Welcome to Celebrating Positive Practice in County Durham and Darlington 19 September 2013 Mrs. Jo...

Welcome to

Celebrating Positive Practice

in County Durham and Darlington

19 September 2013

Mrs. Jo Turnbull, Chairman

PATIENT & CARER INVOLVEMENT

Lucy Prowse – Patient & Carer Involvement Support Officer

Anthea Motson - Patient & Carer Involvement Officer

Pam Elliot - Carer

Paul Wait – Ward Manager, Farnham Ward,

Lanchester Road Hospital

What is involvement?

Involvement partnership

Our relationship

Work together to help shape and improve our services and help with people’s recovery

Types of involvement activityMeetings and consultationsTask and finish groups - reviewing services and providing

feedbackService improvement workshopsHospital inspections (PLACE visits)Ward visits (validation visits)Recruitment and selectionStaff training and inductionRecovery stories – sharing your experienceTrust conferences and eventsReaders’ panel – reviewing our leaflets and information

How to get involved

Do you have experience of our services and are interested in being involved?

Details held on our database

Involvement opportunities sent via email or post

What our service users & carers have said about involvement:

“My involvement with the Trust has enhanced my recovery since my discharge and I feel the best I’ve been in my life” from a service user.

“I have found absolute salvation being involved with various carers groups and being involved helped put my mind at rest from personal problems” from a carer.

Recruitment & Selection

ANTHEA MOTSON

Patient & Carer Involvement Officer

Recruitment & Selection

Background:

Historically staff involved service users and carers in recruitment and selection by inviting them to sit on interview panels.

Partnership working with HR was undertaken to promote involvement in their documentation and Trust Induction.

Recruitment & Selection Currently:

The Medical Education department hold their own database & train service users and carers in recruitment & selection.

Work is ongoing obtaining 360 degree feedback on the current interview process.

The trust is hoping to arrange a Values Focus Group to involve service users and carers in recruitment of staff on the basis of the Trust Values.

A focus group was set up to look at job descriptions to see if they are sufficiently service user / carer focused.

Recruitment & Selection

PAM ELLIOT

Carer

Training for Carers

PAUL WAIT

Ward Manager, Farnham Ward

Lanchester Road Hospital

ANY QUESTIONS

Crisis TeamsThe Future

What Does A Crisis Team Do?

Core Provision

Rapid assessment following referral.

A viable alternative to hospital admission.

Intensive home treatment.

Facilitated early discharge from hospital where admission has been unavoidable.

Prevent relapse

Facts24 hour service/7 days a week

Referrals for crisis assessment average around 160/month

Geographical area covered is from Consett to Seaham

We aim to see people within 4 hours of referral

Able to work intensively in people’s homes

Home Treatment case load is often between 20-30 people .

What’s next

Change perception service users/professionals

Be more flexible

Creative crisis care planning

Bespoke home treatment-build around individual needs

Integration with other services

User friendly/stop repetition

Accessible

Listen to feedback/constantly evolve.

BenefitsCare can be delivered at home.

Service user has greater individual input into their episode of care.

Increased carer involvement.

Integrated working.

Supporting community teams.

Build on existing coping mechanisms and social networks.

Developments

The Shildon Crisis and Recovery House

Purpose built

Intensive home treatment in our home

Help stabilise mental health

Step up

Step down

Can assist in early discharge

Seeing it from the service users perspective.

Benefits

Why

Give people greater choice –an alternative

Provide supportive care – relapse prevention

Step in earlier to prevent escalation of crisis

Facilitate resolution in crisis situations particularly for those with limited support or felt to be vulnerable

Focus on recovery

ConclusionCrisis Teams have been established for several years

within mental health services. The development of the new Crisis and Recovery House is the next step. It will enable people to have more choice with regards to their treatment and care, and allow services to intervene earlier, which ultimately improves outcomes and aids recovery.

A different way of doing things!!!

HOW SERVICE USERS WITH A DRUG PROBLEM ARE SUPPORTED IN SUBSTANCE MISUSE SERVICES

JUDITH DURKIN - CLINICAL COORDINATOR.

ANGELA SCULLY-SERVICE USER, SMART RECOVERY FACILITATOR.

