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Transforming CareNext Steps
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Contents
IntroductionAbout Transforming Care page 4
What we are doing now page 7
Our next stepsEmpowering people and families
Listening to what people told us page 10
Care and Treatment Reviews page 12
Getting the right care in the right place
Stopping people going into hospital whenthey don’t need to page 15
Changing the shape of services page 18
Supporting commissioners to work togetherto transform care page 21
Making quality better with rules and inspections (checking) page 22
Building and supporting the workforcepage 24
4Transforming Care
About Transforming Care
After the Winterbourne Viewscandal, the Governmentsigned an agreement onTransforming Care.
Transforming Caremeanschanging things from thebottom to the top to makehealth and social care better.
The Government and organisations across healthand social care are makingplans to transform care forpeople with learning disabilities, autism, mentalhealth issues or behaviourthat challenges.
Introduction
5
But people are angry andfrustrated because we havenot done enough.
Too many people with learning disabilities go intohospital when there shouldbe a better option for them.
The agreement promised tomake health and socialcare better and to move allpeople with learning disabililties and/or autismwho should not have beenplaced in hospital into community care.
We have made someprogress so far. You can findout about what we havedone so far in our report ‘TwoYears On’.
Transforming Care
6Transforming Care
When people do need to goto hospital, they often stay inthe hospital for too long.
Sir Stephen Bubb wrote a report for NHS England onhow to make things better,faster.
The report was about theplan to move more peoplewith learning disabilitiesand/or autism out of hospitalsand into the community withsupport.
Too often the living conditions and care in hospitals are poor.
7Transforming Care
We know that there is a lot ofchange that needs to happen, and we are goingto work together to makesure we succeed.
You can read Sir StephenBubb’s report to find outmore about what he recommended to do.
http://www.england.nhs.uk/2014/11/26/learning-disabilities-action/
NHS England, the Department of Health, theLocal Government Association (LGA), the Association of Directors ofAdult Social Services(ADASS), the Care QualityCommission (CQC) andHealth Education Englandare working together.
What we are doing now
8Transforming Care
We want all of our work to beco-designed and co-produced in partnershipwith people with learning disabilities and/or autism,their families, carers, doctors,commissioners and other organisations in the healthand social care system.
We have made a deliveryboard that includes the people who are most responsible for makingchange happen from eachof the organisations. NHS England will chair thedelivery board and ADASSwill be the deputy chair.
We made a plan that showshow the Transforming Careteam are going to work together and who is responsible for what. Theyeach have different rules andlaws to follow.
9Transforming Care
10Transforming Care
Sir Stephen Bubb’s reportsaid: “People with learning disabilities and/or autism andtheir families have an array ofrights in law or Governmentpolicy … [but] the lived experience of people withlearning disabilities and/orautism and their families istoo often very different. Toooften they feel powerless,their rights unclear, misunderstood or ignored.”
The Department of Healthwants to put ‘individual wellbeing’ at the heart of decisions made by healthand social care organisations.
Our next steps
Empowering people and families
Listening to what people told us
They want to make sure thatpeople are fully included inchoosing the options that areright for them.
They want to do this by looking at how services andsystems join up around people and empower them.
The Department of Healthalso wants to look at how theMental Health Act works forpeople with learning disabilities and/or autism.
Some examples of this arepersonal health budgets andtreatment and support in thecommunity.
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12Transforming Care
Sir Stephen Bubb said thatpeople should have theright to challenge the careand treatment they aregetting.
NHS England will offer Care and Treatment Reviews (CTR) for people in hospital or families of someone in a hospital if they ask for one.
CTRs will support patients andtheir families to have a voice,and will support everyone towork together and plan forthe person to come out ofhospital and into community.
The CTR will be done by ateam of experts, which will include a doctor and an expert by experience. The expert by experience couldbe a family carer or a personwith learning disabilities.
Care and Treatment Reviews
13Transforming Care
CTRs will be options for everyone, including for patients who in the past haddoctors say there was a reason they should not leavehospital.
CTRs will be able to make recommendations on how toget the right help and support in the community orat home and make a planfor patients to leave hospital.
The experts will work with theperson and their family to askwhether the person needs tobe in hospital and why theircare and treatment needscan’t be supported in thecommunity.
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By mid-January we had doneover 1,000 reviews and weexpect to do many more before April.
566 of the people who hadCTRs were able to leave hospital by the middle of January.
We want to make sure thatall people with learning disabilities and/or autism thatare in hospital but do notneed to be in hospital canmove into community care.
Recently NHS England hasstarted a programme of CTRsfor people who have been inhospitals the longest andwho don’t have a plan forleaving hospital.
