Mental Health Services Clinical Governance Annual Report 2011 - 12
Version: Final Prepared by: Dr John Taylor, Associate Medical Director Derek Barron, Associate Nurse Director Angela Rowe, Quality Lead Facilitator Date of publication: 10 August 2012 Dissemination arrangements: • • • • •
Mental Health Services Executive Team Mental Health Services Governance & Development Group Members NHS Ayrshire & Arran Clinical Governance Committee Assistant Director, Healthcare Quality, Governance and Standards Unit Clinical Governance Group Chairs, Mental Health Services
1
Content
Page 1.0
Chairman’s Foreword
3
2.0
Mental Health Services Governance and Development Group
4
3.0
Quality Strategy
4-5
4.0
Person Centred Care 4.1 Patient Focus and Public Involvement 4.2 Work undertaken that focuses on ensuring person centred care
5-6 6-10
5.0
6.0
7.0
Safety 5.1 5.2 5.3 5.4 5.5 5.6
Adverse Event Reviews and DATIX Incidents Risk Register Complaints Litigation Scottish Service user Safety Programme Work undertaken that focuses on improving safety
10-13 13-14 14-15 15 15-17 17-19
Effectiveness 6.1 National Standards, Guidelines and Accreditations 6.2 Research & Development 6.3 Work undertaken that focuses on improving effectiveness
19 20 20-28
Key Drivers for 2012/13
28-29
Appendix 1 – Clinical governance structures in Mental Health Services Appendix 2 – Quality Measures Framework in Mental Health Services
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1.0 Chairman’s Foreword The Institute of Medicine’s six dimensions of quality are central to our systems-based approach healthcare quality improvement: o
o o o o
o
Person-centred: providing care that is responsive to individual personal preferences, needs and values and assuring that service user values guide all clinical decisions; Safe: avoiding injuries to service users from healthcare that is intended to help them; Effective: providing services based on scientific knowledge; Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy; Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socio-economic status; and Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care.
The Quality Strategy[1], published by the Scottish Government in May 2010, focuses on three of these dimensions (person-centred, safe, effective) and these constitute the Quality Ambitions. Delivering for Mental Health[2] was published in 2006 but is still relevant in the service until the new strategy is launched. The 2006 strategy addressed the need to set targets and commitments for the development of mental health services in Scotland. Current initiatives to improve quality of care in mental health services are being guided nationally by both Healthcare Improvement Scotland and the Scottish Government. The implementation of Integrated Care Pathways (ICPs) in the five major service user groups (schizophrenia, depression, bipolar disorder, dementia and personality disorder), access to psychological therapies and the national Dementia Strategy are among some of the main initiatives which are currently shaping, or will shape, programmes of work in Mental Health. The Mental Health Strategy 2012-15[3] is due to be published in late summer 2012 and will outline the revised national priorities for improving services. In addition to these, the Scottish Patient Safety Programme in Mental Health (SPSP-MH) is in the process of development. This is a four year programme spanning August 2012 – August 2016 with the initial focus on adult mental health and forensic inpatient units. NHS Ayrshire and Arran will be actively involved from the outset with the first year being focused on testing. Additional information can be found at: http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programme/about In recent years, a real driving force for mental health policy and practice in Scotland has been the ethos of recovery. “Recovery is about building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems.” 4 Recovery relies on many factors, and includes social circumstances. Mental health problems can affect anyone but people who are likely to be socially excluded, such as people living in deprived areas, are at higher risk. The current Scottish Government consultation on the integration of adult 3 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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health and social care will have major implications for the way in which mental health services are delivered in future. The effective implementation of these programmes of work will ensure that we are in a stronger position to deliver high quality, accessible mental health services, based on the principles of recovery, to those most at need in Ayrshire and Arran. This report outlines a sample of the work which has been undertaken over the period from April 2011 – March 2012 in our determination to continuously improve mental health services which are first and foremost safe, but also effective and person-centred.
Dr John Taylor Associate Medical Director Mental Health Services
1. 2. 3. 4.
Derek T Barron Associate Nurse Director Mental Health Services
NHSScotland Healthcare Quality Strategy 2010 http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/NHSQuality Delivering for Mental Health http://www.scotland.gov.uk/Publications/2006/11/30164829/0 Mental Health Strategy for Scotland 2012-15 http://www.scotland.gov.uk/Topics/Health/health/mental-health Shepherd, Boardman and Slade 2008
2.0 Mental Health Services Governance and Development Group (GDG) The Mental Health Services (MHS) Governance and Development Group (GDG) met eight times between April 2011 – March 2012 and is chaired by the Associate Medical Director for the service. Each service within the directorate has a functioning clinical governance group (Appendix 1 shows the governance structures in MHS). A rolling programme has been established for services to report to the directorate governance group. The service reports include key governance information such as adverse incidents, complaints and risks, service developments and issues to be escalated. The aim is to provide assurance in terms of clinical governance and to monitor progress on governance activities, sharing learning between services. The GDG completed its work on the eight priorities previously identified within the MHS CG Annual Report 2010-11 and has set new priorities for the forthcoming year. These can be seen in Appendix 2 (Quality Measures Framework). 3.0 Healthcare Quality Strategy for NHS Scotland The aim of the Healthcare Quality Strategy is to deliver the highest quality healthcare services to people in Scotland and, through this, to ensure that NHSScotland is recognised by the people of Scotland as amongst the best in the world. The Quality Strategy outlines three Quality Ambitions to provide a focus for the delivery of safe, effective and person centred care. To ensure effective clinical governance processes it was proposed that a standardised reporting framework for clinical governance activity be fully implemented 4 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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across the organisation. The framework embraces the Quality Strategy by streamlining arrangements and mapping activity against the Quality Ambitions. This report is formatted in a similar fashion mirroring the Quality Ambitions. 4.0 Person Centred Care 4.1 Patient Focus Public Involvement The Mental Health Services Public Reference Group (PRG) has a current membership of around 20 service users, carers and members of the public. It meets 10 times a year and continues to fulfil the main remit set out in its terms of reference, to be “the main vehicle for communication with, comment from and participation of service users, carers and members of the public in the ongoing development of mental health services in Ayrshire and Arran”. Throughout 2011/ 2012, activities have included face to face engagement with managers and clinical leads for many mental health services, and participation in several projects and/or areas of service development. Members contributed to the development and review of operating guidelines for community mental health teams (CMHTs), information leaflets for the Crisis Service, the Adult Mental Health CMHTs, and Addiction Services among others. The group has considered and responded to Scottish Government consultations regarding the Dementia Strategy and the national Mental Health Strategy. It has received several reports from the Mental Welfare Commission which they have followed up by scrutinising practices in Ayrshire and Arran. Members have also participated in the Mental Welfare Commission annual visit and the Scottish Government’s performance implementation visits. Members of the PRG provide lay input to other groups within NHS Ayrshire & Arran, and the group provides the peer support for this, as well as being a forum for the feedback of issues and their follow-up. A representative from the PRG is a full member of the MHS Governance and Development Group. This person provides a valuable link between these groups, promoting the two-way flow of information and ensuring the focus of service delivery remains on person-centred care. The Chair of the GDG also attends the PRG annually to allow two way dialogue about a range of service and clinical governance issues. The PRG also had a representative on the Local Impelmentation Group for the mental health nursing review – this group is on hold while the national programme is re-focussed. In addition, the group provides a range of representation to the public consultation group and workstream groups for the development of the proposed North Ayrshire Community Hospital and has nominated a representative to join the Scottish Patient Safety Programme –Mental Health Ayrshire & Arran Steering Group.
