WALTHAM FOREST
JOINT STRATEGIC VISION AND COMMISSIONING PLAN FOR ADULTS WITH LEARNING DISABILITIES
2018-2023
CONSULTATION DRAFT - 21 November 2017
TELL US WHAT YOU THINK BY COMPLETING A SURVEY:
Waltham Forest CCG
London Borough of Waltham Forest
CONTENTS
2 / The Care Act / Page 5
3 / Accommodation / Page 7
4 / Health / Page 9
5 / Having an active life / Page 11
6 / Preparing for adulthood / Page 12
7 / Family carers / Page 14
8 / Friendships and socialising / Page 15
9 / Workforce / Page 17
10 / Making it happen / Page 19
1. Introduction
This Joint Strategic Vision and Commissioning Plan sets out the priorities for health and social care for adults with learning disabilities in Waltham Forest and how they will be achieved over the next 5 years.It covers a period when there is increasing pressure on limited resources as a result of growing demand and the Government’s austerity measures in public services.
People with a learning disability have a reduced ability to understand new or complex information, and to learn new skills, with reduced ability to cope independently which started before adulthood, with a lasting effect on development (Valuing People, 2001).
They can experience a range of different needs, including mental and physical health problems. In addition, people with learning disabilities are one of the most socially excluded and vulnerable groups in our community. They experience significant barriers to accessing the things that most of the population take for granted.
At a time of significant and increasing pressures on funding it is important that we focus resources on those who require most support, whilst continuing to enable others to improve or maintain their wellbeing and independence. In this context our vision and commissioning plans describe local changes aimed at improving support for people with learning disabilities.
We call upon other organisations to support us in this endeavour. In particular we expect our public sector partners to put their weight behind this Vision. At the same time we expect individuals, families and communities to be self- reliant as far as that is possible.
There are about 4500 people with learning disabilities in Waltham Forest and at any one time about 750 people receive a specialist service. Waltham Forest Council spent over £25 million on social care and support services for people with learning disabilities and their carers in 2015-16.
The needs of people with learning disabilities are everyone’s business and we plan to ensure that they will be embedded in mainstream strategies such as assistive technology, housing, transport, employment, leisure, public health, personalisation and the wider prevention agenda. This plan covers services that need to be specifically commissioned for adults with learning disabilities and their family carers.
Our vision
Our vision is thatpeople with learning disabilities will:
Live healthier, more active lives
Be tenants in their own right, for the most part supported by mainstream services and networks
Benefit from the sharing of information and good practice between commissioners and providers
Have good access to leisure, recreation, education and employment opportunities
Be supported by specialist services when they have more complex needs
With reasonable adjustments and the right support locally, be able to exercise their rights and responsibilities as citizens, have a good quality of life, be safe and in control of their choices, have parity of esteem with other cohorts of people and experience equitable and positive outcomes
In line with our joint Health and Wellbeing Board priority “Integrating health and social care”, the Council and the CCG will work together, and with other partners, to bring about change and improvement by jointly commissioning services and making best use of resources across the system.
Joint strategic aims
Our shared strategic aims are to:
Use outcome based commissioning models to best effect
Meet the outcomes of the national Transforming Care programme
Understand current needs and model future needs of people with learning disabilities in Waltham Forest
Review current services, including what they cost, how they perform and how they need to change to meet future needs and expectations
Explore the potential for Pooled Budget arrangements between the Council and the CCG, and for individuals
Explain joint commissioning intentions, with a delivery plan
This Strategic Vision and Commissioning Plan is closely aligned with the Transforming Care Plan for Inner North East London to ensure that people with a learning disability held in assessment and treatment units are returned to community settings when they are ready, and to prevent new admissions.
2. The Care Act: Progressing to Independence and Personalisation
The Care Act 2014 broughttogethera range of different laws and good practice and set out a new national vision for social care based upon the concept of wellbeing.
Most people with learning disabilities are capable of progression. People with learning disabilities have the potential to learn new skills at all stages of life, albeit at a different pace to other people. Given a choice and free from undue influence most people with learning disabilities choose independence over dependence. Our job in health and social care is to help people to maximise their independence.
Personalisation is an approach to care in which every person who receives support will have choice and control over the shape of that support in all care settings, whether provided by statutory services or funded by individuals themselves.
Personalisation also entails that services are tailored to the needs of each individual. It includes the provision of improved information and advice on care and support for families, investment in preventive services to reduce or delay people’s need for care and promotion of independence and self-reliance among individuals and communities.
