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Mansell 2 Services for people with learning disabilities whose behaviour presents a challenge. Jim Mansell. Overview. Analysis Service models Commissioning Conclusion. Analysis. Typical problems. Community placements break down Out-of-area placements increasingly used

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mansell 2 services for people with learning disabilities whose behaviour presents a challenge

Mansell 2Services for people with learning disabilities whose behaviour presents a challenge

Jim Mansell

overview

Overview

Analysis

Service models

Commissioning

Conclusion

typical problems
Typical problems
  • Community placements break down
  • Out-of-area placements increasingly used
  • Poor quality institutional solutions persist
  • Care planning overwhelmed by crises
  • Costs increase while quality declines
reasons for these problems
Reasons for these problems
  • Amount of challenging behaviour depends on service competence
  • Most placements can only support people without problems
  • There is not enough planning ahead for individuals
action needed now
Action needed now
  • Increase capacity of local services to understand and respond to challenging behaviour
  • Provide specialist services locally which can support good mainstream practice as well as directly serve a small number of people with the most challenging needs
  • Replace low-value high-cost services with better alternatives
  • Avoid increasing the burden on family carers by reducing levels of service
service models1
Service models
  • Supporting people living with their family
  • Supporting people in other accommodation
  • Education, work and day opportunities
  • Access to other health and social services
  • Specialist support to services
supporting people living with their family
Supporting people living with their family
  • Re-examine use of residential schools away from people’s homes
  • Provide practical support
    • Equipment
    • Advice and training
    • Staff support to work with the individual
  • Short breaks available to every family
supporting people in other accommodation
Supporting people in other accommodation
  • Best model likely to be support to enable people to live in ordinary housing
  • Direct payments and individual budgets should be more widely available
  • Stop using services which are too large to provide individualised support; serve people too far from their homes; and do not provide people with a good quality life in the home or as part of the local community
education work and day opportunities
Education, work and day opportunities
  • Everyone should have access to innovative day opportunities, further education, supported employment and other day opportunities
  • Commissioners should take the lead in developing a much wider range of alternatives to day centres
access to other health and social services
Access to other health and social services
  • People have the same right of access to mainstream health services as the rest of the population
  • Mental health services available to the whole community should increase their ability to meet the needs of people whose behaviour presents challenges and who have a diagnosed mental illness
  • Psychiatric hospital admission only for short-term, highly focused assessment and treatment of mental illness
specialist support to services
Specialist support to services
  • Specialist multi-disciplinary challenging behaviour support teams are essential
  • Make commissioners, managers and professionals work together to ensure that advice is both practicable and is acted upon
  • Emergency support available 24 hours a day, seven days a week
  • Budgets to fund a much wider variety of interventions as an alternative to placement in special units
commissioning1
Commissioning
  • Commitment
  • Agency responsibility
  • Value for money
  • Service development
  • NHS role
commitment
Commitment
  • Cornwall demonstrates importance of focus and commitment
  • Reasons why this should be a priority
    • These individuals have the greatest needs for services
    • Quality services achieve marked improvement
    • Failure to develop local services threatens the policy of community care
agency responsibility
Agency responsibility
  • Partnership working established in some areas
  • Problems remain:
    • Unilateral withdrawal of NHS finance
    • Reduction of Supporting People finance for individuals with relatively high needs for support
    • Continued use of residential special schools a long way from home
  • Government improving coordination between departments
value for money
Value for money
  • Need a person-centred, comprehensive view of benefits and costs
  • Take account of hidden costs of failure to develop local services
service development
Service development
  • Make sure every person whose behaviour presents serious challenges has a proper person-centred plan
  • Build capacity in the local system, rather than waiting until crises occur
  • Strengthen commissioning to combine expertise about challenging behaviour with the ability to actually develop the services needed
nhs role
NHS role
  • Keep contributing the money needed for joint work
  • Not undermine strategy by commissioning poor-quality services themselves
  • Continue to provide professional support to sustain good practice in community
  • Provide short-term psychiatric assessment and treatment, but only as part of an integrated pathway of care for the individual that gets them back into the community
  • Enable fair access to health services for people with learning disabilities whose behaviour presents a challenge to services
the right strategy
The right strategy
  • Only commission services that prevent challenging behaviour developing or getting worse
  • Develop effective local services for people presenting the most severe challenges
  • Replace low-value high-cost services with better alternatives
  • Avoid increasing the burden on family carers by reducing levels of service
what should councils do now
What should councils do now?
  • Replace procurement with service development
  • Combine expertise with authority to actually develop services
  • Think about people not units
two examples
Two examples
  • 4 young men with mild learning disabilities, mental health needs and substance abuse problems
  • From out-of-county placements in 2007 to individual flats supported by voluntary sector outreach support
  • Cost in first week £7400; cost 2009 £3970
  • 2 young men with severe learning disabilities and serious challenging behaviour
  • Secure units in 2001 at c£2900 per week each
  • Now sharing a house with skilled staff support
  • Costs now £1175 per week
what works
What works?
  • Building support and accommodation around people, not setting up ‘units’
  • Working with individual, family, service provider
  • Sticking at it over the long haul (working through difficulties)
  • Focusing on the quality of day-to-day support from well-matched and skilled staff
conclusion1
Conclusion
  • Critical factor is to change commissioning to build and sustain the capacity to meet the needs of people in each area