5b winterviewprogressmeeting-1

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WINTERBOURNE REVIEW – PROGRESS MEETING

07/12/2015 – Coin Street

NOTES: Unfortunately I was sitting next to a person who was

constantly coughing, and so you will see [] which means

something was said that I didn’t understand or it hasn’t

come out clear enough on the recorder for me to decipher

what’s being said. So this note isn’t for reference, but to give

you a ‘flavour’ of the last meeting of the steering group.

Sir Stephen The purpose today is a review of where we have got to really,

just over a year since I published Winterbourne View, Time for

Change. It was a really hard hitting report which highlighted fiveyears of failure. We let people with learning disabilities down.

We made promises to them and their families that weren’t keptand frankly it wasn’t good enough. Six months on from that I

produced a further report where again I highlighted the prettyshocking lack of progress, still stubborn numbers stuck ininstitutions and I said we needed to get cracking with closuresand we needed to scale up community provision that was thepretty straight forward message.

I think we have now made progress. I was pleased with thereport, the plan that came out some four weeks ago. I think that

shows great promise. But it is against the background of thatappalling failure. It is against the background where still we

have the same numbers of people in institutions as we did at thetime of Winterbourne View. There is a lot to do and frankly this

is the last chance saloon because if we don’t deliver on closures

and scaling up community provision there will be hell to pay.

I have recently conducted consultations which you will hear

about later, and I think there is a lot of hope that things havechanged but there is also a lot of cynicism because there havebeen so many reports, including mine that have said great things

and made great promises, but as yet nothing has happened.

So today is really about let’s see what actions are now being

taken. Let’s see where the problem areas are. Let’s see what weare going to do about them and the emphasis this morning is on


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discussions and dialogue. I’m hearing from people in the roomabout where they think things need to happen where they thinkthere are problems where actually we can find some further

progress and finally I’m going to produce a year review report inJanuary which is going to build on a lot of the discussions we

have had today and consultations I’ll be having, and so Jane it’sover to you.

Jane

Cummings

(NHSEngland)

[Slide 3]

Thanks Stephen and welcome to everybody. I think this is

exactly as Stephen said. This is an opportunity just to take stock

on what’s been delivered since this time last year and actuallylast week I was at [] again which is where we launched Stephen’s

report and we held a workshop there around learning disabilitiesand what the future looked like and Gavin Harding who wasworking alongside Stephen was there and he was just brilliant in

terms of his ability to really get to the heart of what we need to

do and to describe it from a personal sense so that was reallyconstructive.

I’m not going to say very much. It’s much more important we

have the opportunity to go through the [] that was done andcolleagues and the key partners that we work with have done and

you’ll know that after the report was published last yearNovember all the key organisations did a response which wepublished at the end of January and as a result of that we agreed

there would be a change in terms of the Government and also we

had identified actions from Stephen’s report that we said wewould work on and implement and I think the key today and the

discussions we’ve had with Stephen is this needs to be a briefupdate and overview and more importantly discussion so that as

a collective we can work together to look at how far we’ve gotwhat were meant to be done. Is there anything else we need help

with or people support us with, and advise us on etc so that weactually deliver on what we say and I completely get Stephen’s

comments that while people have welcomed the work we have

published at the end of October and that did land pretty well

there is a lot of cynicism and a lot of ongoing concern about, itsvery easy to say but very difficult to do and people we accept arecompletely fed up with being told this is going to happen and it

takes ages although we also have to recognise that this iscomplex, this is difficult and for individual people it can take

some time to get those [] in the way that’s [] and appropriate.

I will stop there as I think it’s much more important that we


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actually look at what we got. You’ll know there are some slides[] the evidence [] maybe the NHS and others do that more oftenbut that’s the agenda we’ve agreed with Stephen’s office so we’ll

follow through that. Is it worth just checking whether everybodyknows where everybody is? Would that be useful?

EVERYBODY BEING INTRODUCEDSarah

McClinton

(DH) [Slides4-9]

I was just going to start by talking a little bit about the first two

work streams: the empowerment and the data and information

work stream.

Proposals within that, which includes strengthening range ofstatutory guidance, piloting access to a named social worker, so

someone who can work in a relational way with families rather

than a [] model which is much more about process. The idea ofthese pilots is actually to see what the benefits will be if you have

a social worker who is working with families over a period oftime, getting to know them and thinking about planning in the

future with them. It also includes some thinking on how weexercise the Care Act and the market shaping duties within theCare Act and how that also applies to joint planning

arrangements between the local authority and CCGs.

The second phase of work sets out some changes tostrengthening the rights of individuals and families within thecontext of the Mental Health Act and so setting out really how

we might go further from the revised Code of Practice which waspublished last year.

One of the proposals for example was that the Code of Practiceshould apply to CCGs as local authorities already applies to and

also within that thinking about the potential for single advocacymodel so we also have the Law Commission working on their

report in terms of the Mental Capacity Act and the proposal

within that, that we want to think about alongside any changes to

the Mental Health Act. And then the third [] areas is to make

sure that if progress is not being made, and that progress is beingmonitored closely by Ministers, so part of the Secretary of States

delivering meetings and also monitored through theTransforming Care Assurance Board which is, many of you will

be familiar with that, co-chaired by the Minister and by someonewith a learning disability, and the Board essentially is made up ofmostly individuals and families, and so it’s a very close

monitoring programme with that process.


