Complex Needs Supports – Working Together JIT/MHD Regional Event Beardmore Hotel and Conference Centre, Glasgow > > Michael McCue > Joint Improvement Team

‘Complex Needs Supports – Working Together’ JIT/MHD Regional Event Beardmore Hotel and Conference Centre, Glasgow

> > Michael McCue

> Joint Improvement Team Action Group

Introduction and Scene Setting

> National Working Group – 2007 -2010> Service Modelling Exercise> Key Service Characteristics> JIT Capacity for Change Programmes> Related Work-streams ;

N.E.S / M.C.N./ S.A.Y.I.G./ P.M.L.D./ Service Transitions / Future Service Demand

Learning Disabilities Complex Needs

ISSUES OF TRANSITIONfor young people with learning

disabilities plus other complex needs

Dr Sally CheseldineJIT Associate

"Why is it so difficult to put (good transitions) into practice"

Mittler, 2007.

Who?

What does a good Transitions Process look like?

What range of services is required?

Who pays?

Evaluation and review

WHO?

"LD plus complex needs"

Issues: Consistency of definition; Age cut off

Robust data; Out of area

WHO? - RECOMMENDATIONS

National/local agreement on definition

Sharing information

Health Boards responsible for regional data

Forward planning/role of Public Health

WHAT DOES IT LOOK LIKE?

ONE plan: Start at 14th birthday

Named person in C/F & Adult services

Annual reviews/planning meetings

Good communication/information

Clear budget plan

Examples of good practice

SO:

Clear Pathway

Funding clarity

Information for families

User involvement

Adult services MUST engage

RANGE OF SERVICES:

Jointly funded; local;

Person-centred; effective

Trained workforce

FUNDING?

Move from out-of-area: Bridging?

Innovation

Rainy-day pot?

EVALUATION & REVIEW

Key service characteristics

Changing Demography of people with learning disabilities

Dr. Michael BrownLecturer and Nurse Consultant

Edinburgh Napier Universityand

Elaine KwiatekProject Manager

Learning Disability MCN

LEARNING DISABILITIESMANAGED CARE NETWORK

Aims of the presentation

•Overview of demographics issues

•Overview of health needs evidence

•Workforce issues•Challenges and opportunities

for the future

The wider determinants of health

Wider issues – Poverty & learning disabilities

‘Poverty can increase the risk of a child having an impairment… Having a disabled child can also mean that parents find it harder to maintain full-time employment, their housing can be inadequate for their child’s needs, and expenditure on basic needs is increased.’

Prime Minister’s Strategy Unit, 2005

Changing demographics of the learning disability population

• Estimated 120, 000 children and adults with intellectual disabilities in Scotland – few ever in hospital– Projected 11% increase over next 10 years – Increasing learning disability subpopulation – Ageing learning disability subpopulation– Increasing number of people with complex

learning disabilities• People with learning disabilities have greater health needs • Health inequalities exist and need to be addressed• Health needs never historically addressed

What the evidence tells us…

• Pre term infants with multiple disabilities

• Foetal alcohol syndrome disorder• ADHD• Autism Spectrum Disorder• Increasing numbers of people with

complex physical disabilities• Increasing numbers of older

people with complex needs and end of life care needs

• Changing demographic phenomenon

• Therefore increases at both ends of the lifespan

Common health needs

• Gastrointestinal disorders• Respiratory disease• Cardiovascular disease• Epilepsy• Cancers• Haematological disorders• Ophthalmic disorders• Musculoskeletal disorders• Accidents and trauma

Additional care needs due to: - • Autism Spectrum Disorder• Communication disorders• Challenging behaviours• Mental illness

For example….The UK Nursing Workforce

• The UK registered nursing workforce, as with many others in the developed world, is ageing.

• In 2008 1 in 10 was aged less than 30 years.

• One in three was aged 50 or older. • Over 200,000 nurses on the

register were aged 50 or older in 2008. (Buchan, 2009)

• Some learning disability nurses can retire at 55 creating a workforce gap

• Reflected in the workforce as a whole?

Workforce Planning in a Context of an Increasing Need for Services

• At the recent RCN Learning Disability Nursing summitProfessor Carpenter, National Director for SpecialEducational Needs, stated that there are now 950,000 children with learning disabilities in the UK, a 25% increase in the past 5 years.

