accreditation for acute inpatient mental health services aims picu

1. Accreditation for Acute InpatientMental Health Services (AIMS)PICU Dr Stephen Pereira & Alan Metherall

3. The Road to Accreditation Practice Development Network PICAS – joint venture with CCQI Reviews AIMS Acute Inpatients

4. Findings from NAV – Problems in acute care Focus on community developments: Assertive outreach, CMHT etc. Under-investment Role of acute ward ill-defined ‘Dumping ground’ when community care fails Care versus containment Atherapeutic environment Medication versus therapy

5. Findings from NAV - 2 Wards can be chaotic and dangerous Fire-fighting Dual diagnosis Lack of leadership and control Staffing crisis Bank and agency Recruitment/retention; morale/sickness Bed management Control over admission ‘Bed-blocking’

6. Wards offer a timely and purposeful admission in a safe and therapeutic environment AIMS ‘Mission Statement’

7. Developing the Standards AIMS developed with extensive consultation and cross referencing. Standards for Better health NICE HCC Inpatient Reviews (200&) SCG draft guidance National Minimum Standards for PICU Continual cycle of feedback and review by the Accreditation Advisory Committee The AIMS PICU standards were developed using the AIMS Acute standards as the framework to cross reference other national guidance around PICU The cross referencing of 100s of different standards and the evidence base behind those standards was considered and detailed These included: NICE Guidance 25, HCC 2007 Inpatient review , SCG draft guidance on security and the National Minimum Standards for PICU I Appreciate that to date many of these documents only relate to health services in England and that documents in Wales and Scotland not considered in this first cycle Whilst compliance with the AIMS PICU standards will help provide evidence for meeting the S4BH, so far not been able to consider the CQC process for registration at this time, something Matt will pick up on later in the conferenceThe AIMS PICU standards were developed using the AIMS Acute standards as the framework to cross reference other national guidance around PICU The cross referencing of 100s of different standards and the evidence base behind those standards was considered and detailed These included: NICE Guidance 25, HCC 2007 Inpatient review , SCG draft guidance on security and the National Minimum Standards for PICU I Appreciate that to date many of these documents only relate to health services in England and that documents in Wales and Scotland not considered in this first cycle Whilst compliance with the AIMS PICU standards will help provide evidence for meeting the S4BH, so far not been able to consider the CQC process for registration at this time, something Matt will pick up on later in the conference

8. Membership Involvement Internet Conferences Focus Groups Executive Committee Membership feedback Time constraints Many hours were spent by NAPICU members and executive team cross referencing the standards in preparation to submit the first draft to the AIMS team. This was achieved by a number of online conference meetings, focus group and at NAPICU Executive meetings Time was not on our side but deadlines were set to ensure the programme continued to move forward. Own participation derailed by preparation for a job interviewMany hours were spent by NAPICU members and executive team cross referencing the standards in preparation to submit the first draft to the AIMS team. This was achieved by a number of online conference meetings, focus group and at NAPICU Executive meetings Time was not on our side but deadlines were set to ensure the programme continued to move forward. Own participation derailed by preparation for a job interview

9. Areas covered in AIMS - PICU General Standards Timely and Purposeful Admission Safety Environment and Facilities Therapies and Activities The full set of standards is aspirational and it is unlikely that any unit would meet all of them.

10. Category of Standards • Type 1: failure to meet these standards would result in a significant threat to patient safety, rights or dignity and/or would breach the law; • Type 2: standards that an accredited ward would be expected to meet; • Type 3: standards that an excellent ward should meet or standards that are not the direct responsibility of the ward.

11. Accreditation - Levels Level 1 – accredited with excellence Level 2 – accredited Level 3 – deferred Level 4 – not accredited (i.e. failed)

12. Level 1 Accreditation All Type 1 Standards 95% or more of Type 2 Standards (not meet <10-12 individual standards) Significant proportion of Type 3 Standards

13. Level 2 Accreditation All Type 1 Standards Approximately 80-85% or above of Type 2 Standards No significant gaps in a particular area of the standards Meet many Type 3 Standards

14. Level 3 Accreditation One or more Type 1 Standards is not met Less than 80-85% of Type 2 Standards Significant gaps in a particular area of the standards (e.g. training) Deferral can be for anywhere between two and six months Renewable (up to one year)

15. Accreditation Process Self-Review Peer-Review Accreditation Advisory Committee (AAC) Royal College of Psychiatrists’ Education, Training and Standards Committee (ETSC)

16. Self-Review Checklist Staff Training Grid Environment and Facilities Audit Health Record Audit Questionnaires: Carer Questionnaire Patient Questionnaire Staff Questionnaire Ward Manager Questionnaire (Peer-Review Carer Questionnaire) (Peer-Review Patient Questionnaire) (Observation Tool – AIMS-OP only)

17. Peer-Review 1 day Visiting team of four - three professionals and one Service User or Carer Validate self-review data The visit is an opportunity to verify the self assessment process, check evidence, clarify issues and importantly provide an opportunity to spread good practice between the team and the reviewersThe visit is an opportunity to verify the self assessment process, check evidence, clarify issues and importantly provide an opportunity to spread good practice between the team and the reviewers

18. Accreditation Advisory Committee Representatives from key stakeholder and professional bodies, including Service Users and Carers Reviews the results of the self- and peer-review Recommends an accreditation status for the ward So of you already involved in other AIMS projects or if you have already signed up for this one may have been invited to join this group. NAPICU has a place on the AACSo of you already involved in other AIMS projects or if you have already signed up for this one may have been invited to join this group. NAPICU has a place on the AAC

19. ETSC Royal College of Psychiatrists’ senior educational committee Meets at fixed times through the year Ratifies the recommendation of the AAC – awards accreditation Has the power to question decisions and overturn recommendations

20. Interim Reviews Year 1 – Questionnaire and Action Plan Year 2 – Full Self-Review Year 3 – Questionnaire and Action Plan Accreditation status can change following Year 2 Self-Review – can be suspended or withdrawn Excellence can be awarded following further Peer-Review Visit

21. Why PICU only ? SUI in 2008 DH Guidance issued on Security Implications for definition of PICU and the PICU service user population NAPICU stakeholder in DH discussions SUI in a unit in the south west which brought significant media attention. Even though not defined as a Low Secure Unit providing mental health services, the DH developed draft guidance for SHA to inspect providers of service. Again this appears to only have happened in England and not Wales or Scotland Roland will be speaking later about the issue of definition of PICU and LSU services which will highlight the issue and why at this time LSUs were not able to be includedSUI in a unit in the south west which brought significant media attention. Even though not defined as a Low Secure Unit providing mental health services, the DH developed draft guidance for SHA to inspect providers of service. Again this appears to only have happened in England and not Wales or Scotland Roland will be speaking later about the issue of definition of PICU and LSU services which will highlight the issue and why at this time LSUs were not able to be included

22. What Next Fees - (£2400 per ward): Identify first wave participants Training days for Reviewers £2,400 per annum £8,640 for the full 4 years (10% discount) VAT @ 15% £2,400 per annum £8,640 for the full 4 years (10% discount) VAT @ 15%

23. www.napicu.org.uk www.rcpsych.ac.uk/aims AIMS@cru.rcpsych.ac.uk