SHHD/DGM(1991)1

7 January 1991

Dear Sir/Madam

COMMUNITY CARE IN SCOTLAND

COMMUNITY CARE PLANNING

Summary

1. This circular introduces new legislative requirements on community care planning and provides guidance to social work authorities and Health Boards on the preparation of community care plans (CCPs) and planning agreements. It requires local authorities, together with their planning partners, to establish a joint planning structure and to prepare community care plans. (This revised version of the original circular includes, for the sake of completeness, references to material issued after the original was published.)

Action

2. Social work authorities should make the necessary arrangements to comply with the terms of section 5A of the Social Work (Scotland) Act 1968 in respect of community care planning. The Secretary of State has directed that the first community care plans are to be prepared and published by 1 April 1992. A copy of this Direction is enclosed.

3. Health Boards should submit community care plans related to Local Health Strategies by 1 April 1992. The expectation is that plans will be joint.

4. Initial planning agreements between local authorities and Health Boards should be prepared by 1 July 1991, and may form part of a joint plan.

Introduction

5. Section 5A of the Social Work (Scotland) Act 1968, inserted by section 52 of the National Health Service and Community Care Act 1990 requires social work authorities to prepare and publish plans for the provision of community care services. The Act also requires local authorities to consult a range of other bodies while preparing or reviewing community care plans.

6. Health Boards are also required as part of the strategic planning process to prepare community care plans. The first Health Board plans for community care should also be prepared and published by 1 April 1992. These should be part of, or relate closely to, Local

Health Strategies. While not required in statute, the expectation is that community care plans will be jointly prepared by social work authorities and health boards.

7. Community care plans should cover a 3 year period. The first plans should cover 1992 - 1995. Plans should be reviewed annually and rolled forward.

8. In view of the importance of ensuring that there is close collaboration and consistency of objectives between social work authorities and Health Boards, they should enter into planning agreements. Guidance on the nature and purpose of such agreements is also included in this circular. Local authorities and Health Boards are invited to produce initial planning agreements by 1 July 1991.

9. This Circular should be read in conjunction with more recent guidance on community care planning in the following Scottish Office Circulars:

- SWSG 4/93 "Directions on Consultations": this requires local authorities to state in their plans the process for consultation and requires them to consult organisations representing providers in the independent sector;

- SWSG13/94 "Directions on Purchasing": this directs local authorities to include in their community care plans a statement of their purchasing intentions;

- SWSG14/94 "Community Care Planning": this amends parts of this circular (SWSG1/91) by revising the expected content of plans to make them more of a management tool, focussed on intended action in support of strategic objectives. This is the key document on the content of community care plans;

- SWSG7/94 "Community Care - The Housing Dimension": this identifies, amongst other things, the role of housing at the strategic and operational levels and sets out the expectation that housing should be an equal partner in community care planning;

- Env 9/94 Housing Plans, Annual Policy Statements on Annual Policy Projects

- SWSG letter of 2 February 1995: this invites local authorities in their community care plans for 1998 to disaggregate information on current and prospective services to the areas of unitary authorities;

- In addition, a wide range of guidance on community care and joint planning has been issued to the NHS in Scotland. Of particular relevance in this context are that on resource transfer (NHS, MEL(1992)55) and the Priorities and Planning Guidance from the NHS Management Executive expecting development of particular care group strategies on a joint basis, including the reprovisioning of long-stay hospital care.

Principles

10. It is important that planning should not be an end in itself but should lead to action. The purpose of community care planning is to enable the considerable and complex resources and skills available, through social work and housing authorities, Health Boards and voluntary and private organisations, to be used to the best effect for the vulnerable groups they are designed to serve. Plans should therefore identify local needs and should propose specific action to improve the way services are delivered.

11. The development of community care planning is evolutionary and the first plans for 1992-95 are the start of a process which increasingly will direct the way in which services are delivered. Progress needs to be monitored regularly at both national and local levels to provide both steady feedback on the achievement of objectives and a firm basis for future planning. Monitoring arrangements should enable shortfalls in both the quality and quantity of services to be identified and judgements made on how to meet needs within the resources available. Plans should also be useful to those in the field involved directly in caring for people through their potential for matching services more closely with people’s needs.

