1. Into the Community from Orchard Hill Hospital

2. 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 evaluation Implication for policy

3. 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’).

4. Implications for policy Safeguarding Better outcomes – less cost Attachment based work – Social work not care management Human rights Workforce development – Provider Assessor

5. An evaluation of the resettlement programme from Orchard Hill Hospital to supported living Professor Roger Ellis OBE Research Findings

6. Trident Approach Outcomes Quality of life measure Based on best international practice Proxy completion by three trained auditors Process Partnership Specification based on social need Procurement procedures Stakeholder perspectives Residents by proxy Parents/relatives Staff

7. Trident Approach Outcomes Quality of life measure Based on best international practice Proxy completion by three trained auditors Process Partnership Specification based on social need Procurement procedures Stakeholder perspectives Residents by proxy Parents/relatives Staff

8. Quality of Life Audit Tool Seven domains Quality and location of housing Care planning and governance Physical wellbeing Social interaction and leisure activities Autonomy and choice Relationships Psychological wellbeing

9. 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

10. Results Highly significant statistically.0001 level Overall quality of life All seven domains Ranking of domains

11. 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% to81% Physical wellbeing 57% to 59%

12. 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

13. An evaluation of the resettlement programme from Orchard Hill Hospital to supported living Professor David Sines CBE Lessons for the future

14. 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.

15. 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.

16. 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’.

17. 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.

18. Achievements Orchard Hill Hospital and NHS Campus Homes 85 in total in supported living 5 in specialised residential care (dementia) 5 in bespoke residential care + other Local Authority placements

19. 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% LocalLast 5 years Sutton’s net budget - reduced by 28%

20. Case study Glynis Admitted 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 living Moved into new flat October 2008

21. 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

22. Into the Community from Orchard Hill Hospital