Better Lives, Better Health for Adults with Learning Disabilities in North Essex

Transcription

1 Better Lives, Better Health for Adults with Learning Disabilities in North Essex An integrated strategy for adults with learning disabilities Page 1 of 17

2 Section 1: Introduction Background Essex County Council (ECC) and the Northeast Essex Clinical Commissioning Group, Mid Essex Clinical Commissioning Group & West Essex Clinical Commissioning Group (north Essex CCGs) have agreed to integrate their commissioning arrangements for adult learning disability services. These integrated commissioning arrangements will be hosted by ECC. The purpose of this strategy is to describe the shared commissioning intentions of ECC and the north Essex CCG s, and outline how these intentions will be delivered through the new integrated commissioning arrangements. What is meant by Integrated Commissioning? The term integrated commissioning describes a single collaborative approach to commissioning learning disability services across north Essex, with the eventual aim to roll this out across the whole of Essex. This will take the form of a legal partnership underpinned by Section 75 of the NHS Act 2006 between ECC and the north Essex CCGs. These integrated commissioning arrangements will be supported by: An integrated health and social care strategy describing the priorities for service transformation (this strategy); Joint arrangements for commissioning and contracting with health & social care providers; Governance arrangements across the partnership with delegated decision making mandates; Financial arrangements that support integrated commissioning. Why are integrated commissioning arrangements needed? Valuing People (2001) 1 described the importance of effective partnerships in promoting holistic services and social inclusion for people with learning disabilities. There is a strong history of joint commissioning of learning disability services in north Essex. This was the foundation for the successful closure of the learning disability long stay hospitals and NHS campus units with many people who lived as in-patients moving to their own homes in the community. However, many areas remain disjointed with the commissioning of specialist health in-patient and community services undertaken separately from the commissioning of social care. The integration of ECC and CCG commissioning arrangements will make possible the fullest integration of health and social care services, ensuring that adults with learning disabilities experience an integrated care and support pathway that delivers the best possible outcomes. Integrated commissioning should also yield efficiencies that will help both ECC and the CCGs to manage the demand for services within the budget constraints that they face. How was the strategy developed? The strategy has been developed jointly by commissioners working for ECC and the north Essex CCGs. The views of people with a learning disability and family carers expressed in previous engagement activities and consultations including the Big Health days and the Increasing Independence (2013) 2 consultation have shaped the core principles that underpin this strategy. Page 2 of 17

3 All commissioning activity that falls within the responsibility of the new commissioning arrangements will be undertaken in partnership with people with learning disabilities and family carers and any new solutions will be co-produced. Any proposed changes to services will be subject to formal consultation focused on the specific changes to these services. What is the shared vision for health and social care? The vision declared in the Joint Health and Well Being Board Strategy for Essex (2013) is: By 2018 residents and local communities in Essex will have greater choice, control, and responsibility for health and wellbeing services. Life expectancy overall will have increased and the inequalities within and between our communities will have reduced. Every child and adult will be given more opportunities to enjoy better health and wellbeing. 3 To achieve this vision for adults with learning disabilities, ECC and the north Essex CCGs will work together so that: Adults with learning disabilities can lead ordinary lives with the same life expectations, opportunities and outcomes as other citizens. This involves having the same expectations with regard to housing and employment, the same opportunities to participate fully in their local communities; and the same access to mainstream public services (including health services) as their non-disabled peers. What outcomes is this strategy trying to achieve? The implementation of this strategy will contribute to the achievement of the following outcomes for adults with learning disabilities as detailed in Essex County Council s Outcome Framework, the Adult Social Care National Outcomes Framework 2013/14, NHS Outcomes Framework 2013/14 and the Public Health Outcomes Framework as detailed below. The Essex County Council Outcomes Framework People in Essex enjoy good health and wellbeing. People in Essex live in safe communities and are protected from harm. People in Essex can live independently and exercise control over their lives. People in Essex have aspirations and achieve their ambitions through education, training and life-long learning. Adult Social Care National Outcomes Framework 2013/14 Ensuring quality of life for people with care and support needs. Safeguarding adults whose circumstances make them vulnerable and protecting them from avoidable harm. Delaying and reducing the need for care and support. Ensuring that people have a positive experience of care and support. NHS Outcomes Framework & Public Health Outcomes Framework 2013/14 Increased healthy life expectancy and reduced differences in healthy life expectancy between communities. Preventing people from dying prematurely. Treating and caring for people in a safe environment and protect them from avoidable harm. Enhancing quality of life for people with long term conditions. Ensuring that people have a positive experience of care. Page 3 of 17

