How does subscribing support local improvements?

How does subscribing support local improvements?

During the review of support to the North West from NWTDT, subscribers and other stakeholders told us that they wanted to pool the resources available through subscription to develop a core offer providing a more robust way of delivering work against agreed priorities along with an infrastructure that was available to respond quickly, efficiently and effectively to support emerging issues either with no additional costs or within an agreed budget e.g. support for Transforming Care, suitably trained and supported Experts by Experience for Care and Treatment Reviews.

Priorities identified by commissioners, self-advocates and families partly through developing local Transformation Plans have become part of the work plan(s) for the ‘coproduction and support structure’ (see graphics) which have been agreed and shared with the Regional Forum, Regional Family Forum, Lead Officers group, the NW Confirm and Challenge Group and the NW Learning Disability Board.

Through discussion with all stakeholders the core offer provided by NWTDT/Pathways for subscribers is detailed below.

NWTDT will –

  • Facilitate a number of forums that meet at least quarterly – Regional Family Forum and Regional Self-Advocates Forum, Living Well, Staying Healthy and Being Safe.
  • In response to requests from health and social care commissioners, Heads of Service etc. from subscriber organisations we have ensured that NWTDT are present at local Commissioners/ Network meetings instead of holding what used to be quarterly meetings for Lead Officers from across the North West.
  • Facilitate one NW Lead Officers meeting via the NW Regional Forum Conference.
  • Last year we again supported the National Forums – National Valuing Families Forum and National Self-Advocates Forum. Unfortunately, the Department of Health has ceased funding for 2017/18 and in response we have supported the establishment of a NW National Campaigns group, bringing together the Regional Forum and Family Forum.
  • Organise the Regional Self-Advocates conference including subsidising delegate places so that delegates only fund their accommodation and meals which are negotiated to the minimum charged by the hotel.
  • Facilitate Confirm and Challenge groups sub regionally for GM, Pan Lancashire, Cheshire/Warrington/Wirral and Merseyside to support co production and delivery of the three Transformation Plans.
  • Offer to attend the Learning Disability Partnership Board in every area once a year. This ensures that local priorities continue to be fed into the regional structure and work plans.

All of these regional and national links with self-advocates and families provide a resource for subscribers that can be used for general or specific consultation, engagement and coproduction. The groups continue to be used to respond to national consultation programmes as well as more local engagement/ coproduction activity. The North West is the only region in the country in a position to support this work on the scale that we do, that is solely down to 30+ years investment by public services working together to ensure people with a learning disability, autism or both and their families remain at the heart of what we do.

NWTDT also –

  • Support the ADASS lead(s) for learning disability in the region
  • Support the ADASS Learning Disability group.
  • Support NHSE Learning Disability groups
  • Support the NHSE/ LGA/ ADASS Northern Expert Advisory Group.
  • Facilitate a regional support structure to ensure the voices of people are heard and valued embedding real co-production and engagement at the heart of all we do.

To support subscribers NWTDT also –

  • Produce regular monthly policy bulletins/briefings
  • Attend Lead commissioners or commissioners workstream meetings or equivalent in Greater Manchester, Lancashire, Merseyside and Cheshire, Warrington and Wirral.
  • Provide support to develop and deliver the Physical Health Workplans for Greater Manchester, Pan Lancashire and Cheshire/ Merseyside
  • Provided support to develop and deliver the Workforce Development work streams in Greater Manchester and in Pan Lancashire.
  • Provide support to the infrastructure which facilitates and enables the NW Expert Hub recruit, train, coordinate and pay Experts by Experience to support a range of activities including CTRs, LeDeR Steering Groups etc.
  • Share information, learning and signposting to good practice and sources of information and help on LD related issues.
  • Provide a coordinated approach to training opportunities linked to the 3 work streams, some examples of training opportunities include the Health Equalities Framework, Positive Behavioural Support training, Mini Pass-add training, training for families, Y be Shy, Speaking up, Train the Trainers, Leadership training for families etc.
  • The Regional Learning Disability Board is in place chaired by the Director of Adult Social Care in Tameside. This Board provides overall governance to the work of the team, monitors quality and finance etc. Work plans from each of the 3 groups are approved by the Board and finance for the work programmes approved.

The NW Regional Forum hosts an annual Conference for people with a learning disability from all over the NW, subscriptions heavily subsidise the conference enabling the delegate charge to actually only fund board and accommodation at a reduced rate agreed with the hotel. The conference runs in February, in Blackpool. The agenda is developed by the Regional Forum and draws national, regional and local speakers. Issues in relation to Transforming Care have been high on the agenda particularly since the conference in 2012, post Panorama. A link to the agenda/ presentations from conference in 2017 can be found at –

Representatives from most areas attend conference and often do sponsored events to raise the funding for their places during our All About Us Fundraising period in the summer.

