www.england.nhs.uk

Learning Disabilities:

Share and Learn Webinar

25 August 2016

Topic One:

Co-production and a long term

relationship Samantha Clarke

Chief Executive, Inclusion North

Topic Two:

The CQC approach to registering

services for adults with learning

disabilities Theresa Joyce and Sue Mitchell

Care Quality Commission

www.england.nhs.uk

Date Topic Guest speaker Venue

29 Sept 2016

Self-Care Support Bev Matthews, Sustainable Improvement

Team, NHS England and Philipa Bragman and

Catherine Carter, CHANGE

Webinar

27 Oct 2016

Launch of Care Treatment Review Policy

Guidance for TCPs in relation to children and

young people

Anne Webster and Gavin Harding, NHS

England

Phil Brayshaw, NHS England

Webinar

24 Nov 2016

To be confirmed To be confirmed Webinar

26 Jan 2017 To be confirmed To be confirmed Webinar

23 Feb 2017 To be confirmed To be confirmed Webinar

30 Mar 2017 To be confirmed To be confirmed Webinar

Learning Disabilities: Share & Learn webinar programme

Co-production A long term relationship & different

conversations

Webinar August 2016

Samantha Clark @smclark @InclusionNorth

What is co-production?

Produce Means to make something or bring something into existence

Co Means ‘together’ or ‘with’

Co-production – Elinor Ostrom:

Chicago Police started patrolling in

cars

Clear up rates went down, crime

reported went up

The police needed the unrecognized

contribution of citizens & those

relationships to do their job

The Core Economy

Family,

neighbourhood,

community

drive activity

MONEY drives

activity

We have 2 economic systems:

This is all the private and public sector

organisations that do things in

exchange for money. It includes the

services and supports provided

through health or social care.

This is all the unpaid activity that is

driven by our hearts and minds, our

care and compassion and love for

people close to us. It is the work we do

to bring up our children and look after

our wider families and older people. It

is the things that build communities. It

is the

Core Economy

We can’t ‘deliver’ a family a best friend a peer group a network someone who loves you

Services can’t ‘deliver’ community (but they try!)

Sometimes, it feels like services say,

‘If you want more attention and more help, come back with another and bigger problem’ That means that the only assets we have are our problems. We can be really good at having problems – but it won’t make us feel great!

We don’t deliver pizza. But maybe, we can make Some together and then share it!

Co-production principles

Recognising

people as assets

Promoting

reciprocity

Building social

networks

Valuing work

differently

Different Conversations

Community – place based, connecting

interests

Individual & service connections –

Local Area Coordination

Out there in the real world – social

media & beyond

Community conversations

Asset Based Community Development

Based on 4 years of work by McKnight &

Kretzmann in North America

“Can you tell us what people who live here have

done together that make things better?”

Collected 3000 stories – that they renamed

case studies http://www.abcdinstitute.org/publications/basicmanual/index.html

“Information about deficits are useless”

McKnight

When they analysed they decided people used 5

things in these stories

- Individuals

- Associations

- Institutions

- Physical Assets

- Connections

Asset based & internally focused & relationship

driven

The shift –

producers not clients

• What do we care about in our community

& what we can do together about that?

• What could we do if we have some outside

help?

• What can’t we do as a community &

someone outside needs to do?

Connecting the people on the margins

Valuing all contributions

Not service driven but people (citizen) driven

A different conversation - stories

Inclusive Change - stories

‘The Post Office shut suddenly’ (the Methodist Church now host the

Post Office and a cash machine)

‘You do it for your community – to make it a better place to live’

‘People that come (to the food bank run by local volunteers) aren’t just

coming for food’ ‘it is a place where they can come and have a bit of

company’

‘On the day can stand back and think we did that’ (of a community

event organised and run by a local parents forum on a voluntary basis)

The only disability is having no

relationships

Judith Snow

Individual & service connections

Local Area Coordination

Local Area Coordination started in Western Australia in 1988.

Approach to building individual, family and community capacity.

Focus on making services more personal, flexible, accountable and

efficient.

Prevention & practical, local solutions – catalyst for reform of social

care and health services.

Simplifying & “Turning the system upside down”

http://lacnetwork.org/

Who do they work with?

Local Area Coordinators support: People

•People not yet known to services to help build resilience

and remain part of their community (staying strong –

avoiding need for services)

•People at risk of becoming dependent on services to

remain strong in their own community diverting the need for

more expensive “formal service” responses. (reduce

demand)

•People already dependent on services to become less

so and more resilient in their own community.

Evidence

Research on Local Area Coordination demonstrates that it:

• Builds individual, family and community resilience;

• Reduces demand for services;

• Reduces isolation and loneliness; Increases choice, control and

contribution;

• Builds inclusion and citizenship;

• Is a catalyst for reform;

• Simplifies the system for local people

• Seeks to encourage cultural change within Councils – towards

community based, person-centred, more effective support

Thurrock & Derby – Social value evaluation

£3.50 - £4.00 for every £1 invested

Just a prevention service?

A life not a service

• Instead of asking

– “what services and money do people

need?”

• They ask

– “what makes a good life for you and

what are the different ways we can get

there?”

