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Achieving our ambitions for the life that people deserve: part one

In the first of two blogs, Dr Julie Higgins, NHS England’s Director of Transformation – Learning Disabilities and Senior Responsible Officer (SRO) for the Transforming Care programme, reviews the last year of work to transform care for people with a learning disability.

Transforming care for people with a learning disability is about much more than making sure people receive the best support we can provide, in the best possible place; it’s about giving people opportunities to live the life they deserve. We have those opportunities firmly in our sights and we are ambitious.

But in looking back over the last year, we must start with the foundation of this programme, which is first and foremost about supporting people to move out of hospital and into the community, and making sure their life is good there.

From April last year, the 48 Transforming Care Partnerships we set up to do that started publishing plans and we are now seeing beds closing – 148 last year; and new services opening – 21 last year. I am confident that his progress will lead to the improvements needed to enable people and families to live the best possible life.

Everyone rightly has high expectations of these improvements, because we published a service model setting out what support people should get. So earlier this year we produced a practical tool (service specifications) to help commissioners make sure services are developed in line with the model. £20m of transformation funding has already been allocated over the last two years and we have just announced over £10m more in the latest wave, to develop services that will keep people out of hospital.

The number of people in hospitals is coming down – in the year 2016/17 there were around 1,705 discharges from hospital to the community and nearly 190 people have been discharged who had been in hospital for five years or more.

This comes down to people’s ambition and determination to put things right, to give people a good life and opportunities to thrive. For example, in a recent article, the former joint SRO for Surrey TCP and former Assistant Director for Transforming Care for the Local Government Association, Jo Poynter, describes how in her area they successfully moved the rehabilitation service from being a bed-based service to a community support service, and relocated their assessment and treatment unit into the community.

The last stand-alone NHS hospital for people with a learning disability was absorbed into Mersey Care NHS Foundation Trust; and following an extensive consultation which over 1,000 people responded to, a decision has been made to move both medium and low secure services off the Mersey Care Whalley site (formerly known as Calderstones Partnership NHS Foundation Trust), re-providing services in a different way.

We are getting better at knowing what will keep people out of hospital – when we published the Care and Treatment Review (CTR) policy in October 2015 we committed to reviewing how they worked and learning lessons from their roll-out.  We have done that, and – following a wide-ranging consultation – we published a revised CTR policy earlier this year.

CTRs are our way of making sure that every effort goes into finding out what someone needs to live the best life for them, as an individual – of questioning everything. We have conducted over 5,000 CTRs since their inception. This includes over 2,000 in 16/ 17, and we are conducting on average 50% more CTRs per month than we did in the previous year.

Community services are being set up so we know the alternatives are available for people to go to a better place and remain there. In Arden for example they have established a new Intensive Support team – using Transforming Care funding from NHS England – which can respond quickly to make sure people aren’t readmitted, enabling several people to remain either with their families or in their supported living placement during times of crisis.

There is a renewed focus on children and young people: our work to transform care for children and young people has developed and focussed throughout the last year. In 2016 we received an impressive selection of bids for grants we gave out to groups to do work connected to NHS England’s Learning Disability Programme, which included the delivery of family support and Child and Adolescent Mental Health Services (CAMHS) services in woodland settings.

A new Care, Treatment and Education Review (CETR) has been  introduced to meet the specific needs of children and young people, ensuring their learning needs are also considered, working with key people from education.

We are around a third of the way through this three year programme and whilst we still have a long way to, I strongly feel we have the right components in place to succeed. I say again that this work is about people’s right to a good life, it’s about empowering people to take control of their life, and crucially and as we’ve shown this last year, not settling for anything short of our ambitions.

In the follow-up to this post I will talk about all the work that’s underway to understand where the inequalities lie for people with a learning disability – and, crucially, to close the gaps.

Dr Julie Higgins

Julie has held a number of NHS positions including Chief Executive, Deputy Chief Executive and Director of Public Health in PCTs; she led the development of CCGs in Greater Manchester. She has been the Regional Director of Commissioning in NHS England as well as and has been SRO for large scale hospital reconfigurations following hospital merger to improve child and maternity services. Julie was Vice Chair of the Greater Manchester Public Health Network which carried out a number of ground breaking public health initiatives including the development of the Greater Manchester Health Commission.

Before joining the NHS, Julie worked at London University in the field of immunology after gaining her PhD. Julie is a Fellow of the Faculty of Public Health. She has a strong commitment to reducing health inequalities and alongside her working life has undertaken voluntary work with Youth Offending Teams.

In her Current role as Director of Transformation/SRO Learning Disabilities she is leading on:- Reducing health inequalities and improving health outcomes for people with Learning Disabilities; Improving services and reducing reliance on hospital beds, for people with learning disabilities and/or autism with mental health issues and/or behaviours that challenge.

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