Turning Things Around'

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Turning Things Around.

• How Cornwall Made
• Change Happen
• Geoff Baines, Director of Change

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Background

• Serious concerns raised by East Cornwall Mencap
  May 2005
• Change team brought in October 2005
• Joint Investigation report published July 2006
• Findings widespread failings, particularly
• 4 Long Stay Hospitals, 34 people
• 168 people in 44 Unregistered Supported Living
  Services
• Adult Protection Procedures (39 referrals)

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How did it happen?

• Late 1980s innovative good quality services
• Eroded over time
• over focussed on Mental Health
• Lack of planning
• and commissioning
• Poor adult protection processes
• Isolated from
• regulation, inspection
• Lack of training, supervision
• and development
• NHS Trust and Council 3 stars

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Adult Protection

• Serious flaws in the Trusts procedures
• Senior managers failed to identify and correct
• The Council, as leading agency, failed to
  adequately co-ordinate interagency arrangements

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Community Care

• The Council did not do community care assessments
• CSCI considered that the supported living
  services were unregistered care homes of an
  unacceptable standard
• Poor training, policies and no choice for people

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Management and Other Agencies

• The Chief Executive and the Trusts board
  struggled to accept the Trusts services were
  poor.
• Governance arrangements did not allow the Trust
  or board to monitor service effectively
• PCTs and SWPSHA all criticised for failing to
  commission effectively and monitor performance.
• Poor partnership working between the Trust and
  Council

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2 Special Measures

• 1. The External Change Team to
• Oversee quality of services
• Ensure an action plan is properly implemented
• Ensure that sufficient funding, from health and
  social services, is available to sustain changes
  and improvements
• 2. External review of the performance and
  membership of the Trusts board

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What we did - Organisational

• Created action plan Project Team
• Chief Officers Group Monthly, chaired by SHA
• Joint planning, funding and assessment processes
  set up
• Agreed guiding values principles
• Strengthened safeguarding - a priority
• Assessments, Info, choice, provider market,
  housing, indicative resource allocation

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What we did ..... milestones

• Budock Hospital closed Dec 06
• Other Hospitals in 2007
• Safeguarding addressed 2007
• New providers chosen by March 2008
• Special measures reviewed August Dec 2007
• Special Measures Lifted March 2008
• Significant improved outcomes for people

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Impact on People

• Now much safer
• Hospitals now closed
• People have more choice and control
• Living in their own homes
• Better primary and secondary health services
• Greater and growing advocacy

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Accelerators

• leadership
• Capacity
• Project brief ambitious shared goals
• Citizenship equality
• Step change in style of working
• Commitment to Partnership
• Involving people at the center!

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Successful delivery factors

• Dedicated cross boundary (change) team
• Senior joint collaboration joint accountability
• Regular Chief officer meeting to make urgent
  decisions (giving not taking)
• Performance management of action plan/SHA
  Check, double check and check again!
• DoH Regulators pressure quarterly
• Local stakeholders

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Successful Change

• Has Worked best when at all 4 levels
• 1. People who use service/families
• 2. Operational level
• 3. Directors/No2s
• 4. Chief Officers

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Outcomes
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Is it any better?
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Kerrs new world.

• Since the age of 16, Kerr Moody has lived in
  residential care, sharing with groups of people
  who have learning disabilities. Now, for the
  first time he has his own place which he rents
  from Golden Lane Housing.

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Kerrs Mum

• there never seemed to be much for Kerr to do and
  he lost skills over the years he stopped going
  to church, writing poetry and using a computer.
  She feels that Kerrs abilities have always been
  underestimated and that staff in the past have
  misunderstood his disability.

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Kerr says

• Living with so many people wasnt good, there
  was always someone getting on your backIm now
  in a completely different world.
• I have more freedom now Im getting out with
  staff but doing more on my own too. The best
  thing about having my own place is getting to do
  the things that I really want to do.

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Michael Lloyd a Home Owner

• Michael is so much happier now and he hasnt
  asked once about the house he lived in for so
  long. In the past he used to break things when he
  was angry but it doesnt happen now, he seems to
  take a pride in his house- theres a place for
  everything. His health has also improved.
  Everyone said that his mobility was getting worse
  and worse but hes walking every day (Michaels
  sister, Wendy)

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Richard says, It was the right move

• My daughter had been living in the wrong place
  with the wrong people and this is what led to her
  behaviour becoming difficult.
• Since moving, she has not asked about the old
  house or anyone in it.
• My daughter has coped with the change much
  better than we could have imagined, shes more
  relaxed now.

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Key lessons

• What does it mean for you?

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Real, Personal and Ultimate Accountability

• Denial and speed of action
• Sutton and Merton comparison
• Less stars
• People no longer in post
• Individuals named
• Referred to professional
• bodies
• Police Investigations
• Board review for competence

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Create Counter-measures to Prevent Poor Practice

• Up to date performance managed
• Evidence based - governance
• National/ regional networks
• Training and development
• Supervision of staff
• No isolation
• Secondments/students/rotation/open door
• Invite challenge
• Involve outsiders
• Look for the above warning signals

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National Recommendations will apply

• Anyone, (providing care) must seek to register
  their services with CSCI immediately
• ensure that community care assessments are
  offered
• National Audit of services commissioning

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Need to Check

• Adult Protection is robust
• Good performance
• Role of the Learning Disability Partnership Board
• Role of Strategic Health Authority

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Learning for everyone.

• Involving people who use the service, Advocates
  (Citizen, self, peer advocates) carers and
  families.
• Supporting self advocates and carers to grow
  stronger
• Clear leadership for this

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Learning for everyone.

• Openness to acknowledge any failings and
  determination at senior level to address them.
• Commitment to Partnership
• Quality is a result of persistent hard work
• Be brave do did- get -got

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Geoff Baines, Director of Change
Geoff.Baines_at_southwest.nhs.uk Tel [phone]