Sandy Bering - Nov The Way Forward for Health Services & The Role of the NHS in Adult LD Services Adapted from materials presented at the DOH Conference (July 2008)

2Sandy Bering - Nov 2008 In General, the NHS is Concerned With Promoting good health Promoting good health Addressing ill health Addressing ill health Delivering healthcare in a fair and equal way Delivering healthcare in a fair and equal way Being ‘personalised’ Being ‘personalised’ Applying ‘best practice’ and using new technology Applying ‘best practice’ and using new technology Meeting its legal requirements Meeting its legal requirements BUT NHS performance for Adults with LD = Failures

3Sandy Bering - Nov 2008 The Evidence About the Healthcare of Adults with LD DRC: Formal Investigation DRC: Formal Investigation ‘Death by Indifference’ ‘Death by Indifference’ NHS Ombudsman Independent Inquiry (soon) NHS Ombudsman Independent Inquiry (soon) Healthcare Commission reports into Cornwall, Sutton & Merton and Bromley Healthcare Commission reports into Cornwall, Sutton & Merton and Bromley Healthcare Commission Audit of Specialist NHS Services Healthcare Commission Audit of Specialist NHS Services The Healthcare for All Inquiry The Healthcare for All Inquiry

4Sandy Bering - Nov 2008 LD has risen on the health agenda in the last few years with concerns raised about the poor experiences of people with ld in LD has risen on the health agenda in the last few years with concerns raised about the poor experiences of people with ld in Mainstream general and Mainstream general and Specialist mental health and Specialist mental health and Specialist ld services Specialist ld services Healthcare commission has reported that institutional failings are depriving people with ld of human rights and dignity with increased risks of neglect/abuse Healthcare commission has reported that institutional failings are depriving people with ld of human rights and dignity with increased risks of neglect/abuse

5Sandy Bering - Nov 2008 Govt’s vision is that services should be designed around person and is particularly pertinent to LD services Govt’s vision is that services should be designed around person and is particularly pertinent to LD services Investment in and provision of specialist health services varies across the country Investment in and provision of specialist health services varies across the country Result has been the updating of commissioning and best practice guidance - Healthcare Commission and Michael’s Inquiry called for sweeping and sustained changes Result has been the updating of commissioning and best practice guidance - Healthcare Commission and Michael’s Inquiry called for sweeping and sustained changes

6Sandy Bering - Nov 2008 The Key Essential Recommendations More effective leadership within PCTs and NHS More effective leadership within PCTs and NHS Govt direction to commissioners of healthcare to develop more appropriate, proactive, ‘reasonably adjusted’ health services for people with ld, including health checks and staff to support access to the NHS Govt direction to commissioners of healthcare to develop more appropriate, proactive, ‘reasonably adjusted’ health services for people with ld, including health checks and staff to support access to the NHS Core Standards for Better Health amended to ensure services are accessible to people with ld Core Standards for Better Health amended to ensure services are accessible to people with ld

7Sandy Bering - Nov 2008 The Key Essential Recommendations Strengthening of inspection and regulation systems at all levels, including assessment of the provision of health services to people with ld Strengthening of inspection and regulation systems at all levels, including assessment of the provision of health services to people with ld Govt establishment of National Condidential Inquiry and Public Health Observatory Govt establishment of National Condidential Inquiry and Public Health Observatory Data and info systems improved across the board to identify people with ld Data and info systems improved across the board to identify people with ld

8Sandy Bering - Nov 2008 The Key Essential Recommendations Education and training on ld to be made compulsory for medical students and other NHS staff Education and training on ld to be made compulsory for medical students and other NHS staff Local services to work in real partnership with people with ld and their carers to plan care Local services to work in real partnership with people with ld and their carers to plan care Trust Boards to demonstrate that they have effective ‘reasonably adjusted’ services in place Trust Boards to demonstrate that they have effective ‘reasonably adjusted’ services in place

9Sandy Bering - Nov 2008 Demand for and supply of LD health services is changing due to 3 main factors Demand for and supply of LD health services is changing due to 3 main factors Significantly increased no’s of people partly caused by people living longer as a result of medical and tech advances Significantly increased no’s of people partly caused by people living longer as a result of medical and tech advances Significant changes in demographic profile with increased no’s of people with complex needs (inc higher prevalence in certain Asian communities) Significant changes in demographic profile with increased no’s of people with complex needs (inc higher prevalence in certain Asian communities) Increasing empowerment of people with ld and their families resulting in higher expectations and better quality outcomes Increasing empowerment of people with ld and their families resulting in higher expectations and better quality outcomes

10Sandy Bering - Nov 2008 National LD Health Policy Three main things for the NHS to do 1. Deliver mainstream health services to a high quality (Health Action Plans, Liaison/Supported Access and Facilitation, Physical/Mental Healthcare) 2. Modernise and apply best practice to specialist health services (Positive CB Support Plans as opposed to Over-Use of Drugs/Control/Admissions) 3. Stop doing the things the NHS should not be doing (Social care – Houses/Respite/Day care/ Transport/Personal Care & Support and Sending challenging people away from local homes/services)

