Agenda item

To receive an update of the current status, progress and upcoming plans for specialist Learning Disability and Autism inpatient provision within the Lancashire and South Cumbria Transforming Care Programme.

Rachel Snow Miller and Sharon Walkden, Midlands and Lancashire Commissioning Support Unit, Andrew Simpson, NHS England and Ian Crabtree, Lancashire County Council gave an update of the current status, progress and upcoming plans for specialist Learning Disability and Autism inpatient provision within the Lancashire and South Cumbria Transforming Care Programme.

Updates were provided on Medium Secure Units (MSU) and Low Secure Units (LSU) provision including the determined location of the MSU and the options for future provision of the LSU.

The paper also outlined plans for the future model of care for non-secure, Clinical Commissioning Group commissioned beds and the upcoming consultation process.

The current provision of CCG commissioned beds was through the Enhanced Support Service (ESS) based on the Mersey Care Foundation Trust (MCFT) Whalley site (Calderstones).  This was supplemented by a number of spot-purchased, out of area beds from independent providers.  At the start of the Transforming Care Partnership programme in 2016/17 Lancashire and South Cumbria were required to discharge 61 patients from Specialised Commissioning (SC) Beds and 46 patients from CCG commissioned beds.  Any patients who were admitted to ESS/out of area beds in the meantime were also added to the numbers counted.

Papers detailing transformational proposals and project timelines, in line with national requirements were presented and approved at the Collaborative Commissioning Board (CCB) and the Joint Committee of Clinical Commissioning Groups (JCCCG) in November 2017. The initial plan approved a two staged approach that incorporated an interim solution and the development of a long-term, permanent model.

Interim Solution - It was proposed that during 2018-19, care would be delivered through the optimisation of the existing ESS service on the MCFT Whalley Site.  This would enable patients from out of area placements to return to Lancashire and South Cumbria and help retain a highly skilled learning disability workforce.

Permanent Model – was developed by clinical experts within the North West Learning Disability and Autism Operational Delivery Network (ODN). Their proposed model satisfies the Building the Right Support (BRS) target for the Lancashire and South Cumbria footprint. The model incorporates:

·  Provision of 14-16 beds in a specialist in patient unit (a mix of rehabilitation and Assessment and Treatment beds) co-located / in close proximity to a hospital site and on a bus route and close to amenities/community. 

·  10 step-up / step-down placements (homes not beds).  It was proposed that these placements were Care Quality Commission registered as Domiciliary Care and not as hospital beds.  These placements would offer short term placements with a clear pathway into supported living once appropriate. 

In addition there would be a need for a number of individual tenancies for service users who would be provided with the necessary packages of support in their own homes.  Initially it was suggested that 10 such tenancies would be required.

Based on this approach the total model would take up to 2021 to deliver. It was now clear that this time line would not be acceptable to NHS England and that all learning disability patients must be relocated from the Whalley site by July 2019.  On that basis it was now recommended that the Transforming Care Partnership move directly to implement the permanent model without an interim solution with the ambition to move all patients off the site at Whalley by April 2020. 

A plan for public, patient and stakeholder consultation on the model of care was in development, this would comply with NHS England’s Four Tests for Service Change:

·  Strong public and patient engagement;

·  Consistency with current and prospective need for patient choice;

·  A clear clinical evidence base; and

·  Support for proposals from clinical commissioners.

For the consultation a six step process would be undertaken, underpinned by engagement and involvement with patients and carers, public, clinicians, staff and stakeholders.

The Board also noted the higher mortality rate for people with learning disability compared to the general population.  The Learning Disabilities Mortality Review (LeDeR) programme was aimed at making improvements to the lives of people with learning disabilities.  Reviews were being carried out with a view to improve the standard and quality of care for people with learning disabilities.  It was really important in supporting individuals, parents and families with complex difficulties and will support the Total Neighbourhoods programme discussed earlier.

Resolved:  That the Health and Wellbeing Board:

i)  Noted the update for Secure Inpatient Services.

ii)  Noted the update for the CCG Commissioned Inpatient Service.

iii)  Noted the update on the CCG commissioned beds consultation process.

iv)  Would receive a further update in relation to life expectancy and health and wellbeing outcomes for people with learning and disabilities and their carers.