Success factor 4: Improvement through equality and human rights

Shadon House Dementia Resource Centre, care home specialising in dementia care, respite and assessment.

They base their work on the human rights FREDA principles - fairness, respect, equality, dignity and autonomy. They are embedded into training and procedures so they affect all their work.

Joanne Matthewson, registered manager: No challenge would be too great if you were providing a quality service for your own family and the service user has to be as important as your own family.

Castlebar Nursing Home, catering for people who need nursing care and for those living with dementia.

This home challenges accepted views to move from risk aversion to providing the least restrictive care possible. This improves the quality of care and helps people live more fulfilled lives by:

• being able to do as much as possible for themselves,
• seeing change as the norm and being open about death and dying
• giving many opportunities to ry new activities.

Style Acre, supported living service for people with learning disabilities and autism.

People are encouraged to maintain and improve their independence through positive risk taking, alongside support to understand how to keep themselves safe. For example:

• risk assessments which included people’s rights
• bus training so people can go out independently
• role play to help people check someone's identification when a visitor arrives at their home
• support to check their epilepsy monitoring equipment and self-administer medicines.

Frith House, residential care home for 83 older people.

The registered manager had found some staff were risk averse. Staff had decided a person living in the care home was not safe to leave the home on their own. The manager then assessed that person's capacity and agreed they could come and go freely.

To support this, the manager developed business cards with the persons' name and the home’s address. People could carry the cards and give them to someone in the community if they become lost. This way, the care home supports people’s right to maintain their autonomy.

Cygnet Elms, hospital for people with a learning disability and additional mental health needs.

Positive risk taking and least restrictive practice is embedded within the culture. The service is committed to discharging patients to independent or supported living.

Proactive discharge planning starts at the point of admission. They work with the patient and partner agencies to manage discharge as soon as is safely possible.

• Patients are actively involved in managing their own risks using risk assessments, positive behavioural support plans and working collaboratively with staff.
• There is a least restrictive practice group and a restrictive intervention reduction programme with board-level lead.
• They carry out restrictive practice audits and work to use the least restrictive approaches when managing challenging behaviour.
• Patients are involved in shaping least restrictive practice through engagement activities.

St Paul’s Way Medical Centre, inner-city GP practice, with around 10,000 patients.

The practice monitors outcomes for patients by comparing their own performance information against national indicators, for example to look at uptake of screening programmes.

Recent published results showed they were performing well on these measures overall, but had a low uptake for breast, bowel and cervical screening.

They developed initiatives to improve screening uptake, taking account of the equality characteristics of their patients and the barriers they face accessing services. For example, they use advocates and a Patient Health Champion in the reception waiting area to help patients, many who do not speak English as a first language, to access services. Their Patient Health Champions also encourage the local community to take up screening opportunities