c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

The User Exchange: Transition Project:

Where swift action on failure’s lessons brings prom ise of success.

Whilst availability of user input and timeframes proved the User Exchange Project to be overambitious, lessons were captured for commissioners:

• Projects should be driven by unmet, user-expressed’ need • Users should lead and shape the design of the project • Expert advice should be made available to ensure accuracy of information published • Users should receive tangible benefits and products from engagement.

As part of the Project, the Director was made aware of the scale of distress that arises for parents of children who become young adults lack understanding around MCA/DoLS.

We were really shocked to be told we’ve no right to make decisions on behalf of our son. He has been dependent on us all his life. That hasn't stopped just because he is eighteen. He is still our son who we love very much but he still can't make decisions for himself" (Parent)

"It's offensive when professionals imply we might not be making decisions in our child's best interests. They might not say it but that's what they imply. We’ve always had her interests at heart, often at the expense of our own needs. I know that some people aren't great parents, I get that, but you've known us for years and you know we would always act in his best interests." (Parent)

Immediately heeding her own advice, the Project Director successfully petitioned the Board to fund the Transition Project to assist with the solution. The late-funded project was rapidly launched in September 2015. Parent-led throughout, its purpose is to ‘design, deliver and audit an online toolkit for parents of children with compromised mental capacity so that they receive timely information about their legal rights and can make sound arrangements for - and improve the quality of – the young person’s transition into adulthood.’

The project began with a single event for parents. Made aware of the legal facts around transition by an expert lawyer, the opportunity to create a web-based information tool for parents was offered.

At first, most parents at the workshop were wary contributors. On a one-to-one over lunch, one grandparent told us she had ‘nothing to say’ but after just a moment or two, she poured out her experience and concerns around her grandson’s transition.

Then, as an expert facilitator went from table to table informally speaking with people, group’ confidence grew and suddenly everyone was in free fall with their ideas and able to come together as a single creative group. The professionals sat at the back of the group, their body language revealing their intent to watch and listen - and holding back their own ideas.

Huge smile as Project Director welcomes parents to the first workshop to collect their experiences

c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

Significant information on these parent’s experiences and concerns was collected that afternoon and immediately welded into website materials ‘whilst still fresh in our minds’.

With a view to completing the website design by December, website’ proposals are being reviewed at two evening events with parents. Where attendance is not possible, to ensure the views of the full span of parents are incorporated, the coordinator (a nurse experienced nurse in transition, hospices and MCA/DoLS), will email and visit parents in their homes to collect further perspectives.

“To maximise the effectiveness of the tool, we need to do two things” recognised the Project Sponsor and Local SAB Chair, “Understand what the parents’ have said about their experience and be ready to respond and change the way they provide the service.”

The dual-use of the website and its materials was recognised early on by its Director. “Although designed in ‘plain English’ for parents, practitioners will inevitably be able to access the site. We expect it will provide valuable information for training staff on transition and assist them improve communication with parents.” Programme’ Staff Exchanges will be working in tandem to ensure local providers learn from, and are committed to, any ‘provider protocol’ that the parents devise.

With a national charity’s offer to host and keep the website updated in future, the longevity of the Project is secure - and the chance grasped to extend its reach to parents and professionals nationally.

The plan is to launch the website for parents January 2016 and draw up a communications plan, with an emphasis upon local parents, but with the full range of stakeholders in mind to ensure the widest reach. In April, the coordinator returns to review use of the website including access by health practitioners. The project will cost no more than £40,000 with Rainbows Hospice investing significant expertise, connections and facilities alongside.

“It was an unusual way to use the funding” reflects the Director of Nursing and Quality, Midlands and East “now has a sustainability that sits outside the life of this Programme, an application and use reaching beyond our area to all parents - and to all professionals in every sector which ensuring we meet the NHS’ safeguarding and transitions agenda, including the realisation of CAMHS transformation.”

The Director Leicester CCG will be providing the ongoing support and governance sponsoring on behalf of Leicester, Leicestershire and Lincolnshire.

For the full story and background review the MCA Im provement Programme Compendium (Chapter 2, User Exchange)

Staff watch on as parents take the lead.

Transition Project facilitator draws in parent views

c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

PROJECT CASE STUDY 2

Leicestershire & Rutland [L&R] Staff Exchange:

Where adaption of a forerunner provides a short-cut to success.

Modelled on the pre-existing Leicester City’ Staff Forum, local leaders were able to build upon the experience of their predecessor – and then shape three new Staff Exchanges exchange in line with local staff requirements.

