LDAG News
Issue 6 Summer-Autumn 2014
Inside this issue: LDAG update
3-6
Sub-group updates
6-8
CB CoP update 9-14
First Minister announces Cabinet reshuffle First Minister Carwyn Jones announced a surprise reshuffle of his Cabinet on 11 September 2014 via Twitter. Media headlines focused on the return of former Education Minister Leighton Andrews to the Cabinet in a new role as Minister for Public Services. His main responsibility will be public sector reform, including delivering the Williams recommendations, but will also include cross-cutting responsibility for the strategic approach to the delivery of public services as well as a number of other areas including domestic violence, justice policy and the fire and rescue services. However, there were a number of significant changes that were largely overlooked by the media, not least the departure of Gwenda Thomas, Deputy Minister for Social Services. Gwenda had served in this role since 2007 and during her time in office she worked with both the current Learning Disability Advisory Group and its predecessor the Learning Disability Implementation Advisory Group (LDIAG) to improve the lives of people with a learning disability living in Wales. Mark Drakeford continues in his role as Minister for Health and Social Services, and following the departure of Gwenda Thomas, takes over the policy and oversight of the provision of all social services activities in Wales including issuing statutory guidance. From now on, the LDAG will therefore provide advice directly to Mark Drakeford. Responsibility for the day-to-day oversight of all (Continued on page 2)
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aspects of NHS delivery and performance in Wales will now be the remit of Vaughan Gething as the newly-created Deputy Minister for Health. Both Jeff Cuthbert and John Griffiths left the Cabinet in the reshuffle while Julie James joined the Cabinet for the first time as Deputy Minister for Skills and Technology, and Ken Skates moved to the role of Deputy Minister for Culture, Sport and Tourism. Prior to the changes, Lesley Griffiths was Minister for Local Government and Government Business but now takes on the role of Minister for Communities and Tackling Poverty. Her new list of responsibilities is wide-ranging and includes a number of key areas:
Evans’ role remains largely unchanged as Deputy Minister for Farming and Food. Both Edwina Hart and Huw Lewis retained their ministerial roles with very few changes.
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Welfare Reform
Children’s and young people’s rights
Financial inclusion
Regeneration
All housing-related activities of local authorities and housing associations
Aids and adaptations, including Disabled Facilities Grants and Physical Adaptation Grants
Digital inclusion
Equality
Voluntary sector and volunteering.
Jane Hutt continues in her role as Minister for Finance with additional responsibility for Government Business. Carl Sargeant is now the Minister for Natural Resources while Rebecca
Following the announcement, Carwyn Jones said: “This is a cabinet equipped
with the skills and experience to deliver the changes that Wales needs in the crucial months ahead.” Cabinet in full: Carwyn Jones, First Minister of Wales Edwina Hart, Minister for Economy, Science and Transport Mark Drakeford, Minister for Health and Social Services Huw Lewis, Minister for Education and Skills Jane Hutt, Minister for Finance and Government Business (Continued on page 3)
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Leighton Andrews, Minister for Public Services Lesley Griffiths, Minister for Communities and Tackling Poverty Carl Sargeant, Minister for Natural Resources Vaughan Gething, Deputy Minister for Health
Page 3 Ken Skates, Deputy Minister for Culture, Sport and Tourism Rebecca Evans, Deputy Minister for Farming and Food Julie James, Deputy Minister for Skills and Technology. Full details of the roles and responsibilities of all the members of the Cabinet can be found on the Welsh Government website: http:// wales.gov.uk/about/cabinet/?lang=en.
LDAG update The Learning Disability Advisory Group (LDAG) met for the ninth time on Wednesday 10 September in Cardiff. The agenda included a number of presentations and topics for discussion. Roger Banks was unfortunately unable to attend so Ruth Northway agreed to step in to co-Chair the meeting with Sophie Hinksman.
