Out of Area Treatment Policy (For Adults over the age of 18. Patients from NTW area requiring specialist placements or extra packages of care)

Document Title Reference No: Lead Officer Author(s) (name and designation) Ratified by Out of Area Treatment Policy (For Adults over the age of 18. Patients from NTW area requiring specialist placements or extra packages of care) Lisa Quinn Executive Director of Commissioning and Quality Assurance Janice O Hare OATS Case Manager Business Delivery Group Date ratified March 2015 Implementation Date March 2015 Date of full implementation March 2016 Review Date September 2018 Version number V02.3 Review and Amendment Log Version Type of change Date V02.1 Update Jul 15 V02.2 Update Sep 17 V02.3 Update Mar 18 Description of change Removal of NTW(C)14 Transitions Policy, replaced with CC-CPA-PGN-09 Transitions, which now sits with NTW(C)20 CC/CPA Policy Update due to clinical transformation Change of Author, Lead Officer and Extension to review to Sep 2018 This policy supersedes: Document Number V02.2 Title Out of Area Treatment Policy (For Adults over the age of 18 - Patients from NTW area requiring specialist placements or extra packages of care)all mental health specialist placements/extra packages of care

Out of Area Treatment Policy (For Adults over the age of 18 - Patients from NTW area requiring specialist placements or extra packages of care)all mental health specialist placements/extra packages of care Section Contents Page No: 1 Introduction 1 2 Scope of Policy 1 3 Purpose 2 4 Duties and Responsibilities 2 5 Definition of Terms 4 6 Overarching Good Practice Principles 4 7 Process 5 8 Out of Area Treatment Pathway Emergency-Unplanned 6 9 Out of Area Treatment Pathway - Planned 7 9.1 Stage 1 Routine inpatient or community multi-disciplinary team meeting / care programme approach review 9.2 Stage 2 Consultation multi-disciplinary team meeting 8 9.3 Stage 3 Out of Area Treatment/enhanced care package meeting 9 9.4 Stage 4 Placement proceeds 11 9.5 Stage 5 Out of Area Placement Review 11 9.6 Stage 6 Service user returns to NTW Placement 13 10 Support for Carers of Service Users on OAT Placements 13 11 Overarching organisational monitoring 14 12 Conclusions 14 13 Identification of Stakeholders 14 14 Training 15 15 Implementation 15 16 Monitoring Compliance 15 17 Equality and Diversity 16 18 Fair Blame 16 19 Fraud, Bribery and Corruption 16 20 Associated documentation 16 21 References 16 Standard Appendices attached to policy A Equality and Diversity Impact Assessment Form 18 B Communication and training Checklist and Needs Analysis 20 C Monitoring and Audit Tool 22 D Policy Notification Record Sheet - click here 7

Appendices to be listed separately to policy Appendix No: Description Issue Date issued Appendix 1 Unplanned/Emergency Out of Area Treatment Pathway Acute Services Review date 1 Mar 18 Sep 18 Appendix 2 Appendix 3 Out of Area Treatment Policy Flowchart Application for Out of Area/Enhanced Care Package Funding 1 Mar 18 Sep 18 1 Mar 18 Sep 18

Background Information In order to ensure that resources are used effectively it is important that NHS Trusts work closely with Local Commissioners (CCGs and their commissioning support services) to ensure that placements are both appropriate to need and represent effective use of resources Evidence suggests that people with severe mental illness and disorder are socially excluded, find it difficult to sustain social and family networks, access education systems and obtain and sustain employment. Whenever possible In-patient care should therefore be provided close to the home so that family and community links can be maintained The Commission for Health Improvement state that there is strong evidence that Mental Health Provider Trusts can significantly reduce the number of people sent out of area by implementing new models of care This document intends to cover those placements that fall outside agreed contracts/service Level Agreements. This includes specialist packages of care both out of locality and within locality where these fall outside existing agreements. However all Service Level Agreements should be subject to ongoing monitoring and considered, where appropriate, alongside other service developments to provide more localised services