Priorities
Our priorities are to
- Ensure that the social care offer to people with learning disabilities is based upon need and is consistent with what is offered to people with other social care needs
- Support people with learning disabilities to progress to the maximum level of independence they are capable of
- Provide personalised services over which people with learning disabilities are able to exercise choice and control
- Have effective adult safeguarding systems and practice that enable people with learning disabilities to experience a positive approach to risk management
- Provide good quality advice, information and advocacy for people with learning disabilities
- Manage the market of social care providers to ensure a sustainable and aspirational range of provision
- Deliver services within the budget available
Our approach
We will:
Review the care needs of each person with a learning disabilitywho has a social care need at least once a year
Supportpeople with learning disabilities to move to the least restrictive setting that meets their social care need
Monitor providers to ensure they comply with the London Multi Agency Safeguarding Policy and Procedures, including staff training and supporting people with learning disabilities to raise concerns
Review the Council’s contracts for information, advice and advocacy services to make sure that they meet the needs of people with learning disabilities
Refresh the commissioning and brokerage function to take an active approach to managing the market for social care services
Success Measures
Our priorities will be achieved when
All people with a learning disability who have social care support have their case reviewed at least once every 12 months
All people with learning disabilities who have an assessed social care need have a tailor-made package of support to meet that need
At least 36 people with learning disabilities move from residential care to supported living and 18 from supported living to a general needs tenancy by April 2019
All contracted social care services are monitored regularly
All social care service providers are compliant with the London Multi Agency Safeguarding Policy and Procedure
There is a range of good quality, sustainable and affordable care and support services in Waltham Forest for people with learning disabilities
3. Accommodation
Having choice and control over where we live and who we live with is a basic foundation block to fulfilling our human potential to thrive and succeed in life. We can make a big difference to the quality of life of people with learning disabilities by improving the local housing offer.
Priorities
Our priorities are to:
- Support more people with learning disabilities to live in ordinary community settings, in good quality housing with their own front door
- Provide specialist accommodation and adaptations as needed
- Reduce the number of people living in residential care homes
- Reduce the number of people placed out of borough
- Increase the number of people living in a range of different types of supported housing close to their family and community, including more specialist cluster schemes, Shared Lives and Extra Care Housing
- Increase the number of people with learning disabilities who are home owners and tenants of ordinary “general needs” housing
- Make sure people with learning disabilities have the support they need to feel safe in their home
Our approach
We will:
Work with housing and support providers to make sure that the right mix of different kinds of accommodation is available
Aim to open at least one new learning disabilities specialist clustered block of flats with on-site support each year for the next 5 years
Help people to understand the range of housing options open to them
Use the Learning Disabilities Supported Living Framework Agreement to procure housing support services andreview it to ensure that it delivers good quality outcomes for a reasonable price
Make best use of vacanciesin specialist accommodation through the Council’s Brokerage Team
Test and promote advances in new technology that enable people to be independent in their home
Success Measures
Our priorities will be achieved when:
Wehave substantially fewer residential care home placements, down from about 140 to less than a hundred
We have substantially more supported living placements, up from about 145 to over 200
More older people with learning disabilities move to extra care sheltered housing
The shared lives scheme expands by at least 2 places each year
More people move on to an ordinary tenancy
More people with learning disabilitiesowntheir own home through shared ownership schemes
Assistive technology around the home is the norm
4. Health
People with learning disabilities are subject to health inequalities the consequences of which include: premature mortality, increased experience of ill health and impoverished quality of life. Mitigating against these factors influences our local pathways focussing them on improving features which are associated with adverse health outcomes as well as supporting mainstream health services to become more accessible to people with less complex disabilities.
The Waltham Forest Learning Disability Health Transformation Board has been set up to develop effective oversight of the implementation of local health agenda for people with learning disabilities and to ensure improved health outcomes.
