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Annual Forum 2008. 28 March 2008 Introduction: Past, Present and Future Rex Haigh, Project Lead. Who are you all?. Past. Now we are six Good Old Days Land of milk and honey Adrian’s unwelcome advice Excitement of the new. Present. The different networks and membership
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Annual Forum 2008 28 March 2008 Introduction: Past, Present and Future Rex Haigh, Project Lead
Past • Now we are six • Good Old Days • Land of milk and honey • Adrian’s unwelcome advice • Excitement of the new
Present The different networks and membership How the TCs are doing Accreditation The antidote to regulation Our review of what we offer The London office team What we cost and need to charge Regulatory frameworks and us
Future The new core standards and value base The new breed of ‘modified TCs’ and Mini TCs Realignment of the UK foundation charities for TCs Accreditation trial in social care sector European and Australasian initiatives Therapeutic Environments TC research network and our evidence base
The different networks and membership 1: “Old CofC” 54 Full Members and 2 Guests
After this year... • We will be running all the networks as a single network • Theoretical reasons – “fusion model” • Financial reasons – economy of scale • Practical reasons – pool of lead reviewers etc • Educational reasons – more to learn from diversity • Eg children’s communities, community within community; LD • Nature of this learning: tolerance and curiosity required • We are not impressed with a “we know best” attitude! • It is not a league table or a competition... ...but we will still aim to give choice of peer reviews
How the TCs are doing2: core standards in the different networks
How the TCs are doing3: core standards - interesting findings Slight variations between cycles 5 & 6 but no overall trend Children & Young People’s TCs consistently score higher The best met were CS1 and CS15:- The whole community meets regularly - Positive risk taking is seen as an essential part of the process of change The worst met were CS4, CS11 and CS 13:- All community members share meals together - All community members are involved in some aspect of the selection of new staff members - The whole community is involved in making plans for a client member when he or she leaves the community
How the TCs are doing4: a comparison between 10 different TCs Addiction TCs Their first cycle of operation Using the core standards And six groups of different quality improvement standards(the addictions TCs have an extra section on “treatment programme”) Anonymised (with silly names!) Interesting to think about what the individual ‘fingerprints’ mean
How the TCs are doing4: things to be concerned about? Picked out as poor and declining performance More discussion in the annual report
Issues for Adult Democratic TCs and Comparisons Erosion of Informal Time?
Issues for Adult Democratic TCs and Comparisons Leaving the TC
Issues for Adult Democratic TCs and Comparisons Staff selection
Issues for Adult Democratic TCs and Comparisons Are TCs stopping eating together?
Suggestions about how to improve things ...are always included individually in each TC’s report This is our first main attempt to look at it across ALL TCs 4 interesting findings from the recent cycles More detail and discussion in the annual report
How the TCs are doing5: a comparison between 10 different TCs Addiction TCs Their first cycle of operation Using the core standards And six groups of different quality improvement standards(the addictions TCs have an extra section on “treatment programme”) Anonymised (with silly names!) Interesting to think about what the individual ‘fingerprints’ mean
Accreditation in the NHS is now in place First TC to gain this was Acorn Unit at the Retreatin York Now several have been through the process: Mandala TC, Nottingham Manzil Way, Oxford Winterbourne TC, Reading Henderson Hospital, London Main House, Birmingham 2 are in progress, 1 is deferred and 2 have had developmental accreditation visits All were deferred in their progress towards this ...an important task looms before too long: to review the commissioning standards
Accreditation in the prison TCs Now in its 4th year 12 prison TCs have had their accreditation peer reviews Accreditation decisions will be made on 23 April
The antidote to regulation Paul Lelliott (personal communication, c 2005):quality networks as the antidote to accreditation Always our hope and intention to steer a middle way - since the 1998 debate at Windsor Up to our members to keep us on track (neither to “sell out” nor fail to appreciate the adaptations we need to make to survive) And certainly not to bend with every wisp of the wind Establishing our integrity through what? -1 strong network of participating communities; - 2 solid backing of long-renowned professional organisations like ATC;-3 extensive archive of the field’s work; -4 evidence base and research ...
