Taking a whole system approach to learning disabilities

1. Taking a whole system approach to learning disabilities Debra Moore Managing Director Debra Moore Associates www.debramooreassociates.com debra@debramooreassociates.com

2. Learning disability policy and guidance – the 3 bus scenario

3. Including…… • Valuing People and Valuing People Now • Commissioning Specialist LD Health Services • Mansell 2 • Green Light • Professional guidance e.g BPS/RCPsych • SCIE Knowledge Review • Primary Care Service Framework for Learning Disabilities & DES • Healthcare Commission Specialist Inpatient Audit • Michaels Inquiry • Commissioning Services Closer to Home • No-one Knows – Prison Reform Trust • DRC Report – Closing the Gap • Mencap Reports • Parliamentary Report – Human Rights of Adults with Learning Disabilities • Our Health Our Care Our Say • Putting People First • Darzi • On the horizon…..2nd Audit of Inpatient Services and Joint Commissioning Review • Health Action Planning and Health Facilitation Guidance • World Class Commissioning re Learning Disabilities • Bradley review

4. Making all the pieces fit • The Confirm and Challenge Model is concerned with improvements in primary, acute and specialist health services

5. Developing the 6 C’s model key considerations • Need to articulate a clear ‘ask’ that aligns with mainstream interests • Need to make sense of the broad range of relevant policy and guidance • Need to drive up standards in commissioning and practice • Need to be clear to people who use services and their families about what to expect • Empowering people to get involved in setting and monitoring standards from the bedside to the boardroom

6. A key principle in the development of the 6C’s Model “Don't let what you cannot do interfere with what you can do” John Wooden

7. 6 core outcomes to achieve for mainstream and specialist health • Each outcome has a set of key principles to guide commissioning and service delivery and examples of the types of evidence for each principle

8. CTLD version • Led by Anne Hutchinson • Responds to requests for support and clarity • Supports commissioners and providers • Uses core framework but adapts examples of evidence to reflect particular role of the team • Will be ‘live’ on the website in September

9. 1.Centredness • Putting the person and their family at the centre – personalised services that are dignified and respectful of individual needs • Person centred approaches underpin practice and service delivery • Partnerships are built that promote and support the needs of individuals and their families • A range of communication tools and approaches are available and employed to meet individual need • People who use services and their families are involved in service planning and evaluation at both strategic and individual level • The service can demonstrate that service developments are based on the needs and wishes of the local population • Centredness • Community • Citizenship • Commissioning • Competence • Checking

10. 2. Community • Promoting health and wellbeing, focusing on prevention and early intervention and delivering services close to home • People are able to access individualised support, close to home and in the least restrictive setting • Skilled specialist support is available to ensure the availability of early intervention, assertive outreach and crisis intervention • People should be supported in accommodation that meets their individual needs and promotes health and wellbeing • Specialist health professionals work in partnership with local authority colleagues to include people with complex needs in opportunities to increase choice and control e.g self directed support • Partnership working promotes, maintains and facilitates key relationships and the use of mainstream services within the community • Centredness • Community • Citizenship • Commissioning • Competence • Checking

11. 3. Citizenship • Increasing choice and control, promoting inclusion and a ‘rights based approach’ • Services are provided that maximise individual choice and control • People are supported to develop a social network and utilise natural and universal supports • There is clear understanding, and promotion, of legal and civil rights • Inequalities are identified and challenged • Centredness • Community • Citizenship • Commissioning • Competence • Checking

12. 4. Commissioning • Working in partnership to deliver improved outcomes and reduce inequalities • Commissioners and health and social care providers work together to promote health and wellbeing and reduce inequalities – ensuring benefit from intiatives such as world class commissioning • Specialist learning disability services are commissioned to provide support and advice to mainstream health services and social care as well as directly serving those with the most complex needs • There is access to a range of community based specialist learning disability services • Centredness • Community • Citizenship • Commissioning • Competence • Checking

13. 5. Competence • Developing skills and knowledge within services and within people who use services, their family carers and supporters • Local workforce development strategies are comprehensive and account for the need to develop capacity and capability in the community and in mainstream health and social care • Workforce development strategies demonstrate the requirement to develop specialist skills and knowledge in both specialist community and in patient settings • Use of person centred approaches underpin all activity relating to personal and organisational development and service delivery • Centredness • Community • Citizenship • Commissioning • Competence • Checking

14. 6. Checking • Ensuring services are high quality, clinically effective and safe • Robust performance systems are in placed that are able to translate policy and best practice into useful metrics and monitor progress and delivery • People and family carers are at the centre of, and participate in, standard setting, performance monitoring and service evaluation • Quality is ‘everyone’s business’ and all staff are encouraged to look at the way they ‘measure what matters’ in their work and make best use of person centred plans and health action plans to assess outcomes • Strategies are in place to protect vulnerable adults • Centredness • Community • Citizenship • Commissioning • Competence • Checking

15. Don’t get the ‘Dibleys’

16. To conclude • The 6C’s Confirm and Challenge Model offers a way for all services to ensure that they are serving all their population well • Not confined to learning disabilities – the 6 principles are transferrable to other groups e.g. older people and other settings e.g. mental health services • A way of organising effort and resources • Offers a way of remembering what’s important to people and families and ensuring delivery reflects this from the bedside to the boardroom • A QUOTE…………..

17. The triumph of anything is a matter of organisation. If there are such things as angels, I hope they are organised along the lines of the Mafia. Vonnegut – The Sirens of the Titan

18. Practical support • Website www.debramooreassociates.com • Self assessment tool • Web based forums • Workshops & bespoke packages of support for commissioners and provider organisations • Started with specialist LD health services with different versions now in development – community teams, acute hospitals, primary care, mental health etc