The impact of commissioning changes on adults with Learning Disabilities

Stephan Brusch

Head of Health Access

Key Impact • National & Regional system leadership to handover• Three commissioning organisations• Main focus on Winterbourne View- forgetting Six

Lives • Ongoing Commitment through the transition and

move to wider vulnerable groups without being lost• Loss of expertise at regional and local level• Risk of new system having to relearn all lessons

learned • NHS Constitution and new commissioning model

presumes active participation.

NHS Commissioning

Board

Providers

The new NHS landscape

FundingAccountabilityOther

Parliament

Patients and PublicLocal HealthWatch

contractAccountability for results

Health & Wellbeing Boards (HWBs)

Public Health England

Clinical Commissioning Groups (CCGs)

contract

cont

ract

Monitor (economic regulator)

contract

Local Authorities (incl. Public Health)

Commissioning Support Services

NHS Trust Development

Authority

NHS CBPatch Teams

NHS Trusts

Version 0.5

Joint licensing between Monitor and CQC

CQC

Nat

ion

alS

ecto

r‘F

oo

tpri

nt’

/ L

oc

al

Health Education England

DH

NHS CB London Sector

NHS TDALondon Sector

FTs

LETBs

Work together to ensure

commissioner support for

aspirant FTs

Clinical Senates

PHELondon Sector

NHS Commissioning Board • Single Operating Model

• Held to account through NHS Outcome Framework

• Ensure directly commissioned services meet specific requirements (Offender and Forensic Services and Direct Enhanced Scheme for People with LD)

• CCG Assurance includes Safeguarding and Learning Disabilities

• Leadership role for NHS• Develop and sustain partnership

working (DH, Local Authority, Metropolitan Police, ADASS, Monitor and CQC)

Clinical Commissioning Authorisation

•Arrangements in place for CCG to involve and seek advice from LD clinicians and practitioners.• CCG has the capacity and capability to commission improved outcomes for the people it serves•Lead clinicians selected from member practices for CCG commissioning priority areas•CCG to outline commissioning arrangements for learning disabilities •Providing Support via self assessment framework, data analysis and economic benchmarking.

Clinical Commissioning Authorisation

• Appropriate systems for safeguarding Adults at Risk

• CCG plans to train staff in recognising and reporting safeguarding issues.

• Clear line of accountability for safeguarding is reflected in CCG governance arrangements.

• CCG has arrangements in place to co- operate with LA in the operation of LSCB and LSAB.

• CCG has safeguarding adult lead supported by relevant policies and training

Mental Capacity Act

Clinical Commissioning Groups(CCGs) need to:

• Have an identified Mental Capacity Lead

• Ensure they have knowledge of their continued responsibility for cases authorised by their predecessor PCT that ceased before the 1st April 2013

• Ensure processes are in place to access all relevant archived information on closed cases.

Mental Capacity Act

• Retains responsibility for assuring through the commissioning process compliance with the MCA 2005 and DoLS legislation of all providers of health care

• Work with health providers and local authorities to ensure appropriate capacity in the system of professionals qualified to carry out best interest assessments

• Support the training and education of health professionals and best interest assessors to deliver effective safe quality patient services.

National levers and Horizon scanning

• Statutory Guidance: No Secret Making Safeguarding everybody’s business

• Legislative Framework: Mental Capacity Act, Equality Legislation, Vulnerable Peoples Act, Autism Act

• NHS and Social Care Outcome Framework

• NHS CB Mandate • NHS CB: Arrangement to secure

children’s and adult safeguarding in the future NHS

• Clinical Commissioning Group Authorisation Guide for applicants

• Concordat

New National Leaders leading post Winterbourne View

• Michael McShaine- Long Term Conditions

• Sam Cramond – Directorate of Partnership

• Chris Bull- Joint Improvement Program

• Jane Cummins – Chief Nurse will appoint to Band 9 Mental Health and LD lead

Local whole System

• Safeguarding Adult Boards, underpinned by statue

• Local Authority as lead commissioning organisation

• Health and Wellbeing Board: Strategic Responsibility for assessing local needs, including vulnerable people (JSNA) and agreeing commissioning stratetgies

• Regulators: Monitor, CQC and professional regulators.