KEY THEMES

INDEPENDENT/SUPPLEMENTARY NON MEDICAL PRESCRIBING WITHIN SUBSTANCE MISUSE SERVICES

THE DISTRIBUTION OF NALOXONE TO SERVICE USERS/PARENTS/ CARERS AND OTHERS.

WORKING AND SUPPORTING PREGNANT SERVICE USERS.

ROAD TO RECOVERY - ANGELA SCULLY.

LEGISLATION AND GUIDANCE WHICH HAS SUPPORTED THE DEVELOPMENT OF NON MEDICAL PRESCRIBING - NEIGHBOURHOOD NURSING A FOCUS FOR CARE 1986, FIRST CROWN REPORT 1989.

CHANGING PROFESSIONAL BOUNDARIES.

SUPPORTING THE ETHOS OF THE NHS.

RENEGOTIATION IN HEALTH CARE LABOUR.

INTRODUCTION OF NURSE - LED CLINICS.

INDEPENDENT/SUPPLEMENTARY NON MEDICAL PRESCRIBING

THE FIRST NURSES IN THE SUBSTANCE MISUSE SERVICES COMPLETED THEIR TRAINING IN 2005.

AT PRESENT THERE ARE 17 NURSES IN COUNTY DURHAM, A MINIMUM OF 2 WORKING IN EACH CENTRE WHO ARE QUALIFIED AS NON MEDICAL PRESCRIBERS.

BENEFITS OF NON MEDICAL PRESCRIBING TO SERVICE DELIVERY AND CLIENT CARE

TIMELY ACCESS TO SUBSTITUTE PRESCRIBING.

IT IS AN APPROPRIATE, EFFECTIVE AND COST EFFECTIVE INTERVENTION .

IT IS STRUCTURED AROUND CLIENT NEED.

GIVES PATIENT CHOICE AND CONVENIENCE.

AND GIVES CONSIDERATION TO BEST PRACTICE BASED ON EVIDENCE .

LEADING TO CONSISTENCY OF CARE DELIVERY FOR CLIENTS.

NON MEDICAL PRESCRIBING PROVISION WITHIN THE SUBSTANCE MISUSE DIVISION

COMMUNITY SUBSTANCE MISUSE SERVICES – SUBSTITUTE PRESCRIBING, DETOXIFICATION, SYMPTOMATIC RELIEF,OPIATE BLOCKERS.

HARM MINIMISATION SERVICES – ANTIBIOTICS, VACCINATIONS

RECOVERY INJECTABLE OPIOID SERVICE – SUPPORTING THE SMOOTH TRANSITION BETWEEN SERVICES.

RECOVERY ACADEMY – SUBSTITUTE PRESCRIBING AND SYMPTOMATIC RELIEF DURING DETOXIFICATION TO SUPPORT RECOVERY.

COMMUNITY ALCOHOL SERVICES – ALCOHOL DETOXIFICATION TREATMENT REGIMES, PRESCRIBING TO PROMOTE PHYSICAL HEALTH.

FUTURE DEVELOPMENTS

NON MEDICAL PRESCRIBING PROVISION INCREASED TO 75% ACROSS COUNTY DURHAM.

INCREASE ACCESS TO NURSE LED CLINCS.

DEVELOP THE ROLE OF THE INDEPENDENT NURSE PRESCRIBER AND THE PRESCRIBING OF CONTROLLED DRUGS.

NALOXONE DISTRIBUTION

IN 2011 – THERE WAS A TOTAL OF 1,772 MALE AND 880 FEMALE DRUG POISONING DEATHS INVOLVING BOTH LEGAL AND ILLEGAL DRUGS.

HEROIN/MORPHINE DEATHS HAD DECREASED BY 25% TO 596 IN 2011 BUT WAS STILL 596 DEATHS TO MANY.

THE HIGHEST MORTALITY RATE WAS IN THE AGE GROUP 30-39.

OPIOID DEPENDENCY INCLUDING HEROIN AND OTHER OPIOID DERIVITIVES HAS A HIGH MORTALITY RATE DUE TO ACCIDENTAL OVERDOSE.

