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www.england.nhs.uk
Building the Right Support for Learning Disabilities
Turning improvement ideas into local action
Kia Oval, Surrey County Cricket Club, London SE11 5SS
19 July 2016
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Building the right support for people with learning disabilities:
Turning improvement ideas into local action
Dr Julie HigginsSenior Responsible Officer
Transforming Care Programme
Kia Oval 19 July 2016
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Making it happen – working together and turning
plans to reality
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• Making sure less people are in hospitals by having better services in the community
• Making sure people don’t stay in hospitals longer than they need to
• Making sure people get good quality care and support in hospital and in the community
The transforming care work has three big aims:
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What have we achieved?
• 6 fast tracks• 48 new Transforming Care Partnerships• 48 sets of plans to transform local services
for local people and families• 48 sets of milestone plans that will enable
us to tell the story of change
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Further progress made on
• Fewer people in hospital • Care and treatment
reviews rolled out• Data quality
improvements• Revised financial
guidance, Frequently Asked Questions ‘Who Pays’, aligning the specialised commissioning budget
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Working with seven groups of Transforming Care Partnerships who have the greatest challenges. These TransformingCare Partnerships together account for more than 50% of the proposed inpatient reductions planned for 2016/17
• North East Group - Cumbria and the North East
• North West Group - Cheshire and Mersey, Lancashire, Greater Manchester
• Yorkshire Group - North Yorkshire, Barnsley, Wakefield, Kirklees and Calderdale, Bradford, Leeds, East Riding and Hull, and South Yorkshire
• West Midlands Group - Coventry, Rugby, North Warwickshire and South Warwickshire, Black Country, Birmingham and Staffordshire
• Kent and Medway Group - Kent and Medway
• Hertfordshire, North London and Essex Group - NW London, NC London, Essex and Hertfordshire
• North Central Midlands Group - Derbyshire and Nottinghamshire
Going further: Extending the community of fast tracks
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£30 million over three years – about half the 24 Transforming Care Partnerships funded for 2016/17
Funding distributed this week
Transformation funding
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• Learning and Improvement• Working together • Sharing what works• National support offer for Transforming Care Partnerships:
• Putting you in touch with experts by experience• Bespoke advice from our Change and Improvement
Steering Group• Open access to the national team, comprehensive
skills mix • Online learning and development (courses, webinars)• Visits and onsite coaching
Focus today:Supporting Sustainable change
Transforming care for people with learning disabilitiesThe Coventry, Warwickshire and Solihull ExperienceBecky Hale, Strategic Commissioning Service Manager All Age Disability, Warwickshire County CouncilAli Cole, Project Manager Transforming Care, Arden & GEM CSUKaren James, Operations Manager Specialist Community Services, Coventry and Warwickshire Partnership Trust
The Transforming Care Journey• Our approach • Our challenges• Our achievements• Our lessons
The Local Context – March 2016
• Learning Disability and Autism Population = 29,000. Predicted to rise by 11% by 2030.
• Local inpatient facilities:– Gosford Ward, Coventry (9 beds) (NHS)– Brooklands Hospital, Solihull (96 beds) (NHS)– No independent inpatient services
• Only 25 of 105 beds in the TCP area populated with local residents.
• 1 person in acute mental health bed• Out of area:
– 5 adults in forensic rehabilitation beds– 2 adults in complex continuing care beds– 11 adults in secure beds– 11 young people in CAMHS beds
The Transforming Care Journey
• Winterbourne made us work together• Dec 2013 - Accelerated Learning Event to shape our
strategic response• 2014/2015 – Co-produced a new model of care with
stakeholders• Learning from Solihull (since 2009)• Learning Disability Strategies, Joint Plans and
Transforming Care structures in place across health, social care and local provider
• Problem solving approach (we all own the issues)• NHS Change Model
The Transforming Care Journey
• Summer 2015 - Fast Track Arden, Herefordshire and Worcestershire.– Development of the bid challenging – unfamiliar footprint,
timescale, beds vs people, bid support.• Oct 2015 - Funding received from NHSE• Dec 2015 - New model of care launch• March 2016 - Gosford ward (9 beds) closed• Building the Right Support – TCP area changed to
Coventry, Warwickshire and Solihull with revised plan submitted in March 2016.
