Care Bill [Lords]

Written evidence submitted from Craegmoor (CB 32)


· Craegmoor is the UK’s leading independent provider of support for people with learning disabilities, autism, complex needs, mental health problems as well as those with behaviours that challenge

· The Care Bill has a crucial role in ensuring that the health and care system addresses recent, high-profile failings. As part of the focus on protecting the most vulnerable in society from poor quality care, it is vital that the Bill gives greater priority to supporting people with learning disabilities and challenging behaviours

· To achieve this aim, Craegmoor has identified the following areas where, in our view, the current proposals can be strengthened to better support those people with complex needs to lead safe and independent lives:

- Prioritisation: Ensure local commissioners are focused on driving the same standards of high quality care for learning disabilities services as those being advocated to NHS services

- Quality and transparency: Promote more effective monitoring and quality reporting for learning disability services, similar to that being adopted across NHS services

- Regulation: Ensure the levels of regulatory scrutiny are applied consistently across all learning disability care providers throughout the market

- Fragmentation: Greater clarity on how the Bill will support people with learning disabilities to access the wide range of interventions required to meet their complex and evolving care needs

Craegmoor welcome the opportunity to submit written evidence to the Public Bill Committee considering the Care Bill to ensure that the legislation fully caters for the needs of all those adults requiring access to high quality care and support services, including those with learning disabilities.

This document sets out our views on how the Bill can support the protection of the most vulnerable people using health and social care services. It also includes an overview of the processes in place at Craegmoor, and throughout the Priory Group, to support the delivery of high quality services and provide greater openness about the standards of care we are providing.

Ensuring the Care Bill delivers for adults with learning disabilities

Craegmoor fully supports the aim of the Care Bill to bring together existing care and support legislation into a single framework to establish an adult social care system geared towards people’s wellbeing and reforms the funding system for care and support. This includes important reforms for regulating healthcare providers in response to the recommendations of the Francis Inquiry following the failings at Mid-Staffordshire Foundation Trust.

However, it is important that those provisions primarily geared towards secondary care services are balanced with robust measures aimed at protecting vulnerable adults in residential and educational

care settings. These must also underpin the commissioning of the full range of services and support which will enable those with life-long care needs to lead safe and independent lives.

This legislation has a vital role in tackling the different aspects and underlying causes of poor quality adult care and support services such as poor organisational leadership, staff training and audit processes, highlighted as key findings in the Serious Case Review of Winterbourne View.

Recommendation: The Bill must support the implementation of the key tenets of the Transforming Care programme which aims to transform services for people with complex and challenging needs and behaviours.

Oversight and regulation

Craegmoor welcomes moves to give the Care Quality Commission (CQC) greater operational independence, as well as establishing a more specialist approach to inspections. We believe that a more tailored regulatory processes should provide more insightful information on the quality of care delivered by providers and make it easier for commissioners to benchmark services.

In order for the new regulatory regime to operate effectively there needs to be steps taken to define what constitutes high quality care, including what effective safeguarding looks like. The new regulatory framework must evidence-based and proportionate in the way it is applied to providers. It will be important the public, independent and voluntary sectors are monitored and inspected to the same level to maintain consistency across the market.

In its current form, the Care Bill includes the creation of a new legal framework designed to ensure that key organisations and individuals with responsibilities for adult safeguarding can agree on how they must work together and what roles they must play to keep adults at risk safe.

Practically, the Bill requires local authorities to set up a Safeguarding Adults Board (SAB) in their area, giving these bodies a clear basis in law for the first time. At present, SABs must include representation from the local authority, the NHS and the police, develop shared plans for safeguarding and report to the public annually on their progress.

Recommendation: The Bill should look to strengthen the contribution and insights local providers can offer in supporting SABs to discharge their statutory functions. Clear and effective dialogue between commissioners and providers, as well as regulatory and other agencies, is key to helping to mitigate the risk of abuse or neglect of service users.

 Focus on high quality care and transparency

Craegmoor is focused on operating market-leading practices, through care quality processes and governance arrangements, and looking at new ways of delivering services more effectively.

We aim to improve on best practice standards by listening to our service users and being open and transparent about the performance of our services. By putting our users first and by understanding people better, we can offer tailored care and support packages and improve what we do. As part of this commitment, we have developed the first annual Quality Account for Craegmoor services. The findings from the Craegmoor Quality Account for 2012-13 are shown below.

