Barnet, Enfield and Haringey. Mental Health NHS Trust. Trust Clinical Strategy

Transcription

1 Barnet, Enfield and Haringey Mental Health NHS Trust Trust Clinical Strategy

2 Contents Section 1. Introduction 3 Section 2. Our clinical priorities for the next five years 4 Section 3. About us and what we do 12 Section 4. Improving the quality of our services 19 Section 5. Working with our partners 20 Section 6. Next steps 25 Appendix. National Mental Health Clusters 26 2 Clinical Strategy

3 1. Introduction Welcome to our Clinical Strategy for In this document we will describe who we are, outline our services, and explain our clinical development plans and ambitions over the next five years. We will demonstrate our commitment to providing the highest possible standards of clinical quality, and show how we are listening to our patients, staff and partners, and how we will work with them to deliver services that are relevant to the people who use them. We will also confirm our commitment to contributing to the wider health and social care system locally, to help address the wider health inequalities experienced by local people and promote their overall health and wellbeing. We have consulted with our patients, their carers, our clinical staff, our commissioners and our partners in primary care and social care in developing this strategy, to produce a document which reflects their views and provides a summary of the plans for the future development of the Trust s clinical services. This document reflects, and supports, the formal Commissioning Strategies of our local Clinical Commissioning Groups. We will continue to work with our commissioners, local authorities and other partners to further develop the clinical model of care, with more detailed, borough specific, plans which support the delivery of this overarching Clinical Strategy. Progress will be regularly monitored internally and by our commissioners. As part of this, we are working with our commissioners, local authorities and other partners to agree specific service quality standards, building on our Quality Strategy. Public confidence in health services is low, following recent events, particularly the Francis Report, which followed the lapses in care at Mid Staffordshire NHS Foundation Trust several years ago. We want to provide information to all our stakeholders in this document that demonstrates why we are the best choice for providing mental and integrated healthcare to all members of the diverse populations we serve. We want to achieve this in the most clinically effective, efficient and innovative ways, understanding that there is little new funding available for health services, particularly in Barnet, Enfield and Haringey, which has one of the most financially challenged health economies in London. We want to use the limited resources that we have to deliver the best possible services for our patients and their carers, which does not compromise on the quality of care received. We believe our knowledge and expertise in our areas of work will help us to achieve these goals. This document describes our vision for the future as an organisation and outlines our top clinical priorities and aspirations. It gives an overview of the Trust as it is now, and how we expect to develop and improve our clinical services over the next five years. This will require a strengthened culture of co-operation with the people who use our services, both patients and their carers, and the organisations with which we are partners, particularly our colleagues in primary care, acute hospitals and social care. Maria Kane Chief Executive Dr Marc Lester Interim Medical Director Clinical Strategy 3

4 2. Our clinical priorities for the next five years 2.1 Our vision for the future The Trust s core purpose is to improve the health and well-being of the people of North London and beyond. We will achieve this by working in partnership with our patients, their carers, our partners and our commissioners to provide integrated high quality, person focused services that maximise personal choice, independence and quality of life. Our overall vision for the future is to be the lead local provider, co-ordinator and commissioner of integrated care services to improve the health and wellbeing of the people of north London and beyond. We want to play our part in addressing the significant health inequalities experienced by local people. In particular, we are focusing on improving the health and wellbeing of people with long term conditions, whether physical or mental health related, especially in the areas where these overlap. We believe that the integration of mental and physical healthcare is fundamental to high quality services and to good patient care. The 2011 National Mental Health Strategy No Health without Mental Health describes six key objectives to improve mental health outcomes: More people will have good mental health More people with mental health problems will recover More people with mental health problems will have good physical health More people will have a positive experience of care and support Fewer people will suffer avoidable harm Fewer people will experience stigma and discrimination We share these objectives and they are at the heart of our plans. Our services for patients with mental health problems are underpinned by a recovery-focused approach, and, in Enfield, our integration of mental health and community health services is enabling the development of new care models maximising holistic mental and physical healthcare. Our focus for the future is on actively promoting holistic mental and physical well-being, prevention of ill-health, recovery and enablement, delivered as close as possible to patients homes. We no longer regard ourselves as just a mental health provider, but as an integrated care provider. We are integrating Enfield Community Services with our existing services to create an organisation focusing on the care of people with long term conditions. We believe that this model will be applicable across organisational boundaries, allowing better joined-up working across health services. Working in partnership with other organisations and most importantly with patients and their carers is central to the success of our strategic vision. We increasingly expect to be working across organisational boundaries with our colleagues in primary care, acute care and social care to support patients and their carers to get well and remain well. We are uniquely placed in the local area to work with our colleagues in primary care, the local acute hospitals and social care to facilitate the care of more people in community settings, rather than in acute hospitals. This is not only better and more effective for patients, but is also more cost effective for the tax payer. Our organisational vision has been developed in close collaboration with our commissioners and reflects their new Mental Health Commissioning Strategy, which promotes a Stepped Care model, with four levels of care, aimed at helping people to remain well and live happy and productive lives with the minimum clinical intervention necessary. Our Clinical Strategy closely reflects the new Mental Health Commissioning Strategy, with the following four levels of care, summarised below: 4 Clinical Strategy

5 Summary of the Stepped Care Approach Level 1 Supporting the whole population through health promotion, early intervention and helping people to keep themselves well Level 2 Primary care GPs and nurses providing low level clinical interventions for anyone with a moderate health condition Level 3 Secondary health services providing specialist services for those with more serious health conditions Level 4 Highly specialist services for severe conditions The levels above can be aligned to the national Mental Health Care Clusters, as outlined below: Mental health interventions provided for each level: LEVEL 1 Advice and support in Primary Care This corresponds to Mental Health Care Clusters 0 and 1 LEVEL 2 Treatment in Primary Care and from IAPT and counselling services These would fall in Mental Health Care Clusters 2 and 3, and some in Care Cluster 4. These patients wouldn t need to be seen by specialist secondary care mental health services, although clinical advice could be offered by those services to support primary care or IAPT LEVEL 3 Treatment in Secondary care services, with more severe depressive illness in Mental Health Clusters 4 and 5, and other more severe mental health problems in Clusters 6 and above. Patients would be seen in the complex care teams or in the support and recovery teams. They may need input from Crisis and Home Treatment services As a secondary care provider, our clinical services are mainly focused at Level 3, with some at Level 4. Within these services there are varying levels of care, from outpatient or community follow-up services, through to more intensive community and home treatment services, then to our recovery houses and finally inpatient care. Our recovery-focused model aims to allow our patients to move between these levels of care as seamlessly as possible, and be supported in the most appropriate setting. We always aim to use the least restrictive care setting, but this has to be balanced against risk when deciding between home treatment, recovery house or inpatient care. These different services can seem inflexible to some patients and referrers and we are committed to simplifying our care pathways. Once discharged to primary care, we aim to make re-referral back into our secondary care services as simple as possible, without unnecessary delays. As well as directly providing a range of services at Levels 3 and 4, we also have a responsibility to work with our partners, to support them in providing services for people with health issues and problems at Levels 1 and 2. Our Clinical Strategy involves us working even more closely with primary and social care services to help them manage the growing demands for healthcare from the local population without the need for them to refer on to secondary care, unless clinically required. We support our partners through training and providing the specialist back-up they need to provide safe, effective, local care. This collaborative relationship is essential in managing the health needs of the local population as effectively as possible and ensuring that patients who need more specialist care continue to receive it, particularly in times of financial constraint across the NHS and social care. Our vision for the future sees the Trust continuing to provide the full range of specialist and very specialist services, whilst also playing a key role in the wider health and social care system, supporting local people and our partners in improving the overall health and wellbeing of people across Barnet, Enfield and Haringey. LEVEL 4 Specialist treatment for patients with severe mental illness, in different Care Clusters, depending on their diagnosis For a more detailed list of the national Mental Health Care Clusters, please see the Appendix. Clinical Strategy 5

