2.4 Learning Disability and Autism What the Population Assessment told us There are an estimated 1,483 people over 18 with a moderate or severe learning disability in West Wales (2015 figures), representing just under 0.5% of the total adult population and comparable with other parts of Wales This number is expected to rise over the next two decades, but in proportion with overall population growth A more significant rise of 33% in people over 75 with a moderate or severe learning disability is predicted over the same period Data relating to the incidence of autism is not collected routinely; however between January 2013 and November 2015 were 265 referrals to diagnostic services and the between April and November 2016 was 99. In Ceredigion and Pembrokeshire (where data is collected) there were 40 and 113 open cases at the time of the Population Assessment The way in which the needs of people with a Learning Disability are met has changed over the last twenty years. People who would historically have been placed in institutional care are increasingly being supported to live in their communities. Health and social care services along with the third sector collaborate to maximise the independence and potential of those who use our services. Gaps and areas for improvement we identified Relevant Objectives within the Delivery Plan Improving the recognition, diagnosis and the treatment and management of people with neurodevelopmental disorders including ASD and ADHS 1.9; 2.7 Empowering people with a learning disability to decide who provides their support and what form that support takes 1.20; 1.21; 2.11 Strengthening pathways back to local communities through developing local education, volunteering and work opportunities in communities, making the necessary adjustments for people with a learning disability 1.20; 2.12 Increasing access and availability of appropriate, suitable housing and accommodation to enable people with a learning disability to live as independently as possible, in a place of their choice 2.12 Developing consistent, integrated commissioning and procurement processes that are based on co-production principles, which involve community-based groups and fora in the design and delivery of services 1.20; 2.11; 3.8; E5 existing packages of care to ensure they meet current needs, facilitate personal development, increase independence and deliver cost-effective services that ensure best outcomes for service users 2.12 Developing a consistent, outcomes-based performance framework for service delivery across the region, utilising data to support future planning and commissioning 3.8
Section 3: Delivery plan Prevention Stage 1: Stay well and independent within the community Objective Timeframe Strategic priority Population Groups to Overarching Recs/ Areas for Improvement Links to National Outcomes Implementation Plan/s 1.1 Develop a shared, Health and Wellbeing Strategy for the region which embeds prevention and reduces health inequalities through mainstream action across the whole system 2018-19 IAA and prevention All OR3 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9, N13, N14, N17, N19, N22 Insert link/s 1.2 Establish regional preventions framework based on effective local practice and aimed at building community resilience 2018-2019 IAA and prevention All OR3 OR7 N1, N2, N4, N5, N6, N7, N8, N9, N13, N14, N17, N18, N19, N22 Insert link/s 1.3 Establish and implement regional standards for IAA services 2018-2020 IAA and prevention All OR3 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9 Insert link/s 1.4 Embed and promote Dewis and Infoengine as primary service portals, linked to the NHS 111 service and local Family Information Services 2018-2020 IAA and prevention All OR3 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9 Insert link/s
1.5 Establish and implement regional strategy for Technology Enabled Care (TEC) 2018-2020 IAA and prevention All OR3 OR7 N7, N8, N9, N14, N22, N24 Insert link/s 1.6 Enhance out of hours provision across the region 2018-2020 IAA and prevention All OR1 OR7 N1, N2, N4, N8 Insert link/s 1.7 Develop Technology Enabled Care to support independence within the community 2018-2020 IAA and prevention All OR1 OR7 N1, N2, N4, N8 Insert link/s 1.8 Deliver integrated training and development programme to support practice around IAA and preventions 2018-2020 IAA and prevention/ Workforce Development All OR3 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9 Insert link/s 1.9 Establish regional advocacy service for adults 2020 IAA and prevention All adults OR1 OR6 OR7 OR8 N1, N2, N3, N4, N5, N6, N10, N12 Insert link/s 1.10 Ensure adults and children with autism, who do not have a learning disability or mental health problems, receive appropriate IAA and signposting to relevant support and services in the community through the development and implementation of a regional Integrated Autism Service, 2018-2023 IAA and prevention Autism OR3 OR7 N1, N2, N3, N4, N9, N15, N17, N18, N19 Insert link/s 1.11 Raise awareness of carers through Carer Aware/ Young 2018-2022 Carers Carers OR3 OR4 N1, N2, N4, N5, N6, N9, N11, N12, N18 Insert link/s
