Transforming Care

1 EnglandModel Service Specifications: Supporting implementation of the service model Transforming Care2 NHS England INFORMATION READER BOXD irectoratePublications Gateway Reference: 06324 MedicalNursingFinanceCommissioning OperationsTrans. & Corp. and InformationCommissioning StrategyDocument Purpose ToolsDocument Name Model Service SpecificationsAuthor NHS EnglandPublication Date 06 January 2017 Target Audience CCG Accountable Officers, Local Authority CEs, Directors of Adult SSs, NHS England Regional Directors, NHS England Directors of Commissioning Operations, Directors of Children s Services, Transforming care PartnershipsAdditional Circulation List CCG Clinical Leaders, care Trust CEs, Foundation Trust CEs, Medical Directors, Directors of Nursing, Allied health Professionals, NHS Trust CEsDescription Resource for commissioners to develop service specifications to support implementation of the national service model for people with a learning disability and/or autism who display behaviour that challenges.

2 Including those with a mental health conditionCross reference Building the Right Support - National Service Model October 2015 Superseded documents N/A(is applicable)Action required To support implementation of National Service ModelTiming deadlines N/A(is applicable)Contact details for information Document StatusThis is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the Service Specifications: A resource for commissioners to develop service specifications to support implementation of the national service model for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health number: 1 First published: January 2017 Prepared by: Kevin Elliott NHS England, Transforming care TeamClassification: OFFICIALG ateway number: 06324 Equality and health Inequalities statement Promoting equality and addressing health inequalities are at the heart of NHS England s values and the Transforming care programme of work.

3 Throughout the development of the policies and processes cited in this document, we have: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health guidance for NHS Commissioners on Equality and health Inequalities legal duties is 41 Introduction 5 About this document 6 Delivery 7 Outcomes Frameworks 82 Model service specification: Enhanced/Intensive Support 10 Population Needs 11 Scope, Functions and Outcomes 14 Applicable Service Standards 22 Applicable quality requirements and CQUIN goals 233 Model service specification.

4 Community-based Forensic Support 24 Population Needs 25 Scope, Functions and Outcomes 28 Applicable Service Standards 38 Applicable quality requirements and CQUIN goals 394 Model service specification: Acute Learning Disability Inpatient Services 40 Population Needs 41 Scope, Functions and Outcomes 43 Applicable Service Standards 51 Applicable quality requirements and CQUIN goals 52 Annex A: Case studies, delivery of Enhanced/Intensive Support functions 53 Ealing Intensive Therapeutic Short Break Service 54 Southwark Enhanced Intervention Service 56 Gloucestershire Additional Support Services 59 Annex B: Case studies, delivery of Community-based Forensic Support functions 63 Avon Forensic Community Learning Disabilities Team 64 Secure Outreach Transitions Team (Tees, Esk and Wear Valleys) 68 Annex C: More about the Advisory groups 7241 Introduction5 Supporting commissioners to develop service specifications to support implementation of the national service model for people with a learning disability and/or autism who display behaviour that challenges, including those with a mental health conditionAbout this documentThe Transforming care programme aims to improve the lives of children, young people and adults with a learning disability and/or autism who display behaviours that challenge, including those with a mental health condition.

5 The programme has three key aims: To improve quality of care for people with a learning disability and/or autism To improve quality of life for people with a learning disability and/or autism To enhance community capacity, thereby reducing inappropriate hospital admissions and length of stayThese model service specifications are aimed at supporting health and social care commissioners to develop their own, locally-specific service specifications which support implementation of the national service model. They build on the service model by providing additional detail for commissioners about the purpose, functions and intended outcomes of three aspects of the service model1. These are:1 Enhanced/Intensive Support (principle 7 of the service model)2 Community-based Forensic Support (principle 8 of the service model)3 Acute Learning Disability Inpatient Services (principle 9 of the service model)These three aspects of the service model describe specialist health and social care provision aimed specifically at supporting people with a learning disability and/or autism who display behaviour that challenges.

