Agenda item - The Outcome of the Learning Disability Review & 'A Good, Happy & Healthy Life. A Strategy for Adults with Learning Disabilities in Brighton & Hove

Report of the Executive Director of Adult Services (copy attached).

(1)      The Board approve “A Good, Happy & Healthy Life”: Adults with Learning Disabilities in Brighton & Hove (Appendix 1), a Strategy for adults with learning disabilities in Brighton & Hove.

(2)      That delegated authority be granted to the Executive Director of Adult Services (Denise D’Souza) and, as appropriate, the Chief Operating Officer of the CCG (Geraldine Hoban), to develop a Delivery Plan in accordance with the aims and objectives set out in the Strategy and in this paper.

(3)      That it is noted that any aspects of the Delivery Plan that require specific decisions to be made by the Board will be presented at the relevant time.

Introduction

58.1    The Board considered a report of the Executive Director of Adult Services which informed members that an independent review of Learning Disability services took place in October 2014, in order to inform the future commissioning and provision of services for adults with learning disabilities.  The current paper presented both the outcome from the Learning Disability Review and a new vision and strategy for adults with Learning Disabilities in Brighton & Hove.  The review made 26 recommendations, organised into four areas, Vision, Commissioning, Engagement and Providers.  The report was presented by Denise D’Souza and the Commissioning Manager for Adults with Learning Disabilities.   

          Questions & Discussion

58.2   Pinaki Ghoshal stressed that this review was closely linked to the review of special educational needs and disability including behavioural emotional and social difficulties (considered earlier at the Joint Meeting). 

58.3   Councillor Jarrett informed the Board that the report back from the Learning Disability Partnership Board had suggested quite a few changes to the language of the review, which had been written from the perspective of adults who did not have a learning difficulty.    Representatives from Speak Out had been very definite that they wanted greater ability to make choices, have their say and do their own thing.  Councillor Jarrett felt that some of the services on offer for adults did not always make that possible.   

58.4   Councillor Jarrett stated that there was an appetite for change and improvement.  The Partnership Board had a small number of representatives.  There was a wider group of parents and carers across the city whose views also had to be taken into account. 

58.5   Councillor Norman stressed the need to continually move forward and to be prepared to change and improve.  He thanked everyone involved in preparing the report.  Councillor Norman referred to the paragraph concerning political context on page 25 of the agenda.  This stated that ‘There has been a lack of decision making about the future of Learning Disability services …’   Councillor Norman stated that he was not sure if he agreed with that statement. There would always be political differences; however there was a need to make sure that these differences were kept to a minimum in order to move forward.  

58.6   Councillor Norman referred to paragraph 2.2 on page 27 of the agenda in relation to commissioning.  This referred to macro and micro commissioning.  Not everyone would know what this meant and Councillor Norman suggested that this should possibly be defined differently. 

58.7   Councillor Morgan welcomed the report and acknowledged all the work carried out by officers.  Councillor Morgan stated that outcomes mattered and that every individual should have the opportunity to be given the support to fulfil their individual potential.  There was a need to keep parents and carers on board and to ensure that where Day Centres remain appropriate a provision should be available.  Councillor Morgan stressed that supported employment and routes into work would be vital to the success of the strategy and he would like to see work within commitment from employers.   There would be a decision in the budget with regard to Able and Willing and Councillor Morgan wanted to inform that decision with some indication of how that decision fitted into the strategy.

58.8   Denise D’Souza replied that Able and Willing and the shift of people’s aspirations from day services were closely linked.  There was a need to look at that relationship.  There were some people who would need day services.  However there was also a need to help more people with learning disabilities to gain employment. 

58.9   Councillor Theobald thanked the Commissioning Manager for the honest independent report.  Councillor Theobald recollected that last year a decision had been postponed with regard to making a decision about the reconfiguration of services.  This related to 7 council supported living services, all in the voluntary and independent sector.  The current report pointed out that the council services were 17% more expensive than those provided by similar councils.  The council’s in house provision came under particular criticism, with the report describing them as lacking ambition for service users and providing old fashioned paternalistic services rather than the personal ones that should now be the norm. 

58.10  Councillor Theobald regretted the delay in making a decision to modernise the service and wanted to know whether the recommendations in the current report revived the plans from the June 2014 report to re-commission these services.     

58.11  The Chair replied that he considered that the Board were better off as a result of having a review of the whole service. The review had been joined up with the review of young people’s services and there was now a consistent approach for all people in the city who were affected by these disabilities. 

58.12  Denise D’Souza stressed that with regard to personalised services, there would need to be a more holistic approach with individual assessments.  As a result, services provided would need to be reviewed.  It was necessary to consider what did the person needed; whether they needed to be somewhere else; whether they wanted to be somewhere else; and what services they wanted.  Recommendation 3.3 might result in some service changes.  For example, there might be a need for more employment provision and fewer day services options.  There might be a need for more supported living and fewer residential services.  These decisions would be brought back to the Board.

58.13  Frances McCabe was pleased to see that people with learning disabilities had the right to universal services.  She questioned whether there were levers and sanctions for the local authority & health services to ensure this happened.  With regard to markets and opportunities, Ms McCabe stressed that these opportunities and options should be available so that people could see that there was a different way of having the life they wanted.  She asked what was being done to ensure this happened and to ensure that the right sort of staff, with the right kind of cultural attitudes, were in place to enable services to change.    

58.14  The Chair stressed that the report was about a cultural shift that needed to be embedded.

58.15  Denise D’Souza concurred with regard to universal services.  People with learning disabilities wanted to access the same services as everyone else.  Meanwhile, there was a good diverse market in the city.  As a result of changes at Buckingham Road, people had been able to visit these services to test them out before making choices.   

58.16  The Commissioning Manager acknowledged that there had been much concern about the independent sector.  However, when people experienced trying out these services the feedback had been positive.  There had been massive growth in diversity, range and quality of provision in the independent sector.

58.17  Geraldine Hoban stressed that universal services were key.  The Clinical Commissioning Group carried out an annual learning disabilities self-assessment which looked at the range of access across all health care services and identified where more work was needed in terms of targeted support.  The CCG had a number of facilitated workers in primary care looking at GP access, care, and annual health checks for people with learning disabilities.  There were also some facilitator posts within the acute trust in order to try and make all universal services as appropriate to the needs of people with learning disabilities as possible. 

58.18  Ms Hoban noted that there were many similarities in terms of the personalisation agenda and what was being done through Better Care and in Children’s Services.  She questioned whether there was a way of joining up some of the challenges that were being tackled in terms of brokerage and developing the market rather than delivering different pieces of work in parallel. 

58.19  RESOLVED:

(1)      That the Board approve “A Good, Happy & Healthy Life”: Adults with Learning Disabilities in Brighton & Hove (Appendix 1), a Strategy for adults with learning disabilities in Brighton & Hove.

(2)      That delegated authority be granted to the Executive Director of Adult Services (Denise D’Souza) and, as appropriate, the Chief Operating Officer of the CCG (Geraldine Hoban), to develop a Delivery Plan in accordance with the aims and objectives set out in the Strategy and in this paper.

(3)      That it is noted that any aspects of the Delivery Plan that require specific decisions to be made by the Board will be presented at the relevant time.