5a 20151207 - Stephen Bubb Group Meeting - Papers

8/20/2019 5a 20151207 - Stephen Bubb Group Meeting - Papers

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Winterbourne

Progress Meeting

Sir Stephen Bubb

7 December 2015Coin Street Neighbourhood Centre

1


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Agenda

• Welcome & introductions

• Overview of Progress

• “Building the Right Support” - update

• Workforce - update

• Feedback from Sir Stephen Bubb consultation

• Update on wider NHS England LD work

Wider NHSEngland LD work

WorkforceFeedback from SB

consultationBuilding the Right

Support Overview of

ProgressAgenda 2


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Transforming Care – Next Steps:

update on progress

3Wider NHSEngland LD work



Support Overview of

ProgressAgenda

• Transforming Care – next steps 29 January 2015 publication set out:

– Single crosssystem programme six organisations !or"ing toget#er

– $%$SS& '($& %)& )**& C+C& ,)S *nglan- – Copro-uction built in to all aspects

• .i/e interlin"e- !or"streams: – *mpo!erment %) lea-

– %ata an- information %) lea-

– egulation C+C lea-

– ig#t care ig#t place ,)S *nglan-& '($ an- $%$SS lea- – “Building theright Support” to be covered in depth

– 4or"force )** lea- – to be covered in depth


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Empowerment (DH)

Empowering individuals and families – scope of work

Encouraging self-advocacy an- peer

support

$ccess to high quality

advocacy for in-i/i-uals

in t#e Transforming Carerogramme

6nformation on rightsan- access to support

Empowering local people

!it# information to

influence& s#ape an-

c#allenge local ser/ices




Support Overview of

ProgressAgenda


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Empowerment (DH)Progress since July

J68%) fun-ing to

support series of

facts#eets for families

– le- by encap8C.;

ublished October

2015

6ncrease- in/estment in non

statutory a-/ocacy ser/ices

e;g; selfa-/ocacy

%isc#arge pac" commissione-

C)$,(* – complete

-iscussions ta"ing place !it#

,)S *nglan- re; -issemination

an- embe--ing into practice

e;g; /ia CTs

'ocal information pac" by

t#e ,ational .orum foreople !it# 'earning

%isabilities& an- ,ational


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Empowerment (DH)Government response to No Voice Unheard, No Right Ignored

consultation

$ focus on #o! people can li/e

independently in t#eir communities an-

ma"e choices in t#eir li/es

• 6ssuing gui-ance for commissioners on #o! to

support people to li/e in-epen-ently in a #ome

t#at t#ey c#oose& an- in/ol/ement in t#e -esign8

-e/elopment8 -eli/ery of ser/ices

• !iloting access to a named social wor"er to be aprimary point of contact and provide a

professional voice across the system

• 4or"ing !it# partner organisations to pro/i-e

-efiniti/e information on rig#ts

• #onsidering how #are $ %reatment &eviews can

be e'tended to local authority-led placements

and be strengthened

• Enabling patients and families to challengewhether their wishes and feelings were

appropriately considered in detention decisions(

• Consi-ering intro-uction of a single a-/ocacymo-el bringing toget#er existing sc#emes=

• &eviewing whether the )ental *ealth ct should

continue to apply to people with learning

disabilities and autism(

* subject to further consultation




Support Overview of

ProgressAgenda

+ey proposals in the ,overnment response

>


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Data and Information (DH)Scope of work

efining t#e ?at ris"@co#ort

.mproving the quality of

-ata an- information to

#elp us un-erstan-

progress

&emoving barriers toinformations#aring

+uality of 'ife an- +uality

of Care indicators for

inpatients an- community

settings

AWider NHSEngland LD work



Support Overview of

ProgressAgenda


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Data and information (DH)

Progress since July – 1

Since /eb 2015& $ssuring Transformation -ata is

collecte- by )SC6C on a li/e Clinical $u-itlatform& an- since ugust submitte- -ata

collections for t#e pre/ious > mont#s can be

correcte- as -ata Buality an- /ali-ation

impro/es;

,)S *nglan- #as been !or"ing !it# commissioners to Buery all

patients reporte- in t#e 2017 '% Census t#at are not inclu-e- in

t#e $ssuring Transformation -ata; To -ate o/er >00 recor-s #a/e

been reconcile-;

,ational -ata

publis#e- monthly-etaile- -ata

publis#e- quarterly

e-uce- reliance on inpatient ser/ices !ill be

monitore- using $ssuring Transformation -ata& an-from pril 201 t#e ental )ealt# Ser/ices Single