12. In a field as complex as community care the plans must allow room for local initiatives and the use of resources in imaginative and flexible ways. Some of the most promising developments have arisen from individuals, local groups or teams identifying and meeting needs. Community care planning should help this to continue and create a climate which will encourage it.

Scope of Plans

13. Plans should address the needs of a wide range of care groups for vulnerable adults (described fully in Annex A to subsequent Circular SWSG14/94). Local authorities and Health Boards are of course responsible for addressing other needs and will wish to ensure that community care planning is consistent with planning arrangements for other care groups.

14. Services for children are excluded from the definition of "community care services" in section 5A(4) of the 1968 Act. In preparing plans for particular care groups local authorities and Health Boards will, however, wish to address the needs of any children in that care group. The Scottish Office will monitor developments for such children as part of its monitoring of the progress of community care plans.

15. In addition to drawing up CCPs social work authorities are required to produce a 3 year plan for those services which are eligible for 100% grant under the National Standards for Social Work Services in the criminal justice system. The largest significant care group not therefore subject to a formal planning requirement for the present is children. However, the Children (Scotland) Act 1995 includes a provision to require social work authorities to procedures strategic child care plans. Guidance on their substance will be issued in due course.

16. Health Boards are required in their Local Health Strategies to consider the needs of their residents over the next ten years and to specify in detail the full range of care they plan to obtain for their populations over the next three years. This will necessarily involve addressing residents’ needs for community care. NHS Trusts and directly managed providers of health care are also required to produce three year financial, manpower and service plans for the full range of their business (including community care provision) and to review and roll forward those plans every year. The Health Board input to a community care plan is in effect, part of its Local Health Strategy but this cannot be drawn up in isolation from the providers of health care and needs to reflect the capability of providers to adapt services towards identified needs within the resources available. Planning for community care will necessarily involve a range of agreements between different agencies at different levels.

National Objectives and Priorities

17. Among other things community care plans should be designed to achieve the Government’s key objectives for community care. These objectives were set out in the White Paper "Caring for People", as follows:

(a) to promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible;

(b) to ensure that service providers make practical support for carers a high priority;

(c) to make proper assessment of need and good care management the cornerstone of high quality care;

(d) to promote the development of a flourishing independent sector alongside good quality public services;

(e) to clarify the responsibilities of agencies and so make it easier to hold them to account for their performance;

(f) to secure better value for taxpayers’ money by introducing a new funding structure for social care."

18. These objectives set out the Government’s expectations for the development of community care. Social work authorities and Health Boards will set their own priorities in the light of local circumstances but should do so within the framework of these national objectives. The Government will measure progress by the extent to which these national objectives are realised.

19. The priorities identified for the Health Services in "Scottish Health Authorities Review of Priorities for the Eighties and Nineties" (SHARPEN) have been endorsed by the Government. They also apply to community care services provided by social work authorities. Community care planning should be driven by a local assessment of need but should take account of these priorities.

Planning Agreements

20. Effective inter agency planning and working is essential to the success of community care. In preparing CCPs social work authorities and Health Boards must therefore work in partnership. Their joint plans can be underpinned by a planning agreement. While the content of a CCP is now set out in Circular SWSG14/94 the joint plan/planning agreements should, between them, cover all the subjects listed in paragraph 22.

21. The main purpose of planning agreements is to clarify responsibilities for action and drive that action forward. This will require local authorities and Health Boards to identify their objectives; to agree which matters are the sole responsibility of a particular agency and those which require joint action; to determine the standards of care required for the local population and timetables for achieving those standards; and to agree the financial commitment which each agency will make towards achieving their joint objectives. Planning agreements can also be made with other agencies eg housing, to the same effect. The essence is that planning agreements should indicate who does what, for whom, to what standard, when, at what cost and who pays.

22. In planning agreements (or within joint plans) social work authorities and Health Boards should:

- make a shared assessment of local needs for community care;

- agree common goals for particular care groups derived from national policy aims for particular client groups (as currently set out in SHARPEN and in the White Paper "Caring for People");

- decide what they are trying to achieve and by when;

- agree policies on key operational areas including client access, assessment procedures, hospital discharge arrangements, care management and consultation with users and carers;

- allocate responsibilities for obtaining services for each care group;

- identify the financial resources to be provided for the next 3 years to obtain these services;

- specify the standards of care required for the provision of services for each care group;

- agree areas of joint contracting and service specifications for jointly managed provision.

