Adult Disability Provider Forum 11 th December 2019
Agenda • HCC Commissioning Update • LeDeR (mortality review) Learning for Services • Health Liaison Update • Annual Health Check Survey • Classes for Service Users
HCC update Nadine Raenke Community Commissioning - Adult Disabilities www.hertfordshire.gov.uk www.hertfordshire.gov.uk
Supported Living framework • 79 referrals made so far: 41 Supported Living; 38 Community Support • Response rates: Supported Living 90%, Community Support 61% • Referrals: worth responding with offer, even if not exact requirements • Transforming Care: community of practice (‘champions’) • Housing: let’s have conversations prior to decisions • Next steps: -summarise and share gaps information -publish referrals in clusters -improve long term planning -will extend response times www.hertfordshire.gov.uk
ADS Accommodation Strategy 2019-2021 • Main need: single occupancy housing in small clusters or ‘pepper-potted’ to enable shared care integrated in community • All to meet M4(2) and some to meet M4(3) building regulations • Enabled for assistive technology • Key challenge: housing for people with more complex needs • Link with Regional TC lead, NHS capital money available • Need to link with STP processes Three work streams: Working with Working with PVI HCC’s Assets Districts sector • Shared vision • Use of land • Networking support • Prospectus • Redevelopment of • Capital grant current buildings • Standard protocols • ‘Homesin’ software for referrals • Capital Investment • Shared ownership www.hertfordshire.gov.uk
Shortbreak Services (Respite) • Consultation closed in November. As result of feedback now re-opened with a additional option to be considered https://www.hertfordshire.gov.uk/about-the-council/consultations/adult- social-services/additional-short-breaks-respite-consultation.aspx# • Consultation to end in January 2020, through political process for decision in February 2020 • Development of new specification for new contract • ADS residential providers interested in offering shortbreaks? https://surveys.hertfordshire.gov.uk/s/shortbreakssurvey/ www.hertfordshire.gov.uk
Community Opportunities (Day Services) • Contracts for preventative sector extended to June 2020 • Contracts for spots extended to September 2020 • Between April and now a number of financial and pre- procurement workshops took place • Final PPME took place 9.12.; confirmed details; well attended • Grant and Framework process will open in January • Grant to be implemented by 01.07.2020 • Framework to be implemented by 01.10.2020 • PLEASE APPLY (for new & existing placements) • In-house services are undergoing separate process but are expected to adhere to same specifications www.hertfordshire.gov.uk
Orange Travel Wallet • To help maintain people’s independence • Can be used by anyone who travels on a bus and has: a learning disability a physical disability hearing or sight loss • Travel wallets are free • Good to include in travel training • www.hertfordshire.gov.uk/orangetravelwallet www.hertfordshire.gov.uk
thank you www.hertfordshire.gov.uk www.hertfordshire.gov.uk
www.hertfordshire.gov.uk
LeDeR Learning Disability Review of Mortality Kathryn Dempsey - LeDeR Local Area Contact Kathryn.dempsey@hertfordshire.gov.uk & Hansa Nariapara - Commissioning Officer Hansa.nariapara@hertfordshire.gov.uk
Background It is well documented that people with a learning disability die, on average more than 20 years sooner than people in the general population, with some of those deaths identified as preventable had the person received better quality health or social care.
