Building the right support for people with a learning disability and/or autism: one year on and two years ahead

www.england.nhs.uk

Building the right support for people with a learning disability and/or autism: one year on and two years ahead

Welcome#improvingLD

8 November 2016

www.england.nhs.uk

Jane CummingsChief Nursing Officer for England

Building the right support for people with a learning disability and/or autism:one year on and two years ahead

8 November 2016

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• One year since Building the right support.

• Our ambitious national plan to develop community services and close inpatient facilities for people with a learning disability and/or autism who display behaviour that challenges including those with a mental health condition.

Why are we here?

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• 48 TCP plans developed • Invested an additional £10m to speed up

transformation in six areas last year and providing £30m revenue funding over the next three years, matched by CCGs

• National support offer now available• Clinical appointments: senior psychiatrists Dr

Jean O’Hara and Dr Roger Banks and chief pharmacist Peter Pratt

• Employing learning disability advisors and network managers

• Consultation launching soon for learning disability services in the North West

What we have achieved (1)

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• In three years we expect to need hospital care for only 1,300-1,700 people.

• Number of people in hospital is falling – 10% inpatient reduction between March 2015 and September 2016 and the inpatient count has reduced consecutively month on month since January 2016. But need to get better.

• Four inpatient units have already closed: two in London, one in East Riding and one in Hampshire. Clinical experts and experts by experience are involved.


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• Care and Treatment Reviews (CTRs) have been rolled out across the country and are embedded into standard practice. Between April and September 2016 ,1345 care and treatment reviews took place (including 290 pre-admission CTRs).

• CTR policy refresh and discharge standards published soon.

• National guidance for children and young people and report on children in 52 week residential schools published soon.

• 1200 people with a learning disability had personal health budgets last year.

• Stopping the over-medication of people with learning disability pledge, July 2016


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• Sharing and learning from the good work that is happening

• Putting people with a learning disability and/or autism, their families and carers at the heart of the TCP plans

• ‘Fast track’ areas starting to show what kind of transformational change is possible

• Fewer admissions and reduced reliance on in-patient beds

• Improving community support and preventing crisis admissions

Transforming Care Partnerships in the regions

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• Some plans need more work – we are working with local areas to get more ambition into such plans.

• Need the culture to be as bold and dynamic as we can, to see the potential for people to thrive.

• We need more progress in resettling people who have been in hospital for over five years.

• Need to move faster – expect to see more real progress in next two years.

What we need to do more of

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Two men and a dogShared Lives

NHS Transforming Care

Tuesday 8 November 2016

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How many different houses did you live in?

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How long were you at Chalfont?

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What was it like?

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What did you do at Chalfont?

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How did you feel about living at Chalfont?

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Bronte

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New House , Job & VotingCommunity life

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Community Connections & Citizenship

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Community Connect Day April ‘16

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We have formed a company to help others make friends and connect to their community

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Medication, Health, Support to Stay Well• Results of over medication• Right to specialist care• Role of Specialist Epilepsy Community Nurse in the community• Acute Liaison Nurse in General hospital

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Impact on James’ Health• Huge reduction in epileptic seizures and non epileptic attacks• From an average of 2 a month and all the recovery that takes but there were

clusters last one was 23.11.15• Cognition improved• Motivated• Energy• Able to get up in the morning• Happy• Forward focused

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To Finish

• Community, community and more community• Life not a service• Ordinary Life• Consider Shared Lives asan option model of care

Hertfordshire PartnershipNHS Foundation Trust

Building the Right Support for Barry

@HPFT_NHS


Community Assessment & Treatment Service

Who we are…

Intensive Support Nurses

Psychiatrists

Clinical Psychologists

Art Therapists

Speech & Language Therapists Occupational Therapists

Counsellors - •Bereavement & Loss•Sexual Health

Dieticians

@HPFT_NHS


Nursing• Role• Time limited follow up • Implementation of PBS• Collaborative Working• Discharge


Early Intervention & Practice Development

EIPD

@BeverlySeeley @HPFT_NHS


Who are we? We are a new team within the community

assessment and treatment service commissioned under the transforming care

agenda.