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During the year, some of the members of the PRG have left either by resignation or through ill health, and five new members, with current or recent experience of mental health services have joined the group. MHS supports the PRG through a lead officer for service user and service user involvement. The Mental Health Executive has confirmed its continuing support for the PRG, although a working group has been established to explore ways of ensuring the long term sustainability of service user and carer engagement. 4.1.2 Ayrshire Recovery Network Ayrshire Recovery Network is a group of individuals with lived experience of mental health issues, and carers of individuals, who come together four or five times per year. The Network supports individuals to share experience, co-support the wellbeing of members and acts as a two way vehicle to share information on services within Ayrshire and Arran and nationally. Mental Health Services continue to support the organisation of the Network in terms of administration and organisation of meetings. Although not a formal consultative group the Network plays an important role in the lives of individuals who attend it. 4.2 Work undertaken that focuses on ensuring person centred care 4.2.1 Service User Experience Feedback Whilst being awarded Charter Mark in MHS and subsequently Customer Service Excellence accreditation, it was recognised that service user experience feedback was not consistently collected by all services. In an attempt to address this, a service user and carer workshop was arranged within Mental Health Services in December 2009 to seek feedback on what aspects of care and treatment mattered most to service users. It was acknowledged that a lengthy questionnaire would not be suitable for feedback, and so the participants attending the workshop prioritised the aspects of care and treatment which they felt were most important for inclusion in the questionnaire.This prioritised list was used to develop a service user experience questionnaire for use in the community and then following this, further refined for use in an inpatient setting. Service user feedback is reviewed at service clinical governance groups and used to inform future service and quality improvements to try and ensure best service user experience possible and identify any areas for improvement. To date, there are 605 completed questionnaires across services in the directorate. Comments from service users have been overwhelmingly positive, with some listed below in 4.2.2:Services improve by receiving and acting upon unfavourable comments too. Some of these can be seen in 4.2.3. 6 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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4.2.2 What are we doing well? “As a long term service user, the service has got much better in the last 3-5 years especially communication: GP/CPN/Psychiatrist/ Psychologist. With my illness I feel there is backup to hand”
“Kind staff and a healing environment make all the difference”
“My OT has changed my life for the better. I'm not there yet but I will be”
“Medication was called individually which is respectful and mindful of privacy… waiting in a queue would have been humiliating and I am thankful this was not practice here” ”I believe that the service helped greatly in my recovery”
“I found the workers very helpful and very friendly, you can talk to them without them judging you”
“I can't understand why hospitals get such bad press my stay paved the way to recovery”
“As a long term service user, the service has got much better in the last 3-5 years”
“Excellent care and attention, very informative and extremely helpful from Irvine Eating Disorder Team”
“Professional, caring, approachable. I was treated with respect and understanding. Informed of choices and involved in decisions”
4.2.3 What could be better? “My main problem was with the length of time that I had to wait, I feel my health really did suffer as a direct result of this”
“Psychologist was fantastic receptionist was rude”
“There needs to be more beds available for dementia review and assessment”
“The food was perfect but the portions rather small”
“It took longer than I thought to get an appointment”
“Sometimes staff seemed battle hardened”
“Felt my father should have been assessed in hospital as inservice user to allow a proper review”
“I was disappointed that I couldn’t spend enough time not only with my named nurse but any nurse as they are snowed under with paperwork”
“I would have liked quicker admission. It was upsetting and stressful”
“It was good to have someone understand but a 45min appt isn’t long enough”
“Pass medications always a problem. Never ready, despite nursing staff giving plenty of notice. Accordingly, several passes and transport had to be rearranged to accommodate delay in medications”
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The Child and Adolescent Mental Health Service (CAMHS) uses the nationally developed questionnaire for children and young people entitled ‘ Your Story’. The service is in the early stages of implementing this. 4.2.4 Improvement Work in Acute Inpatient Services Some improvement work has already been undertaken in Acute Adult Inpatient Services, as a result of the feedback gathered from service users and carers. The admission process was identified as being lengthy and repetitive, as both Nurse and admitting Doctor cover similar information, so at University Hospital, Crosshouse, a joint admission/assessment has been put in place and this is now being extended to Ailsa Hospital. Feedback showed that just over half (52%) of service users were informed about advocacy services on admission. This has been improved by including an overview and contact details of advocacy services in the service user information leaflets issued as part of induction to the ward. Posters are also displayed prominently in the wards with the necessary information. Arrangements have now been put in place at University Hospital, Crosshouse, that on admission the multi-disciplinary team agrees with the service user an “estimated date of discharge (EDD)” and care plans are framed around this, which involves the service user/carer. When the discharge date is agreed, the pharmacist signs the required ordering form and this cuts down the delays, allowing medicines to be available on the agreed date. This has been tested at wards 1D and 1E and is now being extended to Ailsa Hospital. 4.2.5 Rehabilitation Services (formerly non-acute/Continuing Care) Reconfiguration of Services With a view to further reinforce the underlying principles of recovery, the ‘nonacute’/’Continuing Care’ nomenclature has been dropped and the whole service is now being described as ‘rehabilitation’ services. Whilst there is still the fast-track mixed gender rehabilitation service, the former non-acute/Continuing Care wards are now classed as (slow stream) rehabilitation and the over-arching model of care will be informed by the formation of the Rehabilitation Improvement Group. Service user/carer involvement will be pivotal in progressing this piece of work. As of April 2011, services in Ailsa Hospital for those requiring rehabilitative care were reconfigured to provide two gender specific ground floor wards, all bedroom accomodation is provided in single rooms with opportunites for self catering and access to dedicated garden space. All of these areas are now non-smoking for all service users. Research recognises that smoking can be harmful to mental health. There is evidence from large population studies that smoking increases the risk of developing a mental health problem, as well as data that indicate a clear relationship between the amount of tobacco smoked and the number of depressive and anxiety symptoms experienced by all smokers. The good news however is that giving up smoking is associated with significant 8 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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mental health gains, particularly in relation to these symptoms of anxiety and depression (McNally, Does smoking cessation affect mental health?, 2009). In 2008 all mental health units in England became smoke-free by law, and the Scottish Government has recently produced guidance to support the implementation of smoke free wards within mental health hospitals in Scotland. In recognition of these smoking related health inequalities experienced by people with mental health conditions, and in anticipation of this policy change within mental health hospitals, Fresh Airshire (the smoking cessation services for NHS Ayrshire and Arran) worked collaboratively with colleagues in mental health services to support service users who seek to quit. Person-centred care is integral to the rehabilitation wards at Ailsa Hospital. Strong nursing leadership has promoted a recovery focused approch which has fully involved service users in many of the changes and new processes within the ward environments. Service users are encouraged to take responsibility for their care and to use all facilities available to them. Having all areas (dining areas, kitchen, bathing areas) open to service users all day was a big change. Service users choose and buy their own food and making snacks for themselves with support from staff was inspirational. Changing the mindset of staff and service users was a day to day challenge but one which was embraced as being a positive move towards recovery. The care delivered is respectful and responsive to individual needs and values. The service users guide many decisions around the ward environment, for example, the choice of colours in their rooms, furniture and plants for garden. Service users were also actively involved in developing new names for the wards to signal the changes underway both in function and the increasing focus on the recovery ethos. Announced visits by the Mental Welfare Commission (MWC) were carried out in May 2011 with very positive feedback being received and the rehabilitation wards within NHS A&A being cited as areas of good practice with regards to compliance with legislation around the utilisation of T2 and T3 forms (consent to medical treatment) and consent issues. The MWC also asked for a journalist reporting on their ‘Left Behind’ report to write a piece on Cloncaird Ward to show ‘what could be done’ (‘Left Behind’, MWC, July 2011). The rehabilitation services were then detailed as an example of good practice by the MWC in an article in the Glasgow Herald about long stay patients (‘The Forgotten’, Glasgow Herald, 25 March 2012). 4.2.6 Peer to Peer Hepatitis C Project As part of the Hepatitis C Action Plan for Scotland, NHS Health Scotland’s role has been to identify appropriate educational interventions for NHS Boards to implement. These would be aimed at vulnerable individuals, people who inject drugs, and those at risk of starting to inject.