• The number of children with profound and multiple learning disabilities has increased by 29 % over the same period.

• Children of today – adults of tomorrow….

21

What has this got to do with people

with learning disabilities?

Equality, inclusion and outcomes & the sweety shop

• Look and not touch?

• Equal access to health & social care will present challenges for the future

• Access & support has to lead to equal outcomes & wider inclusion

• Enabling access to services has to lead to person-centred care & outcomes

Changes in demand for support

• Increases in lone parent families

• Increasing rates of maternal employment

• Increases in % of older people with Learning Disability where parents have died or are frail

• Changing expectations among families regarding the person’s right to an independent life

The situation currently

• Co-morbidity will increase, with greater prevalence of gastrointestinal disorders, pneumonia, sensory impairments, epilepsy, dental disease and osteoporosis in the LD population – the list goes on

• Increasing demands on mainstream healthcare systems that are struggling to effectively meet needs now and will do so in the future

• Increasing demands on specialist health and social care systems now and in the future

• ? Policy mismatch - increasing demand V decreasing funds

Addressing the challenges of the future today

• The Numbers of People with LD is increasing and will continue to increase

• The level of healthcare needs experienced by people with LD is increasing and becoming more and more complex

• Workforce demographics• Knowledge, skills and experience

of the workforce• Models of care to meet changing

needs• Funding mismatch• Learning from previous

experiences of joint working

The Need for Learning Disability Practitioners in the Future

• There is a clear need for specialist learning disability practitioners in the future

HOWEVER…

• The role and function will be one of knowledgeable and expert practitioner who can educate, assess, plan, coordinate, safeguard and deliver evidence-based interventions for a population with high and complex care needs

The future direction?

Scanning the horizon to identify need and plan for the future

Where we want to get to …

Any questions?

[email protected]@nhs.net

mailto:[email protected]

mailto:[email protected]

Educational Solutions for Workforce Development

Developing the workforce in Learning Disability services

Tommy Stevenson

Educational Project Manager

NES


Project objectives

Scottish Government funding through Equally Well monies looking at health inequality and implications for workforce:

Analyse data on the educational needs of current workforce linked to models of care

Work with partners to identify existing educational provision and identify gaps short, medium and long term

Produce a report for consideration by partners on the future direction of learning disability health services and workforce needs

Commission appropriate educational resources


Strategic drivers

Same as You

Promoting Health Supporting Inclusion

Health Needs Analysis Scotland

Better Health Better care

Equally Well

Health for all Children

Inequalities in Health

Ready, Willing and Able

Self Directed Care and Personalisation

Autism Strategy ?


Principal care groups

Transitions (child to adult, adult to older)

Children, young people and adults who challenge services

People with long term and complex health conditions e.g. ASD, dementia, syndrome specific

Multiple care needs

General health care

Older people services


Initial activity

Project Management Group

Steering Group

Development of task and finish groups:

Transitions

Primary/acute care

Specialist services

Third sector

Education providers


Current picture

Complex and ongoing work streams:

JiT- Commissioning and integration in practice with strategic planning

QIS-A broad range of work streams (Tackling Indifference)

SAY national group- Reviewing and discussing all aspects of learning disability services including health

Learning disability and Co-Morbidity- Reviewing complex needs and mental health

MCN- models of care, partnership, integration and commissioning

A risk of duplication and being disconnected


Educational Solutions for Workforce Development- Factors for success?

Clarity of problem/issue that needs solving and clarity that the solution is educational

Workforce solutions are part of a bigger picture

Clearly linked to policy and service development agenda

Engagement and buy in

Impetus for implementation – targets and commitments (noting unintended consequences)

Realism. achievability, and sustainability

Scope, focus and reach

Synergy with other initiatives


Consulting with workforce

Initial Task & Finish Groups Targeted Focus Task & Finish Targeted Response

Transition

Acute/Primary Care

Mental Health and

Learning Disability

Complex Needs

Education providers

Third Sector

Acute/Primary Care

Transition:

Child to Adult

Complex Needs

Third Sector

Complex Needs

Managing knowledge requirements

The focus in consultation was to develop achievable and sustainable solutions to priority workforce concerns for people with a learning disability


