Key Impact

1. The impact of commissioning changes on adults with Learning DisabilitiesStephan BruschHead of Health Access

2. Key Impact • National & Regional system leadership to handover • Three commissioning organisations • Main focus on Winterbourne View- forgetting Six Lives • Ongoing Commitment through the transition and move to wider vulnerable groups without being lost • Loss of expertise at regional and local level • Risk of new system having to relearn all lessons learned • NHS Constitution and new commissioning model presumes active participation.

3. The new NHS landscape Funding Accountability Other Parliament Version 0.5 DH Public Health England National NHS Commissioning Board NHS Trust Development Authority Monitor (economic regulator) CQC Health Education England NHS CB London Sector NHS TDA London Sector LETBs PHE London Sector Sector Joint licensing between Monitor and CQC Health & Wellbeing Boards (HWBs) Clinical Senates NHS CB Patch Teams Work together to ensure commissioner support for aspirant FTs contract Providers Commissioning Support Services Local Authorities (incl. Public Health) Clinical Commissioning Groups (CCGs) NHS Trusts FTs ‘Footprint’ / Local contract contract contract Accountability for results Local HealthWatch Patients and Public

4. NHS Commissioning Board • Single Operating Model • Held to account through NHS Outcome Framework • Ensure directly commissioned services meet specific requirements (Offender and Forensic Services and Direct Enhanced Scheme for People with LD) • CCG Assurance includes Safeguarding and Learning Disabilities • Leadership role for NHS • Develop and sustain partnership working (DH, Local Authority, Metropolitan Police, ADASS, Monitor and CQC)

5. Clinical Commissioning Authorisation • Arrangements in place for CCG to involve and seek advice from LD clinicians and practitioners. • CCG has the capacity and capability to commission improved outcomes for the people it serves • Lead clinicians selected from member practices for CCG commissioning priority areas • CCG to outline commissioning arrangements for learning disabilities • Providing Support via self assessment framework, data analysis and economic benchmarking.

6. Clinical Commissioning Authorisation • Appropriate systems for safeguarding • Adults at Risk • CCG plans to train staff in recognising • and reporting safeguarding issues. • Clear line of accountability for • safeguarding is reflected in CCG • governance arrangements. • CCG has arrangements in place to co- • operate with LA in the operation of • LSCB and LSAB. • CCG has safeguarding adult lead • supported by relevant policies and • training

7. Mental Capacity Act Clinical Commissioning Groups (CCGs) need to: • Have an identified Mental Capacity Lead • Ensure they have knowledge of their continued responsibility for cases authorised by their predecessor PCT that ceased before the 1st April 2013 • Ensure processes are in place to access all relevant archived information on closed cases.

8. Mental Capacity Act • Retains responsibility for assuring through the commissioning process compliance with the MCA 2005 and DoLS legislation of all providers of health care • Work with health providers and local authorities to ensure appropriate capacity in the system of professionals qualified to carry out best interest assessments • Support the training and education of health professionals and best interest assessors to deliver effective safe quality patient services.

9. National levers and Horizon scanning • Statutory Guidance: No Secret Making Safeguarding everybody’s business • Legislative Framework: Mental Capacity Act, Equality Legislation, Vulnerable Peoples Act, Autism Act • NHS and Social Care Outcome Framework • NHS CB Mandate • NHS CB: Arrangement to secure children’s and adult safeguarding in the future NHS • Clinical Commissioning Group Authorisation Guide for applicants • Concordat

10. New National Leaders leading post Winterbourne View • Michael McShaine- Long Term Conditions • Sam Cramond – Directorate of Partnership • Chris Bull- Joint Improvement Program • Jane Cummins – Chief Nurse will appoint to Band 9 Mental Health and LD lead

11. Local whole System • Safeguarding Adult Boards, underpinned by statue • Local Authority as lead commissioning organisation • Health and Wellbeing Board: Strategic Responsibility for assessing local needs, including vulnerable people (JSNA) and agreeing commissioning stratetgies • Regulators: Monitor, CQC and professional regulators. • Healthwatch to be consulted Safeguarding Strategic plans

12. Pan London work with ADASS • Joint Strategic Needs Assessment • Market Positioning Statement • Commissioning Jigsaw explained • Self Assessment Framework • Network