Blue Light Protocol

‘Blue Light’ Protocol’

Urgent meeting protocol for those with Learning Disabilities and Autism at risk of inpatient admission

Date / Author / Authorising Sign-off
13th June 2016 / Tracy Gagetta

Learning Disabilities Commissioning Manager
Brent Council

Contents

Statement of Purpose

Relevance to CTRs

CTR Policy Abstract

Urgency Meeting

Blue Light Process and Steps

Meeting Terms of Reference

Community Stakeholder Involvement

‘No Blame’ Principle / Guidance

Role of CCG Commissioner for ‘Blue Light’

Outcomes

Follow up

Documents to Consider

Policy / Reference Guidance

Appendices

Appendix A

Appendix B

Appendix C

Appendix D

1 /

Statement of Purpose

1.1 / The ‘Blue Light’ protocol provides the commissioner with a set of prompts and questions to prevent people with learning disabilities and/or autism being admitted unnecessarily into inpatient learning disability and mental health hospital beds. It is also intended to help identify barriers to supporting the individual to remain in the community and to make clear and constructive recommendations as to how these could be overcome by working together & using resources creatively.
1.2 / The ‘Blue Light’ protocol will work in conjunction with Care and Treatment Reviews (CTR) and a Care Programme Approach (CPA) that maybe already in place for an individual and their health and social work professional.
1.3 / The ‘blue light’ protocol meeting and register (Appendix C) will operate as a practical guide for health and social care practitioners to escalate those cases of an individual with a learning disability and autism that has continually challenging behaviour or is at risk of inpatient admission or has been previously admitted.
1.4 / The protocol will ensure that an urgent meeting is arranged to agree and put into place a support plan that allows the individual to receive the needed support to stay in the community. It will consist of a multi-disciplinary group of professionals who are familiar with the case and have a full understanding of the current crisis.
2 /

Relevance to CTRs

2.1 / A Care and Treatment Review (CTR) has been developed as part of NHS England’s commitment to improving the care of people with learning disabilities and autism with the aim of reducing admissions and unnecessarily lengthy stays in hospitals. The review brings together those responsible for commissioning services for individuals who are at risk of admission or who are inpatients in special learning disability hospitals.
2.2 / The aim is to bring a person-centred and bespoke approach to ensuring that the treatment and support needs of the individual and their families are met and the barriers to progress are challenged and overcome.
2.3 / The ‘Blue Light Protocol’ will involve an ‘at risk of admission’ register and will identify those people who are likely to require (or already have) a ‘Community CTR’ to prevent their unnecessary admission, or to ensure that if admission is required it is for the shortest possible time and has clear outcomes.
2.4 / Where admissions are unplanned, the CTR maybe difficult to set up due to urgent time constraints, therefore, the ‘Blue Light Protocol’ will provide the commissioner with a set of prompts and questions to prevent people with a learning disability and autism being admitted unnecessarily into mental health beds and hospitals. It is also intended to help identify barriers to support the individual to remain in the community via various health and social care practitioners who work directly with the individual.
2.5 / Organisations are encouraged to sign up to this protocol within Brent Borough to support prioritising of their time and resource to respond both flexibly and at short notice.
2.6 / The protocol can be used where there is neither prior knowledge of the escalating risk of admission nor the time to set up or hold a CTR.
2.7 / An outside expert may be requested, at Commissioners discretion, to provide objectivity of a ‘Blue Light Protocol’ or if the case is at a standstill with no resolution insight, the expert will provide suggestions and mediate.
3 /

CTR Policy Abstract

3.1 / The Blue Light Protocol is subject to CTR Policy exemplar standard 11;
CTRs and any related recording or disclosure of personal information will be with the express consent of the individual (or
when appropriate, someone with parental responsibility for them, unless LPA is in place), or if they lack capacity, assessed to be in their best interests applying for Mental Capacity Act 2005 and its Code of Practice.
4 /