1 Introduction 1.1 On some occasions services, clinical teams and individual Lead Professionals /Care Coordinators face complex problems presented by service users that may not be easily resolved, this can result in gaps emerging in relation to service users packages of care. This may result in difficulties identifying suitable service placement for individuals, in particular where the service users needs cut across service and or organisational boundaries. 1.2 All service users should have timely access to the appropriate service placement to meet their needs. Where complex needs are encountered it is incumbent on all parties to ensure service users and carers needs and wishes are central to any planning process; and that service specifications or organisational boundaries should not adversely impact upon such. Issues with regards to placement should be wherever possible resolved at a team /clinician level without unnecessary delay. 1.3 This policy should only be used when local Northumberland, Tyne and Wear NHS Foundation Trust (the Trust/NTW) services are deemed not able to meet an individuals needs and operated in conjunction with the Trust s policy, NTW(C)20 Care Coordination and Care Programme Approach, Practice Guidance Note CC- CPA-PGN-09 - Transitions. 1.4 This policy has been developed with reference to National Policy Guidance a guide to good Practice in the use of out of area placements Royal College of Psychiatrists Nov 2012 and specifically the Trust s NTW(C)20, Care Coordination and Care Programme Approach policy plus practice guidance notes. It also reflects best practice guidance, in which the benefits of well-coordinated care for those with mental health and learning disability needs have been consistently highlighted. 1.5 The policy describes an escalating approach to the effective placement of service users with complex clinical issues. The policy describes the key stages for clinicians to follow when local services cannot meet the needs of an individual safely and a placement out of area has to be sought. 2 Scope of Policy 2.1 This Policy applies to: Mental Health, Learning Disability and Neurological Services Inpatient services Outpatient services Community services Northumberland, Tyne and Wear NHS Foundation Trust 1 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

2.2 This policy covers all services managed by the Trust. Services for the following patient groups are provided by other organisations:- Services for children and young people in North Tyneside are provided by Northumbria Healthcare Trust with regional in-patient facilities available at the Young Person Unit in Newcastle Services for older people living in North Tyneside are provided by two Trusts. (For those people living in the North West of the borough i.e. Longbenton, services are provided by NTW. For Older People living in North Shields, Whitley Bay and Wallsend, services are provided by Northumbria Healthcare Trust.) Services for older people living in Gateshead are provided by Gateshead Foundation Trust. 3 Purpose 3.1 Provide a framework to ensure service users receive timely access to services to support the Out of Area Treatment (OAT) policy framework. 3.2 Provide a framework to resolve placement issues where complex needs cannot be resolved at team/clinician level as described within the Trust s policy, NTW(C)20 Care Coordination and Care Programme Approach, Practice Guidance Note CC- CPA-PGN-09 - Transitions. 3.2 Provide services, clinical teams and professionals with a positive framework to deliver high quality service user focussed care where services, teams or clinicians cannot on their own provide or identify suitable placement to meet service user needs. 3.3 Identify principles which will underpin effective cross service/organisational working and clinical practice. 4 Duties, Accountability and Responsibilities 4.1 The staff / groups who will take responsibility for implementing and overseeing the policy; 4.2 Responsibilities of Commissioners Attend Stage 3 meetings Provide decisions on Out of Area Treatment placements in a timely manner wherever possible at stage 3 reviews or, within 3 days of Northumberland, Tyne and Wear NHS Foundation Trust 2 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

receiving application or sooner if clinical needs dictate urgent placement To ensure resources are used effectively Whenever possible to ensure services are provided locally Consider unmet needs and gaps in service Monitor quality of placements- this may involve attending CPA reviews, monitoring of repatriation plans and/or visiting provider services Consider requests for transfer to an alternative OAT placement (this may arise when the placement provider is not managing risks appropriately or the service users outcomes are not being met over consistent period) 4.3 Responsibilities of Care Coordinator Refer to the Trust s NTW(C)20 Care Coordination, Incorporating Care programme Approach (CPA) Policy To attend all Care Programme Approach Reviews and make every effort to attend all other reviews. Minimum visits/attendance at reviews 3 monthly To liaise with service user and carers throughout whole process Overall responsibility to oversee completion of OAT Monitoring Plan and other necessary documentation and to work closely with both Multi-Disciplinary Team (local and out of area MDTs) To communicate minimum 6 monthly with Associate Director, Commissioners and internal NTW OAT monitoring service as appropriate in relation to progress and outcomes being achieved via progress report 4.3 Responsibilities of Link Worker Provide support to the Care Coordinator in the management of the OAT placement. Provide specialist advice, assessment and interventions as agreed in the care plan. Northumberland, Tyne and Wear NHS Foundation Trust 3 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Stand in for the Care Coordinator when it is agreed this is appropriate and in the best interests of the service user. 5 Definition of Terms 5.1 Carers This term within this document is a global one covering next of kin, family and close friends who provide social, practical or emotional support to the service user 5.2 Link Worker A Link Worker is a professional who supports the Care Coordinator in the management of a case, providing additional input such as specialist assessment, specialist advice and/or long term working relationship and knowledge of the service user. Not all service users will require a Link Worker in addition to a Care Coordinator and the identification of such a worker will result from the assessed needs of the service user. Examples may include the involvement of a Link Worker from a specialist Personality Disorder service to support and advise a Care Coordinator in the case management of a patient with complex personality disorder receiving OAT placement 5.3 The Host Is the out of area placement provider 5.4 Out of Area Treatments Out of Area Treatment (OAT) is the current mechanism within the NHS for funding episodes of care which fall outside of existing Service Level Agreements between Commissioners of service and providers such as NTW 6 Overarching Good Practice Principles 6.1 Good practice principles are that service users should be cared for: As near as possible to individual s homes and/or carers and families As far as possible in the community Under conditions of no greater security than is justified by the degree of risk they represent to themselves or to others Northumberland, Tyne and Wear NHS Foundation Trust 4 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

