To review the draft Learning Disability Strategy 2018-2028, particularly transitional arrangements between children and adult services, before its presentation to Cabinet.

 

The Committee was invited to review the draft learning disability strategy 2018 – 2028, particularly transitional arrangements between children and adults services, before its presentation to cabinet.

 

The Chairman welcomed all in attendance including the witnesses present to comment on the learning disability strategy.

 

The SCO provided the presentation, as attached to the agenda papers and introduced the strategy.

 

The following witnesses were then invited to speak: Helen Huxley, a local student; Ian Harper, Service Quality Director, Aspire; Jade Brooks, Deputy Director of Operations Herefordshire Clinical Commissioning Group; and Mary Simpson, Healthwatch.

 

In summary witnesses made the following principal observations: 

 

Helen Huxley

 

Ms Huxley explained that she was a student who had recently passed through transition and had found a greater level of support after moving from a foster care arrangement to supported living. She enjoyed more freedom than she had experienced previously and wouldn’t change anything about her transition. The transition from sixth form college to college had also been a positive experience and she had settled into the new educational environment very easily.

 

Ian Harper

 

Mr Harper explained his involvement with local learning disability charities and advocacy groups. A challenge facing learning disabilities in the county concerned limited public transport and difficulty securing bus passes. There was also a problem in identifying what services were available with sites such as WISH providing some, but not all, details of services. A further challenge concerned the withdrawal of support for people with moderate or lower learning disabilities. Mr Harper explained that people with learning disabilities wanted to work or to volunteer and identified the 50/50 challenge in Gloucestershire as a good example of securing vocational opportunities for people with learning disabilities. Planning around transitions was felt to be too little too late and the impact on wellbeing and families was felt to be significant. It was queries when an alternative to 1 Ledbury Road would be opened and an accessible version of the strategy for people with LD was proposed.   

 

Jade Brooks - CCG

 

It was important that the learning disability strategy linked to the children and young people plan. The strategy needed to support people with learning disabilities throughout their lives and the links to employment and housing. Some elements of the strategy may only affect a small number of people but access to good healthcare was paramount. There was a challenge to address health inequalities and better access to healthcare. The strategy also provided for people transitioning back in to the county following receipt of LD services elsewhere.

 

Mary Simpson - Healthwatch

 

The tone and aspirations contained in the strategy were welcomed. There was a need to ensure the effective use and access to universal services and establishing best practice in ensuring reasonable adjustments are in place for people with learning disabilities. A system wide implementation of reasonable adjustments was required which should be commissioner-led. There appeared to be training initiatives in some areas of the strategy but not in others. Access to day opportunities and integrated services was important and the new tone in later iterations of the strategy was welcomed. It was important for people with learning disabilities to have varied and many opportunities to socialise. Job coaches are welcomed in the later version of the strategy as well as mention of other vocational opportunities. The engagement document at the end of the strategy was not clear how adults have been consulted; the new questionnaire was welcomed but there was concern that there was no room for comments or suggestions.

 

Following the witnesses the SCO provided points of clarification and explained that an accessible version of the strategy would be developed and a change to the questionnaire would ensure that comments and suggestions would be possible. It was confirmed that a link between the registers held at GP surgeries and council services would be an assistance to provide evidence for people with learning disabilities to claim bus passes.

 

Councillor PA Andrews spoke in respect of the strategy. This was a much needed long-term strategy and it was important that all those partners and organisations involved in the production of the document were co-ordinated in its delivery. The membership of the Learning Disability Board was unclear. Children’s services look after people up to 25 years but adults services care for people for the rest of their lives with complex health needs. Herefordshire has traditionally been considered to provide good learning disability care. It was queried how the introduction of universal credit would impact upon people with learning disabilities. The SCO explained that the introduction of new benefits arrangements had the potential to have adverse impacts upon people with learning disabilities who may not fully understand the changes and their effects.

 

The points below were raised in the discussion that followed:

 

·         The committee questioned why there was not a single, comprehensive, learning disability strategy across children and adults services? The SCO explained that from the age of 14 health action plans were directed towards transition and integrated commissioning. At 14 adult-focused work commenced which took account of aspirations moving into adulthood and provided alignment to adult services for people with LD.