Urgency Meeting

4.1 / If a meeting is urgent and cannot commence within a 2-week period, a secure video or teleconference will be organised between the individual in question, the family/guardian, carer and all relevant health and social care professionals and advocates. This will allow participants to attend at short notice.
4.2 / Although it is recommended that a face to face meeting must be attempted in the first instance, this may not be possible within reasonable timeframes.
5 /

Blue Light Process and Steps

5.1 / Anyone involved in the care of a person with a learning disability and autism can raise concerns about an individual who is at risk of being admitted to hospital. This can include a family member, guardian, carer, advocate, social worker, third sector worker and healthcare professional intrinsically involved in working with the individual.
5.2 / The Head of Continuing Health Care and Complex Care have been identifiedas the NHS Lead Commissioner or ‘chair’ in charge of the risk register for the ‘blue light protocol’. The commissioner appointed must have budgetary authorisation and access to clinical expertise and can appoint a deputy to chair the meeting if the lead commissioner is unavailable.
5.3 / The commissioner’s role is responsible for ensuring that a pre-admission (unplanned) ‘blue light’ meeting is organised, chaired and running in a timely manner according to CTR protocol. The commissioner also has final authorisation on any additional funding needed for the care of the individual within the community or inpatient service.
5.4 / Those involved in the ‘Blue Light’ meetings include;

individual considered for admission
family member/guardian/carer
psychiatrist
named nurse
named social worker
independent LD advocate
commissioner
GP

5.5 / The ‘blue light’ meetings process will involve the following;
► The Chair is made known to participants and the current situation is shared.
► The needs and wishes of the individual areidentified. This includes hearing from the person and their family members, guardian and/or carer.
► Clinician and healthcare professionals(and social worker as appropriate) identify current risk, support plan and recommended plan moving forward.
► Options are discussed amongst the group. The individual is also included in conversation and with accessible information provided and any reasonable adjustments to allow the process to be understood.
► The availability of resources and potential resources are discussed; this includes funding in the short or long term.
► Decision regarding future care is agreed, with new support plan in place, listing strict timelines and procedures.The need for longer term funding changes will also if applicable be reflected in the individuals Education, Health and Care plan (EHC plan)
6 /

