Guidance on the oversight of CCG-commissioned inpatient care for people with learning disabilities and autism should be ‘fully implemented’ by the end of March, NHS England has said.
The guidance – which was published yesterday (1 February) after being delayed due to Covid – sets out the responsibilities for a local ‘host commissioner’ who must oversee the quality of inpatient provision in their area.
In most cases, the host commissioner should be the CCG with the inpatient unit in their geographic patch, it said.
The stronger oversight arrangements were first announced by former care minister Caroline Dinenage in May 2019, who said there would be new responsibilities for a host CCG to oversee and monitor the quality of care in learning disability units to ensure people are not ‘out of sight and out of mind’.
CCGs who place patients in inpatient units – ‘placing’ commissioners – still retain responsibility for the individuals they place and oversight of placements, the guidance said.
‘The role of the host commissioner is not to replace this; rather, to act as a single point of escalation for a particular unit and to ensure that intelligence is shared across the relevant system,’ it added.
The document outlined four minimum requirements the host commissioner is expected to meet during the pandemic, which includes maintaining their responsibilities for overseeing concerns relating to local inpatient provision.
Although the host commissioner is not expected to make in-person visits, they must continue to accept and follow up any concerns and where necessary escalate these via the appropriate safeguarding processes, it said.
All placing commissioners should also inform hosts of any inpatient units where they have an individual placed, the guidance added.
As host commissioners are likely located closer to inpatient units, however, they may be ‘in a better position’ to visit inpatient services than placing commissioners ‘in the first instance’.
Deadline for implementation
Under the guidance, any specialist mental health inpatient unit that provides CCG-commissioned care to people with learning disabilities or autism will need a host CCG.
Host CCGs are expected to finalise arrangements with key stakeholders and fully implement the guidance by the end of March 2021, NHS England said.
While the default host commissioner will be the CCG with the inpatient unit in their patch, the document said that in some cases it may be more appropriate for a CCG that has previously been identified as lead commissioner for contracting purposes to be the host.
‘Even if CCG and provider are not located in the same geographic area, this will ensure a consistent approach to quality oversight, and grant the CCG the authority to work with the provider on any required actions,’ it added.
Arrangements should be determined on a ‘case-by-case basis’, NHS England said, ‘with the regional lead for learning disability and autism taking overall responsibility for ensuring the most appropriate host CCG is identified’.
The guidance also states that host CCGs must name an individual host commissioner, and that they must have a full list of individuals with a learning disability or autism placed in units for which they have responsibility.
Host CCGs should also make themselves known to placing commissioners and regional leads, it said.
‘We are aware that this will create an additional set of responsibilities for CCGs and individuals assigned as the host commissioner,’ NHS England said.
‘Support will be led through each regional team, and we will be producing materials to enable regional leads to support local areas to implement this guidance.’
NHS England also published its framework for commissioner oversight visits to inpatients alongside the guidance.
According to the framework, commissioners should prioritise visiting services where quality concerns have been raised and should ensure face-to-face visits are carried out safely.
Although in-person visits can continue, virtual visits should take place at least every eight weeks for adults and every six weeks for children and young people, it added.
In July last year, NHS England also announced plans to appoint seven areas to become ‘exemplar’ sites to help improve learning disability care and boost uptake for annual health checks.