Manchester’s Health and Social Care Locality Plan and the ‘Transforming Care’ agenda Mari Saeki, Project Officer Greater Manchester Autism Consortium project November 2016

WHAT IS THE MANCHESTER LOCALITY PLAN? It is the strategic plan underpinning the transformation of health and social care services in Manchester. It is based on three pillars which are: Single Hospital Single Commissioning Function Local Care Organisation Here is the link to the full document http://www.manchesterccgs.nhs.uk/download.cfm?doc=docm93jijm4n5 397.pdf&ver=6648 In these slides we have tried to pull out the most relevant sections for people with autism.

WHAT DOES IT HAVE TO DO WITH PEOPLE WITH AUTISM? All people with autism and/or a learning disability are the group targeted within the learning disability transformation for Manchester The document mentions autism specifically a few times. This is mainly under the learning disability section but there also a few references under mental health. Many of the other sections are about everyone of all ages living in Manchester so would equally apply to people with autism.

WHY ARE WE ASKING YOU ABOUT THE PLAN? Manchester Clinical Commissioning Groups have asked the Greater Manchester Autism Consortium Project to take this report and ask for views from people with autism and family members across Manchester. They have particularly asked for views on the section about that describes the transformation of services and pathways for people with learning disabilities. The CCGs have asked us because they feel we may be in touch with a wider group of people than the CCGs are aware of. They recognise that they need the views of people with autism, including those who have never accessed formal statutory services. We plan to do this in a variety of ways including visiting groups, online survey and via an event to be held on 22nd November (details to follow).

1. SUMMARY POINTS- Learning Disabilities Transformation programme: Learning Disability Nature of problem: Recognition that the current configuration of care pathways across Manchester is disparate and fragmented. This does not match the national requirements or the aspirations for Manchester set out in the Locality Plan. Solution: Redesign community services and pathways Develop for people with learning disabilities across health and social care in Manchester based on the national specifications and service model. Key Programmes: Living Longer, Living Better/One Team GM LD Fast Track Programme Transforming Care for People with Learning Disabilities, Next Steps

2. SUMMARY POINTS – Learning Disabilities Outputs Integrated care plans between health and social care Single point of access for community services People discharged form long stay patient care into safe accommodation with wrap around support packages Improved access to healthcare including annual health checks and GP practice staff who are able to accommodate reasonable adjustments. Mainstream services (non specialist) will be better trained to support people with learning disabilities and/or autism People with learning disabilities will be able to access employment, volunteering opportunities, skills development and training.

3. SUMMARY POINTS – Learning Disabilities Outcomes Number of people who require specialist inpatient admissions. Crisis/avoidable emergency hospital admissions among people with learning disabilities. Length of stay in hospital among people with learning disabilities. Number of delayed discharges among people with learning disabilities. Re-admissions to hospital among people with learning disabilities. People in employment and actively accessing skills and training opportunities.

a) THE PRIORITIES Crisis Management & Outreach service to prevent, reduce & respond to incidents of crisis for people with learning disabilities. Integrated community health and social care learning disability teams into 1 service with 3 localities with a single point of access Care co-ordination function & integrated health and social care planning within the community service Personalisation options for people with learning disabilities. Safe accommodation with wrap around support packages Robust Transition Pathways for children and young people with Autism and Learning Disabilities, including Looked After Children.

b) THE PRIORITIES Adult Autism services and pathways in Manchester. Specialist Intervention team for people with learning disabilities showing early signs of dementia.  Better trained primary care staff (GP & Nurses) so that they understand how to communicate with and respond to people with learning disabilities Quality and outcomes framework for learning disabilities services.

THE PLAN- MENTAL HEALTH Section 3.75 under the Mental Health section is where we found the specific mention of autism. It states that across GM work will be carried out on:- CAMHS LD Psychosexual services Autistic Spectrum Conditions Crisis

WHAT ELSE? Transforming Care In Manchester there are a significant number of people with severe learning disabilities who have been admitted on a longs stay basis to a specialist inpatient unit Manchester patients represent the highest proportion within the Greater Manchester footprint. Manchester CCGs and Manchester City Council continue to work together to ensure the safe and effective re-settlement of patients back into their own communities.