Meeting Terms of Reference

6.1 / Meetings to be named ‘Blue Light Meeting’.
Meeting to be called when there is a risk of inpatient admission due to on-going challenging behaviour or deterioration in mental health from an individual with a learning disability or autism in the community.
6.2 / Purpose
To ensure the individual has sufficient levels of support in the community and that all necessary steps are taken to stabilise before an inpatient admission is considered.
6.3 / In scope
All ages to include those service users engaging in children’s, transition, and adult services within the community.
Those who have been identified as having a learning disability and autism and are at risk of inpatient admission due to challenging behaviour or in crisis.
Those who have a history of inpatient admissions for extended periods of time.
Those who have been previously admitted to inpatient services or long-term hospital care.
Includes those subject to Ministry of Justice restrictions, other than for the pre-admission part of the pathway where the route into hospital is through the courts or from prison. There is recognition that some people transfer to hospital via the criminal justice system and these individuals can be subject to a MoJ restriction order. That means they have to serve a minimum sentence. In these circumstances even though CTRs cannot speed up the discharge process they can check that the individual is safe, getting the appropriate and effective current care and treatment based on their reason for admission to hospital (rather than prison) and that there is planning taking place for discharge.
Where there is an intention to transfer a person to a setting of higher security then this should trigger a CTR using the ‘community’ template.
6.4 / Out of scope
Does not apply to those LD and autism individuals admitted to hospital for physical health conditions.
6.5 / Authority
Decision regarding overall care and steps taken moving forward, to be agreed by panel and individual, with specific levels of care and changes in support plan to be recommended by psychiatrist and/or named nurse or social worker.
If a decision regarding individual’s care cannot be reached, the commissioner can recommend an ‘independent advisor’ to attend a second emergency meeting to assess the case, initial meeting and be the deciding factor in what is best for the individuals care and future support plan.
The independent advisor will be chosen from a list of recommended psychiatric consultants or other relevant healthcare professional via Brent CCG.
6.6 / Membership
Person being considered for admission
To provide a first-hand account of issues and what would help. Listening to the individual is essential and should be prioritised and facilitated.
Family member / guardian
To provide additional information and support.
Psychiatrist
To provide feedback on assessed clinical needs and risks. Role in mental health act processes.
Nurse
Care management and coordinating role. Provider of clinical information.
Social worker
Care management and coordinating role. Provider of social care information.
Independent LD advocate
As and when required.
Commissioner
To provide support to fund alternatives to institutional care and independent advisors.
GP
To ensure effective support around health needs (if required).
6.7 / Quorum
A quorum can be used in cases where not all members of the requested meeting can attend. The quorum should consist of at least 60% of the healthcare professionals requested, along with a family member and/or guardian to support the individual being considered.
6.8 / Meeting arrangements
Anyone involved in the care of a person with a learning disability and/or autism can raise concerns about an individual who has challenging behaviour and is at risk of hospital admission.
Meeting requests must be raised via the care manager or care coordinator and requested via email to the lead commissioner. The commissioner will then contact all relevant members and arrange a face to face meeting in the first instance to commence within 5-working days. If this cannot be arranged within 5-working days (or sooner depending on urgency); a teleconference or video call will be arranged and commence within 24-48-hours.
A ‘blue light’ meeting may take a full working day, depending on levels of care of the patient. The commissioner and care coordinator will discuss between them the amount of time possibly needed for meeting from beginning to end.
6.9 / Reporting
All reporting will be via minutes taken at the meeting, along with case notes and written recommendation via professionals and family members. This will then be submitted to the CCG, CHC and local authority (if social worker involvement) for data protection and confidentiality purposes.
6.10 / Resources and budget
Names and funding provisions for external psychiatric consultants as and when needed. To be confirmed by CCG and CHC.
6.11 / Deliverables
A revised support plan for the individual to remain in the community that must involve a fully comprehensive step-by-step list of services, resources and support tools. The individual must also agree to this plan, unless they do not have the capacity to do so and an inpatient admission is necessary for the safety of the individual and those around him/her.
6.12 / Review
Should be carried out according to current legislative CTR protocols, unless agreed during ‘blue light’ meeting.
7 / 7.1 /

Community Stakeholder Involvement

The ‘Blue Light Protocol Meeting’ requires the following from its community stakeholders;
Close, collaborative working across health and social care that will enable an improved understanding of the local population
Assist commissioners to track individuals, identify existing gaps in current service provision and design
Partnership working with relevant stakeholders, to better consider the types of resource required to provide more robust community based alternatives
8 /

‘No Blame’ Principle / Guidance

8.1
8.2 / It is important for all involved to sign up to the ‘no blame’ principle, in
order to give individuals and organisations the confidence to speak up should they face difficulties fulfilling their contractual role/s.
This is to be agreed and recorded in the meeting minutes.
8.3 / Any conflict of interest reported during the meeting will be recorded and the person/s or professional/s in question will be asked to be omitted from the meeting via the ‘chair’. The omitted individual can challenge the conflict of interest to the ‘chair’ in writing or email for further feedback, or applicable, be advised of Brent CCG’s complaints procedure.
9 /

Role of CCG Commissioner for ‘Blue Light’

9.1 / The chair should manage the conversation as follows;

The chair is made known to people and the current case/situation is shared
The needs and wishes of the person are identified including hearing from the individual and family, carer or clinicians
Current risks are identified
Care and treatment needs – options considered (preference list)
Capacity of current resources and potential resources identified
Decision made and support plan agreed. Actions for responsible people and follow up plan identified
Funding arrangements confirmed