Subscribing Lead officers/ commissioners, NHSE, ADASS are invited to join conference for the final day to listen and work with delegates from local areas to coproduce plans which respond to issues raised at conference. In addition, Conference hosts an annual question time panel which responds to questions from conference and particularly identified via the coproduction structure. The questions posed at conference 2016 and the responses can be found by following the link above where there is also an accessible newsletter from Conference which also will show you that alongside the hard work there is a great deal of fun too.

This infrastructure provided by member’s subscriptions means that we can rapidly respond to emerging issues to support you.



Coproduction and consultation/ engagement are very different; historically public services have not done well when relying on consultation or engagement. Coproduction is a long-term relationship; we have the foundations to support that in the NW because of the infrastructure available through your subscriptions, the infrastructure we have is unique and celebrated outside the North West.

Future Coproduction support for Subscribers

In addition to the existing coproduction structures referred to above the Expert Hub is developing the work it can do to more widely support Subscribers, we acknowledge that coproduction is not happening properly in many areas.

A big concern in the NW from the Regional Forum relates to a reduction in funding for peer advocacy. The reality is that it is those peer advocacy skills that are vital to Experts by Experience and Coproduction.

NWTDT/ Pathways have worked with Experts by Experience to develop a training plan that focuses on strengthening and retaining the skills and competency of experts and families empowering them to speak up. This programme can lead to potential employment options for people through additional training e.g. CTR Expert by Experience, Train the Trainer, Welcome Values Quality Inspector etc.

Collaborative approaches to using subscriptions

Collaborative approaches to using subscriptions

Our intention is to always strive to identify and deliver work that will benefit or have a positive impact on a wider area, such as a STP area or indeed the whole NW footprint. In this way, we believe that we are delivering value for money for all subscribers. These are some examples from 2017/18:

  • In Greater Manchester, we have worked with the Local Eye Health Networks to roll out the Eye Health Made Easy scheme and we are currently contributing to the development of a Framework for Transforming Eye Health Services for people living in Greater Manchester. We supported the implementation of a similar scheme in Cheshire and Merseyside.
  • We have facilitated a legal workshop for the Pan Lancashire area “Understanding the legal requirements and processes for discharging patients to community settings and using these to ensure that people are supported in the least restrictive environment”
  • Greater Manchester subscribers have asked us to do some work to increase the uptake of annual health checks for people with LD. Learning from this work was shared at an event. We have developed a toolkit that can be used to review and develop whole system improvement plans to increase the number of people who have had an Annual Health Check. We have worked with a couple of CCG’s to support their improvement plan and as part of the subscription offer we are able to facilitate a workshop for each area that would like to use the toolkit.
  • We have supported the physical health work streams across the NW by activities such as mapping and sharing cancer resources,
  • We have worked with NW Universities and other partners to bid for cancer related research funding,
  • We have facilitated STOMP workshops to share good practice and worked with the North regional STOMP leads to ensure that learning from across the wider footprint is shared,
  • We have supported LeDeR Steering Groups to establish in Greater Manchester, Pan Lancashire and Cheshire/ Merseyside and supported Experts by Experience to be actively supported as members of the Steering Groups.
  • We have mapped and collated some good practice examples of health-related outcomes for inclusion in social care provider frameworks and shared these with commissioners.
  • Subscribers have asked us to facilitate some workshops to support the sharing of best practise in relation to Employment, Housing, Friendships and Relationships.
  • Social isolation is proven to contribute to poor mental and physical health. In 2015 Public Health England concluded that ‘the quality and quantity of social relationships affect health behaviours, physical and mental health, and risk of mortality’ (‘Reducing social isolation across the life course’, Practice resource: September 2015) therefore any initiatives that reduce social isolation are likely to promote better health and wellbeing amongst target groups.

In Greater Manchester the North West Training and Development Team will be working locally to develop projects and community activities to reduce social isolation amongst people with learning disabilities, autism or both. The primary focus will be upon helping people to develop sustainable activities in their localities, which will include activities that help people to gain the skills and confidence that is needed to seek gainful paid or unpaid employment.

In Pan Lancashire/ Blackburn/ Blackpool and South Cumbria we supported the development of a bid for additional resources to develop this work also.

  • NWTDT has supported Greater Manchester through establishing the Greater Manchester Joint Training Partnership which, with the support of people with a learning disability, autism or both, their families, commissioners and providers of services is developing annual programmes of training for service providers to add value to the training currently on offer. This will include providing induction and values based training for staff as they enter the field, and training to assist in career development. Given the high turnover over staff in the field this will not only support improvements in service quality, but also retention of staff across sectors.
  • In Cheshire/ Mersey we have supported the LeDeR Steering Group to develop a short film to explain more about the LeDeR Programme. This video has also been shared with GM and Pan Lancashire’s LeDeR Steering Groups who have added their own local piece to the film.
  • We supported Blackpool self-advocates consider how they can best link to the wider Confirm and Challenge group work supporting coproduction. Members from Blackpool attend the Pan Lancs group to help provide a link.
  • The NW Expert Hub supports CTRs and CeTRs for people who are (or are at risk of becoming) in-patients and provides employment opportunities for self-advocates and families from across the North West to work as Experts by Experience. The NW Expert Hub is only able to exist because it can build on the infrastructure created through subscription to NWTDT.

