Reasons for the review

Background and remit

The first Lothian learning disability strategy saw the creation of a range of community-based services and facilitated the closure of long stay learning disability institutions in Lothian. The resettlement of Lothian residents from all other long-stay learning disability hospitals in Scotland saw the final phase of this joint strategy conclude in 2002. Over recent years new needs have emerged and further needs are predicted; present service arrangements are not able to meet these needs.

Notwithstanding the agreement of four joint Partnership in Practice Agreements (PiPs) in the four Lothian areas, there has not been a review of the Lothian Learning Disability Strategy since 1996, and so there is no single Lothian Strategy for learning disability services at the present time. The proposed strategic review should take precedence in setting future direction at a Lothian level, but it will take account of several strands of work undertaken to date:

	Local partnerships submitted new Partnership in Practice Agreements in September 2004, and the Scheme of Establishment for Community Health Partnerships was submitted to the Scottish Executive in December 2004. These will help us to review what elements of learning disability services should now be sustained or developed at a Lothian level.
	A South East Scotland Managed Clinical/Care Network for adults with learning disabilities is now in place and further development will set new structures for service planning and delivery at a South East Scotland level.
	Within NHS Lothian Primary and Community Division, a learning disability inpatient service review has begun.

1.Key drivers

"The same as you?" the report of the Scottish Executive’s National Review of learning disability services was published in May 2000. Local authorities were identified as the lead agencies in drawing up Partnership in Practice agreements. A consistent framework for PiPs was agreed across the four councils. All four Lothian Partnerships have PiPs in place and are in the process of implementing them.

Promoting health, supporting inclusion The national review of the contribution of all nurses to the care and support of people with learning disabilities (June 2002) set out an important additional agenda for the NHS – particularly with respect to the role of generic primary and other health services.

The Public Health Institute for Scotland National Health Needs Assessment of people with learning disabilities confirms that despite their having higher health needs than the general population, there is very poor uptake of heath services by people with learning disabilities. It also demonstrates that people with learning disabilities and complex needs and or dual diagnosis are living longer as are people with learning disabilities generally, and these two factors help to explain the recent growth in the number of people with high levels needs seeking a service.

People with Autistic Spectrum Disorder - the Scottish Executive Health Department has indicated that their position as stated in "The Same as You?" has changed, and this is set out in the Public Health Institute for Scotland National Needs Assessment. It states that specialist services should be developed for some people with people with Autistic Spectrum Disorder and challenging behaviours, and that services relating to Autistic Spectrum Disorder should be developed and delivered within learning disability programmes. Over the last 10 years there has been significant growth in the number of people with an ASD seeking a service.

The Mental Health (Care and Treatment) (Scotland) Act 2003, places new responsibilities on both Health and Local Authorities. Existing in-patient learning disability services will need to be reconfigured to meet some of these requirements.

Transition from children’s services to adult services is probably the other single biggest issue/driver to address.

Community Health Partnerships / Joint Future - arrangements for CHPs are being implemented. However further work is required on how learning disability services will be:

	jointly resourced and managed
	jointly commissioned
	jointly funded for new developments

and making the most of the opportunities single shared assessment offers

2.Scope

It is proposed that this review should

	focus primarily on Lothian-level requirements, planning and services.
	take account of PiP work at local level
	focus primarily on Adult Services
	describe how local services will interface with the emerging Managed Care Network at regional level.
	Inform and build on proposed arrangements for Community Health Partnerships and Joint Future.
	Build on recent developments of joint working and service developments such as those aimed at reducing delays in discharge from hospital.

3. Key elements of work

Produce:

Current and future needs analysis,

audit of current service supply, and

audit of current levels of resourcing (NHS and councils)

Review and refresh models of care for pan-Lothian services, making explicit statements about the valuable role of Person Centred Planning in the context of resource constraints

Develop new, revised Eligibility Criteria – for accessing services across Lothian

Review the effectiveness and role of all NHS specialist learning disability services

Identify, review, and recommend any required developments for meeting the needs of adults with ASD and Asperger’s syndrome

Identify and develop preferred options for improving the provision of

Health Improvement

Primary Health Care

Specialist NHS care

for people with learning disabilities

Review processes for admission and discharge from NHS in-patient units

4. Public / patient / user and carer involvement

"The same as you?" drew on thorough national consultation – the main themes have not changed, and are still being pushed by the cross party group. Work to develop the four Partnership in Practice Agreements has likewise been based on broad consultation with stakeholders, often via self-advocacy organisations and local groups. Within NHS Lothian Primary and Community Division an inpatient consultation group has been developed. Rather than starting from scratch existing consultation mechanisms will be used for this review as far as is possible, linking effectively in to the core work of the review.

Links: SHAS report 2000

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Background and remit

1.Key drivers

2.Scope

4. Public / patient / user and carer involvement

Last modified: November 06, 2006