Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge

5. Framework to Support Register

Without a framework to support the use of the Register, it may be ineffective in facilitating the broad systemic change required to address this long-term and challenging issue. The following framework will support the purpose of the Register and will consist of:

5.1 Complex Support Needs Pathway

A Complex Support Needs Pathway will contain guidance and a set of standards which will provide a context for the use of the Register. This will include the person-centred steps to avoid service breakdown and subsequent admission to hospital or being placed out-of-area, as well as the steps to plan for discharge from hospital or from out-of-area placement in order to help facilitate a return home.

A person-centred pathway for achieving discharge or return from out-of-area will provide timescales and milestones. It will incorporate the various standards from a range of already existing legislation, guidance documents and good practice reports, including from NICE, the Care Inspectorate, SSSC, the Royal College of Psychiatrists, and the Mental Welfare Commission, into one pathway.

5.2 Peer Support Network

It is acknowledged that many clinicians and practitioners for people with learning disabilities and complex support needs may not have contact with others nationally who are doing similar roles, or who are working through similar challenges. Recognising how uniquely complex some of the care circumstances can be, this can only be solved by bringing people together to help each other and to provide peer support. Working more closely together as a sector can help us to provide better services across Scotland for people with complex care needs. A process of peer support will help give guidance and advice to HSCPs for people with particularly complex care needs whose support has been challenging to get right.

A Peer Support Network should be established to facilitate people coming together to learn and share best practice, and to get support when planning services for individuals with particularly complex care needs.

This support and advice will be provided from clinicians, commissioners, social care providers and family members from around Scotland who have expertise and experience in developing and delivering services to people with learning disabilities and very complex support needs. The purpose is primarily to put HSCPs in touch with peers who have expertise in particular areas, so that local teams can learn from others who have already done what they are working towards, and to provide a safe space to share experiences, pool resources (staff/buildings) and learn from each other.

Local areas may wish to consider appointing a dedicated "change champion." This person will have expert knowledge of the needs of people with learning disabilities and an understanding of the challenges faced in their area. By having ownership, this individual is then best placed to collaborate regionally and nationally and utilise the support offered through the Peer Support Network.

5.3 National Support Panel

A National Support Panel should be established as a national body who will work on behalf of the Scottish Government and Local Authorities to ensure that the Register is achieving positive outcomes for people with learning disabilities who are currently in hospital or living in out-of-area placements. The primary purposes of the Panel are:

• To work with HSCPs and partner organisations by providing support and expertise for their decision making and solutions for individuals in a collaborative forum.
• To provide checks and balances to ensure that people with learning disabilities are receiving the best care in the most suitable environment.
• To understand and hear from families and individuals about their individual circumstances.

The Panel will work with and support nominated HSCP leads and hold regular reviews for anyone on the Register, monitoring progress towards discharge or out-of-area return against the Complex Support Needs Pathway. The Panel will work with HSCPs to assess if the milestones within the Pathway are being met. This will include requiring information from the responsible HSCP in order for the panel to work with commissioners to provide person-centred assistance such as:

• Progress towards accessing suitable accommodation
• Progress in relation to financing the support package
• Identification of a suitable provider
• The support plan in the person's current placement
• Any issues or concerns, e.g. use of restraint, high levels of challenging behaviour or serious risk factors.

The expertise available via the panel will, for example, help to match HSCPs with other areas who may be looking to pool resources, share existing good practice that has led to sustainable solutions and provide additional advice about staffing, training and suitable providers. This is designed to help address the barriers recognised earlier in this report.

Recognising that call for expert support and expertise the Scottish Government should establish the panel urgently. The SLWG view is that the panel should be backed with statutory powers in order to support their function, including the authority to require any information that enables the panel to carry out their role, as well as powers to make placements and/or require funding of a support package.