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Date: July 2018

Day Services in Birmingham. A ReviewBill Love, Edana Minghella and Peter Bates

Day Services in Birmingham. A Review, NDTi, July 2018 2

National Development Team for Inclusion

First Floor30-32 Westgate BuildingsBath BA1 1EFT: 01225 789135F: 01225 338017

www.ndti.org.uk

http://www.ndti.org.uk/

Contents

1. Background.................................................................................................................5

2. Methodology...............................................................................................................6

3. Our thanks..................................................................................................................7

4. Notes on the report.....................................................................................................8

5. Patterns of use – BCC in-house....................................................................................9Findings and observations.............................................................................................................9Reflections...................................................................................................................................10

6. Planning with people.................................................................................................12Entering services...................................................................................................................12Findings and Observations...........................................................................................................12Reflections...................................................................................................................................12

In services.............................................................................................................................13Findings and Observations...........................................................................................................13Reflections...................................................................................................................................13

Leaving services....................................................................................................................14Findings and Observations...........................................................................................................14Reflections...................................................................................................................................14

7. Service management.................................................................................................15Findings and Observations...........................................................................................................15Reflections...................................................................................................................................15

8. Service staffing..........................................................................................................17Findings and Observations...........................................................................................................17Reflections...................................................................................................................................18

9. Senior management..................................................................................................19Findings and Observations...........................................................................................................19Reflections...................................................................................................................................19

10. Transport...................................................................................................................20Findings and Observations...........................................................................................................20Reflections...................................................................................................................................21

11. What people do.........................................................................................................22Findings and Observations...........................................................................................................22Reflections...................................................................................................................................23

12. Community Engagement............................................................................................25Findings and Observations...........................................................................................................25


Reflections...................................................................................................................................26

13. Externally-Commissioned Day Services......................................................................27

14. Individual planning and commissioning.....................................................................28Findings and Observations...........................................................................................................28Reflections...................................................................................................................................29

15. The services...............................................................................................................30Findings and Observations...........................................................................................................30Reflections...................................................................................................................................31

16. Recommendations.....................................................................................................32

17. Principles...................................................................................................................33

18. Delivery.....................................................................................................................34

19. Appendix...................................................................................................................36


1. Background1.1 Birmingham City Council (BCC) provides and commissions a range of day services

across the city. Provided and commissioned services currently cost about £7 million each. Like other councils, BCC is considering how day services can best be planned and delivered to contribute to people who use services having high-quality lives, and family carers receiving the support that they need.

1.2 As part of this conversation, BCC asked the National Development Team for Inclusion (NDTi) to bring its experience of exploring, reviewing and developing day services to offer an external reflection on planning and delivery.


2. Methodology 2.2.1 We spent time in every BCC-provided service and some third and private sector

services observing and, more importantly, talking with people who use services, families, staff and management teams. Because of the size of services in Birmingham, we could not meet with every person, family member or staff team member. Because we were not undertaking a consultation or offering reflection in individuals’ services, this was not necessary.

2.2 Service managers and their teams, commissioners, social workers and senior managers provided us with information about the services. We did not ask for details of individual service users. Because this information was gathered across a few weeks and some records were missing, we have chosen to show most of the information as percentages – we believe that this is robust enough for the report, our observations and recommendations.

2.3 The NDTi team members involved bring a range of experiences across the design, leadership and provision of day opportunities, commissioning and individual planning, service review and change. Our reflections on practice and possibilities are drawn from services around the country who we believe are developing good practice in day opportunities, planning and community engagement.


3. Our thanks3.

3.1 We would like to offer our thanks to all the people who use services, their families, staff, management teams and commissioners who very willingly offered us their time, experiences and ideas and who, with real enthusiasm, engaged in discussion about ideas, challenges and possibilities. We understand how busy day services are and how disruptive visitors can be; but in every service, we were made to feel very welcome.

3.2 We are aware that, especially in times of widespread conversations about the cost and future of all services, it is easy just to see criticism and challenge. In this report, we hope that we have reflected the very real commitment and skill of so many people involved in day services while we are offering challenges, sometimes very significant challenges, to help move services forward.


4. Notes on the report 4.

4.1 BCC requested that our writing style make this report as accessible and useful to as many people as possible. A plain English summary, with photo symbols, will be available.

4.2 Notes on language: in the first section, when we talk about the services we mean those provided

by BCC; ‘supports and services’ opens this up to include all the different ways of

assisting someone – for example personal assistants, micro enterprises or traditional services;

‘day opportunities’ or ‘day supports and services’ includes all the different ways of assisting people to undertake a range of different activities that most people do during the day;

‘individual assets’ is used to describe the full range of their skills, interests, passions and contributions.

4.3 BCC provides and commissions day services. Many of the planning and delivery issues are common but mindful of the different audiences for this report we have chosen to separate provided and commissioned until the recommendations stage.

