The Need for Change: Summary of key issues
The Panorama programme that disclosed the abusive practices by staff at the private hospital, Winterbourne View, has provoked a series of investigations, reports and recommendations regarding the need for change. The Serious Case Review highlighted numerous areas of concern relating to providers, commissioners and regulators of health and care services. Transforming Care: A national response to Winterbourne View clearly sets out a national programme for change.
In the West Midlands, ADASS has commissioned a toolkit aimed at all commissioners of services for children and adults with learning disabilities, and others to assist them in ensuring that the changes needed become a reality, making a positive impact on the lives of people with learning disabilities and their families.
The need for change has been known for many years. It is now time to make change a reality. In 2007, the second Mansell report “Services for People with Learning Disability and Challenging Behaviour or Mental Health Needs” reiterated that commissioners of child, adult, health and social care services have a responsibility to:
- Ensure local services meet needs of individual and family
- Focus on personalisation and prevention
- Commission high quality services
- Commission local supports
In summary, the change needs to include:
- Early identification and local support offer to all young people with learning disabilities who experience behaviours that challenge
- Person centred approaches from an early age
- Partnership and respect for the family viewpoint
- Reliable supports for families
- Access to advocacy and self-advocacy
- Strong linkages between child and adult services to ensure whole life planning
- Health services and supports that promote positive health and wellbeing
- Access to community supports and leisure opportunities
- Access to meaningful activities, including employment
- Skilled staff and others who see the person not the behaviour
- Positive behaviour support plans that focus on prevention not reaction
If all of the above are in place, an individual is less likely to require specialist treatment.
There will be situations where an individual may require a short period of assessment and treatment in response to a specific health need. In order to ensure that services are safe, high quality and effective, the following systems need to be in place:
- Know your local population- the Joint Strategic Needs Assessment should identify people with learning disabilities
- Links across Learning Disability and Mental Health services, and supports for people with autism
- Partnership commissioning arrangements of local services
- Multi disciplinary approach
- Positive engagement with individuals and families
- Support staff and providers adequately trained to support people with behaviours that challenge
Think Local Act Personalhighlights the central importance of personalisation, and sets out what people whouse services should expect to see in a genuinely personalised care and support system. This requires :
work towards: Very tailored approaches, co-produced withthe person and a strong link between person centredplanning and strategic commissioning, sothat market development work is built on information about what people want.
move away from: Planning that slots people into one size fits all service models.
No clear route to feed information fromperson centred planning into strategiccommissioning.
Further reading:
Dept of Health full final report and related documentation
ADASS compendium of key findings
South Gloucestershire Serious Case Review
Inclusion North briefing on key reports
Mencap and Challenging Behaviour Foundation “Out of Sight” report and call to action
Care Quality Commission report and action plan
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