After Dispatches; Stop locking vulnerable people up and sign the petition

2nd March 2017 1 Comments

I hope you all managed to watch the Channel 4 Dispatches documentary last night: Under Lock and Key?  It was a shocking and disturbing insight into the bad practice at St Andrews in Northamptonshire, one of England’s large specialist hospitals.  Indeed, I think this is scandal which regrettably will raise many of the same issues raised by the Winterbourne View documentary in 2011.  The learning disability sector is once again working together to raise awareness and seek change as a result of this documentary.

It is such common sense that the starting point should always be to treat every person as an individual to be nurtured, rather than as a problem to be contained. Clearly St Andrews solution to good care is exactly the latter.  Seclude, sedate and restrain ‘whether they liked it or not’ and effectively punish people for their Autistic behaviour.

This is in stark contrast to the absolutely brilliant and person centred, autism specific care the young people featured in the documentary are now receiving in Alderwood.  As Fauzia’s mum said; ‘it’s as different as night and day’.  I know Alderwood has received many calls and texts this morning from family members of people in their care to say how blessed and grateful they are that Alderwood is in charge of the care of their loved ones.  I am so proud of each and every member of the Alderwood staff team. You are doing an amazing job and what a great demonstration of the fantastic transformations you make to the lives of some of the most vulnerable and challenging people.

I am also pleased to say that Norman Lamb MP, who featured on the programme, will be hosting our STOMP (Stopping Over Medication of People with Learning Disabilities) event in June at The House of Commons, to launch our Best Practice Guide. Matthew’s mum and dad and Fauzia’s Aunt will also be speaking at the event.

I have dedicated my career to making care more personalised by closing long-stay institutions and moving people back to the community with bespoke care packages.  There is mounting evidence in favour of personalised care, and a move away from the type of institution featured in the programme. The £45 million investment in the facility featured in the documentary is money that could be far better spent on services that match the government’s stated policy of moving toward independent living in conjunction with bespoke support.

The Challenging Behaviour Foundation has launched a petition today to the CEO of NHS England, to stop sending people with a learning disability to large inpatient units. Please do sign and share.

https://www.change.org/p/simon-stevens-enough-is-enough-nhsengland-stop-keeping-people-underlockandkey-in-institutions

Matthew - Alderwood
Dispatches Under Lock and Key
Fauzia - Alderwood
Under Lock and Key

Large scale institutions are not the answer

24th February 2017

Large scale institutions are not the answer to good quality support

I visited 26 services this week including a number who have joined CMG in the last 6 months.  I was very pleased with the positive feedback I received from staff in those services about their experiences since joining the CMG family.

I was also very impressed with the quality of the daily diaries at Chetwynd Road in Portsmouth. They are extremely detailed and provide really good evidence of the support we are providing and the outcomes people we support are achieving.

I became aware recently that a Local Authority in England is planning to develop a block of over 40 supported living flats for people with learning disabilities.  This really concerns me as it would be a return to ghettoisation for disabled people and the development of an institutionalised service model.

This isn’t the first time that I’ve come across a Local Authority developing large scale supported living services in order to save money and deal with their cost pressures.  Whilst I appreciate Local Authorities do have cost pressures, there are different and more creative ways of finding savings rather than re-developing outdated service models which have a very poor track record.  Just because a service is called ‘supported living’ that doesn’t mean it is necessarily good quality.  An institution is an institution whatever it’s called.

 

Working as a paid member of a rock band and reducing the need for ‘chemical restraint’

14th February 2017

I visited 15 services last week and was particularly impressed by our 283 Dyke Road service in Hove. I carried out a social inclusion audit there and they scored top marks. Eight young people live at 283 and seven of them work in either paid or voluntary employment, including being a paid member of a rock band. They are all actively supported to participate in a range of clubs and sporting activities, including boxing and street dance and clubs for non-disabled people. They are also all supported to maintain relationships with their friends and family.

