Service User and Carer Forum. Boardroom, Ground Floor, Chorlton House 70 Manchester Road, Chorlton, Manchester M21 9UN

Transcription

1 A University Teaching Trust Service User and Carer Forum Boardroom, Ground Floor, Chorlton House 70 Manchester Road, Chorlton, Manchester M21 9UN Monday 22 nd February :00-16:00 Present: Patrick Cahoon (PC) (Chair) Kome Ogowewo (KO) Clement Cooper (CC) Simon Katzenellenbogen (SK) Anne Scott (AS) Gaynor Morgan (GMo) Catherine Lowe (CL) James Langford (JL) Edith Garvey (EG) Amanda Owens (AO) Lisa Crowther (LC) Janet Sinclair (JS) (Minutes) In attendance: Gill Mayer (GM), Clinical Audit and Quality Coordinator Ann Wainwright (AW), Community Matron Petra Brown (PB), Chief Pharmacist Richard Keers (RK), Clinical Lecturer in Pharmacy No: Item: Action 1. Introduction & Apologies Apologies were received from Anne McCrystal, Manoj Mistry, Garry Lythgoe, Christine Smith, Jennifer Ritchie, Lillian David, Tom Harrington, Shamim Akhtar, Bob Little, Verona James, Lisa Ritchie, Neil Walbran, Michele Moran and Gary Gillett. 2. Table top Feedback EG wanted to know if there was an update on the phone audit and how things were going with this. AS stated that she was involved in the first one as well as the most recent one and there was a huge difference between the two. PC said that the Clinical Audit and Quality Coordinator would be attending the meeting today and therefore would be asked for an update later. SK asked if we knew anything about the money coming into mental health. PC said that this would not be immediate and that there were no clear details at this stage. AS spoke about services being cut, but all that they ve done is pass it on to private services. PC explained that it was unfortunate that NHS Trusts are in the difficult position of having to retract services, but that in the case of MMHSCT no alternative arrangements have been made with private providers. 3. Notes of the last meeting (25 th January 2016) The minutes of the last meeting were approved as a correct record. Where People Matter Most

2 4. Matters arising Physical Health EG asked for an update on physical health and parity of esteem. PC informed the forum that Karen Keighley had been appointed as Physical Health Matron and would be attending the forum in the near future. Trust Future PC reported that there was no update as yet. However, it was noted that Pennine Care had a CQC Inspection a few months ago and GMW (Greater Manchester West) are currently having a CQC Inspection, and so we would expect to know more around Easter as to who will be the preferred organisation. JL asked if all hospitals were in deficit. PC explained that not everyone was in deficit, but there are unprecedented national funding reductions taking place. AS said that it was good to see mental health getting a mention on BBC, and programmes such as EastEnders and the story about Stacy having bipolar. It was good to see that mental health is getting air time. CQC Action Plan PC reported that most of the actions were in the process of being delivered. Once this is progressed we will receive an update from Gary Gillett, Deputy Chief Nurse and Deputy Director of Quality Assurance. EG wanted to know that when mental health services are taken over by a new Trust, what about the service users and carers. PC stated that this was our responsibility and will continue. EG asked that whoever takes over, that will do what they want to do, and maybe mis-match between services. National Patient Survey PC explained that even though we have recently received the results for the last National Patient Survey, members may be asked to complete the next survey and encouraged everyone to complete this. Policing Standards Consultation This item was deferred to the next meeting. 5. Clinical Audit Programme GM explained the process of putting together the Clinical Audit Programme for 2016/2017. The Quality Improvement Team are working closely with stakeholders, which include the Prison, Pharmacy, Matrons, Heads of Profession etc, to ensure that the audits added to the programme will be robust and achievable in the timescale set. GM came to the group today to ask whether they were happy with the audits currently listed on the draft programme and also had they considered any other audits that may be relevant to add to the programme. Page 2 of 9