With regard to the quality of care and proper attention to the needs of individuals In such a way as to maximise recovery, rehabilitation and chances of sustaining an independent life Independent Advocacy Services should be available to all service users in Out of Area Treatment facilities and to their carers Independent Mental Capacity Advisor where appropriate where service users lack capacity Carers should be supported to maintain contacts with their relatives and friends in Out of Area Treatment placements All service users in long term placements purchased by CCGs and Local Authority Social Services Depts. including OAT placements, must be subject to Care Coordination Care Coordinator from appropriate services in the person s area of residence will be appointed for each service user in receipt of OAT placement. Link Worker(s) may be appointed to support the Care Coordinator in the management of the case depending on the service users identified needs (see section 5.2 above). Care Coordinators must be NTW employees where the contracting responsibility for the OAT placement rests with NTW The Care Coordinator and Link Worker(s) from the area of origin should attend Care Programme Approach Reviews with the aim of maintaining a link with local services and supporting social inclusion Commissioners must ensure local services are adequately resourced to maintain contact with individuals in OAT placements Clinicians from the referring service must be involved in the clinical transfer to an initial OAT placement and may be involved in the ongoing monitoring of Out of Area Treatment placements through Care Coordination and according to patient need. For members of Trust staff who require Mental Health Service and do not wish to access NTW services, a protocol should be developed separately to ensure appropriate access to another service 7 Process Northumberland, Tyne and Wear NHS Foundation Trust 5 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

7.1 The decision to request an OAT usually originates within a Clinical Team. 7.2 The reasons for seeking support for such placements will fall into one of the following categories: Capacity none available locally to provide the service that the service user needs at the time they need it and no satisfactory alternative exists within NTW. Specialist Service one which is not provided by NTW. Exceptional circumstances where services are provided locally and capacity exists but where circumstances exist which make the placement undesirable or unnecessarily risky for the service user, interested others or staff involved. Or if the service user has developed links to an out of area placement i.e. close to a family member. (These circumstances are likely to be rare) 7.3 Out of Area Treatment applications will fall into either a planned or unplanned category and are dealt with in different ways. 7.4 The process of monitoring arrangements for out of area placements will be undertaken by individual local Commissioning Teams in liaison with the identified Care Coordinator. Arrangements for monitoring will differ depending on locality. 8 Out of Area Treatment Pathway - Emergency/Unplanned (see flowchart Appendix 1) 8.1 Local bed gate keeping services (CRHTT), Bed Management Service or other depending on local arrangements) will match service user need to appropriate NTW Trust placement utilising agreed pathways and contingency protocols. 8.2 If no match is available, the bed gate keeping service will identify the nearest and most appropriate vacant bed and facilitate transfer to that OAT placement utilising agreed pathways and contingency protocols. 8.3 At the earliest opportunity following the unplanned OAT placement the bed gate keeping service will inform the Associate Director and the Commissioning Team for that service user s area of residence. If the event occurs at a weekend or out of office hours the on call Senior Manager should be informed at a reasonable hour. All efforts will be made to bring the service user back to the local area as soon as possible and this will be the responsibility of the bed gate keeping service. Northumberland, Tyne and Wear NHS Foundation Trust 6 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

