‘Partnering’ - The Way Forward

‘Partnering’ - The Way Forward Sandy Bering Head of Service – Learning Disabilities/ Consultant Clinical Psychologist/Lead Clinician Halton PCT & Halton Borough Council

Aim of the Session • The Need for a Modern LD Workforce • Understanding the context for change - Valuing People • Examples of Changing Practice • The Halton Community LD Team structure & approach to delivering the Valuing People White Paper • Paving a clear way forward in organising and delivering modern, effective local multi-disciplinary and multi-agency community team services • Sharing experiences of multi-agency joint training initiatives in LD services across Cheshire and Merseyside • Building cultures of collaboration • Identifying the Development Challenges in Adapting and Re-designing the Workforce? Sandy Bering - November 2004

Valuing People Support Team

Rights Choice Independence Inclusion Sharing good practice Providing ideas Nurturing leadership Building new partnerships Pushing the boundaries Removing obstacles Calling to account Valuing People - KEY PRINCIPLES

‘Valuing People’ Themes • Mainstream services responding to individual needs • Specialist services helping mainstream services • Tackle social exclusion • Community NOT Institutions • LT Hospitals and people with learning disabilities living in NHS provision NOT an option • Increased support offered near home and to families • Specialist services maximising choices of people sustaining independent living • Promote person-centred support, backed by partnership working • Health and social services working with people with learning disabilities, families and other council departments to offer best support

Valuing People’ Themes 2 • Conditions of no greater security than is justified by real danger to self and others • Highly individualised service planning and support • Changing roles for specialist health and social work professionals • Developing and expanding local expertise • Supportive role for mainstream professionals, support workers, agencies and family carers • Health facilitation, health promotion, teaching and service development • Enabling Citizenship – self-determination, direction, personal control over money/direct payments, a real home, flexible/helpful individual support and a community life

Valuing People • Locally based community LD services are seen as key components of the modern NHS, providing vital support to people with learning disabilities and their carers • Valuing People wants to see some real changes in the ways in which health and social care services for people with learning disabilities work Sandy Bering - November 2004

Valuing People • Wants dedicated NHS LD services to direct their efforts towards helping people to enjoy better health and healthcare, in ways which open up opportunities for independence and inclusion • Person-centred services showing high quality expertise • Essential that sufficient good quality multidisciplinary specialist services are available Sandy Bering - November 2004

Valuing People • Community LD services must: • Achieve integrated professional working to ensure that all professional staff become accountable for the outcome of their work to local partnership arrangements • Help achieve social inclusion • Ensure that organizational structures encourage and promote inclusive working - Matching efforts to results! Sandy Bering - November 2004

Valuing People • Professional staff … provide vital support … But their role must change … tasks be refocused to give greater emphasis to provide high quality specialist expertise and support access mainstream services • Listening carefully to the views and experiences of people with learning disabilities and their families … encourage a critical role in the education and training of paid staff Sandy Bering - November 2004

Valuing People • Important to enhance the competence of local services • In addition to their clinical and therapeutic roles specialist staff should take on the following complementary roles: • Health promotion • Health facilitation • Teaching staff in statutory/independent sector • Service development Sandy Bering - November 2004

Valuing People • Health action plans strategies • Good quality services that ensure people with additional and complex high support needs are appropriately cared for and they lead fulfilling lives. Includes people who: • Have severe and profound physical/sensory disabilities • Have epilepsy • Have an autistic spectrum disorder and also have a ld • Present with behaviour that challenges carers and services • Develop conditions associated with old age Sandy Bering - November 2004