4 What are the principles that will inform integrated commissioning? ECC and the north Essex CCGs are committed to enabling people with learning disabilities to gain life skills, achieve greater independence and lead healthier lives. This will be achieved through commissioning services together based on the following principles that were consulted on as part of the Increasing Independence 2 programme. People with learning disabilities should have access to all the accommodation options available, especially those providing maximum housing rights. People with learning disabilities should be protected from harm without there being a risk adverse stance from services. The support people receive should be person centred and focus on enablement and progression. People with learning disabilities should be enabled to exercise the same level of control over their lives as their non-disabled peers. Services should be available locally so that family, work and social networks are not disrupted by the need for support. There should be equality in the service offer to people with learning disabilities across Essex. Employment should be the normal expectation for adults of a working age. Carers should be supported to continue in this role for as long as it is appropriate for them and their family member. People with learning disabilities should have the same access to and experience of mainstream public services as their non-disabled peers. Health and social care services should operate seamlessly so that people with learning disabilities experience the support when they need it irrespective of who funds it. People with learning disabilities should be enabled to maintain healthy lifestyles, recover quickly from illness and manage their health and care needs. Service systems should adopt a whole-life approach to constructing and funding support. Services should deliver value for money outcomes. What do these principles mean in practice? More adults with learning disabilities will live in their own homes, either as a tenant, or owner-occupier. Fewer people will live in residential care homes. The support people receive will be focused on enabling them to become as independent as possible, and through this to realise their aspirations. The amount of support people receive will be based on what they need. It will be flexible to take into account the progression that people make, but also be able to respond when people have difficult periods in their life. Services will be available that can offer intensive support to people in crisis to avoid admissions to registered care homes and closed communities. Page 4 of 17

5 If people need specialist in-patient hospital placements, this will be for assessment and treatment only and for the minimum time necessary. More adults with learning disabilities will be in paid work or participating in meaningful activities that contribute to their local communities. Fewer people will be using traditional day services. Carers will be supported in their caring role and receive support to prepare for the time when they can no longer sustain this role. Adults with learning disabilities will be supported through mainstream services. Only where mainstream services are inadequate or unable to achieve comparable outcomes will specialist learning disability services be commissioned to prevent people being at a substantial disadvantage. Adults with learning disabilities will be offered a personal Health Action Plan; be supported to have Annual Health Checks with their GPs; and to take up health screening for the early detection of ill health. Services will only be commissioned if they are robust, fit for purpose and personcentred. Services will only be commissioned from providers who are competent, careful, committed and compassionate. Services will be available locally to avoid people being placed away from their family and local community. Section 2: Needs Analysis What is the likely demand for services in the future? The estimated population of adults with moderate or severe learning disabilities living in North Essex in 2012 was 3,753 (see table 1 below). If nothing changes, based on population growth and increased life expectancy, the number of adults with a moderate or severe learning disability is estimated to increase by 8% between 2012 and % of adults with moderate or severe learning disabilities are estimated to be living with their parents who are likely to be providing a substantial amount of care and support. Area Braintree Chelmsford Maldon Colchester Tendring Epping Forest Harlow Uttlesford North Essex Table 1: Population estimates for adults with moderate or severe learning disabilities aged 18+. Source PANSI, based on Emerson & Hatton (2004) Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England Table 2 shows the numbers of adults with learning disabilities receiving social care services from Essex County Council. The Council supported 2,574 adults (aged 18-64) and 356 older people (aged 65+) with a learning disability in 2012/13. There is a higher prevalence of adults with learning disability known to social care in Tendring, Page 5 of 17

