Urquhart Castle, Loch Ness North of Scotlad Maaged Cliical Network for Eatig Disorders Aual Report April 2008 March 2009 St Magus Cathedral, Orkey Isle of Lewis Tay Rail Bridge, Fife Crathes Castle, Grampia Lerwick, Shetlad
North of Scotlad Maaged Cliical Network for Eatig Disorders Aual Report April 2008 March 2009 Cotets Foreword 04 Summary of Network Achievemets over the past year 05 Network Activities The Ede Uit 06 Patiet Cosultatio Evet 09 Cofereces 11 MCN 10 Years O Evet 12 Grampia Eatig Disorders Service 12 Tayside Eatig Disorders Service 13 Highlad Eatig Disorders Service 15 Eatig Disorders Educatio ad Traiig Scotlad 16 Electroic Cliical Record 17 Quality Assurace Programme 19 Fiacial Report 20 Membership 21 Appedices Appedix A Patiet & Carer Cosultatio Day Report 22 Appedix A1 34 Appedix A2 35 Appedix A3 36 Appedix A4 37 Appedix A5 38 Appedix B 39 Page 02 03
Foreword Summary of achievemets i the past year The Eatig Disorders Maaged Cliical Network has had a very busy year which has culmiated i the opeig of the 1st NHS Eatig Disorders Ipatiet Uit i Scotlad. Pages 5 7 of this report explais more about the uit. This HDL reiterated the core priciples uderpiig MCN developmet ad covers issues such as itegratio of MCN s with other NHS bodies; leadership ad maagemet; patiet ad carer ivolvemet; accreditatio; ad iformatio techology. These are all areas i which we have bee workig o i the past year. We would like to take this opportuity to thak all staff across the Maaged Cliical Network for all their hard work i the past year which has cotributed greatly to the good progress we have made. The Ede Uit opeed its doors to patiets o 1st February 2009. A successful Patiet & Carer Cosultatio evet took place i Jue 2008. A quality assurace sub-group has bee formed. Referral pathways for NHS Grampia, NHS Highlad ad NHS Tayside have bee developed. Aother successful Eatig Disorders Coferece was held i Aberdee i November 2008. Work is progressig o the Natioal Eatig Disorders Educatio ad Traiig Scotlad project. Cotiue to be ivolved i discussio with NSD ad private sector providers. Geeric Cliical System Electroic patiet record. Work cotiues o this project ad it is hoped that this will be rolled out to NHS Tayside ad NHS Highlad i the ext few moths. Lida Keea Network Maager Dr Harry Millar Lead Cliicia The system is beig used i the Ede Uit o a daily basis. A core set of eatig disorders questioaires are beig used i Eatig Disorder Outpatiet services i the North of Scotlad. Poster Presetatio at the Maaged Cliical Network 10 years o Coferece. Participatio i the North of Scotlad Plaig Group (NoSPG) Aual Plaig Evet. Cotact: Lida Keea, Network Maager, Maaged Cliical Network for Eatig Disorders, Beachie Buildig, Royal Corhill Hospital, Corhill Road, ABERDEEN, AB25 2ZH. Tel: 01224 557624 Email: lida.keea@hs.et Web: www.eatigdisorder.hsgrampia.org 04 05
Network Activities The therapeutic programme ad treatmet approaches, where possible, will be used accordig to evidece based criteria ad guidelies produced by NICE ad QIS. The followig therapeutic modalities will be available i the uit: Cogitive Behaviour Therapy (CBT). Motivatioal Ehacemet Therapy. Body Image Work. Psychiatric/Medical maagemet icludig re-feedig. Eatig Skills Developmet. Attetio to excess exercise, vomitig, laxative misuse ad other abormal behaviours associated with eatig disorders. Self Esteem work. Nutritioal educatio. Family work. Art Psychotherapy. The uit will be led by a full-time Cosultat Psychiatrist who is joitly fuded by NHS ad Aberdee Uiversity. I additio to the Psychiatrist there will be the followig skill mix of staff: The Ede Uit Work has bee ogoig throughout 2008 i preparatio for the opeig of the ew ipatiet uit. The uit will serve the 6 North of Scotlad Health Boards (Grampia, Highlad, Tayside, Orkey, Shetlad ad Wester Isles pop. C1,306,300). It is based i Royal Corhill Hospital, Aberdee ad the operatioal maagemet will be by the Specialisms Directorate of NHS Grampia Metal Health Services. The uit will serve the populatio aged 18-65 years. I certai, exceptioal circumstaces admissios