AMHP – Approved Mental Health Practitioner AWP – Avon and Wiltshire Partnership Trust BME – Black and Ethnic Minority BPD – Borderline Personality Disorder CCG – Clinical Commissioning CAMHS – Childrens and Adolescent Mental Health Service CCG – Clinical Commissioning Group CPA – Care Programme Approach CQC – Care Quality Commission CQUIN – Commissioning for Quality and Innovation CSU – Commissioning Support Unit ED – Emergency Department EDT – Emergency Duty Team IAPT – Improving Access to Psychological Therapies IST – Intensive Support Team LD – Learning Disability MH – Mental Health MHA – Mental Health Act NSC – North Somerset Council NSCP – North Somerset Community Partnersip OOH – Out Of Hours PCLS – Primary Care Liaison Service PCC – Police and Crime Commissioner SWASFT – South West Ambulance Service Foundation Trust TBC – To Be Confirmed (due to changing personnel involved in current projects) WAHT – Weston Area Health Trust RAG RATING (for work yet to be started this has been left Green – Action complete or good progress towards action and on track to deliver on time – Action partially complete with some progress towards delivering Red – Action not completed on time or at risk of not completing on time based on progress to date
Doc ref Principle Current Gaps Actions Lead Time frame Progress against action as of June 2015 RAG A1 Early intervention - protecting people whose make them vulnerable 24/7 mental health service with single point of access via PCLS 8am - 8pm (IST out of hours) Community teams in place with clear pathway to step people up or down within services to ensure appropriate clinical response to need. Learning Disability early intervention available, and enhanced by new intensive support team. Liaison and diversion service in place Respite Individual placement project, to include in scope need for short stay 'crisis' and respite beds. CCG (Angela Kell) NSC (Alison Apr 16 Project held due to capacity Access for with dementia - particularly to support inpatient stays and facilitate earlier discharge, ambulance crews often have little choice but to take to ED Reconfiguration of later life services to allow community response before crisis and prevent admission CCG (Angela Kell) Oct 15 Bed review completed. LL IST to be implemented Jan 16. Dementia liaison post at Weston Hospital to enhance dementia care for those experiencing mental health crisis alongside physical health crises CCG (Angela Kell) AWP (Suzanne Howell) Dec 14 Completed Joined up approach towards suicide prevention North Somerset Suicide prevention group reviewing and updating local action plan, to include adults and children. Action plan been developed. NSC (Helen Yeo) April 15 Local group (NS Zero Suicide Collaborative) have met and developed action plan. This will link with this action plan. To add document from Zero Suicide steering group. Scoping feasibility of 'postcard scheme' locally for people presenting with self harm AWP (Suzanne Howell) Sept 15 Funding by NSC and CCG secured. Scheme started Sept 15. Measures to be put in to monitor impact.
Direct access for SWASFT into MH services is inconsistent Review access routes into all services to identify opportunities to streamline / simplify access and address training needs AWP (Suzanne Howell) SWASFT (David Partlow) Oct 15 Training an issue for SWASFT. No outstanding access issues by SWASFT into MH services. Access for those with dual diagnosis Implementation of a pilot (via a CQUIN) mental health nurse into the drug and alcohol service. This will include development of a dual diagnosis passport and a more integrated approach. Evaluation from this pilot will inform future development of this service NSC (Ted Sherman) CCG (Natalie Huggens) AWP (Suzanne Howell) Apr-16 CQUIN is now in place and joint working has already started within the IAPT service. AWP & Addaction exploring clinical pathway to enhance service delivery. Peer support in crisis Work with Service User Groups and voluntary sector (including Advocacy Services) to identify local need and opportunity for offering peer support to people in crisis. CCG (Natalie Huggens) AWP (Stephen Budd) Mar-16 Meeting arranged with Mary Adams on 9th October to discuss how to progress this. Easy access for year olds to IAPT services New IAPT pathway from April 16-18 targeting 16-18 year olds, with development of a ‘specialist’ younger persons IAPT worker. This is part of the Send agenda CCG Angela Kell, AWP – Ted Riley July 15 Pathway in place. Action completed B1 People in crisis are vulnerable and must be kept safe, have their needs met 24/7 services available – with PCLS, IST, AMHP and EDT services Community and hospital based services available EDT cover anecdotally reported to be inadequate at times North Somerset AMHP team and EDT to jointly develop an improved model for out of hours response to MHA assessments. This will include a review of current AMHP / EDT activity / demand. NSC (Amanda March 16 Business case being developed to explore options for different ways of working to improve current offer. 18
appropriately and be helped to achieve recovery Limited community services for people with dementia in crisis Options appraisal for community based Later Life/Dementia Intensive Support Team CCG (Angela Kell) AWP (Suzanne Howell) Oct 16 Investment secured for in Jan 16. Model and service specification being developed. Access to inpatient beds not always available in area due to bed pressures North Somerset bed review to full scope issue and identify service improvement options CCG (Angela Kell) March 16 NS bed review completed, with recommendations to be implemented during 15/16. B2 Equal Access BME access is not considered to be an issue in NS. Good access for LD with IST Good local advocacy services This can be validated by local Service user forums Compare access BME data to population BME data March 16 To be reviewed as part of JSNA B3 Access and new models of working for children and young people services available up to age of with shared care protocol in place for people aged 16-18 with mental health needs. Access to S136 bed or 16-18 year olds Delayed response times reported Lack of services specifically for 14-25 year olds. Options appraisal for reconfiguration of services for 0-25 year olds, with any service changes to be included in the re-procurement of CAHMS. CCG (Mark Hemmings) CAMHS (TBC) AWP (Andy James) April 16 Procurement process ongoing. Options appraisal for a strengthened response for children and young people in mental health crisis CCG – Mark Hemmings, CAMHS - Trish Tallis March 16 secured for improved CAMHS crisis response. Recruitment underway B4 All staff should have the right skills SWASFT have clinical guidelines for patients Limited multi-agency training Develop a plan for local training programme in mental health AWP (Anita Hutson) April 15 Plan in development.
