The HOPE(S) model is an ambitious human rights based approach to working with individuals in segregation developed from research and clinical practice.
The clinical model developed by Mersey Care reduces the use of long term segregation sometimes experienced by autistic adults, adults with a learning disability and children and young people. NHS England and NHS Improvement are funding the roll out of this model across services in England.
Admission to hospital can cause distress and may lead to situations in which there is an increased chance of restrictive practice being used. Children and young people (CYP) and adults with a learning disability and autistic adults can struggle with such restrictions. As a result, they can sometimes be caught in a cycle of restrictive practice and increased security. The resulting impact on their wellbeing and human rights can cause trauma which may impact on their length of stay in hospital, experience and discharge to a home in the community.
NHS England and NHS Improvement and the Centre for Perfect Care, a part of Mersey Care NHS Foundation Trust, are working together to implement the HOPE(S) programme across England. Mersey Care has been chosen for this work because of its experience in this complex area.
The HOPE(S) clinical has a relentlessly positive approach to supporting people in long term segregation.
The model describes:
It encourages teams to Harness the system through key attachments and partnerships
Create Opportunities for positive behaviours, meaningful and physical activities;
Identify Protective and preventative risk and clinical management strategies;
Build interventions to Enhance the coping skills of both staff and people in services
Whilst engaging in these tasks clinical teams and the System needs to be managed and developed to provide support throughout all stages of the approach.
This work allows clinical teams and the person in segregation to understand the significant issues, barriers and systemic issues maintaining the segregation. It identifies three intervention targets to allow the team to prioritise interventions and resources, establish ‘quick wins’ and a sense of hope and direction for the person and the team. The model has been developed over a number of years and has been used in a wide range of settings.
Download accessible and easy read information about this programme by clicking on the below links:
Mersey Care has considerable experience of good practice in complex care settings and continues to collect clinical evidence as part of its commitment to learning.
A 2021 inquiry by parliament’s Health and Social Care Select Committee into the treatment of people with a learning disability and autistic people received evidence that indicates changes in culture and practice were critical for systemic change. As the report noted, families of people living in these conditions for prolonged periods of time can also be traumatised by the lack of access to their loved one. In response to this as part of the programme we are offering independent trauma support for families.
The Care Quality commission has issued a brief guide to long term segregation.
The roll out of the model is designed to enable culture and practice change by building capacity and capability in the system. The improvement programme will be delivered through the NHS-led provider collaboratives to support providers to work in a way that reduces the levels of restrictions and prevents harm and escalation in the system.
This will improve the experience of people in these settings and reduce their length of stay in hospital with appropriate planning for discharge and community support.
We will be working to embed the model across inpatient services to deliver change and reduce segregation and overall reliance on restrictive practices on a national scale. It will have deliverable outcomes for individuals, their families and carers, NHS funded organisations and the wider system.
We will deliver the HOPE(S) clinical model of care nationally by creating a team of specialist clinical practitioners and building on existing successful quality improvement programmes.
The model will:
The focus is on those individuals currently in Long-Term Segregation who are:
However, the clinical skills, practice leadership and pro-active model will influence mental health and learning disability settings for all ages across the NHS led provider collaboratives.
The programme's outcomes will be evaluated by an independent research body and the work is subject to a National Oversight Group which meets quarterly to provide governance. The independent evaluation is an important part of understanding the impact of the model on people in services and teams providing a robust evidence base and making sure the HOPE(S) is delivering goals supporting the evidence base and sustaining HOPE(S). Timelines will be published shortly and we expect to see significant progress in the initial three year period.
Long term organisational and system impact
Workforce capability and development
Culture and practice change
Individual and family quality of life
Dr Jennifer Kilcoyne: firstname.lastname@example.org
Clinical Director CfPC and Director for National HOPE(S) NHSE Collaborative
Danny Angus: email@example.com
Associate Director for National HOPE(S) NHSE Collaborative
Sue North: firstname.lastname@example.org
Head of Improving Quality NHS England and Improvement, National Learning Disability and Autism Programme