The impact of
commissioning
changes on adults
with Learning
Disabilities
Stephan Brusch
Head of Health Access
Key Impact
• National & Regional system
leadership to handover
• Three commissioning organisations
• Main focus on Winterbourne Viewforgetting Six Lives
• Ongoing Commitment through the
transition and move to wider
vulnerable groups without being lost
• Loss of expertise at regional and
local level
• Risk of new system having to relearn
all lessons learned
• NHS Constitution and new
commissioning model presumes
active participation.
The new NHS landscape
Sector
National
Funding
Accountability
Other
Version 0.5
PHE
London Sector
‘Footprint’ / Local
Health & Wellbeing
Boards (HWBs)
Local Authorities
(incl. Public Health)
Parliament
Public Health
England
DH
Health
Education
England
NHS Commissioning
Board
NHS Trust
Development
Authority
LETBs
NHS CB
London Sector
NHS TDA
London Sector
Clinical
Senates
NHS CB
Patch Teams
Commissioning
Support Services
contract
contract
Clinical
Commissioning
Groups (CCGs)
Monitor (economic
regulator)
Joint licensing between
Monitor and CQC
Work together
to ensure
commissioner
support for
aspirant FTs
contract
NHS Trusts
FTs
Providers
Accountability for results
Local HealthWatch
CQC
Patients and Public
NHS Commissioning
Board
• Single Operating Model
• Held to account through NHS
Outcome Framework
• Ensure directly commissioned
services meet specific requirements
(Offender and Forensic Services and
Direct Enhanced Scheme for People
with LD)
• CCG Assurance includes
Safeguarding and Learning
Disabilities
• Leadership role for NHS
• Develop and sustain partnership
working (DH, Local Authority,
Metropolitan Police, ADASS, Monitor
and CQC)
Clinical Commissioning Authorisation
•Arrangements in place for CCG to involve
and seek advice from LD clinicians and
practitioners.
• CCG has the capacity and capability to
commission improved outcomes for the
people it serves
•Lead clinicians selected from member
practices for CCG commissioning priority
areas
•CCG to outline commissioning
arrangements for learning disabilities
•Providing Support via self assessment
framework, data analysis and economic
benchmarking.
Clinical Commissioning
Authorisation
• Appropriate systems for safeguarding
Adults at Risk
• CCG plans to train staff in recognising
and reporting safeguarding issues.
• Clear line of accountability for
safeguarding is reflected in CCG
governance arrangements.
• CCG has arrangements in place to cooperate with LA in the operation of
LSCB and LSAB.
• CCG has safeguarding adult lead
supported by relevant policies and
training
Mental Capacity Act
Clinical Commissioning Groups
(CCGs) need to:
• Have an identified Mental Capacity
Lead
• Ensure they have knowledge of their
continued responsibility for cases
authorised by their predecessor PCT
that ceased before the 1st April 2013
• Ensure processes are in place to
access all relevant archived
information on closed cases.
Mental Capacity Act
• Retains responsibility for assuring
through the commissioning process
compliance with the MCA 2005 and
DoLS legislation of all providers of
health care
• Work with health providers and local
authorities to ensure appropriate
capacity in the system of
professionals qualified to carry out
best interest assessments
• Support the training and education of
health professionals and best interest
assessors to deliver effective safe
quality patient services.
National levers and
Horizon scanning
• Statutory Guidance: No Secret Making
Safeguarding everybody’s business
• Legislative Framework: Mental Capacity
Act, Equality Legislation, Vulnerable
Peoples Act, Autism Act
• NHS and Social Care Outcome
Framework
• NHS CB Mandate
• NHS CB: Arrangement to secure
children’s and adult safeguarding in the
future NHS
• Clinical Commissioning Group
Authorisation Guide for applicants
• Concordat
New National Leaders leading
post Winterbourne View
• Michael McShaine- Long
Term Conditions
• Sam Cramond – Directorate
of Partnership
• Chris Bull- Joint
Improvement Program
• Jane Cummins – Chief
Nurse will appoint to Band 9
Mental Health and LD lead
Local whole System
• Safeguarding Adult Boards,
underpinned by statue
• Local Authority as lead
commissioning organisation
• Health and Wellbeing Board:
Strategic Responsibility for
assessing local needs,
including vulnerable people
(JSNA) and agreeing
commissioning stratetgies
• Regulators: Monitor, CQC and
professional regulators.
