2016 Re-designing Adult Mental Health Secondary Care Services through co-production and consultation 1 Adult Mental Health Secondary Care Services
Contents Forward Vision & Values Introduction Adult Mental Health Services in Worcestershire - Primary Care Services - Secondary Care Services Why redesign? - The importance of quality - Contractual changes - Environmental issues - Financial constraints Co-production Staff engagement The proposals Your view Next steps Contact details 2 Adult Mental Health Secondary Care Services
Thank you for your interest in supporting us with the changes we have to make to some of our mental health services. As a Trust we are committed to engaging both formally, through consultation, and informally with our patients, service users and the wider community to ensure the services we provide our fit for purpose and meet people s needs as well as they can. The challenges facing health and care services are well documented and while these do mean tough decisions are needed, we really believe that by getting out and talking to people who have first-hand experience or an interest can make a real difference Thank-you again for supporting this consultation; your views are important and they will inform the final the outcome we reach. Sarah Dugan, Chief Executive, Worcestershire Health and Care NHS Trust These consultation proposals have been informed by months of engagement and through conversations with current patients and service users, carer representatives, the wider community and our own staff. Although we have to save money, it has been clear through these conversations that we can re-focus these services in a way which can actually improve their overall effectiveness, support someone s recovery, and which better reflects what people who have experienced serious mental health conditions tell us works well. But we can only achieve this in partnership with our communities which is why we want these proposals to be considered by as many people as possible. Mental health can affect any of us so even if you re not in receipt of services currently, we still want you to take part in this and let us know whether these proposals are right for Worcestershire. Mark Dickens, Worcestershire Health and Care NHS Trust s Lead for Adult Mental Health Services 3 Adult Mental Health Secondary Care Services
Forward Worcestershire Health and Care NHS Trust is committed to making improvements to the way Mental Health Services across Worcestershire work. As part of this, work has already been undertaken to develop an enhanced primary care service (Worcestershire Healthy Minds); a single point of access for Adult Mental Health referrals (SPA); and a new vocational service (New Opportunities) This consultation document relates to a number of other secondary care services, that we also need to re-design for a number of reasons. Patient, family and carer feedback and recent audit recommendations and inspections told us that some things in these services work well, but that other things need to change. In addition, the development of the new services above, and the need to make savings meant we have needed to look again at how and where resources are being used. To achieve this we have embarked on a service re-design to look at how we do things and how services could be made more effective, more efficient and how they could offer a better patient experience and outcomes. The need to do the work within certain time frames, and to design a service within the resources we have been given, plus the fact that we need to meet key clinical and environmental standards presented an enormous challenge. To help us meet this challenge we turned to co-production - namely a collaboration between ourselves and individuals who use our services, their carers and other stakeholders who have worked with us in so many ways over a considerable period of time. We have facilitated a series of co-production workshops and staff engagement workshops, plus we have spoken to patient representatives, to the Health Overview and Scrutiny Committee, and have held monthly meetings with commissioner colleagues. This means from the outset we have involved very many stakeholders including patients, carers, staff, the voluntary and community sector, managers, clinicians, patient representatives, HOSC members and commissioners. Through this work we have developed themes, have looked in depth at their various strengths and weaknesses, have visited other Trusts to learn from them and have sense-checked our ideas with patients and clinicians to make sure they meet various criteria and above all to make sure they stayed true to what people told us. Through all of these conversations we have been better able to understand and establish what works well, what the issues and concerns are, and to start to develop new approaches that provide better ways of working. This consultation document is the product of this work and of the large number of workshops, meetings, presentations and discussions that have taken place. Over the coming months, we expect to further engage and consult with many people. As part of this, we are now asking for your comments, views, support and commitment on the proposals contained within this document, to help us take this work forward. Thank you for taking the time to read this document and for giving your view. We very much appreciate it. 4 Adult Mental Health Secondary Care Services