8.4 All such placements must be reviewed within a maximum period of 7 working days by the referring Clinical Service and a copy of the information sent to the respective Commissioning Team. 8.5 Placement beyond two weeks will require a full review using the protocol steps outlined under the planned OAT process from Stage 6 with consideration given to calling an urgent Stage 2 Consultation Meeting 9 Out of Area Treatment Pathway Planned (Appendix 2) Note: All existing Out of Area placements will need to be included in this process (from Stage 6) on agreement of protocol 9.1 Stage 1 Clinical Review Meeting (In-patient or Community Multi- Disciplinary Team Meetings and Care Programme Approach reviews) A clinical review meeting identifies that the service user s needs are unmet in the present environment and no clear alternatives are available and agrees that Stage 2 of process needs to be implemented The clinical review meeting must clarify and document the needs of the Service User that are not met in the present environment, detail desired outcomes and the clinical interventions needed to achieve these. Consideration should be given to referral for clinical assessment from appropriate NTW clinical specialists if this has not occurred previously Advocacy (Independent Mental Health Advisor/Mental Capacity Act) Services is offered to the service user if not already in place The Care Coordinator informs the Associate Director of the need to investigate alternative options/resources/placement which may lead to an Out of Area Treatment application Appropriate information gathering takes place to facilitate discussion at a Stage 2 meeting It will be usual to invite clinical specialists appropriate to the Service Users needs to the Stage 2 meeting (i.e. Forensic Services, Rehabilitation, PD specialist) to inform the decision making process The Service User and Carers (where appropriate) will be involved in the process throughout, i.e. invited to the review/consulted regarding Northumberland, Tyne and Wear NHS Foundation Trust 7 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

their view of the situation or decision to consider alternative options for care and treatment. It must be made clear to both the service user and the family that OAT placement is only one of the potential options for further care and treatment under consideration The Stage 2 meeting is arranged by the MDT to facilitate consideration of options and consult with key clinical and other staff outside the MDT. Key Multi-Disciplinary Team members, the Nurse Consultant/Lead Nurses (where appropriate), the relevant Associate Director (or delegated representative) and a representative from service responsible for NTW wide OAT monitoring must be in attendance 9.2 Stage 2 - Consultation Multi-Disciplinary Team Meeting 9.2.1 Based on service user needs, the Stage 2 meeting should consider the need for:- Further specialist assessment if this has not taken place previously. The OAT process should not proceed to Stage 3 without a clinical assessment by an appropriate NTW specialist clinical service if this is available Development of an extra care package of support within the existing placement. If this is a feasible option then further discussion may be undertaken with Commissioners regarding provision of this service. Further examinations of facilities and placements within the wider Trust which can better meet the service users needs/outcomes Please note: Complex case review should only be considered for a small minority of cases and the Protocol for Referral to the Complex Case Panel must be followed After consideration of the above the Stage 2 meeting then confirms the clinical needs, desired outcomes and clinical interventions required and produce an action plan detailing next steps Where it has been agreed existing NTW placement can meet their needs and is available then the service user should be transferred following protocol and good practice. Efforts should be made to place the service user in services within or nearest to their locality of residence. If such services are not available then other suitable NTW services should be used before considering an OAT placement If the Stage 2 meeting agrees an OAT placement or enhanced care package may be necessary, a further meeting needs to take place Northumberland, Tyne and Wear NHS Foundation Trust 8 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

(Stage 3). The commissioner should be informed that the Stage 3 process will be undertaken and invited to a meeting If a Stage 3 meeting is required the Stage 2 meeting should identify responsible clinicians to explore potential placement options. Placement inquiries should be made prior to the Stage 3 meeting and thus prior to any approval of funding. Care should be taken not to raise individual service user expectations prior to Stage 3 meeting as approval for funding must be obtained from the appropriate Commissioning Team prior to arranging any placement. Services responsible for NTW wide OATS monitoring will assist clinicians in this process Placement inquiries should be made of a minimum of 2, and preferably 3, alternative provider services. Inquiries should communicate the agreed clinical needs, desired outcomes and recommended interventions for the service user that have previously been agreed. Potential placement providers should be asked to make an outline tender against these criteria and indicate whether placement is available and broad outline costs. Services responsible for NTW wide OAT monitoring will assist clinicians in this process The application for OAT funding (see Appendix 3) should be drafted and circulated at this point by the clinician(s) making placement enquiries. The application should include details of all enquiries made. The application should be completed with input from a range of professionals and the service user and carer. The application must be fully completed prior to a Stage 3 meeting. The commissioner and Associate Director must receive a copy of the report prior to the Stage 3 meeting 9.3 Stage 3 - Out of Area Treatment /Enhanced Care Package Meeting The Funding application [Appendix 3] must be fully completed and supported by the Associate Director before a Stage 3 meeting can go ahead The Commissioner for the area and IMHA (If appropriate) must be invited and it is expected that all key Multi-Disciplinary Team members, Associate Director, Clinical Nurse Managers, Senior Clinical Nurse, Bed Management Service/OAT Case Managers and appropriate community services representatives will attend this meeting. Representatives from specialist or other NTW services should be invited as appropriate, dependent on the patient s needs. The purpose of this meeting is to: o Discuss the funding application and all alternative OAT placements identified as the result of the Stage 2 process Northumberland, Tyne and Wear NHS Foundation Trust 9 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