• Healthwatch to be consulted Safeguarding Strategic plans

Pan London work with ADASS

• Joint Strategic Needs Assessment

• Market Positioning Statement

• Commissioning Jigsaw explained

• Self Assessment Framework

• Network

LONDON LEARNING DISABILITES PCT RAG FRAMEWORK RESULTS SUMMARY

Organisation 1.1 1.2 1.3 Overall Rating 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Overall Rating 3.1 3.2 3.3 3.4 Overall Rating 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 Overall Rating

Barking & Dagenham g g a g r a r a a r r r r r g a a a a r r a g a r r r r n/a r

Barnet g a a a a a a a r a r r a a a r a a a a r a a r r a a r n/a a

Bexley g g r a r r r a r r r r r r r r a r r a a a r r r r r r n/a r

Brent r r a r a r r a a r r a a a g g a a a a a g a r a a r a n/a a

Bromley r a a a a r a g a a a a a a a a a a a a a a a a a a g a n/a a

Camden g g g g a a r g a a a a a a a a r a a a a g a a a g g a n/a a

City & Hackney g g g g g a r g r a r g r a a a r a a g a a g r a a a r n/a a

Croydon g g r a r a a a a r r a a a a a a a a a a a a r a a a r n/a a

Ealing g a r a a r r r r a r r r r g r r a r a r a a a r a g a n/a a

Enfield g g g g a r r a r r r r r r g r a r r r r a r r r r r r n/a r

Greenwich g g g g r r r r r r r r r r a r r r r a r a r a r r a r r r

Hammersmith & Fulham g r r r a a a a a r r r r a a r r r r r a a r r r r r r a r

Haringey g g r a a a r r a r r r r r a r r a r a a a a a a r r r n/a a

Harrow g a a a a a a a r a r a a a a a r a a a a g a a a r a r n/a a

Havering g g g g r r r r r r r a r r a a r r r a a a r a r r r r n/a r

Hillingdon r a a a r a r a a r r r r r g a a r a a a a a r a g a a n/a a

Hounslow g a r a a a a r a a r a r a g a a g a r a a a r a r a r r r

Islington g g a g r r r a r r r r r r g a r r r a a a a r a r a r r a

Kensington & Chelsea g g a g r r r a r r r r r r g r a a a a a a a r a r a r n/a a

Kingston g g g g a a a a r r r r r r g a a r a r r a a r r r a r n/a r

Lambeth g a a a g a a r r r r a r r a a r r r a a a r a r r r r r r

Lewisham g g a g r a r a r r r r a r a r r a r r a a r a r a r r n/a r

Newham g g r a a r r r r a r r r r a r r r r r r g a a a r r r n/a r

Redbridge g g g g a a r a r r r r a r a r r a r a a a a a a r a a n/a a

Richmond g g r a a r r a r r r r r r a r r g r g a r r r r a r r n/a r

Southwark g g a g r r r a a r r r r r a a r r r a a g r a a r a r n/a a

Sutton & Merton g g a g r a r r r r r r r r a r r r r a r a a a r r r r n/a r

Tower Hamlets g g a g a a r g a a a a r a a r a r r a a a a r r r a r n/a a

waltham forest r r a r a a a a g r a a a a g a a r a a a a r r a a r r n/a a

Wandsworth g a a a a a a a a a r r a a a r a a a a r a g r r a a r r r

Westminster r a g a g g g a a a a g a a g g r g g a a a g g g g g a n/a g

Sector

1.1 1.2 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 3.1 3.2 3.3 3.4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11

Campus closure Out of Area Placement Primary CareAnnual Health

ChecksDisease

PreventionWider Primary

CareContracting

(acute, non-acute)Inclusive comm.