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So the third phase we looked at what else might need to be doneif we don’t see progress through building right support that has

been set out. So moving on then to data and information there’sbeen lots of work done to improve the quality of data and

information, where we continue to see the data growing strongerin terms of its quality. There’s some work under way to look atempowering [] a wider cohort of people. They call it ‘at risk’ on

that slide I think probably there’s a better terminology, what

we’re talking about is how we make sure we’re looking at a

cohort of people where we can make sure we’ve got the rightpreventative measure in place. It’s not just simply there’s peoplealready inpatients.

There’s work going on that, and work to develop quality of life

and quality of care indicators so that the sort of measures we useensure progress is being made, its actually based on people’sexperiences in terms of the difference it makes to their lives and

the quality of care they receive and the other piece of workwithin this work stream is looking at barriers to information

sharing. So we know that some of the legislation doesn’t help usin terms of sharing information across the system and there’s

been work done to develop a consent form that will enable us tomake sure that at local level information will be sharedappropriately.

In September this year we run the third census to provide

information about people inpatient services and that’s a different

collection from the assuring transformation collection which is acommissioning collection so there are some differences in these

two data sets. It enables us to triangulate to get richer and deeperinformation about people’s experiences and inform how we want

the data set to work going forwards.

I’ve already mentioned some of the work going on to tackle the

information government issues and as I said we’re also workingto develop a set of indicators that can measure the quality of life

and quality of care effectively so that work is predominantlybeing done alongside families and individuals and as part of thatthere’s a workshop this week very shortly that will look at what a

patient input outcome or patient input experience measure mightlook like and how it can be incorporated into the CTR process

and to the care and treatment review process.


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So I’m going to pause there for discussion and will run throughto CGC.

Theresa

Joyce

(CQC)Regulation –[Slides 10-

12]

As you know CQC is one of the partners in the transforming care

and delivery process and our function really we inspect and

regulate health and social care services and that involve threethings [] – one is inspecting services as they are, one is takingenforcement action for services that don’t meet the required

standards and the third and important is registration of new

services.

So let’s say a little of what we’ve done from each of these threeissues.

I will start with enforcement and clearly I think we’re all aware

that when a service may need to change or close significantly it’snot always clear the role of all the partners in what should bedone and who should be doing what. So we’ve been doing somework on trying to get a sense of clear responsibilities of each of

the agencies that may be involved in that process and we haveproduced a statement on the role of the partners when

enforcement action is taken and it’s been developed and its outfor consultation and it considers what each of those partnersshould do. So in terms of commissioners they need to be

thinking in terms of placement and specialist teams to go in and a

whole host of other things. And we’re trying to allocate whoshould lead on what and the commissioners in the room will be

pleased to know that a lot of the leadership will come down tocommissioning because actually in the end they are the people

who purchase the services and they have responsibility for whatthey are purchasing. The CQC needs to take the lead in actually

helping commissioners think about [] service and other issuesthat providers say – anyway that up for consultation and we

hopefully will get something much more finalised in the next

year so that the main piece of work on that.

We’re also as you know using warning signs data to identify aservices where there may be concerns so we look at safeguarding

data we look at [] and actually further work is underway to tryand see what other signs we can see to try and help us identify

those services where there are problems. We worry about a

service that makes no reports on safeguarding probably as onethat make a large number because that service is not noticing


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what’s going on.

In terms of inspection methodology there’s been a lot of work

looking at hospitals and our aim is to support inspectors inanalysing what good looks like in learning disability services and

[]domain the CQC looks at which I’m sure you’re all familiarwith, safe effective [] well led. So we’ve developed a number ofmethodological supports if you like, so we’re looking at learning

disabilities specific table for gathering evidence in relation to the

five domains specifically in hospitals. Some of you may have

experienced or know about the comprehensive inspections thatwe do when a team of 80 people descend on poor unsuspectingtrusts and [] when actually we need to have structure to enable

people to make sense of [] so we make a lot of work on helpingpeople structure what they ask and bring back and corroborate

the evidence. We’re been doing learning disability specifictraining for inspectors on communication and how wecommunicate effectively with families.

Supporting living services are a real concern to many people and

there is guidance being developed on how to inspect supportedliving services and I’m sure everyone is familiar with the reality

there are many people with complex needs who may be insupported living and supported 24 hours a day. The reality islegally that’s their tenancy and legally CQC has no right to cross

their thresholds unless they give consent and as you will alsoaware many people may not be able to give consent so we’re

working on how we develop the methodology that will allow us

to ensure we really do see those services and we’re looking forindicators like 24 hours care and support so there’s work going

on and actually there’s a pilot on how we’re going to start doingthat more effectively starting from next year. And we’d have

completed brief guides for hospital inspectors on: [see slide 11].I think some of you have seen some of those. And the last one forus is registration and the aim of this is to align registration

services with the Transforming Care service model and NationalPlan. So what we’ve done so far is the Learning Disability

Programme Board within CQC now as you probably know andwe’re asking all learning disability applications are considered bya dedicated team within registration division within CQC and

because the service model is now able to ask much clearerquestions about how the service is complying with the service

model. We have a position statement on the CQC approach to


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registration and new registration which will be published on ourwebsite this week and it says things like – but it actually says thatnew applications will be considered in how they comply with the

service model and it also says if you are seeking to reregisteringexisting service we will compare it again to show it aligns with

the service model and we’d want to make sure you’re making achange in line as oppose to changing your name and there’d be afull policy statement developed hopefully within the next couple

of [] but we wanted to get the statement out now so that

providers already making applications are clear that actually we

have a position on this and it’s in line with the transforming careservice model.

QUESTIONS?

