Discussion Paper For the Development of a Community In-Care Adult Survivors Service submitted by FBGA Ltd July 2007


  1. Introduction


    1. Adult In-Care Survivors face a challenging future with currently no dedicated service provision in Scotland. More cases of past in-care abuse are being disclosed everyday such as the recent Kerelaw institution.


    1. Delays in providing an independent dedicated service provision for in-care survivors has exacerbated an already fraught situation impacting on a particular group of vulnerable adults.


    1. A national joined up strategy is required to address the pressing issues in line with past policy commitments to meet the current and long term future demands of all in-care survivors past and present.


  1. The Main Priorities.


What are the Priorities


A.      Ensure policy making is joined up and strategic with regards the policies for In-care adult survivors in Scotland.


B.     Make sure that public service users (Survivors) in Scotland not providers are the focus by matching services more closely to peoples lives.


C.     Deliver an Independent public service for all adult survivors in Scotland that are of a high quality and efficient for survivors.


D.     Improve Quality and Access for all in-care adult Survivors in Scotland to primary care.


E.     Improved Quality and Access for all adult in-care Survivors in Scotland to secondary care / services.


F.      Improved efficiency of Survivors services measured by fair access for all adult in-care survivors regardless, delivered with professionalism, quality and responsiveness.





A.     An independent model of an integrated public & voluntary service which delivers a professional high quality service to all adult in-care Survivors regardless of which institution they devolve from..


B.     Increased and improved Survivor satisfaction with Services.


C.    Preventing Survivors from becoming more vulnerable.


D.    Provide long term care which meets the needs of a vulnerable group of adults who were potentially abused within the care system in the past.


E.     Providing a high quality service to all in-care adult Survivors in Scotland who need it.


F.     Promoting positive attitudes to vulnerable people in the wider society (Adult in-care Survivors) who are looked upon favourably.


G.    Independent Seamless service delivery for all in-care adult Survivors in Scotland.



  1. Why a Joint Integrated Team within the service provider?


    1. There would be instant access to professional social care and health services which would be of benefit to in-care survivors who may present with a multiple of Health and Social issues in addition to other issues.


    1. There would be clarity and a distinct in-care survivors service and distinct roles within that service which would link in with other services including voluntary and non-voluntary services as required.


    1. There is currently a lack of clarity and service. This would reduce current confusion and uncertainty around aspects of service delivery for users (Survivors) and some voluntary and non voluntary organisations in the Adult in-care Survivor field.


    1. A more integrated or joint team would provide a clearer comprehensive service to users and organisations working in Survivor related areas.


    1. Increased referrals from all sectors to the service provider would increase good mechanisms of communication between the Service provider and other sectors providing help and support such as voluntary and non-voluntary.


    1. Referrals would have a distinct care pathway with cases being discharged or referred onwards depending on the needs of the individual clients. Whereby individual clients can receive the professional level of support and help appropriate to their needs.


    1. Discharged clients can re-engage at a later stage if required with the service provider through referral pathways, self referral or other means.


    1. Increasing involvement of other aspects of the health care services and GPs ect and other agencies down the line would suggest the need for better lines of communication and integration of services for in-care adult survivors such as social care and health.


    1. The Service Providers team structures would enable Users to gain the full range of services which could be extended nationwide if required or tailored to specific regions needs going forward.


    1. Team members with specific qualifications can be seconded in depending on timescale and budget allocations.


    1. Common assessment tools and care pathways currently being used within the NHS provide for a seamless service and can be used in relation to all referrals mechanisms in acute and other areas of care. These could be adapted or evolved if required.


    1. Cost effectiveness of Joint working team approach e.g Social Care, Health and Service provider in a single service, should also be fully considered in relation to being cost effective. Given the pressures of budget and financial allocations to other services.


    1. Best Value also indicates the need for closer joint working arrangements.


    1. Given the context in which the NHS and local Authority are expected to plan and deliver services in the future. These Options can be explored. Which will ensure delivery, good practice and improved models of care for Adult In-care Survivors as the way forward in Scotland. This is imperative given this particular client groups past history and who present with pressing care needs which require to be fully addressed now and in the long term.


