To review the services commissioned by the council and the clinical commissioning group for adults with learning disabilities in Herefordshire.

A presentation was given by the senior commissioning officer, Herefordshire Council and the community learning disability team service manager, 2gether NHS Foundation Trust. It was noted that the presentation was a brief tour of the service, which provided long-term work covering each person’s life span, all health needs and all aspects of daily living.  

The presentation highlighted the following key points:

·         Although statistics could not be relied upon, it was estimated that 2.32% of the county’s population had a learning disability diagnosis, and this covered a wide spectrum of needs.  This figure broadly fitted national demographics; however it was noted that the county had a good reputation for the care of people with a learning disability which resulted in people moving here to access services

·         In terms of funding, learning disability services represented 30% of the adult social care budget, supporting 550 people, which was broadly equivalent of 25% of council tax income, and which was typical of national picture.

·         As shown in the adults and wellbeing blueprint, there was a move towards mainstreaming peoples’ experience and accessing universal services rather than looking to adult social care, which represented significant culture change. 

·         Work on developing access to information and improving the “front door” would help people know where to access information and support. Success in achieving changes to the pathway was facilitated by community brokers, in getting more consistent and richer information, and all information was being linked into WISH online which was starting to show success.

·         In terms of health provision, providers and commissioners were working together to ensure contracts were directed in the right way and meeting long term needs. The focus was on making sure reasonable adjustments were made so that people could routinely go straight to the service they needed.  This was supported, for example, in acute care by acute liaison nurses. Herefordshire had been successful in limiting the use of out of area placements for people with learning disabilities, and those people who were out of county were on planned return. This was an excellent position as continuing healthcare for this small cohort was known to present a challenge, and the intention was to bring everyone home to the county.  Service provision cost around £250k per person annually, so a possible way to support this outcome was to develop specialised services shared with neighbouring authorities.

·         Access to the community learning disability team was supported by a multi-disciplinary approach and an open referral system. The aim of the service was to provide person-centred support for people to access mainstream services whilst recognising the need for some specialist support.

·         The service was supporting access to annual health checks and there was a lead nurse providing training for GPs to increase access which was currently around 60%. Take-up of health checks was lower than in the general population, so this was being promoted with input from the Clinical Commissioning Group and the council. This was a critical area of focus as someone with a learning disability could  ...  view the full minutes text for item 42