Vision for the future“The future is where people with learning disabilities and autism:
are not put in a position where they become unwell because of their environment;
don’t have to go into hospital unless absolutely necessary; are supported with their needs, emotions and feelings; are supported to grow and develop; are not taken away from their family and friends and isolated; live in their local community; go out in their local community; work in their local community; and are seen as a valued member of society”
• Living My Life DVD – Transforming Care Chapter
The Local Transformation Plan• Outcome focused – Living my Life• Reduction in inpatient beds in line with the 10 – 15 ratio.• Reduced length of stay• Transfer of funds from inpatient to community services• Phased plan :
– Phase 1 – Enhanced Support and emergency accommodation in the community for adults, Gosford ward closure
– Phase 2 – community support for children and young people, people with Autistic Spectrum Disorder only, people from specialised services population, understanding impact on specialised services
• Long term purpose built accommodation• Personal budgets, joint commissioning and pooled budgets
Model of CarePersonalised care and support
Extra support when things change
Hospital is a last resort. Support in hospital to return home
Implementing our new Model of Care
• Community Intensive Support Team• Mental Health Liaison Nurses.• Admission avoidance agreements, funds and
accommodation.• Long term accommodation with support
developments.• Re-design of mental health services for children
and young people (CAMHS).• Model of care DVD and workforce
development.• Continued customer and carer engagement.
Achievements so far…… • Phase 1 completed
– Intensive support team– Emergency accommodation– Gosford ward closed
• 33% reduction in inpatients• Average length of stay reduced from 105 days
to 30 days*• £1.4M reinvested in community services
*NB In Solihull, the numbers of inpatients are so small that average length of stay is not a meaningful metric.
Current Focus• At Risk Register.• Understanding our cohort of children and young people
and people with autism in specialised services.• Detailed planning (jointly) to support potential discharges.• Understanding the potential pressure (financial and
capacity) and how to use current funding differently.• Market engagement and development.• Workforce development.• Commissioning infrastructure - joint commissioning and
pooled budgets. • Communication and engagement• Developing new accommodation based services.
Challenges so far…… • People NOT numbers• Understanding our target population with NHS England
and what this means (including changing plans for discharges)
• Governance and financial context.• Adjusting plans based on new partnership area.• NHS England monitoring and timescales.• Dedicated resource for the programme and Care and
Treatment Reviews• Consultation plans – listening to the right people• Making sure the right services are in the area to support
people (market development)
Benefits so far…… • Early agreement and clarity of purpose. • Transitional funding – £825,000.• Escalating pre existing plans.• LD/Autism higher on the priority list locally.• Focus on pooled budgets and joint working.• Clinical review activity with NHS England
Specialised Commissioning.• Overwhelming support for model of care.
Challenges so far…… • Recruitment & Development of the team• Developing clear roles, differing opinions and
expectations• Developing services at the same time – Acute Liaison
Nurse for mental health services, Intensive support accommodation
• Issues around timely Care and Treatment Reviews, decision making, involvement
• Different agencies at different stages of development• Capacity
Benefits so far…… • Fewer people have gone into hospital• People have returned home more quickly when they go into
hospital• Worked alongside existing community teams who knew people
well• More intensive involvement allowed more time and focus and
led to a better outcome for the person• Working more closely with mental health staff • Being able to access money quickly to put extra support in
place
Case Study - Dave• The Intensive support team worked with Dave
during his hospital stay• Joint assessment process across Health and
Social Care and new provider identified• Ready for discharge – use of the enhanced
accommodation• Joint transition work between the team and
service provider• 5 weeks of intensive support from the IST• Continued review and assessment of positive
interventions• Handover back to the community team
Case Study - Dave• Think differently• Be creative• Never give up!
Our Lessons Learned• Build the model of care from the bottom up = buy in.• Evidence-based change methodology• Focus on enhancing work already happening locally.• Learn from others (Solihull).• Accessible model of care (DVD).• Dedicated resources for ongoing customer and carer
engagement.• Think about potential need for public consultation early.• Transparency and collaborative working with service providers.• Consider best use of time and resources
Our Lessons Learned• Culture change is key• Be Brave! – change the conversation• Working together and not being afraid to challenge -
“what is the art of the possible?”• Openness• Equal partners in the team
Questions?
