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.