• Healthwatch to be consulted
Safeguarding Strategic plans
Pan London work with ADASS
• Joint Strategic Needs
Assessment
• Market Positioning
Statement
• Commissioning Jigsaw
explained
• Self Assessment
Framework
• Network
LONDON LEARNING DISABILITES PCT RAG FRAMEWORK RESULTS SUMMARY
Organisation
1.1
1.2
1.3
Overall Rating
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
Overall Rating
3.1
3.2
3.3
3.4
Overall Rating
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
Overall Rating
Barking & Dagenham
g
g
a
g
r
a
r
a
a
r
r
r
r
r
g
a
a
a
a
r
r
a
g
a
r
r
r
r
n/a
r
Barnet
g
a
a
a
a
a
a
a
r
a
r
r
a
a
a
r
a
a
a
a
r
a
a
r
r
a
a
r
n/a
a
Bexley
g
g
r
a
r
r
r
a
r
r
r
r
r
r
r
r
a
r
r
a
a
a
r
r
r
r
r
r
n/a
r
Brent
r
r
a
r
a
r
r
a
a
r
r
a
a
a
g
g
a
a
a
a
a
g
a
r
a
a
r
a
n/a
a
Bromley
r
a
a
a
a
r
a
g
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
g
a
n/a
a
Camden
g
g
g
g
a
a
r
g
a
a
a
a
a
a
a
a
r
a
a
a
a
g
a
a
a
g
g
a
n/a
a
City & Hackney
g
g
g
g
g
a
r
g
r
a
r
g
r
a
a
a
r
a
a
g
a
a
g
r
a
a
a
r
n/a
a
Croydon
g
g
r
a
r
a
a
a
a
r
r
a
a
a
a
a
a
a
a
a
a
a
a
r
a
a
a
r
n/a
a
Ealing
g
a
r
a
a
r
r
r
r
a
r
r
r
r
g
r
r
a
r
a
r
a
a
a
r
a
g
a
n/a
a
Enfield
g
g
g
g
a
r
r
a
r
r
r
r
r
r
g
r
a
r
r
r
r
a
r
r
r
r
r
r
n/a
r
Greenwich
g
g
g
g
r
r
r
r
r
r
r
r
r
r
a
r
r
r
r
a
r
a
r
a
r
r
a
r
r
r
Hammersmith & Fulham
g
r
r
r
a
a
a
a
a
r
r
r
r
a
a
r
r
r
r
r
a
a
r
r
r
r
r
r
a
r
Haringey
g
g
r
a
a
a
r
r
a
r
r
r
r
r
a
r
r
a
r
a
a
a
a
a
a
r
r
r
n/a
a
Harrow
g
a
a
a
a
a
a
a
r
a
r
a
a
a
a
a
r
a
a
a
a
g
a
a
a
r
a
r
n/a
a
Havering
g
g
g
g
r
r
r
r
r
r
r
a
r
r
a
a
r
r
r
a
a
a
r
a
r
r
r
r
n/a
r
Hillingdon
r
a
a
a
r
a
r
a
a
r
r
r
r
r
g
a
a
r
a
a
a
a
a
r
a
g
a
a
n/a
a
Hounslow
g
a
r
a
a
a
a
r
a
a
r
a
r
a
g
a
a
g
a
r
a
a
a
r
a
r
a
r
r
r
Islington
g
g
a
g
r
r
r
a
r
r
r
r
r
r
g
a
r
r
r
a
a
a
a
r
a
r
a
r
r
a
Kensington & Chelsea
