Resoluciones Ministerio de Salud
RESOLUCIÓN Nº 124 - UOAC/09
It was wdely acknowledged that there was a sgnfcant shortfall n current capacty for adoptng a more strategc approach to commssonng servces and support for people wth learnng dffcultes. Whle there was clear varaton n local practce, far too many localtes appeared to be charactersed by underdeveloped systems for:
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mappng current and antcpatng future need (especally at the pont of transtons)•
evaluatng the costs and outcomes of placements (especally out-of-area placements)•
developng jont protocols, servce specfcatons and other mechansms for delverng more sophstcated commssonng responses n lght of ths need. It was also argued that, at present, there was a real shortage of readly avalable qualty ndcators and servce specfcatons for determnng what makes an effectve hgh-qualty servce for people that present a challenge to servces. There was a clear consensus that effectve commssonng requred much more robust nformaton on what servces were (or were not) delverng for people. That s, montorng needed to move from countng ‘how many’ (for example, how many plans have we done? how many bed spaces do we have?) to lookng at the qualty of lfe of people recevng servces.In some areas the perceved falures of strategc commssonng were contrasted wth ncreasng nvestment of resources n contract montorng teams and operatonal teams undertakng mcro-commssonng. Whle capacty n mcro-commssonng was seen as essental to any system commssonng person-centred local support, there was a general consensus that, n a market domnated by the achevement of short-term goals and domnated by exstng provders, mcro-commssonng all too often descended nto spot purchasng.
A number of comments were also made regardng:
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the dsjuncton n the tme requred to develop strateges whch would35 complex needs) and the pressure on operatonal teams and care managers to fnd
solutons for people n crss
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the dffculty of securng fundng to support planned development (ncludng captal fundng) compared wth the often ready avalablty of money to fund emergency (and often out-of-area) placements•
the falure to support effectve transton plannng that would enable people to move out of ther famly home n an approprate way or enable chldren who were beng educated out-of-area to move back•
the falure to provde effectve support to famles carng for a relatve wth learnng dffcultes.I am a parent of a severely autstc predomnantly non-verbal 18-year-old son and also of a 19-year-old son wth Asperger syndrome. My ex-husband and I set up and ran a Natonal Autstc Socety support group for eght years. I am also a learnng dsablty nurse. I am now speakng as a parent: my son, although n a specalst out-of-county placement snce the age of eght, has never to my knowledge (and I presumably should have been told!) had anyone dong any specfc work on hs transton, although I have asked for t. He has recently moved off hs school ste to an eght-bedded house (ths s a newly developed placement for those aged 16-24 years from the same school) whle we awat whether our fundng wll come through for July 2008 when he s due to leave educaton. We have lttle contact wth the transton worker and have made formal complants to the Drector of Socal Servces n the past, whch were upheld. In fact the transton worker or a councl representatve dd not attend hs Aprl revew or send any statements as to progress!! I read n my journals about some people havng specfc communcaton work carred out and I have offered to do a PCP and ELP for my son, but my offer was not taken up. My ex-husband and I are wonderng whether to brng n an ndependent advocate as we are often just gven the brush off, I sense as ‘nterferng parents’ the same goes wthn the professon. Parents seem to get n the way of organsatons routnes and procedures!.
The result of these trends were summarsed n terms of a focus on ad hoc
commssonng (or spot purchasng), drven by the pressures to dentfy the cheapest (or only avalable) placement. The falure n some areas to develop a clear strategy for supportng at-rsk groups (for example, people wth challengng behavours) was consdered to both reflect and exacerbate these types of problems.
In addton to capacty ssues relatng to takng a more strategc vew of the commssonng process, concerns were rased n some areas wth regard to the contnung falure to develop effectve jont commssonng between PCTs and CSSRs reflected n contnung dsagreements over agency responsbltes and the prospect of cost shuntng wth assocated squabblng between health and socal servces (see above).
It was noted that the Healthcare Commsson, Commsson for Socal Care and the Mental Health Act Commsson have undertaken to carry out a jont programme of work n 2008–09 to assess the qualty of commssonng of servces for people wth hgh support needs. They wll pay partcular attenton to the use of hgh-cost, out-of-area placements both n terms of the qualty of outcomes for people and the
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ADULTS’ SERVICES
effectve use of resources. The decson to undertake ths work reflected concerns hghlghted by the commssons through ther work to date. Ther ntenton s to establsh what t s lke to be a person wth learnng dffcultes wth hgh support needs requrng support n a place where servces are commssoned on ther behalf, such that they are able to assess the effectveness of those commssonng arrangements through the organsatons responsble for delverng them.
In lght of these shortcomngs and developments t was recommended that: