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Sheffield Health & Social Care NHS Foundation Trust. Adult CMHT Reconfiguration. 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
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Sheffield Health & Social Care NHS Foundation Trust Adult CMHT Reconfiguration
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
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
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
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
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
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
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
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
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
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
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
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
Related Issues • Implementation of Self Directed Support • Introduction of Mental Health Clusters and PBR
Localities • Retain a 4 Locality Model • More equitable Localities • BUT also aim to keep disruption to a minimum
Progress Update • Service User & Carer feedback • Proposal supported by Board of Directors October ’11 • Staff Consultation • Staff Confirmed into roles
Preparatory Work Practical Caseload management, Estates, Rotas, IT systems, Medicine Management Systems, HR related processes Communication Service Users and Carers, GPs, Other Stakeholders
Development Work • Detailed practicalities of model within teams • Embedding Principles of Recovery • Key relationships • Training Issues
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