Health Policy

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Health Policy

• Debra Moore
• Valuing People Support Team
• Department of Health
• Quarry House
• Leeds
• Debra.Moore_at_dh.gsi.gov.uk

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Are you sitting comfortably?Are you able
to concentrate on health policy?A quick test!a
picture to study can you see any differences?
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(No Transcript)
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Purpose of the session

• Outline the development of recent health social
  care policy influencing the commissioning and
  provision of services and support for people with
  learning disabilities
• This will include an exploration of key themes
  and drivers for change.

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Background

• Govt. policy of de-instiutionalisation in England
  Wales
• Better Services for the Mentally Handicapped 1971
• 65,000 people in NHS Long stay in 1960s
• 1,500 people in NHS Long stay 2003
• NHS Campuses quality of life significantly
  poorer than in dispersed housing schemes

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Learning disability health policy

• Health services for People with Learning
  Disability HSG(92)42
• Services for People with Learning Disabilities
  and Challenging Behaviour or Mental Health Needs
  (Mansell 1992)
• Reed Report (1993)
• Signposts for Success (1998)
• Valuing People (2001)
• DH Clarification note on commissioning close to
  home (2004)

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Key policy principles

• Individuals should be cared for as far as
  possible in community rather than institutional
  settings
• People should be cared for as near as possible to
  their homes and families
• Individuals should be in conditions of no greater
  security than is justified by the danger they
  present to themselves and others
• Services should maximise rehabilitation and the
  individuals chances of sustaining an independent
  living

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Key policy principles cont.

• The differing needs of people with challenging
  behaviour should be responded to by highly
  individualised service planning and delivery
• Development and expansion of the capacity of
  local services to understand and respond to
  challenging behaviour
• Local specialist services should be provided
  which support good mainstream practice as well as
  directly serving people with the most challenging
  needs

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The broader picture

• Services for people with learning disabilities
  are influenced by specific policy but equally
  important general health and social care policy
  that it driving the pace and direction of change

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The 6 Cs

• Centredness
• Community
• Clarity
• Competence
• Checking
• Citizenship D.Moore 2005

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Centredness

• Person/patient at the heart of planning,
  commissioning and delivery (VP, NHS Plan, NSFs,
  Green Paper, Life Chances for Disabled People,
  PPF)
• Having a voice nothing about us without us!
  (New PPI structures, forums, surveys etc,
  Advocacy,VP, NHS Plan)
• Having a choice (choose book, Green Paper, VP)
• Control self determination (VP, Green Paper-
  assessing own needs)
• Personalisation -Flexible and convenient services
  ones that are tailored to the realities of
  individual lives (Public Health White Paper)

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Community

• Increasing local power, capacity competence
  (StBOP,VP, Mansell, Reed, NHS Plan, Clarification
  note)
• Increasing access to the primary care gateway
  (NSF, Prison Health, VP)
• Primary care led commissioning and provision (NHS
  Plan)
• Local strategic partnerships across agencies and
  sectors housing, health, education etc
• Healthy Communities (Public Health White Paper)
• Reducing inequalities (VP, Prison Health, BME,
  DRC Inquiry, Choosing Health, SEU Report, Public
  Health White paper)

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Clarity

• Needs and wishes of patients
• (VP, NHS Plan)
• Standards for Better Health (HCC)
• Partnerships fit for purpose (VP,StBOP, Green
  Paper)
• Delivery plans responsibilities (PPF)
• Prevention focus early intervention (NHS Plan,
  VP, Public Health WP, Green paper)
• People with highest needs receive support and
  protection (Green Paper)

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Competence

• Effective leadership (NHS Plan, VP, NSFs)
• Modernising agenda redesign and improve
  services (NHS Plan, Green Paper,VP, NSFs)
• Workforce new job roles, empowering frontline
  staff (NHS Plan, VP, NSFs, 10 key roles)
• Clinical competence and effective treatment (NHS
  Plan)
• Expert patients and supporting and training
  family carers (EPP, Public Health White Paper
  Green Paper)
• Commissioning expertise (Clarification note)

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Checking

• Safety Governance procedures (NPSA, An
  organisation with a memory)
• Standards for Better Health (HCC)
• Involving patients in checking Patient surveys
  etc (VP, NHS Plan)
• Clinical effectiveness (VP, NHS Plan)

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Citizenship

• Inclusion
• Legal and civil rights
• Independence
• Risks shared with the person and balanced against
  benefit
• Personalised budgets
• Housing
• Role of the wider community natural supports,
  voluntary and community sector
• (VP, Green Paper, Life Chances etc)

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What might this mean for forensic services?

• Centredness CPA, HAP PCP, advocacy, self
  advocacy, leadership training, making decisions
  about treatment, BME Gender issues, support for
  consultation meetings, accessible information,
  individual packages of support, equity audits etc
• Community- devolved budgets and authority,
  increased capacity and robust infrastructure,
  access to mainstream local provision, non bed
  based approaches e.g. prevention outreach,
  managed clinical networks, reduction in OATS,
  reduction in spot and emergency placements,
  prison in reach, primary care access etc
• Clarity vision, local population needs
  analysis, aggregate needs and wishes of patients
  families, review current service provision and
  trends, commissioning roles and roles of other
  agencies sectors, LIT LDPBs leads strategy
  for forensic provision, protocols between
  services, Partnership Board exclusion policies
  etc
• Competence role clarity and new ways of
  working, leadership training, building and
  sharing forensic expertise, empowering clinicians
  and frontline managers, informed commissioning,
  effective treatment options, least restrictive
  setting, risk management etc
• Checking patients involved in setting and
  checking standards, using developmental
  standards, local standards eg Better Metrics,
  equity audits, cost and quality of placement
  data, evidence based practice, safety, best value
  etc
• Citizenship legal and civil rights,
  individualised and direct funding, self
  determination and control re-support, inclusion
  in housing and employment strategies etc

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Bottom line - ensuring a good patient experience
The opportunity to lead a full and purposeful
life So liberate your talents!
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Thankyou