o Agree the appropriateness and funding of an OAT/extra care package and the preferred provider o Identify the Care Coordinator to lead the OAT placement process. The Care Coordinator must be an NTW employee in order to allow direct monitoring of the placement and to coordinate any plans for repatriation to NTW services. (In some circumstances, it may be appropriate for a different professional/staff member rather than a Care Coordinator to make the necessary arrangements/obtain information for the transfer. o This professional would be an identified Link Worker - The Care Coordinator will:- Complete OAT monitoring plan baseline (see Appendix 4) to include:- Agree patient outcomes and future monitoring arrangements including expected repatriation plans Identify a clear action plan and responsibilities Establish any further actions to be taken Seek service user, advocate and carer views Sign off the agreement The placement can only take place (except in emergency situations and/or outside of working hours) when agreement has been obtained from the respective Commissioning Team and all of the above stages 1 3 have been completed. It is expected that agreement can be approved and signed off at Stage 3 meetings (if funding application has been fully completed and forwarded to commissioner for consideration before stage 3 meeting). In some circumstances the commissioner may need further time for consideration. In these circumstances it expected that agreement will be given within 3 working days or sooner if needs/risks dictate more urgent decision. Northumberland, Tyne and Wear NHS Foundation Trust 10 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

The service users OAT monitoring must be agreed by all involved, including service user/carers where possible, as it forms a baseline for future monitoring and review. This plan will be reviewed at a minimum of 6 monthly intervals through CPA reviews. 9.4 Stage 4 - Placement Proceeds Once placement is confirmed the Care Coordinator (or Link Worker if agreed) will liaise with the placement provider and provide necessary information to ensure that they are fully aware of the individuals needs/risks and are able to meet the agreed identified outcomes. An assessment by the OAT placement provider will need to be arranged as soon as possible to enable transfer. The Care Coordinator and/or Link Worker will ensure the client is supported to move to the OAT placement and that all required information including the agreed service users OAT Monitoring Plan, property and documentation moves with them. Service users should be informed that placement will last as long as required and all efforts will be made to return the service user to NTW or other local services as soon as possible. The Associate Director or nominated other must inform NTW finance dept at this point of the transfer to the OAT placement. Where the service user is from the areas where the OAT contracts are managed by NTW the Finance Department will contract with the placement provider. Resource Implications - Visits to service users in placements out of area can require high levels of time and travelling. In choosing the Care Coordinator and any necessary Link Worker(s) consideration should be given to maximising economies of scale (where possible and if appropriate) i.e. if several service users are in one OAT placement then these being coordinated by one person would be sensible. Minimising expenses to carers and families should also be considered. Advocacy - It is expected that on transfer to an OAT placement that the advocacy will transfer to services linked to the host provider. Given the importance of trust in the advocacy relationship, the service user should always be offered the option of keeping their existing Advocate where feasible. 9.5 Stage 5 - Out of Area Placement Review 9.5.1 The individual s Care Coordinator (or Link Worker if agreed) will: On transfer, visit within the first month and then at least every 3 months for the first 6 months of placement, or more frequently if need dictates, Northumberland, Tyne and Wear NHS Foundation Trust 11 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

offering support and information to relatives and tracking early indicators of success of the placement Be in contact with the service user and OAT provider either by phone or a visit on a 3 monthly basis to monitor the placement and ensure smooth transition Attend Care Programme Approach Reviews at least 6 monthly to formally assess against the needs, desired outcomes within the OAT Monitoring Plan. The OAT Plan review proforma must be completed by the Care Coordinator / Link Worker. Be responsible for liaising with the OAT provider and/or Host Care Coordinator and the Trust to ensure the service user is enabled to move back to their local area as soon as is safe and practicable to do so Monitor that carers and other relevant parties are involved and informed of progress. Highlight any issues or concerns about the care provided with the relevant Commissioner. Work together with NTW Bed Management Service and NTW OAT Case Manager (when this role applies) to provide information to inform service planning and jointly make plans for return to NTW services. The placement provider may need to make immediate increases or changes in the contracted care provision to maintain the safety of the Service User. An example is an increase in supervision/observations due to increased risks. Where the changes are outside of contracted arrangements, and may incur increased costs, and the contract for the placement is managed by NTW the provider must inform the Care Coordinator and NTW OAT Case Management support service at the earliest opportunity and a request for additional funding made. NTW will organise a CPA meeting within 5 working days to review the circumstances, consider alternative options and agree any ongoing changes to the contract. When the Provider wishes to request changes to the contracted care provision and the requested change is not related to the immediate safety of the Service User, the Provider must request a contract change if the contract is managed by NTW. There may be occasional circumstances where a patient plan is not to be repatriated to NTW or other local services. NTW will retain responsibility and continue input into such cases until CPA transfer to Northumberland, Tyne and Wear NHS Foundation Trust 12 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

