1. Learning Disability Services in South Tyneside
Dr James Gordon
GP Clinical Director South Tyneside CCG

2. Transforming care

3. National Winterbourne View 2011
Reduction in Assessment and Treatment Beds
Moving those living in hospital back to the community
Care and Treatment Reviews – inpatients/admissions/at risk
Regional transforming care boards
Abuse of people in A+T beds, often in non NHS provision, many miles form home and family, lived in for many years – out of sight, out of mind
The CTR focuses on four areas: is the person safe; are they getting good care; do they have a plan in place for their future and can their care and treatment be provided in the community
Strict regional trajectories for bed closures, North East seen as an outlier, South Tyneside is not, community models now being developed

4. Local Context Integration and Alliancing
A history of joint working and co-location within learning disabilities services
Pooled budget
Care and Treatment Review process
3 tiered governance structure
Transforming Care Board
Learning Disability Strategy Group
Complex Commissioning Group
All organisation committed to working together to ensure the best outcomes for population and maintain financial sustainability
ST LD team previously worked together with good reports from those who were there at the time
Fully pooled budget eliminating perverse incentives/conflicts in the system – e.g. funding stream shouldn’t determine care, only needed to determine whether a person contributes towards their care or not (fully social care funded vs CHC etc). Often being in hospital costs more than being at home with a package – but the costs are shared across all partners
TCB – strategic direction – what will we do?
LDSG – work of LD groups plus scrutiny and challenge of TCB
CCG – Individual cases that require decisions outside of remit of the usual MDT.

5. £23 Million Rose Lodge Day opportunities S117 Placements
Psychiatry and Psychology
Community Nursing Team
£23 Million
Adult Social care placements
Community Therapies
Respite
Joint liability and shared responsibility
The same money that pays for the package of care you’re putting to together or the hospital placement that your admitting a person to pays for our salaries.
How do we remain financially sustainable and continue to commission and provide highest quality person centred care?
Its our collectively responsibility – you must think about the financial impacts of the care provided and commissioned for your clients and equally your decisions and recommendations should be respected.
Its difficult (own GP experience) but essential if we are to continue to operate a health and care system
CHC Funded Placements
Learning Disability Social Workers
Other hospital placements

6. Personalised Commissioning and Service Design
Meaningful activity, achievement and contribution to society
Principals of promoting autonomy and supporting people to make decisions about their own lives and care
Reasonable adjustments to mainstream services, mainstream services used in the majority of cases (may require a degree of support to access)
Avoiding paternalism, least restrictive care, accepting reasonable risk
But we will need better community services – integration, 7 days access, specialist functions – PBS etc, intensive support/crisis
Personalised Commissioning and Service Design

7. Next steps Health and Social care teams will come together
Less duplication, professional support, joint working
Right service, right time, right person.
More complex care in the community
More community care providers – training and support roles for NHS and Social Care staff.
New roles and responsibilities for staff
Community Teams and community based care provision will be more important than ever as people with more complex needs move out of hospital.
Traditional roles may change, we will need to consider how this impacts on care coordination, the role of third sector workers, etc
We need you to tell us how we can achieve this – what works well now, what doesn’t, how can things be better, what do we need to change?