Table Of ContentResearch Report for the
Supported Living and Ageing
Well Strategy (SLAWS) 2016
prepared by the SLAWS Working Party
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Contents
Executive Summary
Section 1 Introduction and background
1.1 Introduction
1.2 Drivers for Change
1.3 The SLAWS Working Party
1.4 Strategic Framework
1.5 Research and Consultation
Section 2 Existing services and strategic context
2.1 How does SLAWS relate to other key
strategies?
2.2 What care and support services are currently
available?
Section 3 Developing the Care Community and strategic
planning
3.1 The need for a shared strategic direction
3.2 Defining and communicating the role of the
public sector, working in partnership with the
third and private sectors
3.3 Co-ordination
3.4 Promote the development of services where
there are acknowledged service gaps
3.5 The need for improved strategic information
3.6 Linking to other strategic areas – workforce,
population, housing and land planning
3.7 Financial planning
3.8 Information and advice from service users
3.9 Regulation and the need for information on the
quality and safety of care
3.10 Summary
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Section 4 The provision of long-term care and support
services in Alderney
Section 5 Social Attitudes
5.1 Attitudes towards Ageing
5.2 Culture of care provision
5.3 Loneliness
Section 6 Service development priorities
6.1 Support for carers
6.2 Co-ordination, information and advice
6.3 Community services and re-ablement
6.4 Specialist housing and care homes
6.5 Addressing specific conditions
6.6 Eligibility
6.7 Health Promotion
6.8 Other service needs
Section 7 Sustainable funding
7.1 Preventing cost escalation in the delivery of
care
7.2 Overview of existing funding arrangements and
strategic issues
7.3 Stage 1: Increasing the Long-term Care
Insurance Fund Contributions by 0.5%
7.4 Stage 2: Care, accommodation and living costs
7.5 Stage 3: Expanding the Long-term Care
Insurance Fund
7.6 Summary
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Appendix A Glossary of Terms
Appendix B Terms of Reference of the Working Party
Appendix C Original SLAWS Principles and Objectives
Appendix D SLAWS Consultation – Summary of Findings
Appendix E Case studies, extra-care housing and Learning
Disabilities
Appendix F Case study on care-coordination and
integration
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Executive Summary
The Supported Living and Ageing Well Strategy focuses on adults
(18+) with enduring care and support needs. This includes, but is
not limited to, services for people with physical and sensory
impairments, chronic illness, neurological conditions, stroke
survivors, autism, learning disabilities, dementia, conditions
associated with ageing and enduring mental health conditions. It
covers the full range of services from those provided to people
living at home who are mostly self-sufficient or are cared for
primarily by a family member; to community services, extra care
housing, residential and nursing care homes, specialist care at
the Duchess of Kent or Lighthouse Wards, and off-island
placements.
A Supported Living and Ageing Well Strategy (SLAWS) Working
Party was formed by the Policy Council’s Social Policy Group in
November 2013. The Working Party has set out to examine what
services should be provided to adults (18+) with enduring care
and support needs, to consider who should provide care and
support services, and how they should be funded.
Guernsey and Alderney face significant challenges in coming
years. There is identified need for improvement in the current
system, over which there is little strategic oversight at present.
There is less public funding available than there has been. With
an ageing demographic the available funding is likely to decrease
(due to a shrinking working population), the workforce available
to provide care is also likely to decrease, and the number of
individuals over the age of 85 who require care and support is
likely to increase significantly. The current system is not
sustainable. Maintaining the status quo is not an option.
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The role of this report
This research report accompanies a Policy Letter which will be
taken to the States for debate in February 2016. The Policy Letter
provides a summary of the strategic framework, asks for
commitment to be made to the strategic direction, recommends
an uprating in Social Security Contributions to take immediate
action to address funding issues and requires the newly elected
Policy & Resources Committee to establish a prioritised and
resourced plan for implementing the recommendations put
forward by the Working Party as set out in this research report.
This report: provides details of the areas that the Strategy
covers; its relationship to other strategies; the issues considered
by the Working Party to date; and the further work which needs
to be undertaken in order to move the Strategy forward. It is
intended that this report will act as a resource for the States,
working in partnership with the private and third sectors, to
build on the work and research undertaken so far. Making this
report available publicly will assist future joint working by which
the three sectors can combine their efforts and resources to
provide better for the long-term health and social care needs of
the two Island communities going forward.
