National managers meetings
This slideshow was used for a presentation to the National Registered Managers Conferences in 2012
Published on: Mar 3, 2016
Transcripts - National managers meetings
In the eye of the storm Debra MooreDirector of Nursing & Patient Safety Castlebeck
Aim of the session Transforming The Workplace Culture – including findings from the external review of the culture Learning And Implications For Other Learning Disability Providers
Do we use this a chance to do somethingdifferent? Can we take stock and rebuild?“Her death has become one of those major modern occasions wherethere seems to have been a collective sense of empathy for astranger’s fate. She has become an embodiment of the betrayal,vulnerability and public abandonment of children.The inquiry must mark the end of child protection policy built on ahopeless process of child care tragedy, scandal, inquiry, findings, briefmedia interest and ad hoc political response. There is now a rarechance to take stock and rebuild”Peter BeresfordProfessor of Social Policy, Brunel University
Personal and professional
What do I know?
How did I become involved? –my response to Winterbourne View“You have many choices. You can choose forgiveness overrevenge, joy over despair. You can choose action overapathy.”Stephanie Marston
Abuse - is anyone, anywhere safe?For 10 years, Gordon Rowe raped, kicked, punched, drugged, starved andneglected the adults with learning difficulties who lived in his residential homes inSouth Buckinghamshire. (Longcare Inquiry)One on occasion she attended the hospital at around 6 am to find her mother in aside room calling ‘please help me, please help me’. The patient was covered indried faeces and was completely naked. She ran down the ward to find the staff‘chatting and laughing’. She assisted in washing her mother and it was ‘awful’.Her ‘hands were absolutely caked’ and it ‘was dried and it was up her arms and itwas round her neck’. The patient died later that night. (Mid Staffordshire)One person interviewed was raped, age 7, by a family friend; then abused, aged10, by her foster brother who had Downs Syndrome; and then, at age 14,sexually abused by her cousin. (Lemos & Crane)In October 2007, Pilkington, then 38, drove herself and her 18-year-old daughter,Francesca Hardwick, to a layby …the then set the Austin Maestro on fire, killingthem both…an inquest heard how the family had been kept virtual prisoners intheir own homes by youths who threw stones, flour and other objects and kept upa relentless stream of abuse
Abuse - is anyone, anywhere safe?“appalling examples of discrimination, abuse and neglect across the rangeof health services” Death by Indifference“People with dementia are the most vulnerable in society and it is shockingthat this study has found that they are being subjected to abuse in their ownhome” Alzheimers SocietyInspectors for the Care Quality Commission - which regulates home care inEngland - found that 217 companies were employing workers who were notproperly qualified. One company in Birmingham employed 23 carers withcriminal convictions for offences including theft and assault. One carer inCoventry locked a vulnerable person out in the garden while another put acarrier bag over a care users head.Scotland Yard, which is co-ordinating the investigation into Saviles allegedoffences, says it is following up 340 lines of inquiry, following complaints ofabuse and sexual assault by him. It is also in contact with 14 other policeforces. In total, officers are in contact with 40 potential victims.
In Winterbourne View What do all these scandals tell us about the setting conditions for abuse? What is the recipe for disaster?Lack of voice in terms of service users/families/advocacyLack of respect for the individuals and their familiesUnclear purpose and valuesMix of service users with widely differing needsBoredom – lack of activitiesInstitutional and impoverished environmentsGeographically isolated servicesLow staffing levels and high use of bank/agency staffPoor training and staff developmentLack of management supervision and appraisalClosed inward looking culturePoor incident reporting systems and low level governanceWeak management and low visibilityLack of clinical/nursing leadershipPoor whistleblowing proceduresFailure to act on complaints/concernsPoor intra-agency reporting and liaison Where could we see all this happening?
Methodology of the review Site visits to 12 hospitals between June and August 2011 Winterbourne View not included as subject to on-going police investigation Assessment of services against Confirm & Challenge Outcomes Framework Review of literature and government policy Interviews and observations with people who use services and their families Observation of key meetings – service user forum and staff meeting Confidential Interviews with staff across all departments including housekeeping, administration, nursing, clinical and training Confidential Interviews with Executive Team Analysis of documentary evidence – rota’s, MDT and CPA minutes and notes, nursing and clinical notes Summit with key stakeholders to inform recommendations (Sept 2011)
Findings and recommendations9 key areas1. Assessment, care planning and therapeutic interventions2. Multi-disciplinary team working3. Planning and delivering person centred care4. A meaningful day5. Environment and facilities6. Workforce and staff training7. Organisational structure and culture8. Commissioning9. Clinical governance and patient safety
Assessment, care planning and therapeutic interventions – key lessons Ensure a clear purpose and focus for in-patient provision – ‘short term psychiatric assessment & treatment’ with the aim of returning people to the community Agree admission criteria and a proper care pathways with individual outcome measures and discharge planning from the start Ensure there are the resources and expertise to deliver specialist interventions – therapies and programmes Create a meaningful day – combat boredom! Promote healthy lifestyles Invest in person centred care planning – INVOLVING PEOPLE & FAMILIES!
Multi-disciplinary team working – key lessons Be clear about the role of each person and support activities that bring them different professional groups together such as training Ensure that the MDT is visible within services and spend time with direct care staff – accountability The role of named nurse & key worker need to be defined and accountable Listen and respond to the views of people and families – don’t confuse!
Planning & delivering person centred care – key lessonsReally connect with PEOPLE AND FAMILIES Increase opportunities to hear the voice of people who use services and their families Support people and families with knowledge and information - expert patient/expert carer skills Ensure materials are accessible and enable people and families to engage fully in assessment and care planning processes Ensure people know their rights!
A meaningful day – key lessonsBuilding skillsPerson centred active supportPositive Behavioural SupportIntensive interactionCommunicationMeaningful occupation andemployment opportunities
Environment and facilities - key lessons Smaller environments – better compatibility Involve service users and families in setting and monitoring environmental standards Remember the ‘healing’ aspect of the environment Space for therapeutic activity
Workforce and staff training - key lessons Induction – first point of contact – emphasis on values, rights and safeguarding Robust preceptorship, induction and clinical supervision Rolling programme of training prioritising person centred thinking and approaches, care planning and HAP as well as clinical skills Training needs analysis and effective staff matching vital – KSF linked to appraisal Involve people and families at every stage Look outwards – network, network, network
Organisational structure and culture - key lessons Patient care and outcomes must be focus of Board level discussion and communication Robust management supervision and clear accountability Staff who are related should not work in the same team Managers need development and training All meetings need to be purposeful, strengths based and appreciative High visibility - Management by wandering about!
Commissioning - Key lessons Focus on patient experience and quality of care Use of multi-media to see what the life of the person is like e.g. video diaries Undertaking regular population needs analysis aggregated information from care plans, HAPs, patient exit interviews, family carer surveys etc. Ensuring manager understand commissioning landscape and expectations and work in partnership
Clinical governance and patient safety- Key lessons Be clear about expectations – agree the Quality Strategy – clear outcomes and accountability Weave achievement of quality targets into appraisals of all staff Ensure people and families are involved in all aspects of setting and monitoring standards Robust governance systems and data Board reporting ZERO TOLERANCE
In summary My report contains nothing new – it is, sadly, an echo of other reports detailing failings across the NHS, Social Care, Independent Sector and in people’s own homes How many times do we have to say it? We need to stop blaming each other and get on with changing things…! We need to create the conditions for person centred care to flourish
A personal ‘call to action’“It is all built on trust, so Itrust you to look after myson”