Independent investigation into the care and treatment of M

1. All Plus One and Plus Two services for children and young people with a learning disability and/or autism are commissioned in line with the NHS England (2017) Transforming Care service model. 2. All Plus One and Plus Two services for children and young people with a learning disability and/or autism are commissioned in line with the Building the Right Support (2022) service model. 3. All Plus One and Plus Two services for children and young people with a learning disability and/or autism are commissioned in line with the NHS England (2017) Transforming Care service model. 4. All Plus One and Plus Two services for children and young people with a learning disability and/or autism are commissioned in line with the Building the Right Support (2022) service model.

1. All families of children with a learning disability and/or autism in hospital are offered advocacy support. 2. All families of children with a learning disability and/or autism in hospital are offered advocacy support. 3. All families of children with a learning disability and/or autism in hospital are offered advocacy support. 4. All families of children with a learning disability and/or autism in hospital are offered advocacy support.

1. NHS England (NHSE) and Integrated Care Boards (ICBs) will work through regional and national workforce planning to take active steps to address the gap between what is needed and what is currently available in the workforce. 2. NHSE and ICBs will work with providers to understand the workforce needed to provide support to people with a learning disability and autistic people and families in the community. 3. NHSE and ICBs will work with providers to understand the workforce needed to provide support to people with a learning disability and autistic people and families in the community. 4. NHSE and ICBs will work through regional and national workforce planning to take active steps to address the gap between what is needed and what is currently available in the workforce.

1. All commissioners of mental health inpatient care for children and young people with a learning disability, autism or both are expected to commission care that is consistent with the NHS England (2017) Transforming Care service model specifications/Building the Right Support (2022). 2. All commissioners of mental health inpatient care for children and young people with a learning disability, autism or both are expected to commission care that is consistent with the NHS England (2017) Transforming Care service model specifications/Building the Right Support (2022). 3. All commissioners of mental health inpatient care for children and young people with a learning disability, autism or both are expected to commission care that is consistent with the NHS England (2017) Transforming Care service model specifications/Building the Right Support (2022). 4. All commissioners of mental health inpatient care for children and young people with a learning disability, autism or both are expected to commission care that is consistent with the NHS England (2017) Transforming Care service model specifications/Building the Right Support (2022).

SAH conducted a self-initiated full scale review of its CAMHS service, recognising that there needed to be changes to the functions alongside a reduction in capacity to enable a more focussed care programme for a smaller cohort of patients. This was co-designed with the patients already receiving care and support at that time, seeking to ensure that there was a focus on positive interventions and trauma informed care. As a result the service has changed significantly since 2015. It has reduced from a 11 ward (110 bed) service to a 3 ward (31 bed) trauma informed system of care embedded service. The service is also located in a new building exclusively for CAMHS, with patients full involvement in the design and layout. This was completed in 2018 and the new wards opened in 2019 Following the service redesign a Training Needs Analysis was completed to ensure that all staff had the necessary skills to meet the needs of the Children and Young People. An environment and sensory assessment completed by National Development Team for Inclusion (NDTI) was commissioned prior to moving into the new CAMHS service, Smyth House. Actions from this were completed as part of the building redevelopment design. NDTI have been commissioned to complete further review of environment, staffing and culture during 2022. Trauma informed care has been embedded into CAMHS service supported by training package for all staff and is the overarching philosophy for the CAMHS division. Positive Behaviour Support (PBS) used to co-develop care and behaviour support with young people and their families is the foundation for all care planning. All young people have a co-produced formulation between young people, family, other care agencies and St Andrew's team at the start of admission and is regularly reviewed and updated to inform PBS updates. Autism and communication modules included in local induction Autism eLearning package available for all staff PBS training module incorporated in local induction All eligible staff trained in MAPA There is also a train the trainer programme to cofacilitate specific autism training across the service and this will be rolled out across 2022\23. 4) Work has been undertaken to support the recruitment of Learning Disability (LD) specialist nurses. This includes working with the University of Northampton to support staff to complete their LD Nursing degree. This runs alongside the St Andrew's Healthcare ASPIRE programme, which is an initiative to provide both financial and pastoral support for existing staff studying for their degree. Nurse Manager and two clinical leaders are all learning disability nurses. Remaining Nurses have either learning disability or mental health registrations. Active recruitment plans are in place supporting learning disability nurse appointments.

NHS England Midlands Specialised Commissioning (NHSE SC) has a contract with St Andrew's Healthcare (SAH) for the provision of specialist mental health services for children and young people with a learning disability and/or autism. NHSE SC undertakes regular contract monitoring and quality assurance activities with SAH to ensure that the services provided are safe, effective, and of high quality. This includes: • Regular contract review meetings. • Quality and Safety Group meetings. • Clinical reviews of individual patients. • Unannounced visits to the services. • Review of incident reports and complaints. • Review of patient outcomes and experience. NHSE SC also works closely with SAH to ensure that the service is responsive to the needs of patients and their families, and that any concerns are addressed promptly. NHSE SC will continue to monitor the services provided by SAH to ensure that improvements are sustained and that patients receive the best possible care. NHSE SC will undertake a full service review of SAH CAMHS services every 12 months and a quality check review of every patient placed in the services.