NHS Rotherham. Contact Details: Lead Director: Kath Atkinson Lead Officer: Alice Kilner Title: Director of Strategic Planning and Development

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1 Board - 20 September 2010 NHS Rotherham Feedback on the 2010 NHS Rotherham Submission under the Yorkshire and Humber Strategic Health Authority Learning Disabilities Health Assessment Framework Contact Details: Lead Director: Kath Atkinson Lead Officer: Alice Kilner Title: Director of Strategic Planning and Development Title: Joint Commissioning Manager Purpose: To provide feedback to The Board on the 2010 Learning Disability Health Assessment Submission to the Yorkshire and Humber Strategic Health Authority (SHA). Recommendations: The Board is asked to note the outcome of the assessment and the progress made in improving access to health services for people with a learning disability in Rotherham. Background: The NHS Rotherham Board received a report at their meeting on 17 th May 2010, which outlined work to improve health and access to health services by people with a learning disability in Rotherham. The Board also received the scores which NHS Rotherham and its partners in the Local Authority (Joint Learning Disability Service and Learning Disability Partnership Board) had sent to the SHA in April 2010, in their third annual submission on the Health Assessment Framework. Since the Board Meeting, colleagues from Rotherham including the two co-chairs of the LD Partnership Board - attended a validation meeting with the SHA to discuss our submission, and in late July we received letters of feedback, and information on our scores relative to those in the rest of the Region. This feedback has been overwhelmingly positive. The Yorkshire and Humber Healthy Ambitions Chapter mentioned in the May 2010 report to Board - was published on 6 th September The report will be discussed by the Health Sub-Group to the Rotherham Learning Disability Partnership Board at their meeting on 5 th October 2010 and any actions arising from it will be taken forward by this group. Analysis of Risks: Capacity to maintain and improve our position in the 2010/11 health assessment and beyond.

2 2 Mitigation: A health support team has been established in the Joint LD Service, with a service specification which includes their lead responsibility for key aspects of this work. Delivery of the action plan now rests with the Joint Service and this will be performance managed by the Partnership Board s Health Sub-Group Chaired by Alice Kilner. Ongoing prioritisation of this agenda with up-coming changes to NHS commissioning arrangements Mitigation: The Partnership Agreement and lead commissioning arrangements give on-going responsibility for commissioning services, including specialist health services for people with a learning disability to the Local Authority. Under the current government proposals Local Authorities will have a new responsibility to tackle health inequalities and though our joint work the LA has already demonstrated its commitment to this important work-stream. NHS Rotherham and Local Authority commissioners will aim to raise this important priority with future GP consortia as they emerge. Future funding and sustainability of the GP Learning Disability Annual Health Checks Directed Enhanced Service (DES). The GP annual health checks provide important data for the assessment exercise and are a significant opportunity for people with learning disabilities to have any health issues identified, and where possible resolved, early. The DES was a two year agreement, ending 31 st March A series of options and an action plan is being developed for sustaining the annual health checks beyond March Additional funding would need to be found if the DES is to continue nationally, or if a local enhanced service is developed. There has been no announcement to that effect so far. Return on Investment: NHS Rotherham have funded a full-time Strategic Health Facilitator (liaison nurse) post for 18 months from Sept 2009 and, until June 2010, provided project officer capacity in the MH Programme Team to support the annual health assessment and action plan. The significant progress in the last 12 months is in large part due to the increased capacity and a more robust project management approach. Analysis of Key Issues: Annual Health Assessment Submission 2009/10 NHS Rotherham and our partners completed the third annual self assessment against the SHA Health Assessment Framework between January and April Each year managers in NHS Rotherham and in the Joint Learning Disability Service have developed a local action plan following the assessment submission, and provided feedback to PE and NHS Rotherham Board with the results. The submission for 2010 was sent to the SHA in mid-april and we met with them in mid June to validate our scores. We received detailed feedback and a comparison of our scores with the regional picture in late July and a Regional Overview Report in early September. A report on the outcomes of the assessment and validation was provided to PE on 1 st September Last year Rotherham appeared as an outlier in the region and we were told that our scores did not properly reflect the good progress that had been made. At our meeting with the SHA in June 2010 they commended us on the significant changes to our scores and on the robustness of our local processes, in particular for involving service users and carers.