6 2.2 Our strategic clinical development plans for the next five years Our key clinical development plans and ambitions for the future have been informed by our overall vision and our local Clinical Commissioning Groups future commissioning strategy. They are as follows: 1. Putting Quality at the heart of our services We will continue to improve the experience of all our patients and ensure that patients and carers are at the centre of their care. In particular, we will: Build on the Trust s existing Quality Strategy to further develop a culture of care and compassion for all patients and provide better support for carers Actively promote the Recovery Model for all patients, including promoting the wellbeing of all patients through extending this model to all patients with long term mental health conditions Strengthen care co-ordination and continuity of care across care pathways and extending the model currently in place in mental health to other long term conditions Develop our partnerships with patients, carers and voluntary groups, including more support into employment Change the model and practice of care for people with serious and enduring mental illnesses, including: o Personalised goal-setting o Promotion of personal resilience o Support for medication compliance o Greater emphasis on psychological therapies, as an alternative to other forms of care patients and have made it a firm priority to improve our support to our colleagues in primary care. We also want to improve the pathways through which patients and carers can access our services, and the mechanisms for referral into those services for GPs. We will achieve this through: Simplifying access to our services for patients and GPs, with simple and clear access routes into our services for urgent and routine referrals. We are establishing a 24 hour urgent referral service, providing immediate assistance and support to referrers and providing a response by the Trust s Urgent Care Team within four hours Improving all communications with GPs, with defined and managed standards for responses provided, with standardised templates, giving all essential information, within 24 hours of patient contact Providing a telephone Advice Line for GPs to raise any clinical issues with Trust Consultants and obtain advice and support Co-locating more Trust services in primary care and community premises, where appropriate, encouraging more of our senior clinicians working with primary care colleagues to improve access to clinical advice Actively supporting GPs and helping to increase GPs confidence to be able to manage patients in primary care effectively, including the development of the new Primary Care Academy, offering training and development support for local GPs Jointly developing clear and explicit access and quality standards and protocols and ensuring they are consistently achieved across the organisation Jointly developing the stepped care approach, which ensures that patients are diagnosed and treated in primary care whenever possible and only referred to secondary / special services when clinically required and that patients, carers and GPs are supported to help patients step down from secondary care to primary care as they recover 2. Improving access to our services for patients and GPs We recognise that our support for GPs and other clinicians working in primary care has not always been as good as it needs to be. We have listened to the concerns expressed by GPs about the way we support them in caring for their 6 Clinical Strategy

7 3. Developing better integrated physical and mental healthcare and promoting holistic wellbeing, particularly for people with long term conditions We see ourselves as a key provider of holistic health services for our patients. Whether as a direct provider of mental health and community health services, as in Enfield, or in partnership with other providers, our philosophy of integrated care and maximising health outcomes remains the same. We do not believe that organisational boundaries should be a barrier to achieving this goal. Ensuring that people with long-term multiple health problems of all types have their care planned and delivered in an effective and co-ordinated way Ensuring that people with serious and enduring mental health problems from all backgrounds have equitable access to physical healthcare and people with physical health problems have appropriate access to mental healthcare when needed Working in partnership with our local acute hospitals to extend liaison psychiatry provision in all local acute hospitals, to ensure effective mental health interventions, particularly for older people Working with commissioners and our local acute hospital partners to fully implement Rapid Assessment, Interface and Discharge (RAID) systems 4. Developing acute treatment services and reducing admissions to hospital We will work in partnership with patients, carers, primary and secondary care colleagues, social care and other partners to support all our patients to recover from ill health and build their resilience to stay well and live fulfilled and active lives, making valuable contributions to society. We will also actively promote holistic wellbeing and healthy lifestyles. We will offer early intervention in order to help people to help themselves in staying well and avoiding ill health. This is a particular priority for our children s services, where early intervention and developing resilience are fundamental to life-long wellbeing. Our priorities in these areas are: Developing new care pathways in community settings for people with a wide range of long term conditions currently cared for in acute hospitals, as the Trust has already done in mental health services. Co-locating teams from Enfield Community Services and our mental health services will strengthen partnership working and more integrated care Contributing to the overall improvement of the health and wellbeing of our local population and reducing health inequalities, through building health resilience and intervening early in cases of ill health to maximise the long term physical and mental health of local people We continue to develop our services for those who are acutely ill and reduce the need for them to be admitted to hospital by offering better alternatives, both in mental and physical health settings. In particular, we will: Further develop our home treatment teams and recovery houses and how they operate, offering more alternatives to inpatient care, leading to further reductions in inpatient mental health bed usage over time Work with the Police to ensure the best use of Section 136 facilities Separate our inpatient services for older people with organic and functional illnesses Work with our commissioners on the expansion of inpatient child and adolescent mental health services (CAMHS), including developing a child and adolescent mental health high dependency unit. We are also developing more CAMHS stepdown services to provide high intensity services in Clinical Strategy 7

