Wendy Brown

| Adult Swindon Borough Council
Social C 3% floor, Wat Tyler West
ocial Ware Beckhampton Street

Swindon SN1 2JG

Tel: 01793 445500
Fax: 01793 465866

Swinpon

BOROUGH COUNCIL

Private & Confidential Please ask for:
David W G Ridley

Senior Coroner for Wiltshire & Swindon DirectDial Mo:
Wiltshire & Swindon Coroner's Court Email:

26 Endless Street
Salisbury, Wiltshire Our Ref: — JneH/s/
eft 10 Date: 6 May 2014
Dear Mr Ridley

Regulation 28: Report to Prevent Future Deaths
Re: Wendy Bernadine Brown deceased

With reference to your letter of 13 March 2014, ref DWGR/dr/1586.13.
Addressing the matters of concern:

5a)

This paragraph refers to the lessons learned from the death of WB and the complex
nature of Adult Social Care. The challenges for Adult Social Care are recognised
nationally with increasing pressure from major financial reductions to overall Local
Authority funds, upward demographic pressures within all client groups, and concerns
over the complex legislative framework that have brought about the Care Bill shortly
due for Royal assent with partial enactment scheduled for April 2015 and full
enactment in April 2016.

a . a young person with complex needs_and her Grandmother Wendy Brown

demonstrated both her commitment for caring forfJand her frustration and anxieties
from providing that care. There were difficulties in providing services that were
available, and Mrs Brown would accept, especially over the summer of 2011, her
frustrations and concerns are recorded where she believed BB needs were not
being met, carers assessments confirm this but also her commitment to maintain the
majority of the caring role.

Reference is made in the Regulation 28 report to the creation of SEQOL and
complexity of Adult Care. Swindon Borough Council recognises that the separation of
Adult Social Care functions to a retained commissioning service and provider services
located in a Social Enterprise (SEQOL) was a major change. It may be helpful to
reprise the reasoning behind creation of SEQOL, and the roles they and SBC have
undertaken since October 1st 2011.

l2

& www.swindon.gov.uk

-2-

Under “Transforming Community Services” the then Primary Care Trusts (PCT) were
required to separate out their provider functions from their commissioning functions. In
Swindon there had been a rich history of integrated working with joint teams of PCT
and SBC staff for Older People, Physical Disabilities and Learning Disabilities. Both
organisations had formed the view that integration was the most effective way to meet
client need, and were reluctant to let the requirement to separate health provider
functions undermine the progress made; for example a protocol was in place that the
Chief Executive of the PCT and the Director of Adult Social Services were to be vested
in the same person, this arrangement only coming to an end as a necessary
consequence of the structural changes to PCTs through Transforming Community
Services, however Integrated Commissioning managers funded by both Swindon
Clinical Commissioning Group (CCG) and Swindon Borough Council continue to be a
feature of the commitment to integrated working.

Swindon was not unique in arriving at a Social Enterprise as the vehicle to deliver
integrated provider services, but it was unusual. In the main the Integrated Health and
Social Care Social Enterprise was the approach taken by the few communities where
borders of the two organisations were roughly congruent and integration was already
at a more advanced stage than the norm. Health organisations were supported by
DH guidance including national model contracts, no such infrastructure was available
for Local Authorities in creating the commissioner provider relationship.

In support of the change both internal and external legal advice was taken and a
series of internal audits carried out to understand the responsibilities of the Social
Enterprise and those of the retained responsibility of the Council. In addition these
audits were undertaken to give assurance that systems, process and protocol were in
place prior to the formal transfer.

The working arrangements of SEQOL were established through contract and continue
to be managed through monthly contract performance meetings covering quantative
and qualitative issues from Health and Social Care perspectives.

Whilst there were major structural changes inherent in the move to a commissioner
provider relationship, the day to day impact on service users and carers was minimal.
Staff involved in face to face contact with service users / patients were TUPE’d across
to the new organisation and case allocation so there was no wholesale reorganisation
of case load at that time. Contact arrangements such as the Free Phone “CareLine”
for Adult Social Care enquiries was maintained as was the duty phone number for the
Learning Disabilities Team. These numbers have remained constant through office
moves brought about on efficiency grounds subsequent to SEQOLs creation.