Variety of beds available depending on needs of service user Crisis plans are in place for known service users Placements for patients younger than 18 are commissioned on an ad hoc basis according to need LD IST in place Cross – agency access to crisis plans is an issue SWASFT to consider use of care summary record and enhanced care summary record SWASFT – Partlow Mar 16 Connecting Care available to be accessed by GPs, AWP, NSC, NSCP. Availability of longer term placements for people to 18 Currently under review, with planned opening of additional beds over forthcoming year NHS England Mar 16 Ongoing programme of work B6 People in crisis in the community where police officers are first point of contact should expect them to provide appropriate help. But the police must be supported by health services, including mental health services, ambulance Place of safety - S136 Suite jointly commissioned at Southmead Hospital SWASFT currently unable to report if meeting the 30 minute target for ambulance response for a MH crisis. Manual work-around process in place to collect data, which is to be reported alongside other SWASFT metrics SWASFT (David Partlow) Mar 15 Complete The management of intoxicated patients is an issue when it may not be clear if there are mental health needs also To scope feasibility of street triage project or direct access to dedicated mental health expertise to support emergency services by rapid mental health assessment and response Work up and submit business case to PCC for additional funding A&S Police (TBC) CCG (Angela Kell) AWP (Suzanne Howell) March 16 Street triage project on hold Avon and Somerset wide decision re commissioning control room triage. Monies identified and project plan to be developed There is some 'hidden' demand - police will take Evaluation of S136 suite within one year of implementation, and will include information on CSU on behalf of CCG Oct 15 Timeframe for evaluation has
services, and Emergency Departments people elsewhere rather than to SMH POS There are many cases where police are staying at POS whether custody suites are still being used as POS in any circumstances and whether police are released promptly on handing the service user over to the S136 staff (Andew Keefe) been slipped by CSU B7 When people in crisis appear (to health or social care professionals or to the police) to need urgent assessment, the process should be prompt, efficiently organised and carried out with respect Community assessments in situ Anecdotal reports that mental health act assessments are occasionally delayed when local inpatient beds are not available. Currently this data is not collected or reported Undertake review MHA assessment processes, response data capture, and reporting. Formulate an action plan based on outcome Amanda Ralph – AMHP Lead May 15 Initial review complete. More formal report/ evaluation to follow by Sept 15 – latter not yet complete & to be part of EDT review. Regional inconsistencies in S12 practice Region wide review of S12 Doctors CSU on behalf of CCG June 15 Evaluation / report awaited by CCGs. Need up-date from CSU. B8 People in crisis should expect that statutory services share essential 'need to know' information about their needs Information sharing protocols and information governance policies in place for each organisation AWP is now part of connecting care, allowing NSCP and care providers to view basic patient information Barrier to more efficient information sharing is use of different IT systems – GP (EMIS) system not yet linked in Connecting Care programme of work underway. This currently includes acute trusts, community health and social services, GP, ambulance trust. This work is being progressed in 15/16. Existing Connecting care programme AK to be the link April 17 The timeframe for full roll out in NS is unclear but should be in 15/16. It is working well already in NSCP. Need to establish link with Ambulance service
B9 People in crisis who need to be supported in a health based place of safety will not be excluded Health based place of safety is S136 suite at SMH Close links with alcohol liaison service and psychiatric liaison service with Emergency departments Efficacy of pathway for intoxicated people is currently unclear and the use is inconsistent Evaluation of S136 to include management of intoxicated individuals to ascertain extent of problem and need for service redesign. CSU on behalf of CCG June 15 CSU evalutation to be completed. No place of safety in Weston Reconsider need for and viability of as part of the S136 suite review and NS bed review, and as part of the evaluation of the embedded MH expert project CCG (Angela Kell) March 16 S136 evaluation awaited. Scope for safehaven beds will be considered as part of the bed review. Details will need to come from S136 suite evaluation. B10 People in crisis who present in Emergency Departments should expect a safe place for their immediate care and effective liaison with mental health services to ensure they get the right on going support Access to 24/7 psychiatric liaison service via ED (provided by IST out of hours). ED staff offered training to ensure effective screening for MH problems Provision of and access to services is reviewed on an ongoing basis as part of the contract management process. Where issues are identified, specific action plans will be developed and incorporated into this action plan if appropriate / necessary. Extended psychiatric liaison operational 7 days a week, in place from 1st July 2015