betwee the ages of 16-18 may be cosidered. The total populatio of these areas for the age group 18-64 is circa 813,400. The uit is a 10 bedded uit with a itegrated day patiet programme accessible by the i-patiet populatio ad o a day patiet basis. It has 6 sigle e-suite bedrooms ad a 4 bedded bay. There is a therapeutic kitche, patiet s sittig room, group rooms ad iterview rooms. The uit is self cotaied with the staff havig their ow office space withi the uit. A cliical operatioal policy ad a busiess operatioal policy has bee developed which will help iform decisio makig aroud admissios ad maagemet. A itegrated formulatio method will be used to guide the psychological itervetios for a give idividual, ad the expectatio is of a idividually desiged care pla for each patiet, usig the itegrated formulatio as a guide. 05. wte Staff Grade Doctor i Psychiatry. 0.2 wte Staff Grade Doctor i Gastroeterology, i cojuctio with Aberdee Royal Ifirmary. 1.0 wte Bad 7 Nurse. 1.0 wte Bad 6 Nurse. 8.76 wte Bad 5 Nurses. 9.20 wte Bad 2 Nursig Assistats. 1.0 wte Dietitia. 1.0 wte Occupatioal Therapist. 0.5 wte Physiotherapist. 0.3 wte Art Therapist. 0.2 wte Pharmacist. 1.0 wte Cook. 1.2 wte Secretarial Support. 1.0 wte Domestic. 0.10 wte Phlebotomy. 0.5 wte Social Worker. The day patiet programme has the followig skill mix of staff: 1.0 wte CBT Therapist. 0.5 wte Bad 5 Nurse. 0.5 wte Occupatioal Therapist. There are resources held over, i wait of a substative Cosultat Psychiatrist appoitmet, to further develop the psychological therapies of the uit. The majority of staff were i post as of 1st Jauary 2009 ad spet the first moth udergoig a extesive traiig ad iductio period. 06 07
Patiet & Carer Cosultatio Evet 17th Jue 2008 The full report from this evet is available at Appedix A. I Jauary 2008 the Maaged Cliical Network for Eatig Disorders North Scotlad applied to the Scottish Health Coucil for a small grat to do a umber of thigs with the mai oe beig to host a Patiet ad Carer Cosultatio Day. The aims of the day were to: Show them the proposed space set aside for the uit. Ask them what they thought the uit should look like. Ask them what they feel would help aid their recovery. What types of therapy have they foud useful. What they felt would ot be helpful. Have a ope discussio o the outpatiet jourey of care. I March 2008 we were iformed that our applicatio had bee successful ad plaig bega. To publicise the evet drew up a flyer ad set this to everyoe we could thik of icludig GP surgeries across the North of Scotlad, volutary orgaisatios, other eatig disorder services i North Scotlad. We also issued a press release ad did radio iterviews to publicise the evet. The respose was good ad there were several iterested parties, some of whom were uable to atted the evet but were willig to submit writte feedback ad complete ay questioaires that we could sed them. We used 2 questioaires plus a evaluatio questioaire. These were set out for completio before the evet ad attedees had access to them o the day. We also set out a iformatio sheet to give people a little bit of the history ad decisio makig uderpiig the uit. There were 17 people atteded o the day, with a mixture of patiets/ex-patiets ad carers. The day cosisted of 3 workshops cocetratig o the followig: Workshop 1 Therapies. Workshop 2 Facilities for the ew uit. Workshop 3 The outpatiet jourey. The evet was a great success ad may ideas ad suggestios for the ew ipatiet uit were take o board. Feedback was extremely positive with almost all who atteded agreed that they would be happy to be cotacted i the future about ay areas that required patiet ad public ivolvemet. 08 09
