The Department of health review – will it make a difference?

1. The Department of health review – will it make a difference? Tony Holland

2. It’s about local services • Disruptive behaviour developing in childhood • Developmental delay • ADHD • Epilepsy? • Residential school – residential home • Behaviour continues • Major adverse event • Enters the ‘secure’ system • Moves within the secure system • No long term perspective (formulation) • Continues to be seen as dangerous – not manageable in the community • Local champion to bring her back

3. Its about local services • It is local services • that made the decision to place out of area; • that fund out-of-area placements; • that have the power to bring back • Benefits (of local services) • It’s the right thing for the person with LD and his/her family • Develop local skills/services • Contain costs • Reduce the potential for and more quickly detect abuse if it was to occur

4. What are the issues? • Solid research base and conceptual models for how we understand CB and mental ill-health in people with LD; • Failure to apply this knowledge where it is required (Type II translational gap); • Lack of understanding of, and a failure to develop and maintain the necessary local services and partnerships to deliver the above expertise – complex.

5. Key Objectives • Improve the capacity and capability of commissioning – prevent hospital placement • Clarify roles and responsibilities – but ensure integration • Promote innovation and positive behavioural support, reduce the use of restraint

6. What needs to be done? • 12ii ‘to develop a clear description of all the essential components of a model service’ (NHS Commissioning Board and ADASS); • 12iv Collaborative commissioning (NHS Commissioning Board, Clinical Commissioning Groups, & Health and Wellbeing Boards)

7. Problems and points of confusion • The process of ‘assessment and treatment’ and ‘assessment and treatment units’ • Responsibility of community teams • In-patient services as part of local community-based LD services and in-patient assessment and treatment ‘units’ out-of-area • Levels of security • Hospitals vs homes where people live • Hospitals are not homes - admission to hospital is for a defined purpose and must be legally and clinically justified • Responsibility of local services and the problems of out-of-area placement • Lack of understanding over time of the person by local services • Long versus short term responsibility • Move back to the community

8. The function of an IP service • As a hospital based service to provide a safe environment for assessment and treatment when, because of the person health and/or their safety or because of a potential risk to others, it cannot be provided elsewhere • Through the processes of assessment and formulation to arrive at an understanding of the index problems and in partnership with the person with LD and others to enable the person to return to live in the community.

9. NIHR CLAHRC Initiative • Using Cambridgeshire specialist services for adults with an LD as an exemplar to establish the following: • What is a specialist adult LD service there to do? • Purpose • What should such a service look like? • Design • How should it do it? • Function

10. SPECIALIST SERVICES FOR ADULTS WITH LD STRUCTURES (CAMBRIDGESHIRE LDP) CASE STUDY Social support providers People with LD, families and others who support them City, East, Fenland, Huntingdon, South General Practice and primary care services Generic secondary care services Five integrated community teams for adults with LD Two intensive Assessment and Support Service (IASS) (in-patient) Intensive Assessment and Support Service (IASS) (community) Cambridge Peterborough Regional secure services Norwich