WE OPEN EYES.

The issue

In December 2012, the Department of Health published Transforming care: A national response to Winterbourne View hospital. It highlighted the abuse suffered by people with learning disabilities in hospital and that they were often being admitted to hospital for too long. One of the key actions the report outlined for hospitals was for them to carry out care reviews of all their patients with learning disabilities by June 2013. In addition, a number of subsequent reports have also strongly recommended the use of Care and Treatment Reviews (C(e)TR) to reduce unnecessary admissions and shorten stays in hospital.

What we’ve done

In response to the Winterbourne View hospital report, three NHS trusts commissioned us to carry out reviews of approximately 60 individuals living in assessment and treatment units or locked rehabilitation units. To date, we have also organised and facilitated a further 300-plus C(e)TRs for 10 clinical commissioning groups. All of which have taken place within an agreed timescale, and many have been carried out at short notice, for example, before a person is admitted to hospital or within 10 working days of an admission.

As part of the C(e)TRs, we provide clinical reviewers and experts by experience (a person who has used services or a family member).

These reviewers undertake a thorough analysis of the assessment and treatment of a patient and make recommendations for further assessment or treatment, where required.

We also support people with a learning disability and their family members to ensure they are being listened to and become equal partners in a care and treatment pathway.

We explore community options and additional packages of support to help prevent people with learning disabilities being admitted unnecessarily into hospitals or mental health units.

And we ensure any admission to a hospital is supported by a clear rationale of planned assessment and treatment with measurable outcomes and timescales.

The issue

NHS England and NHS Improvement established the Learning Disabilities Mortality Review (LeDeR) programme in May 2015. Its aim is to drive improvements in the quality of health and social care for people with a learning disability, and to help reduce premature deaths and health inequalities.

As part of the programme, local authorities must carry out LeDeR reviews that examine the circumstances leading to a death and how such deaths could potentially be avoided in the future through improvements in health and care services.

What we’ve done

So far, we have carried out over 200 LeDeR reviews on behalf of six integrated care boards. These have all been completed with a set timescale, which has resulted in each local authority achieving high completion rates.

In comparison, many local authorities throughout England have struggled to achieve high rates, with significant challenges being reported.

The issue

The NHS Long Term Plan 2019 and Building the Right Support are both national plans committed to improved NHS delivery for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition. Baroness Hollins Thematic Review identified key themes and The Cawston Park findings and learning need to be considered when developing the individual inpatient life plans.

What we’ve done

It is better for an individual’s physical and mental wellbeing to leave hospital as soon as they are medically optimised for discharge. At Positive Support Group we think ‘Why not home? Why not today?’ ‘What will it take?’ every day. We provide support for an individual’s safe, appropriate, and timely discharge. Our Independent Life Plans are developed to find out how an individual’s care and treatment can be made better, and how their discharge from hospital can be supported.

We achieve this by:

• Ensuring that the voice of the individual/families and carers involved are listened to

• Supporting the MDT and Social Worker to put a plan in place to support discharge

• To look at any current barriers to discharge and what actions are required to prevent delayed discharge

We are always in consultation with NHS England and ICB’s to ensure the individuals’ needs are met.