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Stopping over medication of people with learning disabilities and autism
June 2016
www.england.nhs.uk/learningdisabilities
Thankyou for inviting us
David Branford
Carl Shaw
Ben Briggs
Learning Disability ProgrammeNHS England
www.england.nhs.uk/learningdisabilities
• Background to this work• Why is this work important?• The aims of STOMPLD• YOUR role in this
What we’re going to talk about
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This work is part of Transforming CareThere are 6 partner organisations, and 48 local Transforming Care Partnerships. We all work with people with learning disabilities, families and services.We want to:1. Reduce the number of people in
learning disability and mental health hospitals
2. Reduce how long people stay in these hospitals
3. Improve the quality of care and support for people in hospital and community settings
www.england.nhs.uk/learningdisabilities
Medicines Programme Structure
Medicines Oversight Group(Chaired by Hazel Watson)
Provides oversight, scrutiny and advice on the work of the delivery group
Medicines Delivery Group(Chaired by Anne Webster)
Responsible for delivering on the work set out in the STOMPLD Project Plan, including
communications, TCP delivery of STOMP and engagement with a wide range of stakeholders
Learning Disability Programme Board
and Transforming Care Assurance Board
Hazel Watson- Quality Assurance and
Health Inequalities Work stream Lead
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So what’s it all about?
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Psychotropic medication?• Medication for psychosis – antipsychotics• Medication for depression –
antidepressants• If people have psychosis or depression
these medicines can be really helpful
When is it a problem?• Too much• Too many• Too long• Giving prescriptions without finding out
what is wrong• Using it to manage people’s behaviour
Problems of over-medication
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Ann and her son who was at Winterbourne View Hospital
It was 3 years before he went home
This is why we’re here
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• If you are drugged up, you can’t communicate with people properly
• The world passes you by• It can make your behaviour more
challenging in the long run• It doesn’t help you learn or change• It doesn’t help you get out of
hospital, the opposite in fact• People shouldn’t be living like that
A human rights issue
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Why?There’s usually a reason:• Not listened to or understood?• Abuse or trauma?• Unable to deal with feelings?• Too much physical restraint?• Too little contact with others?• Poor relationships with staff or
patients?• Pain or illness?
• Is medication always the answer?
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Figures from Public Health England
Think of 100 adults with learning disabilities
• Doctors are prescribing antipsychotics for 17of those people
• Doctors are prescribing antidepressants for 17 of those people.
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• 7 people are being prescribed both
• Only 4 of those 100 adults with learning disabilities have psychosis
• Fewer than 7 people have depression
• 16 are taking one or other drug and don’t have either a psychosis or depression
Figures from Public Health England
www.england.nhs.uk/learningdisabilities
Medicines Project Core Message
Public Health England estimates that every day 30,000 to 35,000 adults with a learning disability are being wrongly prescribed an antipsychotic, antidepressant or both.
Unnecessary use of these drugs, puts people at risk of significant weight gain, organ failure and even premature death.
www.england.nhs.uk/learningdisabilities
Time to change - STOMPLD
• This is about improving people’s lives• This is about helping people live
longer and giving families more time with their loved ones
• This is about stopping the use of these drugs to manage people’s behaviour
• Stop Over Medicating People with Learning Disabilities - STOMPLD
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The STOMPLD PledgeThe STOMPLD pledge was signed at a summit in London on 1 June by • Royal Colleges of Nursing,
Psychiatrists and GPs• Royal Pharmaceutical Society• Challenging Behaviour Foundation • British Psychological Society• NHS England• The Minister Alistair Burt They have pledged to work together and with people with a learning disability and their families, to take real and measurable steps to stop over medication
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First steps – GP campaign
• As part of this, a new booklet for GPs has been launched.
• It was written by NHS England and the Royal College of GPs
• It encourages family doctors to only consider psychotropic drugs to manage behaviour when the person is at severe risk of harming themselves or others
• And only when all other options have been explored
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STOMPLD is about more than….
