Is this right for me?

Report from the regional forums to the TCAB

Good information
In the West Midlands knowledge was still limited amongst selfadvocates about Transforming Care. Self-advocates that are
involved in their Local Learning Disability Partnership Board or
Regional Forum knew about Transforming Care. Doing this work
has meant some people have tried to find out more about
Transforming Care.
Very few self-advocates knew who was leading the Transforming
Care work in their area, or how many people with learning
disabilities were in Assessment and Treatment Units. Families
knew about Transforming Care but were not aware of what was
happening locally, but were keen to know more. In the West
Midlands both families and self-advocates felt there was not
enough information, especially in easy read.
In the Eastern region some self-advocates were involved
We have our Champions (self-advocates) on the Partnership
Boards and in the Transforming Care workstreams but some
people were not as clear We are told people with direct
experience of Transforming Care and their families are involved in
the Transforming Care work but we have no evidence of this.
Inclusion East and ACE Anglia are working on easy read resources
for Care and Treatment Reviews, and from some people there was
a sense that Parents have a strong voice and sit on groups with
people, parents are representing people with complex needs and
using case studies.
In the East Midlands self-advocates from 8 of the 9 areas across
the region said Transforming Care had been talked about at the
Board meetings and people seem to have a better understanding
of what this work is:

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Its about people having better care in the community

Its about winterbourne view not happening again
People not going into hospital
In Yorkshire and Humber and the North East the regional forums
have combined to work closely with NHS England colleagues to
develop resources and information sharing events about
Transforming Care.
They have planned two Transforming Care Partnership events,
one in October in Yorkshire and Humber and one in November in
the North East. The events will support local Transforming Care
Partnerships to think about co-production and how this can be
embedded within local plans. They will get support on how to
engage people and families along with sharing best practice. The
sessions will be a round table discussion with each Transforming
Care Partnership completing their own PCP Path.
They are also running two further people and family events.
The events are being held in ATUs in Yorkshire and Humber and
the North East. These events will be for people who are currently
in low, medium or high secure units, their family members and
support staff. These event will be about giving people and their
family members key pieces of information about their rights and
inspiring hope.
Essex, Southend and Thurrocks experts by experience group
reported that they have been looking at the easy read Essex
Transforming Care plan but have said that this is not easy read
and they will be asking for it to be redone.
The North West have reported that they have a large well
established coproduction network which meets regularly. There are
at least 2 opportunities across the NW each month for
Commissioners/ Self-Advocates and Families to meet and discuss
current issues. Everyone with a learning disability and/or autism is
affected by Transforming Care. The Regional Forum and Regional
Family Forum have said, and continue to say, very loudly that this
must not just be about hospital beds this must be about creating

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and supporting communities as a way of preventing unnecessary

