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  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 NHS Independent 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

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in Bromley  Concerns about safety of some individuals, and a poor care environment  Concerns about quality of care, out of date care plans and lack of activities  Poor management arrangements between PCT and Local Authority  Not enough staff training  Large numbers of people in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 Findings My 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

Thank you Fiona Ritchie Lead Learning disabilities

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?