Robust person-centred commissioning Competent health and social care providers Skilled and accessible specialist support Strong Community Teams Proactive community development Liberated talents Valuing People‘Putting the Jigsaw Together’ Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • All the health professionals contribute to the design, creation and monitoring of support arrangements, particularly those people who need a lot of support from family and community, and a range of agencies • They spend a lot of their time working with other services/agencies across primary care, social care, housing, education, employment and leisure to support people with learning disabilities. In particular, they seek to develop the competencies of staff and managers Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team The Team provides focused support and practical assistance to improve the quality of life of individuals with learning disabilities in line with good practice: • A wide range of co-ordinated community support services • Individualized clinical assessments & specialist health/social interventions • Advice/consultation to other staff • Development of good practice policies/protocols in relation to the promotion of positive health/social care experiences • Training, development and research activities which support the availability of effective and high quality services Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Fully integrated team-working providing a single service with almost total overlap and a New Name • Integrated training/development programme • Single point of entry for health/social work referrals • Common Contact Assessment/Core Client Database • Integrated health and social work team management • Shared initial Single Assessment Process • Essential Info Record/Access to Info from previous records • Case Allocations meetings (care managers/co-ordinators) • Common Care plan/Review systems • Care 1st/Performance Indicator reviews • Agency Contract/Development Reviews Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Inter-disciplinary team membership including: • Admin Support, Community Care Workers, Social Workers • Admin Support, Clinical Assistants, Clinical Psychologists, Community Nurses, Community Support Workers, Occupational Therapists, Physiotherapists, Speech Therapists • Clear Professional leadership and supervision arrangements • Shared team meetings meetings • Referrals, Updates, Critical case/Development projects reflection • 2 developed/extended shared Team bases • Fortnightly Resource Allocation Panel meetings • Revised common resource application forms Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Each professional team member takes on 3 roles • Individual Named Person/Service Care Co-ordinator • Specialist Professional practice • Training/Project/Clinical specialist development supporting Valuing People targets • Community care tasks, Day services, Housing, Respite, Transition, Joint Training, Supporting Carers • Abuse/Vulnerable witnesses, Complex challenging needs (CBs/ Forensic/Mental Health), Multiple disabilities (Physical/Sensory/ Mobility), Physical Health (Health action plans/Primary care facilitation & Secondary care/Hospital liaison) • Integrated Workload Review Management systems and Team Development programmes Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Collectively responsible for clear and identifiable areas of work in delivering the Valuing People targets – rather than separate professional responsibilities • Aims and/or goals are clear and it is possible to assess whether the Team is succeeding (e.g. access, support capacity, training, health/social care outcomes) • It contains members with varying degrees of skills, abilities, experiences and problem-solving strategies Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Little or no difference in ‘status’ between members • Opportunities for team members to interact and meet both easily and frequently - formally and informally • There is a fair amount of cross activity, which means that other members of the team are able to understand and, if needs be, carry out other people’s responsibilities - at least on a short-term basis Sandy Bering - November 2004

The Halton Integrated Health & Social Work Community LD Team • Each member has independent responsibilities, and knows what these are • Team has the authority to make decisions about how to get the work done - Empowered to pursue it’s goals • As team resources are freed up, decisions on recruitment based on functional needs of the service rather than fixed professional staff establishments Sandy Bering - November 2004

‘JOINT’? Vs ‘Real Partnership’ • A genuinely Joint Integrated LD Service • Not about take over • Trust and respect for different perspectives • Challenging for Professions • Challenging for Organisations • Not the organisational form that matters • A single focus on Learning Disabilities but developing in a wider whole population context Sandy Bering - November 2004

Clarification of Roles • Confidence in own professional roles • Not about Generic professionals • Avoiding too much emphasis on similarities and not enough awareness of differences • Team working and professional respect • Avoiding too much emphasis on friendships and relationships • Confidence to work in different ways • Desire to confront diversity tensions • Roles in a Primary - Secondary continuum • Scoping of partnerships Sandy Bering - November 2004

Workshop ?s • What are the Current Workforce Issues? • Service Priorities and Developments • Leadership • Staff shortages – General/Particular Professional Groups • Lack of Appropriate Skills/Competencies in Existing Workforce • What is the impact of Role Changes? • How to Introduce New Ways of Working • How to Adapt and Re-design the Workforce • How can we Apply the Lessons Learned to date Sandy Bering - November 2004

Changing the Culture- Recognising common responses to change • Removers • Not about moving people out (though some still do) but in terms of removing the responsibility for change and ascribing responsibility for the removal of obstacles to change to others (e.g. ‘not enough £, or partners would cooperate) • Containers • Local implementation strategies are limited to cultures and practices that prevailed before Valuing People (e.g. using new names to label old service responses) • Developers • Innovators that recognise need for fundamentally new ways of working with services users and families leading change (e.g. new partnerships and radical collective problem-solving) Sandy Bering - November 2004

Leadership Vision, Commitment and Relationships Organisation Participation, Flexibility, Management and Communication Strategy Strategic development, Information and Evaluation, Action and Review Learning Valuing people, Knowledge and skills, and Supporting Innovation Resources Social capital, £ Resources, Information and Technology Programmes Planning, Delivery and Monitoring The Working Partnership Sandy Bering - November 2004