admissions too.
The coproduction network is continuing to work closely to
coproduce plans in the North West providing many opportunities
for people to get involved and informed.
Attendance at the regions Confirm and Challenge group meetings
continues to grow in numbers with links to each CCG/ Local
Authority area in the North West. All the plans, meeting notes,
dates, information about numbers and agendas are shared on the
networks facebook page Transforming Care in the North as well
as shared on distribution lists which has links with local groups in
every area who also help to distribute information.
The North West have developed a one page information leaflet for
experts by experience to leave with in-patients and families so they
know how to find out more and are working to create more
opportunities for experts by experience to meet with current inpatients.
An expert by experience has been involved in reviewing all out of
area in-patients for Cheshire/Merseyside.
Some self-advocates and families have continued to feel that
those of them who are connected and those numbers continue to
grow - often know more than paid people locally about
Transforming Care. Experts by Experience have been delivering
briefing sessions to community teams in their areas,
It is fair to say that most people with learning disabilities and their
families are still not linked into the wider work have not heard of
Transforming Care or know what is happening locally. Most public
service employees are not aware, or may be aware but not clear
and those are the people who can help us connect with new
families who are not already linked to peer support networks. The
North West is working to address these issues.
The North West regional forums have reported that part of the
issue of some people not knowing about Transforming Care is that
the people that come along to confirm and challenge meetings etc
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quite often are not the people most directly affected by the work in
relation to bed reduction. Most people have not, and never will,
spend time in an ATU.
The North West have supported experts by experience to attend
well over 500 CTRs in the NW and have developed ways that
support those patients and their families have the chance to learn
more about Transforming Care at the CTR to enable better links,
including going to meet with in-patient groups.
The North West are still looking at how they better link to hear
the voices of children/ young people and their families who
are not involved in any meetings and they held an event in
September focusing on children and young people. They are
working closely with children and young people in West Cheshire
in relation to Integrated Personal Commissioning and are linking
that work closely to the transforming care agenda locally and
regionally
All the people who come to the coproduction network meetings
know more about Transforming Care and have been actively
involved in developing local Transforming Care plans, the
challenge continues to be to reach wider.
Individuals and families are reporting that they now get such
little support that they are reluctant to use the support they
get to attend meetings. This is a real challenge in ensuring
that self-advocates and families get good information.
The North West have developed social media to reach wider to
people who dont want to get involved in meetings etc. in a
relatively short space of time their page has 240 likes. Through this
they have shared the plans from across the North West,
information about events and meetings, photos, notes etc.
In Oxfordshire, there is increasing awareness of the work of the
Transforming Care Programme Board, as a result of previous
engagement events. The South East and London regional forums
are also networked with Bringing Us Together to support the work
they are doing across the UK for families.

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These, plus the engagement event they ran across the region in
May 2016, through the NHS England Engagement funding has
spread the work more widely and has led to greater awareness
and also commitment to working on the issues, based on the fact
that the next event in Oxfordshire has doubled the numbers of
attendees from 55 to 115.
Locally, in Oxfordshire, the region has seen a recent increase
in the numbers of people who are placed in secure units. The
numbers are not high, compared with some parts of the
country, but it is disappointing that the numbers have
increased again.
The regional forum intends to formally write to the Transforming
Care Board to find out why this has happened. Some of the
people who are out of county have autism and mental health
needs, rather than learning disabilities.
The region have some thoughts on why this may be happening.
The problems with Southern Health Foundation Trust mean that
the local unit remains closed and there are discussions about what
should happen to the site in Oxford. This is not under the control of
the local Clinical Commissioning Group as it will be decided by
Southern Health FT and by NHS Improvement.
Local people are very concerned about the loss of local funding, if
this site is sold as it could affect what can be developed in
Oxfordshire. The nearest other unit is at High Wycombe and this is
closing. This is run by Southern Health FT.
The region are also concerned at the number of people in St
Andrews as they have concerns about the safety of patients
in St Andrews
They are also concerned that St Andrews and other private
hospitals are continuing to expand, despite what the
Government says should happen.
London and the South East region want to know what the
Government are going to do about this.

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The region has reported that it is proving very difficult for

some families to get the support they need, so there are
problems with getting skilled support workers in the South
East and London, where it is expensive to live and where
people can get easier work.
One young person is due to be discharged at the moment but
cannot get enough staff to build a team. There is a high risk he will
be re-sectioned if he does not get a good staff team around him
when he moves back into the community.
We also know from the CTR work that some members of the
region are involved in that there are people who were moved on
early but now some of the people that remain have higher support
needs and do not have good enough communitybased support
with skilled nurses to help them move on. These are people who
have been in medium secure units for years in some cases.
There is growing awareness of the TCP leads in some areas,
especially the shire counties but London TCP is complex
because of the number of boroughs and this does not make it
easy.
London and the South East reported that in some areas, local selfadvocates are not being involved properly as information is not
accessible enough and time is not always taken to make things
easy to understand.
Timescales put a lot of pressure on the TCPs to work quickly
and this does not help people with learning disabilities, or
autism.
More work needs to be done away from formal meetings to
give people with learning disabilities and mental health needs
or distressed behaviours a chance to work on the issues at a
slow pace.
Linking families to other families through projects like Bringing Us
Together could help enormously.

