Learning the Lessons, Improving

Lives & ensuring people receive the

Best Care Now

Gavin Harding
Learning Disability Adviser - Improving Lives
Team & Best Care Now Support Team
NHS England

All those people...

All those lives...
Where are they now?
Morrissey (1986)

So...

Whats changed?
What have we learned?

Every decade
since the 1970s there
has been a national scandal
involving the care of people
with learning disabilities

1980s - St Lawrences Hospital,

Borocourt, Rampton...
1970s Ely
Hospital, South
Ockendon,
Farleigh,
Normansfield...

1990s - Longcare /Stoke place...

2000s Cornwall, Sutton &
Merton, Atlas Care,
Winterbourne View...

Reports of Preventable Deaths

Death by Indifference...

Confidential Enquiry
(CIPOLD)...
Healthcare for All...
Six Lives...
Death by indifference - 74
deaths and counting...

Are we a profession
with a memory?

Are we harnessing and

deploying all the
learning we possess in
order to ensure we
prevent a recurrence of
past failings?

Are we truly the Leaders that we profess;

or are we merely Followers?

WHO LISTENS?
When we
suggest change?

When we
challenge?
When we
suggest a
new idea?

When we
complain?

When we
wont
collude??
When we
blow the
whistle?

What does GOOD (enough) look like

for people with learning disabilities?

Good
enough?

For many people in

hospital, restraint
and seclusion is
used too readily.
Often in the
absence of other
interventions...
Good
enough?

People with learning

disabilities experience
much higher rates of
prescribing of
psychotropic
medication, often with
no clear justification
and they take these
medications for long
periods without
adequate review.

Good
enough?

Many people in
hospital are not in receipt
of active treatment and do not
know when they are likely to be
discharged.

Good
enough?

For many people who have close family ties, they end
up being placed miles away from home. In many cases
the persons family are not actively involved in
decisions about their loved ones care.

Good
enough?

Huge inequalities
continue to exist for
people with learning
disabilities, with
avoidable
contributory factors
having led to
hundreds of
premature deaths.
Good enough?

For many people with learning disabilities placed

in specialist hospitals, communication and
engagement from their local services is very poor.

Good
enough?

Are WE really doing

everything we can
to ensure the
people we support
and care for; lead
full & meaningful
lives?

Stop telling us what

we already know!
We would, but...
All of the previous slides remain a
reality for many people with
learning disabilities, their families
and carers...
Until we get things right and really
achieve our ambitions, the issues
will remain...

Reviewing Lives
To date, the Improving Lives Team and Best Care Now
team have undertaken over 120 reviews.
In addition, multiple Care & Treatment Reviews (CTRs)
have been carried out across the country .
The findings of these reviews have identified many
of the themes we have mentioned previously.
They also highlighted some novel and creative
practice and saw many people having a good life.

All of the solutions are

out there...
But rather than bore you with bar charts & graphs...

Here are Seven Great Realities

Reality Number ONE

Measured, well supported,
flexible risk taking enabled
Mary to be reintegrated and
start to enjoy meaningful
pursuits again. Prior to this,
she had been living in long
term segregation for 4 years.

Reality Number TWO

Genuine, wholesome
co-production
made all the difference
when bringing together
all the different
knowledge people had
about Lucy and how
best to approach her
move to the
community.

Reality Number THREE

Bringing together lots
of local stakeholders
to map out what local
capability and
capacity looked like,
really helped when
planning for a group
of people who had
challenging and
complex
needs/reputations.

Reality Number FOUR

Truly understanding and
implementing Positive
Behavioural Support in
order to build detailed
person centred
approaches,
significantly improved
Javeds quality of life
and helped in the design
of a robust support plan

Reality Number FIVE

Using effective
person centred
thinking and planning
approaches to create
a step-wise route to
employment, proved
extremely successful
for Joanne who now
works full time in a
local restaurant.

Reality Number SIX

Delivering intensive
support as part of an
integrated service
model helped to
prevent unnecessary
admissions to hospital
and develop much
more flexible
approaches within the
community.

Reality Number SEVEN

Where inpatient services

had clearly defined
pathways of treatment,
interventions and
measurements of
outcomes, individuals
length of stay was shorter
and discharges were
more successful.

Whats your reality?

1) Practical Risk Taking

2) Meaningful Co-production
3) Knowing Capability and Capacity
4) Proper Positive Behavioural Support
5) Effective Person Centred Approaches
6) Available & Responsive Intensive Support
7) Clearly Defined Pathways

Thank you for listening

Gavin Harding
Learning Disability Adviser - Improving Lives
Team & Best Care Now Support Team
NHS England

gavin.harding@nhs.net