Social Services and Well-being (Wales) Act Anthony Jordan, Head of Sustainable Social Services Implementation within Welsh Government, delivered a presentation on the Social Services and Well-being (Wales) Act. The Act received Royal Assent on 1 May 2014 and provides a new legal framework to bring together and modernise social services law in Wales. It will fully come into force in April 2016 once the new legislative framework is in place. The Act is designed to make social services sustainable by addressing
“To catch the reader's attention, place an interesting sentence or quote from the story here.”
economic challenges, taking into account how the population is changing and giving people more choice and control in their care and support. There is a focus on early intervention and prevention as this can lead to long term cost-savings as well as better outcomes for people. There are a number of fundamental principles enshrined within the Act: People – putting individuals and their
needs at the centre of their care, giving them a voice and control. Well-being – supporting people to
achieve their own well-being and measuring the success of this care and support. (Continued on page 4)
Page 4 (Continued from page 3) Early intervention – increasing
preventative services within the community to minimise the escalation of critical need. Collaboration – strong partnership
working between all agencies and organisations including local/ community services, health and the voluntary sector. The legislative framework to accompany the Act will include approximately 40 new regulations and several codes of practice. The regulations will be secondary legislation providing further detail on specific areas of the Act while the codes of practice will be guidance ‘with the force of law’ to help people and organisations work within the new framework. Local authorities will have to comply with the codes of practice with very few exceptions and there will be several pieces of statutory guidance that will apply not only to local authorities but also other agencies such as safeguarding boards. “To catch the reader's attention, place an interesting sentence or quote from the story here.”
According to Mr Jordan’s presentation, the main aims of the new legislation are as follows: Individuals get the support they need
in the way they want it. There is a greater range of
preventative services available to keep people independent for longer. Local authorities and local health
boards work closely to better understand people’s needs.
LDAG News Implementation of the legislation will be achieved in a number of ways, led by local authorities and their partners, with funding from Welsh Government in the form of a ‘Delivering Transformation Grant’ and training resources to help the workforce adapt to the changes. Timetable There will be two rounds of formal consultations on the draft regulations and code of practice. The first will be launched in November 2014 and the second in summer 2015. Following the consultation process, the regulations and codes of practice will be approved by the National Assembly from summer 2015 onwards. Staff training on the changes will take place during 2015 and 2016 with the Act finally coming into force in April 2016. For more information please visit the following websites: Welsh Government http://wales.gov.uk/ topics/health/socialcare/act/?lang=en National Assembly for Wales http:// www.senedd.assemblywales.org/ mgIssueHistoryHome.aspx?IId=5664
Adult Practice Reviews Richard Chivers from Welsh Government gave a presentation on Adult Practice Reviews (APRs). In January 2013, Child Practice Reviews were introduced, replacing Serious Case Reviews. Ministers then decided that adult safeguarding services should align with children’s services and introduce Adult Practice Reviews. (Continued on page 5)
Issue 6 Summer-Autumn 2014 (Continued from page 4)
The Social Services and Well-being (Wales) Act provides a legal basis for adult protection and adult reviews. Work began on the development of Adult Practice Reviews back in August 2013 and draft guidance was published in January 2014. The formal consultation process took place between April and June 2014, and the new reviews were piloted throughout the first 6 months of 2014. The final version of the guidance will be published soon and the implementation process, including training for relevant staff, will continue until the end of the year. Key features of the guidance:
Page 5 Guidance sets out the stages for the
process Staff who were involved in case
directly engaged in the APR process Internal Management Reviews and
Chronologies replaced with Timelines and Individual Interviews Learning events Brief reports of findings and
recommendations to inform learning and change Focussed action plans Reports and work on their “To catch the reader's attention,
implementation to be disseminated widely so that learning shared
place an interesting sentence or quote from the story here.”
APRs underpinned by a set of
principles Safeguarding Adults Boards have
specific responsibilities APRs will be about
learning what ‘problematic’ cases can tell us about our systems Context of Standing
Multi-agency Practitioners’ Forums
APRs managed by
sub-groups of the Safeguarding Adult Boards Revised criteria for when APR required Panel established to undertake each
APR
Reviewers may be invited back to
review progress Extensive set of appendices to
support APRs. Criteria for Adult Practice Reviews According to the guidance, the reason for using criteria is so that only cases that have given rise to serious concerns are analysed and learned from. It also states that the type of review carried out should be ‘proportionate’ and that the criteria should also help to promote consistency in the use of Adult Practice Reviews across Wales.
Each APR has independent chair and
two reviewers
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The criteria apply to ‘adults at risk’. A person is an adult at risk if he or she: is experiencing or is at risk of abuse or
neglect and has needs for care and support
(whether or not the authority is meeting any of those needs), and as a result of those needs, is unable to
protect himself or herself against the abuse or neglect or the risk of it. The criteria state that reviews must be commissioned where an adult at risk: “To catch the reader's attention,
place dies (including death by probable an interesting sentence or
suicide) or
quote from the story here.”
sustains a potentially life-threatening
injury or serious long standing or permanent impairment of health or
has been subjected to serious sexual
abuse and either abuse or neglect are known or
are suspected to be a contributory factor. Next steps The guidance will be launched soon as good practice before it becomes statutory on implementation of the Social Services and Well-being (Wales) Act. Welsh Government is planning a programme of training to compliment the launch of the guidance. The Child Practice Review process is currently being evaluated and this could lead to possible changes to the guidance for both children and adults. Minutes of previous LDAG meetings are available on the website: https:// www.ldag.info/about-us/minutes-ofmeetings.aspx.
