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