Learning disability strategy 2010-15
Making it happen
Contents
Foreword by Adult Health and Social Care Leads.............................. 3 The Scope................................................. 4
• Embracing the shared values........ 5 • Partnerships............................... 5-6
Serving the local community..................... 7 What are we already developing?............. 8
• A range of housing options........... 8 • Promoting day opportunities......... 8 • Health............................................ 9 • Personalisation.............................. 9
The delivery plan 2010-15....................... 10 Challenges for the service....................... 11 Conclusion.............................................. 11 Key documents that have helped us to shape this strategy......................... 12
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November 2010 Learning Disability Strategy
Foreword
Learning Disability Services have changed and developed significantly since the closure of the long stay hospitals in the 1980s. More recently the Government has aligned social care and the NHS to ensure that services are timely and seamless. The Health Inequalities Agenda and the Valuing People White Paper have recently been built upon in a number of documents, including Valuing People Now and the Six Lives, Ombudsman report, amongst many others. The Council and NHS Kensington and Chelsea are pleased to launch this joint strategy, setting out how we will work together with adults with a learning disability to improve their health and quality of life. In addressing these broad issues, the importance of targeted and specialist services for those with more complex needs, younger people and people from Black and minority ethnic communities, have not been overlooked. As a result of this targeted approach, this strategy will be explicit about what arrangements will be made to meet those needs. Amongst the many stakeholders we have consulted with to produce this document, are those from the carers’ community who have helped steer the outcomes referred to in this development. It reflects ideas and knowledge of the borough’s learning disabled community.
Jean Daintith Executive Director Housing, Health and Adult Social Care The Royal Borough of Kensington and Chelsea
Mark Creelman Director of Strategic Commissioning NHS Kensington and Chelsea
Most of all, people with a learning disability have had a chance to comment on the content of this strategy.
Jane Clegg Director of Operations Central London Community Healthcare NHS Trust
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The scope
This strategy is inclusive of the shared values of NHS Kensington and Chelsea and the Council and their commitment to the continuous improvement and development of services for adults with a learning disability.
according to individual needs. Individual care planning is at the centre of support and planning with adults with a learning disability within this borough. It is a key objective that everyone has a detailed care plan.
The joint service defines Learning Disability as:
The joint service is led by a vision as set out in Valuing People in 2001: that all people with a learning disability are people first with the right to lead their lives like any others, with the same opportunities and responsibilities, and to be treated with the same dignity and respect. They and their families and carers are entitled to the same aspirations and life chances as other citizens.
A significantly reduced ability to understand new or complex information and new skills, together with impaired social and life skills functioning which started before adulthood and has a lasting effect on development. For ease of reference and to support our Commissioning Strategy and targeting of resources, the Learning Disability Service usually define adults with learning disability in three main categories; Mild, Moderate and Severe. This categorisation can in itself create its own problems, in so much that there is an assumption that someone with a mild learning disability may only require minimal support. In reality, each person is an individual in their own right and as such is provided with services
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November 2010 Learning Disability Strategy
Shared values and partnership working is fundamental to the delivery of this strategy and the scope of this document outlines the main objectives in delivering and developing services.
Embracing the shared values Achieving excellence for health and social care service users and their carers is underpinned by addressing the challenges outlined in Valuing People Now. There are four key areas within which the partners have set out their goals and agreed priority areas. These are:
Including everyone This development area builds on recognising that some groups are least likely to be heard and more likely to be excluded. These include people with complex needs, people from Black and minority ethnic groups and people with autism.
Personalisation Sound person-centred planning has been at the centre of delivery for some time, but transforming how services are built and delivered are now core to the changes and developments needed. Shaping future service models and co-production will be central to giving more independence and choice.
Having a life Improvements in health equalities continue to be a key feature of the strategy and pathways already in place will be further embedded into usual practice. Alongside improving health, this objective continues to ensure that housing, work, education, relationships and having a family remain key to future developments. There will be a particular emphasis on planning the transition of young people from children’s services to adult services.
People as citizens One of the challenges facing the local Partnership Board (a group of professionals, carers and learning disabled adults, who meet to plan service developments and track progress) is the development of high quality advocacy for people with complex needs and from minority
ethnic communities. Key priorities continue to be transport, leisure services, safety in the community and access to justice and redress. The key objective of the Learning Disability Strategy is to shape the way forward to deliver our services, jointly with other agencies, services users and carers and ensure that people are engaged at an individual and strategic level in a meaningful way.
