Learning disabilities (health and wellbeing needs in South Tyneside)

National Policy

"Valuing People" and the more recent "Valuing People Now" set out how children and adults with learning disabilities and their families should be enabled to live full and independent lives as part of their local communities.

"Valuing People Now" set out the following national priorities:

• Personalisation - so that people have a real choice and control over their lives and services;
• What people do during the day (and evenings and weekends) - helping people to be properly included in their communities, with a particular focus on paid work;
• Better health - ensuring that the NHS provides full and equal access to good quality healthcare;
• Access to housing - housing that people want and need with a particular emphasis on home ownership and tenancies;
• Making sure that change happens and the policy is delivered - including making partnership boards more effective.

Key national policies and legislation:

• Health, Our Care, Our Say A new direction for community services. Department of Health 2006
• Death by Indifference and Six Lives reports, 2007
• Mental Capacity Act 2005, Code of Practice, 2007
• Services for People with Learning Disabilities and Challenging Behaviour or Mental Health
• Needs; Mansell Report revised, 2007
• Putting People First - A shared vision and commitment to the transformation of Adult Social Care, 2007
• Care Standards Act 2000, Regulation 2010
• Caring for our future: reforming care and support, 2012
• Transforming care: a national response to Winterbourne View hospital; 2012
• Children and Families Act, SEND Reforms
• Health care for all
• Care Act, 2014
• Building the Right Support, 2015

Following the publication of the Mencap report "Death by Indifference" on the deaths of six people with Learning Disabilities in social and health care settings, there has been one independent inquiry and one major investigation carried out jointly by the Local Government Ombudsman and the Parliamentary and Health Service.

Personalisation outlined in "Putting People First (2010)" has changed the way services are commissioned and delivered. It emphasises independence, social inclusion, rights, employment, choice and control. As part of this, person-centred planning and self-directed support have become mainstream. Personal budgets are offered to everyone eligible for publicly funded social care support other than in circumstances where people require emergency access to provision.

Since the investigation into the abuse at Winterbourne View and other similar hospitals, there has been a cross-government commitment to transform care and support for people with a learning disability and / or autism with challenging behaviour and / or mental health conditions. In October 2015 "Building the Right Support" was published which reinforces the values in "Transforming Care" and sets out the national ambition and the financial framework to support the closure of inpatient settings and shift investment into community based services, early intervention, and high quality personalised support.

The national plan is aimed at improving services and support for young people or adults with a learning disability and / or autism who:

• Have a mental health condition such as severe anxiety, depression, or a psychotic illness, and those people with personality disorders, which may result in them displaying behaviour that challenges
• Display self-injurious or aggressive behaviour (not related to severe mental ill health), some of whom will have a specific neuro-developmental syndrome where there may be an increased likelihood of developing behaviour that challenges
• Display risky behaviours which may put themselves or others at risk and which could lead to contact with the criminal justice system (this could include things like fire-setting, abusive or aggressive or sexually inappropriate behaviour)
• Often have lower level support needs and who may not traditionally be known to health and social care services, from disadvantaged backgrounds (e.g. social disadvantage, substance abuse, troubled family backgrounds) who display behaviour that challenges, including behaviours which may lead to contact with the criminal justice system

The different kinds of shift in service response required to better meet these different needs are set out in more detail in a national service model.

"Green Light for Mental Health (2013)" is a nationally recognised guide to auditing and improving local mental health services so they are effective in supporting people with learning disabilities.

The Autism Act 2009 indirectly introduces a number of provisions that are also relevant to clients with Learning Disabilities. It stresses the importance of medical diagnosis as triggers for assessment (and re-assessment if necessary) of needs. It establishes the need for developing effective methods of diagnosis for the condition in relation to the provision of services and it requires that public services should be able to identify adults with autism regardless of the severity of the conditions, and provide appropriate services for each individual.