Work I.T.BME / Learning

Disability Complex NeedsNational

Investigation MCA. DDA and LD ComplaintsSafe-guarding and

LD Respite CareCommunity

Provision Transition User EngagementPartnership

(Funding) Older People (LD) AutismChallenging Behaviour

Mental Health / LD workforce

Criminal Justice System

NWL Brent2 1 2 2 1 1 2 1 1 2 2 2 2 2 2 3 3 2 2 1 1 2 2 3 1 2

NWL Harrow2 2 2 3 2 1 2 2 1 2 1 2 2 1 1 1 2 2 2 1 2 1 1 2 1 2

NWL K&C3 3 3 2 2 2 2 2 2 2 2 3 3 3 3 2 2 2 2 2 2 2 2 2 2 1

NWL H&F2 3 3 3 2 3 3 2 2 2 2 3 2 2 2 2 2 3 2 2 2 2 1 2 2 3

NWL Westminster2 2 3 3 2 3 2 3 2 3 2 3 2 2 2 2 3 3 2 3 2 3 3 3 2 2

NWL Ealing2 2 2 1 1 2 2 2 2 2 2 3 1 2 2 2 3 3 3 2 2 2 3 3 2 2

NWL Hillingdon2 2 2 2 1 2 1 1 2 1 1 3 2 3 1 1 2 2 2 2 2 2 2 2 2 2

NWL Hounslow2 3 3 2 2 2 2 2 2 2 2 3 2 2 3 2 2 3 2 2 2 2 2 2 2 2

ONEL Barking & Dagenham3 3 3 2 3 2 2 2 2 1 2 3 2 2 2 1 2 2 2 2 2 2 1 2 1 1

ONEL Havering3 2 2 1 1 2 1 2 2 2 2 3 2 2 2 1 2 2 2 2 1 1 1 2 1 1

ONEL Redbridge3 3 3 3 2 2 1 1 1 2 1 2 1 2 2 2 2 2 2 2 1 2 1 2 2 2

ONEL Waltham Forest3 3 3 3 2 3 2 2 2 2 2 3 2 2 2 1 2 2 2 2 1 2 2 2 1 2

EL&C City and Hackney3 2 3 3 3 3 2 2 2 1 2 2 2 2 2 2 2 2 2 3 2 2 1 1 1 1

EL&C Newham3 3 3 2 2 3 2 2 2 2 2 3 2 2 2 1 2 3 3 3 3 2 2 2 2 2

EL&C Tower Hamlets3 2 2 2 1 1 2 1 2 1 1 2 1 2 2 1 2 2 2 2 2 2 1 1 1 1

SEL Bexley3 1 1 1 2 2 1 1 1 1 1 1 1 2 2 2 2 2 2 1 1 1 1 1 1 1

SEL Bromley1 2 2 1 1 3 2 2 3 2 2 3 2 2 2 3 3 3 2 3 2 2 2 3 2 1

SEL Greenwich3 1 2 2 1 1 1 1 2 1 1 2 2 1 1 2 2 1 2 2 1 1 1 1 1 2

SEL Lambeth3 2 2 2 1 2 3 2 2 2 3 2 2 2 2 2 2 3 2 3 2 1 2 3 1 2

SEL Lewisham2 2 2 2 1 1 2 1 1 1 2 2 1 1 1 2 2 1 2 2 1 2 2 2 1 2

SEL Southwark3 3 2 2 1 2 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 1 1

NCL Barnet1 2 3 2 2 3 2 2 2 2 2 3 2 3 3 2 2 2 3 3 3 2 1 2 2 1

NCL Camden2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 2 2 2 2 2 2 2 2 2 2

NCL Enfield3 1 1 2 1 2 1 1 1 1 1 2 1 2 2 2 2 2 2 2 2 1 2 2 1 1

NCL Haringey3 2 2 2 1 2 2 1 2 1 1 2 2 2 2 2 2 2 3 2 2 2 2 2 1 2

NCL Islington3 2 2 2 2 2 2 2 2 2 1 2 1 2 3 2 2 2 3 2 2 2 2 3 1 1

SWL Croydon3 3 3 3 3 3 2 2 1 3 2 3 2 3 3 3 2 3 3 3 2 2 2 3 2 2

SWL Kingston2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 2

SWL Richmond and Twickenham3 1 1 1 1 1 2 2 1 1 2 2 1 1 2 1 3 2 1 1 1 1 1 1 1 1

SWL Sutton and Merton3 3 2 3 2 2 2 2 1 2 2 3 2 2 3 2 3 2 2 2 3 1 2 3 1 2

SWL Wandsworth1 3 2 2 3 3 2 2 2 1 2 2 2 2 2 1 3 2 2 3 2 2 3 2 1 1

1. Access to Healthcare 2. Being Safe 3. Safeguarding, Governance and Quality

Organisations Summary AA1 A2 A3 A4 A5 A6 A7 A8 A9 A10 Summary B B1 B2 B3 B4 Summary C C9 C10 C11 C12 C13 C14 C15 C16

NELC Summary 256 24 25 28 30 23 19 22 24 30 32 95 27 23 27 18 205 23 27 26 23 26 26 28 26

