The role of the LD nurse in safeguarding

1. The role of the LD nurse in safeguarding Debra Moore Debra Moore Associates

2. In this session • We will look at briefly at the similarities and lessons learned from Mid- Staffordshire and Winterbourne View. • Consider theactions that organisations and individuals can take to make a difference • Look at a practical example of how improvements in governance, patient safety and outcomes can be made by LD nurse leadership – Cedar Vale Autism Service

3. 2 big icebergs in NHS and Independent Sector Mid- Staffordshire NHS Foundation Trust Winterbourne View

4. Remember the stories • One on occasion she attended the hospital at around 6 am to find her mother in a side room calling ‘please help me, please help me’. The patient was covered in dried faeces and was completely naked. She ran down the ward to find the staff ‘chatting and laughing’. She assisted in washing her mother and it was ‘awful’. Her ‘hands were absolutely caked’ and it ‘was dried and it was up her arms and it was round her neck’. The patient died later that night.

5. What did the 1st Inquiry Find and how does this compare the DMA findings of the review of Castlebeck ? • Lack of basic care • Poor culture – high priority on achievement of targets, punitive, secretive, low morale • Acceptance of poor standards • Consultant body dissociated from management • Management thinking dominated by financial matters and achieving FT status • Absence of effective clinical governance • Lack of urgency at the Board to remediate some problems such as governance • Lack of patient experience data and not enough focus on outcomes • Lack of internal and external transparency • NO ONE DETECTED ANYTHING WRONG – HCC (CQC), Commissioners etc.

6. How did Castlebeck respond strategically post WBV and how do these actions respond to the Francis report? • Emphasis on and commitment to common values throughout the system by all within it (Your role at Castlebeck) • Readily accessible fundamental standards and means of compliance (Quality Strategy, QDR’s, ISR’s) • No tolerance of non compliance the rigorous policing of fundamental standards (Zero tolerance approach & performance monitoring at Turnaround/Transformation/ISR) • Openness, transparency and candour in all the systems business & accessible information for patients (Info materials, Team Brief, Turnaround, Website, Interviews in Media etc) • Strong leadership in nursing and professional values – caring and compassionate (DoN and Regional Nurses & KSF etc) • Strong support for leadership roles (Strengthened Ops and Clinical) • A level playing field for accountability (All levels including Board) • Emphasis on attention to SUI’s and complaints (Governance systems in place) • Information accessible and usable by allowing effective comparison of performance by individuals, services and organisation (Governance and compliance data on shared drives, shared at ISR, regional and Board level, improved appraisal and supervision of individuals)

7. Name one thing… • Please name one thing you will do differently or do more of or less of as a response to the Francis report? • Please put your response on a post it note and place on the poster so we can collate them and share

8. A Case Study Some of the action taken by a Learning Disability Nurse Manager post Winterbourne View.

9. Cedar Vale Autism Service • Cedar Vale is a 16 bed independent hospital providing specialist support and services for men on the Autism spectrum with associated complex needs.

10. Cedar Vale Autism Service • The objective of the service is to provide a safe and structured environment, treatment and support to each service user, based upon individual need and is aimed at assisting each person to achieve their full potential. • Cedar Vale aims to promote the development of each individual through the application of the key principles of Valuing People: rights, independence, choice and inclusion.

11. Cedar Vale Autism Service • Clinical Governance was seen by the staff team as a tool which could help the service progress and develop further. • The objectives of Cedar Vale’s Clinical Governance are to : • Monitor and improve quality of care • Improve service user safety • Enhance service user involvement • Improve staff involvement • Ingrain evidence based practice into the service

12. Cedar Vale Autism Service How is this done? • Nurse key responsibilities • Comprehensive quality and assurance audits • Service User Forums and Family Forums • Incident Root Cause Analysis • Share good practice and evidence based research as an MDT • Comprehensive and specialised training package • Risk Management • Involvement and Accountability

13. Cedar Vale Autism Service What are the outcomes of our Clinical Governance? • Reduction of Safeguarding incidents • Reduction of physical intervention • Empowering the Service Users • Continue and develop individualised care (Activity Programme) • Environmental improvements • Commitment to training and ensuring specific training needs are met • Supervision and support for all staff (from support workers to ancillary) • CQC compliance • Continuing Professional Development • Meeting the four key principles of Valuing People; rights, independence, choice and inclusion.

14. Some headline dataIn a 12 month period at Cedar Vale • The use of restrictive physical interventions reduced by 41% • Serious incidents (A-C) reduced by 28% • Incidents (D&E) reduced by 32% We are getting better at predicting the risks

17. To conclude - the role of the Learning Disability Nurse in safeguarding • Remember that your closest and most loyal relationship is to the service user and their family • Be clear about your own standards and values and ‘benchmark’ them externally – network • Hold tight to your code of conduct – cherish your role as a nurse • Be clear about what to do if you are not happy with care delivery and never be fobbed off • Use information wisely – governance data, complaints, incidents, restraints etc. are all tools to help you determine the quality of care and provide ‘red flags’ – early warning and anticipatory. It is your duty to know this. • You are responsible for your own practice – instil this in others. • ZERO TOLERANCE

18. MONKEYS ARE NOT WISE

19. Final Message – make it personal – have a call to action • “It is all built on trust, so I trust you to look after my son”