1. and service user Task & Finish Group May 2014 – June 2015 Doncaster CCG Implement partnership vision of crisis support for Doncaster population Establishment of a Multi-agency and service user Task & Finish Group to redesign the crisis care pathway for Doncaster – MH Trust, Emergency Service, Social Care, 3rd Sector and Service User representation. Remit of the Group is to action: Crisis pathway/service review and redesign from Doncaster wide engagement across health and social care system and service development of key features document and translation of that into a service specification for crisis service including, Street Triage, Triage Hub, and crisis management and care co-ordination support for older people, access to CAMHs and dual diagnosis (substance misuse) 2. Review current care pathway with MH Trust, Police and Ambulance Service May 2014 – September 2015 Doncaster CCG Doncaster will have a clearly defined crisis response service that is responsive to services users and other crisis response services. Mapping of both the emergency response services and treatment and discharge components of the crisis pathway. Conduct capacity and demand of component services across the current pathway service to further understand the relationship of service and service users. Doncaster Crisis Hub is working collaboratively with Yorkshire Ambulance Service MH Triage Service GREEN
RDASH to implement the development of a Locality Facing Model (mirroring GP Locality Clusters) Improved partnership working in Doncaster locality 1. Involvement of service user groups From 2014 onwards Doncaster All Partners will be included in the ongoing development of mental health services across Doncaster and Service users will lead the way Assurance of service user voice on Task and Finish Groups, frequent CCG attendance at Service User Group to Consultant on each step of the care pathway and Service User membership on the Crisis Care Concordat Action Group has been secured GREEN 2. Scope out Psychiatric Liaison Services in the Acute Trust 2015/16 Doncaster Patients attending the Acute Trust and have mental and physical will experience a joint care pathway which is seamless and reflects the needs of the patient A scoping exercise of MH Service support and care in the acute trust will take place in December 2015. An agreed improvement plan will be implemented that will bring the Psychiatric Liaison Service in line with the key principles of the MH Task Force on better access and care AMBER 3. Multi-agency Working - Outcome Metrics - An agreed joint data set to establish baseline and capture demand and responses for people in mental health crisis (SABP, EDT, Police, 136, Ambulance, A&E’s, 111) 2015/16 Doncaster CCG/S.Yorks Police/RDASH The vision is to have a joint Performance and Quality Outcomes Framework (PQOF) across all agencies Develop and introduce measures to quantify and measure the nature of the demand profile created by mental ill health, both quantitatively and qualitatively. A PQOF Framework has been developed between the CCG and the MH Trust, but this needs to be extended to include other agencies involved in the pathway. The Liaison & Diversion Project Pilot will include the development of a MH Trust and Police Dashboard – this is still in development SYP are to introduce a new MH monitoring form to gather data to support the early identification and management of vulnerable people. The proposed form has been shared with RDASH to enhance discussion to develop a joint performance framework. In due course the new dataset will shared with partners. AMBER
This work will be supported by a multi-agency T&FG to progress this workstream 4. S/Yorks Police – Introduction of a tiered strategic Governance Framework Gold – Exec Level Strategic Board Sliver – County partnership oversight Board Bronze – CCG area based delivery group 2015/15 S/Yorks Police Include representation from all internal departments to develop and reinforce inter-departmental understanding and cooperation in designing the response to mental health related demand Governance and accountability Strategic direction and control SYP have mapped existing governance across the police MH portfolio and are in consultation with each Trust to replicate this exercise with partners in line with organisational changes. This will ensure we have efficient and effective structures at Operational, Tactical and Strategic level to support those in crisis, whilst also developing innovative pathways, processes, policies and systems which meet the needs of the community, support future commissioning and comply/meet legislative/statutory guidance. 5. S/Yorks Police – Work with partners to develop assessment process for patients and potential offenders 2015/ongoing Doncaster Police Vulnerable people coming into the contact with the Police will be assessed for need, and a support programme put in that will either support them through the criminal justice system or divert them from it. Develop tiered case management systems, to identify early risks to victims, patients, offenders and locations – linked to Integrated Offender Management Programme Develop and embed links across internal departments and external agencies, The Wave 2 Liaison and diversion has now been established with Doncaster & Rotherham Custody suites. The service aims to provide an initial screening and triage facility for those arrested and detained at a police station. Outcomes are determined on an individual basis (dependant on need), support can be provided by the L&D team and/or existing community resources. L&D will provide information relevant to the Court to inform outcomes decisions. The current service is to be expanded to cover 12 hours and in due course will also support referral pathways for voluntary attendee’s and those subject to community resolutions. (This work supports the new Home Office IOM Principles) AMBER