Partnerships When talking about partners, we mean all the people and organisations that we rely on to make the strategy happen.
Service users The service users are those who are known to Health and Social Care as having a learning disability or who present with needs that can be best met by Learning Disability Services.
Carers The unpaid workforce of carers providing support to adults with learning disabilities are critical partners due to their unique knowledge of individuals and experiences of services.
Commissioners Commissioners develop and purchase services to meet the local needs of adults with a learning disability in Kensington and Chelsea. A critical part of the commissioning role is that of selecting services and monitoring them. This part of the Commissioning role is only achievable through excellent networking with service users, carers and other providers within the borough. The decommissioning of services which require significant change or development also occurs; as well as services that are no longer required. November 2010 Learning Disability Strategy
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Community Learning Disability Team The Joint Learning Disability Team is made up of Health and Social Care staff. The primary purpose of the team is to assess people’s needs and provide the tools to enable them and their carers to access appropriate resources.
Inform
Individuals
Initiate
Improve
Providers There is a large range of providers, including Central London Community Healthcare NHS Trust, which is commissioned to provide services to learning disabled adults within Kensington and Chelsea. Housing or accommodation providers include Equal People, Yarrow, Life Opportunities Trust, CY, Octavia, and Look Ahead. They are commissioned by the Royal Borough of Kensington and Chelsea to ensure that the borough can provide a wide range of accommodation options for people with learning disability. After-school clubs, day services and other groups include Equal People, Scope, Full of Life and a full range of leisure facilities. Schools, colleges and other educational facilities are available, alongside Pure Innovations which supports individuals to gain employment. All partners are responsible for informing agendas to improve outcomes and initiate programmes of work.
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November 2010 Learning Disability Strategy
Serving the local community There are approximately 326 adults with a learning disability in contact with the Community Learning Disability Team. There are a further 39 young people (16 to 18) who are known to the service and active work is undertaken to support them through transition. This is a term used for young people aged 16 to 25, who are usually making the biggest changes and choices from childhood into adulthood. There is a changing population of people with learning disabilities, which is reflected both nationally and locally. The overall budget for learning disability services is £16,640,000. It is broken down as illustrated below:
The Learning Disabled adult population is broken down into the following ethnic groups: Ethnicity
Numbers
White British
151
White Irish
15
White Other
39
Black African
23
Black Caribbean
24
Black Other
4
White and Black Caribbean
4
White and Black African
3
Residential care Asian Indian
2
Supported living Asian Pakistani
4
Day services Asian Bangladeshi
2
Community White and Asian Learning Disability Asian other Team
11
Any other mixed background Advocacy arrangements and support Chinese
4
Other
Residential care
£7,659
Supported living
£626
Day services
£1,880
Community Learning Disability Team
£1,378
Advocacy arrangements and support
£86
Other: Carers’ services, homecare, other aggregated services, services and central management costs allocated to LD services
£5,011
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Other ethnic group
1 30
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What are we already developing? The current developments within the borough build upon existing services and strategies, as set out in the Council and NHS Kensington and Chelsea’s Joint Strategic Needs Assessment, Valuing People Now, and incorporate a number of other strategic documents to ensure that adults with learning disability are supported to make choices and take control of outcomes.
A range of housing options: Equal People, CY, Life Opportunities Trust, InHouse Services, Look Ahead and Yarrow are the key providers of accommodation-based services. The Royal Borough of Kensington and Chelsea and private landlords provide other solutions and ensure that the commissioners and adults with learning disability have a choice of accommodation. Accommodation developments for people in transition (16 to 25) are due to be available from March 2011 and will be based in Amy Garvey House in the north of the borough. We are currently looking into, and consulting on, the option of extending services to adults with complex needs. A group of council officers and providers meets fortnightly to explore and develop a range of housing options; through which positive changes have occurred and will continue to occur. Service users and carers have provided positive feedback to this process. “His last move has been a great success and he has blossomed since moving to his own flat” feedback from a carer following her son’s move to supported living accommodation.
