83200 sitra bulletin no 2 2014 (3) by Sitra

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bulletin THE MAGAZINE FOR HOUSING WITH CARE, HEALTH AND SUPPORT

expertise, training & consultancy in housing with health, care & support

2014 â&#x20AC;&#x201C; NO.2

Real London Lives

BU Be Amazing

The Care Bill

Simply Empowering

Dementia Leaders

Change Makers www.sitra.org

Star Quality

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Contents 03 04

CEO’s Comment Real London Lives Mairéad Anne Carroll, Head of Policy and External Affairs for East Thames Group and project lead for Real London Lives discusses how the new g15 project is challenging and changing the assumptions made about people who live in affordable homes by collecting and sharing their stories.

Cover Story

Mayday’s BU Be Amazing goes international! Joanne Sharp from Mayday Trust describes how their innovative new project BU Be Amazing not only delivers excellent personalised results for young people but also saves money.

One page profiles: Simply empowering Helen Sanderson, CEO of Helen Sanderson Associates shares her pledge to create one thousand one page profiles for NHS change day and describes this will help improve our ability to understand what is important to someone and how best to support them.

Creating Dementia Leaders in the NHS

Change Makers

In the last bulletin, Sitra’s involvement in the intergenerational Schools Dementia Project was featured here Sitra Consultant Tim Parkin highlights a Dementia Leaders Programme which has been implemented for NHS staff in the South East.

Star Quality Joy MacKeith, co-Director of Triangle and co-author of the Outcomes Star suite of tools explains how Triangle plans to drive up the quality of services by offering recognition of Star users who meet essential quality standards.

First Response: A one stop shop for preventative services Bushra Baig Daykin from Redbridge describes how First Response helps to effectively coordinate all services through one access point.

Making change through technology Alison Rogan from Tunstall Healthcare celebrates the change makers who are delivering better outcomes through integrated technology-enabled innovation across housing, health and social care.

Sitra Training

Sitra Staff Chief Executive Vic Rayner Deputy Chief Executive Lisa Harrison Policy Officers Geoffrey Ferres Sue Baxter Policy and Research Co-ordinators Dani Cohen Burcu Borysik Business Development Manager Tim Parkin (interim)

Contracts Officers Anna Robertson Wendy Green Business Support Lana Lewis Sarah Pink (Maternity leave) Georgina Gorton Head of Finance & Central Services Berihu Mohammed Finance Officer Ray Naicker Finance Assistant Alison Quinn

Office Co-ordinator Gill Cotton Central Support Monica Antolin Interns Roselee Molloy Alice Cheatle Jordan Gerlack Apprentice Sharelle Hunte

If you would like to receive the bulletin in large print or in other accessible formats, email post@sitra.org

Contributors

Sitra Offices

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London 3rd Floor, 55 Bondway London SW8 1SJ Telephone: 020 7793 4710 Fax: 020 7793 4715 Birmingham BVSC, 138 Digbeth, Birmingham B5 6DR Telephone: 0121 678 8891 Email: geoffreyf@sitra.org Southampton Fairways House, Mount Pleasant Road, Southampton SO14 0QB Telephone: 023 8023 0307

Editorial To contact the editor please email burcub@sitra.org Thanks to our guest editor Jordan Gerlack on this issue.

Submissions and queries If you have any comments, queries or suggestions, a letter for publication or wish to submit a news story or article please contact us via one of the methods opposite.

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CEO’s Comment

changemakers 2014 As I write this copy, we are only a week away from our fantastic annual conference which will showcase the radical thinkers, and most critically doers that shape and influence the future of housing with health, care and support. It will be a great opportunity to hear from the change makers how far and fast things are moving in our sector- and I am delighted that Sitra are engaged and involved with many of these leaders. This Bulletin continues with theme of change and drills down into some of the key ways in which the paradigm continues to shift- particularly around the development of assets based approaches and coproduction. The term Advantaged Thinking may be a new one on many – but it is a term that works very effectively when applied to work with young people – and it has been embraced by Sitra member The Mayday Trust. It is another evidence for paradigm shifting. Mayday’s positive approach that explore their strengths rather than needs and harness their potential has received European recognition. In addition, it is great to hear positive examples of coproduction, with Sue Brown from Sense relaying their engagement with the drafting of the Care Bill and how positive steps were taken to ensure meaningful engagement. Great change often comes from great leaders – and this edition picks up on change through leadership under a number of themes. It is an opportunity to announce a new role for Sitra utilising a new partnership with The University of Worcester and the Housing LIN developing and delivering Dementia Leaders training. We are doing this to build on some exciting work we have been involved in around Dementia Leaders and Acute Health Settings. The success of that programme is related here, plus news of this new and exciting partnership. We hope to have more details of the first opportunity to take part in this exciting leadership programme in the very near future.

Vic Rayner Chief Executive Email: vicr@sitra.org

This edition is also a testament to how innovative service design and delivery tools can change individual’s lives. While the digital technologies by Tunstall Care transform the experience of individuals, Outcomes Star certification recognises the unique strength of organisations in measuring change. We are especially delighted to be working with Helen Sanderson Associates to bring leadership to the sector around the introduction of One Page Profiles, a wonderful tool for personalisation – much heralded in the health and social care sector – but new to housing – and we will be jointly launching a challenge to the sector at the conference. Be ready! Finally – as ever – we like to bring a bit of ‘myth busting’ to the Sitra Bulletin. Real London Lives is a comprehensive piece of research commissioned by the G15 housing associations to provide a more updated and accurate picture of who is living in social housing. It makes for interesting reading, and useful statistics to combat some of the more polarised perceptions of who is, and who should be residing in social housing. One more thing – don’t forget to check out our website for the latest position on supported housing costs. We continue our ongoing engagement with the DWP, DCLG and sector partners to ensure that the views of the sector are heard – and all updates relating to this will be shared as soon as they are available.

