Department for Health and Ageing RESPONSE TO THE COMMUNITY MENTAL HEALTH REPORT. Draft

Transcription

1 Department for Health and Ageing RESPONSE TO THE COMMUNITY MENTAL HEALTH REPORT Draft 2 March 2017

2 Contents 1. Introduction Review Workshop Issues and Opportunities Review Recommendations Key Action Areas, Recommendations and Actions Key Action Area 1: Resetting the Strategic Direction Key Action Area 2: Community Mental Health Service Operational Model Key Action Area 3: Organisational Service Structure Key Action Area 4: Interface with Service Partners Key Action Area 5: Discharge Planning and Improved Patient Care Key Action Area 6: Systems Improvement and Service Monitoring Key Action Area 7: Training and Development Next Steps Summary March-17 Page 1

3 1. Introduction Mental Health is a part of the clinical productivity improvement arm of Transforming Health. A review of community mental health services was commissioned and subsequently completed by Deloittes in July The broad objectives of the project were: assess and analyse the efficiency and effectiveness of community based mental health services with the aim to maximise mental health consumer flow and support; and identify options to improve the capacity, flow and effectiveness of Community Mental Health (CMH) in metropolitan Adelaide Local Health Networks (LHNs). The project involved extensive stakeholder consultations, primary data collection and data analysis. The approach included: A census of the current mental health consumers being supported by specialist community mental health across Metropolitan Adelaide LHNs; An online survey of Consumers & Carers distributed through the state-wide mental health lived experience register; The development and completion of an online survey of community mental health staff; and Qualitative staff consultations at the team level, along with the facilitation of consultation forums with senior community mental health psychiatrists and allied health professionals working in community mental health. Shortly after the Review was completed, a summary of consultations with mental health staff was undertaken by a joint project between SA Health and the Australian Nurses and Midwifery Federation (ANMF). 2. Review Workshop Issues and Opportunities A summary of the key issues and opportunities from the Review are summarised in Attachment 1. These were described in the following four broad areas: Managing Complexity of Consumers; Barriers to Transfer of care of consumers within the Community Mental Health Teams; Clinics, Other Services and Access; and How Community Mental Health services work as a team. 3. Review Recommendations The Community Mental Health Review ( the Review ) was completed in July 2016 and made a series of key findings and recommendations to improve community mental health services. The recommendations are summarised below: Recommendation 1: Define the core business of Specialist Community Mental Health (SCMH) in line with refined primary care models and commissioned services. Recommendation 2: Refine the operating model for SCMH with implementation of acute community and ongoing community streams. Recommendation 3: Revise the current community mental health business rules to provide a more flexible framework and define those items that need standardisation. Recommendation 4: Review and enhance the functioning of the mental health triage process. 2 March-17 Page 2

4 Recommendation 5: Model staffing in acute and ongoing community streams based on the likely daily/weekly referral patterns and the transfers needed back to primary care or self-management. Recommendation 6: Support the development of rapid access assessment function in each community team, including for stable SA Ambulance Service transfers. Recommendation 7: Identify the community based specialist skills and support required for each phase of care, and allow SCMH health professionals to practice at top of scope. Recommendation 8: Implement mechanisms for review of consumers after a set number of sessions with early discussion with consumers and carers of progress and transfer to shared care. Recommendation 9: Enhanced primary care and NGO interfaces and capacity development support. Recommendation 10: Implement Shared Care as default for all ongoing care consumers. Recommendation 11: Consider the trialling of community transfer of care positions in each SCMH team to facilitate shared care and closure of long stay maintenance consumers. Recommendation 12: Streamline care plans and reduce the amount of time required for documentation. Recommendation 13: Investigate refinements to CBIS functionality, including the ability for CBIS to be converted to a full electronic medical record prior to full implementation of EPAS. Recommendation 14: Implement Community dashboards with targets and flow expectations. Recommendation 15: Invest in the development of frontline team managers to understand flow, accountability and performance management. 4. Key Action Areas, Recommendations and Actions The Review has been analysed and a number of key action areas have been identified that encompass the recommendations and key issues The following summarises key action areas to manage the implementation of the Review as well as recommendations associated with those areas and actions to implementation them. The actions also take account of the issues raised by the ANMF consultation process as well as responses to the Review by Local Health Networks. 2 March-17 Page 3