Cofereces NHS Grampia Eatig Disorders Coferece November 2008 Aother very successful Eatig Disorders Coferece was hosted by NHS Grampia i November 2008. The Coferece was etitled Co-morbidity ad Complexity i Eatig Disorders. It was extremely well atteded ad received with reowed speakers such as Professor Gle Waller ad Professor Bria Lask. A Poster Presetatio sessio was also well received ad the MCN for Eatig Disorders has a poster at this sessio (Poster attached at Appedix 2). The posters o display were a mixture of research ad iformatio posters. It is hoped to ru a similar sessio at the ext coferece. Aother Coferece is plaed for 26th & 27th November 2009 etitled Research ito Practice. Preparatios are well uderway with maifloor speakers already cofirmed icludig Professor Chris Fairbur, Oxford Uiversity Departmet of Psychiatry, Dr Ulrika Schmidt, Kigs College, Lodo, Dr Joh Morga, St Georges Uiversity of Lodo ad Ursula Philpot, Seior Associate lecturer: Dietetics, Leeds Metropolita Uiversity. As a follow o from the evet 3 patiets came alog ad helped to pick furishigs ad fabrics for the ew uit. A fial report was set to the Scottish Health Coucil i March 2009 ad the full report from the evet has also bee published o the Evolvig Practice Website. www.evolvigpractice.org. The coferece is becomig well established ad is attractig audieces from far ad wide. If you wish to book a place o the coferece for this year please cotact Carol Deas (cdeas@hs.et) who will be happy to assist you. Below is some of the feedback received from the November 2008 Coferece:- A well orgaised coferece. Packed with excellet preseters. Ejoyed poster presetatios. This is the first time I have atteded ad I have ejoyed both days. The coferece was iterestig, motivatig ad thought provokig. From the coferece I took away the kowledge of eurosciece ad aorexia ervosa, kowledge of midfuless ad a slight axiety about future practice. Officially the best coferece I have bee to. The quality ad cotet of speakers was excellet ot ofte do I remai iterested at these thigs from start to fiish but with this coferece I did! Oe of the best cofereces that I have ever atteded. The cotet ad facilitators have bee excellet. I hope to retur ext year. 10 11
Maaged Cliical Networks 10 Years O Tayside Eatig Disorder Service Both Dr Millar ad I atteded the above coferece i November 2008. The coferece was ru i cojuctio with NHS Scotlad, The Scottish Govermet ad the Istitute of Healthcare Maagemet. It was a Coferece to celebrate 10 years of Maaged Cliical (ad other) Networks i Scotlad. We provided a poster presetatio for the evet (See Appedix F) which cocetrated o how we, as a MCN for Eatig Disorders were achievig the Core Priciples for MCN s as laid dow i NHS MEL (1999) 10 Itroductio of Maaged Cliical Networks withi NHS Scotlad ad HDL (2007) 21 Stregtheig the role of Maaged Cliical Networks. The Coferece was extremely well atteded ad provided us with a isight ito other MCN s ad how they were progressig ad developig. It also allowed us to make cotact with other etworks ad fid out how they worked ad what areas they cocetrated o. It became apparet that collatig good quality data was a extremely complex but vital part of the work of a MCN. This was somethig that we were already aware of ad oe of the areas we hope to cocetrate o over the forthcomig moths. Curret Cliical Staff (listed i order of appoitmet) 0.6 wte Cosultat Cliical Psychologist/Lead Cliicia Paula Colli (curretly o materity leave util summer 09). 3 x 0.5 wte Cliical Psychologists (oe each for Dudee Gillia Paterso; Perth & Kiross Suzae Deas; ad Agus Louise Hobbs). 1.0 wte Dietitia Elizabeth Stewart. 1.0 wte Specialist Nurse Bria Grieve. 1.0 wte Admiistrator Diae Atkiso. 0.5 wte Cosultat Psychiatrist Akur Gupta. Teachig Commitmets Teachig o the maagemet of eatig disorders is provided by the service o a ogoig basis to both professioal ad o-professioal groups, locally ad atioally: NHS Tayside Psychiatry CPD sessio (July 08). NHS Tayside Psychological Therapies CPD day (July 08). Grampia Eatig Disorder Service I the last year the departmet has udergoe further chage with ew ad experieced staff comig o board ad loss of other staff to ew challeges. There remai two posts still to be filled but with every expectatio that will take place i the comig few moths. The departmet has cotiued to try ad develop the services it offers so that i adoptig a more motivatioal stace with its patiets. The Cotemplatio Group has ow bee ruig for some time ad has proved of great worth to some service users, likewise the