About Sitra Sitra is a membership organisation championing excellence in housing, support and care. Membership benefits include discounts on all services and events, access to free advice, an annual subscription to the bulletin and regular briefings on key policy developments in the sector. Sitra works with local and central government to ensure that the needs of its members are recognised, understood and met by resource providers. If you would like to join Sitra please contact the Membership Administrator on 020 7793 4710 and ask for an application form, or download one from www.sitra.org Content ©2013 SITR (Services) Ltd except where stated, All right reserved. All images © individual photographers & illustrators. Opinions expressed by individuals writers are not necessarily those of Sitra or the magazine’s Editorial Team. E&OE. Design: Aquatint BSC 020 8947 8571 www.aquatint.co.uk

Keep up to date with our Blog Keep up with developments and add to the debate at Sitra CEO’s blog at www.sitraceo.wordpress.com

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Real London Lives Mairéad Anne Carroll, Head of Policy and External Affairs for East Thames Group and project lead for Real London Lives discusses how the new g15 project is challenging and changing the assumptions made about people who live in affordable homes by collecting and sharing their stories. Housing one in ten Londoners, the g15, the group of largest housing associations in the capital, has set out to tell the stories of those living in affordable homes. Focussing on residents who are of working age, we want to start to challenge some of the myths that surround people living in affordable housing, taking the narrative away from the ‘striver versus the skiver’ by developing a real insight into our residents. What does it mean to live in affordable housing, who are our residents, how are they coping with the challenges in the external environment, what are their hopes?

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Through a unique project involving filmed case studies and independent research led by Dr Julie Rugg form the University of York, Real London Lives hopes to answer these questions.

as well. You can see her story and others on the Real London Lives website http://www.reallondonlives.co.uk/

The research Hearing from the one in ten A key part of our project is giving our residents a voice. We are inviting residents to tell their own stories though films that are available on our website. Fiona’s story shows the determination, despite setbacks, to get into work and be a positive role model not just to her own child but to others

In what is one of the largest surveys of residents living in affordable housing, we commissioned an independent survey company to carry out 1,648 telephone interviews covering the London boroughs in which we work. The survey asked 70 questions to get a comprehensive baseline of our are residents are. Questions ranged from the reasons people moved into affordable

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housing and how they feel about their communities, to the amount of hours they are working and how much they are being paid, to who is living with them and their caring responsibilities, to benefits received and levels of arrears. The idea is to understand our residents, their current circumstances, and to learn about their aspirations.

Our findings so far We are beginning to challenge some of the myths that have been perpetuated about residents living in affordable housing. They are not all single parents â&#x20AC;&#x201C; 32% are single person households, 24% are couples with and without children, 29% are single parents with dependent children, and 14% are all adult households. Nor are they all unemployed, the majority of our residents are in work, with most of our couple households being employed. For couples with dependent children our research shows that 82% are in work, whilst for couples without children 80% are in work. Despite the good news, our residents are facing a quiet storm of economic pressure. These include problems such as high inflation, increasing fuel bills, a range of welfare reform changes such as the benefit cap, council tax, increased sanctions, and reductions in housing benefit for those under occupying, as well as cuts to local support services. The cumulative affect means 1 in 4 of the residents involved in Real London Lives were already facing a constant struggle to keep up with bills. For those who had seen a reduction in their housing benefit since April 2013, this figure nearly doubled.

Nearly 1 in 4 are currently in arrears with their rent payments. Amongst housing benefit recipients, there was a greater likelihood of arrears if a household is receiving partial rather than full housing benefit, and where households had seen a fall in housing benefit since April 2013. Respondents whose housing benefit had fallen since the beginning of April 2013 comprised a significant proportion of each household type, including 30% of the all-adult households and 25% of all households containing dependent children. We asked our households why they thought their housing benefit had been reduced, with 38% stating the new rules on the social sector size criteria, 25% reported that it was due to the fall in the benefit cap, however 23% did not know why their housing benefit had decreased. Along with the quantitative survey we are also conducting 60 in-depth qualitative interviews with residents to understand their lives more accurately and in detail. even

more about their lives. The case studies will consist of a representative sample of the five most common households. â&#x20AC;&#x201C; two parent households with dependent children, lone parent households with dependent children, a range of all adult households, households with a member who either has a long-term sickness or disability and migrant Bengali and Somali households. Dr Julie Rugg and her team are currently speaking to residents. So far they have found that residents want to work, but a lack of flexible, affordable childcare creates barriers.

Next steps Our aim is to have the full quantitative report published by the end of March and the qualitative report out in June. We are also looking to film some more case studies over the next few months. We will keep updating our website and our twitter feed @reallondonlives so please follow us to find out more.

If you would like further information about the project, please visit the project website, www.reallondonlives.co.uk or write to RealLondonLives@gmail.com. You can follow MairĂŠad on twitter @MaireadAC.

Would you like to keep up to date with recent and forthcoming developments in the key areas of welfare benefits, housing and debt? Why not attend our Welfare Reform Update briefings? Contact Georgina Gorton at georginag@sitra.org or register online http://www.sitra.org/training/

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Mayday’s BU Be Amazing goes

international! Joanne Sharp from Mayday Trust describes how their innovative new project BU Be Amazing not only delivers excellent personalised results for young people but also saves money. Mayday Trust’s new Northampton youth project (BU Be Amazing) received a massive boost recently when it received worldwide recognition with the charity being selected to present it’s work at the annual international What’s Working for Young People 2014 Conference. What’s Working for Young People is an annual global conference which is taking place in Dublin on the 26-27 March 2014 and brings together some of the world’s leading experts in the field of adolescence. Each year the

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conference explores the most effective and innovative ways of working with young people,

examining policy, practice and research in relation to prevention and early intervention.

“

We are delighted that this project has been internationally recognised for its innovative nature. We have extensively researched what works for young people and are committed to providing a service that delivers particularly in light of the local authority cuts.

”

Pat McArdle, Mayday Trust’s Chief Executive

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Local charity Mayday Trust is proud to have been invited to speak about their innovative new youth project, BU Be Amazing at the conference this year. The project works closely with community organisation Blackthorn Good Neighbours, national charity In Control, the families and wider local community to support young people (clients) at risk from social or educational exclusion; offending; homelessness and/or substance misuse. By intervening early Mayday focuses on developing existing skills and talents, known as ‘personal assets’ to get clients learning, working, achieving and positively involved within society. Mayday’s BU Be Amazing stands out from other UK youth projects because of their new and exciting approach based on programmes that have been proven across the US to achieve excellent results. The initiative enables young people to create their own long-term, stable support network made up from family or guardians, members of the community and their peers. Mayday aims for each intervention to last approximately six months with a view to promote personal progression rather than on-going reliance. Mayday will work with up to 100 young people and their families in an area of Northampton which experiences high levels of deprivation. The aim will be to improve the life chances of young people in the area, raise their aspirations and give them some individual opportunities that they would not have access to usually. The project will assist young people to find their ’spark’ and help them build a positive network of support around them which will last long after they are in contact with the project. As part of the project and in collaboration with a University in the US, Mayday have developed an on line profiling tool which can be used to measure the growth in the young persons external and internal ‘assets’ (skills, abilities and

competences) The tool has been used with over four million young people in the US and demonstrates the correlation between increase in a young persons ‘assets’ and the move away from harmful behaviours. This is an exciting development for the new project and the first 30 participants have used the tool. The approach taken by the project is similar to the type of support offered to Olympic athletes, with high quality mentoring, and encouragement to set and reach aspirational targets using their own strengths and talents. To support this, a personal budget is available for each young person enabling flexible investment to build on their strengths.

A parent of one of the first young person’s to benefit from the BU Be Amazing pilot project, said:

“It’s not been long since my child started the Mayday Trust with Matt but I have already found a slight difference in her…She looks forward to going

Mayday are working closely with In Control to integrate personal budgets for young people as part of the project. This would give young people real choice and control in how they progress. Mayday is part of the In Control National Steering Group developing a Personal Budget Outcome Evaluation Tool (POET) which will be used to measure the young persons experience as well as their outcomes. In Control are working with groups of young people across the county to develop this tool, some from Blackthorn Good Neighbours Community Centre.

to school arrives home

The next stage of development for the project will be the Mayday App which a group of Mayday staff and young people are currently working on.

hope continuing this

BU Be Amazing has been developed to be available through a spot purchase model which means that it offers commissioners a real opportunity to deliver better results with less money.

on time. I feel as a whole family we have benefitted from it so far because my daughter doesn’t normally socialise with anyone except on a Saturday when she chooses to hang around town with the wrong people…I

will show her how to become independent and the right path to lead, becoming confident and believing in herself.”

Katie-Lee Percival, BU Be Amazing Manager said: “To speak alongside massively influential figures such as Karen J Pittman, former Director of the Crime Prevention Council who worked with President Clinton during his administration is fantastic and will really help raise the profile of our organisation. It has been an incredible opportunity to showcase how our ambitious plans and innovative approach will provide massive benefits for the people we work with and the wider community.”

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The Care Bill: Making it work better Sue Brown, Head of Public Policy at national deafblind charity Sense illustrates how the coproduced nature of the Care Bill will enable individuals not just get by, but to live full and active lives. In October a group of deafblind people came together to meet officials at the Department of Health working on the detail of assessments under the Care Bill. “I hope it’s going to make a lot of difference,” said one of the people attending. “I’ve said what I feel; assessments are the biggest thing as far as I’m concerned, and I think I’ve put my point across that assessments need to be done by people who have experience with people who are deafblind.” This way of working is important to Sense – giving deafblind people themselves a voice, putting those who make decisions in front of those who will be affected by them.

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The Bill represents a complete review of social care legislation, a process which began in 2010 with a Law Commission review of adult social care law. This made a range of recommendations to consolidate and simplify the law, which have been developed with the aim of improving and modernising the legislation, and establishing adult social care law based on personalisation. The Bill is now completing its passage through parliament, regulations and guidance will be consulted on in May and the Care Act will come into force in April next year. Hopes are high that it will make a big difference to the experience of people who need care and support.

Over recent years we have seen rising numbers of people needing support while budgets are cut. This has led to ever increasing eligibility thresholds in many authorities, so that people with lower levels of need are denied support. As a result their needs increase, and long term costs to social care or the NHS escalate. The Bill aims to ensure that people receive support at an earlier stage to avoid this, by giving local authorities a duty to provide services which will prevent or delay the development of needs for care and support. These will be universal services not subject to eligibility or financial assessments. There will also be a duty to provide universal information and advice on care and support,

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allowing people to plan and prepare for their future needs and those that pay for their own care and support to make better decisions. The first clause of the Bill defines the scope of social care as being to maximise well-being. This should make it clear that the focus of social care is not simply personal care, but a wider range of other factors such as involvement in work, education, ability to continue to the community. This should benefit people with learning disability and sensory loss whose needs are often not personal care. “As a deafblind person that is the most important part of my life that I get some social aspect within my daily life. And without the correct support, I’m unable to do my voluntary work, or to carry on living independently, and that’s a big thing for me.” Personalisation runs throughout the Bill. The starting point for assessment will be well-being and the outcomes the person wishes to achieve. The intention is to put the person much more firmly at the centre of the process, involved in both the assessment and development of the care plan. For some people there will also be a right to an advocate to ensure their involvement is possible. Carers will also have stronger rights to a carer’s assessment and for the first time, to support following that assessment. The quality of assessments is one issue that deafblind people have been raising through the process of change. The Law Commission were so convinced that the current situation is not adequate that they recommended assessment regulations contain a requirement for specialist assessment for deafblind people. This is what the officials were consulting on at the event in October. By meeting deafblind people in person officials were able to hear first hand the problems people face at present, to see the range of different communication support people were using, to really understand the importance of the regulations they were writing. This

One participant said: it’s really important that they have proper training, so that they work with the individual, so that they’re involved and engaged with the whole process rather than the process being done with them or to them.

