Let's Talk

Hi Pene Great news - am sure it is okay to use Crispin's presentation. We will ber putting a standard one on the website eventually but until then, this is fine. The electronic version is nearly there but not quite. Hopefully in next week or so. best wishes Sue

have had the meeting with our commissioner Xan Brooker, and agreed that we would like to use the HEF against our KPIs.

Have also had discussion with Head of service , who is also enthusiastic and we have agreed that I will call a meeting of all heads/associate heads of profession (S&LT, physio,sensory,OT and nursing) introduce the tool, with a view to setting up a pilot. I would like to use CH's presentation for this. Is this ok? and is the electronice part sorted yet??

I am a newly appointed Commissioner of LD services and would really appreciate your help in trying to get up to scratch with the LD SAF. I have the Framework and data collection tools and wondered whether anyone is able to share with me a timetable/project plan? I have heard anecdotally that this years SAF might not be going ahead, can anyone clarify this? Any help and infomration is greatly appreciated. Shona

Mark Crawley from Suffolk has sent in a set of detailed outputs from a major consultation day they held. I have posted these in the Resources Section. Mark - Do you want to add anything?

It is concerning that the combination of the two self assessments significantly dilutes the impetus for 'new' health commisisoners to drive improvement and to be held to account for improving access and quality of all specialist and generic health services for people with learning disabilities. There also need to be a clear guidance document for health commisisoners, explaining the process and 'scoring' regime for performance.

Comments from North Somerset Learning Disabilities Partnership Board - Members of the Learning Disabilities Partnership Board generally thought that combining the Health and Partnership Board Self Assessments was a good idea. It was considered that collecting service user stories will be a crucial part of preparing the final document. Members thought that comments would be better from individuals rather than carers if possible. The questions in this year’s document appeared easier to understand than in previous years and would be better for checking progress in the future.

Comments from specific people / groups:

North Somerset People First - Members of North Somerset People First have said the new joint Health & Social Care Self assessment is much easier to understand and feel that they will be able to contribute their own personal experiences in a meaningful way by using real life stories. They like the idea of it being a joint assessment and feel it will save time and more importantly reduce the number of forms to complete. Overall members have said the process and content feels more 'person centred'.

Carers - The new joint Health and Social Care Self assessment will replace the two current self-assessments for the Learning Disability Partnership Board (LDPB) and Health. The group thought that this was a good idea. The new format was easy to understand and the group thought that the “Lived experience” life story would give examples of when things have worked well and how this was achieved, which will make the document meaningful for families. The family carers felt that they would be able to contribute in more detail through each sub group and were happy for David and Kate to sign off the document on their behalf as has previously been the process for the LDPB annual report

Comments from Information Manager -

Question 1 - would read better if locality was replaced with community so that it is clear that we're talking about the population at large.

Question 1 - presume data on complex /profound and ASD would come from the census, so if so how would this be maintained in the intervening years

Question 1 - people died should read 0-17 for continuity. Also higher figure should be 55 and over.

Question 1 - people in paid employment - this is only collected for LD and MH, so cannot provide figures for people who do not have a Learning Disability, also close bracket should be after the word employed, and the grammar for this section is not good!

Question 2 - social care services / personal budgets - would be better if these stated Aged 18+ as children get these services too.

Question 3 - Not clear if the first 4 questions are all ages or 18+. I took it to be 18+ until I read the fifth which implies it is all age. Suggest this is split / better defined.

Question 3 - The OOA queries should be 0-17 not 0-18 for consistency.

Delayed Discharges - not sure where this data would come from as SC currently do not have access to who the delays are.

Accommodation. Again - we only have this data currently for LD aged 18-64, and presumably AWP could provide for MH aged 18-69, but we do not have this level of data for the rest of the client types and for older adults.

Comments and feedback on the Self Assessment Consultation

The Joint Self Assessment is proposed as a way off ensuring that health and Social Care work closely together to provide good quality and evaluated care to people with a learning disability and their carers. It will replace the Self Assessments that have been done by Commissioners of Health services in previous years and will combine it with the Partnership Board reports,

The letter for the consultation was sent out on the 3rd December and gave a 2 month period during which Health and Partnership Boards could consult with people who have a learning disability, their carers and providers of services..

Unfortunately the time span was over Christmas and the New Year which has made it a challenge to have as wide a consultation as we would have liked.

The Consultation suggests a day with workshops but this has proved too much to get organised within the time scale.

In place of a whole days workshop we were able to access other established groups where we were given some time to have a short presentation and a discussion about the self assessment.

The groups we attended were across the county and included some representation from people who attended self advocacy groups, family carers groups, a parenting group for parents who have a learning disability, and commissioners of services.

It is to our advantage that we have been very good at involving a wide range of people in all the previous Self Assessments so people were familiar with the process.

COMMENTS AND SUGGESTIONS

The comments that people made were as follows:-

There was some concern that if this Self Assessment was to be completed by each individual CCG there would be duplication of work.

Some people thought that it would be a lot of work and the organisations may not complete it as thoroughly as the previous Self Assessments have been.

It was suggested that perhaps Local Authorities should be the lead agency and that the completion should be the responsibility of the Health and Wellbeing boards.

