abide by the CQC's principles, as set out in Registering the right support10. We expect providers to work with us from the start of any planned development to ensure that any new service is:

  • designed to meet a clearly identified local need
  • co-designed by people who use services, their family and representatives
  • prioritised for people who already live nearby or whose families live nearby, so they maintain their local networks
  • located in a place where people can participate in the local community
  • located near to local health, social care and other services
  • sufficiently small-scale to avoid being institutional or "campus-style11"

The organisation which provides care and support to an individual should be separate from the organisation that provides their accommodation. Personal care and accommodation arrangements should be provided under separate legal agreements to ensure tenancy rights are protected even if care provision changes.

We will develop and expand our high-performing Shared Lives and Shared Days services, so that people with learning disabilities, autism spectrum conditions and/or mental health conditions can benefit from being matched with a Shared Lives carer.  During 2021/22 (up to end of February 2022), 43 people with learning disabilities, 8 people with mental health conditions and 2 people with autism spectrum conditions used this service. The service has continued to recruit new carers and is marketed across social media, as well as on Wiltshire websites.

The aims and actions of this strategy will be developed in the context of an emerging Integrated Care System (ICS). Bath & North East Somerset, Swindon and Wiltshire (BSW) Partnership is an ICS made up of NHS and local authority organisations working together. The Partnership brings together one ICA, three local authorities, three hospital trusts, private providers, a mental health trust, an ambulance trust and voluntary sector organisations. Within the Partnership, Wiltshire Integrated Care Alliance (ICA) has focused on supporting people to go home from hospital more easily, helping people with long term conditions get the care they need, and providing support for our ageing population and those with complex needs. Wiltshire ICA is moving away from a sole focus on service improvement and integration to improving the health and wellbeing of our population and working collaboratively with the interests of the Wiltshire population at the heart of all decisions. This Independent Living Strategy reflects these priorities.

1 NHS England, 2016

2 NHS England, 2016

3 Care Quality Commission, 2020

4 NHS England, 2019

5 Care Quality Commission, 2020

Safeguarding Adults Reviews (SARs): Joanna, Jon and Ben - published September 2021 (norfolksafeguardingadultsboard.info) (opens new window)

7 Admissions after 31/10/21 are not in scope of this reviewing activity

8 Whole life commissioning - market position statement (PDF, 1 MB)(opens new window)

9 Growing up and moving on

10 Care Quality Commission, 2017

11 Campuses are defined by CQC as group homes clustered together on the same site and usually sharing staff and some facilities. Staff are available 24 hours a day.

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