On 28 July NHS England, ADASS and the LGA published "Supporting People with a learning disability and/or autism who have a mental health condition or display behaviour that challenges".
This is a draft service model for commissioners. A final version will be published in the autumn.
The Service Model
The model sets out nine overarching principles which define what ‘good’ services should look like:
- Providing more proactive, preventative care, with better identification of people at risk and early intervention
- Empowering people with a learning disability and/or autism, for instance through the expansion of personal budgets and personal health budgets and independent advocacy
- Supporting families to care for their children at home, and the provision of high-quality social care with appropriate skills
- Providing greater choice and security in housing
- Ensuring access to activities and services that enable people with a learning disability and/or autism to lead a fulfilling, purposeful life (such as education, leisure)
- Ensuring access to mainstream health services (including mainstream mental health services in the community)
- Providing specialist multi-disciplinary support in the community, including intensively when necessary to avoid admission to hospital
- Ensuring that services aimed at keeping people out of trouble with the criminal justice system are able to address the needs of people with learning disabilities and/or autism, and that the right specialist services are in place in the community to support people with a learning disability and/or autism who pose a risk to others
- Providing hospital services that are high-quality and assess, treat and discharge people with a learning disability as quickly as possible
The document reminds commissioners what the default position should be including:
- Presumption of capacity
- Restraint should be the least restrictive and for the shortest period of time
Capacity assessments can often be easier said than done. We have a lot of experience in assisting both commissioner and provider clients taking them through the key sections of the Mental Capacity Act 2005 and obtaining independent opinions where necessary.
Personal health budgets
Personal health budgets (referred to in the 2nd principle and covered in detail at pages 21 - 24) are an area where we have advised many commissioning clients, particularly in the context of NHS Continuing Healthcare. The model tells commissioners that while many patients have a right by law to PHBs they should be rapidly and ambitiously extending this offer beyond rights guaranteed in law. Commissioners are encouraged to take a positive approach to risk. However, PHBs can be complex and present varying challenges in terms of implementation. Do let us know if you have any PHB queries that you need our input on.
There are several references throughout the document to market shaping eg, the need to ensure there is a range of options for PHB holders to choose from and provision of short breaks for parents.
Information governance issues feature in the draft service model too. CCGs are told to create an “at risk of admission” register for which a data controller must be designated and ensure that the data is stored securely and managed in line with law and best practice.
In terms of compliance with the Equality Act 2010 the model reminds us that mainstream NHS services are required by law to make reasonable adjustments to ensure they are accessible to people with LD and/or autism.
The last section of the document reminds us that there is no disorder or diagnosis which, in itself, requires treatment in a hospital and that with the right support at the right time in the community use of inpatient services should be very rare.