looking at repeat, complex and multi-agency demand. Tiered model with robust reporting, referral and accountability processes to maximise opportunities to intervene at the earliest opportunity. Influence and inform the development of processes and the deployment of partnership resources before, during and after crisis The establishment of the hub will include appropriate resourcing of AMHP and S.12 MHA Approved clinicians to ensure rapid access to appropriate care pathways and supporting services within both the health and CJ system. Liaison and diversion scheme will compliment this work as will the crisis hub which will house the out of hours AMHP’s Implement a Vulnerable People Panel to review complex cases and ensure robust case management L&D services will be supported by the Crisis HUB AMPH’s out of hours The establishment of the Crisis HUB includes appropriate resourcing of AMHP and S.12 MHA Approved clinicians to ensure rapid access to appropriate care pathways and supporting services within both the health and CJ system. Implementation of the new Vulnerable People Panel will support the effective identification and management of complex cases SYP are currently reviewing demand data to establish a consistent process to support the identification of repeat callers/locations. In due course this will feed into the Vulnerability Panel to aid the early identification and assessment of risk/needs. 6. Children & Young People MH Transformation Plan – Collaborative Oct 2015 DCCG Doncaster will have a collaborative approach to addressing the needs of Doncaster partnership has submitted its Children & Young People Mental Health Transformation Plan on 16 October which has been signed-off by the Health & Wellbeing Board. GREEN
2. Review of Primary Care Mental Health Pathway and redesign of service 2014/15 Doncaster CCG/RDASH All patients requiring access to Psychological Therapies will be seen within 28 days of the referral being made and will be placed on the appropriate step of the Step-care model Development of a primary care pathway that will support people with mental health problems, better in the community Integrated support for people with anxiety and depression through the review of access to Improving Access to Psychological Therapies (IAPT) Through the development of integrated support between primary and secondary care, people with enduring mental health problems will have access to early interventions in community to prevent escalation into crisis Improved Physical health checks for people with mental health problems will be provided in primary care to ensure Parity of Esteem GREEN 3. S/Yorks Police - Monitor the implementation and effectiveness of the national Criminal Justice and Liaison Service pilot 2014/15 Police, Doncaster CCG/RDASH Partners will know and understand how to support vulnerable people in the community who come to the attention of the police. Access to liaison and diversion services for people with mental health problems who have been arrested for a criminal offence, and are in police custody or going through court proceedings is in place The local evaluation for this project will be presented to Doncaster Commissioners (health) at the end of February 2016 to inform future commissioning intensions Liaison and diversion team implemented in April 2015 and team fully staffed, NHS England are evaluating data. SYP have requested data to confirm the number of referrals being made to
5. Public Health S/Yorks Police - The Suicide Prevention and Audit Group will identify the at risk groups to inform the commissioning cycle. 2015/16 Public Police Doncaster will have a locally agreed Suicide Prevention Strategy and Action Plan that will be monitored by the Health & Wellbeing Board. Doncaster Public Health Unit and Doncaster CCG will develop a Suicide Prevention Strategy and work with partners to implement local actions SP Action Plan has been developed by PH and a recent audit has been undertaken. SYP were part of a national to provide real time data in support of suicide prevention. At this time SYP are reviewing the real time data capture to quality assure the processes and review how PH have utilised the dataset to inform the development of local action plan and enhance bereavement support. Within the new ‘Authorised Professional Practice’ to be issued by the College of Policing in 2016, there will be a chapter on suicide prevention. This will support the National SP strategy and outline the role of the police. SYP have benchmarked a number of forces to review their approach to suicide prevention, bereavement support and training. Consultation with PH will continue to consider how this will compliment/contribute to local action plans. AMBER 3. Urgent and emergency access to crisis care
No. Action Timescale Led By Outcomes Summary progress against actions (include outcome measures where relevant) (RAG) Improve NHS emergency response to mental health crisis 1. Street Triage Pilot Implement a model of liaison and diversion Telephone crisis clinical triage will be operational in the Doncaster ‘Hub’ 2014/15 DCCG Anyone experiencing a mental health crisis will receive an immediate response, feel listened to, receive the most effective care for their diagnosis and have a recovery focused outcome All 3 service components have been put in place Evaluation Frameworks for each element of the pathway are being developed that will measure outputs, partnership arrangements and most importantly, patient reported outcome measures – across all age ranges GREEN Social services’ contribution to mental health crisis services 1. Step-down beds & Integrated Care 2015/16 Doncaster CCG