retur of a Body Image Treatmet Group which we would hope ca play a regular part to the service provisio of the departmet oce staffig umbers are more optimal. As a service we cotiue to work extesively with Video Therapy cotacts ad also triage patiets by video lik. Likewise the ogoig developmet of the Excelicare Electroic Patiet Record cotiues with staff members icreasigly makig use of it i preferece to the multiplicity of paper records. A ew Operatioal Policy has bee agreed withi the service ad this fial draft will shortly be put to Local Maagemet Teams. Departmet staff cotiue to take a role i educatio through other departmets ad also a umber of staff members are highly ivolved i the ruig of the Aual Eatig Disorder Coferece i Aberdee which eters its fourth year o 26th/27th November 2009. Fially a Local Educatio Group is ow up ad ruig which will be shared betwee us, other iterested parties ad of course the North of Scotlad I-patiet Uit staff. NHS Tayside GPs CPD sessio (September 08). The Priory Hospital, Glasgow, CPD sessio (October 08). NHS Tayside CMHS CPD sessios i Dudee ad P&K (November 08). NHS Grampia 3rd Aual Eatig Disorders Coferece (November 08). 9th Iteratioal Eatig Disorders Coferece, Lodo (March 09). Traiig Placemets There is curretly 1.0 wte (Flexible) Traiee Cliical Psychologist, Vivie Smith, attached to the service (o materity leave from April 09). Aother traiee, Melissa Haa, is due to begi a six-moth specialist placemet from April 09. I additio, short-term placemets have bee offered to two medical studets ad a studet urse over the past year. Further placemets are aticipated (e.g. a four-week placemet has bee arraged for aother studet urse i September 09). Meetigs/Committees/Professioal Groups British Psychological Society (Divisio of Cliical Psychology) Eatig Disorders Special Iterest Group Paula Colli, member. NHS Educatio Scotlad Natioal Eatig Disorders Educatio ad Traiig Committee o represetatio from Tayside i Paula Colli s absece. North of Scotlad Maaged Cliical Network for Eatig Disorders Paula Colli, NHS Tayside a Cliical Psychology represetative (Gillia Paterso i Paula s absece); Elizabeth Stewart, Dietetics represetative (also a member of the Quality Assurace Group); Akur Gupta, Psychiatry represetative (also atteds regular Ipatiet Uit meetigs). Scottish Dietitias Eatig Disorders Cliical Forum Elizabeth Stewart, member. NHS Tayside Nutritio Network Elizabeth Stewart, member. Scottish Eatig Disorders Iterest Group Paula Colli, Suzae Deas, Louise Hobbs, Gillia Paterso ad Elizabeth Stewart, members; Suzae Deas, committee member. 12 13
Research Activities A programme of joit eatig disorders research is ogoig, with NHS Tayside Psychological Therapies Service workig i partership with The Priory Hospital, Glasgow. Service Challeges Developig ad deliverig a accessible ad resposive eatig disorders service for NHS Tayside patiets ad their carers. Takig a lead i dissemiatig, ad esurig the delivery of, the curret evidece-based approaches to the maagemet of eatig disorders across Tayside ad also the North of Scotlad. Cotiuig to develop close liks with other orgaisatios/services maagig patiets with eatig disorders. Desigig ad dissemiatig research ito aspects of eatig disorders. Implemetig a efficiet service by utilisig a variety of itervetio formats (e.g. group treatmets, active o-itervetio ). Participatig i plas for a service user/support group. Securig a adequate base for the service, particularly i respect of cliical duties withi the Dudee area. Service Iovatios Ogoig participatio i a MCN workig group, which is aimig to harmoise the use of cliical assessmet/outcome measures throughout the North of Scotlad. Participatio i a MCN workig group, focusig o the ogoig developmet of the 10-bed ipatiet uit ( The Ede Uit ) at Royal Corhill Hospital, Aberdee, for the itesive treatmet of patiets with severe eatig disorders from the North of Scotlad. This uit opeed i February 09 ad cliical staff atteded a ope day i Jauary 09. To date, oe patiet has bee admitted from NHS Tayside. Maitaiig liks with NHS Educatio Scotlad Natioal Eatig