6 Colchester and Braintree due to the legacy of the old long stay hospitals in these areas. Area Total Rate per 1,000 pop aged 18+ Braintree Chelmsford Maldon Colchester Tendring Epping Forest Harlow Uttlesford North Essex Table 2: Adults with a learning disability known to adult social care during the year 2012/13 (Source: Essex CC) Only 69% of the population estimated to have moderate or severe learning disabilities are receiving services from the Council. There are 2 main reasons for this difference. Firstly some people with moderate learning disabilities may not meet the Council s eligibility criteria for social care services. Secondly some people will have been placed in residential care or independent hospitals by other commissioning authorities and are not the responsibility of Essex County Council, although they are entitled to receive health care from local mainstream and specialist health services. The number of adults with learning disabilities supported by ECC increased by an average of 2.8% per year between 2008 and This growth was due to the: increasing number of children with profound and multiple disabilities surviving into adulthood; increasing life expectancy of adults with learning disabilities due to improved lifestyles and advances in health care. This has resulted in a 2.5% annual growth in the number of adults with learning disabilities supported by the ECC aged 18-64; and a 5.6% annual growth in those aged 65 and over. The complexity of people s needs also appears to be increasing. For example between 2008 and 2012 the growth in the number of people receiving low intensity services (interventions under 14 hours a week) was 8%; whereas the increase in people receiving more intensive services (interventions over 14 hours per week) was 21% over the same period. Section 3: Current Situation How has the current pattern of learning disability services been shaped? The history of learning disability services in north Essex has had a profound impact on the current shape and distribution of services. The large long stay hospitals in the Braintree, Colchester, and Tendring districts (Bridge Hospital, Turner Village and the associated NHS Campuses) led to large numbers of adults with disabilities being exported to Essex from across the country. These hospitals were closed as part of the Better Lives resettlement programme between 1999 and 2003, and large numbers of people moved into supported living. To enable this to happen significant NHS funding was invested in developing supported living properties, owned by Registered Social Landlords but with guaranteed nomination rights for adults with learning disabilities. Page 6 of 17

7 Alongside the re-provision programme, the roles of specialist health community learning disability teams were broadened in line with the recommendations in Valuing People (2001) 1 so as well as their direct clinical roles staff also had: a health promotion role - working closely with the local health prevention initiatives a health facilitation role - working with primary care teams and secondary services a teaching role working with social care services to ensure people have their health needs met; a service development role. The Way Ahead (2001) 4 was the first health and social care strategy for adults with learning disabilities in Essex. It was published alongside a 3 year Joint Investment Plan. Between 2004 and 2007 there was a programme of work to fully integrate the health and social care community learning disability teams. Co-location was achieved in most localities and shared business processes and lines of accountability were agreed. In 2008 Essex County Council implemented Putting Essex People First, in line with the national Putting People First concordat (2007) 5, with a focus on achieving greater personalisation. As part of this programme the social care community teams were reconfigured and the teams supporting adults with learning disabilities and physical and sensory impairments were integrated. In 2010 the Allied Health Professionals (Speech and Language Therapists; Dieticians; Occupational Therapists etc.) within the specialist health community learning disability teams were transferred to the local main stream community health provider, however these services continue to be commissioned via a discrete contract specifically for adults with learning disabilities. Following the 2008 reconfiguration there was a gradual decline in the level of integration between the health and social care community learning disability teams. These teams are no longer co-located. In 2010, in line with the Valuing People Now (2009) 6 national guidelines that responsibility for commissioning and funding all social care for people with learning disabilities should be transferred from the NHS to local government, 31.4 million was transferred from the north Essex PCT s to Essex County Council to fund services for the people discharged from the long stay hospitals and campuses. Why does the current pattern of service provision need to be change? The current configuration of service provision does not always deliver good outcomes for adults with learning disabilities and feedback from people who use or provide these services tell us that many service models are no longer fit for purpose. Who Will Care (2013) 7, the Independent Commission tasked with finding solutions to prevent a future crisis in health and social care in Essex identified that further work was needed to understand whether services for people with learning disabilities in Essex were optimal given the large financial investment made. During their engagement with service users and providers they report hearing few if any compliments from families and service providers alike. Page 7 of 17

