into the community from orchard hill hospital. shaun o’leary executive head of adults &...
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Into the Community from Orchard Hill Hospital
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 evaluationImplication for policy
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’).
Implications for policy
• Safeguarding
• Better outcomes – less cost
• Attachment based work – Social work not care management
• Human rights
• Workforce development – Provider
Assessor
An evaluation of the resettlement programme from Orchard Hill Hospital to supported living
Professor Roger Ellis OBE
Research Findings
Trident ApproachOutcomes
Quality of life measure
Based on best international practice
Proxy completion by three trained auditors
ProcessPartnership
Specification based on social need
Procurement procedures
Stakeholder perspectives
Residents by proxy
Parents/relatives
Staff
Trident ApproachOutcomes
Quality of life measure
Based on best international practice
Proxy completion by three trained auditors
ProcessPartnership
Specification based on social need
Procurement procedures
Stakeholder perspectives
Residents by proxy
Parents/relatives
Staff
Quality of Life Audit Tool
Seven domainsQuality and location of housing
Care planning and governance
Physical wellbeing
Social interaction and leisure activities
Autonomy and choice
Relationships
Psychological wellbeing
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
Results
Highly significant statistically .0001 level
• Overall quality of life
• All seven domains
• Ranking of domains
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% to 81%
Physical wellbeing 57% to 59%
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
An evaluation of the resettlement programme from Orchard Hill Hospital to supported living
Professor David Sines CBE
Lessons for the future
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.
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.
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’.
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.
Achievements
Orchard Hill Hospital and NHS Campus Homes
85 in total in supported living5 in specialised residential care (dementia)
5 in bespoke residential care+ other Local Authority placements
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%
Local Last 5 years Sutton’s net budget - reduced by 28%
Case study
GlynisAdmitted 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 livingMoved into new flat October 2008
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
Into the Community from Orchard Hill Hospital