Learning Disability Providers Network 10/12/12

1. Learning DisabilityProviders Network10/12/12

2. Safeguarding Update Winterbourne Interim Report Published SCC Conference SABP Conference Awaiting Final Report (Autumn)

3. 14 Actions Identified

4. Review of the culture & clinical safety at Castlebeck Debra Moore Managing Director Debra Moore Associates Selected extracts

5. In Winterbourne View What 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?

6. Findings and recommendations 9 key areas • Assessment, care planning and therapeutic interventions • Multi-disciplinary team working • Planning and delivering person centred care • A meaningful day • Environment and facilities • Workforce and staff training • Organisational structure and culture • Commissioning • Clinical governance and patient safety

7. 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!

8. 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!

9. Planning & delivering person centredcare– 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!

10. A meaningful day – key lessons Building skills • Person centred active support • Positive Behavioural Support • Intensive interaction • Communication Meaningful occupation and employment opportunities

11. 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

12. 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

13. 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!

14. 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

15. 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

16. 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

17. Andy Erskine – Selected Extract

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

26. In April 2013, when primary care trusts (PCTs) cease to exist, their supervisory body responsibilities under the Deprivation of Liberty Safeguards relating to hospitals will pass to local authorities. May not affect you directly Unless you have a service user Admitted to hosp. who requires Their liberty to be restricted.

29. Local Safeguarding Update: Missing Persons – Local Response Agreement Final draft anytime now – 30 days for comments Safeguarding Training Level 2 - Safeguarding Adults in Practice 22ndJanuary 2013, 9.30am – 4.30pm – Runnymede Centre, Chertsey 21stFebruary 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

30. Expected Messages Key Themes: Winterbourne/CQC Reviews Personalisation/Empowerment Challenges in Providing SL Where it has worked Highlight for Me: The old block contract has been converted to 83 ISFs with 83 personalised support plans created. • ‘Waking-nights’ have been removed from 11 services (29 people) 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 has begun. • A Shared Lives service has been established. • Local authority offered a £1,795,073 reduction in price on a £6.5 million contract (29.75%)

31. Copies available

32. CQC, Regulation etc. General trends etc ref shape of sector

33. Other News etc. http://discuss.bis.gov.uk/focusonenforcement/your-experiences-of-dealing-with-regulators/ Red Tape Challenge

37. http://www.thecarechannel.co.uk/index.php SKY Channel 212