People said that they were concerned that it should be meaningful and not a ‘tick box’ exercise. To be meaningful it would need to be accessible and easy for them to understand. With clear outcomes

If each CCG were to be responsible they may not all take care to include people with a learning disability and their carers when they are getting information, or people may be asked to provide the same information to different groups of commissioners.

One comment from a carer was that there are so many organisations that may be included in the SA how do we think we would monitor effectively and report accurately. Can Health and Social care share information for data collection. If not how will they get the information they need.

They also wanted to know what would happen if providers were not doing everything they should be to provide good quality care. How the information would be shared so that we will all know what is good and what needs improving. Which organisation would be responsible for overseeing that things were improved?

CONCLUSION:

From the discussions in the groups, people seemed to agree that it made sense to combine the Health Self Assessment with the Partnership Board report. Concerns from this were that it may become fragmented if each organisation/CCG does a SA. Will there be guidance on who will take the lead to collate it. (By which organisations?)

In the groups people with a Learning Disability said that they wanted to feel they could help with the validation. They felt it was important to know how things were being done and what was being done in Health and Social care.. They understood the Red Amber Green rating system and thought it would be a good idea to use it in a combined report for both Health and Social care.

They felt that the questions were the right things to ask. They thought the ‘I’ Statements were a very good idea. However they felt that there needed to be information in different formats for it to be inclusive.. Also there was a lot of information required under each heading and they wondered if this could be made easier.

The questions on compliance they thought were the right things to ask and wanted to know more about some of the areas such as how we would collect the information from all the areas needed. They felt the timetable was ambitious.

There were some concerns about the volume of information to be collected may be too much…..eg how to get statistics on the general population as well as the LD population, also some information may not be available…we should only be collating info that is easy to obtain, rather than being scored red for not being able to collect it

Also a concern about how much resource will need to be deployed to collect all of the information when public bodies are cutting resources, therefore a streamlined and more focussed assessment would be more practical and achieveable. These were thr thought s from Groups across Norfolk and Waveney

Hi all,

My name's Katrina and I work in the Wills and Trusts team at Mencap. I wanted to let you know about the next lot of Planning for the Future events that we have taking place in the North East region during March 2013.

If you're worried about how your family member with a learning disability will manage financially when you are not around to support them, then come along to one of these FREE two-hour seminars for families and carers, with information and advice on wills and trusts provided by a specialist local legal professional.

The next seminars will be taking place in the following locations:

Wednesday 20th March, 6.30pm - 8.30pm Newcastle City Library, Charles Avison Building, The Bewisck Hall, 33 New Bridge Street West, Newcastle, NE1 8AX

Thursday 21st March, 12.30pm - 2.30pm The Bar Convent, The Beddingfield Room, 17 Blossom Street, York, North Yorkshire, YO24 1AQ

Thursday 21st March, 6.30pm - 8.30pm St George's Centre, Great George Street, Leeds, West Yorkshire, LS1 3BR

For dates and locations of other seminars we have taking place throughout England, Wales and Northern Ireland please visit http://www.mencap.org.uk/pffe

These seminars are always very popular, so please book your place(s) as soon as possible. All places and venue details will be confirmed in writing 2 weeks before the event.

To book your place at any of the events please use our online booking form: https://www.mencap.org.uk/webform/book-place-planning-future-event

Alternatively, please contact Gina Collins on 020 7696 6925 or email willsandtrusts@mencap.org.uk

Best wishes, Katrina

As this consultation is drawing to a close, and we are in the process of submitting our responses, could we be advised of the next steps of the process. When can we expect to have sight of the final documentation? It is particularly important at this time of transition that adequate time is available for successful handover of the SAF responsibility and related local knowledge.

Picking up the point about lead responsibility overarching CCGs and LAs - an appropriate lead is the newly reformed Public Health function. Much of the information is relevant to the JSNA and data about specific local need properly analysed to support commissioning decisions should be aided, standardisation across England should be facilitated, a public health focus for people with learning disabilities maintained, data comparability across agencies hopefully improved, co-ordination across CCGs resolved and so on.

Although discussion has been invited here on the forum. Am I right in saying that the official way to respond to the consultation is by replying to healthsocialcareframework@gmail.com The link is not particulalry visible on the website unless you click the 'more' button and it is imporatnt that discussions above are seen as part of that process.