5 4.1 Key Action Area 1: Resetting the Strategic Direction Recommendation Agreed/Not Agreed Actions Responsibility Agreed In-Principle Prepare a high level strategic core business document as well as the high level principles for SA Community Mental Health Services. The principles will be adapted from the current Pathways to Care policy Recommendation 1: Define the core business of Specialist Community Mental Health (SCMH) in line with refined primary care models and commissioned services. Strategic Operations in partnership with the Department for Health & Ageing. 4.2 Key Action Area 2: Community Mental Health Service Operational Model Recommendation Agreed/Not Agreed Actions Responsibility Agreed In-Principle Recommendation 2: Refine Develop an overarching high level model of the operating model for SCMH care adapted from the Pathways to Care with implementation of acute policy and to create two overarching service community and ongoing streams in community care Acute and Non community streams. Acute. The model of care should also enable local managers to tailor services to meet local population needs. Recommendation 3: Revise the current community mental health business rules to provide a more flexible framework and define those items that need standardisation. Agreed In-Principle Develop high level overarching principles and practices based on the processes of Pathways to Care policy and guidelines as well as community specific KPIs. Strategic Operations lead in consultation with the Department for Health & Ageing. Strategic Operations lead in partnership with the Department for Health & Ageing. 2 March-17 Page 4

6 4.3 Key Action Area 3: Organisational Service Structure Recommendation: Agreed/Not Agreed Actions Responsibility Not Agreed Recommendation 4: Review No further action required following discussion Not Applicable and enhance the functioning of that it would be too costly to have single triage the Mental Health triage services in each LHN and may confuse the process. consumers, carers and the community. Recommendation 5: Model staffing in acute and ongoing community streams based on the likely daily/weekly referral patterns and the transfers needed back to primary care or self-management. Recommendation 6: Support the development of rapid access assessment function in each community team, including for stable SA Ambulance Service transfers. Recommendation 7: Identify the community based specialist skills and support required for each phase of care, and allow SCMH health professionals to practice at top of scope. Current single telephone line is more effective. Agreed In-Principle Develop services based on two service streams in community care Acute and Non Acute. Key high level functions under two service streams need to be developed to ensure some consistency across LHNs, but also enable local managers to tailor services to meet local population needs. Complete an activity analysis of community mental health services. Undertake an analysis of service referral patterns and caseload management across community mental health services. Agreed In-Principle Develop an immediate at risk assessment function that is consistent across Local Health Networks and supports ambulance and police services. Agreed In-Principle Identify key competencies for community mental health staff for the two service streams Acute and Non Acute as well as their speciality sub functions. Strategic Operations lead in partnership with the Department for Health & Ageing. Strategic Operations. Strategic Operations. 2 March-17 Page 5

7 4.4 Key Action Area 4: Interface with Service Partners Recommendation: Agreed/Not Agreed Actions Responsibility Agreed In-Principle Recommendation 9: Develop a system and process to outline Enhanced primary care and clearly the roles and responsibilities of all NGO interfaces and capacity mental health service delivery partners Strategic Operations development support. (including NGOs and PHNs), and the services lead in partnership with they provide, how they are accessed and how the Department for consumers are transferred seamlessly. Health & Ageing. 4.5 Key Action Area 5: Discharge Planning and Improved Patient Care Recommendation: Agreed/Not Agreed Actions Responsibility Agreed In-Principle Recommendation 8: Develop a high level set of guidelines based Implement mechanisms for on the Pathways to Care policy that articulate review of consumers after a how a consumer may step through the set number of sessions with community mental health service streams, the early discussion with average length of stay within a service stream, consumers and carers of discharge criteria for each service stream and progress and transfer to how a consumer s progress is reviewed at shared care. each step. Recommendation 10: Implement Shared Care as default for all ongoing care consumers. Recommendation 11: Consider the trialling of community transfer of care positions in each SCMH team to facilitate shared care and closure of long stay maintenance consumers. Agreed In-Principle Develop a memorandum of understanding that is applicable to all services partners about how a consumer s needs are shared to ensure optimum mental health outcomes. This includes re-entry through the phases of care for a consumer whose mental health needs change even after discharge. Agreed In-Principle Develop high level discharge protocols and episode of care closures for all service partners within a shared care process. Consider the establishment of community transfer positions. LHNs (Clinical Directors Strategic Operations) Strategic Operations Strategic Operations 2 March-17 Page 6