“

engagement is something which the Department of Health have welcomed; their aim is to ‘coproduce’ the legislation, involving stakeholders at all stages. There is a lot of hope that the Bill will improve practice in social care, putting people who need support at the centre of the process. There is optimism that providing support at an earlier stage will both benefit the person concerned and also prevent the need for more expensive support at a later stage. However, there are two things which will affect this. Firstly, this is a lot of change for social services departments to implement. Most local authorities are already putting together plans for implementing the Bill and national support for this is being provided by the Department of Health, LGA and ADASS but no one is underestimating the size of the task.

”

Secondly, there are questions over whether the Bill can achieve its promise while the local authorities face ever increasing cuts. At times of austerity there is a tension between increasing numbers of people with eligible needs and the desire to intervene earlier and provide more universal services. It remains to be seen whether the promise of cost savings through integration, prevention and community approaches will be sufficient. Social care support is a basic essential for many people. Add to that their friends and family as well as those who work in social care, and a significant proportion of the population is affected by the quality of social care. Making it work better would be a very popular move. We must hope that the Government will have the courage to do just that.

It is not possible in an article of this length to go into all the areas the Bill will change such as transition from children’s to adults services, the lifetime cap on cost of care, market development, and a host of other issues. A series of factsheets on the Bill have been produced by the Department of Health. https://www.gov.uk/government/ publications/the-care-bill-factsheets Information in implementation can be found here. http://www.local.gov.uk/care-support-reform The Bill builds on the Draft Care & Support Bill published in July 2012 and takes account of the findings of the public consultation, engagement and pre-legislative scrutiny. It also considers the findings of the Dilnot Commission’s Report into the Funding for Care and Support and the Francis Inquiry into the failings at MidStaffordshire Hospital. Read the Sitra factsheet that summarises the main changes that the Bill brings to the heath, care and housing sector on http://www.sitra.org/documents/care-bill-2013/

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One page profiles:

Simply empowering Helen Sanderson, CEO of Helen Sanderson Associates shares her pledge to create one thousand one page profiles for NHS change day and describes this will help improve our ability to understand what is important to someone and how best to support them. For many years now we have been working with people who want to make positive changes in their lives, organisations and communities through personcentred practices, like one-page profiles. So when Helen Bevan, Chief Transformation Officer at the NHS Institute for Innovation suggested we make a pledge for NHS ChangeDay, to support 1000 staff and patients in the NHS to use one-page profiles, I said; of course! On reflection, it was quite an ambitious pledge to make. Not because it isn’t workable but because at the time we were just eight weeks away from NHS ChangeDay!

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So why did it feel like an important thing to do? Personalisation exists to increase choice and control in the lives of people, to shift from a service and system focussed culture, to a culture that is person-centred, supporting individuals in a way that makes sense to them. This matters in health, just as much as in social care. A one-page profile is a way to get started. A one-page profile is a single sheet of paper that records key information about a person under three headings; ‘What people appreciate about me’, ‘What is important to me’ and ‘how best to support me’. Its

power lies in its simplicity and its ability to empower individuals and communicate important information succinctly. All of this means that one-page profiles are now routinely used with people to share what matters to them and or as the first step towards personalising their support. OnePage Profiles are also used within organisations, with staff to match people well, improve team work, celebrate and recognise skills and gifts. One-page profiles are used throughout social care. They are used in schools, nurseries, universities, in hospices, care

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homes, to support people well in their own homes and now in a few hospitals. There are no limits to the ways that this can be applied nor who can benefit from it other than the limits we set upon ourselves. Knowing this, I felt I absolutely wanted to make this pledge - because by introducing the people working in and using health services to one-page profiles we have the opportunity to make a positive change to the work and care experienced by so many.

Why with patients? People using health services are placing themselves in the care of the NHS and trust in the service they will receive. For many, the experience will be good. For some, the experience will be less so. In all cases, we have learnt from our work in health that there are ways that we can make it better. For the last 12 month we’ve been working with Spiral Health’s Bispham Hospital to develop their patient-centred journey. Their aim has been to improve the customer experience for patients and their families and to support people as individuals – caring for the person not the condition. This journey has started with a one-page profile. All patients coming to the 40 bed rehabilitation unit are supported to create their own one-page profile, which is then put on a board above their bed, visible to everyone and added to as relationships and conversations develop throughout their stay. They provide essential, easy to read information about the person rather than the condition I’ve recently been in touch with Lynne Craven who approached me on twitter, interested in creating her own one-page profile. Lynne is a mother and partner – she loves spending time with her family, riding her bike, eating, socialising with friends and work. Lynne has lived with Multiple Sclerosis for 20 years and wanted to use a one-

page profile with her GP because she feels that it could help them work better together. She said: “Sadly my experience has been that health care professionals often see my condition and not me as a person. I was once told by my GP that her job was to keep me alive as long as possible. What an odd thing to say – isn’t that my job? Isn’t her job to help me live the life I choose – to ask me questions about who and what I am and collaboratively develop a plan that enables me to manage this condition well? I told my GP that I want to work in partnership with her and I am serious about that. My hope is that when she reads my one-page profile, she will understand me better and from there we can work together.”

for people. This is what I believe being patient-centred is. And this is what one-page profiles can help us to achieve.” As well as the team benefits and benefits to the way staff can support patients, creating onepage profiles with staff fulfils another very important objective. In order to support patients to use one-page profiles and to truly understand their value, we, as healthcare professionals must first learn to use them ourselves. Creating and using profiles amongst staff will assist us in using them with others, truly changing the health service experience for both patients and staff.

