Transforming Care Programme in Sheffield 2016-2019

Update on the national Transforming Care Programme In 2016 NHSE set out an ambition of a 55% reduction in specialist hospital beds for the learning disability population in England, to enable people to live in the “least restrictive environment closest to home”. As at April 2019 nationally, only 19% of beds have closed, and NHSE have been considered to have failed to meet the ambition stated in Transforming Care, therefore the programme has been extended for 2 years until 2021 Sheffield, by contrast, has overachieved on its trajectory, and we are here to tell the story of the achievements, challenges over this programme, and to share lessons learnt around collaborative working Governing Body should note that the people in the cohort involved in this programme have extremely complex needs and are challenging to support, and many have “lived” most of their adult lives in hospital because of the challenges that they present and will continue to present in the community. Consequently, the programme has required significant partnership working with regional CCGs, NHSE, MOJ, Local Authority and SHSC, and with experts by experience NHSI national development team have recently visited the South Yorkshire Transforming Care Partnership to gather information for a national lessons learnt post programme review, and to shape the future programme, as due to progress over the last 12 months, we were selected as a exemplar area As predicted by the South Yorkshire Transforming Care Partnership the programme has created cost pressures, and is not the cost neutral programme that NHS E had – standing at £4m locally to Sheffield CCG and LA. NHSI have now acknowledged this as a national picture, for the first time

The Sheffield story: Collaborative working with SCC, SHSC and Experts by Experience In April 2016: Original Cohort of 24 people in CCG commissioned beds in out of city locked rehabilitation settings; in local acute mental health beds, and local specialist Assessment and Treatment beds National target set of no more than 7 commissioned beds by programme end, April 2019 2016-2019: We have had 50+ discharges to the community between 2016 and April 2019, including 14 people stepped down from secure NHS England commissioned beds We have avoided 45 admissions in this period Length of stay has appropriately reduced in both locked rehabilitation and at the SHSC Assessment and Treatment Service (ATS). In 2018-2019 made progress on the Children’s Transforming Care Agenda- this was nationally implemented later than the Adult programme. City-wide steering group with partners including expert by experience and held a series of engagement events on future LD Community service configuration.

* 2 further discharges since end of March 2019 SCCG Transforming Care Cohort (CCG Commissioned Beds) by Financial Year End Mar-16 to Mar-19 * 2 further discharges since end of March 2019

Transforming Care Cohorts 2016-2019 CCG Inpatient Locations

Discharged 5+ Years Cohort (Individuals who have been discharged, having been in institutional or hospital secure/locked care for 5+ years)

Avoided Admissions Other potential admissions were avoided where it was deemed there was not the need for a CTR within Communities through early intervention via intensive mdt input/respite or contingency care provided by SHSC CISS and SCC social care providers.

Patient Experiences 2016-2019 Case 1: “John” Case 2: “William” Dyan Bell, CHC Lead Nurse (LD)- presented “John”, a patient success story from Transforming Care to Governing Body in March 2019: One of the most complex cases under TCP in Sheffield In health institutions for over 30 years, history of violence and aggression Discharged to community residential/nursing placement in March 2019. This was his first ever planned move Case 2: “William” Individual under TCP previously in prison and secure care for 40 years Significant forensic history, complexities with MOJ/MHA restrictions around community living Joint working between pathway coordinator at SHSC (CCG delegated role) and SCC Social Worker removed barrier after barrier until he was discharged Now works in paid employment as an Expert by Experience for inpatient Care and Treatment Reviews (CTRs) in South Yorkshire Case 3: “Kate ” In health institutions for over 30 years, history of serious violence and secreting weaponry In dispute with NHSE previously regarding level of security needed. Previous psychiatric reports stated that “Kate” would “never leave hospital”. Discharged to community residential/nursing placement in April 2019

Lessons Learnt Multi-agency working in Sheffield e.g… Bi-weekly Transforming Care CTR Outcomes Group- MDT support and challenge Regional collaboration Enhanced Complex Needs Supported Living Framework Co-commissioning of SHSC ATS inpatient facility (2019) PBS regional rollout and LeDeR knowledge exchange Local Patient knowledge Time invested into visits and reviewing care plans/meetings with family Person-centred focus/bespoke solutions for community placements i.e. holistic view, not merely clinical diagnosis- the complexity of cohort both enforced and supported this approach.

Transforming Care Programme 2019-21: Next Steps Ongoing review of community placements due to complex needs Reviewing pathways from residential care into Supported Living- move to the least restricted environment Focus on better independent quality of life – not a “hospital in the community” Further integration of transition-age processes for early intervention and awareness of future cohorts. Expansion of the SHSC Community Intensive Support Service Still a need to focus on people with ASC that do not have a learning disability- particularly prevalent in younger cohort. Focus on wider health determinants and prevention agenda for people with learning disabilities: