Success factor 8: Courage

East London NHS Foundation Trust, mental health and community trust.

An external human rights expert looked at psychiatric intensive care inpatients, so staff learned about patients' experiences from the anonymous results. The trust is now:

• developing human rights focused training for psychiatric intensive care wards
• investigating the experiences of those in different situations

Lorraine Sunduza, Director of Nursing: "Be bold. Have the conversation. Name the elephant in the room. Allow everyone to contribute to solutions"

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

Staff discovered a resident's distress was because they could no longer care for their hens. Shadon House now has free range hens – reducing this person's distressed behaviour and giving enjoyment to others.

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

They encourage that 'you are never too old to try something new' and activities include:

• Sweet readers – an intergenerational, arts based programme with a local school
• Namaste - a multisensory programme for people with advanced dementia offering individualised activities and promoting dignity
• ballet classes
• in-house physiotherapist
• a wide range of social activities and visits
• supporting significant days, including an International Day of Older People walk and a Caribbean summer party
• supporting individuals to follow specific interests.

First Community Health and Care CIC provides services in a hospital and in the community to 178,000 people in south east England. It is a staff-owned social enterprise employing 450 people.

Staff helped develop a values-based framework alongside an agreed set of core behaviours. The values framework includes guidance for difficult conversations, presented so staff can easily understand it.

Leaders of the organisation told us that they were not afraid to make difficult decisions where staff are not upholding values. One executive director said the organisation was far too small to carry someone who was not upholding the values and behaviours of First Community.