Agenda item

Report of the Head of Democratic Services (Nottingham City Council)

Sally Seely and Caroline Baria, Senior Responsible Officer and Deputy Responsible Officer for the Programme, gave a presentation on the Transforming Care Programme for People with Learning Disabilities and/or Autism who display challenging behaviours in Nottinghamshire, highlighting the following points:

(a)  there is a national focus on building up community capacity and reducing inappropriate hospital admissions following the investigation into abuse at Winterbourne View;

(b)  Nottinghamshire was one of 6 ‘fast track’ areas chosen to form Transforming Care Partnerships (TCPs), involving CCGs, local authorities and NHS England specialist commissioners. A Transformation Plan to ensure affected citizens are kept healthy, well and supported in the community was submitted in September 2015, and public consultation on the Plan will commence in February 2016;

(c)  those most affected will be citizens currently in in-patient care, for which a resettlement programme will be required. In future, the expectation is that hospital admission will only be when necessary, and will be time-limited;

(d)  all 10 commissioning organisations in the area are involved with the programme’s Transformation Board, under which a Professionals Reference Group of health and social care specialists sits. An Operational Committee manages 6 workstreams: Admission and Prevention, Strategic Commissioning, Operational Commissioning, Workforce Planning and Development, Integrating Care and Support/Finance, and Communications and Engagement;

(e)  a number of key deliverables to June 2016 have been identified, including developing Strategic Commissioning and Workforce Development Plans, establishing multiagency pooled/aligned budgets, establishing emergency and longer term crisis support services, extending Care and treatment reviews to children and those with autism and no learning disability.

The following issues were raised and points made during discussion:

(f)  a councillor criticised the lack of specific detail on numbers of children with disabilities in Nottingham City and Nottinghamshire County. In response, Ms Seely explained that commissioners were also frustrated by the lack of clarity on this issue within the Joint Strategic Needs Assessment;

(g)  Ms Seely also shared councillors’ concerns about challenges involved in securing a trained and dedicated workforce in the time available, and confirmed that the focus was on ensuring that the health and social care sector offered attractive career options. She also assured councillors that workforce concerns have been fed back to NHS England, Local Government Association and Association of Directors of Adult Social Services;

(h)  it was very important to consult as widely as possible with both existing and potential service users, as well as through focus groups which reflected the demography of local populations. Ms Seely agreed with the assertion that it would have been preferable to consult current service users sooner, but explained that Nottinghamshire was not originally aware that it would be ‘fast-tracked’. There was insufficient time to carry out full consultation within the nationally set timescales for submission of the Plan but some limited consultation did take place with existing inpatients and their families. She also stated that the Plan was open to significant alteration, depending on consultation outcomes;

(i)  the Nottingham Healthwatch representative supported the aims of the Plan, but expressed concern about the deliverability of the Plan, especially around IT, service integration and simplified procurement, within the timescales. He also asked whether savings realised from reducing numbers of inpatient beds (approximately 40 beds) were ring-fenced for reinvesting in community services. In response, Ms Seely explained that not all beds are commissioned by the CCG.  Some beds are commissioned by NHS England and currently there is no route for money released by decommissioning these beds to automatically flow to the CCG.  Funding flows is a national issue that is  still being worked out, but that this process should speed up now that the Programme was going live nationally;

(j)  several councillors expressed surprise that the Programme was being launched nationally before outcomes from the 6 pilots areas were known;

(k)  Ms Seely confirmed various models were being explored with existing providers to deliver crisis accommodation under the Plan, and that the proposed ‘Skills Academy’ will cover both new and existing skills;

(l)  Ms Seely confirmed that currently crisis services are not available across the area but crisis provision needs to be operational quickly and therefore it is intended that interim arrangements are procured by June.  There is a crisis house in the City and lessons can be learnt from that service for future procurement. 

(m)  Councillors and the Healthwatch Nottingham representative commented on the importance of having sufficient services available in the community, including crisis support, before any inpatient beds are closed.

RESOLVED to request that consultation outcomes and information on if/ how the Plan is changing in response to those outcomes; and progress against key deliverables to June  for the Transforming Care Programme are presented to the Committee’s July 2016 meeting.