9.2 / The CCG Commissioner, in working with partners who are involved in supporting people in the community, will identify those individuals who are at risk of admission. The risk register is to be held locally and in accordance with the local CTR Policy. The risk register will be subject to review within Brent CCG which will be developed and held by the Lead Consulting Psychiatrist or Clinical Lead of the inpatient service provider within Brent Borough.
9.3 / To build the register, it is expected that there will be closer working
relationships developed with health and local authority commissioned providers, as well as third sector and advocacy organisations working directly with the individual considered for admission or in crisis. Other organisations such as the Police and Accident and Emergency, etc.; should also be included if these emergency stakeholders have been involved with the case during crisis.
9.4 / Through this the CCG Commissioner will ensure that there is the highest possible level of awareness of people in their community with a diagnosis of learning disabilities and autism.
10 / 10.1 /

Outcomes

The outcomes of the meetings or conference call should be recorded as per local policy and lead to an updated CPA care plan and risk assessment.
10.2 / The 6-monthly CTR will focus on the safety, care and future planning for those people who are at risk of specialist inpatient assessment and or treatment services. The emphasis will also be on establishing the reasons for extended hospital stay, barriers to progression and discharge and a review of whether the correct or most effective treatments are being provided. The review will be solution-focused to find ways to overcome barriers to discharge, agree actions, identification of needs differentiating between S117 after care needs and other needs, responsibilities and timelines.
11 / 11.1 /

Follow up

If an individual is at risk of admission and they are not part of the Care Programme Approach pathway, it is likely that they now meet the criteria for CPA and a care coordinator is to be allocated to follow up the agreed care plan.
11.2 / The revised care plan will require regular review in line with the CPA Policy by the care coordinator to ascertain effectiveness and quality. The individual will then be placed on the register if they are not already on it.
11.3 / Should admission take place following a ‘Blue Light meeting’ a full CTR will need to take place within 10-working days.
12 / 12.1 /

Documents to Consider

Questions for the individual
Appendix A
12.2 / Preference List
No placement should take place out of area without the agreement of the commissioner.
Appendix B
12.3 / Information held on Register
Appendix C
12.4 / External Professional Services Payment Form
Appendix D

Policy / Reference Guidance

Commissioner Tools. ‘Blue Light Protocol’
Retrieved from
DH Winterbourne View Review Concordat: Programme of Action – December 2012
Retrieved from
Equality Act 2010
Retrieved from
MHA Code of Practice
Retrieved from
Mental Capacity Act 2005
Retrieved from
CTR Policy
Retrieved from

Appendices

Appendix A

Questions for the individual during Blue Light Meetings

1 / Gather a pen picture.
2 / What are my and my family’s / carers’ views of the current situation?
3 / What are my symptoms including physical health.
Do any of these diagnoses mean I need to be in hospital?
Have I had an annual health check and do I have a health action plan?
4 / What are the current issues and risks and how can I stay safe and keep others around me safe?
5 / What’s working well / what doesn’t work?
What has helped me before?
6 / What support has been/can be put into place so that I can stay in the community.
7 / What treatment do I get including prescriptions, therapy, diet and care that keep me safe and well?
8 / Can the care and treatment I need be given in the community setting?
9 / What additional support is needed to keep me/others safe in the community?
10 / What resources are available/can be created or used in a different way to support me?
11 / What additional support is needed for my family/carers? Has there been a carer’s assessment?
12 / Do I need advocacy to support me to understand my care and treatment?
13 / What is the reason for considering inpatient admission?
14 / What would the outcomes be for me from an admission? What are the plans for me following discharge (should be planning this from the date of admission)?
15 / What would the impact of admission be on me and others around me? (i.e. moving away from home, being away from loved ones)
16 / Do I have a personal budget, personal health budget or integrated personal budget, and would this help meet my needs better?

Appendix B