Presentation on theme: "Michael McCue Joint Improvement Team Action Group"— Presentation transcript:
1 Michael McCue Joint Improvement Team Action Group ‘Complex Needs Supports – Working Together’ JIT/MHD Regional Event Beardmore Hotel and Conference Centre, GlasgowMichael McCueJoint Improvement Team Action Group1
2 Introduction and Scene Setting National Working Group –Service Modelling ExerciseKey Service CharacteristicsJIT Capacity for Change ProgrammesRelated Work-streams ;N.E.S / M.C.N./ S.A.Y.I.G./ P.M.L.D./ Service Transitions / Future Service Demand
3 Learning Disabilities Complex Needs ISSUES OF TRANSITIONfor young people with learning disabilities plus other complex needsDr Sally CheseldineJIT Associate
4 "Why is it so difficult to put (good transitions) into practice" Mittler, 2007.
5 Who?What does a good Transitions Process look like? What range of services is required?Who pays?Evaluation and review
6 Issues: Consistency of definition; Age cut off WHO?"LD plus complex needs"Issues: Consistency of definition; Age cut offRobust data; Out of area
7 National/local agreement on definition Sharing information WHO? - RECOMMENDATIONSNational/local agreement on definitionSharing informationHealth Boards responsible for regional dataForward planning/role of Public Health
8 ONE plan: Start at 14th birthday Named person in C/F & Adult services WHAT DOES IT LOOK LIKE?ONE plan: Start at 14th birthdayNamed person in C/F & Adult servicesAnnual reviews/planning meetingsGood communication/informationClear budget planExamples of good practice
9 Information for families User involvement Adult services MUST engage SO:Clear PathwayFunding clarityInformation for familiesUser involvementAdult services MUST engage
10 Jointly funded; local; Person-centred; effective Trained workforce RANGE OF SERVICES:Jointly funded; local;Person-centred; effectiveTrained workforce
11 Move from out-of-area: Bridging? FUNDING?Move from out-of-area: Bridging?InnovationRainy-day pot?
12 Key service characteristics EVALUATION & REVIEWKey service characteristics
13 Changing Demography of people with learning disabilities MANAGED CARE NETWORKChanging Demography of people with learning disabilitiesDr. Michael BrownLecturer and Nurse ConsultantEdinburgh Napier UniversityandElaine KwiatekProject ManagerLearning Disability MCN
14 Aims of the presentation Overview of demographics issuesOverview of health needs evidenceWorkforce issuesChallenges and opportunities for the future
16 Wider issues – Poverty & learning disabilities ‘Poverty can increase the risk of a child having an impairment… Having a disabled child can also mean that parents find it harder to maintain full-time employment, their housing can be inadequate for their child’s needs, and expenditure on basic needs is increased.’Prime Minister’s Strategy Unit, 2005
17 Changing demographics of the learning disability population Estimated 120, 000 children and adults with intellectual disabilities in Scotland – few ever in hospitalProjected 11% increase over next 10 yearsIncreasing learning disability subpopulationAgeing learning disability subpopulationIncreasing number of people with complex learning disabilitiesPeople with learning disabilities have greater health needsHealth inequalities exist and need to be addressedHealth needs never historically addressed
18 What the evidence tells us… Pre term infants with multiple disabilitiesFoetal alcohol syndrome disorderADHDAutism Spectrum DisorderIncreasing numbers of people with complex physical disabilitiesIncreasing numbers of older people with complex needs and end of life care needsChanging demographic phenomenonTherefore increases at both ends of the lifespan18
19 Common health needs Gastrointestinal disorders Respiratory disease Cardiovascular diseaseEpilepsyCancersHaematological disordersOphthalmic disordersMusculoskeletal disordersAccidents and traumaAdditional care needs due to: -Autism Spectrum DisorderCommunication disordersChallenging behavioursMental illness
20 For example…. The UK Nursing Workforce The UK registered nursing workforce, as with many others in the developed world, is ageing.In in 10 was aged less than 30 years.One in three was aged 50 or older.Over 200,000 nurses on the register were aged 50 or older in (Buchan, 2009)Some learning disability nurses can retire at 55 creating a workforce gapReflected in the workforce as a whole?
