Adult Social Care Prevention Engagement Report · Adult Social Care Prevention Engagement Report...

October 2018

Adult Social Care Prevention Engagement Report Version 3.0

Adult Social Care

Adult Social Care Prevention Engagement Report October 2018 2

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Adult Social Care Prevention Engagement report

1. Introduction 3

2. Key audiences, activities and timetable 4

3. Engagement results summary 7

4. What would help people to increase their social inclusion and sense of belonging? 9

5. What would help people to self-manage their health and wellbeing? 12

6. What would help people to maximise their independent living skills? 14

7. How can support for homeless people be improved? 18

8. Feedback about proposed models and the tendering process 23

9. Feedback from other Local Authorities 28


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1. Introduction

This report presents results of the Adult Social Care (ASC) Prevention Offer

engagement activities carried out from May 2016 until October 2018. The

feedback gathered will be used to inform the future model of prevention

provision planned from 2019 onwards.

ASC Prevention services aim to support adults in Cornwall in staying happy,

healthy and independent for longer and to help them to connect to their local

communities.

We engaged with over 700 people of all ages (18+) from all geographical areas

of Cornwall and from various backgrounds including providers, service users,

social workers and other Cornwall Council colleagues, members of the public,

voluntary sector and partners like NHS Kernow, housing and police.

Over 300 people responded to our online survey. We also engaged with

approximately 200 people via workshops, face to face meetings and events.

Additionally, a crowdsourcing event with a further 200 participants, an online

conversation that resembled a digital focus group, helped us to gain greater

insights into local perceptions of loneliness and isolation and to facilitate

development of plans to address this.

“People should be empowered to

help each other and grow caring

community spirit. “

Community Workshop Participant,

2018

Survey

“Integration - it is happening but too slowly

-we don't want privatisation of services but

we do want joined up thinking which

means people at County Hall, CPFT, RCHT &

KCCG must start working together instead

of just saying they are working together,

otherwise the new model of care, that

makes eminent sense is just not going to

happen.”

Survey Respondent, 2018


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For more information about the project visit our website:

www.cornwall.gov.uk/preventionservices.

In addition Cornwall Council and NHS Kernow together with the Council of the

Isles of Scilly completed a series of engagement events to inform the plans for

Shaping Our Future (Cornwall and the Isles of Scilly Sustainability and

Transformation Plan). The engagement included a public survey, a series of

community events from Bude to Penzance and the Isles of Scilly (10 events) and

four open provider events. Individuals and organisations also submitted

responses online via email. The engagement focused on the priorities for the

general public in relation to health, social care and wellbeing. Relevant findings

for this project have also been considered.

2. Key audiences, activities and timetable

People Accessing Services/ Members of the Public and Service Providers

Date What/ where Who Aim

May-September 2016

Questionnaires People accessing existing prevention services and existing service providers

Gather feedback on what is working well/ less well and what is needed

31 November 2017

Meeting at Liskeard

Older Person’s Partnership

Gather feedback on what is working well/ less well and what is needed

3 May 2018 ‘Crowdsourcing’ online

Members of the public/ volunteers

To help find ways communities can

“If you employ middle class white folk who own their own house and drink prosecco and eat avocados they are not going to relate to the mixed race, alcohol dependent homeless guy who has schizophrenia and doesn't like taking his meds. So using charitable organisations to identify volunteers with lived experience who can help support people and show real empathy for their experiences and actually valuing those volunteers and what they contribute.”

Survey Respondent, 2018

http://www.cornwall.gov.uk/preventionservices

https://www.shapingourfuture.info/engagement-events/public-engagement/


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conversation best tackle loneliness and social isolation.

7-9 June 2018 Royal Cornwall Show

Members of the public

To help find ways communities can best tackle loneliness and social isolation.

27 July-7 September 2018

Online questionnaire

Members of the public (promoted to existing prevention service providers, people accessing prevention services and others stakeholders)

To inform service specifications

25 July 2017 St Austell CC Offices

Current Service Providers and Partners Event – Wellbeing Services

Workshop to co-design new homeless with complex needs support pathway

24 August 2017 St Austell CC Offices

Current Service Providers and Partners Event – Wellbeing Services

Workshop to co-design new wellbeing support pathway

April 2018 Soft market test through Due North

Providers To share proposed model with provider market and gather feedback.

3 and 5 October 2018

Workshops: St Austell and Redruth

Service providers, people accessing services, stakeholders.

To gain feedback about proposed service models

September and October 2018

Community

workshops in in

Penzance, Hayle,

Helston, Truro

Newquay, Bodmin,

St Austell, Truro,

Falmouth and

Members of the public

To inform service specifications


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Penryn.

Staff – Brokers/Buyers, Social Care Teams, Healthcare Teams, Care Workers


Sent 12 October 2017

Questionnaire Questionnaire sent to all ASC staff including ASC Teams, Quality & Safeguarding, Access Team, Business Support, Brokers. Received feedback from 7 operational teams including attending three team meetings.