%ata Set )S%S& incorporating -ata from t#e

'earning %isabilities Census an- $ssuring

Transformation -ataset;

%) commissione- a 'earning %isability Census 2015 to

buil- on t#ose in 2013 an- 2017 to pro/i-e a snaps#ot of

-ata collecte- by pro/i-ers

.mproving the quality of data and information




Support Overview of

ProgressAgenda


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Data and Information (DH)Progress since July – 2

To ma"e sure information is s#are- in line !it# t#e la!& professional stan-ar-s an- goo- practice !e #a/e

-e/elope- a consent form an- gui-ance for professionals an- patients to obtain an in-i/i-ual@s consent

before information is s#are-

roblems !it# information s#aring bet!een -ifferent organisations can act as a barrier to effecti/e

planning an- commissioning& an- re-ucing a-missions;

%elp#i exercise complete- to agree a set of in-icators

T#e in-icators co/er four care settings: local psyc#iatric inpatient mental #ealt# care

specialist inpatient mental #ealt# care communitybase- mental #ealt# care an-

!i-er general #ealt# care an- map to t#e ser/ice mo-el;

Ongoing

4or" being

commissione- an-

fun-e- by%epartment of

)ealt#

3arriers to information sharing

roposals -e/elope-

for D8*

4or"s#op

4ecember 2015

6uality of Life

D8* by

pril 201

-eli/ere- /ia

refres#e- CT

gui-ance

6uality of #are

7t ris"8 cohort 9

the 2:000

Wider NHS EnglandLD work



Support Overview of

ProgressAgenda 9


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Update on objectives – enforcement (CQC)

• $im: to get clear -efinition of responsibilities of partners8agencies

• Statement on roles of partners !#en enforcement action is ta"en#as been -e/elope- an- is out for consultation

• artners inclu-e ,)S*& '$ '($8$%$SS& %)& )**

• ole of pro/i-ers an- commissioners also inclu-e-

• Ese of ?!arning signs@ -ata to i-entify ser/ices !#ere t#ere may

be concerns




Support Overview of

ProgressAgenda


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Update on objectives – inspection methodology

(CQC)• $im: to support inspectors in analysing !#at goo- loo"s li"e in '%

ser/ices& !it#in t#e fi/e -omains

• Complete- -e/elopment of '% specific tables for gat#ering

e/i-ence in relation to 5 -omains in #ospital ser/ices• '% specific training for inspectors on communication& furt#er

-e/elopment of met#o-s to communicate !it# families

• (ui-ance on inspection of Supporte- 'i/ing ser/ices in-e/elopment

• Complete- brief gui-es for #ospital inspectors on – syc#oacti/e me-icines learning -isabilities – estraint p#ysical an- mec#anical

– (oo- communication stan-ar-s for people !it# a learning -isability orautism

– ositi/e be#a/iour support for people !it# be#a/iours t#at c#allenge – %isc#arge planning in '% ser/ices – $!aiting appro/al – .unctional assessment




Support Overview of

ProgressAgenda


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Update on objectives – registration (CQC)

• $im – to align registration of ser/ices !it# Transforming Careser/ice mo-el an- ,ational lan

• To -ate:

– 'earning -isability applications consi-ere- by -e-icate- team toa--ress compliance !it# ser/ice mo-el

– osition statement on C+C approac# to registration an- reregistration to be publis#e- on !ebsite

– .ull policy statement un-er -e/elopment




Support Overview of

ProgressAgenda 12


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Right Care Right Place (NHS England, ADASS, LGA) –

headlines

Inpatients

1. Total no: 2620 – reducing (31 March 2015: 2720), but further to go – all NHS England regions actively

managing progress with commissioners.2. Admissions and Discharges.

3. Care & Treatment Reviews. Inpatient CTRs established (770 + done this year); pre-admission workbeginning to take effect; increased focus on issues preventing discharge.

4. Length of stay: increasing focus onto people with Length of stay >5 years.

5. Data quality: significant work to improve completeness and accuracy of Assuring Transformation (AT)dataset. AT refresh implemented, to enhance usefulness.

Future care deliverables - published on 30 October 2015:

• Service model - guidance on what health and care services should be in place.

• National plan for building up community support and closing inpatient services – Building the RightSupport. – The service model and national plan will be discussed in more detail later in the meeting.

• Finalised Care & Treatment Review (CTR) policy - incorporating the learning from over 2000 CTRs.