4.4 Within this report we have a made a number of references to the need for BCC to find and explore good and emerging practice. We are mindful that what elected members, commissioners and delivery teams want from good and emerging practice will differ so, rather than use the report to point readers to services and people who we think are useful, we are inviting BCC, through this report and the subsequent conversations, to identify areas you would like more information on and we will then work with you to connect you to sites to visit or people to invite to Birmingham.


5. Patterns of use – BCC in-house1

Findings and observations2

5.

5.1 BCC spends approximately £7 million providing day services.

5.2 Services range in size from 71 to 108 people. Harbourne serves 71 people, Ebrook 77, Heartlands 77, Alderman Bowen 97, Elwood 98, Hockley 106 and Moseley 108.

5.3 Approximately 5% of people attend for one day a week, 16% for two days, 17% for three days, 12% for four days and 50% for five days. Within this, usage patterns vary across the service with, for example, 49% of people at Elwood attending two days a week and 65% of people at Hockley attending five days a week. It is not recorded what people do on other days.

5.4 84% of people using the service are identified as having a learning disability and 12% a physical impairment3. Each service is different so, for example, people with learning disabilities make up 98% of those attending the Moseley but just 9% at Elwood.

5.5 50% of people using the service are aged 50 and over, but just 12% are aged under 304. It is worth noting that within these figures at Elwood only 4% of people are under 30 and at Harbourne 8%.

5.6 40% of people using the service have been doing so for in excess of 20 years while less than 20% have been doing so for three years or less5.

5.7 Approximately 63% of people using the day service live with their family and approximately 28% of people live with paid support6.

1 The information used in this section is drawn from a number of sources and taken on different dates. As a result of people entering and leaving the service, the total numbers may no longer be accurate; but percentages should give an accurate picture of the service. In some situations, for example how long people have been using the service, records may not be accurate and we asked services to give us their best estimate. The figures for living situation and impairment do not include ‘other’. 2 NDTi were provided with and gathered some information on, for example, personal care and finance that has not found a natural place within this report but with is available if wanted. 3 Many people using the service will have more than one impartment4 <20 = 1%, 20-29 = 11%, 30 – 39 = 16%, 40-49 = 23%, 50-59 = 31%, 60-69 = 16%, 70 >3%. 5 <1 year = 5%, 1-2 = 5%, 2-3 = 8%, 3-5 = 11%, 5-10 = 12%, 15-20 = 12 5, 20 plus years = 40%. 6 9% of people are identified as living independently. We don’t know whether this means that they do on do

not receive paid support.


5.8 70% of people receive transport provided by the service. Within this, there are significant variations - for example, 86% at Ebrook and 90% at Harbourne but 35% at Heartlands.

Reflections5.9 There is a difference in some services between the identified capacity and the

attending numbers. The capacity figure appears to be somewhat arbitrary, focusing more on the size of the building than the capacity of the staff team to offer high-quality services. Because any increase in the number of people has to be viewed against the impact on people currently using the service and potential for development of community activities, we suggest that it would not be appropriate to view the difference as potential vacancies.

5.10 The population of people using the day centres is ageing. It is welcome to see that people can continue to receive day services into their 60s and 70s; but inevitably over the next 20 years a significant number of people currently using the service will die or choose alternative forms of support.

5.11 The number of people who are aged over 50, who use the day centres four or five days a week and who live with older family members is very significant and raises the need for prompt, future-focused planning (see section on individual planning).

5.12 The number of people who live with families and who use the service for four or five days a week highlights the essential role that daytime support plays in providing respite7 to families. We did hear mention of day services as being a respite for paid carers, but we would question the appropriateness of any residential service where paid staff indicated a need for respite from the people they support.

5.13 A significant number of people using the day centres also receive some form of paid support at home. This raises an opportunity to use high-quality planning to better think about all their aspirations and needs and for services to work together to offer more holistic support. This is not being done.

5.14 With 38% of people using day service for three or fewer days a week, it would be useful to know how they spend the rest of their time. Are they, for example, actively engaged in other activities or are they at home and isolated?

5.15 Very few young people are entering the day centres. We understand that this is, in part, because the option has not been open to them; but we are mindful that, in our experience, when young people and their families are part of an aspirational transitions and planning process few choose traditional day centres. Young people should not be directed into existing services simply to fill vacancies. We understand that little planning takes place before July or August.

5.16 It would not be appropriate to assume that the large group of people who are over 50 and have been using the service for 15 or more years indicates that they will not want

7 We are aware that the word ‘respite’ is rightly going out of use but we are using it here as it is the term that has been used in our conversations with families and staff.


to see some (perhaps significant) changes. In our experience, older established users of day services engage as much as anyone else in thinking about their own lives and seeking change.

5.17 When thinking about future demand, it is worth noting that demand for meaningful days is increasing but, when offered quality community-based alternatives, fewer people choose traditional centre-based models.


6. Planning with people Entering servicesFindings and Observations6.

6.1 As noted earlier, most people using day services have been doing so for many years; in these instances, it is not possible to identify the level of planning that went into them entering the services.