Gather feedback about people’s needs and what the new services should look like

9 October 2017 3 Conversations evaluation event, Epiphany House, Truro

Ops teams involved in developing 3 model conversation, finance team

Engagement with ops teams and establishing links with 3 conversation model

10 October 2017

Innovation Site Team Meeting-Mid, St Austell

Ops teams involved in developing 3 model conversation


12 December 2017

Innovation Site Team Meeting-West, Camborne

Ops teams involved in developing 3 model conversation


Other Local Authorities


October-November 2017

Phone calls, emails South Gloucestershire, Plymouth City, East Sussex, West Sussex, Durham,

To find out what prevention services are available in other local areas, how


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Lancashire, Torbay and South Devon NHS Foundation Trust

other councils respond to higher demand and budget reductions and to be able to share good practice

Other Stakeholders – Senior Ops Managers, Community Network Managers, Other CC services and partners


From 21 September 2017

Monthly meetings Prevention Project group – ASC, NHS Kernow, Strategic Housing, Finance, Procurement

To oversee the review and service redesign

14 March 2018 St Austell CC Offices

Strategic Housing, Cornwall Housing, Cornwall Home Solutions, Drug and Alcohol Action Team, Community Safety, Community Resilience Service, NHS Kernow

To complete SWOT analysis on the proposed service delivery model

August/September 2018

St Austell, Truro Safer St Austell and Safer Cornwall

To promote the consultation and gain feedback about the proposed service model

3. Engagement results summary

Community is all about belonging, being a part of something, supporting

others and also being supported. Helping to get out and about, helping

with wellbeing and wellness and linking to other people with shared

interest would mostly help people to feel they belong to their local

community.

The holistic approach to social care, health, wellbeing and homelessness

agreed between the Council, Health, police, voluntary sector and other


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agencies will need to become a golden thread of any strategies and

planning of services and community activities. Leaders should be

prepared to put wellbeing at the very heart of their agendas.

Lack of connection with local community and poor personal health were

identified as main factors contributing to loneliness.

It has become evident that there are a lot of services, community groups

and activities in local areas of Cornwall that need marketing and

publicity including current information portals as people do not know

about them. Lack of awareness is the main issue preventing current

community based services and groups from having a greater reach.

Generally, people aged under 50 prefer to search online, whereas people

over 50 use community boards and leaflets. Therefore various channels

of communications need to be considered depending on the audience.

Increasing early intervention mental health support, emotional

wellbeing and help to build self-confidence are also very important for

people with a variety of needs including homeless people and those who

suffer from social isolation. People also suggested alternatives to

counselling and formal therapies; for example mindfulness, mentoring or

tapping therapy.

Many respondents felt that people should be better in managing their

own health and wellbeing. Group activities that help people to stay

mentally stimulated would be a key type of support. Local and voluntary

organisations should be supported to help people with independent

living, including support at home and out in the community and with

accessing home adaptations.

We should provide services that people want and need to empower local

communities to influence what services and activities are out there.

The majority of people said if they felt lonely, they would talk to friends

and family and that it was very important for the services to help people

to socialise with their family and friends. If friends and family were not

available, the majority cited their GP being the next confident. This was

followed by neighbours and then online communities.

Transport issues were mentioned by the majority of people as stopping

them from getting involved in activities and going into towns. The Council

is committed to further improve public transport links and as part of

Cornwall’s Devolution Deal has embarked upon a project called “One

Public Transport System for Cornwall”.


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The majority of people liked the idea of funding community projects via

an online platform with match funding and crowdfunding opportunities,

providing small local community organisations can access support with

applications.

About half of the people that resonded to the survey felt that support to

help people to stop rough sleeping, access short term accommodation

with support, access support after moving on from short term

accommodation and support at home to maintain tenancy were very

important to address homelessness.

Over half of the respondents to the survey felt the long term place to

stay which can be called “home” and support with drug and alcohol

addictions were very important.

There was also a strong view that people who receive benefits, including

homeless people, should give something back to their communities

through volunteering and community work so they can gain purpose

and sense of belonging.

The Council should be investing in the right housing which is accessible

and affordable and ought to support landlords and tenants. People

should be encouraged to downsize or change accommodation when

appropriate.

Outreach support for people to help with their tenancies, finance

management and good information and advice provided in a

compassionate manner were mentioned as key areas to prevent crisis

and homelessness.

Crisis accommodation and supported accommodation should be evenly

spread across the county and not in cummulation. Small scale

developments are the only solution for a lot of clients.

There were some strong views about needing to have local connections

to be able to access homelessness services in Cornwall and to support

people to return to their local areas when possible.

