Case study summary:
A new, collaborative approach between system partners has helped address health inequalities while transforming the lives of people with a learning disability, autism or both across Leicester, Leicestershire and Rutland Integrated Care System (ICS).
Judged as failing by regulators in 2020, Leicester, Leicestershire and Rutland ICS have transformed their learning disability service to one that’s now in the top third for performance in the country. 25% fewer people have long term stays in hospital since 2019.
Leicester, Leicestershire and Rutland ICS.
What was the aim:
The aim was to remove barriers for autistic people and people with learning disabilities in accessing true integrated care, with the end goal being a more seamless, flexible, person-centred service where people with additional needs are helped to live happy, fulfilling lives, closer to their families and carers.
What was the solution:
Recognising that the needs of service users were best met through collaboration, partners from across the system including social workers from three local authorities, NHS providers and commissioners came together in autumn 2020 into one virtual team to transform services and embark on a transformation programme together.
This commitment to remove gaps in care pathways and ensure that people with a learning disability, autism or both receive better integrated care led to the formation of the Learning Disability and Autism (LDA) Collective.
They wanted to achieve national standards by March 2021 and used a set of clear goals to hold themselves to account, such as:
- deliver annual health checks to more than 67% of their eligible population with a learning disability
- complete every learning from a death review (LeDeR) within six months
- have 38 adults or fewer in long-term hospital stay.
What were the challenges:
Overcoming a negative culture, which many staff said was making closer integration more difficult. Staff had to get people to see the difference the learning disability service could make to tackling health inequalities and the wider determinants of health, and that it wasn’t just a niche provider of care.
What were the results:
Judged as failing by regulators in 2020, Leicester, Leicestershire and Rutland ICS have transformed their learning disability service to one that’s now in the top third for performance in the country.
By March 2021, they carried out more health checks in 2020/21 than ever before, delivering to 71% of their eligible population with a learning disability. For the first time ever, they completed every LeDeR review within six months and reduced their long-term hospital stay figures by 25% since 2019.
Continuing to recognise the challenges within their system, NHS and local authority partners have worked together to increase the availability of local accommodation to improve their discharge pathways from hospital. Additionally, system partners have led on 25 quality improvement initiatives.
As a result of this partnership working, duplication of work has been removed with different teams coming together to resolve shared challenges and protect people with autism and/or learning disabilities from falling into gaps in care pathways created by prior organisational silos.
What were the learning points:
Right from the beginning, their success can be attributed towards the system’s commitment to delivering a full cultural change and recognising the valuable insight that different system partners bring when coming together to design and deliver solutions for their local population.
Prior to this transformation, the service’s work was seen as specialised. Through their work on annual health checks, they have shown system partners how individuals with additional needs can and do access primary care services.
This approach has spotlighted how important it is to support hard-to-reach communities, ultimately changing how other services are provided and helping to tackle wider inequalities.
They continue to ensure that everyone in Leicester, Leicestershire and Rutland understands the need for people with a learning disability, autism or both to lead fulfilling lives and their role in supporting this.