23. In addition to these planning agreements between local authorities and Health Boards, detailed implementation arrangements will have to be negotiated between health, housing and social care providers in order to achieve the objectives identified in planning agreements. The different providers of community care services - social work departments, directly managed (Health Service) units, NHS Trusts, GPs, voluntary and private sector organisations and housing authorities and agencies - should produce detailed agreements about the use of resources and the provision of appropriate packages of care.

24. Planning agreements should be reviewed regularly, and at least every 3 years.

25. The Scottish Office Social Work Services Group, the NHS Management Executive and the Housing Group together will monitor co-operation between social work authorities, Health Boards and housing authorities to ensure, as far as possible, the production of effective planning agreements and community care plans.

26. Collaboration on community care has until now been effected largely through the process of joint planning on the lines set out in the joint Departmental circular of 25 April 1985 (also issued as SWSG5/85, SDD5/85, SED1127/85, NHS1985(GEN918)). Joint planning has been stimulated by the availability, initially, of allocations for support finance and has also led to other joint financial arrangements between local authorities and Health Boards. It is vital that these commitments are maintained and there should be no withdrawal from existing financial commitments. Indeed the Government expects planning agreements to increase the level of financial collaboration and partnership.

Content of Community Care Plans

27. The original guidance in the content of plans in SWSG1/91 has been superseded by that in Circular SWSG14/94 of 11 November 1994.

Contributions to Plans and Consultation

28. Section 5A(3) of the 1968 Act requires that in preparing community care plans local authorities should consult

- Health Boards;

- local housing authorities;

- voluntary organisations representing service users;

- voluntary organisations representing carers;

- voluntary housing agencies;

- other bodies providing housing or community care services;

- such other persons as the Secretary of State may direct.

29. Education authorities are excluded from this list because they are part of the same body as the social work authority itself. The engagement of education interests (including community education and colleges of further education) in community care planning is, however, just as important as the bodies identified above. Other voluntary and statutory agencies may also have useful contributions to make and social work authorities should consider which bodies should be consulted. This could include bodies with interests in education, employment services, leisure and recreation. The published copy of the plan should indicate which organisations have been consulted and the nature of their contribution.

30. The terms of this circular, at least as regards consultation, have been extended by the requirements on consultation in Circular SWSG4/93 "Community Care Plans: Direction on Consultation" of 26 March 1993.

31. Social work authorities and housing authorities clearly have to be closely involved in the planning of community care services in the NHS. Other parties which have an interest in the health component of community care plans and who should therefore be consulted on these development are:

- NHS Trusts;

- relevant voluntary organisations;

- representatives of service users and carers;

- general practitioners;

- health care professionals;

- bodies providing community health care services in their area;

- local Health councils.

32. The purpose of consultation is to ensure that consulted bodies have real opportunities to contribute to community care plans. It is recognised that effective consultation will not be easy and will take time to develop. The Scottish Office does not intend to prescribe how consultations should be conducted. There are many methods of consultation and local authorities and Health Boards should decide what is appropriate in the light of local circumstances and after discussion with the organisations and groups to be consulted. The onus for enabling consultations to take place lies with the social work authority and Health Board. As part of their lead responsibility for the development of community care the social work authority will have to co-ordinate the contributions of the other bodies involved in planning and providing community care services.

33. Consideration will also have to be given to the process of consultation. In many places planning structures have been set up which give other statutory and voluntary agencies places on local planning groups. Mechanisms to produce appropriate representation of the voluntary and private sectors and of service users and carers will be required, and social work authorities and Health Boards should facilitate and encourage their involvement.

34. Some bodies should be involved throughout the planning process and should also be consulted when plans are being reviewed. Other bodies may be consulted more formally when plans are approaching their final stage. The social work authority will have to make judgements about these matters within the context of the statutory requirements on consultation. The Health Board will also have to make similar judgements. In monitoring plans The Scottish Office will look closely at the quality of consultation with the voluntary and private sectors, and services users and carers, as well as with other statutory agencies.

