Learning Disabilities: Turning improvement ideas into local action (Alison Cole)
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Presentation delivered by Alison Cole at the 'Transforming care for learning disabilities' event on 19 July, 2016.
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Learning Disabilities: Turning improvement ideas into local action (Alison Cole)
- 1. 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
- 2. 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
- 3. The Transforming Care Journey • Our approach • Our challenges • Our achievements • Our lessons
- 4. 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
- 5. 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
- 6. 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.
- 7. 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
- 8. 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
- 9. Model of Care Personalised care and support Extra support when things change Hospital is a last resort. Support in hospital to return home
- 12. 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.
- 13. 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.
- 14. 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.
- 15. 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)
- 16. 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.
- 17. 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
- 18. 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
- 19. 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
- 20. Case Study - Dave • Think differently • Be creative • Never give up!
- 21. 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
- 22. 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
- 23. Questions?
Editor's Notes
- Key messages: Locally we have been advanced in our thinking and planning on our new model of care. The footprint for the Fast Track has been a real challenge as there is no natural synergies apart from Coventry and Warwickshire. Patient flows largely cover Birmingham not Herefordshire and Worcestershire.
- Key Messages: Ambition has been developed and jointly signed off as part of our joint plan in response to Winterbourne and is also key to our new LD Statement of Intent. New model of care predicated on personalised local services, hospital being the last resort.
- Key Messages: Ambition has been developed and jointly signed off as part of our joint plan in response to Winterbourne and is also key to our new LD Statement of Intent. New model of care predicated on personalised local services, hospital being the last resort.
- Jacqueline – use your words – the below are some suggested points to cover and tried to keep it plain english where possible. You have 10 minutes in the agenda so it only needs to be the key points. People will have an easy read version of the model of care to refer to. The Model of care has been developed through engagement with lots of people It focusses on giving people support which is personalised to their needs and which gives people choices about how they live their life. We want to support people to do the activities they enjoy, to have friends and a good life There are some things we want to do better to support people: Key staff – 1 person who coordinates your care and support Learn about you – learn more about things that upset and worry you or that make you feel unwell and how you would like to be supported when you are unwell · Training- Your carers can have training to understand the best ways to support you when you feel upset or unwell. Your carers will help you understand and communicate your feelings and needs. Sometimes you need more help than your carers can give you. This is because you are unwell or have had changes in your behaviours and the plans your carers have are not keeping you safe and well. When this happens we will provide extra support in your home. This could mean: · More people caring for you and more hours of support each day · Carers will have more training to understand your needs and to support your care plans · You get treated for any mental illnesses that are making you feel upset or unwell We will have emergency accommodation available in the community for when people need somewhere to stay for a few days. This is not a hospital, but will provide a safe place for people to stay if they can’t be in their home. When people need extra support we want to make sure they get it as soon as they need it so that things don’t get worse. Often we can anticipate when people need extra support So we want to get better at supporting people to stay at home and not go into hospital Sometimes people will still need to go into hospital, but we want this to be a last resort. When this happens we are going to support that person so that their stay in hospital is not a long one and they can return to their own home as soon as possible.
- Community Intensive Support Teams implemented. LD and MH Liaison Nurse posts. Admission avoidance agreements, funds and accommodation. Long term accommodation with support developments. CAMHS Re-design. Model of care DVD and workforce development. Continued customer and carer engagement.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.
- Key messages: Poor take up of screening and primary healthcare - perpetuates inequalities, health problems going unnoticed. Need a better understanding of our children’s population – especially those transitioning into adult services. People out of area due to a lack of appropriate accommodation with care locally. Short term assessment and treatment beds – used because they are there. Recognise the need to support people in specialised commissioning to return to their local area – more active involvement early on to support effective discharge.