Disorders Educatio ad Traiig Committee, which is developig a system of accreditatio for traiig i eatig disorders. The service is cotiuig to explore the possibility of adoptig a speciality-specific computer-based records system curretly i use withi NHS Grampia Eatig Disorders Service. Meetigs have bee held with NHS Tayside s IT departmet ad will cotiue oce a umber of glitches have bee iroed out with the system as it stads. The use of videocoferecig remais a possibility ad a couple of local sites have recetly bee visited. A draft of a iformatio leaflet for sufferers ad their carers has recetly bee forwarded to our Cliical Goverace Coordiator. A iformatio pack for GPs has bee produced. The service is cosiderig the most efficiet ad effective meas of deliverig this iformatio. A post outlie for specialist GP sessios is curretly i preparatio. Highlad Eatig Disorder Service 2008-2009 has bee aother busy year for us, begiig with recruitig some ew staff. We ow have a Staff Grade Psychiatrist workig with ourselves withi the Psychotherapy Departmet ad a ew Nurse Therapist has take up a retiremet vacacy. This brigs our staffig complemet up to the followig: Cotiued professioal developmet has ivolved attedace at a umber of evets: BABCP coferece (July 08), Behavioural Family Therapy (March 09), Schema-Focused Therapy (March 09), Cogitive Behavioural Therapy (March 09). The service is facilitatig research i the field by assistig a fial year cliical psychology traiee with recruitmet for her doctoral thesis. Cosultat Psychiatrist 0.3wte. Two Nurse Therapists 1.2wte. Dietetic iput 0.3wte. Staff Grade Psychiatrist 0.6wte. We also have two traiig placemets filled at the momet with oe Nurse Therapist o secodmet for oe day per week ad a ST4 Psychiatric Traiee with us for aother oe day per week. There has bee a icrease i our referral umbers but we have still maaged to achieve our target of seeig urget referrals withi oe week ad routie referrals withi two to three moths. Expasio of staffig ad icreased cliical activity has icreased the eed for additioal office space ad we have just moved from our base at Larch House to a ewly reovated buildig at Greefields House o the New Craigs Hospital site. Whilst maagig the move has geerated cosiderable work for the team, we are ow successfully established i our ew premises. We cotiue to be able to offer CBT, DBT ad IPT to our patiets. Oe of the Nurse Therapists o secodmet with us last year has moved oto a post providig IPT traiig ad supervisio for NHS Highlad ad our recetly recruited Nurse Therapist has take up a place o NHS Highlads first IPT traiig course. She is also participatig i DBT traiig ad workig towards BABCP accreditatio as her colleague has already attaied. Our Staff Grade is traied i EMDR ad is also earig completio of the South of Scotlad Post Graduate Diploma i Cogitive Behavioural Therapy. As a team, we cotiue to participate fully i all of the MCN workig groups ad cotribute to NEETS ad SEDIG developmets. Further details of our service are available o both the MCN website ad Highlad Iteret Site. 14 15
Eatig Disorders Educatio ad Traiig Scotlad Electroic Cliical Record Iitial fudig of 5700 was allocated by NES to develop a 3 year busiess pla for Eatig Disorders Educatio ad Traiig i Scotlad. The origial Project Proposal has bee updated ad was submitted to NES at the ed of March 2008. A SLA has bee agreed ad further fudig of 33,700 has bee allocated by NES to take the project forward. Work has bee ogoig to develop the Accreditatio pack durig 2008 ad is curretly beig piloted by members of the group. The pack is a evidece based pack where people udertakig the accreditatio process have to provide evidece that they have completed the ecessary sectios. The traiig which couts towards accreditatio ca iclude attedace at cofereces, workshops ad other traiig evets. It may also iclude some electroic ad distace learig activities. It must total a miimum of 100 hours ad iclude the acquisitio of both kowledge ad skills. There is also a compoet of cliical practice where a desigated supervisor will assess whether or ot someoe has