6.2 Reflecting on people who been referred over the last few years, service managers identified that for most, nothing is done to raise their and their family’s aspirations of what is possible before planning and identifying a service. Entry planning has not considered, and it has not been identified how day services fit the person’s wider life plans and aspirations. BCC is working on its transitions service and this should address planning with young people and families.

6.3 Entry planning processes are not person-centred8. With the exception of some enablement services, few or no goals, other than to use day services, are identified. The focus appears to be on filling time, fulfilling people’s support needs and, where appropriate, providing respite for families.

6.4 There is an assumption that people will want and continue to use days services in an open-ended way rather than the service making a specific and time-limited contribution to their life9.

6.5 People are usually allocated to a service based on their impairment and where they live. We found little evidence of people choosing or having chosen for them a service because of the activities on offer. Staff indicated that many families appear to be more focused on the availability of a service than the nature of the service.

6.6 Staff responsible for leading, planning and commissioning/agreeing a day service appear to have very little awareness of what day opportunities can be beyond traditional day centres.

8 On this and other occasions where we refer to ‘person-centred ‘we mean a general approach that starts with the person’s aspirations and needs, considers their whole life and seeks to develop outcomes based on these, not on narrow service offerings. 9 One staff team told us that where a timescale for services had been discussed, some families were suspicious about the motive.


Reflections6.7 Inevitably, a lack of knowledge and aspiration in staff leading the planning process will

have a significant impact on the individual and their plan. It is less likely that questions will be asked, that challenge will be offered and that creative solutions will be considered.

6.8 Without an investment in building individuals’ and families’ awareness of the range of day time opportunities that could be available, it is likely that many will choose or reluctantly settle for what they see is available.

6.9 As a result of this lack of aspiration, planning and identified outcomes, it is difficult to identify the types of support and services that need to be available and to consider how successful existing services are in meeting people’s aspirations. This will have a very significant impact on the value of the current ‘coproduction’ process.

In servicesFindings and Observations6.10 For people currently using the services, there appears to have been little review and

ongoing planning with social workers or commissioners. We understand that some reviews have taken place over the phone. As a result, there is little external oversight or challenge and opportunities to connect people’s experiences and activities at day services into their wider life are missed.

6.11 Despite this, in some services we found examples where staff had tried to link activities to other areas of people lives; for example, using iPads where people had access to them elsewhere or using gas or electric cookers in cookery sessions depending on what people have at home.

6.12 Planning with people currently using services is being led by day service staff and uses the Individual Service Statement system. With one exception, staff teams are no longer trained in or use person-centred approaches.

6.13 Staff work hard to use the Individual Service Statement system as an opportunity to reflect on the activities that people are involved in and to identify new possibilities; however, activities on offer tend to be from a restricted menu of traditional day centre pursuits (this will be discussed later). In three of the services we asked the management teams to identify the last time that the planning processes had identified something out of the ordinary that they had found hard or been unable to accommodate, they couldn’t.

6.14 We found little to suggest that current planning includes longer-term aspirations and goals, or seeks to identify individual’s assets (skills).

6.15 We understand that social workers have recently been allocated to day services and are being trained in asset-based approaches to planning.


Reflections6.16 A lack of effective commissioner/social worker involvement in planning indicates a

lack of effective external oversight of the style, delivery and appropriateness of people’s day services.

6.17 A lack of knowledge and aspiration in people leading the planning process will have a significant impact on the individual and their plan. It is less likely that questions will be asked that challenge or creative solutions will be considered.

6.18 As a result of this lack of planning and identified outcomes, it is difficult to identify the type of services that need to be available and to consider how successful existing services are in meeting people’s aspirations. This will have a very significant impact on the value of the current ‘coproduction’ process.

Leaving servicesFindings and Observations6.19 From conversations with service leaders, we understand that most people who move

on from current services do so as a result of death, moving or, occasionally, developing behaviours or support needs that services feel unable to support.

6.20 We were not made aware of anyone recently moving on from services because day services had achieved their desired outcomes or people had identified another service that better met their aspirations.

Reflections6.21 There appears to be an assumption that once people enter day services they will not

leave. Considering how long people may use services for should not be about removing certainty; rather, it should be a reflection that high-quality services can help people move to their next goal, or that there may be changes to the individual’s life and/or eligibility.


7. Service management Findings and Observations7.

7.1 Typically, in-house day services are led by a management team of a service manager, a deputy and senior staff. In this report, we are using ‘managers’ to include all this group. Together this team, supported by transport coordinators and administrative staff, are responsible for the day-to-day running of the centres, staff teams and transport. They set the tone for services and oversee the development of new activities and opportunities.

7.2 Across the services, we were greatly impressed by the commitment of the management teams to their service, staff teams and the people using it.

7.3 Management team members have a long history of working in services within Birmingham. We are not aware of any management team members who have recently worked in or led day services outside of BCC or the city.

7.4 We discussed with some management teams whether they have had the opportunity to visit progressive day opportunities around the country looking for inspiration and challenge. None had. Some managers were keen to engage with NDTi team members about other day opportunities that we have been involved with.

