Topic one: What helps makes a successful Care and Treatment Review? Guest speakers: Anne Webster, Clinical Lead, Learning Disability Programme, NHS England Gavin Harding, MBE, Learning Disability Advisor, Learning Disability Programme, NHS England Maggie Graham, Learning Disability Programme, NHS England The presentation focused on everyone’s role in a Care and Treatment Review and explored the vital role of the chair of the panel, the expert advisers and also people who attend a panel, for example the role of an advocate at a CTR. The presentation was also provided an update on the policy refresh, what is happening and when, and a discussion about the role of the learning disability advisers in the programme. Topic Two: Guidance for TCPs in relation to Children and Young People Guest Speaker: Phil Brayshaw, NHS England The presentation considered how Transforming Care Partnerships can plan and deliver local support and services for children, young people and their families. This is ahead of the publication of “Developing support and services for children and young people with learning disabilities and/or autism” later this year (November). The presentation also considered each of the 9 principles of the Service Model: Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition: Service model for commissioners of health and social care services, how they relate specifically to children and young people and what this will mean in terms of local commissioning intentions going forwards.

1. www.england.nhs.uk
Learning Disabilities:
Share and Learn Webinar
27 October 2016
Topic One:
What makes a successful
Care and Treatment Review?
Anne Webster, Gavin Harding and
Maggie Graham, Improving Health &
Quality Team, NHS England
Topic Two:
Guidance for TCPs in relation to
Children and Young People
Phil Brayshaw, Service Model Lead (Children and
Young People), Learning Disabilities Programme,
NHS England
#improvingLD @NHSEnglandSI

2. www.england.nhs.uk/learningdisabilities
Care and
Treatment
Reviews
27 October 2016

3. www.england.nhs.uk/learningdisabilities
Thankyou for inviting us today
• Anne Webster
• Gavin Harding MBE
• Maggie Graham
Improving Health and Quality Team

4. www.england.nhs.uk/learningdisabilities
In the Learning Disability Programme
• Work stream delivery -
• Learning disability advisers:
1. Gavin Harding MBE
2. Carl Shaw
3. David Gill
4. And looking to appoint a family carer
adviser to start in the New Year
• Engagement team -
• Learning disability network managers:
1. Aaron Wood
2. Katie Matthews
Employing people with lived experience
Gavin
Carl
David
Aaron
Katie
Gavin

5. www.england.nhs.uk/learningdisabilities
• We have had feedback from over 200
people about the CTR policy
• We are analysing the feedback and
meeting with our advisory group soon to
agree what it means for the policy
• The feedback will make the policy even
stronger
• We aim to publish a revised policy by the
end of January 2017
• At the same time we are working with
Inclusion East to develop ‘Gold Standards’
for Care and Treatment Reviews eg
• What makes a good CTR chair?
• What makes a good expert by
experience?
• What makes a good clinical expert?
• What makes a good CTR?
The Care and Treatment Review
Policy Review
Maggie

6. www.england.nhs.uk/learningdisabilities
What makes a good…
CTR Chair
Maggie

7. www.england.nhs.uk/learningdisabilities
Is the commissioning lead with
current knowledge of processes.
Independent – never worked in or for
that provider and should declare any
interests.
Brings out the skills and knowledge
of the people involved – supporting
panel members to be equally involved.
Qualities and credentials
Is assertive and critical of poor
practice when they see it.
Maggie

8. www.england.nhs.uk/learningdisabilities
Knowledge about Transforming Care
and empathy for the person –
“hospital is not home”.
Has understanding of person
centred approaches and tools.
Supportive of other panel members
when they identify issues.
Knows about the contract with the
setting.
Qualities and credentials
Gavin

9. www.england.nhs.uk/learningdisabilities
Knows about innovative alternatives to
hospital. This could be through visits or
finding out about examples of good
practice where people live in the
community.
Is prepared to ask and encourage
very basic questions.
Qualities and credentials
Reflects with others to develop their
skills as the chair
Gavin

10. www.england.nhs.uk/learningdisabilities
• Has the skills to make sure
that everyone is working
together to improve the
person’s care and plans
• Takes a shared approach
to problem-solving
• Enables difficult topics to be
discussed in a constructive
way
Qualities and credentials
Anne

11. www.england.nhs.uk/learningdisabilities
Asks for the information needed for
the Care and Treatment Review from
the hospital setting.
Sets the agenda and establishes what
each panel member should do
according to skills and knowledge.
Requests panel members to say if
there may be a conflict of interest.
Visits the ward even when not
meeting the person.
Takes Action
Anne

12. www.england.nhs.uk/learningdisabilities
Arranges to report back to panel
members about urgent actions.
Makes sure that the next review will
use the same expert by experience
to maintain consistency – unless there
is a reason why it should be somebody
else.
Pick up on any challenges for panel
members that might need further
discussion.
Takes Action
Gavin