The future Why use one-page profiles with health care professionals? One-page profiles can be used with staff, to help build relationships amongst colleagues and people they support, by understanding what matters to each other. They can help improve communication in teams, and ensure that managers know how to support each team member well. Well supported staff, who feel valued, who feel that they are contributing to the learning of the organisation, who see that their gifts are appreciated are likely to, feel more motivated, stay around longer and have more positive and productive relationships with the people they work with and care for. Ward Sister Maria recently shared how she felt one-page profiles could be used in her hospital: “I would love to see staff have one-page profiles so that we could understand each other better but also so we could introduce ourselves properly to patients. ‘Nurses all look the same in blue’ – this is something I hear regularly from patients and visitors throughout healthcare and this is what I want to change. I want us to be people, treating and caring

This year’s NHS ChangeDay took place on 3 March. The aim was to encourage people to Pledge, Change, Do and Inspire so that the NHS can be the very best it can be. I’m excited by what we have achieved so far and the conversations that are developing from making our pledge. We have been contacted by Nurses, GPs, Therapist, Hospital Chaplains, Commissioners, patients, Hospital CEOs and Assistant Chief Nurses to develop their one-page profiles. We have shared a YouTube Video and App and 100 examples of how one-page profiles are currently being used from www.onepageprofiles. wordpress.com. The future of personalising health services depends on our ability to understand what is important to someone and how best to support them. One-page profiles can help us achieve this. An ambitious pledge? Yes. But one I am absolutely committed to. Sitra are pleased to announce our new collaboration with Helen Sanderson Associates to introduce one page profiles in housing. We will launch a new challenge at our conference, so watch this space!

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Creating Dementia Leaders in the NHS In the last bulletin, Sitra’s involvement in the intergenerational Schools Dementia Project was featured here Sitra Consultant Tim Parkin highlights a Dementia Leaders Programme which has been implemented for NHS staff in the South East. Responding to the increasing number of people with dementia is one of the major challenges of our time. The National Dementia Strategy, first published in 2009, was the first of its kind. This was subsequently reinforced by the Prime Minister’s Dementia Challenge, published in 2012, setting out the key priorities for improving the care and support of the estimated 670,000 people in England with dementia, a figure which is expected to double over the next thirty years. One area for action is improving the quality, experience and consistency of services provided by the NHS, particularly for those receiving treatment in acute hospitals. Acute hospitals are very busy and often overstretched and some struggle to create an environment conducive to meeting the needs of older people with dementia. The situation can be compounded if health care professionals lack knowledge and understanding of dementia and its affects. As surprising as it may seem many NHS staff have received little or no training in working with older

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people with dementia and their carers’. Developing the workforce is therefore seen as a crucial component of improving services for people with dementia. In order to address the issue in the South East, in 2012 the South Coast NHS Strategic Health Authority (now defunct following NHS reforms) allocated funding to run a dementia leaders programme targeted at NHS staff working in acute hospitals. The overarching aim of the programme was to create clinical leaders who could lead and stimulate improvement within their own hospital trust, by cascading learning and sharing knowledge through out the workforce. The Health & Social Care Partnership (now part of Sitra) was asked to manage the programme. The Association of Dementia Studies (ADS) based at the University of Worcester led by Professor Dawn Brooker, a renowned expert and leader in the field of person centred dementia care and support, delivered the training.

The success of the initial programme led to Sitra being commissioned to co-ordinate the organisation of three further programmes in 2013, all delivered by ADS, across a 3 Acute and/or community trusts in the South of England. Each programme lasted a total of eight days, taught in two day blocks. In total 77 health professionals undertook one of the four programmes, some of whom elected to undertake an extra assignment in order to gain an accredited module worth 20 university credits. Most participants were general nurses, but others taking part included occupational therapists and physiotherapists. Whilst the programmes were tailored to the specific cohort, they were all orientated towards increasing participant’s knowledge of dementia and ‘what good looks like’ in terms of standards of care. Participants undertook a self assessment of their organisation against the VIP framework that ADS has developed and undertook a project in an area of their

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This programme enabled me to gain an understanding of person centred approaches in caring for people with dementia and how this can be implemented within the acute hospital environment. The inclusion of people with dementia and carers in the programme, in particular, enabled me to gain insight into the needs of both the patient and the families/carers and to fully understand the importance of a partnership approach to care.

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choosing to make practical improvements in their work setting. Examples included improving the design and layout of a ward and introducing protocols for sharing person centred information. Each of the programmes was evaluated. For some there was the undoubted challenge of making the time available to attend the course and undertaking some work in between teaching blocks. Overall, the vast majority of participants felt that taking part had proved a positive learning experience and felt that they had greater confidence and knowledge to lead and stimulate further improvements. One positive side effect seems to have been that bringing together people who might not otherwise have met fostered better mutual understanding of roles and pressures, an important precursor to improved collaboration and joint working. This was the particular case in Oxfordshire where the

programme brought staff together from two large trusts who worked together to develop and pilot a patient passport for patients with dementia. The passport contains key information about the person, with the aim of improving the continuity of care and making it more person-centred.

There is still along way to go but with staff training like this and more and more hospitals signup to become Dementia Friendly, it is hoped that we will continue to see significant improvements in the care people living with dementia receive when they are in hospitals as both when admitted and as outpatients.