4. What would help people to increase their social inclusion and sense of belonging?

Community activities

According to the participants of the survey, help to get out and about, help with

wellbeing and wellness and linking people to others with shared interest, would


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assist people to feel they belong to their local community. Almost 45% of

respondents thought that people’s perspective and thinking would need to

change to achieve this and 32% acknowledge that support to access technology

and the internet would also help.

There was a strong view that opportunities to volunteer, participating in

community activities, classes, and evidence-based programmes, that encourage

people to help themselves, would significantly increase social inclusion and a

sense of belonging. This could include drop-in sessions and support networks

for people of all ages, as well as sessions targeted at people with different

needs, for example people with sensory loss. The voluntary sector or GPs could

employ community navigators who could drive all the above initiatives.

Also, befrienders that go to people’s homes, as well as support with going out,

and should be focused on increasing people’s independence. Services that visit

people in their own homes could have mobile internet access with them which

would help those without internet access or computer knowledge to access

services/community groups etc.

Feedback suggests that there is no consistency in relation to types of

services/support networks available and their location. Some areas have more

services and activities than others. Services/support networks are usually

concentrated around big towns that not everybody can access due to lack of

transport. There is also a shortage of volunteers in East Cornwall.

Communication and information

It has been emphasised that information about what’s available in local areas in

relation to health, wellbeing, diet, finance and volunteering opportunities,

needs to be more easily available and accessible. This includes the promotion of

already existing channels like Support in Cornwall portal and town and parish

councils’ newsletters. Other suggestions included using: leaflets, radio, word of

mouth, local newspapers, shops, noticeboards, vets, football clubs, men’s clubs,

school events, tuberculosis testing, libraries, home library service, GPs, village

halls, churches and social media.

It was suggested that it would be useful to identify community knowledge hubs,

and/or to utilise “the person in the know” (local person that can be contacted

for information regarding support networks in that particular area).

“There is one Deaf Club in Cornwall which is self-supported as a charity and no support networks for people with hearing loss”. Comment from Hearing Loss Cornwall, 2018


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It was also highlighted that we need to think about all channels of

communication to reach people in different ages, including those with sensory

loss.

Services that people want

It has been emphasised that we need to empower people to influence what

services and community activities are out there. It is important to provide

services that people want to use and access.

Linked communities

Increasing social capital, social connections, social opportunities and sharing

resources were considered to be vital to preventing the need for health and

social care. Support needs to be provided through collective community action

not reliable on the Council or NHS funding. A county wide network of wellbeing,

preventative services or community connectors supported by a professional

team and an ‘army of volunteers’ should be created to ensure it is a funding

priority, therefore reducing the future costs of emergency, health and social

care.

Events and activities in communities should flow and be linked together to

prevent duplication and ensure efficiency. Before organising a project/activity,

check what is already happening around.

Also the Council should try to support existing groups to expand and build on

things that have been done (like Living Well project), instead of trying ‘new

bright ideas’ that sometimes grow quickly but then stop.

It has been recognised that voluntary organisations are dedicated to help

vulnerable and isolated people to promote independence, choice and control

and respond to demand in their communities.

Environment

It was suggested that people ought to pay more attention to the environment

they live in. Participants felt that if we care about our environment we are more

likely to care about ourselves and each other.

It was highlighted that the Council need to remember about environmental

adaptations, for example pavements wide enough for wheelchairs and lower

curbs.

Funding for community projects via online platform

“Single voice of the community with a shared vision will help people

understand what the community stands for.”

Survey respondent, 2018


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Most people liked the idea of the an online platform with match funding and

opportunities for crowdfunding, and thought that funding for local community

projects would be helpful in all the above areas, with access to volunteers being

the most popular. It was also suggested that it could help community groups

who struggle to find funding for internet access, premises, support with

sustainability, training for professionals and volunteers, DBS checks, insurance

and management skills. Community groups would also be able to apply for

funding to support people to self-manage mental health and drug and alcohol

addiction (suggested by people at Penzance workshop). People also suggested

some ideas for projects like: group walks, local community events, coffee

mornings, bring and buy, fun runs/walks, book clubs, games club, exercise

classes , music events, art events, environment, budget cooking, sport events,

an online platform to find flatmates.

Attendees of community workshops in Mid Cornwall and East Cornwall

(Bodmin) were a bit more sceptical and felt that a match funding and

crowdfunding approach either would not work and the Council should be paying

for services, or people would need some support to use the online platform.

5. What would help people to self-manage their

health and wellbeing?

The vast majority of people who completed the survey felt that group activities

that help people to stay mentally stimulated would be a key type of support for


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people to self-manage their health and wellbeing. All other areas were also

popular, with the lowest score of just under 50% in relation to support to

identify hazards and prevent falls at home.

People that engaged in the survey thought that individuals could support

themselves. The right support with home adaptations, technology, public health

campaigns and available community support, including befriending, was

considered to be essential. Also, it was considered important to change people’s

thinking and behaviours; this view strongly came across in “other” responses to

the question about what would help people to feel they belong to their local

community.