g
g
a
g
r
r
r
a
r
r
r
r
r
r
g
r
a
a
a
a
a
a
a
r
a
r
a
r
n/a
a
Kingston
g
g
g
g
a
a
a
a
r
r
r
r
r
r
g
a
a
r
a
r
r
a
a
r
r
r
a
r
n/a
r
Lambeth
g
a
a
a
g
a
a
r
r
r
r
a
r
r
a
a
r
r
r
a
a
a
r
a
r
r
r
r
r
r
Lewisham
g
g
a
g
r
a
r
a
r
r
r
r
a
r
a
r
r
a
r
r
a
a
r
a
r
a
r
r
n/a
r
Newham
g
g
r
a
a
r
r
r
r
a
r
r
r
r
a
r
r
r
r
r
r
g
a
a
a
r
r
r
n/a
r
Redbridge
g
g
g
g
a
a
r
a
r
r
r
r
a
r
a
r
r
a
r
a
a
a
a
a
a
r
a
a
n/a
a
Richmond
g
g
r
a
a
r
r
a
r
r
r
r
r
r
a
r
r
g
r
g
a
r
r
r
r
a
r
r
n/a
r
Southwark
g
g
a
g
r
r
r
a
a
r
r
r
r
r
a
a
r
r
r
a
a
g
r
a
a
r
a
r
n/a
a
Sutton & Merton
g
g
a
g
r
a
r
r
r
r
r
r
r
r
a
r
r
r
r
a
r
a
a
a
r
r
r
r
n/a
r
Tower Hamlets
g
g
a
g
a
a
r
g
a
a
a
a
r
a
a
r
a
r
r
a
a
a
a
r
r
r
a
r
n/a
a
waltham forest
r
r
a
r
a
a
a
a
g
r
a
a
a
a
g
a
a
r
a
a
a
a
r
r
a
a
r
r
n/a
a
Wandsworth
g
a
a
a
a
a
a
a
a
a
r
r
a
a
a
r
a
a
a
a
r
a
g
r
r
a
a
r
r
r
Westminster
r
a
g
a
g
g
g
a
a
a
a
g
a
a
g
g
r
g
g
a
a
a
g
g
g
g
g
a
n/a
g
1.1
1.2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
3.1
3.2
3.3
3.4
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
Campus closure
Out of Area Placement
Primary Care
Annual Health
Checks
Disease
Prevention
2
1
2
2
1
1
2
1
I.T.
BME / Learning
Disability
Complex Needs
National
Investigation
MCA. DDA and LD
Complaints
Safe-guarding and
LD
Respite Care
Community
Provision
Transition
User Engagement
Partnership
(Funding)
Older People (LD)
Autism
Challenging
Behaviour
Mental Health /
LD
workforce
Criminal Justice
System
1
2
2
2
2
2
2
3
3
2
2
1
1
2
2
3
1
2
2
2
2
3
2
1
2
2
1
2
1
2
2
1
1
1
2
2
2
1
2
1
1
2
1
2
3
3
3
2
2
2
2
2
2
2
2
3
3
3
3
2
2
2
2
2
2
2
2
2
2
1
2
3
3
3
2
3
3
2
2
2
2
3
2
2
2
2
2
3
2
2
2
2
1
2
2
3
2
2
3
3
2
3
2
3
2
3
2
3
2
2
2
2
3
3
2
3
2
3
3
3
2
2
2
2
2
1
1
2
2
2
2
2
2
3
1
2
2
2
3
3
3
2
2
2
3
3
2
2
2
2
2
2
1
2
1
1
2
1
1
3
2
3
1
1
2
2
2
2
2
2
2
