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
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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
Date What/ where Who Aim
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
Engagement with ops teams and establishing links with 3 conversation model
12 December 2017
Innovation Site Team Meeting-West, Camborne
Ops teams involved in developing 3 model conversation
Engagement with ops teams and establishing links with 3 conversation model
Other Local Authorities
Date What/ where Who Aim
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
Date What/ where Who Aim
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'. “
Survey respondent, 2018
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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”
Survey respondent, 2018
“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. “
Survey respondent, 2018
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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.
Survey respondent, 2018
“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.”
Survey respondent, 2018
Survey respondent, 2018
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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’.”
Survey respondent, 2018
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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.”
Survey respondent, 2018
“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).”
Survey respondent, 2018
“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.”
Survey respondent, 2018
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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!”
Survey respondent, 2018
“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.”
Survey respondent, 2018
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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
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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
Benefits Risks Mitigations
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
Benefits Risks Mitigations
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;
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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