Welcome to Celebrating Positive Practice in Teesside 21 March 2013 Mrs. Jo Turnbull, Chairman

1. Welcome toCelebrating Positive Practice in Teesside21 March 2013Mrs. Jo Turnbull, Chairman

2. Psychiatric Liaison Inpatient support Lorraine Ferrier, Service Manager Caroline Hart Jade Goodwin

4. Intensive Community Liaison Service (Tees wide)“Providing the most intensive interventions when they are needed most” Dr Graeme Flaherty-Jones Principal Clinical Psychologist / Service Clinical Lead & Vicki McDonald – Advanced Practitioner

5. Overview • Care Home Liaison • Intensive Community Liaison Service • Innovative change • How it will benefit our patients

6. Current Care Home Liaison Servicecurrently provides… Assessment and Interventions for older people with dementia or mental health difficulties in care homes Support Workers Occupational Therapy Nursing Psychology Advice and support = link-worker Medication monitoring

7. If it isn’t broke...? • Care home liaison has developed an excellent reputation, • So why change? • We listened to what the people who use our services told us...

8. New Intensive Community Liaison Service will provide... • 7 days a week / 365 days a year / 8am – 8pm • Faster referral process • Comprehensive mental assessment within 24hrs • Input in the community and care homes • The Intervention Toolkit

9. What are we aiming to achieve? • Providing the most intensive interventions when they are needed most to: • Improve patient wellbeing • Reduce carer stress • Reduce behaviour that challenges carers • Reduce unnecessary admissions to hospital

10. New philosophy to interventions ‘Patients, with a plan, in a day’ What do you want right now? Where do you want to be in 6 weeks time? ‘Child in a chair in a day’ Right assessment, Right equipment, Right first time Ruth Owen (Chief Executive, Whizz Kidz)

11. Intervention Toolkit • Focused evidence based interventions: • Activity & Sleep Monitoring • Dementia Care Mapping • Life story work • Simulated Presence Therapy • Reminiscence Therapy • Solution Focused Brief Therapy • Cognitive Behavioural Interventions • Attention and Awareness Interventions

12. Time of change “Always remember that striving and struggle precede success, even in the dictionary” (Sarah Ban Breathnach)

13. Summary The service developments will lead to: Faster access, to more people, more often ‘Patients with a plan in a day’ Better outcomes for our patients

15. SERVICE USER & CARER INVOLVEMENT 2011 – 2012 Pauline King – Patient & Carer Involvement Manager PALS Validation Visit & Essential Standards User Group: Bev Conde, PALS Officer Philippa Thomson, Clinical Assurance Facilitator Mark Eltringham, Audrey Lax & Terry Taylor, Volunteers

16. SERVICE USER & CARER INVOLVEMENT 2011 – 2012 Patient Experience & Involvement Strategy 2011 -14 • Commitment to involving service users and carers in the continued improvement of our services • An involvement procedure to advise staff on • different ways of involving people • process for paying travelling expenses & Honorariums

17. How do we involve people and receive feedback on our services? • Involve patients & carers in decisions relating to individual care and treatment (care planning) • Surveys (inpatient & community) local & national • Validation Ward Visits (more info to follow) • PALS issues (1,128 in 2011- 12) • Complaints (141 in 2011 -12)

18. SERVICE USER & CARER INVOLVEMENT 2011 – 2012 How people are involved on a regular basis:- • Recruitment of staff • Patient Environmental Inspection visits • Reference groups for pharmacy, psychological therapies, essential standards, learning disability • Training nurses as part of their induction & NVQ training for support workers :-

19. Bev Conde, PALS Officer - Validation Ward Visits • Staff working Patient Experience team & volunteers & service user & carer representatives visit wards across the Trust (some here with us today) • Ask patients about their care – based on Care Quality Commissions - Essential standards of Quality & Safety • Questions are asked about their privacy & dignity, being involved in decisions about care & treatment, patient information, care plans, safety, contact with staff & assessing quality of service provision • Since 2011 to date 112 visits have taken place with reports given to wards after visits

20. SERVICE USER & CARER INVOLVEMENT 2011 – 2012 • Mark, Terry and Audrey from the Trust’s Essential Standards Reference group are going to tell us about their experience of validation visits ……………….

