Agenda item

6.1

The Sub-Committee received a report informing Members on the future of health services for adults with a learning disability in Sheffield.

6.2

Present for this item were Greg Hackney (Senior Head of Service, Sheffield Health and Social Care NHS Foundation Trust), Dr. Hassan Mahmood (Clinical Director, Learning Disability Service, Sheffield Health and Social Care NHS Foundation Trust), Heather Burns, Deputy Director of Mental Health, Learning Disability, Autism and Dementia Transformation, NHS South Yorkshire Integrated Care Board) and Richard Kennedy (Engagement Manager, NHS South Yorkshire Integrated Care Board).

6.3

Heather Burns thanked the Committee for inviting the team and gave some background on the work being carried out over the last year on the future of learning disability services for adults in Sheffield. This was part of a large programme of work called ‘Transforming Care’ that aimed to keep people with learning disabilities out of long-stay specialist in-patient units, and encouraged enhancement of community services as an early intervention and prevention method. Ms Burns explained that due to the success of this work, it had been found that Sheffield no longer needed the number of beds that had been previously commissioned. Firshill Rise was a seven-bed in-patient unit, and the success of the programme had led to very few admissions. The pandemic had led to a further reduction in admissions, and along with some quality concerns, the decision to close the unit was made. The unit had remained closed whilst work carried on around enhancing community services. This had been an extensive piece of work involving two organisations of experts (Mencap and Sheffield Voices) to look at how this might impact on the population. It was then proposed to bring a further report as the development of the model is progressed and implemented. She explained that analysis suggested that a maximum of one to two admissions was needed into this type of specialist unit due to the improvement work carried out to keep people at home in a less restrictive environment. The Integrated Care Board had liaised with Sheffield City Council social workers and clinicians at Sheffield Health and Social Care Trust on prevention work. Dynamic Risk Registers were utilised to oversee admissions and avoid admissions where possible. Despite the unit being closed since May 2021, there had been no increase in the need for admissions to this type of specialist in-patient unit.

6.4

Ms Burns explained that the Sheffield Health and Social Care Trust had signed up to working on the Green Light Toolkit, which was a national toolkit that supported people with a learning disability or autism if they were in need of in-patient admission for acute mental health conditions rather than behavioural challenges, which Firshill Rise had been a specialist unit for. An audit of South Yorkshire in-patient found that 33% of patients in in-patient units for specialist learning disability placements did not require to be in that restricted environment. 13% of those in more secure services had struggled to be discharged into appropriate placements, mainly due to the lack of specialist support in the community. Teams had worked closely with the South Yorkshire Integrated Care Board and partners to see if there were any options for co-commissioning, however, as their need for this type of in-patient unit had also reduced, this was not considered to be an option for the foreseeable future. Continuing to provide beds that were no longer needed restricted enhancement of prevention work by community learning disability services.

6.5

In terms of engagement, Ms Burns said that the feedback previously received from the Health Scrutiny Sub-Committee had been very useful. There had been concerns about increased travel for those who needed a specialist hospital placement and whether there would be adequate oversight of those admitted to hospitals outside of the city.  She explained that better community services aimed to prevent the need for those admissions. At the Health Scrutiny Sub-Committee meeting of 23 March, 2023, members had discussed how to move forward and align with the national ‘Building the Right Support’ model, aiming to prevent admissions and enhance community services. Ms Burns stated that in terms of the proposed way forward, Firshill Rise was not considered a viable means of delivering a dynamic and high quality service.

6.6

Ms Burns explained the criteria for further exploration: Is there a strategic benefit to the proposed model, and is it in-line with the national model of transforming care? Is the option deliverable? Does it give an improvement to services? Is there a service user benefit? Does it address the findings from the Service User and Care Engagement? Is there a financial benefit, and does it represent value for money and is it affordable? She explained that following evidence and feedback received from the Health Scrutiny Sub-Committee, and through the NHS England Assurance Checkpoint, it was now intended to develop a more sustainable and enhanced community service for the population of Sheffield. The aim was to use funding for the Firshill Rise in-patient unit more creatively to enhance community services, and to jointly develop a financial support ‘pot’ should a bed need to be commissioned elsewhere.

6.7

In recognition of the concerns raised regarding the proposed changes, Ms Burns stated that work would continue with Sheffield Voices and Mencap to further mitigate any impacts. ‘Safe and Well’ checks of anyone in a hospital placement were required every 6-8 weeks. It was proposed to enhance this standard by carrying out monthly visits for anyone placed in hospital outside of the city. Through the work carried out with NHS England on the assurance process, a proposed clinical model would be taken to the Clinical Senate (a national team of experts), to look the proposal in detail and to shape it in line with best practice. The proposal would remain open to any commissioning trends across South Yorkshire Integrated Care Board, in particular, around the increase of the needs of adults with autism presenting in crisis. The proposed model had been outlined in section 6 of the report and proposed a central point of access into an integrated team. A co-ordinated community, multi-disciplinary team would take a care plan approach, including management of medication within the community. Opening hours would be extended during the week, in-line with feedback from families. The overall aim was to prevent crisis admissions with early clinical intervention by a clinical team.