8 community settings, reducing the need for inpatient admission and, where this is required, minimising the length of time a child or young person needs to spend on a ward away from their family Develop a full repatriation programme for mental health patients in longer-term out of area placements, working in close collaboration with our commissioners Increase the proportion of low-secure Forensic mental health beds, in response to our commissioners priorities 5. Improving services for older people, particularly those with dementia In March 2012, the Prime Minister launched his Challenge on Dementia. He simply said, Dementia will affect us all. In England today there are an estimated 670,000 people living with dementia and this is expected to double in the next 30 years. In response to this significant increase in the proportion of local people with dementia over the next five years, we will build on recent developments in our dementia services and continue to expand the range of services available and their capacity to meet the increases in demand expected. We will continue to improve our services for older people, particularly those with dementia, through: Enhancing our dementia assessment and treatment services, in order to meet the demands of the increased older population, by providing timely and accurate assessment, with subsequent treatment and support Integration of community and mental health services for older people to provide more seamless care, and better outcomes for mental and physical health problems Working with residential and nursing homes to reduce unnecessary admissions to hospital Working with commissioners, social services and other partners to develop new models of care for older people, including working with local acute hospitals in improving care pathways for dementia and liaison psychiatry We understand that not all mental health problems in older people are related to dementia. We will also improve the care pathway for older people with functional mental health problems, such as depression and psychotic disorders. We will improve access for older people to home treatment services and recovery houses to help reduce the need for admission to hospital as far as possible. Through our hospital liaison services, we will ensure that mental health needs of older people in acute hospital settings are identified and treated as effectively as possible. 6. Developing our specialist services The Trust provides a range of more specialist services, serving a wide population across North London and beyond. We will continue to develop and expand these services, where there are opportunities and where this is appropriate. We will: Work with a wide range of commissioners and other partners to explore opportunities to expand our services for people with personality disorders Pursue opportunities with prison services to increase our provision of in-prison healthcare and court diversion services 7. Expanding our portfolio of services, where we believe we can add value to them, both locally, and in the wider health economy Where it makes sense for patients, commissioners and the Trust, we will pursue opportunities to tender to provide new clinical services. We will do this where we have the appropriate expertise and can provide innovative models of care, whilst maintaining the quality of care. 2.3 Our role in supporting the wider health and social care system The provision of integrated, holistic, care which supports patients recovery from illness and optimises their wellbeing is not something that the Trust can do on our own. Most of our services are provided through a wider network of care, involving partners in primary care, acute hospitals, social care, the voluntary sector and others, working together to support patients and their carers to help themselves. Working together, all these partners form part of a network of care, through which patients move, wherever possible towards recovery and discharge, allowing them to live as full and independent lives as possible. As a specialist provider of secondary and some tertiary mental health and community health services, our role is two-fold. It is firstly to focus on those parts of the care network which require our specialist skills, where we can use our specialist clinical expertise and resources most 8 Clinical Strategy

9 effectively. Our other, equally important role, is to support other parts of the care network, particularly primary care, so that more patients can be helped and supported in primary care, without needing to access specialist secondary services, unless they are clinically required. We are committed to the nationally and internationally accepted principle that care is best delivered as close as possible to patients, as all the evidence shows this is best for their overall recovery and wellbeing. We are working closely with our commissioners, local GPs and other primary care colleagues to develop a Stepped Care approach, in line with current best clinical practice and our local Clinical Commissioning Groups Commissioning Strategy. The stepped care approach means that care is delivered as locally and in the least intense ways as possible initially, moving to the next level of intensity only if the first intervention is not successful. We are committed to working collaboratively with GPs and other primary care clinicians to ensure that patients are diagnosed and treated in primary care whenever possible and only referred to our secondary and specialist services where this is clinically required and then supported to step down back to primary care as soon as possible. The model applies to all our services, in mental health care and in community health services. We are also committed to working with our other health and social care partners, particularly with the local authorities Public Health Departments on wider initiatives to promote wellbeing and reduce health inequalities across the boroughs we serve. It is well recognised that many of the wider determinants of health and wellbeing are social factors such as the availability of reasonable housing, meaningful employment and leading healthy and active lifestyles. The Trust will continue to work with all our partners on this wider agenda, for the benefit of local people. 2.4 Supporting our clinical development plans In order to achieve our clinical development plans, we have to ensure that all the necessary supporting structures are in place and fit for purpose. These include: Education and training Primary Care We understand the competing demands on primary care, and recognise that, in order to support the model of stepped care, that more patients will need to be managed in primary care. For this to happen safely and effectively, we need to support our colleagues in primary care and help increase their skills and confidence to provide high quality services to patients and their carers. In order to achieve this, we have developed the Primary Care Academy, in partnership with our local Clinical Commissioning Groups and additional funding from the former NHS London. This is a programme of education and training that will deliver opportunities for training across a number of settings. There will be direct educational events, delivered at local practices, and within existing GP locality groups, on topics that have been identified as priorities. The Academy will also deliver web-based educational resources for those unable to attend these events, or who prefer to learn using new media. We have already started delivering training events, which have been well-received. Students We have a long history of providing excellent training to medical and other professional student groups, and we want to build on this with new opportunities for training the clinical professionals of the future. We will continue our tradition of providing excellent medical education, working with our Education partners. Staff We are committed to our organisational aim of developing excellent services and staff. Our focus for the next three to five years is to ensure that we develop our staff at all levels and within all professions across the organisation. We will develop all our clinical and other staff to reach their potential, providing support with new innovative role progression, such as non-medical prescribing, and our Senior Nurse Assessors, which we have pioneered locally and are now being rolled out nationally. We are rolling out our Staff Development Framework to ensure that all staff are clear about the competencies required to perform at each level of the organisation. We will support staff to ensure they have well developed personal development plans to achieve, maintain and develop their competencies. This will enable staff to understand and plan their career progression through, and beyond, the organisation by outlining the competencies they will need to achieve and the values and behaviours they will need to demonstrate in order to advance their career. Information Technology Supporting our staff to work more effectively The Trust s new IT system will increasing help our staff, particularly those working in community services, to work more flexibly and more effectively by increasing mobile working and their ability to access patients information remotely. This will increasingly help improve the Clinical Strategy 9

10 integration of patient care and help our staff to be more effective and efficient in how they work. Developing the use of Tele-health where appropriate Tele-health via the internet and digital media is rapidly developing nationally and internationally and the Trust will work with patients, carers and our partners to make full use of it to improve access and the availability of clinical information, particularly for children s and young people s services. Examples include patients being able to text or in updates about their progress and remote monitoring of patients adherence with their medication. Developing our management structures The Trust has moved forward a long way over the last five years, with improved clinical services and significant improvements in overall performance. We were one of the first Mental Health Trusts in London to move to a service line management model, giving responsibility to clinicians for leading and managing service lines. These service lines comprise all the staff and services focused on specific clinical services, offering the opportunity to develop clinical pathways that are evidence-based and reflect the needs of our patients. We recognise the value of clinical leadership and the clear evidence that it improves outcomes for patients, and delivers the most cost-effective models of care. We are actively promoting this and developing future clinical leaders across all professional disciplines. We are listening to feedback from our patients, their carers and our partners and using this, with other evidence, to refine the service line structure over time. We are removing possible barriers to effective, seamless care and matching our service structure to support our belief in holistic care and integrated mental and physical healthcare. We are currently reviewing the make-up of our service lines, with a view to aligning them around specific patient groups such as adults, children, older people and specialist services. Improving our facilities, particularly at St Ann s Hospital in Haringey We are committed to continuing to improve the quality of our facilities across the Trust, to provide the best possible environments for patients to be cared in and our staff to work in. We have made a number of major improvements 10 Clinical Strategy