35. Housing has a vital role in community care. The 1968 Act, as amended by the NHS and Community Care Act 1990 requires social work authorities to consult local housing authorities and voluntary housing agencies when preparing plans. Housing authorities have the strategic overview of housing needs and resources and the responsibility for enabling the development of an appropriate range of housing in the area which they cover. Consultation should also take place with Scottish Homes, housing associations, and any other bodies which provide a local housing service, including private providers. The crucial role of housing authorities and specialist housing associations should be recognised in discussions during the planning process and social work authorities, Health Boards and housing agencies should be consulted during the preparation of each other’s plans. In the case of community care plans, and housing authorities’ housing plans, it is essential for each authority to be consulted by the other when preparing its plan. This will allow community care plans to cross refer to the plans of housing bodies and allow housing plans to take account of the objectives in community care plans. In some areas of Scotland social work departments are already heavily engaged in joint planning with housing bodies. These proposals will build on and extend current further good practice.

36. The initial guidance from The Scottish Office in Circular ENV8/91 "Housing and Community Care", dated 28 March 1991, has been cancelled and replaced by Circular SWSG7/94, "Community Care: The Housing Dimension", dated August 1994. That needs to be read in conjunction with both this Circular and those referred to in paragraph 9 above.

37. Voluntary and private sector organisations together bring a valuable store of expertise and experience in dealing with care needs through various forms of community care services. In many places these bodies are key providers of care. Plans must therefore reflect careful consideration of what contribution the voluntary and private sectors might make to future care provision and representatives of these sectors should be widely consulted. For the voluntary sector, these should include main service providers as well as umbrella organisations which represent groups of voluntary bodies and those concerned with the interests of volunteers. Providers will be interested in seeing plans so that they are in a position to develop services to meet future demands. As plans will contain proposals about future provision of services it will be important that these are based on consultation with representatives of different service providers. Some voluntary bodies will also have a role in the planning process as representatives of service users and their carers (see paragraph 39). The particular role of volunteers in the community care field is also significant and local authorities should outline in plans the contribution to be made by organisations acting as local recruitment or advisory bodies on volunteers and voluntary work.

38. Private sector care providers also need to be consulted. Some of these service providers may not as yet be organised into representative groups and the representative process may not therefore be as well developed as in the voluntary sector. But some bodies do exist and there are also some large providers. As an initial step local authorities might draw up a list of known private providers and consult them on the preparation of their community care plans. The way in which this will be done will vary from authority to authority depending on the scale of private provision and the form of its organisation.

39. Service users and carers have a great deal to contribute about the nature of care needs and about the pattern of services which might be most appropriate. Local authorities require to consult voluntary organisations which represent the interests of users and carers when preparing plans. There may be other service users and carers who have an interest in community care plans who are not represented by voluntary bodies. Particular efforts will be required to engage such users and carers effectively. In monitoring plans the Department will be taking particular interest in how users and carers have been consulted.

Publication of Plans

40. Section 5A(2) of the 1968 Act requires local authorities to publish their community care plans. Health Boards should also publish their plans. The joint plans should therefore be available to local populations and should be written in a form and language which is readily understandable to the general public. The existence of the plans should be well advertised. Approaches to publication need to suit local circumstances and preferences. The full plans might be made available in libraries and other public authority buildings; they may be sent to groups and organisations known to have an interest in community care; and they could be distributed to the local press and other media. The availability of copies of the plans should also be publicised.

41. In addition to the full plan local authorities and Health Boards might consider producing summaries for wide distribution and these could become part of wider public information packages about social work and health services.

42. The Scottish Office, in partnership with Scottish Homes, has commissioned the Nuffield Centre for Community Care Studies at Glasgow University to provide a database of good practice on all aspects of community care, including consultation processes. The Database holds a number of recent examples of methods and approaches to consultation on planning which we would commend to others. Requests for searches can be made by contacting the Database direct on 0141 330 4554.

Data

43. Guidance issued to Health Boards on strategic planning indicates what information should be included in local health strategies and service provision plans. Actual performance against plans will be measured through the Accountability Review process using the same information. The health content of community care plans should contain similar information on planned expenditure and activity levels to be achieved in terms of community care.

44. Wherever possible plans should include quantified targets for the changes that are intended in the numbers of people receiving different forms of care as well as an outline of the quality standards which are being pursued. Figures should also be used to describe changes in levels of staffing and expenditure. The purpose of such data is to facilitate the identification of targets and the monitoring of their achievement.

