veterans, Black, Asian and Minority Ethnic communities and students, as well as working with housing providers and other services which come into contact with those experiencing debt. The review will include an assessment of commissioning gaps and consideration of how these are addressed by partner organisations. Healthcare NHS Foundation Trust, CityCare Partnership 5 Update the Joint Strategic Needs Assessment to include information to help plan and monitor against the Concordat actions 15-16 Partnership County Council and Nottingham City Council Public Health Departments, all CCGs Commissioners have robust data through to monitor services Nottinghamshire County: drafts of the Mental Health Adults and Older People and Suicide Prevention chapters are due to be presented to the peer review panel early December. and young people mental health JSNA has been published. Adult mental health revised JSNA chapter is in draft and will be shared with the next mental health JCG. Suicide prevention, mental wellbeing and physical health needs of people with mental illness chapters are in draft. Suicide and self-harm deaths audit is taking place across City and County to add more insight to the JSNA chapters.
3. Urgent and emergency access to crisis care No. Action Timescale Led By Outcomes Summary progress against actions (include outcome measures relevant) (RAG) Improve NHS emergency response to mental health crisis 16 The cross-agency Partnership Board will oversee all joint policies, procedures, protocols and guidelines to ensure clear signed protocols, to demonstrate effective partnership working This will include: s136 pathway Agreed response times for conveyance and Mental Health Act assessment Information sharing protocols 15-16 All To ensure robust partnership working and locally agreed messages, roles and responsibilities, to protect and safeguard service users and staff s.136 pathway agreed between NHFT and Nottinghamshire Police. Ratification by each organisation expected by January 2016. Discussions have place at the Street Triage Board regarding extending triage for daytime coverage within Police control room for telephone advice. A proposal is being costed up and will be presented at the next Street Triage Board. Response ambulance: agreement in place between AMPs and EMAS in regard to ambulance attendance following the assessment. Adherence to the target depends on the other priorities they are dealing with. Response no agreement in place yet in place for psychiatrists attending a MHA assessment. Escalation policy in the process of being developed where an AMP has identified the need for a bed but none are available Review of protocols taking as part of Urgent Care Vanguard, this will further develop work with Early Supported mental health Discharges
Escalation policies Security protocols Review of the use of restraints by police in settings Explore opportunity of having a mental health practitioner within the police control room Monitor compliance with missing persons/ Absent Without Leave from care protocols focusing on joint understanding, response protocols (including response times) and pathways with all partners across the whole system 17 To monitor and evaluate the performance and outcomes of the Street Triage Team pilot and make recommendations for future commissioning 15-16 All CCGs, Police To reduce s136 detentions Service users experience more joined up care To inform commissioning decisions from 16-17 onwards Evaluation report which includes recommendations for future commissioning completed in October 2015 and will be submitted to CCG Boards during Q3. Current funding is non-recurrent. Funding solution to be by end of December 15. Continuation of the service requires all CCGs and Police to commit funding. 18 To analyse current Rapid 15-16 All CCGs Working with: To ensure an adequate of support is provided to acute trusts Authority led review of substance misuse element of RRLP service has taken
the Mental Health Act regularly complete external Mental Health Act Compliance audits Nottingham City Council and Nottinghamshire County Council have provided assurance that Codes of Practice are applied consistently Services for children and young people 20 CCGs to commission a pilot for child and adolescent mental health service for children and young people during 15/16 and 16/17 15-16 All CCGs Working with: Healthcare NHS Foundation Trust, Police, Nottingham University Hospitals NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Nottingham To provide emergency mental health care for children and people Individuals in crisis should expect that their needs can be met appropriately at all times Responses should be on par with responses to physical health funded via CQUIN money over a two year period Service is due to start at the end of Q3 NHFT and Commissioners have been working to develop a model during Q1-2 Site visit undertaken by NHFT and Commissioners to Sunderland to learn from their model Further work to be undertaken to ensure the crisis service links with liaison psychiatry service
the education work plan To continue to engage with National Ambulance Mental Health to create mental health education for paramedics to be agreed nationally To continue to engage with the national Joint Royal Colleges Ambulance Liaison Committee working group in the development of mental health guidelines started with the CAT team which has been well received from feedback questionnaires. A wider process of training will be developed for frontline staff. EMAS plans to move towards a locality “mental health champion” within different stations. Improved services for those with co-existing mental health and substance misuse issues 34 To review pathways between mental health, domestic violence and 15-16 Nottingham Crime and Drugs Partnership, To identify gaps in provision and inform future commissioning intentions Nottingham City Public Health led review of alcohol services in ED carried out as part of alcohol strategy Recommendations are being reviewed and
between adults’ and children’s services. 36 Mental health service providers to collect data on the 9 protected characteristics as part of the 15-16 Mental Health Contract Work with Public Health to analyse the information provided. 15-16 All CCGs, Healthcare NHS Foundation Trust, Nottingham City and County Public Health To support the Equality Act To ensure appropriate access to services for all service Requirement included within the 15/16 contract with NHFT All services are developing Equality Impact Assessments as part of revised service review process 37 To revise the current arrangements for quality visits and service reviews and strengthen as part of contract management processes 15-16 All CCGs Services are subject to systematic review, regulation and reporting Service review process has been redesigned New process approved by the CCG Quality Improvement Committee Go live date set for January 2016 38 To ensure that service specifications are current and reflective of guidance from bodies including the National Institute for Health and Care Excellence, Mind 15-16 All CCGs Services are subject to systematic review, regulation and reporting Action is taken where services are not meeting required standards Service review process has been redesigned and is due to go live from January 2016 Specifications will be systematically reviewed via service review process
