9. david harling and maggie graham ilt and preventing admissions work

8/20/2019 9. David Harling and Maggie Graham ILT and Preventing Admissions Work

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Presentation for

National Valuing

Families Forum24 June 2015


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People with learning disabilities

are an NHS England priority in 2015-16

*Department of Health. Valuing People: A New Strategy for Learning Disability for the 21st Century.


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1. Changing how people in specialist hospitals are cared for -

Making sure that people only go into specialist hospitals when

there is no other choice, continuing to improve patient care,

treatment, and pathways for people to leave hospital.

2. Investing in the community -

Working with partners to reduce the number of patients inspecialist hospitals and investing in more local community

services.

3. Supporting young adults with learning disabilities -

Ensuring that all young people with a learning disability leaving

residential school will have an Education, Health and Care Plan

by March 2016.4. Reducing premature deaths -

Using information gathered about premature deaths to improve

future services.

5. Collecting data -

Gathering information to make sure services are improving.

Transforming care for people with learning disabilities –

what is NHS England doing?


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Transforming care for people with learning disabilities

The NHS England work is led by…

Supporting patients with complex needs - carrying out in-depth Improving Lives reviews

for hospital patients with complex needs.

Best Care Now – making sure that people only go into specialist hospital when necessary,

receive good quality care, and have a clear pathway from the start and all the way through to

leaving hospital with good care plans for the future.

Future Care Design - a new service model for commissioners to provide better local and

community-based services.

Reducing the number of people in specialist hospitals - planning to ensure that less

people are living in specialist hospitals for long periods of time.

Access to Healthcare – improving access to key services, such as annual health checks.

Data and information – collecting the right information to support services.

Dominic Slowie

National Clinical Director

Jane Cummings - CNO

Lead National Director

Fiona Clark

Programme Director


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Transforming Care for people with Learning Disabilities –

Next Steps

Five key work areas:

1. Empowering individuals – giving people with

learning disabilities and/or autism, and their families,

more choice in and say over their care.

2. Right care in the right place – ensuring we deliverthe best care now, whilst re-designing services for

the future; care should be in the community and

closer to home.

3. Regulation and inspection – driving up the quality

of care.

4. Workforce – developing the skills and capability of

the workforce to ensure we provide high quality care.

5. Data and information – making sure the right

information is available at the right time for the

people that need it, and continuing to track and

report progress.


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Cross System Transforming Care Programme - structure

Minister + co-

chair


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Email - [email protected]

Making a difference

The Improving Lives Team

Supporting good quality care for people with learning disabilities

in specialist hospitals

Safe?

mailto:[email protected]:[email protected]


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Defining a life...

Life No 1: Lisa

• 9 years in long term segregation.

• 5:1 staff ratio when required.

• Communicated via a hatch in the wall.

• The ‘staff

observation

shed’• Allowed Lisa to

be viewed in a

small area

surrounded by a

9ft high fence.

• A worn

area of lino

where staff would sit

during their

12 hour

shifts.

Improving Lives

Team


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Defining a life...

Life No 2: Kenny5 years in long term

segregation... No stimuli, just

an anti-rip mattress.No clearly defined

treatment rationale.

The status quo supported a

‘containment’ approach to

challenging behaviour.Zero risk taking

Staff team divisions

and burnout1500 incident forms

per month.

‘Sit in the corner of the room...Put your hands on your knees...Are you risk free?’

Improving Lives

Team


10/30

Making a difference

• We stopped Kennyfrom going to high

secure hospital

• He has contact with

other patients again• He goes out every

day - 150 outings

and no incidents

• Discharge fromhospital is now a real

possibility

• Lisa now lives inher own flat in

the grounds of a

small hospital

• She has her ownbelongings again

• She goes out

twice a week -

shopping, to the

bank etc

• There is still

some way to go,

but her life is a

lot better now

Improving Lives

Team


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The Improving Lives team was formed in 2014.

To review the care of the 48 people who lived at

Winterbourne View and other serious cases of concern.

Our film tells you more!




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Since 2014, the Improving Lives Team has carried out

over 100 in-depth reviews of the people who lived at

Winterbourne View and other people whose care is a concern.

Plus follow-up reviews,

CTR support, sharing events

and other work.

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How we work

• A review usually lasts two days

• The team includes Experts by

Experience and professional advisers

• We meet all the people involved

• We make recommendations about

how the person’s care can improve…

• At the review and in a report which the

commissioner sends to everyone

• We carry out follow-up reviews to see

how things are going

Improving Lives

Team


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What difference do we make?

• It’s not just about beingdischarged from hospital

• It’s also about making sure that

people have the best care now

and a good quality of life in

hospital eg. less medication,less seclusion and restraint,

better health, activity,

communication, family and

patient involvement

• Better safety – and positive risk-

taking!

• Reviews provide support,

advice, challenge and

recommendations

Many services

and people’s

lives have

greatly improved

Improving Lives

Team


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The big 3 questionsImproving Lives

Team

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People tell us how they feel

‘Staff and patients get angry and shout,then I get angry, I turn the music up full

blast.’

‘I like exercise, I do it in my own room.

It’s hard to get to the gym, because of the

(risk) levels. If I go back to level 1, I have

nothing in my room. On 2 I can keep

things. If I kick off they hold my arms but

sometimes I go to seclusion.’

