Castlebeck Implements Change Programme

25 November 2011 - Castlebeck, the specialist provider of healthcare services, today announced details of an Action Plan to make fundamental changes and improvements to its care services across the UK. The Action Plan is Castlebeck’s response to the Panorama Programme into one of its facilities - Winterbourne View. The implementation of the Action Plan is already underway and significant steps have been taken, which will make a real difference to people in our care, their families and friends, as well as staff at each of Castlebeck’s 20 facilities. The Action Plan is designed with one simple objective in mind - to ensure that we are delivering the best possible service to the people entrusted to our care in a safe environment.

Key elements of the Action Plan are:

  • Castlebeck’s management structure is to be completely overhauled to maximise accountability of each individual unit and ensure best practice in the corporate and clinical governance in every one of our facilities.
  • Key new appointments have been made, including a new Director of Nursing and Patient Safety, a Group Medical Director and a Group Head of Governance, Risk and Compliance
  • The Group Medical Director and the new Director of Nursing and Patient Safety will both sit on the Board; further appointments to the Board are expected in the coming weeks.
  • Increased investment in staff and staff training across Castlebeck.
  • Castlebeck has put in place an improved whistle-blowing policy, managed by an independent external company through which staff can raise concerns; a newly formed corporate safeguarding and whistleblowing committee has also been established reporting to the Board.
  • New activities programmes will offer more personal choice for people in our care. Our key areas for focus will include educational, employment and recreational opportunities.
  • Castlebeck has reviewed its advocacy capabilities and following a national tendering process awarded contracts to two independent external advocacy organisations. This will ensure people in our care have their voices fully heard at all times.
  • Castlebeck has entered discussions with the British Institute of Learning Disabilities (BILD) about a detailed training needs analysis for our support workers, with the aim of ensuring that people in our employment provide the best possible care.

The Action Plan includes the implementation in full of the recommendations proposed by PriceWaterhouseCoopers (PwC). This follows a review of the business that was commissioned by the Castlebeck Non-Executive Directors. It should be noted that PwC was restricted by the ongoing police investigation into Winterbourne View and therefore PwC did not undertake an independent investigation into Winterbourne View. The report is therefore primarily focused on recommendations for change at Castlebeck as an organisation.

Speaking today announcing details of the Company’s Change Programme, Castlebeck Chief Executive Lee Reed said:

"Major improvements have been made at Castlebeck and resources are being committed to ensuring that consistently high standards of care are once again delivered to some of the most vulnerable people in our society. We have taken decisive and swift action where necessary, and this involved closing three of our facilities, including Winterbourne View.

"The Action Plan we are announcing today gives us a formal framework for change that will significantly raise standards across Castlebeck and embed them in the culture of the organisation. While most of our facilities have always provided good standards of care, as the CQC has acknowledged, deficiencies in our organisation meant that a small number were allowed to fall badly short.

"Poor quality will not be tolerated. We remain deeply sorry and apologise for incidences where our services have in the past not met the high standards that we, those we support and their families, expect and deserve. Castlebeck has been providing care for vulnerable people for over 20 years, with the safety and well-being of people in our care our top priority. There is a real commitment from everyone at Castlebeck to implementing this Action Plan and we will not rest until it is completed in its entirety.

"We would like to thank the CQC, Department of Health, Commissioners and many other stakeholder groups, each of whom has engaged and worked proactively with us throughout the period".

Enquiries:

Castlebeck, 01325 252 001, Dawn Shaefer, media@castlebeck.com

Click here to download a copy of the PwC Report

Supplementary information

Castlebeck is taking action to improve in the following key areas:

  • Operational and Clinical Leadership
  • Quality Governance
  • Service User Mix and Activities
  • Investment in staff
  • Service User and Carer involvement
  • Advocacy
  • Board Engagement
  • Change Implementation and Stakeholder Engagement

A summary of the key actions is set out below:

Operational and Clinical Leadership

A central recommendation of the PwC report is that management structures need to be reviewed in order to achieve better regional cover, scrutiny of individual units, and delivery of an effective corporate and clinical governance process including risk management. Castlebeck has responded by overhauling its management structure and made a number of key new senior appointments, with further appointments pending.

