Memorandum from Midstream (West Lancs)
Ltd
Midstream (West Lancs) Ltd is a not for profit
Registered Charity based in Skelmersdale, West Lancashire.
The charity provides opportunities for young
people and adults with a wide range of learning disabilities,
physical disabilities and mental health issues to obtain nationally
accredited vocational qualifications, and to partake in "real
life" work activities at it's purpose built facility in the
following vocational areas:
— Business Administration.
The organisation has also successfully operated
supported employment in kerbside recycling, and has an employment
placement advisor who works with clients to access job vacancies
within the wider business community.
The charity has been in existence since March
1995, and has a proven track record of working with its client
group. Currently the charity is financially self-sustaining in
the recovery of its revenue costs, having initially benefited
from grant funding up to 2003.
The charity was founded by the parent carer
of an adult with Downs Syndrome, who had expressed a wish to "go
to work like his younger brother." Upon investigating the
resources available to help her son access work, the parent carer
found that there were few opportunities in existence locally.
Due to this, she decided to explore the possibility of instigating
a service that would support and address the needs of her own
son, and others with special needs, in accessing employment.
In consultations with other parents who were
the main carers of young people and adults with special needs,
it became apparent that such a service was in dire need by this
sector of the community of West Lancashire.
It became the parent carer's main mission to
address this service need, and the organisation that she founded
focussed on the provision of challenging opportunities for young
people and adults with special needs.
These opportunities offered individuals the
experience of acquiring the work related skills necessary for
employment, increasing personal confidence and enabled the local
community to engage with and recognise the skills possessed by
individuals with special needs.
Midstream continues and enhances this initial
work in a caring and supportive environment, and the organisation
currently promotes the participation of people with special needs
within their own communities by:
(i) The acquisition of new vocational skills
and knowledge.
(ii) The recognition of the benefit to the
individual's wellbeing offered by the raising of ones own self
esteem by partaking in worthwhile activities.
(iii) The improved life chances that opportunity
and engagement within the world of work can facilitate.
Service users access the current opportunities
at Midstream via referral, which can be from statutory organisations
(Social Services Directorate), carers and individual service users
themselves.
All of the service users accessing the activities
at Midstream require day care support to enable them to partake
fully in the work activities offered. To facilitate this, the
charity levies a daily charge of £37.50 (£5.00 per hour)
to each service user, which is a part contribution to the recovery
of the revenue costs of the organisation in relation to providing
this support. This daily charge is usually funded via the service
users care package, which can be administered by the statutory
organisation or the individual themselves via direct payments
or "In control" funding.
The package is calculated on an individual basis
and is a reflection of the service users assessed care need.
With the advent of the Government white paper,
Valuing People, it was anticipated that service users would
be given increased choices and control over how their care packages
were derived, and the opportunities that they would be able to
access via the package. However, in the majority of individuals
referred to Midstream over the previous three years this has not
proven to be a reality. Members of the West Lancashire commissioning
team have informed Midstream that due to budgetary restrictions
and "over spend" service user's preferences cannot be
taken into account when commissioning services. In-fact, the commissioning
team is actively exploring ways to provide services "free
of charge" by accessing finite grant funding and short term
educational programmes. This obviously does not reflect the needs
and aspirations of the individual service user, and impinges on
their human rights by restricting their exercising of choice in
relation to their daytime activity.
Two recent cases involving service users accessing
services at Midstream demonstrate this increasing trend of restricting
individual choice.
Case Study 1
P is a male service user with severe learning
disabilities, Downs Syndrome and related health issues. P lives
at home with his parents and other siblings. P's mother has returned
to work, advancing her career, due to P's settled involvement
with his current daytime activity.
P attended Midstream for five days per week,
and accessed horticultural activities. P requires one to one support
to undertake the activities, but can also partake in small group
activities. P enjoys the activities he is involved in, having
attained three units of an Entry level qualification and has had
the opportunity of growing a wide range of plants from seed through
to full maturity in glass house and amenity settings. P's health,
weight and stamina have positively improved due to his inclusion
within physical activity. P's speech and interpersonal skills
have also improved due to his inclusion within the small group
settings.
P recently had a review of his service, and it
was felt by the reviewing officer at this review that P's needs
could be met by him moving from his current placement at Midstream
to attending the local authority day centre.
This centre is part of the current daytime opportunities
for people with special needs in West Lancashire, and is resourced
via a "block contract" which operates regardless of
the number of individuals accessing the centre. By P attending
this centre, the referring organisation would obviously make a
saving of the costs paid to Midstream.
P's parents are his main carers and advocates
and at the review they expressed their concerns at this change,
as they recognised that it was a "cost saving measure"
and not to the benefit of P. They also felt that the centre was
inappropriate for P's needs and future development. P's parents
felt so strongly that the centre was inappropriate for P that
P's mother felt she would be forced to leave her employment to
care for P during the daytime.
P's parent's concerns were noted by the reviewing
officer, but they were told that P's service requirement would
have to be decided by panel.
This panel consists of senior commissioning team
managers, and as such P's parent's felt that P's service provision
would be changed.
As they were unwilling to allow this to happen,
P's mother wrote to senior members of the Social Services Directorate,
and her Member of Parliament expressing her concerns and dismay,
and also stating that P's change in service would have a wide
ranging effect on his family. In addition to these letters, a
detailed progress report was undertaken by Midstream to demonstrate
P's achievements and submitted to panel.
At the panel meeting P's funding for his service
at Midstream was agreed for a further thirteen weeks to allow
Social Services time to gather further information regarding the
best placement for P in order to meet his needs now and in the
future.
