HQIP Case Study: Brandon Trust Quality improvement in social care

HQIP Case Study:Brandon TrustQuality improvement in social careBrandon Trust is a UK charity working throughout the South West of England,supporting approximately 1500 people with learning disabilities to live the lives theychoose. It employs nearly 2000 people and its services include Supported Living,Education, Work, Learning & Leisure, plus various types of registered ResidentialServices. Brandon Trust prides itself on centring on the needs of individuals and seesthis as being at the core of what it means to be a high quality service.ORGANISATIONAssuring qualityAREA TEAMSupporting qualityLOCALITY MANAGERDeveloping servicesreflecting local needsCARE WORKERUsing Plan for LifeINDIVIDUALBEINGSUPPORTEDDeveloping the framework and audit toolBrandon Trust has adopted three inter-linked approaches to improving quality, each designed to focus its work as closely aspossible on the people it supports. These inter-linked approaches have involved: Developing tool s for care workers to supportprovision of a more Find personalised out more: service; www.brandontrust.org.ukdeveloping the structure of the organisation to be more locally focused; and developingan audit process that assures and promotes the quality of services.

Developing tools to support a morepersonalised serviceBrandon Trust believes that quality starts atthe relationship between the individual andthe person supporting them – they need towork together to understand what someonewants and needs and provide services for thatperson accordingly. To help achieve this, theorganisation has developed the ‘Plan for Life’;this is the essential planning document for allclients.The tool enables staff to take people througha guided discussion that starts with theoutcomes that they want and helps themthink through how they want to be supportedto achieve them. It also includes a morefunctional assessment looking at their health,nutrition and other support needs and howthey want them to be met. The Plan for Lifeis reviewed with the person being supported6 monthly to yearly depending on theindividual.Designing the structure of theorganisation to support qualityThe structure of the organisation is built upfrom the person the organisation issupporting. Individual workers are equippedwith the Plan for Life to ensure the servicesthey provide are developed around the needsand preferences of the individual they areworking with. Those individual workers arethen managed by locality managers, eachmanaging about 20 staff.The locality managers act like entrepreneurs –it’s their job to understand what the differentpeople they support locally need, and developservices accordingly – so each localityfunctions as an independent business unit,and services may look quite different in onearea from another. The locality managersreport to an Area Director. Each AreaDirector has a team that includes leads forquality, performance, business development,finance and HR, who work with the localitymanagers to support them and ensure theirservices are performing well.Using quality systems and auditThe final part of Brandon Trust’s approach isits quality systems and quality improvementcycle, which – as in the NHS – the organisationcalls ‘audit’.Ensuring the quality of the service provided toeach individual is very important to theorganisation and every couple of monthsevery single person receiving support fromBrandon Trust is visited by someone who isnot involved in their service to find out theirexperience of the service.At a more systemic level, Brandon Trustcarries out an annual quality audit of all itsservices to check that the organisation isdoing what it says it does, ensure that itcomplies with the legal and regulatoryframework and to help to identify areas thatmay need some attention. As an absoluteminimum the audit ensures that BrandonTrust complies with the law, but the intentionis to support the organisation to achieve‘excellence’ not just compliance.The audit standards and criteriaThe audit uses 17 Outcomes derived from TheEssential Standards of Quality and Safety asspecified in the Regulations of the Health andSocial Care Act. Each standard starts with astatement of what the service is trying toachieve for the individual using it i.e. thedesired ‘outcome’.Find out more: www.brandontrust.org.uk

E.g. evidence around safeguarding might bethat a Safeguarding Officer from the LocalAuthority has visited the service and spokento staff and all staff have been provided withan information leaflet. The response to eachcriteria is then scored using a system where:1 = do not comply,2 = comply3 = exceed compliance.Where a particular criterion is ‘notapplicable’ then it is scored as a 2.By adding the scores against each criteriatogether, Brandon Trust is able to obtain anindication of how well (or otherwise) eachindividual service is meeting the necessarystandards. Where it is identified that aservice is not able to demonstrate that itcomplies with a standard, the service isobliged to develop an action plan on how itwill achieve compliance and provide this withits audit return.The whole process and the template thatsupports it have been designed to be easy touse. Jon Minall explains: “Our workers do anincredibly complex job, making judgementsabout and interventions in the lives of thepeople we support, but many of them haveno training in completing a formal writtenassessment process such as the auditrequires. We need to acknowledge theirskills, and make this process easy for them toengage with.”As far as possible, the process is paperless,and the evidence is entered into a centralsystem. The senior support worker is usuallythe person who completes the audit. Thelocality manager or equivalent verifies theassessments and adds comments in order toconfirm the integrity of the audit and supportthe action planning that follows.Using the evidenceThe types and range of evidence that differentservices provide are wide and provide a richpicture of practice across the organisation.These, in turn, contribute to the Trust’sQuality Manual where the Trust tries tocapture all the approaches that contribute toa high quality service.When all returns have been completed, theArea Quality Managers then do a review ofthe findings in their area and distil the keythemes locally, then work together to identifyany themes that are common across theorganisation. Their report goes to theExecutive Management Team and theOperations and Standards sub-committee ofthe Board.Where there are common themes – forexample this year the audit identified theneed to focus on processes around theemerging ‘best interests’ requirements –plans can be developed on an organisationwidebasis. More commonly the processidentifies local issues and the Area QualityManager works with locality managers toensure that these are included.“The audit findings are not normally asurprise, but help to triangulate whatwe have heard from other sourcesand provide the evidence to help usfocus our response, for examplethrough the training and developmentwe provide.”Jon MinallFind out more: www.brandontrust.org.uk