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The use of peer education in Hepatitis C harm reduction approaches in Scotland was an identified recommendation following an international evidence review of effective educational interventions. NHS Ayrshire and Arran is one of only four Health Board areas which are taking part in a pilot scheme looking at enhancing the levels of engagement of people who inject drugs in order to increase understanding of Hepatitis C risk factors related to injecting behaviours and promote access to testing in order to reduce levels of onward transmission. 4.2.7 New Horizons – Learning Disabilities Service The Learning Disability Service is currently involved in a review of its role and function (referred to as the New Horizons project), encompassing all aspects of the service and its involvement with the communities it works with. To date, this has involved significant consultation with staff within the service via online questionnaire, focus groups, and interviews, and has also seen the beginning of what is hoped will be an ongoing process of engagement with service users and carers within the three localities. With regard to the service users, roadshows have been run in each locality by the East Ayrshire Learning Disability Partnerships (the VIPs), a service user led organisation which carries out a wide range of community activities for people with learning disabilities; for carers, a questionnaire has been disseminated, which will be followed up with a consultation event later in 2012. Feedback from the community has been very positive, but has also highlighted change opportunities, either in terms of identified areas for improvement, or positive aspects which the service would seek to maintain while also taking forward any change programme recommended as a result of the process as a whole. The New Horizons project team continues to engage with a range of stakeholders within and outwith the NHS, with a view to supporting the service to best respond to the varied and complex agendas facing it. These challenges include integration, the role of services in relation to the broader community, the recent review of learning disability nursing, and the forthcoming review of the implementation of The Same as You. 5.0 Safety 5.1 Adverse Events The total number of adverse events reported and investigated by Mental Health Services over 2011-12 was 4289. • • • •
39% of Adverse Events were classified as insignificant minor events totalled 40.5% 1.5% of incidents received major categorisation 1% were extreme. Of these, one Significant Adverse Event Review (SAER) occurred in this reporting period (April 2011-March 2012). This is a significant reduction from seven in 2010-2011 and four in 2009-2010. 10
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Figure 1.1 – Number of Adverse Events by Service 2000
1859
1800
1684
1600 1400 1200 1000 800 600 440 400 200
144
108
20
17
12
5
Prison Health
Psychology
0 Addictions Adult Community Mental Health
Adult Mental Health Inpatient
Child Adolescent Mental Health
Elderly Mental Health
Forensic
Learning Disability
Figure 1.2 – Number of Adverse Events by Consequence Score and Month
250 200 Insignificant Minor
150
Moderate
100
Major Extreme
50
Ja n Fe b M ar
Se p O ct No v De c
Ju l Au g
Ju n
Ap r M ay
0
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Figure 1.3 – Top 10 Adverse Events by Category
Category
Violence/Abuse/Harassment Slip, Trip or Fall Security Related Incidents Self Harm Other - Only use this if no other category is appropriate Medication Infrastructure/Resources Related(staffing/facilities/environment) Smoking Fire, Fire Alarms and Fire Risks Implementation of care or ongoing monitoring/review
Number from 1 Apr 2011-31 Mar 2012
% Total Adverse Events (n=4289) 2011-12
Number from 1 Apr 2010-31 Mar 2011*
% Total Adverse Events (n=4409 2010-11
1934 695 402 382
45% 16% 9% 9%
2108 674 389 546
48% 15% 9% 12%
133 101
3% 2%
124 99
3% 2%
90 79 69
2% 2% 2%
60 0 44
1% 0 1%
64
1%
0
0
*From 1 April 2010 – 31 March 2011, another 64 incidents (1%) were categorised as physical,
chemical and biological hazards.
