This includes the work we are undertaking with BME communities. Progress Mental health awareness training commissioned jointly between CCGs and Public Health 40 courses to run 2015-17. Courses will target public-facing in a variety of organisations and communities across Derbyshire to further develop infrastructure of support for people with MH issues. 1.5 We will develop an integrated of voluntary sector neighbourhood delivery. We will support the development of Voluntary Sector single point of access for primary care and professionals to facilitate befriending support, community resilience and access to the full range of community supports for people. Progress Erewash Model in place and progressing well. 2014 launch Service user review of Problems to be resolved. 2015 development of new model including VSPA development. In Erewash CCG we will work on a first phase which will help us develop this elsewhere in the county with partners and service receivers Erewash CCG SDVSMHF MHAG • Single of access to support within voluntary sector and Community for Primary Care. • Improved access to community support to help prevent crisis escalating • Obstacles and issues raised by Service receivers addressed Social capital working MHJCB Erewash Vanguard arrangements 1.6 We will support recovery colleges and other approaches to 2015 Local authority and CCG commissioners Improved personal resilience and help to other people who can gain from lived experience. MH Plan JCB
Direction of Travel for Carers approved at Adult Care Board in November 2015. Further detailed planning sessions in process with recommendations for final approval to Adult Care Board in March 2016 1.9 Develop and implement trauma pathway Brought forward action from 2015 plan April 2017 People experiencing mental health crisis will receive safe, evidence based care when they need it in the most appropriate setting People who have been victims of sexual violence will have appropriate support Transformation Board Contract arrangements Health and well Board OPCC 1.10 We will work with our employers and our own organisations promoting healthier workplaces and sign up to the Time to Change and mindful employer initiatives Derbyshire CC has TTC Action Plan in and has identified MH champions across area teams. We will continue to deliver and expand the Derbyshire Healthy Workplaces Programme. We will review the employment support work post in Derby City with a 2014-16 Ongoing JCBs Time to Change Alliance (made up of voluntary sector) Public Health, Derbyshire County Council SDCCG/Derby City Council Improved response to people experiencing Mental Health Problems at work. Awareness of how to get help in the workplace and retention of employment. Settings based approach; Employees engaged to support management of health and wellbeing; Employees supported to prevent illness and injury Employment for people with a SMI. MH Plan Public Health Plans
view to a sustainable approach following a review by EMAHSN 1.11 We will review how we develop, promote and sustain self-help community groups. This is included in the Social Inclusion review at 1.7. Recommendations by March 2016 2015-16 DCC Adult Care /Hardwick CCG,NDCCG NDVA. Locality partnership groups. Increased opportunities to attend and/or develop local self-help groups and community activities CCG plans, MH plan. KPI 2. Improved partnership working in Derbyshire and No. Action Timescale Led By Outcomes How can this be monitored 2.1 We will establish a Crisis concordat group to ensure we produce a joint plan and to ensure delivery, co- sponsored by Hardwick CCG for the NHS and The office of the Police and Crime Commissioner (PCC). Completed concordat group meeting for next 6 months of 2016. July 2014 EMAS, CCGs, DHCFT, PCC, probation, DCHS, Derbyshire County Council Derby City Council Bringing together information and data sources Agreeing priorities Producing a joint plan Supporting joint delivery of solutions. Health and well being board. Bi monthly plan update for city and county JCB CCGs and stakeholders. 2.2 The police will produce and monitor a detailed action plan covering areas where joint operational arrangements need improving. Done November 2014 Derbyshire Constabulary Enabling operational issues to be progressed. Where required jointly worked on within the 136 working group and inter-professional groups or the crisis concordat group Crisis plan reporting. 2.3 Review the terms of reference 136 and the multi professional group done Ongoing functioning of group County Council Derbyshire Ensure operational day to day problems in communication, procedure, and other barriers to joint working are removed.