Sub-group updates Transforming Care This group has met several times now, and recently submitted the 5 Priorities Report to Gwenda Thomas, Deputy Minister for Social Services. The report has been accepted by Welsh Government and the Deputy Minister has asked the sub-group to continue working on the identified priorities and draw up clear action plans for successful implementation of all recommendations. The CB CoP will continue to act as an expert reference group for this work. In the first instance, the main work of the sub-group is to expand on the 5 priorities
identified to detail exactly what actions need to take place and by when. In order to do this, the sub-group has established 4 smaller working groups to focus on the first 4 priorities. Although the fifth priority, the repatriation of people from out of area placements, is obviously a key objective, it is crucial to develop a robust infrastructure for comprehensive, high quality services to be developed and adequately supported locally before attempting to bring people back. The report’s recommendations will be designed to fit with key legislation (Continued on page 7)
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including the Social Services and Wellbeing (Wales) Act, Regulation and Inspection Bill, and the Sustainable Social Services Programme. Welsh Government officials are delivering presentations to sub-group members in order to ensure compatibility. The action plans being developed are focusing on: immediate goals ie things that can be put into place straight away; short-term goals that can be achieved within three to six months; and longer term goals that can be progressed within a year or two. The sub-group has been asked to report on progress to the Minister for Health and Social Services every 6 months with the first report due in December. Priority 1 working group (joint planning and commissioning) has drafted an initial action plan. Priority 2 working group (database) has met with representatives from the Data Unit Wales to discuss the possibility of collaboration and is seeking advice from existing learning disability registers throughout the UK. Any register would need to be funded in the first instance, but with a likely expectation that it becomes self-funding in the longer term. It will therefore be important to convince local authorities etc of the value of the database, for example, planning services and commissioning. One of the first tasks is to generate ideas about the range of variables to include and examples of possible uses a register could fulfil. Priority 3 and 4 working groups (workforce competencies and regulation/inspection) are working in tandem at first as there is significant overlap in the initial tasks required. The
first steps are to draw up clear descriptions of what good services look like, and then draft good practice guidance from the perspective of all key stakeholders (commissioners, inspectors, managers, direct care staff and so on). Training needs can also then be highlighted for stakeholders.
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As the Regulation and Inspection Bill is not due to be introduced to the National Assembly until early next year, work on Priority 4 will be progressed over a longer timescale than Priorities 1, 2 and 3. Priority 5 (repatriation). There is no separate working group for this as yet. However, several major projects are already underway in Wales for the systematic resettlement of people placed out of county. Descriptions of how these schemes operate are being drawn up by sub-group members for presentation to the Welsh Government as an early response to this priority area. The sub-group also plans to respond to a number of the forthcoming consultations on specific regulations and codes of practice linked to the Social Services and Well-being (Wales) Act, starting in early November. (Continued on page 8)
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Health inequalities This sub-group has identified 6 workstreams and set up working groups to take forward each of these priorities: Measurement of health inequalities in
Wales and the relative impact of the determinants of health on people with a learning disability. Review and make recommendations
on the impact of the Welsh annual health check. Provide advice on the impact of
changes in social policy on health and support to access healthcare. “To catch the reader's attention,
an interesting sentence or placeReview and make recommendations quote from the story here.”
on NHS provision in primary, secondary and specialist NHS care in Wales.
Advise on the research evidence
and activity in Wales on the health of people with a learning disability. Review and make recommendations
on best practice across Wales. The sub-group intends to produce a final report with recommendations by early 2015 to be presented to the LDAG.
Advocacy Joe Powell recently decided to step down as the lead of this sub-group as he was concerned that, as the Director of All Wales People First (a selfadvocacy organisation), he could be perceived as having a conflict of interest. Joe has written to the LDAG coChairs to suggest that someone who does not work for an advocacy organisation, preferably from a research background, is invited to lead the group from now on.
