Case study summary
Newcastle Gateshead Clinical Commissioning Group (CCG) are supporting children and young people with a learning disability, autism or both to live in their own homes rather than in hospital. Their new learning disability co-ordinator role was created to help deliver the national transforming care programme.
Learning disability co-ordinator, David Cook, works with children and young people, their families and support staff to prevent them from going into hospital unless absolutely necessary. He makes sure there is capacity for the young people to live in the community and can provide additional support if needed. He reviews processes to make sure support is being provided in the best way.
When somebody does have to go into hospital, David makes sure there is a plan to discharge that person, and that everyone is working together to make this happen.
Using a dynamic support register to review people at risk
The CCG is developing a risk stratification process which will be used to avoid unnecessary hospital admissions. This focuses on knowing the local population and ensuring that every child, young person and adult at risk of being admitted to hospital has the right support to stay well and remain in the community.
They use a dynamic support register which helps the team respond better to incidents and events. It highlights and allows them to review the situations of people who are displaying behaviours which may result in significant harm to themselves or others, and/or are at risk of abuse or exploitation.
Care, education and treatment reviews (CETRs)
CETRs are designed specifically for children and young people, and aim to reflect the significant role that education plays in their lives.
The learning disability co-ordinator makes sure that any young person who has been identified through the dynamic support register process as at risk of admission is given a community CETR. This allows everyone involved to objectively review and address their current and future care.
When it is appropriate to admit a young person to hospital, and when someone is already an inpatient, David works with the multidisciplinary team to make sure that everyone is planning for and working towards their discharge, so they are in hospital for a minimum length of time. They do this by attending relevant meetings and supporting the case management process.
Cohesive support for families
The CCG are now working with the children’s services and health teams, to make sure all relevant children and young people are included in the dynamic support register process.
David says: “If it wasn’t for this role, families would have to contact lots of different people so I’m here to make sure that services are joined up. I can give cohesive support for young people and their families when they most need it.”
The learning disability co-ordinator also works with adults with a learning disability, autism or both to provide support to help them live at home.
Contact: David Cook at email@example.com