1. The impact of commissioning changes on adults with Learning Disabilities Stephan Brusch Head of Health Access

2. Key Impact National & Regional system leadership to handover Three commissioning organisations Main focus on Winterbourne View- forgetting Six Lives Ongoing Commitment through the transition and move to wider vulnerable groups without being lost Loss of expertise at regional and local level Risk of new system having to relearn all lessons learned NHS Constitution and new commissioning model presumes active participation.

3. NHS Commissioning Board Providers The new NHS landscape Funding Accountability Other Parliament Patients and PublicLocal HealthWatch contract Accountability for results Health & Wellbeing Boards (HWBs ) Public Health England Clinical Commissioning Groups (CCGs) contract Monitor (economic regulator) contract Local Authorities (incl. Public Health) Commissioning Support Services NHS Trust Development Authority NHS CB Patch Teams NHS Trusts Version 0.5 Joint licensing between Monitor and CQC CQC National Sector ‘Footprint’ / Local Health Education England DH NHS CB London Sector NHS TDA London Sector FTs LETBs Work together to ensure commissioner support for aspirant FTs Clinical Senates PHE London Sector

4. NHS Commissioning Board Single Operating Model Held to account through NHS Outcome Framework Ensure directly commissioned services meet specific requirements (Offender and Forensic Services and Direct Enhanced Scheme for People with LD) CCG Assurance includes Safeguarding and Learning Disabilities Leadership role for NHS Develop and sustain partnership working (DH, Local Authority, Metropolitan Police, ADASS, Monitor and CQC)

5. Clinical Commissioning Authorisation Arrangements in place for CCG to involve and seek advice from LD clinicians and practitioners. CCG has the capacity and capability to commission improved outcomes for the people it serves Lead clinicians selected from member practices for CCG commissioning priority areas CCG to outline commissioning arrangements for learning disabilities Providing Support via self assessment framework, data analysis and economic benchmarking.

6. Clinical Commissioning Authorisation Appropriate systems for safeguarding Adults at Risk CCG plans to train staff in recognising and reporting safeguarding issues. Clear line of accountability for safeguarding is reflected in CCG governance arrangements. CCG has arrangements in place to co- operate with LA in the operation of LSCB and LSAB. CCG has safeguarding adult lead supported by relevant policies and training

7. Mental Capacity Act Clinical Commissioning Groups (CCGs) need to: Have an identified Mental Capacity Lead Ensure they have knowledge of their continued responsibility for cases authorised by their predecessor PCT that ceased before the 1 st April 2013 Ensure processes are in place to access all relevant archived information on closed cases.

8. Mental Capacity Act Retains responsibility for assuring through the commissioning process compliance with the MCA 2005 and DoLS legislation of all providers of health care Work with health providers and local authorities to ensure appropriate capacity in the system of professionals qualified to carry out best interest assessments Support the training and education of health professionals and best interest assessors to deliver effective safe quality patient services.

9. National levers and Horizon scanning Statutory Guidance: No Secret Making Safeguarding everybody’s business Legislative Framework: Mental Capacity Act, Equality Legislation, Vulnerable Peoples Act, Autism Act NHS and Social Care Outcome Framework NHS CB Mandate NHS CB: Arrangement to secure children’s and adult safeguarding in the future NHS Clinical Commissioning Group Authorisation Guide for applicants Concordat

10. New National Leaders leading post Winterbourne View Michael McShaine- Long Term Conditions Sam Cramond – Directorate of Partnership Chris Bull- Joint Improvement Program Jane Cummins – Chief Nurse will appoint to Band 9 Mental Health and LD lead

11. Local whole System Safeguarding Adult Boards, underpinned by statue Local Authority as lead commissioning organisation Health and Wellbeing Board: Strategic Responsibility for assessing local needs, including vulnerable people (JSNA) and agreeing commissioning stratetgies Regulators: Monitor, CQC and professional regulators. Healthwatch to be consulted Safeguarding Strategic plans

12. Pan London work with ADASS Joint Strategic Needs Assessment Market Positioning Statement Commissioning Jigsaw explained Self Assessment Framework Network

