Learning DisabilityProviders Network

10/12/12

Safeguarding Update

Winterbourne

Interim Report Published

SCC ConferenceSABP Conference

Awaiting Final Report (Autumn)

14 Actions Identified

Review of the culture & clinical safety at Castlebeck

Debra MooreManaging Director

Debra Moore Associates

Selected extracts

In Winterbourne ViewWhat do all these scandals tell us about the setting conditions for abuse?

What is the recipe for disaster?

• Lack of voice in terms of service users/families/advocacy • Lack of respect for the individuals and their families• Unclear purpose and values• Mix of service users with widely differing needs• Boredom – lack of activities• Institutional and impoverished environments• Geographically isolated services• Low staffing levels and high use of bank/agency staff• Poor training and staff development• Lack of management supervision and appraisal• Closed inward looking culture• Poor incident reporting systems and low level governance• Weak management and low visibility• Lack of clinical/nursing leadership• Poor whistleblowing procedures• Failure to act on complaints/concerns• Poor intra-agency reporting and liaison

Where could we see all this happening?

Findings and recommendations 9 key areas

1. Assessment, care planning and therapeutic interventions2. Multi-disciplinary team working3. Planning and delivering person centred care4. A meaningful day5. Environment and facilities6. Workforce and staff training7. Organisational structure and culture8. Commissioning9. Clinical governance and patient safety

Assessment, care planning and therapeutic interventions – key lessons

• Ensure a clear purpose and focus for in-patient provision – ‘short term psychiatric assessment & treatment’ with the aim on returning people to the community

• Agree admission criteria and a proper care pathways with individual outcome measures and discharge planning from the start

• Ensure there are the resources and expertise to deliver specialist interventions – therapies and programmes

• Create a meaningful day – combat boredom!• Promote healthy lifestyles• Invest in person centred care planning – INVOLVING

PEOPLE & FAMILIES!

Multi-disciplinary team working – key lessons

• Be clear about the role of each person and support activities that bring them different professional groups together such as training

• Ensure that the MDT is visible within services and spend time with direct care staff – accountability

• The role of named nurse & key worker need to be defined and accountable

• Listen and respond to the views of people and families – don’t confuse!

Planning & delivering person centred care – key lessons

Really connect with PEOPLE AND FAMILIES

• Increase opportunities to hear the voice of people who use services and their families

• Support people and families with knowledge and information - expert patient/expert carer skills

• Ensure materials are accessible and enable people and families to engage fully in assessment and care planning processes

• Ensure people know their rights!

A meaningful day – key lessons

Building skills

• Person centred active support• Positive Behavioural Support• Intensive interaction• Communication

Meaningful occupation and employment opportunities

Environment and facilities - key lessons

• Smaller environments – better compatibility• Involve service users and families in setting and

monitoring environmental standards• Remember the ‘healing’ aspect of the environment• Space for therapeutic activity

Workforce and staff training- key lessons

• Induction – first point of contact – emphasis on values, rights and safeguarding

• Robust preceptorship, induction and clinical supervision• Rolling programme of training prioritising person centred

thinking and approaches, care planning and HAP as well as clinical skills

• Training needs analysis and effective staff matching vital – KSF linked to appraisal

• Involve people and families at every stage• Look outwards – network, network, network

Organisational structure and culture- key lessons

• Patient care and outcomes must be focus of Board level discussion and communication

• Robust management supervision and clear accountability

• Staff who are related should not work in the same team

• Managers need development and training• All meetings need to be purposeful, strengths based

and appreciative • High visibility - Management by wandering about!

Commissioning- Key lessons

• Focus on patient experience and quality of care• Use of multi-media to see what the life of the

person is like e.g. video diaries• Undertaking regular population needs analysis

aggregated information from care plans, HAPs, patient exit interviews, family carer surveys etc.

• Ensuring manager understand commissioning landscape and expectations and work in partnership

Clinical governance and patient safety- Key lessons

• Be clear about expectations – agree the Quality Strategy – clear outcomes and accountability

• Weave achievement of quality targets into appraisals of all staff

• Ensure people and families are involved in all aspects of setting and monitoring standards

• Robust governance systems and data• Board reporting• ZERO TOLERANCE

In summary• My report contains nothing new – it

is, sadly, an echo of other reports detailing failings across the NHS, Social Care, Independent Sector and in people’s own homes

• How many times do we have to say it? • We need to stop blaming each other

and get on with changing things…!• We need to create the conditions for

person centred care to flourish

Andy Erskine – Selected Extract

http://www.terrybryan.co.uk/

In April 2013, when primary care trusts(PCTs) cease to exist, their supervisorybody responsibilities under theDeprivation of Liberty Safeguardsrelating to hospitals will pass tolocal authorities.

May not affect you directlyUnless you have a service userAdmitted to hosp. who requiresTheir liberty to be restricted.

20121018 SSAB MI - Copy.ppt

Local Safeguarding Update:

Missing Persons – Local Response AgreementFinal draft anytime now – 30 days for comments

Safeguarding TrainingLevel 2 - Safeguarding Adults in Practice

22nd January 2013, 9.30am – 4.30pm – Runnymede Centre, Chertsey21st February 2013, 9.30am – 4.30pm – Godalming Baptist Church, Godalming

practical rather than strategic and addresses the issues likely to arise in day, residential and home based care settings. It will demonstrate implementation through the use of many examples and case studies. This course is aimed at care staff within residential, day and home based services who have some practical experience and a basic knowledge of Safeguarding Adults and who are now ready to take their understanding to the next level

? Additional/Different content for Supported Living

Expected Messages

Key Themes:Winterbourne/CQC ReviewsPersonalisation/EmpowermentChallenges in Providing SLWhere it has worked

Highlight for Me:The old block contract has been converted to 83 ISFs with83 personalised support plans created.• ‘Waking-nights’ have been removed from 11 services (29people) making Southwark ‘waking-night’ free.• Increased use of Assistive Technology.• 18 care homes are de-registered.• Phased closure of a former PCT campus-like site hasbegun.• A Shared Lives service has been established.• Local authority offered a £1,795,073 reduction in price ona £6.5 million contract (29.75%)

Copies available

CQC, Regulation etc.

General trends etc ref shape of sector

Other News etc.

Red Tape Challenge

http://discuss.bis.gov.uk/focusonenforcement/your-experiences-of-dealing-with-regulators/

http://www.thecarechannel.co.uk/index.php

SKY Channel 212