Transforming Care

The scandal that unfolded at Winterbourne View is no secret and some of the outcomes from this continue to expose wider issues in the care system across all sectors of care and support.

As much as events at Winterbourne View and those within other services raise significant concerns surrounding the state of care provision and indeed some staff practice, it is vital that we treat and use all of these findings to inform real change and improvement in the future.

The review and subsequent publication; Transforming care: A national response to Winterbourne View Hospital Department of Health Review: Final Report (Dec 2012) (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/127310/final-report.pdf.pdf) is a key factor in making these fundamental changes. The report lays out clear, timetabled actions for health and local authority commissioners working together to transform care and support for people with learning disabilities or autism who also have mental health conditions or behaviours viewed as challenging.

There is a shared objective is to ensure that the health and social care systems get to grips with past failings by listening to this very vulnerable group of people and their families, meeting their needs, and working together to commission the range of services and support which will enable them to lead fulfilling and safe lives in their communities.

While the report focuses on the need for change, it does acknowledge “there are places which already get this right”, we at ASC Healthcare aim to be one of those places and in doing so demonstrate below some aspects we consider are unique and specific to ourselves as providers in our achievement of this.

Throughout the development of The Breightmet Centre for Autism, from concept to on-going service delivery, Autism Initiatives (http://www.autisminitiatives.org) have been engaged as our specialist consultants.