8 People with a learning disability generally have worse health and unequal access to mainstream public services compared to the general population. The Michael Report: Healthcare for All (2008) 8 and the Mencap report: Death by Indifference 74 Lives and Counting (2012) 9 provide clear evidence that people with a learning disability have unequal access to health services and are often at risk through failures to make reasonable adjustments to meet their needs. At times these risks are fatal. This became even more pressing in the context of the Mid Staffordshire NHS Foundation Trust Public Inquiry report (2013) 10, which highlighted the need for health services to focus on the quality and safety of patient care. The combined impact of greater health needs and unequal access to general health services is that people with a learning disability are likely to die prematurely. The recently published Confidential Inquiry into Premature Deaths of People with a Learning Disability (2013) 11 identifies from the cohort they studied that men with learning disabilities died on average 13 years sooner and women died 20 years sooner than their non-disabled peers. Overall, 22% were under the age of 50 when they died; 43% of the deaths investigated were identified as unexpected and 42% premature whilst fewer deaths of people with learning disabilities (38%) were reported to the coroner compared with the general population (46%). The BBC television Panorama programme on Winterbourne View (2011) exposed the vulnerability of people with a learning disability and/or autism who have challenging behaviours to abuse and mistreatment. The Department of Health report, Transforming Care: A national response to Winterbourne View Hospital (2012) 12 set out the expectations of NHS England for the transformation of services for this group of young people and adults through joint plans and pooled budgets by mid-2014 and beyond. The current configuration of service provision in Essex encourages dependency and does little to help adults with learning disabilities to learn the skills they need to progress and develop. The Council spends 44% of the adult learning disability budget on registered care - the average for similar authorities is 40%. Whilst registered care may be appropriate for people with the most complex needs, people living in their own homes have greater opportunities to develop independent living skills and access opportunities within their local communities. A barrier to people with learning disabilities living independently is that they do not always feel safe in their local communities. The Be Safer 13 survey of people with learning disabilities in Essex found that over half reported having been the victim of some kind of abusive behaviour, and one in six felt worried where they lived. The Council and the Clinical Commissioning Groups are also facing significant financial challenges. Both face increasing cost pressures related to rising demand for services at a time when funding from central government is reducing in real terms. The demand on the social care budget for adults with learning disabilities is expected to increase by 5.5% per annum as a result of the increased numbers of people and the complexity of their needs. In addition the cost of services is increasing as a result of inflation. This level of increase is not financially sustainable. To ensure that ECC can continue to meet the demand for services within the budget it has available it will need to reduce the anticipated cost pressure arising from this increased demand by 66% over the next 3 years. The CCGs also have to manage any new demand within the current financial envelope. Page 8 of 17

9 In place of the current service configuration that encourages dependency the ambition of this strategy is to improve services so adults with learning disabilities experience better health outcomes and become more independent. As a result this should reduce their reliance on ECC and CCG funded service enabling the local health and social care economy to be able to respond to the increasing demographic pressures. Section 4: Resources The health and social care budget available for adults with learning disabilities The estimated* budget for health and social care services for adults with learning disabilities in North Essex for 14/15 is 132 million. This expenditure is broken down in the table below. Service Budget Residential and Nursing 47.8m Home Care and Supported Living 35.4m Direct Payments 16.5m Employment & Inclusion 5.4m Assessment & Care Management 5.2m ECC Owned Residential Care 3.7m Transport 2.5m Day Care (External) 2.0m Respite & Other Costs 1.1m Specialist Health Services 9.4m Specialist Allied Health Professionals 2.7m Individual Hospital Placements 0.6m Other Health Expenditure 0.1m Total Spend 132m The estimated additional demand on the learning disabilities social care budget in North Essex is estimated to be 20 million* by March The Increasing Independence programme aims to reduce the impact of demographic growth on the social care budget by 12 million* in North Essex. Specialist health services will be delivered within the existing budget envelope for these services. * The cost of social care services; the estimated impact of future demand; and the savings from Increasing Independence have been apportioned between North and South Essex to arrive at these numbers based on the proportion of service users supported in these areas. As such they should be considered estimates and not exact figures. Section 5: National Policy and Guidance The services and support commissioned by health and social care for adults with a learning disability are shaped by key polices and strategies from national government. Although some of these documents were issued over 10 years ago they are still relevant and valid today. Other guidance is more recent and was issued after the discovery of unacceptable practices at Winterbourne View Hospital. Valuing People (2001) 1 offered a vision for the lives of people with learning disabilities and their families based on four principles: - Rights. People with learning disabilities and their families have the same human rights as everyone else. Independent living. All disabled people should have greater choice and control over the support they need to go about their daily lives; greater access to Page 9 of 17

