Overview of South West London TCP Plan Template

Table of Contents

Introduction

Planning template for south west London Transforming Care Partnership

1. Mobilise communities

Governance and stakeholder arrangements

Background and national context

The local context – south west London

Governance

Stakeholder Engagement

Coproduction

2. Understanding the status quo

Baseline assessment of needs and services

South west London Demographics:

Inpatient usage

Public Health England Statistics (2013/14 data)

The Current System in south west London

Estates

Case for Change

Patient Case studies

3. Develop your vision for the future

Describe your aspirations for 2018/19.

Improvement measures

Principles

4. Implementation planning

Overview of the new model of care in south west London

What new services will you commission?

What services will you stop commissioning, or commission less of?

What existing services will change or operate in a different way?

Describe how areas will encourage the uptake of more personalised support packages

What will care pathways look like?

How will people be fully supported to make the transition from children’s services to adult services?

How will you commission services differently?

How will your local estate/housing base need to change?

How does this transformation plan fit with other plans and models to form a collective system response?

5. Delivery

Programmes of change/work streams

Key Milestones

Risks, assumptions, issues and dependencies

6. Finances

Appendix A – Risks Assumptions issues and Independencies

Appendix B – Developing a basket of quality of care indicators

Appendix C – Population breakdown across south west London

Appendix D – Population predicted to have a learning disability, moderate or severe learning disability or a learning disability, predicted to display challenging behaviour in south west London

Appendix E – National Outcome Measures that relate to this Plan

Introduction

Purpose

This document provides the template and key guidance notes for the completion of local plans aimed at transforming services for people of all ages with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition, in line with Building the Right Support – a national plan to develop community services and close inpatient facilities (NHS England, LGA, ADASS, 2015). These plans should cover 2016/17, 2017/18 and 2018/19.

Aims of the plan

Plans should demonstrate how areas plan to fully implement the national service model by March 2019 and close inpatient beds, starting with the national planning assumptions set out in Building the Right Support. These planning assumptions are that no area should need more inpatient capacity than is necessary at any one time to cater to[1]:

10-15 inpatients in CCG-commissioned beds (such as those in assessment and treatment units) per million population
20-25 inpatients in NHS England-commissioned beds (such as those in low-, medium- or high-secure units) per million population

These planning assumptions are exactly what the term implies – assumptions for localcommissioners to use as they enter into a detailed process of planning. Localplanning needs to be creative and ambitious based on a strong understandingof the needs and aspirations of people witha learning disability and/or autism,their families and carers, and on expert advice from clinicians, providers andothers. In some local areas, use of beds will be lower than these planning assumptions, but areas are still encouraged to see if they can go still further in supporting people out of hospital settings above and beyond the these initial planning assumptions.

National principles

Transforming care partnerships should tailor their plans to the local system’s health and care needs and as such individual plans may vary given provider landscape, demographics and the system-wide health and social care context.

However local plans should be consistent with the following principles and actively seek to evidence and reinforce these:

a.Plans should be consistent with Building the right supportand thenational service model developed by NHS England, the LGA and ADASS, published on Friday 30th October 2015.

b.This is about a shift in power. People with a learning disability and/or autism are citizens with rights, who should expect to lead active lives in the community and live in their own homes just as other citizens expect to. We need to build the right community based services to support them to lead those lives, thereby enabling us to close all but the essential inpatient provision.

To do this people with a learning disability and/or autism and their families/carers should be supported to co-produce transformation plans, and plans should give people more choice as well as control over their own health and care services. An important part of this, is through the expansion of personal budgets, personal health budgets and integrated budgets

c.Strong stakeholder engagement: providers of all types (inpatient and community-based; public,private and voluntary sector) should be involved in the development of the plan, and there should be one coherent plan across both providers and commissioners. Stakeholders beyond health and social care should be engaged in the process (e.g. public protection unit, probation, education, housing)including people with direct experience of using inpatient services.

Summary of the planning template

Overview of South West London TCP Plan Template

Planning template for south west LondonTransforming Care Partnership

1. Mobilise communities

Governance and stakeholder arrangements

Describe the health and care economy covered by the plan

Guidance notes; consider the following: current providers, statutory, independent and voluntary sector contracts. Collaborative commissioning arrangements, key commissioning blocks (block contracts, geographical boundaries, provider relationships)

Background and national context

In 2012, following an investigation into criminal abuse at Winterbourne View Hospital, the Department of Health initiated a national programme of action “Transforming Care” to transform services for people with learning disabilities and/or autism who display challenging behaviour or have mental health conditions. Transforming care aims to reshape services for people with learning disabilities and autism away from institutional models of care, closing some inpatient provision and strengthening the support available in the community. This vision is set out in ‘Building the Right Support – a national plan to develop community services and close inpatient facilities’.