• Better record keeping• Better transfer of information about
medicines between GPs and specialists (and everyone else involved)
• Ensuring people get a diagnosis • Stopping prescription errors• Although these are all important too
• It is about quality of life
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Over to you
What can you or your organisation do to stop the over medication of people with learning disabilities or autism?
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• Visit the NHS England website• www.england.nhs.uk/learningdisabilities
For more information
www.england.nhs.uk/learningdisabilities
Health and Social Care Information CentreLearning Disabilities Census Report – Further analysis England, 30 September 2013
• Survey responses were received from 104 provider organisations on behalf of 3,250 service users
• Over two thirds of service users (68.3% or 2,220) had been given anti-psychotic medication leading up to Census day. Of these, 93.0% (2,064) had been given them on a regular basis. .
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http://www.cqc.org.uk/sites/default/files/20160209-Survey_of_medication_for_detained_patients_with_a_learning_disability.pdf
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Data from CPRD General Practice prescribing study
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Data from CPRD General Practice prescribing study
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Make psychotropic medication the last resortThe NICE guideline [NG11] Published date: May 2015 ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’
• Consider antipsychotic medication to manage behaviour that challenges only if:• psychological or other interventions alone do not
produce change within an agreed time or• treatment for any coexisting mental or physical
health problem has not led to a reduction in the behaviour or
• the risk to the person or others is very severe (for example, because of violence, aggression or self-injury).
• Only offer antipsychotic medication in combination with psychological or other interventions.
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International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilitiesDeb S et al ,World Psychiatry. 2009 Oct; 8(3): 181–186
• The medication should be prescribed at the lowest possible dose and for the minimum duration.
• Non-medication based management strategies and the withdrawal of medication should always be considered at regular intervals.
• If the improvement of the behaviours that challenge is unsatisfactory, an attempt should be made to revisit and re-evaluate the formulation and the management plan.
Transforming Care in Lincolnshire: Coproduction, Coproduction,
Coproduction
Sharon Jeffreys – Head Commissioning of Learning Disabilities and Autism Jo Minchin - Expert by Experience
True Co-production with those with a lived experience
- Engaging with people who use the services and their families and carers to find out what works well and what we need to do better
- Partnership Boards- Expert by Experience Workers
Engaging with people who use the services and their families and carers to find out what works well and what we need to do better
What we did• Sent all invites in easy read• Put our photos on the
invites• Held events all around the
county• Different times of the day
Feedback from Events• People felt like we really
wanted them to attend• High turn out compared to
other engagement events• People felt listened to• People liked that we
smiled on our pictures
The Re-launch of the Autism Partnership Board – 30th January 2015
The Re-launch of the Autism Partnership Board – 30th January 2015
The Launch of Lincolnshire's All-age Autism Strategy – 2nd April 2015.
The theme was creativity of people
with ASD
Status Cards
Making bigger meetingsautism friendly
Also known as flapplause. Flap, don’t Clap.
Display Cards
Other reasonable adjustments• Maps to, and of the venue.• Consider lighting and background noise.• Ask participants if there are things that
might cause a problem before the meeting.
• One page profiles.• Making the adjustments individualised.• Match people to their strengths.
Expert by Experience workerI work with other autistic people, in one work stream I do this on the Autism Partnership Board (APB). I chair the A-team, collaboration group of autists and parent carers of autistic people, and I don’t think that the group would thrive as it does if it were not being steered by an autistic person. I can also be seen by the members to be a valued part of a bigger team within service shaping and commissioning. I am paid to do my role, that is noteworthy and valued deeply by the other A-team members. I don’t have to convince them that I am on their side, and they see that I do bring their views and concerns to those deeper within the commissioning team.My involvement in Care and Treatment Reviews (CTRs) has been both useful for the team and for the individuals the CTR has been for. In some cases, I am the only member of the team the individual has wanted to talk to. I have the experience of a disability, there is already a shared understanding between us.