A selection of actions taken by delegates as a result of the course: l Dementia knowledge days organised for all staff who have high level of contact with dementia patients l Making changes to wards to make them dementia friendly l Actively working with and influencing the Dementia steering group and writing group and individual objectives l Incorporating Dementia as part of staff induction and exploring the idea of all newly qualified staff working on a dementia ward as part of their experience l Ensuring stakeholders and senior managers are on board with vision l Introduction of e-learning, hot topics, workshops for dementia champions and making dementia gateway e-learning mandatory in some areas l Enlisting Dementia volunteers and government funded apprentices to spend time with patients l Implementation of a Patient Passport which contains key information about the patient helping with person centred care and continuity across staff. Positively responding to the challenges of dementia is not the sole preserve of the health and social care system, however important. The majority of older people with dementia live in their own homes and the housing sector has a vital contribution to make in helping older people with dementia live well, whether they reside in specialist provision, such as sheltered housing and extra care, general needs housing, or are owner occupiers. Building on the success of the Dementia Leaders programme for the NHS, Sitra is now working in partnership with ADS and the Housing LIN to develop a programme tailored to a housing audience. With generous funding support from the Department of Communities and Local Government a pilot programme is being developed for strategic leaders in housing (covering both commissioners and providers) and one for scheme managers. The former will be a two and half day programme, whilst the one for scheme managers will last four days. Both programmes will run from a venue in Birmingham. As we go to press details are being finalised. If you are interested in finding out more with a view to registering your interest in attending one of the programmes, please contact Dani Cohen. danic@sitra.org

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Star Quality Joy MacKeith, co-Director of Triangle and co-author of the Outcomes Star suite of tools, explains how Triangle plans to drive up the quality of services by offering recognition of Star users who meet essential quality standards. When the Outcomes Star for homelessness was published in 2006 our aim was to make the tool available as widely as possible to enable as many organisations as possible to evidence and learn from their achievements. It quickly

became apparent that the model was applicable in other fields too, including mental health, vulnerable families, back to work projects and the management of chronic health conditions so a single tool became an ever growing suite of Stars â&#x20AC;&#x201C; now

twenty and counting â&#x20AC;&#x201C; in use all over the world (See Box 1). We took the same approach with these new Stars too, making them freely available to download from the Outcomes Star website. Our view at that time was that these were clear and intuitive tools and that our role was simply to make them widely available. Over time, two things have become clear: 1. The benefits of using the Star are much greater than we understood then. In addition to providing nuanced outcomes information, the Stars make new conversations possible, give service users new hope, respect and self-belief and enable keyworkers to work in a more consistent, holistic, person centred and outcomes oriented way. 2. Using the tool well and getting the most from it requires training for key-workers to use the tool skilfully with their clients, consistent management support and integration with IT systems.

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Without this, many of the benefits are lost. Initially this learning came through our own experience of supporting implementation and feedback from users. Now these findings have also been confirmed by two recent independent evaluations. York Consulting evaluated Family Action’s implementation of the Family Star. Their report1, published earlier this year, concluded that: “… Family Star data can be used as a valuable interim indicator of distance travelled towards achieving longer term outcomes and impact” (evaluation overview) and that “… the Star helped develop service user resilience and helped workers reflect on their practice, particularly in terms of improving outcomes” (page 6) It also pointed out that: “In order to use the Family Star effectively, it has to be integrated and embedded within an organisation’s work processes”. And “….in order to use the Star effectively, staff need to have the skills and knowledge to support having ‘difficult conversations’ with service users” (evaluation overview)

Without training, one common problem can be that staff may not complete the Star collaboratively with service users. This means the scores do not reflect the knowledge and experience of both parties and the process does not build a shared perspective on the issues and the actions needed. Other problems include not making reference to the Star scales, not analysing the data or inconsistent completion leading to unreliable data. The Australian academics conclude similarly that: “……the Star provides a unique innovation in human service delivery because it attempts to equally occupy the areas of ‘practice’ and ‘accountability’….. but if implemented poorly [the Star] risks further entrenching bad practice while not capturing adequately the gains made by clients with complex needs” (page 17) To support quality, Triangle will soon be recognising projects that have received training and have a means of analysing their Star data through the Star Online or another approved 1

system as “Recognised Star Users” on the Outcomes Star website (see Box 2). This will enable them to demonstrate to commissioners and other stakeholders that they have met the minimum required standards for using the Star. At the same time, the Stars themselves are no longer available to download without training and a license (the Outcomes Star for homelessness is an exception). The intention is to drive up standards by enabling organisations that have invested in their staff and systems to use the Star well to distinguish themselves from those who have not. The move has been welcomed by organisations such as St Mungos and Family Action who have led the field in their implementation of the Star and use of data for management and service improvement. We hope that it will lead to a much fuller understanding on the part of commissioners and service providers alike of both the benefits of using the Star and the commitment and investment that are required to realise them

“Family Star Evaluation: Summary Report” by York Consulting, Published by Family Action, London, April 2013. “Implementing the Outcomes Star well in a multi-disciplinary environment” by Dr Lisa Harris and Dr Sharon Andrews, RMIT University, published by the Salvation Army, Crisis Service Network, Victoria, Australia, 2013.

Another study2 by two Australian academics identifies twenty benefits of implementation including “a common approach to case management which is ‘whole person’ and client centred” and “an opportunity (for clients) to understand their journey in a holistic way, beyond their presenting need” (page 2). They also are at pains to stress that achieving all these benefits requires a culture change exercise and that

Box 1

“Successful implementation means that the Outcomes Star is embedded in all levels of the organisation: in client to worker interactions, in assessment and programme documentation, in the direct practice supervision protocols between line-managers and workers, in the organisation’s internal data analysis, and even in program and line-manager’s work plans” (page 19)

Box 2

Star Statistics l There are now 20 versions of the Outcomes Star including the Mental Health Recovery Star, Family Star, Older Person’s Star, Young Person’s Star, Alcohol and Drug Star, Well-being Star (for people managing chronic health conditions) and Work Star. l Triangle has partnerships with organisations in Australia, New Zealand, Canada, USA, France, Italy and Denmark to train and support the use of the Star. l Over 25,000 people have registered on the Outcomes Star website to access the Star tools

Recognised Star Users will: l Have trained all front-line workers using the Star with service users l Be using the Star Online or another approved system for recording and analysing the data l Be able to evidence their quality use of the Star to commissioners and other stakeholders through including the Recognised Star User logo on their project materials

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Bushra Baig Daykin from Redbridge describes how First Response helps to effectively coordinate all services through one access point