demostrated competece. For further iformatio o the pack ad eligibility to udertake the accreditatio process please cotact Lida Keea o 01224 557624 (email: lida.keea@hs.et). Ay system for accreditatio which was developed would be compatible with other systems e.g. CBT accreditatios ad KSF. Sice November 2006 Grampia EDS has bee usig the GCS to documet all cliical activity ad cliicias are ethusiastic ad fully committed to usig the system as its primary cliical record. The system has may excellet features such as a electroic diary fuctio ad liks to laboratory results ad SCI Store, which are extremely useful ad time savig for cliicias ad admiistrative staff. A web-based versio of the system will be available i the ear future ad this will allow relatively easy extesio of the system to other health boards i the North of Scotlad. Discussios have take place with NHS Tayside ad NHS Highlad ad SLA s are curretly beig draw up. The system is curretly beig used withi The Ede Uit ad oce it has bee rolled out to NHST ad NHSH it will allow cliicias to check o their patiet s progress whilst they are i the uit ad will be used for MDT meetigs betwee the uit ad the local services. A area of the system o which there requires more work to be doe is the reports side of thigs. To this ed the MCN have employed a Itelligece officer (1 day per week x11 moths) to desig ad develop reports i the system which staff will the be able to use o a regular basis. The Itelligece Officer will also moitor the quality of the data curretly i the system ad advise o how to improve this. Some examples of the type of iformatio we ca glea from the system is show below: Videotherapy Ecouters by moth December - April 2009 25 20 15 10 5 0 DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR 2006 2007 2008 2009 16 17
Summary of Eatig Disorder Referrals i North Scotlad 2008/2009 Quality Assurace Programme 25 20 New Referrals to Eatig Disorder Outpatiet Services i North Scotlad 2008-2009 NHS QIS produced a draft of the Quality Assurace Programme Guidace i April 2008. It cotais a umber of templates which ca be adopted by etworks. It states that etworks must adopt a robust QAP to facilitate the equitable provisio of high quality services for patiets. The purpose of the MCN QAP is to: 15 10 Measure performace agaist agreed stadards ad the core priciples. Support improvemets i care ad services. Lear from challeges ad share stregths. Report opely. 5 0 APRIL MAY JUN JULY AUG SEP OCT NOV DEC JAN FEB MAR The documet sets out the quality assurace accreditatio arragemets which will be udertake by NHS QIS. A evet is plaed for April 2009 to lear more about the ew process which will be atteded by the Network Maager. GRAMPIAN 18 17 14 14 11 16 12 21 20 11 13 22 TAYSIDE 4 6 6 6 3 11 8 4 3 2 6 4 HIGHLAND 4 7 9 13 3 3 4 5 6 7 9 4 The MCN for Eatig Disorders have set up a Quality Assurace Sub-Group ad oe of its aims will be to take this forward over the forthcomig moths. Re-Referrals to Eatig Disorder Outpatiet Services i North Scotlad 2008-2009 10 9 8 7 6 5 4 3 2 1 0 APRIL MAY JUN JULY AUG SEP OCT NOV DEC JAN FEB MAR GRAMPIAN 6 1 5 3 6 2 3 3 5 4 5 9 TAYSIDE 0 0 0 0 0 0 0 0 0 0 0 0 HIGHLAND 0 3 3 6 1 3 4 1 2 1 4 1 18 19
Fiacial Report - 2007 to 2008 MCN For Eatig Disorders Membership of the Maaged Cliical Network for Eatig Disorders Steerig Group 12 Moths to 31March 2009 Budget Actual Variace 000 000 000 Year to 31 March 2009 Budget Forecast Variace 000 000 000 Name Title NHS Board Area/Orgaisatio Ms Jackie Agew Service Maager NHS Highlad Miscellaeous Icome - Other -63.7-56.0-7.7-63.7 0.0-63.7 Miscellaeous Icome -63.7-56.0-7.7-63.7 0.0-63.7 Grad Total Icome -63.7-56.0-7.7-63.7 0.0-63.7 Medical 38.3 32.9 5.3 38.3 0.0 38.3 Admiistratio 54.6 44.9 9.6 54.6 0.0 54.6 Total Pay Expediture 92.8 77.9 14.9 92.8 0.0 92.8 Istrumets & Sudries 0.0 0.0 0.0 0.0 0.0 0.0 Other Medical Supplies 0.0 0.0 0.0 0.0 0.0 0.0 Hospitality Miscellaeous 0.2 1.3-1.1 0.2 0.0 0.2 Expediture 0.0 1.3-1.3 0.0 0.0 0.0 Pritig & Statioery 0.5 0.1 0.4 0.5 0.0 0.5 Traiig Expeses 3.5 1.4 2.1 3.5 0.0 3.5 Admiistratio Costs 4.2 4.0 0.2 4.2 0.0 4.2 