6 However, mainstream health and social care services can and should meet a large proportion of people s everyday needs. The following key principles (as described in the national service model) therefore apply to all three aspects of provision described in this document: 1 The starting point should always be for mainstream services to support people with a learning disability and/or autism, making reasonable adjustments where necessary and with access to specialist multi-disciplinary support as appropriate;2 A core element of any such specialist provision should therefore be on enabling mainstream services, and other partners, to support people directly. Where meeting health and care needs are particularly complex, more intensive specialist multi-disciplinary support may be needed in order to ensure equity of outcome for people;3 The onus is on service providers to put forward a compelling rationale for any proposal to deviate from the principle of supporting access to mainstream provision, whether community or hospital based Three advisory groups were established to support development of the three model service specifications.

7 See Annex Children, young people and adults with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition have the right to the same opportunities as anyone else to live satisfying and valued lives and, to be treated with the same dignity and respect. They should have a home within their community, be able to develop and maintain relationships and get the support they need to live a healthy, safe and fulfilling life. Vision statement, national service model set out in the service model, the underpinning approach to transformation must be based on a whole system approach to delivering high quality support and services for people. For this to be a reality, services need to demonstrate a strong commitment to a shared value base which place individuals and their quality of life at the centre everything they do. This value base should reflect the golden threads of the service model and be evident on the basis of capable environments2 within which care and support is delivered.

8 Capable environments are characterised by: Positive social interactions, Support for meaningful activity, Opportunities for choice, Encouragement of greater independence, Support to establish and maintain relationships and Mindful and skilled family/carers and paid support/ care staffDeliveryWhat is described in these model service specifications are three functions of support that are needed locally to ensure improved outcomes for people. How these functions of support are delivered will vary from area to area. The answer may not necessarily be about having one service delivering each function (one dedicated Enhanced/Intensive Support service, one dedicated Community-based Forensic Support service, one specialist inpatient service). For example, it may be that one service can deliver two or more of the functions The solution will be dependent on local populations and geographies, and the capability and capacity of existing local services to deliver the functions of support outlined, as well as to meet the needs of differing groups with the wider population of people with a learning disability and/or autism who display behaviour that challenges ( children or people with autism who don t have a learning disability).

9 It is likely that in some areas, pathways of care and support will need to be provided in partnership with already established teams, developing skills within those teams to provide for this population, rather than as discrete teams. Whilst the focus and shape of Transforming care Partnership (TCP) transformation plans will vary, commissioners might find the following questions helpful in considering how the core functions of support described in these documents will be delivered locally: How are the core functions described currently being delivered? Where are the gaps? How are we reducing health inequalities in access and outcomes? How can the core functions be delivered in the future as part of local transformation? What data does the TCP have on this population ( people known to services; young people approaching transition to adulthood; those in contact with the criminal justice system)2 See: Case studies setting out how some of these functions of support are being delivered locally are included in the Annex of this document for the enhanced/intensive support and for the community forensic support delivering these functions of specialist support should agree clearly defined pathways for people, ensuring that individuals experience continuity of care and support and that there is clarity in the roles and responsibilities of different teams.

10 These should be developed using a no wrong door principle and be based on Government is expected to publish its response to the National Data Guardian review of consent/opt-outs and cyber security. It may be necessary to review steps on the collection and use of data for these models, in the light of recommendations and requirements made in the response: Outcomes Frameworks In commissioning the following services, commissioners should be mindful of the following outcome domains adapted from the NHS England Outcomes Framework, the Public health Outcomes Framework and the Adult Social care Outcomes Framework: 8 OutcomeMeasurement DomainWhat this would mean for the individualPreventing people from dying prematurelyImproving the wider determinants of healthNHS Outcomes Domain 1 Public health Outcomes Framework Domains 1 and 4 My health needs are met by services making the reasonable adjustments I need.