13. www.england.nhs.uk/learningdisabilities
• Some points to add….
• Gives the person time to take part in the
review in the way they feel most
comfortable
• Makes sure that people use words that
everyone can understand
• Makes sure the report is written in words
that everyone can understand
• Makes sure that someone is following up
on the actions
• Makes sure that any problems with
carrying out actions are dealt with quickly
• Any more points to add?
Takes Action
Gavin

14. Questions
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15. www.england.nhs.uk/learningdisabilities
Transforming Care Partnerships
(TCPs)
• 48 Transforming Care
Partnerships
• 48 sets of Plans to transform
local services for local people
and families
• 48 sets of Milestones that will
enable us to tell the story of
change

16. www.england.nhs.uk/learningdisabilities
Building the Right Support and the
National Service Model

17. www.england.nhs.uk/learningdisabilities
• Every Transforming Care Partnership should have a
lead for Children and Young People
• Clear links between Transforming Care Planning,
work around the Special Educational Needs and/ or
Disability (SEND) Reforms and CAMHS
transformation programme
• Local areas should understand legislative framework
• Service Model should be implemented from the point
of view of Children and Young People (and their
commissioning needs)
Supplement to the Service Model for
Children, Young People and their
Families

18. www.england.nhs.uk/learningdisabilities
Child, Young
Person and
Family/
Parent
Carers
I have an
enjoyable and
interesting life
My care and
support is well
planned
I have choice and
control about my
care and support
My family and paid
staff get the help
they need to support
me to live in the
community
I have a choice
about where I live
and who I live with
I get good care and
support from
mainstream health
services
I get expert health and
social care support in
the community if I
need it
I get help to stay
out of trouble with
the law if I need it
If I need to stay in
hospital because of
my mental health or
behaviour it is good
quality
The 9 Principles of the Service Model

19. www.england.nhs.uk/learningdisabilities
I have an Enjoyable
and Interesting Life
My Care and Support
is Well Planned
I have Choice and
Control about my Care
and Support
• Supported by people with high aspirations
(social model training)
• Join in everyday local activities -
playgroups, leisure etc.
• Attend their local school with the right
support
• Have friends and positive relationships
• Local Offer/ Timely Access to
Information
• Integrated Personalised
Commissioning
• Personal Budgets Should be
Offered
• Independent Advocacy
• Understand the local population and their
changing needs – dynamic register
• Person Centred Approaches
• Single Assessment and Planning
• Keyworking for families

20. www.england.nhs.uk/learningdisabilities
My Family and Paid
Staff get the Help they
Need to Support me to
Live in the Community
I Have a Choice about
Where I Live and Who I
Live With
I Get Good Care and
Support from
Mainstream Health
Services
• Early support and intervention
• Healthy Child Programme
• Evidence based Parenting programmes
• Family support – information, emotional
support, and practical support
• Specialist short Breaks
• Timely diagnosis with concurrent
support
• Hospital passports and liaison
• Paediatric assessment and access
to health checks age 14+
• Early access to flexible specialist
support
• Comfortable, well-adapted home
• Accessible information on housing
• Timely planning and support
(transition planning)
• Provision for children living away from
home

21. www.england.nhs.uk/learningdisabilities
I Get Expert Health
and Social Care
Support in the
community if I need
it
I Get Help to Stay
out of Trouble with
the Law if I Need it
If I Need to Stay in
Hospital because of
my Mental Health or
Behaviour it is Good
Quality
• Integrated, community based, specialist
support
• Specialist staff support early intervention
• Positive Behaviour Support and other
specialist intervention (IAPT, SALT etc.)
• Flexible support and services
• Multi-agency, preventative approach to support and
intervention (Family Support)
• Access to the same early intervention and prevention
services (YJS)
• Recognise and signpost learning disability and/ or
autism
• Consultancy, supervision and training
• Liaison and Diversion Schemes
• Community/ pre-admission Care and
Treatment Review (CTR)
• Relationships with friends and family
• Clear rationale for any specialist admission/
inpatient stay
• Independent advocacy
• Governance of out of area placements

22. www.england.nhs.uk/learningdisabilities
Questions?

23. www.england.nhs.uk
Date Topic Guest speaker
24 Nov 2016 Enhanced Care Service
and
Strategic resettlement,
personalisation at scale and pace
Caroline Kirby and Angie
Simmons, Adult Services and
Health Commissioning Unit,
Worcestershire
Pól Turner, Head of
Improvement, NHS England
26 Jan 2017 To be confirmed To be confirmed
23 Feb 2017 To be confirmed To be confirmed
30 Mar 2017 To be confirmed To be confirmed
Learning Disabilities: Share & Learn webinar programme