Questions -Marcella

Can I say just ask about the social worker named. It’s a goodidea but it seems to me that we’re going backwards and forward

as before we, as families, have been asking for years, can wehave a social worker. I mean so far my son has had about six

different ones and he displays everything we’re arguing abouthere and I just don’t understand why the local authoritythemselves cannot think this is the best way to go, because if you

have a social worker this is the person you have to go –otherwise we have to repeat the same thing again and again, so

for me we’re going back to the past because that’s how it used tobe.

ANSWER

fromsomeonefrom DoH

Remember there’ll be lots of individuals who might have been

receiving a specialist service and not going anywhere near theirlocal authority so part of what DH is intending in thoserecommendations is that local authorities have got new and

additional responsibilities about the availability of social workersis a particular new role and defining in a particular way and that

might not be apparent on what was being said so far.

I think what I’d also add to this is it’s a pilot and it’s the

opportunity to test actually advocacy and what difference it doesmake and what should be the future model.

Sir Stephen But that’s very different from advocacy – social workers aren’t

that – it’s a very different issue.

Viv My question is about advocacy – on slide [] it says [VIV was toofar for the recording] – but actually families are saying that

people don’t have access to high quality independent advocate sowhere are those people coming from because it says here again

they could have access to them how will that []


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Answer We’ve set out within the service model that [] in terms of thedifferent types of advocacy in the system and whether we shouldbe considering a simple model – in the future []

Question Just a quick one on the CQC. Does that mean if a provider

comes up with something that doesn’t conform with the contents

of transforming care and the service model, that will be refusedor turned down – that will be fabulous – I’m not arguing with it.

Answer We did get applications from providers who wanted to build very

big services that aren’t really locally integrated in any way at all.It’s very difficult because sometimes they’ve built them beforethey come to us and I think now that we have a positionstatement on the web which is publicised it will be much easier

for providers to know this is going to be something they will find

difficult not impossible because actually we have to register ornot register in line with regulations but actually the regulations

talk about premises, they talk about person centred care andvarious other things so meaning better care we can’t just say no

we’re [] leave in doubt but actually none of those models will notmeet the requirement of the regulations so we have to be verycareful in ensuring that we’re looking closely at the regulations.

There are times when that has happened up till now we’ve doneit as part of commissioning saying no we’re not going to

commission that service so the combination of commissionersnot commissioning and the service model []

Sir Stephen I think the CQC being very hard on this will indeed be welcome

and it will be good if we start deregistering places like St.Andrews.

Alison I was looking last week for information for families about CQC’srole and about the standards they look for and so on and I was

thinking it will be really helpful if all the information was put onthe slides would be in one place at the CQC website that’s easy

for the public to find. I don’t know if that’s the intention but it

will be great to put in.

Answer The enforcement work won’t be on the website until we’ve doneit. The position statement we’re hoping to be on the website by

the end of the week and certainly it has to go through internalprocess and it’s nearly at the end. We’re going to be sending outthe information to providers and the forums so it will be going

out at the end of this month. Then a full policy statement willfollow.

Alison I was thinking about the range of guidance that was up on theslides I was thinking for families who are looking for guidance


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on how services are being assessed it will be really useful to seethat up.

Sir Stephen One question from me on the slides about progress onempowerment it was very interesting when I did one of my

meetings in Leeds with people with a learning disability this was

with CHANGE they’re produced an extraordinary good easyread guide for people with learning disabilities about how tochallenge the system and get out of institutions etc and

apparently although that was funded I think by either NHS

England or DH no one is funding it to be distributed to peoplewith learning disabilities and they were told this is the MENCAP

thing by the way and they’ve been told there isn’t any money todistribute it. Am I right Kate? I think what it’s called.

Kate The independent []. It was produced for the JIP. It was theoriginal one.

Answer It’s taken a while to get in the [] but I’m not aware there arebarriers to it being published and certainly we expecting it to bepublished. So I’m not quite sure where that’s coming from.

Sir Stephen Perhaps you and Kate can pursue that with CHANGE. It wasactually extraordinary good for the easy read stuff.

I think it’s the CHANGE document you’re referring to [] we’re

worked quite hard with CHANGE to get it in that position []

Sir Stephen That was very helpful – can we move on to Fiona.

Fiona ClarkNHS

EnglandRight Care,

right place

[Slide 13]

I’m assuming people have the slides in their packet, what Iwanted to do was talk about the work stream that is snappily

titled, Right Care Right Place which encompasses the work that’sbeing led by NHS England and ADASS and LGA. We’ve

allowed quite a lot of time this morning on Building the Right

Support which is what happens next – but taking Sir Stephen’schallenge its very well talking about the future what’s going on

now because that matters too. My sole purpose is standing hereto draw your attention to the things we’re doing at the moment

primarily NHS England led and just to not because I wish you toread all the detailed data that’s on these slides but I wanted

competent assurance that we’re taking very seriously what’s

happening out there today in addition to working out what weneed to do for tomorrow. I think this slides talk about the work

on inpatients and I will literally turn over the next few slidesbecause I believe the [] is data rich.

The things we talked about pretty much on a weekly basis and itleads you to the commissioning team on a daily basis []

inpatients and people in hospitals. As some of you were aware


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we had quite a challenge last year to actually [] – not being ableto identify people who need care and support but let’s be honestwe didn’t know who they were, and so we’ve spent quite a lot of

time and effort with the health commissioners and HSCRC toreduce the number of [] record [] and paperwork we can’t find.

So you will see that as we find people that should be on the listyears ago the numbers go up, but this slide which is the slide welook at in discharges we are seeing admissions fall [slide 15].

We are doing quite a lot of work across the entirety of the

country to reduce the people going into hospital we have to getthem out as well but we’re doing quite a lot of work on stoppingpeople going in. You will see that the blue lines on the slides are

number of admissions at the time and that is actually us doingwhat we’re supposed to be doing keeping people out of hospital.