and the Royal College of Psychiatry; key performance indicators are relevant measures of quality and performance 39 On-going review and support of Nottinghamshire Healthcare NHS Foundation Trust’s ‘No Force First’ programme around restraint 15-16 Healthcare NHS Foundation Trust To ensure principle of least restraint To safeguard service users and staff No First Lead Clinician including literature search, relationship building and Post-Incident Reviews (hereafter PIRs) introduced as outlined below: All ward management teams in both the City and County North have been visited and introduced to the project and specifically the PIR formulation and process. Ward teams are currently identifying NFF champions for each ward. Introduction of the No Force First Project has been made to both the ‘Sign up to Safety’ Blanket restriction Group and the Violence Reduction group, with further visits to the Ideal ward round Involvement group, the Rosewood Involvement Group and the No Force First Film Group. Currently 13 PIRs have been offered with 7 completed and fed back to the various ward teams Underpinning all of the above work is the week by week analysis of Incident reports to identify when hands on restraint has occurred and to identify opportunities for Post-incident reviews, this includes analysis of all incidents and work
42 Monitor and scrutinise service user safety issues and safeguarding by analysing and responding to individual serious incidents, ensuring appropriate practice and lessons are learned across organisations whom services are commissioned from 15-16 services, all CCGs To understand range of issues and risks via routine reporting Opportunities for appropriate scrutiny and confirm and challenge All serious incidents are reported to the CCGs by providers. Each incident is subject to completion of a root analysis report which is required to be submitted to the CCG for review within 60 working days as stated within NHS England’s National Serious Incident Framework. Each report is reviewed by the CCG’s Quality Governance Team and relevant commissioners who ensure that lessons learnt and recommendations are adequate for closure. If further assurance/challenge is required this is requested. 43 To request and receive regular reports from commissioned services that evidence trends and highlight issues and risks and take action as appropriate 15-16 All CCGs Working with: all providers To understand local issues, pressures and risks To put appropriate in place to improve service user safety As part of contractual requirements learning from serious incidents is included within the 6 monthly lessons learned reports for NHFT. NHT produce a specific Suicide and Self Harm report for Contract meetings that identified themes and trends. Primary Care do not currently produce reports identifying themes and trends however a quarterly serious incident report is submitted to the CCG’s Quality Improvement Committee highlights the number and type of serious incidents and any lessons learnt/changes to practice that have been identified.
Staff safety 44 To monitor incidents involving staff to understand issues and to ensure risks are minimised when managing service users in community settings and performing 24/7 assessments as part of the enhanced Crisis Resolution and Home Treatment service 15-16 services, all CCGs To ensure that Nottinghamshire Healthcare NHS Foundation Trust staff are appropriately protected and understand any issues presenting All serious incidents involving staff are reviewed by the Quality Governance Team in line with the National Serious Incident Framework. Ensuring staff and patient safety through risk assessment would be considered during review and assurance that steps have been taken to mitigate any further instances would be sought. Physical Assaults against staff are an indicator on the Quality Matrix which is reviewed and discussed at Quality and Contract Review Meetings. 45 To explore broader risks with other stakeholders to identify if action is required in relation to the management of service users in community settings 15-16 Partnership Board To understand the to staff across the broader community relating to AMPs not being able to access inpatient beds has been raised at Crisis Concordat Partnership Board and an escalation process is being developed Review of eCRHT being commissioned by NHFT Quality subgroup established which will review broader risks. Subgroup to be chaired by Director from City CCG. Primary care response 46 To explore and design a Protected 15-16 Nottingham City CCG, GPs To ensure appropriate of knowledge around crisis and crisis pathways in primary care PLT events are taking place in November and December 2015
users who are identified as at high risk of admission 50 To review criteria for entry and discharge from mental health secondary care as part of wider Crisis service pathway review To include review of protocols to ensure service users can access preventative specialist health and social care 15-16 All CCGs, Healthcare NHS Foundation Trust Service transitions between primary and secondary care will be improved Nottingham City have developed a proposal for a Primary Care Mental Health Service includes discharging chronic, stable patients from clusters 5 and 7 Nottinghamshire County reviewing opportunities for providing cluster 4 in a primary care setting Rushcliffe CCG has a mental health element to its Multi-speciality provider vanguard which includes closer working between primary and secondary care NHFT reviewing the numbers of patients in clusters 1-3 to see if stable patients can be discharged into primary care 51 To develop a pathway between Child and Adolescent Mental Health Services tier 4 inpatient beds and the Child and Adolescent Mental Health Services Crisis Service 15-16 All CCGs, Healthcare NHS Foundation Trust Service users’ transitions between primary and secondary care will be improved Children and Young People’s Crisis Team will support access to Tier 4 beds from the community and also provide Home Treatment in the community following discharge. The new service will be up and running from 1st January 2016.