Our internal review of what we offer A short audit of ‘how we were doing’ (one of many processes to maintain our own standards) Done by semi-structured telephone interviews Undertaken by Kelly Davies Most immediate finding:...how busy everybody is and how difficult it is for staff to spend time talking to Kelly
Our internal review of what we offer: SELECTED RESULTS n=10 9/10 “helped us improve our service” 10/10 “helped us communicate the value of our service” All found accreditation standards helpful 7/10 found (old) core standards useful 10/10 found accompanying lead reviewer of high quality Worst scores: 30% “very satisfactory” for information for visiting another TC50% “very satisfactory” for information pre-own peer review50% “very satisfactory” national reports50% “very satisfactory” information sheets
Verbal comments: “very supportive at every stage” “usually very interesting and always very helpful” “feel sense of belonging to a larger network” “raised managers’ understanding” “helped us evolve during a steep learning curve” “it’s helped us speak to commissioners” “it shows we are not a Mickey Mouse operation” “prison TCs were very isolated before” “it has given us a voice and made our practice more evidence-based” “the frequency of reviews could be a bit less” “6 weeks intense work” “money – including the cost of getting to the Forums etc” “lack of recognition of mini-TCs” “the logistics of it are huge” “there can be a temptation to feel that your TC is being interrogated” “people come to us without enough information” “money”
Personnel • Rex Haigh – Project Lead • Adrian Worrall – Head of CCQI • Sarah Paget – Programme Manager • Katherine Larkin – Quality Improvement Worker • John O’Sullivan – Quality Improvement Worker • 1 Vacant Posts (included in budget forecast ) likely to be cut • 1 Vacant Post - cut
What we cost and need to chargeThe Headlines We are not currently charging enough to survive We have lost 2 staff who will not be replaced We need a new invigorated ATC – as the only organisation in the field with paid staff, we end up taking on roles we can no longer afford to The level of service to members will not be noticeably different We will be increasing our fees After much agonising about many different formulae, we are having a flat fee plus fee per place In the future we are looking to better coordinate this with membership of ATC, CHG and maybe other TC organisations.
Finance • Since 2002 Community of Communities has aimed to become self-financing but has remained dependent on funding • In order for Community of Communities to survive it needs to cover the cost of delivery from members subscriptions • The cost of delivering the service is a minimum of £2000 per TC and is not relative to the size of the TC • On the basis of the current way we calculate fees the average cost per TC is £1361 • Similar CCQI project fees range from £2300 to £3500 per service
Actual and Budget Forecasts to 2010 – Annual Fee increasing by 8%
The challenge It costs about £270K to run CofC This calendar year we have £94K lottery income, next calendar year £10K, then none We need to substantially increase fees if we are to survive We need to make being part of the process affordable to marginal members 2008 fee increases require membership to remain around 50-90 (including the new networks) Income will be reviewed in October’s advisory group
The Changes to Membership and Fees Three New Membership categories: • Associate Membership • Full Membership • Accredited Membership
Associated Membership: Self-review and report plus other benefits of membership; no peer-review; no use of the logo to signify quality (self-review not ratified). Expectation to participate in peer-reviews of others (details in ‘types of membership’ document) £600 per community
Full Membership: Members fully participate in annual cycle (as since the beginning of CofC) and have use of standard logo to demonstrate quality. £600 per TC plus £70 per available client places (no cap)
Accredited Membership: Members undergo accreditation process appropriate to their sector, hold accredited status (on Royal College website) and have use of “accredited TC” logo £1200 per TC plus £70 per available client places (no cap)
Regulation and Government Department news Ministry of Justice – has now reorganised their ‘DSPD’ programme as ‘DSPD and Prison TCs’ programme Work continuing on developing coherent pathways to and through offender programmes Particular lack of ‘step-down’ into non-custodial sector CofC standards are recognised in the national contract for preferred providers as a key performance indicators for therapeutic childcare Continued involvement in various DH working groups, committees and professional networks, including NICE.
Sarah’s ‘Good Things’ • Increased use of discussion forum – interesting exchanges across different TCs • Accredited TCs • Increasingly recognised process – Standards for Children and Young People recognised as part of the National Contract • KPIs for Children's Services and HMP TCs • Increasing number of TCs in the NHS • Increased interest in TC approach – Therapeutic Environments • European interest in standards and methods – addiction standards adopted by all EFTC members all of whom are signed up as guest (no money for full membership) • Learning Disability Communities coming on board – will lead to widening out the process to increasing number on coming year
Therapeutic Environments based on TC theory & the derived core values and standards for quality assured therapeutic environments A much simplified set of standards To move towards kite-marking like “investors in people” for services in all sectors (health, social services, criminal justice, education) for all client groups and maybe others (certain categories of employer?) who wish to be gain recognition for having a “healthy environment”
The new breed of ‘modified TCs’ and ‘mini TCs’ Key: pink = planned; orange = future uncertain;red = existing & stable
Accreditation trial in social care sector We now have rigorous and robust accreditation processes in prisons (4 cycles) and NHS (2 cycles) Social Care sector has a very heavy burden of regulation and inspection We need to develop similar processes for them, and hopefully help make some of it more meaningful CHT (London) and Threshold (Belfast) have agreed to help us run a pilot year with their 10 communities