You could argue about the accuracy of the data and we wouldn’tdisagree but actually we’re reducing the number of people goinginto hospital.

Care and Treatment Reviews

Sir Stephen Can you just pause? What’s the difference between discharge

and transfers? Does that mean they’ve moved to another place?

Fiona Transfers are indeed moving to a different type of setting and wehave a different type of data capture challenge we will go awaycome January is that the system captures data and can’t tell the

difference at the moment. We have just designed a new technicalsolution that can tell the difference and that is now being used

and with effect from January it becomes mandatory.

Hazel A transfer doesn’t count as a transfer unless people are movingdownwards in their level of security. So somebody will count as

a transfer from high secure to medium secure, medium to low orfrom low to locally commissioned.

Sir Stephen So it wouldn’t be just to another unit

Hazel No. Not in a similar level – as otherwise it will count as anadmission or for moving up or people getting more unwell or

we’re not [] as we should so that will count as an admission, andif we’re moving downwards that will class as a transfer.

Fiona From January it will be mandatory to complete data capture in away to allow us to tell the difference. Care and Treatment

Reviews is a mixture of really powerful information and quite achallenge because we actually need to make sure that now an

account of these 2,000 something of them we’re now in a muchbetter grip – we’ve also identified sticky cases of individuals []


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hard to get the right care and support. We have just finalised thecare and treatment review policy, having been designed this timelast year and tested both on [] and pre-admission. Finalised

policy published on 30th October. The next plan will be a proper

audit of what is going on and the actions which have been swept

up and created part of care and treatment review to make sure it’snot just [] people discharge in the past. Two things at the bottomwhat the Care and Treatment Reviews tell us we have to do next.

Criminal justice. Nobody can pretend we are yet where we need

to be on handling [] criminal justice system and there are

individual cases which are sticky in that they require a great dealof care and support that [] yet ready and able to advise and []make sure those have impact we want but what is encouraging if

we can catch cases where are [] that is what is making thedifference.

As an illustration of things we look at internally you know lastyear we talked about 2014 [] we are meeting the needs we set

out. The other area we talked.

[I’m stopping here – not easy to understand] – but look at

Slides 13-24 – and the speaker who came afterwards

recording not very good]

Workforce –

Update LisaBayliss-Pratt

and AshokRoy

See slides [25-47] – [This was also difficult to pick, especially

Ashok – so lots of []]

We have a total patient cohort of 2,500 people that we’re tryingto manage, we also recognise there are ten times more than that,

25,000 people that are at high risk of being admitted so that willdemonstrate the task in hand and how we have to tackle the

whole workforce not just specific [] of it. We working reallypersonally and valuable in the relationship with Skills for Health

and Skills for Care and we think the PBS training has been

particularly successful and Ashok will talk more about it. We

talked about the education and training of learning disabilitiesworkforce a little bit through a link that unfortunately didn’twork but it’s interesting for us that the learning disability

workforce of the future because I don’t know whether peopleknow about the changes following the comprehensive spending

review with regard to behaviour term, medical workforce so

nurses, AHTs and therapist we don’t have to send levers all thetime because that’s going to [] market so we won’t say we need


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15,000 learning disability nurses or mental health nurses that willbe [] market – how do we know what the right workforce shouldbe moving forward and I think what we will move towards is

more scenario planning and workforce modelling, but actuallythe [] of how many people should actually be in the system at a

particular time or place will change for us so it’s important that Ihighlight that for you.

As a result of the comprehensive spending review and indeed the

lobbying of universities UK and the council [] for Health there

was a view that workforce planning has never been successfuland actually wouldn’t it be better if the non-medical workforcepaid their own fees and tuition grants like other students and

access different financial support mechanisms and that sort ofgain a lot of momentum in light of the money that we had to save

and as a result that was agreed that would be the approachlooking forward. Now as you would expect it has caused somenoise and disruption amongst [] nursing, and they are lobbying

the government but as it currently stands that change will happenand its more about how we manage that change, not to stop it or

not.

The good news is the medical workforce will still be carefullycommitted as it has been all these years and we get it so rightdon’t we – but there is the perfect need between needs and

supply.

[Ashok] The way we are working now – one of the concerns that

has been expressed this is a health led programme but it isactually trying to promote social care and a social model of care.

I spent the first six months of my link with HEE saying yes,we’re dealing with this post as well, and through this we’re

working with partners, Skills for Care and Skills for Healthwhom we work pretty seamlessly now. Our main programme ofactivity. Here’s what happened now. [see slide 27] that is the

person providing the care and the next box the blue box that iswhere the quality of the service either happen or doesn’t happen.

That box is the space which defines the quality of services if weget it right we’ll get everything right, if we get it wrong we’ll geteverything wrong.

The person with a learning disability comes with a range of

needs which is on the right hand side and then to go to the


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bottom we’re supposed to make the workforce somehowunderstand those needs and be prepared to meet them and thenprovide the skill workforce which then goes to the left hand

corner and then meet the needs.

The problem is that if we don’t understand the needs of thepopulation then we can never match the needs with the skills ofthe workforce and I think we still don’t pay enough attention to,

we [] ten people in hospital can we have 20 care staff, 40 of this,

40 of that, without really not knowing what the person’s needs

are or the needs total of the populations are in a way that isunderstood and can then be transferred into an educationalpackage which can make a difference in the top left corner. I’m

just going on about it because I really feel quite passionately thatwe spend a lot of time actually talking about – I was telling Lisa

yesterday – we get some staff around, what we’re supposed to doin our job and leaving it up to Lisa, we need to find more Lisa’s –but no one dares ask what’s the actual problem? Have they got

autism, have they got dysphagia have they got depression, havethey got something else and that’s [] talk about.