Almost half (45%, n=1934) of the reported adverse events in 2011-12 were categorised as ‘violence/abuse/harassment’. This showed a very slight decrease on the 2108 (48%) of reported adverse events categorised as ‘violence/abuse/harassment’ during 2010-11. The Adverse Event Review Group (Core members are: Associate Nurse & Medical Directors and both MHS Healthcare Managers) meets on a weekly basis and discusses all incidents reported to them via SBAR (Situation, Background, Assessment, Recommendations) format or Datix (incident reporting system) that week. This group then decides whether the incident is closed (for example, it may be a service user management issue), further information is required, or whether a review of the incident needs to take place. This review can take on different formats and it may be a service-led review or an adverse event review chaired by a clinical lead independent to the service. For major and extreme incidents, this would be escalated to the Executive Medical and Nursing Directors by the Associate Nurse Director/Associate Medical Director with a recommendation regarding the appropriate next step. It is at this point that it will be decided whether a Significant Adverse Event Review is necessary. When an adverse event report is completed, resulting actions/recommendations normally take two formats. Firstly, there are specific actions, changes or developments that must be 12 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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made to how we deliver services. These actions have measures of implementation and measures of effectiveness attached to them. The second outcome relates to issues of learning or good practice we wish to share widely across services. This second ‘learning’ process is issued across clinical teams in the form of a Learning Note. Learning Notes are distributed widely across clinical teams and uploaded to a designated area of AthenA. This approach is aimed at sharing experiences, good and bad, to support the knowledge of clinicians and as reminders/prompts for good practice. The services reporting the highest number of incidents (Adult and Elderly Mental Health) were the same as 2010-11. During 2011-12, 43% (n=1859) of adverse events occurred in Adult Mental Health Inpatient Services, compared with 46% (n=2053) the previous year. Elderly Mental Health had 39% (n=1684) of reported adverse events compared with 37% (n=1648) the previous year, and similarly, Learning Disabilities reported 10% (n=472 / n=440) respectively both years. Each service regularly reviews their adverse events reported in Datix and plans interventions to reduce their occurrence. Elderly Mental Health services recognised that the number of violent and aggression incidents had risen and this was giving cause for concern. As a result, a three-day violence and aggression training programme was developed for staff to ensure they were better equipped to deal with these situations, and to provide techniques for de-escalation of such incidents. Aspects of the ward environment and the patient mix at pavilion 1 at Ayrshire Central Hospital were also felt to contribute to the high number of incidents reported so building work was undertaken to change the environment, and patient mix was reviewed. Signs are encouraging that the number of incidents has decreased since these changes have been made. Similarly, improvement work has been undertaken to reduce the number of slips, trips and falls in the directorate. Staff in Elderly Mental Health noted that inpatient falls tended to occur when patients were outwith the general observation area in pavilion 1, Ayrshire Central Hospital. A review of the environment was carried out and building work has been completed to alter the layout of the pavilion. Since then, the number of falls in that pavilion has reduced markedly. A number of significant constraints caused by environment throughout all inpatient services have been previously identified and updated to inform the planned 206 bedded community and mental health hospital proposal for 2015. 5.2 Risk Register At time of reporting (August 2012)* Mental Health Services had a total of 56 active risks on the Datix Risk Register. There are currently no risks which are past their assigned review date. There are five high risks and these all have associated action plans. *The Risk Register is a dynamic system, and as such, the most recent information has been included. The MHS clinical governance report for 2010-11 was presented at the Clinical Governance Committee (CGC) on 29 February 2012. The report of Risk Registers showed that over the course of 2010-11, a consistently high percentage of high and very high risks did not 13 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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have an action plan attached. In March 2011, only 15% of high and very high risks in Mental Health had associated action plans compared to 33% for all directorates. It was noted in the report that the decline in MHS performance was due to the recent addition of several high risks. The CGC members raised concerns that only 15% of high and very high risks on the MHS Risk Register had associated action plans. The Risk Register was reviewed by the Mental Health Executive Team in March 2012. This review identified duplicated risks and risks which were no longer present within the service. The Risk Register has now been updated and accurately reflects the risks present within the service. 5.3 Complaints Mental Health Complaints April 2011 – March 2012 No. of complaints During the period April 2011 – March 2012, there were 51 received complaints received. Quality Improvements identified as a result of complaints received Average time response time in days %age answered within timescale
17
16 days 92% were answered within the timescale.
Analysis of the 51 complaints received: Upheld
Partly Upheld
8
18
Not No Irresolvable Upheld Consent
13
3
Unreasonable Transferred Withdrawn Complaint to other Unit
1
3
1
4
Issues identified – 61 The three main areas of complaints were as follows: • • •
Clinical treatment – 29 Attitude and behaviour – 12 Date for appointment - 5
The number of complaints (51) has fallen slightly this year from last year’s figure of 57 during 2010-11, 56 over 2009-10 and 42 over 2008-9. The average response time during this year was 16 days which is an improvement on last year’s average of 19 days. The 14 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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percentage of complaints answered within the timescale has shown an encouraging increase to 92% from 78% last year. The main areas of complaint focused on the same areas as last year, which were clinical treatment, attitude and behaviour and dates for appointments. In terms of improving staff attitude and behaviour, the directorate completes regular audits for the Customer Care Commitments which are focused on delivering exceptional customer service experience. The results can be presented to ward/team level hence giving opportunity to target service improvements. The recent development of the Mental Health Competency Framework for staff across the directorate also has components of good communication, attitudes and behaviours of staff and outlines how these may impact on service user care. The roll out of the 10 Essential Shared Capabilities (NES 2009) training has continued and this too addresses the need for therapeutic relationships and the importance of staff attitude and behaviour in building these relationships. 5.4 Litigation The service has two clinical claims, two employer’s liability claims, one public liability claim, and 14 potential claims currently active. During the quarter, one clinical and two employer’s liability claims were closed. Four employer’s liability claims were settled. Clinical claims over the last year have been assaults to staff by service users. Employer’s liability claims have largely been as a result of moving and handling. Three service improvements were identified as a result of litigation. Amongst the service improvements were that staff should attend Control & Restraint up-date training every 18 months, and service user observations should be carried out in line with Ayrshire and Arran’s updated Safe and Supportive Clinical Observation Guideline. The Mental Welfare Commission will issue a report on violence and aggression in mental health settings in 2012. 5.5 Scottish Patient Safety Programme (SPSP) 5.5.1 The NHS A & A Clinical Improvement Web Based Portal is a data management system that allows frontline staff to access feedback on real time data. All clinical areas are now using the portal for data monitoring on hand hygiene (see hand hygiene data below) and other measures such as those required for the Scottish Patient Safety Programme and the Clinical Quality Indicators (CQIs) which are now routinely monitored across the organisation.
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Figure 1.4 Percent Compliance with Hand Hygiene
This graph shows the percentage compliance with hand hygiene across all of the directorates. The average compliance across the year in Mental Health Services is 96.4%. This is above the Board average of 95.8%. The highest compliance in Mental Health was achieved in October 2011 and was 99% during that month. Over the same time period, national compliance with hand hygiene was 95-96%. 5.5.2 Infection Control Meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile Infections (CDI) remain at very low levels in the directorate. Over the course of April 2011 to March 2012, there were two cases of CDI and five cases of MRSA. There were no Staphylococcus aureas bacteraemia (SABs) during the course of 2011-12. Hand hygiene is considered one of the most effective measures in reducing and preventing healthcare associated infections. As can be seen above in figure 1.4, staff in mental health inpatient settings remain vigilant and committed to eliminating infections by complying with hand hygiene routines. 5.5.3 Medicines reconciliation Medicines reconciliation is about obtaining the most accurate list of service user medicines, allergies and adverse drug reactions and comparing this with the prescribed medicines and documented allergies and adverse drug reactions. Any discrepancies are then documented and reconciled. If this is not undertaken, medication errors can occur resulting in potential harm. To improve medicines reconciliation at hospital admission, NICE/NPSA has recommended that all healthcare organisations that admit adult inpatients should make sure that they have policies in place for medicines reconciliation on admission (this is also a specific workstream of the generic SPSP programme). Over all wards in Mental Health during June and July 2011 61 new inpatients attended 16 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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multidisciplinary ward reviews. Of those 61, 40 patients had completed medicines reconciliation forms (66%). This is due to be re-audited in 2012. It is expected that Mental Health Services will consolidate and build on much of the above work as part of the SPSP-MH programme. 5.6 Work undertaken that focuses on improving safety 5.6.1 Multidisciplinary Risk Assessment (Ayrshire Risk Assessment Framework) and Safety Planning The key issue in sound risk assessment is that there is open and in-depth dialogue between all members of the clinical team, and with appropriate others including relatives, carers and the service user themselves. Risk assessment and safety planning is a dynamic process that requires shared understanding of risks and constant review. Ideally a multi-disciplinary team should always make these decisions. However, on many occasions (particularly at weekends and evenings) decisions may have to be made by a doctor and the ward nursing team. Such decisions should always be reviewed at the first available opportunity with a larger number of the full team. Reinforcing the value of reviewing risk on a multidisciplinary basis was central to a piece of work which was carried out across the service. Firstly, raising the profile of the importance of sound and rigorous risk assessment, and then reviewing service users’ FACE* records at their multidisciplinary review to ensure implementation. The former risk assessment aid (Ayrshire Risk Assessment Tool) has been reviewed, and renamed the Ayrshire Risk Assessment Framework. A comprehensive training course on identifying and recording clinical risk will be rolled out June to December 2012 across Adult and Elderly Mental Health Services. This is now embedded within the Generic Integrated Care Pathway and is used extensively by clinicians. Across all Adult and Elderly Mental Health wards during June and July 2011, 532 service users were seen at multidisciplinary ward reviews. Of the 532 service users, 96% (513) had multidisciplinary clinical risk assessments undertaken and safety plans developed as a result.