Vision and Values The vision of Worcestershire Health and Care NHS Trust is to be a leading organisation that works effectively in partnership with our stakeholders to deliver high quality integrated health and care services. The Trust has the following defined set of values that clarify what it believes in and how it will behave: Courageous: Displaying integrity, loyalty and the courage to always do what is right Ambitious: Striving to innovate and to improve through effective teamwork Responsive: Focusing on the needs and expectations of people using our services Empowering: Empowering people to take control of their own health and wellbeing Supportive: Enabling our staff to achieve their full potential and take pride in the services that they deliver The Trust Strategic Goals explain what it aims to achieve. These goals are: We will always provide an excellent patient experience Our services will always be safe and effective We will work in partnership to improve the integration of health and care Our organisation will be efficient, inclusive and sustainable Our re-designed Adult Mental Health Secondary Care Services must reflect the Trust vision, values and goals 5 Adult Mental Health Secondary Care Services
Introduction This consultation document is your opportunity to give your view on the proposed model for Adult Secondary Care Mental Health Services in Worcestershire. To enable you to give your view, this document gives you lots of information. It explains what services make up adult mental health care, and what services are included in the re-design. It then goes on to explain why a re-design is necessary, and the various factors quality, contractual, environmental and financial - that have called for us to look again at how services are organised and delivered. This consultation document also details the work that has been undertaken with a range of stakeholders to better understand what works well, and what needs to change. It explains what came out of these conversations and how feedback has been used in further discussions to shape and develop the proposals. The proposals are explained fully, and are supported with further information to show what they would mean for various groups, if they are adopted. We invite you to consider all the detail, the work that has been undertaken, and the proposals themselves and then please give us your view. Towards the end of the document we outline what will happen next and who to contact if you wish to discuss this re-design. 6 Adult Mental Health Secondary Care Services
Adult Mental Health Services in Worcestershire The Worcestershire Health and Care NHS Trust (WHCT) provide a range of primary and secondary care adult mental health services. Here, we outline all of them - both primary services as these have recently changed, and these changes are an important factor in this re-design, and secondary services, to show all those that are provided, and to show which are part of this re-design, and which are not. All services are now accessed through a new single point of access this is one place where all referrals go so that they can be directed to the most appropriate service. Primary Care Services - Worcestershire Healthy Minds (WHM) The majority of the referrals into the single point of access go to the Worcestershire Healthy Minds (WHM) primary care mental health services (70+ %). These services have been recently re-designed. The services that make up WHM are as follows: A Well-Being Hub this is provided through a voluntary sector organisation called Community First. This means that those wishing to access services can do so more easily and through self-referral. The hub will provide access to a Directory of Services to sign post people to a range of voluntary and community sector provision. Mood Master this is a course for those people experiencing low level anxiety and mood disorders. It is provided by Worcestershire voluntary and community service providers. Peer Supporters a network of people across the county who are there to offer support to others. This will be provided from October by Worcestershire voluntary and community service providers. Talking Therapies quicker access through a screening process to a range of therapies including counselling, cognitive behaviour therapy, psychology and family therapy. Gateway Workers professionals who liaise with GP s and who support a patient s transition from secondary to primary care. This service will be county wide from October 2016. The work that has been undertaken around the re-design of these services will make it easier for people to access early support from a range of providers statutory, voluntary and community. It also means that the same service is now being offered across the county. One example of this is the Improving Access to Psychological Therapies Services (IAPT) which was previously only available in certain locations, and is now offered across Worcestershire. The diagram below shows all the primary care services we have and how they work together: 7 Adult Mental Health Secondary Care Services
8 Adult Mental Health Secondary Care Services
Secondary Care Services The services that make up secondary care include Inpatient Acute wards, Community Mental Health Teams (CMHTs) and Home Treatment Teams (HTTs) and a number of specialist services and units. The full list of services is below: Community Mental Health Teams A Community Recovery Service (currently South of the County only) A Home Treatment Team An Eating Disorder Service A Peri Natal service An Enhanced Early Intervention in Psychosis Service Acute Inpatient wards Psychiatric Intensive Care Unit Recovery Inpatient Units Assessment / Crisis Service Psychiatric Liaison A&E Assessment Service Approved Mental Health Professionals Section 136 Suite ECT Suite Reablement and Vocational Services (New Opportunities) Not all of these services are included in this re-design. The services that are included in this proposal for re-design are: Acute inpatient wards: Hillcrest in Redditch, Harvington in Kidderminster and Holt in Worcester. The wards provide inpatient assessment and treatment of people with acute episode mental illness Home Treatment Teams: The teams offer a community-based service as an alternative to hospital admission to a psychiatric ward, and facilitate early discharge for admitted patients Community Mental Health Teams: Wyre Forest, Redditch and Bromsgrove, Wychavon, Worcester and Malvern. These teams offer assessment and treatment for people with severe and/or enduring mental illness or disorder in the community Recovery Service: South Worcestershire 9 Adult Mental Health Secondary Care Services
