The impact of commissioning changes on adults with Learning Disabilities Stephan Brusch Head of Health Access

Key Impact National & Regional system leadership to handover Three commissioning organisations Main focus on Winterbourne View- forgetting Six Lives Ongoing Commitment through the transition and move to wider vulnerable groups without being lost Loss of expertise at regional and local level Risk of new system having to relearn all lessons learned NHS Constitution and new commissioning model presumes active participation.

NHS Commissioning Board Providers The new NHS landscape Funding Accountability Other Parliament Patients and PublicLocal HealthWatch contract Accountability for results Health & Wellbeing Boards (HWBs ) Public Health England Clinical Commissioning Groups (CCGs) contract Monitor (economic regulator) contract Local Authorities (incl. Public Health) Commissioning Support Services NHS Trust Development Authority NHS CB Patch Teams NHS Trusts Version 0.5 Joint licensing between Monitor and CQC CQC National Sector ‘Footprint’ / Local Health Education England DH NHS CB London Sector NHS TDA London Sector FTs LETBs Work together to ensure commissioner support for aspirant FTs Clinical Senates PHE London Sector

NHS Commissioning Board Single Operating Model Held to account through NHS Outcome Framework Ensure directly commissioned services meet specific requirements (Offender and Forensic Services and Direct Enhanced Scheme for People with LD) CCG Assurance includes Safeguarding and Learning Disabilities Leadership role for NHS Develop and sustain partnership working (DH, Local Authority, Metropolitan Police, ADASS, Monitor and CQC)

Clinical Commissioning Authorisation Arrangements in place for CCG to involve and seek advice from LD clinicians and practitioners. CCG has the capacity and capability to commission improved outcomes for the people it serves Lead clinicians selected from member practices for CCG commissioning priority areas CCG to outline commissioning arrangements for learning disabilities Providing Support via self assessment framework, data analysis and economic benchmarking.

Clinical Commissioning Authorisation Appropriate systems for safeguarding Adults at Risk CCG plans to train staff in recognising and reporting safeguarding issues. Clear line of accountability for safeguarding is reflected in CCG governance arrangements. CCG has arrangements in place to co- operate with LA in the operation of LSCB and LSAB. CCG has safeguarding adult lead supported by relevant policies and training

Mental Capacity Act Clinical Commissioning Groups (CCGs) need to: Have an identified Mental Capacity Lead Ensure they have knowledge of their continued responsibility for cases authorised by their predecessor PCT that ceased before the 1 st April 2013 Ensure processes are in place to access all relevant archived information on closed cases.

Mental Capacity Act Retains responsibility for assuring through the commissioning process compliance with the MCA 2005 and DoLS legislation of all providers of health care Work with health providers and local authorities to ensure appropriate capacity in the system of professionals qualified to carry out best interest assessments Support the training and education of health professionals and best interest assessors to deliver effective safe quality patient services.

National levers and Horizon scanning Statutory Guidance: No Secret Making Safeguarding everybody’s business Legislative Framework: Mental Capacity Act, Equality Legislation, Vulnerable Peoples Act, Autism Act NHS and Social Care Outcome Framework NHS CB Mandate NHS CB: Arrangement to secure children’s and adult safeguarding in the future NHS Clinical Commissioning Group Authorisation Guide for applicants Concordat

New National Leaders leading post Winterbourne View Michael McShaine- Long Term Conditions Sam Cramond – Directorate of Partnership Chris Bull- Joint Improvement Program Jane Cummins – Chief Nurse will appoint to Band 9 Mental Health and LD lead

Local whole System Safeguarding Adult Boards, underpinned by statue Local Authority as lead commissioning organisation Health and Wellbeing Board: Strategic Responsibility for assessing local needs, including vulnerable people (JSNA) and agreeing commissioning stratetgies Regulators: Monitor, CQC and professional regulators. Healthwatch to be consulted Safeguarding Strategic plans

Pan London work with ADASS Joint Strategic Needs Assessment Market Positioning Statement Commissioning Jigsaw explained Self Assessment Framework Network