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Local people working together

In Essex, Southend and Thurrock there is an experts by
experience group consisting of people with a learning disability,
their advocate supports and family carers. The group is co-chaired
by someone with a learning disability and a family carer and both
attend the transforming care board.
The group has been going for just over a year and has been very
much involved in designing what the care pathway should look like
going forwards.
They have had a series of workshops for each of the cohort groups
there have been meetings for people who have experienced the
service or may in the future and family carers, there has then been
a meeting of practitioners who have looked at what the experts by
experience have said and added what they think too, then there
has then been a joint meeting of everyone to further discuss what
the pathway should look like.
The region reported that it hasnt always been easy to make sure
every voice has been heard and that some cohorts being more
difficult to engage with although the families have been very much
listened to. For those who have been unable to have their voice
heard so far as the method of hearing it has excluded them the
group is looking at speaking specifically to those individuals on a
one to one basis that works for them.
One member of the Eastern region reported that The Council
have so worked hard using total communication, to develop
pictorial stories. This works very well for people with learning
disabilities and professionals to help them think who they are
doing this work for.
Another said Commissioning Officers are more comfortable
seeing people with learning disabilities around the table and
thinking about them.
But other comments included A County wide CCG meeting said
the first meeting would not be appropriate for people with
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learning disabilities to attend and said they would set up a

separate meeting for them, this still has not happened.
There was a general feeling that whilst some areas were really
working hard to co-produce plans others didnt really get coproduction:
Professionals think it is a stage in the work, not all the
way through.
As outlined in the Good information section the Yorkshire and
Humber and North East regions are working together with selfadvocates, families, NHS England colleagues and Transforming
Care Partnerships to inform, work together and develop plans.
In the West Midlands just over a third of groups and self-advocates
were involved in planning around Transforming Care. Families
reported knowing little about the Transforming Care Plans. Selfadvocates and families felt that transforming care was
complicated, and that not enough easy read information was being
produced to help them understand and get involved in their local
plans.
Lincolnshire have just advertised for a person with a learning
disability to be an expert by experience within the Transforming
Care Team this will be a permanent role (16 hours per week).
There is already a person with autism working in the team.
In Lincolnshire there is a Transforming Care Team who are leading
on this work. They ran information sessions across the county to
explain more about Transforming Care and the work they do. Very
few people attended.
In the North West the coproduction network have links to family
and self-advocate groups in each Clinical Commissioning Group/
Local Authority area who are encouraged and supported to get
involved in developing local plans and monitoring progress.
Information is shared with all the groups who are invited to local
meetings the notes etc of which are shared also.

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Experts by Experience have visited local group meetings to brief

people also.
In Cheshire, Warrington and Wirral the Transforming Care Board is
co-chaired by an Expert by Experience who has a learning
disability. Other self-advocates and family members representing
each delivery hub area are also on the Board
Sub Regional Confirm and Challenge groups have shared some
key questions that they have said need updating at each meeting
these include
Number of discharges
Number of delayed discharges and reason
Number of admissions and reasons
Number of admissions avoided
Number of readmission and reason etc.
In Oxfordshire, the CCG and the local mainstream mental health
trust are working hard to find out about what families think and
about what people with learning disabilities want. They are also
working with people with autism and their families.
There is a new LD Programme Director at Oxford Health
Foundation Trust. This has helped a lot as she is very good at
working with people with learning disabilities and families. She is
meeting people informally on a regular basis as well as at the
big meetings. The CCG have also given us a lot of time and
are listening well.
The South East London TCP coordinator said that they were
planning to set up a forum for self- advocates with lived experience
but as yet there are no further detail for how this is going to
happen.
Over all in London over the past 3 months there have been more
people discharged than admitted. However it seems that the CCGs
have had less people discharged than they planned for, whereas
social care have had been under pressure with many more people
discharged than planned for.

