LPFT Clinical Strategy

LPFT Clinical Strategy 2014-19 1. Introduction 1.1 Review of 2012-15 strategy Following extensive consultation with staff, service users, carers, commissioners and other key stakeholders, LPFT s Clinical Strategy for 2012-15 was developed. The objectives of this strategy are: More patients will report that they have an improved quality of life More patients would recommend our services to their families and friends More staff would recommend our services to their families and friends The Trust will be providing more services to more people in Lincolnshire and beyond 2012-14 priorities Status Create a single point of access Single Point of Access rolled out to all four CCG areas in Lincolnshire Implement the Nursing Strategy in line with the 6Cs Develop Psychiatric Liaison services into acute hospital centres to assist with managing demand for care where people have a mental health condition as well as a physical condition Integrate services for people with Dementia Develop integrated community services Develop a Managed Care Network Implement Service Line Reporting, Service Line Management and Payment by Results to benefit front line patient care by devolving decision making to front line staff Developing step down accommodation for people being discharged from inpatient services Developing Drug & Alcohol Services in line with the new commissioned model of care Nursing Strategy developed and being implemented; Annual nursing conference Hospital Intensive Psychiatric Service being piloted in Lincoln County Hospital; PACT partnership to facilitate hospital discharge Service transformation programme in place for both inpatient and community services The Trust s new integrated multi-disciplinary teams, aligned to CCG boundaries, deliver a range of skilled interventions tailored to meet the individual needs of service users. Specific professional expertise includes psychological, medical and social aspects of care as well as assertive outreach and early intervention Working in partnership with LCC, the Trust has developed a network of local groups and third sector organisations, to support people who are discharged from LPFT services. SLR: Report development will be concluded in Feb 2014 for full roll out; SLM: Performance Framework and Devolved Decision Rights Framework developed and agreed and will be rolled out in Feb 2014 PbR: Clustering service users Partnerships developed with local authorities, charities and housing associations. Supported accommodation developed in partnership with Advanced Housing in Boston New DART service full implemented 1

1.2 Developing the 2014-19 Clinical Strategy This year, the Trust is striving for a more service-led, clinically driven business planning process. The refresh of the Clinical Strategy has been led by General Managers and Clinical Directors, with support from the Director of Nursing and Medical Director. Individual strategies have been developed for all services this work has involved frontline staff. Clinical strategy discussions have been framed with these key principles: Improving the patient journey Improving patient health outcomes Effectiveness and efficiencies of services that are as close to home as possible Keeping people in their homes as long as possible by providing high quality care by suitably qualified professionals Templates were provided to services to assist the development of their clinical strategy. The template guidance included prompts regarding service user/carer needs, expectations and involvement. Draft strategies are being circulated to Governors and the Group of 1000 2. Service Strategies Here are the headlines of the draft clinical strategies developed by the services. This is a long list of potential developments - in some cases, these plans will be subject to business case development, consultation and governance, identified funding and/or Board of Directors/Council of Governors approval. 2.1 General Adult Services Single Point of Access Working with 111 providers to facilitate direct referrals to LPFT via the SPA Expanding LPFT s SPA platform to other services in Lincolnshire and beyond IAPT (Lincs & Derbyshire) Sustain/develop a Patient/Service User Group to inform and support development of the service, and ensure meaningful engagement and consultation Expand the range of NICE approved psychological treatments available within the current contract Increase range of access and appropriate accommodation facilities Reduce waiting times Derbyshire: ensure a clinically and financially viable service under the AQP contract Lincolnshire: plan for the potential introduction of Any Qualified Provider Integrated Community Teams Reorganisation of the medical and psychology workforce to ensure integrated service delivery Training of all staff in early intervention ethos, interventions and treatment in order to maintain the EI service model Increasing the numbers of non-medical prescribers Implementation of OO-AMHS & the Recovery Star to support a move towards improved health and well-being and independent living 2

