Presentation for

National Valuing
Families Forum
24 June 2015

People with learning disabilities

are an NHS England priority in 2015-16

*Department of Health. Valuing People: A New Strategy for Learning Disability for the 21st Century.

Transforming care for people with learning disabilities

what is NHS England doing?
1.

Changing how people in specialist hospitals are cared for Making sure that people only go into specialist hospitals when
there is no other choice, continuing to improve patient care,
treatment, and pathways for people to leave hospital.

2.

Investing in the community Working with partners to reduce the number of patients in
specialist hospitals and investing in more local community
services.

3.

Supporting young adults with learning disabilities Ensuring that all young people with a learning disability leaving
residential school will have an Education, Health and Care Plan
by March 2016.

4.

Reducing premature deaths -

Using information gathered about premature deaths to improve

future services.
5.

Collecting data Gathering information to make sure services are improving.

Transforming care for people with learning disabilities

The NHS England work is led by

Jane Cummings - CNO

Lead National Director

Dominic Slowie
National Clinical Director

Fiona Clark
Programme Director

Supporting patients with complex needs - carrying out in-depth Improving Lives reviews
for hospital patients with complex needs.
Best Care Now making sure that people only go into specialist hospital when necessary,
receive good quality care, and have a clear pathway from the start and all the way through to
leaving hospital with good care plans for the future.
Future Care Design - a new service model for commissioners to provide better local and
community-based services.
Reducing the number of people in specialist hospitals - planning to ensure that less
people are living in specialist hospitals for long periods of time.
Access to Healthcare improving access to key services, such as annual health checks.
Data and information collecting the right information to support services.

Transforming Care for people with Learning Disabilities

Next Steps
Five key work areas:
1. Empowering individuals giving people with
learning disabilities and/or autism, and their families,
more choice in and say over their care.
2. Right care in the right place ensuring we deliver
the best care now, whilst re-designing services for
the future; care should be in the community and
closer to home.
3. Regulation and inspection driving up the quality
of care.
4. Workforce developing the skills and capability of
the workforce to ensure we provide high quality care.
5. Data and information making sure the right
information is available at the right time for the
people that need it, and continuing to track and
report progress.

Cross System Transforming Care Programme - structure

Minister + cochair

Safe?

Making a difference
The Improving Lives Team
Supporting good quality care for people with learning disabilities
in specialist hospitals

Email - England.improvinglives@nhs.net

Improving Lives
Team

Defining a life...

Life No 1: Lisa
9 years in long term segregation.

5:1 staff ratio when required.

Communicated via a hatch in the wall.

The staff
observation
shed

Allowed Lisa to
be viewed in a
small area
surrounded by a
9ft high fence.

A worn
area of lino
where staff
would sit
during their
12 hour
shifts.

Improving Lives
Team

Defining a life...

Life No 2: Kenny
No clearly defined
treatment rationale.
Zero risk taking.

Staff team divisions

and burnout

5 years in long term

segregation... No stimuli, just
an anti-rip mattress.
The status quo supported a
containment approach to
challenging behaviour.

1500 incident forms

per month.

Sit in the corner of the room...Put your hands on your knees...Are you risk free?

Improving Lives
Team

Lisa now lives in

her own flat in
the grounds of a
small hospital
She has her own
belongings again
She goes out
twice a week shopping, to the
bank etc
There is still
some way to go,
but her life is a
lot better now

Making a difference
We stopped Kenny
from going to high
secure hospital
He has contact with
other patients again
He goes out every
day - 150 outings
and no incidents
Discharge from
hospital is now a real
possibility

The Improving Lives team was formed in 2014.

To review the care of the 48 people who lived at
Winterbourne View and other serious cases of concern.
Our film tells you more!

Email - England.improvinglives@nhs.net

Since 2014, the Improving Lives Team has carried out

over 100 in-depth reviews of the people who lived at
Winterbourne View and other people whose care is a concern.
Plus follow-up reviews,
CTR support, sharing events
and other work.

Improving Lives
Team

How we work
A review usually lasts two days
The team includes Experts by
Experience and professional advisers
We meet all the people involved
We make recommendations about
how the persons care can improve
At the review and in a report which the
commissioner sends to everyone
We carry out follow-up reviews to see
how things are going

Improving Lives
Team

What difference do we make?

Many services
and peoples
lives have
greatly improved

Its not just about being

discharged from hospital
Its also about making sure that
people have the best care now
and a good quality of life in
hospital eg. less medication,
less seclusion and restraint,
better health, activity,
communication, family and
patient involvement
Better safety and positive risktaking!
Reviews provide support,
advice, challenge and
recommendations

Improving Lives
Team

The big 3 questions

Improving Lives
Team

People tell us how they feel

I like exercise, I do it in my own room.

Staff and patients get angry and shout,
Its hard to get to the gym, because of the
then I get angry, I turn the music up full
(risk) levels. If I go back to level 1, I have
blast.
nothing in my room. On 2 I can keep
things. If I kick off they hold my arms but
Family carer: X should have moved nearer to home by
sometimes I go to seclusion.