Holistic approach

Adult Social Care should be engaging Economic, Planning and Environment

services with health and wellbeing strategies, and look at the whole picture in

establishing services. The Council should also progress with health integration

and work effectively with other partners.

Increased funding

“It’s important to recognise there are cultural factors and that ultimately people need to find their own personal motivation for health and wellbeing. There is a limit to what Councils can do, and it’s a fine line between supporting and empowering, and 'nannying'. “



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Some people felt frustrated by that essential services have been cut i.e. police

and social care, and would still like to rely on the Council services and would like

the funding for support services to increase.

Education

Respondents felt that people should be educated from the early age on how to

promote autonomy, self-independence and social responsibility.

Carers and care workers

It was recognised that support for people caring for family members, paying

decent wages for care workers and investing in good support are important.

6. What would help people to maximise their independent living skills?

What are the types of support that the Council should fund to help people to

live independently? In the survey people were asked to indicate which types of

support were important using the 1 to 5 scale.

Lifestyle

For almost 40% people who responded to the survey it was very important and

for just over 30% it was important that the Council funds support with their

lifestyle.

Support with being active in community

30% of respondents classed this as very important and for 30% this was

important.

Participants felt that people should be supported to access community groups

so they know their neighbours and can look out for each other.

Socialising with their family and friends. Almost 50% of survey respondents felt that it was very important and 30% thought it was important.

“More funding and a caring government”


“Having a carer/befriender who doesn't wear a uniform but looks smart to go places

with them like shopping, coffee, clubs and other outings as a lot of people lack the

confidence or ability to do these normal things on their own and it is a stumbling block

to them living a more enjoyable life. “



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Support with money

30% of people that engaged in the survey thought that this was of medium

importance, almost 25% said it was very important.

Housing

Over 50% of survey respondents felt it was very important for the services to

support them with housing, 25% thought it was important.

It was recognised that encouraging downsizing and home adaptations would

help people to live independently and moving to retirement accommodation

could help address isolation.

Survey participants noted that various housing options with renewable energy

should be available.

There was a view that young people with chaotic life styles should not live next

to older people as this may increase their isolation and they could become

targets of antisocial behaviour.

Issues with moving property have been mentioned when people can’t access

vans/drivers and they lose their belongings.

Also it was suggested that there should be a better regulation of houses, for

example checking that the right people are living in them.

Education/training

Over 30% survey respondents agreed that this was medium important, almost

25% said it was very important.

There was a suggestion of courses to help people to live independently, learn

practical skills and support with tenancies which could be organised by

volunteers/providers.

Employment

35% of survey participants thought that support with employment was medium

important, over 20% said it was very important.

Transport

Almost 50% survey respondents felt that help with transport solutions and

improvements to public transport are very important, just over 27% thought it

was important.

Transport issues were recognised by the majority of people who attended

workshops as a barrier to getting involved in activities and going into towns.


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The Council’s Transport service has advised that public transport is not just the

remit of Cornwall Council – only 50% of the bus network is under contract to the

Authority. Nevertheless, the Council spends over £12m annually maintaining

the bus network to provide access to essential services such as employment,

education and health. The representative of the Transport service has ensured

that the Council is committed to further improve public transport links and as

part of Cornwall’s Devolution Deal has embarked upon a project called “One

Public Transport System for Cornwall”. The aim of this project is to deliver a

fully integrated and sustainable public transport network that will include:

twice-hourly mainline rail service in Cornwall

integrated public transport network: bus and rail

integrated smart ticketing, fares and timetables to deliver combined

travel between bus, rail and ferry services (and air where achievable)

for people in Cornwall.

Technology

40% people who engaged in the survey thought technology was medium

important and just over one third thought it was important.

Other technology solutions have been suggested:

Usage of interactive apps available like MIND UK, Alexa, Echo, Dot,

The King’s Fund; visual prompts with meals, medicines, a warning app

or contact to report a neighbour or person who needs help but has

slipped through the net

Expand Smartline project

Provide internet courses and low cost tablets

Use of technology-based solutions that exist, eg. Google analytics, 3

Rings, etc

Providing TVs which majority of older people use that connect them

to Skype, etc. Many don’t like, or know how to use laptops and

computers, but they could connect to friends and family via their

remote control.

Mental Health support Mental Health support was frequently mentioned in the survey’s responses and

at the workshops. It was recognised that increasing early intervention mental

health support, help with mental health issues for different levels of needs,

emotional wellbeing, bereavement, and help to build self-confidence is


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important to people and it should be accessible via various channels such as

self-service/online and face-to-face/phone/skype.