We work with individuals and their support networks to help support a person’s transition from long stay hospital to a place of their own

and help maintain that placement.



What we doWe provide staff teams free training in Positive Behaviour Support, Person

Centred Active Support and Autism/SPELL Framework.

Following training, we assist staff to develop competencies by providing

individual coaching and support.



What we doProvide information on local community

opportunities for people to feel a part of their neighbourhood and community.

We provide support to help solve problems as they arise and can signpost the

person/service to mainstream or specialist supports as early as possible.



How we have helped build the right support for Barry

We provided Hillcrest with PBS and PCAS training. This training has helped all involved in

Barry’s care to understand his needs.

Following training, we have been supporting the staff to implement Barry’s PBS

plan and are currently supporting practice development action plans.



Incidents of Challenging Behaviour

August September October0

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4

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Incidents of Challenging Behaviour



EIPD Coordinators and Senior Support Workers monitor and support Barry, his staff and his family.

Providing long term support enables us to be able to signpost Barry and his staff team to

mainstream/specialist services early as possible.

How we have helped build the right support for Barry



Contact Details• Team Leader:

[email protected]: 07990 550680

• Practice Development: [email protected]: 07833 293439


The importance of leadership in changing culture to enable better outcomes

Dr Jean O’Hara FRCPsychClinical Director & Consultant PsychiatristKing’s Health Partners AHSC; South London & the Maudsley NHS FT,Senior psychiatric lead, NHSE Learning Disability Programme

Our service model

Mental Health Learning Disabilities (MHLD)

Small team: 45 clinicians + admin, covering 4 South East London boroughs and population over 1 millionCaseload in the team approx. 860 adults

Model of service:• MHLD model: embedded in a Mental Health Trust using Mental Health frameworks & resources• Estia centre (1999)

Sits within a Clinical Academic Group (CAG) ≈ Directorate: secure & community forensic services, offender health, national autism services and diagnostic clinics.

King’s Health Partners (2010): • translating research into clinical practice• integrated Mind-Body approach • Value Based Health Care by demonstrating outcomes and costs

Our Values

Commitment to improve the lives of people with learning disabilities & additional mental illness

Social inclusion, Human Rights … and challenging inequalities

Provide specialist assessment & treatment that complements AMH/CTLD & primary care

Provide a responsive service – personalised & meets the person’s needs

Our work is evidence-based … & we strive to provide the evidence for our effectiveness/continuous improvement

Support our workforce … personal/professional development & Estia MDT programme

Support the wider network through delivery of education/training events (Estia)

Outcomes books

Share and publish data/outcomes

Benchmark/peer pressure

Outcomes – capturing KHP vision

Sharing good practice and QI

Articulate & demonstrate value in what we do

Knowing and working on our ‘gaps’ – so we demonstrate year on year improvements

Preventing out of area placements or admissions to ATU

Enhanced intervention service – Southwark pilot (psychology led)

Funding: Local Authority and Better Care Fund

Integrated multi-agency approach (v small flexible team, complements MHLD Southwark)

Particularly for those who should not go though a mental health pathway;

Demonstrated good outcomes

Valued by families

Financial savings (unexpected)

Can this model be rolled out across South East London TCP?

Reducing health inequalities

Funding: Health Education/KHP funded project (2014-2016) Lead by psychiatry: to address health inequalities through training and education

Appointed a project lead (CPN)Under the umbrella of EstiaIn collaboration with King’s Health Partners Education Academy &King’s Health Partners Mind and Body Programme

Accessible ‘my recovery and support plan’ – sample pages

Quality of Life measures (pilot 2016/2017)

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Starfish +.

Norfolk Community Health and Care NHS Trust

Dr Melanie Bruce, Clinical Psychologist and Clinical Lead.

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• Starfish +

• intensive, multi disciplinary assessment and intervention for children and young people with learning disabilities and behaviour that challenges and/or mental health needs

Building the right support for people with a learning disability and/or autism: one year on and two years ahead

Healthcare