LDAG News
March 2014
www.ldag.info
Inside this issue: LDAG update
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Project Enable: 6-7 Opening the door to a better future Diary dates
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New Care Bundle Launched Minister for Health Mark Drakeford launched the All Wales “Care Bundle for People with a Learning Disability in a General Hospital Setting” at the Senedd on 13th January 2014. The Care Bundle has been developed jointly between Abertawe Bro Morgannwg University Health Board, Public Health Wales 1000 Lives Improvement Service and the Welsh Government. It sets out key steps at various stages of a patient’s stay that, if carried out consistently for all patients, will reduce the vulnerability of people with a learning disability in hospital settings. Speaking at the launch, Professor Jean White, Chief Nursing Officer for Wales said, “We are determined to ensure that our most vulnerable people are not only protected but are given the highest possible standards of care in all healthcare settings. “This care pathway is workable for all clinicians, and will make a difference to patients who have additional needs when they are admitted into general hospital settings.” Background The care bundle is supported by the new 1000 Lives ‘How to’ guide, “Improving general hospital care of patients who have a learning disability”, which includes information about the general health of people with a learning disability and their particular needs if they are admitted to hospital. The guide outlines three (Continued on page 2)
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key ‘drivers’ and related interventions for improving care, concentrating on effective communication with patients and carers, providing dignified person-centred care, and ensuring patients are reviewed regularly and discharged from hospital safely. It also gives examples of local practice and ‘top tips’ for better acute hospital services for people with a learning disability. Background
Paul Ridd (centre) with his brother and sister
the work within the health board and asked Public Health Wales 1000 Lives Improvement Service to work with them to develop a care bundle that could be implemented in all hospitals across Wales.
Early work on the care bundle began within Abertawe Bro Morgannwg University Health Board as part of a During the launch of the guidance at hospital pathway for adults with a the Senedd, Mark Drakeford said: learning disability requiring hospital “In Wales, we are proud of our NHS and care. This pathway was developed in the service it provides. However, we are response to the Public Services aware that mistakes happen, and when Ombudsman report into the death of they do, we must learn from them. Paul Ridd in one of the health board’s hospitals. The report made a number of recommendations to “I met with Mr Ridd’s family last the health board to improve the summer. I wanted to assure them care and treatment of people lessons have been learned from Paul’s with a learning disability in its death and we were in the process of hospitals. The health board developing a set of guidance to make responded to the report in a number of ways including working sure that the health needs of people closely with Paul Ridd’s family to with learning disabilities are met.” implement the necessary changes. Paul’s siblings, Jonathan Key steps and Jane, attended the launch event and gave a very moving speech about The care bundle sets out the key steps the loss of their brother. It was through that must be taken to ensure the safety Jonathan and Jane and their contact of all patients who have a learning with the Minister for Health that the disability who are being cared for as an Welsh Government became aware of “To catch the reader's attention, place an interesting sentence or quote from the story here.”
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Challenges
in-patient, a day case or in an Emergency Department within a general hospital:
Implementation of the care bundle across Wales is not without its challenges. There is a need for a cultural shift in relation to patients with a learning disability within many of Wales’ hospitals. The introduction of the care bundle is one of several steps necessary to see overall service improvement. The need for staff education, training and development in working with people with a learning disability is essential if staff are to fully embrace the principles within the care bundle.
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Early recognition of patients who have a learning disability
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Effective communication with patients, family members, carers and hospital staff
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Patient-centred care planning
Effective review and discharge planning through multi-agency joint working.
You can read the ‘How to’ improvement guide on the 1000 Lives Plus website: http://bit.ly/1fprT8O.
“To catch the reader's attention, place an interesting sentence or quote from the story here.”
Benefits It is hoped that a number of benefits will be achieved as a result of introducing the care bundle across Wales. These include: •
Health services being more responsive to the individual needs of patients with a learning disability.
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Improved clinical outcomes and experiences for patients and their carers.