education and adult education facilities outside of the borough. It is unlikely that developments in education will be commissioned within the borough in the future. However, it is recognised that there is a gap in services for young people with complex needs leaving education and needing a robust menu of services. Commissioning processes and consultation are underway to meet this challenge and it is envisaged that a new service will be created in March 2011 to meet these challenging needs. The Council has contracted Pure Innovations to continue to promote employment for people with learning disabilities. Pure Innovations is a not for profit company which helps to secure jobs for people with disabilities, including those with a learning disability. Employment outcomes for adults with learning disabilities remain unsatisfactory, although it is important to note that the Royal Borough of Kensington and Chelsea is one of the highest achievers in performance in this area. The Partnership Board recognises the benefits for adults with learning disability in employment and really values work opportunities: “Pure Innovations helps us look for work – I work two days a week at the Town Hall, I like it, the people are nice, it keeps me busy – before, I was bored at home” Feedback from a service user. “I’d never used a computer before starting my job, now I check my emails and write emails every day” Feedback from a service user.
Promoting day opportunities:
“Working means I get to meet more people. I feel more confident since having a job” Feedback from a service user.
Equal People, Full of Life, Scope and The National Autistic Society are the main providers of opportunities during the day for the young adults with learning disability and people with complex needs within the borough. The Learning Disability Service is reliant upon specialist
A strategic review of day opportunities was undertaken in early 2010. The review looked at local needs, what local people and their carers thought about day opportunities and sought the views of local professionals. There were a number of key themes that developed
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November 2010 Learning Disability Strategy
from this exercise that will support the future commissioning of day and life opportunities. These included:
• moving away from traditional day centres to utilising “spaces” to maximise opportunities for people, for example using community spaces and developing changing spaces
• bringing opportunities to those with complex needs
• having a mix of services and opportunities, developing more choice in support and how services are offered
• person-centred travel planning
• developing social enterprises (businesses with a strong community focus) to support training and employment.
Health: It is clear that adults with learning disability are benefiting from targeted Health Action Planning and further developments need to be achieved in this key area. Valuing People Now recommended that everyone with a learning disability has their own health action plan, which looks at their areas of need and how these can be met. The health action plans have provided the Learning Disability Service with clear indicators that there are gaps in the provision of screening and health promotion. Currently the Learning Disability Service is providing ad-hoc training to our partners in primary and secondary healthcare, which will change the outcomes for adults with learning disability within the borough. “At the leisure centre I do swimming, badminton, bowling and dancing, I love swimming the most” Feedback from a service user who is supported to maintain good health through a variety of activities.
We have developed the Green Light Toolkit, as recommended by the Department of Health as a key way to provide a link to Mental Health Services. This guidance and procedure helps to make sure that Learning Disability Services and Mental Health Services work together to provide bespoke services for people with highly complex needs. Further work to provide robust pathways between the two services and develop commissioning services to ensure the best outcomes for adults with learning disability is needed. Diagnostic overshadowing (where people’s ailments are not properly diagnosed and assumptions are made about an illness) continues to be a key area of weakness within Mental Health and Dementia Services pertaining to adults with a Learning Disability.
Personalisation: Underpinning all of the key delivery areas, is the continued work in person-centred planning, advocacy and personal budgets (an amount of money that an individual can be paid directly, which they can spend on services of their choice, to meet their needs), providing more choice and control in individuals lives. In December 2007, the Government’s Putting People First set out a vision for transforming social care. During 2009-10 there was a change in outcomes for adults with learning disability in so far that in March 2009, six people had a personal budget, by March 2010; 60 people had a personal budget. This has been a significant shift and continued emphasis is a key outcome for the coming years ahead, with everyone in receipt of a personal budget by 2015 or sooner. “My person-centred DVD is all about me; it shows people what my needs are and how to help me and support me, what I like to do and what I dream about doing” Feedback from a service user about their multi-media person-centred plan. November 2010 Learning Disability Strategy
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The Delivery Plan 2010-15
Key area for development
Success criteria
Including everyone
•P eople within these groups are adequately represented in key consultative activities, planning processes and the Partnership Board. •T he way that the Learning Disability Team is organised makes sense to this underrepresented group and achieves improved outcomes as directed by the Partnership Board. •T he Partnership Board and Executive Group (a part of the Partnership Board that deals with strategy development) will implement robust quality assurance systems to provide a basis for checking and managing implementation plans are timely and appropriate.