Support Overview of

ProgressAgenda


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Care & Treatment Reviews (CTRs)

Data to 15/11/2016 shows:

• 2,340 inpatient CTRs have been carried out since October

2014.• Inpatient CTRs continue – with 771 completed to date in

15/16.

• CCGs are being supported to mobilise pre-admissionCTRs, and local assurance processes are in place tochallenge all new admissions. Nationally 63% of pre-CTRsresult in a decision ‘not to admit’.

Source: $ssuring Transformation -ata

Inpatients

2&395 2&775 2&7A5 2&510

2&5>5 2&>00 2&595 2&>20

2&A20 2&>5 2&>95 2&>A0 2&>>5 2&>>0 2&>25 2&>20

1&000

1&200

1&700

1&>00

1&00

2&000

2&200

2&700

2&>00

2&00

3&000

ar15 $pr15 ay15 Jun15 Jul15 $ug15 Sep15 Dct15

original inpatient count re/ise- inpatient count

Reconciled Inpatient Count (October 2015)

;o of

!atients

*igh

5 1225

;orth

9>0 = 1>5 315 70

)idlands

10A0 55 230 700 35

London

2A5 10 35 >0 1A0


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Admissions & Discharges

15/16: Discharges/Transfers and

Admissions/TransfersThere have been 985 reported discharges ortransfers year to date, and 885 reported admissionsor transfers year to date 15/16. This represents asteady rate of reduction in the inpatient cohort acrossQ1 and Q2.

* Data source: Assuring Transformation. Totals includepatients admitted and discharged within the same month.Published data has these patients listed separately and thetotals obtained by adding rounded published data may not

match the totals here calculated from source data

15/16 All Inpatient: National Monthly Admissions & Discharges*




Support Overview of

ProgressAgenda 15


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1>

Policy

• National policy now published.

• CTR-based approach forms part of Government response toGreen Paper.

Impact

• Pre-admission CTRs showing good success rate for avoidingadmission (table right); now working to increase use, across thecountry.

• Regions actively tracking delivery of inpatient CTRrecommendations.

• National Quality Audit to be carried out December / January – toimprove understanding of issues and root causes.

Issues being addressed next• Admissions from Criminal Justice System.

• Delayed transfers of care related to individual commissioningcomplexities.

Care and Treatment Reviews

Latest period

42 wee"s(

=%(

6npatient CTs A> AA1

Con/ersion rate

FT%39G

range: 3172G

rea-mission

CTsA >5

Con/ersion rate

FT%>3G

range: 53100G




Support Overview of

ProgressAgenda

* Data source: NHS England management information


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April 2014 Cohort – National and Regional Position;ational ischarge %ra>ectory 3 CTs #a/e been

un-erta"en& !it# a national a/erage of 77G being foun- ?fit for -isc#arge@;

$ll outstan-ing CTs are planne- before t#e en- of +3;

139 patients are yet to #a/e a CT in lo! an- non secure settings& an- t#e

reasons for t#is broa-ly brea"-o!n as belo!:

ischarges?

Df t#e 2>71 patients in t#e original co#ort& A1 patients #a/e been

-isc#arge- to 31st Dctober; .urt#er 11A -isc#arges planne- by t#e en-

of %ecember to bring t#e total -isc#arge- to 9& 500 of !#om being

-isc#arge- since t#e intro-uction of CTs in ,o/ember 2017;

397 patients remain in #ospital follo!ing a CT -ecision to -isc#arge& 2AA

A0G of !#ic# #a/e a -isc#arge -ate;

11A patients remain in #ospital !it#out a -isc#arge -ate;

Hey reasons for -elaye- -isc#arge :

• patient@s con-ition -eteriorate- since CT• Care pac"ages not a/ailable• 'egal c#allenge or -elay – DJ& Treatment Dr-er& family consent

•'ac" of personcentre- care planning

• .in-ing suitable community pro/i-er or -elays in contracting

ischarge @

months

0 >

;o of

!atients

*igh

>0

;orth

>90 = 130 2A5 20

)idlands

A15 55 15 305 1A0

London

1A5 10 25 75 95


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Length of Stay – National and Regional Position

Care and Treatment Reviews (5yr+):A total of 417 CTRs have been completed for this cohort.118 patients are in low/non secure and are yet to have a CTR (Alloutstanding CTRs are planned before the end of Q3).