Social inclusion - CMG
Dyke Road doing great social inclusion

I don’t think I’ve mentioned STOMP before in my blog. It stands for: Stopping Over-Medication of People with Learning Disabilities. A shockingly high proportion of people with learning disabilities are prescribed excessive amounts of psychotropic medication. This is medication prescribed for treating mental illnesses which is often given to people with challenging behaviour to ‘chemically restrain’ them or sedate them . A lot of people who challenge and who are prescribed psychotropic medication do not have any diagnosed form of mental illness.

NHS England has launched new guidance about STOMP, which has been signed up to by the Royal Colleges of Nursing, Psychiatrists and GPs, as well as the Royal Pharmaceutical Society and the British Psychological Society. Many learning disability providers are also supporting STOMP including CMG. We have a number of excellent examples in both CMG and Alderwood of people being supported to either come off psychotropic medication entirely or for their dosage to be substantially reduced.

Effective use of positive behaviour support is one of the most important ways of helping people come off medication, as is effective working with GP’s and psychiatrists. CMG is developing a good practice guide which includes information on how to help people come off excessive amounts of medication. We will be launching this guide at the House of Commons on the 13th June thanks to Norman Lamb MP who has kindly agreed to host the event. I would actively encourage everyone in CMG to look at the levels of medication that the people we support are receiving, particularly if it relates to their behaviour. If you would like any advice on how to safely help people reduce the level of medication they are on, please contact Michael Fullerton, our Quality and Clinical Director.

 

Shift planning, CQC and supported living versus residential

6th February 2017

I visited 18 services last week and was particularly impressed by Kings Road’s ‘fun fruit Friday’.  Every Friday they think of a fun activity to encourage the people they support to make and eat healthy snacks and desserts involving fresh fruit.  What a great idea!

Composition of various exotic fruits isolated on white background

At another service I got engaged in a discussion with staff about shift planning. It’s always seemed fairly obvious to me that shift planning, by definition, means planning at the start of the shift what’s going to happen as people go through their shift.  In this service, some of the staff thought shift planning involved recording afterwards what’s taken place.  Shift planning is a really important tool as it makes sure that the right staff are allocated to the right people we support and that they participate in meaningful activities.  I would be grateful if our managers could remind and re-enforce this point with our staff.

With a degree of trepidation, I am going to put my foot into the very controversial waters surrounding ‘registering the right support.’ This is a new initiative by CQC to try and make sure no new services are opened for people with learning disabilities which are large and institutionalised. Having spent a large part of my career closing dreadful old long stay hospitals, I feel very passionately that I don’t want to see any new institutions develop for people with learning disabilities. However, I am not sure I agree with CQC’s view that services should generally be for no more than 6 people. I have certainly seen larger services that can work very well for people.  For example, our Avenue Road supported living service, that was recently rating ‘outstanding’ by CQC supports 9 people each in their own studio flat. Sometimes, when we take over tenders from other providers supporting people in 3 person and smaller supported living services, they can feel quite lonely compared to some larger services which have a more buzzing atmosphere.  As non-disabled people, we all choose to live in a wide variety of different living situations and I don’t see why it should be different for people with learning disabilities.  In my experience, what matters most is the calibre of the registered manager and the values of the staff team.  However,  I do draw the line at larger services for people with very challenging behaviour.  Firstly services of that nature can easily become controlling and abusive with a punitive approach to responding to peoples’ behaviours. Secondly, people with very complex and challenging behaviour do require highly skilled and personalised interventions.

I am going to finish by reverting to a topic I’ve mentioned before; the downside of supported living which nobody apart from me seems to mention.  I am not anti supported living; in my time at CMG we have opened more than 30 supported living services. However I do feel frustrated by the simplistic attitude prevalent across our sector that residential care is bad and supported living is good. The quality of the manager and the staff team is far more important than the label over the door in determining the quality of life that people will experience. One of my concerns about supported living is the lack of inspection and oversight compared to residential care. For example, last week I visited a provider who has around 30 supported living services, all under one registered domiciliary care office. At their last inspection, the CQC inspector visited the registered office and only two of the services.  How can this be right?