Increased use of technology and support mobile working capabilities Develop Service User and Carer groups Opening and continued development of the Recovery College with full service user involvement and engagement. The Recovery College is aimed at supporting service users to better understand mental health and well-being, to develop life skills including problem solving, returning to learning and resilience. The intention is for this to be focussed on promoting recovery and inclusion working in partnership with a wide variety of organisations and linking in closely with the Managed Care Network Acute & 24 hour community services Review Crisis & Home Treatment Service and its interface with the HIPS, Rapid Response and Emergency Duty Team services Reduce bed occupancy, aiming for an average length of stay of below 28 days Achieve AIMS accreditation for all inpatient services Improve the overall acute environment for patients at Lincoln Services in development To have a fully-funded HIPS service provided in each of the ULHT acute sites of Lincoln, Boston and Grantham Provision of Out of Hospital Care as an integrated Rapid Response team in conjunction with LCHS to support complex elderly patients closer to their homes and prevent admission into acute care when not clinically indicated 2.2 Specialist Services CAMHS Lincolnshire Tier 2 - Primary Mental Health Team - Additional investment from commissioners will be used to increase staff capacity which will enable the PMHT to continue to develop the early intervention/prevention part of their role in terms of training and awareness-raising Tier 3 - Core community team: service redesign to incorporate findings from the service review - Therapy Service for Children and Young People who are displaying Sexually Harmful Behaviours: develop integrated care pathway with all relevant agencies across health and social care - Self-harm: pilot additional capacity for working with children that are admitted to paediatric wards following self-harm or indicating suicidal ideation. The team also provide specialist training and advice to parents and other professions across Lincolnshire - Explore expansion of paediatric psychology services across a range of chronic physical health conditions to include the current child diabetic psychology service Work with commissioners to explore the development of a Tier 3+ service which would: - provide an intensive home treatment service to help step children and young people down to Tier 2 and Tier 3 - enhance the self-harm pathway in A&E - prevent admission to T4 services - provide emergency assessments, crisis response and facilitation of timely discharge from acute healthcare settings Tier 4 - Transform Lincolnshire s Tier 4 inpatient provision in light of local need, Tier 2/Tier 3 redesign and the change in commissioning arrangements 3

CAMHS North East Lincolnshire Evaluate performance of the new service model to inform future service provision Mental Health Rehabilitation Deliver mental health rehabilitation services in line with the new regional specification Achieve AIMS accreditation for all wards Implement the Productive Ward approach Rehabilitation pathway development - Review the unlocked rehabilitation wards - Continue to develop step down accommodation options for people leaving LPFT s inpatient services, working with partners including district councils, charities and housing associations Drug & Alcohol Recovery Team (DART) Work with Public Health to support the review of drug and alcohol services in Lincolnshire Work with the Dementia & Specialist Older Adult Mental Health Services to review a dementia pathway for Korsakoff s Syndrome with a view to creating the specialist input for this condition Dementia & Specialist Older Adult Mental Health Community service redesign: - Development of nurse led clinics in GP practices and care pathways - Development of CCG aligned community teams with functional mental health/dementia specific clinical pathways and skills - Integrated team working & enhanced CPNs to support primary care frailty agenda - Nursing Home support Improving the quality of older adult inpatient services, with a view to: - ensuring that people with functional illness and organic illness who are over the age of 65 are cared for in separate ward environments - incorporating evidence based environmental design for dementia - relocating the current dementia ward at Pilgrim Hospital (currently on the first floor) to a ground floor location on the same site, with access to suitable outdoor space. - developing behavioural, psychological support services in the community for people with complex behavioural needs Develop Shared Care protocol/follow up reviews with GPs Extend the Managed Care Network to support service users over the age of 65 Collaborative training and pathway development with St. Barnabas Trust for end of life care Collaborative working with LCC, Carers Partnership and Carers Connect around quality information and education Increase in psychological mindedness/treatment for dementia; - Community CST provision & delivery (linking to carer education) - In-patient therapeutic tool-box clinical pathway implementation Offender Healthcare Offender Personality Disorder (PD) pathway - Continue to work in partnership with key organisations such as Lincolnshire Probation Trust and HMP North Sea to deliver the offender PD pathway commissioned to date - Participate in the next stages bidding to secure funding to develop Psychologically Informed Planned Environments in Lincolnshire Prison healthcare - Develop a compelling new service model for integrated prison healthcare services in Lincolnshire, which is successful in retaining the existing business 4