LeDeR Programme The Learning Disabilities Mortality Review (LeDeR) is a national NHS England programme which requires that any death of a person over the age of 4 years with a learning disability is reviewed. It was established to: identify learning from deaths and take forward the learning into service improvement initiatives to improve the standard and quality of care for people with learning disabilities. National LeDeR Report Women dying 27 years & men 23 years sooner than general population Reasons for death: pneumonia; aspiration pneumonia, sepsis (48%) Other causes: Dementia, Cancer and epilepsy
Hertfordshire data (to 31 October 2019) Number of deaths reported in % of total 146* total (since April 17) Number of deaths reported in 45 2017/18 (to March 18) Number of deaths reported in 58 2018/19 (to March 19) Number of deaths reported in 43 2019/20 (to end Oct 19) . Total number of reviews 45** 30% completed
Reasons for death In line with this year’s national report, the Pneumonia Aspiration Pneumonia Sepsis Cardiovascular top 3 causes of death are pneumonia, Neoplasms Digestive Systems aspiration pneumonia and sepsis. These Dementia and behavioural Neurological account for 49% of the total deaths Others Not known (Review not completed) reported since April 17. 11, 8% ‘Other’ causes of death reported include an 32, 22% 11, 8% overdose & choking on food. For one case the cause of death was stated as ‘Downs Syndrome’ . 11, 8% 6, 4% 18, 12% 7, 5% 15, 10% 24, 16% 11, 7%
Age range of reported deaths 70 68 30 8 4 yrs -17yrs 18 yrs - 64 yrs 65+ Under 50 • The Median age of the cases reported in total since April 2017 is 63 yrs (58yrs nationally). This is considerably lower than the median age of the general population which is approximately 81 years. • The age range of reported cases is 9 years to 98 years of age
What have we found in Hertfordshire? • 78% of the people who have died since January 2019 lived in a Provider setting • Poor understanding/ application of Mental Capacity Act • DNACPR processes not always followed • No advance care planning taking place • End of life plans put in place too late • Limited examples of joined up working
Case Example Identified Issue Learning Recommendation to address issue XX wanted to die at Whilst not formally placed Providers should put end of life plans home but there was on an end of life pathway, in place for all people using their insufficient time between XX's death was not services and these should include her admission to hospital unexpected and some time arrangements including fast track and her death for a elapsed between the arrangements for fulfilling their wish to meeting to take place to hospital consulting her family die at home where this is the case. consider this. The SJR about non resuscitation and These arrangements should avoid notes that consideration her actual death. This transporting people from their homes was given to returning period of time proved to hospital when death is imminent if her home and this was insufficient to hold a meeting they have expressed the wish to die at ruled out as she was about her end of life care. home. insufficiently stable to travel.
Addressing Outcomes of Reviews Improving Health Outcomes Group – the ‘doers’ Same representation – as on Steering group but operational staff and several additional specialist practitioners i.e. End of Life; sepsis; specialist dentistry and colleagues from Public Health Have developed a shared action plan across steering group and IHOG What evidence change has been effective?
Diagnostic Overshadowing • Website – easy read information available • Videos developed – for example, Sepsis and hand washing • Top to Toe Folder • Thinking about a campaign on what a good day looks like to share with health professionals and a development of an app being discussed.
Annual Health Check and Flu Jabs • Carers preparation checklist • Website has a dedicated page for carers • Health Action Plan following annual health check
Advance Care Planning and End of Life Care • ‘My plan’ easy read version being piloted • Dedicated training for providers – to date (12 homes in total 80 staff trained in East and North Herts, 30 in West Herts)
Communication • Purple Folders – support to keep them updated for professionals • Understand the law – accessible standards/reasonable adjustments • East of England contract - one of the standards- expectation of providers is ‘health’
Next Steps • Work with HCPA - training Learning Disability awareness will be mandatory in 2021 • Daily Caring – for example, good diets to avoid diabetes, constipation, obesity • Areas to work on – application of Mental Capacity Act, Best interest, Dols. • Always ask questions
Useful links & information HCC Website: www.hertfordshire.gov.uk/LDmyhealth NHSE information: www.gov.uk/government/collections/reasonable-adjustments- for-people-with-a-learning-disability LeDeR: www.bristol.ac.uk/sps/leder/
Annual Health Check s- Everyone should get a health check action plan – this is joint responsibility – so support staff need to make sure they have done the ground work for the annual health check and considered all the areas of health in the carer Prep tool – they need to raise with the GP any areas of concern. Staff need to also enable people to become health resilient and health savvy Use all the tools on the web pages to support Professionals can find information on our service and tools available at www.hertfordshire.gov.uk/ldprofessionals
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