Barking and Dagenham24 2 2 3 3 2 2 2 2 3 3 8 2 2 2 2 16 2 2 2 2 2 2 2 2

Barnet23 2 2 2 3 2 2 2 2 3 3 10 3 2 3 2 20 2 2 2 2 3 3 3 3

Camden 19 2 2 2 2 2 2 1 2 2 2 7 2 2 2 1 16 2 2 2 2 2 2 2 2

City and Hackney 22 3 3 3 3 2 2 2 2 1 1 6 2 1 2 1 13 1 2 2 1 2 2 2 1

Enfield 21 2 2 2 2 2 2 2 2 2 3 8 2 2 3 1 17 2 2 3 2 2 2 2 2

Haringey 23 2 2 2 2 3 2 2 2 3 3 11 3 3 2 3 19 1 3 2 2 3 2 3 3

Havering19 1 2 2 3 1 1 2 1 3 3 4 1 1 1 1 18 1 3 2 2 3 2 2 3

Islington22 2 2 3 2 2 1 2 2 3 3 10 3 2 3 2 21 3 3 3 3 3 2 2 2

Newham 26 3 3 3 3 2 2 2 3 2 3 9 3 2 2 2 18 3 2 2 2 1 3 2 3

Redbridge21 2 1 2 3 2 1 2 2 3 3 7 2 2 2 1 18 2 2 2 2 2 2 3 3

Tower Hamlets 15 1 2 2 1 1 1 1 2 2 2 8 2 2 3 1 14 2 2 2 2 1 1 3 1

Waltham Forest 21 2 2 2 3 2 1 2 2 3 3 7 2 2 2 1 15 2 2 2 1 2 3 2 1

NWL Summary 168 16 16 17 19 14 15 15 18 18 20 68 17 16 18 17 149 16 18 19 16 14 20 19 22

Brent16 1 2 1 2 2 1 1 2 2 2 5 1 1 1 2 13 1 2 2 2 1 1 2 2

Ealing 16 1 2 2 1 1 1 2 2 1 3 8 2 2 3 1 19 1 3 3 2 2 3 2 3

Hammersmith and Fulham24 3 2 3 3 2 2 2 2 2 3 9 2 2 2 3 19 2 2 2 2 2 3 3 3

Harrow 21 2 1 1 3 3 2 2 2 3 2 9 2 2 2 3 15 2 2 2 2 2 2 1 2

Hillingdon 15 1 2 1 2 1 1 1 2 2 2 5 2 1 1 1 16 1 2 3 2 1 2 2 3

Hounslow22 2 2 3 2 1 2 3 2 2 3 11 3 2 3 3 21 3 2 3 2 2 3 3 3

Kensington and Chelsea26 3 2 3 3 2 3 2 3 3 2 10 2 3 3 2 24 3 3 2 2 2 3 3 3

Westminster28 3 3 3 3 2 3 2 3 3 3 11 3 3 3 2 22 3 2 2 2 2 3 3 3

SEL Summary 122 10 13 11 16 11 12 10 13 14 14 49 13 11 14 11 113 13 16 13 14 14 15 14 14

Bexley17 1 2 1 2 2 3 1 3 2 2 6 1 1 2 2 19 1 3 2 2 3 3 2 3

Bromley18 1 1 2 3 2 1 2 2 2 2 10 3 2 3 2 20 2 3 2 3 2 3 2 3

Greenwich 23 2 3 2 3 2 3 2 2 2 2 8 2 2 2 2 18 3 3 2 2 2 2 2 2

Lambeth23 2 2 2 3 2 2 2 2 3 3 9 2 2 3 2 17 2 2 2 2 2 2 3 2

Lewisham 16 2 2 1 2 1 1 1 2 2 2 7 2 2 2 1 16 2 2 2 2 2 2 2 2

Southwark 25 2 3 3 3 2 2 2 2 3 3 9 3 2 2 2 23 3 3 3 3 3 3 3 2

SWL Summary 108 11 11 10 12 10 9 10 11 11 13 43 11 11 13 8 83 8 11 10 9 9 12 12 12

Croydon 28 3 3 3 3 2 2 3 3 3 3 11 3 3 3 2 22 2 3 2 3 3 3 3 3

Kingston 22 2 2 2 3 2 2 2 2 2 3 7 2 2 2 1 15 1 2 2 2 2 2 2 2

Richmond16 2 2 1 1 2 1 1 2 2 2 9 2 2 3 2 16 1 2 2 1 2 2 3 3

Sutton and Merton 20 2 2 2 2 2 2 2 2 2 2 9 2 2 3 2 17 3 2 2 2 1 3 2 2

Wandsworth 22 2 2 2 3 2 2 2 2 2 3 7 2 2 2 1 13 1 2 2 1 1 2 2 2

London-wide 654 92 99 97 116 87 85 87 102 108 118 390 102 93 110 85 843 91 111 104 95 93 113 111 115