Transforming Care Team Recruitment
The interview panel process and any other activity that is conducive to enhancing positive images, results, maintenance and other such elements in relation to autistic people and essentially the entire community, is wholly endorsed by myself and it was an absolute pleasure to be given the opportunity to provide authentic input. Authentic input is integral to all elements mentioned above and beyond because autistic people are not hopeless, motionless, un-impactful beings and deserve to be majorly if not completely involved in everything that concerns them and others which is not to imply 'them' and 'us' but to confidently communicate that this approach is for everyone's benefit. Callum, expert by experience
panel.
Transforming Care Team RecruitmentIt was vital that we knew how the panellists felt about working with autistic people. One of the best ways to do that is to actually see how they interact with us, and deal with our sometimes quirky behaviour.One of the panellists conducted most of his part of the interview whilst lying on the floor behind some filing cabinets. I spent much of it spinning thread on my spindle, and the other panellist had some pressing questions on an issue that he is campaigning about. We all had something different and unique to bring to the process, and we made a good teamIt was interesting to see how people responded to our question about how they felt about working with us. Most responded with a carer / patient scenario, whereas a few more enlightened ones started talking about us as work colleagues. That was the answer we were looking for, though we admit, it’s a very forward thinking model at the moment. I wish it wasn’t.Jo: Expert by experience panel
Transforming Care Team Recruitment I feel that it was a good opportunity to see what kinds of people wanted these jobs, and to see how well they could set aside the jargon and formality in exchange for frank communication. I will say that the technical qualifications went over my head. I could not possibly judge whether someone is capable of doing something I cannot. However, seeing how an applicant dealt with one of their interviewers lying on the floor was a useful test, I think. It is a very comfy floor.And, of course, the obvious: It's good to have at least one autistic person involved at in selecting someone who will have significant influence over many other autistic people.Joshua: Expert by experience
panel
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Help us to Help you
Pól Toner RN MScHead of Improvement and enablement
Strategic Resettlement“Thinking and Planning for a Better Future”
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Supporting Service Changes Locally
• We, as a national team are here to support you e.g.• Practical support locally to help you improve more quickly• Housing people working with us to help move more
quickly• Service people working with us to get the care right and in
the right place for the many people we need to support• Maggie and team will say how we will do this with
your help• We welcome your views• The help is about your needs
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Two Main Parts to Thinking and Planning better services
• Thinking and Planning ahead to meet the needs locally.
• Working to ensure new services that are in place provide what local people say they need and that they are involved
• Sustainable and permanent positive change for people with Learning Disability and ASD.
• “Personalisation at scale”
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• Firstly this is about thinking and planning ahead
• It relies on the partnerships locally having good plans developed and prepared to meet the needs for this patient group so changes can happen for many patients quickly.
• Secondly the future needs to allow for other service ideas so we can continue to meet the needs , for people with Learning disabilities and ASD, both now and for future Generations.
The basis
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What is Thinking and Planning ahead?
• Its about Planning
• Understanding the needs of the people you need to plan ahead for
• Impact of much fewer beds in the system
• Understanding many people will be leaving hospital sooner and how to make sure this goes smoothly
• Its about putting new services in place to meet changing needs
• Care and housing for many individuals
• Supporting people who give care now to understand why change is happening and how they can help to meet the needs of the new services as they happen
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How it fits• Its business as usual but a little faster
• Planning is about Building the Right Support
• Fits with Discharge planning guidance
• We need to make sure we can do everything we said we will do in our plan with the people and money we have locally at the right time to meet local needs
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Strategic planning
Transforming Care Partnerships need to understand the needs of people with Learning Disabilities in their local area
Housing, care providers’ and workforce people need to be involved and work to making sure the new services are supported by the right workers and the right housing and right care in the right place at the right time
Plan to support people outside hospital rather than in hospital beds
Solid discharge planning and arrangements in place
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Strategic commissioning
• Bring all commissioning work together in the local area
• Thinking and planning ahead should mean that contracts in place support reducing beds
• Involve people who provide care
• Make sure the care system is in a good place for now and the future
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In the Regions• Regional teams all work slightly differently but will
need to ensure everything is working well
• Regional teams will support the changes planned or underway locally
• The team can do this face to face or make it easier using technology
• Managing a steady and consistent development of community services and bed reduction as set out in their plans.
