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| Commissioning will be key in changing learning disability care | |
| (34 minutes later) | |
| Last summer, 24-year-old Jo moved from a secure inpatient setting in the west of England to a flat not far from her parents in the south. | Last summer, 24-year-old Jo moved from a secure inpatient setting in the west of England to a flat not far from her parents in the south. |
| Jo, who has a learning disability and behaviour regarded as challenging, had a history of self-harm and violence. Because local services doubted they could successfully support Jo, commissioners placed her far from home at a weekly cost of £5,500. | Jo, who has a learning disability and behaviour regarded as challenging, had a history of self-harm and violence. Because local services doubted they could successfully support Jo, commissioners placed her far from home at a weekly cost of £5,500. |
| However, after a review, commissioners found a supported living flat nearer home. After six months of transition planning involving family members, both providers, the commissioner and social workers, Jo moved into a self-contained flat with 24-hour support from two care staff. She now works on a local farm, sees her family more regularly, has stopped self-harming and is more settled. | However, after a review, commissioners found a supported living flat nearer home. After six months of transition planning involving family members, both providers, the commissioner and social workers, Jo moved into a self-contained flat with 24-hour support from two care staff. She now works on a local farm, sees her family more regularly, has stopped self-harming and is more settled. |
| Jo’s care now costs £3,100 a week, an annual saving of around £125,000 and commissioners are confident her placement is sustainable. Funds released from the closure of a local assessment and treatment unit will be reinvested into creating a community team providing support to prevent placements like Jo’s from breaking down – and families are involved in designing new services. | Jo’s care now costs £3,100 a week, an annual saving of around £125,000 and commissioners are confident her placement is sustainable. Funds released from the closure of a local assessment and treatment unit will be reinvested into creating a community team providing support to prevent placements like Jo’s from breaking down – and families are involved in designing new services. |
| Jo’s story shows how de-commissioning secure services in favour of community-based support can improve lives and save money. Her experience is shared in our report, Together we can, which focuses on effective commissioning in light of the recent plan from the NHS and local government, Building the right support (pdf). | Jo’s story shows how de-commissioning secure services in favour of community-based support can improve lives and save money. Her experience is shared in our report, Together we can, which focuses on effective commissioning in light of the recent plan from the NHS and local government, Building the right support (pdf). |
| High quality, sustainable support is vital for the 2,500 people with learning disabilities and autism in settings like assessment and treatment units, and for the 24,000 the NHS identifies as being at risk of inpatient admission. | High quality, sustainable support is vital for the 2,500 people with learning disabilities and autism in settings like assessment and treatment units, and for the 24,000 the NHS identifies as being at risk of inpatient admission. |
| But while a large number of people need to move from hospitals to home-based settings, the financial context makes that more complicated. This year alone we know directors of adult social care services (pdf) have made reductions by around 13% (or £17m) in residential services for people with learning disabilities. Meanwhile, NHS trust deficits totalled £1.6bn for the first half of 2015/16, which could compromise approaches to provision. | But while a large number of people need to move from hospitals to home-based settings, the financial context makes that more complicated. This year alone we know directors of adult social care services (pdf) have made reductions by around 13% (or £17m) in residential services for people with learning disabilities. Meanwhile, NHS trust deficits totalled £1.6bn for the first half of 2015/16, which could compromise approaches to provision. |
| So how do we commission more effectively? | So how do we commission more effectively? |
| The first step is communication and co-production. The perspectives of people and families are as important as those of professionals, commissioners and providers; it’s a network, not a hierarchy. | The first step is communication and co-production. The perspectives of people and families are as important as those of professionals, commissioners and providers; it’s a network, not a hierarchy. |
| Mutual understanding of different viewpoints could be encouraged by simple actions, such as a day in the life of a family member or service user. Commissioner and provider secondments could be trialled as part of the NHS transforming care partnerships that are piloting new models of support. Good communication creates mutual trust. | Mutual understanding of different viewpoints could be encouraged by simple actions, such as a day in the life of a family member or service user. Commissioner and provider secondments could be trialled as part of the NHS transforming care partnerships that are piloting new models of support. Good communication creates mutual trust. |
| Take Jo’s commissioners in the south-east. They have a strong relationship with local social care organisations through regular provider forums, and specific staff who manage commissioner-provider relationships. In another area a provider network created by the local authority receives all referrals from commissioners, so providers can spot gaps in support and develop provision. | Take Jo’s commissioners in the south-east. They have a strong relationship with local social care organisations through regular provider forums, and specific staff who manage commissioner-provider relationships. In another area a provider network created by the local authority receives all referrals from commissioners, so providers can spot gaps in support and develop provision. |
| Commissioning and procurement of social care services need to change. They can be largely mechanistic, carried out by centralised council departments with little expertise in support for people with complex needs. Providers’ procurement and tender costs are high. Organisations might be able to bid for contracts to provide services, but then find price is more important than quality. There is little to encourage innovation or enable providers to influence service design. | Commissioning and procurement of social care services need to change. They can be largely mechanistic, carried out by centralised council departments with little expertise in support for people with complex needs. Providers’ procurement and tender costs are high. Organisations might be able to bid for contracts to provide services, but then find price is more important than quality. There is little to encourage innovation or enable providers to influence service design. |
| In response, commissioners could provide data showing needs and likely demand for services for people with complex needs. Developing integrated personal commissioning – blending health and social care personal budgets – means people can more easily choose and buy support themselves. This provides important steps to independence so absent with inpatient approaches. | In response, commissioners could provide data showing needs and likely demand for services for people with complex needs. Developing integrated personal commissioning – blending health and social care personal budgets – means people can more easily choose and buy support themselves. This provides important steps to independence so absent with inpatient approaches. |
| Training and staff are vital. We need to build community workforce capacity so, as inpatient services close, the right skills, capabilities and – crucially – the right numbers of staff are in place. | Training and staff are vital. We need to build community workforce capacity so, as inpatient services close, the right skills, capabilities and – crucially – the right numbers of staff are in place. |
| Turning to money, we need funding for community services before closing inpatient beds. This is acknowledged in the Building the right support plan (pdf). But is the £60m of funding and £15m of capital the plan proposes adequate? Further challenges in some areas include the cost of housing and land on which to develop supported living services. | Turning to money, we need funding for community services before closing inpatient beds. This is acknowledged in the Building the right support plan (pdf). But is the £60m of funding and £15m of capital the plan proposes adequate? Further challenges in some areas include the cost of housing and land on which to develop supported living services. |
| Funding problems might be solved by bringing together people who use integrated personal commissioning, creating purchasing power and meeting combined needs. Social care can also do more to raise awareness of the need for supported housing. We need progress on social finance and social investment bonds to help finance this work longer term. | Funding problems might be solved by bringing together people who use integrated personal commissioning, creating purchasing power and meeting combined needs. Social care can also do more to raise awareness of the need for supported housing. We need progress on social finance and social investment bonds to help finance this work longer term. |
| Transforming care requires a long-term and pragmatic approach. The barriers are clear but, as Jo’s experience proves, not insurmountable. As one provider explains in our report: “It’s not all been roses, but it has been about having the provisions, the health teams, the providers, the families, working together and continuing support for the long run”. | Transforming care requires a long-term and pragmatic approach. The barriers are clear but, as Jo’s experience proves, not insurmountable. As one provider explains in our report: “It’s not all been roses, but it has been about having the provisions, the health teams, the providers, the families, working together and continuing support for the long run”. |
| Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) to keep up with the latest social care news and views. | Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) to keep up with the latest social care news and views. |