Castlebeck is committed to introducing a new regional operational management structure, with new nursing leadership roles, to ensure higher standards and better scrutiny of individual units. A Chief Operating Officer will be appointed to ensure the effective operational management of all Castlebeck units. Debra Moore has been appointed as our new Director of Nursing and Patient Safety and has joined the Company’s Board, reporting directly to it. Ms. Moore is implementing an appropriate nursing and quality support structure to ensure that both nursing leadership and quality have greater prominence across the organisation.

A revised clinical structure has also been implemented with the new post of Group Medical Director replacing the former Group Clinical Director role with more focus on establishing a strong presence across all of Castlebeck’s services and to provide more visible leadership to an increased clinical team. They will provide representation of professional groups at the internal board, joint working with the Director of Nursing in relation to quality and safety, professional management and lead for research and audit.

Castlebeck has also appointed a Group Head of Governance, Risk and Compliance, who will be responsible for ensuring the delivery of an effective corporate and clinical governance process. This individual will be assisted with the appointment of new Regional Audit and Governance personnel. A Turnaround Director has also been appointed to provide additional capacity at Board level.

Quality Governance

Whilst the Company had a Quality Governance procedure in place, we are now completely overhauling our policies, procedures, monitoring and reporting systems. Our new Director of Nursing and Patient Safety, and our Group Head of Governance, Risk and Compliance will be responsible for finalising and managing the process. This will include ensuring that all these new processes are properly embedded into the operations and culture of the organisation. As part of our new Governance and Quality structures, they will also be responsible for the delivery of a more comprehensive risk register and auditing system. This includes the development of an online incident reporting system, allowing better and quicker tracking of investigations and any subsequent remedial action. Five new Audit and Governance positions to support the implementation of this process have been created and the recruitment process is underway. In addition to this, a newly formed corporate safeguarding and whistleblowing committee has also been established chaired by a Non-Executive Director, who will report directly to the Board. Castlebeck has already put in place an improved whistle-blowing policy, managed by an independent external company to provide a further method by which staff can raise concerns if required. A Physical Intervention Review has been completed with the assistance of external input and support and a new policy for managing aggressive and / or violent behaviour has been developed. A key component within this is to ensure greater focus on de-escalation. Our priority in this regard is to protect the well being of people in our care and those of our employees.

All of our new policies will be consistently monitored and audited to ensure effectiveness in the interest of the people in our care.

Service User Mix and Activities

The Company is reviewing the size, location and function of each unit, jointly with external stakeholders. Castlebeck has also completed an Activities Review, which is currently being implemented by newly appointed Activity Coordinators at each Castlebeck hospital or residential service. New activities programmes will offer more personal choice for people in our care. Our key areas for focus will include educational, employment and recreational opportunities.

Investment in staff

The Company has increased investment in staff, support staff and training throughout Castlebeck. Following a comprehensive review of our staff induction programme, we have introduced further safeguards to make it more effective. The new induction programme has commenced which is the subject to a month by month review, and will be modified as appropriate to ensure effectiveness. We are in discussions with the British Institute of Learning Disabilities (BILD) about undertaking a detailed training needs analysis for our support workers. We are also introducing new appraisal systems which will include externally facilitated assessment days to identify core skills and weaknesses of personnel, and we will build upon this to develop individual career development plans for staff. The adequate provision of training to staff will also become a key performance indicator for the appraisal of unit managers.

Service User and Carer Involvement

We are taking additional steps to ensure that service users are at the heart of their care planning process. A Regional Carer Forum is in the process of being established. There will be greater engagement across all levels of the organisation, formal patient and carer experience monitoring through questionnaires and site meetings, with results and findings reported directly to the Board. The Company will be working with families to ensure an increase in the level of carer involvement in care programme approach and multi-disciplined meetings. The improved engagement process also includes members of the Board meeting at first-hand with service user forums.