Why re-design? A re-design of secondary services is necessary for a number of reasons. These reasons are detailed below: The Importance of Quality The services regularly receive feedback through a range of audits, inspections, surveys and through compliments and complaints. Whilst the feedback received from these Quality Governance mechanisms is routinely used to help improve patient experience and safety, taken together they began to show that more comprehensive and farreaching changes were needed both to build on what we do well and to change what isn t working for those who use services. Patient and carer feedback was at the heart of the co-design process and more detail is provided about this later. However, to illustrate why the feedback from a range of sources contributed to the decision to re-design, a summary of comments and key themes are included here: What some people have said they find helpful about our services: Staff are compassionate, supportive, understanding. They listen, give people time and provide reassurance Patients are welcomed onto safe wards by staff who treated them respectfully Patients know how to contact staff and those who sought crisis support said they were given help when they needed it. Patients felt they were supported in other areas of their life Teams were complimented for listening, for being supportive and encouraging and for providing compassionate care and a safe space What is good is the friendly relationship with staff, someone to talk to, safety, feeling supported, being listened to Staff who help with practical things to enable people to get back to a stable existence as quickly as possible Services that enable people to keep living their own lives, whilst receiving treatment 10 Adult Mental Health Secondary Care Services
Issues and concerns that need to be addressed: Parking isn t so good at some sites Some of the buildings are noisy, poor quality and cold There are not enough activities for patients on wards Patients said they want more information and involvement in the health and care they receive. They want clear communication There needs to be greater access to talking therapies not just medication There needs to be better integration across different teams and other services There needs to be more peer support Patients said they want improved timely access across services Patients said they want better access to crisis services Patients want person centred care Patients want waiting list times to be reduced Patients said they only want to be on wards if they really need to be there Contractual Changes In the spring of 2015, the Clinical Commissioning Groups (CCGs) decided to re-design primary care mental health services. The outcome of this work was the development of the new enhanced primary care service that offers easier access to a wide range of services across the whole of Adult Mental Health. Another important role of this service is to promote easier movement across services so that as needs change, patients get access to the right service at the right time. The Worcestershire Healthy Minds service was first launched in April 2016, with development continuing right through to October 2016. This service was explained earlier. A second reason why secondary services need to be re-designed is that investment is needed to pay for these new WHM services. This investment has to be found from existing funding allocated to secondary care. In total 500,000 needs to be released from the Community Mental Health Teams to pay for the development of Worcestershire Healthy Minds new primary care service and the county wide single point of access. 11 Adult Mental Health Secondary Care Services
Environmental Issues In 2015 a Care Quality Commission (CQC) Inspection raised issues and concerns about a number of buildings used by secondary care adult mental health services including some inpatient wards and other facilities. The inspection of Harvington Ward in Kidderminster resulted in the need to undertake an extensive upgrade if it is to be made fit for future use. The cost of this was estimated to be 820,000 in 2014/15. An upgrade has already been undertaken at Hillcrest at a cost of 590,000. This inspection also raised concerns with the quality of the buildings at Orchard Place in Redditch and Waterside in Evesham, both currently used by patients in the community The third reason why secondary services need to be re-designed is to look again at the buildings we have, the resources we have, and how we can best provide high quality and safe services. Financial Constraints During 2016/17, the Trust needs to find savings of 2.3 million from the Adult Mental Health Secondary Care Services. As previously explained, some of this money is needed to pay for the new Worcestershire Healthy Minds service. Some of this money is what Commissioners and the Local Authority have asked us to find, and this is absorbed back into the local health and social care economy. In summary, a re-design is necessary to look again at services, what is provided, and how they are organised and delivered. The challenge of the re-design was to: develop clinically effective and safe services meet service user and commissioner expectations; adhere to NICE guidelines make the best use of the resources we have, including our estate; deliver within a reduced budget ensure implementation ensured within clear time lines 12 Adult Mental Health Secondary Care Services
