£45M SERVICE TRANSFORMATION PLAN LAUNCHEDPeople with a learning disability and/or autism* will be supported to lead more independent lives and have greater say about the support they receive under a national plan published today to radically improve learning disability services.
Central to the progress set out by the plan over the next three years will be new, high-quality, community-based services.Hundreds of people with a learning disability and/or autism are expected to benefit from new, better care options in the community instead of hospitals, with more never being admitted in the first place.
The plan predicts that, as these services are put in place, there will be a reduction of up to 50 per cent in the number of inpatient beds, meaning that some units will close altogether.In particular, a key plank of plans developed in Lancashire and Greater Manchester will be to close and re-provide services offered by Calderstones, the only remaining standalone learning disability hospital trust in England.
Building the right support: A national implementation plan to develop community services and close inpatient facilities is being published today (Friday 30th October) by NHS England, the Local Government Association (LGA), and the Association of Directors of Adult Social Services (ADASS). The plans it contains have been developed with significant contribution and constructive challenge from people with learning disabilities and/or autism, their families and carers, and a range of commissioners, providers, voluntary sector and representative groups.It represents a key milestone in the ongoing cross-system Transforming Care programme, which has seen a number of reforms including the roll out of Care and Treatment Reviews and an upcoming consultation response on strengthening the rights of individuals.
While local areas will be able to design bespoke services with those who use them, the plan sets out the need for:
- local housing that meets the specific needs of this group of people, such as schemes where people have their own home but ready access to on-site support staff;
- a rapid and ambitious expansion of the use of personal budgets, enabling people and their families to plan their own care, beyond those who already have a legal right to them;
- people to have access to a local care and support navigator or key worker, and;
- investment in advocacy services run by local charities and voluntary organisations so that people and their families can access independent support and advice
To achieve the shift from inpatient to community-based services, Building the right support sets out three key changes:
- Local councils and NHS bodies will join together to deliver better and more co-ordinated services - 49 new local Transforming Care Partnerships will work with people with lived experience of these services, families, carers and key local stakeholders to agree robust implementation plans by April 2016, and then deliver on them over three years. They will be made up of clinical commissioning groups, NHS England’s specialised commissioners and local authorities, and will cover the whole of England.
- Budgets will be shared between the NHS and local councils to ensure the right care is provided in the right place – A new financial framework will aim to speed up discharges, particularly for those who have been in inpatient care the longest, and make better use of resources so that services can be increased and improved. Central to the new framework will be the opportunity for local pooled budgets which encourage better use of resources for all people in a local area with learning disabilities and/or autism. Funding guidance will also be reformed to enable swift discharges. For people who have been in hospital five years or more, specific payments will be made by the NHS to local authorities to enable their needs to be met in the community.
- National guidelines will set out what support people and families can expect, wherever they live –
Simon Stevens, Chief Executive of NHS England, said: “As good and necessary as some inpatient care can be, people with learning disabilities are clear they want to live in homes, not hospitals.
“We’ve seen some progress over the last few years, but now is the moment to grasp the nettle and build the excellent community-based support that will allow people to move out of hospitals."
Jane Cummings, Chief Nursing Officer for England and Chair of the Transforming Care Delivery Board, said: “Society has failed this group of people for decades. Now is the time to put things right, and with this far-reaching plan I am confident that we can finally make quick, significant and lasting improvements to their lives.”
Ray James, ADASS President and Vice-Chair of the Transforming Care Delivery Board, said: “ADASS welcomes this clear and ambitious national plan and is committed to ensuring that people with learning disabilities are supported to lead meaningful, independent lives in their local community wherever possible. This is already the case in many parts of the country: it can and must be done everywhere else.”
Cllr Izzi Seccombe, Community Wellbeing Spokesman, Local Government Association, said: “Councils want people with learning disabilities to have access to the right care and support they need in the right place, at the right time. Local authorities and the NHS have been working hard to make progress in providing this, but we also know that there is still more to be done.
"It is right that the transforming care plan is aiming to improve how care is provided for people with learning disabilities, including autism, and this needs to happen urgently.
LGA is fully committed to supporting this programme but at a time when councils
are facing continued financial pressures, it is vital that the Government
properly funds the changes needed in the social care system so that people who
need support get the vital help that they deserve.”
In England, around 24,000 people who have a learning disability and/or autism are classed as being at risk of admission. Although the number of discharges or transfers has increased by 38 per cent over the last year, 2,595 people were in inpatient settings as of 30 September, more than three quarters of whom had been in inpatient facilities continuously for longer than a year.While these placements are often a necessity in the short term, in too many cases they are used as a long-term option due to a historic lack of community-based services. These arrangements do not deliver the best outcomes for these people. They are also expensive, costing the health and care system on average over £175,000 per year for often-inappropriate care.
As new and better alternatives become available in the community, the plan predicts a reduction in inpatient beds of between 30 and 50 per cent nationally. In some areas that have relied on inpatient settings more than average, the number of beds which will be commissioned may be reduced by up to 70 per cent.This should free up hundreds of millions of pounds for investment in community-based support, as well as improving the quality of remaining inpatient units so that they can meet the needs of patients in the new system.
A national NHS England fund of £45m will be available to Transforming Care Partnerships over the next three years to aid the transition, focussing on ensuring that the right support is available in local areas to enable the first discharges. £15m will be available for capital projects, and £30M is available on a match-funding basis for local commissioners to ‘double-run’ services, meaning a total transformation fund of £75m.Bed closures will be staged, taking place when suitable alternatives are available. Providers such as hospital trusts will be supported by NHS England and others to adapt to the new model, shifting their own services to the community where possible.
