Into the Community from Orchard Hill Hospital

1. Into the Community from Orchard Hill Hospital

2. Statistically significant evaluation Implication for policy Shaun O’Leary Executive Head of Adults & Safeguarding London Borough of Sutton Professor Roger Ellis OBE University of Chester/ Buckinghamshire New University Professor David Sines CBE Buckinghamshire New University Professor Elaine Hogard Northern Ontario School of Medicine

3. Research specification • The aim of the evaluation is to evaluate the quality of life before, during and after the resettlement for the service users of Orchard Hill Hospital. • It must deliver evidence of qualitative change to people’s lives measured through appropriate indicators, including health, psychological and social outcomes • (based on the 7 national outcomes identified in ‘Our Health, Our Care, Our Say’).

4. Implications for policy • Safeguarding • Better outcomes – less cost • Attachment based work – Social work not care management • Human rights • Workforce development – Provider • Assessor

5. An evaluation of the resettlement programme from Orchard Hill Hospital to supported living Professor Roger Ellis OBE Research Findings

6. Trident Approach • Outcomes • Quality of life measure • Based on best international practice • Proxy completion by three trained auditors • Process • Partnership • Specification based on social need • Procurement procedures • Stakeholder perspectives • Residents by proxy • Parents/relatives • Staff

7. Trident Approach • Outcomes • Quality of life measure • Based on best international practice • Proxy completion by three trained auditors • Process • Partnership • Specification based on social need • Procurement procedures • Stakeholder perspectives • Residents by proxy • Parents/relatives • Staff

8. Quality of Life Audit Tool • Seven domains • Quality and location of housing • Care planning and governance • Physical wellbeing • Social interaction and leisure activities • Autonomy and choice • Relationships • Psychological wellbeing

9. Four Audits for 39 Residents • Retrospective to Orchard Hill Hospital • Six months • Twelve months • Eighteen months • Clear Improvement developed and maintained

10. Results • Highly significant statistically .0001 level • Overall quality of life • All seven domains • Ranking of domains

11. Results: Percentage of Possible Maximum Score • Quality of life 35% to 68% • Care planning and governance 2% to 81% • Autonomy and choice 37% to 87% • Quality and location of housing 58% to 94% • Relationships 28% to 45% • Social interaction and leisure 30% to 44% • Psychological wellbeing 69% to 81% • Physical wellbeing 57% to 59%

12. Recommendations • Disseminate - internationally • Repeat audit – 2011/2012 • Repeat stakeholder questionnaires • Audit against risk factors • Develop social interaction audit • Staff development including self audit • Routinise audit

13. An evaluation of the resettlement programme from Orchard Hill Hospital to supported living Professor David Sines CBE Lessons for the future

14. Hearing the Voice of Users • Need to ensure that the user voice is heard loud and clear, triangulated by the views of significant family members and support employees. • Integrating narrative with empirical research measures. • Focussing on multi-dimensional aspects of life experience and wellbeing. • Co-designing and co-delivering robust assessment tools that are meaningful to the reality of the lived experience of users.

15. Being Inclusive - Achieving Balance • The perception of how we measure quality of life is as much about the users themselves as well as the experiences of their significant family members and employed supporters. • All are on the same journey of resettlement.

16. Workforce Priorities • ‘Staff are central to creating and sustaining quality services...many of the staff working with individuals moved with the service users from the hospital environment to a new community setting....the need for increased training and appropriate management to diminish the risk of trans-institutionalisation is needed’.

17. The O’Leary Model • Users first! • Multi-sectordialogue and collaboration. • Collaboration with significant family members and employees. • Effective life and individual care planning processes. • A solid business case and effective communications strategy. • Rigorous tender process with the location of future providers on site early in the process. • Challenging procurement barriers – REACH standards. • Commitment to evaluation and productivity.

18. Achievements • Orchard Hill Hospital and NHS Campus Homes85 in total in supported living5 in specialised residential care (dementia)5 in bespoke residential care+ other Local Authority placements

19. Savings • 2007 – residential care (Orchard Hill) £2,500 per week • 2011 – private NHS hospital care £3,500 + per week (e.g Winterbourne) • 2011 – residential care £3,000 per week • 2011 - community supported living £1,900 per week • 2012/13 – planned(including state benefits) £1,800 per week • National Learning Disabilities net budget - increased by 25% • Local Last 5 years Sutton’s net budget - reduced by 28%

20. Case study • Glynis • Admitted to Orchard Hill as a child – over 40 years agoAssessed by NHS as needing mental health hospital care for life Vocabulary range of 40/50 words Diagnosed compulsive behaviour disorderSocial Work assessed supported livingMoved into new flat October 2008

21. Case study • Glynis • Now has a vocabulary range of 1400 words • She is happy and developing new skills everyday • “Since moving into her own flat, Glynis has received fantastic care. She has been guided and supported along the path to develop into a mature and contented woman. She has found herself.” • www.sutton.gov.uk/orchardhill

22. Into the Community from Orchard Hill Hospital