Agenda item

13.15

Representatives from the Oxfordshire Clinical Commissioning Group (OCCG), Oxfordshire County Council (OCC) and Southern Health Foundation Trust will provide an update on Learning Disability Care in Oxfordshire.

A joint report prepared by OCC and OCCG is attached at JHO10. A presentation on the report will also be given.

An update including annexes from Southern Health is also attached at JHO10.

The Chairman welcomed:

Ian Winter CBE – Independent Chair, Transforming Care Partnership Board;

Ian Bottomley – Head of Mental Health Services & Joint Commissioning – Oxfordshire Clinical Commissioning Group (OCCG)

Sula Wiltshire – Director of Quality & Chief Nurse – OCCG

Helen Ward – Senior Quality Manager, OCCG

Lesley Stevens – Medical Director, Southern Health NHS Financial Trust (SH)

Kate Terroni – Deputy Director for Adult Social Care (Joint Commissioning) – Oxfordshire County Council

Ian Winter CBE addressed the meeting prior to the presentation. It was his view that successive governments had often failed in their quest to find a successful strategy for Learning Disability policy over the years. However, the latest Transformation Care Plan was a positive initiative in that it did not separate patients across the age ranges or by condition. He spoke about the importance of the Transforming Care Plan being underpinned by the Transforming Care Partnership Board. One of the issues for Oxfordshire was about the successful transfer of services to other providers. The role of the Board was to ensure the safe and effective transfer and transformation of services by means of challenge, championing and collaboration. He hoped the Committee would reach some level of confidence in the action that was being taken.

Kate Terroni and Ian Bottomley then gave a presentation on the current arrangement with Southern Health and how the transition to other providers would be managed. Ian Bottomley referred members to Appendix 1 ‘Oxfordshire’s Health & Social Care Transformation Plans’ which was set out in the Addenda to the Committee.

A member asked if the general community health services, as health care providers, would have the appropriate expertise to deal with people with conditions such as autism. Ian Bottomley responded that resources were already in place to provide a service, in the form of the existing contract which would be rolled over. He stated that there was no imposed solution – all had to be fully engaged and inform the OCCG of general risks and of financial risks. Moreover, the OCCG needed to be satisfied that providers were able to do the job. The contract was already provided by the existing community services located at the John Radcliffe Hospital. Here there was a good liaison service in place for people with a learning disability because staff and ward teams had a familiarity with the patients.

In response to a question asking how would intelligence be collected in order to access data, Ian Bottomley stated that the OCCG’s working approach would be to identify the outcomes for meeting the health needs for a person with autism or a learning disability, and then to monitor how well the patient had done against those outcomes. Moreover, there was also a need to monitor how well the OCCG was picking up this condition generally, by asking the question of how the organisation might assess whether somebody had got autism. Sula Wiltshire explained further that the commission had made recommendations in relation to the investigation of deaths. She explained that there was an acceptance that good data on people with a learning disability was not apparent and there was therefore a need to know how to secure intelligence in order to determine how robust professionals were, for example, on how incidents were interrogated.

A member stated that it was reassuring to hear that the OCCG aimed to keep staff engaged as a priority, asking if anybody would be monitoring engagement criteria with patients – and would the criteria be set locally or nationally? Ian Bottomley responded that learning disability was not an exact, scientific diagnosis. In general it was known what future demand would be for adult and children’s services but mental health, and particularly autism assessments were more difficult. The big challenge was to design a way of assessing which related to professionals looking for signs under the principle ‘behaviour always means something’. The specialist aspiration was that everybody would go through the front door of Health. Dr McWilliam commented also that learning disability and autism were not concepts that could be nailed down using socially constructed, imposed definitions. To try to apply to very strict quality standards was ‘slippery’, and then to be asked to measure it, ‘difficult’. At some time the Panel would try to transform services making it routine care rather than specialist care. He added that it was difficult to define what they were going measure, and then to put into contracts at this time, as there were legal contracts to unpick.

A member asked the Panel to expand a little more on what the vision was for the future of in-patient support within Oxfordshire and how spot-purchasing would go forward. Kate Terroni explained that originally there were 8 spot purchases which had reduced to 6. These were managed by a multi-disciplinary team of nurses and clinicians to enable staff to be supported and to keep a person in that environment. Now that there was a move to fewer beds, some patients would be placed as near to home as possible, and with a consistency of staff for in-reach and support, with a view to re-integrating the person into the community. She added that there would only be a small number of circumstances when beds would be required. Ian Bottomley added that in circumstances when there was a need for crisis provision, it would be managed by nationally imposed targets. The aim was to end with a model which only used beds when required, and for as short a time as possible. He added that the OCCG would be monitored on a reduced number of beds during the lifetime of this contract.

A member asked if there would be a point of contact with a member of staff for patients. Kate Terroni explained that professionals would look at the individual to assess whether they would suit that particular placement.

When asked what the CCG was expecting out of mainstreaming, Ian Winter stated that the aim was that people with a learning disability and autism should receive the same access to broad health care as a person without the condition.

Sula Wiltshire then gave a presentation the Commissioners’ response to Mazars report into Mental Health and Learning Disabilities deaths in Southern Health NHS Foundation Trust.

The Chairman thanked Sula Wiltshire for the presentation.

Lesley Stevens explained that one challenge was that this was the first real examination of deaths in the community. In the past there had no clarity of guidance about who should investigate and no criteria to apply in particular settings. It is a huge amount of work as there are no tools to apply in the community sector. The data for 50% of the cases was required for the work.

A member asked who was doing the work – and would it have been undertaken if Oxfordshire had not teased out the data. Sula Wiltshire responded that it would not have been undertaken and it was the Health Economy Group who were doing the work. They were due to be trained very soon. She explained that the Group would pick up the recommendations from the thematic review and compile a number of questions to be explored. For example, was the liaison good for that person? Was there a delay in diagnosis?

A Committee member asked if a change in Board leadership had been considered, given the need for a dispassionate eye for how things needed to change. Lesley Stevens responded that it had been considered, in fact much scrutiny around the leadership had taken place, however, Monitor was the body to take such a decision and an Improvement Director would be working with the Trust. She added that there was confidence in both the Director and the Board and a wish that they should stay. She added further that the Trust had been the subject of a significant amount of external scrutiny to date and had received reassurance about improvements made and the safety of services.

The representatives were thanked for their attendance and for allowing a frank, open discussion.