Low secure inpatient service - Review and enhance the patient environment to ensure compliance with NHS England s standards Community forensic team - Service review and redesign to integrate the team into a broader offender health pathway Anorexia Nervosa Develop day services to improve eating disorder symptomology in those patients experiencing the most intensive problems from anorexia nervosa. This will lead to a reduced need for inpatient care, preventing or delaying admission and enabling patients to return to a community setting more quickly, and therefore reducing the overall use of out of county hospital beds Evaluate the effectiveness/proposal of a Halfway House to prevention admission to Tier 4 and facilitate earlier discharge from specialist eating disorder units Learning Disabilities Aspirations for developing LD services include: Inpatient services - Reviewing all LD inpatient services (assessment & treatment plus rehabilitation) - Offering respite beds for people who challenge services and cannot be managed in the community with CAST support - Scoping out expansion of inpatient services to admit people on lower end of autistic spectrum who present with mental health needs but are difficult to manage in mainstream inpatient settings Community services - Reviewing of the acute liaison nursing service with a view to providing a 7 day, 8am-6pm service. This will enable more people with a LD to be supported by the service in all 3 acute hospitals in Lincolnshire - Expanding Linkage enhanced psychiatry service to deliver psychology - Work with partners towards developing an integrated health and social care service for people with a learning disability - Exploring the viability of integrating CAMHS LD with adult LD services into an ageless LD service - Integrating CAST & Psychology into the 4 community locality teams to be part of integrated community teams delivering healthcare for people with a learning disability - Lowering the age of service users who can be referred to CAST to 14 years of age. This will allow young people with behaviours that challenge services to receive specialist behavioural interventions which could improve their health outcomes and reduce the need for inpatient care. This will require a business case to commissioners 2.3 Cross-divisional There are a number of services that have cross-divisional implications that require joint-working across the Trust and with external partners to improve pathways and services e.g. PD, ADHD, ASD, eating disorders and long term conditions Lincolnshire Assessment & Reablement Service: LPFT s priority is to create a more integrated rehabilitation and recovery service. This integration of health and social care will provide easier and faster access to better quality services, particularly for those suffering from a combination of health and social care conditions. Following staff consultation in January/February, the new system would then begin on 31 March 2014. 5