*FACE Electronic Service user Record FACE (Functional Analysis of Care Environments) is the service user record for both community and inpatient mental health services. 5.6.2 Cumbrae Lodge Inspection An announced inspection was carried out at Kintyre, Iona and Jura Units at Cumbrae Lodge, Castlepark Road, Irvine in April 2012. This independent provider is contracted to provide care on behalf of NHS Ayrshire and Arran to 45 service users with mental illness or dementia. The inspection team consisted of a Healthcare Manager in Mental Health Services, a Service Manager in Elderly Mental Health and a Quality Lead Facilitator. This followed concerns which had been raised about the care delivered within the residential establishment in a recent Care Inspectorate report.
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Kintyre, Iona and Jura Units within Cumbrae Lodge are contracted directly to Ayrshire and Arran Health Board and Consultant Psychiatrists visit weekly. At the time of inspection, 36 service users were resident across the three units. The care home is owned and operated by Four Seasons Health Care. A programme was established for the day and prior to the inspection, the Older People in Acute Care standards self-assessment and the Quality & Improvement Leadership checklist were both reviewed to develop an appropriate inspection tool. Environmental design is extremely important in recognising the specific needs of the service users in these units, so the work undertaken by the Dementia Development Centre at Stirling University was incorporated into the inspection materials. During the inspection, the team spoke with service users and staff members in each unit. Both environmental inspections and general observations of the three NHS Units – Kintyre, Iona and Jura were also undertaken. Five staff-service user interactions were also observed and recorded. As part of the inspection, it was felt important to review the quality of health records, so three health records were examined. Following this, a discussion with the Home Manager took place prior to feedback to the Home Manager of the key findings of the day’s review. The team noted where Cumbrae Lodge was performing well in relation to the care and treatment provided. All of the service user-staff interactions observed were very positive and person-centred. There were good social interactions between staff and service users. The team acknowledged, too, the improvement work which has already been undertaken since the new Home Manager came into post. Service users were engaged in appropriate activities, and there were some good examples of this. There were areas for improvement noted and these included:• Staff training on dementia and values-based care • Clinical governance structures and reporting • Staffing levels and skill mix (including the ratio of Registered Mental Nurses in Cumbrae Lodge) • The jaded décor and environment in some units of Cumbrae Lodge, and the design of external garden areas. An improvement plan has been developed by Cumbrae Lodge and approved by both the Care Inspectorate and NHS Ayrshire and Arran to ensure these areas of concern are addressed. Close liaison with the Care Inspectorate and North Ayrshire Council Social Services Community Care department continues. A moratorium on admission to Cumbrae Lodge, which also provides care home placement in its other units, was put in place and will be reviewed in August/September 2012.
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5.6.3 Review of the Psychiatric Emergency Plan (PEP) Being admitted to hospital in a psychiatric emergency can be one of the most frightening events in a person’s life. It is vitally important that all agencies work in partnership to ensure as smooth a transition as possible. An event to review the Psychiatric Emergency Plan (PEP) was held on Tuesday 6 December 2011. Almost 40 delegates attended the day, with representation from all relevant services, staff groups and partner agencies. The aim of the day was to share developments since the issue of the previous Psychiatric Emergency Plan in 2008, identify areas for further development, and agree a plan of action to take these developments forward. The PEP is now in the late stages of review and will be disseminated by end August 2012 and implemented by end September 2012.
6.0 Effectiveness 6.1 National Standards, Guidelines and Accreditations During the year April 2011 – March 2012, the following standards, relevant to Mental Health Services, were published by Healthcare Improvement Scotland: • Integrated Care Pathways for Child and Adolescent Mental Health Services During the same period, self assessments / updates were completed on the following topics: • Feedback to Health Improvement Scotland on Draft Quality standard • Attention Deficit and Hyperkinetic Disorders – Services over Scotland (ADHD-SOS) Follow-up The Ayrshire ADHD multiagency pathway has now been developed. This streamlines the multiagency assessment for children with suspected features of ADHD from Education and Primary Care, to Secondary Care including diagnostic assessment, and integrated multisystemic treatment approaches. In addition, work continues to follow-up action plans from various standards that have gone before. Healthcare Environment Inspectorate (HEI): The HEI undertook an unannounced inspection visit during the year:
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• Crosshouse Hospital -17 January 2012 which included the acute admission General Adult Psychiatry wards. The following SIGN Guideline was published this year (April 2011- March 2012):• SIGN 127 – Management of perinatal mood disorders (March 2012) – one of the contributors was Dr Malcolm Cameron, Clinical Director, Adult Mental Health Community Services, NHS A & A. 6.2 Research, Development and Evaluation (R, D & E) In 2011-12, there were a total of fifteen research projects registered locally with a mental health focus. The scope of these studies includes establishment of a Scottish Mental Health Research Register Database, evaluations of effectiveness of treatment, the physiology of conditions, homicide by service users with schizophrenia: a case control study, and the roles of different staff groups and their training. The R, D & E team continues to support its colleagues in the Mental Health Directorate to develop the range of activity including both commercial and non-commercial studies and to develop links with the Scottish Mental Health Research Network (SMHRN). These links have included the development of a grant application to the CSO with a number of key collaborators and the funding from SMHRN has allowed the organisation to proactively support the recruitment of service users and carers into the research database. 6.2.1 Research Governance All research undertaken within the NHS is subject to research governance legislation and guidance and to ensure compliance with such legislation training in GCP both on-line training package and face-to face, statistics training and advice service and access to R&D training is provided. In addition to the existing activity a national Research Nurse Forum has been established to provide professional development and networking opportunities. Nurses in Ayrshire are part of this forum. A proposal for a dedicated multi-disciplinary research session one afternoon each month was put forward recently at the GDG by Dr Everett Julyan. This was accepted by members as a positive step for the directorate to encourage collaboration between disciplines, and increase the number of publications arising from Mental Health in Ayrshire and Arran. 6.3 Work undertaken that focuses on improving effectiveness of services Many initiatives have been implemented across the service to help improve the standard of care for the service user group. Below are some examples. 6.3.1 Child and Adolescent Mental Health Services Waiting Time (HEAT Target A12) Timely access to healthcare is a key measure of quality. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the 20 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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impact on other aspects of their development such as their education, so improving their wider social development outcomes. The HEAT target 26 weeks referral to treatment for the CAMH service has required a number of different approaches to meet this challenge. Choice and Partnership Approach (CAPA) has been implemented within the service. This is a new approach to clinical skills and job planning, including lean thinking to address demand and capacity issues. It aims for better service user outcomes, a more collaborative approach and reduced waits. Year April 2011 March 2012