Co-Production The re-design commenced with four co-production workshops that were held during February and early March 2016. In this context our co-production approach has been a collaboration from the outset between ourselves, individuals who use services and their carers, staff and wider stakeholders to generate ideas, develop a shared understanding of what needs to be changed and how best to achieve this. The workshops were open to and were attended by a large number of patients, carers, staff, managers, representatives from the voluntary and community sector, foundation trust members, patient forum members and interested members of the public. Attendees heard from a range of presenters about the challenges, the givens and the constraints of this work. They also heard about other approaches and how things are done in other parts of the country. However, the largest part of the workshop focused on patient and carer experiences of services communicated through survey feedback and patient stories. Through these feedback mechanisms attendees heard that patients want staff that have time to care, they want to be listened to and they want to receive information and be involved in their treatment. Patients said they want calm, spaces in which to recover and that sometimes the mix of patients in wards was not conducive to that recovery. They said they want services to understand they are more than their illness and that they want the focus to be less medicalised and more therapeutic and recovery based. Through a series of discussions five key themes emerged. The themes focused on both the structure of services and what needs to change to improve patient experience and they are below: Reduce inpatient acute wards, and provide facilities at a centralised base or one in the north, and one in the south Provide inpatient wards that have a clear function to provide a) intensive triage/assessment and b) treatment for the acutely mentally ill only Provide alternative provision in the form of locally available Crisis Beds or Safe Houses and Recovery/Rehab focussed units to step down from inpatient acute care An increased and improved Home Treatment Team service to care for more people in their own home Specialist Community Mental Health Teams with a clear function and remit to provide services to patients with serious mental illness At a final workshop, these themes were considered in more depth their strengths, weaknesses and how these could be resolved. These key themes were taken forward to a series of re-design workshops with managers and clinicians where the proposals were more fully developed 13 Adult Mental Health Secondary Care Services
Staff Engagement Four re-design workshops were held with managers and clinicians. The workshops focused on how services could be re-designed to reflect the five key themes and what patients said were important, and ensure services offered were safe, adhered to guidelines, made best use of resources and allowed the organisation to realise the necessary savings. The workshops looked at both inpatient and community care and considered many approaches and ideas. Some clinicians also visited other Trusts to learn more about how they deliver a high quality assessment and treatment models of care, as this was one of the five key themes from the co-production work. In addition, four staff workshops were held to give the wider staff group the opportunity to hear about the work and give their views and ideas. All of the feedback was used to develop the proposals that we now need to consult on. 14 Adult Mental Health Secondary Care Services
The Proposals The proposals below have been developed to reflect the following key themes: Reduce inpatient acute wards, and provide facilities at a centralised base or one in the north, and one in the south Provide inpatient wards that have a clear function to provide a) intensive triage/assessment and b) treatment for the acutely mentally ill only Provide alternative provision in the form of locally available Crisis Beds or Safe Houses and Recovery/Rehabilitation focussed units to step down from inpatient acute care An increased and improved Home Treatment Team service to care for more people in their own home Specialist Community Mental Health Teams with a clear function and remit to provide services to patients with serious mental illness Community Mental Health Teams At the co-production workshops, many participants shared the view that they were not clear of the function of Community Mental Health Teams, and some suggested that the role of the teams be clarified, and the caseloads be looked at again to make sure the patients were receiving the right service for them and that staff were only working with those with serious mental illness. In order to provide community teams with a clear function and remit to provide services to patients with serious mental illness, we are proposing a Community Assessment and Recovery Service (CARS) be developed. We have already undertaken an in-depth analysis of current staffing, role, function, caseloads and location and whilst this work continues we better understand which patients need secondary care and which patients have needs that would be better served by being transferred to Worcestershire Healthy Minds. We have reviewed the Gateway Worker role and these staff will be there to help support such transfers by liaising with GP s. This would help ensure that the teams do have a clear function to care for those with serious mental illness and it would help make sure that patients were receiving the care and support that is right for them. Inpatient care Through the workshops, participants told us that inpatient services should only be provided for those who are acutely unwell, with home care and treatment being offered much more than it currently is. Many patients said that they wanted to be treated at home and they felt that some admissions were unnecessary. Many also expressed 15 Adult Mental Health Secondary Care Services