Stories – Derby. Community connection – bakery. Reputation. Shared lunch – different conversation. M.Health/housing issues. Linking and supporting – consistent relationship. Giving something back. “Introduced to a man with schizophrenia – I met a musician”

The question

determines the answer

Good life conversation

Allows a different

conversation – one that

builds capacity &

confidence

Out there in the real world

Social media

Justice for LB – campaign, Parliamentary Bill

Much more than just a campaign for justice – a big

public conversation

35.2K Tweets – asking questions & discussing

Use of lots openly available information

George Julian's blog

Chris Hatton's data crunching

Lots of people’s stories

Connecting across

hierarchy & sectors

Sharing stories across

the world

Shifting the power?

Opening up the

system?

“Consultation is a 1

night stand…………..

Co-production a long

term relationship”

Laurence Clark

And finally……..

The Parable of the blobs & the squares

https://vimeo.com/42332617

If only for Brian Blessed

Registering the Right Support

NHSE

August 2016

Regulation

CQC is the independent regulator of health and social care services in England. It uses a number of methods, including

- Registering providers and inspecting services to make sure they meet standards

- protecting the rights of vulnerable people, including those detained under the Mental Health Act

- taking enforcement action when services fall below standards

- talking to users of services about their care

• Providers have to be registered with the CQC if they are going to provide regulated activities.

• Includes NHS and independent sector

• Providers apply to deliver regulated activities in different types of service: hospital, residential care homes with and without nursing, domiciliary care

• Application assessed against regulations, which include an expectation that services consider good practice, policy and guidelines

• CQC published its registration policy for services for people

• with learning disabilities in February 2016

• Has carefully considered Building the Right Support and the Transforming Care program in what it says.

Registration

• “Providers are required to demonstrate how their model of support is built on evidence-based care, for example, National Institute for Health and Care Excellence (NICE) guidelines, and that it is in line with national policy, for example, Department of Health, Association of Directors of Adult Social Services (ADASS) and NHS England guidance. We expect providers of services for people with learning disabilities to refer to Building the Right Support and the accompanying service model when designing or redesigning service delivery”Delivering .

Delivering good practice and policy

Three main areas….

This policy statement applies to three key areas of registration:

1. Applying to provide regulated activity in specialist hospital provision, such as an assessment and treatment unit for people with learning disabilities.

2. Applying to provide regulated activity in other services specifically for people with learning disabilities.

3. Applying to vary the provider’s conditions of registration by adding or removing a location, or increasing the number of places provided at a location.

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• Transforming Care is a partnership between NHSE, LGA, ADASS, HEE (inc SfH,SfC) and CQC

• CQC can only deliver a part of this programme, and development of new services requires joint working across all agencies

• CQC is responsible for registering new services, and needs to consider whether the service to be developed is in line with the policy – and whether local commissioners have considered it as part of their planning

Working with commissioners

Some current issues…..

• An independent provider wishes to de-commission a hospital ward, and re-open (or “re-provision”) it as a care home with nursing

• Scenario 1: The patients who live there would not move. The provider tells us that the local commissioner supports this, as they see it as in line with Transforming Care - it will result in discharge from hospital. Scenario 2: The new service will receive patients from hospitals out of area, but they originate from the local area. It is described as “step-down

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• A provider wants to build four 6-bedded bungalows for people with complex needs, including those with forensic histories and those with autism and severe challenging behaviour. The residents will come from out of area hospitals, but will be from a number of local areas (up to 1.5 hours drive away). They have identified some potential residents with some local commissioners. The site is in a rural location, with few amenities close by. They say they will provide their own MDT.

Some current issues…..

Some current issues….

• A provider has 4 small scale services grouped together on one site. They provide residential care for 14 people. They want to build another 2 bungalows, each for 3 people. The service is set back from the road, on the edge of a small village. It has its own transport, as local transport links are poor. Only one of the proposed new residents will come from the local area.

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• Size

• Location

• Where people are from

• Links with local community

• Access to CTLD and specialist support

• Distance from family and friends for residents

• Commissioning intentions

• Available activities and community integration

• Part of the local Transforming Care plan

• Issues to consider….

Supported living

• We register providers to carry on the regulated activity of personal care (e.g. in the case of domiciliary care agencies), not the agency itself or the locations from or at which they operate.

• We restrict the provider to managing the regulated activity at/from locations which we list in a condition of registration.

• People’s own homes are generally not listed as locations if people are tenants with tenancy agreements.

• Please refer to CQC’s guidance on “What is a location” for further information

• We refer providers who wish to provide a supported living service to our guidance “ Housing with Care” and to the real tenancy test

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• Registering the right support - CQC’s policy on registration and variations to registration for providers supporting people with learning disabilities

• Building the right support -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

• Housing with Care Guidance on regulated activities for providers of supported living and extra care housing

• The Real Tenancy Test - tenancy rights in supported living- NDTi Housing and Social Inclusion Project

Useful guidance and policies

• Scope of Registration CQC guidance on Regulated Activities

• Guidance for providers on meeting the regulations -Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) (as amended) and Care Quality Commission (Registration) Regulations 2009 (Part 4) (as amended)

• All the above can be found on our website www.cqc.org.uk

Useful guidance and policies