Ld Plan Review Meeting at Falcon House (Hampshire Room)

LD PLAN REVIEW MEETING AT FALCON HOUSE (HAMPSHIRE ROOM)

31.05.2017

Who is here today: Richard Creighton, Martin Lenaerts, Amanda Kent, Leon Major, Richard Dean, Sam Davenport, Ian Penfold, Paul Hatt, Janet Chierchia, Liz Rolfs, Marcia Lawman, Florence Garland

Apologies: Sue Windess, Sally Eshraghi

Intro/welcome/what we said last time:

• Look at how the LD plan has been implemented over the past 2.5 years and to look at promises.
• Review the responses back from promisers of the plan.
• Promisers have “rated” themselves on their progress. We have asked them to see if there are new promises relating to the chapters.
• Review promises in each chapter.
• Hearing how the agencies have rated themselves. Discrepancies? If concern about the response, we can go back to the promisers for some clarity.
• Be mindful of consistency depending on locality.

Richard: how do we get trees to go on the internet? Answer: they log on.

Feedback in order of chapters:

The right support (Paul/Sue)

Some parents are struggling to get assessments for their family member, so of course nothing else can happen until the assessment is in place.

PCP's are not always followed, in one instance a support plan had to be re-written by a parent as it was inaccurate and not a true reflection of needs.

Support Plans are not always in place from the outset of care provision.It took 8 months in one case to provide a support plan.

Although concerns are often expressed, with regard to the consistency and reliability of some support staff,Service Users and Carers often feel ignored.

There appears to be a difference of accountability when agency staff are used temporarily by care providers when they are short staffed.Sometimes providing staff who have no prior knowledge of the person they are supporting.

Some care providers are reluctant to explain how 1:1 support hours are being used despite repeated requests from parents.

One parent commented on the use of the word "expectations" at the front of the document saying "some things may be impossible but who explains this?He will receive a care package for cooking/shopping but who covers expectations?"

Sam - understanding the comments along AS. Is there a coloration or are we seeing the same thing?

ACTIVE CITIZENS – Mencap (Eastleigh)

The Group liked the comments at the start of the chapter made by other people with learning disabilities. They said these accurately summed up what they expected of their support.

People did not think that management in support agencies were good at communication, they complained that often someone different turned up to complete a shift who they were not expecting and who they had never met. They would like some notice if their usual support was unavailable. They did not like to find someone new had come to support them, without being given any notice of the change and they did not like to be supported by a stranger who knew little or nothing about them. They would have preferred to know two or three support workers who could alternate shifts during holiday times so they were always familiar with the support and the support worker knew them.

In supported living settings this worked well as one person said he knew about five support workers who had worked for the agency for many years and he was happy to see any of them and valued the support given.

One person in the group wondered if Adult Services knew how many times they were give agency workers to replace their regular support workers.

One person said he was never informed of changes in support worker or of venue changes when facilities closed or altered. He was dissatisfied with his treatment and had made a complaint.

One person said that too many support workers sat around together in sessions where lots of people were engaged in one activity with a trained facilitator. At these sessions support workers chatted together, not taking any notice of what people were doing and not supporting them in their session.

Some people said they had not seen their care plan and did not know what was in it.

No one said that they could remember working with a social care team to “write clear support plans that tell providers how much support they need and how they would like it to be provided”.

Not everyone thought they had regular annual reviews. One person thought he had not had a review for four or five years.

People in the group did feel they could ask for a support worker to be changed. But this was seen as quite a hard thing to do, especially if they only had one support worker and had to try to make contact with the person’s manager to ask for a replacement. Again if there were two or more named regular support workers then a change might be more easy.

They thought that some support workers did still use their phones for personal use during shifts and disliked this. There was an acceptance that phones were essential and that they could be put to good use in support sessions however they maintained that personal usage was quite common.

The group struggled to know if the promises made by Adult Services had been kept. They felt they had little contact with Adult Services. They wondered how Adult Services knew about the quality of the support (which they were paying for) as they did not ask or attend sessions to see how people were supported. They suggested random drop-in visits by Adult Services staff.