The reasons for not having a CTR broadly breakdown as:

5yr+ Stay patients588 patients who have been in hospital for 5 years or more arecurrently identified within regional management trackers. Thisnumber is less than reported on Assuring Transformation, andwork is being done to reconcile this gap.

Of the 588 known long stay patients, 317 (54%) have a discharge

date. Of those 118 (20%) are expected to be discharged this year.

237 patients remain in hospital without a discharge date. Theremaining 34 patients are either not yet suitable for discharge, orexpected to be discharged to a different setting.

ischarge@

months

ont#s A0 25 25 30

> – 12 ont#s 35 20 35 70

1 – 2 Fears20 25 30 25

2 – 5 Fears 25 20 25 15

ore t#an 5 Fears 35 15 30 30

LoS Profile for Current Inpatients : 31st October 2015

Source data: Assuring Transformation.

ean 5;32 Fears

e-ian 3;0 Fears

G o/er 5 Fears 37;0G

LOS Profiles for Inpatients Discharged within thequarter

Source data: Assuring Transformation.




Support Overview of

ProgressAgenda 1


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‘Assuring Transformation’- improving quality of information

!ercentage of ata ;on-


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Building the Right Support (NHSE, ADASS, LGA) –

update

Publications

• a service model - guidance on what health and care services should be in place.

• a national plan for building up community support and closing inpatient services – Building the Right Support.

National Commitment: c. 35-50% reduction in total inpatient numbers

Calderstones Partnership Foundation Trust – specific plans

Delivery: to be led by Transforming Care Partnerships

Support for delivery




Support Overview of

ProgressAgenda


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National Commitment c. 35-50% reduction in totalinpatient numbers.

In three years local areas should need hospital capacity to care for no more than:

• 10 – 15 inpatients in CCG-commissioned beds per million adult population at any one time

• 20 – 25 inpatients in NHS England commissioned beds per million adult population at anyone time

• Approx. 35-50% reduction nationally (from c. 2,600 to c.1,300-1,700)

-80.0%

-70.0%

-60.0%

-50.0%

-40.0%

-30.0%

-20.0%-10.0%

0.0%

W e s

s e x

S o u t h W

e s t

S o u t h C e n

t r a l

L o n d o n

S o u t h E

a s t

C M i d l a n d s

E

a s t

E n g l a n d A v e

C h e s h i r e & M e r

s e y

Y o r k s & H u m

b e r

L a n c s & G M

N M i d l a n d s

W M

i d l a n d s

C u m b r i a &

N E

% reduction -upper

% reduction -lower

England ve




Support Overview of

ProgressAgenda 21


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• Last learning disability hospital trust with 223 beds

• Greater Manchester and Lancashire fast tracks plans published and

consultation and engagement central to the process of change• All beds on the current Calderstones site will close (subject to

consultation) and be re-provided on a case by case basis for each patient,in the community or elsewhere in the North West

• Mersey Care NHS Trust will take over Calderstones Partnership NHSFoundation Trust – which from July 2016 will cease to exist

• Joint medical director to provide clinical leadership for change

• ACEVO – piloting ‘support package’ approach in Lancashire – creativecommunity based solutions

Calderstones Partnership Foundation Trust




Support Overview of

ProgressAgenda


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Locally, delivery will be led by Transforming Care

Partnerships

• Partnerships of CCGs, local authorities and NHSEngland specialised commissioners are currently

being mobilised and in place by 15th December.

• Specialised commissioning budgets for LDservices will be aligned by April 2016

• Draft plan by 8th February

• Final plans assured by March 31st

• Bespoke package of support will be put in placeto help areas plan for transformation

23Wider NHS

England LD workWorkforce

Feedback from SBconsultation

Building the RightSupport

Overview ofProgress

Agenda 23


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Support for Delivery

• £30m transformation funding and £15m capital – directed for impact• Regional teams to enable planning, assure, strategic resettlement, accelerated

support

• Improvement programme – hearts and minds, spread

• Cross-sector support package – commissioners and providers

• Redesign services• Developing local responses to emergencies

• Train the local workforce• Secure the capital• Broker and connect for solutions




Support Overview of

ProgressAgenda


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Workforce – update (HEE)

Phase 1: Development of transformation enablers

Phase 2: working with the Fast Tracks

Phase 3: Building the Right Support - Working with Transforming Care Partnerships




Support Overview of

ProgressAgenda


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Overview of workforce work

The overall aim of programme is for more people with a learning disability and/or autismwho have a mental health condition or display behaviour that challenges, to live in thecommunity