11 in many of our facilities over the last few years and this will continue over the next five years. We will also be reviewing our estate to make sure that it is all used as effectively and efficiently as possible, in order to ensure that more of our resources are spent on direct patient care, rather than maintaining inefficient buildings. Our aims include: Providing the highest quality facilities for our patients, their carers, our staff and visitors and improving their experience of our facilities, particularly around equality and diversity issues Creating a sense of safety and a healing, therapeutic environment for patients Creating flexible facilities, recognising that clinical services and the use of our facilities will change over time Developing facilities which are more environmentally sustainable Reducing overall Trust expenditure on our facilities Haringey, the other local NHS organisations serving Haringey, local politicians and community leaders, patients, carers and local people to develop plans to deliver improved health care facilities on the site. Following a successful public consultation in 2012, the vision for St Ann s is to create a modern healthcare campus with a sustainable mix of mental health and other services including the existing Moorfields Eye Hospital, Whittington Health community health services, North Middlesex Hospital and breast screening services, with new housing and public open space. This development will be planned alongside a phased rationalisation of the site and disposal of surplus land, which will be reinvested in the new development. Outline planning consent from the London Borough of Haringey is planned by early 2014, following a series of public and stakeholder engagement exercises as the future site plan is developed. The redevelopment is planned to begin by late 2014 for around two years. The biggest development of our facilities will be at St Ann s Hospital in Haringey, where the current mental health facilities are in need of urgent improvement. The Trust is working closely with the London Borough of Clinical Strategy 11

12 3. About us and what we do 3.1 Overview We are a large provider of integrated mental health and community health services, following the transfer of Enfield Community Services in We currently employ just under 2,800 members of staff and our annual income in is 189 million. We provide specialist mental health services to people living in the London Boroughs of Barnet, Enfield and Haringey, and a range of more specialist mental health services to our core catchment area and beyond. The three boroughs in which we work have very different populations and needs, with differing health networks and other services. There is great ethnic diversity in the populations of these boroughs, and our services reflect this diversity, and contribute to our understanding of the needs of different cultural and ethnic groups, avoiding stigmatisation or assumptions about the care needs of our diverse population. Following the transfer of Enfield Community Services, we also provide the full range of child and adult community health services in Enfield and are increasingly integrating these with our mental health services to provide a range of more holistic services. Over the last few years, there have been major improvements in the quality of our services, with a considerable expansion in the provision of services based in the community. This has allowed us to reduce the number of mental health inpatient beds being used over the last four years, as we are able to offer alternative pathways to traditional hospital admission. To support our clinical services, we have a successful research and development programme, run in collaboration with local universities. We also work in partnership with a range of educational establishments to support staff training. Our research and educational activities are important to our aim of achieving excellence in service delivery to patients, through developing innovation locally, identifying and learning from best practice elsewhere and ensuring that our staff remains up to date with leading-edge practice. 3.2 Future demand for our services Demand for our services is primarily linked to the size and nature of the local population. Overall, the population we serve is not predicted to change dramatically over the next five years; however, there will be a significant increase in the numbers of older people. Demand for older people s mental health services is therefore expected to rise, particularly for services such as memory assessment and dementia care. The predicted population growth for children and adolescents in Barnet and Haringey and in adults in Barnet may also lead to some increases in demand for child and adolescent and adult mental health services. The main population-related changes in demand for Enfield Community Services are likely to be increases in demand for age-related services, with demand for other services remaining broadly similar. The overall aging of our local population will also impact on the diversity of the population we serve. Our local population is becoming more ethnically and culturally diverse and as the population gets older, there will be more older people from diverse populations than at present. This means that our services, particularly for older people, will need to continue to be culturally appropriate to our population. We will continue to work closely with our local NHS commissioners and local authorities, in assessing future demands for our services, and jointly planning how these can be met within the resources available. 12 Clinical Strategy

13 3.3 Description of our services Our current services are outlined below: Community Services Mental Health Services Child and Adolescent Mental Health Services (CAMHS) Increasing Access to Psychological Therapy (IAPT) services, in partnership with Whittington Health Primary Care Mental Health Services Acute hospital liaison services, including health psychology, at the North Middlesex Hospital Complex Care services Service for patients with psychotic illnesses Older people s community Mental Health Services Learning Disabilities services Physical Healthcare Services Enfield Community Services provide the following services: Universal, targeted and specialist services for children: Health visiting School nursing Community paediatric nursing for children with complex health and palliative care needs Children s community therapies, including specialist services to help prevent teenage pregnancy and support young parents Universal, targeted and specialist services for adults and older people: District nursing Long term conditions nursing and therapies Rehabilitative services Contraception and sexual health services Inpatient Mental Health Services CAMHS specialist (Tier 4) inpatient services Acute working age adult inpatient services Continuing care for working age adults with chronic and enduring mental illness Acute inpatient care for older adults Continuing care for patients with severe dementia Continuing care for older adults with chronic and enduring mental illness Recovery Houses, in partnership with Rethink Specialist Mental Health Services Eating disorders services, including inpatient and outpatient care. This is one of the country s largest eating disorders services, providing care for people with anorexia, bulimia and other eating disorders across North London, Hertfordshire and Essex Drug and alcohol services Personality disorder services, including The Halliwick Centre in Haringey for the care and rehabilitation of people with personality disorders, which serves the population of Barnet, Enfield and Haringey. Psychiatric liaison services at the Royal National Orthopaedic Hospital Forensic Services The North London Forensic Service provides the following services for Camden, Islington, Barnet, Enfield and Haringey: Medium and low secure inpatient care including specialist services for people with learning difficulties and services for women Services to prisons and other parts of the Criminal Justice system Fixated Threat Assessment Service National Stalking Clinic Court diversion services Community outreach services Clinical Strategy 13