Supporting some of the most challenging and complex people in the country

27th January 2017

I am going to focus this week’s blog on profiling Alderwood; the outstanding subsidiary of CMG which became part of our organisation just over a year ago.  I have visited Alderwood services regularly in the year since they have been part of CMG and I never fail to be massively impressed by the work that they do.  Alderwood support some of the most complex and challenging people with a diagnosis of Autism in the whole country and recently have been taking a number of people being discharged from hospital under the transforming care programme.

Whenever I visit Alderwood services, the staff are always hugely positive and motivated even if they have just experienced a very challenging incident and have been personally injured. The level of structure in place is quite exceptional; people have activity programmes broken down into every 15 minutes, which gives the people we support the security about what is happening in their lives that reduces the anxiety that can often lead to challenging behaviour.  Any time I visit an Alderwood service, the activity for the individual is happening exactly as planned and on time.  Alderwood also use a great deal of visual communication methods which work really well with many people with Autism and they have their own studio that designs bespoke visual tools for each person.

In CMG, as you know, we strongly emphasise social inclusion, particularly the importance of employment.  Every single one of the people supported by Alderwood has a voluntary or paid job.  Given that these are some of the most complicated people in the whole country, this is an amazing achievement.

I would like to finish with a brief case study of a young man who spent ten years in hospital settings. When he was living in hospital, he did very little and was heavily medicated. He very rarely saw his family.  Now he sees his family regularly, has learnt skills like managing simple financial transactions, how to dress himself and plays an active part of the community including developing a real passion for football. He is a Chelsea supporter and recently went on a VIP tour of the Chelsea football ground.  Last but not least, he was on a huge cocktail of medication which has now been significantly reduced.

Fauzia - Alderwood
Under Lock and Key

Some fantastic news about CMG’s CQC ratings !

23rd January 2017

Today I received some fantastic news about CMG’s CQC ratings, which I’m very proud to share with you all, especially our staff teams who work in our adult services in England.

Following on from CMG being awarded a 3rd ‘outstanding rating’ from the CQC last week, we did a review of CMG’s CQC ratings and compared them to all of the other major learning disability providers in the sector.

And CMG came out top!  We have achieved a higher percentage of ‘good’ and ‘outstanding’ ratings than any of the other major learning disability providers in the learning disability sector.  This is a fantastic achievement.  Congratulations to everyone in CMG for making this possible.

This result is made all the more significant, because most other providers group their supported living services under their domiciliary care business.  This means that CQC is only required to inspect the registered office of the domiciliary care business not each of the individual supported living services, so it is possible for 30 odd services, for example, to be grouped under one domiciliary care business. (CQC is required to inspect every individual adult residential service).

In CMG, we register all of our supported living services individually, so each has to get inspected.

We will continue striving to improve still further on these results, but my thanks to all our staff for their amazing contribution to our ongoing success.

A third ‘Outstanding’ rating for CMG in England!

13th January 2017

Avenue Road achieves a third ‘Outstanding’ rating for CMG by the CQC 

It joins our Kings Road service in Hampshire and our Ridgeway service in Essex.

Avenue front 1

We also have an amazing 70 CMG services now rated as ‘good’ with the vast majority of these rated ‘good’ in each of the 5 areas, which is a fantastic achievement.  Unfortunately we do have 5 services rated as ‘requires improvement’ but we are working hard to improve these.

These ratings put CMG well ahead of the national average.  CQC’s national figures report there are 71% of services good, 1% outstanding, 26% requires improvement and 2% inadequate. Ours are significantly higher than these and we have zero services rated as inadequate.

So what does Pam Hirsch our manager at Avenue Road attribute to Avenue Road’s success:

“The overriding feeling I have is that it wouldn’t be possible without the loyalty and responsiveness of the whole staff team. They are a very diverse group with a range of strengths (and weaknesses) but apart from some everyday minor issues they appreciate each other and are so supportive of the service and our goals. They are also incredibly patient with me when I’m asking them to do something ‘extra’ or to change the way they do things and they have a good understanding of why we do what we do. They are not afraid to challenge and will not accept second best. I am so proud of them all.”