• Total in patient cohort of2,500 with a high riskcommunity population of25,000

• Transforming care by

working with Skills for Care

and Skills for Health

• Education and Training for

LD Workforce

• Education and training for

the whole workforce

• Workforce Planning for LD

2>Wider NHSEngland LD work



Support Overview of

ProgressAgenda

Ph 1 D l t f T f ti E bl


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C o m m i s s i o n b e s p o " e t r a i n i n g

p a c " a g e s t o m e e t n e e - s & i e 3

5 : S & ' e a - e r s

# i p & m e n t a l

# e a l t # a s s

e s s m e n t

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i m p l e m e n t

n e ! r

o l e s

E n - e r t a " i n g l e

a r n i n g n e e - s

a n a l y s i s t o e s t a

b l i s # t r a i n i n g

n e e - s o f t #

e e x i s t i n g

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o r c e

4 o r " f o r c e p l a n n i n g a n -

m o - e l l i n g !

i t # s e r / i c e

p r o / i - e r s

E t i l i s i n g

s " i l l s I

c o m p e t e n c y

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4 o r " f o r c e p l a n n i n g ! i t #

c o m m i s s i o n e r s

)eat# Isocial care

nee-s

CC( loo"s to

commissionser/ice

pro/ision

S"ille-

4or"forceSupply

Support from local

)** teams& SfC I

Sf)

4or"force rogramme *nabling ro-ucts

!erson with aLearning

isability

Phase 1: Development of Transformation Enablers

*mploye- by ,)S&social care or -irectly

by ser/ice user




Support Overview of

ProgressAgenda 2A


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Case Study: Alex's Story

#ttps:88#ee;n#s;u"8!or"programmes8mental#ealt#an-learning

-isability8learning-isability8e-ucationan-trainingforlearning-isability

!or"force8




Support Overview of

ProgressAgenda 2


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• Appropriate needs assessment

• Understanding personal aspirations and advocating leisure activities

• Safe risk mitigation

• Responding early to deteriorating physical and mental health

• Developing core skills within the workforce

• Multi agency skills mapping

What do we need to address?




Support Overview of

ProgressAgenda 29


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• Behaviours to enable resilience

• Reducing challenging behaviour

• Good physical and mental health• Meaningful and fulfilling lives

• Appropriate level of skills, competencies and knowledge

across whole and specialist learning disability workforce

What do we need to achieve?




Support Overview of

ProgressAgenda 30


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• Education and Training for LD Workforce

• Workforce Planning for LD

• Education and training for the whole workforce

Key Programme Areas




Support Overview of

ProgressAgenda 31


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Education and training of the learning disability workforce

• Learning Disability Skills and Competency Framework is available on HEEwebsite and is being promoted across England.

• Skills for Health, Skills for Care and Health Education England are developinga Learning Disability Core Skills Framework to map education curricular to acompetency framework.

• PBS-Autism training fund.

• Series of inspirational videos from leaders at all levels across health and

social care.




Support Overview of

ProgressAgenda


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Workforce planning for learning disabilities

• Completed a review of the learning disability workforce demand andeducation commissions across England.

• Secured increase of learning disability nursing education commissions in2016/17.

• Scoping how to increase intelligence of learning disability workforceacross health and social care and attractiveness of a career in learningdisability nursing.

• Improvements to occupation codes to enable workforce planning acrossall professions.




Support Overview of

ProgressAgenda


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Education and training of the whole workforce

• Learning disability awareness resource

• Shortlisted for two Nursing Times Awards• Website 10000 hits

• Emphasis on training and development for carers and scoping

a series of workshops• Autism awareness training resource guide




Support Overview of

ProgressAgenda


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Phase 2: Fast Track Sites

• Support offered to each CCG SRO and provider organisation through anamed lead.

• Workforce commissioning specification developed to support fast trackplans.

• Workforce guidance written into ‘Building the right support’ National PlanDocument.

• First cut plan submissions reviewed and feedback guidance given onworkforce improvements.




Support Overview of

ProgressAgenda


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• Facilitated fast track site workshops acrossgeographies in partnership with NHS England

• Support to establishment of workforce workstreamsub groups

• Liaison and support to LD leads in local HEE teams

• Supporting geographical SROs with high levelworkforce plans

Fast track site support




Support Overview of

ProgressAgenda

Fast Track Site Workforce Priorities


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Fast Track Site Workforce PrioritiesDelivered at Scale

• Utilisation of the Learning Disability Skills and Competency Framework, to includemodelling of crisis teams and community learning disability teams on a competencybasis, as opposed to professional mix

• Leadership development for commissioners and system leaders across health andsocial care. It is anticipated a series of action learning sets will be delivered by March2016

• Modelling of workforce requirement based upon service models as they emerge andmapping of both NHS an social care workforce supply

• Delivery of PBS workshops through a unique model that includes family carers and

paid professionals.