Number of service users waiting over 26 weeks 76 16
Figure 1.5 CAMHS Waiting Times
As noted in the above table, CAMHS waiting times have significantly reduced in the year 2011 – 2012 and are well in advance of meeting the 26 weeks referral to treatment target by March 2013; reducing to 18 weeks by December 2014. 6.3.2 Psycho-Social Interventions (PSI) Project in Adult Acute Inpatient Unit With actions from national drivers such as Rights, Relationships and Recovery: Refreshed (RRRR) (2010), highlighting the need for development in the mental health nurses’ role in delivering psychological therapies, and stating this must be ‘progressed using a stepped approach to competency development’, the need for awareness raising, training, and assurance that the governance, supervision and support arrangements are in place to support staff and service development is evident. Historically there are very few nurses in the inpatient wards, who have post graduate training in formal psychological interventions. A decision was taken to design and deliver a training programme on psycho-social interventions (PSI) approaches and clinical supervision, within the adult acute wards in University Hospital, Crosshouse. Working closely with the University of the West of Scotland (School of Nursing, Health and Midwifery) we appointed an Honorary Nurse Consultant who delivers training and supervision one day per fortnight within the ward setting. A total of 12.5 % of Mental Health Nurses on the Crosshouse Site have now been trained to deliver 3-4 evidence based psychosocial interventions suitable and relevant for clinical work on acute inpatient units. Working with our academic partners at the University of the West of Scotland (UWS), we now deliver a Masters in PSI (3 year programme), which can be studied at certificate, diploma or full Masters level. Further work with UWS will see a postgraduate certificate in Cognitive Behavioural Therapy (CBT) delivered in September 2012. Five Advanced Nurse Practitioners (ANP) are now competent Non-Medical Prescribers providing safe, timeous, clinical interventions on Crosshouse site in keeping with RRRR (2010). One ANP will commence the course this year (September). 21 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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Realising Potential, the Allied Health professions action plan, was launched across Scotland in June 2010, bringing together for the first time the work of Allied Health Professionals (AHPs) in mental health in partnership with service users and carers, professional organisations and NHS boards. Psychological Therapy awareness events during April 2012 were attended by seventy AHP clinicians to increase their knowledge around psychological interventions with a view to connecting various interventions to their own clinical area. Psychology services locally were heavily involved in the planning and delivery of these events, with this involvement being continued in the implementation of this recommendation within the action plan. 6.3.3 Wellness Recovery Action Planning (WRAP) A key achievement highlighting marked improvement for people who use the Learning Disabilities Service has been the four (16 hour) Wellness Recovery Action Planning (WRAP) workshops which were delivered to family carers across Ayrshire. WRAP is a self management tool that can support people to better manage their own mental well being. Outcomes included participants reporting increased levels of hope, improved confidence and an improved score on the Warwick Edinburgh Mental Well Being Scale (WEMWBS). The groups’ score increased by five points during the training then a further five points after the WRAP course. The results imply that family carers had more positive views in relation to their mental well being as a result of taking part in the WRAP training and this was sustained and indeed improved during the month after training ended. 6.3.4 Addiction Services Waiting Times (HEAT Target A11) There has been considerable improvement in waiting times within Addiction Services over the last two years. In December 2009, there were 301 service users waiting (for anything up to two years) to be seen. This had reduced to two service users on the waiting list by December 2010. The national HEAT (Health improvement, Efficiency, Access, Treatment) target A11 expects that by March 2012:• 90% of people who are referred to Addiction Services will wait no longer than five weeks from referral received to appropriate drug or alcohol treatment that supports their recovery (and no-one will ever wait any longer than 10 weeks from referral to treatment). Ayrshire & Arran is currently exceeding these targets with 94.95% of people currently waiting three weeks or less.
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Figure 1.6 – Addiction Services Waiting Times (HEAT Target A11) % Waiting 3 weeks or % waiting times 5 less weeks or less HEAT NHS Target Local March Target 2013 March Target Area 2012 Actual Actual Ayrshire & 90% Arran Board 90% 89.90% 94.95% 99.34% East Ayrshire 90% ADP 90% 89.90% 93.04% 99.27% North Ayrshire 90% ADP 90% 89.90% 94.24% 98.92% South Ayrshire 90% ADP 90% 89.90% 98.51% 100%
Length of longest wait
Target
Actual
< 10 weeks
36 - 42 Days
< 10 weeks
36 - 42 Days
< 10 weeks
36 - 42 Days
< 10 weeks
22 - 28 Days
There are now no service users waiting over 10 weeks. Addiction Services is on track to meeting this access HEAT target. 6.3.5 Alcohol Brief Interventions (HEAT Target H4) The HEAT H4 Target was established in response to growing concerns about the harm caused by the high level of alcohol consumption in Scotland. The Scottish Government set NHS Ayrshire & Arran the target of delivering 4,076 Alcohol Brief Interventions (ABIs) between April 2011 and March 2012. Ayrshire and Arran exceeded this target with trained practitioners embedding ABIs into their routine practice with 7,501 ABIs having been delivered by March 2012. 6.3.6 Access to Psychological Therapies (HEAT Target A12) Within Psychology Services, there are 276 service users waiting more than 18 weeks as at 29 February 2012, which is a decrease of 44 (13.7%) from 320 service users at 31 January 2012. Of the seven services contributing to this, four have shown a decrease in the number of service users waiting more than 18 weeks. The services contributing to this are Adult Community Mental Health with 136 service users (24.0% decrease), CAMHS with 15 service users (36.4% increase), Community Paediatrics with 31 service users (40.9% increase), Coronary Heart Disease Psychology with one service user (previously zero recorded), Non Epileptic Seizures/Acquired Brain Injury with 16 service users (11.1% decrease), Pain Clinic with 44 service users (12.0% decrease) and General Medicine with 33 service users (5.7% decrease) all waiting over 18 weeks. Increased access to Psychological Therapies is being progressed via four specialty groups which have addressed re-design in Adult Mental Health Services, establishment of training and supervision systems, a change in structure and balance of work within Psychology 23 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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Services and remodelling of an electronic system to report information for the Psychological Therapies HEAT target. 