The advocate comes on the ward

sometimes. Never talk to her. Dont
talk about worries with staff or
family. Dont want to worry them.

My support is good. Im treated with

dignity and respect here.

now but theres nowhere to go. We arent getting any

younger and its a long journey. Wed like to see him
settled in a place that will be a real home for a long
time, nearer to us.
This is my house. I like my house. My bedroom is
purple. My house feels safe. You can get the
police, the ambulance, be happy. I get on with
staff fine. Ive got five people. I helped choose
them. If I dont get on with staff, they get sacked.
Its important to get your own house, you feel
good, you live.

Improving Lives
Team

We provide support and challenge

We work in partnership with
the professionals
But we also challenge and set
goals where things need to
improve
We help to solve problems
And check that things have
improved
We take further action when
needed
And share the learning
Email - England.improvinglives@nhs.net

Improving Lives
Team

4 big themes around building better care

Weve made
about 800 recommendations!

Improving Lives
Team

Some recommendations were made

because services were not good enough
or not right for that person
If we had very serious concerns about
someones safety or care we dealt with
them there and then
Some recommendations were to help
really good services be even better

Improving Lives
Team

How have things changed since last year?

Eg. for the Winterbourne Group
357 recommendations made
200 completed
57 partially completed
29 not completed / not now
applicable

Improving Lives
Team

How our work is developing

Staying connected with Winterbourne
View group, providers and commissioners.

Our main work is now with other

in-patients and teams.
National outcome - Care and Treatment
Reviews.
Supporting other workstreams and teams
eg: reducing hospital admissions,
empowerment, discharge planning,
Using reviews to explore themes eg:
- Use of CTRs in high secure settings
- Impact of hospital closure on individual
patients

Improving Lives
Team

Our key strengths

Week-by-week practical experience of
people, places and issues faced
Ability to test out and research
Real life skills and experience

One of the first NHS England teams to

employ a person with a learning disability
Co-producing the work with partners
Our role and relationships with
commissioners, clinical and social care
teams
Email - England.improvinglives@nhs.net

Care and Treatment Reviews

Making Care & Treatment Reviews

(CTRs) everyones business
David Harling

Why do we need to carry out a

Care & Treatment Review?
We are still admitting too many people to
learning disability hospital settings.
Many people still feel hospital is the safest place.
We are still very reactive when peoples needs
change and this means we spend lots of time
responding in a crisis.
We see peoples behaviours as a disorder which requires
treatment.
There is a real lack of high quality community alternatives.

So what exactly is a Care &

Treatment Review?
A CTR is a person-centred review which can be used to prevent an admission
or to review the care someone is currently recieving in hospital. The review
carried out by a team of 3 people... the persons commissioner, an external
professional and a person with a learning disability or family carer as an
external expert by experience.

The CTR review team spend a day looking at the care the person is receiving
in the learning disability hospital. They meet the person, they read about the
person, the meet people who care for the person and they talk to people
who know the person well.

How will the Care & Treatment

Review help the person?
It provides a fresh pair of
eyes to look at the persons
care.

It can help providers to

think differently about the
care they are providing for
the person

If needed, it challenges the

current care and
treatment the person is
receiving.

It promotes the inclusion

of people with learning
disabilities and family
carers being recognised as
experts in reviewing care.
It helps to work out if the
person needs to be in
hospital.

It offers hope to people

who are in hospital by
making recommendations

What have we learnt from Care &

Treatment Reviews so far?
Better
alternatives to
hospital are
possible.
We need to improve
local planning for
people who we know
have complex needs.

Many treatments being

delivered in hospital
could be delivered in the
community.

Great
idea!

Sounds like
a plan!

Putting more resources

in place prior to
admission can prevent
admission.

Working flexibly, adapting

current resources and
being creative helps
prevent admission.
CTRs provide a valuable
independent opinion and
as a result actively kickstart peoples discharge

When do we carry out a Care &

Treatment Review?

CPA Care Programme Approach

REQUEST FOR ADMISSION

CHECK AT
RISK
REGISTER

ALWAYS
LOOK TO
PROVIDE

PLANNED
ASSESSMENT

Pre-Admission
CTR (CPA)

UNPLANNED
ASSESSMENT

RIGHT TO
REQUEST (CTR)

Blue Light
Meeting (CPA)

CPA within
2 weeks

SUPPORT AT HOME IN THE LOCAL COMMUNITY

DISCHARGE

1 YEAR
CTR (CPA)
MANDATORY

What next?
Between June and
September we will be
rolling out the new CTR
process and testing how it
works.

We will strengthen
our links with the
expert hubs/groups and
keep gathering the
learning.

We will be working closely

with the 4 regions of NHS
England and a number of
other stakeholders to embed
CTRs.

From September CTRs will

become business as usual
across the 4 regions of
NHS England.

THANKYOU FOR LISTENING

Any Questions?