Anyone who is experiencing a mental health crisis which is being exacerbated due to their social circumstances will receive appropriate multi-agency assessment, treatment and care appropriate to their needs Plan to re-commission/re-provide community based support during 2015/16 in partnership with the Local Authority AMBER 2. Advice and Support function to be provided via the Crisis Hub 2015/16 DMBC The Crisis Hub will provide this service which has been specified to include access to social care support, peer led support groups, patient advocates, guided self-management, housing/accommodation and floating support and debt management advice and advocacy. Social Prescribing Model for Doncaster has been commissioned using the Better Care Fund GREEN 3. Crisis Assessment Service 2015/16 A joint assessment and case management approach will be in place between health and social care. The Crisis Assessment Service/Hub has local operation policies between RDASH and DMBC with integrated systems to deliver unified day to day management, joint staffing and joint case management. AMBER
999 and 111 Systems or young person is not put in a police cell as a place of safety New pathways have been circulated to SYP Communications staff and Doncaster officers. Further discussions will taken place to consider the transfer of calls from the Police control room to the Crisis HUB (link to Triage review). 3. Inclusion of GP MH Champions 2015/16 Doncaster CCG/GP Clinical Commissioning Leads Doncaster GPs will have the full support of the MH and access to local training and education to enhance their skills in supporting patients with mental ill health Service users will feel confident that their GP fully understands their condition and that they will be directed to the most appropriate care pathway A development programme for GPs is under development and the SCN for MH Regional Lead) is delivering a Master Class in November 2015 for interested GPs. Named CAMHS Workers will be allocated to primary care to enhance service deliver and support to primary care but also will improve learning and education, AMBER Improved training and guidance for police officers 1. Training for Police – equip agencies and staff to respond appropriately 2015/16 S/Yorks Police S/York Police will have received mental health awareness training so that they can provide appropriate and sensitive response to the public/people who are During August/September 2015, RDASH delivered vulnerability awareness training to all custody staff to support the identification and GREEN
2. To review use of police restraint for patients to have mental health disorder with a view to joint training initiatives January 2015 RDASH Joint training is implemented and safe restraint practices will be used only when absolutely necessary. This is subject to ongoing review. RDASH are working closely with SY Police to develop joint policies regarding dealing with mental health emergencies. Lord Carlisle is currently overseeing a national working group to review the police response to calls for assistance within MH settings and the use of restrain. NHS England, the College of Policing, the RC of Psychiatrists and a number of other national bodies are involved. SYP MH Team and Trusts leads are in initial consultation to review existing structures pending further guidance being issued. 3. Audit of the minutes from the MH Collaborative Ongoing RDASH Service users and carers are aware of, and can contribute to crisis services and their development. Where practicable, service users and carers are represented at the crisis care pathway development groups. Where this is not the case minutes from meetings are shared GREEN Staff safety 1. Review lone worker arrangements to ensure appropriate safety measures are in place when dealing with people in crisis situations December 2015 RDASH Lone working procedures reviewed in each team. Crisis hub has relevant safety procedures in place. All staff risk assess community visits. Standard operating procedures updated GREEN Review management of violence and aggression protocols in light of police resource December 2015 This is being reviewed as part of the joint management of mental health incidents with South Yorkshire Police. Additionally RDASH are reviewing management of violent patients internally. Partnership working protocols developed AMBER
limitations and legalities of use of police to support incidents of violence on wards. Primary care response 1. Active engagement with GP’s 2015/16 - ongiong Doncaster Community Doncaster has a fully informed and skilled primary care workforce who are responsive and supportive of those presenting with a mental illness Establish Primary Care Mental Health Work stream Task & Finish Group – Completed GP Clinical Lead for MH established and leading on Primary Care Mental Health Redesign Work Communication Plan established to: Consult with GPs in localities regarding the pathway redesign Active engagement with the LMC to understand opportunities and impacts of any redesign on GP workload Monthly Newsletter/bulletin developed to keep GP community informed GP clinical lead involved in transformation plans. RDASH clinical director is engaging directly with influential GP’s re pathway redesign. 2. Review of Primary Care Mental Health Pathway and redesign of services including discharge 2015 – 2016 Doncaster CCG/RDASH The primary care pathway will be accessed at the of need and the access waits will be in line with the national target Doncaster is meeting a locally agreed target for access from referral to treatment within 28 days A Social Prescribing Model/Service has been commissioned and has 100% coverage across the practices The Social Prescribing Service is offered to services users contacting the Crisis Hub and GREEN