Health Service

The group felt that they had seen some changes which related to the Health Service promises as they had seen Kym Anderson on a few occasions who told them about signing up all the surgeries in the borough for the Annual Health Checks.

They were also aware of the LD Friendly surgeries idea and the training that GPs’ surgeries were receiving.

Advocacy

The group supported the Advocacy promises but could not comment about whether they were being kept.

Several people said they had an advocate but had not needed to work with them.

One person said he did not know he could have an advocate.

Police

The group felt that some years ago they had had a lot of contact with the Police but that had stopped. The promises were good but the group members had no idea if they were being kept or were making any difference.

Sam: some really good and rich feedback with fair responses. We hear the same themes again and again.

Janet: LD group – AS promises generally came amber or red. For PC plans, very difficult to get AS to come to get to reviews or the providers who is supposed to do the support. Where is the commitment for updating someone’s plan or creating a plan. Monitoring?

Sam: support planning – people need to have a clear support plan. Outcomes to be met.

Based on feedback we can look at promises and feedback together. We can go back to the agencies.

Amanda: people might think that they are meeting their promises but the fact is that they might not. Reality check.

Paul: support workers are on the minimum wage. Recruitment is difficult. Care providers cannot keep staff.Funding is not good.

Sam: national issue. HCC pays those agencies more than the minimum wage. How to care providers use the money is another matter. Commissioning arrangements with providers (overheads, and management fees etc). Sustainability.

Janet: action plan for yellow/amber to come back in 12 months and tell us what they have done as improvement.

Amanda: evidence based from a group of people.

Richard D.: his friend had some poor experience with a support worker.

Liz: PCSOs don’t stay there for long.

Chapter 2 – staying healthy (Ian Penfold)

Note – ‘Making sure that health staff talk mainly to the person with a learning disability.’ This is not always appropriate.

Health will make sure that:

Page 24:

Add a commitment to reduce psychotropic medication (STOMP)

Page 25:

People with learning disabilities are involved in their care and treatment including stopping treatment? I want this explained further?

Add highlighted words - That their staff work with people with a learning disability AND THOSE THAT KNOW THEM BEST using Mental Capacity Assessments and Best Interest Decisions

Page 26:

Health Facilitators and other staff will work with you and your family and staff to get the healthcare you need CHECK IF THIS IS STILL VALID

Quality and inspection visits are made by the Vulnerable Adults Team who will take action where there are any concerns or worries Add - CQC, QUALITY CHECKERS, HEALTHWATCH?

Add Personal health budgets somewhere in this Health section

Add regular screening

GP reps to attend LIGs?

Strategic Health Facilitator for each area to attend LIGs

Add highlighted words - ‘Staff in doctor’s surgeries are aware of the need to register patients and their carers on their GP records and to support access to health checks to carers over the age of 40.’

Adult Services Promises

Page 27:

Perhaps add something about person centred planning to meet the assessed needs?

Add highlighted words - It continues to work together WITH HEALTH AND OTHERS to plan and design services for people with learning disabilities

Please check wording – ‘It works with people with a learning disability plan or provide health services to make sure people have a health action plan and a health passport when they want or need one’

Add promise for Adult services to work with and respect carers (comment from Laura that carers are mentioned in other sections). We need them added to this section though.

Page 27: Adult, Children’s Services and Health

Amend wording to – ‘They work together to keep people healthy particularly through transition and all play a full part in EHCPs’.

Page 28: Advocacy will make sure:

Include parents and carers

Page 28: The Police will make sure?

Add reasonable adjustments

Page 29: Passenger Transport

No comment

Lyndsey’s feedback

Thinks things are getting better and the accessibility Information Standards is helping

Best Interests and Mental Capacity decision making is improving also.

There seems more support health wise

Guidance on reasonable adjustments needed particularly where the patient has difficulty cooperating with medical procedures and where restraint or a GA may be needed to complete.

Health checks getting better but no clear action plans following annual health checks.

Double appointments as standard

Consultants need support in meeting the needs of their patients who present with a learning disability and perhaps other things such as autism.

