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Transforming Care - Critical Friend

A lot of effort has gone into Transforming Care in the last few years, but in our view there are still some fundamental problems to be addressed in many areas.

These include:

  • A lack of good, person centred support in local communities, based on people’s whole lives. For further information see our guest blog by Doreen Kelly on what good could look like.
  • People with learning disabilities and families not included in local planning
  • A lack of early intervention and prevention services for children, young people and adults
  • A failure to use evidence about what works and replicate current good practice

Some of the things that NDTi have done to address these issues are included below:

Co-ordinating the input of Experts by Experience into Care and Treatment Reviews in NHS South

We recruit, train and support Experts by Experience to take part in the Care and Treatment Reviews of patients in Assessment and Treatment Units (Commissioned by NHS South). The work started in December 2014 and has led us to be closely involved with the Transforming Care leads nationally and regionally as well as individual commissioners from both CCGS and specialised commissioning. We have shared the experiences of our family carer EbyE and self-advocate EbyEs with them to help inform the process but also the wider Transforming Care agenda in the region. Consequently we have an in-depth but objective understanding of the issues that encompass both the commissioning and the providing of such services. We are centrally involved in the Region’s Quality Assurance programme as well as members of the Quality Assurance group. Wherever possible we push to have the voices of people with lived experience heard. 

A pathway for children

These materials were commissioned by the NHS England Transforming Care Programme and developed by NDTi and CBF. They are designed to help Transforming Care Partnerships to support children and young people whose behaviours challenge, and are complementary to Building the Right Support (NHS England et al., 2015). To develop the pathway we visited four areas across England to meet with commissioners, families, young people and providers.  We wrote a report highlighting what worked well when engaging with the different groups of stakeholders including some ‘tips and wrinkles’ around engagement that are likely to be helpful to Transforming Care Partnerships developing work with children and young people whose behaviours challenge and their families.

Reviewing the commissioning arrangements of services for children and young people with learning disabilities and/or autism who challenge services.

We piloted a review of commissioning arrangements of these services in five local authority areas, wrote a summary report of findings from the review and developed some commissioning guidance based on learning from the reviews. Further information about the review is available here along with contact details should you want more information on implementing a review in your area. 

The Critical Friend role

On behalf of NHSE, NDTi undertook an informal ‘critical friend’ role with approximately 40 Transforming Care Partnerships (TCPs) to offer an external view on their draft plans.

TCPs were free to use or set aside our advice as they choose and while it would not be appropriate to offer full comment, common observations were that:

  • The planning process has successfully drawn together a range of service partners to deliver plans in each locality
  • Where plans involved people with learning disabilities and their families the quality of the planning was improved. Unfortunately few plans involved significant levels of coproduction
  • Planning has tended to focus on traditional services (housing, behavioural support, etc.) rather than reflect the whole of people’s lives (relationships, community, work, etc.)
  • There is a current and planned reliance on traditional forms of provision. This is frequently isolated from communities and ordinary living. Many plans do not involve the very significant level of market development necessary to offer real choice and change
  • Plans are not always based on current and emerging best practice; important lessons from, amongst others, Mazars, Mansell and Verita are not reflected

Market Development 

Market development needs people who plan and commission services to work in genuine coproduction with people who use services, families, members of the wider community, a range of professionals and, of course, existing and emerging providers. Our support for market development focuses on four key steps: the knowledge, aspirations and needs of people; understanding what is and isn’t available now; coproducing local marketplace plans; developing the market. Read more.

Other practical tools and support we can offer include:

A rapid review of commissioning arrangements regarding people who challenge

NDTi developed best practice commissioning guidance based on the Mansell report principles, and outlines what commissioners need to do to develop local services, with the right skills, that deliver better outcomes for people and save money. This guidance – like the Mansell report - is still just as relevant today, and to support local commissioners NDTi are offering a ‘Quick Review’ of commissioning arrangements that will enable them to identify the key actions and changes that are needed to help ensure that services and supports for people with learning disabilities and/or autism who challenge are reflective of national best practice. Read More

The Green Light Toolkit

Following the publication of our Reasonably Adjusted? report in 2012 sharing the adjustments being put in place within mental health services for people with learning disabilities and autism, the NDTi  produced materials to help services review their own quality and replicate good practice. The Green Light Toolkit includes a recently updated audit framework and toolkit, and easy read version summaries for:

  • People with learning disabilities
  • Family carers
  • Clinical Commissioning Groups
  • Provider organisations
  • Health and Wellbeing Boards

The Green Light toolkit is referenced in the new service model and guidance ‘Supporting people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition’, and has been updated to reflect this. The guidance says that "Everyone should expect mainstream mental health services to regularly audit how effective they are at meeting the needs of people with a learning disability and/or autism. The Green Light Toolkit should be used to both evaluate services and agree local actions…

Contact us for further information about our tailored support to implement reasonable adjustments in your service that include developing a number of action learning sets and incorporating a benchmarking club that uses the audit tools we have produced.