WHAT DO THE CCG WANT TO KNOW FROM YOU? Do these plans reflect your priorities for Manchester? What are the things (people, communities, organisations, services, anything) that work well for you at the moment? What needs to be improved? What needs to change? Let us know by the survey below https://www.surveymonkey.co.uk/r/VXC6P67 Or by telling us in meetings by inviting us to come and see your group Or by coming to our event on 8th December Or by emailing/writing to us at the address at the end of this presentation.

WHAT IS TRANSFORMING CARE? Transforming Care is about people with a learning disability and people with autism being well supported, in their communities, close to home.

Why Do We Need Transforming Care? The terrible abuse that happened at Winterbourne View. The report that followed into the care and support of people who challenge. NHS England have committed to making changes. A review in 2014 said that not enough change has happened. There are still 3,000 people living in hospitals.

What needs to Happen ? We need to make sure that all those people who are in hospital have good care and support. We need to plan for people leaving hospital. We need to prevent people from going into hospital. If we are going to do these things we need to make sure that people with learning disabilities, their families and professionals have the right information, services and support. We need to work with children, young people and adults.

WHAT IS HAPPENING IN GM? It was chosen to be a ‘Fast Track area’ in 2015 This means there is a 3 year programme to identify good practice and develop new systems with a small pot of new money. There is a realisation we need people with lived experiences to contribute to this work. There are numerous work streams and a group called Confirm and Challenge. There are regular events happening around GM and the North for the fast track areas.

Building Relationships across Greater Manchester 10 Local Authorities. 12 Clinical Commissioning groups. Build on the work that is already happening in Greater Manchester and the Northwest. People with lived experience of learning disability and autism NHS England CQC

WHAT ARE THE MAIN AIMS? All people with learning disabilities and/or autism will be supported within the community wherever possible. People will be integrated into typical neighbourhoods, work environments and community settings, rather than creating a situation where people with severe disabilities and complex support needs get stuck at the wrong (most restrictive) end of a continuum, or in more restrictive placements that do not prepare them for moving to less restrictive placements. Support will be provided for the placement of individuals with severe disabilities and complex needs in homes and natural settings. This will include earlier interventions and support at times of crisis to minimise the reliance on in-patient services and the need for out-of-area placements. Community living arrangements will be family-scale and / or in line with age-appropriate communal styles. They will all enable individuals to have their own space. We will encourage the development of social relationships between people with severe disabilities and complex needs and a range of other people Individuals will be supported to participate in busy community life and develop functional, meaningful, interesting and community living skills.    Families and service users will be involved in the co-design, development, active delivery and monitoring of services. This will incorporate a real and honest appreciation of where choice and self-control need to be balanced with safety and well-being issues.

TRANSFORMING CARE AND AUTISM Many people with autism have been placed in secure units but not all of these have a learning disability. Sometimes the processes and interventions for people with LD are not appropriate for them. There are also people with autism admitted into Adult Treatment Units (or Medium Secure Units) via the courts if they get into trouble with the law. Many of these people do not have an LD but may have autism. Families who have challenging or complex children, young people and adults with autism may need specialist understanding and support . We need to help identify what is needed to prevent future young people and adults with autism needing secure provision, and only those with lived experienced can really comment on this.

WHY ARE WE TELLING YOU THIS? We need more people with lived experience of autism (with and without an LD) to be contributing to the discussion about early intervention and prevention. Those who do not access services are already isolated and may not be linked to others with the same condition and this can increase risks for people. We would love you to get involved in whatever way you feel able to. Let us know how this might work best.

3 CRUCIAL QUESTIONS……… When were/are the most stressful/challenging times and circumstances for you? What would/would have prevented such vulnerabilities/crises? What would it take to keep the most challenging/complex people local and within community settings?

WHO CAN GIVE YOU MORE INFORMATION? The Greater Manchester Autism Consortium project (GMAC) via mari.saeki@nas.org.uk Tel: 0161 998 4667 Pathways via Lynn James- Jenkinson, join the Co-Production group, ‘Confirm and Challenge’ lynn.james- jenkinson@pathwaysassociates.co.uk Karishma Chandaria For more info on the work streams and leads karishma.chandaria@nhs.net Your local Autism Lead. If in doubt check with us at the GMAC Project.

THANK YOU for more information please contact:- Mari Saeki, Project Officer Greater Manchester Autism Consortium Project 0161 998 4667 mari.saeki@nas.org.uk