Agenda item

To receive information on the progress in delivering the actions and outcome contained in The Big Plan 2018-21, which is a Health and Social Care Commissioning Strategy for Adults with a Learning Disability, since it was published in 2018.

The Head of Strategic Commissioning – Disabilities briefly explained Item 6, ‘The Big Plan 2018-21 Commissioning Strategy for Adults with Learning Disabilities Progress’, before introducing the People First Forum.

The Assistant Manager of the People First Forum explained the group’s current structure, their aims and vision, the services they provide to the community and the main enquiries that they receive. These enquiries ranged from questions on emotional wellbeing, assertiveness, being heard and the groups and events that the group organise. Members were told of the Safe Place project, the Witness Profiling service, the Easy Read Information and Quality Checking work that the People First Forum had undertaken. The Committee were told about the main events that the People First Forum arrange in the community, including the Big Night Out with Suttles that is attended by 600 adults with a learning disability.

The trainer for the People First Forum explained what the Bill of Rights Charter was, what the main rights were, how the Charter had been developed and how many organisations had signed up to it. The group’s members had agreed that the Charter should include the following rights: the right to feel safe when going out, to feel safe when at home, to receive support when needed, to relationships, to say no, to confidentiality, to independence, to public facilities, to good healthcare, to be heard and to have feelings and more. The Committee were asked whether they would continue to support the Charter and whether it would be part of BCP Council’s plans in the way they work. Finally, the Trainer provided some significant figures and information on how rights had not been respected for adults with a learning disability or autism.

Members commented on the successes of the People First Forum’s work and noted that over 800 people had become members of the group. It was explained that new members often joined after attending a People First Forum social meeting or after visiting a friendship centre. A question was asked on whether the People First Forum could attend the Council meeting at which the Bill of Rights Charter would be considered. The Democratic Officer advised that if the Committee were minded to include this in their recommendation to Council, this could be investigated and the possible arrangements would be assessed.

One member asked about the challenges that adults with a learning disability or autism may face when voting in elections. The Committee heard that Easy Read material was produced nationally to assist people with a learning disability or autism when voting, and that this was very important in supporting them during this process.

The Head of Strategic Commissioning – Disabilities gave a presentation on the Big Plan 2018-21 Progress Report. To start, an overview of the local population of people with a learning disability across the BCP area was given. 820 people received Adult Social Care services, 2,467 were registered with a GP and 7,772 was the estimated number of those with a learning disability in the local population.

From this, the Head of Strategic Commissioning – Disabilities explained that the priority workstreams for transforming the care of those with a Learning Disability or Autism were as follows:

·       Preventing and reducing the specialist in-patient placements.

·       Conducting quality assurance visits every 6-8 weeks.

·       Conducting Care Education and Treatment Reviews (CETR) and Care and Treatment Reviews (CTR).

·       Encouraging Annual checks for people with a Learning Disability.

·       Identifying common themes and learning points from the Learning Disability Mortality Review Programme (LeDeR).

·       Engaging with the Supporting Appropriate Medication reviews (STOMP/STAMP).

The Committee were informed of the in-patient numbers and annual health check figures. It was heard that only 35% of adults had attended an annual health check in the first three quarters of 2019/2020. However, this was noted as being ahead of the 2018/2019 trajectory for the same period. The Head of Strategic Commissioning – Disabilities stated that 53 reviews of the LeDeR had been undertaken in 2019/20, 9% of which resulted in recommendations for the service. It was heard that these recommendations are followed up on a routine basis. The Committee were told that the CETR/CTR process had been developed and was in place and that monthly cohort meetings were scheduled to review at-risk cases. Similarly, a medicines optimisation transformation group had been formed to oversee polypharmacy and prescribing activity. This coincides with the STOMP/STAMP campaign which had been shared and publicised.

