Commissioning to allow earlier intervention and responsive crisis services No. Action Led By Outcomes Summary progress against actions RAG Matching local need with a suitable range of services 1001 Procurement of one stop shop for information, advice and guidance April 2015 Herefordshire Council Accessible IAS Community Hub able to provide comprehensive and coordinated information, advice and signposting to promote choice and control. This will be part of the evolving MH Strategy that will assure prevention, early detection and intervention and targeted support. New WISH (wellbeing information signposting in Herefordshire) developed, with provider in place. Online service available with new community hubs developed in 2015/16. Action Complete Green 1002 Development of a suicide prevention strategy April 2016 All Reduce risks for vulnerable patients Suicide prevention will form a key element of the evolving Strategy allied to Mental Health and a range of services comprehensive and complementary in nature to prevent and avoid self- harming behaviour, inclusive of suicide prevention. Mental Health Partnership Working party set up a process to review all suicides or attempts in the county to try and learn from them. Mental health needs assessment with a suicide audit (over 40 years) completed and published. Green 1003 Development of a suicide template June 2015 Herefordshire Clinical Group Improved information on suicide and locations will assist suicide prevention planning. As above. Template designed and disseminated across primary care. Follow-up by CCG to ensure completion by Primary Care. Action Complete Green 1004 Continuation of the easy access to Ongoing Samaritans Improved and easy access to listening service to people to help avert MH crisis Information about accessing Samaritans service in police Green
Samaritans Referral Scheme custody suites. 1005 Street pastors scheme – operating: With support from SRG Opening of Emelia’s Place Diverting from and to A&E 2014 Herefordshire Venture Improved and easy access to listening and recovery service for people recovering from a night out in Hereford (to include people with substance misuse and mental health needs) Scheme in full operation every weekend. Action complete Green 1006 Make information available about local services / alternative care pathways 2015 WMAS 2gether NHS Foundation Trust WVT Improved urgent care and crisis care response for people requiring support, advice, information and assistance. Good progress with CAMHs crisis card in place with details of alternative services and adults given out of hours number. Further work on documenting local services as alternatives to be developed. Amber 1007 Support access for early intervention – preventing crisis: Develop a support pathway for DOS/111 provision to support patients, carers, and practitioners. 2015 WMAS Reduction in crisis management Reduce demand upon emergency services with managing MH sections Reduce the risks to support workers, families and emergency services Work underway / on track – need to localise. To be discussed at future interagency group. Green 1008 To progress Troubled Families Herefordshire Council Early intervention for parents or children with health problems Programme in place. Documented in the refreshed CYP Plan. Green
programme to becoming part of our emerging approach to early intervention and targeted support for families: of CYP Partnership to include a subgroup for Families First. To manage Families First Programme April 2015 Ongoing Action complete 1009 Progression of the Transformation Programme Board (TPB) and the Project Team for the purpose of: The of integrated community teams to include health and April 2016 All Improved patient access to multi-agency support, including people with MH. Reduce risks for vulnerable patients Transformation Board and project team in place. Public engagement planned for December 2015 Green
social care including Mental Health and General Practice Staff Integrated working with sector at a local level to provide formal and informal networks of support for those receiving care. Improving mental health crisis services 1010 Reconfiguration of services into a single point of access for mental April 2016 2gether NHS Foundation Trust Improved access to specialist advice Good progress - New shared duty function in place. Green
health services. 1011 Pilot of a 24 hour helpline for advice August 2015 HCCG Improved access to information that will aid appropriate action for people in a MH crisis. Reduction in s136 detentions due to alternatives. Plans for helpline in place. Date of implementation to be confirmed Red 1012 Explore the potential for new technologies within the 111/999 setting to enable better responses to people in crisis. April 2016 WMAS Improve immediate care to patients in crisis, carers and practitioners. Project work underway Green Ensuring the right numbers of high quality staff 1013 Multi-agency Mental Capacity Act, and suicide prevention training: Programme agreed and in place 2015 All Frontline staff are appropriately trained Herefordshire Council is aware and committed to further enhancement of capability and capacity allied to MCA to assure compliance. This will include rolling MCA training open to relevant staff and across sectors of the market to build the required assurance. This is already in place and consideration will be given to adding suicide prevention programme. MCA training taken place. Mental Health Partnership Working party set up a process to review all suicides or attempts in the county to try and learn from them. New action to update the completion date as programme to continue during 2016 to increase access to training. Green 1014 Improve access to MH education within WMAS Trust: Identify gaps in provision Incorporate April 2016 WMAS Improve appropriate management of patients in MH crisis. Reduce risks for vulnerable patients Full update at next Interagency meeting