7.5 Apart from offering occasional cover, management team members are hands-off and spend most of their time in managing staff and processes.

7.6 Managers expressed frustration at the amount of time taken up by the demands of BCC central processes and bureaucracy and by their lack of freedom to vary staffing within the agreed complement, change opening times, identify staff training and development opportunities and engage in partnerships with external organisations. Managers have little effective control of service budgets.

7.7 In our view, managers receive little creative input or developmental support and challenge from the wider service.

Reflections7.8 To be leaders rather than just managers, management team members need access to ideas

and other services that will inspire and challenge them to develop images of what is possible for individuals and their own and the whole service.


7.9 The opportunity to explore and develop ideas needs to run alongside managers’ ability and freedom to use their own resources, financial and other, to best deliver the changing service.

7.10 It appears that layers of processes and bureaucracy have been imposed or allowed to develop that are absorbing time that would better be spent on leading change, developing the services, supporting staff and working with individuals.

7.11 The number of roles that are ‘hands off’ would seem to be excessive for the size of the service10.

10 This is not to suggest that the fewer posts are needed, but to question how posts are used.


8. Service staffingFindings and Observations8.

8.1 Each service employs a combination of day centre officers and assistant day centre officers. Some staff are employed as a combination of driver and day centre officers.

8.2 Turnover rates are very low and, increasingly, staff have entered the role following redeployment from other services. We are not aware of any staff who have, in the last five years, been recruited into day services because of experience in particular day service activities such as sport or community engagement.

8.3 Most of the staff we meet talked with great passion about their role and the people they support. They placed a strong emphasis on the quality of relationships with people using the service and their families. This commitment is best reflected by the determination to keep service open during this year’s snowstorms, fundraising undertaken to buy basic equipment and the number of staff who have been in their role for over fifteen years.

8.4 People who use services and their families talked about the value they place on the strong and ongoing relationships that they have with staff.

8.5 Most ideas for new activities are generated from within staff teams.

8.6 Staff training focuses on BCC identified core requirements such as medications, moving and handling and food hygiene11. Much of the training is delivered through online courses12. We did not meet any staff who have had training in community mapping, community engagement and training in Systematic Instruction13.

8.7 We discussed with some staff whether they had had the opportunity to visit progressive day opportunities around the country or within the region: none had. Stimulation for ideas and challenges tends to come from other members of the staff team and the local management team. Some staff were very keen to engage with us in discussing services we have seen elsewhere and the potential for developing current activities.

11 We are aware of a small number of staff who have had specialist training connected to person-centred planning, therapies and horticulture but this was some years ago. 12 We understand that additional training can be applied for from within the Council, but this tends to connect with the core requirements. 13 This is some of the thinking and tools that we believe best equip staff to offer more person- and community-focused supports.


8.8 It varies from service to service, but our impression is that many staff are spending a considerable amount of time record keeping and responding to over bureaucratic processes.

8.9 Typically, staff work Monday to Friday between the hours of 8.30am and 4.30pm.

Reflections8.10 Staff are a, perhaps the, major force in driving forward new service ideas. The lack of

investment in developing current staff’s knowledge and aspiration and challenging them is reflected in the current service offer14.

8.11 It would appear that current recruitment (the commitment to redeploy staff from other services) focuses more on the needs of BCC than on the activities people using the service aspire to. In our experience, recruitment processes that focus on the applicants’ previous day service and community experiences, community involvement and skills can support the delivery of a wider range of activities and engagement.

8.12 While recognising the need for some processes and bureaucracy, these are currently absorbing a considerable amount of staff time that would be better spent supporting people.

8.13 The limited range of working hours and the inflexibility of staff beginning and ending their working day at a base may be hindering the flexibility and development of services.

14 In making this broad statement, we do not wish to devalue the creativity shown by some staff in the planning and delivery of activities but to reflect that this was driven more by them as individuals than the wider system.


9. Senior management Findings and Observations9.

9.1 Within this project, we did not specifically look at the role of senior management (i.e. above service manager).

9.2 While clearly committed to people using services, our impression is that senior managers do not have knowledge or aspirations for people’s day opportunities that enable them to inspire and creatively challenge service managers.

9.3 Rather than offering leadership, the role of senior managers is seen as focusing on budgets and processes.

9.4 It varies from service to service, but our impression is that many staff are spending a considerable amount of time record keeping and responding to over bureaucratic processes.

9.5 Typically, staff work Monday to Friday between the hours of 8.30am and 4.30pm.

Reflections9.6 As has been noted earlier, to be leaders rather than just managers, people need

access to ideas and other services that will inspire and challenge them to develop images of what is possible for individuals and for their own and the whole service.


10. TransportFindings and Observations10.

10.1 70% of people receive transport provided by the service. Within this, there are significant variations - for example, 90% at Harbourne but 35% at Heartlands.

