How can we get better services for children and adults who present

How can we get better services
for children and adults who
present challenges?
Liz Bruce
Strategic Director Adults, Manchester City Council.
ADASS NW lead for learning disability
Why, 10 years after Valuing
People is there still a problem?
The problem has deep roots.
• Devaluation of learning disabled
people in our society.
• Great progress made towards
ordinary lives but bad attitudes and
low priority run deep.
Defining the problem
Slide 2
“The underpinning issue is one of the
overall service and system design.”
Letter to the Prime Minister
“Whilst the organisations that particularly failed
in allowing the abuse at Winterbourne View
should be held to account for their failures, (the
provider, the regulator and the various
commissioners), focusing only on them would
be a mistake. The underpinning issue is one of
the overall service and system design – hence
the need for Government to take a lead.
Without the type of actions we suggest below,
there is a very real risk of similar things
happening again, elsewhere.”
No place for hospital care.
“There is no place for specialist hospitals in the care of
people with learning disabilities (outside of serious
forensic issues). There is clear evidence that such
hospitals provide poor outcomes, often at very high
cost, and that there are better, alternative ways of
supporting people that have behaviour labelled as
‘challenging’. There is a place for a small number of
local assessment and treatment beds, integrated with
other local community services.”
Letter to the Prime Minister
In the North West we have moved furthest from
traditional models of care.
Local gaps
“People are being placed in services such as Winterbourne
View because of:
(i) a lack of local services with the skills and resources to
deliver supports that are known to work and deliver better
outcomes, and/or
(ii) because local commissioners lack the knowledge and skills
on how to commission local, evidence based and individualised
services for people who are labelled as ‘challenging services’.”
Letter to the Prime Minister
Is regulation the answer?
“The regulatory framework is failing to pick up on and reduce
the risk of such service failings.”
Letter to the Prime Minister
We need multiple safeguards
•good design and commissioning,
•good assessment sand reviewing,
•skilled and well supported workforce,
•whistle-blowing and complaints taken seriously,
•contract monitoring,
•independent regulation,
•advocacy and the empowerment of learning disabled people
and their families.
Defining the solution
Valuing the expertise of people and
their families.
“If the voices of people with learning
disabilities and their families were heard
better, then the risks of such abuse would
be greatly reduced”
Letter to the Prime Minister
Not just voices – but active partnership in the
design and monitoring of provision.
Some very practical priorities (1)
Effective monitoring of 24 hour settings:
• Individual reviews coordinated with contract monitoring.
• Use of advocates and lay assessors – including learning
disabled people and family carers.
• Escalation processes to raise issues .
• Quality Board in place which has an overview of all
complaints, safeguarding incidents or quality concerns.
Individual Care Plan Reviews.
• Structured reporting and programme of compliance visits
undertaken to all services that provide 24 hour care.
• Communication with the regulator to ensure effective joint
action when needed.
Some very practical priorities (2)
High quality commissioning
•Use the evidence base on what works in challenging behaviour
provision: Preventative approach based on understanding needs and
providing structured care and support to access opportunities.
•Involve learning disabled people and families in planning.
•Value and utilise provider experience and know-how.
•Ensure buildings are fit for purpose.
•Clear commissioning plan based on population need (including
disinvestment in poor provision).
•Person centred assessment and care management to select among
alternatives and design bespoke solutions.
•Work across organisational boundaries to ensure a whole system
Children  Transition  Adults
Social care / Health / Housing / Other resources