- National funding released to drive transformation of local services
- Summary plans for new and innovative care and support options published
- £100m in capital available to build the right support
Local plans to transform care for people with a learning disability and/or autism have been published today, backed by millions of pounds of dedicated funding announced by health and care leaders.
The announcement marks a major stage in delivering the reforms set out in Building the right support: A national implementation plan to develop community services and close inpatient facilities, published in October 2015 by NHS England, the Local Government Association (LGA), and the Association of Directors of Adult Social Services (ADASS).
Building the right support set an ambition of empowering individuals and their families to have more say in their care by developing and strengthening good quality support options in their communities and, as a result, reducing the number of people with a learning disability and/or autism in England who are in hospitals by up to half over three years.
48 local Transforming Care Partnerships (TCPs) – which are made up of people who use the services, their families, providers of services, Clinical Commissioning Groups, local authorities and NHS England specialised commissioning hubs – are tasked with taking forward these intentions and designing new, high-quality, community-based services which reflect the wishes and circumstances of local residents.
The first awards from a £30m, three-year NHS England revenue fund to help TCPs where there is a need to speed up the delivery of new services – announced at the same time as Building the right support – have now been finalised.
Funding of almost £6.5m has been designated to 23 TCPs on a match-funding basis to help get new services up and running while older models of care are still in place, allowing for safe and effective transition between the two. Bids for funding were assessed and approved on the basis of where the biggest impact will be anticipated to meet ambitions of Building the right support.
Examples of new services being backed by this funding include:
- In North Central London, funding will help develop support for people to stay well in their own homes, with a Community Crisis Intervention Team offering personalised home treatment support, including evidence-based Positive Behavioural Support, and a ‘crash pad’ pilot scheme providing a temporary ‘recovery house’ model as an alternative to hospital.
- In many areas, such as Leicestershire, existing outreach teams are being enhanced, offering support seven days a week or greater therapeutic input.
- In Kent and Medway, a new community service to support people whose behaviour leads to contact with the police or criminal justice system is being established. Essex TCP are also introducing a similar service.
- In Devon, a new service to support people with autism is being set up.
- TCPs across the South have been assigned more than £500k to support joint work focussing on bringing patients who have been placed in inpatient care outside of the region back to their own communities, with the right support in place to meet their complex needs.
£2m has also been assigned this year to contribute to the acquisition of the former Calderstones Partnership NHS Foundation Trust by Mersey Care Foundation Trust, which was completed in July.
The planned merger was a step towards the longer-term intention to radically remodel the provision of services in the North West of England, plans for which will be set out for public consultation shortly.
Summary initial plans from all 48 local TCPs, covering the whole of England, setting out how they intend to enable people with a learning disability to lead more independent lives and have greater say about the support they receive, have also been published, and are available through the NHS England website.
Examples of plans being published include:
- Buckinghamshire TCP will be exploring the development of a shared-ownership housing scheme, one of a number of options being considered which aims to improve the quality of life for people with learning disabilities and/or autism by delivering services in their own homes, not hospitals.
- Suffolk TCP is one of a number which will deploy Positive Behavioural Support, an evidence-based model of care, to support people with a learning disability and/or autism, in this case offering training in this approach to families, schools and care providers.
- Humber TCP is one of a number which will further develop the advocacy services available to people with a learning disability and/or autism and their families – in many cases involving local charities and voluntary groups.
- Outer North East London TCP will develop an intensive community support offer, including crisis support and CLDT forensic training, and will explore support for families and carers that helps current arrangements to be maintained with positive family relationships.
NHS England has also confirmed that £100m of capital funding will be available over five years to support Transforming Care projects – up from the £15m announced at the time of Building the right support. Investment totalling more than £20m has already been provisionally earmarked for schemes across the country in 2016/17, including new housing and services.
Jane Cummings, Chief Nursing Officer for England and Chair of the Transforming Care Delivery Board, said: “Building the right support was rightly praised for its ambitious and comprehensive plan to improve the lives of people with a learning disability and/or autism.
“This will by no means be easy, but it’s extremely encouraging to see how local NHS organisations and councils have taken up the mantle, built on existing good practice and engaged with families and organisations in their areas to develop their own innovative plans to suit their areas.
“We and our national partners are backing their plans, including with this significant additional investment over the coming years, and I look forward to seeing the improvements in people’s lives and health we can deliver together.”
Ray James, ADASS Immediate Past-President and Vice-Chair of the Transforming Care Delivery Board, said: “ADASS recognises the encouraging progress made by many local partnerships, who are working together to transform the choices available for local people.
“The transformation funds announced today will help ensure that more people with a learning disability and/or autism are supported to lead fuller, more independent lives in their local community.
“We know there is much more that needs to done, but today marks another important step in our work with and for local people, their families and carers.”
The Local Government Association’s Community Wellbeing Portfolio Holder, Cllr Izzi Seccombe, said: “This is a significant milestone in improving the lives of people with a learning disability and autism, and ensuring they are supported in the community rather than the hospital.
“Councils remain absolutely committed to supporting people with a learning disability and autism to live close to family and friends, in good quality accommodation with support from highly skilled staff. On occasions when a person’s mental health needs does require an admission to hospital, steps must be taken to ensure it is properly managed with the individual discharged in a safe and timely way.
“As plans are implemented by Transforming Care Partnerships, councils will continue to work with individuals and families, health colleagues and other local partners to see that the support people receive directly meets their needs and wishes.”
Today’s announcement represents a key milestone in the ongoing cross-system Transforming Care programme, which has seen a number of reforms including the roll out of Care and Treatment Reviews – around a hundred of which are now carried out every month.
In England, around 24,000 people who have a learning disability and/or autism are classed as being at risk of admission. 2,530 were in inpatient settings as of 30 June according to the latest official figures; although that number has reduced by 285, or 10%, since March 2015, around a third of patients had been in inpatient facilities continuously for five years or more.
While short-term inpatient care is sometimes a necessity, in the vast majority of cases it does not deliver the best outcomes, and is expensive, costing the health and care system on average over £175,000 per year for often-inappropriate care.
As new and better alternatives become available in the community, Building the right support predicts a reduction in inpatient beds of between 30 and 50 per cent nationally. In some areas that have relied on inpatient settings more than the average, the number of beds which will be commissioned may be reduced by up to 70 per cent.
Local TCP plans to achieve this will be ‘living’ documents, continuing to be developed in partnership with service users and their families, as well as charities and other groups, to ensure they meet local need and continue to drive up the quality of care.
NHS England is developing packages of support for TCPs, ranging from a generic list of high impact actions TCPs can implement to a more intensive support package, along with accelerated learning events where TCPs can get together to share good practice.