1. Improving services for people with a learning disability
Improving services for people with a learning disability. Dispute Resolution Process

2. Why is this required?
A Dispute Resolution process is required to support situations where people are not receiving the right support as a result of disputes between different stakeholders. Dispute may arise over a range of issues; clinical disagreement, finance, family concerns etc.
The quality of care for individuals is the primary concern. Disputes between stakeholders must not impact adversely on the individual, and must be resolved quickly.
This Dispute Resolution Process supports local accountability across health and social care and will be used only when local stakeholders cannot agree a way forward themselves

3. Principles behind the approach
Person-centred - the views of the individual and/or their family/advocate are central to the discussion
Subsidiarity – It is expected that issues will be resolved locally; only if necessary deal with at regional level, and if required at national level
Solution-focused, supportive approach, seeking resolution not attributing blame
Building on existing NHS and Local Authority processes (escalating clinical/quality/safety concerns; NHS assurance / LGA sector-led improvement)

4. What triggers escalation
Care and treatment of an individual or group of individuals is not agreed by all stakeholders
Individual and/or family remain concerned about clinical consensus
Differing legal frameworks appear not to align – ie Safeguarding, Mental Capacity Act etc - and cannot be resolved locally
Resource disputes between NHS commissioners – Specialised and CCGs
Funding disputes between NHS and Local Authorities
Escalation to regional level only triggered if key leaders in commissioning organisations (AO for CCG; CEO for LA; regional director of spec com for NHSE) have tried but not been able to resolve dispute

5. Clinical Commissioning Group /Specialised Commissioning dispute
CCG Director of Commissioning
Local Spec Comm Lead
CCG Accountable Officer
Regional Director of Spec Comm
NHS England Local Area Team
NHS England Regional Medical Officer or Regional Chief Nurse

6. CCG/Local authority dispute
NHS
Local Government
CCG Director of Commissioning
LA Director of Social Services
CCG Accountable Officer
LA Chief Executive Officer
NHS England Regional Medical Officer or Regional Chief Nurse & LGA regional lead
Regional LGA leads
Jo Poynter - South and sharing Midlands and East with Hilary 
 Hilary Paxton - North and sharing Midlands and East with Jo 
 Jane Alltimes - London

7. Regional Escalation/Facilitated Help
NHS
Local Government
Regional Medical Director
Regional Commissioning Ops
Regional LGA Lead
Supporting resources if required
Supporting resources if required
Finance Lead
Legal Support
Independent Clinical Support
Finance Lead
Legal Support
Independent Clinical Support
Resolution to be led for NHS by Regional Medical Director in acknowledgment of legal medical responsibilities, and for local government by regional LGA lead building on existing sector-led improvement arrangements
These regional lead(s) to facilitate a discussion between the parties to the dispute, subsequent to which the parties either a) come to an agreed way forward, or b) produce a clear statement on what they agree, and what they agree to disagree upon; and set out clearly a request for facilitated help from NHS England and/or LGA or an independent third party.
Where disagreements over funding are preventing an individual from getting the right support, the right support should be put in place and funded on a without-prejudice basis. A person’s discharge/transfer plans should not be delayed due to funding disagreements. The person should be discharged/transferred with funding continuing from the current commissioner until resolution can be achieved.  If resolution determines a different commissioner is responsible then back payment to the day of discharge will be made.
Regional Lead Officers must be assured that Patient and/or family voice is central to the situation resolution and be able to demonstrate good engagement.

8. National Executive Director for Learning Disabilities
National Support
NHS
Local Government
National Executive Director for Learning Disabilities
National LGA Director
Sarah Mitchell
Department of Health
If dispute still unresolved after regional support, report to be written jointly by Lead Officers to NHS England CNO and LGA Chief Executive giving specific reasons for lack of resolution and identifying what additional national support would be required to ‘unblock’ remaining issues. If necessary, the CNO and LGA CEO may ultimately choose to involve the SoS for Health and SoS for Local Government.

9. Oversight
The Learning Disability Quality Framework process will have oversight of the number of situations requiring conflict resolution.
Quality Surveillance Groups will review this information as part of their governance function – working with other system partners ie CQC to provide support as required
NHS England will assess capacity and capability of CCGs to manage partnerships with Specialised Commissioners and Local Authorities as part of the CCG Improvement and Assessment Framework for 2017 (we will need to discuss this with the independent panel overseeing the IAF).