Plan Template Introduction Purpose This document provides the template and key guidance notes for the completion of local plans aimed at transforming services for people of all ages with a learning disability and/or autism who display behaviour that challenges, including those with a mental health condition, in line with Building the Right Support – a national plan to develop community services and close inpatient facilities (NHS England, LGA, ADASS, 2015). These plans should cover 2016/17, 2017/18 and 2018/19. Aims of the plan Plans should demonstrate how areas plan to fully implement the by March 2019 and close inpatient beds, starting with the national planning assumptions set out in Building the Right Support. These planning assumptions are that no area should need more inpatient capacity than is necessary at any one time to cater to: 10-15 inpatients in CCG-commissioned beds (such as those in assessment and treatment units) per million population 20-25 inpatients in NHS England-commissioned beds (such as those in low-, medium- or high-secure units) per million population These planning assumptions are exactly what the term implies – assumptions for local commissioners to use as they enter into a detailed process of planning. Local planning needs to be creative and ambitious based on a strong understanding of the needs and aspirations of people with a learning disability and/or autism, their families and carers, and on expert advice from clinicians, providers and others. In some local areas, use of beds will be lower than these planning assumptions, but areas are still encouraged to see if they can go still further in supporting people out of hospital settings above and beyond the these initial planning assumptions. National principles Transforming care partnerships should tailor their plans to the local system’s health and care needs and as such individual plans may vary given provider landscape, demographics and the system-wide health and social care context. However local plans should be consistent with the following principles and actively seek to evidence and reinforce these:
1 Proportion of inpatient population with learning a disability or autism who have a person-centred care plan, updated in the last 12 months, and local care Mental Health Services Data Set (MHSDS) Average census calculation applied to: Denominator: inpatient person-days for patients identified as having a learning disability or autism. Numerator: person days in denominator where the following two characteristics are met: (1). Face to face contact event with a staff member flagged as the current Care (MHD_CareCoordinator_Flag) in preceding 28 days; and 2. Care review (Event record with MHD_EventType ‘Review’) within the preceding 12 months. 2 Proportion of people receiving social care primarily because of a learning disability who receive direct payments (fully or in part) or a personal managed budget (Not possible to include people with autism but not learning disability in this indicator) Short and Long Term Support statistics This indicator can only be produced for upper tier local authority geography. Denominator: Sum of clients accessing long term support, community services only funded by full or part direct payments, managed personal budget or commissioned support only. Numerator: all those in the denominator excluding those on commissioned support only. Recommended threshold: This figure should be greater than 60%. 3 Proportion of people with a learning disability or autism readmitted within a specified period of discharge from hospital Hospital Episodes Statistics (HES) and Assuring Transformation datasets. Readmission following discharge with HES main specialty - HES is the longest established and most reliable indicator of the fact of admission and readmission. Denominator: discharges (not including transfers or deaths) from inpatient care where the person is identified as having a learning disability or autism Numerator: admissions to psychiatric inpatient care within specified period The consultation took 90 days as the specified period for
Psychiatry of Learning Disabilities or diagnosis of a learning disability or autism. readmission. We would recommend that this period should be reviewed in light of emerging readmission patterns. Particular attention should be paid to whether a distinct group of rapid readmissions is apparent. NHS England is undertaking an exercise to reconcile HES and Assuring Transformation data sets, to understand any differences between the two. At present NHS England will use Assuring Transformation data as its main source of information, and will be monitoring 28-day and 12-month readmission. 4 Proportion of people with a learning disability receiving an annual health check. (People with autism but not learning disability are not included in this scheme) Calculating Quality Reporting Service, the mechanism used for monitoring GP Enhanced Services including the learning disability annual health check. Two figures should be presented here. Denominator: In both cases the denominator is the number of people in the CCG area who are on their GP’s learning disability register Numerator 1. The first (which is the key variable) takes as numerator the number of those on their GPs learning disability register who have had an annual health check in the most recent year for which data are available Numerator 2. The second indicator has as its numerator the number of people with a learning disability on their GPs learning disability health check register. This will identify the extent to which GPs in an area are participating in the scheme 5 Waiting times for new psychiatric referral for people with a learning disability or autism MHSDS. New referrals are recorded in the Referrals table of the MHSDS. Denominator: Referrals to specialist mental health services of individuals identified in this or prior episodes of care as having a learning disability or autism Numerator: Referrals where interval between referral