Translating inpatient care planning and risk management into community setting for offenders with ASD -Gavin Thistlethwaite, Programme Lead Transforming Care NHSE -Caroline Jones, Head of Mental Health Transforming Care NHSE -Harinder Bains, Clinical Director for Neurodevelopmental Services - Elysium Healthcare Supporting Adults with Complex Autism in the Community Monday 15th October 2018

Winterbourne – Before and After Mansell report 1993 and revised 2007 Winterbourne- BBC Panorama programme 2011 DoH Winterbourne view – Concordat of Action 2012- Rapid reduction of beds by 1 June 2014 - all inappropriately admitted people in community - PCTs to have a list of all PWLD in hospital

‘Building the right support’ Oct 2015 NHS committed to closing down inappropriate and outmoded inpatient services in Feb 2015 National plan for building community services for people with learning disability ‘with behaviours that challenge’ – and close down inpatient services. National Service model by March 2019 LD Census for 3 consecutive years – 2600 beds

45-65 % reduction in CCG commissioned beds 25-40% reduction in NHS commissioned beds Overall 35-50% reduction Mainly in low secure provision Bring number down to 1300-1700 from 2600 Reduction of capacity but appreciation of need Variance nationally in reduction (70% in north to 20% in south) AIM 10-15 CCG beds/Million population 20-25 NHSE beds/Million population

Specialised Commissioning and Transforming Care South Region Issues Too many out of area – paradoxically, not enough beds Insufficient capacity in Medium Secure Virtually no services for women No specialist capacity – autism in particular Limited pathways – poorly connected to wider system Solutions Bed capacity development Substantial increase in MSU beds Female MSU … all very obvious but nothing transformative Developing partnerships with independent sector Establishing specialist pathways

What have we done? Transferred money Attempted to define a new pathway National funding transfer agreement Attempted to define a new pathway Use CTRs as a filter Introduce Life Planning as our methodology for person-centred planning Seek to support development of community support arrangements (see above!) and specialist capacity Recognised the gap between Specialised Commissioning/Secure Care and the communities that people come from There is a need to recognise the individual specific needs of people Agree treatment that will happen both in hospital and following discharge Engage key stakeholders – Commissioners, local clinical teams, Police, MoJ Establish the pathway, timescale and planned outcomes together

Where are we going? If the objective is to “transform care” for this group our intentions are: Effective treatment in the community Changed understanding and description of risk Commitment to “personalised” commissioning and support Transfer of resources to the community Treatment closer to home Integrated pathways From secure care to the community Focus on treatment and moving people through Strong connections back to home and community Specialist functions led by acknowledged experts Recognising where expertise counts Empowering pathways to work together Exploiting New Care Models as a vehicle for change

Transforming Care Model Service Specification 2017 Partnership arrangements are encouraged which are essential to delivering the Transforming care agenda Focus on enhanced/intensive support The document emphasises the need for the enhanced tier to have this specialist skill

Transforming Care Model Service Specification 2017 The scope of enhanced services is suggested to be wider than LD There is still the confusion between ‘challenging behaviour’ and forensic needs. The reports sets a target of 25 to 40% reduction in secure care. Reliance on community forensic teams to meet the targets. Partnership working for forensic support between health care and social

Transforming Care Model Service Specification 2017 The scope has been widened to include people with ASD The document is focused on ‘inappropriate admissions’ and that is a welcome change from previous position of no admission. Put forward the idea of a dynamic register which will be maintained by providers and commissioners.

Challenges at point of service delivery with translating care plans and risk management from inpatient into community settings?

Commissioning challenges with integrated care planning (inpatient to community) and management of transition