11Sandy Bering - Nov 2008 Specialist LD Services – Commissioning Guidance (2007) The Clue is in the Name Specialist: Services are about doing things that mainstream services cannot or should not do Health: The focus of staff and services should be on addressing health needs, not providing social care because the NHS believes it can do it better or because of people’s labels

12Sandy Bering - Nov 2008 Key Principles and Components Promote competence by supporting whole mainstream system and directly serve people with complex needs, through: Clinical Therapeutic roles Clinical Therapeutic rolesAND Health Promotion (not doing health checks for all) Health Promotion (not doing health checks for all) Health Facilitation (mainstream and acute support) Health Facilitation (mainstream and acute support) Training and Teaching Training and Teaching Strategic Service Development Strategic Service Development

13Sandy Bering - Nov 2008 Key Principles and Components 2 NHS employment NHS employment Integrated management/leadership (usually with LA led services) Integrated management/leadership (usually with LA led services) Clear professional/specialist supervision Clear professional/specialist supervision Linked BUT Different eligibility criteria Linked BUT Different eligibility criteria Investment to grow as demand and services change (especially with respect to needs of older people and complex needs) Investment to grow as demand and services change (especially with respect to needs of older people and complex needs) Forensic challenges increasing Forensic challenges increasing

14Sandy Bering - Nov 2008 Key Principles and Components 3 Focus on people at particular risk of exclusion Focus on people at particular risk of exclusion Include elements of Include elements of Early intervention Early intervention Crisis resolution/Home treatment Crisis resolution/Home treatment Assertive outreach Assertive outreach Small no’s of Assessment/Treatment beds Small no’s of Assessment/Treatment beds Integration with mental health services wherever possible Integration with mental health services wherever possible Avoid risks of de-skilling others (confidence, competence and capacity) Avoid risks of de-skilling others (confidence, competence and capacity) Stop sending people away (Mansell reports) Stop sending people away (Mansell reports)

15Sandy Bering - Nov 2008 Aims of Specialist LD Health Services Specialist LD healthcare staff need the skills to provide specific and responsive care in all settings for people with ld and their families/carers Specialist LD healthcare staff need the skills to provide specific and responsive care in all settings for people with ld and their families/carers These staff should offer advice and support to other professionals/services and those who provide day-to- day care, as well as direct interventions with people with ld and families These staff should offer advice and support to other professionals/services and those who provide day-to- day care, as well as direct interventions with people with ld and families

16Sandy Bering - Nov 2008 Aims of Specialist LD Health Services Support mainstream practice and serve those with the most complex needs Support mainstream practice and serve those with the most complex needs Promote safe, person-centred support and evidence- based practice Promote safe, person-centred support and evidence- based practice Integrated planning and development of care pathways that promote individualised services closer to home Integrated planning and development of care pathways that promote individualised services closer to home

17Sandy Bering - Nov 2008 Aims of Specialist LD Health Services Directing people away from institutional responses to crisis and put support around people in community settings Directing people away from institutional responses to crisis and put support around people in community settings Swift access, when needed, to medical, nursing and therapy professionals Swift access, when needed, to medical, nursing and therapy professionals Investment in training and development for specialist professionals, families and front-line support staff Investment in training and development for specialist professionals, families and front-line support staff

18Sandy Bering - Nov 2008 Aims of Specialist LD Health Services A robust community infrastructure that takes a broad view on addressing health needs and the range of health and other factors associated with social exclusion and New alliances and approaches to secure better and more inclusive services A robust community infrastructure that takes a broad view on addressing health needs and the range of health and other factors associated with social exclusion and New alliances and approaches to secure better and more inclusive services Fulfilling all legal requirements – MH Act, MCA and DDA, ensuring voice of individuals and families is heard, including access to appropriate representation/advocacy Fulfilling all legal requirements – MH Act, MCA and DDA, ensuring voice of individuals and families is heard, including access to appropriate representation/advocacy

19Sandy Bering - Nov 2008 Continuing Health Care Support specialist assessments, specifications and monitoring roles Support specialist assessments, specifications and monitoring roles Only bed-based services where health input is highly intensive or unpredictable Only bed-based services where health input is highly intensive or unpredictable Assessment and treatment should involve assessment and treatment Assessment and treatment should involve assessment and treatment Start from ordinary housing and support with specialist clinical health input added on Start from ordinary housing and support with specialist clinical health input added on CBs are not a basis for 100% NHS Continuing Healthcare responsibility CBs are not a basis for 100% NHS Continuing Healthcare responsibility

20Sandy Bering - Nov 2008 Modern, Best Practice Specialist LD Health Services Follow the Commissioning Guidance Follow the Commissioning Guidance Part of a ‘whole system’ approach Part of a ‘whole system’ approach Investment in community-based, preventative supports Investment in community-based, preventative supports Learn from good practice across UK and abroad Learn from good practice across UK and abroad Recognise that we know how to do things differently Recognise that we know how to do things differently ‘We have the ‘Knowledge and Technology’ But have we the ‘Will to Do It’! ‘We have the ‘Knowledge and Technology’ But have we the ‘Will to Do It’!