EVIDENCE SHOWS THAT THESE NUMBERS CAN BE REDUCED IF NALOXONE IS GIVEN TO SERVICE USERS, CARERS AND OTHERS .

NALOXONE IS AN ANTIDOTE THAT RAPIDLY BUT TEMPORARILY REVERSES THE EFFECTS OF HEROIN AND OTHER OPIOIDS. IT IS REQUIRED TO BE ADMINISTERED VIA INJECTION TO THE OVERDOSE VICTIM.

IN 2005 THE LAW WAS AMENDED TO PERMIT EMERGENCY ADMINISTARTION OF NALOXONE BY TRAINED MEMBERS OF THE PUBLIC.

KAIZAN EVENT KEY THEMES

INCREASE AWARENESS OF OVERDOSE PREVENTION AND THE USE OF NALOXONE

DEVELOP AN OVERDOSE PREVENTION TRAINING PACKAGE – TO INCLUDE, BASIC LIFE SUPPORT AND ADMINISTRATION OF NALOXONE

TRAIN STAFF TO DELIVER THE PACKAGE

OUTCOMES OF KAIZAN

PATIENT GROUP DIRECTION.

TRAINING PACKAGE.

PROCEDURE.

STANDARD WORK.

LEAFLETS.

QUESTIONNAIRES.

POSTER.

EVALUATION

OVER 50 TRAINING EPISODES COMPLETED.

A KEY PRIORITY FOR SERVICES.

THREE NALOXONE USED IN OVERDOSE SITUATIONS WHICH ARE 3 LIVES SAVED.

SUPPORTING PREGNANT SERVICE USERS

MULTI AGENCY GROUP ESTABLISHED TO EXPLORE THE DELIVERY OF A ROBUST SERVICE MODEL

REVISITED AND UPDATED IN 2012, LEADING TO -

STANDARDISED WORKING ACROSS COUNTY DURHAM.

THE PROMOTION OF PARTNERSHIP WORKING WITH THE WIDER CARE TEAM ENSURING CONSISTENT SAFE PROACTIVE PRACTICES.

SERVICE USER INVOLVEMENT

SUPPORTING THE DEVELOPMENT OF THE PREGNANCY PATHWAY.

DEVELOPMENT OF SERVICE USER LEAFLETS.

DEVELOPMENT OF THE PREGNANCY CARE PLAN.

2012 SERVICE USER AUDIT.

IDENTIFIED -

GOOD PRACTICE IN SAFEGUARDING THE NEEDS OF THE CHILD

APPROPRIATE REFERRALS TO THE LOCAL AUTHORITY WHEN CONCERNS WERE IDENTIFIED

POSITIVE CLIENT ENGAGEMENT WITH SUBSTANCE MISUSE SERVICES POSTNATALY

ROAD TO RECOVERY

ANGELA’S STORY.

Hospital Liaison Service Update

Chris Binns, Operational Service Manager

Hospital Liaison Service Psychiatric liaison services provide mental health care to people being

treated for physical health conditions in general hospitals.

Mental health disorders such as depression, anxiety, alcohol and memory problems are very common in general hospital. Research has shown that they are often not recognised or treated

Untreated mental health issues can lead to longer hospital admission and poorer physical health overall in hospital inpatients and increased health care costs.

An effective liaison psychiatry service offers the prospect of saving money as well as improving health

.

What did will be different? Extend location of services and visibility

Better Support to hospital staff

Increased hours of working

Improved Multi disciplinary approach

Post discharge support

Service for High Intensity Users of Hospital Services

Patient stories

Whats next...Improving follow up for people who self harm

Working with Specialities within the Hospital

Development of MUPS service

Service Evaluation

And hopefully long term funding....

Questions?

Refreshment BreakRefreshments served on the mezzanine level and

market place

Patient and Carer FeedbackHow the Trust obtains and acts on

feedback from patients and carers, what it tells us and what we do about it.

Corinne Aspel

Lead Senior Nurse Patient Experience

Trust Values and Associated Behaviours

Commitment to quality

Respect

Involvement

Wellbeing

Teamwork

Benefits in collecting and using patient feedback....helps to improve communication between patients and

staff

helps to build trust and confidence in the NHS locally and nationally

informs planning and service improvement

helps the organisation to provide accessible and responsive services based on people’s identified needs and wants

helps patients to shape the services that they use.