Health Priorities
Our priorities are to:
- Improve the uptake of Health Checks for people with learning disabilities
- Consider the best way of delivering specialist services
- Ensure mainstream services make requisite reasonable adjustments to support people who do not require specialist support
- Progress the Learning Disability transformation aspect of the Mental Health and Learning Disability Transformation Programme
- Improve access to Positive Behavioural Support (PBS) based training for local parents and providers
- Create a network that is committed to a PBS approach that enables people with complex behaviours to be supported and to continue to live well locally
- Find better ways of including carers and people who use services in decision making and evolving strategy development
- Ensure people with challenging needs get the best local support possible in line with the Transforming Care Strategy
- Provide good support and expert care for the increasing population of people with a learning disability suffering from the impacts of dementia
Our Approach
We will:
Make reasonable adjustments to Primary Care services: this may include responsive changes like longer GP appointment times, or appointments made at times when surgery is less busy and availability of easy read information
Encourage carers, providers and people with learning disabilities themselves to take advantage of health screening opportunities
Use Health Check information to draw up dynamic health action plans
Support people to access community health service wherever possible; this would include adult community nursing, rehabilitation teams and mental health teams
Support identified providers of care to develop the skills and resources to manage complex and ageing residents to remain supported locally
Develop the local PBS network; comprising parents, educators, specialist clinical staff and support providers
Secure funding for additional PBS work through the CEPN (Community Education Provider Network) and other funding opportunities
Provide NHS continuing healthcare (CHC) for adults who have needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone
Increase the numbers of adults with CHC funding using Personal Health Budgets (PHBs) to deliver their care and support
Create innovative PHB offers that improve health outcomes
Support people with the most complex and challenging needs to remain living in the local area with PBS being a significant element of the support approach
Ensure that the specialist Learning disabilities clinical team is structured and resourced in terms of its skills mix and construction to be able to support proactively those at risk of placement breakdown and hence prevent out of area moves
Implement a system of reviews to learn from the deaths of people with learning disabilities
Success Measures
Our priorities will be achieved when:
Mainstream health providers have been supported and trained to work with less complex patients and are confident and competent in doing so
More people with less complex health and social care support needs are supported by mainstream services
More people understand the diseases they are at higher risk of including epilepsy, diabetes, heart disease, conditions associated with being over or under weight, and health issues arising from particular syndromes
The community nurses are recognised as pivotal for people and their carers to support a deeper understanding of their specific health needs and give people confidence to self-manage their conditions
Increased numbers of people use Health Passports
There is a decreased number of bed days of people occupying inpatient beds in Assessment and Treatment Units and a reduction in out of area use of specialist placements
155 PHBs are in place year ending March 2018
More people with complex needs are supported locally & less people placed in Assessment and Treatment Units
Good and appropriate dementia and end of life support is provided to people with learning disabilities
5. Having an active life
It’s great to be as independent as we are able to be but we need to think about how we spend our time. For all of us it helps to be active citizens with something to give, to feel fulfilled and enjoy life. People with learning disabilities sometimes need a bit of extra help to make that happen.
Priorities
Our priorities are to:
- Ensure a range of choices for daytime activities that meet the preferences, outcomes and needs of people with learning disabilities within the money available
- Help people with learning disabilities to access a range of work opportunities, including paid and voluntary work
- Build the role of adult education as a bridge to independence and employment
- Have a sustainable, personalised, innovative and attractive range of day opportunities services
- Ensure people can travel to their daytime activities safely and in a cost effective way
Our approach
We will:
Develop an action plan with the DWP, Economic Development and Adult Learning to increase the number of people with learning disabilities in paid employment by making better use of existing resources and initiatives
Consider the business case for commissioning a specialist employment support service
Make a long term plan for the future of the Council’s Markhouse Road Day Centre
Review the market for independent day centre services
Make a plan to increase the number of people working as Personal Assistants to people with learning disabilities
Promote personal budgets and help people to manage their personal budget
Review the transport offer for working age adults with care needs and work with Transport for London and others to ensure it is affordable and safe
Success Measures
Our priorities will be achieved when:
More people with learning disabilities have paid work
Public bodies set a good example to other employers in the employment of people with learning disabilities
More people with learning disabilities use a personal Budget to exercise real choice over their daytime activities
More people with learning disabilities achieve outcomes that sustain independence through their daytime activities
People with learning disabilities feel safe when they travel around Waltham Forest
6. Preparing for adulthood
If we get things right for a young person with learning disabilities it will have a beneficial and lasting effect throughout their life.
Priorities
Our priorities are to:
- Ensure that young people with learning disabilities are able to experience a transition to adulthood that is consistent with that experienced by other young people and supports them towards meeting their aspirations
- Plan for the individual needs of each young person with a learning disabilityas they transition to adulthood
- Support young people with learning disabilities to be as independent as they are able with clear pathways that include employment, training and support into accommodation
- Protect young people with learning disabilities from abuse
Our approach