Before he stepped down, Joe met with Dr Mike Shooter to discuss the issue of advocacy. In 2013, Mike was appointed as the chair of a ministerial expert group to provide advice and recommendations to the Deputy Minister for Social Services on the development, quality and delivery of advocacy services for children and young people in Wales. Joe and Mike agreed that there is a major financial crisis within advocacy services for both children and adults, with many advocacy organisations under threat due to lack of funding. LDAG members suggested that it would be useful to carry out a mapping exercise of the existing advocacy services for people with a learning disability and their carers in Wales. All Wales People First are able to do this for People First self-advocacy groups and Wayne Crocker from Mencap Cymru agreed to do the same for other advocacy groups across Wales. The BILD report due out shortly will provide an indication of the impact of the cessation of the BILD grant funding on advocacy services. It was agreed that the LDAG should link in to the work being carried out by Mike Shooter’s expert group and also Welsh Government’s group on advocacy policy within the Social Services and Well-being (Wales) Act.
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CB CoP update The Challenging Behaviour Community of Practice (CB CoP) met twice in recent months: 4 July and 24 September. The main item on the July agenda was the “Transforming care for people with a learning disability and challenging behaviour” report to the Deputy Minister for Social Services, which has recently been accepted by the Welsh Government. The group were asked to come up with a list of possible variables that should be included in a learning disability register for Wales and suggestions for how the register could be used. It is important to clarify that the purpose of having a register is not for eligibility but for strategic planning and monitoring progress. There were also a number of presentations on a variety of topics such as dementia, quality standards, anger awareness and Deprivation of Liberty Standards (DoLS).
Touch Trust and Dementia Karen Woodley talked about the Touch Trust’s work with people suffering from dementia. This is a charity that works with physically challenged children and adults through art, music and movement, and has recently developed a new programme for working with people with dementia. Feedback from carers has been very good, especially in relation to more severely disabled people, who are often the hardest to engage. Further information about the charity and its work can be found on their website: www.touchtrust.co.uk.
Driving Up Quality Claire Pritchard from Care Management Group (CMG), a large, independent sector care provider working mainly in learning disability and with some mental health services, talked about the Driving Up Quality code. The code was developed by an alliance of provider organisations in England in response to the Winterbourne View scandal. It was launched at the House of Commons last year and now has over 100 organisations signed up to it. The code is based on 5 sets of standards: “To catch the reader's attention, place an interesting sentence or quote from the story here.”
1. Support is focused on the person 2. An ordinary and meaningful life 3. Being happy and quality of life 4. Good culture and the organisation 5. Lead and run the organisation well. There is also an accompanying selfassessment tool. Sign up is open to all organisations and all materials are freely available on the website: www.drivingupquality.org.uk.
Care without Compromise Tony Doyle, Matthew Hodder and Katie Jane Davies from Care without Compromise, an independent sector (Continued on page 10)
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residential care provider in South Wales, delivered a presentation on a recent evaluation of their service. This is a family -run company that has been operating for about four and a half years. An external evaluation of the service was commissioned about a year ago, and the results were presented at the meeting. The data came from a variety of sources using a mixture of measures to assess the quality of life for the nine service users in residence at the time, the impact of the service on the incidence of challenging behaviours and the use of reactive strategies. Qualitative data was also collected from service users, their families, care staff and care managers. “To catch the reader's attention, place an interesting sentence or quote from the story here.”
It was emphasised that this was a ‘snapshot’ picture rather than a long term evaluation. Initial results were very positive and the full report is available on request. See their website for further information: www.carewithoutcompromise.org.uk.
