Joint Commissioning Strategy
For People with a
Learning Disability
Presentation by
Stephen Rogers
What is Commissioning
• Strategic analysis of need.
• Understanding current service provision and
resources.
• Gap analysis.
• Service redesign.
• Close links with Contracting and Procurement .
• Monitoring of performance.
• Outcome measurement and review
That people get the best
outcomes possible from
public money
Joint Commissioning Strategy
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Approved by Cabinet in April 2011
Meeting future demand
Redesign services
Shows what will change and how far it will
change by 2015
Commissioning Objectives
MORE PEOPLE
MOVING INTO
EMPLOYMENT
IMPROVED
ADVOCACY
PERSONALISATION
HATE CRIME
PREVENTION
MORE
SUPPORTED
LIVING
VALUING
PEOPLE
NOW
BETTER HEALTH
PRIMARY/ACUTE
WITHIN
BUDGET
REDUCE BED
BASED A&T
CRIMINAL JUSTICE
IMPROVEMENTS
(Bradley)
BETTER DEMENTIA
SERVICES
SOUND
TRANSITION
NEW RESPITE
SERVICES. AND
BETTER
CARER
SUPPORT
CHANGE
TRADITIONAL DAY
SERVICES
REFOCUS
MARKET
NCC NO
LONGER A
PROVIDER
MARKET MGT
QUALITY INCENTIVES
VFM
CHANGE COMMUNITY
TEAMS – SKILLS MIX
REVIEW – FIRST STEP
Key Objectives for 2013/15
• Follow the Joint Commissioning Strategy
– Meeting Increasing demand
– Keeping within budget
– More Choice and helping the market to respond
to personal preference
– Improving Health Outcomes in Primary and
Acute Care….Plus
• Winterbourne View recommendations
Increases in demand
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General Population Growth
Norfolk is a popular destination
More young people with complex needs
Increasing needs of older people
already receiving service
• Increasing customer expectation
• Section 117 and Ordinary Residence
issues
Increased Demand for Learning Difficulties Services
Predicted Growth of LD Service Users in Norfolk 2009-2014
3500
3000
Number of Service Users
Actual Client Numbers
2500
Lowest Growth
Estimate
2000
Highest Growth
Estimate
1500
2004 Predictions
1000
Trend (Actual Client
Numbers)
500
0
2007
2008
2009
2010
2011
Year
2012
2013
2014
Keeping within Budget
• The Department of Health now pays most of the Health
contribution direct to local authorities
• In Norfolk this means that the County Council will spend £
100.2 million on services in 2013/14
• The NHS continues to directly commission assessment and
treatment services, very specialised hospital placements
and continuing health care £15 million. CCGs hold these
budgets
• Joint Commissioning in place to ensure effective
commissioning across the whole market takes place.
• Financial savings are required to meet future demand and
keep the books in balance.
• EU Social Investment Fund
How the NCC cash is spent
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£81.5m Purchase of care
£3m
Transport
£6.5m Joint Community Teams
£9.5m In house services (supported living
and day services)
• 0.85m Psychiatry
• 0.56 Specialist Health Respite
More Choice
• Valuing People and Think Local Act Personal
• All who want a personal budget will have one
• All people assessed for service will have been
offered support with a PCP.
• Market responding to provide services that
meet individual needs
• Range of services are becoming available to
meet changes in service demand
Improving Health
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Get all Norfolk GPs signed up to DES.
More people having annual health checks
Numbers of Acute admissions going down
Numbers of readmissions going down
A good experience when in Hospital
More people using mainstream health
services rather than having specialist
services
Supported Living/Residential Care
• New Models – eg sharing overheads leading
to Value for Money
• Planning with Housing Providers and Social
Landlords and families.
• Planning with Residential Providers
• Good Supply and Demand Management in
local areas.
Better Transition
• All young people who attend special schools,
mainstream schools with 25 hours + support, Out
of County placements or are Looked after
Children have Comprehensive Transition plans
• The information from these plans informs the
development of services.
