Agenda item

            The Committee considered the undernoted report:

 

“Relevant Background Information

 

Purpose

 

      To bring to the attention of the Strategic Policy & Resources Committee details of a further “Excellence and Choice” consultation by the Belfast Health and Social Care Trust (the Trust) on its future service delivery, this time in relation to Learning Disability Services in Belfast, and to present a draft response for further comment and endorsement.

 

Background

 

      Towards the end of 2008 the Trust issued the consultation: “New Directions: A Conversation On The Future Delivery Of Health And Social Care Services In Belfast” which set out its strategic thinking regarding future service delivery generally.  This consultation document builds on the thinking set out in New Directions and outlines the strategic direction and plans for the future of learning disability services in Belfast and at MuckamoreAbbey Hospital.  Some consultation has already taken place with people with learning disabilities and their families in developing the strategy. The purpose of the paper is to seek views on the strategic direction for adult learning disability services from the wider population.

 

Key Issues - Strategic Context

 

      Policy

 

      The regional policy for learning disability services is set out in the Equal Lives report (2005), developed as part of the Bamford review on mental health and learning disability, and in the subsequent Implementation Action Plan (2009) which sets out the Government’s proposals on how to take forward the recommendations of Equal Lives.  The strategic direction of the Belfast Trust as outlined in the consultation paper is in line with the recommendations in the government’s Action Plan.

 

      The Equal Lives report highlighted that people with a learning disability in Northern Ireland do not enjoy equality of opportunity and that they are often excluded from the opportunities that other citizens enjoy. 

 

      Financial Implications

 

      The Equal Lives report made 74 recommendations and the cost of implementing these in full was estimated at approximately £175 million over a fifteen to twenty year period.   Initially an extra £17m has been secured by the Minister of Health to begin this process over the 3-year period 2008/09 to 2010/11.   The Belfast Trust’s share of this is almost £3.8m.  The Belfast Trust currently has around £52m available annually from the Health and Social Care Board to support the delivery of adult learning disability services. However, the Trust has to achieve efficiency savings of 3% a year from 2008 – 2011 as well as managing an underlying deficit. This equates to £5m efficiency to be achieved over the 3-year period for adult learning disability services.   The Trust recognises that there will be challenges in delivering its vision for Learning Disability Services in the current financial climate and that the implementation of some of the proposed elements will rely on appropriate levels of funding being secured.   The Trust therefore aims to make the best use of existing resources and any new funding to invest in more modern services and achieve efficiencies in order to deliver the services that people with learning disabilities have said they want and which are detailed in Equal Lives.   Some of the recommendations within the report are therefore subject to resources.

 

      Young People

 

      Elected Members have previously expressed the view that there are limited facilities provided for people with learning difficulties, particularly young adolescents, and as such additional resources needed to be targeted in that area.  Within this consultation, the Trust states that as part of the further enhancement of the Trust’s community based (non centre) daytime provision for adults with a learning disability, an initial focus will be on the needs of school leavers.   

 

      Guiding Principles

 

      The Trust has developed a number of guiding principles, in collaboration with service users, their families and carers, to guide the approach to learning disability services.   The fundamental principle underpinning reform in learning disability services is individualisation.  The direction of travel for the service is away from congregated living and large institutional establishments towards services that are flexible and tailored to suit the needs of an individual.

 

Summary of the Consultation

 

      The Trust currently delivers services to people with learning disabilities through three strands.  They are:-

 

1.   Somewhere to live and a fuller life.

2.   Access to additional support in the community, including specialist community treatment and support services and respite.

3.   Access to specialist inpatient assessment and treatment services.

 

      Within these parameters The Trust is proposing:

 

1.   Somewhere to live and a fuller life:

 

·         An expansion of supported housing across the city of Belfast.

·         The replacement of the four remaining residential homes with a range of supported housing options for the people who live there to improve their quality of life.

·         The further enhancement of its community based (non centre) daytime provision for adults with learning disability, focusing initially on the needs of school leavers.

·         The re-provision of existing out dated centres with purpose built facilities providing no more than forty places at a time.

·         That in future day centres will only provide services for people who are unable to meaningfully participate in integrated community opportunities.

·         The further development of the supported employment model and supported employment opportunities in Belfast.

 

2.   Access to additional support in the community, including specialist community treatment and support services and respite:

 

·         The reprovision of residential respite services in dedicated respite facilities no more than four beds in any one facility.

·         Enhancement of Community/ leisure - based respite.

·         Increase of Family respite placements as a form of respite break.

·         Increased access to mainstream services where appropriate.

·         The expansion of Multidisciplinary Community Learning Disability Teams to provide proactive services and support to people with learning disability to access mainstream & learning disability specific services.