21 Workforce Planning in a Context of an Increasing Need for Services At the recent RCN Learning Disability Nursing summitProfessor Carpenter, National Director for SpecialEducational Needs, stated that there are now 950,000 children with learning disabilities in the UK, a 25% increase in the past 5 years.The number of children with profound and multiple learning disabilities has increased by 29 % over the same period.Children of today – adults of tomorrow….The UK is facing an unprecedented rise in the number of children born with learningdisabilities, according to a prominent government expert. Professor Barry Carpenter told an RCN summit of leading learning disability nurses that the increase is mainly due to the growth in the number of children born with fetal alcohol syndrome disorder(FASD), and better survival rates among premature babies.2121
22 What has this got to do with people with learning disabilities?
23 Equality, inclusion and outcomes & the sweety shop Look and not touch?Equal access to health & social care will present challenges for the futureAccess & support has to lead to equal outcomes & wider inclusionEnabling access to services has to lead to person-centred care & outcomes
24 Changes in demand for support Increases in lone parent familiesIncreasing rates of maternal employmentIncreases in % of older people with Learning Disability where parents have died or are frailChanging expectations among families regarding the person’s right to an independent life
25 The situation currently Co-morbidity will increase, with greater prevalence of gastrointestinal disorders, pneumonia, sensory impairments, epilepsy, dental disease and osteoporosis in the LD population – the list goes onIncreasing demands on mainstream healthcare systems that are struggling to effectively meet needs now and will do so in the futureIncreasing demands on specialist health and social care systems now and in the future? Policy mismatch - increasing demand V decreasing funds
26 Addressing the challenges of the future today The Numbers of People with LD is increasing and will continue to increaseThe level of healthcare needs experienced by people with LD is increasing and becoming more and more complexWorkforce demographicsKnowledge, skills and experience of the workforceModels of care to meet changing needsFunding mismatchLearning from previous experiences of joint workingThere’s been a 25% increase in the numbers of children with LD in the past 5 years (Parrish, 2010)There’s been a 29% increase in the numbers of children with PMLD (Parrish, 2010)People with LD are ageing and presenting with complex ageing healthcare conditions requiring specialist nursing interventions such as Dementia and Alzheimers Disease.People with LD have a higher risks of coronary disease and treble the risk of dying from respiratory illnesses (Elliot et al. 2003).26
27 The Need for Learning Disability Practitioners in the Future There is a clear need for specialist learning disability practitioners in the futureHOWEVER…The role and function will be one of knowledgeable and expert practitioner who can educate, assess, plan, coordinate, safeguard and deliver evidence-based interventions for a population with high and complex care needs
32 Developing the workforce in Learning Disability services Tommy StevensonEducational Project ManagerNES
33 Project objectivesScottish Government funding through Equally Well monies looking at health inequality and implications for workforce:Analyse data on the educational needs of current workforce linked to models of careWork with partners to identify existing educational provision and identify gaps short, medium and long termProduce a report for consideration by partners on the future direction of learning disability health services and workforce needsCommission appropriate educational resources
34 Strategic drivers Same as You Promoting Health Supporting Inclusion Health Needs Analysis ScotlandBetter Health Better careEqually WellHealth for all ChildrenInequalities in HealthReady, Willing and AbleSelf Directed Care and PersonalisationAutism Strategy ?