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In the RegionsMuch work is already underway
• Regional team should establish a resettlement team function
• This resettlement function should develop expertise
• Ward/ unit/ hospital closure level changes should be led by the local Transforming Care Partnership commissioners including specialised commissioning, with providers.
• National Team will support the regions with provider engagement Regions will have a good understanding of the entirety of the patient cohort
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Commissioning Development We need to consider the wider context of commissioning, including
Local Authority and Clinical Commissioning Group commissioners and consider the impact on and expertise and leadership required within these teams going forward.
We need to strengthen coordinated commissioning for people a learning disability or Autistic Spectrum Disorder.
We need to strengthen admission and discharge management, through length of stay and escalation management
Encouraging life planning
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Over the summer and where work is beginning
• Regional teams will be supported to expand their ideas about how they will work with everyone else on this,
• Over July and august and by September 2016, each Transforming Care Partnership and Region to have developed local thinking and starting to plan ahead for engagement with housing and care providers,
• Need to ensure those who organise more specialised care and others who provide care are talking and working together
• Transforming Care Partnership’s to map out their plans and what the issues are and what do we need to do to reduce any risks around our plans
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• During the summer, regions will have identified, from this information collectively from Clinical Commissioning Groups, wards and units for Transforming Care Partnerships to earmark for closure and start to plan closure, We can then support with next steps.
• Where units and wards have patients from outside the region, regions and Transforming Care Partnerships will need to work together (and where this is the case) identify a lead Clinical Commissioning Group to manage the process and closure, based on a fairness model.
• At Regional level to enhance their plans to deliver the changes around their patients at a steady state between then and march 2019, including a ward/ unit closure programme.
• By October 2016, a full meeting will have been held to outline new community model of care being proposed and new reducing based model
Work will continue
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• As a goal we want Transforming Care Partnerships to manage discharges/ movements and follow individual bed closures
• We want regions to work together and to follow regional closure profiles and ensure Clinical Commissioning Groups work together on ward and into closure
• Nationally we want to follow ward and unit closures • So every patient is managed and their progress
recorded and help given if necessary
Prioritise Discharge Management
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The tasks/ expectation:• Its not just about bed reduction, for all regions;
• its also about repatriation back nearer home and the development of new service models
• Identify wards and units affected as part of their 3 year profile to achieve the 50% closure.
• Expectation will be to now strategically discuss discharges and ward and unit changes/closures, with providers, at Transforming Care Partnerships and Regional Level based on ambitions for new models of care and services,
• but local teams will still need to concentrate on patient centred case management and personalised delivery of effective care.
www.england.nhs.uk
• Transforming Care Partnership planning process, will be about moving the plans from planning to transformation and closures.
• This is not just at patient level but at ward and unit closure level and to permanently close the door to increased admissions
• Effective provider engagement• ensuring the new service model is sustainable and supports
people living well outside hospital with the right support locally• We will work with the systems to monitor and support practical
progress on this
In Conclusion
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“safe and sustainable personalised care planning at scale and pace”.
Thank You
Pan LancashireTransforming Care Partnership (TCP)
‘Right Track’Plan
Transforming Care Partnership (TCP)
Providers
Population with Learning Disabilities and/or Autism
Specialised Commissioners
NHS England via Northern England Programme Board
Calderstones & Mersey Care Partnership Board
Lancashire Collaborative Commissioning Board Transforming Care Partnership Steering Group
Learning Disabilities Commissioning Network Children’s Network Sub groups
Health & Well Being Boards Overview & Scrutiny Committee
Reporting & Developing
Implementation
Steering Group
ComissionersNetworks HousingFinance
ResettlementTeam Procurement Workforce
Co Production Confirm & Challenge
CCB
Stakeholder Events
Create a Vision for a New Community Model of Care Resettlement of long term hospital placements Understand the Financial Implications Development of Services to Support Consider New Methods of Delivery look for Innovation and Partnership Approaches Improve Quality and User Experience Change the Culture
Pan Lancashire Priorities
Supports the delivery of the changes required Housing Strategy Development Procurement/Contracting/Commissioning – developing a flexible
agreement Workforce Understanding the Service Demand – Risk Registers/Data
Sharing Community Service Specification – New Model/All Age Avoiding Placement Breakdown/CRISIS Resettlement Programme Improving Health
Route Map- Work streams
Engagement Lancashire Confirm & Challenge group
established North West Events Supported Lists of existing groups Developing communication processes Asked about needs for homes, communities
, support requirements and staffing for service users and carers
Also invited to stakeholder events
What have we done and what have we learned………………….….…!
