Agenda item

The report was presented by Charlotte Hammond, Head of Service for Safeguarding, Learning Disabilities and Mental Health.

The report provided a summary and history of the Transforming Care agenda for people with a learning disability or autism and an update of progress. It informed members of Lancashire's inclusion in a National "Fast Track" programme, and its subsequent mainstreaming to form a Transforming Care Partnership, a strategically led, pan Lancashire collaboration of 8 Clinical Commissioning Groups (CCGs), 3 local authorities and NHS England specialised commissioners, to plan and implement the transformation needed.

Charlotte Hammond said that the pressure from NHS England to move people quickly from Calderstones into other care settings was a cause of some concern. Calderstones is a facility that provides medium secure, low secure and specialist NHS services to adult men and women with learning disabilities or other developmental disorders who present with extremes of serious challenging or offending behaviour. It was recognised that a new service model needed to be developed, however, a broad range of alternative provision would need to be provided to safely accommodate the 47 Lancashire people currently resident there. Ministry of Justice restrictions would need to be maintained in some cases, and it was most important that people with complex needs were placed in suitable settings which would best support them from the outset and take account of potential risks.

Charlotte explained that funding was also a significant concern given the pressures already facing local authorities. Negotiations were underway regarding the provision of a dowry from the NHS for those people currently resident in Calderstones who would be transferring to the care of the local authority.

Members were invited to make comments and raise questions and a summary of the main points arising from the discussion is set out below:

·  Members were most concerned about the funding of care for those people moving out of Calderstones and also funding of 'new' cases - those people with similar needs, not resident in Calderstones, who would require care in the future. It was explained that care packages for those moving out of Calderstones would vary, with some costing as much as £300,000 per year, but some costing much less. The annual cost was estimated to be £6 million; dowry provision from the NHS had not yet been ratified. There were also issues around changes to housing benefit. It was a very complex funding picture and future commitments were not yet clear.

·  The Committee was informed that a letter had been sent to the Secretary of State for Health expressing concern about the financial impact of the transforming care programme on the County Council. In response the Minister had provided some assurance that, as part of a whole system approach, investment would shift between services. What this would look like in practice was as yet unclear.

·  The Chair assured members that this Committee would liaise closely with the Health and Wellbeing Board in a joint approach.

·  The Chair informed Committee that the Steering Group was to meet with the commissioners of this service on 8 February to talk about the roles of the different organisations involved in the redesigning and commissioning of the community and in-patient services. The Steering Group would, as usual, report back to members; he invited other members of the Committee to attend if they wished.

·  There was some discussion about the type and range of support that was to be provided for the people leaving Calderstones. The Committee was assured that safeguarding was a priority and that personalised, cost effective support packages would be developed taking account of many possible risks, including potential for isolation and safety of housemates, carers and the public.

·  It was recognised that, for people with autism, change could be difficult to cope with and could often cause distress; members were assured that transition arrangements would be on a personalised basis and that significant recruitment was ongoing to ensure that sufficient staff were in place to provide the necessary support. The County Council was also looking at what support was already available in the community.

·  It was acknowledged that supported housing could be a good option for people with relatively low level needs, but Supported People Funding was currently being compromised.

·  In response to a question about how the residents of Calderstones felt about moving out, it was acknowledged that whilst some were excited about the prospect others were concerned and that some people liked the reassurance that a hospital setting could provide, especially in the short term. However it was believed that long-term residence in an institution did not lead to the best outcomes and that a learning disability and/or autism should not mean that a person must live in hospital.

·  It was confirmed that the people in Calderstones had access to advocacy services, indeed the Care Act 2014 was clear that people must have access to advocacy services to ensure that their voices were heard.

·  It was acknowledged that support for carers was an important part of planning risks and it was important to have services in place and to provide that support when carers said they could not cope.

·  It was recognised that, owing to ignorance and fear, members of the community might target individuals from this group moving into their area.  This was a concern and it was, of course, acknowledged that such attacks could be very distressing. It was expected that support staff would be present and it would be most important to carefully monitor such possibilities.

Resolved: That,

1. Progress made in developing the Transforming Care agenda in Lancashire be noted;
2. The Health Scrutiny Committee would provide future support and challenge that would enable effective engagement;
3. Discussions taking place regarding the funding arrangements for this group of people be noted; and
4. A further update report be provided to this Committee at its meeting on 14 June 2016.