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What is a learning disability?

A learning disability is described as a reduced intellectual ability and difficulty with everyday activities – for example day to day tasks such as household tasks, socialising or managing money – which affects someone for their whole life.

People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people. 

The level of support someone needs depends on the individual. For example, someone with a mild learning disability may only need support with things like getting a job. However, someone with a severe or profound learning disability may need full­time care and support with every aspect of their life – they may also have physical disabilities.

Our plans for learning disabilities 

Our plans for learning disabilities focus on transforming care. These plans are based strongly on the transforming care for people with learning disabilities – next steps report which follows on from the Winterbourne View Concordat.  

The author of the report, Stephen Bubb, states: "over the past few years people with learning disabilities and / or autism have heard much talk but seen too little action". Transforming care for people with learning disabilities - next steps, therefore focuses on improving services for people with learning disabilities and / or autism, who display behaviour that challenges (including those with a mental health condition). This will drive system-wide change and enable more people to live in the community, with the right support, and closer to home.

The programme reinstates that children, young people and adults with a learning disability and / or autism have the right to the same opportunities as anyone else to live satisfying and valued lives, and to be treated with dignity and respect. They should have a home within their community, be able to develop and maintain relationships, and get the support they need to live healthy, safe and rewarding lives.

Over the past 10 years, we have been making strides to ensure this vision becomes a reality. Locally Bradford’s changing lives programme has been the vehicle to implement this strategy for people with learning disabilities. However, for a minority, we continue to remain reliant on inpatient care - a view often held by families.

We are also following the NHS England policy and guidance following a care and treatment review

How are we doing?

Our data looks at two key areas to assess how we are doing with improving learning disabilities services; specialist inpatient care (delivered through the Transforming Care Programme - building the right support) and annual health checks. 

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Transforming care programme - building the right support

The NHS is committed to a programme of closing unsuitable and outdated inpatient facilities and establishing stronger support for those with learning disabilities in the community.

In Bradford, the Transforming Care Partnership have established plans for a year-on-year reduction on the reliance on specialist inpatient care for people with learning disabilities and / or autism.

The commissioning of inpatient beds for those with learning disabilities and / or autism is split between our CCG and NHS England. Per million population, by 2019 no area should need more inpatient capacity than is necessary at any one time to cater for;

  • 10-15 inpatients in CCG commissioned beds
  • 20-25 inpatients in NHS England commissioned beds
  • In our local transforming care programme (developed across Airedale, Wharfedale & Craven CCG, Bradford City CCG and Bradford Districts CCG), there are 13 beds for our population of 662,004
  • this is based on 20-25 beds per million of the population.

Number of people with learning disabilities and/or autism receiving specialist inpatient care (per million population);

  • in our CCG, 52 per million population
  • across Bradford and Airedale planning footprint the CCGs are on track to deliver use of between 20-25 beds per million of the population by 2020. 

What we are doing to reduce out-of-area placements for people with learning disabilities and/or autism

The joint commissioner for learning disablities works closely with specialised commissioning to understand the needs of people in out of area low/medium secure provision in order to plan service provision that will meet their needs. There are currently 18 people identified by specialised commissioning as being part of Bradford’s transforming care cohort. Of these 18 people it is projected that potentially seven people may return to the responsibility of the CCG – although these numbers have not been confirmed. NHS England regional team are working with all transforming care partnerships within Yorkshire and Humber as to whether a regional response can be made to support people returning to community settings.

Locally, the CCG commission six inpatient beds which supports people with learning disabilities who require inpatient services. This provision is considerably lower that the recommended number as described by NHS England and the aim of  Bradford’s transforming care plan is to reduce these 6 beds down to 3 beds over a three year period, whilst at the same time developing a robust and flexible community support for people with complex needs. It is believed that future planning around inpatient provision can be delivered on a needs based arrangement as oppose to the current block contract arrangement. This reduced number of beds will meet the needs of people within the district.

Annual health checks

GPs conduct annual health checks for people with learning disabilities who are over the age of 14. The aim of these annual health checks is to ensure that people with a learning disability are in good health and receive care and support from mainstream health services. 

The number of annual health checks is assessed using the general practice learning disability register.

