Independent Life Plans & Transforming Care: What have we found so far?
Due to the high levels of people with a learning disability in inpatient beds the government completed a white paper ‘Building the right Support 2015’. As part of this report ICB’s made a pledge to reduce their reliance on secure and non secure inpatient beds, and reduce the length of time people are an inpatient (1/3 of people in hospital in 2015 had been there for 5 years or longer).
Alongside this report, a new Service Model was created which stated:
People should have a good and meaningful everyday life
Care and supported should be person centred
People should have choice and control over their health care needs
People should live in the community with the right support
People should have a choice about where and how they live
People should use mainstream NHS services
People should access specialist health and social care support in the community
People should have support to stay out of trouble
Only when necessary should they have high quality inpatient care
In order to fulfil the ICBs obligations and meet ‘Building the Right Support’ requirements PSG Transforming Care Division has completed Independent Life Plans with Nottinghamshire (16), Lincolnshire (10), Leicestershire (6), Derbyshire (4) and Northamptonshire (5).
The aim of an ILP is to support the person to be discharged from inpatient services whilst also:
Hearing the individual’s voice
Improving their quality of life
Increasing their access to the community
Increasing their engagement in meaningful activities
Reducing the amount of chemical and physical restraint
Improving staff confidence
The ILP is a whole person document which outlines the history of the person, where they are now and where they want to go. The process looks at all the available information and written documents about the person, includes talking to the person and NOK where we have consent, and all of the MDT. The plan also includes recommendations which will help the person move on with their life.
What have we found?
From the 41 ILP’s Transforming Care Division have completed to date, we have learned some interesting facts which could help services in their planning and help PSG better understand the client group we serve.
The reasons people do not move on from long term inpatient settings include;
No appropriate provider was available (locally).
No clear legal framework to support discharge where risks to others are still present, and a hesitance to use long-term section 17 leave.
Loss of the person’s independence with activities of daily living due to length of time spent as an inpatient.
No discharge plans started on admission resulting in a delay in social care finding a provider/accommodation.
No Mental Capacity Assessments were completed regarding where to live, care and support. treatment.
Lack of consistent approach by staff.
Lack of consistent staff communication with the person.
Lack of meaningful activities.
Lack of positive risk-taking to test the person’s risks prior to discharge into the community. Essential if the Ministry of Justice must give consent to discharge.
What’s next?
Transforming care has fed back these findings to each ICB and discussed recommendations to overcome barriers to discharge. We hope this will help MDT’s to think more creatively, plan positive risk-taking, start discharge plans from admission, and be more consistent and holistic in their approach. We are also looking into the possibility of community ILPs where the person’s quality of life could be improved even though they may not be an inpatient.
We still have more ILPs to complete which will add to our understanding of delayed discharges and people who are ‘stuck’ in hospital. The more we understand the better inpatient services for people with a learning disability/ASD and mental health disorders will become.
