Agenda item

To provide a summary of the recent history of Transforming Care in England and an overview of Blackpool’s response to the requirements of Transforming Care for people with a learning disability and/or autism and other challenging behaviours.

Ms Helen Lammond-Smith, Head of Commissioning, Blackpool Clinical Commissioning Group presented an update regarding the development of Transforming Care for people with learning disabilities and/or autism and other challenging and complex behaviours.

She outlined the national background which led to the required local improvements. Crisis support existed in mental health nationally but until now had not for people with learning difficulties. NHS England had issued crisis support guidance.

Ms Lammond Smith stated that as with other health and social care work, it was necessary to help support people so that they had less need to access hospital services and could live independently, with support, in communities.

She referred to a key successful innovation ‘Care and Treatment’ Reviews which involved a small number of professionals (clinician, ‘expert by experience’ and a Blackpool Clinical Commissioning Group officer as the commissioner of services).  Care and Treatment Reviews looked at people’s needs to establish the best support required and where that support should be and aimed to ensure that people were only in hospital if necessary and sought to promote community-based options. Members noted that assessments took place every six months.

Ms Lammond-Smith explained that an ‘at risk’ register was maintained which identified people whose needs met relevant criteria for support and whether they needed to be support through hospital services or within the community. There were nine patients in hospital under various levels of secure settings and around another twenty supported through community care. The register included contingency plans and contact details of carers/families. 

She added that Care and Treatment Reviews were common for people with autism but it was possible more people with learning disabilities were not known to services. The register also aimed to capture the transitional element to ensure people progressed effectively from children’s services to adult services and were not ‘lost’. Details of children in residential care, including 15-16 year olds, were held and details of families. Effective responses to breakdowns in children’s care packages were prepared.

The Committee noted that key challenges included securing local specialist accommodation providers and good development support for well trained staff as current accommodation was costly as it was specialised and ‘out of area’ in Calderstones. Ms Lammond Smith stated that no local specialist facility existed but local provision needed to be developed. One problem for ensuring the most effective CTR assessment decisions was that staff were usually housed within mental health services but not always dedicated learning disabilities.

She added that ‘delayed transfers of care’ (availability of beds for patients moving between different stages of care in health and/or social care), as also referred to under the health and social care integration item, was a significant issue nationally and locally and also involving a great deal of reporting requirements.

She referred to the local governance arrangements for transforming care which were led by the Blackpool Clinical Commissioning Group and the Council who jointly shared transformation responsibilities.

The Committee referred to a recent local press article which had highlighted exceptional low budget levels for mental health services at just over 1% of commissioned health services locally which was one of the lowest rates nationally. Ms Lammond-Smith reported that the article was not precise or clear. Transforming Care was part of wider emotional health and wellbeing services which were well funded and Blackpool had the best rate amongst local neighbours.

The Chairman queried whether just having nine people in hospital meant that more people were being missed. Ms Lammond-Smith explained that hospital patients were those needing the most support in secure beds and included people who had committed offences resulting in court orders to be detained. These were complex long-term cases ranging from as much as three to fourteen years in terms of hospital stays. She added that the joint partners had undertaken some good work before the Review of Winterbourne View recommendations had been made. She advised the Committee that learning disability needs had been incorporated within the Accommodation Strategy and that whilst some patients needed to be placed within secure accommodation the ethos was still on promoting community care in, or as close as possible to, people’s homes.

The Chairman enquired what type of housing support provision existed. Ms Lammond-Smith explained that properties were mixed including some that offered support for 24 hours per day, 7 days per week and that most properties were shared occupancy.

The Committee enquired how many people with relevant conditions, who had committed crimes, were actually sent to prison rather than supported through transforming care. Ms Lammond-Smith did not have offending statistics but was able to confirm that relevant people would have assessments undertaken.

The Chairman referred to the community care focus and enquired whether safeguards were in place to ensure people were progressing well and safe. Ms Lammond-Smith explained that there were numerous process requirements for people securely detained under the Mental Health Act and that these included reviews, risk assessments and opportunities for patients to appeal against decisions. She added that people in hospital had the highest needs and costly, complex care packages.

Mr Marshall added that patients could be introduced through either the legal route or referrals from their GP and that for either route, best practice was for assessment and planning to start early at the admission stage with consideration being given early for progressing to community care and independence.

The Chairman requested assurance that families and friends were appropriately involved with patients’ wellbeing.  Mr Marshall explained that there was a statutory requirement to consult family and friends.  Ms Lammond-Smith added that they were also involved in assisting with Care and Treatment Reviews and concluded that those were proving highly effective in supporting patients’ needs and promoting their wellbeing.