  • in our CCG, 54.6% of people with a learning disability received an annual health check,
  • in West Yorkshire, 48.1% of people with a learning disability received an annual health check,
  • the national average for annual health checks is 37.1%

What you have told us about learning disabilities services 

We make sure that we are listening, engaging and involving patients in the planning and design of their local NHS. To do this, each programme of work has the infrastructure to engage and collect information from people through:


The insight and feedback you give us makes sure that we don't just collect information, but that we have the means and ability to use it to inform our commissioning activity and improve quality. All the insight and feedback is pulled together in a system we call grass roots.

For each programme of work, in addition to the above, we tailor engagement to ensure we are reaching people who use the services.

Grass Roots

Grass Roots pulls together information reported through NHS Choices, Patient Opinion, Healthwatch, complaints, local groups and direct patient, family and community feedback to inform CCG planning and decision making

The following represents feedback received in to Grass Roots:

LD - grassroots

Case study 

What have we done in 2016/17?

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We have been working on delivering on the actions in our local transformation plan:

  1. the provider framework for providers of residential and nursing including specialist service went live in October 2016,
  2. three sites have been secured to build and develop housing options for people with learning disabilities, autism or both,
  3. care and treatment reviews are being carried out for people in both in the community and within inpatient services to avoid admissions or ensure timely discharges from hospital.
  4. we continue to work towards offering personal health budgets to people with a learning disability, autism or both,
  5. there is now a transforming care reference group consisting of people with a learning disability, family carers, self-advocates and professionals. This group ensures the transforming care programme is delivered in a co-produced way,
  6. joint health and social care funding panels are now held,
  7. we are part of care and treatment reviews for local people in forensic services out of area and are work with colleagues in NHS England to support people either back to their local area and/or a community setting,
  8. an integrated workforce development plan has been develped to ensure people with complex needs are supported by appropriately trained staff,
  9. we are developing a ‘dynamic risk register’ to ensure we are planning for people who may be at risk of admission to inpatient or residential services.

We are also moving towards integration between health and social care:

  1. a lead has been appointed for the integrated transitions team,
  2. discussion is taking place around the benefits of moving from a joint commissioning model to an integrated commissioning model,
  3. we are going out to procurement for a provider to deliver the positive behaviour support service. This service will sit within the Council children’s service and will work across health, education and the local authority,
  4. improving the lives of the most vulnerable through the NHS England Better Care Fund programme. This will put people at the centre of their care and support and result in improved patient experience and better quality of life.

What we are doing over the next two years

We are continuing to work towards transforming care for people with learning disabilities, autism or both.

Over the next three years we will be further developing community services and closing unnecessary inpatient services. This will be done in partnership with Bradford Districts CCG, Airedale, Wharfedale and Craven CCG, the local authority and NHS England specialised commissioners. 

We are also working with key partners across Bradford and Airedale to develop and deliver our Transforming Care Plan (TCP):

Key objectives of our transforming care plan are:

  1. workforce development, to develop a skilled workforce to support people who present with complex conditions within the community, 
  2. working with Bradford District Care NHS Foundation Trust (BDCFT) to create a flexible crisis response approach to support families and people with learning disabilities who may also have autism to remain within their community if possible,
  3. the development of new housing options, 
  4. working with specialised commissioning to support people who are in forensic services to return to appropriate community settings with the right support, 
  5. continuing to promote and support people with learning disabilities to access an annual health check.
  6. developing a ‘dynamic risk register’ across children and adult services to help identify people who may access inpatient services.
  7. delivering the positive behaviour support service - led by the Bradford Council children's service, 
  8. continuing to carry out care and treatment reviews (CTR’s) for people within an inpatient service and those who may be admitted to an inpatient service,
  9. continued roll out of personal health budgets.

Our plans for the next five years

Over the next five years we plan to improve care and the quality of the services we commission. We will be doing this by creating a system-wide model for the delivery of planned care.

Our focus is on transforming both mental health services and learning disability services. The main aim is to make sure that those with mental health problems, learning disabilities and autism get the same standard of health and care as the rest of the population.

There are also a number of recommendations that have been set out by the national Mental Health Taskforce that we will be addressing, namely:

For children, we have a school liaison and prevention project. This is a model of therapeutic integrated care for vulnerable children and young people. The project is currently also implementing a single point of access to preventative support.

The main things we will be doing are...
LD - next five years