Autism training for medical people including GPs is needed.

Amanda feedback

Gap during transition for LD & MH, no adult MH service.

Need for Southern Health to step up and make promises

Given the number of Health providers delivering services who is actually making the promises?

Paul’s feedback

Paul said that he has seen some good changes thanks to good health facilitation.

Paul also submitted the following:

On the basis of our own experiences, we have encountered different approaches to medications used by service users, between two different Hampshire County Council run residential respite centres.

One is more comprehensive on entry with a one-to-one handover using a meds form. The other just accepts the medication, but does not conduct a handover.

There is a clear lack of consistency in this respect.

General Feedback

Someone suggested that instead of separate sections we combine everything in one so things are not missed.

Amanda: Annual Health Checks, loads of good things and loads of information but massive gaps for young people with mental health who come to advocacy instead.

Liz: training of doctors: ½ day training on LD.

Janet: some students come to the LD group. Experience and good on CV. New chair at Southern Health.

Sam: some things are really positive. Liaison nurses back in hospitals.

Chapter 3 – the right place to live (Martin Lenaerts/Liz Rolfs)

Keeping people generally involved in plans for housing.

This promise is currently satisfied by visits to LIG by Jenny Dixon.

Ensure that no one is unfairly discriminated against

There is evidence to show that people with learning disabilities have access to a range of rental options but this needs to remain in any revision of the plan and further work is required to ensure that local authorities, housing associations and private landlords are on board with this, especially as many private landlords fail to realise what good tenants many people who have learning disabilities can be and are unwilling to consider people who are on Housing Benefit.

Involve people with LD in the planning and design of new housing

There was some uncertainty about what was meant by the words – planning and design of new housing projects.

Whereas it was recognised that people with LD could say what they would like in their house/flat, according to their ability to express their wishes and understand their options, the actual planning of new housing projects seemed a little ambitious, and may be the wording should more specifically say that the views and opinions of people with LD would be taken into consideration when planning new developments. But even with this, we must bear in mind that there will be many who would find it difficult to understand the concepts and express their opinions and so the Promise should also say something about involving the parents/carers of those whose housing opportunities are being considered

Involving people with LD in the design of new housing has been demonstrated by the new build in Emsworth where people have been able to choose their colour schemes. But that is as far as it went we believe. What about the choice of furniture, position of furniture and height of cupboards etc? Again, if this included parent/carers then it would make more sense.

When two people with LD, attending the LIG meeting, and who had recently been housed where asked about their involvement, one said that she had not been involved in the planning and design whilst the other said she had been involved in items such as colour schemes and furniture.

It was felt that this promise must remain in the plan but should be more realistically worded to show that people at all levels of ability can be appropriately involved.

With regard to planning new accommodations, we felt that attention needs to be paid to developing homes near transport facilities.

Amanda: it has happened in Basingstoke with flats for people with LD being built. People with learning disabilities value this sort of consultation. Different models of houses, people being consulted.

Martin: some people might find this consultation different. parents/carers should be included.

Ian part of SHIP (transforming care), housing options etc. parents/carers involved. More service users should be involved but we know it is difficult.

Working with District Councils, housing providers and private landlords to enable choice and appropriate support.

This has been happening but not to the extent required and there have been reports of inadequate support in terms of both quantity and quality.

A view was expressed that it is a shame there is not an organisation that can provide initial training and assessment to establish the level of support a person will need and the type of accommodation that would suit their needs.

This promise needs to remain as it is and will always be a work in progress.

Paul: common sense. You need to be put on the accommodation list as soon as possible.

Ian: huge bit of work in the North/East Hampshire to be done.

Leon: make sure young people and families know about the list. Making sure people have the information.

Martin: forward planning. Useful to AS.

Buy services to provide support to enable people who have LD to live as part of the community, to find the right place to live and provide housing related support if needed

We have received mixed responses to these issues as the quality of support varies from very good to poor. Comments have been made that the level of pay received by support workers is inadequate to the task and the skills required and so, people who may have the appropriate skills do not see this as a realistic career path.

This needs to remain as a promise.