LONDON LEARNING DISABILITES PCT RAG FRAMEWORK RESULTS SUMMARY Organisation Overall Rating Overall Rating Overall Rating Overall Rating Barking & Dagenhamggagraraarrrrrgaaaarragarrrrn/ar Barnetgaaaaaaararraaaraaaaraarraarn/aa Bexleyggrarrrarrrrrrrrarraaarrrrrrn/ar Brentrrararraarraaaggaaaaagaraaran/aa Bromleyraaaaragaaaaaaaaaaaaaaaaaagan/aa Camdenggggaargaaaaaaaaraaaagaaaggan/aa City & Hackneygggggargrargraaaraagaagraaarn/aa Croydonggraraaaarraaaaaaaaaaaaraaarn/aa Ealinggaraarrrrarrrrgrrararaaaragan/aa Enfieldggggarrarrrrrrgrarrrrarrrrrrn/ar Greenwichggggrrrrrrrrrrarrrrarararrarrr Hammersmith & Fulhamgrrraaaaarrrraarrrrraarrrrrrar Haringeyggraaarrarrrrrarraraaaaaarrrn/aa Harrowgaaaaaaararaaaaaraaaagaaararn/aa Haveringggggrrrrrrrarraarrraaararrrrn/ar Hillingdonraaararaarrrrrgaaraaaaaragaan/aa Hounslowgaraaaaraararagaagaraaarararrr Islingtonggagrrrarrrrrrgarrraaaarararra Kensington & Chelseaggagrrrarrrrrrgraaaaaaarararn/aa Kingstonggggaaaarrrrrrgaararraarrrarn/ar Lambethgaaagaarrrrarraarrraaararrrrrr Lewishamggagrararrrrararrarraarararrn/ar Newhamggraarrrrarrrrarrrrrrgaaarrrn/ar Redbridgeggggaararrrrararraraaaaaaraan/aa Richmondggraarrarrrrrrarrgrgarrrrarrn/ar Southwarkggagrrraarrrrraarrraagraararn/aa Sutton & Mertonggagrarrrrrrrrarrrraraaarrrrn/ar Tower Hamletsggagaargaaaaraararraaaarrrarn/aa waltham forestrraraaaagraaaagaaraaaarraarrn/aa Wandsworthgaaaaaaaaarraaaraaaaragrraarrr Westminsterragagggaaaagaaggrggaaagggggan/ag

Sector Campus closureOut of Area PlacementPrimary Care Annual Health Checks Disease Prevention Wider Primary Care Contracting (acute, non-acute) Inclusive comm. WorkI.T. BME / Learning DisabilityComplex Needs National InvestigationMCA. DDA and LDComplaints Safe-guarding and LDRespite Care Community ProvisionTransitionUser Engagement Partnership (Funding)Older People (LD)Autism Challenging Behaviour Mental Health / LDworkforce Criminal Justice System NWLBrent NWLHarrow NWLK&C NWLH&F NWLWestminster NWLEaling NWLHillingdon NWLHounslow ONELBarking & Dagenham ONELHavering ONELRedbridge ONELWaltham Forest EL&CCity and Hackney EL&CNewham EL&CTower Hamlets SELBexley SELBromley SELGreenwich SELLambeth SELLewisham SELSouthwark NCLBarnet NCLCamden NCLEnfield NCLHaringey NCLIslington SWLCroydon SWLKingston SWLRichmond and Twickenham SWLSutton and Merton SWLWandsworth

1. Access to Healthcare 2. Being Safe 3. Safeguarding, Governance and Quality OrganisationsSummary A A1A2A3A4A5A6A7A8A9A10Summary BB1B2B3B4Summary CC9C10C11C12C13C14C15C16 NELC Summary Barking and Dagenham Barnet Camden City and Hackney Enfield Haringey Havering Islington Newham Redbridge Tower Hamlets Waltham Forest NWL Summary Brent Ealing Hammersmith and Fulham Harrow Hillingdon Hounslow Kensington and Chelsea Westminster SEL Summary Bexley Bromley Greenwich Lambeth Lewisham Southwark SWL Summary Croydon Kingston Richmond Sutton and Merton Wandsworth London-wide