 

·         Priority 6 of the current children and young people plan concerned children and young people with disabilities. One of the objectives under the priority was the creation of an integrated pathway to provide multi-disciplinary support to disabled children and young people from 0 to 24 years old. The committee asked where this strategy left this aspiration. The CWBSA explained it was encouraging that the strategy included young people between the ages 14 – 25 and there was an alignment with the children and young people plan. The DCW explained that the children and young people plan focused on elements of people’s lives and the strategy linked to the disabilities priority contained in the Plan.

 

·         The importance of domiciliary care was emphasised and how the council would ensure that providers delivered appropriate training to staff working with people with learning disabilities. The SCO explained that a new framework for contracting required potential providers to detail the training that was being undertaken. The ASCCM explained that the market for domiciliary care was problematic with challenges existing in the recruitment and retention of people to the sector. It was acknowledged that people with learning disabilities favoured consistency of carers and work force audits and business development plans would look into retention of staff. Karen Hall, Chief Executive, Aspire, explained that conscientious providers invested in good staff training and there was great value in settled staff and a stable workforce. At Aspire staff were encouraged to spend time with those who they supported to become familiar and learn more about them. 

 

·         The confusing legislative framework for learning disabilities was raised; the disability report in 2017 made difficult reading. In Herefordshire it appeared that the current guidance and legislation was being effectively put into practice. The SCO confirmed that the legislative picture had been confusing but the Care Act 2014 had sought to combine and coordinate the law into a form of comprehensive legislation.

 

·         It was queried where NHS England was involved in the provision of services for people with LD? JB explained that the NHS delivered specialist services to people with learning disabilities such as heart surgery. People with LD were likely to be disproportionately affected by illnesses such as heart failure.

 

·         How the LD strategy complemented the autism strategy was queried? The SCO explained that there were distinct pathways for autism and learning disabilities. It was important to retain separate strategies and it was explained that people on the autistic spectrum did not necessarily have learning disabilities.

 

·         The positive comments from Ms Huxley were welcomed but there was also a concern regarding the transition from primary to secondary school for children with learning disabilities.

 

·         The issue raised by Mr Harper concerning bus services was acknowledged and it was recognised that use of local bus services was falling. The ASCCM acknowledged that this was a complex issue and officers were working collaboratively across departments to attempt to produce a pragmatic solution.

 

·         Detail regarding the function of the Preparing for Adulthood (PFA) tracker was requested and how it worked. The SCO explained that the Tracker included detail of 16-18 young people in transition whose trajectory to adulthood was tracked and whose needs were mapped across issues such as healthcare and housing. The tracker had been developed in collaboration with partners and further improvements to the facility would be sought.  

 

·         The amount of £5,000 for carers support shown in the strategy was queried. The SCO explained that the amount should be considered in the context of the wider care budget in Herefordshire. 

 

·         It was queried what assessment had been undertaken to ensure the strategy complied with the Equality Act 2010. JB explained that GP surgeries registers could help inform reasonable adjustments that were required. Suggestions such as extending the length of appointments were reasonable adjustments; such adjustments would be informed through the registers held at GP surgeries.  

 

·         It was queried whether the adoption of the strategy would place greater pressure on GPs. JB explained that GPs were required to participate in annual health checks of patients with LD. In Herefordshire 63% of people with learning disabilities received a health check which was a figure that did not compare favourably to other areas and needed to be improved.   

 

·         The committee queried how the Council and the CCG, as employers and procurers of services, were seeking to support the employment of people with learning disabilities? The percentage of people with learning disabilities currently employed in the Council was sought and information on how the numbers of people going into internships would be measured. The SCO referred to innovative practice across the county and the need for the council to be an exemplar of best practice to other employers in Herefordshire. The creation of community interest companies and the identification of work where skills could be developed and qualifications gained was important. The SACWB commented that supported internships existed for young people between the ages of 16-24 with an education and health care plan. Internships were with local employers and consisted of a placement of a minimum of three days per week and were undertaken in conjunction with education. Currently there were 8 young people in an internship which also provided a social and friendship element. At the Council it was confirmed that one young person had started an internship with Balfour Beatty. Supported internships forums were new and intended to increase internships and employment of young people. The tracker helped to identify the number of people in internships and also to identify suitable placements. The detail of the current percentage of people with learning disabilities employed at the council would be provided following the meeting. – Action Note

 

·         The importance of publicising the strategy was highlighted and it was felt that that the appointment of a member champion for LD would support this aim.