14 3.4 Examples of our current services We have summarised some examples of our current services below: i. Working age adult acute mental health inpatient care: Nine acute inpatient wards, including psychiatric intensive care inpatient beds Three home treatment teams Three recovery houses, providing 31 non-hospital beds for patients in crisis During the past five years, we have been able to close 48 acute inpatient mental health beds, a 25% reduction in our bed base. Our average length of stay has gone down from 48 days to 25 days. To support this reduction in the inpatient bed base, we have increased staffing in our home treatment teams and developed new Recovery Houses as improved alternatives to admission. The aim of the service is to provide acute care to all those who need it in the least restrictive settings and to minimize the use of inpatient beds. The philosophy of care is best described as one which offers care in the least restrictive setting and allows patients to move in and out of home treatment, inpatient care and recovery houses as their needs change, during each episode of care. As a result, during each episode of care, patients may spend some of the time in inpatient beds and receive care from the home treatment teams during the rest of the time. ii. Children and Adolescent Mental Health Services (CAMHS): Assessment of presenting difficulty/problem for children, young people and their families A range of therapeutic interventions including systemic family therapy, cognitive behaviour therapy, child psychotherapy aimed at the individual child, young person or as a family system Group and individual therapies such as dance and movement, music and art therapy. Pharmacological treatment Extensive multi-agency collaboration and participation in key initiatives e.g. joint assessment clinics with Youth Offending Teams, Multi Agency Safeguarding hubs/teams, Children with Disability teams and consultation for professionals from a range of children s services Support for carers and families Inpatient services provided in the form of high dependency beds, acute beds and goal based treatment as one component of an integrated adolescent service iii. Complex care / Personality Disorder Services: These services provide: Assessment, diagnosis and recommendations for most appropriate treatment Care coordinated, recovery-focused, multidisciplinary team treatment and support for those with the most complex presentations Pharmacological treatment, regular case reviews and discharge planning / follow-up care Meetings with carers and families, with patients consent, to provide carers with information about the patients diagnosis and psychological difficulties, and how to support them with this More specifically: In complex care targeted specialist treatments for conditions with evidence based protocol driven or manualised treatments for complex personality disorders and severe obsessive compulsive disorder In complex care single intervention treatments where there is evidence that these will be effective (e.g. cognitive behaviour therapy, psychodynamic therapy, systemic therapy) In the personality disorder service a range of therapeutic programmes are offered iv. Improving Access to Psychological Therapies (IAPT) Assessment and recommendations for psychological therapy Treatments include computerised cognitive behavioural therapy and individual counselling Five teams provide therapy services for 12,000 patients per year IAPT is the fastest expanding mental health service in the Trust. It is a national Department of Health programme aimed at improving and increasing access to a range of evidenced based psychological therapies. IAPT is the only mental health service to be included in the NHS Mandate. 14 Clinical Strategy

15 The Trust s IAPT service is involved in key London-wide initiatives such as the Long Term Condition Pathfinder Programme. Our IAPT service has established links with physical health care teams and is expanding these links across the three boroughs in order to improve access to psychological therapy for people with long term conditions. This supports our vision for the increased integration of mental and physical healthcare. 3.5 Example Patient Journeys Listed below are some examples of the journeys taken by our patients as they move through our services. They are not based on individuals, but have been devised by our senior clinicians to illustrate our services. i. Case Study Learning Disabilities Service Referral Mr A was a 28 year-old man with mild learning disability and a history of Tourette s Syndrome. In six years he had had four placements in a supported living setting. The placements had broken down because of his aggressive behaviour, in spite of receiving support. Assessment Assessment led to positive findings of childhood Attention Deficit Hyperactive Disorder, Tourette s Syndrome and Autistic Spectrum Condition. This led to a review of his medication and social circumstances. Intervention Mr A was placed in residential accommodation that was ethnically supportive to him. His behaviour became worse, leading to referral to a forensic psychiatric service for a period of assessment. Changes to his medication were made, leading to improvements in his behaviour. As a result, admission to an inpatient service was not necessary. Outcome Mr A continues under probation to remain in the community. His quality of life has improved, allowing him to enjoy managed contact with his family and to establish important social connections with friends. ii. Case Study Memory service Referral Mrs C, a 75 year old lady living on her own, was initially referred to the Memory Service by her GP as she was concerned about her memory. At the assessment she was found not to have symptoms of dementia but was depressed so was referred to the Community Mental Health Team for Older People. At the allocation meeting it was agreed that the Community Mental Health Occupational Therapist (OT) would take her onto his caseload as there were concerns about her level of functioning in activities of daily living. Assessment The OT went to meet Mrs C in her home. She was recently widowed with two children; she has lost contact with her daughter, her son visited irregularly. Mrs C said she felt concerned about her memory and that she she was no longer able to manage with cooking, cleaning, shopping and managing her medication. Over the following home visits, the OT gathered a range of information from Mrs C; listening to how she described her situation, carrying out a functional assessment to identify her strengths and limitations in daily living, her interests, hobbies and routines. Intervention The OT then discussed his assessment with Mrs C and they agreed a programme of weekly goal setting, behavioural activation and implementing motivational techniques to build on her strengths and gradually rebuild her confidence. Over the next few weeks her attitude towards accepting help shifted, she made progress in picking up daily living tasks that she had been neglecting and she reported signs of an improvement in her selfconfidence and esteem. Outcome At the end of the ten week intervention Mrs C was able to commute on her own using public transport and is now attending the local YMCA club. Mrs C has picked up the daily living skills that she had been struggling with and is now cooking, shopping, attending to her personal care and managing her own medication. iii. Case Example Community Mental Health Services Referral Miss P was a 35 year old woman who was referred by her GP as she had recently moved into the area with her partner. She had a ten year history of Schizophrenia, was previously under the care of the Mental Health Team in another area. She was experiencing a recurrence of her symptoms due to stress of the move. Her symptoms were not being adequately controlled by her prescribed medication and were causing minor problems with her work. Clinical Strategy 15