2
2
2
2
3
3
2
2
2
2
2
2
2
2
3
2
2
3
2
2
3
2
2
2
2
2
2
2
2
3
3
3
2
3
2
2
2
2
1
2
3
2
2
2
1
2
2
2
2
2
2
1
2
1
1
3
2
2
1
1
2
1
2
2
2
2
3
2
2
2
1
2
2
2
2
1
1
1
2
1
1
3
3
3
3
2
2
1
1
1
2
1
2
1
2
2
2
2
2
2
2
1
2
1
2
2
2
3
3
3
3
2
3
2
2
2
2
2
3
2
2
2
1
2
2
2
2
1
2
2
2
1
2
3
2
3
3
3
3
2
2
2
1
2
2
2
2
2
2
2
2
2
3
2
2
1
1
1
1
3
3
3
2
2
3
2
2
2
2
2
3
2
2
2
1
2
3
3
3
3
2
2
2
2
2
3
2
2
2
1
1
2
1
2
1
1
2
1
2
2
1
2
2
2
2
2
2
1
1
1
1
3
1
1
1
2
2
1
1
1
1
1
1
1
2
2
2
2
2
2
1
1
1
1
1
1
1
1
2
2
1
1
3
2
2
3
2
2
3
2
2
2
3
3
3
2
3
2
2
2
3
2
1
3
1
2
2
1
1
1
1
2
1
1
2
2
1
1
2
2
1
2
2
1
1
1
1
1
2
3
2
2
2
1
2
3
2
2
2
3
2
2
2
2
2
2
3
2
3
2
1
2
3
1
2
2
2
2
2
1
1
2
1
1
1
2
2
1
1
1
2
2
1
2
2
1
2
2
2
1
2
3
3
2
2
1
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
2
2
2
2
1
1
1
2
3
2
2
3
2
2
2
2
2
3
2
3
3
2
2
2
3
3
3
2
1
2
2
1
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1
2
2
2
2
2
2
2
2
2
2
3
1
1
2
1
2
1
1
1
1
1
2
1
2
2
2
2
2
2
2
2
1
2
2
1
1
3
2
2
2
1
2
2
1
2
1
1
2
2
2
2
2
2
2
3
2
2
2
2
2
1
2
3
2
2
2
2
2
2
2
2
2
1
2
1
2
3
2
2
2
3
2
2
2
2
3
1
1
3
3
3
3
3
3
2
2
1
3
2
3
2
3
3
3
2
3
3
3
2
2
2
3
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
1
1
1
1
1
1
1
1
1
2
3
1
1
1
1
1
2
2
1
1
2
2
1
1
2
1
3
2
1
1
1
1
1
1
1
1
3
3
2
3
2
2
2
2
1
2
2
3
2
2
3
2
3
2
2
2
3
1
2
3
1
2
1
3
2
2
3
3
2
2
2
1
2
2
2
2
2
1
3
2
2
3
2
2
3
2
1
1
Sector
NWL
Brent
NWL
Harrow
NWL
K&C
NWL
H&F
NWL
Westminster
NWL
Ealing
NWL
Hillingdon
NWL
Hounslow
ONEL
Barking & Dagenham
ONEL
Havering
ONEL
Redbridge
ONEL
Waltham Forest
EL&C
City and Hackney
EL&C
Newham
EL&C
Tower Hamlets
SEL
Bexley
SEL
Bromley
SEL
Greenwich
SEL
Lambeth
SEL
Lewisham
SEL
Southwark
NCL
Barnet
NCL
Camden
NCL
Enfield
NCL
Haringey
NCL
Islington
SWL
Croydon
SWL
Kingston
SWL
Richmond and Twickenham
SWL
Sutton and Merton
SWL
Wandsworth
Wider Primary
Contracting
Inclusive comm.