Purchase of Equipmet 1.0 0.9 0.1 1.0 0.0 1.0 Service Cotracts 0.7 0.1 0.6 0.7 0.0 0.7 Equipmet Costs 1.7 0.9 0.8 1.7 0.0 1.7 Travel & Subsistece 1.0 2.6-1.6 1.0 0.0 1.0 Trasport Costs 1.0 2.6-1.6 1.0 0.0 1.0 Mr Peter Cartwright Lead Nurse (MH) NHS Argyll & Bute Dr Paula Colli Cliical Psychologist NHS Tayside Dr Jo Cresswell Public Health Medicie NHS Grampia Dr Yvoe Edmostoe Cosultat Psychiatrist NHS Highlad Mrs Paulie Mile Uit Maager, The Ede Uit NHS North Scotlad Mr Neil Fraser Strategy & Performace Maager NHS Tayside Mr Bill Harriso Geeral Maager NHS Grampia Ms Roseae Urquhart Head of Healthcare Strategy NHS Highlad Mrs Lida Keea MCN Maager NHS North Scotlad Dr Harry Millar Cosultat Psychiatrist & Lead Cliicia NHS North Scotlad Mr Ala Murdoch Commuity MHT Maager NHS Shetlad Dr Elaie Aderso Cosultat Psychiatrist NHS Wester Isles Vacacy Geeral Practitioer Mrs Elizabeth Stewart Dieticia NHS Tayside No-Pay 6.9 7.5-0.6 6.9 0.0 6.9 Expediture 99.7 85.4 14.3 99.7 0.0 99.7 Dr Cleo Hart Cosultat Psychiatrist (CAMHS) NHS Grampia Total Operatig Surplus/(Deficit) 36.0 29.4 6.6 36.0 0.0 36.0 20 21
Appedix A Eatig Disorders Patiet ad Carer Cosultatio Day 7th Jue 2008 Itroductio I Jauary 2008 the Maaged Cliical Network for Eatig Disorders North Scotlad applied to the Scottish Health Coucil for a small grat to do a umber of thigs with the mai oe beig to host a Patiet ad Carer Cosultatio Day. The aims of the day were to: Show them the proposed space set aside for the uit. Ask them what they thought the uit should look like. Ask them what they feel would help aid their recovery. What types of therapy have they foud useful. What they felt would ot be helpful. Have a ope discussio o the Outpatiet jourey of care. I March 2008 we were iformed that our applicatio had bee successful ad plaig bega. North of Scotlad Maaged Cliical Network for Eatig Disorders Patiet & Carer Cosultatio Day Report 7th Jue 2008 To publicise the evet drew up a flyer ad set this to everyoe we could thik of icludig GP surgeries across the North of Scotlad, volutary orgaisatios, other eatig disorder services i North Scotlad. We also issued a press release ad did radio iterviews to publicise the evet. The respose was good ad there were several iterested parties, some of whom were uable to atted the evet but were willig to submit writte feedback ad complete ay questioaires that we could sed them. We used 2 questioaires plus a evaluatio questioaire (please see Appedix A3, A4 ad A5). These were set out for completio before the evet ad attedees had access to them o the day. We also set out a iformatio sheet (Appedix A2) to give people a little bit of the history ad decisio makig uderpiig the uit. O the Day There were 17 people atteded o the day, with a mixture of patiets/ex-patiets ad carers. The day cosisted of 3 workshops cocetratig o the followig: Workshop 1 Therapies. Workshop 2 Facilities for the ew uit. Workshop 3 The outpatiet jourey. 22 Lida Keea, Maager, Maaged Cliical Network for Eatig Disorders North Scotlad 23
Workshop 1 Therapies Durig pass outs there should be a ivolvemet process i.e. carers wat to kow what to expect/what to do (the worst case sceario would mea they could be more prepared, beig give practical examples would be good). Support for sibligs as well as parets. The participats split ito 2 groups, oe of which cosisted of patiets/ex-patiets ad the other cosisted of carers. Iformatio of what idividual therapy ad group therapy actually etailed was explaied to the carers group. Carers Group Feedback The mai poits which came out of this discussio were as follows: Psychological Therapies The group felt that although idividual therapy was importat, group therapy was equally importat. Body Image Sessios although carers felt these may be difficult there was a strog feelig that they were absolutely ecessary. It was felt that group therapies were good for people as they kept them iteractig with each other socialisatio elemet to it. A key poit was that the relatioship with a therapists ad cotiuity of care with that therapist was of paramout importace. It was felt that patiets had