Respondents also suggested several alternatives to counselling and formal

therapies such as:

Mentoring, peer support groups, e.g. Project100, community cafes

Art therapy, drama therapy

Mindfullness, walking, yoga

Wellness and recovery social groups

Prescribed gym attendance with no fee

Fast counselling etc., with no huge waiting lists

EMIOR – Tapping work that changes memories instead of repeatedly

talking about problem (counselling).

The science of giving back There was a popular view amongst the survey respondents that people who receive benefits should give something back to their communities through volunteering and community work so they can gain purpose and sense of belonging.

Short term crisis service There was a suggestion of a small flexible 24 hour service that would consist of mixed profession teams available for short term crisis intervention

Step down from hospital Survey respondents suggested a step down from hospital service before returning home in order that people can be rehabilitated in a non-hospital environment.

Personal budgets

Folks on benefits should, if able, earn their benefits i.e. litter picking, street cleaning, hospital portering. Promoting a sense of self-respect and social interaction.


“Small pots of money available as personal budgets for individuals to use for

the things that help them get out and about to support their health, wellbeing

and social interaction.”




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Independent Advocacy

People who responded to the survey noted that Independent Advocacy for

people with a Learning Disability Autism and Asperger’s to listen to their views is

essential.

7. How can support for homeless people be improved?

Holistic approach to homelessness

It has been recognised that there need to be a better coordination of health,

welfare, police, Cornwall Housing neighbourhoods and homeless organisations

to address homelessness, crime and antisocial behaviour and to work on the

projects like MEAM, Blue Light / Alcohol Concern, Safer Towns, Naloxone. Also

seasonal effects need to be taken into consideration.

What are the most important types of support to address

homelessness? In the survey people were asked to indicate which types of support was important using the 1 to 5 scale.

Stop rough sleeping Over 55% people who responded to the surevy felt that support to help people

to stop rough sleeping was very important, over 22% felt it was important.

It was noted that more funding is needed for emergency beds across the

county.

Survey participants also suggested small home sites called "container homes"

with intensive multi discipline support available 24hours and churches used as

overnight hostels.

“Understand issues such as poverty, domestic abuse (emotional and physical),

austerity, food poverty, fuel poverty, poor quality housing, poor health, poorly

paid jobs, access to good local food, understand what drives homelessness,

provide joined up emergency and preventative support, assess the (massive)

levels of inequality across Cornwall and use strategic tools (i.e. joined up

objectives across social, economic and environment strategies) to deliver a

county that is truly for one and all. 'Cos it's not, right now’.”



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Short term accommodation with support

Almost 50% survey respondents felt this was very important, over 30% felt it

was important.

Supported accommodation is valued by service users who felt that staff

members are very helpful and the access to additional courses and

opportunities is useful and inspirational. It was also recognised that this can

become too comfortable and people need to be motivated to move on.

Survey participants thought that crisis accommodation and supported

accommodation should be more evenly spread across the county and not in

cummulation. It was recognised that small scale developments are the only

solution for a lot of clients.

Some survey respondents didn’t agree with wet houses as effective supported

accommodation to help people to address their addictions and would like to

introduce some restrictions within this approach.

People who attended the workshops noted that there should be some women-

only services available and were conerned about cuts in numbers of supported

accommodation, the quality and condition of some of the units and also how

this would reflect a number of support workers.

Support after moving on For 50% survey respondents access to support after moving on from supported

accommodation was very important, for 30% it was important.

It was suggested that transitional support/aftercare could link into the

community outreach support.

The long term place to stay -“home”

Over 60% survey participants felt that support in finding “home” was very

important, almost 23% thought it was important.

Housing First model has been mentioned as the right solution for some people.

Also, many survey respondents thought that the Council should be investing in

the right housing which is accessible and affordable and should support

landlords and tenants.

A wider range of affordable private lets, caps on what private landlords can

charge and more secure tenancies have been suggested

People were concerned that ‘move on’ accommodation availability is really

restricted and landlord “cherry pick” people.

It also has been mentioned that rents going straight to landlord could impact on

the clients’ efforts towards independence and that incentive schemes with

funding to cover damages could attract more private sector landlords.


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Support at home to maintain tenancy

50% of survey respondents thought this was very important, 25% felt it was

important.

Outreach support for people to help with their tenancies, finance management

and mental health, links to independent living and tenancy sustainment courses

were mentioned as key areas to support homeless people. Service users liked

the idea of regular visits from workers which they felt would give them the

prompt they needed to keep on top of their tenancy. It was noted in the survey

that there is a risk that some people will always prefer to be homeless and

won’t bother with maintaining tenancies.

Support with drug and alcohol addictions

60% survey participants thought that was very important, 25% thought it was

important.

On the contrary there were some views that the Council should not support

people with their addictions as they are self-inflicted.

Mental Health support

In the survey over 70% respondents thought this was very important to

homeless people and 20% thought it was important.

Both service users and providers recognised that a strong partnership with

Addaction is hugely beneficial; however, mental health needs are going unmet.

