Improving Learning Disability and Autism Services
Author: Alastair Mitchell-Baker
8 July 2024
The Challenge
Tricordant were commissioned by a County Council and Integrated Care Board (ICB) to review the system governance and planning for services for individuals with learning disabilities and/or autism (LD&A), building on an earlier Regional review focussed on accelerating the improvement regionally in reducing inpatient care for people with LD&A. System leaders knew the county faced workforce shortages, financial pressures, and poor-quality care provision, leading to worse outcomes for individuals with LD&A.
Our approach
After an initial engagement and discovery phase, the Review used an agile project methodology with an integrated client and Tricordant program team to address challenges and refine recommendations. This methodology helped develop shared understanding and improve commissioner relationships.
Detailed analysis and modelling was undertaken of current activity, capacity and spend and used to populate a demand and capacity model showing future service and cost pressures. This helped identify key commissioning priorities.
Alongside this an in-depth review of the LDA workforce was undertaken across health and social care which identified several opportunities for local workforce development, including consolidated provider pipelines to facilitate better engagement with higher education, use of apprenticeships and development of advanced practitioner roles.
A review of the business processes between the Council and ICB was undertaken covering person-centred contracting for CHC, nursing care and LDA aftercare. This identified a number of key issues and developed a shared strategic map and set of priorities which are now being progressed by a joint project team.
The team analysed current commissioning patterns and spend against Building the Right Support national service model, which emphasises community-based services, aiming to reduce the need for inpatient care. The analysis showed that fragmented commissioning of specialist healthcare providers hindered collaboration and strategic planning but that significant resources were concentrated on a small number of individuals, with 80% of costs allocated to 10% of the LD&A population. Despite high spending, outcomes remain poor, with disparities in mental health, education, employment, and life expectancy compared to the general population.
The Results
The review found, in common with many ICSs, fragmented LD&A commissioning and governance across the Council and ICB, lacking clear leadership attention and overall funding agreements.
The Review proposed a strategic reset, with establishment of an LD&A Executive Board, overseeing revised commissioning structures, enhanced joint quality improvement, joint workforce development and underpinned by joint funding agreements. The recommendations were accepted in full and the new LDA Board met for the first time in early 2024.
Critical Success Factors highlighted include the importance of co-production, provider involvement, clear accountabilities, workforce planning, and trust-building among stakeholders.
The review provided a comprehensive analysis of system planning and governance of LD&A services, highlighting systemic challenges and proposing strategic solutions. Implementation of the recommendations promises to streamline governance, improve collaboration, enhance service quality, and ultimately, advance outcomes for individuals with LD&A locally.