The Report is informed by expert advice; internal research; and
public engagement and consultation (as described in section 1
below). However, it is acknowledged that further research is
required in a number of areas.
The Working Party accepts that the scale of transformational
change envisaged cannot and will not happen overnight;
pragmatically, services need to be developed incrementally.
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Some actions can be progressed faster than others. Many need
further research, consultation and deliberation before
implementation. In order to ensure progress is made, sufficient
resources will need to be allocated to further research and the
implementation of the proposed changes.
The Strategy
The key elements of the Strategy are outlined in section 1 below.
The Strategy recognises the need to balance improved outcomes
for the individual with the effects on the community as a whole.
The vision for the Strategy is: to have an adaptable and
continuously improving care and support system that is fair,
person-centred, enabling and sustainable.
Changes need to be made to ensure that people experience a
coordinated and joined-up response to their needs. They should
be provided with clear information and offered support
appropriate to their needs across a full range of community and
residential care services. They should be included in decisions
made about their care. Every effort should be made to prevent
the avoidable increase of needs. Focusing on meeting people’s
needs and supporting people to prevent avoidable deterioration
should reduce costs in the long-term.
Core areas for change
The Working Party believes that in order to align provision with
the strategic direction identified and outlined in section 1,
significant changes need to be achieved in the following areas:
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A. Developing the role of the States of Guernsey [Section 3]
The States of Guernsey should take a strategic role in
developing a “care community” working in partnership with
the private and third sectors. This will involve effective data
gathering and analysis; appropriate data sharing; providing
information to the public; regulation of care services; analysis
and development of the relationship between different
services in order to improve coordination; and effective linking
with other key areas of strategic policy.
B. Addressing unhelpful social attitudes [Section 5]
Attention must be given to addressing ageism, and ensuring
disabled people and their carers are socially included.
Community approaches to loneliness should be explored. It is
important that care and support is enabling and supports
people to live meaningful lives, and that care and support are
not seen as simply doing things for people.
C. Reconfiguring and developing services (in-house and through
other providers) [Section 6]
Services need to be developed in all areas including care
homes, supported living services and care in the community.
However, areas for immediate priority action should include
expanding support for informal carers (including short-break
services); establishing a re-ablement service to help people to
regain independence after being admitted to hospital; and
establishing a proactive care coordination service where a
single point of contact can case manage an individual’s care,
where they are receiving care from multiple providers, in order
to ensure that the approach is effectively joined-up and that
individuals are aware of all of the services open to them.
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D. Reconfiguring the funding structure [Section 7]
The funding structure should be sustainable and should
balance the mitigation of financial risk to the individual
against the tax burden on the wider community. A three
staged approach is suggested: firstly, increasing Social Security
Contributions by at least 0.5%; secondly, by increasing the
long-term care co-payment (in order to cover living and
accommodation costs); and thirdly, to expand the scope of the
Long-term Care Insurance Scheme to allow Long-term Care
Benefit to be used to purchase domiciliary care at home and in
supported housing options. This is likely to involve exploring
whether further measures are required to make the system
financially sustainable and the exploration of the possibility of
introducing personal budgets.
This report outlines in detail the initial actions that the Working
Party believes need to be undertaken to move forward in each of
these four areas.
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Section 1: Introduction and overview of the Strategy
1.1 Introduction
This research report presents the findings of the work carried out
to develop a Supported Living and Ageing Well Strategy, also
known as ‘SLAWS’. The Strategy is intended to review all care
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and support services provided to individuals aged over the age
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of 18 years with enduring care and support needs .
What is care and support?
For some, the term ‘long-term care’ has become synonymous
with the care provided in private residential and nursing homes.
However, the Strategy covers all forms of care and support
provided or received in Guernsey and Alderney.
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Whilst related to health care, this report focuses primarily on
‘social care’. This does not include medication, treatments,
diagnosis, screening programmes, operations or specialist
appointments. Social care is the care and support that a person
needs to live on a day-to-day basis - this might be, for example,
help getting out of bed, help with food preparation, help with
washing or dressing, assistance with paper work, or attending
appointments.
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This report purposely does not define ‘enduring care and
support needs’, as it proposes a needs based/social approach
and not a clinical definition. Individuals with care and support
needs may include, but are not limited to, individuals with
physical impairments, learning disabilities, enduring mental
health conditions, autism, chronic illness, neurological
conditions, and conditions associated with ageing.
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