10 housing, education, employment, leisure and transport opportunities; and participation in family and community life. Control. People with learning disabilities being involved in and in control of decisions about their life. Inclusion. People with learning disabilities being able to participate in all aspects of community to work, learn, get about and meet people, be part of social networks and access goods and services. It put forward new ways to give people and families a voice, to be at the centre of their own plans, and to have some control over how resources were spent on them, initially through Direct Payments and then through Personal Budgets. The cross-government concordat, Putting People First (2007) 5, set out a vision for social care services that support people to live independently, stay healthy and have the best possible quality of life, irrespective of illness and disability. It confirmed a shift in emphasis towards greater personalisation. The three-year strategy, Valuing People Now (2009) 6, reaffirmed the principles of the original Valuing People strategy and introduced a stronger emphasis on: - Improving opportunities for people with learning disabilities to make an informed choice about where, and with whom, they live; Addressing social exclusion; Increasing the number of people with learning disabilities in paid employment; Improving support for people with complex needs; Improving healthcare outcomes; Improving support for family carers. The Department of Health s review, Transforming Care; A national response to Winterbourne View Hospital (2012) 12 challenges health and social care agencies to radically overhaul their approach to commissioning to improve services for people with a learning disability and/or autism whose behaviour is deemed as challenging. It also stated the clear expectation that CCGs and local authorities will commission services collaboratively and do so with pooled budgets. This report led to the publication of a multi-agency concordat committing CCGs and local authorities to achieve the following objectives by 1 st June 2014: - ensure that the right local services are available, regardless of who commissions them; ensure all people with challenging behaviour in in-patient assessment and treatment services are appropriately placed and safe, and if not to make alternative arrangements for them as soon as possible; review existing contracts to ensure they include an appropriate specification, clear individual outcomes and sufficient resource to meet the needs of the individual; ensure that everyone has a named care co-ordinator; improve the general healthcare and physical health of people with learning disabilities; involve children, young people and adults with challenging behaviour and their families, carers and advocates in planning and commissioning services; ensure that planning starts early with commissioners of children s services; Page 10 of 17

11 ensure that from April 2014, health and care commissioners, set out a joint strategic plan to commission the range of local health, housing and care support services to meet the needs of children, young people and adults with challenging behaviour in their area. Section 6: Customer / Stakeholder Views Local service users and family views Local people have shared their views on the services we commission through the Big Health Days - the engagement event that supports the annual joint health and social care learning disability Self-Assessment, and the recent public consultation on the Increasing Independence programme of work. The important messages from the Big Health Days were: - GP Practices signing up to Directed Enhanced Service Agreements and providing Annual Health Checks; Annual Health Checks being linked to individual Health Action Plans; Opportunities for service users and carers to understand more fully the Mental Capacity Act; Better understanding of the Mental Capacity Act by clinicians; Transition of children with disabilities with specialist health needs (CAMHS); Safer access to secondary care and learning from Six Lives 14 & 74 Lives and counting 9 ; Reasonable adjustments and increased staff awareness of LD in Accident & Emergency Departments; Full access to health screening for women and men; Access to dentistry with reasonable adjustments; Health checks for carers. There was broad agreement in the Increasing Independence consultation to the principles described in section 1. In addition the following key messages from the consultation were: Housing There needs to be more appropriate, suitable and safe accommodation for people to live in. People need the right support and training to enable them to live in their own homes. There is a lack of information and advice on the different accommodation and support services available to people. Social isolation is a risk and access to public transport is critical in preventing people becoming isolated. Although residential care may create dependency it may be the best option for some people. Increasing Independence The level of independence that each person can reach differs depending on the person. It is important to be able to respond if someone s need increases or in the event of a crisis, and people should have a named person to contact. Staff need to be trained how to use enablement principles consistently. Page 11 of 17