45. It is widely agreed that a common information base for social work and health and housing would facilitate local planning, assessment of individual need and service delivery. Many difficulties have to be overcome to achieve this but the potential benefits are substantial. Work is being undertaken to this end under the aegis of a number of linked multi and single agency groups. They are sponsoring a number of initiatives, including:

• the sharing of personal information between community care professionals is being addressed by the Locality Information Sharing Programme (LISP) of local projects, which will share experiences via the dissemination of learning materials;

• the assessment of population needs is the subject of a handbook to be published in Autumn 1995;

• common information standards are being developed for community care planning, starting with an inter-agency agreement on a classification for Client Groups, and common information bases are being advanced both via the inclusion of Community Care questions in the major Scottish House Condition Survey 1996, and the extension of the NHS project on the healthcare thesaurus of terms (the "Read codes) to encompass social care terms.

Monitoring of Plans

46. The requirement that social work authorities review community care plans will ensure that planning is a continuous process. In order to inform this process local authorities will new systematic arrangements for monitoring and evaluating the provision of care in their own services and in the voluntary and private sectors.

47. The Scottish Office intends to take a close interest in the content of community care plans and planning agreements. Copies of plans should therefore be sent to The Scottish Office as soon as they are published along with associated planning agreements.

48. The health content of plans will be monitored primarily through the Accountability Review process.

49. Monitoring of the plans and planning agreements by The Scottish Office will be a joint process involving all the relevant social work, health and housing interests in The Scottish Office.

50. Meetings will also be held from time to time with representatives of voluntary and private sector bodies interested in community care to discuss their contribution to community care planning.

51. The first community care plans for the period 1992-95 are to be prepared and published by local authorities and Health Boards by 1 April 1992. Plans should be reviewed and rolled forward annually to a timetable compatible with local financial planning cycles. Although plans should cover a three year period strategic objectives may need to encompass a longer period. Health Boards are expected to produce 10 year strategic plans for this purpose and elements of social work authority plans may need to do likewise.

52. It is recognised that implementation of plans cannot be finalised until resource allocations become known. It is also recognised that Health Boards and social work authorities operate different systems for the approval of plans and that plans must be prepared and consultations undertaken without such approval in place. However planning always has to take place using assumptions or estimates about funds likely to be available. In drawing up plans such assumptions should be made explicit and it should be recognised that plans may need to be adjusted once final resources have been allocated each year.

Monitoring

53. The first community care plans for the period 1992-95 are to be prepared and published by local authorities and Health Boards by 1 April 1992. Plans should be reviewed and rolled forward annually to a timetable compatible with local financial planning cycles. Although plans should cover a three year period strategic objectives may need to encompass a longer period. Health Boards are expected to produce 10 year strategic plans for this purpose and elements of social work authority plans may need to do likewise.

54. It is recognised that implementation of plans cannot be finalised until resource allocations become known. It is also recognised that Health Boards and social work authorities operate different systems for the approval of plans and that plans must be prepared and consultations undertaken within such approval in place. However, planning always has to take place using assumptions or estimates about funds likely to be available. In drawing up plans such assumptions should be made explicit. It should also be recognised that the details in plans may need to be adjusted once final resources have been allocated.

Enquiries

55. Enquiries about the terms of this circular or requests for advice should be addressed in the first instance to Mrs L Malcolm, Social Work Services Group, Room 48c, James Craig Walk, Edinburgh EH1 3BA, telephone (0131 244 5424).

Yours faithfully

DON CRUICKSHANK N G CAMPBELL

Chief Executive Under Secretary

NHS in Scotland Social Work Services Group

PLANS FOR COMMUNITY CARE SERVICES

DIRECTION

The Secretary of State, in exercise of the power conferred on him by Section 5A(1) of the Social Work (Scotland) Act 1968 [ a) 1968 c.49 Section 5A was inserted by section 52 of the National Health Service and Community Care Act 1990 (c.19)] a), and of all other powers enabling him in that behalf, hereby directs that the period within which each local authority shall prepare and publish a plan for the provision of community care services in their area shall be one year commencing on 1 April 1991 (being the day appointed for the coming into force of the said Section 5A).

Under Secretary

Scottish Education Department

December 1990