3 PC suggested that the PLACE (Patient Led Assessments of the Care Environment) assessments or the 15 Step Challenge could be listed as an audit that would include service user participation and the group considered this. The group agreed that an audit on the 15 Step Challenge process should be added to the programme and several members showed interest in taking part. There are National Audits which are mandatory for inclusion, as below:- POMH (Prescribing Observatory for Mental Health) The main themes for 2016/17 are:- Physical Health; CPA (Care Programme Approach); Medicines Management; Audits as a result of the CQC Action Plan. Other audits listed consisted of:- Mental Health Rights and Advocacy; Volunteer Audit of Policy and Processes; Record Keeping; Physical Health; Access to Psychological Therapies; Safeguarding Quality Assurance Audit; Social Work Supervision Audit; AMHP 2016/17 Social Circumstances Audit. GM advised that she met with Jo Daniels that day to review HMP Manchester and Buckley Hall audits and these would be prioritised and added to the programme. GM is awaiting a response from Petra Brown in respect of the Medicine Management audits for the Trust and HMP Manchester and Buckley Hall. GM had also met with Stuart Logan as the Interim Head of Patient Safety and Risk Management and they were reviewing audits for inclusion that had been highlighted by the Quality Improvement Groups. PC pointed out that you need to be mindful of who the Audit Team consisted of, which is namely Gill and James Noel. PC reported that as the Trust will be going through due diligence, capacity to do this will reduce as we go through the process. We have to ensure that the Clinical Audit Programme is manageable and meaningful. EG said that she would like to see physical health and mental health linked together. PC stated that we should be saying that when we assess we use the MANCAS (Manchester Care Assessment Schedule) and physical health. PC pointed out that clinical audit is used to test out measures and plan for any improvement/implementation of actions. No: Item: Action Page 3 of 9

4 AS said that previously physical health and mental health were separate, but this has changed and there are weekly physical health checks taking place. PC stated that there was a split between what the acute hospital does and what our services do in providing follow-up. PC stated that one of the National CQUINs (Improving Physical Health Cardio Metabolic Assessments) show that our results have vastly improved during 2015/16. The telephone audit came under discussion and GM reported that this had involved discussion with the Director of Operations and presently this has been put on hold. PC explained that they had been keeping an eye on this via the Complaints and PALs processes. AS suggested Risk Assessments in respect of self harm incidents and the shortfall between evening and day. PC advised that this would not fall into the remit of a clinical audit. PC announced that the Clinical Audit Programme would be tabled at the Integrated Risk Management & Clinical Governance Committee in March. GM was thanked for coming along to the meeting today. 6. Community Matron Role and Care Programme Approach (CPA) AW introduced herself as having started her role as Community Matron in January having worked for the Trust for 25 years. Of which she spent 20 years working in the community. She is covering 6 community adult teams, the 3 Later Life teams, the Manchester Engagement Team (MET) and the Review Team focusing on quality assurance. The main areas AW will initially be focusing on are the Care Programme Approach and Physical Health. CPA The CPA framework includes a full assessment of people s health and social care needs; a Care Plan; having a Care Co-ordinator and having regular reviews. AW is looking at quality, focusing on whether care is safe, effective and responsive to the persons needs. AW has undertaken audits to look at whether service users care is recovery focused, whether carers are involved, people s resilience and self-management skills and also crisis in care planning. It was highlighted that early warning signs are identified, but focus will also be given to self-management techniques and actions people can take both in and out of working hours. AW stated that she had met with Karina Lovell to ensure everything links in and will be attending the training from the EQUIP study in March. Page 4 of 9