21. Philippa - What happens to the feedback given during the visits? • Report sent to each Ward following visit. • Can be used as evidence by ward in the event of a CQC inspection. • Quarterly Reporting of the Essential Standards Group to the Trust’s Quality Assurance Committee. • Feedback given to Commissioners at quarterly Clinical Quality Review Groups.

22. Any questions?

23. Listening to Patients and Carers Corinne Aspel Lead Senior Nurse Patient Experience

24. Trust Quality Indicators for Patient Experience Trust quality indicators for patient experience – what patients and carers told us was important to them: • Attitudes of staff • To be treated with respect and dignity • To be involved in and informed about decisions about care and treatment • A good environment • Enough appropriate activities • A range of care and treatment options • Timely access to services and appointments • Staff knowledge and expertise • Good quality of food • Safety

25. Trust Values and Associated Behaviours • Commitment to quality • Respect • Involvement • Wellbeing • Teamwork

26. Current Patient Experience System • 52 devices covering 105 areas across the Trust • 12 questions for short stay, 10 for long stay and 14 Community • Carer survey included and staff survey (being piloted in Forensic Services) • Bespoke surveys developed with patients in LD Forensic and LD services • Work in Children and Young Peoples Services underway to design surveys for use • Short stay Inpatient assessment and Treatment services surveys before discharge • Long stay areas every three months • Community services devices rotated available in each team for two months twice a year

27. Questionnaire Development Key areas which are common to all patients experience were identified as: • Respect and dignity including being listened to and treated as an individual • Access to services • Involved in and informed about decisions/treatment These will be the basis of core questions that will always be asked additional questions will vary over time and be related to other information sources i.e. national patient survey results

28. What else are we asking and why ?? • National in-patient survey results • Complaints/PALS • CQC visits • Demographic questions • Carers survey • Staff survey

29. Response rates- Patient Experience feedback was received from 269 patients October - December • Mixed response rates for the Tees Locality for this quarter with variation in response rates across wards. • Stockdale, Lincoln and Overdale ward areas will be targeted by the team for improvements in their response rates and the drop in Bransdale numbers were targeted in November and increased in December. Stockdale had a device out of action for in November but this does not account for the low scores in December.

30. Continued • In community services Parkside continues to have a good number of people completing the feedback survey. Stockton substance misuse team improved their response numbers in November following intervention by the project team. • Two long stay areas were surveyed this quarter with reasonable response rates. Carer response numbers dropped significantly in December, this is an area for improvement in all areas.

31. What patients are telling us • In short stay adult wards overall rating of care was consistently high with scores between 75% and 94% (n 100) across the quarter. In older peoples wards scores were also very good with scores between 75% and 100% but with a much smaller sample (n 23). • Two of the adult wards (Overdale and Bedale) had low scores for feeling safe during their stay in November but these improved in December for feeling safe during their stay in Overdale going from 33% to 100% in December and Bedale 40% in November to 75% in December. • Scores for being given information about medications purpose and side effects were high across all adult wards ( this had previously been an area for improvement in all adult wards) the only exception being Wingfield older peoples ward with a score of 50% in December for explaining side effects.

32. What patients are telling us • In this quarter two long stay areas carried out their three monthly surveys. • In community services all areas demonstrated excellent quality scores and all had improved response numbers with overall ratings of care between 75 and 100% (n119).

