national audit of learning difficulty in- patient services 2007 fiona ritchie
TRANSCRIPT
National audit of learning difficulty in- patient services 2007
Fiona Ritchie
1 What did we do?
2 What did we find?
3 What happens next?
Agenda
What did we do?
What did we look at?
We decided to focus on specialist inpatient NHS and independent health care providers because of the investigations we had recently done
We did not include services run by health that were registered by the Commission for Social Care Inspection
We developed two questionnaires,one for the senior management board of the organisation and one for the individual service
People with learning difficulties,family carers and professionals helped us to develop the questions to measure the quality of the services
The questionnaires were for people to tell us how they felt their individual services were doing and to help us identify services to go and visit
Questionnaires and Visits
We sent out 638 unit questionnaires and 89 board questionnaires
92% and 96% response rate respectively
For services that didn’t respond we made sure we chose them for a visit
Peer review visits
154 services visited
65 Central
26 London & SE
23 South West
40 North
Includes 6 adolescent units
and 21 provided by the
independent sector
Peer review visits: Methodology
3 peer reviewers per team
After visits individual reports sent for factual accuracy, not published
National report published Dec 07
SHA charged with monitoring action plans from site visits HCC charged with monitoring IHC action plans
What did we find?
Population Findings
0
20
40
60
80
100
120
140
160
Nu
mb
er
of
peo
ple
Number of people
0
200
400
600
800
1000
1200
1400
12-1
5yrs
16-1
9 yr
s
20-2
4 yr
s
25-3
4 yr
s
35-4
4 yr
s
45 -
54 y
rs
55-6
4 yr
s
65-7
4 yr
s
75+ y
rs
Nu
mb
er o
f p
eop
le
Number of People
Over 4,000 people are in these services
63% were men
Highest concentration between ages of 25 – 44
Most men in low medium secure, assessment and treatment and campus provision
NHSIndependent Health Care
Population Findings
92% white
1.5% mixed
3.2% Asian or Asian British
2.8% Black or Black British
0.3% Chinese or other ethnic group
0.2% not known
White
Mixed
Asian or Asian British
Black or Black British
Chinese or OtherEthnic Group
Not Know n
Service Findings
Six services had potential safeguarding issues
Two were from one trust (Bromley PCT) and significant concerns were raised about the quality of care in these services. This was escalated and the Healthcare Commission took further action
What we found in Bromley
Concerns about safety of some individuals, and a poor care environment
Concerns about quality of care, out of date care plans and lack of activities
Poor management arrangements between PCT and Local Authority
Not enough staff training
Large numbers of people in campus provision with little to do and little choice
General Service FindingsMy Choices
Basic day to day choice’s for people not generally available:
What people ate
What time people got up/went to bed
What they did during the day
What friends they had
What staff supported them
Who lived with them (in residential services)
Little easy read communication to support choice
Service Findings
My Day
Poor level of activities
Poor choice of activities
Little access to community facilities
General lack of engagement from staff to people in services and from people to people
Lack of good treatment plans
Service Findings
My Rights
Lack of understanding in regards to what is independent advocacy and access to advocacy
Many areas more restrictive than is needed i.e. more locked areas which prevent independence choice and peoples personal freedom
Good access to healthcare professionals 81%
But some need to wait considerable time for instance access to speech and language therapy in some organisations
Poor person centred care planning
Service Findings
Me, and others
Not many people had friendships other than with paid staff
High staff sickness 10% compared to national average of mental health establishments being 5.3%
High level of agency staff in some organisations 1 in 3
Lack of basic mandatory training in many services
Service Findings
Me, and others continued
Appraisals and supervision appear to be happening in most services
Staff reported feeling isolated from senior management
Lack of monitoring by commissioners
Lack of monitoring by senior management
Service Findings
My wellbeing Poor safeguarding, lack of training, lack of knowledge re what
safeguarding procedures were
Lack of clarity re CRB and POVA checks for staff
Low levels of reporting under whistle blowing
Low levels of physical intervention but high levels of PRN used (80% of services)
Poor attention paid to addressing cultural issues of people in the services
Financial control clearly with the organisations which rarely allowed people using the service to use their money or be independent in their financial situation
What Happens Next?
All services to review care now and ensure improvements take place in every service
Strategic Health Authorities to ensure campus closure and monitoring of action plans following the audit
Joint work instigated with Commission for Social Care Inspection and Mental Health Act Commission around commissioning
Some more visits during 2008 to ensure progress has been made, this will include all organisations not previously visited , peer review teams currently being reformed
Working with the Department re performance indicators for ld
Working with Valuing People to support change
Workshop 1
In your group please discuss the following:
What issues from the audit findings do you recognise in your services?
What does this mean for you?
As a group are there any issues that are common to you all?
What three issues …the big issues need addressing as a priority?
Workshop 2
•Consider how the services you commission/provide reflect current policy and identify 3 areas where you feel strategic change is needed e.g. reducing out of area placements
•What do you think are the first steps you need to take to make change in the 3 areas?
•What would help/support you to overcome potential barriers to change or speed progress?
•Who will do what? When? How?