Learning disabilities (health and wellbeing needs in South Tyneside)

Several workshops where completed within South Tyneside around present services and areas for development - Common Themes that Emerged from the Workshops:

What was thought to currently works? (no particular order of priority / emphasis)

• Access to health care - single point of access e.g. Target Cancer Screening
• Good multi professional working within health
• CTR Process is nationally recognised good practice
•  Advocacy drop-in - Jarrow provides good links, reduces service isolation and could provide a basis for the model to be extended to other areas of the borough
• Pockets of good work in the community and with the community team
• Liaison post working into hospital / community
• Self / peer advocacy

What Currently Not Working? (no particular order of priority / emphasis)

• IT and Information Sharing - Multi IT Systems and information sharing protocols and processes that aren't compatible between health and social care services
• Transitions - people not moving from children's to adult services smoothly; no planning for the future, working in a reactive way, including transition from children's to adult services. There is a need to manage the expectations of families / carers through the transition process. "Links to reactive"
• Autism - lack of specific services for people with on the Autistic Spectrum.  There isn't always a dual diagnosis with learning disabilities
• Preventative, Community Services / Infrastructure -local community services aren't there / are disjointed to prevent people needing services in the first place e.g. Tenancy Support Officer (a few hours a week)
• Reactive -Reacting rather than looking ahead to future needs, particularly around transitions;  Focus on people who are already entering crisis rather than a focus on prevention; "Links to management and response to crisis"
• Social Work Team - turnover of staff is high, joint working between health and social care/workers result in duplication and people seeing different professionals but answering the same questions. Social Workers communication with health professionals would benefit from improvement. "Links to IT systems and communication"
• Advocacy's - waiting list for service, there is no specific Care Act Advocacy Service, other advocacy services lack Care Act knowledge of legislation. "Links with No clear appeals process to challenge decisions and other IAG"
• Crisis - focus on people who are already entering crisis rather than a focus on prevention, crisis management; feel people can be left until crisis. Need better representation from LA at meetings where people at risk of entering crisis are being discussed. People can yo-yo between being stable and crisis. "Link to preventative and maintenance"
• People still placed out of area / in hospital/residential settings
• Access to information e.g. services, day services/activities, direct payments, service directory / resource pack.
• Inadequate support for family when resident / client is in acute service

Ideas and Solutions

• Co-location, integrated teams - multi-agency team including a range of disciplines: e.g. welfare assistants, health and social care, housing, voluntary sector, transition worker / team Advocacy, transition worker.
• This would reduce duplication of work; in addition to the reduction of confusion and anxiety of families and carers navigating "the system"
• Step-up, Step-down - develop a response / transition pathways between health and social care step-up step-down services - joint processes Joint contingency planning, including in patient and crisis
• Improved crisis response service - Inclusion of social worker in team, South Tyneside to have its own 24 hr team, have a joint commitment to social care, health, family advocacy when in crisis to prevent hospital admission
• Pathways - adopt a life span approach to aid a seamless journey / less confusion for people, and less duplication. Implant a more flexible approach across children and adult pathways; e.g. PH / MH / PBS Integrated. 
• Overarching Manager - continuity, "joint care, coordination, and continuity of team, shared responsibilities. Specialist leads. This would also contribute to the improvement of transition management
• Staff, Skills Asset - multi-talented workforce, skill development, assessment training, "specialist" Staff (social workers / nurses - care providers)
• ICT- system(s) that meets needs of integrating teams, a single electronic system across all services? Ideally each individual would have one record that could be shared and access by all appropriate professionals. Utilisation of social media, Facebook, etc. for communication with clients / families / carers of individuals with learning disabilities. Make sure the appropriate governance is in place that allows agencies to share assessments and information. Shared admin function across the multi-disciplinary team
• Market and Providers Development - encourage and support providers to be more creative and innovative, especially those related to new housing options, e.g. concierge accommodation, Keyring model localities etc.

What does success look like?

• Staff, service users, families / carers will be really clear about what is available in different situations; how to access it and be assured it will be responded to in a coordinated, seamless way across health and social care - prevention through to crisis.
• People are resilient and supported and integrated into their community accessing local universal services
• Services are outcome focused, not focused on a diagnosis and or contact
• Excellent communication between partners; system support integrated working 
• Agencies and providers are able to provide support in a timely flexible way that meets the need of the person and their family / carer
• Person reaches their goals earlier without hitting point of crisis.  Person, staff and family are happier with positive outcomes achieved sooner
• Effective transition processes understood by families. Earlier interventions, information / knowledge passed on from school. 
• Appropriate individuals involved; driven by the individual's need

A 100 people project was carried out by a group of people with Learning Disabilities in 2016 and focused on the follow areas:

• 100 voices on employment
• 100 voices on leisure and culture
• 100 voices on staying health and well
• 100 Voices on young people

The recommendations from these projects were:

• People would like the opportunity to get real work experience in a supported environment.
• People want to learn new skills to help them find work - including interview skills and job searching
• People would like clear information -especially around how employment affects benefits
• People want parents and carers to be involved
• People want to learn in a safe environment
• People feel travel training should be built into employment training
• People want to be offered employment training at annual reviews
• People attending day opportunities enjoy the range of activities, staff support and "feeling safe"
• People are unlikely to sign up to employment training without a firm alternative structure in place to support them
• People would like the opportunity to get out in the evening and at weekends
• People want more staff support to do this
• People would like clear information -especially around timetables
• People want parents and carers to be involved
• People want to feel safer on the street
• People feel travel training should be built into any action plan around leisure and culture
• People would like more "easy read" health information
• People want parents and carers to be involved in diets - especially around making a healthy lunchbox
• People would like to go out more at weekends and evenings (our research shows young people go out more than older people)
• People want more travel training to promote independence
• People want more access to sport and leisure at these times
• People want more staff available to support this
• People want to have somewhere they can meet at weekends to relax with friends
• People want more support with bereavement
• People want more groups supported by Your Voice Counts staff
• Young people with learning disabilities want to work and plan for the future.
• They want to learn new skills and gain a varied work experience
• Young people want work experience that reflects their interests e.g. learning more about designing computer games and placements in games shops
• They like the Project Choice model - and want it to be more widely available
• They want support around life skills, travel training, job hunting on line, sex education and internet safety
• They want statutory services i.e. council, health, fire and police to offer work experience - and real employment opportunities
• They want employers, council staff, transport companies and statutory services to receive more awareness training around autism and mental health issues
• They want parents and carers to be less protective
• They want more places to go at night
• They want more information on sport and leisure facilities across South Tyneside