Market Stimulation – ACEVO Report Undertook a Request For Information February
16 Held an event in March 16– 93 Providers Many providers are interested in Lancashire Need to strengthen Leadership Need to commission smarter Need to Quality Assurance Need to harness partnership working Currently developing a flexible agreement Pan
Lancashire
What have we done and what have we learned………………….….…!
What have we done and what have we learned………………….….…!
Community Model Held a community team stakeholder event Developed a draft integrated service
specification Shared and discussed at a wider adult
stakeholder workshop Shared and discussed at a wider children’s
stakeholder workshop Had a ballot for all age specification Currently incorporating the comments and feed
back
What have we done and what have we learned………………….….…!
Housing Agreed to develop a Pan Lancashire Housing
Strategy Commenced data collection on population –
definitions and categorisation problematic Considered voids Engaged with District Councils Considered the models required to meet the
needs of the population Need to incorporate Children’s and transition
requirements
What have we done and what have we learned………………….….…!
Finance Urgent requirement to establish a pooled budget Identified a set of principles Held a workshop to develop Identified risks and anxieties Devised an Memorandum of Understanding – requested
sign up from all organisations to agree to work together Developed a draft plan Identified the current spend/ organisation populations Local Authorities reviewed line by line to clarify inclusions Footprints to be agreed Risk agreement considered the priority
What have we done and what have we learned………………….….…!
Workforce Plan developed with Health Education
England Stakeholder workshops held - adults and
children Engaged with providers to undertake mapping Considering how to incorporate into contracts PBS being considered as a specific
development Recruitment and retention are a concern and
have delayed discharges
What have we done and what have we learned………………….….…!
Resettlement Ratified the cohort, Clinical Commissioning
Groups & Specialised Commissioned Discharge co-ordination team Report to the steering group Devised a 12 point discharge plan Started a strategic approach to commissioning Considered models of care that will better
meet the needs of the population Complex cases – unique solutions in place
Ministry of Justice resistance
Know the population – what data and from where Data Holding/Sharing issues Acquisition programme Commissioner resources to progress Additional resources to support transition Development of STP – differing footprint Pace – systems are not established to support
decision making Doing too much all at once Appetite to be bigger, bolder and braver
Challenges
This is just the beginning…..
Need to maintain strong lasting partnerships Need to establish robust communication
links Need to learn what we still don’t know Engage those we haven’t yet reached Continue to work together to make a
difference
Ongoing Progress
Building the right supportWorkforce
Tim Alex
Unpaid – Family, Friends, Carers
Work, Manager, HR, Admin
Local Authority
Health
Main stream services Tim
Unpaid – Family, Friends, Carers
Health
Main stream services
Social Care
Alex
Personal Assistants
Social Care
Health
Main stream services Alex
Work, Manager, HR, Admin
Unpaid – Family, Friends, Carers
Unpaid - Families and Carers
Personal Assistants
Social Care
Health
Main stream services
Market supply and confidence
Changes to the nature of
work
Technology
Shift of power
Effective approaches
Commissioning
Inter-disciplinary Relationship
s
Todays staff and
skills
Training Pipeline
New Roles
Skill DevelopmentRole EnhancementRole enlargement
Skill Flexibility Role substitution
Role DevelopmentWhat's needed
Adapted from Imersion, Castle Clarke, and Weston 2016
People who are keen and want to stick around
Retention Workers equipped with new skills meet Alex’s needs
ReskillingMore social care and Personal Assistant’s
RecruitmentPeople working in new kinds of jobs that fit in Alex’s life
Roles (new)
RetentionNHS EmployersRecruitment and retentionA working reflection tool for practitionersNHS Employers retain and improve
Roles (new)HEE ApprenticeshipsSkills for Care Workforce planningNew Role TemplatesNursing AssociateCare Navigator
ReskillingLearning Needs AnalysisWorkforce Shaping (SfC),Learning Disability Made clearAutism awareness learning resourcesCo-production self-assessment tool
RecruitmentSkills for care (int)Workforce intelligence (int)Competencies and Learning Need Analysis (int)Attracting recruiting for values
Learning Disability and the Transforming Care Programme
James Moreton – Regional Director East
Who we are• We are the recognised Sector Skills Council for the whole UK
Health Sector, licensed by Government• We are a not–for-profit organisation• Our aim is to improve the way health services are delivered
through improving operational efficiency, quality and productivity
All Staff E-Rostering and Time & Attendance
Consultancy(Workforce Planning &
Organisation Development)
Learning & Development Related Services
Occupational Standards(Competence Frameworks)
HOW WE ARE INVOLVED WITH LEARNING DISABILITY PROGRAMME?