12 Support plans should be person centred with regular reviews to ensure the level of support matches what people actually need. There needs to be more information about Assistive Technology and its use should be tailored to each person. Community services such as social centres and schools provide good support in gaining independence. There isn t enough support available for people with behaviours deemed challenging and their carers. A more diverse market would offer bespoke and innovative services. Employment The levels of training and support needed before looking for a job is very individual and some people will continue to need support when in employment. The Council and Job Centre need to work closer together. More supported employment schemes are needed and day services could be adjusted towards supporting people into work. There are not enough employment opportunities for people with disabilities and the council should invest to create these. Employers need support and training to ensure they have the skills and understanding to support people with disabilities in the workplace. The type of work people undertake should be based on individual circumstance. Supporting Carers Carers would benefit from support systems that provide advice and support and this would reduce their reliance on social care services. Social workers can only be accessed at a point of crisis, and carers felt they often had to fight to get the support they needed. Supporting older carers and carers of people with behaviour deemed as challenging is particularly important. Short breaks make a big difference to carers lives. More information is needed particularly during the transition of leaving school. Carers need to be supported with developing contingency plans and to plan for the future, including the making of wills and planning the accommodation and support for the people they care for. Improving health Health and social care need to work together. More support should be available to help people with a learning disability access health services. Health access champions had made a difference in their area, but more support is needed. A change in culture and skills is needed in mainstream services such as doctors and dentists etc. If mainstream services had disability training there would be less need for specialist services. Visiting the dentist was particularly difficult for some people with a learning disability. There was inconsistency in the way annual health checks were administered. Care plans should include the support people need to access health appointments Page 12 of 17

13 Use of resources An investment in additional support may be required to enable people to gain independence. Social care reviews were not consistent or thorough enough to support people in being more independent. Longer term solutions to the support people get should be considered. For example working with family carers to plan earlier for the future support of the people they care for. People were concerned about the impact of the welfare and benefit changes and the impact this would have on people s independence. The council should support good quality providers that already work with people to enable them to become more independent. Section 7: Future Design What do future services need to look like to achieve the desired change? The table below summarises the key objectives of this strategy and the actions that are required to achieve this. Objective Improved Health and Wellbeing Greater Choice & Control Increased Independence Improved Support for Family Carers Greater Opportunities to lead a Meaningful Life Actions required Annual Health Checks and Health Action Plans; Better and improved access to mainstream health care; Better community adjustments for dentistry, eye and hearing checks; Specialist crisis response services to avoid in-patient admissions. Greater uptake of personal health and social care budgets; A focus on building community capacity; Flexible contractual arrangements with providers. Greater use of assistive technologies; People having outcome based support plans; Providers incentivised to deliver progression; Responsive services that deliver support when needed rather than all the time. Access to short breaks that meet the needs of family carers and people with learning disabilities; Ensuring Carers have access to health checks; Ensuring emergency care plans are in place and providing support to plan for the future; Ensuring that carers have access to the training they need. Support to access and maintain employment; Improved access to transport; Improved access to education and training; Greater opportunities to make friends and engage in personal relationships; Improved access to mainstream leisure activities. Page 13 of 17

14 Improved opportunities to have Your Own Front Door Appropriate care for people with the most complex and profound needs People feel safe in their local communities and protected from harm People experience a better transition from children s to adult services Develop new housing and optimise the existing housing stock; Support people to move on from residential care and hospital placements; Avoid admissions to residential care; Develop a crisis response service to prevent unnecessary admissions; Develop the housing brokerage service; Invest in shared ownership models; Create a culture where supported living is the default position. Develop an integrated pathway for people with behaviours that challenge; Develop capacity to undertake person centred support planning and work with the market to create individualised services; Ensure crisis response and early intervention services are available; Access to training for providers and families; Dedicated care co-ordination; Reduced use of in-patient services and improved community services. Robust person centred plans; Commercial arrangements that ensure the availability of competent, careful and caring providers; Adherence to SOVA processes; Effective monitoring of providers; Community involvement in creating safe communities. All age commissioning pathway; Early planning for young people at 16+; The development of a clear and consistent service offer so young people and their families know what to expect from adult services. These actions will be delivered by making best use of the budget available. This will be achieved through: Integrated commissioning of health and social care services; The development of services that enable people to progress and become less reliant on social care services. Better market management and service procurement; Re-investment of monies in local services that have traditionally been used to purchase expensive out of county placements; The development of cost effective service models that are sustainable and the de-commissioning of outdated and inefficient services. The actions will be implemented through a programme of work to transform the current pattern of services into a model that enables people to progress and develop. This model is summarised in Figure 1 below. The implementation plan for these actions can be found in Appendix 1. Page 14 of 17

