To enter into such agreements that are necessary with the Kent and Medway Clinical Commissioning Group (CCG) and other local NHS organisations to create a new strategic planning and delivery framework for Kent’s residents with a learning disability and autistic people and delegate authority to Corporate Director of Adult Social Care and Health to finalise and approve the formal agreements to establish the new framework.
Reason for the decision
In 2015/16 Kent County Council and the seven NHS Clinical Commissioning Groups (CCG) covering Kent and Medway, agreed to establish an integrated and partner strategic planning, commissioning and delivery framework covering healthcare, council social care and other support for Kent’s residents with a learning disability, and autistic residents. This framework is governed by an agreement between Kent County Council and Kent and Medway CCG, agreed in accordance with the provisions of section 75 of the NHS Act 2006. This framework includes an Alliance Partnership comprising the council’s adults social care service and the two NHS provider trusts that deliver specialist community health care for people with a learning disability and autistic people. This includes Kent Community Health NHS Foundation Trust (KCHFT) and Kent and Medway NHSand Social Care Partnership Trust (KMPT).
The framework covers community delivered services for people living in nursing and residential care; residents living with carers and their families and people living in their own homes or who live in specialist housing with support. The arrangement also covers specialist healthcare and support for residents with a learning disability and autistic people with highly complex needs, including Kent residents admitted to specialist hospitals located both in and outside Kent.
A review of the arrangements summarised above, commissioned by Kent County Council but jointly agreed with Kent and Medway CCG identified challenges with how the council and NHS plan together to design and deliver effective solutions that can achieve strong and improving health and well being outcomes for Kent’s residents with a learning disability and autistic people.
The challenges identified:
· Kent’s current Learning Disability and Autism (LD&A) governance and programme management framework is:
- Confusing with several bodies duplicating effort and decision making and ineffectual structural relationships between each body
- Not competent to develop and implement a whole system strategy and strategic commissioning programme
- Not fully sighted or driven by the priorities, challenges and resource pressures of all partners and is largely reactive to short term issues and targets
- Less than clear about how the voices of learning disabled and autistic people impact or affect key decisions, with a deficient approach to coproduction and system codesign
· Improvement is required in the effectiveness of whole system commissioning and programme management
· Significant improvement is needed in whole system accountability and performance reporting, as investment decisions lack clarity on why and how they were determined and there is a lack of effective data and narrative to demonstrate the outcomes that are being achieved
· Improvement is also needed in the alignment, commissioning and coordination of service delivery across adults, children and young people and complex needs to ensure:
- Effective and seamless care pathways;
- Person centred and codesigned support;
- Outcome driven delivery;
- Stronger market management and micro-commissioning, to address service deficits and to support innovation to address changing needs and expectations.
Through extensive engagement and coproduction of the solutions to address the challenges above, the proposals summarised below emerged through a clear consensus of council and NHS leaders, frontline professionals and health clinicians and critically through face to face engagement and workshops with people with a learning disability, autistic people and carers supported by advocates and advocate organisations.
The establishment of:
§ A single senior level strategic leadership body of equal partners across the local authority, CCG, user and carer voice and system provider
§ A joint LD&A strategic commissioning and programme management unit, supporting whole system planning, development and change management and the function of the strategic leadership body
§ A trusted system provider based on an effective NHS and council partnership, delegated to deliver and micro commission all LDA health and social care support.
Decision type: Key
Reason Key: Affects more than two Electoral Divisions;
Decision status: For Determination
Division affected: (All Division);
Notice of proposed decision first published: 23/02/2021
Decision due: Not before 24th Mar 2021 by Cabinet Member for Adult Social Care and Public Health
Lead member: Cabinet Member for Adult Social Care and Public Health
Lead director: Richard Smith
Department: Social Care, Health & Wellbeing
Contact: Clare Maynard, Head of Commissioning Portfolio - Outcome 2 and 3.
Financial implications: The expectation is that the proposals set out will not result in any significant additional funding or investment commitment from the council. However, the proposals are expected to maximise the potential of council and NHS investments, to deliver significant improvements in the outcomes achieved for people with a learning disability and autistic people through more effective and focused partner planning and decision making of all LD&A health, social care and other services.
Legal implications: A new section 75 agreement will be needed between the council and CCG that sets out the governance requirements and accountability that will cover the proposed LD&A strategic leadership body and system provider partnership.
Equalities implications: An equalities impact assessment has been completed. It identified significant wellbeing and health inequalities affecting the lives of Kent’s residents with a learning disability and autistic people including: -A lack of effective health checks linked to residents with a learning disability and autistic people having a substantially lower life expectancy than all other residents and significantly increased risk of death from Covid -More Kent autistic residents and residents with a learning disability with additional mental health and behavioural needs, are in specialist hospital services in comparison to the rest of England -This adversely affects and impacts their choice, independence and human rights -There is a need for more effective equalities monitoring of people with a learning disability and autistic people cared for in specialist hospitals as national evidence suggests that black and black British people are 4 times more likely to be compulsorily admitted to spec