2.17 Review training needs of mental health staff in respect of substance misuse and substance misuse staff in respect of mental health CCGs, Public Health, DHCFT 3.Primary care Response In our five year plans we have stated that we will develop over time Primary MH service capacity. Primary Care mental health services are being developed in the context of our Integrated locality commissioning plans. We have MH Lead GPs in each CCG working on how the response people can receive when the go to their practice can be improved. We also have a Derbyshire wide clinical reference group and there are Primary care MH Forums in North Derbyshire CCG and Southern Derbyshire CCG. The work being undertaken on transforming the services provided by DHcFT is directly linked to this. Actions included in our first section on prevention and supports are relevant for example the development of a single phone number for primary care staff to call to access the voluntary sector. Work is being undertaken in each CCG and we have some pilot approaches in development. This element of the plan will therefore develop further as part of our overall Mental Health Strategy and 5 year plans. No. Action Timescale Led By Outcomes How Can this Be Monitored 3.1 Hardwick CCG will appoint a GP to work within the commissioning team for MH to support primary care development done August 2014 Hardwick CCG Lead clinical coordination of developments for parity of esteem and primary care development. Implemented Clinical Reference Group 3.2 We will develop over time primary care based MH services 2014-2020 MH Leads in each CCG People still go their GP at a time of crisis and this should enable more timely and effective local care Clinical Reference 3.3 We will develop a locality integrated system of care with less hand of points between services. 2014-2020 Locality services with less hand of points should enable delivery of support at the right time at the right level of intervention. It will facilitate more agencies staff being able to respond to MH issues and enable more effective of responses when required. CCG Integration Planning Clinical reference Group Locality MH Forums 3.4 We will continue to provide MH training to primary care on going CCG MH for Clinical Reference Primary Care Staff will be able to sign post more effectively to resources that are already available to help people. MHCT CCG Forums CRG
produce a training plan for April 2016 Locality MH Forums, Lead GP Staff will feel better able to offer support themselves. Staff will know when more specialised help is required. 3.5 We will enable primary care to have faster access to community support services through development of voluntary sector single point of access scheme (vspa) and similar approaches We will enable out of working GPs (DHU) improved access to care plans and professional advice via the MH Triage hub. 2015-16 Through development of a single number to call services will be empowered to support patients to get help when they need it. People needing help will be more likely to get help they need. MH Triage starting in September 2015 full implementation Jan 16 3.6 We will a primary care based mental health support worker in Buxton (In progress) November 2015 North Derbyshire CCG Buxton Practices Practice based support, sign posting and practical help. Improving access to support, responding faster to emerging crisis. Practice providing more coordination of care Resilience data High Peak project. 3.7 Erewash CCG will develop improved links to primary care integrated teams including training, coordination and crisis support. (Underway) April 2015- April 2017 Erewash CCG and DHcFT By investing in additional capacity we wish to identify how MH can be undertaken in a more integrated way with primary care coordinators and primary care services. Erewash CCG Lead GP 4. Urgent and emergency access to crisis care
planning and national investments we intend to increase access to support in the community and in reach in the Hospitals. (paediatric liaisons). Southern Derbyshire and Erewash CCG prioritised significant investments in 2015 and we intend to see developments across the whole county as resources allow. We intend to hold specific Children summit in 2016 to take these actions forward. Substance misuse There is separate substance misuse planning arrangements. There are standards for response times and access to services. We have not included the substance misuse services in our concordat plans to date (the liaison teams investment being an exception) but have made arrangements to jointly review our MH and substance misuse strategies in regard to dual diagnosis in 2016. No. Action Timescale Led By Outcomes How can this be monitored 4.1 We will support the 5 Year Transformation Plans of Derbyshire