appropriate services is completed. No patient may be discharged from NTW services until CPA transfer takes place. 9.6 Stage 6 - Service User Returns to NTW Placement As soon as is practicable, the Care Coordinator in conjunction with the host service will facilitate the individual s return to NTW services. A Community Placement Questionnaire (CPQ) must be completed at this stage to identify needs, type and level of service required for repatriation purposes. This will include convening a CPA review/ Multi-Disciplinary Team Meeting of appropriate Clinicians, Managers and NTW Bed Management /OATs Case Manager to complete a Repatriation Plan. This plan should include: o Identification of a suitable placement using CPQ analysis o Formulate action plans, (all action plans should include risk assessment, risk indicators and management plan) to support the transition back to NTW including transfers of Responsible Clinician (RC) responsibilities o Liaise as necessary with the service user, the OAT placement and NTW Multi-Disciplinary Teams, the family, the Associate Directors and the local Commissioners o The point of transition will be facilitated by a full Multi-Disciplinary Team Review by the placement provider o The Associate Director informs finance and the local Commissioners of the transitions back to service No transfer should take place until all of the above is in place 10 Support for Carers of Service Users on OAT Placements 10.1 All professionals involved will ensure that the service user and carers are actively involved in all stages of the process. 10.2 The Care Coordinator will ensure service users and carers are supported practically and emotionally to remain in contact with each other and have a voice within the process. Support such as offering to transport carers to CPA meetings or similar should be considered. 10.3 Where contract responsibility is held by a CCG, requests by carers for financial support to maintain contact should be made to the CCG. NTW Care Coordinators will advise service users regarding this process and supply information about other potential routes to funding where necessary. Northumberland, Tyne and Wear NHS Foundation Trust 13 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

10.4 Where contract responsibility is held by NTW it will not usually be possible to financially support carers to maintain contact with service users. Care Coordinators and the NTW Case Manager will advise carers on potential routes to funding from other sources such as the social fund or local authority discretionary funds. 10.5 Where there are pre-existing arrangements for NTW to provide financial support to carers to maintain contact with service users in OAT placements, consideration should be given by Care Coordinators and management teams to the continuation of this 11 Overarching Organisational Monitoring 11.1 The Trust will identify a service or department responsible for overarching OAT monitoring and associated Case Management and this service will: Hold central data file on OAT placements. Identify from Care Coordinators and Multi-Disciplinary Team visits what future provision is required to bring the service user back to their local area Provide reports, regarding unmet needs and monitor future service provision and requirements required to facilitate service user s return to NTW/local areas 12 Conclusion These guidelines are intended to supplement good practice and represent the minimum requirements for successful OAT placement issues as per CPA and good practice guidance. All actions undertaken to facilitate effective and safe placement between services must be recorded in accordance with the Trust s NTW(O)09 - Management of Records Policy, Practice Guidance Note MR-PGN-02 Record Keeping Standards. 13 Identification of Stakeholders 13.1 This policy has been agreed by commissioning representatives and has been written in line with national good practice guidelines as referenced. 13.2 This policy has undergone a Trust wide consultation process and was circulated to those listed below: North Locality Care Group Northumberland, Tyne and Wear NHS Foundation Trust 14 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Central Locality Care Group South Locality Care Group Corporate Decision Team Business Delivery Group Safer Care Group Communications, Finance, IM&T Commissioning and Quality Assurance Workforce and Organisational Development NTW Solutions Local Negotiating Committee Medical Directorate Staff Side Internal Audit 14 Training 14.1 This is an update to an existing policy and specific training is not required 14.2 All qualified staff will be made aware of their responsibilities in relation to this policy. 14.3 All other staff to be aware of this policy. 15 Implementation 15.1 This policy will be cascaded via existing management and agreed policy cascade processes. If for any reason the target date of one year from date of issue for full implementation cannot be met, then the author will develop an action plan. 16 Monitoring Compliance 16.1 OAT placements and processes will be overseen by Bed Management Service and associated OAT Case Managers. Report on activity, Key Performance Indicators and associated data will be managed through Bed Management Strategy Group which will report to Group Business Meeting and monitoring of the following will take also take place: To monitor whether patients in out of area placements receive the minimum six monthly monitoring review To monitor whether all patients who are transferred out of area have a stage 3 meeting as per policy. Northumberland, Tyne and Wear NHS Foundation Trust 15 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