33. Comments: “Other patients made me feel unsafe” (Bedale) “Waiting for medication before going home is interminable” (Bilsdale) “Noisy environment at times wandersome patients sometimes trying my bedroom door at night” ( Wingfield)

34. Comments: “I got looked after well by all the staff and Doctors” (Wingfield) “I am happy with the care and support I got” ( Parkside) “My overall experience of Bilsdale ward and its staff was very pleasant ...the staff should be commended for their care and understanding of the environment in which patients live... A credit to the struggling NHS system..I appreciate all the help and care I have and will continue to receive ...thank you all very much for your understanding and excellent care at this difficult chapter of my life ..many thanks” “Thank you for helping me at a bad time” (Lakeside)

35. Carers Survey - Background • Trust carer strategy developed in 2011 • How do we measure the strategy? • Development of survey questions to measure key elements of the strategy • Introducing electronic devices to collect patient feedback – ideal opportunity to add carer survey

36. Carer Questions • Opportunity to speak to staff about the person you care for • Supported by staff for your own needs • Treated with dignity and respect • Involved in decisions about the care and treatment of the person you care for

37. Questions continued Given or offered information about the following: • Mental health conditions • How to raise concerns • How to give feedback • Carer support services

38. Progress so far ( early days!)... • Feedback received from 43 carers October -December 2012 • Each areas scores vary with some getting consistently high levels of feedback and other with areas for improvement. No consistent themes emerging.

39. Next steps • Increase response rates • Work with teams to address issues raised • Ensure patient experience feedback is shared in a timely way with patients and staff • Carer feedback is fed back to local carer forums • Implement rolling programme in community services • Implement system in Children and Young Peoples and Learning Disability Services

41. Cleveland Street Triage Team

42. National Liaison and Diversion Development Network • In 2010 national funding became available for projects which would enhance current Liaison and Diversion Services • An area identified for development was around detentions under Section 136 of the Mental Health Act 1983 which were higher in Cleveland than the national average

43. Section 136 Mental Health Act 1983 • If a constable finds in a place to which the public have access • a person who appears to him to be suffering from mental disorder • and to be in immediate need of care or control, • the constable may, if he thinks it necessary to do so in the interests of that person or for the protection of other persons, • remove that person to a place of safety.

44. The Picture in Cleveland • Data was collected from Cleveland Police and cost savings were worked out based on figures from the Sainsbury Centre (registered charity) • In a 12 month period 511 people were detained under S136, however 388 were released as not having a mental disorder • The cost of putting someone through the custody process without any following sanctions was estimated at £1,780 per person • 388 x £1,780 = £690,640 so in 12 months this much money had been spent dealing with people that didn’t need to be dealt with in this way • A proposal was then developed to tackle this issue

45. The problem • Police officers are not mental health professionals • But they do have the power to detain someone if they believe them to have a mental disorder • The outcome; people were being detained by police in the belief that they were mentally disordered instead of officers seeking a professional opinion • This started the person off on a journey through the criminal justice system which they didn’t need to be on • And often led to them being discharged from custody without any follow up for the issues which had brought them to the attention of the police in the first place

46. The Solution • To have a team of mental health professionals who could respond to the police on the front line when they were considering using the Mental Health Act to detain someone • The team could assess the person and offer professional advice to the officer who could them make an informed decision about the way forward • If successful this would reduce the number of Section 136 detentions • A proposal was forwarded to the NLDDN for approval of such a team • This proposal was accepted and approved and a team was commissioned for a two year pilot study

47. Street Triage Team • 2 mental health professionals working from 4pm till midnight 7 days a week • They have police radios and are contacted by the police control room and sent to the officers location • They respond to officers requests and carry out triage assessments at or near to the location • They then advise officers of the outcome of that assessment and any action they deem necessary • This may be to detain the person in a place of safety or to take them home or to another location • And would include referral onto other services if felt appropriate and a seven day follow up

48. Outcomes to date

49. Outcomes to date

50. Outcomes to date • 237 people triaged • 11 went on to be detained under Section 136 • 123 were from Middlesbrough area • 55 were from Stockton area • 16 were from Hartlepool area • 43 were from Redcar area • 133 were Male • 104 were Female • 103 were found to have no mental disorder • 61 had drug or alcohol issues • 170 engaged at follow-up