Improving access to social care for adults with autism
The mechanisms for joint working
Social care services need to work in partnership with other parts of the service landscape to provide a coherent response to the needs of people with autism. However, social care itself also needs to be more joined up. As we have seen, people with autism, especially those with Asperger's Syndrome or high-functioning autism, can fall between the gaps in social care provision, and sometimes receive little or no social care support, until perhaps their needs escalate to crisis point. More collaborative efforts, at strategic and operational level (35), can prevent this happening (36).
Locally, the key strategic mechanism for this is the Joint Strategic Needs Assessment*. Currently, these are produced by Local Strategic Partnerships and led by directors of public health. The Joint Strategic Needs Assessment in each area will, pending legislation, become the responsibility of the local Health and Wellbeing Boards, which will bring together local authorities, general practice commissioners, other public and voluntary sector bodies and - via Healthwatch - user and carer representatives.
Fulfilling and Rewarding Livesplaces the Joint Strategic Needs Assessment at the heart of joined-up planning for people with autism (10). The first task for Joint Strategic Needs Assessments is gathering accurate data on the number of people with autism in the local area. From there, local areas, led by the lead commissioners for autism, can jointly plan a commissioning strategy to develop the services that are needed. To do this well, Joint Strategic Needs Assessments should include:
- key characteristics such as the age, race and sexuality of people with autism, as well as where and with whom they live (11)
- links with health, education, housing, employment and community groups
- input from children's services as they relate to people with autism
- facilities for joint training and pooled budgets to allow for as much flexibility as possible.
Lead local commissioners for autism are vital to good planning and joint working. They need to:
- be on mainstream health and social care commissioning bodies as well as autism-specific ones, so that people with autism are on the agenda of all relevant planning groups, and are not seen as a minority interest
- ensure that all relevant contracts include the requirement to meet the needs of people with autism
- link up with autism charities and user-led organisations, and promote the involvement of people with autism and their carers in service design and delivery
- promote localised, non-residential provision (23), which will involve good partnership working with housing services
- ensure that local provision is available for people with autism with behaviour that challenges services, including in an emergency
- develop clear protocols as to where people with autism will receive support, to avoid the gap between mental health and learning disability services
- promote effective information sharing between and within public bodies and voluntary organisations
- consider the extra costs of autism in their commissioning strategies, and when setting up Resource Allocation Systems*.
Fulfilling and Rewarding Livessuggests (but does not insist) that autism planning can be done by local autism partnership boards, which bring together people with autism, their carers and advocates, service providers and statutory commissioners to look in more detail at how services for people with autism can be improved (10). Another proposed option is an autism subgroup attached to learning disability or mental health partnership boards. The strategy also calls for an expanded role for community and autism user-led organisations in leading on this joint working (10).
Local areas are beginning to make progress with this agenda, and have already begun to self-assess against the goals of Fulfilling and Rewarding Lives, looking at not just social care, but also links with employment, housing and other mainstream services, and at locally determined priorities.
How joint working on autism is developing at a regional level varies from area to area, but as central government direction reduces and pilot developments such as Community Budgets take shape, local autism bodies have the opportunity to influence provision in meaningful ways. In some regions, the needs of people with autism are included in general themes such as employment or housing in Joint Improvement Partnership plans, drawn up by local authority leads, strategic health partners and other key agencies*. In other regions, Joint Improvement Plans take a specific autism focus in their delivery mechanisms. Each region has a Department of Health deputy regional director who can advise on how autism developments are making progress. The deputy regional directors, alongside the regional bodies they support, will also identify local autism specialist services that may be able to build their capacity (10).
* Joint Strategic Needs Assessments, Resource Allocation Systems and Joint Improvement Partnerships do not operate in Northern Ireland. For commissioning information, refer to guidance produced by the Health and Social Care Board in Northern Ireland, Priorities for action and related Public Service Agreements (37). Mechanisms for joint working are a focus of the DHSSPS strategic action plan for autism 2008/09–2010/2011 (15).