‘Complex Needs Supports – Working Together’ JIT/MHD Regional Event Beardmore Hotel and Conference

1. ‘Complex Needs Supports – Working Together’ JIT/MHD Regional Event Beardmore Hotel and Conference Centre, Glasgow Michael McCue Joint Improvement Team Action Group

2. Introduction and Scene Setting National Working Group – 2007 -2010 Service Modelling Exercise Key Service Characteristics JIT Capacity for Change Programmes Related Work-streams ; N.E.S / M.C.N./ S.A.Y.I.G./ P.M.L.D./ Service Transitions / Future Service Demand

3. Learning Disabilities Complex Needs ISSUES OF TRANSITION for young people with learning disabilities plus other complex needs Dr Sally Cheseldine JIT Associate

4. "Why is it so difficult to put (good transitions) into practice" Mittler, 2007.

5. Who? What does a good Transitions Process look like? What range of services is required? Who pays? Evaluation and review

6. WHO? "LD plus complex needs" Issues: Consistency of definition; Age cut off Robust data; Out of area

7. WHO? - RECOMMENDATIONS National/local agreement on definition Sharing information Health Boards responsible for regional data Forward planning/role of Public Health

8. WHAT DOES IT LOOK LIKE? ONE plan: Start at 14th birthday Named person in C/F & Adult services Annual reviews/planning meetings Good communication/information Clear budget plan Examples of good practice

9. SO: Clear Pathway Funding clarity Information for families User involvement Adult services MUST engage

10. RANGE OF SERVICES: Jointly funded; local; Person-centred; effective Trained workforce

11. FUNDING? Move from out-of-area: Bridging? Innovation Rainy-day pot?

12. EVALUATION & REVIEW Key service characteristics

13. LEARNING DISABILITIES MANAGED CARE NETWORK Changing Demography of people with learning disabilities Dr. Michael Brown Lecturer and Nurse Consultant Edinburgh Napier University and Elaine Kwiatek Project Manager Learning Disability MCN

14. Aims of the presentation • Overview of demographics issues • Overview of health needs evidence • Workforce issues • Challenges and opportunities for the future

15. The wider determinants of health

16. ‘Poverty can increase the risk of a child having an impairment… Having a disabled child can also mean that parents find it harder to maintain full-time employment, their housing can be inadequate for their child’s needs, and expenditure on basic needs is increased.’ Prime Minister’s Strategy Unit, 2005 Wider issues – Poverty & learning disabilities

17. Changing demographics of the learning disability population • Estimated 120, 000 children and adults with intellectual disabilities in Scotland – few ever in hospital • Projected 11% increase over next 10 years • Increasing learning disability subpopulation • Ageing learning disability subpopulation • Increasing number of people with complex learning disabilities • People with learning disabilities have greater health needs • Health inequalities exist and need to be addressed • Health needs never historically addressed

18. What the evidence tells us… • Pre term infants with multiple disabilities • Foetal alcohol syndrome disorder • ADHD • Autism Spectrum Disorder • Increasing numbers of people with complex physical disabilities • Increasing numbers of older people with complex needs and end of life care needs • Changing demographic phenomenon • Therefore increases at both ends of the lifespan

19. Common health needs Gastrointestinal disorders Respiratory disease Cardiovascular disease Epilepsy Cancers Haematological disorders Ophthalmic disorders Musculoskeletal disorders Accidents and trauma Additional care needs due to: - Autism Spectrum Disorder Communication disorders Challenging behaviours Mental illness

20. The UK registered nursing workforce, as with many others in the developed world, is ageing. In 2008 1 in 10 was aged less than 30 years. One in three was aged 50 or older. Over 200,000 nurses on the register were aged 50 or older in 2008. (Buchan, 2009) Some learning disability nurses can retire at 55 creating a workforce gap Reflected in the workforce as a whole? For example….The UK Nursing Workforce

21. Workforce Planning in a Context of an Increasing Need for Services • At the recent RCN Learning Disability Nursing summit Professor Carpenter, National Director for Special Educational Needs, stated that there are now 950,000 children with learning disabilities in the UK, a 25% increase in the past 5 years. • The number of children with profound and multiple learning disabilities has increased by 29 % over the same period. • Children of today – adults of tomorrow…. 21

22. What has this got to do with people with learning disabilities?

23. Equality, inclusion and outcomes & the sweety shop Look and not touch? Equal access to health & social care will present challenges for the future Access & support has to lead to equal outcomes & wider inclusion Enabling access to services has to lead to person-centred care & outcomes

24. Changes in demand for support • Increases in lone parent families • Increasing rates of maternal employment • Increases in % of older people with Learning Disability where parents have died or are frail • Changing expectations among families regarding the person’s right to an independent life

25. The situation currently • Co-morbidity will increase, with greater prevalence of gastrointestinal disorders, pneumonia, sensory impairments, epilepsy, dental disease and osteoporosis in the LD population – the list goes on • Increasing demands on mainstream healthcare systems that are struggling to effectively meet needs now and will do so in the future • Increasing demands on specialist health and social care systems now and in the future • ? Policy mismatch - increasing demand V decreasing funds

26. Addressing the challenges of the future today • The Numbers of People with LD is increasing and will continue to increase • The level of healthcare needs experienced by people with LD is increasing and becoming more and more complex • Workforce demographics • Knowledge, skills and experience of the workforce • Models of care to meet changing needs • Funding mismatch • Learning from previous experiences of joint working

27. The Need for Learning Disability Practitioners in the Future • There is a clear need for specialist learning disability practitioners in the future HOWEVER… • The role and function will be one of knowledgeable and expert practitioner who can educate, assess, plan, coordinate, safeguard and deliver evidence-based interventions for a population with highand complex care needs