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Length of admission more appropriate to the patient’s clinical needs and more effective timely discharge.
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Improved joint working between statutory and third sector providers.
Better communication and information sharing between stakeholders.
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LDAG News
LDAG Update The Learning Disability Advisory Group (LDAG) met for the seventh time on 13 January 2014 in Ty Hywel, Cardiff Bay. Topics discussed included Adult Serious Case Reviews, Social Services and Wellbeing (Wales) Bill, Learning Disability Transformation Project and sub-group updates. Social Services and Well-being (Wales) Bill Penny Hall from Welsh Government provided a brief update on the progress of the Social Services and Well-being Bill. It is hoped that the Bill will complete Stage 4 and receive Royal Assent by end of March 2014 however it will not be legally enforceable until all aspects of the Bill are in place. All legal regulations related to the Bill need to be revised and therefore the Bill may not be fully in force until April 2016. “To catch the reader's attention, place an interesting sentence or quote from the story here.”
Learning Disability Transformation Project Nygaire Bevan from the Social Services Improvement Agency (SSIA) came along to the meeting to provide an update on the Learning Disability Transformation Project. This project involved several local authorities from across Wales and the aim was to transform learning disability services in order to make them more cost-effective and improve outcomes. Members of LDAG suggested that it would be useful to hear from the regional co-ordinators involved in the project about the impact for service users and their families. It was therefore agreed to
invite some of the regional co-ordinators to a future LDAG meeting to deliver presentations on the impact of the project in their region including real life examples of the progressive model principles and outcomes. Edwin Jones, Challenging Behaviour Community of Practice, added that we need to ensure that local authorities reinvest any cost savings back into learning disability services, especially supported living. LDAG Co-Chair Roger Banks, Betsi Cadwalader University Health Board, voiced his concerns about regions producing their own learning disability strategies without an all-Wales overview as this could lead to a ‘postcode lottery’ for people with a learning disability living in Wales. He also raised the issue of where people live as many are living at home with elderly parents due to the lack of suitable supported housing. Roger suggested adding this topic to the LDAG’s list of workstreams and setting up a sub-group to look into the issues. LDAG sub-groups Ray Jacques, Royal College of Psychiatry, updated the group on the progress of the health inequalities and social determinants of health sub-group, which will be focussing on recommendations and actions rather than simply debating what the inequalities are and how they occur (Continued on page 5)
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etc. The sub-group agreed to invite representatives from social services and both primary and secondary healthcare to provide additional input into the group. The next step is to produce a detailed work programme with deadlines.
Page 5 with a learning disability and challenging behaviour Regulating and inspecting services for people with a learning disability and challenging behaviour in Wales Repatriation of people placed out of area.
Joe Powell, All Wales People First, explained that the first meeting of the advocacy sub -group was scheduled to take place on 20 January in order to agree the remit and terms of reference for the group.
“To catch the reader's attention, place an interesting sentence or quote from the story here.”
Gwenda Thomas, Deputy Minister for Social Services, attended the meeting to discuss the five priorities identified by the Challenging Behaviour Community of Practice to inform the work of the transforming care for people with a learning disability and challenging behaviour sub-group. These five priorities were taken from the action plan developed by the group to ensure that the abuse that took place in Winterbourne View does not happen in Wales. Gwenda had asked the group to identify the top five priorities from within the action plan for Welsh Government to take forward and Edwin Jones delivered a presentation on these priorities at the meeting: Joint planning and commissioning Knowing who the people are, where they are and how much money is being spent Professionalisation of the care and support workforce supporting people
The Deputy Minister has already written to all directors of social services and chairs of local health boards to request information on out of area placements and is currently awaiting the responses. She welcomed Edwin’s presentation and asked the sub-group to sequence the actions within the five priorities so that it is clear whether they are short, medium or longer term. New website LDAG Information Officer Sam Williams informed the group that the initial designs for the new website www.ldag.info will be available for approval shortly and asked members for content suggestions. She will also be emailing all members of the group after the meeting to ask for their thoughts on the proposed structure of the new site, which she hopes will go live before the end of March 2014.
