Dr Ahmad Khouja MRCPsych DPhil MBChB BA DipMedSci
Deputy Medical Director
Clinical Director Forensic Services
Consultant Psychiatrist in Learning Disability
Forensic Service
Cleveland Way
Roseberry Park
Marton Road
Middlesbrough
TS4 3AF
PRIVATE AND CONFIDENTIAL
(Not to be disclosed without permission of the author)
Ref: AYK/bav
Tel: 01642 837529
Fax: 01642 837689
email: barbara.vallely@tewv.nhs.uk
10th January 2014
Pricing and Currency Forensic Subgroup
LD and Autism Spectrum Task and Finish Group
Dear Colleague
Many thanks for attending the initial LD and Autism Spectrum Pricing and Currency Forensic
Subgroup meeting, which took place at West Park Hospital in Darlington on the 7th January 2014.
The group comprised of me, Carole Green, Jon Painter, Barry Ingham and Jon Painter.
I am writing to summarise what was discussed during the meeting and highlight the various actions
that were agreed.
Terms of reference
The group was grateful to Elisa Taylor for drafting up the Terms of Reference based on the other
Task and Finish Groups. We had the opportunity to go through the terms, which I have written up
and attached below. Please let me know if there are any inaccuracies or omissions. You will recall
that we had a long discussion about what to call the group as it was recognised that we wanted to
include people on the autism spectrum who did not have a learning disability. The term neurodevelopmental disorder (NDD) was looked at, however it was agreed in the end to simply call the
group ‘Learning Disability and Autism Spectrum’ as then it was clear to everyone what we are
about.
14 July 2003
We felt that it was important that as a Task and Finish Group the membership was tight but
representative of all levels of security, the independent sector as well as NHS. A commissioner link
was also useful, as well as linkage to the LD CPP. Maintaining links with the National CPP LD
group will be important, and we are grateful to Barry and Jon for providing their expertise.
Very kindly, you suggested that I continue to chair the meeting. As well as those present at
today’s meeting, it was suggested that we approach the following for membership of the group:
 Dan Dalton from Hertfordshire Partnership NHS FT (Ahmad to do)
 Alick Bush from St Andrews Hospital Group (Carole to do)
 Caris Vardy, for a representative from NHS England – Lyn Bradford’s name was mentioned
(Ahmad to do).
 We also need a representative from high secure (Carole to do).
As I will not be attending the next Forensic Pricing and Currency subgroup, Carole agreed to take
the Terms of Reference to January’s meeting for ratification.
Dr Ahmad Khouja
Tees, Esk and Wear Valleys NHS Foundation Trust
Page 2 of 4
Clustering tool
Jon introduced and orientated the group to the Integrated Mental Health and Learning Disability
Clustering Booklet. This has nine additional clusters compared to the Mental Health Clustering
Toolkit, six around learning disability and challenging behaviour (clusters 9a-f) and three around
learning disability and physical health issues (clusters 22-24). The new clusters have been
accepted by the Department of Health.
Integrated MH&LD
CT Booklet
The group believed this formed a great basis on which to develop LD and autism clusters for
forensic services. It was also agreed that it made sense to use as the foundation the latest version
of the forensic clustering tool book, to which we would add the additional cluster items 9a-f, 22, 23
and 24 as these clusters are now well developed.
Looking at the 9 new clusters in some detail, the group considered that of the nine, only three were
likely to be of primary use in forensic services