People who are homeless described commonly experiencing mental health

problems and how harmful coping strategies such as drugs and alcohol have

been adopted to numb their experiences. Service providers have also found that

many clients who are homeless and have complex needs have mental health

issues and they are also using drugs and alcohol. Yet, there are significant

difficulties in attaining treatment for individuals with a Dual Diagnosis and they

are not being appropriately supported to improve their situation. It was also

suggested that some support workers could have additional specialised training

in mental health to improve their understanding of conditions and develop

more positive communication methods to benefit service users. Providers also

felt that there was a lack in partnership working with Community Mental Health

Teams (CMHT) and relationships could be improved.

Also, it was recognised that there should be more active liaison with families of

homeless people with respect to mental health and addiction problems.

Some responses in relation to suicidal cases and suicidal thoughts were

concerning. The Council and the support services need to make sure people

know where to access help and are not turned down


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Education/prevention/information

People that engaged in the consultation emphasised that help and advice at an

early stage for people at risk of being homeless need to be provided. It was

noted that financial and benefits advice should be easily accessible and housing

officers could be more compassionate while providing advice. Organisations like

CAB were found as valuable service that needs more allocated funding

Employment/training/volunteering

Volunteering opportunities, help with training and employment to increase

confidence, social skills and sense of belonging were considered to be essential

by the consultation respondents.

There were some strong views that people need to give something to their

communities. An example was given that homeless people could carry out jobs

such as street and beach cleaning or gardening for older people, which would

“Mental Health provision and access to psychological services is

perhaps one of the most fundamental failings in Cornwall at present.

It is far too difficult to access treatment that would help more serious

illness developing and the bar is set far too high for access to services

when you are already struggling. This MUST change if we are to get

anything else right around addiction and homelessness.”


“Increased drug & alcohol education to help prevent addiction. It needs to be

really hard & shocking (images and testimonials) at secondary school age (not

namby pamby).”


“Repatriation of those who have travelled to Cornwall or transfer of funding

from their home towns to Cornwall- that's probably a pipe dream! Promote

the reality of living in Cornwall to deter people- i.e. difficulties with

accommodation, lack of jobs, high cost of living, not all sun, seasonal jobs and

surfing.”



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give them a purpose, help to improve their wellbeing and the perception of

being more employable.

It was suggested that organisations could recruit volunteers within people who

were using their service as they could easier relate to and understand vulnerable

people and their experience.

There were some other comments and suggestions related to homelessness

made by people who participated in the consultation:

Drop in centres that allow dogs

Higher council tax for second home owners

Compulsory purchase of unused properties which can be used to house

homeless and / or create more social housing

Trauma informed approaches

Psychologically Informed Environment (PIE) approach – which takes into

account people’s thinking, emotions and past experience in addressing

homelessness

Keep giving the ‘Intensive Housing Management’ not ‘support’ message

Assessment process for dual diagnosis

Storage for belongings for example tents

Local connection

It was noted in the survey that people shouldn’t move to Cornwall to become

homeless and should be supported to return to their local areas.

People treated with dignity and respect

Many respondents emphasised that people need to be respected, valued and

not stigmatised.

“To ensure this is only for local people and not those coming into the county

who have heard the resources here are quicker to access than up country as

heard on the local news from homeless people from up country!”


“There is a massive stigma around homelessness in Cornwall and a campaign to

help highlight this could help change people’s minds and may make them more

willing to volunteer to help.”



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People’s responsibility

According to some views expressed in the survey people need to take

responsibility for their wellbeing and we may help some people too much.

Foster carers for homeless people:

There was a suggestion of a scheme of foster carers for homeless people so they

can be supported in a home environment where they can relearn their life skills.

8. Feedback about proposed models and the tendering process

Based on the feedback gathered at the workshops we have introduced some

changes to our proposed model of Adult Social Care Prevention services as

below.

Proposed new model of Adult Social Care Prevention services

For more details on our proposal visit www.cornwall.gov.uk/preventionservices.

Originally there were three geographical areas for the Empowering

Independence - Mental Health and Substance Misuse contracts. Many

http://www.cornwall.gov.uk/preventionservices


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participants felt that these contracts would cover too large an area and

so we have split the contracts in five areas.

There was some confusion in relation to number of people with

disabilities supported by the outreach contract. Also it was noted that

people often have multiple needs and that emotional wellbeing should

be closely allied with physical disabilities. For example, deafness not

treated early and properly could lead to dementia. Therefore we decided

to propose one joint physical health and disabilities countywide

community outreach contract, to allow for the number of people

supported with different needs to be flexible within the provision.

In relation to the Empowering Independence services, originally a

framework was proposed rather than block contracts. However, concerns

were raised regarding whether this would give the provider market the

security required to plan for the future and whether this was needed.

Therefore the intention is the services will be commissioned as block

contracts.