5 Physical Health AW stated that she would be also focusing on physical health. Mental ill health is often linked to physical ill health and vice versa. AW stated that the Manchester Care Assessment Schedule (MANCAS) is the assessment tool used and consists of 20 different domains which focuses on health and social care needs. This includes a persons physical wellbeing. AS stated that when you are ill you don t want to see people. AW said that it was important to be aware of this and under reporting physical health needs. AS gave an example of views made by her GP, as they won t speak about physical health when they know you have a mental health problem. AW spoke about physical health needs being addressed and good communication with GPs. GMo stated that it was about the amount of weight her son put on caused by the medication he was taking. He wasn t informed that it would put weight on, but when mentioned to the GP, was told to go to the gym, but now this is too difficult for her son due to the weight gain. PC said that when someone is in hospital, what doesn t happen, people are discharged and often don t monitor what medication someone is taking. AS stated that the people who miss out are people who don t have carers. PC pointed out that some Care Plans are superb, flagging the risks, have regular reviews etc, but then sometimes they can be the opposite. AW said that she was hoping to put Care Plans in the hands of the service user, ensuring care plans are personalized and recovery focused. GMo asked what if the person was will, could the carer views be taken on board? AW said that the cares views should always be considered and with the service users agreement carers are involved in the assessments, care planning and reviews. GMo pointed out that her son says what he thinks you want to hear. AW explained that this is sometimes the case and this can still be identified on the Care Plan. However the Care Plan can also involve the carer s views and also have the multi-disciplinary team involvement. GMo questioned as to whether the Care Plan would move with the patient, particularly if going out of area. AW stated that when people move to another Trust there is a transfer of care with their assessment documents and Care Plans being transferred. However different Trusts will use their own documentation. Page 5 of 9

6 SK said that although there was talk about the CPA and when looking at the agenda regarding the Community Matron, he wanted to know should this be the role of a Community Matron. AW pointed out that this was a new post and will look at improving quality and the Care Programme Approach (which consists of assessment, care planning, co-ordination and reviews) covers a persons care and involves both service users and carers. SK stated that he assumed this is a developing role, but looking at quality of CPA will be vastly different, as individuals have different ideas. PC explained that as with any process you expect to be covered and part of AW s role is to ensure the minimum standards are met. AW reported that they have been monitoring assessments and Care Plans by monitoring 3 Care Plans per Care Co-ordinator, per month. AW will be looking at this again in July. EG raised an issue about if someone was taking their normal tablets at home and then goes into hospital, the doctor always changes the medication when they go in. It was asked whether a recommendation could be given to ensure that the person s medication doesn t change. AW reported that the Care Co-ordinator makes contact with the ward staff and service users when they have been admitted to hospital to share information. It is the role of the Care Co-ordinator to link in with the hospital when someone is admitted. AW was thanked for coming along today. 7. Research and Pharmacy PB reported that she came to this forum 2-3 years ago talking about medication usage and the difficult risk areas for which work had been done around this. A particular issue raised by the forum was that of complications at the interfaces of care and how medicines errors were introduced through poor communication and confusion, in particular at discharge. PB introduced RK who works with the Trust 1-day per week at Park House. RK works also at Manchester University and had previously worked at 5 Boroughs. RK discussed an earlier study he was involved with that investigated medicines safety issues at hospital discharge; prescribing errors, basic clerical errors, and drugs stopped in hospital and not communicated to the GP were all commonly seen problems. Plan to move to the next step which is to improve the situation as part of a new project. It was noted that AS and JL were already involved initially in this new project with the Pharmacy Team who know about medication and for service users and carers who need to be involved. The types of things that were to be considered:- Were any of my medicines missing or incorrect at discharge? Did I feel confident to use my medicines safely? Did I have enough support with my medicines at discharge? Did I feel involved in my care at hospital discharge? Page 6 of 9