Advocacy

An advocate is an independent person who visits services to communicate with and on behalf of service users to establish their best interests, wants and needs. Castlebeck has reviewed its advocacy and following a national tendering process awarded contracts to two independent external advocacy organisations. Voiceability will provide advocacy services to all Castlebeck service users in England; and Dundee Independent Advocacy Service will provide a similar service in Scotland. All service users at Castlebeck will have access to an independent advocate to speak on their behalf. This will be in addition to local advocacy arrangements that service users may have chosen to support them. Regular reports on the advocacy provision, trends identified and key issues will be submitted to the Board.

Board Engagement

In response to recommendations that the Board needs to improve its oversight of the organisation by greater engagement and improving the composition / range of skills and experience at Executive and Non-Executive level into the future, the Company has responded by committing to having a Board that is more engaged and which has better representation from the health and social care sectors. A new Board constitution and membership has been developed and a number of suitably experienced health and social care professionals have been appointed including the Group Medical Director and the new Director of Nursing and Patient Safety posts, with further appointments to be made over the coming weeks.

Better reporting systems have been put in place to give Board Members better oversight across all key areas of the organisation. The Board also has a clear care quality strategy and it will be served by better information - a new Key Performance Management System will be developed for future Board meetings with a greater focus on clinical quality and outcomes. A subcommittee will be formed to make sure that effective quality monitoring and risk management arrangements are in place. The Board will receive summary level information in relation to care standards, quality performance and risks. Board meetings will be held at locations around the country and an ongoing programme of Board member visits to units (announced and unannounced) has commenced.

Change Implementation and Stakeholder Engagement

The Company believes that the implementation of its comprehensive Action Plan, which is underway, involves working together with all stakeholders and that a solution that comes through cooperation will also minimise disruption for the people who matter most.

Castlebeck is committed to implementing a programme of fundamental change. All of the key focus areas are now standing items on the Boards Agenda and updates have been provided and subject to Board discussion. This is a major project and a dedicated resource support structure will work with the Chief Executive to implement the plan and report to the Board. The executive team and regional management will also develop a communications plan and ensure that sufficient time is devoted to the management of relationships with external stakeholders. The Company will promote greater engagement with Commissioners, the CQC and industry representative groups, as well as greater transparency - publishing pertinent quality related Board meeting minutes, plus key governance and performance management information. We hope this approach will be reciprocated to allow all stakeholders to work together going forward for the benefit of the people in our care and their family and friends.

The CQC are conducting regular rigorous inspections across all healthcare providers, including Castlebeck. The majority of our facilities have met or exceeded the outcomes measured, but a number of them did not. Major improvements have been made at Castlebeck in the last six months and resources have been committed to ensuring we strive to deliver the best in class care. Where decisive action has been needed, we have not been afraid to take it, including closing three of our facilities. The facilities that fell short of expectations, have all been re-inspected and we are pleased to report that with the exception of some minor concerns, which are being addressed, all are now compliant against the outcomes that they were measured against.

We were all very disturbed and deeply saddened by what we saw was happening at Winterbourne View, not only for the people directly affected, but for their families and friends. These events also caused serious distress to the vast majority of people employed at Castlebeck, the vast majority of whom the CQC acknowledges are providing a high level of care to some of the most vulnerable people in our society. Many of our employees have worked at the organisation throughout its 20 year history and we are determined that they should be proud again to work for Castlebeck. --

Notes to Editors:

Castlebeck is a specialist provider of healthcare and support for people with learning disabilities, mental health needs, people on the autistic spectrum with and without a learning disability and for people with brain injuries with associated challenging behaviour. Castlebeck operates services across the UK. The company has 20 hospitals and care homes in Scotland and England and across the group employs over 2,000 people.

To complete the review, PWC visited 15 units, confidentially interviewing over 100 Castlebeck staff, including care support workers and service users. The units selected were based on a risk assessment. A review of relevant documents and records held within Castlebeck was also carried out.