Health and Justice Strategy: fully inclusive of people with a learning disability and autistic people

Greater Manchester is the first city region to develop a Health and Justice Strategy. It is fully inclusive of people with a learning disability and autistic people. It was the first time that health, social care, and criminal justice services came together to look at the issues in an integrated wider strategy.

The strategy utilised research and coproduction to make sure that it was evidence based and focused on the issues important to people. The aim of this strategy is to improve the health of people who are already in the criminal justice system, or who are at risk of entering it, either as a victim or offender. The aim is that this will reduce the risk of some people becoming a victim and prevent others from getting involved in crime.

This cross-sector work covers autistic children and adults, and children and adults who have a learning disability and applies to Greater Manchester. Funding to support the strategy comes via the Greater Manchester Mental Health Commissioning Hub, but some funding is matched by probation services and covers the cost of a programme manager post and the co-production work.

Whilst all children, young people and adults seen in the criminal justice system across Greater Manchester are intended to benefit from the strategy, the four groups that particularly emerged from the development and engagement processes are:

• Children and young people up to age 18, however, where young adults have additional vulnerabilities, this could extend to age 25.
• Marginalised female victims of domestic abuse and/or sexual violence.
• People with a learning disability, autism, or a communication disorder.
• People who are rough sleeping.

This work programme includes vulnerable young people who require that their needs are comprehensively assessed in a timely way. They also identified a need for better support for young people with additional vulnerabilities such as learning disability, autism, school exclusion, or childhood trauma, to help to break the cycle of becoming a victim or offender.

It was the first time that health, social care, and criminal justice services came together to look at the issues in an integrated wider strategy.

The 2016 devolution of responsibilities for health and social care was brought to life through the ‘Taking Charge’ plan, and the 2019-2021 justice devolution agreement, created an opportunity for Greater Manchester to innovate and integrate public policy and services in the field of health and justice.

The development of the Health and Justice Steering Group for learning disability and autism was led by the Partners in Care and Health's North West Care and Health Improvement Advisor, who was able to give an adult social care perspective.

This strategy was developed and based on initial research undertaken in 2017 and 2018 at Nottingham University. The research looked at where people people who had a learning disability or autistic people were getting caught up in the criminal justice system. It proved hypotheses that were being considered within Manchester at the time and identified a number of groups that have been badly served by the current criminal justice system in the past.

The strategy puts forward an ambitious work programme over the next five years, which will be monitored by the Health and Justice Board. One of the early priorities identified in the delivery plan is to create a progress dashboard and logic model, which will help to monitor high level progress and understand the process of change. Until this is developed, these are some examples of the types of practical improvement, the group would expect to see for vulnerable people in this population group.

• Vulnerable young people will have their psychological and mental health, physical health, and specific developmental / learning disability / autistic spectrum / communication needs comprehensively assessed in a timely way.
• Better support for young people with additional vulnerabilities such as learning disability, autism, school exclusion, or childhood trauma, to help to break the cycle of becoming a victim or offender. The strategic plan draws together an approach that utilises a Systematic Intervention Model and considers where across the wider health, social care and justice system people might “touch” those services and creates opportunities for early help and prevention.

Direct benefits of having powerful people supporting the work were also reflected in well-connected and useful governance structures to which the health and justice strategy group reported.

Over time, it is natural that key people leave or retire, so it is important that the ongoing support is seen as part of any new post-holder’s role.

Funding for the programme was and still is ad hoc. The continuation of funding over time requires people to look at what “pots” of funding existed and see how these could be used creatively to meet this need. Again. this takes commitment and trust on behalf of leaders. Also, it is evident that nowhere else is undertaking this approach yet, and whilst it is novel, it needs to be recognised that Manchester has not shied from doing something wholly different, but fundamentally based in common sense.

The contextual environment is that of a devolved health and social care services and the Greater Manchester Combined Authority that has provided committed leadership, using all its focus to support preventative action around justice. Additionally, regular use of robust evidence and support from academic institutions has been important in driving evidence-based change.

Key Ring are providing ongoing support and have been involved working directly with individuals. They support coproduction of the strategy. They have stories of people with lived experience that have been in touch with the justice system in the past. This information was used to shape the developing strategy.

Looking ahead there is support for the work, but ongoing funding may be an issue. We have good support from leaders currently but there is concern that if key people left and they were replaced by other who are less interested this may be an issue.

The chair offered leadership and support from a social care perspective and even since leaving her role has been supporting this work within her own time.

A major lesson was the senior people involved really got it. In the main this was because all individuals had either a personal connection with, or a deep understanding of, the needs of people with learning disabilities, and/or autistic people. Misunderstanding is also reflected in the ascribed values and principles that underpinned the developing strategy.

As well as being able to influence hearts and minds, delivering and developing a successful strategy requires having leaders who also have “teeth” - in effect the pose and influence to make change happen."

The access to and use of power to support the implementation of inclusive and integrated strategy cannot be underestimated.

• Key Ring
• People with a learning disability and autism in the criminal justice system