December 2015 1018 Joint operating procedures for Place of Safety, warrants and assessments on private premises, absent without leave, mentally disordered offenders, MCA, conveyance for adults and children and young people. June 2015 All Shared understanding of clearly defined and consistent processes for Herefordshire. Maintenance of low use of custody suite for people with mental health needs. Low utilisation of A&E for only red flag patients only. Effective and efficient Patient care, with assessments conducted in appropriate settings. Children under 18 are not placed in Police custody as a Place of safety. Not signed S136 protocol – albeit it is drafted ready for this. Low volume of s136 continues Red 1019 Monitoring of the Crisis Care Concordat action plan by Health and Wellbeing Board June 2015 HWBB Quarterly progress reported with continued partner’s engagement Interagency meeting in place with updates supplied Green 1020 Management of the Crisis care Action Plan: Overview of the Crisis care concordat action plan progress by Ongoing May 2015 Police HCCG WVT Herefordshire Council WMAS Regular shared information on activity and performance: Ensure people who are detained in Police custody are for appropriate reasons Achieve reduction of detentions in custody by 50% compared to baseline in 2011/2012. Monitoring of crisis management in emergency settings Police 99% reduction in custody detention for only S136 matters. All criminal detentions that involve a MH assessment are reviewed to assess suitability of arrest in first place. Police intergral part of Multi agency group. Local data discussed at Interagency group Green
Group to include statutory and voluntary sector partners. Improve local data collection to inform continuous and evaluation including length of detention 2gether NHS Trust 1021 Development of CYP Partnership to include a subgroup for Emotional and Mental Health: To progress actions including a parental mental health April 2015 Herefordshire Council HCCG 2gether NHS Trust CLD Trust YOS Innovation in alternatives places of safety To promote and enhance the health and wellbeing of children and young people through more effective multi-agency working and coordination of care and support. CYP Partnership in place with new CYP plan. A steering group set up with good level of interagency representation. Led to the development of 5 year transformation plan. Crisis care is one of the areas. Action complete Green being agency
user engagement: Assurance visits Family and Friends Test Experts by Experience 2gether NHS Foundation voice heard and participate in the design and review of services that will impact on mental health crisis care including feedback on urgent or crisis care. 2004 Access to crisis resolution and home treatment for adults 24/7 (as alternative to admission) Ongoing 2gether NHS Foundation Effective and efficient Patient care, with assessments conducted in appropriate settings. Improved access to home treatment where appropriate. Provision in place Action complete Green 2005 Improvement in crisis contingency planning: based on a recovery outcome approach for working age adult service users with a mental health need addressing their April 2016 2gether NHS Foundation Prevention of relapse and encouraging >90% service users to maintain their mental health at home by having a personalised crisis contingency plan whilst under the care of the Crisis and home treatment (CRHTT), Recovery, Assertive Outreach and Early Intervention teams and at point of discharge from community mental health team to GP. Audit of all crisis plans completed. Second stage of work to consider adjustments to Crisis care plans template Green
individual needs 2006 Complete scoping exercise re: current liaison & diversion provision across the West Mercia and Warwickshire area. Local review of scoping exercise to identify any gaps and areas for improvement. June 2015 July 2015 West Mercia Police All Model for alternative care pathways that can identify, assess and offer support that meet the needs of Herefordshire. Scheme to place AMHP in police control room advancing. Police fully engaged in working groups. Local protocols to support dealing with interagency complaints about MH provision in place Green 2007 Improve awareness of and access to crisis management plans Ongoing 2gether NHS Foundation Trust WVT WMAS Improved quality of care for people in mental health crisis. Reduce numbers of inappropriate attendance and conveyance to ED. This links to action 2005 and individual practitioners have been putting crisis care plans in place across secondary mental health services. Further work by the Interagency group to expand the use of crisis care plans awareness to people not currently in secondary mental health services. Green 3. Urgent and emergency access to crisis care No. Action Led By Outcomes Summary progress against actions Update Improve NHS emergency response to mental health crisis 3001 Review processes within the Trust to May 2015 WMAS Delivery of high quality patient care with specific regard to a person’s dignity and Full update expected at next Interagency meeting.