Ula Peazold, Regional Director for Avenue Road has added:

“Having a manager in place who has a consistent, fair, competent and supportive approach to her staff  has definitely contributed to the success of the service.  Staff know the tenants really well and respond to small issues before they get too big. Pam also ensures outstanding communication with families, service users and external professionals and has an extremely good eye for detail and understanding of procedures and CQC requirements.”

CMG’s Welsh services are inspected by CSSIW. All CMG’s Welsh services currently have ‘no requirements’ for improvements.

These ratings speak volumes about the care and support that CMG provides nationally to the people we support.  It also provides further evidence of what can be achieved by a competent manager and great staff team who work so cohesively together.  Many congratulations to Pam, her team and the tenants at Avenue Road.

Perseverance and creativity brings benefits to diabetes outcome

15th December 2016 3 Comments

I’ve just returned from two weeks annual leave and was really impressed today to see a presentation from Kellie Barker, Lead Support worker at Kings Road in Hampshire (and keyworker to ‘C’). The presentation demonstrated the fantastic efforts the staff team at Kings Road have made in managing C’s complex diabetes type1.

Diabetes is a serious life-long health condition that occurs when the amount of glucose (sugar) in the blood is too high because the body can’t use it properly.  Type 1 diabetes is an auto immune condition where the body attacks and destroys insulin producing cells, meaning no insulin is produced. This causes glucose to rise quickly in the blood.

C not only has complex diabetes, he also has a complex learning disability, so there was no standard solution to his diabetes and when he arrived at Kings Road, his condition had been badly managed and relations with the community support team had broken down.

The Kings Road staff team supported C to better understand his diabetes, better manage his insulin and also gave him restrictions with his diet, which although improved things, made his life more restrictive given it revolved a lot around eating the right foods at the right time. Even with these improvements, C’s insulin levels continued to fluctuate badly.

In 2015, the manager Sophie and Kellie became even more determined to make improvements for C. They re-established the relationship with the community health nurse and made visual representations of C’s glucose levels via colour coded spreadsheets.  It took over a year to see success with staff working daily at some points with the community team, but C’s blood glucose levels are now stable.  This is clearly represented by the graphs below:

Pink = too high

Green = about right

Blue = too low

C’s blood glucose levels in 2015

Diabetes-2

C’s blood glucose levels in 2016

 Diabetes-2016

The resulting health benefits to C are obvious but he is also now able to eat a less restrictive diet and can once again enjoy eating with his housemates and not feel so isolated because of his diet.

This is a great result and shows that with perseverance, creativity and good working relationships great results can be achieved which can make a real difference to a person’s quality of life.

Chris-at-Kings-Road-diabetes-2

Four great social inclusion audits

25th November 2016

As mentioned in a previous blog, I have started carrying out social inclusion audits when I visit services each week. I’ve done a few now, but I’d like to highlight four of them as they were particularly good: Masons Hill in Bromley, Heathcote in Epsom, The Green in Sutton and Cheam Road in Sutton. I score them on a scale of 0–3 in each of the 10 categories (below) and in each of these four services their scores ranged from 25/30 to 29/30.

10 categories:
Active support
Employment
Regular us of community facilities
Independence training
Promoting sport and physical health
Promoting emotional well being
Maintaining contact with family and friends
Sensory stimulation
Use of public transport
Involvement with clubs and societies

Scoring:
0 = No evidence
1 = Limited evidence
2 = Stronger evidence, but patchy
3 = Regular evidence

PTAIT_20160728_0619

I saw so many great examples of how this social inclusion is being achieved and the fantastic outcomes that have resulted for service users that we are going to create a best practice book highlighting these examples. This should be available in the New Year.