16 Assessment Her case was discussed at the team meeting and was allocated for a Multidisciplinary Assessment by a community psychiatric nurse and a doctor. A full assessment of needs was carried out and it was noted that her partner was finding it difficult to cope with looking after their two children. A Care Plan was formulated including monitoring of her mental state by the care coordinator, medication adjustment and assessment for psychological therapy, which led to her referral into a psycho-educational group intervention. A carer s assessment was also completed. Intervention The care coordinator visited her regularly and monitored her mental state as well as working collaboratively with her and the family. Miss P attended several group sessions where she met other people with similar experiences. Through these sessions she was able to learn strategies for managing her condition. Her symptoms gradually subsided. She was reviewed regularly and her Care Plan was updated. The care coordinator worked closely with the family, educating them about the warning signs and strategies for managing her symptoms. Outcome After a period of 18 months of symptoms being under control, Miss P and her family felt confident that they would be able to manage a future crisis and be able to access services appropriately if they were to be discharged from the secondary care services. Discussions were held with her GP who agreed it was now appropriate to take over her care and she was discharged from the Trust s service back to the care of her GP, with support available from the Trust to the GP as required. Assessment Child J attended some appointments with CAMHS, but was not consistently engaging. He was referred to the school based Speech and Language Team from Enfield Community Services as it was queried whether he had difficulty with English as a second language or whether there was an underlying specific language impairment. Intervention A professionals meeting was co-ordinated and it was decided that it would be more effective for him to access the Place 2 Be, a school-based charity working in his school to improve emotional resilience and learning. CAMHS, and the charity, worked closely to monitor progress with counselling sessions. The Education Welfare Officer did a home visit with an interpreter and it was evident that bereavement, housing, financial and parenting capacity issues were of concern. A referral was accelerated to seek help from a number of agencies in order to provide more family support to help Child J and his family, which has resulted in steady improvements. Outcome School attendance is no longer a problem and Child J is using alternatives to challenging behaviours to express his frustrations /confusion and the need for a break. His Mum has attended a six week parent /school staff workshop at school on language disorders and helping strategies. Child J and his parents continue to access Place 2 Be. iv Case Example Children s Mental Health and Community Health Services Referral Child J, aged 10, was referred to Enfield Children and Adolescent Mental Health Services (CAMHS) by his primary school due to erratic attendance and an increase in challenging behaviour at school. The school was aware that an older sibling had recently died. Child J had been in the country with his parents and two siblings for two years and English was his second language. His Mum found it difficult to attend school appointments and was often alone caring for the children, as his Dad was often away for extensive periods of time. 16 Clinical Strategy

17 3.6 Examples of innovative care models within the Trust i. Personality Disorder services iii. Enfield Care Home Project Set up in 2011, this initiative aims to provide true multidisciplinary assessment and treatment to older people living in residential care in Enfield, reducing the need for unnecessary admissions to acute hospitals, with improved quality of life for residents, and reduced cost to the whole health system. The team comprises district nurses, a consultant physician and mental health professionals. It is a joint initiative, led by Enfield Community Services, in partnership with Barnet and Chase Farm Acute Trust, and Enfield Older People s Mental Health Services. The project has been well received and discussions are underway to roll out the scheme in Barnet and Haringey. iv. Accredited Memory Services The Prime Minister has urged the NHS to develop specialist memory services where they did not exist, and for existing services to accredit with the Memory Services National Accreditation Programme (MSNAP), run by the Royal College of Psychiatrists. The Halliwick Centre is an internationally recognised centre of excellence for the care and treatment of patients with personality disorders. The model of care it pioneered is now being applied across the Trust for the treatment of patients with these difficulties. The treatment programmes of the Personality Disorder Service are designed to enhance the capability of our patients using Mentalisation- Based Treatment, which has been developed and researched within the unit. The Trust recognises this challenge. Indeed, we were ahead of the game. By the time the Prime Minister s challenge was announced, two of our memory services were already being assessed to see whether they reached the standards for accreditation with MSNAP. In January 2013, Enfield and Haringey Memory Services became the 31st and 32nd memory services in the UK to reach the standard for accreditation with MSNAP. This is an excellent endorsement of our current services, but we are not complacent and will look to improve our services and seek further patient and carer involvement in the development of our memory services. ii. National Stalking Clinic This clinic provides assessment for individuals with a history of stalking, or those with a perceived high risk of this activity. It accepts referrals from health practitioners and the criminal justice system, such as the probation service and also provides training and consultation in assessment, treatment and management. The clinic has attracted national publicity, and continues to grow, since its inception by the North London Forensic Service in December Clinical Strategy 17

18 4. Improving the quality of our services 4.1 What are our values? Our values reflect the most fundamental principles of providing care, they are to: Put the needs of our patients and their carers first, and involve them fully in their care Show kindness and compassion in all aspects of the care we provide Behave with honesty, integrity and openness Create a safe, friendly and caring environment, where people are treated with respect, courtesy and dignity Strive for excellence, recognising achievements and valuing hard work Support our staff to be the best that they can be Our most important priorities as an organisation are patient safety, patient experience and patient wellbeing. Despite the challenging financial environment we face, we will continue to focus on the quality of care provided and ensuring that patient safety is prioritised at every level of the organisation, including safeguarding children and adults. We have structures and processes in place to ensure that the delivery of quality services and the maintenance of patient safety lie at the centre of everything we do. With the recent publication of the Francis Report into the failings of care in Mid Staffordshire NHS Foundation Trust between , all parts of the NHS have an urgent responsibility to review their quality assurance processes, and provide assurance that patient care is safe and effective and the Trust is actively doing this. The Trust Board drives the Trust s quality agenda and reviews our progress in the delivery of further improved services at each Board meeting. All Board members are closely engaged in the ongoing quality and safety of the Trusts services. Comprehensive training programmes in the application of the Recovery Model and in clinical risk management are being rolled out to all clinical staff. We also run a number of training programmes aimed at improving the quality of staff and patient interactions. These include a customer care course delivered by Trust psychologists for inpatient staff, the Talkwell programme (a nationally endorsed programme designed by a user of Trust services to enable inpatient staff to further improve 18 Clinical Strategy their engagement with patients). We also provide a course designed and delivered by patients, which aims to help our staff to encourage patients to become more active collaborators in their own care. The Trust also has a number of training programmes focusing on equality and diversity, to ensure our staff can meet the different needs of our diverse local population. We have a series of initiatives to improve our patients experiences of our care. These include electronic patient experience tracker systems for getting real time feedback from patients. Patients are involved in the design and delivery of patient experience tracker and other patient survey systems. Patients are also employed by the Trust in the clinical audit team to help in carrying out a rolling programme of privacy and dignity audits on our inpatient wards. We also carry out mystery shopping exercises to gauge the responsiveness of our services to requests for help from patients and their carers. 4.2 Our Quality Strategy for Our Quality Strategy for sets the context, framework and direction for the delivery of quality services across our organisation. The Quality Strategy summarises our vision and targets for quality improvement and how these will be measured. We recognise that high quality care can only be achieved by all our staff; both clinicians working directly with patients and those staff who support them. Our Quality Strategy will be underpinned by quality clinical leadership and by a robust structure for the delivery of quality, clinical governance and risk management that will ensure that quality standards are set and achieved and that patients receive care delivered with compassion and commitment from all our staff. The quality of our clinical services is dependent on the quality of our clinical staff. We expect the highest quality standards in the performance of every staff member. We will deliver this by the careful recruitment of the right people; ensure their rigorous and continuous training, line management, coaching and performance management. We will reward and advance the best people. Our Quality Strategy will help us to deliver this by developing a culture which focuses on the delivery of consistently high quality care for every patient and does not tolerate poor standards of care anywhere in our organisation.

