What happens next?

Jan 2013

Winterbourne View

DH review

DH review drew on:

• Criminal investigation, 11 prosecutions sentenced

• CQC inspection of all Castlebeck Care services & 150 learning disability hospitals & homes

• NHS South of England reviews of SUI & commissioning of places at WV

• Independent Serious Case Review commissioning by South Gloucestershire Safeguarding Adults Board

• Experience & views of people with ld or autism and mental health conditions or behaviours described as challenging, their families and carers, care staff, commissioners and care providers

Winterbourne View

• The abuse at WV was criminal

• Staff routinely mistreated and abused people with learning disability

• WV revealed significant weakness in system to hold leaders of organisations to account

Key failings

• Gap in the regulatory framework

• CQC inspections of 150 hospitals & care homes found many people there who don’t need to be there and stay there for too long

• Significant failure in service design, commissioning and provision

• Failure to assess quality of care or outcomes of very high cost places

• For some people the best hospital care will not be appropriate, people shouldn’t live in hospital

Concordat – the headlines

• Concordat actions are expected to lead to rapid reduction in hospital placements by 1 June 2014.

• People’s dignity and rights through a commitment to the development of personalised, local, high quality services will be safeguarded. Alongside this the closure of large-scale inpatient services & improved safeguarding arrangements

Concordat - the detail

• Develop by 1 April 2013 & maintain local registers of all people placed in NHS funded care setting out clearly which CCG & LA is responsible for them

• Review by 31 May 2013 the care of all people in learning disability or autism inpatient beds. Based on review develop comprehensive personal care plan based on the individual and families needs & agreed outcomes

• Bring back into community based settings as soon as possible and no later than 31 May 2014 everyone inappropriately placed in hospital

• Commission independent advocacy support to support moving on

• Evidence based strategic plans for 2014/15 to commission the range of local health & care support services needed

• Health & social care commissioners commission against clearly defined standards of quality, safety & openness in contracts with all providers to drive up quality

• Drive up clinical leadership & practice within NHS/independent providers

How it will be achieved• National Commissioning Board

responsibility through a ‘Learning Disability Joint Improvement Programme’

• NCB Steering Group’s responsibility to deliver concordat with focus on joint health & social care commissioning

• Regional commissioning board will link with Area Teams to deliver locally.

• CCGs & LA responsible for individuals

Core Service Specification• Multi agency national steering group

leading work

• Regional events

• Summarised/analysed existing service specifications (157)

• Summarised/analysed learning disability CQUINs (27)

• Schedule of visits arranged

• Specification document being developed

• Core service specification will include areas that should be included into any format, NHS or LA

• Positive Behavioural Support will likely be key feature of service specification

• Will be signed off by 31 March 2013 for implementation

NE Advocacy Project

• Scoping with all PCT Commissioners across the North East

• Initial Scoping with LA Commissioners - patchy

• Advocacy Providers - want change

• Action for Advocacy – define good advocacy

NE Headlines

• Bigger picture – commissioning intentions • Develop / explore approaches to advocacy –

range outside of statutory advocacy • Cohesion / strategic picture and influence • Standards of providers – people coming into the

area• General perception of advocacy • Not good enough – need to raise the standard • Little (of any) investment in informal advocacy

including in families

Real NE example• Young women admitted for treatment and

assessment – indefinite time plan • Family – don’t understand, feel disempowered

and need help • Advocate struggled to get onto the Ward, to see

the day to day practices • Little clarity of pathway to discharge and having

a life • Commissioners – not always clear on the quality

of this service • We don’t want this in the North East

Funding is focused

Little investment

Focus our Attention

Funding continues

Advocacy is everyone’s responsibility

Do it and prove it!• Develop and define what good self advocacy looks like

in specialist services (people must be heard) • Develop and define what a good family empowerment

program would look like (families need to be empowered)

• Share the Tees Commissioning Advocacy Framework is in a written report (an approach for good commissioning)

• Develop a Critical Friend approach with direct workers (we all have an advocacy role)

• Define good Advocacy in Specialist Services the North East (we must have good proactive advocacy)

Any questions?

Judith.thompson@northeast.nhs.uk