‘My support is good. I’m treated with

dignity and respect here.’

‘This is my house. I like my house. My bedroom is

purple. My house feels safe. You can get the

police, the ambulance, be happy. I get on with

staff fine. I’ve got five people. I helped choose

them. If I don’t get on with staff, they get sacked.

It’s important to get your own house, you feel

good, you live.’

‘The advocate comes on the ward

sometimes. Never talk to her. Don’t

talk about worries with staff or

family. Don’t want to worry them.’

Family carer: ‘X should have moved nearer to home by

now but there’s nowhere to go. We aren’t getting anyyounger and it’s a long journey. We’d like to see him

settled in a place that will be a real home for a long

time, nearer to us.’

Improving Lives

Team


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We provide support and challenge

• We work in partnership withthe professionals

• But we also challenge and set

goals where things need to

improve• We help to solve problems

• And check that things have

improved

• We take further action whenneeded

• And share the learning

Improving Lives

Team




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4 big themes around building better care

Improving Lives

Team


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We’ve made

about 800 recommendations!

• Some recommendations were made

because services were not good enough

or not right for that person

• If we had very serious concerns aboutsomeone’s safety or care we dealt with

them there and then

• Some recommendations were to help

really good services be even better

Improving Lives

Team


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How have things changed since last year?

Eg. for the Winterbourne Group• 357 recommendations made

• 200 completed

• 57 partially completed• 29 not completed / not now

applicable

Improving Lives

Team


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How our work is developing• Staying connected with Winterbourne

View group, providers and commissioners.

• Our main work is now with other

in-patients and teams.

• National outcome - Care and TreatmentReviews.

• Supporting other workstreams and teams

eg: reducing hospital admissions,

empowerment, discharge planning,

• Using reviews to explore themes eg:

- Use of CTRs in high secure settings

- Impact of hospital closure on individual

patients

Improving Lives

Team


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Our key strengths

• Week-by-week practical experience ofpeople, places and issues faced

• Ability to test out and research

• ‘Real life’ skills and experience

• One of the first NHS England teams to

employ a person with a learning disability

• Co-producing the work with partners

• Our role and relationships withcommissioners, clinical and social care

teams


Improving Lives

Team



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Care and Treatment Reviews

Making Care & Treatment Reviews

(CTR’s) everyone’s business

David Harling


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Why do we need to carry out a

Care & Treatment Review?

We are still admitting too many people to

learning disability hospital settings.

Many people still feel hospital is the safest place.

We are still very reactive when peoples needs

change and this means we spend lots of time

responding in a crisis.

We see peoples behaviours as a disorder which requires‘treatment’.

There is a real lack of high quality community alternatives.


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So what exactly is a Care &

Treatment Review?

A CTR is a person-centred review which can be used to prevent an admissionor to review the care someone is currently recieving in hospital. The review

carried out by a team of 3 people... the persons commissioner, an external

professional and a person with a learning disability or family carer as an

external ‘expert by experience’.

The CTR review team spend a day looking at the care the person is receiving

in the learning disability hospital. They meet the person, they read about the

person, the meet people who care for the person and they talk to people

who know the person well.


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How will the Care & Treatment

Review help the person?

It provides a fresh pair of

eyes to look at the persons

care.

If needed, it challenges the

current care and

treatment the person is

receiving.

It helps to work out if the

person needs to be in

hospital.

It can help providers to

think differently about the

care they are providing for

the person

It offers hope to people

who are in hospital by

making recommendations

It promotes the inclusion

of people with learning

disabilities and family

carers being recognised as

‘experts’ in reviewing care.


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What have we learnt from Care &

Treatment Reviews so far?

Great

idea!Sounds like

a plan!

Better

alternatives to

hospital are

possible.

We need to improve

local planning for

people who we know

have complex needs.

Putting more resources

in place prior to

admission can prevent

admission.

Working flexibly, adapting

current resources and

being creative helps

prevent admission.

Many treatments being

delivered in hospital

could be delivered in the

community.

CTR’s provide a valuable

independent opinion and

as a result actively kick-

start peoples discharge


28/30

?

When do we carry out a Care &

Treatment Review?

SUPPORT AT HOME IN THE LOCAL COMMUNITY

UNPLANNED

ASSESSMENT

PLANNED

ASSESSMENT

CPA within

2 weeksBlue Light

Meeting (CPA)

ALWAYS

LOOK TO

PROVIDE

CHECK AT

RISK

REGISTER

?

DISCHARGEREQUEST FOR ADMISSION CPA – Care Programme Approach

Pre-Admission

CTR (CPA)RIGHT TO

REQUEST (CTR)1 YEAR

CTR (CPA)MANDATORY


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What next?

Between June and

September we will be

rolling out the new CTR

process and testing how it

works.

We will be working closely

with the 4 regions of NHS

England and a number of

other stakeholders to embed

CTRs.

From September CTR’s will

become ‘business as usual ’

across the 4 regions of

NHS England.

We will strengthen

our links with the

‘expert’ hubs/groups and

keep gathering the

learning.


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THANKYOU FOR LISTENING

Any Questions?

9. david harling and maggie graham ilt and preventing admissions work

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