Learning disability services:

· 98% of service users have a current assessment of their needs

· 98% of service users have a named key worker

Autism services:

· 100% of service users have a named key worker

· 94% of service users are engaged in activities in the local community

Mental health services:

· 98% of support plans include personalised, outcome driven goals

· 90% of service users have a named key worker

Improving monitoring and quality reporting in the adult care and support sector should be an important mechanism for driving better standards of care.

Recommendation: The Bill should give consideration to expanding the use of Quality Accounts by public, independent and voluntary care providers. This would give greater disclosure to patients, commissioners and regulators about the quality of the care delivered by individual providers, enable easier benchmarking of services and make informed decisions about accessing, procuring and scrutinising services.

Service integration

For vulnerable individuals with complex and evolving care and support needs, timely referral to appropriate services is vital to ensure that they receive an appropriate package of care in a timely way. Integrated care and support needs to be continuous and coordinated with services tailored to the needs and preferences of the individual, their carer and family. This approach means moving away from episodic care to a more holistic view of health, care and support needs which involves primary care, community health, social care, the acute sector and wider partners.

Crucially, the Care Bill gives local councils a duty to promote integrated services which provides them with the opportunity to develop more localised solutions which enable more joined-up care. Providers can offer important operational experience and detailed understanding of user and patient needs to assist commissioners in the designing and development of new or existing services.

Craegmoor works in partnership with our service users and their families, as well as commissioners, regulators and other stakeholders, to provide the best possible outcomes at every stage of an individual’s care pathway. From our experience, the willingness of NHS and local authority commissioners to engage with providers of frontline services has been mixed, and the Bill presents an opportunity to develop this further.

Recommendation: The Bill should ensure that health and wellbeing boards, in discharging their statutory functions for integrating care in local areas, are actively engaging with care providers to ensure that services are meeting the needs of local patients.

Case studies

By providing a seamless transition for our service users as they progress between higher and lower dependency services, we ensure continuity of care that underpins the delivery of successful outcomes.

Our integrated approach to treatment supports service users’ progression by providing sustainable placements and, where appropriate, the opportunity to move back into a community setting. This means that service users within Craegmoor can benefit from rapid access to acute and complex mental healthcare services within Priory Healthcare, as well as specialist educational facilities within our education services. Our older service users can also receive specialist care to meet their changing needs within our Amore Care division.

We have included below a series of case studies to give an overview of how the different types of personal services we deliver are helping those accessing our services to achieve positive outcomes:

Case study A:

· Neil has been in services for the last 20 years and has made the transition through our integrated care pathway – through secure services, nursing care, rehabilitation and now supported living

· He started with a high package with visits most days, but for the last two years he decided that he wanted an on-call package that was tailored to suit his support needs better. Neil now has a 24/7 on-call package, with 6 hours per week face-to-face support built in if he chooses to use them

· Neil has become more independent and adapted well to community life. He is now the volunteer leader for local projects, working alongside the council teams and community leaders on local projects

Case study B:

· Shay has made the transition through from nursing/rehabilitation into supported living

· He has a tailored support plan that is built around the support needs that he identified himself in relation to managing his finances and budgeting.

· Since his admission in January 2013, he has already had one reduction in support hours

· Over the last two months, Shay has progressed from collecting his monies from the registered office twice a week, to opening his own bank account and having an amount transferred to him each week

Case study C:

· Nicolas has lived in Craegmoor accommodation for almost a decade after 60 years living in different residential settings, including long-stay institutions

· In March 2010, we supported Nicolas to move out of central accommodation and into his own nearby flat, including help from his designated care manager to secure a mortgage from a specialist provider

· He continues to receive regular support throughout the day with daily tasks and remains in close contact with many of the friends he made when he was living in central accommodation

About Craegmoor

Craegmoor, part of the Priory Group of Companies, is the country’s leading independent provider of support for people with learning disabilities, autism, complex needs, mental health problems as well as those with behaviours that challenge. The breadth and depth of our range of services means that we are able to provide flexible, evidence-based care, which is personalised to meet the needs and preferences of the individual.

January 2014

Prepared 5th February 2014