Deprivation of Liberty Safeguards (DoLS) and Supported Living At the July meeting, the group discussed the general lack of clarity over responsibility, particularly when residents do not have care managers. It
LDAG News is often not clear who is in breach of the safeguards, the care provider or local authority. It is also impractical in some cases to complete assessments in the time allowed. It was suggested that the group ask an expert to speak at a future meeting to describe DoLS specifically in relation to supported living. Edwin Jones then asked Richard Griffith, Senior Lecturer in Health and Social Care Law at Swansea University, to attend the September meeting to explain this complicated piece of legislation. Richard began with a summary of the Bournewood case that was taken to the European Court of Human Rights in 1998. The court ruled in favour of HL (the person at the centre of the case), stating that it was a violation of Article 5 of the Human Rights Act for a Consultant Psychiatrist to detain someone against the wishes of the carers and family. As a result, the UK government introduced the new Deprivation of Liberty Safeguards and Code of Practice, which came into force in April 2009. This framework applies in both England and Wales. The Deprivation of Liberty Safeguards provide extra protection for the human rights of people who lack capacity and find themselves deprived of their liberty. As well as people with a learning disability and mental health conditions, this could apply to older people in care homes. The Safeguards provide a rigorous process by which services have to prove that compulsory detention is the best solution for the individual concerned. Prof Griffith then went on to outline the March 2014 Cheshire West ruling on the cases of two sisters with learning disabilities (P and Q or ‘Mig and Meg’) (Continued on page 11)
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and a man with cerebral palsy and Down’s syndrome identified as P. In all three cases, the Court of Appeal had ruled that the living arrangements were in the best interests of the individuals and did not represent a deprivation of their liberty. However, the Supreme Court ruled that all three had in fact been deprived of their liberty. The Court of Appeal had argued that a person’s life had to be compared with that of another person with the same characteristics, eg another disabled person, and therefore what was a deprivation of liberty for some people might not be a deprivation for others. The Supreme Court said that we must not confuse the quality of the care arrangements with the question of whether these arrangements constituted a deprivation of liberty. People who lack the capacity to make (or implement) their own decisions about where to live may justifiably be deprived of their liberty in their own best interests. They may well be a good deal happier and better looked after if they are. But that does not mean that they have not been deprived of their liberty and are therefore subject to the DoLS legal framework. The European Convention states that human rights apply to “everyone” (Article 1). Physical liberty is also the same for everyone, regardless of whether or not they are disabled. What would be a deprivation of liberty for a non-disabled person is also a deprivation for a disabled person. The key feature according to the
Page 11 Supreme Court is whether the person concerned is under “continuous supervision and control” and is “not free to leave”. This has now become the ‘acid test’ for deciding whether or not a person should be subject to DoLS: Is the person subject to continuous
supervision and control? This could include needing to know where the person is and/or what they are doing for the majority of the day, even if they are not physically supervised 24 hours a day. Are they not free to leave? For example, if the care providers would not wish the person to leave until they had received assurances that it was in the person’s best interests, then they are not free to leave. “To catch the reader's attention, place an interesting sentence or quote from the story here.”
The person’s compliance or lack of objection to their placement, the purpose of it or the extent to which it enables them to live a relatively normal life for someone with their level of disability were all irrelevant to whether they were deprived of their liberty, ruled the court. It said that the state should “err on the side of caution” when considering what constitutes a deprivation of liberty for vulnerable service users. It was anticipated that the ruling would lead to a sharp rise in DoLS and Court of Protection applications. The state is also obligated to “actively ensure that periodic independent scrutiny occurs for those at risk of having their liberty deprived”. This is to ensure that the deprivation of liberty continues to be in the best interests of the individuals concerned and must be (Continued on page 12)
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carried out by a Best Interest Assessor. For adults living in hospitals and care homes, a deprivation of liberty must be authorised using a DoLS application while those in supported living, residential schools or own home, or those aged 16-17, should have their deprivation of liberty authorised by the Court of Protection by means of a Court Welfare Order. Children under 16 are subject to the Children’s Act and therefore the DoLS legislation does not apply.
children they support to recognise when and why they became angry and to develop coping strategies for dealing with their anger. Feedback from these groups stated that while the children generally enjoyed these sessions, they struggled to understand a lot of the information and often became confused or bored. Also, the people who supported the children on a daily basis were not involved in the sessions so were not encouraging them to use the skills they had learnt during their daily lives and the handouts made little sense to them.
Richard also pointed out that DoLS cannot be used to prevent long term contact with a person’s family, friends etc or to prevent someone from moving on to a new placement. Situations such as these would require applications under the Mental Capacity and Mental Health Acts.
In light of the feedback, the team decided to develop a new, more engaging and accessible course called ‘Don’t blow your top!’. The course is based on Cognitive Behavioural Therapy (CBT) principles but is very in line with the PBS model. Children and young people are encouraged to:
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“To catch the reader's attention, place an interesting sentence or quote from the story here.”
