The Chair made reference to the work undertaken by the Respite Opportunities and Short Breaks Joint Health Scrutiny Committee in respect of South Tees and HaST CCGs current consultation on the future of respite provision for people with learning disabilities, complex needs and autism.
The panel was reminded that a meeting of the Joint OSC had been held on 5 February in Stockton. At that meeting the CCGs provided an update on the decision taken at the CCGs Governing Body in Common meeting, held on 1 February 2018. The CCGs had taken the decision to progress to implementation Option 2. Other changes to make the service more equitable for people with a learning disability included:
Changing the assessment and allocations process, making it more needs led;
Offering more choice and improved focus on the needs of people with a learning disability and their carers and families;
Buying flexible community-based respite services and clinically-led outreach support services so that people with a learning disability could choose from a range of respite activities with the appropriate support they needed.
In light of the CCGs decision to introduce changes to respite services for adults (18+) with a learning disability, complex needs and autism each local authority now needed to consider its position in respect of next steps in the process.
Following the information discussed at todays meeting the panel would need to determine any outstanding concerns the local authority had in relation to the decision made, whether the local authority would be minded to make a referral if those concerns could not be resolved and on what basis a referral would likely be made.
During the negotiation period consideration would also need to be given to possible concessions that could be made to help deliver the best possible outcomes for all parties.
In order to assist the panels discussion and as requested at the last meeting a representative from Adult Social Care, as well as a Parent / Carer Representative from Bankfields was in attendance.
During discussion the following points were raised:-
The panel was concerned that a decision had been made even though there were no firm proposals for any alternative respite provision. The CCGs had advised that there was capacity and capability in the market to support varied respite options yet such provision remained untested. Throughout the consultation period no current or potential future providers of flexible community based respite in the region had been identified for the panel / Joint OSC and no visits or detailed information had been presented. The decision provided no certainty in respect of future respite provision. Adult Social Care had also advised that there was a lack of learning disabilities nursing provision within the independent sector locally, which presented a real risk to future service provision.
The panel was concerned that the decision would have a detrimental impact on the future provision of bed based respite at Bankfields and Aysgarth. It was the panels view that a reduction in funding for this provision would impact on the NHS and future sustainability of service provision on both sites. Costs to deliver the service over both the short/longer term needed to be met in order to sustain the service.
The panel remained concerned that although a financial envelope of £1.5m had been identified for future respite provision it was not possible to state that the future needs of those eligible to receive health funded respite would not exceed that financial allocation. Further consideration was needed on this matter given that the new assessment criteria has yet to be developed or approved.
In terms of the consultation, the panel was of the view that although the CCG had undertaken a consultation the views expressed by parents / carers / the Joint OSC and local politicians in response to that consultation had not been fully taken into account.
In terms of safeguarding the panel was not satisfied that its concerns had been addressed. The latest CQC inspection (2015) of Bankfields and Aysgarth highlighted that in terms of safety the offer provided at both facilities was outstanding. The CQC defined safe as being protected from physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse and avoidable harm. It was the panels view that it would not be possible for the CCGs to commission community based respite, which matched the current standard of respite care at Bankfields and Aysgarth. By reducing bed based respite at Bankfields and Aysgarth those currently in receipt of the service would be faced with a choice of either accepting lower quality care or declining the alternative provision.
Qualified staffing remained a key concern and at present all medication at Bankfields and Aysgarth was administered by a qualified NHS nurse. NHS nurses at these facilities had also undertaken advanced qualifications in, for example, Autism and were experts / specialists in their field. The panel was of the view that this level of specialism would not be replicated in the provision of community based respite, at a time when it was recognised nationally that there had been a catastrophic decline in specialist LD nurses. This had implications for both the health and well-being of people with learning disabilities and the skills, experience and future resilience of the local health service.
Mencap had highlighted renewed concerns recently (February 2018) that nationally up to 3 people with learning disabilities die from avoidable deaths in hospital every day in the UK. One of the reasons given is the lack of specialist LD knowledge amongst the medical profession. It was clear that the presence of NHS nurses at all times at Bankfields and Aysgarth provides carers and family members with the confidence that those caring for their loved ones were appropriately trained and had developed the necessary skills and experience to care for people with severe and profound needs. The panel was concerned that if the provision of care at our specialist respite centres was reduced the risks to those with the most profound and severe needs would be increased.
The panel had concerns that staff employed in the delivery of community based respite may not be qualified in the administration of medication, epilepsy rescue, challenging behaviour (aggression / psychosis), hoisting, hygiene, nappies and toileting, feeding tubes and fluids and the delivery of severe and profound care. Questions were also raised as to whether providers of community based respite would be required to demonstrate knowledge of and experience in the Mental Capacity Act 2005, Deprivation of Liberty Safeguards, use of ligature risk assessments, observation policies and restraint care plans, as well as other appropriate safeguarding measures.
It was the panels understanding that the way individuals would be assessed in the future would mean that there would be less eligibility for health based respite. This could result in increased costs to the local authority and needed to be considered.
The panel was concerned that the number of bed based respite nights people currently receive at Bankfields and Aysgarth was to be reduced. It was the panels understanding that there was no option within the proposal for those who wished to use all of their allocated entitlement at Bankfields and Aysgarth. Within the proposals Option 2 stated that choice would be improved and bed based respite at Bankfields and Aysgarth would be retained. However, current service users who wished to continue to solely access bed based respite at Bankfields and Aysgarth appeared unable to exercise that choice.
The consultation findings highlighted that overnight bed based respite was considered the most important element of respite care by carers from the list of possible flexible community based respite services offered. Parents / carers advised, in response to the consultation, that at home support was not viewed as respite. The panel was of the view that home support should be removed from the menu of options.
AGREED that the panel was unanimous in its decision that there were grounds for making a referral to the Secretary of State, if the concerns outlined above could not be resolved with the CCGs. The referral would be submitted on the basis that the Health Scrutiny panel was not satisfied with the adequacy of the content of the consultation and considered that the proposals would not be in the interests of the health service in our area.