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This may mean that the figures are not accurate due to data
protection issues. It may also be that social care services are
having to support people who are discharged from a range of
psychiatric services, not just ATUs. It may also be because
people move from other parts of the country to be in London.
The London area self-advocate rep. attended the meeting of the
London Transforming Care Board in September.
He reported that the meeting was very inaccessible. The reports
from each of the TCP partnership areas focussed on data,
they did not talk about how co- production was working (or
not working) in each of the areas and no one spoke about
how they were involving people with a learning disability.
(This matches up with what people with a learning disability
have been saying at our regional meetings - no one has been
involved in the TCP work or plans in the London area ).
Data protection does come up as a theme around barriers. There
has been discussions about how data can be shared safely with
experts by experience and family carers.In Oxfordshire, there is a
suggestion that people could sign a confidentiality agreement with
the Caldecott Guardian in the CGG in Oxfordshire. Data could be
anonymised so that the focus can be on numbers of people and
their needs at the time of admission, through the treatment
process and discharge. As the numbers are small , it is still a risk
that people can be identified if care is not taken.
In Kent, there is work going on with further engagement which will
also be used to inform and co-produce the design of a pilot forum
with the local TCP. This will engage two groups: one who are
currently inpatients and another who have been successfully
discharged and are supported to live in their community.
Please see attached document for full reporting on this
project. It shows the importance of meeting people with
complex needs in a way that works for them if it is to be
successful.

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Can you give some examples of what is happening, things

that are working and things that are not?
Working:
In the North West engaging people with Transforming Care by
experts by experience going to meet with local groups and talk
about the work and how to get involved.
Not working:
In Lincolnshire the Transforming Care Team ran information
sessions across the county to explain more about Transforming
Care and the work they do. Very few people attended.

Good care in hospital

In the Eastern region some self-advocates were involved as peer
advocates in secure hospitals:
we work as peer advocates in secure hospitals, so we are able to
feedback to the board meeting what people think and take them
questions
But what they struggled with were very detailed reports of where
things are at every 3 months. This information is really hard to
understand and to share with people with learning disabilities.
Self-advocates have been going into their local Assessment and
Treatment Units to talk to them about things that are happening
We tell people they can have a Care and Treatment review but
most patients dont know what they are
In the West Midlands there was less knowledge amongst selfadvocate and families about discharge plans and care coordinators. However more were aware of Care and Treatment
Reviews and the experts by experience involved. Self-advocates in

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the region were going to go back to their Transforming Care

Partnership for more information.
One family carer raised concerns about hospitals being privately
run, and that they therefore might not want people to leave hospital
because they do not want to lose money in fees.
In the North West information about numbers has been shared by
commissioners at all sub regional confirm and challenge meetings
and question sets developed as previously stated to support
people to further scrutinise the numbers and the stories behind
the numbers.
The North West are working closely with Commissioners to make
sure that all North West Care and Treatment Reviews have an
expert by experience present. Survey monkey type questionnaires
are completed after every CTR by experts to report back on issues
they feel need scrutiny.
Information about numbers has been shared, as have high level
plans. Groups are developing their own scrutiny of the data and
are aware that there could be some issues, e.g.confidentiality as,
for local people, it may be easier to identify patients.
The North West have raised concerns that the independence of
clinical advisors and experts by experience may be affected going
forward as, despite all the positive feedback, limited funding
means the cost of paying additional support is being considered.
In London and the South East local groups seem to be aware of
Care and Treatment Reviews and some family carers and selfadvocates take part in reviews.
Gloucestershire Voices are linking up with My Life My Choice
in Oxfordshire. My Life My Choice are offering to shadow and
support people from Gloucestershire Voices to help them gain
more experience in Care and Treatment Reviews.
Local authority cuts are having an impact on the availability of
social workers and care managers generally and there is a major

