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In recent decades there has been considerable progress regarding the rights and opportunities for people with a learning disability and/or autism. Long stay campus provisions run by health authorities are less common that they were although still present in some countries. Despite such general improvements, particular cohorts within this population continue to be poorly supported. In particular, people with a learning disability and / or autism (henceforth described as ‘people’) with behaviour that challenges and / or severe mental health problems are one of the most excluded and deprived groups in society. Discrimination, under-investment and lack of societal interest contribute to the poor quality of life and health outcomes commonly experienced by these people and their families. Furthermore, when there is policy interest, fragmentation between governmental departments, regional administrators, and frontline clinicians and practitioners prevent meaningful impacts being achieved and sustained in the long term. Policy & Population: This submission will analyse a series of national policy initiatives in England between 2011 and 2017 to improve the quality of life of these people. These initiatives were launched in response to the abuse suffered by people detained in the Winterbourne View assessment and treatment unit. The uncovering of this abuse led to the conviction of staff in this unit and reviews of the commissioning and practice arrangements that were in place. These subsequently led to national policy pledges underpinned by a range of national, regional and local governance structures, good practice guidance, care co-ordination processes and additional investments. Unusually for such policy developments there was a general consensus across political parties and stakeholder groups about the nature of the problem and the outcomes to be achieved. Implementing these in practice has though proved extremely challenging. The analysis will be themed around the ‘big windows, little windows’ framework developed by Exworthy & Powell 2004. This considers integration at, and between, different levels of a system, and the connected policy (goals and objectives), process (including causal, technical and political feasibility) and resources (financial and human). It will draw upon policy documents, independent reviews and empirical research in order to provide an objective critique of the aspirations, implementation and reality of these high profile policy developments. Highlights: The analysis will provide learning not only for those responsible for improving support to this group of people, but more generic insights regarding the large scale implementation of integrated care across multiple layers of a system and sectors.

Opening the windows: Integration as a means to improve the quality of life of people with a learning disability and/ or autism