The Head of Strategic Commissioning – Disabilities summarised the programme’s Key Longer-Term Developments up to 2023/24. These included:

·       National learning disability improvement standards for all NHS funded services

·       A ‘digital flag’ in the patient record to ensure staff know a patient has a learning disability or autism.

·       A designated keyworker for all children and young people with a learning disability, autism or both who have the most complex needs.

·       The offer of the opportunity to have a personal health budget (PHB), where eligible.

The Committee were then shown an overview of the ‘Big Plan 7 Big Aims’ and were updated on their progress. With this, members heard that out of an overall thirty-seven pieces of work scheduled to be completed, thirteen had been started and five had been completed. There were no pieces of work that had not been started or were delayed.

Members were updated on the ‘Big Plan’s key successes, for example: the increase in availability of supported accommodation, the formation of the BCP wide Learning Disabilities and Autism Care and Support framework and the fact that there were no out of area CCG commissioned adult admissions in 2019/20.

An area where further work was required included to increase the uptake of annual health checks for people with a learning disability. Also, employment support opportunities that are built around the individual and developing support in the community were both identified as areas of improvement.

The level of completed health checks was raised as an issue by members, specifically why this figure was so low. The Director of Primary and Community Care provided further information and context around the figures. The Committee heard that level of health checks was expected to be around 55% by the end of the final quarter. One area of improvement that was highlighted was the de-medicalisation of the offer and for thought on how and where health checks can be undertaken more successfully. The role of Healthwatch as being a critical partner in developing the offer for health checks was raised during the discussion. One member asked how people with a learning disability or autism were notified and reminded of their health checks, to which the Committee were informed that an Easy Read style letter was sent by the relevant GP Practice as an initial first point of contact. Additionally, the ‘Yellow Health Book’ was referenced as a resource that assisted with health-related matters including a person’s health information and their health action plan.

Both the Assistant Manager and Trainer of the People First Forum gave information on the barriers that they and others had faced when attending a health check. It was heard that the experience of attending health checks differs from person to person and that practices and doctors are received differently by different service users.

A Councillor not on the Committee, Cllr D Butler, addressed the Committee and asked whether mobile health checks had been considered to accommodate for those individuals who may struggle with attending GP practices or hospitals. The Director of Primary and Community Care NHS Dorset Clinical Commissioning Group responded to the question by explaining that a model for mobile health checks was being explored and that the service understood the importance of working out in the community.

A Member commented on the LeDeR and the mortality levels, highlighting that these were not good enough. The Director of Primary and Community Care NHS Dorset Clinical Commissioning Group explained that the Learning Disability and Autism Board discussed this topic at their last meeting and feedback was given to those partners who provide services. The Head of Strategic Commissioning – Disabilities informed the Committee that meetings are held with the relevant service providers three times a year and that LeDeR is a standing item at these meetings.

A member of the Committee suggested that a People First Forum training session be offered to all members of the Council to better inform Councillors of the experiences and the work/services that they do in the community. The motion was proposed and seconded, and the Committee agreed to request a training session be arranged for all member of the Council by the People First Forum to Council. Another member of the Committee suggested that the People First Forum be invited to the future Council meeting where BCP Council will be recommended to formally adopt the Bill of Rights Charter. The Democratic Officer advised the Committee that they would work with the Chair and key officers to assess how the People First Forum could engage at the future Council meeting.

RESOLVED that:-

The Committee agreed to:

(a) In conjunction with the Cabinet member for Health and Adults recommend to a Council that the Bill of Rights Charter for people with a Learning Disability is formally adopted by BCP Council.

(b) Request that a report is presented to the Committee for scrutiny in March 2021 on the progress in delivering of the Big Plan 2018-2021 and in preparations for developing a future strategic plan.

(c) Request an update in six months on the progress of health check figures and an item on the Council’s paid employment offer for adults with Learning Disabilities and Autism.

(d) Request that a training session be offered to all BCP Councillors by the People First Forum of their experiences and the work/services they do in the community and for the People First Forum to be invited to the relevant future Council meeting.