6.3.7 Professional Development Award – Accreditation In conjunction with staff within the Vocational Qualification (VQ) centre at Ayrshire Central Hospital and the Scottish Qualifications Authority (SQA) in Glasgow, a Professional Development Award (PDA) in Brief Interventions for substance misuse was developed. The PDA has been specifically designed to offer a nationally recognised workbased qualification within the addictions field, and is validated by SQA. It is now available nationwide for approved centres to use. The first cohort of four candidates is due to finish at the end of June 2012 and discussions are currently underway with the VQ centre to finalise the details of the next cohort due to commence in September 2012. 6.3.8 Integrated Care Pathways (ICPs) There are five diagnostic Stakeholder Groups and additional short term work flow related sub groups supporting the development of the ICPs in Mental Health (Dementia, Depression, Bipolar Affective Disorder, Borderline Personality Disorder, and Schizophrenia). The Dementia ICP will be the first pathway to feature on the new web based version of the electronic service user record FACE. Some changes to the pathway are required following the Scottish Government’s guarantee which means that everyone receiving a diagnosis of dementia in Scotland will have access to a year of support, from a named and trained individual, based on the Alzheimer Scotland Five-Pillar model. To determine the Ayrshire & Arran model of support, a Post Diagnostic Support Project to scope what is available has been funded by the Scottish Government. This funding is for six months. At the end of this period, the post holder will be required to produce a report detailing the mapping exercise results and a proposed way forward for delivery of one year’s guaranteed post diagnostic support within Ayrshire & Arran. Work to progress the other ICPs is ongoing and includes the development of algorithms for pharmacological management of Bipolar Affective Disorder and the development of information leaflets for service users and carers on the diagnosis of Borderline Personality Disorder. In addition, it has been recognised that Alcohol Related Brain Damage (ARBD) poses an increasingly significant problem in Ayrshire and Arran, and as a result, initial steps have been taken to establish an ICP for people with this condition. A truly integrated approach between all agencies is vital to support people affected by ARBD. 6.3.9 Clinical Governance Symposium A Clinical Governance Symposium for Mental Health Services staff was held on Thursday 3 November 2011 at the MacDonald Education Centre, University Hospital, Ayr. The aim of the day was to share good practice between services in Mental Health to support the 24 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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implementation of safer, more effective, person-centred care. The service has hosted two previous clinical governance events in March 2009 and March 2010. Over 90 clinicians registered prior to the day, with 86 delegates attending on the day. Ruth Glassborow, National Programme Manager with the Quality and Efficiency Support Team (QuEST) at the Scottish Government, was the keynote speaker. Her remit includes leading work to support the national Dementia Demonstrator Sites and supporting the development of the Mental Health Patient Safety Programme. Jamie Malcolm, Clinical Adviser at the Suicide Review Team at Healthcare Improvement Scotland (HIS), outlined the findings from the recent Learning and Improvement Review. Jamie highlighted the fact that of the 31 inpatient suicides in Scotland reported to HIS from April 2008 – June 2011, over half of these (19) involved hanging. He also discussed further ideas for improving the sharing of good practice across Scotland. A former service user of the Community Eating Disorder Service spoke about his experience of the service and his journey through recovery. This was very powerful, and well-received by staff. The young male’s father also recounted his experience and the impact his son’s condition had on the whole family. As part of the evaluation of the day, the delegates were asked to complete an online survey. Of those, 62 delegates responded, resulting in a 72% response rate. It was encouraging to gain the feedback below. • 95% of delegates learned something new at the event • 82% felt that they had learned something that could be adopted into their working practice 6.3.10 Promoting Excellence in Dementia One of the key challenges outlined in the Dementia Strategy is that general healthcare services do not always understand how to respond well to people with dementia and their carers, leading to poor outcomes. The particular needs of people with dementia are often poorly understood by healthcare staff working in general medical settings such as general hospital wards and Accident and Emergency Units. This reflects the knowledge and skills of staff in these areas and the support which is offered to them. In addressing this challenge, three Dementia Training Officers commenced on 16 April 2012 as part of the Change Fund. These posts are funded for one year and the purpose is promoting excellence in dementia care across health, local authority and care homes. There continues to be a high demand for this training from both University Hospitals at Ayr and Crosshouse, with high satisfaction evaluation and an eagerness and willingness to introduce learning from the programme into practice. The ‘This is Me’ leaflet is in the process of being introduced across all Ayrshire & Arran hospital sites, being led by the first cohort of Dementia Champions. This is an aide 25 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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memoire document which is completed by carers to provide staff with information about their relative with dementia. The Community Care Home Liaison Nurses have completed a Training Needs Analysis and are currently evaluating the use of psychotropic medication within Care Homes. 6.3.11 Publications and Awards The undernoted references are contributions to the national agenda from clinicians working in Mental Health Services in NHS Ayrshire and Arran. From April 2011 Barron, K. (2011) Book Review: How We Treat the Sick: Neglect and Abuse in Our Health Services British Journal of Wellbeing, Vol 2, No. 6 pp 47 Brady, L and Barron, D (2011) Suicide prevention training in Ayrshire and Arran: a collaborative gain. British Journal of Wellbeing, Vol 2, No. 7 pp14 Downie, S and Lauder, W (2011) Smoking cessation – links to recovery Scottish Recovery Network Available at: http://www.scottishrecovery.net/Latest-News/smokingcessation-links-to-recovery.html Holly, D. (2011) The psychological impact of the implantable cardioverter defibrillator: A systematic review. Arrhythmia Watch 2011; Issue 17 (Oct) Forte, M., Jahoda, A. and Dagnan, D. (2011) An Anxious time? Exploring the nature of worries experienced by young people with a mild to moderate intellectual disability as they make the transition to adulthood. British Journal of Clinical Psychology, 50, 398-411. Kane, G (2011) Reach for the stars. Nursing Standard Vol 25 No 41 p 64 Lavalette, H., Alexander, J., Gilmour, C., Allan, J. and Sloan, G. (2011) Separating clinical and line management supervision in occupational therapy British Journal of Wellbeing Vol. 2, No. 6, pp 18 - 21 O’Connor, S., House, E. and Carney, T. Paediatric Medicine - Identifying emotional distress in children. (2011). GP online Sloan, G (2011) Book Review: Designing and Managing Your Research Project. Nursing Management 18(5), pp.13 Sloan, G (2011) Book Review: Therapy skills for healthcare - an introduction to brief psychological techniques. Nursing Standard. 26(14), pp.31 Sloan, G (2011) Book Review: The Mindful Way Through Anxiety - Break Free From Chronic Worry and Reclaim Your Life. Nursing Standard. 