10.2 Each day service has access to a combination of BCC and independently-provided vehicles. These are large buses. Vehicles are driven by day centre staff who also provide, where needed, escorting support. The expectation that many staff will also drive introduces a much-needed skill into the staff team.

10.3 The common pattern of use is for vehicles to pick people up between 8.00 and 9.00 in the morning and take then home between 3.30 and 4.30 in the afternoon. Vehicles drop people off at and pick them up from their centre15. Transport is available Monday through Friday. We are not aware of any transport dropping people off at or picking people up from community-based activities.

10.4 Vehicles are then available for use by the day centre during the day. In practice this is limited.

10.5 Across the service, transport coordinators successfully ensure that no one spends more than an hour coming in to or leaving the service on provided transport and meeting people’s needs for adapted vehicles and support.

10.6 Individuals’ access to transport is part of the initial assessment and referral process and by their historical use. We understand that during the initial and ongoing assessment processes there is an assumption in favour of providing transport.

10.7 Day service managers have identified that a significant number of people accessing services receive mobility allowances and contribute towards the costs of a vehicle. However, day service staff do not have access to these vehicles to support people’s day services and there is an assumption that commissioners/social workers do not challenge families and residential staff about this.

10.8 We understand that if people choose not to attend the centre nearest their home they are expected to make their own travel arrangements.

15 This can include offshoot projects.


10.9 Staff in two services16 are trained in travel training and regularly use this to support people in making best use of public transport. This does not happen in other services.

Reflections10.10 For some people, the availability of transport is an essential part of their day

services, for others, it is not. Effective, strengths-based, review processes would consider all the travel options open to the person. This would include provided transport, mobility vehicles, travel training and public transport.

10.11 Current use of transport (dropping people off at and picking them up from a centre) seems to help lock people into traditional patterns of day service. A greater range of meaningful activities could be supported, with less inactive time (see section on activities) if people were able to start and end their day in a community location.

10.12 It can be argued that bussing people away from their homes to a centre out of their local community reduces opportunities for community participation and builds reliance on services.

10.13 Diversifying the fleet to include smaller vehicles would facilitate more widespread access to community-based activities.

16 Elwood and Heartlands.


11. What people doFindings and Observations11.

11.1 Each service is slightly different but a common pattern17 for the day within day centres can perhaps be described as: People arrive between 8.30 and 9.30am and head to either a base room or have a conversation with a key worker18 (where they will have a drink, receive personal care, plan for the day ahead). From this, they will go to an activity for between 60 and 75 minutes. Then there is lunch19. After lunch, people go into a second activity, again of between 60 and 75 minutes, before going back to their base room or a shared space to reflect on the day and prepare for going home between 3.00 and 3.30pm.

11.2 Activities vary between services but commonly include crafts, horticulture, sports, sensory, leisure pursuits, recycling, discos and education.

11.3 Activities tend to be generated by staff and will often reflect their knowledge and interests. Most of the activities on offer are what we would expect to find in a traditional day centre.

11.4 Similar activities take place within different services but can vary in terms of creativity and outcomes. Beauty therapy is a good example of this. In one service there is a dedicated spa space with staff having received additional training and an investment in spa type furnishings. In another centre, this takes place in one of the base rooms without the spa environment or focus. We did not find any evidence of encouraging services to learn from and challenge each other.

11.5 We were very encouraged to see how staff were working to ensure that as many activities as possible are open to people with more significant impairments and that when activities took place outside of the centre the core activity was augmented with a chance to enjoy time with friends over coffee or a pub lunch.

17 There are of course exceptions to this. 18 We understand that one service has moved from base groups to key work believing that it delivers better outcomes for people using the service. Without reflecting on which is better, it is interesting to note that this conversation has not been had across the whole service as a way of reflecting on practice. 19 Each service provides an opportunity for people to either bring in their own food or buy a full cooked lunch; take-up varies.


11.6 We understand that some popular activities, such as café projects and community options, were stopped following central BCC, not service level, decisions.

11.7 Discussing the services with participants and their families, many activities have their staunch fans and generally there is a strong sense that people value the opportunity to spend time with friends and to go out.

11.8 Where activities take place depends on the service; however there appears to be a strong pattern that in the learning disability service activities are very likely to take place within a centre, and within the physical impairment services more community locations are used.

11.9 Some people have less opportunity to engage in community activities because family careers or paid staff can be reluctant to meet additional costs.

11.10 We noted that some people attend day services with a one-to-one support worker not employed by day services, and that the quality of this support varies greatly. We understand that review processes have not considered whether the availability of one-to-one support should mean an expectation that people are involved in community activities.

11.11 The condition of the centres varies across the services. People using the services, families management teams and staff have worked hard to try and keep the buildings welcoming however traditional layouts and thinking about the use of buildings and a lack of investment has meant that it is difficult to see how some of the building value the people who use and work in them or can be considered fit for purpose20.

11.12 Two of the services have horticulture off-shoots, one a recycling-focused project. In each of these projects, there is a positive feel of the service having focus and providing more opportunities to understand and use individual’s assets. Although not explored as far as they could be, there are more opportunities for interaction with the wider community. Limited control of budgets and transport hinders creativity.

