the 2006 ld census interim feedback 5 th may 2006 …repeated 22 nd june 2006
TRANSCRIPT
The2006 LD Census
Interim Feedback5th May 2006
…repeated 22nd June 2006
Warning!
You are spending circa £16 Million and you do not know what you are getting!
“Why interim?”
This presentation will explain,
– What we did,
– What we got, and…
– Why we want more!
Cumbria and
Lancashire,
1 SHA
13 PCTs
4 LAs
2 UAs
Where?
What we did and why
• Listened to Martin Routledge who said,– “If there is one thing the SHA could
do to improve learning disability services it would be to understand where people are placed and why”
Census Objectives
• To provide an accurate picture of,
– Who was where?– What was their status?– Why were they placed there?– How long have they been there?– How long are they expected to stay
there?– How much does it cost?
Scope
• Adults,
• With a LD who have been placed– Out of area– Out of sector/pathway– Or both
• Originating from Cumbria and Lancashire SHA footprint.
• The project must be useful not merely academic
Definitions
• Out of area,– Placements where individuals are
placed outside of the PCT/Local Authority catchment area
• Out of sector/pathway,– Placements where individuals are
placed outside of the Agency’s mainstream learning disability provision.
Data Returns
• No naming names! (well not much!)
• 10 out of the 13 PCTs
• 2605 total placements
• 257 out of area and/or pathway (10%)
• Financial data on 149
The Who
• 66.5% (139) male
• 32.5% (68) female
• 1% (2) where gender not recorded
• 96% white British– 1% white other, Asian British, Black
British, and not known respectively.
Age GroupsAge of Out of Area or Out of Pathway Placements
7
17
33
68
43
1812 91 1
0
10
20
30
40
50
60
70
80
Under 20 Between20-25
Between26-30
Between31-40
Between41-50
Between51-60
Between61-70
Between71-80
More than80
Age notrecorded
Ag
e at
tim
e o
f ce
nsu
s
3%1%
6%
9%
21%
33%
16%
8%
4%
Diagnosis - ASDExtent of Autism Spectrum Disorder (ASD)
Number and Percentage of Out of Area and Out of Pathway Placements
4
8 8 8 8
11
00
2
4
6
8
10
12
Blackburn withDarwen
Blackpool Chorley andSouth Ribble
Fylde and Wyre Morecambe Bay(Lancaster)
North CumbriaPCTs
Preston
Total Out of Area or Out of Pathway placements in census = 209
0%
13%
21% 24% 31% 21%
65%5%Note:
Overall % of Patients with ASD = 22%
One area 0% one area 65%!
Is this is a clinical,
operational, financial or a definitional
issue?
Dual DiagnosisDual Diagnosis
NO DUAL DIAGNOSIS, 89, 43%
LD/Challenging behaviour, 41, 20%
LD/Forensic, 26, 12%LD/Mental Health, 24,
11%
LD/Physical Health, 23, 11%
LD/Personality disorder, 2, 1%
LD/Substance Misuse, 2, 1%
Not known or not stated, 2, 1%
43% of LD placements have no Dual Diagnosis
43% combined MH, Forensic
and challenging behaviour
Reason for PlacementReason for Original Placement
Not Known or Not Recorded, 59, 28%
Breakdown in care network, 39, 19%
Multiple reasons, 31, 15%
High Risk behaviour, 22, 11%
Assessment, 19, 9%Forensic/Court report,
15, 7%
Crisis, 10, 5%
Physical Healthcare, 7, 3%
Faith and Culture, 4, 2%
Nearness of family, 3, 1%
‘Not known’,‘Multiple
reasons’ and ‘breakdown in care’ accounts
for 62% -
We need a better
understanding of this
Reason for ContinuationReason for Continuing Placement
Placement meets current needs, 108, 51%
Not Known or Not Recorded, 37, 18%
Further assessment required, 22, 11%
Other , 14, 7%
No alternative, 8, 4%
Meets current needs, 7, 3%
Changed circumstances since admission, 6, 3%
Social and/or legal reasons, 5, 2%
Local service capacity not sufficient, 2, 1%
Over half of placements ‘meet current needs’ –
yet over half have no record of their last
review!
Reason for ProviderReason for Choice of Provider
Other , 67, 32%
Local service capacity not sufficient, 49, 23%
Local services not appropriate, 27, 13%
Agreed provider for Client Group, 16, 8%
Eligibility criteria, 14, 7%
Not Known or Not Recorded, 13, 6%
Social and/or legal reasons, 13, 6%
Local urgent service capacity not available, 10,
5%
The lack of appropriate local services was the
reson for choice of provider in 13% of
cases
What does ‘other’ mean
in this context?
Type of ProviderType of Provider Placed with
Residential Care, 122, 59%
NHS Learning Disability Provider, 27, 13%
NHS Secure Provider, 20, 10%
Independent Non Hospital Provider, 13,
6%
Nursing Care, 9, 4%
Independent Hospital, 8, 4%
Not known or not recorded, 6, 3%
Supported Living, 3, 1%
Supported Tenancy, 1, 0%
122 out of 209 placements (59% of total) were placed in Residential Care
60% Residential Care – who pays for this health or
social care?
Plurality of Providers
• 114 providers for 209 placements– caution, some providers may have
multiple names, i.e., hospital, unit, ward)
• Only 8 providers hosted more than four placements (39%)
• 61% of placements are provided by a highly fragmented market
Legal Status• Caution – re: Bournewood!...but,• 76% not subject to MHA• 11% Section 3• 3% Section 37• 2% Section 37/41 • 2% Section 47/49• 2% Other• 2% not known• 1% 117
Variation between locations
52-95% not subject to MHA
Why?
Reviews• Caution – CPA/PCP… but,
• 24% subject to CPA (76% not)Time since Last Review
2%1%
2%4% 3% 3%
53%
14%16%
0%
10%
20%
30%
40%
50%
60%
Within 7days
Within 14days
Within 30days
Within 60days
Within 6months
Within 365days
Within 2years
Over 3years
Not Knownor Not
Recorded
Perc
en
tag
e o
f cen
su
s r
ep
lies
No caption needed!
Care Co-ordinator
• 17% None
• 40% Not known or recorded
• 43% Yes
Future PlansFuture Plans
No current plans, 53, 26%
Not Known Or Not Recorded, 50, 24%
Placement meets current and long term needs, 39,
19%
Further assessment required, 30, 14%
Transfer to Supported Accommodation, 19, 9%
Transfer to other provider, 11, 5%
Discharge Own Home, 4, 2%
Transfer to Rehabilition, 2, 1%
None, 1, 0%
50% either ‘no plans’ or ‘plans not
known’
Why?
Costs
• 149 financial returns• £1246 average (mean) per week• Ranged between £100 - £6,128• Actual cost for 149 = £185,642 pw
or £9.65 million per year• If replicated to 209 = £260,000 pw• Or £13.53 million• For all 13 PCTs = …?• For NW =…??, nationally =…??
Next steps – our proposals
• Extend submission date till June 06
• NOT to change data – but to make it richer, as it was on the 16th Feb
• Report July 06
• Roll out across the NW summer 06
• Roll out across whole of North of England – Autumn 06
• Repeat census February 07
Thank you!
For further details please contact,
or