www.england.nhs.uk
Learning Disabilities:
Share and Learn Webinar
25 August 2016
Topic One:
Co-production and a long term
relationship Samantha Clarke
Chief Executive, Inclusion North
Topic Two:
The CQC approach to registering
services for adults with learning
disabilities Theresa Joyce and Sue Mitchell
Care Quality Commission
www.england.nhs.uk
Date Topic Guest speaker Venue
29 Sept 2016
Self-Care Support Bev Matthews, Sustainable Improvement
Team, NHS England and Philipa Bragman and
Catherine Carter, CHANGE
Webinar
27 Oct 2016
Launch of Care Treatment Review Policy
Guidance for TCPs in relation to children and
young people
Anne Webster and Gavin Harding, NHS
England
Phil Brayshaw, NHS England
Webinar
24 Nov 2016
To be confirmed To be confirmed Webinar
26 Jan 2017 To be confirmed To be confirmed Webinar
23 Feb 2017 To be confirmed To be confirmed Webinar
30 Mar 2017 To be confirmed To be confirmed Webinar
Learning Disabilities: Share & Learn webinar programme
Co-production A long term relationship & different
conversations
Webinar August 2016
Samantha Clark @smclark @InclusionNorth
What is co-production?
Produce Means to make something or bring something into existence
Co Means ‘together’ or ‘with’
Co-production – Elinor Ostrom:
Chicago Police started patrolling in
cars
Clear up rates went down, crime
reported went up
The police needed the unrecognized
contribution of citizens & those
relationships to do their job
The Core Economy
Family,
neighbourhood,
community
drive activity
MONEY drives
activity
We have 2 economic systems:
This is all the private and public sector
organisations that do things in
exchange for money. It includes the
services and supports provided
through health or social care.
This is all the unpaid activity that is
driven by our hearts and minds, our
care and compassion and love for
people close to us. It is the work we do
to bring up our children and look after
our wider families and older people. It
is the things that build communities. It
is the
Core Economy
We can’t ‘deliver’ a family a best friend a peer group a network someone who loves you
Services can’t ‘deliver’ community (but they try!)
Sometimes, it feels like services say,
‘If you want more attention and more help, come back with another and bigger problem’ That means that the only assets we have are our problems. We can be really good at having problems – but it won’t make us feel great!
We don’t deliver pizza. But maybe, we can make Some together and then share it!
Co-production principles
Recognising
people as assets
Promoting
reciprocity
Building social
networks
Valuing work
differently
Different Conversations
Community – place based, connecting
interests
Individual & service connections –
Local Area Coordination
Out there in the real world – social
media & beyond
Community conversations
Asset Based Community Development
Based on 4 years of work by McKnight &
Kretzmann in North America
“Can you tell us what people who live here have
done together that make things better?”
Collected 3000 stories – that they renamed
case studies http://www.abcdinstitute.org/publications/basicmanual/index.html
“Information about deficits are useless”
McKnight
When they analysed they decided people used 5
things in these stories
- Individuals
- Associations
- Institutions
- Physical Assets
- Connections
Asset based & internally focused & relationship
driven
The shift –
producers not clients
• What do we care about in our community
& what we can do together about that?
• What could we do if we have some outside
help?
• What can’t we do as a community &
someone outside needs to do?
Connecting the people on the margins
Valuing all contributions
Not service driven but people (citizen) driven
A different conversation - stories
Inclusive Change - stories
‘The Post Office shut suddenly’ (the Methodist Church now host the
Post Office and a cash machine)
‘You do it for your community – to make it a better place to live’
‘People that come (to the food bank run by local volunteers) aren’t just
coming for food’ ‘it is a place where they can come and have a bit of
company’
‘On the day can stand back and think we did that’ (of a community
event organised and run by a local parents forum on a voluntary basis)
The only disability is having no
relationships
Judith Snow
Individual & service connections
Local Area Coordination
Local Area Coordination started in Western Australia in 1988.
Approach to building individual, family and community capacity.
Focus on making services more personal, flexible, accountable and
efficient.
Prevention & practical, local solutions – catalyst for reform of social
care and health services.
Simplifying & “Turning the system upside down”
http://lacnetwork.org/
Who do they work with?
Local Area Coordinators support: People
•People not yet known to services to help build resilience
and remain part of their community (staying strong –
avoiding need for services)
•People at risk of becoming dependent on services to
remain strong in their own community diverting the need for
more expensive “formal service” responses. (reduce
demand)
•People already dependent on services to become less
so and more resilient in their own community.
Evidence
Research on Local Area Coordination demonstrates that it:
• Builds individual, family and community resilience;
• Reduces demand for services;
• Reduces isolation and loneliness; Increases choice, control and
contribution;
• Builds inclusion and citizenship;
• Is a catalyst for reform;
• Simplifies the system for local people
• Seeks to encourage cultural change within Councils – towards
community based, person-centred, more effective support
Thurrock & Derby – Social value evaluation
£3.50 - £4.00 for every £1 invested
Just a prevention service?
A life not a service
• Instead of asking
– “what services and money do people
need?”
• They ask
– “what makes a good life for you and
what are the different ways we can get
there?”