The Review States ASC Healthcare Response – What We Do
‘Almost half of the patients at Winterbourne View were placed far away from their homes in excess of 40 miles’. Our intent is to provide local services for local people.Cautious and careful location planning for our service The Breightmet Centre for Autism, has ensured that it is strategically placed at the heart of the local community within a densely populated area with good access routes.There are more than 4.5m people living within a 40 mile radius of The Breightmet Centre, (http://www.ons.gov.uk) and therefore an estimated asc population of 45,000 (http://www.autism.org.uk/about-autism/myths-facts-and-statistics/statistics-how-many-people-have-autism-spectrum-disorders.aspx)We acknowledge that only a small percentage of these people will require a stay period within a hospital setting during their lifetime and while we accept that there are other providers within the region providing asc specific hospital services as part of larger campus / generic sites, there are no asc specific hospital centres that are specifically defined and designed exclusively for people with asc.
‘People were staying at Winterbourne View hospital for lengthy periods. The average length of stay at Winterbourne View was around 19 months but some patients had been there more than three years when the hospital closed’. My Shared Pathway Programme will detail proposed length of stay periods on an individual basis from point of pre-admission to the service. The length of stay will be agreed with the individual, family members and commissioners, part of the My Shared Pathway Programme details SMART Outcomes to ensure progress can be routinely measured.
‘There was little evidence of urgency in considering discharge and move-on plans for Winterbourne View patients. It is worth noting for instance that 10 patients detained under Mental Health Act powers remained in Winterbourne View after their period of detention ended – in one case for a further 18 months’. ASC Healthcare are able to provide a number of ‘Discharge Solutions’ and routinely work with a range of other providers to ensure length of stay is never unnecessarily prolonged.Discharge Solutions are considered at point of pre-admission to ensure an identifiable solution will be readily available within a defined timescale.
One of the most striking issues is the very high number of recorded physical interventions at Winterbourne View (i.e. of patients being physically held to prevent danger to themselves or others). All ASC Healthcare staff provided with training in partnership with PROACT-SCIPr-UK®, (http://www.proact-scipr-uk.com/index.html) This training provides a person-centred whole service approach and promotes positive behaviour thereby reducing the need to use behaviour that may be considered challenging. Skills are developed to offer comprehensive autism therapy by recognising triggers and early warning signs, actively avoid difficult situations and create reactive plans to better manage times of crisis.Our governance and audit processes will be such that all situations described as challenging will be routinely recorded – the detail and content of these records will be routinely and frequently reviewed by our clinical team to ensure the on-going monitoring and development and implementation of least restrictive practices. This information will routinely be available and shared with commissioners and regulators.
‘The Serious Case Review also sets out very clearly that for a substantial portion of the time in which Winterbourne View operated, families and other visitors were not allowed access to the wards or individual patients’ bedrooms. This meant there was very little opportunity for outsiders to observe daily living in the hospital and enabled a closed and punitive culture to develop on the top floor of the hospital. Patients had limited access to advocacy and complaints were not dealt with’. ASC Healthcare has policies and procedures in place that actively encourages and supports patient visitors. In most cases such visits are regarded as vital in the well-being and support of patient recovery.While we have facilities specifically designated for visitor use, these are intended to allow visits to proceed with a level of freedom and flexibility with ease of access to social and meaningful activity and refreshments. No visitor would ever be denied access to any of our residential areas subject to satisfactory completion of risk assessment and implementation of a visitor support plan.We have robust policies, procedures and complaints registers in place to ensure that all complaints are adequately and satisfactorily resolved – we will share this information as required and appropriate with commissioners, regulators and our local safeguarding team.We have an SLA in place with a local independent advocacy service MhIST (http://www.mhist.co.uk) who provide a tiered service to all of our patients ensuring their voice and also training to our staff.
‘…approaches to staff recruitment and training did not demonstrate a strong focus on quality. For example, staff job descriptions did not highlight desirability of experience in working with people with learning disabilities or autism and challenging behaviour – nor did job descriptions make any reference to the stated purpose of the hospital’; At ASC Healthcare, job descriptions will include a distinct learning disability and/or asc focus irrespective of the position being held and will be relating to our service operation, values and philosophy. Our person specifications will detail the minimum requirements we would expect of any potential employee.Our recruitment processes have been designed to test out the beliefs’, attitudes and values base held by all shortlisted candidates to ensure their suitability for appointment. As an additional safeguard we have the most robust probationary processes in place with routine review being undertaken throughout this period.We believe that part of the recruitment and appointments process must include ‘good’ induction which is informed by ‘best practice principles’. To ensure the success of our induction programme and that all our employees are well informed at ASC Healthcare all of our Senior Management Team members will be engaged within our induction process and undertake specific roles alongside external training providers.
‘…there is little evidence of staff training in anything other than in restraint practices’; Alongside our induction programme as per the above, ASC Healthcare will provide a comprehensive and detailed staff development programme which is further supported by a detailed staff support / supervision and appraisal system with regular internal / external review.
‘…it is striking that adult safeguarding systems failed to link together the information. NHS South of England’s review highlighted the absence of processes for commissioners to be told about safeguarding alerts’ Our internal safeguarding alert system underpinned by our own policy and procedure is designed to link directly with our local safeguarding team in Bolton and will be under constant external review (http://www.bolton.gov.uk/website/pages/Safeguardingandprotecting.aspx)The system is such that at the same time any alert is raised, the same alert is received by the responsible commissioner, care co-ordinator / social worker and the CQC. This ensures that all parties who may have any concern relating to any alert are well informed and can respond accordingly and within short timescales to ensure that we as a provider are continuing to do all we can to protect the individual(s) concerned and that our systems are efficient in their openness and transparency.
‘The interim report identified concerns about the quality of person centred planning, involvement of people and families in developing their care plan, and in ensuring personalised care and support’. My Shared Pathway Programme will ensure an excellent system of medical treatment when it comes to autism therapy. This will include a Person Centred Planning which in turn informs staff practice – Person Centred Care and Support.We always regard the individual receiving care and support first and foremost as the expert in their condition. Part of this Programme will routinely and frequently require information and updates from family members and external professionals who we regard as ‘Equal Partners’ throughout this programme to ensure a complete and holistic view is consistently maintained – this information is required at the pre-admission stage and at a number of milestones within the programme itself.
‘…there is consensus that large hospital units are outdated and inappropriate and do not provide the care which people with challenging behaviour need…Sending people out of area into hospital or large residential settings can cause real harm to individuals by weakening relationships with family and friends and taking them away from familiar places and community. It can damage continuity of care. It can also mean putting people into settings which they find stressful or frightening. This can damage mental health or increase the likelihood of challenging behaviour’. The unique design and layout of The Breighmet Centre is such that we have four main residential areas with a total of 19 beds.The Centre has incorporated a number of unique design principles to take into account some of the many environmental difficulties faced day to day by people with asc.In our pre-admission preparations we will undertake a series of compatibility impact assessments and learning disability tests to help ensure any potential anxiety, stress or trauma initially caused by transition is minimised and does not impact on the well-being of the individual longer term or that of others.Within our care / support planning arrangements, we have developed transition plans and tools which span over micro and macro transitions daily.Our policy relating to family links helps ensure that these are maintained and our emphasis on activity, inclusion and participation ensures continuity of contact within local communities that the patient is familiar with.
‘Evidence on best practice Commissioning needs to draw on the evidence of what is best practice in the care of people with challenging behaviour. The Model of Care set out in this report is based on well-established evidence. To strengthen the evidence base, NICE is developing further standards and guidelines for this group of people, to go alongside the standards already published on autism clinical pathways’. At ASC Healthcare we aim to be up to date with the most cutting edge evidence based practice, research and development. While we adopt standard NICE guidelines surrounding best autism practice to strengthen all of our work, our model of care is different across the asc spectrum. We do not adopt a one size fits all approach and our learning disability treatment, nursing, therapy, care and support is delivered to each individual based on each individual’s unique presentation of their unique condition.
The primary responsibility for the quality of care rests with the Providers of that care. Owners, Boards of Directors and Senior managers of organisations which provide care must take responsibility for ensuring the quality and safety of their services…including the views of people who use services about their experience’. ASC Healthcare as an organisation will continue to develop robust policy and procedure in relation to corporate and clinical governance to support and ensure the quality of their services and the safety of patients. Our audit system will involve the use of internal and external Experts by Experience, particularly those with knowledge of best autism practice and hospital settings. In addition to this, the Breightmet Centre as registered with The National Autistic Society Accreditation Service (http://www.autism.org.uk/our-services/autism-accreditation.aspx) is solely dedicated towards its services and plans to work with utmost sincerity in its each and every endeavour.This includes the review and evaluation of the whole patient and family members experience.People who use our services are encouraged to express their views and opinions through a variety of means in a variety of user friendly formats – some examples are as follows:

  • Within the My Shared Pathway Programme views of progress are sought, recorded, monitored and measured.
  • Weekly picture based experience accounts which include activities, meals, cleanliness, staff approach.
  • Advocacy services
  • Patient community meetings
  • Patient satisfaction survey

All of these will be recorded, monitored and evaluated as part of our overall governance strategy results of which will be published and made freely available.

‘We have heard deep concerns about over-use of antipsychotic and anti­depressant medicines. Health professionals caring for people with learning disabilities should assess and keep under review the medicines requirements for each individual patient to determine the best course of action for that patient, taking into account the views of the person if possible and their family and/or carer. Services should have systems and policies in place to ensure that this is done safely and in a timely manner and should carry out regular audits of medication prescribing and management, involving pharmacists, doctors and nurses’. At The Breightmet Centre, Clinical Review Meetings take place on a weekly basis, it is a requirement that medication reviews are undertaken routinely as a minimum standard within these meetings and that outcomes are reported – a monthly summary of these reviews is to be routinely provided to commissioners in a report format.Patients and their family members are invited to and encouraged and supported to take part in these review meetings.Medication prescribing, its management and administration is audited weekly on an internal basis and will be audited by an external pharmacist.
‘Models of care – key principlesThis is about personalisation, starting with the individual at the centre, living in the community. The first level of support for that individual includes the people, activities and support all people need in their everyday lives – family, friends, circles of support, housing, employment and leisure’. ASC Healthcare and The Breightmet Centre for Autism are not simply about being in Hospital and aspects of residential services.The site has its own distinct Therapy and Activity Suite providing access activity areas including gym, multi-faith room, ADL kitchen and additional Occupational Therapy and Speech and Language Therapy Rooms. This area is designated specifically to those people who due to the complexity of their illness may not be ready or immediately able to access community based facilities or require specific and more intensive support, development and training to enable them to do so.

Our Mission Statement is what we stand by what we believe in and what we do every day to ensure that we consistently deliver a high quality and unique service to unique people:

Through our unique delivery of a social and clinical partnership model, we will actively support individuals to develop a range of life skills and functional strategies. These will allow individuals to live the life they want to live now and in the future.

We recognise and endorse the philosophy that a hospital is not a home, but a place for extra support, during a critical time in a person’s lifetime. The emphasis of our work from point of referral will always focus on discharge preparation.