6.8

Ms Burns explained options were being considered on the provision of short-term crisis beds across South Yorkshire for the few occasions that this was needed, and as another alternative to hospital admission. In effect, the service would work on the full needs of the learning disability population, plus the enhanced support when emotional behaviour breaks down. The next step would be to prepare a full business case, subject to feedback from the Health and Scrutiny Sub-Committee, which would then go through the relevant decision-making process. NHS England had commented that the engagement activity was an example of good practice and would be shared nationally. In addition, the Clinical Senate would assist in further honing the model. She felt that the extensive engagement had provided sufficient insight on the views and concerns of individuals, and that further engagement might cause confusion or uncertainty, or delay the benefits of implementing the alternative provision outlined. Ms Burns asked for a view from the Health Scrutiny Sub-Committee on whether sufficient engagement had taken place and to note the proposed model for future services within Sheffield.

6.9

Greg Hackney noted that a supplementary action had been taken following the Health Scrutiny Sub-Committee meeting of 23 March, 2023, which was to provide an appraisal of the experience of service users with a mild learning disability that may have accessed acute mental health hospital wards. These were not service users that would have accessed Firshill Rise, and the proposals set out within the model would enable a more enhanced offer to these service users in the future.

6.10

Members made various comments and asked a number of questions, to which responses were provided as follows:-

• Currently there were no Sheffield citizens in specialist learning disability placements outside of the city, and there had been one admission in the last 18 months. Firshill Rise had been a very specialist provision, and it had been demonstrated that this type of provision was required less due to the recent work to better support people within the community.

• In addition to clinical activity and contact, there was a national ‘Safe and Well’ standard of 6-8 week checks which this model proposed to exceed. An identified worker would visit the patient monthly with an identified plan to move them out of that placement, together with clinical oversight.

• Dr Hassan Mahmood noted that there had been a change in focus on transforming care, using intensive support to prevent admissions. His team had learned to work with different agencies in a way to prevent admissions, respond more proactively to the needs of patients and prevent lengthy admissions.

• An out-of-area hospital bed manager had been appointed who would work directly with the multi-disciplinary teams and all service users placed out of Sheffield. This had proved to be very effective in reducing placements out of Sheffield, and was expected to continue for those with learning disabilities.

• Following the initial engagement, a health inequality impact assessment had also been carried out in a collaborative way, which considered feedback and experience of individuals, and reviewed impacts that might result from the proposals made in the report. Section 5 of the report outlined this, and included a commitment to provide a programme of support for parents and carers to travel to out of area placements, with an overview of patient experience.

• The proposed clinical model was an exciting time for the services involved, and was an opportunity to learn from each other to transform care by keeping people out of hospital, ensuring the right level of medication and enhance their quality of life. The model aimed to offer a more dynamic service in-line with other parts of the country.

• Sheffield Health and Social Care Trust had a Learning Disability Autism Programme Board, co-chaired by a person with a learning disability. The model developed had been co-produced throughout the year, and engagement would continue as the business case was developed. The enhanced travel offer recognised that some families needed that level of inclusion and financial and/or physical support.

• At the start of the Transforming Care programme, there were 26 people in long hospital stays. Money had been ‘locked-in’ to beds that were not needed due to people at risk of admission being monitored more closely. A hospital was not considered to be a home, which is why the aim was to enhance community services.

• A good community model had the benefits of attracting specialist learning disability staff, and would involve the local authority in providing residential and supported living support. Hospital placements would be sought as close to Sheffield as possible, with a profile and CQC rating appropriate to the needs of the patient. A multi-team approach would offer intervention as needed, and would allow staff and family members to develop their skills. The diversity of Sheffield and different organisations helped to ensure that the needs of all communities were met.

• An enhanced pathway would allow teams to be more responsive according to patient need. Functions of service providers would be clearly defined to enhance patients’ quality of care and life.

• A comprehensive development plan would be in place to ensure clinicians received advanced training on community setting support.

• Work would be carried out closely with local authority colleagues to manage be complex situations more effectively via a whole system approach.

6.11

RESOLVED: That the Sub-Committee:

(a)  thanks Heather Burns, Greg Hackney, Dr Hassan Mahmood and Richard Kennedy for their attendance at the meeting;

(b)  notes the proposed models and options for future of services in Sheffield;

(c)   agrees that sufficient engagement has taken place to enact these proposals following the engagement that had previously been reported to committee; and

(d)  requests a further update in autumn 2023 around implementation of the proposed model.