26(15-17), pp.32 26 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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Snowden, A and Barron, D (2011) Medicines Management in Mental Health. Nursing Standard Vol 26 No 3 p 35 Snowden, A; White, C; Christie, Z; Murray, E; McGowan, C; Scott, R. (2011) Helping the Clinician Help me. Towards Listening in Cancer Care. British Journal of Nursing. Onc Suppl Vol 312 (1) Snowden, A; White, C; Christie, Z; Murray, E; McGowan, C; Scott, R. (2011) The Clinical Utility of the Distress Thermometer: a review. British Journal of Nursing. Vol 20(4); 220-227 Stewart, J and Barber, L (2011) A Flying Start for the newly qualified. Nursing Times.net Vol 107 No 19/20 p 19 From January 2012 Barron, K (2012) Book Review: Promoting Concordance in Mental Health. British Journal of Mental Health Nursing Vol 1 No 1 p 64 Barron, D and Hurley, J (2012) Emotional intelligence and leadership. Emotional Intelligence in Health and Social Care. Radcliffe Publishing London Blair, P. S., Humphreys, J. S., Gringras, P., Taheri, S., Scott, N., Emond, A. M., Henderson, J. and Fleming, P. J. (2012) Childhood sleep duration and associated demographic characteristics in an English cohort. (2012) Sleep, 35 (03), 353-360. Cawthorne. P and Barron, D (2012) Developing the New Schizophrenia Guideline. British Journal of Mental Health Nursing Vol 1 No 1 pp 45 – 51 Gibson, J (2012) How cognitive behavioural therapy can alleviate older people's grief, 12 17. Mental Health Practice 15 (6). http://mentalhealthpractice.rcnpublishing.co.uk/archive/article-how-cognitive-behaviourtherapy-can-alleviate-older-peoples-grief Sloan, G and Grant, A (2012) A rationale for a clinical supervision database for mental health nursing in the UK. Journal of Psychiatric and Mental Health Nursing doi: 10.1111/j. 1365-2850.2012.01894.x. Snowden, A., Gilfedder, M., Ferries, E., Bartling, L. and Barron, D (2012) Concordance in Action: Training Needs Analysis. British Journal of Mental Health Nursing Vol 1 No 1 pp 14 - 19 Snowden, A; Marland, Glenn; Murray, Esther; McCaig, Marie. (2012) Denial of heart disease, delays seeking help and lifestyle changes. British Journal of Cardiac Nursing. Vol 7(3)
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Awards Mental Health Nursing Forum Scotland Awards 2011 (category winner) - Mary Gouck and Stephanie McClymont: Primary Care Mental Health Team - East. Mums Health Class. Mental Health Nursing Forum Scotland Awards 2011 (category winner) - Austyn Snowden, Maria Gilfedder & Peggy Anne Campbell: Partnership between NHS A&A and UWS: Medication management in mental health nursing: joint module development, delivery and evaluation. Mental Health Nursing Forum Scotland Awards 2011 (highly commended) - Mick Fleming & Graham Sloan: Partnership between NHS A & A and UWS: Development and delivery of MSc in Psychosocial Interventions.
7.0 Key Drivers for 2012/13 Strong and effective partnership must be at the heart of driving better outcomes for the people who use Mental Health Services in Ayrshire. The proposed integration of adult health and social care in Scotland will undoubtedly be one of the challenges facing the service in coming years. Separate systems of health and social care are not best placed to adequately meet the needs and expectations of people who use the services. In Mental Health many service users have multiple, complex, and in some instances, long-term conditions. In addressing these challenges, commitment, collaboration and innovation are all necessary. Continuing to work together with our statutory and third sector partners to improve service user outcomes will be a key priority. In terms of some challenges for specific services, continuing to improve access to treatment waiting times for people referred to Addiction Services is a key priority. The new HEAT target for March 2013 is that 90% of clients will wait no longer than three weeks for appropriate treatment to commence. An evaluation year (2012-13) has been added to continue to embed Alcohol Brief Interventions not only within current priority settings but also by looking at expanding the delivery to wider settings, which include both health and non-health settings. There is currently limited evidence of either the feasibility or effectiveness of ABIs in wider settings and there is a desire to take the opportunity to deliver robust pilot projects that have the best chance of making a difference and to create an evidence base. HEAT targets will continue to be a challenge and driver for the service. These are demanding targets, and as such, innovative initiatives are required to reshape services with the aim of meeting these targets. One of the major challenges is the continuation and improvement of the CAPA model in CAMHS to optimise collaborative care and reduce waiting times within CAMHS to 18 weeks referral to treatment by December 2014 and 18 weeks referral to treatment by December 2014 for psychological therapies. The psychological therapies target applies to all ages and therefore has some overlaps with the CAMHS HEAT target. 28 File Name: MHS CG Annual Report 2011-12 Produced by: JT/AR Circulation type (internal/external):Internal
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The redesign of the Community Mental Health Teams (CMHTs) and the Primary Care Mental Health Teams has led to a range of initiatives addressing the waiting lists for psychological therapies and there are encouraging signs that some reductions in waiting times are beginning to emerge. Perceived gaps in the service have also been addressed by introducing a single point of access to ensure the service is easier to access, and weekend services to accommodate demand for the service at a time when there was previously inadequate provision. The national Quality Measures, along with HEAT targets and local service measures, will form part of the Board’s Quality Measurement Framework in future. The approach taken this year to identify clinical governance priorities was to ask each service clinical governance group to pick one or two areas and develop a driver diagram to show where they would like to specifically target improvement work. The Quality Measures Framework for Mental Health that incorporates these priorities can be viewed in Appendix 2. Ensuring that the focus on safe, effective and person-centred care remains integral to the service is a continuing challenge. In February 2012, the Scottish Information Commissioner criticised NHS Ayrshire and Arran for failings in records management and information recovery relating to Critical Incident Reviews and Significant Adverse Event Reviews. Subsequently, Healthcare Improvement Scotland (HIS) reviewed the processes and procedures in the Board area. It is envisaged that new structures and processes may come into being, following publication of the HIS report in summer 2012, to better support the review of adverse events and their associated recommendations. SPSP-MH is a four year programme focussed on improvement within and across mental health services in Scotland. During year 1 (August 2012 – August 2013) the programme will be centred around adult mental health wards. The underpinning aim of the programme is to reduce harm. The aim of the Quality Strategy is to deliver the highest quality healthcare services to people in Scotland. This is ambitious, but it is achievable and we are well placed to deliver. This report is our reflection on progress to date within Mental Health Services.
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Appendix 1
Clinical Governance Structures in Mental Health Services
NHS Ayrshire & Arran Board
NHS Ayrshire & Arran Clinical Governance Committee
Mental Health Services Governance & Development Group Dr John Taylor, Associate Medical Director
Learning
Adult Inpatient Services
Service CG Group
CG Group
Forensic Services CG Group
Dr Helen Lynn
Dr Morag Henderson
(Clinical Director)
(Clinical Director)
Dr Dawn Carson
Disabilities
(Consultant Psychiatrist)
Elderly Mental Health CG Group Dr Seamus McNulty (Clinical Director)
Child and Adolescent MHS CG Group
Addiction Services CG Group
Andrew Smith (Senior Nurse/ Operations Manager)
Dr Jeremy Stirling
Adult Community CG Group
Psychology Services CG Group
Dr Malcolm Cameron
Cathy Kyle
(Clinical Director)
(Clinical Director)
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(Director of Psychology Services)
Appendix 2 Quality Measures Framework 2012 – 13 Mental Health Services 12 National Outcome Measures Healthcare Experience
Staff Engagement
Healthcare Associated Infections
Emergency Admission Rate
Adverse Events
Hospital Standardised Mortality Ratio
Premature mortality rate (
