We will deliver services to children and young people with additional support needs and to adults with learning disability and autism that meet eligible need and reduces inequality.
In February 2021, the Scottish Government allocated a £20 million Community Living Change Fund to Integration Authorities via NHS Boards to reduce the delayed discharges of people with complex needs, repatriate those people inappropriately placed outside of their local area and redesign the way services are provided for people with complex needs. The funding is to be available until 2024.
A year later, the Scottish Government published the ‘Coming Home Implementation Report’ with a mission statement that “By 2024 we want and need to see real change with out-of-area residential placements and inappropriate hospital stays greatly reduced, to the point that out-of-area residential placements are only made through individual or family choices and people are only in hospital for as long as they require assessment and treatment”.
The fund was designed to bring home people with complex needs, including intellectual disabilities and autism, and those who have enduring mental health problems that are placed outside of their local area, to discharge those that have endured long stays in a hospital setting and design community-based solutions that negate, or limit future hospital use and out of area placements. The funding was to be held in reserve within individual Integration Authorities to be used as plans are developed to support improvements up to March 2024.
Shetland noted that during the funding allocation period (February 2021 to July 2022) there were no people with complex needs in delayed discharge from hospital and no people inappropriately placed outwith Scotland.
Placing any individual out with Shetland has significant impact both on the person, family and key others in the ability to maintain contact and impacts on connection of the off island person with their community. With that in mind, Shetland Community Health and Care has made significant investment and prioritised budget to establish an Assertive Community Transition service in Shetland to reduce the risk of people having to be supported off island.
In addition, Shetland Community Health and Social Care have come together to develop and implement a local adult neurodevelopmental pathway, delivering a diagnostic and post diagnostic support service.
Thanks to a test of change pilot project, funding was drawn down from the aforementioned fund to appoint a registered psychologist for one day per week to assess adults on island for autism and provide post diagnosis support.
The waiting list continues to grow and at a speed higher than anticipated. The hope is that by introducing this level of early intervention people that are diagnosed can start to understand their needs and be provided with support to improve their personal resilience to hopefully avoid deteriorating circumstances.
There is an ongoing difficulty to identify sustainable funding beyond 2024 when the Community Living Change Fund expires, but evidence shows that people who have yet to get a diagnosis would benefit from it.