Case study summary
The Commissioning Differently team in Derby are currently supporting three people with complex needs to move from hospital into the community. By supporting a small number of people at one time, they are able to provide the intensive support these individuals need.
Set up in April 2016 as part of the national Transforming Care programme, the Commissioning Differently team in Derby supports people with complex needs to move from hospital into the community. The six person team all have backgrounds as health professionals, covering forensic services, speech and language therapy, learning disability nursing and community mental health nursing.
The team are currently supporting three individuals towards residential care and beyond, some of whom are currently living far away and are being repatriated to their home area. By supporting a small number of people at one time, they are able to provide the intensive support these individuals need. One person was supported to move into the residential services from long stay hospital in January 2017, and is currently thriving. The team are working towards discharging the other two individuals.
- The team helped Gemma to move into step-down accommodation, after eleven years in hospital.
- Gemma is now thriving. She is using language appropriately and is now fully independent in going to the toilet. She has been shopping for new clothes and makeup, tried on and bought trainers and been to the cinema – all huge achievements for Gemma.
- They are now working with her to move into her own home when she is ready.
Gemma (not her real name), is 22 years old, and had been in hospital since she was 11. She was supported by the Commissioning Differently team in Derby to move out of hospital and into step-down accommodation in January 2017. Gemma didn’t feel ready to move straight into her own home and asked to move initially into her own flat in a larger block, with care staff on site. The Commissioning Differently team are still working with Gemma, and will support her to move into her own home when she is ready.
When the Commissioning Differently team first met Gemma she couldn’t bear to be touched and would destroy property. Over six to eight months, each member of the team worked with her and slowly gained her trust. “I told her: ‘I’m not interested in your diagnosis, I’m interested in how we can support you’,” says Professional Leader, Libby Runcie.
Libby tried to engage with Gemma about what the next step would look like but Gemma didn’t have any experience to go off and couldn’t visualise what a flat, house or residential service would look like. Libby approached a couple of local providers who she felt may be able to support Gemma. The team were selected who Libby felt could meet the needs of Gemma in the most person-centred way, in the least restrictive and reactive manner.
Libby worked very closely with the service provider, Derby-based Autonomy. They planned how to support Gemma and what the future looked like for her. Autonomy recruited staff specifically geared towards this, and included Libby and the team in the staffing specification.
When the team found out that there would be a delay to Gemma’s accommodation being ready, both the provider and Libby’s team had to think differently to make sure she could still leave hospital when she was expecting to. “She had told us that she wanted to move after Christmas. She has abandonment issues, and if we had delayed her move I knew it would have had a huge psychological impact.”
To make sure Gemma could leave hospital on the planned day, the team arranged for her to go on a short break with two carers. “We didn’t lie to her; we were honest and told her the accommodation wasn’t ready yet. We gave her the choice, and if she had wanted to stay in hospital she could have done. It was truly person-led, and we did exactly what she wanted to do,” says Libby.
Not only was the short break considerably cheaper than if she had remained in hospital, but it had a big impact on Gemma’s wellbeing. Libby says: “She rang me on the first night to say, ‘I don’t deserve this.’ She told me she was able to choose what she could eat, and how she didn’t know where to put her coat at first. She said, ‘I’ve never been on holiday before.’
Two weeks later, Gemma was able to move into her new accommodation, where she is thriving. Gemma said that she wanted her new flat to be pink, so the decorators gave her pink blinds and embellished her favourite motivational saying across the wall.
“She is challenging and she’s challenged all of us, but she’s doing amazingly well. She is now fully independent in going to the toilet. Her use of language is changing,” says Libby.
Whilst in hospital, Gemma had complex issues with food and eating. “Now she’s eating what she wants,” says Libby. “We went to Nandos and she ate three quarters of it. She asked appropriate questions.” Gemma has also been shopping for new clothes and makeup, tried on and bought trainers and been to the cinema. These are all huge achievements for Gemma.
A different way of working with the provider has been crucial to making Gemma’s resettlement a success. Libby says: “I said to them, ‘we want you to have a shared responsibility.’ It’s very important to recognise and acknowledge errors, but we don’t judge and blame. We work collaboratively as though we are one team.”
Communication is vital and the commissioning differently team and the provider speak or text each other on a daily basis. They have a multi-disciplinary team meeting once a week – alternatively face to face or by phone – and hold review meetings with the commissioners and managers every few weeks.
“One size doesn’t fit all,” says Libby, “It’s about being adaptable and truly meeting a person’s needs.”
For Libby, it’s been crucial to have a team dedicated to moving complex individuals out of long-term hospital placements and able to provide the intensity they need. “I have no doubt that if our team hadn’t been set up, she would still be in hospital today. ‘Normal’ for her is amazing. She said to me, recently ‘I don’t actually think I need hospital anymore.’”
Libby Runcie, firstname.lastname@example.org