11.13 Information about employment is being considered separately.

Reflections11.14 Without disregarding what some people do while in the base groups or over meals, it

is striking how little time people spend in timetabled activities: commonly between two and two and a half hours a day.

20 This observation is not intended to suggest that BCC should focus its energies on the rebuilding of centres. The use of buildings is discussed elsewhere in the report and our conclusions.


11.15 It is disappointing to not see the wider range of options that we would have expected to see in a service if it was led by the aspirations of hundreds of very different people.

11.16 It was noticeable how many activities could be, but were not being, taken to another level. For example, paper shredding or administrative roles within a centre as jobs or volunteering in external organisations, crafts as small businesses, horticulture becoming part of local conservation activities or baking as a contribution to local community cafés.

11.17 There is no clear reasoning for why some activities have been stopped following decisions made centrally or there have not been opportunities for services to learn from each other.

11.18 It was positive to see the value placed on supporting friendships that have been established over many years, so it was surprising not to see investment in supporting these friendships outside of the service.

11.19 Much of the day service sits away from the community. This is discussed next.


12. Community Engagement Findings and Observations12.

12.1 As a city, Birmingham is very vibrant and most of the day centres are located within or close to busy local communities.

12.2 Most activities take place away from those communities within day centre buildings

that are not shared spaces with other community members and groups21. Some, perhaps most, of these activities such as ‘volunteering’, recycling, music and sport, are readily available across the city.

12.3 Discussing the use or not of community spaces with managers and staff, the core reasons appear to be:

the availability of space and equipment within the centre; ease of using day centre spaces; perceived risk from other community members; perceived lack of welcome from other community members and a lack of

toilets and changing spaces.

12.4 We noted that some activities described as being in the community take place within segregated settings and others are segregated groups within mainstream settings.

12.5 Some of the community activities are one-offs – trips to the theatre or cinema, visits to the park or having a pub lunch.

12.6 Community activities are the most likely to be cancelled due to staff shortages, bad weather and transport problems.

12.7 Across the services, we did not find a strong awareness of the range of community activities and opportunities taking place locally.

12.8 The availability of good public transport does not appear to have been an issue when locating services.

21 We understand that some space is rented out to community groups for specific activities, but these seems to be about income generation rather than community engagement. We are not recommending renting out space within day centres as a route to community inclusion.


12.9 The pattern of day services is outside of the times for some of the best opportunities for engaging with community members. For example, many people visit the garden project to buy plants on a Saturday when only staff are available.

Reflections12.10 At the heart of our observations on the connections with local communities and

participating in community actives is a core issue that does not appear to have been considered – is a central role for day services to support people to engage with, be part of and contribute to their local communities? This question requires the service to reflect on whether it genuinely believes that people using day services have assets22 that they can contribute.

12.11 We are unclear whether BCC sees a role for day centre staff in helping to create and support activities that, by being open to all the community, help to create welcome and contribution by people using day services.

12.12 The availability of adapted toilets and changing spaces within some of the centres but not across the city helps to create a draw towards those specialist spaces.

12.13 As has been noted elsewhere, the lack of training and support for staff in understanding and engaging with community organisations creates a further draw towards specialist spaces.

22 ‘Assets’ is used to include individual skills, talents, interests and experiences.


13. Externally-Commissioned Day Services 13.

13.1 BCC currently commissions (or spot purchases) about £7 million of day services from non-statutory23 providers.

13.2 It would not have been possible for us to explore the commissioning and provision for all of these people, so we choose to look at ‘typical’ planning and commissioning processes and a small range of providers who commissioners identified as reflecting the style and quality of services across the city.

13.3 We met with social workers and commissioning teams, and visited the services.

23 This includes voluntary sector (not for profit), community sector (not for profit) and private (for profit) local and national organisation.


14. Individual planning and commissioning Findings and Observations14.

14.1 The system for external, spot-purchased day services was described to us as: explore the internally-provided services first; if internally-provided services are not suitable, do not have vacancies or do not

accept the person, the social worker will explore externally-provided services; the person and/or their family are given a list of providers, advised to look

online or asked if they might know somewhere through word of mouth; the social worker then puts in a request for a place which is then spot-

purchased.

14.2 Reflecting on the ‘assessment’ process, practitioners told us that: for many people using services, their involvement in planning, choosing and

reviewing services is often very limited; planning processes are not person-centred and they focus more on support

needs than aspirations and assets. External placements24 are often made because the individual is identified as having one-to-one support needs.;

people using services, families and professionals involved in planning and commissioning have very limited exposure to or awareness of best and creative practice in commissioning and delivering day opportunities;

some families are in situations25 where they are more focused on the quantity and availability of services than the quality.

