THERE HAS BEEN a great deal of discussion, analysis, inspection and debate on all of the issues. Partnership working has encompassed all stakeholders, and multiple reports have been written. The next significant report, an update and review on the agreed actions within the Concordat and Transforming Care is now being produced. Websites have been created and regular updates/minutes published.
The key question and challenge then to us all, in this period of time, is: what has changed? Has the quality of life and life chances for people with a learning disability and complex needs actually improved? The answer is not straightforward.
Intelligence and evidence are always the best foundations for effecting real change and we have a growing evidence base which helps us to understand the position and the needs and aspirations of the individuals concerned and their families.
We know that this is an all-age issue and solutions must address the continuum and not the artificial boundaries of age. We know and can evidence the relationship between prevention and improved life chances.
We know that co-production is essential and the only way to ensure real change happens.
We have a clear and consistent understanding about the best and most appropriate models of care. We know that community-based services underpinned by positive behaviour support is what works.
We know that the only way to real and sustained change in both practice and culture is through joined up, integrated commissioning which links specialist commissioners to CCGs and local authorities.
We know and have agreed that the funding flows need to work in ways which allow changes to happen for people in a timely and safe way – across the whole health and social care economy.
We know that people need to be supported at a time of crisis (and this happens from time to time) in ways which support people in their own homes and help to prevent readmission – thus avoiding the whole cycle of issues recurring.
We know and agree that the number of treatment and assessment beds needs to reduce and that we are able to be explicit about their use and length of stay.
We understand what the workforce issues are and the challenge we face in terms of behavioural and cultural change.
Having got to the point where there is sector-wide agreement on what needs to happen and how, it is important to note both the simplicity of the actions required and the complexity involved in getting to that point and then moving towards implementation.
In order to mark real progress the Department of Health has now taken the responsibility of programme-managing the whole improvement programme, drawing all strands together, and a coherent programme is close to being completed and published.
We have also moved to a more robust assurance framework, and the Assurance Board itself, which holds the whole programme to account, is in place and jointly chaired by the minister for care services, Norman Lamb and Gavin Harding MBE from the National Learning Disability Forum. Plans are now in place from all key organisations with internal and additional assurance frameworks in place within NHS England, DH and CQC.
NHS England have produced a clear plan for change and improvement and underpinning the development of those issues is the Steering Group chaired by Sir Stephen Bubb, which will produce an overarching report primarily around commissioning and capital investment by the end of October 2014.
After a slow and frustrating burn, the agenda has caught fire, and there is continuing commitment to delivering real and sustainable change.
In terms of practical support the Winterbourne View Joint Improvement Team continue to facilitate discussion and debate in local areas and across the regions, bringing people together to seek local solutions to meet local need. Some of the work to date includes:
* The development of the collaborative commissioning workshops brought together LA commissioners, CCG commissioners and specialised commissioning for the first time. The focus was developing a shared understanding of the existing pathway and the barriers that prevent people’s discharge. An action plan was developed in preparation for the second - due to take place at the end of November/early December this year - which turns the focus on prevention and co-production, extending the membership to families, people with experience and the local inpatient setting to begin to develop a new approach to managing crisis and enabling discharge.
* The housing workshops bring local authorities, social care, housing, CCGs and housing associations together to consider what is possible and to take a step away from traditional models of accommodation to models such as shared ownership. These include real stories from individuals who have moved out of a hospital to their own place in the community.
* Future workshops include Having a Voice – focusing on enabling people with a learning disability and autism to know where and how their voices can be heard contributing to not only their own plan but the planning in their local area.
* A focus on the skills of practitioners in collaboration with Skills for Care, seeing the development of a series of learning sets with the first successfully kicking off in Leeds during September.
* Finding common purpose, following on from joint work between ADASS and the Care Provider Alliance has set work in train to develop a set of tools, building upon the core principals including a commissioning and procurement guide for social care in partnership with the LGA, and support around market shaping.
The role of ADASS now needs to adapt to an environment of delivery: while continuing to challenge and to influence developments we need to give careful consideration to how we define our role in providing advice and support to councils so we can respond to and meet the changes needed. We need to agree what our role is in partnership with the LGA to maximise impact, influence and support wherever we can.
The focus on Beyond Winterbourne View is strong and in many ways can obscure the wider and more positive agenda for people with a learning disability. That agenda is alive and well and, through the ADASS LD collaborative policy network, we have plans to develop a new national framework for learning disability – a framework which will place post-Winterbourne View actions in a much wider and more meaningful context focused on the quality of people’s lives.
Co-chair, ADASS Learning Disabilities Network
Principle Adviser, Winterbourne Joint Improvement Programme, ADASS Lead on autism