Healthcare Foundation Trust services 2014-19 CCGS Enabling 7 day week delivery Extended hours of operation Crisis responses improved More support in the community Less reliance on hospital care Neighborhood approach with improved connectivity with primary care services Clearer pathways of care Transformation Board JCB Contract Management 4.2 We will review how EMAS, the Police, DHcFT, DHU and 111 service can work together to enable effective support at a time of crisis. Done We will continue with the “high demand days” work in Chesterfield. We have established a MH triage hub as a successor to street triaged and to join up access for urgent care services Agreed approach June 2015 Pilot Hub November 16 evaluate June 16 agency Sub group established to take this forward Integrated service approach Reduced inappropriate 136 use Reduced use of Casualty and Police station and appropriate use of place of safety. Increased use of community alternatives such as voluntary sector at the point of crisis. Improved access to a qualified MH professional in a timely fashion. Crisis Concordat group Urgent care high level group
4.3 We will enable the provision of crisis and step down resources across the whole county Done We have supported step down and crisis beds and will continue to monitor their use and consider how we may establish alternative places of safety. In place Ongoing 4 CCGS MHCT Third sector and DHcFT partnerships Beds released for use by those who most need them. Admission avoided loss reduced Independence supported. Best use of specialist MH residential facilities and voids. MHCT – JCB 4.4 We will continue to proactively manage acute MH beds to ensure people do not need to be placed out of Derbyshire for an acute bed. Out of area bed use declining. Hardwick CCG DHcFT Acute MH care provided within Derbyshire providing A better experience of care to patients. Efficiencies in EMAS and Police and AMHP time Contract management Arrangements JCB KPI 4.5 We will support the development of a crisis response service for learning disabilities in the north unit of planning 2015-19 NDCCG Hardwick CCG Derbyshire County Council People supported to stay in their own homes and not admitted to hospital or by the police. LD Transforming Care Board, LD JCB 4.6 We will continue to invest in Liaison services for Chesterfield Royal and Royal Derby Hospitals. RDH in 2014 CRH full 24 hour live date January 2015 SDCCG NDCCG Public Health Assessment and access to appropriate treatment services to anyone who presents with MH substance misuse or learning disability in a crisis at accident and emergency 24 hour assessment of people who present after self-harm Reduction in Suicide risk Improved care of older people and in particular delirium. Contract monitoring. Resilience groups
4.7 We will ensure MH crisis services are supported in resilience funding and opportunities –ensuring MH is not forgotten as a key part of the urgent care pathway reform. MH Triage Hub is basis for new approach. Ongoing Urgent care pathway Group formed and reported September 15 CCGs Resilience planning Reduction in use of non elective treatments Improvement to capacity of urgent care pathway Parity of Esteem Resilience planning arrangements. MHCT JCB 4.8 Analysis of Crisis and Home Treatment Team (CRHT) referral data in order to target resources, staff and partner-agency training on DHcFT Commissioners Services will be equipped with the right skill mix, and staff will have the right skills and knowledge to provide evidence-based practice within the local community. Transforming Care Board Contract monitoring 4.9 Consistently meet 4 hour response time in MH Crisis Service Dec 2014 DHcFT Timely response in line with quality standard 14 of NICE guidance (statement 6) Contract Monitoring KPI 4.10 Review S136 protocols with regard to of substance mis-users, especially with regard to inappropriate use of detention in police cells for people in mental health crisis who are intoxicated June 2016 Home office project 136 and Concordat Group Legal highs causing severe behavioural disturbance and problems for 136 suites. Alcohol intoxication not best treated in a police cell or 136 suites but neither is casualty the best option. Alternative approaches required Concordat sub group. Substance Misuse Strategic Commissioning Group 4.11 We have established that there is a problem in obtaining section 12 Doctors for MH act assessments. The trust medical director will lead a project to look at alternatives. April 2016 draft proposal DHcFT AMHP reps Hardwick Concordat group 136