5b)

Commissioners role in managing community care processes and spend ran in shadow
form from 1* April 2011 up to the go live date of October 1*' 2011. The work of SEQOL
staff is verified by Senior Social Work Practitioners with access to an exceptions panel,
made up of senior commissioning managers, for cases outside the delegated authority
of the Verifications team. Initially there was a high volume of cases requiring

rk)

-3-

consideration by exceptions panel, but overtime the numbers have significantly
decreased allowing the Exceptions panel to focus on the most complex of cases.
Particular reference is made to the timeliness within which applications both from the
funding perspective and service nature are processed. Prior to, and continuing after,
the death of WB support was provided by SBC commissioners to the Learning
Disability team, not exclusively to, but including the Transitions workers. The purpose
of this support was to provide a focus on compliance with the Adult Services
assessment requirements so that applications from the Learning Disability team could
be dealt with efficiently without repeated queries and clarifications being necessary
before public funds could be allocated. Essentially this was a temporary “pre-
verifications” process, coaching LD staff in presenting the right information in the right
format at the right time. Commissioners continue to work closely with SEQOLs
Learning Disability team with both organisations signed up to a series of Workstreams
designed to seek better outcomes for Learning Disability service users and carers.

| was managed through the Transitions process. Swindon Borough
Council along with partner organisations had, and continues to have a Transitions
Protocol in place. This involves the Adult Transitions team (a SEQOL Team) in the
planning of young people in transitions from year 9 (14 years) onwards. Changes to
legislation formally extending the transitions process for young people to age 25 has
required the Transitions protocol to be revisited and re-launched. Work is in
progression finalising the new protocol, whilst transitions is not uniquely the preserve
of Learning Disabilities the majority of young people in transition have a learning
disability with the management of the Transitions and transitions workers resting in
SEQOLs Learning Disabilities Team. Transition therefore forms an important part of
the Learning Disability Workstreams referred to above.

The Verification process is supported by a contracts team and dedicated brokers and
placement officers who access the services that are identified in support plans. The
contracts team are involved in the establishing of service arrangements and the
monitoring of such contracts. There are many commissioning challenges for Adult
Social Care reported nationally, and Swindon is not immune to such challenges. We
believe that the structure allows for these challenges to be addressed and the
commitment to the workstreams in the Learning disability area demonstrates our
commitment to improve in this area. In addition we have recognised that further
development of the local service offer is required and a Market Position Statement is in
draft form and due to be published in the coming months. This will look at current
services, any potential gaps in service provision, and how we develop and/or
commission further services in Swindon.

5c)
In this paragraph you make reference to the lack of appeal process with particular
reference to CHC funding. As referred to above there is an exceptions panel made up
with Senior Managers which deals with cases where resolution has not been achieved
by the Verifications team with SEQOL. Should there be unresolved matters after
exceptions panel has considered the matter then the Adult Social Care complaints
procedure is available to Service users and Carers alike.

4

Swindon Borough Council hosts the Continuing Health Care Team, with the same
manager having responsibility for the Continuing Health care budget and Community
Care budget which helps avoid a lot of the disputes between Local Authority and
Health organisations experienced elsewhere. There is an appeal process for CHC the
first stage of which can be dealt with locally on the basis that the panel considering the
appeal is not made up of those involved in the original decision. The CCG has access
to an Independent review panel; as set out in Department of Health guidance.

Conclusion

The complexity and potential for delays in decision making that are the core to the
section 28 report are real issues. The actions described: robust contractual
arrangements and management, the use of internal audit, development initiatives
regarding process and extensive workstreams seeking to improve Learning Disability
services are all pertinent to the concerns raised. It would be overstated to state that
they arose directly as a result of the death of Wendy Brown, but the actions, both
predating her decease and continuing thereafter do address the areas of concern and
seek to provide a robust, joined up service by Provider and commissioner alike.

An immediate action taken is that, were services over and above the indicative budget
are requested, the indicative budget can be agreed pending any additional information
required to ensure that some services are in place in a timely manner. As detailed
above, services were agreed for lll in September 2011 however her grandmother did
not feel that the services available in Swindon could meet her granddaughter’s needs.
Direct Payments were available to WB from November 2011, she had originall
identified a group of personal assistants that she wanted to provide services a
These Personal Assistants subsequently did not take up the offer from Wendy and
during this time Direct Payments continued to be accumulated within her designated
account whilst she sought alternative services. It was during this time that the
commissioning team introduced Wendy to a support provider who would operate
under an Individual Service Fund to where she could have greater control over how
the support was provided and by whom. This also allowed greater flexing of the
services.

During the weeks and months preceding Wendy’s death, feedback was that she was
happy with the services which were provided t and the flexibility this allowed.

Yours sincerely

Strategic Commissioner Adults Head of Policy, Adult Social Care