Carer Aware e-learning programmes, training and workforce development and the Investors in Carers Scheme, to ensure needs are identified and appropriate support provided 1.12 Ensure appropriate levels of respite and support services for carers, developed using a co-produced approach 2018-2023 Carers Carers OR1 OR3 OR4 OR6 OR7 N1, N2, N4, N5, N6, N9, N11, N12, N18 Insert link/s 1.13 Ensure carers have access to appropriate IAA to support them in their role 2018-2023 Carers Carers OR3 OR4 OR7 N1, N2, N4, N5, N6, N9, N11, N12, N18 Insert link/s 1.14 Support the wellbeing of carers and former carers through supporting them to build and maintain emotional resilience 2018-2023 Carers Carers OR1 OR3 OR4 OR6 OR7 N1, N2, N4, N5, N6, N9, N11, N12, N18 Insert link/s 1.15 Develop community resilience and strengths-based early intervention and prevention initiatives to provide appropriate support for children and families, working with the third sector and focusing on the four wellbeing outcomes for children and young people 2018-2023 IAA and prevention Children and Young People OR1 OR3 OR7 N1, N2, N4, N5, N6, N7, N8, N9, N13, N14, N17, N18, N19, N22 Insert link/s Include VAWDASV
1.16 Implement ‘The Help at the Right Time for Children, Young People and their Families’ regional threshold framework which includes support to reduce Adverse Childhood Experiences (ACEs) 2018-2020 IAA and prevention Children and Young People OR3 OR5 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9,N10, N11, N12, N13, N14 Insert link/s 1.17 Implement the ‘Signs of Safety’ Practice Framework across the Region. Children and Young People OR1 N1, N10, N11, N12 Insert link/s 1.18 Implement the Child Poverty Strategy for Wales within West Wales 2018-2023 IAA and prevention Children and People OR3 OR7 N7, N8, N9, N16, N17, N18, N20 Insert link/s 1.19 ensure preventative services meet the needs of children and young people with Mental Health problems through the Together for Children and Mental Health Strategy for child and adolescent mental health 2018-2023 IAA and prevention/ Transforming Mental Health Services Children and Young people OR1 OR3 OR5 OR6 OR7 N1, N2, N4, N5, N6, N7, N8, N9, N13, N14, N17, N18, N19, N22 Insert link/s 1.20 Ensure community-based preventative support is optimised for people with a Learning Disability, drawing on regional Statement of Intent and Model of Care and Support 2018-2023 IAA and prevention/ Transforming LD services Learning Disabilities OR3 OR7 N1, N3, N4, N5, N9 Insert link/s 1.21 Ensure IAA provision supports people with a Learning Disability in accessing 2018-2023 IAA and prevention/ Learning Disabilities OR3 OR7 N1, N2, N3, N4, N5, N9 Insert link/s
appropriate care and support and enhances their access to generic services Transforming LD Services 1.22 Ensure preventative services meet the needs of people with Mental Health problems through the Together for Mental Health Strategy within the Region 2018-2023 Transforming Mental Health Services Mental Health OR1 OR3 OR5 OR6 OR7 N1, N2, N4, N5, N6, N7, N8, N9, N13, N14, N17, N18, N19, N22 Link/s to plans 1.23 Provide single regional contact number for people with Mental Health problems with to specialised local information and to generic IAA provision in the region 2018-19 IAA and prevention/ Transforming Mental Health Services Mental Health OR3 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9 Insert link/s 1.24 Ensure IAA and preventative services meet the needs of people with dementia through delivery of the Regional Dementia Strategy 2018-2022 IAA and prevention People OR1 OR3 OR7 N1, N2, N4, N5, N6, N7, N8, N9, N10, N13, N14, N17, N18, N19, N22 Insert link/s 1.25 Ensure needs of people with sensory impairment are addressed through: Piloting the Sensory Loss Friendly and rolling out across health and social care Sharing learning from the HDUHB Communication Support Service and applying 2018-2023 IAA and prevention Sensory impairment OR1 OR3 OR6 N1, N2, N3, N5, N7, N8, N9 Insert link/s
good practice across health and social care Undertaking a regional review of services for people with a sensory impairment with a view to enhancing services 1.26 Ensure preventative and IAA services meet the needs of people experiencing VAWDASV 2018-2023 IAA/ prevention VAWDASV OR1 OR3 OR6 N1, N2, N10, N11, N12 Insert link/s Prevention Stage 2: Maintain independence through provision of targeted support that prevents the need for people to be admitted to hospital or long-term residential care, or supports timely discharge Objective Timeframe Strategic priority Population Groups Links to Overarching Recs/ Areas for Improvement to National and Outcomes Implementation Plan/s 2.1 Implement consistent, multi-disciplinary approach to assessment and care planning across the region, supported by 2018-2020 IAA and prevention/ Service Integration All OR6 N1, N2, N3, N4, N5, N6, N7, N8, N9, N10, N18, N22, N24 Insert link/s
