Joint Commissioning Strategy

For People with a

Learning DisabilityPresentation by

Stephen Rogers

What is Commissioning

• Strategic analysis of need. • Understanding current service provision and

resources. • Gap analysis. • Service redesign. • Close links with Contracting and Procurement .• Monitoring of performance.• Outcome measurement and review

That people get the best outcomes possible from public money

Joint Commissioning Strategy

• Approved by Cabinet in April 2011

• Meeting future demand

• Redesign services

• Shows what will change and how far it will change by 2015

Commissioning Objectives

SOUND TRANSITION

MORE SUPPORTED LIVING

MARKET MGTQUALITY INCENTIVESVFM

REFOCUS MARKET NCC NO LONGER A PROVIDER

MORE PEOPLE MOVING INTO EMPLOYMENT

NEW RESPITE SERVICES. AND BETTER CARER SUPPORT

REDUCE BED BASED A&T

HATE CRIMEPREVENTION

CRIMINAL JUSTICE IMPROVEMENTS(Bradley)

PERSONALISATION

BETTER HEALTHPRIMARY/ACUTE

BETTER DEMENTIA SERVICES

CHANGE TRADITIONAL DAY SERVICES

VALUING PEOPLE

NOW

WITHINBUDGET

IMPROVEDADVOCACY

CHANGE COMMUNITY TEAMS – SKILLS MIX REVIEW – FIRST STEP

Key Objectives for 2013/15

• Follow the Joint Commissioning Strategy– Meeting Increasing demand– Keeping within budget– More Choice and helping the market to respond

to personal preference– Improving Health Outcomes in Primary and

Acute Care….Plus

• Winterbourne View recommendations

Increases in demand

• General Population Growth• Norfolk is a popular destination• More young people with complex needs• Increasing needs of older people

already receiving service• Increasing customer expectation• Section 117 and Ordinary Residence

issues

Increased Demand for Learning Difficulties Services

Predicted Growth of LD Service Users in Norfolk 2009-2014

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2007 2008 2009 2010 2011 2012 2013 2014Year

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Actual Client Numbers

Lowest GrowthEstimate

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2004 Predictions

Trend (Actual ClientNumbers)

Keeping within Budget• The Department of Health now pays most of the Health

contribution direct to local authorities• In Norfolk this means that the County Council will spend £

100.2 million on services in 2013/14• The NHS continues to directly commission assessment and

treatment services, very specialised hospital placements and continuing health care £15 million. CCGs hold these budgets

• Joint Commissioning in place to ensure effective commissioning across the whole market takes place.

• Financial savings are required to meet future demand and keep the books in balance.

• EU Social Investment Fund

How the NCC cash is spent

• £81.5m Purchase of care

• £3m Transport

• £6.5m Joint Community Teams

• £9.5m In house services (supported living and day services)

• 0.85m Psychiatry

• 0.56 Specialist Health Respite

More Choice

• Valuing People and Think Local Act Personal• All who want a personal budget will have one• All people assessed for service will have been

offered support with a PCP.• Market responding to provide services that

meet individual needs• Range of services are becoming available to

meet changes in service demand

Improving Health

• Get all Norfolk GPs signed up to DES.• More people having annual health checks• Numbers of Acute admissions going down• Numbers of readmissions going down• A good experience when in Hospital• More people using mainstream health

services rather than having specialist services

Supported Living/Residential Care

• New Models – eg sharing overheads leading to Value for Money

• Planning with Housing Providers and Social Landlords and families.

• Planning with Residential Providers

• Good Supply and Demand Management in local areas.

Better Transition• All young people who attend special schools,

mainstream schools with 25 hours + support, Out of County placements or are Looked after Children have Comprehensive Transition plans

• The information from these plans informs the development of services.

• Develop transition services to help young people develop independence

• Develop services that prevent young people being placed out of County and help them when they return

Respite Care Services

• More innovative respite care options

• Pooling of Personal Budgets

• Guideposts scheme

• Good quality services for people with significant medical needs

Dementia Services

• Improved community services for people with early on set dementia

• The needs of people with LD are well represented in the delivery of the Norfolk Dementia Strategy.

Changing Day Services

• Valuing People – Drive to change large traditional day services - Non segregated models

• Norfolk County Council will no longer be the provider• “Independence Matters” – new social enterprise• Individuals should be able to access support according to their

assessed needs and identified outcomes. Not become dependent upon services

• Help people to progress - so that there is always support to gain or regain maximum independence

• Moving on and on………..Progression• Local Services - Participation in the community• Better routes into employment

Employment

• More people will be in paid, real jobs- 300 by 2015?

• Ist April 2013 -164 in paid employment• 44 in Voluntary employment• 36 in training• Project Search expanded and 50% of students will

secure employment- NHS, NORSE• ASDA, Waitrose, M&S, Co-op• More social enterprises – support into

employment eg CSV cafes

Tackling Hate Crime

• Effective reporting and joint working with Norfolk Police.

• Extend Norfolk Safer Places Scheme

Improved Advocacy

• All Advocacy funding supported by contracts with clear outcomes

• The service will be more equitable across Norfolk leading to improved access

• New contract now in place

Market Management

• Develop Quality Incentives

• Capture and encourage innovation

• Progression and outcomes evidence

• Use of Assistive Technology

Winterbourne Expectations

• Review the care of all people in learning disability or autism inpatient beds – assess who ought to move

• Agree a personal care plan for each individual based on their and their families’ needs and agreed outcomes;

• By June 2014 community based care arrangements need to be in place for all people who do not need a hospital placement and

• Develop the market to ensure people can move into the community

Winterbourne

We want to make sure that we have the right services in the right place so that people with learning disabilities whose behaviour challenges services can:

• Live somewhere that is right for them and

• Have the support to help them to do this.

Winterbourne – Regional Response

• ADASS - Regional work programme to improve the way we work with providers to develop and buy services.

• DOH sponsored‘Developing Care Markets for Quality and Choice’.

• Personalised care for people with challenging behaviour is a priority for the region

Winterbourne Norfolk Response

• Local Steering Group• Oversee the movement of all people who will

move by June 2014• Develop a strategic plan that will ensure all people

in, in patient facilities will be there no longer than necessary and

• Services are developed in the Community which will reduce the need for future admissions

Commissioning Next Steps

• Plan to meet Winterbourne demand• Continue moving forward together in the New Personal

Budget Landscape • Further enhance market intelligence• Continue to encourage innovation • New Models for Local Day Services• New Models for Living in the community• Further develop Community services to prevent hospital

admissions and out of county placements

Autism Act 2009.

The Act made two key provisions:

•that the Government produce an adult autism strategy by 1 April 2010

•that the Secretary of State for Health issue statutory guidance for local authorities and local health bodies on supporting the needs of adults with autism by 31 December 2010.

•Statutory guidance that local authorities and local health bodies have a legal obligation to follow

National Autism Strategy

The Autism Strategy has five areas for action aimed at improving the lives of adults with autism:•increasing awareness and understanding of autism;•developing a clear, consistent pathway for diagnosis of autism;•improving access for adults with autism to services and support;•helping adults with autism into work; and•enabling local partners to develop relevant services.

Autism SAF

The purpose of the Self Assessment Framework is to:•assist Local Authorities and their partners in assessing progress in implementing the 2010 Adult Autism Strategy;•see how much progress has been made since the baseline survey, as at February 2012;•provide evidence of examples of good progress made that can be shared and of remaining challenges.

Thanks

for Listening