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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.