crisis response connected to 111 service, Police and EMAS 5.2 Continue to develop Adult Care mental health offer fieldwork and direct care – enablement model and crisis response Done Model and staffing structure agreed. Awaiting Cabinet approval 2nd Feb 2016 2014-16 Derbyshire County Council Adult Care Adult Care intervention when client presents with a self-perceived crisis with easy route back in to service Professional support from specialist mental health social work and community support workers Derbyshire County Council Cabinet JCB County 5.3 The Council and CCG commissioners will review the of telephone advice services to ensure that there is appropriate advice available to the public on a 24/7 basis. 2015-16 111 reviewed start Vol sector helpline review in 2016 Derbyshire County Council Adult Care Derby City Council Adult Care CCGs MHCT Ensure people have access to advice and support. Care Act responsibilities review. Best use of resources. Avoiding duplication. JCBs 5.4 THE AMHP service will collate information on the use of the Mental Health Act and work with the MHA administration of DHCFT to ensure a baseline on use of the MH act is maintained and can be monitored and reported on. The AMHPS will start collating information on what could have prevented the crisis/deterioration and this will be fed back to commissioners. Report in February 2015 136 Group to review data in ongoing way Joint work with Derby City AMHP and County AMHP service. City and county joint MH act data available in new format for Feb 16 Derbyshire County and Derby City AMHPs Leads DHcFT We will establish a baseline on the use of MH Act and seek to stop the growth of compulsory treatment and over a five year period reduce it. By understanding what could have prevented the use of compulsory powers we may be able to make significant improvement decisions. JCB Crisis concordat Multi professional group
Concordat meeting. 5.5 As a follow up to an carried out by MH consultants, examine current Community Treatment Order (CTO) arrangements – who and how we put people on them and how recalls /revocations are managed and whether there are more effective alternatives. AC Senior Practitioner working with consultants to encourage use of new CTO documentation Ongoing Derbyshire County Council care Improved management and monitoring of people on CTO’s Reduced number of recalls and revocations and incidences of readmission to hospital. 5.6 Strengthen integration between health, housing and social care Review housing and accommodation needs as part of crisis pathways for people with long term enduring mental illness In county -Housing and employment support part of enablement offer. Also include low level HRS in social inclusion model going forward. Strategic review of HRS for MH underway 2016 milestones to be agreed. DCC Adult Care/Hardwick CCG District Councils More joined up approach to ensuring determinants are addressed to encourage stability and crisis prevention Opportunities for people with long term enduring mental ill health have the opportunity to live as independently as possible with support in the community Reduction in number of delayed discharges and admissions to residential and nursing long term accommodation Derbyshire County Council AMT/Cabinet County JCB
national evaluation. National funding ceases in March 2015. We continued to fund street triage and now agreed a successor to cover the whole county MH triage hub and evaluation June 16 Higher conversion rate of taken to hospital place of safety to an admission. Support in community for those that need it Timely health care for those that need it Timely social support for those that need it. 6.2 We will upgrade the hospital of safety suites We will establish how to provide 24 hour dedicated staffing for the Place of safety and how they can link to the MH Triage Hub staffing Completed 2014 Feb 2016 DHcFT To create safe environment in line with Policy guidelines, in line with HMC/CQC inspection. 136 group CMDG 6.3 The AMHP services, DHcFT and police will work together to produce a single unified data source on use of 136 across Derbyshire in order that we can establish benchmarks and monitor performance December 2014 first cut ready for Feb 16 concordat meeting AMHP leads Establishing a benchmark for performance monitoring and improved commissioning information. Crisis concordat group January 2015 KPI from Jan 2016 on 6.4 Conveyance Ensure that county wide conveyance policies reflect wording in the CCC The Conveyance policy was adopted 2014; this is not fully CCC ● By Mar 2015 all conveyance policies will be fit for purpose. Reflect the CCC and other documents (Peer review). Multi Professional Forum Derbyshire Constabulary lead with EMAS and AMHP and DHcFT support. To enable delivery of the Concordat conveyancing principles ● Caged vehicles should not be used ● Police vehicles should not be used to convey between hospitals Crisis concordat group Multi professional forum EMAS contract EMAS MH group.