3AWider NHSEngland LD work



Support Overview of

ProgressAgenda


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Mapping skills and competencies for

intensive support and community teams




Support Overview of

ProgressAgenda

Workforce Development - A piece of the Jigsaw


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)**inter/entions

an- support

4or"force lanning

(eneric 4or"force%e/elopment

Solutions

4or"forceo-elling

%e/elopment oflocal plans an-support !it#in

t#e regions

Workforce Development A piece of the Jigsaw…




Support Overview of

ProgressAgenda


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Building on the LD Skills and Competency Framework




Support Overview of

ProgressAgenda

Existing LD crisis prevention and


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#L%

with embedded crisis

prevention and

intervention function

#&.


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• Developing a document that details the skills and competences for LDcommunity teams

• Identifying generic role descriptors at Support Worker, AssistantPractitioner, Practitioner and specialist levels

• Identifying the essential skills and competencies for the crisis functionin recognition of the three differing models of LD crisis prevention andintervention.

• Modelling the workforce for an Intensive Support Service

Developing a workforce solution




Support Overview of

ProgressAgenda

A holistic approach to improving the LD crisis preventionand intervention response 1


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- E ) ; - / # % O & <

$/ailability of out of #ours '%

#ealt# ser/ices

Support to c#ange mo-els of ser/ice;

Competency frame!or" tool to -e/elop

t#e !or"force

'ocal implementation !it# support

an- tools from )**

$bility of '% #ealt# ser/ices at

lo!er tier to cope

6-entifying 'earning ,ee-s Esing '%

Competency .rame!or" I

Commissioning 6nter/entions

'ocal implementation !it# support

an- tools from )**

)ealt# pro/i-er approac# tocrisis $E or is" $-/erse

Culture C#ange 'ocal inter/entions

Capacity an- s"ills of

complementary ser/ices

4or"force lanning I %e/elopment for

Social Care 4or"force

'ocal approac# to implementation in

partners#ip !it# social care& S"ills for

Care an- )**

Commissioners familiarity !it#

-ifferent approac#es8mo-els'ea-ers#ip

'ocal approac# to implementation

!it# )** lea-ers#ip tools training

for commissioners

.;%E&CE;%.O;< .;%E&CE;%.O; LECEL

and intervention response - 1

Wider NHS EnglandLD work



Support Overview of

ProgressAgenda 73

A holistic approach to improving the LD crisis prevention


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.;%E&CE;%.O;< .;%E&CE;%.O; LECEL

< D ! ! L = / # % O & <

$/ailability of complementary

ser/ices8t#ir- sector supply

4or"force planning -ata I mar"et

-e/elopment

egional approac# !it# support from

S"ills for Care an- )**

*xisting mo-els of ,)S '% ser/ice

-eli/ery



t#e !or"force

'ocal implementation !it# support an-

tools from )**

egional an- sub regional /ariance

in commissioning mo-els an-

approac#

o-elling t#e !or"force for 6ntensi/e

Support Ser/ice

egional approac# to implementation

!it# support from )**

*xisting le/el of integration of

ser/ices



t#e !or"force

'ocal implementation !it# support an-

tools from )**

and intervention response - 2




Support Overview of

ProgressAgenda 77


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• Fast track sites reliance on community learning disabilities teams toreduce inpatient referrals

• Strengthening or development of crisis response services also seenas integral to reduce admissions

• Inconsistency in models of delivery at local level

• No available “recipe” of a workforce and definition of skill setrequired to ensure services are delivered to meet future need

Current challenges




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Phase 3: Building the Right Support - Transforming


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Care Partnerships

• Attending each dialogue event to outline support offer through

national team and local offices

• Augmenting team to provide workforce specialist support in each

geography to coordinate and support local HEE delivery in 49

partnerships

• Continuing to build bank of resources to support workforce

transformation i.e.; new role templates, intensive support team

workforce modelling




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Programme Summary


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Leading andFacilitating

Identifying theGaps

Stakeholdercollaboration

Servicespecification

Families and People

HEE, Skills for Care, Skills for Health, CQC, ADASS, NHS EnglandLocal networks

Leadership Academy

Learning Disability Skills and Competency FrameworkIntensive Support Service and Community Learning Disability Team

modelling

New role templates and training frameworks

Learning Needs Analysis Tool

Workforce Intelligence HEE/ Skills for CareWorkforce Planning HEE/ Skills for Care

