Business Clinic
Danshell – Shaping the future

Danshell has had a period of consolidation since it acquired the Castlebeck portfolio in September 2013. As it comes out the other side, it is shaping its services and the company whilst pushing forward innovation in learning disability provision.

The Danshell Group was founded in 2010 by Efi Hershkovitz, who had successfully built up and sold on Forest Healthcare. Danshell was founded following the acquisition of Oakview Estates which provided treatment and care for young people detained under the Mental Health Act. From this starting point, the Group expanded rapidly acquiring specialist hospitals and residential services across England and Scotland.

Its growth culminated in the acquisition of 20 services formerly operated by Castlebeck. The acquisition was completed in September 2013; the services had been in administration since March of that year when Castlebeck appointed administrators. Following the abuse of clients at Castlebeck’s Winterbourne View, Castlebeck had worked to rebuild trust, confidence and quality care in its services. However, Winterbourne View’s closure and the closure of two other services impacted on Castlebeck to the point that it was unable to continue trading.

In the period since these acquisitions, Danshell has worked to consolidate the services and ensure its standards were implemented across the portfolio. Chief Executive, Efi Hershkovitz and the executive team introduced a new leadership structure; a refreshed Quality Strategy, robust clinical governance and enhanced policies and procedures.

Disposal

Following on from this consolidation the company has now disposed of its acquired brain injury (ABI) and neurological division, developed bespoke services and re-registered two of its hospital services.

In December 2014, Danshell sold its ABI and neurological division to independent secure and step-down mental health provider, Partnerships in Care. The division comprised 50 beds across three sites – Warwick Lodge, Croxton Lodge and The Dalby Unit. All three facilities had been part of the Castlebeck portfolio acquired in 2013.

Andrew Murray, Chief Operating Officer at Danshell told CMM, ‘Part of the company’s strategic planning was to focus on the key service user group of learning disability and Autism. Partnerships in Care was ideal to take on the ABI/Neurological division because of its extensive experience in ABI. This ensured the safety of both the patient group and the staff team.’

Innovation

The company has also looked to innovate and push forward its service offering. In September 2014, it opened its first fully-bespoke service, Hope House in Hartlepool, followed by Thors Park in Colchester and Yew Trees in Frinton-on-Sea. Each service has been commissioned directly to meet the needs of individual service users whose needs were greater than conventional services could offer.

Andrew continued, ‘Danshell was responding to service user and commissioner needs. We identified there were service users with more complex needs requiring extensive levels of support for whom it can be difficult to find a sustainable placement within a community setting. At Danshell the bespoke services are within a safety net of a wider service, giving access to a multi-disciplinary team, activity bases and a wider group of staff.’

At the time Debra Moore, Group Clinical and Nursing Director  at Danshell who was heavily involved in formulating the bespoke services, said, ‘By designing the service to fit the person, rather than trying to fit the person into a more generic care setting, triggers for behaviour that challenges can be reduced. As a result the individual feels valued and listened to and their quality of life is greatly enhanced.’

Re-configuring

Most recently, in January 2015, the company refocused two of its services from hospital to care home with nursing to reflect the changing needs of service users and commissioners. Following consultations with service users, families and commissioners, the former hospitals, Hollyhurst in Darlington and Oaklands in Hexham, now offer a person-centred robust package of residential care with nursing to support service users towards more independent lives.

Andrew Murray added, ‘We want to offer an environment that promotes independence and delivers person-centred care for service users, together with developing care pathways for people with complex needs including learning disabilities and complex physical health issues. It is all about maximising independence for service users. Nobody was detained in the hospitals and the new registration enabled us to meet specific needs and offer a care pathway back into the community.’

Policy context

There is ongoing determination to move policy towards supporting individuals in the community. In November 2014, the Winterbourne View – Time for Change report on the future of services for people with learning disabilities was launched by Sir Stephen Bubb, Chief Executive of the Association of Chief Executives of Voluntary Organisations. In his foreword to the report, Sir Stephen said he was tasked with considering, ‘how we might implement a new national framework, locally delivered, to achieve the growth of community provision needed to move people out of inappropriate institutional care.

‘Only by a big expansion of such community provision can we achieve a move from institution to community.’ This includes a ‘mandatory national commissioning framework that delivers the expansion, pooled budgets and a focus on the individual’s needs not the system boundaries.’