Getting the right care in the right place
We are going to review theway we have done theseCTRs to make sure that welearn lessons and make thembetter in the future.
The NHS is making somethingcalled an admissions gateway to stop peoplegoing into hospital whenthere are better alternativesin the community.
More CTRs will be happeningin 2015, and this should meanmore people with a plan toleave hospital soon.
Stopping people going into hospitalwhen they don’t need to
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16Transforming Care
There are a lot of things wewant to do to make this happen:
• Make sure we knowabout everybody who is atrisk of going into a hospital sowe can check up on howthey are doing.
• Work out the reasons foreach person at risk andmake sure we have a plan toavoid them going into hospital.
• Have a process for challenging every decisionfor someone to go into hospital to check that there isno better option for that person.
17Transforming Care
• Make sure that plans forpeople to come out of hospital go into action andare regularly checked.
We want to work with peoplewith learning disabilitiesand/or autism and their families to test how the admissions gateway is working and to put it into action this Spring.
• Make sure that everyperson who goes into hospital will have a plan,from the very beginning, forcoming out of hospital intosupport in the community orto return home.
18Transforming Care
The NHS also wants servicesto be changed in a biggerway, from the bottom up,and they want thesechanges to last.
Some commissioners don’thave a very clear idea ofwhat kinds of services theyshould commission, and whatkinds they shouldn’t.
So they will use what peoplehave found out in theirresearch to help them makedecisions about services.
Changing the shape of services
We want to develop good,local, personalised services.
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The model will tell commissioners things like howmany hospital beds theyneed, how many peopleneed community supportand what kind of services areneeded in the community.
NHS England, the LGA andADASS are going to workwith people with learningdisabilities and/or autism,their families, carers, doctors and other expertsto make a new model forspecialised health and social care services for children and adults.
Individual plans for care andsupport, personal budgets,personal health budgets andquality standards will be important parts of this newmodel.
20Transforming Care
Commissioners will need different support to makechanges to how they commission services.
In the North of England, weare going to do some extrawork with local leaders tostart making changes to services fast.
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The model will set goals forthe changes we want to seeand standards for the qualityof services.
NHS England will check howwell the commissioners areusing the new model.
Sir Stephen Bubb’s report saidthat having work split between different organisations can make itharder to change care.
NHS England, the LGA andADASS want to support jointworking and shared budgetsbetween CCGs and localcouncils.
Supporting commissioners to work together to transform care
Transforming Care
From April 2015, CCGs willalso be invited to work withNHS England to co-commission specialisedservices and work together to transform services.
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22Transforming Care
In 2015/16 the Care QualityCommission (CQC) will keepworking to make their inspections better.
They will keep doing plannedand ‘surprise’ inspections.
They will make sure that theservices that are not goodenough will be closed.
Making quality better with rules andinspections (checking)
23Transforming Care
The CQC will be strict on newhospitals and try to make surethat they are supporting thebest models of care.
They need to work with others to make sure that closing these services likehospitals with poor care doesnot make a bigger problemfor patients who are most inneed.
The CQC will make sure community services are giving safe, caring andfriendly care for people whohave the most needs.
The CQC will change theway they inspect regular hospitals and doctors tomake sure they meet theneeds of patients with alearning disability.
24Transforming Care
We need to develop the skillsand knowledge of the workforce that gives care,such as care assistants, familycarers, doctors and nurses.
Skills for Care, Skills for Healthand Health Education England (HEE) are going towork with people who needcare and support, families,carers and other organisations to make surethe workforce understandsthe needs of people withlearning disabilities.
Care should be shapedaround people’s individualneeds and should be localand accessible.
Building and supporting the workforce
25Transforming Care
• Make sure the workforceknows how to work well withpeople to find out their needsso they can help them in thebest way.
To do this, they want to: • Make sure the workforceknows about the physicaland social health needs ofpeople with learning disabilities, autism, mentalhealth issues and physical illnesses.
• Make training programmes and courses forthe workforce to learn aboutthese things.
• Making national standards for skills and knowledge in the workforce
26Transforming Care
• Make sure that thechanges in the workforcemake things better for thelives of people with learningdisabilities.
HEE is going to raise awareness in the workforceof the needs of people withlearning disabilities, autismand mental health issues.
HEE is going to make surethat their work reaches theworkforce in the criminal justice system and in socialcare too.
HEE knows that the criminaljustice and social care systems also serve peoplewith learning disabilities andautism, not just the NHS.
27Transforming Care
HEE will teach people in theworkforce how to becomeexperts and leaders on theneeds of people with learning disabilities, autismand mental health issues.
This easy read document was produced by CHANGEwww.changepepeople.org
Transforming Care