15 Figure 1: The progression model adapted from the ALDER model of progression. Section 8: Monitoring Arrangements How will the success of this strategy be monitored? The implementation of the strategy will be monitored through the following key performance indicators. These will be presented quarterly to a Joint Commissioning Board and to the Essex Partnership Board. Outcome: People in Essex enjoy good health and well being Key Performance Indicators Housing: The number of new units of accommodation delivered to enable people with learning disabilities to live in their own homes. (The target is that 156 new units of accommodation will be delivered by March 2017 either through shared ownership or through individual tenancies) The number of people with learning disabilities supported by the Housing Brokerage service to find accommodation. (The target is a minimum of 105 people by 2017) Health: The number of people with Health Action Plans in place. (Baseline to be set; target is to achieve an increase). Carers: Carer reported quality of life (as reported in the bi-ennial Carers Survey) Proportion of carers who report that they have been included or consulted in discussion about the person they care for life (as reported in the bi-ennial Carers Survey) People in Essex live in safe communities and are protected from harm The proportion of people who use services who feel safe (as measured by the annual social care survey) The proportion of people who use services who say that those services have made them feel safe and secure (as measured by the annual social care survey) Compliance with safeguarding processes (measure to be agreed.) Page 15 of 17

16 People in Essex can live independently and exercise control over their lives The number of people that have moved on from residential care to more independent forms of support. (The target is that 129 people will have moved on by March This includes 9 people with behaviours deemed to be challenging). The number of people receiving community based services that have become more independent and less reliant on social care services. (The target is that 309 people will have progressed by March 2017.) The number of admissions to registered care that have been avoided. (The target is that there will be 81 fewer admissions over the 3 years up until This includes 12 fewer admissions for people with behaviours that challenge.) All people currently stuck in In-Patient services who have been identified as ready to be discharged will have moved to community based services by June 2014 (currently 16 people). The number of admissions into Assessment and Treatment units and secure services (Baseline to be set; target is to achieve a reduction). The number of people in Assessment and Treatment units 3 months after being assessed as ready for discharge. (Baseline to be set, target is to achieve a reduction). People in Essex have aspirations and achieve their ambitions through education training and lifelong-learning The number of adults with learning disabilities receiving a cash payment (either via a social care or health personal budget). (Baseline to be set; target is to achieve an increase) The number of adults with learning disabilities in employment. (Current performance is 8.5% of people receiving services; the target is to achieve Best in Class standards tbc) The number of people supported to move on from traditional day services into employment and main stream services (The target is that 116 people will have moved on by March 2017.) Page 16 of 17

17 Appendices 1. Integrated Commissioning Work Plan TCLD workplan v docx 2. Equality Impact Assessment EIA 2014 LD Strategy.doc References 1. Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century 2. Essex County Council (2013) Increasing Independence for Adults with Disabilities Consultation 3. Essex Health and Well Being Board (2012) Joint Health and Well Being Strategy for Essex Essex/Documents/Essex_Health_Wellbeing_Strategy.pdf 4. Essex County Council (2001)The Way Ahead 5. Department of Health (2007) Putting People First: a shared vision and commitment to the transformation of adult social care 6. Department of Health (2009) Valuing People Now: a new three-year strategy for people with learning disabilities 7. Essex Health and Well Being Board (2013) Who Will Care: Five high-impact solutions to prevent a future crisis in health and social care in Essex re%20v.final.pdf 8. Department of Health (2008) Healthcare for all: report of the independent inquiry into access to healthcare for people with learning disabilities 9. Mencap (2012) Death by Indifference: 74 Lives and Counting. A progress report 5 years on. 10. Francis, R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry 11. University of Bristol (2013) Confidential Inquiry into Premature Deaths of People with a Learning Disability 12. Department of Health (2012)Transforming Care: A national response to Winterbourne View Hospital 13. Be Safer Essex (2011) Be Safer Project Report August Mencap (2007) Death by Indifference Glossary Enablement is an approach that is focused on developing people s capabilities to do things for themselves and become more independent. It is based on the principle that the long term solutions to people s care and support needs rest within themselves and also with their families, social networks and surrounding communities. Progression is the term given to the step by step approach to increasing skills and independence and in some cases can mean a move into more independent living arrangements. Page 17 of 17