WCCIS, to ensure a focus on individual outcomes and preserving independence and Pooled Funds/ WCCIS 2.2 Develop integrated community care through locality-based community hubs, providing proactive low level care, step-up facilities and joined up management of chronic conditions, reducing admissions to hospital or long term care and supported by pooled fund arrangements 2018-2022 IAA and prevention/ Service Integration and Pooled Funds All OR3 OR6 OR7 OR8 N1, N2, N3, N7, N9, N10, N12 Insert link/s 2.3 Ensure multi-agency community-based support and step-down facilities are available to facilitate timely discharge 2018-2020 IAA and prevention All OR3 OR4 OR6 OR7 N1, N5, N6, N7, N8 Insert link/s 2.4 Deliver integrated training and development programme to support improved practice in targeted care and services 2018-2020 Workforce Development All OR3 OR7 OR8 All Insert link/s 2.5 Review arrangements for Integrated Community Equipment Stores and implement regional model, including consideration of pooled fund arrangements 2019-2020 Service Integration and Pooled Funds All OR3 OR4 OR7 OR8 N7, N8, N9, N24 Insert link/s 2.6 Review service contracts and consider single regional 2020-2023 Integrated All OR1 OR6 N7, N9, N22, N24 Insert link/s
contract with pooled fund arrangements Service Integration and Pooled OR7 OR8 2.7 Implement Care and Support At Home Strategy in West Wales 2018-2022 Integrated Service Integration and Pooled Funds/ Workforce All adults OR1 OR6 OR7 OR8 N3, N4, N5, N6, N7, N8, N9, N10, N24 Insert link/s 2.8 Ensure adults and children with autism and a learning disability or mental health problem receive appropriate, coordinated, targeted care and support through the development and implementation of a regional Integrated Autism Service 2018-2023 IAA and prevention Autism OR1 OR3 OR6 OR7 N1, N2, N3, N4, N5, N6, N7, N8, N9, N13, N14, N17, N18 Insert link/s 2.9 Ensure appropriate carer involvement in assessment process and that carers are offered their own assessment 2018-2020 IAA and prevention Carers Carers OR3 OR6 N1, N2, N4, N5, N6, N9, N11, N12, N18 Insert link/s 2.10 Deliver and consolidate regional arrangements for the Integrated Family Support Service (IFSS), working in partnership with other services 2018-2022 Service Integration and Pooled Funds Children and Young People OR1 OR3 OR7 OR8 N1, N3, N4, N5, N6, N7, N8, N9, N10, N11, N12, N18, N24 Insert link/s
to maximise opportunities for children and young people to remain or be rehabilitated to their families. Arrangements to include pooled funding as required by the SSWBWA 2.11 Ensure targeted support meets the needs of children and young people with mental health problems through the Together for Mental Health Strategy 2018-2022 Transforming Mental Health Services Children and Young people OR1 OR3 OR5 OR7 OR8 N1, N2, N3, N4, N5, N6, N7, N8, N13, N14, N22 Insert link/s 2.12 Ensure appropriate, integrated step-up models of care are available when needed for people with a Learning Disability, drawing on the regional Model of Care and Support 2018-2023 Transforming LD services Learning Disabilities OR3 OR6 OR7 N5, N7, N8, N9 Insert link/s 2.13 Reduce residential packages for people with learning disability in favour of supported living schemes and improve access to opportunities within the community 2018-2023 Transforming LD services Learning Disabilities OR3 OR6 OR7 N5, N7, N8, N9 Insert link/s 2.14 Ensure targeted support meets the needs of people with mental health problems through 2018-2022 Transforming Mental Health Services Mental Health OR1 OR3 OR7 OR8 N1, N2, N3, N4, N5, N6, N7, N8, N13, N14, N22 Link/s to plans
people with Mental Health problems through the Together for Mental Health Strategy OR7 OR8 3.11 Establish regional pooled fund for older people’s care homes, based on shadow arrangements in place from April 2018 2019-2020 Service integration and pooled funds People OR8 Insert link/s 3.12 Ensure long term care and support services meet the needs of people with dementia through delivery of the Regional Dementia Strategy 2018-2022 Transforming Older People’s Services People OR1 OR3 OR7 OR8 Insert link/s Enablers Objective Timeframe Strategic priority Population Groups Links to Overarching Recs/ Areas for Improvement to National Outcomes Implementation Plan/s E1 Establish regional workforce strategy, with a view to: Improving recruitment and retention rates by working 2018-2022 Workforce Development All OR7 OR8 Insert link/s
commissioning across health and local authorities. E3 Establish a regional ‘Innovations Forum’ bringing together commissioners and providers to support transformation of services and address key issues and challenges 2018 Integrated commissioning All OR7 OR8 Insert link/s E4 Establish consistent regional approach to fee setting across population groups 2019-2020 Integrated commissioning All OR8 E5 Support the further development of social enterprise, cooperatives and user-led services, with the aim establishing new user-led organisations 2018-2020 Integrated commissioning All OR3 OR6 OR7 OR8 Insert link/s E7 Deliver integrated training and development programme to support improved commissioning practice 2018-2020 Integrated commissioning All OR7 OR8 Insert link/s E8 Implement the Welsh Community Care Information System across the region, drawing on experience in Ceredigion and consolidating local pilots run jointly with health 2018-2020 Implementing WCCIS All OR6 OR8 Insert link/s