Leading change

The Clinical and Nursing Lead for Learning Disabilities/Autism Spectrum Disorder (LDASD) at South West London and St George’s Mental Health NHS Trust (SWLSTG) led on the implementation of the Green Light Tool Kit (2017) across the Trust. This programme has improved outcomes, experience and ensured resources are used effectively ensuring services remain focused on individuals’ needs and provision of high quality care.

Where to look

NICE (2018) guidance identifies a set of principle for children, young people and adults with a learning disability and behaviour that challenges to have the support they need to live where and how they want. It identifies the need to support local areas to shift their focus towards prevention and early intervention, enabling children, young people and adults to live in their communities, and increasing support for families and carers. It is anticipated that this should reduce the need for people to move away from their home or community for care, education or treatment.

Although SWLSTG had implemented Learning Disability Champions across the Trust, the nursing lead identified unwarranted variation in truly advocating and demonstrating the new guidance for service users with learning disabilities (LD) and Autism (ASD) in practice.

What to change

The nurse identified unwarranted variation in the support and training available at the Trust to meet the new standards of care for LD/ASD service users and their families/carers. A specific series of changes were targeted across SWLSTG, including:

• Implementing Positive Behavioural Support (PBS) policy across the Trust;
• Continue to provide relevant training and development of LD workforce;
• Consider adding LD/ASD training to the Trust induction;
• Support with development of the LD workforce in mental health units.

How to change

A key framework to support the nursing leads with their improvement programme was the Green Light Toolkit. The toolkit sets out mental health service changes under the following key areas: People, Innovation and Context, developing Green Light Champions in every team, a positive culture across the organisation, induction and training support for every member of staff, promote curiosity and creativity problem solving and innovations in service delivery.

The Green Light includes a standardised service audit tool which helped the nursing leads to benchmark services against the standards both before and during the change to ensure the impact on service user support was positive and that progress continued to be made.

To support roll out across the Trust and successful embedding into ward and service practice, a dedicated person responsible for leading and implementing the Green light tool kit on each ward was identified. Their role remains supported and supervised by the Clinical Lead for Learning Disabilities/ASD.

A series of training sessions to share the new practice standards with staff and to help them focus their practice were held. The nurse leaders implemented an easy read version of the Basic Audit with service users, to support patient engagement and empowerment throughout the improvements.

A Positive Behavioural Support (PBS) policy has also been implemented since July 2018 and Learning Disability trained nurses are now being introduced onto mental health wards to provide clinical support to staff and patients.

Adding value

Better outcomes – There have been significant improvements in successful implementation of the toolkit basic audit. The Trust is now fully compliant with NICE standards which is conducive with providing high quality care to service users, their families and carers. With a focus on holistic care planning, de-escalation and appropriate communication, there has been a positive shift in practice across the wards, however as the programme is in its early stages a full impact assessment is yet to take place.

Better experience – Patients, their families and friends have responded well to the new approaches in practice and when surveyed all service users gave either a ‘Very Happy’ or ‘Happy’ rating regarding how well they thought staff were meeting their needs at one of the Trust’s LD clinics. Staff have also responded positively to the change in approach and are pleased with the impact this is having on the individuals they care for.

Better use of resources – The 2018 Trust report on the implementation of the green light toolkit reported “Whilst there is much more work to be done to ensure that people with learning disabilities or autism can receive high quality care in mental health services, some pioneering staff have made a determined and encouraging start, showing others what is possible if the resources and leadership is provided over the long term”.

Challenges and lessons learnt for implementation

As one of only 5 Trusts to have embedded the toolkit, devising an approach and sharing learning has been challenging at times.

The most significant factor in improvement has been the LD champions. This role has both supported staff to make the changes needed and supported patients, their families and carers to receive the care they need.

Find out more

For more information contact:

• Denise Gentry, Clinical Lead for Learning Disabilities/Autism Spectrum Disorder, South West London and St George’s Mental Health NHS Trust, Denise.Gentry@swlstg.nhs.uk