14.3 Reflecting on how ‘placements’ were made, practitioners told us that: decisions were often taken in a crisis rather than being planned, with

individuals and their families having little time or experience on which to base any choices;

the choice presented to people sometimes felt like a choice between the service offered and nothing;

which day centre is offered is often based more on the knowledge of the practitioner than being based on the aspirations and needs of the individual.

14.4 There are currently no standards for externally-commissioned day services, the list of preferred providers or standards in pricing.

24 We are aware that the term ‘placement’ is against the principles of person-centred and assets-based

approaches. We are using it here when it seems to best describe the process used. 25 Because of their age, impending end of school/college or years of ‘fighting’.


14.5 We understand that some young people, their families and social care staff have increasing aspirations about people’s lives and how they want to spend their day. However, there is a sense that current services are not able to meet these aspirations.

14.6 We understand that many people’s services have not been reviewed for many years26. Without any reflection on their needs, aspirations and satisfaction levels, the person continues to attend and the spot-purchasing arrangements continue. We understand that a system for reviews in now in place.

Reflections14.7 It is difficult to see how the current levels of oversight allows BCC to be sure that

externally provided services are safe.

14.8 The lack of aspiration for what could be possible and knowledge of what is possible among individuals, families, social workers and commissioners are unlikely to deliver high-quality services and supports to individuals.

14.9 Individual planning systems that do not identify and consider aspirations, assets and communities are unlikely to deliver clear goals and desired outcomes with which to commission and review services.

14.10 Processes that are based on being reactive to external timetables and which deliver placements rather than a range of supports are unlikely to deliver high-quality outcomes.

14.11 Without service-wide aspiration, quality standards, reviews and shared learning it is difficult to see how a diverse marketplace27 of services and supports can develop.

26 One examples was for ten years. 27 We are using ‘marketplace’ to include the full range of supports, providers, etc.


15. The services Findings and Observations15.

15.1 There are a large number of third and private sector ‘day service’ providers within Birmingham. It is important to note that we saw a small selection of them so cannot comment across the board however, our visits allowed us to form impressions that, given the commissioning and review processes, we would suggest are common.

15.2 Even if within the community, services tend to have a sense of being separate from that community.

15.3 The buildings used vary from service to service. Some are reasonably well-equipped and modern; others are shabby, not appropriate for their role and do not provide a sense of valuing people who use or work in the service.

15.4 Staff tend to be clearly caring and committed to the people they support. Some come across as empowering, others as patronising.

15.5 We did not find any evidence to suggest that most staff and many people leading services had any awareness of best and creative practice in day opportunities. However, a small number of service leaders are aspirational and creatively looking to develop more person-centred opportunities, although they may lack knowledge of how to make the next steps.

15.6 The quality of individual planning with services varies. Some is person-centred, some is slotting people into provided activities.

15.7 People’s level of busyness in terms of the number of activities they are involved in and the quality of their time in those activities varies across the services. There is a general pattern of use that sees people arriving at the service and then having down time with a drink and friends before engaging in a focused activity, for about an hour, having lunch, another focused activity, more down time and then home. Commonly, focused activity is not the major part of many people’s days.

15.8 Many people using the services clearly value their time there, talking positively of some activities and the opportunity to socialise with other people.


15.9 Most activities are what we would expect to see in traditional day centres with a focus on keeping people entertained. There are attempts to explore volunteering and work preparation but ideas around social inclusion and building community are little-understood.

Reflections15.10 A lack of quality planning with people before they enter and when they are using the

externally commissioned day services means that there is little to drive the range of activities and supports offered by the providers. A focus on filling people’s time does not promote quality.

15.11 A limited awareness of good and emerging practice among people leading and delivering the services does not encourage critical reflection or aspirational development.

15.12 The lack of an effective commissioning strategy means that most of the third and private sector day service providers are not acting to develop the local ‘marketplace’ of day activities and opportunities.

15.13 The focus within one or two of the services on helping people gain new stills indicates an opportunity for viewing day services as a step in people’s lives, rather than a destination.

15.14 The tendency to favour centre based and segregated activities makes it less likely that the contributions of people using the service and recognised and valued and opportunities to build community presence and participation are being missed.


16. Recommendations16.

16.1 The scale and spread of the change needed is considerable but there is an opportunity here to build on the work already started by the commissioning team, enthusiastic heads of services and innovative people using services and team members. Our recommended approach is twofold:

to agree a set of principles across every level and for those principles to identify actions for change;

to adopt a focused approach to change that understands and shows what is achievable.


17. Principles16.2 The principles will need to be coproduced by current and future users of day opportunities,

families, elected members and staff. To stimulate this, from our conversations in Birmingham and experience elsewhere, we suggest the principles include:

an asset-based approach that recognises that every person receiving services has contributions28 that they can make to their community and that every community offers a range of opportunities;

a focus on the workplaces, volunteering places, social activities, leisure places, etc available within communities as the natural place of day opportunities29;

a commitment to building aspiration of day opportunities; that day opportunities are driven and measured by individuals’ stated

outcomes30; people’s choice drives the development and resourcing of support providers,

including a responsiveness to population changes; a culture is developed that informs and supports reflection and challenge

across the planning and provision of day opportunities.