B11 People in crisis who access the NHS via the 999 system can expect their need to be met appropriately Clear clinical guidelines and protocols in place within SWASFT for management of MH patients No direct/embedded MH expertise in place with the emergency services SWASFT - scoping development of in-house MH expertise in SWASFT. Police – develop direct access/ embedded expertise model in year. Submit business case to PCC for joint funding SWASFT (David Partlow) A & S Police (TBC) CCG (Angela Kell) AWP (Suzanne Howell) April 16 MH practitioner now employed in SWAST to offer MH expertise where required CCG funding agreed for control room/ street triage service – to be implemented by April 16 B12 People in crisis who need routine transport between NHS facilities, or from the community to an NHS facility, will be conveyed in a safe, appropriate and timely way Protocol with police in situ Transfers to / from out of area placements and between inpatient facilities are via private ambulance with the appropriate escort arrangements No specific actions required at present. Protocols and operational issues are monitored routinely. B13 People in crisis who are detained under section 136 powers can expect that they will be conveyed protocols with police in situ for medical transportation, and ambulance response time stipulated to be 30 minutes for MH crises Performance against target unclear due to SWASFT reporting See B6 re action for capturing and recording information on response from SWASFT. SWASFT Partlow) March 15 Action complete
by emergency transport from the community to a health based place of safety in a safe, timely and appropriate way C1 People in crisis should expect local mental health services to meet their needs appropriately at all times Access to 24/7 service. Commissioner led review of demand against capacity for local population for beds Dignity policies in place within all provider organisations. North Somerset Bed review to identify opportunities for service redesign to ensure optimal local access for beds AWP undertaking wide bed review CCG (Angela Kell) March 15 Completed. Approved by CCLG. Completed. Recommendations to be rolled out during 15/16 C2 People in crisis should expect that the services and quality of care they receive are subject to systematic review, regulation and reporting Provider self assessment of CQC compliance Commissioner assurance visits Robust local and trust wide performance and quality monitoring processes in place AWP implementing safewards Access to local beds can be an issue with bed pooling arrangement in place North Somerset Bed review to identify opportunities for service redesign to ensure optimal local access for beds CCG (Angela Kell) March 15 Completed recommendations to be implemented in 15/16 Recent AWP CQC inspection highlighted numerous local and trustwide quality concerns and with some compliance notices Development of local and trust wide action plan to address areas of non-compliance and concern noted in partnership with CCG and Local Authority AWP (Suzanne Howell) Oct 14 Action plan submitted. AWP feeding back on achievements to CQC Implementation of Quality Improvement with strong North Somerset representation AWP (Alan Metherall) and CCG Oct 14 This is completed and ongoing and considered part of
(incorporating least restrictive care strategies) (Liam Williams) ‘business as now from a contract monitoring perspective C3 When restraint has to be used in health and care services it is appropriate AWP implementing ‘Safewards’ (incorporating least restrictive care strategies) provider protocols and policies in place Staff training and supervision within main MH providers closely monitored by commissioners Not known what policies and procedures are in place at Weston Hospital re restraint and managing difficult behaviour, or at other independent provider units. Review policy for restraint and managing difficult patients with Weston Hospital, and work with them to develop an action plan if appropriate. Review of security staff remit and role and WAHT to ensure minimal use of police service. Physical intervention used rather than ‘restraint’. CCG- Angela Kell WHAT - Beccie Watkins June 15 Restraint training has been rolled out across the trust. The security policy has been revised with contracted staff offered appropriate training. Action complete Restraint is an issue in ambulance service National work happening with ambulance trusts to enhance knowledge, training around this issue SWASFT – David Partlow TBC C4 Quality and treatment and care for children and young people in crisis CAMHS service in place, but under increasing pressure with increasing wait times for assessments Responsive and flexible local response, particularly for those in crisis options for service enhancement to offer improved crisis response, in collaboration with adult services Incorporate need to offer increased crisis response in CAMHS procurement CCG (Mark Hemmings) (TBC) AWP (Andy James) March 16 Enhanced psychiatric liaison at Weston will include mandate to see 16-18 year olds where appropriate. This is in place for 15/16. D Recovery and staying well/ preventing future crises Crisis completed on initial assessment. Crisis plans reviewed at CPA Care co-ordination in Developing a BPD service to implement local BPD strategy and provide a more pro-active, co-ordinated and planned approach to people with personality difficulties CCG – Angela Kell AWP – Suzanne Howell On Funding panel forum also being used for discussions re services users whose needs are changing