Progress made will be reviewed before the end of 2018 with a view to establishing whether the number of beds could and should be reduced further in following years.
Calderstones Partnership NHS Foundation Trust is the only remaining standalone learning disability hospital trust in England, with 223 beds. Merseycare NHS Trust intends to take over Calderstones Partnership NHS Foundation Trust, which from July 2016 will cease to exist.
The plans developed by Greater Manchester and Lancashire Fast Tracks with NHS England Specialised Commissioners, subject to consultation, will implement a new service model resulting in the closure of remaining inpatient beds at Calderstones. NHS England will cease commissioning secure services on the Calderstones site.All hospital beds on the current Calderstones site will therefore, subject to consultation, close and be re-provided over the next 3 years on a case by case basis for each patient, in the community or in new state of the art units elsewhere in the North West, and the Calderstones site will close.
*Throughout, this term refers to children, young people and adults with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition.
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Notes to editorsFast-track sites
Over the summer of 2015, NHS England, the LGA and ADASS supported six ‘fast track’ areas to draw up plans for service transformation, closing some inpatient beds and shifting investment into community support.
£10million transformation fund was made available to these areas to help fund
the fast implementation of their local plans, which have been published
alongside today’s national documents. The initial allocation of the fund, to
cover workforce development and building capacity in the community, is as
- Greater Manchester - £3.00m;
- Lancashire - £1.32m;
- Cumbria and the North East - £2.06m;
- Arden, Herefordshire and Worcestershire - £825k;
- Nottinghamshire - £1.21m; and
- Hertfordshire - £1.27m
In conjunction with the Building the right support plan and Service Model, NHS England has also published final guidance on Care and Treatment Reviews (CTRs).
CTRs are designed to help reduce unnecessary admissions and lengthy stays in specialist hospitals, and have been part of the ongoing change in practice towards giving people with a learning disability and/or autism a greater say in how and where they get the support they need.
They bring those responsible for the care of people who are in, or at risk of being admitted to, specialist hospitals around the table with the person themselves and their families, as well as independent clinicians and experts by experience, to plan for and ensure that the individual care needs of that person will be met.Over 2,000 people have had their care reviewed since the first reviews took place in October 2014, and 960 have been discharged to the community or transferred to other inpatient settings between 1st March and 30th September 2015.
StatisticsStatistics on current inpatient numbers and length of continuous period of care are drawn from the Health and Social Care Information Centre’s Learning Disability Services Monthly Statistics Commissioner census (Assuring Transformation), September 2015, published 21 October 2015. These are classified as Experimental Statistics. The statistics show:
- 2,595 people with a learning disability and/or autism (including a small number yet to receive a formal diagnosis) were in inpatient care at the end of September
- Of those people, 2,040 had been in inpatient care continuously for one year or more, with 880 having spells of five or more years, and;
- The average length of continuous period of inpatient care stood at 1,938 days.
National Service Model
The National Service Model calls on local commissioners to plan and deliver services which meet 9 key principles for improving the quality of life of people with a learning disability and/or autism, from their perspective:I have a good and meaningful everyday life.
- My care and support is person-centred, planned, proactive and coordinated.
- I have choice and control over how my health and care needs are met.
- My family and paid support and care staff get the help they need to support me to live in the community.
- I have a choice about where I live and who I live with.
- I get good care and support from mainstream health services.
- I can access specialist health and social care support in the community.
- If I need it, I get support to stay out of trouble
- If I am admitted for assessment and treatment in a hospital setting because my health needs can’t be met in the community, it is high-quality and I don’t stay there longer than I need to.
Transforming Care for People with Learning Disabilities - Next Steps outlined a programme of system wide change to improve care for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition (hereafter: people with a learning disability and/or autism).Six organisations - Department of Health (DH), NHS England, Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), Care Quality Commission (CQQ) and Health Education England (HEE) - have come together to form the Transforming Care Delivery Board to deliver these changes, under a single shared Transforming Care programme.
The milestones achieved include:
- a public consultation on the Government’s Green paper to strengthen people’s rights;
- developing care and treatment reviews and an admissions gateway for people with a learning disability and/or autism to prevent unnecessary hospital admissions and lengthy hospital stays, with an onus on finding more appropriate community-based care;
- launching the Fast-Track programme to test and accelerate service re-design, informing a new Service Model for commissioners that describes what good services should look like, in six areas: Greater Manchester; Lancashire; Cumbria and the North East; Arden, Herefordshire and Worcestershire; Nottinghamshire; and Hertfordshire;
- testing a new competency framework for staff, to ensure we have staff with the right skills in the right place;
- ensuring that we have a more robust way of collecting and sharing data to track progress.
Since that report, NHS England has published guidance on Care and Treatment Reviews, more than 2,000 of which have been undertaken.NHSE, LGA and ADASS also published the new draft Service Model for commissioners, which has been adopted by the six ‘fast track’ areas, who have used it to inform their transformation plans over the summer of 2015, and tested it against the reality on the ground ready for a final version to now be published alongside the Building the right support plan.
Alongside this work, NHS England has also commissioned the first review in the world into the premature mortality of people with a learning disability and/or autism, established a major piece of work to reduce the over-medication of this group, and published guidance and encouragement to NHS organisations on employing people with a learning disability, employing 4 people ourselves.