National Learning Disability Commissioning Conference Report

Commissioners and the role they could play in reducing the risk of abuse of vulnerable people in care, feature in a newly available report on issues raised at the National Learning Disability Commissioning Conference held in March this year, in response to the Winterbourne View scandal.

Discussions centred on using commissioning and procurement to ensure good quality and appropriate services for people with learning disabilities.

The conference called for stronger leadership and effective strategic planning to aid improvements in commissioning; and for sharing of good practice.

A number of good practice sessions held on the day, details of which can be found in the report available on the Improvement and Efficiency website. 

A summary report  follows:                                   

National Learning Disability Commissioning Conference

March 2012

Summary Report

Introduction

Revelations by the BBC Panorama programme in June 2011 of the appalling abuse of residents in Winterbourne View Hospital, a care home for people with learning disabilities, led to a myriad of responses from government, statutory agencies, service providers, and advocacy organisations.

Actions taken in response to the situation were swift and essential for ensuring the immediate safety of residents; and for reassuring relatives, carers and the wider the public that Winterbourne View was not representative of the care provided across the country to some of our most vulnerable citizens.

This was not the first example of institutional abuse in recent times, but Winterbourne View highlighted the lessons from previous scandals had not been learnt.

Recent debates on what can be done to prevent similar situations from occurring have touched on the role of commissioners in commissioning and procuring services.

This aspect formed the basis of a conference held for learning disability commissioners in Birmingham, on 1 March 2012. Organised by the Association of Directors of Adult Social Services (ADASS) this report provides a summary of the key issues and challenges raised, and possible solutions.

A more detailed report is available on the Improvement and Efficiency West Midlands (IEWM) website. We hope its contents will add to the debate on how health and social care services can provide high quality, well judged services for vulnerable adults.

Background

The Death by Indifference campaign was pivotal to raising awareness of inadequacies in the way some vulnerable people are cared for.

Led by the relatives of six people with learning disabilities who died whilst in NHS care, the campaign resulted in an independent inquiry and the Six Lives report, which was published by the Health Ombudsman and the Local Government Ombudsman in March 2009.

It concluded that although there were sufficient policies and good practice guidance on planning and providing services, an urgent review was needed of the systems and resources in place to meet the often complex needs of people with learning disabilities.

Developments

Published in October 2010, the Six Lives progress report acknowledged advances had been made, but changes needed to go further. Particular reference was made to the need for commissioners to be clearer in their expectations of service providers and how they meet the needs of people they care for.

Complementing this shift in approach were government policies starting with the Valuing People White Paper (2001) and Valuing People Now (2009), which set out the context for commissioning of learning disability services. The latter publication also gave the Government’s response to the Death by Indifference independent inquiry.

The 2006 White Paper Our Health, Our Care, Our say, highlighted the need for personalised services for everyone including individuals with learning disabilities; and in December 2007 Putting People First was launched as the vision for personalised adult social care.

A Vision for Social Care (November 2011) continued with the themes in Putting People First, by emphasising greater control over services for individuals and their carers, as well as a move towards preventative care and support, and the removal of barriers between health and social care.

The reviews

A serious case review of Winterbourne View and associated issues is currently underway. Chaired by Dr Margaret Flynn, it will consider the role commissioning organisations play in initiating patient admissions to care institutions. Findings will feed into the wider Department of Health (DH) review which is considering implications for policy and practice throughout the health and care system.

DH is due to publish an interim report setting out proposals for actions and solutions before the summer 2012 parliamentary recess. It will be based on findings from the Care Quality Commission’s (CQC) focused inspections of 150 hospitals and care homes, following the Winterbourne View revelations.

Findings from the serious case review will be published after prosecutions arising from Winterbourne View have been completed.

Commissioning guidance post Winterbourne View

Responses and guidance on commissioning following the exposure of practices at Winterbourne View included:

• Demands for an end to commissioning of specialist hospital provision and for more locally based, customised services that meet the needs of individuals who are often labeled as ‘challenging’
• Introduction of an additional sub area to the Strategic Health Authority self assessment, that will focus on ‘commissioning for quality’. Included in the sub area’s data collecting responsibilities is a requirement for NHS commissioners to collate information on commissioning activity which will be available throughout the NHS in England     
• A letter from the Department of Health to local authority chief executives, and directors of both adult and children’s services, reminding commissioners of their responsibility to drive up quality; and requesting the appointment of a coordinating lead commissioner
• Draft guidance in the form of Improving the Health and Wellbeing of People with Learning Disabilities: An Evidence Based Commissioning Guide for Emerging Clinical Commissioning Groups, which has been piloted by a small number of pathfinder clinical commissioning groups
• Consideration of commissioning requirements as part of the DH Winterbourne View review.

The conference

The National Learning Disability Commissioning Conference was attended by 140 professionals from the NHS, social care, service providers, housing, advocacy and other organisations.

Chaired by Anne Williams, CBE, member of the DH expert panel reviewing the Winterbourne View case, former ADASS president, and former National Director for Learning Disabilities, the conference set out to:

• Agree the current position for people with learning disabilities, identify achievements and further objectives
• Reflect on best practice in commissioning and how to spread its use
• Agree a joint vision for the future and practical plans for its delivery
• Develop an understanding of the impact major changes such as NHS reform will have on commissioning
• Identify further support required.

Representatives from local government, health, the voluntary sector and academia held twelve separate best practice sessions – see details in Appendix 1.

Key messages

Conference participants identified a number of obstacles as hindering improvement to commissioning of services. These include:

• Lack of joined up leadership and effective partnerships in integrated commissioning
• Insufficient knowledge, experience and skills
• Distractions caused by NHS reform      
• Limited data and information on best practice
• Budget reductions
• Resistance to change.

Opportunities for improvements were also identified:     

• Using the Winterbourne View reviews as a catalyst for change
• Potential for developing a shared vision and understanding along with robust leadership to drive change
• Using key messages from the SHA self assessment to help shape commissioning practices
• Sharing of best practice as showcased in the conference workshops
• The enhanced role of the regulating body, the Care Quality Commission
• Potential to improve the quality of information and evidence available
•  Improved involvement and engagement with the development of Healthwatch the new consumer champion for health and social care.

Conclusion

A recurring theme throughout conference discussions was the need for strong leadership and effective strategic planning to aid improvements in commissioning of services for people with learning disabilities. Results from the Winterbourne View reviews may go some way towards addressing this concern; but in the interim, delegates have called for continued sharing of information, knowledge and good practice as a way forward.

Appendix 1

National Learning Disability Commissioning Conference March 2012

Best practice sessions:

· Paul McWade, Halton Borough Council: Developing a Positive Behaviour Support Service

· Viv Cooper and Cally Ward, Challenging Behaviour Foundation: Best practice in involving and engaging people with a learning disability and family carers

· Dave Clemmet, Salford Metropolitan Borough Council: Providing person centred support to people and their carers

· Bill Mumford, Managing Director, Macintyre and Chair of the National Market Development Forum: Best Practice, barriers and obstacles

· Frank Garvey and Louise Jenkins, Hertfordshire Health Liaison Team (Nursing Times Team of the Year 2011): Delivering fair and equitable health care for people with a learning disability

· Jayne Leeson and Belinda Dooley, Changing Our Lives and Sandwell Metropolitan Borough Council: Quality of Health and Quality of Life Standards

· Bob Tindall, Managing Director, United Response: Better and more cost effective support for people with complex needs and challenging behavior

· Professor Tony Holland, University of Cambridge: (CLAHRC): Providing good outcomes for people requiring complex, multi-agency interventions.