National Plan guidanceSupport to workstream groups

Facilitated workforce plan development

Model Terms of Reference

System leaders forum

g a a y




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Feedback on “Time for Change” consultation




Support Overview of

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Wid NHS E l d k L i Di biliti


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Wider NHS England work on Learning Disabilities

• Premature mortality review

• Annual health Checks

• Access to healthcare

• Employment of people with learning disabilities




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Premature Mortality Review


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Premature Mortality Review

Established June 2015

• Three-year project involving NHS England, HQIP, and Bristol University.

• First comprehensive, national review set up to get to the bottom of why people with learning

disabilities typically die much earlier than average, and to inform a strategy to reduce this

inequality.• Oversight group including DH and voluntary sector (Mencap, NDTI etc.); Consultation group

– experts by experience

• Working with regions, Strategic Clinical Networks, and emerging Improvement Networks

• Using national data, working with PHE (LD), Patient Safety systems.

Next steps:

• Setting up local Premature Mortality Review functions to review cases. Some areas(Cumbria/NE) already piloting work.

• First report to be delivered – March 2016.

• Case reviews will support health and social care professionals, and others, to identify, andtake action on, the avoidable contributory factors leading to premature deaths in thispopulation.




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Annual Health Checks


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Annual Health Checks

Year Expenditure(£m)

Numberofpractices*

Numberof healthchecks

2013/14 10.70 6693 96,9742014/15 11.57 7181 124,084

Current position• Delivered via DES (Directed Enhanced Services)

• Prior years show increase of expenditure and uptake.• Annual Health checks for 14-17 year olds introduced in

2014-15.• New data due: December 2015 (for 2014/15).• AHC Indicator agreed for CCG Assurance Framework and

Planning Guidance

Next steps (2016/17)• Joint programme with IHaL to increase uptake• Actions to improve alignment to GP flagging systems.• People and families info to increase awareness.

= $ccepting %*S




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Access to Healthcare - 1


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Access to Healthcare 1

52

Objective: Improve coverage of flu vaccinations for people with a learning disability.• Current position - Agreement is now in place that People with a Learning

Disability will be identified as a ‘Priority Group’ in the national Flu Plan

• Next steps – To explore potential mechanisms for monitoring uptake,identifying groups where uptake is low, target hard to reach groups

Objective: Improve access to Cancer Screening programmes (breast, bowel andcervical)

• Current position – Targeted work across the country has demonstratedexcellent progress in improving uptake within areas where this has beenprioritised locally, but difficult to identify the LD cohort prior to appointment.

Working in partnership with PHE to enable this, so that reasonable adjustmentscan be made.

• Next steps – to consolidate the ‘flagging’ of patients within screening systemsand to link access to current best practice (see above) and materials toservices.




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Access to Healthcare 2


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Access to Healthcare - 2

53

Objective: NHS 111 – improving access and response

• Current position – Commitment from NHS 111 to improve awareness andaccess to NHS 111 services for patients with LD . Work underway to review

existing NHS 111 easy read info, to develop training materials and to enable

identification of LD on Summary Care Records (SCR)• Next steps – Consolidate current position, support NHS 111 to incorporate LD

specific training to staff, promote NHS 111 with LD population including careproviders and families, continue work on SCR to achieve ‘flagging’

Objective: Develop LD register systems in Primary Care• Current position – Good coverage of most adults with moderate to more severe

LD, need to improve inclusion of those with milder LD / autism; need to ensurechildren are captured on registers. Being on LD register will link into flagging onSCR

• Next steps – Capacity for ‘enriched’ SCR is now available, we want to utilise thiscapacity to utilise the SCR as a gateway to additional information such ashospital passports, communication plans, crisis plans, PBS plans etc…..




Support Overview of

ProgressAgenda

Employment of people with learning disabilities


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Employment of people with learning disabilities

NHS England and NHS Employers have joined forced to encourage NHS organisations toincrease employment of people with learning disabilities.

• Set of tools and guidance published to help raise awareness and highlight good practice

• NHS organisations are invited to make a pledge to commit, get ready for and then employpeople with learning disabilities.