concern around very unwell patients being on the same wards as those who are recovering. In order to help reduce the use of inpatient ward based beds, and make sure they have a clear function to provide assessment and treatment we are proposing an intensive, 7 day assessment ward, and a separate treatment ward. Having undertaken work around this we know that it is clinically advised to separate the wards this also reflects what people told us they wanted. Based on another Trust s experience, we also know that if the model is to work, a treatment ward needs twice as many beds as an assessment ward, i.e. a ratio of 1 assessment bed to 2 treatment beds. Current estate can only support this if we use Holt (Worcester) and Hillcrest (Redditch). It is important that we use Holt ward for assessment because it also has close access to lots of other facilities such as the Psychiatric Intensive Care Unit (PICU) and the Section 136 suite. As an assessment ward, Holt could offer up to 14 beds. Hillcrest would be the only ward that has the capacity to offer the required treatment bed ratio for this model, namely it could provide up to 25 beds, whereas Harvington has only 18 beds. Also, Hillcrest offers more desirable single room accommodation whilst Harvington retains dormitory style shared areas. There is also the fact that Hillcrest has been refurbished and does not require immediate investment whereas Harvington, as previously stated, would need a substantial amount of investment to reduce risks to patients and could not offer the number of individual treatment beds required, presenting significant additional financial challenges. This proposal would see the closure of Harvington Ward in Kidderminster. Alternative provision to inpatient beds At the workshops we considered a number of alternatives to inpatient beds including crisis and safe house models. Although current estate and financial issues would inhibit the development of this at this time, it is our proposal that to provide alternatives to admission we undertake the following: - Link in with approved, supported living providers, who provide 24 hour supported care, - Review the use of our services at Keith Winter Close and Cromwell House to explore how these facilities may be utilised further, - Explore with commissioners the possibility of a Worcester based specialist Community Personality Disorder service, - Develop a business case with commissioners for a locked Rehabilitation service in Worcester. The above would allow us to explore and possibly develop a range of inpatient alternatives to meet a range of needs. The proposals for the service, and how the various parts of the service will link together, are shown in the diagram below: 16 Adult Mental Health Secondary Care Services
17 Adult Mental Health Secondary Care Services
What would this mean for patients and carers? The scenarios below will give some ideas around what these changes would mean for some patients and carers, if the proposals were accepted. We cannot give examples of every scenario here but these questions reflect some that have been asked of us already. I am currently a patient of the Community Mental Health Team and am seen at a place that is local to where I live. Will this arrangement continue with the new CARS Team? CMHT patients will still be seen locally by their team of Psychiatrist, Psychologist, Nurse or Social Worker, Care Coordinator or Recovery Workers. However those patients and families used to accessing Orchard Place in Redditch will have their appointments offered at Hillcrest or New Brook in Redditch, depending on what is nearest and most convenient for the patients. This would help us address the concerns raised about the quality of Orchard Place. Will the new CARS team work with me in the same way as they do now? The CARS team (the future CMHT) will work with you in a more recovery focussed way. They will do this by working through therapeutic groups and specialist interventions to support you through your recovery. CARS will also have earlier access to the Home Treatment Team (HTT). Earlier support from HTT will help avoid admission to hospital and ensure patients are seen earlier on in to prevent further deterioration of their mental health. The co-production themes said there should be an increased role for the HTT. What else will the HTT do? THE HTT will also be supporting patients to be discharged home earlier from wards. They will do this by offering intensive support packages. This will help to reduce the length of stay in hospital and will mean people can be treated in their homes rather than in a different locality. The HTT will also be working with all patients experiencing a crisis to provide support at an earlier stage. The HTT service will offer Intensive Treatment and Early Discharge functions and through this we will ensure we are safely supporting patients and their carers at home for as long as they need, so avoiding admissions and reducing unnecessary hospital stays. The changes to CMHTs and the current HTT team will help ensure patients are supported in the community and as near to home as possible. 18 Adult Mental Health Secondary Care Services
I am a carer of someone with mental ill-health. An increase of care being offered in the home will have implications for me. How will you make sure you support and involve me? In this model carers receive support directly and when required. This is facilitated by the closer working relationships which develop when patients are cared for in their home and in partnership with themselves and their carers. It also means that the patients needs are more directly addressed - the management of symptoms and psychological distress can be assessed in a meaningful environment where the views of carers on the efficacy of treatment interventions are not clouded by the artificial environment which is created by an inpatient ward. Carers often feel guilt and distress at supporting an admission to hospital as well as the patient often feeling angry that their families/carers did not prevent the admission. This approach means that hospital admission only happens where there is a risk to life or severe neglect. Home Treatment is more convenient and less disruptive for the carers and the wider support network of the patient and reduces the financial impact of a period of ill health. Due to the venue of care being the patient s own home carers are more available to discuss and engage in the process of treatment whilst being able to retain their own daily schedule and similarly the