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Priory Group: Craegmoor Workshop - Partnership with Patients Delivering Quality in a Mixed Economy with People with Learning Disabilities through enabled Environments. Siân Wicks Director of Corporate Assurance & Chief Nursing Officer Gary Laville Divisional Director of Quality
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Priory Group: CraegmoorWorkshop - Partnership with PatientsDelivering Quality in a Mixed Economy with People with Learning Disabilities through enabled Environments Siân Wicks Director of Corporate Assurance & Chief Nursing Officer Gary LavilleDivisional Director of Quality Paddy Behan Positive Behaviour Support, Quality Development Lead
Pricewaterhouse Coopers (PWC) Following Winterbourne View
The Challenges of Multi-Sites • 177 Craegmoor services across the Group: • 13 Mental health services sites • 68 Autism services sites • 87 Learning disability services sites • 20 Supporting you • 160 Registered Services across 4 regulators in the UK: • 149 Care Quality Commission • 4 Care and Social Services Inspectorate Wales • 7 Social Care and Social Work Improvement Scotland • Site level assurance, Divisional assurance, Board assurance
PwC Review 2013Where are we now? In July 2013 PwC returned to undertake a further review following implementation of the recommendations and their key findings are: • “There have been significant improvements in the way in which the group governs for and manages quality, providing a better balance of focus across financial, operational and quality performance.” • “Integrated approach to reporting quality performance and risk” • “The group has made a significant investment inenhancing its capacity and capability to manage, operating more proactively to drive continuous quality improvement.” • “Head of Quality role within each Division improved level of capacity to manage quality improvement.” – Divisional Director
Regulatory Compliance • The Craegmoor division covers England, Scotland and Wales, and is therefore required to work under the standards set out by these regulators • 101 Craegmoor sites across the UK were inspected by regulators during 2013 • These are broken down by regulator as follows: • Care Quality Commission: 95 • Care and Social Services Inspectorate Wales: 1 • Care Inspectorate: 5 Care Quality Commission • The Care Quality Commission inspected 1013 outcomes identified in the Essential Standards of Quality and Safety across Priory Craegmoor English sites between 1st January and 31st December 2013 • 89% were judged by the Care Quality Commission to have been met against a national benchmark of 82%
What do we do? We deliver support to people who have:
What do we do? Supported Living
The Core Elements of our Strategies • Quality assurance and compliance and kitemark • Support planning and record keeping • Enabling environments • Training and skill development • Your Voice – user engagement • Practical leadership
Gary’s Story Gary is a gentleman with a learning disability and autism. Gary doesn't use verbal communication and uses his own form of makaton; Gary does know certain makaton signs however chooses not to use them. Gary would show challenging behaviour towards staff when he felt his needs were not being met or when Gary was unwell. • In 2008 Gary stopped accessing the community; it is unclear why this happened. Gary declined to meet his personal hygiene needs with support and he would be reluctant to change his clothes, Gary would change his clothes on average once a week. Gary’s sleep pattern was also an issue; he would be up all through the night and sleep most of the day getting up around tea time. Gary found it difficult to trust staff and would only interact with others on his terms.
Gary’s Story In Partnership we identified that Gary would need support around:
Gary’s Story What we did:
Gary’s Story • Using Water Play – Gary now bathes daily • Using clothes bags and steps – Gary changes his clothes daily • By focusing on sleep hygiene – Gary sleeps most nights and is ready for the day • By ensuring structure – Gary engages in activities with others • By using backward chaining – Gary accesses the community
Challenging Behaviour or ChallengedEnvironments Typical intervention / activity phase involving “Specialist” involvement Specialist services / Capable environments Typical service capability (due to setting events)
Positive Behaviour Support Strategy Staff Training Functional behaviour assessment (FBA) Behaviour Support Planning Quality of Life Effective Monitoring and Incident Analysis Systems. Practice Workshops Physical Interventions and Restrictive Approach Reduction Plans. Quality Assurance Systems Practice Management and Leadership Quality kitemark
Mr B Individual Data Summary 2003-2011 • Mr B began his placement in October 2002 following a series of placement breakdowns. Included in these breakdowns were his specialist residential school and out of county specialist residential service provider. • Challenging behaviour totals have fallen by over 700 incidents a year from 2003 resulting in a decrease of around 15%. • Restrictive Physical Intervention usage has fallen 100% • The use of PRN medication to support Challenging Behaviour has decreased by 99%. Consecutive years have also seen a fall in the strength of medication administered. • Activity totals have increased some 1175%.
Organisational Data Comparison 2002 - 2011 • This graph demonstrates: • An overall fall in usage from 2'920 to 186 • 94% decrease • Current usage of less than 1 physical intervention per person per month (compared to 12 in 2002) • This graph demonstrates: • An overall fall in recorded incidents of Challenging Behaviour from 45'000 - 17'178 • A decrease of 62% • This graph demonstrates: • An overall increase in engagement in activities from 20'940 - 59'199 • An increase of 282%
WARNING! “The danger of any systemic analysis is that it is typically strong on describing over-arching principles and structures, but is somewhat weaker in articulating the specifics of actual practice” Allen 2007
Positive Behaviour Support...Supporting Quality, Innovation & Value