Black and minority ethnic communities (BME), people with autism and people with complex needs have been identified as in need of more access to opportunities within employment and day and evening opportunities, as citizens and in accommodation as well as improvement in access to health provision. Personalisation Person-centred planning, support planning, brokerage (money management) and direct payments have not yet reached all members of the learning disability community.
•A ll adults with a learning disability have a personal budget. •A ll adults with a learning disability have a person-centred plan. •C ommissioning and organising services will be based on the outcomes of person-centred planning for the whole learning disabled community.
Having a life
•C o-production (the ability of people with learning disabilities to plan their own life), will be embraced in the provision of person-centred services. •H ealth, Housing and Employment will continue to embrace the need for choice and opportunities. These will be in everyone’s commissioning strategies. •P eople with learning disabilities will be supported to maintain a broader range of relationships through specially developed training. •A broad range of specialist communication and mobility aids will continue to be available and everyone will be consulted to ensure that the most appropriate equipment is available to those in need.
People as citizens Citizenship is an encompassing term for inclusion and participation. We know that we need to make changes and improvements in advocacy and safety within the local community.
•P eople with learning disabilities need to have their views represented in the Safeguarding Board. •A dvocacy services (who help people communicate), commissioned by the local authority need to be able to work with people with really complex needs. •B rokerage and the role of the personal assistant need to be developed to make sure that people with a learning disability access the full range of opportunities available in the community.
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November 2010 Learning Disability Strategy
Challenges for the service
Conclusion
A paper from the Centre for Disability Research published in November 2008 looks at the numbers of people with learning disabilities using social care services in the UK. This estimates that the number of adults with learning disabilities known to services in 2006-07 was 187,000 while those using services was 137,000. Further, it estimates that there are currently 147,000 using services. Thus, the number of people using services is predicted to increase by more than 50 per cent by 2018 to 223,000.
The Kensington and Chelsea Learning Disability Strategy is a five year commitment to re-designing and, where necessary, recommissioning services to address gaps identified by needs assessment, including feedback from clinicians, providers, those using services and the public.
This research coupled with local data, which indicates that there is an increased number of children with learning disability coming through transition into learning disability services; highlights the challenge of providing services for a larger service user population, whilst operating in the difficult financial climate. Further, a number of these young adults coming through transition have significant complex needs and will require specialist services to meet their needs and will almost certainly be funded through Continuing Healthcare.
Finally, to ensure that goals are set and achieved, a quarterly Strategic Monitoring Meeting will be put in place to ensure that outcomes are achieved to the required standards and represent value for money.
The document will need to be completely reviewed in five years time, but will need to be reviewed annually by the Partnership Board.
There is also research to suggest that the life expectancy of adults with learning disabilities is increasing, presenting the challenge of providing appropriate and personalised services for this growing group within the learning disability population. The current financial climate is that of public sector fiscal reduction. This demands that all providers of care for adults with learning disabilities utilise the most creative solutions to meet the needs of this group. We must also help to maximise the involvement of people with learning disabilities in mainstream services, ensuring that those services embrace the whole community and see its full potential.
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Key documents that have helped us to shape this strategy 1 P utting People First: A shared vision and commitment to the transformation of Adult Social Care, Department of Health (2007) 2 I ndependent Living Strategy, Office for Disability Issues (2008) 3 Carers at the heart of 21st-century families and communities, Department of Health (2008) 4 Aiming High for Disabled Children: Better Support for Families, HM Treasury/ Department for education and skills (2007) 5 V aluing People: A New Strategy for Learning Disability for the 21st Century (Cm 5086) Department of Health (2001)
7 Healthcare for All, Report of the independent inquiry into Access to Healthcare for People with Learning Disabilities, Sir Jonathan Michael, Department of Health (2008) 8 L ife Like Any Other? Human Rights of Adults with Learning Disabilities (2008 HL Paper 40-1 HC 73-1) House of Lords, House of Commons, Joint Committee on Human Rights (2008) 9 S ix Lives: the provision of public services to people with learning disabilities. Local Government Ombudsman (2009) 10. Planning for the future: the Kensington and Chelsea Joint Strategic Needs Assessment. Summary report. Royal Borough of Kensington and Chelsea and NHS Kensington and Chelsea (2009)
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November 2010 Learning Disability Strategy
Š January 2011. The Royal Borough of Kensington and Chelsea. Design: PIRS Design 020 7361 4325. 13609jcw.
6 The Children’s Plan: building brighter futures. DCsF CM7280 (2007).