The Redbridge First Response Service (ReFRS) is a unique, innovative, multi-agency partnership model in London Borough of Redbridge. It has a strong voluntary sector presence and was developed through consultation and on-going engagement with partners and service users. ReFRS is designed to champion the cause for co-ordinated and effective services for vulnerable adults which lead to shared outcomes across the sectors. The need identified across voluntary sector partners and front line teams was to support service users in a holistic and coordinated way and create an infrastructure where people were able to get the resources they require with a focus on prevention. ReFRS is the first of its kind within the London Boroughs. It bridges the gap between the sectors to ensure that each service user has easy access to an array of identified, lowlevel preventative services. ReFRS has the potential to change the service user’s (SU) quality of life for the better by enabling and empowering them to lead a safe and independent life in the community. ReFRS sets a standard of good practice amongst agencies that ensures that there is effective co-

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ordination of all services through one single access point. There are 22 identified preventative support sections in one simple checklist these include drug/alcohol support, employment support, domestic abuse and various other sections. Once a ReFRS checklist is completed by a staff member with a SU and returned a designated team member will then effectively and efficiently co-ordinate the referral to ensure that each area of need is met with a guaranteed response by each of the agencies that the referral is sent to, only then is the loop of referral closed. ReFRS cuts across sectors by working in partnership with known and trusted organisations. Currently we have thirty five partners including London Fire Brigade, Metropolitan Police Service, Age UK, Redbridge Council for Voluntary Services (RCVS), SHP (Single Homeless Persons), Payments and Benefits team, Leisure and other partners. Our partnership has developed a ‘Warning Signs Tool Kit which ensures that front line workers from any sector are trained to identify significant area(s) of support needed to personalise support for SU’s. The

a holistic and coordinated way to get the resources people require with a focus on prevention.

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toolkit ensures that referrals are being made effectively to the relevant and specialist agency for the appropriate support required.

This toolkit was contributed to and agreed by all of our main partners. The following specific services are to name a few offered via ReFRS l Fire safety check/ fire alarms l Falls Prevention advice, this has a direct impact on supporting the SU to remain for as long as possible within their own home. Falls are amongst the most common reasons for long term hospital admission among elderly patients. l Debt management l Housing Repairs to assist with minor repairs l Employment related support to help those who wish to get back in to or sustain their employment l Volunteering opportunities increased mental wellbeing, reduced isolation and gaining skills that may be beneficial for employment. A volunteer qualification is also offered. l Advice and support for carers/ young carers l Domestic Abuse support l Drug and Alcohol support l Mental Health support l Crime prevention advice

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Sitra’s consultancy solutions Sitra consultancy has been providing tailored an affordable support to organisations of all sizes for the past 30 years. We are recognised across the sector as the organisation to call upon when advice and support, information and guidance are needed. Our Practice and Policy team provides a wide range of expertise to deliver your in-house consultancy. They are supported by our national pool of Associates, who bring additional specialisms and capacity to our work. Our experience and expertise are extensive and span the fields of housing related support, housing management, care provision and health and social care integration. Recent consultancy projects

Developing personalised services to offer more choice and control to clients • Personalisation: Welfare reform: Guidance emerging policies and change management • Exempt accommodation: onEligibility and HCA registrations • Housing law: Advice around emergingadvice local and national agendas and initiatives • Housing management: Tenancy and licence agreements • Policies and procedures: Review of policy portfolio or ensuring compliance with regulatory and legislative frameworks • Demonstrating your worth: Case studies, Cap Gemini cost-benefit analysis and SROI • Commissioning and procurement: Guidance on best practice and innovative commissioning • Tendering: Support to providers when compiling tenders and acting friend • Quality Assessment Framework (QAF): Helping you with all aspectsasina critical improving quality • Research into integration of health, social care and housing •

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Making change through

technology Alison Rogan from Tunstall Healthcare celebrates the change makers who are delivering better outcomes through integrated technology-enabled innovation across housing, health and social care. Under pressure Pressure: we all read about it, hear about it – feel it. It might be meeting the challenges of our ageing population, including the rising number of people living with dementia. It might be satisfying the increasing demands being made on our housing, health and care systems, the relentless need to make savings, or a blend of all of the above. Indeed, as highlighted by the upcoming Sitra conference, aptly titled ‘Change Makers’, it is clear that, when it comes to the way we deliver housing, care and support, it can no longer be the same old, same old. Thus, set in a context of unprecedented pressures, how can we deliver change that improves outcomes, and how can we do it in a more integrated and costeffective way?

New challenges, new opportunities Towards the end of last year, the Chartered Institute of Housing (CIH) and Tunstall Healthcare published a report entitled Delivering housing, health and care outcomes. The report was based on several high-level summits that brought together housing, health and social care leaders to debate the opportunities and challenges facing the sectors. We examined how we can enable the delivery of health and care services either in or

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close to people’s homes, as well as managing risk through technologyenabled support services. We also explored how housing offers to local GPs and Clinical Commissioning Groups can be best tailored to meet local needs across a wide range of services, including supported housing, housing improvements, adaptations, palliative home care and assistive technologies. The general thrust of our discussions was how, together, we can make the best of the challenges and opportunities we face, with a specific focus on our ageing population.

Radical shift There was a call for a radical shift in thinking and working practices and to this end CIH developed an outcomes framework with the Housing Learning Improvement Network (LIN), called Developing your local housing offer for health and care , which was launched during the summits, to help housing professionals demonstrate their value.

of raising awareness. For example, Carers UK commissioned YouGov to examine public attitudes to using technology to support caring for older and disabled people. Here, polling indicated the barrier to using care technology is often a lack of knowledge, advice and information, rather than a resistance to technology. Telecare, the use of monitors, sensors and alarms in and around the home to maximise independence and minimise risks, is one of the most established care technologies. Yet when participants of the YouGov poll were asked if they would use telecare without a description of what telecare is, just over 1 in 8 UK adults said they would, with 80% saying that they were not sure what telecare is. However, when telecare was described to respondents, those saying they would use it to help them if they were caring rose to almost 8 in 10 (79%), so long as it was affordable. This was even higher amongst over 65s (85%), and only 5% of UK adults said they definitely would not consider using it.