For now I’d just like to just mention a few of the social inclusion achievements from Heathcote in Epsom. TC has taken on a voluntary job at Head Start which is a homeless shelter in Leatherhead. Here TC not only does the cooking, but is given the responsibility of deciding on the menus each week and buying and serving the food. For someone who is incredibly quiet and shy, this is a fantastic achievement. For 7 years now, Dan has done paid work, 5 days a week, in a club in Epsom as a cleaner. He also has the additional responsibility for unlocking the club and managing the alarm system. Crystal moved to Heathcote from foster parents and now attends an organisation known as KCFC (Kingston Children and Foster Care). Since joining she was asked to put together an article on the Summer BBQ . She was also successfully nominated for an AQA Award and will be presented with her award by the Exec Director on 7th Dec.

(Dan and Crystal have given permission to use their names)

Evidence of what a difference a good and effective manager can make

14th November 2016

I would like to dedicate this week’s blog to a letter I received from the staff team at our Charmandean Road service in Worthing. It is such a great demonstration of how a good and effective manager can make so much difference to the lives of people we support and the morale of our staff teams:

Dear Peter
We would like to begin with a quote from a recent blog: ‘To others aspiring to provide the highest quality care and support’. You mentioned the ten tips of leaders of social care and as outlined we again remind ourselves of the importance and relevance of these:

• To personally answer all complaints from families
• To personally check improvement plans for any required improvements or inadequate services at least once a month
• Do not take peoples word for it; ask to see evidence
• Be on top of the details that matter; such as turnover, sickness, and up to date training in compliance in the service
• And the list goes on

As a staff team we agreed on the points given and believe this is relevant to what makes good leadership in a social care environment.

Our purpose of writing this letter to you is to acknowledge the phenomenal and outstanding work our manager Jennifer Broadway is doing since taking the mantle as our service manager in Charmandean Road. She has delivered quality service, benefiting all service users and staff, and we wish to continue to support her work.

With her open door policy, Jennifer has valued and respected the needs of her service users dignity and treated staff equally. She has built good rapport and relationships with parties partnered with our service such as GP’s, nurses, OT’s, parents and visitors.

As you are aware, in the past Charmandean has struggled with staffing levels and the attrition rate was increasing. Jennifer has recruited several enthusiastic staff members that complement the needs of running the service.

With her pragmatic leadership, Jennifer has built a strong and competent staff team that execute their duties effectively. Jennifer has been very instrumental in ensuring all shifts are covered where necessary working late, early, long days and night shifts on top of her official schedule.

How could we not be inspired? Seeing our manager take the lead when it comes to service users personal care, laundry and cleaning duties.

We can report to you with sincerity, all the compliances set by CQC have all been followed, for example health and safety checks are regular, and recently all of the electrical supply routes have been tested and the carpets have been professionally cleaned.

Jennifer has booked appointments with health professionals for example, health reviews, flu jabs, occupational therapist reviews. She will personally support them to their appointments.

Jennifer volunteers to drive service users to appointments, activities and to visit family. She does not want them to miss out on opportunities due to lack of drivers on shift.

Over the period as house manager, Jennifer has conducted regular staff, service user and parent meetings, staff appraisals and supervisions. She is vigilant in her work and approachable towards her team.

Jennifer will ensure staff are reminded to follow protocols, complete all documentation for example fire checks, water temperature checks, daily diaries and healthy files.

As the environment is vital to our work she has been advocating for the garden to be maintained and the surroundings we work in to be a clean and safe environment.

The staff morale here at Charmandean is boosted and the atmosphere is very welcoming to work in. We are one happy family which can be demonstrated through our participation celebrating birthdays and Christmas.

Any complaints we are to receive are treated as constructive feedback to help us improve the quality of the service we provide.

We are confident that with Jennifer’s leadership without any doubt we will achieve Outstanding in our next CQC rating. We are therefore appealing to you to give Jennifer the support she needs to continue her hard work to make Charmandean the best service in CMG.

Kind regards
Charmandean staff team

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