Over to the experts…

Policy is increasingly driving change to learning disability services. Danshell is shaping its organisation to meet the needs of commissioners, service users and policy. Is this a step in the right direction for service innovation? Is this where the market should be heading? As a large organisation, is this ability to adapt, change and build bespoke services limited to those providers with large financial backing?


Roger Harcourt Partner, Shakespeares

A step in the right direction

Danshell’s re-shaping is a step in the right direction for service innovation. As a result of the Bubb Report, re-shaping is essential. For providers with hospitals, changes are coming.

There will be many patients who aren’t ready to move into community settings and where specialist hospitals have a role to play in their care pathway. However, there is significant traction in identifying those patients ready to move and setting dates. The deliverability of local services to meet those needs is crucial including suitable accommodation and skilled staff.

For those able to move into community settings, this is where the market should be heading. Relatives frequently say their loved ones are too far away so they don’t see them often. Being able to see family and friends regularly, because they are close by, can make a huge difference to people’s quality of life.

Is there a difference between the capabilities of large and small providers to emulate service re-shaping? Commissioning is driven by local needs and the ability of commissioners to pay. However, there is more commissioner focus on price rather than quality although patients’ quality of life must be consulted upon. The ability to provide quality of life, at an affordable price may favour larger providers with economies of scale, who may be able to deliver a full care pathway and cover the costs of gradual transitions between services.

Danshell is re-shaping and others will too. Providers able to respond and develop innovative solutions via engagement with service users and commissioners will lead the way. However, one word of caution is affordability. With quality of life seemingly less of a priority than cost, local commissioners may still be attracted to lower cost out of area placements despite best endeavours locally.


Tracy Lanes Director of Operations, Choice Care Group

The right thing to do

Moving from hospitals to residential care is the right thing to do. Care homes are based in the heart of the community; smaller than hospitals but big enough to provide the high staffing levels, tiered management/leadership and expertise that is required to support those previously in hospitals. It’s more accessible to families and commissioners who see the whole service and get a feel of the culture. It’s homely and person-centred.

This is where the market should be heading. We support people who’ve been rejected by other providers. We have been able to support them successfully in our residential services, due to our robust infrastructure.

Many of the people we support would’ve been sectioned under the Mental Health Act if they had not had residential placements available to them. Under a section they’ve no option but to be put in a hospital placement.

I believe it was Jim Mansell who said that if people were correctly supported in the community then they shouldn’t be sectioned. I agree and this is what we’ve been able to achieve.

Opening specialist residential care services isn’t cheap and we wouldn’t be able to do this without our investors’ commitment and backing. To accommodate the people we support requires a heavy investment in the physical environment. This must be carefully planned around the specific needs of the individuals and maintained to a high standard, which is costly. It’s difficult to see how smaller providers can achieve this, given the current financial climate and the difficulties of securing investment. That’s not to say that it’s impossible. However the benefits of being part of a large organisation isn’t just finance; it’s different departments and functions that are crucial but are more difficult for smaller providers to achieve.


Lucy Hurst-Brown Chief Executive, Brandon Trust

Time to end institutional care​

In the words of the late Professor Jim Mansell, ‘The real solution… is to stop using these places altogether.’ (2012).  We have known for some 30 years that the best way to support people with learning disabilities and behaviours that are labelled as ‘challenging’ is individually in the community.

Where an individual is able to live in the right setting, with the right amount and type of highly-skilled and consistent support, the positive life outcomes for them and their families have proven this to be the case.

Andrew Murray, Chief Operating Officer at Danshell is correct when he says that, ‘It can be difficult to find a sustainable placement within a community setting’, but his solution to build more specialist hospitals – in the cases of Thors Park and Yew Trees – or change the status of others – such as Hollyhurst with 23 beds – to ‘care homes with nursing’ is simply perpetuating the problem. This is not a correct interpretation of current policy, or where we should be focusing our efforts.

The places described in this article are simply different forms of institutions and are heavily based on a medical model. They continue to be bought by commissioners because they have little or no true community-based options available.

If the NHS funding allocated to these inappropriate services were invested instead in very carefully planned individual community-based solutions, we could actually start to end the practice of ‘placing’ people in Assessment and Treatment Units.

The right thing for large providers with private investors is to use their money to develop community-based support solutions; but I guess that the model, while being the right thing for people with learning disabilities, just might not pay off for shareholders.

Do you agree with the panel? What are your thoughts on local authority in-house care homes? Add to the debate in the comments below. Subscription required.

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