19 Our Quality Aims for : Our key quality aims for the next three years, as set out in our Quality Strategy Action Plan, are: i. Improving Patient Safety Reducing the numbers of mental health patients who go absent from our acute inpatient wards by 10% Ensuring 95% of all inpatients will have a quality risk assessment within 48 hours of being admitted to hospital Ensuring every patient discharged from hospital is seen for follow up within seven days of being discharged from hospital Ensuring all patients who use our Home Treatment Services have a clinical risk assessment using the principles outlined in the National Patient Safety Agency s clinical standards ii. Improving Clinical Effectiveness Getting better at supporting people to take their medicines Ensuring that 90% of patients have an individually identified care goal Improving the physical health and wellbeing of all the people who use our services through ensuring that all inpatients will have at least one physical health assessment and patients physical health is monitored when being cared for in the community Ensuring appropriate academic accreditation of clinical areas to help provide additional assurance about the quality of care and opportunities for staff development iii. Improving Patients and Carers Experience of our care Setting and applying standards for patient and carers involvement and deepening their involvement at all levels to enable us to understand their needs better. We will act on feedback from patients more quickly. Ward groups will allow patients to have their say about the functioning of wards, from meals to activities, and the ward environment. Increasing direct patient feedback through surveys, the patient experience trackers, mystery shopping and other means Improving therapeutic engagement with all our staff, supporting our staff to support our patients and their carers more effectively Improving the experience of our staff, because high quality care is dependent on well trained and wellmotivated staff 4.3 Supporting and developing our staff We fully recognise that effective support and development of our staff is vital in ensuring that we deliver high quality, compassionate, care to our patients. We have a range of staff engagement and development initiatives in place to help achieve this. These include: Regular communications with our staff through our staff intranet and newsletters, the Chief Executive s blog, personal Meet the Chief Executive lunches with groups of staff and 1:1 meetings with the Chief Executive and consultant medical staff Rigorous staff inductions and on-going mandatory training Extensive programmes supporting staff to develop personally and professionally, including formal continuing professional development A focus on developing clinical leaders, both current Clinical Directors and aspirant clinical leaders of the future, to equip them with the skills needed to develop our clinical services further Providing a network for coaching and mentoring staff, linking staff with coaches and mentors across the organisation Helping staff to raise any concerns about the care of patients they are aware of. The Chief Executive has established a personal hot line for any member of Trust staff to raise any concerns about poor care or patient safety, which will be treated in confidence and thoroughly investigated Clinical Strategy 19

20 5. Engaging with our partners There are a wide range of formal and informal forums through which we work with patients, carers and other partners to help continually improve and develop our services and, importantly, contribute to the wider improvement of the health and wellbeing of local people across Barnet, Enfield and Haringey. We have an ongoing programme of engagement with key partners and the wider local community in how we are developing our services and how we support our partners, particularly in primary care and social care in addressing the wider health and social needs of our local population. This will continue, further strengthening the good working relationships we have with all our partners. Our key partnerships are summarised below. Co-ordinate patients care effectively to support them in recovering and living as independently as possible, contributing to wider society and living fulfilling lives Agree treatment goals and care plans for all patients, within the Care Programme Approach for patients with mental health conditions Involve carers in care planning, with the agreement of patients, and seek to support them as far as possible Offer choice to patients and carers wherever possible, being clear about the consequences of each choice 5.1 Patients and Carers Our aim is to continue to improve the ways our services support every individual to enjoy good overall health and wellbeing, live as independently as possible and achieve their full potential. We believe that patients and their carers should be at the centre of their care and all decisions made about it. We are committed to improving the ways that we involve patients and carers in planning and coordinating care and also in planning longer term changes to our services. We recognise that what often makes the difference for patients and carers in how their care is perceived is the quality of the relationships and interactions with our staff. We will continue to train and develop our staff and build a culture across the Trust where all our staff deliver care with compassion and commitment, focused on the needs of each patient. In particular, we will: Involve patients in shared decision-making about their care, recognising the knowledge and expertise many patients have about their own health condition 5.2 Local GPs General Practitioners are key partners in the care of our patients, as referrers and, for many patients, as their main source of clinical support. The Trust recognises that our support for local GPs has been patchy at times and that significant improvements are needed. Section 2.2 earlier sets out a series of improvements we are making to improve our partnership working with local GPs and how we support them to care for their patients more effectively. This includes simplifying the access routes into our services for GPs, improving how our clinicians communicate with GPs about their patients and setting up a range of initiatives to help develop GPs knowledge and expertise to allow them to care for more of their patients in primary care. We are also exploring opportunities to provide more of our services in primary care premises to help support colleagues in primary care more effectively. 5.3 Clinical Commissioning Groups From April 2013, the local Clinical Commissioning Groups (CCGs) are responsible for commissioning (buying) most of the services we provide for local residents. We are developing good working relationships with each of the local CCGs and are working closely with them to develop our services in line with their commissioning intentions. We are very conscious of the major challenges facing our local CCGs over the next few years, particularly, the major financial difficulties in the NHS across Barnet, Enfield 20 Clinical Strategy