Keys to Success in a Complex World • The power of focus and clarity, based on values and principles • Partner with others to clarify values and listen • Decide how to demonstrate value • Focus on goals and key result areas • Focus on specific activities • Keep promises and be fair • Focus on progress, not perfection • Create opportunities for people to practice • Continue to raise the bar • Encourage contact to excellence in action and help apply the lessons • Build and maintain high morale/confidence through consistency and predictability • Be the emotional bridge to the future • Sat things at the right time • Authenticity and legacy Sandy Bering - November 2004

Steps Along the Journey • Structured needs analysis • Targeted individual and population assessments • Understanding the social context • Understanding the wider Trust and LA strategies • High investment in leadership • High investment in CPD • Service re-design to refocus limited clinical resources (e.g. Activity Unit, Clinics, Croft) • Ongoing performance management Sandy Bering - November 2004

Steps Along the Journey 2 • Getting the right people • Recruitment & growing our own • Skill mix • Investment in networks and relationships • ‘Give in order to receive’ • Training and multi-agency partnership working • Focus on understanding & supporting the wider NHS agenda locally • Nurturing value, position and status in the Local Strategic and Delivery Plan strategies Sandy Bering - November 2004

Specific Example of Developing a Modernised LD Nursing Function • All carry an active caseload weighted towards area of special interest • All have link into strategic development • All have a training function • All undertake joint single assessment • Team of 10 individuals (9.25 wte) – Varying grades Michele Teasdale - November 2004

Providing advice, support & education to clients carers & local health & social care providers on needs of people with LD Leading on local strategic service developments re: LD Providing & facilitating health education & health promotion (including access & screening) Accepting Referrals for specified conditions within Agreed Protocols(e.g. Epilepsy; Dysphagia; Autism; Psychosis; etc) Devising Specialist Care Plans & monitoring for efficacy Making Referrals direct to Consultants/GP’s/Therapists/ Social Care colleagues (across health and social care communities) Managing client caseloads & admission/discharge rights Ordering & recommending diagnostic investigations(e.g. Neuro-assessments; X rays; Pathology; Dietician; Therapists, etc) Nurse-led clinics Nurse prescribing Developing Practice Roles for LD Nurses in line with National Strategies Michele Teasdale - November 2004

Lead Nurse - LD - Clinical lead - Senior LD Manager - PCT Professional Lead - Connect the internal & external ‘world’ - Lead the Good Health Implementation Forum - Help set targets & keep people on track - Public health - Trouble shoot - Teaching on JTP - Regional & National links Halton LD Nursing Activity Michele Teasdale - November 2004

Halton LD Nursing Activity • Health Facilitator - Primary & secondary care development - Health Facilitation and Health Action Planning strategy - Training via JTP - Public health & CIA team - Care pathway development - Regional & National links - Health screening of people who cannot access mainstream services Michele Teasdale - November 2004

Halton LD Nursing Activity • Sexual Health Liaison - Linking and educating Sexual Health services - Supporting Access - Policy development - Sexual health promotion - Screening development - School & teenage pregnancy strategy link - Direct clinical support - Care pathway development Michele Teasdale - November 2004

Halton LD Nursing Activity • Older Person’s Liaison - Carers strategy, centres & groups - Health & older people - Care pathway development - Hospital liaison - HAP & older people - Loss & bereavement - Signposting - National & regional links - Nurse education link - Training (e.g. Skills training/TSI) Michele Teadsale - November 2004

Halton LD Nursing Activity • Epilepsy Liaison - Assessment & advice - Training (e.g. epilepsy; Health Action Plans; Men’s health issues, etc) - Risk assessments - Liaison with neurology/rehab services - Men’s health - Health promotion Michele Teadale - November 2004

Halton LD Nursing Activity • Mental Health Liaison - Psychosocial Intervention (PSI) intervention - Care pathway development With in patient facilities - Link with mental health teams - Dementia care development - Relapse prevention - Training staff & carers Michele Teasdale - November 2004

Halton LD Nursing Activity • Behavioural Specialist - Sexuality & personal relationships lead - Adult abuse - Individual & group work - Training & development - Survivor work - Health promotion - Challenging behaviour - Risk assessment - Quality lead - Free Nursing Care & Continuing Care reviews Michele Teasdale - November 2004