To monitor that all patients in out of area placements have a repatriation plan identifying patient recovery outcomes 17 Equality and Diversity Assessment 17.1 In conjunction with the Trust s Equality and Diversity Officer this policy has undergone an Equality and Diversity Impact Assessment which has taken into account all human rights in relation to disability, ethnicity, age and gender. The Trust undertakes to improve the working experience of staff and to ensure everyone is treated in a fair and consistent manner. 18 Fair Blame 18.1 The Trust is committed to developing an open learning culture. It has endorsed the view that, wherever possible, disciplinary action will not be taken against members of staff who report near misses and adverse incidents, although there may be clearly defined occasions where disciplinary action will be taken. 19 Fraud, Bribery and Corruption 19.1 In accordance with the Trust s NTW(O)23 Fraud, Bribery and Corruption Policy, all suspected cases of fraud and corruption should be reported immediately to the Trust s Local Counter Fraud Specialist or to the Executive Director of Finance. 20 Associated documents NTW(C)20 Care Coordination and Care Programme Approach Policy and Practice Guidance Notes (PGNs) o CC-CPA-PGN-09 Transitions (replacing NTW(C)14) NTW(O)09 Management of Records, PGN, MR-PGN-02 Record Keeping Standards NTW(O)23 Fraud, Bribery and Corruption Policy 21 References Out of Area Treatments September 2005 Needs to a Strategy NTW Rehabilitation and Recovery Services Clinical Forum 2007 Working Group Proposals Out of Area Treatment Guidelines Working Group - September/ October 2008 Northumberland, Tyne and Wear NHS Foundation Trust 16 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Department of Health (1992). The review of Health and Social Services for mentally disordered offenders and others requiring similar services, HMSO London Care Services Improvement Partnership / National Institute for Mental Health in England A Good Practice Guide for Commissioners, CPA Care Co-ordinator and Independent Service Providers 2006 A Guide to Good practice in the use of Out of area Placements o Faculty report FR/RS/06 November 2012 Royal College of Psychiatrists faculty of Rehabilitation and Social Psychiatry. Northumberland, Tyne and Wear NHS Foundation Trust 17 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Appendix A Names of Individuals involved in Review Jim Sowter Janice O`Hare Equality Analysis Screening Toolkit Date of Initial Review Date Screening Nov 2014 Nov 2017 Service Area / Locality Policy to be analysed - Out of Area Treatment Policy Is this policy new or existing? Existing What are the intended outcomes of this work? Include outline of objectives and function aims The aims of this policy are to: Outline an escalating process for identifying alternative placements or extra care packages for service users where NTW services are not able to meet presenting needs. Ensure that all options for NTW service provision have been considered before seeking alternative service provision. Ensure that required interventions to meet service user needs are identified by NTW clinicians prior to placement commencing. Ensure that arrangements for ongoing care coordination and monitoring by NTW are in place prior to placement commencing. Ensure that service users are repatriated to NTW services at the earliest opportunity Who will be affected? e.g. staff, service users, carers, wider public etc Service Users and Carers Protected Characteristics under the Equality Act 2010. The following characteristics have protection under the Act and therefore require further analysis of the potential impact that the policy may have upon them Disability Sex Race Age Gender reassignment (including transgender) Sexual orientation. Religion or belief Marriage and Civil Partnership Potentially positive, should ensure that services are considered and arranged for service users with complex and treatment resistant presentations. n/a n/a n/a n/a n/a n/a n/a Northumberland, Tyne and Wear NHS Foundation Trust 18 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Pregnancy and maternity n/a Carers Other identified groups Potentially positive, intended to ensure that carers are involved in decision making and that out of area placements are effectively managed through Care Coordination and are as short as possible. n/a How have you engaged stakeholders in gathering evidence or testing the evidence available? Through Policy review process How have you engaged stakeholders in testing the policy or programme proposals? Through policy review process For each engagement activity, please state who was involved, how and when they were engaged, and the key outputs: Staff, staff side, service user representation Summary of Analysis Considering the evidence and engagement activity you listed above, please summarise the impact of your work. Consider whether the evidence shows potential for differential impact, if so state whether adverse or positive and for which groups. How you will mitigate any negative impacts. How you will include certain protected groups in services or expand their participation in public life. Positive impact Now consider and detail below how the proposals impact on elimination of discrimination, harassment and victimisation, advance the equality of opportunity and promote good relations between groups. Where there is evidence, address each protected characteristic Eliminate discrimination, harassment and victimisation Advance equality of opportunity Promote good relations between groups What is the overall impact? Addressing the impact on equalities Has potential to ensure fair and open decision making processes Yes Yes Positive Will impact on disabilities From the outcome of this Screening, have negative impacts been identified for any protected characteristics as defined by the Equality Act 2010? - NO If yes, has a Full Impact Assessment been recommended? If not, why not? Manager s signature: Jim Sowter Date: November 2014 Northumberland, Tyne and Wear NHS Foundation Trust 19 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Appendix B Communication and Training Check list for policies Key Questions for the accountable committees designing, reviewing or agreeing a new Trust policy Is this a new policy with new training requirements or a change to an existing policy? If it is a change to an existing policy are there changes to the existing model of training delivery? If yes specify below. Are the awareness/training needs required to deliver the changes by law, national or local standards or best practice? Please give specific evidence that identifies the training need, e.g. National Guidance, CQC, NHS Resolutions etc. Please identify the risks if training does not occur. Please specify which staff groups need to undertake this awareness/training. Please be specific. It may well be the case that certain groups will require different levels e.g. staff group A requires awareness and staff group B requires training. Is there a staff group that should be prioritised for this training / awareness? Please outline how the training will be delivered. Include who will deliver it and by what method. The following may be useful to consider: Team brief/e bulletin of summary Management cascade Newsletter/leaflets/payslip attachment Focus groups for those concerned Local Induction Training Awareness sessions for those affected by the new policy Local demonstrations of techniques/equipment with reference documentation Staff Handbook Summary for easy reference Taught Session; E Learning Please identify a link person who will liaise with the training department to arrange details for the Trust Training Prospectus, Administration needs etc. Change to and update to an existing protocol. Training delivery is awareness only via cascade so cascade of amended policy will suffice Changes are as a result of local changes, changes within commissioning arrangements Changes to National standards - A Guide to Good practice in the use of Out of area Placements o Faculty report FR/RS/06 November 2012 Royal College of Psychiatrists faculty of Rehabilitation and Social Psychiatry All staff need to be aware of policy existence. All care coordinators, nursing staff medical and OAHP and any other staff MDT staff member who may be involved in organising an Out of Area placement need to be made aware of procedures to be followed as per this policy. All staff need to be aware. Management cascade. Presentations to relevant operational management and Quality and performance meetings have already occurred.- the fact that change have been made it should be agenda of same groups. N/A Northumberland, Tyne and Wear NHS Foundation Trust 20 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Appendix B continued Training Needs Analysis Staff/Professional Group Type of training Duration of Training Frequency of Training Not applicable awareness only Copy of completed form to be sent to: Training and Development Department, St. Nicholas Hospital Should any advice be required, please contact:- 0191 245 6777 (internal 56777- Option 1) Northumberland, Tyne and Wear NHS Foundation Trust 21 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist

Statement Monitoring Tool Appendix C The Trust is working towards effective clinical governance and governance systems. To demonstrate effective care delivery and compliance, policy authors are required to include how monitoring of this policy is linked to auditable standards/key performance indicators will be undertaken using this framework. Out of Area Treatment Policy - Monitoring Framework Auditable Standard/Key Performance Indicators Frequency/Method/Person Responsible Where results and any associated action plan will be reported to, implemented and monitored; (this will usually be via the relevant Governance Group). 1. All patients in OAT placements receive a minimum 6 monthly monitoring review? 6 monthly Review of all OAT patient records. Clinical Lead for Bed Management Bed Management Strategy Group 2. All patients who are placed in OAT placements have a stage 3 meeting as per policy. 6 monthly Review of all OAT patient records. Clinical Lead for Bed Management Bed Management Strategy Group 3. All patients who are in an OAT placement have a repatriation plan which identifies patient recovery outcomes and outline timescales. 6 monthly Review of all OAT patient records. Clinical Lead for Bed Management Bed Management Strategy Group The Author(s) of each policy is required to complete this monitoring template and ensure that these results are taken to the appropriate Quality and Performance Governance Group in line with the frequency set out. Northumberland, Tyne and Wear NHS Foundation Trust 22 - Out of Area Treatment Policy - (For Adults over the age of 18 - Patients from NTW area requiring specialist