The commissioning of care for people with learning disabilities and complex needs is improving but councils and primary care trusts are failing to adequately assess their needs or ensure care is sufficiently personalised.
That was the message from a report today by the Commission for Social Care Inspection, Healthcare Commission and Mental Health Act Commission, published two weeks before the three organisations merge into the Care Quality Commission.
The study, which focused on nine local authority areas, found progress was being made in moving away from institutional care towards more flexible services, while councils and PCTs were placing tougher conditions on providers in contracts to improve quality.
However, the watchdogs found that joint strategic needs assessments of local populations – which councils and PCTs have been under a duty to conduct since April 2008 – did not contain sufficient information about people with learning disabilities and complex needs.
Person-centred plans rare
Councils and trusts also had underdeveloped strategies for commissioning services for this group, while only a minority of service users had a person-centred plan, and in many of these cases the plans were poor.
Few people with learning disabilities and complex needs had a direct payment or personal budget despite many users and carers wanting them, while carers rarely received assessments and too few were involved in service planning.
The report echoed previous findings of the poor experience of healthcare of people with learning disabilities and complex needs, finding too few people had annual health checks or health action plans, and many had poor experiences of acute hospitals.
Valuing People Now
The report comes two months after the publication of Valuing People Now – the government’s three-year strategy for people with learning disabilities. This emphasised the particular importance of personalised care – including personal budgets – for people with complex needs, and said councils and trusts should plan services for people with the greatest needs first, rather than leaving them until last.
The watchdogs set ten challenges for improving commissioning for this group, which they said were consistent with the Valuing People Now agenda:-
- Person-centred plans, health action plans and access to good advocacy should be a basic right.
- Users and carers should be treated as equal citizens in the planning of services.
- Improve take-up of personal budgets and direct payments.
- Health and social care organisations should share information as part of the commissioning process.
- The effectiveness of learning disability partnership boards should be improved.
- Joint strategic needs assessments should be improved.
- PCTs and councils should ensure the effectiveness of community learning disability teams.
- PCTs should ensure that access to healthcare is consistent and fair.
- Safeguarding arrangements must improve.
- Staff attitudes and skills must improve.
Anna Walker, chief executive of the Healthcare Commission, said: “Services for people with a learning disability have been too low on the priority list for far too long. It is good news that improvements are being made but it is not happening fast enough to bridge the gap between the standard of care that people are entitled to and the standard of care they actually receive.”
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