9b
Risk to self, complicated by moderate – profound LD

9c
Risk to others, complicated by mild-profound LD

9d
Risk to others, complicated by mild LD and ASD
It was acknowledged that there was the lack of an ability to cluster someone with violence or selfharm who was on the autism spectrum but who did not have an LD. However TEWV have links with
those looking at autism spectrum disorders in this context (Helen Pearce and Kirsty Passmore).
Ahmad agreed to approach them as to where they are with their proposed clusters to determine
whether they are at a stage where it might be considered appropriate to add them to the integrated
forensic tool.
Throughout the discussions, we emphasised the importance of building on the work of others, and
also to keep in mind that ultimately we would like to see a single clustering tool and methodology –
so that no matter where a service user was in their treatment pathway, the same tool was used.
This is also reflected in the drafting of our terms of reference.
Jon will go from this meeting and do an initial draft of the new clustering tool so that as a group we
can provide a ‘sense-check’. There will be a need for some modification as existing booklets are
merged, particularly looking at the ratings section as currently the same reference letter is being
used for different concepts. The good news is that the two sets of proposed new clusters (cluster
8s from the forensic clustering and clusters 9, 22, 23 and 24 from the LD toolkit) dovetail nicely
together. Hopefully Jon will be able to get the initial draft to us in a couple of weeks.
We did discuss whether we should pilot a modified 5 Forensic Pathway toolkit. However we
decided that it is better to approach this issue through determining through the pilot whether there
is a need for one through people allocating to a ‘Pathway 0’ (not able to allocate) and from that
determine what additional pathways (if any) need to be developed.
Training
Once the new integrated forensic tool has been drafted, we need to develop training for the
identified pilot providers. In order to tool get enough people in the pilot, we will be looking for
clustering of new admissions into secure services and people at their reviews (we have assumed
that as CPAs are 6-monthly, a 3 month pilot should capture 50% of eligible people within a service).
Learning from previous pilots, we need to ensure we have developed clear guidance on how to
retrospectively cluster at patient reviews.
Dr Ahmad Khouja
Tees, Esk and Wear Valleys NHS Foundation Trust
Page 3 of 4
We felt it would be good if we could involve Mick James (RCPsych / CPP) and Adrian Berry
(SWYT) regarding training given their previous experience. I believe Carole will be chasing this up.
Pilot sites
As a group we looked at potential provider sites for the pilot. We had the opportunity to write up the
requirements required of providers wishing to be part of the pilot (attached below).
Requirements from
pilot providers
Based on the requirements, both NTW (Barry) and TEWV (Ahmad) would like to propose their
Trusts as potential pilot sites. We felt that St Andrews could be approached from the independent
sector to see if they are willing to be involved, as they have significant LD and autism services.
Further potential provider pilot sites will be explored by Carole at the next Forensic Subgroup
(January 30th) and agreed.
Data analysis
It was agreed that TEWV should be approached regarding extending their current information
contract to include data analysis from the pilot. Bob Craig has very kindly agreed to be our link for
this, and Carole will explore how this can be facilitated.
Work will begin now, led by Bob and involving Jon and Barry, on developing the required data set.
We were informed that an important metric to capture is the ‘goodness of fit’ of the clients within
their designated cluster, so this will be built in to the data set.
The group would also like to capture the experience of providers in completing the tool - Survey
Monkey will be used for this.
Data collection for the pilot will commence May 2014. We will try to ensure a test data collection
around June, which can include dummy data if necessary. As data needs to be available for the
task and finish group to analyse in September / October 2014, this will mean final data submissions
from the pilot need to have been received the beginning of August.
Work programme
Based on the above discussions, as a group we were able to draft up a programme of work for
2014. The opportunity to influence 2015/16 contracts helped us to define the timeframe of the
works. Whilst it was acknowledged that this represented a very demanding goal, and there was no
capacity for slippage, we all believed it worth taking such an ambitious approach.
I have drafted up the programme based on our discussions. Again I am happy to be contacted
regarding any acts of omission or commission!
Works programme LD
& AS draft 001
Dr Ahmad Khouja
Tees, Esk and Wear Valleys NHS Foundation Trust
Page 4 of 4
The key milestones were agreed, as follows:
Milestone Description
Provider pilot sites identified at forensic subgroup
Cluster booklet finalised
Training given to pilot providers
Start data collection (3 month)
Test submissions confirm pilot dataset viability
Final data submission
Data analysis completed
T&F group develop recommendations
Data presented to Forensic P&C subgroup
Proposals regarding 15/16 contract are submitted
Date
30.01.14
March 2014
April 2014
May 2014
June 2014
Start August 2014
End August 2014
September 2014
October 2014
November 2014
Accountability
Carole Green
Jon Painter
??
Pilot providers
Bob Craig
Pilot providers
Bob Craig
Ahmad Khouja
Ahmad Khouja
Forensic subgroup
Carole and I will continue to attend the main forensic pricing and currency subgroup. As part of the
reporting structure, I agreed to produce a 4-box summary (the standard way that meeting receives
reports), which I have now done. I have also attached for your reference the meeting schedule for
the forensic subgroup
4 box highlights LD &
AS Jan 14
MH PbR PRG
Forensic sub group Meeting Schedule 2014.doc
Thank you
Finally, I would just like to express my thanks for your contribution to the meeting and commitment
to this programme. As I said at the time, I believe more has been achieved in those two hours than
we have managed in the previous two years! Elisa will be contacting us regarding future meetings
(the next will be a teleconference), and I look forward us to meeting up again.
With warm regards
Dr Ahmad Khouja
Clinical Director Forensic Services