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issue with continuity of care. There are increasing numbers of

locums in Oxon for example, who are very inexperienced. This is
leading to poor quality assessments of need and poor care and
support planning.
In the South East they know of one family who are receiving
funding from a South East local authority. The person was
placed out of county in an ATU in the past, but is still classed
as an ordinary resident in the South East. They have
struggled with getting people to attend reviews and also to
ensure that the personal budget is sufficient to meet the
relatives needs . The whole of the staff team was put in
jeopardy because of delays in agreeing the level of funding
for a Direct Payment and wrangles about what could be paid
for by the Direct Payment. For example, agreeing money to
cover repairs to damaged fixtures and fittings.
London and the South East reported that they are still seeing too
many people without adequate discharge plans and dates for
discharge, though the CTRS in the region tend to now be for those
with much higher levels of need who would need excellent support
in the community to not pose a risk to themselves or others.
The attached report based on work in the Kent area demonstrated
some successful re-integration into the community with very
person-centred approaches.
People involved in CTRs in the region are aware of discharge
plans but they may or may not be linked to the LD Partnership
Boards or Autism Boards.
Otherwise, there is little widespread knowledge of the
discharge plans unless the families or people with learning
disabilities are directly affected.
There has been discussion about selecting anonymised cases at
random for quality checking in Oxfordshire with Experts by
Experience and family carers, looking at the whole of the treatment
process and checking that the provider has given consideration to
planning for discharge from the point of admission and checking
that there has been liason with outside agencies.
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The challenges of recruiting good support staff with the right

qualifications to support people after discharge remains a major
challenge in London and The South East. We know of one
example where this threatens the support to a young person who
is ready for discharge. He is currently in an expensive intensive
care unit on his own.
One of the issues is that the hospital does not offer any
support outside of the hospital gates to support staff who
need training up.
They take the view that the support team is in place, even
though they are inexperienced in supporting that young
person.
They will support staff to come into hospital to train alongside their
staff, but offering real-time support in the community to overlap and
ensure that behavioural support plans will work in the community
does not seem to be offered.
This is a real concern, that at the point of change, support is
not there from the hospital.
This lack of handover and shadowing in the new setting just seems
to make the move into the community very fragile.
Suitable housing is also a major challenge and London and the
South East have reported an example where delays have led to a
family having to take on a rental property but on the first visit, a
neighbour was already complaining vociferously about the noise.
Some TCPs in the South East are tackling this issue by
investing and planning for social housing that can
support people with these very high support needs,
such as Surrey and Berkshire.

Stopping people going into hospital if they do not

need to and Keeping people safe

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In Lincolnshire self-advocates and families reported that the

Transforming Care Partnership are setting up CHAT - Crisis Home
Assessment and Treatment - this service will be for people living
in the community who need urgent help so that they dont need to
go to hospital unless they really need to. It will be open all day and
night, every day.
Most people in the Eastern region werent aware of the number of
people on at risk registers. One person said We are worried
about the title of the register. No, there are no numbers we have
heard. One person said Yes, we have asked at Clinical
Commissioning meetings and the transforming board meetings
show numbers.
People in the Eastern region were able to highlight some positive
examples of what that was going on to keep people safe:
There will be halfway houses instead of going to hospital
People on the Board are clearer on what is happening
Work is from a person-centred point of view rather than
medical model
In the West Midlands a third of the people who were spoken to
knew that groups and self-advocates were involved in planning
what local services and support should look like, but hardly anyone
knew what a risk of admission was.
In the North West Risk registers have been discussed at all
meetings and are scheduled for further local scrutiny at future
meetings with commissioners. Experts by experience are getting
more involved in more preventing admissions CTRs which are
preventing an admission.
Confirm and Challenge groups in the North West are involved in
describing the kinds of services they would like to see, but this is