P's parents were obviously happier at this result,
but the situation regarding P's long term day care was still unclear
which left the family with uncertainty regarding the continuation
of P's mother's employment.
During the 13 week extension of funding, P's
parents were encouraged to visit the day centre to assess its
provision. They did so, but still felt that it was inappropriate
for P.
The reviewing officer also observed P's activities
at Midstream for a full day to ascertain his level of engagement,
and the appropriateness of the service. Midstream was happy for
this to occur, but P's parents did express their concerns, and
were surprised that the authority would use staff resources in
this way. This observation they felt put undue pressure on P and
had an unsettling effect once again upon the family.
Following the thirteen week period, P's service
was again reviewed by panel. P's service funding was reduced from
five days to four for his attendance at Midstream. P was forced
to attend the local day centre for the remaining day. This is
his current level of service provision, and his placement at Midstream
is under review each six months.
P's family feel that they have been forced to
accept a place within the day centre which they feel is inappropriate
and de-motivating for P by the panel decision. This decision does
allow P's mother to continue employment, but they feel that the
six month review of service at Midstream has created an unnecessary
uncertainty for P to contend with and with his attendance at the
centre he may be forced to exchange further days in the future.
The above case demonstrates how a family, and
an individual already disadvantaged by disability, has been forced
to maintain services by questioning decisions made by professionals
regarding their future. Due to the proactive nature of P's family
they have been able to advocate on his behalf. However, even with
this extreme level of support his service has changed, and it
is the belief of the family that the underlying goal of the commissioning
team is to remove P from the services offered at Midstream thus
enabling cost reductions to take place.
Case Study 2
J is a male service user who attended Midstream
from leaving school for two years for three days per week via
funding secured by Midstream to offer land-based activities. This
funding provided sufficient monies to displace all costs usually
associated with service users undertaking land-based activities
and the related day-care support costs attributed to the referring
organisation. J was also able to access Midstream's own supported
employment programme for the remaining two days per week which
meant he was actively engaged for five full days.
At the end of the programme, the professionals
working alongside J within the supported employment programme
assessed him as not being capable of sustaining paid employment.
However, J was keen to continue with his land-based activities
and widen his knowledge and skills by accessing amenity horticulture
activities at Midstream's Skelmersdale facility.
As funding had ceased, to allow J to undertake
the horticulture activities a representation was made to Social
Services by J's parents for him to access day-care at Midstream.
J has a learning disability and Downs Syndrome, and requires constant
prompting to remain on task along with emotional support and direction.
As with Case Study 1, the request for funding
was referred to panel, and initial short term funding was agreed
for J to undertake day-care at Midstream as no suitable alternative
was available.
Unlike Case Study 1, J has a greater cognitive
ability than P, and it was felt by the referring panel that J
should be able to access the Lancashire Supported Employment Team
with a view to them identifying a vacancy that would match J's
skills and ability. However, following J's involvement with Midstream's
supported employment programme, and the findings of the professionals
working alongside J in regards to him maintaining employment,
concerns were voiced by J's parents and they expressed their wish
for J not to be introduced to the County Employment Service. They
also felt that J was in need of a service that would allow him
to access meaningful activities for five days per week developing
his skills and abilities in a caring and supportive environment.
The referring panel was reluctant to commission services on a
long-term basis, again due to cost, believing that J could be
supported into employment, subsequently the panel extended J's
funding several times over the next few months by a few weeks
at a time. This caused distress, uncertainty and anguish to J
and his family.
Coupled with this anguish, J was supported by
an officer from Lancashire Supported Employment who shadowed J
to ascertain his skill levels, and also removed J on several occasions
from his horticultural activities to "Job Search." This
unnerved J, and he expressed his concerns to his parents and professionals
at Midstream.
As J has limited literacy skills, he was unable
to access and apply for job vacancies independently. J also has
a speech impediment that reduces his ability to communicate effectively
with other people. These two items are significant barriers to
J when accessing employment opportunities. J's cognitive ability
also restricts his understanding of the limitations these two
barriers have on his acquiring sustainable employment.
As a consequence of this, J's aspirations of
securing employment were unrealistically raised by the officer
from Lancashire Supported Employment. As no employment opportunity
was secured by J, he became increasingly depressed, and disruptive
at home.
Following the unsuccessful attempts at introducing
J to employment, a review was undertaken at Midstream. At the
review Midstream's Operations and Training Manager outlined his
concerns regarding the way in which J's aspirations towards securing
employment were being unrealistically raised, and the behavioural
and emotional problems this was causing. J's family confirmed
that J was unhappy and unsettled by the process.
Due to the underlying requirement of J being
introduced to employment as a means of reducing the funding requirement
of the Social Services Directorate, it was agreed that the employment
officer would continue to search for opportunities for J, but
would not directly involve him in the process.
The employment officer would only introduce
opportunities to J if there were a realistic chance of J securing
an opportunity. With regards to J accessing day-care it was suggested
by Midstream's Operations and Training Manager that a period of
stability was required by the family and J to help him develop
his skills further, but also to help him regain the emotional
stability that his recent experiences had caused. The reviewing
officer stated that she would pass this to panel, but as yet no
firm decision has been made, and J's day care funding is under
short term review.
In conclusion, the two case studies above outline
individuals and family members who have had their right to choice
changed and denied by others. The main factor for this is due
to lack of County funding to enable these individuals to undertake
their chosen paths.
The two case studies are not isolated incidents,
with many more disadvantaged individuals requiring meaningful
services in West Lancashire to allow them to engage with, and
contribute to their local community. It is hoped that this review
will highlight these issues and facilitate their empowerment.
23 May 2007
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