• Currently, the NHS England Learning Disability programme:

– employs four people with learning disabilities. – contracts with many more as Experts by Experience (for Care & Treatment Reviews and

similar work).




Support Overview of

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Annex

55

uil-ing t#e ig#t Support Context

T#e c#anges !e expect to see nationally

Annex


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Context

5>Annex

National plan is the latest step in a longjourney


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journey

1993: 1st ansell

report

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200A: 2n- ansell

eport

2011:

4interbourne


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learning from fast tracks

• Over the summer, we supported fast tracksites (collaborations of CCGs, local

authorities and NHS England specialisedcommissioners) to develop transformation

plans - to close inpatient services andstrengthen support in the community.

• They were also given the opportunity to bid

for a portion of a £10m transformation fund

Annex 5

The fast tracks proposed bed reductions of c. 50%


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Fast track areas envisageusing c. 300 fewer beds by2020 (c.50% reduction).

All occupied beds

;*


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!ro>ected bed usage per million

population

p g

Annex >0

This translates to major changes to services


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For instance, Calderstones Partnership NHS Foundation Trust:

• The only remaining stand alone learning disability hospital trust in England with 223beds.

• Mersey Care NHS Trust will take over Calderstones Partnership NHS Foundation Trust – which from July 2016 will cease to exist.

• Plans developed by Greater Manchester and Lancashire fast tracks with NHS EnglandSpecialised commissioners, will implement a new service model resulting in asubstantial reduction of beds (>60% fewer than currently).

• All beds on the current Calderstones site will close (subject to consultation) and be re-

provided on a case by case basis for each patient, in the community or in new state ofthe art units elsewhere in the North West

• Ongoing consultation and engagement with people with learning disabilities, theirfamilies and carers will be central to the process of change

• Joint medical director appointed by Calderstones and Mersey Care to provide clinicalleadership in the process of bringing the two organisations together

j g

>1Annex


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The change we expect to see nationally

>2Annex

The services we need


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>3

A national service model, jointly produced by NHSE/LGA/ADASS, outlined in the National Plan and publishedin full alongside it, sets out the range of services we will support local areas to put in place.

A draft of the model was published in the summer (with c. 150 responses from stakeholders), & tested with fasttracks.

The model is structured around 9 principles seen from the point of view of a person with a learning disabilityand/or autism:

1. I have a good and meaningful everyday life.2. My care and support is person-centred, planned, proactive and coordinated.3. I have choice and control over how my health and care needs are met.

4. My family and paid support and care staff get the help they need to support me to live in the community.5. I have a choice about where I live and who I live with.6. I get good care and support from mainstream health services.

7. I can access specialist health and social care support in the community.8. If I need it, I get support to stay out of trouble9. If I am admitted for assessment and treatment in a hospital setting because my health needs can’t be met in

the community, it is high-quality and I don’t stay there longer than I need to.

Annex

National Service Model


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Annex >7

New planning assumptions for inpatient capacity


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Implementing this model of care will result in a significantly reduced need for hospital care.

In three years local areas should need hospital capacity to care for no more than:

• 10 – 15 inpatients in CCG-commissioned beds per million adult population at any onetime.

• 20 – 25 inpatients in NHS England commissioned beds per million adult population atany one time.

These planning assumptions are based on what fast tracks told us was possible, sense-

checked against current geographical variation in use of inpatient care.

Where an area’s current usage (or in the case of fast tracks, their projected usage) is already

below these ranges, they would not be encouraged to increase their bed usage but to stay attheir current rate or consider reducing it still further.

After three years we will take stock and consider going further.

Annex >5

These planning assumptions mean a c. 35-50%reduction in total inpatient numbers.


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p

• Approx. 35-50% reduction nationally (from c. 2,600 to c.1,300-1,700)• Geographically, change greatest in those areas of the country most reliant on hospital care

(North & Midlands)• By service, change greatest in CCG-commissioned units (e.g. Assessment & Treatment) &

low-secure services

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Annex >A

They imply a c. 45-65% reductionin CCG-commissioned inpatients


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They imply a c. 25-40% reductionin NHSE-commissioned inpatients


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• NHS England-commissioned beds: secure services; CAMHS. We expect bulk of change inlow-secure beds, as opposed to medium/high secure & CAMHS.

• Approx. 25-40% reduction nationally (from c.1,350 to c.800-1,000).• Change greatest in those areas of the country most reliant on hospital care (North &

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5a 20151207 - Stephen Bubb Group Meeting - Papers

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