Furthermore people with learning disabilities have poorer health than the general population, much of which is avoidable. These health inequalities often start early in life and result, to an extent, from barriers they face in accessing timely, appropriate and effective health care. The impact of these health inequalities is serious because as well as having a poorer quality of life, people with learning disabilities die at a younger age than their non-disabled peers.

The 2013 Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) found that the median age of death for people with learning disabilities (65 years for men; 63 years for women) was significantly less than for the UK population of 78 years for men and 83 years for women. Thus men with learning disabilities died, on average, 13 years sooner than men in the general population, and women with learning disabilities died 20 years sooner than women in the general population. Overall, 22% were under the age of 50 when they died. This suggests that if we can improve the quality of healthcare and support then we can improve their outcomes.

On 17 November 2015, Clinical Commissioning Groups (CCGs) and Local Authorities (LAs) received a letter from NHS England, the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS), which asked CCG, LAs and NHS England specialised commissioners to come together to form Transforming Care Partnerships (TCPs). Transforming Care Partnerships were to work together with users, carers and providers to build up community services and close unnecessary inpatient provisions for people with learning disabilities and/or autism. As a result, the south west London TCP was set up in late 2015.

The local context–south west London

The six boroughs in south west London include Merton (lead CCG), Croydon, Kingston, Richmond, Sutton and Wandsworth (see map). The CCGs and LAs covering these areas have created the SWL TCP Board to oversee the creation of a plan to transform care for people with learning disabilities and/or autism who display behaviour that challenges, including those with a mental health condition. The Board includes stakeholders from CCGs, Local Authorities, NHS England specialised commissioning, children’s commissioners, providers and service users/carers. A full list of board members is found within the ‘Governance’ section of this document.

South west London is served by two mental health trusts, both contracted via block contracts:

South West London and St George’s Mental Health NHS Trust – covering Kingston, Merton, Richmond, Sutton and Wandsworth
South London & Maudsley NHS Foundation Trust – covering Croydon

There is no in-patient facility, either for local commissioning or specialised commissioning, within the sector. This means that inpatients are admitted outside of south west London; generally in other parts of London, the East of England, Midlands or North – for all commissioned beds. Local commissioners do not hold block contracts with any in-patient providers, as the placements are commissioned, by spot purchase, according to bespoke need.

There are a range of community providers in place, examples of which include:

Sutton College of Learning for Adults
Sutton Mencap Gateway Club (Social club)
Wandsworth: “Keep Independent through enablement” (KITE)
Wandsworth: Emergency residential care and travel support
Merton: Mencap “Evolutions 2gether” (Social Club)
Croydon Employment and Support Service
Richmond Homes and Lifestyle Trust
Kingston: Home Farm Trust (Residential care services)
Kingston: Welmede Housing Association (sheltered accommodation)

Providers deliver a range of community services in south west London which include:

CAMHS
Carer support
Case management
Day time activity
Employment and support services
Residential care
Respite care
Sheltered housing
Supported living

All boroughs in south west London have already been working for some time towards reducing the number of inpatient places available to people with learning disabilities and/or autism (for example in Sutton the resettlement of 36 adults with profound learning disabilities from hospital based accommodation at Orchard Hill Hospital to supported housing in the community and to residential care). The focus has in recent years therefore been on implementing a community based model of care concentrating on prevention, early intervention and maintaining people in the community.

Consequently, there are a range of other providers working in the community to support this patient cohort. An example can be seen in Richmond, a provider of four individual apartments with two communal living areas hasrecently been commissioned to provide supported accommodation for four young people with severe learning disabilities and complex needs associated with autism, challenging behaviours and complex health needs. All four young people moving into the service have been at significant risk of requiring inpatient support. Two have moved back from specialised out of borough placements which had not met their needs.

Governance

Describe governance arrangements for this transformation programme

Guidance notes; who are the key partners, what is their involvement.