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difficult for people who have never, and probably will never, spend
time as an in-patient. The North West are working to find more
ways that in-patients and their families are involved
In the North West most people asked didnt seem to know about
Safeguarding Boards, these links need further discussion and
development.
London and the South East report that their impression is that
family carers are more likely to be involved in a meaningful way
with planning what local services and support look like than people
with learning disabilities and autism. The regional forums have
been informed that the local autism charities and family carers are
very involved in the planning work in Surrey for example.
Oxfordshire has worked hard to engage with people with learning
disabilities and family carers, though engagement with larger
numbers of people with learning disabilities has been less
frequent. They are now beginning to engage with people with
autism and their family . The resources offered to people with
autism who do not have a learning disability remain poor with
very few services. They tend to be offers such as Cognitive
Behavioural Therapy online or GPs prescribing medication. They
are often supported in mainstream mental health services that lack
staff with skills in autism awareness and support.Some people
have been successfully supported by MIND.
We have seen increasing development of Intensive Support
teams, though some like Surrey offer a 24/7 service whilst
others, like Oxfordshire offer a Monday to Friday service only.
There is confusion for families who often think that Intensive
Support Teams offer crisis support, rather than support to
understand why people behaviours in the way that they do and
then to create plans for them.
We have not seen examples of people with the label of
challenging behaviours being involved with groups in
planning services. This was borne out by the recent work in
Kent by the South East Forum.
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The London forum shared data with people with learning

disabilities but this was not accessible to them as interpretation of
the data was not offered.
The Risk of Admission register is still not widely shared in our
experience across the South East.
The data that is shared across the region with people with
learning disabilities and family carers tends to focus on those
who have gone into Assessment and Treatment Units or other
secure units, rather than looking at those who are at risk.
Sometimes it is because professionals who plan and
commission services lack the skills to involve people properly
in a way that works for them.
Time pressures do not help with good planning.
In Oxfordshire through the TCP, we are doing work to build up
case studies of examples of good reasonable adjustments to
services that we plan to share with clinicians and other
professionals .We are using film to gather these studies and
written examples.
Autism Oxford have developed a comprehensive set of DVDs
covering the experiences of people with autism. The National
Autistic Society have also developed a virtual reality headset to
enable people to understand the sensory issues that people with
autism experience. These all help people to understand how to
plan services that are more appropriate.
The biggest barrier seems to be that people with learning
disabilities, autism and behaviours that are seen as challenging or
who have mental health needs are not asked or are not supported
to give their views in their own home or setting. The recent
engagement work in Kent with people with very complex needs
was a good example of reaching out to people

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In London and the South East they have had little evidence of
close and effective work being done with people with learning
disabilities and family carers on the local Safeguarding Board
as equal partners.
Surrey appear to have done work in this area but it is yet to be
developed in other areas though it is being discussed as a
possibility in Oxfordshire.
Whilst there is evidence of lay people on Safeguarding Boards
across the region, we are not sure that they are family carers and
experts by experience.
Where people are known to TCP members, if they go into ATUs,
they are often more closely tracked by self-advocates and family
carers. We think that this helps keep people safer. CTRs also
make people more aware of their needs.
The Bringing Families Together group has drawn on that network
to ensure that families can seek peer support in their area or
advocates for relatives at CPAs and other crucial meetings. Our
impression is that this informal safeguarding through social
media networks is a growing trend.
The Challenging Behaviour Foundation has pioneered support by
families for a number of years and has a network of family carers
able to support and offer information and advice.
Given pressures on local authority budgets, there is a strong trend
for police and social care services and others to start thinking
about creating new ways of supporting vulnerable people in their
community and to keep them from becoming victims of crime or
becoming offenders themselves.
There are initiatives exploring new ways of keeping people
safe in their community.
Some are in the early stages of development as yet, such as
developing community touchpoints that are being explored by
Thames Valley Police. In Langley, in Berkshire, Thames Valley are
pioneering use of post offices as community touchpoints and
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places where vulnerable people can go to link up with their local