What are the Options?


There are in our view two to three predominate scenarios for ways forward with the focus being to improve service delivery for service users (Adult Survivors) and provide cost effective services:


A.      A cohesive integrated community based team within the Service Provider which provides a clinical, health, social care and support team. Flexible and able to respond to needs and increased numbers. Located within the Service Provider.


B.     A community integrated team which helps and supports Adult in-care Survivors within the community and out with while being a partner of the wider NHS, Social Services and Voluntary sectors.


C.     A revisit of past scenarios which previously involved only a limited group of Survivors views and individuals from specific institutions which was not in the view of many survivors reflective and representative of all survivors. This previous scenario proved unsuccessful for a variety of reasons and was also inconclusive in achieving an outcome to deliver an all inclusive cohesive inclusive service providing high quality professional social and health care as a basic requirement by all Survivors.


D.     There is obviously an option to “Do Nothing” although this in our view would be inadvisable as for the status quo to remain as it is would continue to impact severely on a particular group of vulnerable clients (Adult in-care Survivors).


Advantages: A cohesive integrated community health and social care team working in conjunction with the Provider.


         Easier for service user access.


         Clear lines of accountability and responsibility-clear core business defined.


         Lack of opportunities for duplication.


         Care pathway development providing a seamless model of care, including joint referral and assessment tools.


         Common approach to community based work.


         Inclusion and access to relevant clinical meetings including joint discharge planning meetings.


         Highlight service consolidate Name avoiding confusion for service users and other agencies (depending on model and provider).


         Multi agency partnership working across the boundaries.


         May help overcome “service tribalism” and facilitate a breakdown in unnecessary boundaries which are of little or no benefit to Service Users.


         Education programmes on Adult In-Care Survivor issues and highlighting the service within GPs surgeries etc by leaflet.


         Involvement of all Survivors and the groups representing them in education and other programmes funded by the Scottish Executive, which survivors or their groups may wish to participate on or otherwise.


         Cost effectiveness (can be rolled out nation wide if required).


         Planning for future service requirements nationwide which are tailored to regional need.


         Structure of team of team members can be tailored to requirements flexible with some part-time or fulltime as required locally or nationwide.



Advantages: Service Provider with integrated Community Team


         Clinical and social care resources in a one stop setting.


         Opportunities for increased involvement of Social Worker who can undertake assessments if required such as OT and other type assessments.


         Service provider personnel in conjunction with Care and Health personnel to provide core management and discharge liaison planning for all service users.


         This model of social and health care has been previously used in integrated teams concerning other groups of vulnerable adults (such as the elderly).


         Liaison across all boundaries and barriers involvement of other agencies.


Next Steps:


Subgroup to explore and further discuss all options and scenarios with decision makers, possible service providers and others interested parties. Funding provision and costs to be explored also.


A way forward to be explored, agreed and an acceptable model of care service to be agreed by the interested parties.


All Survivors and groups and likely users to be consulted fully prior to implementation and final agreement on agreed models of care and service.


Implementation of actual plan and model of care and social health requirements agreed.


For various scenarios:


        Lead commissioning arrangements.


        A pooled budget approach between the health authority, social care and health commissioners.


        Management arrangements.


        Clinical Governance.


        Service Users involvement in planning with Service provider and others.


        Joint assessment tools and clear Care Pathways.


        Client data-including confidentiality and sharing of information protocols.


        Access and referral mechanisms.



In conclusion, the working group of FBGA who have developed this discussion paper would see benefit in a community service based service with a social and health care component for those adult survivors requiring to be seen in the community. Adult In-Care Survivors are drawn from across the spectrum, many are however elderly and some present with various health and social needs.


The realities are that many survivors feel isolated and abandoned by the system others are mistrustful. They are in need of proper care delivered by qualified practitioners which in our view will require some to be supported long term in the community.


We are of the view that what is required, would suggest a need to provide a fully funded, flexible and responsive service and to ensure a high quality of clinical care and support team which is fully supported from the outset and long term.


FBGA (Former Boys and Girls Abused in Quarriers Homes).