The SWL TCP Board provides governance and leadership for overseeing the development of the TCP in south west London on an integrated and collaborative basis. It includes representation from:

CCGs
Local Government Authority
NHS England Specialised Commissioning
Key stakeholders including service users/carers
Providers (adult and CAMHS)

For the period January – April 2016, the SWL TCP Board is scheduled to meet monthly to oversee and finalise the SWL TCP plan submission. Thereafter the frequency of meetings will be reviewed to determine if quarterly is more appropriate.

While the SWL TCP Board reports to NHS England, there is accountability to local CCGs and Local Authorities.

The first meeting took place on 20thJanuary 2016 at which Terms of Reference were agreed. Please see below for the agreed Terms of Reference and minutes of the Board meeting.

Further meetings took place on the 22nd February and 21st March 2016. Please see below for the minutes of the Board meetings.

Board Members are accountable to the Senior Reporting Officer (SRO), Adam Doyle, Chief Officer of Merton CCG. The deputy is Brenda Scanlan, Director of Integrated Commissioning Croydon Council.

The Board has the following current core members:

Chief Officer/SWL TCP Senior Reference Officer
SWL Transforming Care Partnership Deputy (LA)
Quality & Governance Lead
SWL Transforming Care Partnership Programme Manager
NHS England Specialised Commissioning rep
Local Authority DASS/LA Rep x6
CCG and Joint LD Commissioning Leads x6
Finance Lead
Learning Disability CAMHS reps
Children’s Commissioners
SWL LD & ASD Provider Forum Rep; SWLStG & SLaM
Service User /Carer Rep (from Service User Ref Group)x 2
SWLCC Communication and Engagement Rep
SWL TCP Strategy Managers: Project Support Team
Project Manager Officer SWL TCP: Project Support Team

One area of south west London, Richmond, has joint commissioning arrangements for Learning Disabilities. As a result, one representative is able to cover the meeting from both the Local Authority and CCG standpoint. Kingston LA and CCG are also in the early stages of bringing together their commissioning teams

Many of the Board members have attended one or more of the workshops that have been held in February and March and have also contributed to the submission by supplying performance data. Furthermore Board members have discussed the programme in their localities, such as when attending Learning Disability Partnership Boards.

As the Board becomes more established and the development of the TCP progresses and planning for implementation and delivery advances, additional membership will be sought for the Board including: Workforce, Police and Primary Care (reflected in the January Board minutes).

TCP Programme structure as of January 2016:

The TCP programme is an important element of a range of work across the south west London healthcare economy. There is a South West London & Surrey Downs Healthcare Partnership Programme Board and a weekly meeting of COs and reporting into it is a STP (sustainability and transformation plan) Working Group, which is overseeing the STP process and the work of the TCP Board and programme will align to this group.

Stakeholder Engagement

Describe stakeholder engagement arrangements

Guidance notes; who has been involved to date and how? Who will be involved in future and how?

It is important to explain how people with lived experience of services, including their families/carers, are being engaged.

Effective engagement is fundamental to the success of the SWL TCP Programme and is promoted through a comprehensive communications and engagement strategy and supporting action plan aligned to the local vision and the programme plan.

There are various stakeholder engagement arrangements in existence across south west London, and these help ensure the good work that has been ongoing between CCGs, Local Authorities, NHS England, Providers and patients continues, and that patients continue to receive a high standard of care and involvement in their care. Examples of these groups are:

Croydon: Carers forum and Partnership Board
Kingston:Learning Disabilities Parliament
Merton: Merton Mencap (Adults First)
Sutton: ASD/LD/ADHD Parents and Carers support groups.
Richmond: Provider forum
Wandsworth: Learning Disability Partnership Clinical Reference Group
Children and Young Peoples engaged with, as part of the development of the CAMHS Local Transformation Plan(s).

There is desire and commitment to maximise these groups’ input into the SWL TCP process, as evidenced by the attached communication and engagement plan.

There are four main groups of stakeholders that we are focusing on, as follows:

Those who use the services and their carers/families
The relevant community and voluntary sector organisations.
Those who commission and provide these services (include specialist schools)
Wider general stakeholders such as MPs, councillors, cabinet members, media, NHS staff etc.

A list of existing user and carer groups across south west Londonhas been collated (over 60 organisations) and they have been contacted and invited to participatein a wider stakeholder group. These took place on the evenings of 22ndFebruary and 15th March 2016. These were well attended by carer representatives, relevant community and voluntary sector organisations and Commissioners.