Now on the blue stuff which is quite lengthy is about various []

we use to try and get [] you know one of the things I’ve learntover the years is no matter what you do something will not work– these links – I knew it wouldn’t work, it didn’t work in my

office, it wouldn’t work here. We sent an email to somebodysaying can you make it work, so sorry you won’t hear about Alex

today but you should, you can actually download it and see it,

and it’s a good way of describing somebody – but today I’ll talkabout Craig.

Now this guy – it’s not his real name but it’s a real person I

encountered four or five days ago. He’s 24 years old and he livesat home with his family. He’s got mild learning disability. He’sgot autism and I was told he’s psychotic. The story was quite

horrendous actually. The consultants in the mental healthservices in my patch [] says can you transfer this guy to your

ward. Why? Because the acute medical ward has [] medical fitfor discharge and he’s too disabled to be in my ward. I saidwhat’s the story so she says apparently. I said why is he in a

mental hospital? He had deep vein thrombosis. I said why hashe got deep vein thrombosis, he 23. Oh I think he didn’t move

much and that’s why he got DVT. I said why didn’t he move


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much? Oh he had some medication. I said what medication? Hehad [tresopine troxpoxal?]. What he got [] for? He wouldn’trespond to anything else. It made him supine, got DVT, got

embolism and he got completely very ill indeed, and next thinkyou know he’s got a [] impact. So anyway, I said what’s the

history? The history was that he had a similar episode a year agowhich lasted two weeks, but this one lasted two months. I said ishe well enough to be on the ward which is certified [] yes, but the

physicians want him out. This is just, his father says we can’t

have him home, we’ll take him to a hospital, but I said home is

better, well hospital isn’t bad but home is better. So whathappened then was we then decided we would get a few thingsgoing which is basically stuff like this. So what was the

appropriate needs assessment in this guy’s case and what itturned out to be was get him mobilised properly and he was on

anti[] he also had his bag, he’s also pretty zombed still and hehad to have frequent blood tests because that’s what you do as itstoxic antipsychotic meant for keeping []. I can’t tell you the

amount of times I’ve met with people on tresopine []. What theyhave is autism with a tendency to fly off the handle, have

meltdowns and talk and behave really, really strangely which to amental health professional looks like psychosis.

So the idea is how do we get this guy off medication and laterdecide whether he needs something for anxiety or not but can we

avoid antipsychotics. Why was he having psychotic episodeswas because there was some staff changes in the hospital and that

led to the changes. This kind of picture is so common to people

who have autistic children that this things happen. So the idea ofto look at the activity level, and see whether he would cope. So

what we wanted to achieve a stable level of functioning, see ifwe can good physical health medical, have a life more akin to a

23 year old life, reduce the level of challenging behaviour bygiving the family tools to compute early warning signs andprofessionals will share that information with the family so that

everyone is working from the same hymn sheet and then to lookat what this guy really want to do what he likes doing and start

looking at activities that are structured and also beside what hedoes next as well as perhaps looking at short breaks for thefamily as the family needs to get away from time to time. So I

just want to start with that to tell you the kind of support this guyneeds is very very carefully linked to his actual needs and his

needs are not simple or complex if you know what to look at.


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This kind of assessment can be done in minutes can formulate ina minute because of the scoring, but if we get it wrong it couldtake years to work out what to do.

Lisa

Bayliss-Pratt

The point I found quite fascinating about the story apart from a

catalogue of things that should never have happened was when Isaid to Ashok, well how did the staff manage this then did theyneed lots of skills to think differently? Actually it was the

champion that said let’s ask questions and lets think about things

in a different way which I think is quite reassuring we don’t needto complete [] again with our workforce actually, we required

champions and then support for people just to think twice aboutdoing what they normally do.

Ashok We keep saying, Right Care and Right Place, but what we shouldbe saying is ‘right skills and right needs’ that’s what we should

be saying. That’s what it is about.Marcella I was just going to say the basic lack of understanding of our

children, seriously, because if you understand anything about

autism, what you’re saying to me is a horrific story, one that

should not have been going down the path that you are speaking,and as a parent I am sitting there absolutely gobsmacked about

the whole thing. It should never have happened.

Ashok The good news is where I work perhaps Salford is always seen asnumber one so we [] number two.

Now let’s talk about the Key Programme Areas [slide 31]. Thefirst one is the Education and Training for LD Workforce. Here

we’re talking about two things. The skills and competencyframework which we were talking about. We have basically

drawn up a framework on a pathway model so you have [] end ofa service, [] and then providing the support they need, making

sure they’re alright. So that help [] the competency framework

base and more recently Skills for Health and Skills for Care weare now developing a skills framework to map education

curriculum.

The next thing I want to mention to you is the autism and PBS

training fund of which we’ve got some money ready fortunatelyfrom the Department of Health. We had a lot of interest in this.

This basically is a client centred approach to training, soapplications are based on actual people who are either in hospitalgetting out or coming in and they are then [] for training the teamaround the person for positive behaviour support awareness these


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things need to be linked. That’s still ongoing but I can tell youwe have two rounds of application. The first round we awarded86 out of the 120 odd applications we received, and we offered

£230,000 then and the average cost of training was 2 or 3thousand pounds per person so a lot of people got benefit from

that. The second round is ongoing now the last date is tomorrowand we’ve got 40 applicants already, and the beginning of nextweek to give the rest of the money out. So that’s going to make a

big difference. There are some applications from Calderstones

also to get about eleven people out of there. So it’s all

encouraging giving funds to the right part of the service.

