Workforce issues arising from the Sutton and Merton investigation

1. Workforce issues arising from the Sutton and Merton investigation Lesley Barcham Learning Development Manager

2. Background information about the report • Investigation requested by new chief executive • Following a number of serious incidents of abuse • Focus on the safety of people with a learning disability and the quality of the service • Investigate three parts of the service Orchard Hill Hospital, the community homes and Osborne House

3. Background information about Sutton and Merton PCT • Supports about 186 people with a learning disability • 95 people living in 11 buildings of the Orchard Hill Hospital site • The hospital closure had been delayed by 2 judicial reviews • 59 people in community homes with 24 hour support • 30 people at Osborne House Hastings • A total of about 440 staff in the learning disability service about 340 in the areas under investigation • Learning disability services were only small part of a large PCT

4. How the investigation was carried out • Carried out by a team including a person with a learning disability, inspectors from CSCI and HCC, VPST representative and an expert reference group • 200 interviews with people who use the service, their families and advocates, managers and support workers • Document analysis over 1,200 documents • Questionnaires and interviews with families • Visits announced and unannounced • BILD investigation

5. What they found – general information • Institutional abuse the model of care was rigid, not individualised and promoted dependency • There have been a number of serious incidents of abuse • Low level of activities • Segregated not community based • Housing was poor and often unsuitable • People’s dignity and privacy was compromised

6. What they found – general information 7. No policy or training on behaviour management and restraint 8. Lack of specialist staff and training 9. Protection of vulnerable adults - lack of awareness of policies and procedures 10. Policies and procedures were lacking or not regularly reviewed or monitored 11. Not everyone had access to the complaints procedures

7. What they found – workforce issues • The PCT systems of governance failed to give clear direction and to monitor progress on a range of staffing issues • Services were under resourced and understaffed • Reliance on agency and bank staff • Lack of supervision and appraisal • Many staff lacked the necessary skills to carry out their job • Not all staff knew about abuse or the POVA policies and procedures

8. What they found – workforce issues • Lack of specialist training in communication, swallowing, behaviour management and restraint • No LDAF programme and a limited NVQ programme • Staff unaware of what constitutes good practice • Poor attendance at training often because of staffing constraints • Lack of leadership and management training and support

9. Training details Between April 2002 and May 2006 for about 442 staff the following numbers had attended key training courses • 49 child protection • 12 autism • 60 communication • 5 nutrition • 115 epilepsy • 172 infection control • 131 various courses e.g. mental health issues, but only 11 values training • 41 medication • 44 person centred planning • 7 supervision • 29 leadership See pages 55 - 58 of the report

10. Recommendations - general • Service to be based on Valuing People principles with person centred plans and health action plans for everyone by October 2007 • Care to be provided in accordance with best practice • More community based activities by March 2007 • Promote empowerment of people who use service through advocacy support, information on complaints procedures encourage choice and control • PCT board to monitor quality of care and safety of people • PCT work with LA on redesign of services based on assessment of peoples’ needs and best practice • Move away for hospital and campus provision by 2010

11. Recommendations – workforce related • External team to provide mentoring and coaching to develop leadership skills and embrace new ways of working and inclusive practices • Progress work on appraisals, supervision and specialist support • Ensure workforce with the right mix of skills, training and experience • Effective monitoring of mandatory training and action taken to manage non attendance • All staff to have training on Valuing People principles

12. Recommendations – workforce related • Staff encouraged to visit other organisations to learn from best practice examples • Policy and training on behaviour management and physical interventions, in accordance with guidance • All staff trained in recognition of abuse, how to report abuse and how POVA policy works with the LA • Dedicated programme to improve communication skills of staff • Robust system for reviewing and updating policies and procedures

13. National development and coverage since the report • National audit of NHS and private healthcare provision • DH to clarify what a modern learning disability service should look like • Separation of commissioning and provider roles • Move from NHS commissioned services to local authority responsibility • Skills for Care press release on workforce issues

14. Similarities in the Cornwall and Sutton and Merton investigations • The services were isolated, the model of care was outdated • Staff were often unaware that what they were doing was abuse • People with learning disabilities, their families and advocates were not involved in decision making • There were failings in governance and monitoring, the services were under resourced • Staff supervision and training was poor • Support for people whose behaviour was challenging was poor, training and policies on behaviour management and restraint ignored national guidance

15. Discussion points • How does the training and development plan in your organisation link to quality outcomes for the people with learning disabilities the organisation supports? How is the training and development plan approved and monitored by senior staff? • How do you ensure that the Valuing People principles underpin all of the training you provide? • How do you ensure that the mandatory and specialist training you provide is attended by the right people?