Into the Community from Orchard Hill Hospital

Shaun O’Leary

Executive Head of Adults & Safeguarding

London Borough of Sutton

Professor Roger Ellis OBE

University of Chester/ Buckinghamshire New University

Professor David Sines CBE

Buckinghamshire New University

Professor Elaine Hogard

Northern Ontario School of Medicine

Statistically significant evaluationImplication for policy

Research specification

The aim of the evaluation is to evaluate the quality of life before, during and after the resettlement for the service

users of Orchard Hill Hospital.

It must deliver evidence of qualitative change to people’s lives measured through appropriate indicators, including

health, psychological and social outcomes (based on the 7 national outcomes identified in ‘Our Health,

Our Care, Our Say’).

Implications for policy

• Safeguarding

• Better outcomes – less cost

• Attachment based work – Social work not care management

• Human rights

• Workforce development – Provider

Assessor

An evaluation of the resettlement programme from Orchard Hill Hospital to supported living

Professor Roger Ellis OBE

Research Findings

Trident ApproachOutcomes

Quality of life measure

Based on best international practice

Proxy completion by three trained auditors

ProcessPartnership

Specification based on social need

Procurement procedures

Stakeholder perspectives

Residents by proxy

Parents/relatives

Staff

Trident ApproachOutcomes

Quality of life measure

Based on best international practice

Proxy completion by three trained auditors

ProcessPartnership

Specification based on social need

Procurement procedures

Stakeholder perspectives

Residents by proxy

Parents/relatives

Staff

Quality of Life Audit Tool

Seven domainsQuality and location of housing

Care planning and governance

Physical wellbeing

Social interaction and leisure activities

Autonomy and choice

Relationships

Psychological wellbeing

Four Audits for 39 Residents

1. Retrospective to Orchard Hill Hospital

2. Six months

3. Twelve months

4. Eighteen months

Clear Improvement developed and maintained

Results

Highly significant statistically .0001 level

• Overall quality of life

• All seven domains

• Ranking of domains

Results: Percentage of Possible Maximum Score

Quality of life 35% to 68%

Care planning and governance 2% to 81%

Autonomy and choice 37% to 87%

Quality and location of housing 58% to 94%

Relationships 28% to 45%

Social interaction and leisure 30% to 44%

Psychological wellbeing 69% to 81%

Physical wellbeing 57% to 59%

Recommendations

• Disseminate - internationally

• Repeat audit – 2011/2012

• Repeat stakeholder questionnaires

• Audit against risk factors

• Develop social interaction audit

• Staff development including self audit

• Routinise audit

An evaluation of the resettlement programme from Orchard Hill Hospital to supported living

Professor David Sines CBE

Lessons for the future

Hearing the Voice of Users

• Need to ensure that the user voice is heard loud and clear, triangulated by the views of significant family members and support employees.

• Integrating narrative with empirical research measures.

• Focussing on multi-dimensional aspects of life experience and wellbeing.

• Co-designing and co-delivering robust assessment tools that are meaningful to the reality of the lived experience of users.

Being Inclusive - Achieving Balance

The perception of how we measure quality of life is as much about the users themselves as well as the experiences of their significant family members and employed supporters.

All are on the same journey of resettlement.

Workforce Priorities

‘Staff are central to creating and sustaining quality services...many of the staff working with individuals moved

with the service users from the hospital environment to a new community setting....the need for increased training and appropriate management to diminish the risk of trans-

institutionalisation is needed’.

The O’Leary Model • Users first!

• Multi-sector dialogue and collaboration.

• Collaboration with significant family members and employees.

• Effective life and individual care planning processes.

• A solid business case and effective communications strategy.

• Rigorous tender process with the location of future providers on site early in the process.

• Challenging procurement barriers – REACH standards.

• Commitment to evaluation and productivity.

Achievements

Orchard Hill Hospital and NHS Campus Homes

85 in total in supported living5 in specialised residential care (dementia)

5 in bespoke residential care+ other Local Authority placements

Savings

2007 – residential care (Orchard Hill) £2,500 per week

2011 – private NHS hospital care £3,500 + per week (e.g Winterbourne)

2011 – residential care £3,000 per week

2011 - community supported living £1,900 per week

2012/13 – planned(including state benefits) £1,800 per week

National Learning Disabilities net budget - increased by 25%

Local Last 5 years Sutton’s net budget - reduced by 28%

Case study

GlynisAdmitted to Orchard Hill as a child – over 40 years ago

Assessed by NHS as needing mental health hospital care for life

Vocabulary range of 40/50 words Diagnosed compulsive behaviour disorder

Social Work assessed supported livingMoved into new flat October 2008

Case study

Glynis Now has a vocabulary range of 1400 words

She is happy and developing new skills everyday

“Since moving into her own flat, Glynis has received fantastic care. She has been guided and supported along the path to develop into a mature and contented woman. She has found herself.”

www.sutton.gov.uk/orchardhill

Into the Community from Orchard Hill Hospital