neighbourhood police units, get advice and support. The Fire and
Rescue Service in West Berks are doing home visits to check on
vulnerable people whilst carrying out fire safety checks.
London and the South East region think that people with learning
disabilities and their families were not involved properly in
Safeguarding Boards because of concerns about maintaining
confidentiality when sharing information. They feel training should
be offered to people with learning disabilities and family carers to
take part in this work.
People may worry that some of the issues discussed are
distressing to hear about and people would need support.
It would need Safeguarding Boards to work differently by attending
meetings of people with learning disabilities and to produce
accessible information.

Changing how care and support happens

Most of the regions found this a challenging area to report on as it
still felt as though it was early days with more in depth scrutiny of
plans scheduled for meetings later in the year.
People are more worried that support is reducing as a result of
budget cuts to Local Authorities.
The need for a culture change in members of the paid workforce in
the public sector has been regularly highlighted as necessary in
relation to the transfer of power and control an emphasis on
saving pennies and spending pounds as a result.
The North West reported that There is a lot of talk of
personalisation and a lot of pretending we are doing it. The culture
needs to change with middle managers etc who often are a barrier
to how their team budget can and should be used. Some real
values training and support is needed in services. Personalisation
for many is still not real. Too much power and control remains with
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pubic servants and lots of people who manage to get a good life
through personalisation feel their grip on that is tenuous and will
only last until their social worker/ key worker etc changes. This is
still too much of a lottery of people and action needs to be taken.
In London and the South East the region reported that they have
evidence that some families are using personal budgets in the
form of a Direct Payment to manage their relatives support and
that it has been very successful in maintaining a good quality of
life. They are often well-informed families who have a lot of skills to
manage a team of support staff. This is not something open to
everyone.
Older carers have expressed deep concern that their loved ones
will simply be moved into an ATU or inappropriate residential care
when they pass away, despite them working hard during their life
time to give them a good life using a Direct Payment or working
closely with a provider to create the support that is person-centred.
It is also tiring when they get older to manage staff teams.
Futureproofing the lives of people with learning disabilities,
autism and mental health needs or behaviours that are
challenging is an area of support that is not well addressed.
Long-term planning for people who have very high support
needs is not well-thought out.
People with learning disabilities and autism still need advocates
when their family is no longer around to support them.
Bringing Us Together are piloting Justice Circles for example.
Families still need help with getting support and training in personcentred thinking and approaches
There are still too many people being placed in services that they
have little choice and control over.
There are limited options with regard to support providers
skilled enough to work with people with learning disabilities
and autism and behaviours labelled as challenging or who

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have mental health needs, especially in areas where costs are

high, like the South East and London.
One of the major challenges is to ensure that clinicians work in a
way that is really person-centred.
Psychiatrists and other clinical staff particularly are not used to
working and thinking in a way that recognises the social model of
disability.
It takes time to develop a good person-centred plan and there may
not be staff who are trained in person-centred thinking on the
ATUs. Shortages of social workers, care managers and OTs may
also lead to pressures on time for staff, leading to poorer planning.
The engagement work carried out by Skillnet has shown
some good examples of positive support that is personcentred.
The Kent Partnership Board is confident that care and support is
increasingly person-centred. This is evident in updates from
Transforming Care professionals, who are accessible to the Board.
The people we engaged were not aware of this more widely than
in their own support.
When people have been successfully discharged, support
appeared to be personalised but evidenced gaps that left people at
some risk of regression. For example, support with managing
benefits and coping with the demands of JobCentre Plus was
missing but vital. For another individual, the chance to
volunteer or gain paid work would be the best safeguard
against regression with alcoholism, but the opportunity had
yet to arise.

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