CARE & TREATMENT REVIEWS Induction for expert advisors
Programme: • Background • What is the job to be done? Why? • Why are people with learning disabilities in hospitals? • Understanding challenging behaviour • What is care and treatment? • The care and treatment review process • Role and requirements of expert advisors • What does it intend to do and how? • Potential problems • Support
Who are the people whose care and treatment is being reviewed?
David • Lived with parents all his life • Stalwart of local community • Interests in steam trains – family trips • Sudden change in behaviour – ‘ not normal ’ • Police ‘ riot squad ’ • Parents cannot cope – hospital admission • Physical symptoms • Parathyroid tumour • Fixed but moves to live independently
Evan • 26 yrs old • Severe autism • Self-injury (banging head) since age of 5 • Abused in residential home • Now in hospital under mental health act • In isolation • Evidence of traumatic brain damage (2 ° to SIB)
Mary • Has lived in her own home for 10 years after 30 years of living in hospitals • Admitted to hospital because family could not cope with behaviour • Admitted because that was the ‘norm’ in those days • Rapid cycling bipolar disorder • Large amounts of medication • Is overjoyed to be able to be visited by her family at birthdays and Christmas • Would be traumatised by re-admission to hospital • Has a staff team who love and respect her and are determined that she should remain in her own home.
Six out of 11 care workers who admitted a total of 38 charges of neglect or abuse of patients at a private hospital have been jailed. Five other workers from Winterbourne View near Bristol were given suspended sentences after the acts of abuse were uncovered by BBC Panorama. BUT…
There is a long history of neglect, institutionalisation and abuse: • Ely Hospital 1968-9 • Longcare 1998 • Cornwall 2006 • Sutton and Merton 2007 and more ….
• The abuse of people in hospital care is appalling in itself AND ALSO: • People with learning disabilities should not be living in hospitals
What is the situation for people with LD in England? • 985,000 people with intellectual disabilities in England (2007 Centre for Disability Research, Lancaster University) • 132,300 adults with learning disability using services. (2008/9) • 10-15% present challenging behaviour • “ more demanding ” challenging behaviour is shown by 64% of people identified as showing challenging behaviour; • around 50% of people with “ more demanding ” challenging behaviour live with their families.
• 48% of patients mainly described as receiving learning disability services in mental health facilities in England and Wales had been detained under the Mental Health legislation on admission • In England, a reduction (24%) in the overall number of in- patients from 4,435 in 2006 to 3,376 in 2010. • Within that, the proportion of patients in independent sector provision rose from 21% to 32% and the number of independent sector providers increased (from 48 to 61).
The challenge now:
Why are people admitted to hospital? ENVIRONMENT
Challenging behaviour: Shift focus from individual to carers / environment / professionals Challenge to the system: • Better understanding • More effective responses • Creativity / flexibility • Less punitive / aversive responses SO THAT: • Behaviour will be less often – no longer have same function • OR • People are better able to cope with the behaviour
Challenge is to be accepting and at the same time creative and capable • find more creative responses and solutions • overturn traditional or longstanding responses • adopt counter-intuitive ideas • question the necessity for the established reputation and practice around the individual
Challenge is to be accepting and at the same time creative and capable • take managed risks • adopt a greater flexibility of roles and responsibilities • establish creative and unconventional working partnerships between individuals, community supports, voluntary and statutory agencies, professionals.
‘ Instead of responding to the person we typically react to the behaviour ’ ‘ Most of what passes as assessment seems to be denial about the mutuality of our common condition ’ Herb Lovett ‘ Our job is not to fix people, but to design effective environments ’ Rob Horner ‘ Difficult behaviours are messages which can tell us important things about a person and the quality of his or her life ’ David Pitonyak
What is Care and Treatment? (from Mental Health Act 2007) “medical treatment" includes nursing, psychological intervention and specialist mental health habilitation, rehabilitation and care This means medical treatment in its normal sense as well as the other forms of treatment mentioned. Psychological interventions include cognitive therapy, behaviour therapy and counselling.
What is Care and Treatment? (from Mental Health Act 2007 – Explanatory notes) "Habilitation" and "rehabilitation” describe the use of specialised services provided by professional staff, including nurses, psychologists, therapists and social workers, which are designed to improve or modify patients' physical and mental abilities and social functioning. This can include helping patients to learn to eat by themselves, to improve communication, or preparing them for a return to normal community living. The distinction between habilitation and rehabilitation depends in practice on the extent of patients' existing abilities "rehabilitation" is appropriate only where the patients are relearning skills or abilities they have had before.
What is Care and Treatment? (from Mental Health Act 2007 – Explanatory notes) “medical treatment” - the purpose of which is to alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations.
What does the Care and Treatment Review do? • Support the individual and their family to have a voice • Support professionals to work together with the person and their family to support discharge from hospital • Asks why the person needs to be in hospital, and if there are care and treatment needs why can these not be carried out in the community? • If the resources and support are not be in place to support someone’s discharge, then to make clear recommendations about what needs to be done to get to the point of a safe discharge.
Key Questions in the Care and Treatment Review? • Is it safe? • Is it effective? • Is their experience of the care good? • Why does this care and treatment have to continue in hospital? • Is the person and their family involved in decisions about care and treatment as equal partners ? • What needs to happen to support discharge into the local community?
Who is in the review team? • The CCG commissioner responsible for the individual’s community package of care and treatment ( or someone delegated by the commissioner with delegated authority on behalf of the commissioner) and where appropriate a local authority commissioner will also join the panel • An Expert by Experience • A Clinical Advisor (e.g. psychiatrist, psychologist)
What is the role of expert advisors? • To work as a team carrying out the review of an individual’s service • To contribute another view based on experience: professional and / or personal • To bring experience of working with others to support people who present behavioural challenges in the community and to avoid hospital admission • To improve communication with service users and families to understand better their views and experience • To promote Equality, Diversity and Human Rights
Carrying out a Care and Treatment Review • Regional teams will set up the review • Lead commissioner will contact the service user and their family • Review team will meet at the start of the day and plan how they are going to work • The commissioner leading the review will be responsible for making a record of the main findings and recommendations • The aim of the day is to have open and honest discussions and to support people to find solutions and unblock barriers to discharge
Recommend
More recommend