• Development of Competency Framework in partnership with HEE and providers
• Developed Learning Needs Analysis tool• Competency based Role Profiles• LD Core Skills Training Framework• Elearning related to Care Certificate
National and Regional Work
Learning Disabilities Core Skills Training Framework
• The framework determines minimum standards for LD education and training, and assists in ensuring the standards are met.
• Applicable to health/care employers and educational organisations training those to be employed in the workforce.
• As individuals move employer, core training can be recognised to minimise the duplication or repetition of training.
• Practical applications of the framework for employer organisations; – Identifying key skills and knowledge for roles and teams– Planning and designing content of education & training– Commissioning of education & training– Conducting training needs analysis– Supporting performance management and the assessment of competence
Learning Disabilities Core Skills Training Framework
Tier 3
Tier 2
Skills and knowledge for key staff working with/caring for people living with LD
Skills and knowledge for roles that have some regular contact with people living with LD
Knowledge for roles that require general awareness of LD
WHAT ELSE CAN WE OFFER
• Workforce development consultancy/support• Apprentice Pathway Development – “Grow Your
Own”• Strategic Workforce Planning• Role development to meet future service needs• Skills Passport• Advice and guidance
Additional Services
• James Moreton – EastMobile - 07795 301471Email – [email protected]
• Marc Lyall – WestMobile – 0781 396 4752
Email – [email protected]
Contact details
Cultures and behaviours
“the focus person has begun calling people by their names, where previously she was shouting man or woman” “The focus person for the first time in her life was able to bake cupcakes.” “He is living in his own flat and is actively supported out in the community there is no Physical Interventions in his guidelines.” We have recognised as a specialist CTPLD that the staff team at the home along with it's managers have been struggling to cope with ***'s behaviours and those of others in their home. The staff team presented as overwhelmed, 'out of their depth' and unsupported. As a result of the training the staff team are now demonstrating more resilience and capability and the management are reviewing the ways they support their staff team.
Workforce redesign
Principle 1 Take a whole systems view of organisational change
Principle 2 Recognise the different ways people, organisations and partnerships
respond to change
Principle 3 Nurture champions, innovators and leaders; encourage and support
organisational learning
Principle 4 Engage people in the process; acknowledge value and utilise their
experience
Principle 5 The different ways that people learn should influence how change is
introduced and the workforce supported
Principle 6 Encourage and utilise people’s thinking about values, behaviours and
practice to shape innovation
Principle 7 Actively engage with your community to understand its cultures and
strengths; work with the community to develop inclusive and creative workforce planning strategies
Workforce integration
Principle 1
Successful workforce integration focuses on better outcomes for people with care and support needs
Principle 2
Workforce integration involves the whole system
Principle 3
To achieve genuine workforce integration, people need to acknowledge and overcome resistance to change and transition. There needs to be an acknowledgement of how integration will affect people’s roles and professional identities
Principle 4
A confident, engaged, motivated, knowledgeable and properly skilled workforce supporting active and engaged communities is at the heart of workforce integration
Principle 5
Process matters—it gives messages, creates opportunities, and demonstrates the way in which the workforce is valued
Principle 6
Successful workforce integration creates new relationships, networks and ways of working. Integrated workforce commissioning strategies give each of these attention, creating the circumstances in which all can thrive.
Change
www.england.nhs.uk/learningdisabilities
Question Time
Chaired by Carl Shaw