 

·         It was queried how educational providers would be identified to deliver the study programmes identified for development in the strategy? The CWBSA confirmed that a number of the programmes were already being delivered.  A preparing for adulthood further education group were developing curriculums. Work was also ongoing in partnership with Hoople for young people with EHC Plans to identify specialist educational programmes with the aim of moving into employment when appropriate.  Work would be undertaken on provision for people with moderate learning disabilities. A recent funding change to community learning funding had affected the provision of services but work was ongoing with the job centre to create an employment pathway to support people with LD into employment and access to work funding. 

   

·         Given the low proportion of people with learning disabilities registered how would educational facilities be helping to identify people for diagnosis? JB highlighted the need to ensure staff working in public agencies could identify and be sensitive to people with learning disabilities particularly as people often became known to the public sector during times of crisis. The need for the raising of awareness was of paramount importance. The role of the LD champion would help make links with partner agencies and raise awareness of the strategy. 

 

·         It was queried when the implementation plan would be completed. The SCO confirmed that the plan would be updated before the Cabinet meeting in June at which the Strategy would be considered and work would begin on the commissioning plan.

 

·         The committee understood that the strategy highlighted an intention to identify models of best practice from local authorities and questioned whether there was also an ambition to work collaboratively with neighbouring authorities to develop specialised services for learning disabilities. The SCO explained that learning from other local authority areas was in progress but it was acknowledged that some other areas had significantly higher levels of resource and that best practice had not transferred in full to Herefordshire. There was a need to incorporate in commissioning practices the identification and implementation of innovative solutions whilst ensuring there was adequate resource to deliver such programmes. Currently officers were looking at transforming care programmes and hospitalisations; there was the opportunity to work with other areas to address the causes of admissions with the intention of reducing the level of future hospitalisations.

 

·         The committee queried what specialist housing was being provided in Herefordshire and what pre-application planning advice existed to incorporate the needs of people with learning disabilities into new developments. The SCO explained that specialist services were provided by the Council and the planning process considered the needs of people with learning disabilities. A new development of flats had recently been completed which had been designed for people with moderate needs; housing solutions were also being worked on for people with more advanced needs. There were frustrations expressed regarding the changes sought by developers to reduce the number of affordable houses on development and the effect this could have upon housing for people with learning disabilities.

 

·         The committee asked how many people with LD from outside Herefordshire were present in the county. The SCO explained that this was a very difficult statistic to produce and identifying numbers in the county was a perennial problem. The ASCCM explained that work was being undertaken to begin to compile information about people with learning disabilities resident in Herefordshire but from other parts of the country. This included a self-funder audit and questionnaire of residential and nursing homes in Herefordshire.

 

The committee proposed and seconded a series of recommendations, as below. The recommendations were approved unanimously.

 

Resolved– that the committee:

 

(a)   supports the strategy and requests the missing information, concerning health and wellbeing outcomes and social impact, and the implementation plan is shared with the committee when available;

(b)   requests that the executive prioritise the incorporation of improved metrics in the strategy to measure progress and provide evidence that objectives are realising desired outcomes;

(c)   requests that the executive considers making updates on the development and implementation of the strategy available through an appropriate forum e.g. the corporate budget and performance report;

(d)   asks the executive to provide a report to the committee, in due course, on the re-modelling of the Learning Disability Partnership Board; 

(e)   asks the executive to consider appointing a member champion for learning disabilities;

(f)    asks the executive and the CCG to investigate methods of utilising learning disability registers, held by GP surgeries, to provide evidence for those with learning disabilities to more easily obtain bus passes;

(g)   asks the executive to investigate the promotion of a scheme, similar to the Gloucestershire 50/50 strategy, in Herefordshire to encourage employment opportunities for people with learning disabilities; and

(h)   ensures that following the adoption of the strategy, the CCG and the 2gether Trust are held to account for those elements of the strategy for which they are responsible.   

 

 

Mr Burbidge and Councillor Greenow left the meeting at 12.17 p.m.

 

There was a brief adjournment at 12.17 p.m., the meeting re-convened at 12.25 p.m.