Sheffield Health & Social Care NHS Foundation Trust

1. Sheffield Health & Social Care NHS Foundation Trust Adult CMHT Reconfiguration

2. Sheffield Health & Social Care NHS Foundation Trust Existing CMHT type Services that are part of the Reconfiguration • 4 x Sector Teams • 4 x Continuing Needs Teams • 4 x Early Intervention Teams • 1 x Crisis Resolution and Home Treatment

3. Sheffield Health & Social Care NHS Foundation Trust Why Change? • Budget Reductions. Savings requirement in SHSC of 10%. Savings required in SCC budgets • Existing CMHT model in place for 11 years but significant developments since 2001 • Need to try and make most effective use of resources

4. Why Change? People who use our services • No simple point of access • Depends on diagnosis • Separate teams can bounce between • At point of crisis meet a new team • Waiting from referral to outcome • Where you live affects what you get Sheffield Health & Social Care NHS Foundation Trust

5. Why Change? - Staff • Over burdened sector teams (non psychosis) • Inefficient systems between teams • 100% referred 75% assessed, 25% taken on • Not using their skills • Not enough sharing with GPs, IAPT, Voluntary Sector Sheffield Health & Social Care NHS Foundation Trust

6. CMHT Model • One overall CMHT in each locality with distinct functions • Recovery/ Care Co-ordination Team and Early Intervention • Access and Assessment • Locality based Home Treatment • CMHT’s provide Crisis Assessment and Home Treatment function until 8.30pm

7. Locality Team ASSESSMENT Early Intervention Recovery Primary Care Liaison Consultation signposting RECOVERY Home Treatment Care Co-ordinating GP’s IAPT SPACES HAST Transcultural Rehab/SORT Out of Hours Inpatient

8. Access/Assessment Function • Single point of entry (in locality) for all referrals – routine, urgent, and crisis. • Improved liaison and consultation with Primary Care and IAPT • Effectively manage the boundary • Extended assessment, brief intervention, advice etc • Adult Safeguarding and related social care responsibilities • Extended hours of operation

9. RECOVERY/Care Co-ordination Function • Manage people clearly identified as requiring secondary mental health care • Multidisciplinary approach, promoting relapse prevention and recovery. • Manage crises of existing service users with Home Treatment Workers. • Focussed staff groups

10. Home Treatment • Managed within locality CMHT • Step up care to more intensive approach • Direct access for new referrals as appropriate • Close links with both Access and Recovery function • Covers hours of 8am – 9pm, with Weekend and Bank Holiday Provision via citywide rota

11. Locality Team Manager Locality Clinical Lead (0.25) Recovery (incl. EIS) SHSC staff 1 x Nurse Senior Prac (1 of SPs with EIS focus) 5 x CMHN (Band 6) (1 EIS specific) 2.5 x CMHN (Band 5) (1 EIS specific) 1 x CBT Therapist (Band 7) 2 x STR Workers (Band 3) Education Employment Worker (Band 4) 1 x Psychology (Band 8a) 1 x Psychology (Band 7) 1 x OT (Band 6) 1 x OT (Band 5) 0.6 x Art Therapy (Band 7) SCC staff 1 x Social Work Senior Practitioner 2.5 x AMHP (1 EIS Specific) 2 x Social Worker (Level 2) 2 x Social Worker (Level 1) Access/Assessment SHSC staff 1 x Senior Practitioner 5.25 x CMHN (Band 6) 0.5 x Psychologist (Band 8a) 0.5 x O.T. (Band 6) SCC staff 2.5 x AMHP 1 x Social Worker (Level 2) Home Treatment SHSC staff 1 x Senior Prac 2 x CMHN (Band 6) 2 x CMHN (Band 5) 2 x STR Worker (Band 3) 1xAssistant Team Manager (Band 7) Admin per locality CMHT 1 x Admin Manager Band 5 1 x Info/Governance Band 4 2 x Team Administrator Band4 2 x Med Sec Band 3 3 x Admin Officer Band 3 2 x Admin Band 2 1 x Apprentice 1 x House Keeper Band 2 Medical Input per Locality CMHT Access/Assessment 1.25 Consultant Psychiatrist or 1 Consultant Psychiatrist plus 0.5 Specialty Doctor Recovery 1.25 Consultant Psychiatrist or 1 Consultant plus 0.5 Speciality Doctor Home Treatment 0.25 Consultant Psychiatrist Example Future Job Structure Chart per Locality CMHT

12. Benefits • More Consistent Interface with Primary Care • Clearer Focus on both Longer term secondary care caseload and advice/ support consultation with Primary Care • Maintain some of the specialist skills achieved within current model • Home Treatment more closely aligned to CMHT

13. Benefits continued • Development of Acute and Scheduled Care Pathway • Improved ability to advise / assist Primary Care • Maintains integration of Health and Social Care • More flexible use of resources within Localities

14. Related Issues • Implementation of Self Directed Support • Introduction of Mental Health Clusters and PBR

15. Localities • Retain a 4 Locality Model • More equitable Localities • BUT also aim to keep disruption to a minimum

16. Progress Update • Service User & Carer feedback • Proposal supported by Board of Directors October ’11 • Staff Consultation • Staff Confirmed into roles

17. Preparatory Work Practical Caseload management, Estates, Rotas, IT systems, Medicine Management Systems, HR related processes Communication Service Users and Carers, GPs, Other Stakeholders

18. Development Work • Detailed practicalities of model within teams • Embedding Principles of Recovery • Key relationships • Training Issues

19. Dates for change • Phase 1 Beginning July ’12. CRHT staff move into locality CMHTs • Phase 2 1 – 2 months later establish Access and Recovery sub teams