1. Changing Direction
A response to the Confidential Inquiry into the premature deaths of people with a learning disability.

2. Because mainstream health services have been slow in developing
the capacity and skills to meet the needs of people with learning
disabilities, some NHS specialist learning disability services have
sought to provide all encompassing services on their own. As a result
the wider NHS has failed to consider the needs of people with
learning disabilities. This is the most important issue which the
NHS needs to address for people with learning disabilities
Valuing People 2001
02/12/2018

3. People with learning disabilities have poorer health than their non-disabled peers, differences in health status that are, to an extent, avoidable.
The health inequalities faced by people with learning disabilities in the UK start early in life, and result, to an extent, from barriers they face in accessing timely, appropriate and effective health care. The inequalities evident in access to health care are likely to place many NHS Trusts in England in contravention of their legal responsibilities defined in the Disability Discrimination Acts 1995 and 2005 and the Mental Capacity Act At a more general level, they are also likely to be in contravention of international obligations under the UN Convention on the Rights of Persons with Disabilities.
The Department of Health have continuously emphasised that Primary, Acute and Specialist NHS Trusts must play in a central role in meeting the health needs of people with learning disabilities.
(E Emerson and S Baines: Health Inequalities & People with Learning Disabilities in the UK :2010)
02/12/2018

4. Rights Based
People with a learning Disability have the right to access Universal (mainstream) services
Those Services should make reasonable adjustments to ensure fair access
Where reasonable adjustments have been made but the disability is such that services are inappropriate a specialist service should be there to intervene.
02/12/2018

5. Enabling Specialist Support Network Change Agents
To Provide expert intervention. To ensure quality of intervention with other specialist providers. To facilitate Support networks for learning disability provision in all tiers. Governance
Specialist
Support Network
Work attached to Primary and secondary care. Work primarily with systems. To advise on processes and on individual cases where required. To help systems make reasonable adjustments in mainstream care
Change Agents
To guide through the system. Hands on support.
Enable access to primary and secondary care.
Enabling

6. Universal Care Pathway
Specialist
Joint Working
Consultation
Gate keeper
Specialist
Change Agent
Enablement
Enabling

7. Learning Disability Health Services in Devon.- What is changing?
6 care management teams
4 Special teams working with people with complicated issues.
7 nurses working in Acute Hospitals instead of 3.
20 Nurses working with GP’s instead of 4.
1 unit of 6 Beds in Exeter.
T Fahy and S. Drake

8. Helping change along.
Understanding that “if we always do what we have always done we will always get what we have always got”.
Understanding why we were “separate” as Learning disability services.
Reflecting on our strengths and weaknesses with our stakeholders.
Realising that we could not change practice without making structural changes.

9. -Hearts.
Use of local patient stories- videos shown at our first Clinical Commissioning Group public meeting and Board meetings.
Getting a clinical commissioning lead for the CCG. The business case for the post was co-produced with people who have a learning disability.
Sharing stories from the Joint Health and Social Care Assessment framework days.
Establishing champions at all levels.
Using the Confidential inquiry evidence, and learning from Winterbourne View.

10. Minds Use of Contract monitoring in Acute Trusts.
CQUINs in contracts.( Health Equalities Framework)
Including “Changing Directions” in the joint Commissioning strategy that applies across geographical borders as well as organisations.
Involving people in planning.
Having good project planning, that is properly resourced.
Building on other opportunities-MENCAP “Getting it right” commissioning charter and local project.
Showing how this helps to improve lives and save money.

11. Checking up on change. Evaluation built into practice.(Data)
Feedback from people who have a learning disability and their carers, advocates, staff and providers.
Quality Checkers.
Contractual compliance.
Observing , learning and changing from now on.