Don’t blow your top! Rebecca Saltmarsh, Gary North and Kathryn Davies from Facing the Challenge delivered a presentation on their anger awareness course ‘Don’t blow your top!’. Facing the Challenge is a specialist team within Abertawe Bro Morgannwg University Health Board, funded jointly with Neath Port Talbot County Borough Council, supporting children and young people with learning disabilities and challenging behaviour. The team works closely with parents, carers, teachers and other professionals and follows the principles of Positive Behavioural Support (PBS). The team set up anger awareness groups to help the
Learn to identify their emotions and
what it feels like to be angry Learn to identify what makes them feel angry Learn to identify how angry they are feeling Develop strategies to cope with their angry feelings and to calm down Learn to re-think situations and consider what else they could have done. Staff developed a range of visual aids to support the training and they also ensured that the sessions included a variety of engaging, interactive activities (eg role play, video, action games). Parents, carers and other professionals are encouraged (Continued on page 13)
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to get involved in the course in a variety of ways so that they can reinforce the skills and techniques in the children’s daily lives. There is an individual progress evaluation system and each child receives a personal anger scale and an individual anger plan that can be used at home, school, respite etc. Feedback from the course has been very good with the children finding it enjoyable and engaging while 100% of the parents surveyed stated that they would recommend the course to others. Some children with more severe disabilities were still able to engage with the course even if they did not fully understand some of the more subtle concepts. However, the results from the individual evaluation tool before and after the course are very mixed and it has been almost impossible to draw any conclusions from the data so far without investing in some more in-depth research.
Using video stories Sarah Day from Practice Solutions, a private consultancy offering training and support to the public sector, talked about the ways that organisations can use video to empower people. Video stories can be very powerful and give people an opportunity to document their achievements or have more of a say and greater control over their lives. They can also be used to provide evidence of real outcomes for people and demonstrate to commissioners the true value of person-centred services.
Continuing Health Care eligibility assessments for people with a learning disability Jenny Jagus, ABMU Health Board, gave
Page 13 a presentation on the Continuing Health Care (CHC) framework and the new Decision Support Tool (DST) that comes into force on 1 October 2014. She explained that the large numbers of retrospective claims that have been made to Welsh Government, along with the increased number of complaints to the Ombudsman, clearly demonstrate that there are issues with the interpretation and implementation of the CHC framework.
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A number of key themes have emerged from the complaints upheld by the Ombudsman including: General lack of understanding of the
assessment process and the requirement to consider the overall “primary need for healthcare test”. Failure to carry out adequate assessments or take into account all the relevant facts of the case. Not involving families/carers in the assessment process. Failure to apply the CHC criteria properly or provide adequate justification for decisions. There appear to be many misconceptions with regards to CHC such as the idea that it includes any (Continued on page 14)
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form of health funding when in fact it only applies to care fully funded by health. Jenny also pointed out the importance of explaining the possible consequences of the CHC assessment process, particularly for those in receipt of Direct Payments. People also need to know that they have the right to refuse a CHC assessment or to stop the process at any point. She then outlined some of the mistakes made by staff when completing the Decision Support Tool: Failing to include low needs in the
relevant domains. Not providing a score in the cognition domain for people with a learning disability. Not providing a score in the mental health domain unless person has clearly documented dual diagnosis. Only scoring above moderate for behaviour if person is in secure services. Double weighting across domains. Using domain 12 ‘other’ for needs that should be incorporated elsewhere in domains 1-11. Assuming that a person must have at least 1 priority or 2 severe needs in order to be eligible. No evidence of Primary Health Need (PHN) approach and consideration in four key indicators (ie nature, intensity, complexity and unpredictability) in reaching decision. Not providing robust evidence-based rationales for decisions.
Going forward The new framework has been designed to ensure consistency with clear definitions to avoid confusion. It has an increased focus on roles, responsibility and accountability. A new training module has been developed by Welsh Government and is currently being rolled out across Wales. Further training is also being developed for all-Wales independent panels and a package on communicating effectively. Specific training on learning disabilities and mental health will follow. Guidance on behaviour and the CHC assessment process is available on the NHS Wales Complex Care Information and Support Site (CCISS) http://www.cciss.org.uk/servicespecific. General guidance on the CHC framework, including information in Easy Read, is available on the Welsh Government website: http://wales.gov.uk/ topics/health/nhswales/healthservice/chcframework/?skip=1&lang=en. If you have any best practice examples of the CHC assessment process for people with a learning disability, please send them to jenny.jagus3@wales.nhs.uk so that they can be incorporated into the training package. Copies of all the presentations from both CB CoP meetings are available on the LDAG website: http://www.ldag.info/ cb-cop/meetings/presentations-andpapers.aspx.
For more information or to let us know what you think, contact Sam Williams on 029 20681177 or e-mail: samantha.williams@ldw.org.uk. Check out the website www.ldag.info or follow us on Facebook and Twitter @LDAdvisoryGroup.