deliver safe, appropriate and holistic care respect. 3002 Improve and assure that transport arrangements are robust: Response times are in line with national MHA section 136 protocol for ambulance trusts May 2015 WMAS HCCG Within 30 minutes or within 8 minutes for people who are actively restrained. Action progressing - WMAS reviewing WMAS/ National policy and Ambulance commissioning arrangements for mental health admissions. Meeting likely to take place November 2015. Recent incident for Interagency group to examine (low numbers so able to look at case by case lessons to be learnt). Amber 3003 Development and publication of integrated urgent and crisis mental health care pathway: For Adults For Children and young people August 2015 All Effective and efficient Patient care, with assessments conducted in appropriate settings. Evidence of robust care pathways aligned to effective care coordination to assure positive outcomes. Recognition of vulnerable groups West Mercia Police & WMAS pathways discussed at Interagency group. Final pathways to be developed once place of safety arrangements confirmed. Red 3004 Increase section12 Doctors availability and monitor s12 timescales April 2016 Herefordshire Council HCCG Ensure enough doctors available locally Change in management of s12 doctors rota locally. Rota of section 12 doctors available but limited change in the increase of people on the rota. Amber
3005 Agreement of a protocol for CYP requiring urgent and crisis mental health care; to include s136 and 24/7 access to advice. June 2015 2gether NHS Foundation Trust HCCG Herefordshire Council WM Police WMAS Children under 18 are not placed in Police custody as a Place of safety. Experience of children is improved Adherence to local agreed care pathways is demonstrated Police training in pace and delivered – covered children being taken too Children’s unit at County Hospital. New model of care developed with ambition to increase care available and 7 days per week access to CAMHs assessment. Update to protocol delayed until new model agreed. Current protocol remains in place. Amber 3006 Provision of liaison psychiatry available in A&E. October 2015 WVT 2gether NHS Foundation Trust HCCG Improve appropriate management of patients in MH crisis. Action complete. Links to action 4004 Green Social services’ contribution to mental health crisis services 3007 Development of a MH Housing Plan April 2016 Herefordshire Council Housing Plan to complement and support the Mental Health Strategy. Housing plan being developed Green 3008 Review the availability of AMHP to undertake MHA assessments 24/7. April 2015 Herefordshire Council The Social Care Mental Health Operating Model will provide assurance allied to AMHP to discharge legislative requirements. New team of mental health social workers in place with a rota of AMHPs. Action complete Green 3009 Sharing of AMHP activity with partners including response times April 2015 Herefordshire Council Regular shared information on activity and performance presented to the Group for the Crisis Care Concordat. Agreement by Herefordshire Council to share activity. Reporting should follow the electronic s136 form to supply all information to the Interagency group. As an interim Green
verbal updates given. Action complete 3010 Emergency specialist foster care arrangements are available when a young person is in crisis and require a placement 2015 Herefordshire Council Appropriate accommodation and care for young people in MH crisis Skilled, confident people who are able to understand and meet the needs of young people suffering MH crisis Recruitment campaign underway for new foster carers. Herefordshire Intensive Placement service in place and operational since May 2015. Action complete Green 3011 Provision of statutory advocacy for people 2015 Herefordshire Council Review and revision of current advocacy contract will capture mental health. Provision in place. Action complete Green 3012 Provision of carers assessments and support April 2015 Herefordshire Council The Adult Social Care Mental Health Operating model will address the needs of Mental Health Carers. The contract with Herefordshire Carers will also address the needs of Carers of people with mental health needs. Provision and access to assessments in place. Action complete Green Improved quality of response when people are detained under Section 135 and 136 of the Mental Health Act 1983 3013 Re-commission Place of Safety: For Adults For Children and Young People To include standards To include training for staff 2015 HCCG Sufficient provision that meets local needs. Improve appropriate management of patients in MH crisis. Options paper developed and discussed by HCCG. Preferred model and financial resources being worked up. Refreshed target of March 2016 for a staffed PoS . Interagency group aware and contributed to the options appraisal. Red
