Learning Disability Services in South Tyneside Dr James Gordon GP Clinical Director South Tyneside CCG

Transforming care https://youtu.be/wqYZi19jvBM

National Winterbourne View 2011 Reduction in Assessment and Treatment Beds Moving those living in hospital back to the community Care and Treatment Reviews – inpatients/admissions/at risk Regional transforming care boards Abuse of people in A+T beds, often in non NHS provision, many miles form home and family, lived in for many years – out of sight, out of mind The CTR focuses on four areas: is the person safe; are they getting good care; do they have a plan in place for their future and can their care and treatment be provided in the community Strict regional trajectories for bed closures, North East seen as an outlier, South Tyneside is not, community models now being developed

Local Context Integration and Alliancing A history of joint working and co-location within learning disabilities services Pooled budget Care and Treatment Review process 3 tiered governance structure Transforming Care Board Learning Disability Strategy Group Complex Commissioning Group All organisation committed to working together to ensure the best outcomes for population and maintain financial sustainability ST LD team previously worked together with good reports from those who were there at the time Fully pooled budget eliminating perverse incentives/conflicts in the system – e.g. funding stream shouldn’t determine care, only needed to determine whether a person contributes towards their care or not (fully social care funded vs CHC etc). Often being in hospital costs more than being at home with a package – but the costs are shared across all partners TCB – strategic direction – what will we do? LDSG – work of LD groups plus scrutiny and challenge of TCB CCG – Individual cases that require decisions outside of remit of the usual MDT.

£23 Million Rose Lodge Day opportunities S117 Placements Psychiatry and Psychology Community Nursing Team £23 Million Adult Social care placements Community Therapies Respite Joint liability and shared responsibility The same money that pays for the package of care you’re putting to together or the hospital placement that your admitting a person to pays for our salaries. How do we remain financially sustainable and continue to commission and provide highest quality person centred care? Its our collectively responsibility – you must think about the financial impacts of the care provided and commissioned for your clients and equally your decisions and recommendations should be respected. Its difficult (own GP experience) but essential if we are to continue to operate a health and care system CHC Funded Placements Learning Disability Social Workers Other hospital placements

Personalised Commissioning and Service Design Meaningful activity, achievement and contribution to society Principals of promoting autonomy and supporting people to make decisions about their own lives and care Reasonable adjustments to mainstream services, mainstream services used in the majority of cases (may require a degree of support to access) Avoiding paternalism, least restrictive care, accepting reasonable risk But we will need better community services – integration, 7 days access, specialist functions – PBS etc, intensive support/crisis Personalised Commissioning and Service Design

Next steps Health and Social care teams will come together Less duplication, professional support, joint working Right service, right time, right person. More complex care in the community More community care providers – training and support roles for NHS and Social Care staff. New roles and responsibilities for staff Community Teams and community based care provision will be more important than ever as people with more complex needs move out of hospital. Traditional roles may change, we will need to consider how this impacts on care coordination, the role of third sector workers, etc We need you to tell us how we can achieve this – what works well now, what doesn’t, how can things be better, what do we need to change?