What it says to those who access our services :we need and value your views on how we are doing

we are actively looking at how we are doing, and striving to do better

we look at your comments regularly and give a quick response to your opinions

we are open and honest, showing you how we have responded to your feedback

we will keep you informed about how other patients experienced care here

What it says to staff....we believe that your satisfaction with your work is key

to giving patients and service users a positive experience of care

we will involve you in designing systems to gather and respond to feedback

we will support you to improve services, building our reputation as a high-quality service provider.

Current Patient Experience System Electronic touch screen devices in use to

collect feedback ( anonymous )

A wide range of services are covered

Reports monthly to participating teams pie charts and written feedback

Acting on feedback

Results for Durham and Darlington –July 2013

92 patients completed discharge surveys from inpatient areas. 16 carers gave us feedback

49 patients completed surveys in 3 community teams in July. 13 carers gave us feedback

Adult services Maple ( WPH) scores Farnham (LRH) – scores above

78% for all questions

Elm (WPH) 100% felt staff were friendly and approachable but poor scores for feeling valued and understood similar picture for Tunstall (LRH)

Adult services Cedar (WPH) 58% felt safe during their stay

All areas excellent scores for friendly and approachable staff and being made to feel welcome by staff

Adult Community Two teams surveyed Darlington Affective team and

South Durham Affective team

Overall feedback very good but poor scores for being given a copy of care plans in the Darlington team

Older peoples services Oak (WPH) overall scores excellent lowest scores for

purpose and side effect of medication being explained 60 and 50%

Roseberry (BLU) again overall scores excellent 2 of 3 patients did not always feel listened to or have side effects of medication explained

Community

Sedgefield CMHT – excellent scores for majority of questions except side effects of medication explained 50%) and being given a copy of their care plan but this had increased from 35% in June to 56% in July

Carer feedback Numbers of carers giving us feedback are small and

this is an areas we would like to improve.

No themes are evident from feedback to date but each area are asked to action any questions which score poor.

DevelopmentsFriends and Family Test question introduced in July - early

indications are that we will get more valuable typed feedback ( see display for examples of the feedback received from this question in July 48 positive comments received and 3 negative)

Activity questions added to the inpatient survey to understand the range of activities available and the times they are available, and if they were helpful in the persons recovery

Staff experience

Learning Disability and Children's surveys introduced

Lanchester Road Hospital

Adult Learning Disability Service

Getting Feedback from the people who use our learning disability service.

A Service User from the Trusts Reference Group visit patients once they have been discharged.

They get feedback about the persons stay while in hospital.

The Reference Group

What the people who use our service say…

I was involved in my care, I had choices and options, I could

ask questions.

I didn’t want to be involved in the CPA but staff helped

me understand and I understood it.

I liked the staff, they handled situations well

when I got upset.

I was sick of stopping in, you had to smoke outside. I used to go to the shops and café with the staff. I was fed up,

liked to spend more time outside.

Nothing to do sitting bored – chose to watch the TV

Hard Mattress – making my back hurt!

Sometimes I didn’t really like the food

50% of people did not like the food!

What we did!

We have ordered some newMattresses!

We have changed theway food is cooked.

We bought a new Computer Touch Screen for everyone to

use

We have developed a good timetable

of activities!

Jackie - 0191 441 5800

Learning Disability Service

What support and treatment is available for those patients who may have a Dementia?

Shirley Hall, Occupational Therapist

Children and Young People’s Services

Dr Lynne Howey

CYP-IAPT Model (Duncan Law)

• On-going feedback promotes quality of service

• On-going reflective practice supervision based on feedback

• Clinical staff to deliver the best evidence based interventions

• Service delivery models that are evidence based and shaped by service users. Leadership Role.

Effective services Evidence

based interventions

Service User feedback

and outcomes monitoring

Supervision

Question Time??

Summary of Morning

Mrs Jo Turnbull, Chairman

Lunch available on the mezzanine level

Market place stands

Networking opportunities with your Governors, staff and other members

Expense payments – registration desk

Please take the time to complete your evaluation form and if you have a specific question you have not been able to ask – write it down and leave it with us.