7 A number of other key professionals are part of the project team such as a GP, Consultant, Nurse and the Pharmacy Team, and the 3 areas which came to light to focus on for the hospital discharge improvement project were:- Told might be going home the run up to discharge; The period where hospital discharge happens; Levels of support after discharge (How can support be given on these stages). RK announced that this is the very early stages of what is to be achieved in order to improve and was looking to submit a project bid for a sum of money to do the work. SK said that it was important to remember how quickly you become institutionalized and spoke about when he was in hospital for 3 weeks and then went home, he was used to having things done for him. PB discussed self-medication which is achieved both on Acacia Ward and Anson Road which has been successful. Self-medication helps service users take responsibility for their medication and allows questions to be raised pre being left to manage medication alone. The group identified that after a period in hospital (acute or mental health) you can go home with different medication without being informed. The GP will be sent a copy of the discharge prescription usually electronically, however examples of this not occurring were cited. EG said that when going into hospital and having your medication changed, when you go home and continue with the changed medication for a time, you then go back to your usual medication which you originally had taken. EG spoke about a friend who had dementia who would not take her tablets and would spit them out, but was told to have patches. PB confirmed that there are particular medications which can be given to dementia patients in the form of patches. PB pointed out that we have to check with the GP on what medication the person who has been admitted should be taking. RK stated that there can be mis-communication, so they do a medication reconciliation when patients first come into hospital. He then said that they can do the same on discharge and get the most up to date information for the patient and GP. It was noted that between 2-4 weeks after discharge from any hospital is the most crucial to avoid patients experiencing problems with their medication. AS stated that the review is the job of the Care Coordinator. PC explained that on a 7-day follow up you can be told that you will have an appointment with a Consultant in their Out-patient Clinic. This can create unpleasant side-effects and what support would you get? PC stated that the GP would be sent a discharge summary, but the Trust is not good at doing this. Page 7 of 9

8 GMo discussed problems she experienced at her local chemist when her son was discharged and in trying to get his repeat prescription. RK discussed the Refer to Pharmacy national scheme, where you could ask the patient to go to a community chemist and would be given an appointment to go there after discharge and could wrap the idea of the chemist having medications available. GMo asked whether this would put too much pressure on the small chemists. You can do your shopping, go home and unpack and when you go back to collection your prescription, you get told that they haven t got every item you need to pick up. EG said that the problem is that you can t ring for repeat prescriptions, you have to go into the GP surgery. SK thought it was questionable if large pharmacy chains employ enough pharmacists. SK also said that when you are discharged from hospital you are given 2 telephone numbers and if no-one is there you can leave a message and they would ring you back within a short timeframe. JL wanted to know that if you can t inform your doctor, how would you know if the doctor is told about the electronic prescription, and he was told he had to go to the other side of the city to collect it. PB stated that the Community Pharmacist could help, but would not replace the GP. RK pointed out that by having a named pharmacy, it could be ed to them, but when you have blister packs and book with the Community Pharmacy it shows risks in the first 7-days, and so an appointment is invaluable. EG spoke about the drug company and chemist who at times can change the packaging, so you don t always associate the tablets they have given you as being the ones you usually take. KO agreed with this and said that if medication changed and there is a problem, it can be mental health not physical. RK stated that although there is a high risk, going home, or going to a changed environment, things do change, so we do need to have you to go to the community pharmacy. KO said that she didn t want to change her medication and RK explained that service users should be reassured that issues could pass and changes may not be needed, or speak to someone. Additional support is an important resource. AS stated that we should advertise this more widely. Again, the 3-step principal came under discussion. JL said that it didn t need to be a complicated system. RK announced that this was not new and were trying to get pharmacists to spend more time with the patient, making it clear and simple. Page 8 of 9

9 EG pointed out that if the person is with their carer, it would be best to speak with them as a first point of call. RK suggested that some patients require carer input and it is important to include them where needed, but for many patients they would be fine to talk to the health professional themselves. RO wanted to know what happens when people are isolated. RK explained that when in hospital they will see them, will contact the chemist and tell the patient to go along and have a chat with them. Phone calls are an option. RK asked that people link to other groups. If they have any views they could contact either RK or PB directly by at richard.keers@manchester.ac.uk or petra.brown@mhsc.nhs.uk PB and RK were thanked for coming along today. 8. Any other business Easter Themed Competition There will be an Easter themed completion where they were asking for volunteers to judge photographed entries. This will take place on Friday 1 st April at 10.30am in Hexagon Tower. Anne Scott volunteered herself and her name will be forwarded to Susan Wright. JS 9. Date & Time of next meeting The next meeting will take place on Monday 21 st March 2016, pm, in the Recovery Education Department, Near Park House, NMGH. Apologies in advance from Janet Sinclair. Page 9 of 9