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LDAG News
Project Enable: Opening the Door to a Better Future A very small percentage of people with a learning disability are in paid employment even though many can and want to work. Project Enable is a supported internship programme designed to make jobs in NHS Wales accessible to people with a learning disability. It is a partnership between the NHS Centre for Equality and Human Rights (NHS CEHR), Elite Supported Employment Agency and Cwm Taf University Health Board. As a result of the first pilot internship hosted by the health board, three young people are about to embark on a new career as trainee catering assistants within the Royal Glamorgan Hospital. As catering trainees, the interns will be eligible to compete for internal posts to secure permanent jobs within the health board. “To catch the reader's attention, place an interesting sentence or quote from the story here.”
The project is based on the Project Search Programme in England, which is funded by the Department for Work and Pensions and has achieved considerable success across the public and, more recently, private sectors. Like Project Search, Project Enable has a clear aim: to give young people with a learning disability the skills and experience to compete for real paid jobs either with the host employer or elsewhere. For the pilot, the interns had
the opportunity to work in different parts of the catering department supported by a job coach from Elite. Project Enable is quite unique as a public sector model of supported employment. Most of the employer partners of Elite and other supported employment agencies are either retail companies or small family businesses. In 2013, Elite was able to place 102 people in jobs yet 86% were within the private and third sectors.
“Even more important is the knowledge that employment is really good for our health and wellbeing.” (Continued on page 7)
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Recruitment processes used by public services create barriers to employment for people with a learning disability. The project is about making reasonable adjustments to recruitment processes to enable people with a learning disability to have the same access to the workplace as everyone else. People with a learning disability need a different route into work and the unemployment statistics will not change unless employment is made more accessible. The project offers many benefits as employment is not just about having a job. It is an important part of our identity, it develops our confidence and self esteem, it opens doors to friendships and relationships, and makes it possible for us to think about living in our own homes and being independent. Even more important is the knowledge that employment is really good for our health and wellbeing. NHS Wales is the largest employer in Wales and as an organisation committed to the health and wellbeing agenda, and to reducing health inequalities, it has a critical role to play in creating real job opportunities that will impact positively on these young people’s overall health and wellbeing.
Page 7 The project is also a great opportunity to promote positive attitudes towards people with a learning disability. Having the opportunity to work alongside someone as a colleague and see them develop as capable and enthusiastic members of the team is a very powerful way of making people think differently about people with a learning disability. The project partners are enthused by the success of the first pilot and are making plans for a second cohort of interns to begin their internship in the spring of 2014. Discussions are also taking place with Powys Health Board and Powys County Council to introduce Project Enable Powys. “To catch the reader's attention, place an interesting sentence or quote from the story here.�
To watch the film and find out more about Project Enable, please go to www.wales.nhs.uk/equality or phone 01443 233450.
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LDAG News
Real Opportunities Regional SEN Transition to Employment Initiative
Annual Conference 2014 Thursday 5th June St David’s Hotel and Spa, Cardiff Bay The Real Opportunities transition project for young people with additional needs are holding their third annual conference. Please mark this date in your diary—more details to follow soon! To find out more about the project and our previous conferences please visit www.realopportunities.org.uk. You can also find us on Facebook and Twitter @Real_Opps.
The next meeting of the Challenging Behaviour Community of Practice (CB CoP) will take place on Wednesday 30 April 2014 at Cefn Lea, Dolfor, Newtown. Places are limited so if you have not yet booked, please email Karen Barnett: Karen.Barnett2@wales.nhs.uk.
For more information or to let us know what you think, contact Sam Williams on 029 20681177 or e-mail: samantha.williams@ldw.org.uk. Check out the website www.ldag.info or follow us on Facebook and Twitter @LDAdvisoryGroup.