28. The future direction?

29. Scanning the horizon to identify need and plan for the future

30. Where we want to get to …

31. Any questions? Elaine.kwiatek@nhs.net Michaelj.brown@nhs.net

32. Developing the workforce in Learning Disability services Tommy Stevenson Educational Project Manager NES

33. Project objectives • Scottish Government funding through Equally Well monies looking at health inequality and implications for workforce: • Analyse data on the educational needs of current workforce linked to models of care • Work with partners to identify existing educational provision and identify gaps short, medium and long term • Produce a report for consideration by partners on the future direction of learning disability health services and workforce needs • Commission appropriate educational resources

34. Strategic drivers • Same as You • Promoting Health Supporting Inclusion • Health Needs Analysis Scotland • Better Health Better care • Equally Well • Health for all Children • Inequalities in Health • Ready, Willing and Able • Self Directed Care and Personalisation • Autism Strategy ?

35. Principal care groups • Transitions (child to adult, adult to older) • Children, young people and adults who challenge services • People with long term and complex health conditions e.g. ASD, dementia, syndrome specific • Multiple care needs • General health care • Older people services

36. Initial activity • Project Management Group • Steering Group • Development of task and finish groups: • Transitions • Primary/acute care • Specialist services • Third sector • Education providers

37. Current picture • Complex and ongoing work streams: • JiT- Commissioning and integration in practice with strategic planning • QIS-A broad range of work streams (Tackling Indifference) • SAY national group- Reviewing and discussing all aspects of learning disability services including health • Learning disability and Co-Morbidity- Reviewing complex needs and mental health • MCN- models of care, partnership, integration and commissioning • A risk of duplication and being disconnected

38. Educational Solutions for Workforce Development- Factors for success? • Clarity of problem/issue that needs solving and clarity that the solution is educational • Workforce solutions are part of a bigger picture • Clearly linked to policy and service development agenda • Engagement and buy in • Impetus for implementation – targets and commitments (noting unintended consequences) • Realism. achievability, and sustainability • Scope, focus and reach • Synergy with other initiatives

39. Consulting with workforce Initial Task & Finish Groups Targeted Focus Task & Finish Targeted Response Transition Acute/Primary Care Acute/Primary Care Mental Health and Learning Disability Complex Needs Transition: Child to Adult Managing knowledge requirements Complex Needs Complex Needs Education providers Third Sector The focus in consultation was to develop achievable and sustainable solutions to priority workforce concerns for people with a learning disability Third Sector

40. INTER-CONNECTING ACTIVITY People with complexity in care present with highest risk across the age range Enhancing all areas of workforce on positive health supports statutory, voluntary and independent sectors A need for a skilled workforce across all agencies in managing complexity Essentials for Complex Need Generic health services focusing on acceptability, accessibility, responsiveness and developing initiatives which reduce risk and vulnerability Access to information which is up to date, informative and signposts to similar activity, skills development opportunities and knowledge enhancement Managed Knowledge Network Specialist services which support and enhance practice sustaining people in their own communities Joined up strategic intent Person centred care and support as the driver for service delivery Developing initiatives which can bridge a broad range of priorities are more flexible, sustainable and, importantly, adaptable

41. General Health Care • Develop a workforce with shared understanding of the ‘vulnerable patient’ across primary and acute care • Support the workforce in identifying ‘champions’ in primary and acute care • Develop peer support worker model (Service users & Employment opportunities)

42. Third Sector • Look at current educational needs of social care staff • Current education programmes are they regulated and quality assured • Gaps in workers’ knowledge and skills in meeting complex needs

43. Children and Young People • Leadership • Partnership • Managed care • Collaboration of partners • Mapping into existing programmes • System to share best practice, map into existing initiatives and develop a single point of access.

44. Complex Needs • Meeting the needs of people with profound and multiple disabilities • Building capacity and capability in evidence based/informed interventions to work with people with challenging behaviours • Developing workforce capacity and capability to understand and respond to meeting mental health needs • Support to increase workforce capacity and capability to deliver evidence based psychological therapies through training, clinical supervision and infrastructure support • Develop a ‘new to’ or ‘essential pack’ on working with people with complex needs (encompassing values, attitudes, person centred focus) • Develop a managed knowledge network

45. Agenda to date • National conference • Strategic position • Visible leadership • Workforce challenges • Discussion: • Integration across services • Complex needs and multiple disability • Shared education, examples in practice • Complex need and a changing workforce • Models of care/support

46. Investing • Developing/commissioning educational resources/programme: • Complex needs – The Essentials • Managed Knowledge Network ( learning disability) • Positive Behavioural Support Model - learning Disability Nursing/Allied • Health Professions • (Developing Capability/Competence)

47. Managing information • Most organisations know lots of things but they don’t always know what they know • Managed Knowledge Networks represent a dynamic approach to bridging the gap between “knowing and doing”, enabling people to link learning and practice. They operate by actively engaging people in building communities and managing knowledge resources in specific areas of practice • An electronic portal to support using information to improve care accessed by all partners • Information flows across boundaries

48. Lessons from the south!! • Evidence in relation to current workforce concerns highlight we are not: • Building around service needs and skills required to deliver them • Well integrated with service financial planning (Critical) • Holistic in its approach • Responsive to service changes and development • Supportive of multi-agency training and education

49. Lessons from the south!! • Fragmentation of planning • Lack of leadership and management ownership • Training and education weak across agencies • Career structures poorly informed

50. Thinking workforce Service user The ideal in workforce development