Harnessing technology There is no doubt that technology can help drive better outcomes across housing, health and social care. Yet, to achieve the best outcomes, technology-based solutions must be integrated into systems and redesigned pathways. There is also the issue

Case studies Within the Delivering housing, health and care outcomes2 report are five different case studies that demonstrate how real innovation and transformation can be achieved.

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Domini Gunn, CIH Director of Health and Wellbeing, who chaired the summits, commented: “For health and social care the critical challenge is to keep people well at home and, where possible, care for them at home in times of illness. For people with long-term health conditions, including rapidly rising numbers of people with dementia, the management of personal treatment and care in the home is the preferred (and only economically sustainable) model.”

The report and case studies were supplemented by an inspiring series of blogs by the summits’ key speakers.3

enabled so Tunstall’s latest solutions (which include myworld, a brand new tablet-based solution to enhance independence) can benefit people right across the site.

Herefordshire Housing

Indeed, technology-enabled solutions such as those at Henffordd Gardens not only aid the integration of housing with health and care, but they also support the social and digital inclusion of residents and benefit their overall wellbeing.

Most recently, Tunstall has been working in partnership with Herefordshire Housing, within its new Henffordd Gardens4 scheme, providing integrated telecare and telehealth support for people living with dementia. Henffordd Gardens is one of the most advanced schemes in the country, evidencing Herefordshire Housing’s vision to be a leading provider of housing with care. Henffordd Gardens is fully Wi-Fi

So, here’s to the change makers. They are the innovators envisaging a better future, with better outcomes, empowering people to lead better lives – and they are the ones taking steps towards making it real.

References 1 ‘Developing your local housing offer for health and care’, CIH, 26.06.2013 retrieved online http://bit.ly/CIHreport1 2 Delivering housing, health and care outcomes, Tunstall and CIH, 02.2013, retrieved online http://bit.ly/Tunstall-Feb13 3 ‘Delivering housing, health and care outcomes, Tunstall blog, http://blog.tunstall.com/tag/delivering-housing-health-and-care-outcomes/ 4 ‘We now have a golden opportunity to work together’, CIH, 10.09.2013, retrieve online http://bit.ly/CIH-10Sep 5 Henfford Gardens, http://bit.ly/henfford

The case studies include: l One Housing Group, focusing on turning hospital beds into housing-based solutions for health and social care l Riverside Home Group’s use of assistive technology and the redesign of its support services l Gentoo’s development of Gentoo Living to grow its community support work, allowing it to innovate and develop services that have been challenged l Birmingham City Council, illustrating how telecare is an integral part of their programme to address the rising demand for personal care services l Leeds City Council’s exploration of the concept of ‘living labs’ and the innovative new assistive technology hub

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Sitra Training Safeguarding disabled children

Mental health at older age

2nd April in Southampton

24th April in Southampton

This course has been introduced following the 2013 Ofsted report ‘Protecting Disabled Children – Thematic Inspection’. It is aimed at frontline staff and managers who need to be aware of the main issues surrounding safeguarding disabled children. The course objectives are: • To increase awareness of the nature, scale and impact of the abuse of children with physical and learning disabilities and of what makes disabled children particularly vulnerable to abuse • To be aware of and identify signs and signals of abuse as they may present in disabled children • To be sensitive to the challenges that caring for and supporting disabled children brings • To understand staff responsibilities to identify and report abuse and to be aware of statutory and organisational policies and procedures • To recognise and challenge the barriers to reporting abuse • To be aware of the good practice in the recording and sharing of information regarding safeguarding issues • To develop safe working practices when caring for or supporting children with learning and physical disabilities and to reflect on current practice

This course is designed for those who are providing care for older people in both residential or community settings. The course discusses the common kinds of psychiatric illness facing older people. It helps participants develop a deeper understanding into illnesses such as schizophrenia, paranoid states and depression. It discusses common psychotic symptoms such as delusions and hallucinations, and how to respond to them. It also lists some treatments and professionals able to help older people with the above disorders. By the end of the course participants will be able to: • Discuss their understanding of what constitutes mental health and wellbeing • Identify factors which can promote or undermine mental health as we age, which relate specifically to dementia and depression • Discuss less common psychotic illnesses, such as schizophrenia, and psychotic symptoms, delusions and hallucinations. Plus helpful interventions for clients with these conditions • List some ways in which staff can help older clients to maintain mental wellbeing

4th April in London and 10th April in Southampton

9th April in London

This course is suitable for new and experienced managers of services; service commissioners and frontline staff who wish to develop a specialism in the area of marketing housing care and support services. This course will look at: • Identifying who are your key stakeholders and what type of information is compelling to them • How to present different forms of evidence to support your messages • Using a range of methods to publicise services – from events to Youtube • Producing a marketing/publicity strategy

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Prices New prices with increased discount for members: Half-day: Sitra members £55/Non-members £89 One-day: Sitra members £89/Non-members £149 For a full list of forthcoming courses please visit our website

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Marketing your service

Supported housing and the law The Legal Framework supported housing operates has seen significant changes recently. The Localism Act has seen changes in security of tenure and homelessness duties, the Equalities Act has clarified the law relating to eviction and disability. The Anti Social Behaviour, Crime and Policing Bill is making its way through the parliamentary process. This one day course is essential for those who work with vulnerable people and want to keep up to date with legal developments. This course will cover: • The current legal framework for housing provision • When housing provider activities may be seen as public functions • Ensuring that decisions made are lawful and proportionate • How vulnerability, disability and age impacts on tenure decisions

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Courses suitable for new workers suitable as part of an induction programme Courses suitable for frontline staff, also suitable as refresher courses for managers Courses suitable for new managers or frontline staff moving into management Courses suitable for experienced and senior managers Courses suitable for local authority commissioning and monitoring staff