Examples of work delivered to individual subscribers

Examples of work delivered to individual subscribers

There are occasions when the needs of a subscriber are unique and require specific input. The following are just a few examples of work that members of the team have undertaken in the last year.

  • Supported one CCG to hold a Protected Learning Time event for GP’s.
  • Worked with another CCG to provide support to help them to increase the uptake of Annual Health Checks.
  • In many areas of the NW we have supported Learning Disability Partnership Boards review and refocus their work. We are very happy to support all Partnership Boards in this way.
  • South Cheshire/ Vale Royal CCG asked us to support local self-advocates develop their speaking up skills. This was co delivered by Experts by Experience
  • We were asked to develop a bespoke plan around one individual who is currently an in-patient working in partnership with his team and family to purchase a home/ establish a team/ plan the risk management etc.
  • We were asked by a CCG to support the local planning in relation to one individual to help her remain at home thus preventing an admission
  • We have supported a wide range of events for subscribers in terms of providing keynote speakers etc.

We are happy to discuss any individual requirements that you may have.

In terms of specific pieces of work requested by subscribers, if possible NWTDT will work to see if these can be incorporated into the 3 work-streams from the sub groups. The majority of the work cited above has been included in this way. However, if this is not appropriate or not affordable the work can be commissioned separately at an additional cost at the daily rate for subscribers of £400 + VAT + expenses. This rate has been held since 2008 and will be held again during 2018-19. The daily rate for non-subscribers would be £800 per day plus expenses and VAT.

Some other examples of work funded in this way include;

  • Development of Quality Audits using Welcome Values. Reviews are coproduced locally with teams of Experts by Experience, Commissioners and Providers and create an action plan for improvement embedding a continuous cycle of quality reviews through building local capacity.
  • Development of person centred skills, person centred teams
  • Support planning in complex situations in partnership with individuals, families, friends, allies, partners etc.
  • Turning person centred plans into specifications that can be tendered and embed a culture of change. This has been particularly helpful for areas moving people back to localities from Assessment and Treatment or other hospital settings.

Adding more value to your subscription

Adding more value to your subscription

NWTDT/Pathways sits within the Third Sector which puts subscribers in the fortunate position of having an organisation available to support them by working in partnership to further develop local capacity and available funding.

We have supported a number of areas to apply for funds available through the Third Sector or other funding/commissioning organisations and have used existing subscription as match funding where necessary. We are able to search for appropriate funding opportunities for specific projects that may be useful to you and to act as a third sector partner in developing bids that you may already be considering. Feel free to approach us with any ideas that you are considering.

Some examples

  • We have successfully brought in additional funds to further support our work through Awards for All, Lottery etc. and have used this to develop a wide range of workshops and events for families and people with LD living in the North West
  • We worked with UCLAN to develop a bid and a business case for funding to increase participation of people with LD in the national cancer screening programmes.
  • We supported MMU submit various research bids to further support the GM agenda.
  • A successful bid to the Heritage Lottery Fund has enabled us to establish a research project to record the “People’s Story of Institutional Life in Calderstones and Brockhall Hospitals”
  • We have been funded by Health Education England to coordinate a Leadership Programme for Systems Leaders in the Transforming Care Partnerships during 2017



Using the infrastructure created by subscriptions we are able to run events across the NW which feed into local or national consultation/engagement. A few of these include:

  • HOLD – (Home Ownership for People with Long Term Disabilities) we hosted 3 events in Preston, Oldham and Liverpool to share learning about HOLD.
  • Calderstones – we hosted 12 sessions across the NW to support as many people as possible have their say on the consultation in relation to Calderstones.
  • We hosted 2 events to share learning and good practise in relation to Care Treatment Reviews.
  • The agenda for the annual Regional Forum Conference, held in Blackpool, is currently being developed. Providing opportunities for more people to get involved coproducing local and sub-regional plans form a key part of the agenda.

We have had to turn away, or create a charge for non-subscribing teams for events that we are offering as free to subscribers. There would also be a charge of non-subscriber’s representatives to attend the regional forum conference and any developmental workshops.

CTR work

CTR work

For subscribers, we are able to provide a professional service and find ways of reducing costs e.g. developing independent peer clinical advisers because subscription funds the infrastructure which facilitates all aspects of running the Expert Hub.

There would be additional costs to non-subscribers as an additional service charge on top of the existing costs as a contribution to that infrastructure.

You can find additional information and guides on the ‘Bring us Together’ Website

We have recently published some Webinars on CETRs and you can listen to those here