INTER-CONNECTING ACTIVITY

People with complexity in care present with highest risk across the age range

A need for a skilled workforce across all agencies in managing complexity

Access to information which is up to date, informative and signposts to similar activity, skills development opportunities and knowledge enhancement

Joined up strategic intent

Person centred care and support as the driver for service delivery

Enhancing all areas of workforce on positive health supports statutory, voluntary and independent sectors

Generic health services focusing on acceptability, accessibility, responsiveness and developing initiatives which reduce risk and vulnerability

Specialist services which support and enhance practice sustaining people in their own communities

Essentials for Complex Need

Managed Knowledge Network

Developing initiatives which can bridge a broad range of priorities are more flexible, sustainable and, importantly, adaptable


General Health Care

Develop a workforce with shared understanding of the ‘vulnerable patient’ across primary and acute care

Support the workforce in identifying ‘champions’ in primary and acute care

Develop peer support worker model (Service users & Employment opportunities)


Third Sector

Look at current educational needs of social care staff

Current education programmes are they regulated and quality assured

Gaps in workers’ knowledge and skills in meeting complex needs


Children and Young People

Leadership

Partnership

Managed care

Collaboration of partners

Mapping into existing programmes

System to share best practice, map into existing initiatives and develop a single point of access.


Complex Needs

Meeting the needs of people with profound and multiple disabilities

Building capacity and capability in evidence based/informed interventions to work with people with challenging behaviours

Developing workforce capacity and capability to understand and respond to meeting mental health needs

Support to increase workforce capacity and capability to deliver evidence based psychological therapies through training, clinical supervision and infrastructure support

Develop a ‘new to’ or ‘essential pack’ on working with people with complex needs (encompassing values, attitudes, person centred focus)

Develop a managed knowledge network


Agenda to dateNational conference

Strategic position

Visible leadership

Workforce challenges

Discussion:

Integration across services

Complex needs and multiple disability

Shared education, examples in practice

Complex need and a changing workforce

Models of care/support


Investing

Developing/commissioning educational resources/programme:

Complex needs – The Essentials

Managed Knowledge Network ( learning disability)

Positive Behavioural Support Model - learning Disability Nursing/Allied

Health Professions

(Developing Capability/Competence)


Managing information

Most organisations know lots of things but they don’t always know what they know

Managed Knowledge Networks represent a dynamic approach to bridging the gap between “knowing and doing”, enabling people to link learning and practice. They operate by actively engaging people in building communities and managing knowledge resources in specific areas of practice

An electronic portal to support using information to improve care accessed by all partners

Information flows across boundaries


Lessons from the south!!

Evidence in relation to current workforce concerns highlight we are not:

Building around service needs and skills required to deliver them

Well integrated with service financial planning (Critical)

Holistic in its approach

Responsive to service changes and development

Supportive of multi-agency training and education


Lessons from the south!!

Fragmentation of planning

Lack of leadership and management ownership

Training and education weak across agencies

Career structures poorly informed


Thinking workforce

The ideal in workforce development

Service delivery

Service developmentEducation & training(skilling & reskilling)

Skilled workforce

Service user


Maximising workforce capability

Developing a shared strategic agenda

Sophistication in workforce information management

Detailed and informed commissioning

Being clear about knowledge investment and linking to models of care

Developing a financial plan which prioritises learning and compliments a partnership with colleges, HEI’s and other institutions/organisations


Leading workforce in difficult times

No tweaking around the edges

Transformation in workforce is required

A focus on quality, safety and value for money

A focus on innovation and change

Look at the long term challenges and opportunities

Retain the skilled and talented through the lean years

Designing a workforce for the future

> Origins> Service Transitions / P.M.L.D. / Complex Needs

> Intentions> Local / Regional Perspectives> Generate Key Issues / Challenges> Generate ‘potential’ responses

> Outcomes> Inform work of JIT and related work-streams> Produce brief Regional and National Reports> Promote Local / Regional ‘networking’

Documents

Complex Needs Supports – Working Together JIT/MHD Regional Event Beardmore Hotel and Conference Centre, Glasgow > > Michael McCue > Joint Improvement Team