Improving services for people with a learning disability Improving services for people with a learning disability. Dispute Resolution Process

Why is this required? A Dispute Resolution process is required to support situations where people are not receiving the right support as a result of disputes between different stakeholders. Dispute may arise over a range of issues; clinical disagreement, finance, family concerns etc. The quality of care for individuals is the primary concern. Disputes between stakeholders must not impact adversely on the individual, and must be resolved quickly. This Dispute Resolution Process supports local accountability across health and social care and will be used only when local stakeholders cannot agree a way forward themselves  

Principles behind the approach Person-centred - the views of the individual and/or their family/advocate are central to the discussion Subsidiarity – It is expected that issues will be resolved locally; only if necessary deal with at regional level, and if required at national level Solution-focused, supportive approach, seeking resolution not attributing blame Building on existing NHS and Local Authority processes (escalating clinical/quality/safety concerns; NHS assurance / LGA sector-led improvement)

What triggers escalation Care and treatment of an individual or group of individuals is not agreed by all stakeholders Individual and/or family remain concerned about clinical consensus Differing legal frameworks appear not to align – ie Safeguarding, Mental Capacity Act etc - and cannot be resolved locally Resource disputes between NHS commissioners – Specialised and CCGs Funding disputes between NHS and Local Authorities Escalation to regional level only triggered if key leaders in commissioning organisations (AO for CCG; CEO for LA; regional director of spec com for NHSE) have tried but not been able to resolve dispute

Clinical Commissioning Group /Specialised Commissioning dispute CCG Director of Commissioning Local Spec Comm Lead CCG Accountable Officer Regional Director of Spec Comm NHS England Local Area Team NHS England Regional Medical Officer or Regional Chief Nurse

CCG/Local authority dispute NHS Local Government CCG Director of Commissioning LA Director of Social Services CCG Accountable Officer LA Chief Executive Officer NHS England Regional Medical Officer or Regional Chief Nurse & LGA regional lead Regional LGA leads Jo Poynter - South and sharing Midlands and East with Hilary   Hilary Paxton - North and sharing Midlands and East with Jo   Jane Alltimes - London

Regional Escalation/Facilitated Help NHS Local Government Regional Medical Director Regional Commissioning Ops Regional LGA Lead Supporting resources if required Supporting resources if required Finance Lead Legal Support Independent Clinical Support Finance Lead Legal Support Independent Clinical Support Resolution to be led for NHS by Regional Medical Director in acknowledgment of legal medical responsibilities, and for local government by regional LGA lead building on existing sector-led improvement arrangements These regional lead(s) to facilitate a discussion between the parties to the dispute, subsequent to which the parties either a) come to an agreed way forward, or b) produce a clear statement on what they agree, and what they agree to disagree upon; and set out clearly a request for facilitated help from NHS England and/or LGA or an independent third party. Where disagreements over funding are preventing an individual from getting the right support, the right support should be put in place and funded on a without-prejudice basis. A person’s discharge/transfer plans should not be delayed due to funding disagreements. The person should be discharged/transferred with funding continuing from the current commissioner until resolution can be achieved.  If resolution determines a different commissioner is responsible then back payment to the day of discharge will be made. Regional Lead Officers must be assured that Patient and/or family voice is central to the situation resolution and be able to demonstrate good engagement.  

National Executive Director for Learning Disabilities National Support NHS Local Government National Executive Director for Learning Disabilities National LGA Director Sarah Mitchell Department of Health If dispute still unresolved after regional support, report to be written jointly by Lead Officers to NHS England CNO and LGA Chief Executive giving specific reasons for lack of resolution and identifying what additional national support would be required to ‘unblock’ remaining issues. If necessary, the CNO and LGA CEO may ultimately choose to involve the SoS for Health and SoS for Local Government.

Oversight The Learning Disability Quality Framework process will have oversight of the number of situations requiring conflict resolution. Quality Surveillance Groups will review this information as part of their governance function – working with other system partners ie CQC to provide support as required NHS England will assess capacity and capability of CCGs to manage partnerships with Specialised Commissioners and Local Authorities as part of the CCG Improvement and Assessment Framework for 2017 (we will need to discuss this with the independent panel overseeing the IAF).