·         Development of Specialist service networks including epilepsy services, genetics, complex health services, autism services, primary care mental health services, dementia services, and addictions services.

·         Development of Specialist Mental Health and enhancement of Behavioural Services.

·         Enhancement of specialist treatment options provided across the city of Belfast, including a community forensic service.

 

3.   Access to specialist inpatient assessment and treatment services:

 

·         To provide access to acute inpatient mental health beds for people with high levels of adaptive functioning/mild learning disability who require therapeutic intervention as a result of mental health problems.

·         To bring forward a plan to resettle all remaining longstay patients from Muckamore Abbey hospital by 2014 subject to the appropriate levels of funding being available.

·         To commence a discussion with all relevant stakeholders on the future of inpatient specialist assessment and treatment services at Muckamore Abbey hospital.

 

The full consultation document can be accessed at:

 

http://www.belfasttrust.hscni.net/involving/reference/Excellence and Choice LearningDisability Nov09.pdf

 

Recommendations

 

      The deadline for the consultation is 25^th February 2010 (new extended closing date); therefore the Committee is asked to approve the draft response and its submission to the Belfast Trust subject to Council ratification on March 1st. 

 

Key to Abbreviations

 

      Belfast Health and Social Care Trust - the Trust.

 

BELFAST CITY COUNCIL (DRAFT) RESPONSE

 

Belfast Trust Excellence and Choice Consultation: The Future Provision of Learning Disability Services in Belfast

 

February 2010

 

General Comments on the Consultation Document

 

      BelfastCity Council welcomes the opportunity to comment on this consultation document.  Our Elected Members are particularly interested in the issues affecting health and social care services and had previously requested that ongoing dialogue be established between the Trust and the Council to explore the ongoing implementation of the high level proposals set out in the New Directions report. 

 

      The Council provides a range of services which can impact on people’s health and well-being – leisure services, parks, playgrounds and open spaces, community services, community safety etc; many of which are provided directly within communities. The Council has a number of facilities, such as community and leisure centres, and operates a range of programmes and initiatives which taken holistically contribute to improved health promotion and well-being.  It is important that services such as these, which exist outside the traditional Health and Social Services field, are considered and utilised where appropriate. 

 

      The Council is committed to working in partnership to improve the quality of life for all people of the city.  One of our key priorities is to create a healthy and active city through the services we provide directly and through those we provide in partnership with others. The Council is currently completing a strategic review of leisure where the future leisure provision requirements of the city are being considered.  This includes examining the partnerships required to deliver effective and affordable services to address agreed priorities throughout the community.  We would therefore like to highlight the willingness of Council in working in partnership with the health service and other partners, to assist in service provision where appropriate and shared asset usage, providing information on services available and in providing a civic leadership role in terms of partnership working across agencies. 

                                                                                                           

      The Review of Public Administration will give councils a new power of wellbeing, and Belfast hopes to use this new power to become much more involved in promoting health and wellbeing.  Four Councillors from BCC will be represented on the Local Commissioning Group and plans are well advanced for local collaborative working arrangements between the Council and the new public health agency, and in particular through the creation of a joint health development unit.  

 

      The Council is supportive of the guiding principles outlined in the consultation document and welcomes the focus on the individual and supports a more joined-up approach to addressing the needs of people with learning disabilities.  We look forward to working with the Trust to identify and maximise potential opportunities to work in a more coordinated and holistic person-centred manner in relation to improving health and wellbeing generally. 

 

      In the following sections we provide more specific responses to the question posed on the future provision of Learning Disability Services in Belfast.

 

Consultation Questions:

 

      Somewhere to live and a fuller life

 

1.   Do you agree with the above Trust proposals in relation to having somewhere to live and a fuller life?

2.   What are your concerns about accommodation and day services and do you think these plans will answer your concerns? If not, why not?

3.   Do you have any suggested additions to these plans?

4.   Are there any other issues that you think need to be taken into consideration?

 

      The Council welcomes the Trust’s key objective to support people with learning disabilities in their own home first and foremost and the concept of 24 hour access to support.   We are therefore supportive of plans to expand supported housing across the city of Belfast in collaboration with the Northern Ireland Housing Executive.

 

      However, the Council notes with some concern that the proposed replacement of the four remaining residential homes is subject to resources being available.  It is critical that before any closures or changes to service delivery are made that the necessary resources are in place to enable, at the very least, continuity of care.  Service users must have the necessary support packages in place before changes are made to their care arrangements.  Given the vulnerable nature of this group of people, it is also important that meaningful consultation is undertaken in advance with service users and their families.   In addition assurances are sought that people who need continuing residential accommodation or who may need access to this in the future will not be adversely affected by the proposed policy closures.  