The last one is about inspiration videos from leaders. I think

there is no secret in this room ultimately you can provide all theskills you want, all the financial you want all the opportunities

you want but without leadership nothing will work. Leadershipdoesn’t mean people have a director title or a manager title itspeople working on the ground in teams who have to have leaders

and that’s why I want to make sure that people understandleadership is right near you, right near the person rather than in

an office far away.

We did a - it’s a project from West Midlands which was alearning disability awareness resource which can be downloadedonto a mobile phone actually, it’s very popular and it was

generally very easy to use. And there was also - and it madeavailable autism awareness resources from a number of [] which

can then be used including awareness.

Now the next slide I just want to talk about briefly is what’s been

happening at the Fast Track Sites [slide 35]. And here, we weredeveloping a workforce, the commissioning specification for the

workforce and guidance and this guidance is now built into thebuilding the right support and the national plan so this [] as theplan gets revised and developed so the workforce plans that go

with it. So we basically did a lot of workshop across the fasttrack sites and established a theme that would do this but of

course now what’s happened is we have now moved now to thetransforming care partnership that Julie talked about. Now whatwas coming out of the fast track sites that we met with them was

that, see that last sentence in the first paragraph competencybased approach rather than a professional mix so just say I want

4 therapists, 2 psychologists, 5 nurses and 1 doctor. What does []


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actually want. They want awareness of autism and ADHD. Wewant awareness of local [] we want awareness of local educationand social implications openings etc etc and then create a team

based on those competencies rather than traditional approaches.So that’s the kind of things we want to move to.

We don’t actually in this presentation there’s not been as muchemphasis given as we have out there on the development of

commissioners.

[Julie] – and just to say that with the fast track sites we’ve gotpeople now in local educational and training working veryclosely with the team and we’re having a conversation about how

would you do the local educational and training differently giventhat the service model is happening in front of our eyes.

[Ashok] I quickly want to mention a project we are wanting todo, to the model of training family carers and paid carers at the

same time with the same material and that’s something we’redoing with the Challenging Behaviour Foundation. And I think

what you will find as time goes by, that we become more andmore enlightened about what to put in the support, the correct

time and the correct place. We are looking much more atfamilies than we do so far. At the end of the day although it’s atiny population most of the families are not in paid care anyway

and that’s where the problem often start.

Now let’s talk about this getting on to transforming care

priorities [] now here we have in this slide, in summary the stuffwe are doing. I think I just want to [] workforce planning and

workforce modelling. Workforce planning is what we’re used to[] taking x number of this [] Workforce modelling is much more

of a dynamic approach where there is a functional mapping ofservices to see what the needs [] actually are, what is the userprofile and how is that being recognised and met. And then

we’re trying to make sure that the workforce or the skills basedthat surrounds that client is actually future proof and enable to

anticipate problems and anticipate the course of that person overthe next six months or twelve months or whatever and it iscritically based on the model that we have now that is developing

as a result of the national plan. You remember I mentioned thecompetency framework being sort of pathway based and this is

what this one is about [slide 40]. The first on the left, promoting


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appropriate access to services is the first step. [] That’s the firstrange of skills that working in the services and broader []. Thewhole workforce needs to be sharing that as well as with

families, carers and general services. The second one,assessment formulation and treatment planning so that’s the

second set of competencies. Then you consider enabling healthinterventions, family and carer interventions and on the righthand side, accommodation of welfare and therapeutic

interventions as one umbrella of intervention based competency

and that comes together, okay. And then you move on to

monitoring and measurements on the bottom right, and here wetalk about role support interventions development. So that’s theway the competencies are based and really depending on where

you are in the hierarchy of the service you get different levels of[] I think that’s the only way I can explain it to you, so therefore

when you, we talk a lot about the work that has been pilot in theWest Midlands but it’s about doing a learning needs analysis ofthe workforce in view of the competency being worked and then

decide what particular areas of [] for development in theparticular workforce – that’s how they’re to be used based on

that approach. And then we come to the model – [slide 41] theidea is to keep pushing the arrow to go in the right hand side. On

the top and blue you have different types of model [slide 41]Learning disability team with all its professionals, havingvarying levels of integration with either mental health services or

the intensive support team and some of the crisis team. Thesethree models are essentially styling different levels of integration

and style of joint working between each other. So I suspect as

time goes by and the [money] takes hold next year this is what []Then you come to this slide – the second bullet point [slide 42]

that is to identify the [] structure of the skill person who isactually very near the person needing services because what

parents tells us and families must tell is they have a child withcomplex needs who may be an adult complex needs or whateverand the person who provides the care doesn’t really understand

them [] that they have to go somewhere else to get theirsupervision skills or whatever and they’re wanting to bring the

skills as near the service user as possible but the person whocomes to provide the personal actually understand fairly complexdisabilities and this is where the assistant practitioner approach is

being developed to have a support worker for certain [] this is thepractitioner who is very near the person and understands what’s

going on and the more specialist levels where the input comes


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from the learning disability team or the support team so there’s akind of – and it’s not a health support worker but just a genericsupport worker.

The question is how they’re going to pay for this because once

you acquire skills you become quite expensive, but on the plusside you need fewer such people because you’ve got a moreintelligent approach to dealing with complex needs. The other

thing they’re looking at is to identifying the skills and

competencies required for the crisis function in recognition of the

team model that I showed you on the previous slide. So whereare the skills in the system? Are they with the team itself or arethey with the support service or are they somewhere else in the

mental health service.

The next two slides are actually trying to talk about the demandfactor and the supply factor.