“Two things in particular really helped with the launch” recalls the leader of the new L&R Exchange: “I learnt that, without a target audience, creating content to suit all the varying needs and expectations of audiences is impossible. And to begin with proven areas for interest for content that had been useful to City’s launch – and how to generate relevant topics beyond this.”

Drawing on her learning, the leader selected the target audience for the Staff Exchange: professionals who worked with the MCA and DOLS on a daily basis and who already had a clear and firm grasp of the basics of the Act. Decisions on content were also reached in discussion with Project Director (and City Forum lead) together with the operational DOLS Team Manager in Leicestershire County Council.

Promotion and marketing then made clear the topic and the target group requesting that the experience practitioner had at least completed a specified e-learning package prior to attendance. Events were advertised widely through existing internal and external networks across the agencies.

The first event in May featured a solicitor as guest speaker, well able to share up-to-date case law and best practice regarding DOLS. He stayed on to lend advice through a facilitated case study session, where issues reflected common practice dilemmas identified by the County’s DOLS Team Manager

“The event clarified many MCA & DOLS issues that providers have been asking our Team to support them with” explains a Compliance Manager from the County’s

Quality Improvement Team, “And I’ve been able to cascade this information and learning to officers within our team. They, in turn, have felt more confident to share and put learning into practice when supporting and advising service providers. This way we ensure that local policies and best practice follow law and that where necessary service users are protected under MCA & DOLS.”

Content for the June’ event was guided by May’s participants: A presentation on the impact of Fronto-temporal Lobe Dementia on mental capacity and best practice when undertaking capacity assessments with these patients. Case studies featured links between safeguarding, DOLS and best interest decisions relating to Article 8’ rights to privacy and family life.

Finding the presentation really helpful, a BIA AMHP from Leicestershire’s Deprivation of Liberty’ Team comments on how “I now keep these notes handy when I am doing capacity assessments for the DoLS team. They help me form relevant questions during my interview

The Project Director (right) shares advice on content with the lead of the new L&R Exchange

Expert legal advice and up-to-date case law

c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

to test the person’s capacity – and it helps me gather better, more specific evidence for my opinions”.

L&R events run on different days of the week and at different times, to enable the maximum number of professionals to attend. 86 attended the events so far. Response levels were high, demonstrating the interest in the topic, and the need for support for professionals.

Initial evaluation from delegates reflects that objectives were met. Of the seventy evaluations received, a third said they valued the networking experience, half said they would implement best practice, half said they had already shared knowledge and experience with fellow professionals, and two-thirds had helped shared priorities for future knowledge and learning & development events.

“The programme funded £70,000 for three of these successful initiatives until they are mainstreamed in 2017”, summarises the Project Sponsor “Funding that enabled the rapid roll out of a tested model of staff engagement about MCA / DOLS, supporting many frontline staff in a range of agencies to benefit from this approach quickly.”

Going forward, L&R and other staff exchanges will be extending their programme to draw in user and carer’ perspectives – the very least being addressing issues raised through the User Exchange‘s Transformation Project. They will continue prioritising guest speakers, case studies and topics for discussion as required by participants. They will also aim to attract graduates from the Programme’s other projects and more staff from partner agencies, particularly the Police, Ambulance Service and Leicestershire Partnership Trust. And, assess the longer-term benefits and impact of learning on practice.

“Many topics are not specific to Leicestershire and Rutland and so any Exchange developed could be opened up to professionals from other areas” says the L&R lead explaining that the benefits “could well be economies of scale and definitely enhancement of networking and relationship building across professionals across areas”.

For the full background and the story of the initia tion of the Leicester City’s Provider Forum, review the MCA Improvement Programme Compendium (Ch apter 2, Staff Exchange)

Delegates familiarise themselves with case-studies at L&R Exchange

L & R Attendance (May & June )

Leicestershire County Council: 46

Rutland County Council: 10

Leicestershire Partnership Trust: 10

Leicestershire Police: 1

Registered Providers: 12

Voluntary Sector: 8

L&R Safeguarding Adults Board: 1

A delegate suggests a future exchange topic.

c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

PROJECT CASE STUDY 3

The Best Interest Assessor Project: Where Situation denies Edict, Effort and Investment their Just Reward. One of the three CNO’ monitoring report conditions of funding was for “numbers of health professionals trained as Best Interest Assessors [BIAs] in 2014/15”. What to a layperson seemed a relatively simply directive, provide significantly more challenging in practice.

