Transforming care for learning disabilities

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

www.england.nhs.uk
Building the right support
for people with learning disabilities:
Turning improvement ideas into local action
Dr Julie Higgins
Senior Responsible Officer
Transforming Care Programme
Kia Oval 19 July 2016

www.england.nhs.uk
Making it happen – working together and turning
plans to reality

www.england.nhs.uk
• 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:

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
£30 million over three years – about half the 24
Transforming Care Partnerships
funded for 2016/17
Funding distributed this week
Transformation funding

www.england.nhs.uk
• 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 disabilities
The Coventry, Warwickshire and Solihull Experience
Becky Hale, Strategic Commissioning Service Manager All Age Disability, Warwickshire County Council
Ali Cole, Project Manager Transforming Care, Arden & GEM CSU
Karen 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

• 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

• 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 Care
Personalised care and
support
Extra support when
things change
Hospital is
a last
resort.
Support in
hospital to
return home

Craig’s StoryYouTube link
https://youtu.be/sQU2U-ACbnE

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

www.england.nhs.uk/learningdisabilities
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2016

Thankyou for inviting us
David Branford
Carl Shaw
Ben Briggs
Learning Disability Programme
NHS England

• Background to this work
• Why is this work important?
• The aims of STOMPLD
• YOUR role in this
What we’re going to talk about

This work is part of Transforming Care
There 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

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

So what’s it all about?

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

Ann and her son who was at
Winterbourne View Hospital
It was 3 years before he went home
This is why we’re here

• 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

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?

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.

• 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

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.

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

The STOMPLD Pledge
The 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

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

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

Over to you
What can you or your
organisation do to
stop the over medication
of people with learning
disabilities or autism?

• Visit the NHS England website
• www.england.nhs.uk/learningdisabilities
For more information

Health and Social Care Information Centre
Learning 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. .

http://www.cqc.org.uk/sites/def
ault/files/20160209-
Survey_of_medication_for_det
ained_patients_with_a_learnin
g_disability.pdf

Data from CPRD General Practice
prescribing study

Make psychotropic medication the
last resort
The 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.

International guide to prescribing
psychotropic medication for the
management of problem behaviours in
adults with intellectual disabilities
Deb 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 Launch of Lincolnshire's All-age Autism
Strategy – 2nd April 2015.
The theme was
creativity of people
with ASD

Making bigger meetings
autism friendly
Also known as flapplause.
Flap, don’t Clap.

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 worker
I 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.

It 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 team
It 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

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

Any Questions?
www.lincolnshire.gov.ukLAPB
Sharon.Jeffreys@SouthWestLincolnshireCCG.nhs.uk
Jo.Minchin@SouthWestLincolnshireCCG.nhs.uk

www.england.nhs.uk
Help us to Help you
Pól Toner RN MSc
Head of Improvement and enablement
Strategic Resettlement
“Thinking and Planning for a Better Future”

www.england.nhs.uk
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

www.england.nhs.uk
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”

www.england.nhs.uk
• 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

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
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.

www.england.nhs.uk
In the Regions
Much 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

www.england.nhs.uk
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

www.england.nhs.uk
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

www.england.nhs.uk
• 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

www.england.nhs.uk
• 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

www.england.nhs.uk
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

www.england.nhs.uk
“safe and sustainable personalised
care planning at scale and pace”.
Thank You

Pan Lancashire
Transforming 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
Comissioners
Networks Housing
Finance
Resettlement
Team 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

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

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

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

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

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

Any Questions?
Maria.Howard1@nhs.net
Thank You

Building the right support
Workforce

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
Relationships

Todays
staff and
skills
Training
Pipeline
New Roles
Skill Development
Role Enhancement
Role enlargement
Skill Flexibility
Role substitution
Role Development
What'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
Reskilling
More social care and Personal Assistant’s
Recruitment
People working in new kinds of jobs that fit in
Alex’s life
Roles (new)

Retention
NHS Employers
Recruitment and retention
A working reflection tool for
practitioners
NHS Employers retain and
improve
Roles (new)
HEE Apprenticeships
Skills for Care Workforce planning
New Role Templates
Nursing Associate
Care Navigator
Reskilling
Learning Needs Analysis
Workforce Shaping (SfC),
Learning Disability Made clear
Autism awareness learning
resources
Co-production self-
assessment tool
Recruitment
Skills 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
Tier 1
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

• 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 – East
Mobile - 07795 301471
Email – james.moreton@skillsforhealth.org.uk
• Marc Lyall – West
Mobile – 0781 396 4752
Email – Marc.Lyall@skillsforhealth.org.uk
Contact details

“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.

Question Time
Chaired by Carl Shaw

www.england.nhs.uk
Thank you
Contact us by emailing:
england.learning.disability@nhs.net

Transforming care for learning disabilities

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