3. Quality Priorities 3.1 Patient Safety a. Ensure organisational learning is embedded and sustained (metrics could include: evidencing sustained learning from Serious Incidents through quarterly retrospective audit of an agreed number of implemented SI related action plans; improvement in national patient survey results; achievement of all CQUINs; evidence of involvement and implementation of recommendations made by carers and families identified within SI investigations; and evidence of dissemination of lessons learned via regular bulletins to staff. The Lessons Learned bulletins to include encouragement of staff to share strategies for successful implementation of lessons learned; and also encourage staff to ask for support where this is needed to successfully implement). b. Improve record keeping (metrics could include: evidence of compliance with CQC Essential Standards of Quality and Safety within CQC themed and MHA visits, required standard of record keeping demonstrated through audits completed within teams and across the Trust; evidence of patient and carer involvement in care and planning demonstrated through audit results; maintenance of up-to-date Provider Compliance Assessments (PCAs) across in-patient and community services; and evidence within records audits of responsiveness to allegations of abuse through appropriate safeguarding referrals being made). c. Improve Safety Thermometer outcomes (metrics could include: continued achievement of Safety Thermometer Older Adults, particularly LPFT focus on falls reduction, performance on the pilot Mental Health Safety Thermometer domains (second pilot started end October 2013); and performance on the pilot Medication Safety Thermometer domains (currently in pilot) and likely to be a national CQUIN in 2014/15). 3.2 Patient Experience a. Improve the overall experience of service users and carers (metrics could include: achievement of a higher percentage of excellent and good patient and carer feedback received through patient and carer feedback questionnaires that include the Friends and Family Test (FFT). It is recommended that the LPFT questionnaires are adjusted to take account of the National in-patient survey results (2013); achievement of the local CQUIN Making Every Contact Count (MECC), evidence of responsiveness to patient and carer feedback at ward / unit / team level; and evidence of responsiveness to PALS and Patient Opinion feedback. There is also likely to be a local CQUIN with a carer focus in 2014/15). b. Increase service user and carer involvement in service planning, workforce development; and delivery of care (metrics could include: the successful launch of the Recovery College; evidence of service user / carer consultation in LPFT policies development and review; increase in Involvement by patients and carers through initiatives including peer support and volunteering, service user and carer involvement from Ward / Team to Board levels in recruitment; consultation in clinical strategies and cost improvement proposals; and involvement in PLACE audits and 15 Steps visits). c. Improve responsiveness to service user, carer, staff and partnership agency feedback (metrics could include: improvement in 2014 patient survey results, improvement in 2014 staff survey results, evidence of timely responsiveness to complaints, PALS and Patient Opinion feedback, evidence of initiatives to improve cross agency working including within the Sustainable Lincolnshire project; and evidence of implementation of the recommendations from the Review of the NHS Hospitals Complaints System: Putting Patients Back in the Picture (Clwyd, A and Hart T, October 2013). 6

3.3 Clinical Effectiveness a. Improve early warning detection of risk (metrics could include: Heat Map (with evidence of adjustment to tool in response to local and national drivers such as audit and visits findings, CQC visits feedback, recommendations from SI and complaints investigations). b. Invest in staff leadership development and improve staff engagement (metrics could include: improved results from the Cultural Barometer and staff survey; evidence of achievement of staff Annual Appraisals, evidence of achievement of supervision in line with LPFT policy; and evidence of continued development and engagement of staff within the LPFT Inspirational Leadership programme). c. Increase external accreditation, participation in research; and benchmarking of new and existing services (metrics could include: evidence of an increase in AIMS and re-aims accreditation/other appropriate accreditation standard achievement across existing and new LPFT services (both in-patient and community), evidence of sustained or increased LPFT participation in research; and evidence of an increase in benchmarking, including of incidents and complaints trends). 4. CQUINS 2014/15 Next year s Commissioning for Quality and Innovation payments (CQUINS) are currently being negotiated with commissioners. The CQUINS for the standard block contract in Lincolnshire are likely to include: Autism-focussed local CQUIN (possibly a 2 year CQUIN), with the first year focus being on staff training and awareness Workforce Expectations local CQUIN (possibly a 2 year CQUIN) with a focus on Health Care Assistance, including development and launch of Code of Conduct for HCAs and development of competencies for HCA workforce Dementia-focussed local CQUIN with a quality of life focus and including the implementation of the Older Adult Star Making Every Contact Count (MECC) local CQUIN - awaiting detail of what requirements are likely to be if this is progressed Medication Safety Thermometer it is not clear yet if this will be a national CQUIN, but if it is not a national then it will be a local CQUIN Diagnostic Coding National CQUIN limited details available at present Friends and Family National CQUIN requirements for 2014/15 not yet specified. The CQUINS associated with NHS England commissioned services (i.e. Low secure, CAMHS and prison services) have yet to be agreed. The prison healthcare CQUINs are likely to include the Productive GP series, an adapted Friends & Family Test and healthcare for older prisoners. 7