3 3 The Rotherham scores for the four overall targets are as follows: Target T1 People still in hospital or campus settings Green Green T2 Access to mainstream NHS services Green Red / Amber T3 Safety (in NHS services) Green Amber T4 Services for those needing more support Amber Red / Amber This demonstrates the significant progress that has been made since the last assessment. A copy of the feedback letter from the SHA and a table containing the detail and the scores are attached (Appendix 1, Appendix 2). The comparison of Rotherham s scores with those in the rest of Yorkshire and the Humber is contained in the Regional Overview Report (attached Appendix 3, pages 18 &19). Rotherham appears as the second top performer in the Region in these tables. NHS Rotherham was commended in particular for: 100% of local GP practices are signed up to deliver the annual health checks DES and we have processes in place to capture and audit data from the checks. Continuing sound progress on the safeguarding adults agenda one of the cochairs of the LD Partnership Board is also RMBC safeguarding adults champion; Continuing good progress in transition planning for young people, although we have more work to do to ensure health aspects of transitions are captured to inform commissioning; Comprehensive review of specialist services linked to recent work on the service specifications for LD Specialist Health Services. The Regional Picture The Overview report (Appendix 3) outlines key issues for the Yorkshire and Humber region. There has been progress across the region on consolidating progress in primary care and gaining data from the GP annual health checks and also some progress in engaging with local acute hospitals, although there are still some gaps in some areas and in some directorates. Regional Priorities for 2010/11 are identified as: Better meeting the needs of people with a learning disability from BME communities; Identifying and meeting the needs of people with profound and complex disabilities; Consistent progress by all departments in all hospitals to meet the needs of people with a learning disability; Ensuring all staff understand and operate within the relevant legal frameworks; Strengthening planning for older people with a learning disability, and older carers; Strengthening local planning and commissioning for people with autism, in line with the national strategy published earlier this year; Closely reviewing local progress on the work to support people with a learning disability who offend. Each of these areas is also being addressed in our on-going work to improve services in Rotherham.

4 4 Next Steps An action plan has been developed to ensure that any remaining Amber scores turn to Green at the next assessment. Implementation of the action plan will be overseen by the Health Sub-Group of the Learning Disability Partnership Board; and performance managed by commissioners from NHSR. It has been confirmed by the SHA that the next assessment will be launched in Dec 2010, we assume for submission in April One area of risk identified is that there is likely to be no local strategy for autism by the agreed date of March Further guidance on the national autism strategy is expected in December 2010 and we will discuss with local authority commissioners (who have the lead for this area) how they intend to progress this work following publication of the national guidance. Patient, Public and Stakeholder Involvement: There has been an annual BIG Health Day in each of the last three years to consult people with a learning disability and family carers about the scores for the health assessment. The action plan and assessment submission have been signed off by the Multi-agency Learning Disability Partnership Board and work is progressed through its Health Sub-Group, both of which have strong service user and carer representation. Rotherham was commended for its local involvement in the process of assessment, and in particular that NHS Rotherham has held Health Follow-up Days where we have provided feedback on the assessment and on progress with our action plan, in-year. The event for this year is planned for Tuesday 21 st September. Equality Impact: An Equality Impact Assessment (EIA) Screening Tool has been completed for our local health assessment submission and action plan. The process is recognised as very positive in addressing the inequalities in access to health and health services suffered by people with a learning disability. The EIA summaries are available on the NHS-R intranet. Financial Implications: Non-Recurrent funding in the operational plan supports the Learning Disability Strategic Health Facilitator Post ( 25k in 2009/10 and 50k in 2010/11). 118,950 has been identified in NHS Rotherham budgets to fund the cost of the LD annual health checks DES in 2010/11. GPs receive per patient on their validated LD register as an aspiration payment and a further per patient for each completed health check. The retainer will be re-claimed by NHS R for any patients that do not receive a check. The funding is agreed for one year as the DES is due to finish in March Additional funding would need to be found if the DES is to continue for the future. Approved by: John Doherty Assistant Director of Finance Human Resource Implications: There is a range of training and culture change issues related to improving health care services for people with learning disabilities. These will be for all NHS organisations. RFT have already undertaken training and awareness raising sessions for some key staff and have plans to roll-out further training this year.

5 5 RCHS managers and practice staff have received awareness training, and work on training for MH staff in RDASH and the Primary Care MH Service is being considered this year. Approved by: Pauline Fryer Director of OD, Workforce & Governance Procurement: Not applicable Approved by: Doug Hershaw Head of Procurement Key Words: Learning Disability; Health Assessment Framework 2010; Access to Health Services Further Sources of Information: The Health Assessment Framework (HAF): Available for information if required: NHS Rotherham HAF submission Yorkshire and Humber Healthy Ambitions: Learning Disabilities Chapter (6 Sept 2010) Appendix 1: Rotherham Feedback Letter from the SHA Appendix 2: Table containing detailed validation feedback Appendix 3: Regional Overview Report

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