Care
(acute, non-acute)
Work
1. Access to Healthcare
Organisations
NELC Summary
Barking and Dagenham
Summary A
2. Being Safe
3. Safeguarding, Governance and Quality
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
Summary B
B1
B2
B3
B4
Summary C
C9
C10
C11
C12
C13
C14
C15
C16
256
24
25
28
30
23
19
22
24
30
32
95
27
23
27
18
205
23
27
26
23
26
26
28
26
24
2
2
3
3
2
2
2
2
3
3
8
2
2
2
2
16
2
2
2
2
2
2
2
2
23
2
2
2
3
2
2
2
2
3
3
10
3
2
3
2
20
2
2
2
2
3
3
3
3
19
2
2
2
2
2
2
1
2
2
2
7
2
2
2
1
16
2
2
2
2
2
2
2
2
22
3
3
3
3
2
2
2
2
1
1
6
2
1
2
1
13
1
2
2
1
2
2
2
1
21
2
2
2
2
2
2
2
2
2
3
8
2
2
3
1
17
2
2
3
2
2
2
2
2
23
2
2
2
2
3
2
2
2
3
3
11
3
3
2
3
19
1
3
2
2
3
2
3
3
19
1
2
2
3
1
1
2
1
3
3
4
1
1
1
1
18
1
3
2
2
3
2
2
3
22
2
2
3
2
2
1
2
2
3
3
10
3
2
3
2
21
3
3
3
3
3
2
2
2
26
3
3
3
3
2
2
2
3
2
3
9
3
2
2
2
18
3
2
2
2
1
3
2
3
21
2
1
2
3
2
1
2
2
3
3
7
2
2
2
1
18
2
2
2
2
2
2
3
3
15
1
2
2
1
1
1
1
2
2
2
8
2
2
3
1
14
2
2
2
2
1
1
3
1
21
2
2
2
3
2
1
2
2
3
3
7
2
2
2
1
15
2
2
2
1
2
3
2
1
168
16
16
17
19
14
15
15
18
18
20
68
17
16
18
17
149
16
18
19
16
14
20
19
22
16
1
2
1
2
2
1
1
2
2
2
5
1
1
1
2
13
1
2
2
2
1
1
2
2
16
1
2
2
1
1
1
2
2
1
3
8
2
2
3
1
19
1
3
3
2
2
3
2
3
24
3
2
3
3
2
2
2
2
2
3
9
2
2
2
3
19
2
2
2
2
2
3
3
3
21
2
1
1
3
3
2
2
2
3
2
9
2
2
2
3
15
2
2
2
2
2
2
1
2
15
1
2
1
2
1
1
1
2
2
2
5
2
1
1
1
16
1
2
3
2
1
2
2
3
22
2
2
3
2
1
2
3
2
2
3
11
3
2
3
3
21
3
2
3
2
2
3
3
3
26
3
2
3
3
2
3
2
3
3
2
10
2
3
3
2
24
3
3
2
2
2
3
3
3
28
3
3
3
3
2
3
2
3
3
3
11
3
3
3
2
22
3
2
2
2
2
3
3
3
122
10
13
11
16
11
12
10
13
14
14
49
13
11
14
11
113
13
16
13
14
14
15
14
14
17
1
2
1
2
2
3
1
3
2
2
6
1
1
2
2
19
1
3
2
2
3
3
2
3
18
1
1
2
3
2
1
2
2
2
2
10
3
2
3
2
20
2
3
2
3
2
3
2
3
23
2
3
2
3
2
3
2
2
2
2
8
2
2
2
2
18
3
3
2
2
2
2
2
2
23
2
2
2
3
2
2
2
2
3
3
9
2
2
3
2
17
2
2
2
2
2
2
3
2
16
2
2
1
2
1
1
1
2
2
2
7
2
2
2
1
16
2
2
2
2
2
2
2
2
25
2
3
3
3
2
2
2
2
3
3
9
3
2
2
2
23
3
3
3
3
3
3
3
2
11
11
10
12
10
9
10
11
11
13
43
11
11
13
8
83
8
11
10
9
9
12
12
12
28
3
3
3
3
2
2
3
3
3
3
11
3
3
3
2
22
2
3
2
3
3
3
3
3
22
2
2
2
3
2
2
2
2
2
3
7
2
2
2
1
15
1
2
2
2
2
2
2
2
16
2
2
1
1
2
1
1
2
2
2
9
2
2
3
2
16
1
2
2
1
2
2
3
3
20
2
2
2
2
2
2
2
2
2
2
9
2
2
3
2
17
3
2
2
2
1
3
2
2
22
2
2
2
3
2
2
2
2
2
3
7
2
2
2
1
13
1
2
2
1
1
2
2
2
92
99
97
116
87
85
87
102
108
118
390
102
93
110
85
843
91
111
104
95
93
113
111
115
Barnet
Camden
City and Hackney
Enfield
Haringey
Havering
Islington
Newham
Redbridge
Tower Hamlets
Waltham Forest
NWL Summary
Brent
Ealing
Hammersmith and Fulham
Harrow
Hillingdon
Hounslow
Kensington and Chelsea
Westminster
SEL Summary
Bexley
Bromley
Greenwich
Lambeth
Lewisham
Southwark
SWL Summary
Croydon
Kingston
Richmond
Sutton and Merton
Wandsworth
London-wide
108
654