Delivering Person Care in Secure Environments – a service development programme Debra Moore www.debramooreassociates.com debra@debramooreassociates.com 07950 333884 01723 371446

Debra Moore Associates Provide consultancy, service development, training. Team of managers and clinicians – experience in secure and community based provision. Specialise in promoting person centred health services Primary care to secure services

What do we mean by ‘being person centred’ Finding out from the person what is important from their perspective Acting on what is important to them Shifting power to the person Increasing choice and control OUTCOMES NOT BITS OF PAPER

Walking the talk Most people would say they deliver person centred care but the structures, tools and evidence are often absent Patients surveys and complaints often point to a lack of person centred care delivery Assessments and care planning processes (CPA) often confusing and inaccessible User involvement can be tokenistic It is not about paperwork its about concepts such as choice, power and control and ‘being human’ We can use tools and technologies to ‘set the conditions’ for person centred care to flourish and be nurtured

Why is this being ‘person centred’ so important?

High priority Central to government policy Across all care groups Across all settings Social Care Health Care Criminal Justice System CQC Commissioners - CQUINS

Person centredness – a ‘must do’ Person centred approaches - a process of continually listening and learning, focused on what is important to someone now and for the future, and acting upon this in alliance with their family and friends Valuing People 2001 Person-centredness i.e. meaningful user involvement in treatment processes and all aspects of service development Personality Disorder Capacity Plans DH & Home Office 2005 People are enabled to take control of their own healthcare. A different relationship – a partnership – is established health and social care professionals and service users and their families A Future Vision for Mental Health 2009

Institutional care – need to be vigilant People who are in congregate care settings are at high risk of institutional care delivery Abuses of power and excessive control over patients has been a key feature in many hospital ‘scandals’ Patients in secure services can be viewed as ‘less deserving’ ‘Elimination’ of risk rather than ‘risk management’ a key concern in some services ‘Security’ is often cited as a reason not to be ‘person centred’ Secure services are often ‘isolated’ ‘Good enough for me and mine?’ test

Positive reputation and identity Secure environments present few opportunities for service users to retain a sense of identity and contribution within society – a son, a brother, an employee, a neighbour etc A significant factor in re-offending is that offenders continue to see themselves as criminal - unable to shake off this identity People need to be engaged in their own care and treatment – increasing self care, resilience, hope and recovery

Not just for health services – application in CJS e. g Not just for health services – application in CJS e.g.‘circles of support’ Research – the strongest long-term indicator of a reduction/cease in criminal activity is the strength of family and parental ties. People who maintain relationships with family and friends are less likely to re-offend Almost everyone has someone who they want to maintain a relationship with.

Person centred planning is an ‘evolutionary step’, not a radical departure from the past Professor Eric Emerson

Accordingly, the first thoughts from staff about creating more person centred secure services ranged widely including…….

You’re having a laugh!

Person centredness - doesn’t apply here - cliches! You don’t know what these patients are like…they are different. It won’t work because they are too clever, manipulative, dangerous or not deserving. What do you mean …we need to involve patients in care planning and service delivery - it will be too risky! Our patients can tell us what they want and don’t need any ‘person centred tools’ to help them.

Most staff….. Sensible – took a balanced approach to increasing choice and control within the context of a secure setting Saw it as an opportunity to think ‘outside the box’

Delivering person centred secure services – DMA development programme© Delivery of training and support is bespoke to the service and design confirmed after discussion about needs and outcomes. Blended learning including e-learning. Based around 6C’s Confirm and Challenge Model & Self Assessment Tool Process maps the patient journey and examines the organisational setting conditions – action plan Includes the option to develop a bespoke software package that provides an electronic ‘patient journey’ and includes the tools and technologies to support person centred care (based on CPA and includes commissioning standards such as HCR-20) All this is underpinned by e-learning and repository of organisational policies, tools and research.

Outcomes Increased understanding of the concept of person centred care and creating and sustaining a person centred organisation - from the front room to board room Re-alignment of current planning processes such as CPA to increase user involvement and promote voice, choice and engagement. Development of clear care pathways Improve quality of care and standard of care delivery Increase patient satisfaction Meet commissioner and regulator standards in this area Software to support a person centred patient journey, evidence based practice and governance requirements

What does this mean? That we have an organisation that reflects person centred approaches in every: Interaction Care plan Organisational and clinical policy Training, development and induction programme Business plan Governance plan It is the GOLDEN THREAD

6’s Model – confirm & challenge 6 core outcomes for in-patient services Each outcome has a set of key principles to guide commissioning and service delivery and examples of the types of evidence for each principle