Stories – Derby. Community connection – bakery. Reputation. Shared lunch – different conversation. M.Health/housing issues. Linking and supporting – consistent relationship. Giving something back. “Introduced to a man with schizophrenia – I met a musician”
The question
determines the answer
Good life conversation
Allows a different
conversation – one that
builds capacity &
confidence
Out there in the real world
Social media
Justice for LB – campaign, Parliamentary Bill
Much more than just a campaign for justice – a big
public conversation
35.2K Tweets – asking questions & discussing
Use of lots openly available information
George Julian's blog
Chris Hatton's data crunching
Lots of people’s stories
Connecting across
hierarchy & sectors
Sharing stories across
the world
Shifting the power?
Opening up the
system?
“Consultation is a 1
night stand…………..
Co-production a long
term relationship”
Laurence Clark
And finally……..
The Parable of the blobs & the squares
https://vimeo.com/42332617
If only for Brian Blessed
Registering the Right Support
NHSE
August 2016
Regulation
CQC is the independent regulator of health and social care services in England. It uses a number of methods, including
- Registering providers and inspecting services to make sure they meet standards
- protecting the rights of vulnerable people, including those detained under the Mental Health Act
- taking enforcement action when services fall below standards
- talking to users of services about their care
• Providers have to be registered with the CQC if they are going to provide regulated activities.
• Includes NHS and independent sector
• Providers apply to deliver regulated activities in different types of service: hospital, residential care homes with and without nursing, domiciliary care
• Application assessed against regulations, which include an expectation that services consider good practice, policy and guidelines
• CQC published its registration policy for services for people
• with learning disabilities in February 2016
• Has carefully considered Building the Right Support and the Transforming Care program in what it says.
Registration
• “Providers are required to demonstrate how their model of support is built on evidence-based care, for example, National Institute for Health and Care Excellence (NICE) guidelines, and that it is in line with national policy, for example, Department of Health, Association of Directors of Adult Social Services (ADASS) and NHS England guidance. We expect providers of services for people with learning disabilities to refer to Building the Right Support and the accompanying service model when designing or redesigning service delivery”Delivering .
Delivering good practice and policy
Three main areas….
This policy statement applies to three key areas of registration:
1. Applying to provide regulated activity in specialist hospital provision, such as an assessment and treatment unit for people with learning disabilities.
2. Applying to provide regulated activity in other services specifically for people with learning disabilities.
3. Applying to vary the provider’s conditions of registration by adding or removing a location, or increasing the number of places provided at a location.
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• Transforming Care is a partnership between NHSE, LGA, ADASS, HEE (inc SfH,SfC) and CQC
• CQC can only deliver a part of this programme, and development of new services requires joint working across all agencies
• CQC is responsible for registering new services, and needs to consider whether the service to be developed is in line with the policy – and whether local commissioners have considered it as part of their planning
Working with commissioners
Some current issues…..
• An independent provider wishes to de-commission a hospital ward, and re-open (or “re-provision”) it as a care home with nursing
• Scenario 1: The patients who live there would not move. The provider tells us that the local commissioner supports this, as they see it as in line with Transforming Care - it will result in discharge from hospital. Scenario 2: The new service will receive patients from hospitals out of area, but they originate from the local area. It is described as “step-down
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• A provider wants to build four 6-bedded bungalows for people with complex needs, including those with forensic histories and those with autism and severe challenging behaviour. The residents will come from out of area hospitals, but will be from a number of local areas (up to 1.5 hours drive away). They have identified some potential residents with some local commissioners. The site is in a rural location, with few amenities close by. They say they will provide their own MDT.
Some current issues…..
Some current issues….
• A provider has 4 small scale services grouped together on one site. They provide residential care for 14 people. They want to build another 2 bungalows, each for 3 people. The service is set back from the road, on the edge of a small village. It has its own transport, as local transport links are poor. Only one of the proposed new residents will come from the local area.
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• Size
• Location
• Where people are from
• Links with local community
• Access to CTLD and specialist support
• Distance from family and friends for residents
• Commissioning intentions
• Available activities and community integration
• Part of the local Transforming Care plan
• Issues to consider….
Supported living
• We register providers to carry on the regulated activity of personal care (e.g. in the case of domiciliary care agencies), not the agency itself or the locations from or at which they operate.
• We restrict the provider to managing the regulated activity at/from locations which we list in a condition of registration.
• People’s own homes are generally not listed as locations if people are tenants with tenancy agreements.
• Please refer to CQC’s guidance on “What is a location” for further information
• We refer providers who wish to provide a supported living service to our guidance “ Housing with Care” and to the real tenancy test
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• Registering the right support - CQC’s policy on registration and variations to registration for providers supporting people with learning disabilities
• Building the right support -Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition-Service model for commissioners of health and social care services
• Housing with Care Guidance on regulated activities for providers of supported living and extra care housing
• The Real Tenancy Test - tenancy rights in supported living- NDTi Housing and Social Inclusion Project
Useful guidance and policies
• Scope of Registration CQC guidance on Regulated Activities
• Guidance for providers on meeting the regulations -Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) (as amended) and Care Quality Commission (Registration) Regulations 2009 (Part 4) (as amended)
• All the above can be found on our website www.cqc.org.uk
Useful guidance and policies