Below there are outlined benefits, risks and mitigations in relation to each

proposed area of services based on the feedback gathered at the workshops:

Inclusion

Benefits Risks Mitigations

A lead partner who can be a mentor to smaller organisations

One lead organisation might be a risk if doesn’t work well. Smaller providers can link with others but it’s difficult with some VCSE who don’t work well with others.

Creative and flexible provider needed, could be a partnership bid. The lead provider should be transparent in working with others and refer to the best not who they like best. This should be monitored by contract managers.

One contract will ensure a holistic approach and consistence across Cornwall.

Lack of specialism to support people with various needs.

The tender need to clearly set out the expectations. The lead provider can subcontract.

Lead organisation to support linking portals and ensure information is easily accessible

Barriers in accessing information, lack of consistency in information quality and accessibility in different areas

The lead provider to work towards consistency: Information accessible in different formats and through various channels across Cornwall.


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Marketing of information sources

Volunteers would support people and link them into communities.

There was a view that a number of people linked to volunteering opportunities should be higher than 100 as it currently is proposed.

Lack of volunteers.

Volunteers have no accountability

People’s benefits might be at risk-if people volunteer, they are able to work

Link with other partners who have volunteering networks or need volunteers such as Police, DWP and housing -volunteering through work coaches

Management and training for volunteers

People can work/volunteer for up to 16 hours per week to retain their benefits

We may slightly increase the number of people linked to volunteering opportunities although based on the current contract this might be difficult to achieve.

Crowdfunder:

Is a good resource to access funds for projects and would encourage smaller community projects to spring up.

Changing behaviours is good-change approach so people do it for themselves in their communities.

Would work well with

correct governance and

accountability.

Crowdfunder:

Sounds complicated and a potential barrier.

Safeguarding issues, groups need to be fit for purpose or have the right skills.

If people can understand that projects need funding in addition to their council tax payment.

Fund what’s needed and not necessary what’s popular.

Crowdfunder:

Lead provider would help with this process and would work with existing community groups.

Ensure safeguarding training for communities is available.

The platform well-

advertised and with

clear outcomes

Housing and homelessness


Countywide approach to rough sleepers services seen as good as can be more responsive in terms of where


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the needs are and more consistent.

Housing First-properties will be spread across the county.

Safeguarding of local families and communities

Safeguarding of clients if planned in inappropriate accommodation or communities

Risk of misuse by clients with antisocial behaviour issues etc. and the impact on the local community leading to more resistance towards such schemes

Will need to ensure the properties don’t disappear and others are identified if a person lives there for longer.

More engagement with local communities to increase the awareness of people with complex needs

Empowering Independence Services


Better than current model and greater flexibility when compared to current staged approach

Not adequate flexibility in the system for people to move around housing/support tiers

Not being allowed to

deliver support due to

not being the landlord.

Flexibility required in the contract, could link this with tolerance/no tolerance and need for defining tolerance

Ensure partnership work between support providers and landlords and continuity for the people using the services

Service users keen on the additional community outreach being proposed in the new model

Splitting street outreach from community outreach services

Ensure clear difference between ‘street outreach street vs ‘community outreach’ but how link together. Street outreach to include resettlement. Community outreach to deliver continuity through supporting people by the same providers when moving on from supported accommodation.

Risk of availability of ASC need to work with


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accommodation in all areas, for example Penzance

Strategic Housing, Cornwall Housing and Registered Providers of social housing to understand needs and plan.

High mileage in outreach

given potential travel

distances

Proposed new split into five areas rather than three

Risk splitting Mental Health

only contracts and Complex

Needs contracts.

We are now proposing each locality based Empowering Independence contract will include provision for complex needs, as well as for mental health.

Core and flex within contracts allowing flexibility in delivering support

No out of hours support

within the service

Ensure person centred approach, outcomes focused, clear hours and beds split in the contracts. Balance required between hours/people vs outcomes

Empowering Independence should link to volunteers and independence portion of the model

Opportunity for partnership working across the three strands, opportunity to develop strong links between ASC and providers Opportunity for providers to work together to provide more joined up services

Partnership working does not take place

Links between ASC and the VCS sector not made maintained

Stakeholders work in isolation

Use of forums to encourage working together both for community and the providers, include funding for this within the services, provider led based on localities

Better information sharing

Effect on the model in practice

Consequences of changing model e.g. number of units, number of people

Clear detailed information provided by commissioners, working in partnership with providers and stakeholders.


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supported, geographical location, effect on current staff

Contracts should allow for innovation and collaboration

The providers who attended the workshops noted that if contracts are squeezed

too much there is no capacity for providers to look at added value (e.g. applying

for extra funding) and it stifles innovation of new services/ ways of working.

Contracts should allow for services to develop during the lifetime of the service

rather than be fixed at the outset.