21 and Haringey. The Trust has made its full contribution to the reductions in the costs of our services required by commissioners over the last few years. We are committed to working with our commissioners over the next few years to ensure that we deliver the most clinically and cost effective services and that clinical safety and quality are maintained as top priorities. 5.4 Acute Hospitals The Trust works closely with the acute hospitals serving the local population, particularly Barnet and Chase Farm, the Royal Free, North Middlesex and the Whittington Hospitals. We have a range of clinical relationships, including staff working across organisations to support care networks for local patients. There are a number of initiatives under development to build on these relationships, in particular the proposed Rapid Assessment, Interface and Discharge (RAID) systems with each of the local acute hospitals. This seeks to support patients, particularly older people, with some form of mental illness, including dementia, who are admitted to an acute hospital for a physical health condition and would benefit from more intensive support for their mental health needs, through a multi-disciplinary, physical and mental health care team from across a number of NHS organisations. We are also working with our acute Trust colleagues to develop and improve peri-natal and maternity mental health services. 5.5 Local Authorities Many of the patients the Trust cares for have social as well as health care needs and the Trust has strong and effective partnerships in place with each of the three local authorities across Barnet, Enfield and Haringey. Our services are closely integrated with adults and children s social care and with other local authority services such as education and housing, to deliver joined up support for local people. A number of local authority staff, such as social workers, are seconded to the Trust, working together as part of integrated teams. We have formal Partnership Agreements in place with each local authority to deliver our joint responsibilities around: Personalised care assessment and support planning, engaging carers whenever possible and appropriate Keeping people safe, through adult and children s safeguarding Ongoing reviews of care packages funded by local authorities to ensure value for money and keeping within the local authority s authorised budgets for social care Improving the sharing and use of anonymised service access and outcomes equality data We are active members of the local Strategic Partnership Boards and the new Health and Wellbeing Boards and through these continue to make a significant contribution to improving the overall health and wellbeing of local people. We will continue to strengthen our relationships with each local authority and are committed to positively supporting them in their responsibilities and in achieving their social care performance targets. 5.6 Voluntary Sector Partners A number of the Trust s services are either supported by, or in some cases, directly provided by, voluntary sector organisations. Most of these are through formal contracts where the Trust commissions a voluntary sector organisation to provide a specific service. These include a number of specialist services where a voluntary sector organisation has specialist expertise. The most significant partnership we have with a voluntary sector organisation is with Rethink, a major mental health voluntary organisation. Rethink run the Trust s three Recovery Houses, supporting patients to make the transition from an inpatient ward into the community and, importantly, providing a better alternative to admission for many patients. Our partnership with Rethink has been very successful, with positive feedback from patients and carers. The model of partnership working with Rethink has been so successful it is now being rolled out in other parts of the country, based on our work in Barnet, Enfield and Haringey. As well as service provision, many voluntary organisations play a very important role in supporting patients and carers. We have close links with all the main patients, service users and carers support groups locally and we are committed to continuing to improve how we work with them and engage them in developing our services. Effective risk assessment and risk management planning Clinical Strategy 21

22 An example of collaborative working - Tom s Club in Haringey Tom s Club is an information and therapeutic support group for people with dementia and their carers. Tom's Club aims to meet the needs of both patients and carers, providing cognitive stimulation activities for patients and information and support sessions for carers. Although established in 2009 by the Admiral Nurse Service in Haringey, over the past year, with a grant provided by the Lewis and Mary Haynes Trust, Tom s Club has been expanding. It has been a very positive and exciting year for Tom s Club as two Clubs have been established within the Borough. The original Tom s Club in Tottenham runs in collaboration with Age UK Haringey who work alongside us to provide volunteer support. This Tom s Club has been expanding on a monthly basis and we now have 30 members who attend on a regular basis. Our second Club, which runs at the Haynes Day Centre, Crouch End, is more focused on carers who have yet to access many of the services in the Borough. This Club has developed in partnership with the local authority and has 16 members attending. The feedback provided by our members has been extremely positive. They feel the service provides them with the opportunity to meet people in a similar situation, share concerns with others, find health and support from health professionals and learn about new services, activities and research programmes that they can become involved with. In fact, our members' responses have been so positive that they are asking for Tom s Club to run more regularly! Not only has Tom s Club been recognised as a valuable service by our carers but has also been cited as a good practice case study by the NHS Institute of Innovation and Improvement. Also, Tom s Club was recently invited to showcase its work at the 7th UK Dementia Congress in Brighton on the theme of Celebrating Good Practice in Changing Times'. 5.7 The Police and Criminal 22 Clinical Strategy

23 Justice System The Trust works closely with the local borough Police on day to day operational issues and with the Metropolitan Police at a London wide level on strategic issues affecting mental health and wellbeing. The Police provide regular support to the Trust and our staff in dealing with difficult behaviour of patients on occasion, particularly patients sectioned under the Mental Health Act. We also run the North London Forensic Service, which has close ongoing working relationships with the wider criminal justice system. 5.8 Local Communities The Trust is an integral part of the communities we serve, as the provider of care for many patients, as a partner with other local organisations, as a major employer of local people and a contributor to a range of local planning and development forums. Our aim is to improve the health and wellbeing of the people of North London, through increasingly combining physical and mental healthcare and integrating services across primary, acute and social care. We can only achieve the holistic improvement of the health and wellbeing of our local community through being actively involved in the life of our local community. Some of the areas where we are, and will continue to, contribute to our local community include: population and the ways in which local people can help themselves to remain mentally well and support those they know who may be suffering some form of mental health problem As part of our programme of work to raise awareness and reach out to those who may not yet be informed about mental health and its links to wider issues, we have an active schools outreach programme, involving visits to local secondary schools. This helps educate young people and raise awareness of the importance of early intervention As a major local organisation and major local employer, we recognise our significant corporate social responsibilities. We recognise our responsibility to facilitate sustainable development through all our activities. We have set ourselves a series of sustainability objectives, which include: Reducing the quantity of energy and water we use and reducing the amount of waste we generate Achieving the NHS and national carbon reduction targets Ensuring sustainability in all of our new developments and refurbishment projects Promoting healthier lifestyles and the overall wellbeing of our patients and staff We work with Middlesex University and the University of Hertfordshire in delivering locally based education and training for student nurses and other professions The Trust s North London Forensic Service has particular links with local employers to help aid current patients to gain meaningful employment locally, as part of their recovery We have a large and representative shadow NHS Foundation Trust membership of over 10,000 public Members. We continue to actively recruit Members through attendance at local events, college open days, careers fairs, shows and other events We have an active and ongoing Mental Health Positive campaign, which seeks to raise awareness about the prevalence of mental illness in the Clinical Strategy 23

24 5.9 Ongoing engagement of our stakeholders In developing this Clinical Strategy, we have consulted with a range of stakeholders. The key points that have been made are that all our services need to be accessible and reliable, with prompt assessment and a clear care plan about the treatment being offered. Care plans then need to be clearly communicated to patients, carers (if appropriate and with the patient s consent) and GPs, allowing everyone involved in a patient s care to be fully informed and appropriately involved. We will demonstrate that we are a listening organisation that responds to feedback and changes clinical practice where this is necessary. We will strengthen our means for receiving feedback from all our stakeholders, including: GPs Through regular dialogue and opportunities to comment, including involvement of GPs in new service planning Commissioners Through developing clearer shared objectives, with regular dialogue to assure that these are implemented Staff Through both formal and informal opportunities to provide feedback. We are involved in the national Listening into Action initiative to help give staff a greater say and a louder voice within the organisation Patients and Carers Through regular meetings and ongoing dialogue, as well as ongoing surveys and other work. We are committed to creating ongoing opportunities for patients and carers to influence our clinical developments and the delivery of care 24 Clinical Strategy