13. LONDON LEARNING DISABILITES PCT RAG FRAMEWORK RESULTS SUMMARY Organisation1.11.21.3Overall Rating2.12.22.32.42.52.62.72.82.9Overall Rating3.13.23.33.4Overall Rating4.24.34.44.54.64.74.84.94.104.11Overall Rating Barking & Dagenhamggagraraarrrrrgaaaarragarrrrn/ar Barnetgaaaaaaararraaaraaaaraarraarn/aa Bexleyggrarrrarrrrrrrrarraaarrrrrrn/ar Brentrrararraarraaaggaaaaagaraaran/aa Bromleyraaaaragaaaaaaaaaaaaaaaaaagan/aa Camdenggggaargaaaaaaaaraaaagaaaggan/aa City & Hackneygggggargrargraaaraagaagraaarn/aa Croydonggraraaaarraaaaaaaaaaaaraaarn/aa Ealinggaraarrrrarrrrgrrararaaaragan/aa Enfieldggggarrarrrrrrgrarrrrarrrrrrn/ar Greenwichggggrrrrrrrrrrarrrrarararrarrr Hammersmith & Fulhamgrrraaaaarrrraarrrrraarrrrrrar Haringeyggraaarrarrrrrarraraaaaaarrrn/aa Harrowgaaaaaaararaaaaaraaaagaaararn/aa Haveringggggrrrrrrrarraarrraaararrrrn/ar Hillingdonraaararaarrrrrgaaraaaaaragaan/aa Hounslowgaraaaaraararagaagaraaarararrr Islingtonggagrrrarrrrrrgarrraaaarararra Kensington & Chelseaggagrrrarrrrrrgraaaaaaarararn/aa Kingstonggggaaaarrrrrrgaararraarrrarn/ar Lambethgaaagaarrrrarraarrraaararrrrrr Lewishamggagrararrrrararrarraarararrn/ar Newhamggraarrrrarrrrarrrrrrgaaarrrn/ar Redbridgeggggaararrrrararraraaaaaaraan/aa Richmondggraarrarrrrrrarrgrgarrrrarrn/ar Southwarkggagrrraarrrrraarrraagraararn/aa Sutton & Mertonggagrarrrrrrrrarrrraraaarrrrn/ar Tower Hamletsggagaargaaaaraararraaaarrrarn/aa waltham forestrraraaaagraaaagaaraaaarraarrn/aa Wandsworthgaaaaaaaaarraaaraaaaragrraarrr Westminsterragagggaaaagaaggrggaaagggggan/ag

14. Sector 1.11.22.12.22.32.42.52.62.72.82.93.13.23.33.44.14.24.34.44.54.64.74.84.94.104.11 Campus closureOut of Area PlacementPrimary Care Annual Health Checks Disease Prevention Wider Primary Care Contracting (acute, non-acute) Inclusive comm. WorkI.T. BME / Learning DisabilityComplex Needs National InvestigationMCA. DDA and LDComplaints Safe-guarding and LDRespite Care Community ProvisionTransitionUser Engagement Partnership (Funding)Older People (LD)Autism Challenging Behaviour Mental Health / LDworkforce Criminal Justice System NWLBrent 21221121122222233221122312 NWLHarrow 22232122121221112221211212 NWLK&C 33322222222333322222222221 NWLH&F 23332332222322222322221223 NWLWestminster 22332323232322223323233322 NWLEaling 22211222222312223332223322 NWLHillingdon 22221211211323112222222222 NWLHounslow 23322222222322322322222222 ONELBarking & Dagenham 33323222212322212222221211 ONELHavering 32211212222322212222111211 ONELRedbridge 33332211121212222222121222 ONELWaltham Forest 33332322222322212222122212 EL&CCity and Hackney 32333322212222222223221111 EL&CNewham 33322322222322212333322222 EL&CTower Hamlets 32221121211212212222221111 SELBexley 31112211111112222221111111 SELBromley 12211322322322233323222321 SELGreenwich 31221111211221122122111112 SELLambeth 32221232223222222323212312 SELLewisham 22221121112211122122122212 SELSouthwark 33221222222322222222222211 NCLBarnet 12322322222323322233321221 NCLCamden 22222222222222212222222222 NCLEnfield 31121211111212222222212211 NCLHaringey 32221221211222222232222212 NCLIslington 32222222221212322232222311 SWLCroydon 33333322132323332333222322 SWLKingston 21111111111111221111111112 SWLRichmond and Twickenham 31111122112211213211111111 SWLSutton and Merton 33232222122322323222312312 SWLWandsworth 13223322212222213223223211

15. 1. Access to Healthcare 2. Being Safe 3. Safeguarding, Governance and Quality OrganisationsSummary A A1A2A3A4A5A6A7A8A9A10Summary BB1B2B3B4Summary CC9C10C11C12C13C14C15C16 NELC Summary 2562425283023192224303295272327182052327262326 2826 Barking and Dagenham 242233222233822221622222222 Barnet 2322232222331032322022223333 Camden 192222221222722211622222222 City and Hackney 223333222211621211312212221 Enfield 212222222223822311722322222 Haringey 2322223222331133231913223233 Havering 191223112133411111813223223 Islington 2222322122331032322133333222 Newham 263333222323932221832221323 Redbridge 212123212233722211822222233 Tower Hamlets 151221111222822311422221131 Waltham Forest 212223212233722211522212321 NWL Summary 16816 17191415 18 2068171618171491618191614201922 Brent 161212211222511121312221122 Ealing 161221112213822311913322323 Hammersmith and Fulham 243233222223922231922222333 Harrow 212113322232922231522222212 Hillingdon 151212111222521111612321223 Hounslow 2222321232231132332132322333 Kensington and Chelsea 2632332323321023322433222333 Westminster 2833332323331133322232222333 SEL Summary 122101311161112101314 491311141111313161314 1514 Bexley 171212231322611221913223323 Bromley 1811232122221032322023232323 Greenwich 232323232222822221833222222 Lambeth 232223222233922321722222232 Lewisham 16221211122272221 22222222 Southwark 252333222233932222333333332 SWL Summary10811 1012109 11 134311 13883811109912 Croydon 2833332233331133322223233333 Kingston 222223222223722211512222222 Richmond 16221121122292232 12212233 Sutton and Merton 202222222222922321732221322 Wandsworth 222223222223722211312211222 London-wide6549299971168785871021081183901029311085843911111049593113111115