compliant and has therefore been subject to multiagency review in 2015. This should be ready for sign of by April 16. EMAS Reviewing in order that this may be incorporated in to contract for 2016 for all East Midlands ● By Mar 2015 all conveyance policies will be agreed by stakeholders (public and private). Now being taken forward via EMAS MH group for implementation across East Midlands 6.5 We will ensure that EMAS and patient transport systems are equipped to work with people being detained more effectively and appropriately PTS Procurement 2015 and subsequent mobilisation in 2016 EMAS plan Erewash CCG EMAS, Hardwick Improved dignity of patient transport Improved responsiveness and consistency of response. Hardwick CCG Contract monitoring 6.6 Mandatory training and other approaches are being introduced to ensure: all officers in appropriate positions are fully trained to respond to and deal with mental health incidents ● Police officers to be trained to recognise risk and vulnerability; and identify the need for ● By Summer 2015 all officers, PCSOs, custody staff and CCMC staff will have received Ncalt and classroom training Done New more focused plan for MH triage impact required Derbyshire Police Police trained in mental health and able to support people appropriately. Supported by EMCRIS
We will monitor as exceptional admissions from January 15 We will agree protocols for how best to help people who are intoxicated. These have largely been completed in areas previously served by street triage and now being rolled out however work on intoxication is still required and ongoing work via the 136 group between AMHPs DHcFT and police on working practice. 136 group Crisis concordat group members ● Ensure a ‘fast procedure is incorporated for those who are taken to custody ● Irrespective of other factors, such as intoxication (which alone is not a basis for the use of police cells), or a previous history of offending or violence, individuals suffering a mental health crisis and urgently needing to be detained whilst waiting for a mental health assessment should expect to be supported in a health based place of safety. 6.8 Consider alternative places of safety for particular client groups, i.e. older people with dementia, children and younger adults. Proposals within BCF Parity of Esteem work Milestones to be agreed Informed MOJ of interest in December 15 136 to take forward plus sub group of Concordat re MoJ project proposals People with different difficulties and support needs will be better cared for in a crisis e.g. in a designated care home / community hospital with staff experienced in dementia care as opposed to A&E Crisis Concordat Group 136 Substance Misuse Strategic
criminal justice pathway. Learning Disability nurse to employed into the team 7.3 Develop prison in-reach adult care offer under Care Act responsibilities April 2015 Derbyshire CC Adult Care Individual support for inmates to ensure both physical and mental health needs are appropriately met Care Act Implementation Group (Derbyshire County Council) 7.4 Offender community care pathway. two pronged approach agreed by concordat Work with PH re offender access to health and wellbeing schemes now underway. New work stream on offender health access to MH started PH workstream now on going MH access stream Meeting February 16 PCC, Probation Hardwick DHcFT Derbyshire CC Care Review how probation, prison release and similar arrangements are working in Derbyshire. Are people getting access to the support that is available? Access to public health wellbeing schemes –smoking cessation etc. Access to mainstream MH IAPT etc. MH Offender health care group being established by OPCC 8. Improved information and advice available to line staff to enable better response to individuals in crisis. No. Action Timescale Led By Outcomes How can this be monitored 8.1 EMAS will produce a training plan and utilize the MH information resource used by SW ambulance as part of a EMAS MH strategy MH Plan produced and a clinical trainer appointed October 15 ongoing EMAS Hardwick Staff able to provide more support at time of meeting the patient. Some people supported by other resources –not taken to casualty. EMAS MH planning group 8.2 EMAS pilot of a crisis worker in the control room to provide “live” advice to staff. December 2015 for the plan EMAS Real time advice available to ambulance crews. Possibly alternative options other than casualty conveyance possible EMAS MH planning Crisis concordat group Contract monitoring Resilience plan