• Develop transition services to help young people
develop independence
• Develop services that prevent young people being
placed out of County and help them when they
return
Respite Care Services
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More innovative respite care options
Pooling of Personal Budgets
Guideposts scheme
Good quality services for people with
significant medical needs
Dementia Services
• Improved community services for people
with early on set dementia
• The needs of people with LD are well
represented in the delivery of the Norfolk
Dementia Strategy.
Changing Day Services
• Valuing People – Drive to change large traditional day
services - Non segregated models
• Norfolk County Council will no longer be the provider
• “Independence Matters” – new social enterprise
• Individuals should be able to access support according to their
assessed needs and identified outcomes. Not become
dependent upon services
• Help people to progress - so that there is always support to
gain or regain maximum independence
• Moving on and on………..Progression
• Local Services - Participation in the community
• Better routes into employment
Employment
• More people will be in paid, real jobs- 300 by
2015?
• Ist April 2013 -164 in paid employment
• 44 in Voluntary employment
• 36 in training
• Project Search expanded and 50% of students will
secure employment- NHS, NORSE
• ASDA, Waitrose, M&S, Co-op
• More social enterprises – support into employment
eg CSV cafes
Tackling Hate Crime
• Effective reporting and joint working with
Norfolk Police.
• Extend Norfolk Safer Places Scheme
Improved Advocacy
• All Advocacy funding supported by
contracts with clear outcomes
• The service will be more equitable across
Norfolk leading to improved access
• New contract now in place
Market Management
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Develop Quality Incentives
Capture and encourage innovation
Progression and outcomes evidence
Use of Assistive Technology
Winterbourne Expectations
• Review the care of all people in learning disability or
autism inpatient beds – assess who ought to move
• Agree a personal care plan for each individual based on
their and their families’ needs and agreed outcomes;
• By June 2014 community based care arrangements
need to be in place for all people who do not need a
hospital placement and
• Develop the market to ensure people can move into the
community
Winterbourne
We want to make sure that we have the right
services in the right place so that people
with learning disabilities whose behaviour
challenges services can:
• Live somewhere that is right for them and
• Have the support to help them to do this.
Winterbourne – Regional Response
• ADASS - Regional work programme to
improve the way we work with providers to
develop and buy services.
• DOH sponsored‘Developing Care Markets
for Quality and Choice’.
• Personalised care for people with
challenging behaviour is a priority for the
region
Winterbourne Norfolk Response
• Local Steering Group
• Oversee the movement of all people who will
move by June 2014
• Develop a strategic plan that will ensure all people
in, in patient facilities will be there no longer than
necessary and
• Services are developed in the Community which
will reduce the need for future admissions
Commissioning Next Steps
• Plan to meet Winterbourne demand
• Continue moving forward together in the New Personal
Budget Landscape
• Further enhance market intelligence
• Continue to encourage innovation
• New Models for Local Day Services
• New Models for Living in the community
• Further develop Community services to prevent hospital
admissions and out of county placements
Autism Act 2009.
The Act made two key provisions:
• that the Government produce an adult
autism strategy by 1 April 2010
• that the Secretary of State for Health issue
statutory guidance for local authorities and
local health bodies on supporting the needs
of adults with autism by 31 December 2010.
• Statutory guidance that local authorities and
local health bodies have a legal obligation to
follow
National Autism Strategy
The Autism Strategy has five areas for action aimed at
improving the lives of adults with autism:
• increasing awareness and understanding of autism;
• developing a clear, consistent pathway for diagnosis of
autism;
• improving access for adults with autism to services and
support;
• helping adults with autism into work; and
• enabling local partners to develop relevant services.
Autism SAF
The purpose of the Self Assessment Framework
is to:
• assist Local Authorities and their partners in
assessing progress in implementing the 2010
Adult Autism Strategy;
• see how much progress has been made since
the baseline survey, as at February 2012;
• provide evidence of examples of good
progress made that can be shared and of
remaining challenges.
Thanks
for Listening