patient can continue with their daily tasks when they are able. Is Older Adult Mental Health included in this too? Child and Adolescent Mental Health Services (CAMHS) & Older Adult Mental Health Services (OAMHS) are not affected by this consultation but will be part of the patients care pathway. Our new model will ensure referral criteria in and out of its services is clear and will work closely with CAMHS & OAMH services to ensure smooth transfers of care. The proposed changes outlined here will not have an impact on the transition arrangements laid out in policy which are already in place for patients moving between services provided by the Worcestershire Health and Care NHS Trust. The proposals speak a lot about offering care in the community or at home, where possible. However, what will they mean if I do need to go into hospital? Where admission is needed, the proposed new model is designed to ensure an assessment bed is readily available and the Home Treatment Team will be supporting patients to be discharged home earlier from wards with intensive support packages. This will reduce the length of hospital stay needed and will mean we can treat people in 19 Adult Mental Health Secondary Care Services
their own homes rather than in a hospital ward. The main changes for all patients for whom admission is necessary will be that they will be admitted for assessment on Holt ward (Worcester) and if needs be, they will then be transferred to Hillcrest (Redditch) for treatment. The new model looks to a 7 day admission for assessment and early discharge to HTT or back to CARS for community support. The model provides an assessment and treatment procedure which is delivered by the team in a timely manner within a care system that will work together. Acute in-patient care is considered a brief intensive intervention as it recognised that excessively long stays in inpatient units can be unhelpful for patients. The patients admitted to the assessment wards will benefit from an environment, staffing levels and a range of staff skills which would allow for a rapid assessment of needs and symptom management. We will be working with you towards discharge, from the point of admission. 20 Adult Mental Health Secondary Care Services
Your View We now want to understand what you think about these proposals. Please answer the following: In order to provide community teams with a clear function and remit to provide services to patients with serious mental illness, we are proposing a specialist Community Assessment and Recovery Service (CARS) be developed. Our aim would be to review patient needs and transfer some patients to Enhanced Primary Care (part of the new Healthy Minds service) if they would be better served by that service. Gateway workers would support this work by liaising with GP s. This would help ensure that the teams have a clear function to care for those with serious mental illness and it would help make sure that patients were receiving the care and support that is right for them. Please tell us how you feel about this proposal by ticking one of the following Strongly Agree Agree Neither agree nor disagree Disagree Strongly disagree Please tell us why you chose this option In order to reduce inpatient wards, and make sure they have a clear function to provide assessment and treatment we are proposing an intensive, 7 day assessment ward, and a separate treatment ward. The assessment ward would be in Worcester (Holt Ward) and the treatment ward would be in Redditch (Hillcrest Ward). This would ensure those undergoing assessment have access to the other facilities on the Worcester site. It would also ensure that we could provide the clinically required bed ratio of 1 assessment bed to every 2 treatment beds that is required for this approach. The proposal would see the closure of Harvington Ward. Please tell us how you feel about this proposal by ticking one of the following Strongly Agree Agree Neither agree nor disagree Disagree Strongly disagree Please tell us why you chose this option 21 Adult Mental Health Secondary Care Services
In order to provide alternatives to inpatient beds our proposal is that we undertake the following: - Link in with approved, supported living providers, who provide 24 hour supported care - Review the use of our services at Keith Winter Close and Cromwell House to explore how these facilities may be utilised further - Explore with commissioners the possibility of a Worcester based specialist Community Personality Disorder service - Develop a business case with commissioners for a locked Rehabilitation service in Worcester Please tell us how you feel about this proposal by ticking one of the following Strongly Agree Agree Neither agree nor disagree Disagree Strongly disagree Please tell us why you chose this option If you have any further comments, thoughts or views that you wish us to know, please include them below: 22 Adult Mental Health Secondary Care Services
Next Steps This consultation will be open from 20 th July until 28 th September a period of 10 weeks. During this time, we will be attending many meetings, forums and events to talk to lots of different people, and we will be holding a number of consultation events where we will talk through these proposals and give people an opportunity to explore them and share their views with others. Information about these events will be available on the Trust website. During this time, we will also be consulting with staff and various staff groups Depending upon the outcome of the consultation, we will begin to implement changes from October through to December 23 Adult Mental Health Secondary Care Services
Contact Details If you have any queries about these proposals, you can contact: Jane Thomas, Head of Community Engagement and Patient Involvement at jane.thomas30@nhs.net or by calling 01905 733827 Thank you for reading and completing this form. Your view is very important to us and we very much appreciate your support. 24 Adult Mental Health Secondary Care Services