 

      The Council welcomes plans to enhance community based provision and the creation of purpose built facilities to support the aim of ‘fuller lives’.  The Council is keen to work in partnership with the health and voluntary and community sector to develop more holistic approaches to health and wellbeing generally.  More specifically we encourage approaches that support and make better use of local community facilities, particularly those which also enhance community development and community cohesion.  The council is currently reviewing the facilities and provision available and this may inform and enhance proposed community based provision. The Grove Wellbeing model is a working example which can be developed or act as a baseline for the future development of integrated community provision.

 

      The Council particularly welcomes the proposed initial focus on the needs of school leavers as part of the further enhancement of the Trust’s community based (non centre) daytime provision for adults with learning disability.  Our Elected Members have previously expressed the view that there are limited facilities provided for people with learning difficulties, particularly young adolescents, and as such additional resources need to be targeted in that area. 

 

      The Council is also supportive of plans that lead to improved economic success and welcome plans to further develop the supported employment model and supported employment opportunities in Belfast.  The Council’s Economic Initiatives section is keen to encourage collaborative working and explore opportunities that maximise employability, skills and wealth creation.

 

      Access to additional support in the community, including specialist community treatment and support services and respite

 

1.   Do you agree with the above Trust proposals in relation to the development plans for community treatment and support (including respite) services?

2.   What are your concerns about community services and do you think these plans will answer your concerns? If not, why not?

3.   Do you have any suggested additions to these plans?

4.   Are there any other issues that you think need to be taken into consideration?

 

      The document makes reference to the enhancement of community/leisure based respite.  One of the Council’s corporate priorities is to enhance health and well-being.  As a provider of community and leisure based services within local communities we are keen to explore opportunities that would better utilise these assets to the advantage of local people and their improved quality of life.  The Council has a number of local facilities, such as community and leisure centres, parks, playgrounds and pitches, as well as a range of programmes and initiatives that support health and wellbeing.  It is important that services such as these, which exist outside the traditional Health and Social Services field, are also considered and utilised where appropriate.  Therefore; joined-up approaches between the Council and the health sector are particularly welcomed.  The development of the joint health development unit should provide a useful learning and support tool in this regard and should provide a driver and focal point for developing joint projects and initiatives.  The Council looks forward to working together with the Trust in developing a cohesive health improvement agenda for the city.  Opportunities for community / leisure based respite may provide one visible way of doing delivering this.  Access to provision is also an issue, and the Council is endeavouring to work in partnership to improve access for all sections of the community.

 

      The Council would also welcome ongoing dialogue with the Trust, and other relevant agencies, about the future use of facilities in the city in order that opportunities for shared and integrated facilities can be availed of for the benefit of local communities.

 

      The Council is supportive of proposals to expand multi-disciplinary Community Learning Disability Teams and the concept of a proactive service and support.  Through our experience of working with local communities, we have found that issues are often interdependent and therefore a cross-cutting approach is required to effectively and efficiently address need.  Equally, individuals will be better served when there is a seamless service and connectivity, rather than a silo approach to needs and issues.

     

      The Council recognises that increased access to mainstream services is desirable both in terms of efficiency and for ensuring that individual service users receive all the support and care they may need.  The role of the community teams therefore will be important in ensuring that individuals with learning disabilities are given the necessary support to access these services.  It is not clear from the document how this service will be enhanced and resourced.  Assurances are sought therefore that the necessary resources will be made available to ensure the support is provided to enable users to fully access mainstream services where required. 

 

      Given the rather specialised nature of residential and respite care; we do not feel it would be appropriate for the Council to comment on the more specific elements of this service.  However the Council would stress that the needs of people with learning disabilities are distinct from the needs of those with mental health problems and the approaches need to be very different.  This should be clearly reflected in the proposed future service provision.

 

      Access to specialist inpatient assessment and treatment services

 

1.   Do you agree with the above Trust proposals in relation to the development plans for specialist inpatient assessment and treatment services?

 

2.   What are your concerns about specialist inpatient assessment and treatment services and do you think these plans will answer your concerns? If not, why not?

 

3.   Do you have any suggested additions to these plans?

 

4.   Are there any other issues that you think need to be taken into consideration?

 

      Given the specialised nature of inpatient assessment and treatment services; the Council is not in a position to comment meaningfully on the proposed changes to this service.  However the Council strongly endorses the need for full, open and honest dialogue with all relevant stakeholders on the future of inpatient specialist services at Muckamore Abbey hospital, particularly those individuals and their families / carers who will be affected by any potential changes.”

 

            The Committee approved the proposed response to the consultation exercise.