16.3 The principles will need to be supported at all levels including: individuals who do or may wish to use day opportunities; families of people who do or may wish to use day opportunities; strategists and commissioners; support providers; the wider community (including people providing facilities, transport, etc.

28 This is not to suggest that people do not need support. Rather it provides a starting point for thinking about how support is best considered and developed. 29 This requires BCC to support community places to become more physically accessible and have available changing places.30 This needs to include the stated desire of families for ‘respite’.


18. Delivery16.4 Birmingham is a large city. Achieving change will require focus. We suggest that:

two or three communities31 are chosen as a first wave for change where there will be focus of development support. The choice of communities is significantly driven by their desire for change (but we would anticipate some reflection on current usage patterns – for example the number of people receiving other support or living with older carers);

learning and outcomes are monitored, adapted and shared to support wider development across the city.

16.5 We suggest that the knowledge and aspirations of all stakeholders is raised through information sharing, access to best and emerging practice and skilled challenge of ideas and practice. This to include:

images of possibility (including community activities, employment, volunteering, support arrangements, individualised funding options, etc) relevant to different stakeholder groups. Images of possibility to reflect people’s different impairments, levels of support needed, behaviours considered challenging, etc.;

visits and information sharing relevant to stakeholder groups; opportunities for principles and values driven reflective practice by managers

and delivery staff; a recognition that while the current coproduction activity has been useful to

achieve a snapshot of people’s aspirations today, these aspirations will change with greater awareness and more experiences.

16.6 We suggest that person-centred, asset-based conversations (assessments) are made the standard planning and review process across all teams and services, with minimal bureaucracy and funding options that support individual (and family) control. This to include:

agreeing planning standard across all teams and services; measuring the success of planning in identifying people’s life aspirations32,

goals for services and whether raising challenges to the development of new styles of support33;

making best use of funding processes (direct payments, individual service funds, etc) that best support the delivery of individual plans.

31 We have chosen to refer to communities as a focus for change rather than specific day centres. We have done this to emphasis the principles suggested about, the need for a local ‘market’ and to reflect the role of existing services as a part of the community not ‘the’ community. 32 There are some successful tools that will help with this measurement – for example The Inclusion web 33 This will include a range of travel options and agreed length of service.


16.7 Services and staff within them need to be given the tools to best understand, engage with and support community presence and participation. We propose that this includes:

identifying and valuing individual assets; community mapping (places and people); community engagement; the role of staff in stimulating and facilitating community activities and

organisations.

16.8 If the community is recognised as the natural place for most activities to take place, there will need to be a consideration of what the ‘day opportunities marketplace’ needs to look like. We suggest that a major shift will be away from providers seeing their role as providing activities towards them providing supports. This suggest a need to -

16.9 Enable and support the services currently provided by Birmingham City Council to identify activities and communities to specialise in and to adopt ways of working that will enable them, if they are chosen by people and offer the desired quality, to contribute to the marketplace of support. This is likely to include:

developing service plans that include real costs; having greater control of and flexibility in using transport; hours of services that match the aspirations and activities of people who use

them; levels of leadership appropriate to the size and style of the service; current off-shoot projects becoming separate service.

16.10 Enable and support existing and new external providers to, if they are chosen by people and offer the desired quality, contribute to a marketplace of support. This is likely to include: agreeing standards; support existing service to develop to meet those standards; support local ‘social entrepreneurs’ to develop new services.

16.11 Recognise that a small number of community activities, for example employment, are best supported through a focused provider who will need to be stimulated, developed and monitored.


19. Appendix17.18.19.19.1 Following the completion of our draft report, we had the opportunity to share our

observations and recommendations with some families, people leading services and people commissioning services. They asked that a number of reflections from them be added. These are intended to inform readers and not as a formal consultation.

19.2 Families noted that: Day opportunities provide a major source of support, security and wellbeing.

No changes should take place without engaging with and achieving the agreement of families.

The threat of service closure, inconsistency or a lack of openness creates fear and uncertainty.

People need access to high quality and consistent planning support and planning needs to include safety and risk.

Choice is limited and should not be tied to direct payments. People belong to multiple communities. For some people the day centre is a

community. Advocacy is needed but not or underfunded. There have been a number of previous ‘consultation’ exercises that have not

been listed to or led to change. This has undermined family’s confidence in the Council and change processes.

19.3 People leading BCC services noted: The proposals in this report would require BCC to listen to managers about

what information and support they require and then to ensure that this is delivered.

Service leaders would need to be given effective control over their services. Change requires an environment that welcomes risk and exploration. People

should be encouraged in this. There is an appetite to work in partnership with communities and other

organisations.

19.4 People commissioning services noted that: The proposal for individual planning would require a very significant

investment in support structures for planning and delivery, including staff. Commissioners will need to identify and have access to good practice in day

opportunities.


Developing a range of day services would require commissioners being able to work across BCC and the third and private sectors.


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