The majority of providers thought that contracts should allow for collaborative

working; contracts that allow for partnership arrangements between providers,

shared risk/shared reward and for innovation. Commissioners could arrange

provider engagement events to facilitate partnership working e.g. speed

dating/ideas lab.

In relation to tender process – it is recommended that ensure that the word

count is high enough to evidence approach in method statements; give higher

weighting to quality over price. Involve operational teams in tender evaluation.

Not knowing about the future of the contracts brings a lot of uncertainty for

providers, staff members and service users who need more stability.

Experienced staff members tend to leave and find a job elsewhere. Providers

felt that there are too many workshops, planning events and nothing changes.

9. Feedback from other Local Authorities

We received responses from seven other local authorities in relation to their

wellbeing services. They commission or work in partnership with voluntary

sector to provide befriending and volunteer services, capacity building service,

HIV support, mental health-lower level interventions and time banking. Within

two authorities voluntary services are run separately to their commissioned

provisions, although they commission paid workers to coordinate volunteers for

example to run mental health support sessions. One (partly rural) county

successfully commissions drop in surgeries therefore support workers do not

travel to meet people. Befriending services often include practical assistance

for example housework.


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There are some interesting concepts detailed below which could be utilised in

the new provision in Cornwall.

Social prescribers

South Gloucestershire commission Community Networkers – a social prescribing

service which offers a wide range of support and advice such as:

providing information and guidance

support for people to be connected and active in their communities

help to set up groups and activities that benefit local people

opportunities to meet new people and learn a new skill

sign-posting to local services and agencies.

It is worth mentioning that there is a social prescribing network being

developed in Cornwall led by Public Health.

One “go to place” for information

South Gloucestershire’s Well Aware database is funded by local CCGs and it

provides all information around health, wellbeing and social care. It’s up to

organisations to keep their records up to date. They admit that although it is

well used by organisations, it’s not very much used by people-“you don’t know

what you don’t know” so they are thinking about having it on their website but

still commissioned to Well Aware.

The Council is intending to develop their information portal

www.supportincornwall.org.uk so it links to community projects available in

local communities.

Joint contracts with health, multi service approach

East Sussex have developed a programme to utilise the strengths that

individuals and communities contribute to improving health outcomes, by

embedding asset based approaches across the system. The programme is

focused on re-designing systems across health, social care, voluntary sector and

wider partners to improve health outcomes. The programme has a particular

focus on how they can make best use of already existing settings – the places

where people spend their lives such as communities, schools, nurseries, health

care settings and workplaces, to improve health outcomes. This includes:

Involving communities:

o Ensuring that formal/informal volunteering opportunities match

modern lives and opportunities for neighbourliness are supported

and reach the most vulnerable;

http://www.supportincornwall.org.uk/


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o Ensuring that people are able to access information about what’s

available in communities

Resources - development of community grants and applying for external

funding

Social prescribing, including community networks and locality link officers

Workforce development - identifies the training approaches across the

whole workforce to enable people to embed assets based approaches in

their role.

Aligning programme priorities with other services. A pilot of this

approach secured additional resource for communities including

resources for good neighbour schemes through a Highways contract, and

lifestyle service re-procurement secured staff volunteering and sharing of

building space.

Growing personal resilience and embedding primary prevention activity

across the whole system. The transformation programme has been

supported by a series of grants to key settings to support rapid change

and development in their sphere of influence (rather than change being

led externally).

Joint partnership with wider public sector

The Lancashire Volunteer Partnership (LVP) has been formed to integrate public

service volunteering across the county. The programme was approved by the

Multi-Agency Early Action Oversight Board in June 2016 and is funded by a

Police Innovation Fund grant awarded to the Office of the Police and Crime

Commissioner and by match funding from partners.

This Programme is integral to the wider programme of work which includes

projects such as integrated mental health triage and integrated case

management; those which address reducing vulnerability; and those that seek

to better integrate multi-agency service delivery. Staff members are core

funded, in budgeted posts and are classed as in-house service.

Development Officers from the Programme Team and Volunteer Co-ordinators

from partner agencies will co-locate at work bases across the county with the

aim of delivering consistency and efficiencies and taking shared ownership of

the recruitment and administration of new Community Support Volunteers who

then link people into their communities.

In Central Bedfordshire commissioners have also recommended that all

providers consider working collaboratively with each other to provide elements

of a service where they did not have the expertise to provide this alone, and this


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has proved to add value to particular services; as an example a Visual

Impairment provider subcontracting to provide Hearing loss services.

Adult Social Care have already been working in partnership with organisations like Health and Housing and will be looking into establishing a more joint approach in providing services for vulnerable people in Cornwall.

If you would like this information in another format please contact:

Cornwall Council County Hall Treyew Road Truro TR1 3AY

Telephone: 0300 1234 100

Email: [email protected]

www.cornwall.gov.uk

mailto:[email protected]

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