[WILL END THERE – can’t understand what he’s saying]

Sir Stephen I think at our last meeting there were certain issues around

workforce development – so we want to look at this today – socomments.

Steve I notice a pattern in the West Midlands because I went visiting. Ihave two concerns about the documents currently being

described. If we’re not careful the need for social care workerswill be downgraded against the needs of medical clinicians partly

because of the money and partly because of how these thingstend to pan out we need I don’t know between 8 and 10 thousandskilled support workers if we’re going to deliver [] and there

seems to me in the presentations we have today a sort of []between population based approaches to things and [] and maybe

we could do both as once because clearly we do need to deliver a

service around somebody with the people they know that they

recruit with the appropriate skills but I know other [] do we wait

for that to turn up before we train the staff. So we need to have apopulation based approach in this area it’s likely that we need

these sort of skills [] but I don’t see that approach in social care,workforce planning [] here is Lisa she’s just left hospital with

dysphasia [] no other [] of the world we do that we normallyhave a group of people to support you now you might recruitsome of your own staff as well but we don’t wait for somebody

to turn up we train the workforce first and if you had a well-


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trained [social care?] workforce they can deal with a whole [] ofthings with families and carers that means you don’t need to goanywhere near specialist teams and if we don’t do it relatively

quickly the whole programme with fall over on the back of nothaving enough support workers, practice managers, practice

leaders all that stuff and if we don’t start soon you won’t deliverthat [].

Marie is here from Skills for Care and they do do workforce for

social care and health care and we’re trying to work through how

to get a better prediction of actually what you need but [] you’reobviously part of the programme with us and what’s your

thoughts about Steve’s points around care and support

Marie I think Steve articulating exactly what we said all along it needs

to be a number of directions you can’t do it in one direction. Weknow there are relevant skills that people need to learn they have

to do very specific to that individual they’re supporting, there areskills they need to learn in advance and they know already.

[There were questions around workforce – but some of the

questions and answers didn’t record very well]

It might actually answer some of the other issues that have beenraised to do with the core skills and training framework forlearning disabilities services and what that framework will do if

it was actually defined the content and quality of the curriculumand the learning outcome but by its very nature its structured in

three tiers and the first tier is very generic its very much about

awareness and so it has the facility to work beyond the health andsocial care sectors and actually address the workforce

development needs in for example the justice sector the localauthority and a whole raft of other areas where people may well

engage with an individual with a learning disability or indeedtheir carers, and so actually development of the core skills and

knowledge framework is a very exciting development in terms of

supporting some of this broader learning.

I just wanted to say the place we start from with this is widelydiffering assumptions about how services should be run in

different parts of the country you can see that from what is goingon so if you ask every local areas to do their own evaluation oftheir workforce modelling they will come to different answers

because they think different ways about it. You need to buildsome sort of cross fertilisation mechanism into it in order that

people will begin to understand what the things they don’t havein their area because they’ve never thought of using them

because they hospitalise people might be [].


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I want to come back on the named social worker pilot, so we’recurrently working up plans how we will test that in some areas itmay be doing it around transition for example, but the areas

ultimately chosen will form part of that local transformation planso it will be joined up in that way.

I want to say something briefly about the criminal justice system.From April this year NHS England rolled out the [] diversion

scheme around 50% of the country and depending on spending

reviews and where – depending on business case that’s done –

roll that out across the country is that business plan is successand there is some specific work looking at people with learningdisabilities within that criminal justice pathway.

Feedback on

Time forChangeconsultation– Sir

StephenBubb and

KateBrittain

[Sir Stephen] I think we can do two next bits quite quickly. I

thought that before I produced my findings on the year review Ishall do some talking particular to families and people with alearning disabilities about their views of where we have got toand reflect that back in the report that I make I think probably in

January now so I will ask Kate to say a bit about what we’vedone and what we’ve found.

[Kate Brittain] A brief update on the consultation that we’ve justmade. I lead on health policy at ACEVO and I project manage

Stephen’s Time for Change Review. In what will be quite a

substantive report in the new year we had Time for Change inNovember last year which brought the recommendations to the

steering group. We had a report in July to a Progress UpdateReport.

We’ve gone out to consultation. We’ve asked for written

submissions. People’s been phoning us up. We’ve been on aroad trip around meeting various [] groups including we spent all

day with Viv at the Challenging Behaviour Foundation and

Mencap [] as well. So I have a document on the table.

What it has shown us is that by and large people recognise whattransforming care is trying to do, recognises it is gaining

momentum – and actually what people have told us correlatesquite well with where we are. Care and treatment reviews fast

tracks, commitments around Calderstones, building around

support, all of that is transforming care, setting out its road map.What we’re just starting to see is delivery of that, so people have


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yet to actually see the transformation we’re talking about and Ithink that explains a certain level of cynicism that still pervadesalong all the comments that we’ve had.

The principle of choice was very very foreground in a lot of the

submissions we’ve had and there is a quote, in the service designsection bit around where people don’t get genuine choice, they’removing out of Calderstones what really is going to [] services

they’re receiving.

In doing this consultation we were as much interested in findingout reactions to Stephen’s initial recommendations as more aboutprogress this year so I think given DH’s response to the

consultation it’s important to note in discussing right to challengethe charter right [] we developed in time for change. Actually

there were a certain level of frustration about the need for newlegislation [] the Mental Health Act, Human Rights, and otherbits of []

Stephen throughout his reviews always thought about service

provision transformation alongside that principle enshrined andexplicit by people with learning disabilities and I think there are

still concerns about it whether services can actually [] around themost important of choice and rights for people which [] what’sbeen mentioned quite a bit about advocacy and how that fits in

all the presentations we’ve had today [] What the consultationhas done is to help us focus our [] actually.

