learning disabilities: turning improvement ideas into local action (alison cole)
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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
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?