Halton LD Nursing Activity • Community Nurses - Out-patient clinic support - Client monitoring/reviews - Health promotion - Liaison with primary care - Support to appointments - Bloods & basic screens - PCT links for infection - Control & other forums - Health Action Planning Michele Teasdale - November 2004

Halton LD Nursing Activity • Community Nurses - PMLD link - Training (eating & drinking; epilepsy; PEGs, etc) - Dysphagia - Epilepsy (i.e. assessment & support) - Developing interests/skills in supporting dietetics & diabetes issues, Health Living Centres Michele Teasdale - November 2004

Halton LD Nursing Activity • Support workers - Preparation for tests/examinations - Health promotion programmes - Direct 1:1 support - Health Action Plans - Monitoring & review functions Michele Teasdale - November 2004

Sandy Bering - November 2004

Learning Disability Services- Positives To Build On In Halton • LD Partnership Board/Joint Commissioning Manager • Pooled Budget & Joint Commissioning Resource Panel • Valuing People Implementation Sub-Groups/Projects • Consultation groups, Service-specific workshops, Staff work groups • Halton Speak Out/Advocacy, Housing, Day care, Respite, Transition, Health, Complex needs, Quality, Person-centred planning, Training, Employment, Carers • Established multi-agency Training Partnerships Sandy Bering - November 2004

Learning Disability Services- Positives To Build On In Halton • Integrated Specialist Community Health/Social LD Team providing specialist services and resources in support of White Paper targets • Development programmes/projects • Single assessment process, Complex care management and reviews, Physical health (Epilepsy, Sexual Health and Dysphagia), Multiple disabilities (Sensory/ Physical), Challenging behaviours (Autism, Offenders), Mental health, Sexuality/Personal relationships, Abuse/Vulnerable adults, Skills teaching, Children with Complex Needs, Older people, Culturally-sensitive services, Supporting People Outreach Team Sandy Bering - November 2004

Structure of Learning Disability Services in Halton PCT Exec Board LA/Social Services Exec Board Strategy Implementation Groups Resource Panels Multi-Agency Joint Commissioning Board Disabled children & young people Allocations Learning Disabilities Joint Partnership Board & Pooled Budget Exec Team Care Packages Choice & control Respite/Housing Supporting Carers PCT/LA SSD LD Service Directors Continuing Care Good Health Housing Professional Leads: Nurse; Social Work; O/T; Physio; Psychology; SALT; Training; Admin Principal/Team Managers Out of Area Treatments Fulfilling lives Employment Fully Integrated Specialist Community Multi-Disciplinary LD Team Workforce Planning Quality

Multi-Agency Training Initiatives Cheshire and Merseyside

Joint Training Partnerships History and Time Lines • The original Liverpool Model - 1990’s • Halton & Warrington Joint Training Partnership - 1996 • Cheshire and Wirral LD Sub-Group Consortia Proposal - 2000 • Cheshire & Merseyside Joint Training Partnerships supported by the SHA/WDC - 2002 onwards Sandy Bering - November 2004

The Cheshire & Wirral Joint Training Partnership Model • Education & Training Consortia Learning Disabilities Sub Group – Development Proposal • ‘ …a proposal called the Cheshire & Wirral Integrated LD Multi Agency Education and Training Initiative. The main purpose of the initiative is to provide locally delivered multi agency training across the Consortium area, in line with national and regional strategies…’ Sandy Bering - November 2004

Cheshire & Wirral Training Partnerships – Some of the Key Stakeholders The Alternative Group Progressive Lifestyles Brothers of Charity Services PSS Trust Social Care MacIntyre Care CIC Warrington Community Living Chester Link David Lewis Centre Raglin Care Halton PCT Warrington Social Services Halton Social Services Cheshire Social Services St Helens Social Services 5 Boroughs Partnership NHS Trust PCTs/LAs Cheshire & Wirral Partnership NHS Trust Partners in Policymaking Local Advocacy/Carers Groups LD Partnership Boards Strategic HA/WDC Sandy Bering - November 2004

The Locality Joint Training Initiatives The Current Situation- 4 Linked Joint Training Partnerships • North Cheshire Joint Training Partnership • (formally Warrington & Halton) • Central Cheshire Joint Training Partnership • East Cheshire Joint Training Partnership • Wirral & West Cheshire Joint Training Partnership Planned Additions– 2 more Linked Joint Training Partnerships • Sefton Training Partnership (the extended LDAF group) • Liverpool Training Partnership Sandy Bering - November 2004

‘Partnering’ - The Way Forward