8 4.6 Key Action Area 6: Systems Improvement and Service Monitoring Recommendation: Agreed/Not Agreed Actions Responsibility Agreed In-Principle Recommendation 12: Develop real time dashboards to enable Department for Health & Streamline care plans and community mental health staff to monitor and Ageing (lead) in reduce the amount of time manage consumer caseloads, service flows partnership with the LHN required for documentation. and diagnostic information. Clinical Directors and Directors of Strategic Recommendation 13: Investigate refinements to CBIS functionality, including the ability for CBIS to be converted to a full electronic medical record prior to full implementation of EPAS. Recommendation 14: Implement Community dashboards with targets and flow expectations. 4.7 Key Action Area 7: Training and Development Agreed In-Principle Determine the degree of improvement that can be made to the assessment, risk and care planning tools and the functionality of CBIS and EPAS to support community mental health teams. Agreed In-Principle Determine appropriate amendments to the current suite of community mental health Key Performance Indicators to provide more meaningful outcomes data to inform clinical interventions and monitor consumer pathways including re-entry. Operations Department of Health and Ageing Department for Health & Ageing (lead) in partnership with the LHN Clinical Directors and Directors of Strategic Operations Recommendation: Agreed/Not Agreed Actions Responsibility Agreed In-Principle Recommendation 15: Invest In consultation with LHNs, develop a training in the development of frontline program for managers and team leaders to team managers to understand understand clinical governance and Strategic Operations. flow, accountability and accountability as well as managing consumer performance management. flows and outcomes, risk assessment and mitigation and managing relationships with other service providers in the stepped system of care. 2 March-17 Page 7

9 In addition to the outlined Key Result Areas, a separate process is being undertaken and addressed through Industrial Relation processes and forums. This group will address a numbers of other issues raised in the Deloittes Report and the subsequent ANMF Cultural Review Report. These issues include: Fragmented Care leading to poor services; Poor morale resulting in increased in sick leave; Non retention of experienced staff; Burn Out ; Workload issues; Inefficient processes; Unrealistic expectations; Reported symptoms of stress and anxiety; Hostile work environments; and Toxic team cultures. 5. Next Steps The following outlines the next steps to implement the recommendations of the Review: The Department for Health and Ageing develop an implementation and action plan for community mental health services, including timelines. Establish an oversight committee to monitor the implementation of the recommendations and action plan. Membership of the committee to include the Executive Director Mental Health Strategy, Principal Manager Mental Health Strategy and Reform (DHA), all metropolitan and Directors Strategic Operations as well as representation from CHSALHN to advise on impacts for country residents. Develop a communication plan to ensure the findings and recommendations are understood by key stakeholders that include executives, clinicians, administrators across LHNs, service partners, unions, consumers and carers. 6. Summary It is expected that as the recommendations of the Review are implemented, there will be a number of service improvements. They include: Improved consumer and carer outcomes; Reduced waiting times in emergency departments; Improvement in length of stay in inpatient units; Improved service flows through the stepped system of care, particularly community mental health services; Upskilling of staff and clinical supervision in community services; Improved leadership in service delivery 2 March-17 Page 8

10 Improved interfaces with our service partners that optimise consumer access and care across service areas; and Improved information systems and better use of technology and data to enable clinicians to enhance consumer outcomes, manage work flows and improve performance efficiency and effectiveness. A suite of performance indicators and measures will be designed to monitor these service outcomes in conjunction with stakeholders. 2 March-17 Page 9