In many ways, delivering the BIA training project e pitomises many of the challenges that projects (and the whole Programme) faced: • Whilst the national initiative was understood - loc al information, interpretation and

understanding of the need had to be built across th e Area:

Initial expert advice to Board in October 2014 highlighted that a more significant need than funding BIA training, lay in addressing the range of workforce and practice issues around best interest meetings and the BIA process as a whole. The Board acknowledged the need, recognised that workforce issues were to be addressed in other MCA Programme’ projects1 and requested specific information be presented about BIA capacity.

• Whilst commitment to delivery was high, limited sen ior manager capacity and complex navigation across geography of three Author ities and culture of different agencies, stemmed progress on what was already time -pressured delivery

After the initial Project Director was unable to provide the capacity and focus to deliver, the Programme Manager took up the role and gathered a baseline sketch of existing BIA training need. Its purpose was to support (or dispel the need for) more BIAs locally.

Data collected varied across the three Authorities, making collation and analysis challenging within the short timeframe. It did, however, confirm the escalating backlog of assessments across the area, an increase that would be accelerated by the Cheshire West ruling (2014).

• Whilst funds were welcomed, their short-term nature and tight deadlines proved inadequate in significantly addressing locally ‘pre ferred’ solutions

Yet, whilst Authorities agreed that training BIAs would create a greater BIA pool and some flexibility, they concurred that numbers of Best Interest Assessors would not create any significant additional capacity - until other pressures within and without the system were addressed.

The information gather revealed a realm in which various ‘inhibitors’ existed within both health and social care sectors – each unmoveable within the short-term nature or non-recurrent funding provided by the Programme. Inhibitors that would remain to frustrate attempts at BIA recruitment initiative and limit any significant impact of more BIA (especially within health) were illustrated as being:

• Workforce pressures prohibiting release of and support to potential staff for BIA training, refreshers or even updates and to deliver assessments

• A lack of measures to retain trained BIAs within the service, directly employ (dedicated) BIAs and/or address the part-time nature of health BIAs

• A lack of signatories and signatory capacity or work across the board to improve the

quality of MCA/DoLs referrals, completion of assessment forms etc.

1 Staff Exchange, Leaders at all Levels and Targeted Professionals

c1609.4-Project Case Studies v4

c1609.4-Project Case Studies v4

• As a wide variation in the authorities’ situations excluded the pursuit of a single (and simple) ‘recruitment’ solution, synchronisatio n of three parallel sub-projects was demanded.

Conscious of the imperative to meet the CNO’s specific requirement for more health BIA’s, the Board asked each Authority to pursue efforts wherever possible. Working against the odds, by April, three local authorities shaped their own proposals: • Lincolnshire was to deliver 12 additional BIAs (and a further 6 retrained) with additional

signatories in place for Autumn 2015. • Leicestershire County and Rutland cautiously proposed to recruit 15 BIAs and ensure

the process of recruiting, training, assessing and supporting BIA development is strengthened through a dedicated BIA panel

• Leicester City proposed an innovative health BIA secondment health to the local authority (increasing the number of Best Interest Assessments undertaken in health whilst strengthening understanding and delivery around MCA/DOLS across partners).

The first two proposals received approval: delivery of twenty-five new BIAs, 6 refreshed BIAs, 4 signatories and an innovative BIA post-qualification panel to assure practice, marking and other support and shadowing – all for £45,000.

On the other hand, the City’s proposal faltered, pitted once more against Project inhibitors of limited staff capacity and short Programme’ time-frames in which to secure cross-agency commitments. Abandoned in August, farsighted Board members intervened in October. Recognising the potential value and effort invested in design, members set aside £20,000 for the innovation’s later delivery by City CCG in Winter 2015. And where seeming simple edict and complex situatio n deny effort and investment their true reward In spite the disproportionate time and effort invested by from Board and BIA Project Team members, the Project accomplished relatively little by way of meeting the CNO’s specific criteria for increasing the number of health BIA. Only thirteen of these BIA trainees (together with six retrained in Lincolnshire and four signatories) were from health. All but one health trainee was from Lincolnshire, where the Local Authority’s only contract for BIAs lies with the NHS Partnership Foundation Trust. Yet, the Project also exhibits the commitment of th ose involved to maximise funding available within the restrictions and timeframes pl aced upon them. More so, their determination to deliver the best in a joint, infor med manner, fair to and working with each local area according to need – sharing experti se, providing from their own resources and where necessary, encouraging creative solutions and innovation on route. . For the full story and the L&R BIA Story, review the MCA Improvement Programme Compendium (Chapter 2, BIA Project)

November 2015

Board agree to fund City’s innovative BIA secondment