I also agree with Mark's concern about not identifying specialist needs explicitly enough which is a shame as it creates an opportunity for services to 'hand-off' responsibilities in these areas, where the previous SAF held each service to account. Therefore completing it had the added value of explicitly articulating what is expected of non-LD specialist services; Services/boards will not do more than the minimum that is asked of them (if this happens it is at frontline as result of individual practitioners or local leaders, not by design), I feel this version of SAF asks less of Health services = people with LD will get less from generic health services. I also agree with Mark about tying in outcomes to health action plans and AHC's. In my area less than half GP's have signed up to DES, covering 45% of our known LD population at best. Any targets/monitoring must include the 65% who are excluded from AHC's. The question of who leads is crucial as the relationship/impact between LDPB's and HWB's is as yet unknown, the "must make sure" actions described in the easierread docs will only be as strong as the legitimate authority of agency overseeing the process - so am not sure which agency fits this bill for both health and social services, and the how 'hand-off' of responsibility can be avoided. (There is no joint commissioning in my area either, might work better in areas where there is?) I appreciate the attempt to pull together the SAF and LDPB report - I was always mystified that duplicated questions yielded different results, even the basic question of population size! Am wondering how some of the data required, such as inclusion of SU's and carers in training provided, will be generated. I would like there to be a requirement for all organisations to have a named lead for LD on the Board, and to demonstrate that person (and all safeguarding leads, if not the LD lead) on boards have undertaken LD awareness training, and have active connections to advocacy groups/reference groups/ forums which they use to inform their understanding of LD needs, and that they formally connect with each other to review local LD needs/ performance. Also wondering if some of targets for social inclusion need rewording with broader examples of what this means for the person as not sure examples provided - going to cinema, music festivals etc really says enough about this important target. What is social inclusion for people who don't want to attend these events ? Is this target more about opportunities and choice, community participation? I think these targets are in danger of being trivialised. I hope they can be reworded to convey more gravitas. I really do like the collection of stories idea - this is a good development as it allows people to be heard and is a good way to engage people in commissioning issues.

I agree with Mark Bradley, with regard to its agood idea to combine work and assessments, but the new consultation does not stretch specialist LD/ mental health services. There is no mention on improving services for people with challenging behaviour inlight of the Winterbourne report I thought there would be pressure to develop better community infrastructures and standards of care, as alternatives to hospital admission as a prority for keeping people in thier local communities and having control over their lifes. No targets or mention of access to mainstream mental health services, the framework seems to have a emphasis on physical health only. with people living longer . Planning for old age /end of life and dementia should be within the framework,and lastly I would have liked to have seen some target around advocacy .

Is there a detailed and clear guidance document for commissioners? There are three documents "The Measures", "The Data" and "The Compliance List" it needs to be absolutely clear how these relate to each other.

For 1C.... Amber = Health Action plan has been completed, directly as a result of an AHC, in the current year for 70% of patients. Green = specific health improvement targets that were identified during the annual health check for 50% of patients. I guess this means that for 50% of those with a Health Check generated HAP, health improvement targets have been identified? This is going to be hard to challenge. There is no target for the no. of health checks completed. So, in theory, if your area has done 5 health checks, 5 health action plans and has a couple of health improvement targets for those 5 people - you're green. It doesn't matter if 99% of people haven't had a health check. Personally, I think - forget the icing on the cake - please get the basics right! (We're green on this by the way but have fragile ambers for the no. of health checks using last year's measures). I hope this is replaced.

I see the logic of combining the Health and Social Care Self Assessments and understand the frustrations with duplication etc. However, looking through it, much of the specialist LD service element is lost. The previous 30 outcomes for health alone have been reduced to 24 combined health and social care outcomes? It will be interesting to see how well this holds the attention of CCGs and Public Health as the previous health SAF did? No mention of Prisons, Mental Health, Dementia, CB etc - I fear where specialist groups aren't specifically targeted, a lot of this valuable work will slip off the commissioning radar. This is despite the Winterbourne Programme of Action. Again, I understand the evils of wading through a huge assessment process (and the repetition) but I wonder if this is a necessary evil, given the heterogeneous and complex nature of effectively supporting people with LD? It seems more about the loss of SHAs and leads to support the Health Self Assessment with the unfortunate changes in NHS architecture. The first question about who will be the lead is a very good one. Also, I echo Lucy's thoughts on data collection and further guidance.

My initial thoughts were that it makes sense to combine the PB annual report and HSAF, however the more i think about it with the with the abolition of PCTs and creation of CCGS it will be difficult to get former PCT data and therefore the timing is not great. In areas where there are pooled budgets and lead Commissioning arrangements it will be easier, but not easy. There will need to be clarity about what is meant by 'your locality' - whether this is LA or CCG area, . I will do a full and detailed response. But some initial thoughts on the data collection are about do you mean number of people eligible for social care, on GP practice registers, or in the whole population??? - There would be 3 different answers to this question alone. Therefore further thought and guidance will be required to make this meaningful to draw any comparison

I think this is likely to vary. If the whole PB/SAF process is to be compelled, it will need to come from somewhere. For CCGs, would this be the Commissioning Board rather than the DH next year? For LAs, and I guess public health in LAs it would obviously still be the DH.

Amanda raises a really important point. I quite agree re CCGs as some LA areas have a number of them, and as this is a joint health and social care SAF, and social care is the lead agency, it would be logical for LAs to be the lead. However, getting learning disabilities onto Health and Wellbing Board agendas will not be easy due to the number of priorities they have.

I have a query with regard to which is meant to be the lead agency for completing the new SAF taking into consideration the demise of PCTs. If the lead agencies are CCGs then this would involve a vast amount of duplication. It would perhaps make sense for local authorities to be the lead agency for the SAF as they re Health and Wellbeing Board leads. I look forward to receiving comments as clarity is needed so that ownership of the SAF is allocated appropriately.