services to improve awareness of Ambulance Service ‘special notes’ (AACPs) so that they can be utilised to ensure access to crisis management plans as appropriate. 2015 Foundation Trust WMAS Reduced number of inappropriate conveyance to ED 3020 Progression of National fit for purpose of electronic patient records April 2016 WMAS WVT 2gether NHS Foundation Trust Improved patient records and improved response to crisis care All agencies updating their electronic records systems and come together as part of an Information Management and Technology Committee. Action progressing Green 3021 Consider models for the implementation of Street Triage. Agreement and implementation of a scheme (subject to outcome of above action). April 2015 2015 West Mercia Police /HCCG West Mercia Police / HCCG Alternative care pathways in place that offers support earlier to avoid inappropriate conveyance to a Place of Safety. Planned scheme in place to put AMHP in police control room. Pilot is place covering Worcestershire with evaluation due by March 2016 to inform possible roll-out to Herefordshire. Green Improved training and guidance for police officers 3022 Make available local multi-agency training including Police officers / staff – role specific 2015 West Mercia Police Staff trained in the areas of MH awareness will provide an enhanced, informed and sensitive approach to people in mental health crisis. Training programme delivered to all police staff / officers and process in place to train all new staff as they are employed. Green
where possible (links to action 1013 and 3013) Action complete Improved services for those with co-existing mental health and substance misuse issues 3023 To explore improvements for people with mental health and substance misuse: Accessing A&E. 2015 Herefordshire Council HCCG Low utilisation of A&E for only red flag patients only. Effective and efficient Patient care, with assessments conducted in appropriate settings. Joint discussions concluded and progress moved onto new provision. New service has been commissioned by Herefordshire Council with implementation date of 1 December 2015. New action round creating new care pathways for co-morbidities. Action complete Green 4. Quality of treatment and care when in crisis No. Action Led By Outcomes Update Review police use of places of safety under the Mental Health Act 1983 and results of local monitoring 4001 Frequent activity information to be shared at MAG of use of custody; PoS. Ongoing Police Regular shared information on activity and performance: • Ensure people who are detained in Police custody are for appropriate reasons • Achieve reduction of detentions in custody by 50% compared to baseline in 2011/2012. • Monitoring of crisis management in emergency settings Police 99% reduction in custody detention for only S136 matters. All criminal detentions that involve a MH assessment are reviewed to assess suitability of arrest in first place. Police integral part of Multi agency group. Action complete Green
appropriate safety netting processes: Self referral advice 999/111 advice VP reporting procedures Advice leaflets Referral reporting pathways Access to clinical records 2016 crisis meeting 5002 Continuation of the carers contingency card Ongoing Herefordshire Carers Support Plans are in place to support carers and the person they care for in the event of an unplanned or planned event. Carers registration has increased. Contingency cards being taken up. Action completed Green 5003 Encourage use of advance care plans and advance decisions for people with mental health including people with dementia: Develop EOL forum Refresh April 2015 End of Life Forum, c/o HCCG Individuals have the opportunity to discuss, plan and record their preferences for care (including advance decisions to refuse treatment). Advance care plans designed and piloted. Now rolling out. EOL strategy and forum in place. Action completed Green