[Recording not very good – she speaks too low at times]

Sir Stephen I had a very good meeting with people with learning disabilities

in Leeds and it was extremely good.

Wider NHS

Englandwork on LD

– HazelWatson

Follow on from Ashok said, which is actually learning disability

programme doesn’t equal transforming care it’s important thatwe focus our attention on the 2,000-3,000 that are inpatient

services but also we know that there are a lot of [5 year] peoplewith a learning disability [] and we need to make sure that all of

our healthcare services are accessible for those people. So it isnot my attention to go over the next slide, so slide 50-54 give youquite a lot of details on the area of work we are focussing on, on

the premature mortality review work which is an extremely


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important piece of work to us in helping us better understandwhy we have such a poor mortality for people with learningdisabilities in this country, some significant work on annual

health checks as we need to check people’s health to make surethey’re not missing on physical health care issues contribute to

early mortality and poor health outcomes. Large area of workaround more broadly access to healthcare. At the moment we’vebeen focussing learning disability becoming a priority within the

flu plan for the first time this year. A colleague of mine is doing

a lot with our cancer screening colleagues on how we make

screening programme accessible to people with healthcare andwe’re also starting to put a lot of focus on flagging systemsgenerally; flagging systems in primary care services, flagging up

system in acute care services because actually for people to beable to access healthcare to have the reasonable adjustments

made they need in order to make it accessible, we need to knowwho they are, we need to have proper registers, proper flaggingsystems that indicate that when they have additional needs that

we need to be meeting.

I haven’t got a bullet point up here on mental care, but I will justsay to carry on from where Sarah was saying and we are working

with our mental health programme in NHS England in thespecifications that they are putting out for [] inpatient services fortheir community services we are making sure align absolutely

with the wording in our specification so that we are allsupporting each other to change services we’re making sure its

aligning with the crisis concordat and we’re particularly making

sure the demand we’re putting into CAMMS services andthrough the Education Health and Care Plans and aligning with

the Future in Mind plans that more mainstream CAMMSservices are delivering.

The other thing I wanted to say around access to healthcare is just to follow on from what Theresa was saying about the CQC

earlier. We’re also working closer with them to enable them toinspect mainstream healthcare services so key lines of enquiries

for acute hospitals where is your consent form in easy read,where is your flagging system. Key lines of enquiry for primarycare, actually how well are you doing on your annual health

checks, how are you making your services accessible for peoplewith a learning disability, and also being part of the OFSTED

consultation with CQC around SEND reforms how well are


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clinical commissioning groups are working with local authoritiesand local educational authorities to make sure we are engagingwith Education Health and Care Plans and so we’re really

starting to influence [] on the mainstream healthcare systemwhich is where most people would wish to access healthcare and

obviously important to good quality of life I’d just like tomention that the work NHS England is doing in employment ofpeople with a learning disability.

We’ve made some a small contribution to that in the learning

disability programme. We currently employ 4 people 4 expertsby experience as full team members in our learning disability andwe’re just about to employ a fifth person to come and help us

particularly on the young person’s agenda, and NHS Englandmore broadly has a team of people working to put out guidance

to support the NHS to encourage and promote employing peoplewith a learning disability.

So as I say, Slides 50-54 will give you the details you’ll everwant and on those issues.

Marcella Can I just ask you - I understand with annual health checks that

doctors will get paid regardless of whether someone with alearning disability actually has a health check? Is that correct?

Hazel It isn’t. They get paid per health checks and we’re keeping these– one or two of us may have opinion about paying additional

amounts actually as NHS England decided to keep that again forthis year as we really need to encourage GPs to do that. Also its

part of the Clinical Commission Assurance which means thatCCGs will be assuring against that as well as a key indicator tomake sure that they are doing everything.

Sir Stephen I thought it was an extremely good morning and thank you toeveryone who put this pact together. It’s also extremely useful

collection of data information – so where do we go now? I’m

going to produce a report in January which in a sense is the sixmonth and the year review I promised to do on the report I

produce. So in a sense when I do that I will have completed mypart but I will talk to Simon Stevens who commissioned me to dothis about what next as I guess there is still work to do but in a

sense this is the final meeting of our steering group for this yearreport and we need to think about how we take this forward and I

think there is some need for an external, how shall I put it‘grumpy bastard’ who keeps people to task now whether that’sme or another ‘grumpy bastard’ I don’t know but there is a role I


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think there is still a lot to be done. What I’ve got from thatconsultation if there is an expression there is an optimisticcynicism so there is a feeling that things are changing but

actually has anything changed given the history so there is a lotto prove to people with learning disabilities and their families

that the system will change and there is a lot of pressure that willcontinue to be needed to ensure that happens but we’ll have tosee how we do that so a very big thank you to everybody who

has been involved in this process. This last year it’s been

extremely - how shall I put it ‘challenging’ but also fascinating

experience for me.

I think we have collectively I think we’ve made a difference. I

think we’ve been able to highlight some of the challenges thatpeople with a learning disabilities and their families face. A

community frankly, one of the most vulnerable communities inthe country that has had a really poor rough crap deal anddeserve better, and I think it’s not just a matter how we provide

better care and health for them but actually a fundamental matterof social justice and human rights.

People with a learning disability deserve a better deal. They

have rights. They are often fundamentally abused and that’s thechallenge for us. It isn’t about just looking at better care andhealth. It’s about better lives for people who have been treated

very badly in society.

So thank you very much.

5b winterviewprogressmeeting-1

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