35 Principal care groups Transitions (child to adult, adult to older) Children, young people and adults who challenge servicesPeople with long term and complex health conditions e.g. ASD, dementia, syndrome specificMultiple care needsGeneral health careOlder people services
36 Initial activity Project Management Group Steering Group Development of task and finish groups:TransitionsPrimary/acute careSpecialist servicesThird sectorEducation providers
37 Current picture Complex and ongoing work streams: JiT- Commissioning and integration in practice with strategic planningQIS-A broad range of work streams (Tackling Indifference)SAY national group- Reviewing and discussing all aspects of learning disability services including healthLearning disability and Co-Morbidity- Reviewing complex needs and mental healthMCN- models of care, partnership, integration and commissioningA risk of duplication and being disconnected
38 Educational Solutions for Workforce Development- Factors for success? Clarity of problem/issue that needs solving and clarity that the solution is educationalWorkforce solutions are part of a bigger pictureClearly linked to policy and service development agendaEngagement and buy inImpetus for implementation – targets and commitments (noting unintended consequences)Realism. achievability, and sustainabilityScope, focus and reachSynergy with other initiatives
39 Consulting with workforce Initial Task & Finish GroupsTargeted Focus Task & FinishTargeted ResponseTransitionAcute/Primary CareAcute/Primary CareMental Health andLearning DisabilityComplex NeedsTransition:Child to AdultManaging knowledge requirementsComplex NeedsComplex NeedsEducation providersThird SectorThe focus in consultation was to develop achievable and sustainable solutions to priority workforce concerns for people with a learning disabilityThird Sector
40 INTER-CONNECTING ACTIVITY Managed Knowledge Network People with complexity in care present with highest risk across the age rangeEnhancing all areas of workforce on positive health supports statutory, voluntary and independent sectorsA need for a skilled workforce across all agencies in managing complexityEssentials for Complex NeedGeneric health services focusing on acceptability, accessibility, responsiveness and developing initiatives which reduce risk and vulnerabilityAccess to information which is up to date, informative and signposts to similar activity, skills development opportunities and knowledge enhancementManaged Knowledge NetworkSpecialist services which support and enhance practice sustaining people in their own communitiesJoined up strategic intentPerson centred care and support as the driver for service deliveryDeveloping initiatives which can bridge a broad range of priorities are more flexible, sustainable and, importantly, adaptable
41 General Health CareDevelop a workforce with shared understanding of the ‘vulnerable patient’ across primary and acute careSupport the workforce in identifying ‘champions’ in primary and acute careDevelop peer support worker model (Service users & Employment opportunities)
42 Third Sector Look at current educational needs of social care staff Current education programmes are they regulated and quality assuredGaps in workers’ knowledge and skills in meeting complex needs
43 Children and Young People LeadershipPartnershipManaged careCollaboration of partnersMapping into existing programmesSystem to share best practice, map into existing initiatives and develop a single point of access.
44 Complex NeedsMeeting the needs of people with profound and multiple disabilitiesBuilding capacity and capability in evidence based/informed interventions to work with people with challenging behavioursDeveloping workforce capacity and capability to understand and respond to meeting mental health needsSupport to increase workforce capacity and capability to deliver evidence based psychological therapies through training, clinical supervision and infrastructure supportDevelop a ‘new to’ or ‘essential pack’ on working with people with complex needs (encompassing values, attitudes, person centred focus)Develop a managed knowledge network
45 Agenda to date National conference Strategic position Visible leadershipWorkforce challengesDiscussion:Integration across servicesComplex needs and multiple disabilityShared education, examples in practiceComplex need and a changing workforceModels of care/support
46 Investing Developing/commissioning educational resources/programme: Complex needs – The EssentialsManaged Knowledge Network ( learning disability)Positive Behavioural Support Model - learning Disability Nursing/AlliedHealth Professions(Developing Capability/Competence)
47 Managing informationMost organisations know lots of things but they don’t always know what they knowManaged Knowledge Networks represent a dynamic approach to bridging the gap between “knowing and doing”, enabling people to link learning and practice. They operate by actively engaging people in building communities and managing knowledge resources in specific areas of practiceAn electronic portal to support using information to improve care accessed by all partnersInformation flows across boundaries
48 Lessons from the south!!Evidence in relation to current workforce concerns highlight we are not:Building around service needs and skills required to deliver themWell integrated with service financial planning (Critical)Holistic in its approachResponsive to service changes and developmentSupportive of multi-agency training and education
49 Lessons from the south!! Fragmentation of planning Lack of leadership and management ownershipTraining and education weak across agenciesCareer structures poorly informed
50 Thinking workforceService userThe ideal in workforce development
51 Maximising workforce capability Developing a shared strategic agendaSophistication in workforce information managementDetailed and informed commissioningBeing clear about knowledge investment and linking to models of careDeveloping a financial plan which prioritises learning and compliments a partnership with colleges, HEI’s and other institutions/organisations
52 Leading workforce in difficult times No tweaking around the edgesTransformation in workforce is requiredA focus on quality, safety and value for moneyA focus on innovation and changeLook at the long term challenges and opportunitiesRetain the skilled and talented through the lean yearsDesigning a workforce for the future
53 Origins Intentions Outcomes Service Transitions / P.M.L.D. / Complex NeedsIntentionsLocal / Regional PerspectivesGenerate Key Issues / ChallengesGenerate ‘potential’ responsesOutcomesInform work of JIT and related work-streamsProduce brief Regional and National ReportsPromote Local / Regional ‘networking’