to be ready for therapy i order to egage with it. Complemetary Therapies It was felt that therapies such as massage, facials etc all had a importat part to play. Nutritio Sessios Preparatio for discharge. Cotiuity of treatmet post-discharge. Patiet Group Feedback - Therapies The mai poits which came out of this discussio were as follows: Psychological Therapies. Patiet perspectives. Shared experieces. Peer support. Halfway house day patiets. Recovered patiets attedig groups stregthes recovery. CBT, self awareess. There were discussios surroudig: What a eatig disorder gives a patiet. Why is it so hard to give up? Empowerig people to take cotrol. Motivatioal ehacemet. Neuro Liguistic programmig. Body awareess, relaxatio. Body Awareess Sessios/Occupatioal Therapy Dietitia should have a awareess of the abormal way of thikig of patiets. Some family therapy with the exteded family e.g. sharig a family meal. Geeral It was felt that the Geeral Public did ot kow eough about the illess. GP s required more educatio regardig the illess. What do carers/families eed? Carers felt it was vitally importat for carers to have as much iformatio as possible. They felt that this was extremely importat at the begiig of a patiet s illess. To speak with other people i the same situatio. Coffee/chats with other parets. Built cofidece. Brought ormality ito the rehabilitatio process. Helped with career paths. Focussed i o fuctioality stregths v weakesses. Spedig moey shoppig skills. Arts & Crafts were very importat. Showed you how to occupy your time. Taught day to day life skills. Helped with social skills. Weekeds were importat. Iformal evets. Film club. Group ru by carers to take place i the uit. Telephoe helplie. Carers ca ofte feel pushed to oe side ot really kowig what is happeig withi treatmets. 24 25
It was felt that the above therapies should be challegig otherwise it was too easy to get bored. That the uit should ot be too cosy ad pleasat or else people would have o impetus to get better. Alterative Therapies people would like to have available REIKI. Crystal healig volutary. Art Therapy volutary. Creative writig. Psychotherapy. Psychodrama. Aimal Therapy therapets (bed boud), Equie therapy (beig midful of allergies). EMOR Differet people for differet therapies. Would there be a choice of key-worker suggestio that maybe this should ot be a patiet s oe to oe therapist. Boudaries should be set i.e. do ot allow patiets to talk about weight, abuse, self-harm, specific eatig disorder behaviours. Ecouragig each other was importat. A aoymous drop box for suggestios, commets etc. Commuity Group ucomfortable but useful. Madatory motivatioal work goals for the week (doe i small groups). Geeral commets There should be liks with geeral medical services ad that perhaps severely ill patiets should progress from medical to psychiatric services. Targets should be small targets achievable but ot too big so as to cause axiety. It was geerally felt that a wide rage of therapy was preferable to oe ethos but that there should be a thread of madatory therapies e.g. CBT, self-awareess, axiety maagemet but some groups should be a choice. Geeral Discussio also took place surroudig the followig: Log term v short term admissios. Day patiet status was felt to be very importat with lots of preparatio required for the trasitio from ipatiet to outpatiet. Family therapy (a lot of discussio o this topic with splits i opiio). Therapy for the family. Possibility of a group for parters ad flatmates as well as carers. Should the doors to the uit be locked? - it was geerally felt that they should be locked for patiet s safety i.e. ot allowig other patiets withi the hospital to eter the uit ad to stop patiets from abscodig. Although the morig sessio was aimed to cocetrate o therapies a lot of discussio overlapped ito other topics, which were to be covered more fully i the afteroo. Attached at Appedix 1 are the results of the therapies questioaires which were completed by both patiets/ex-patiets ad carers who atteded o the day. Workshop 2 Facilities for the ew Uit This sessio was aimed at coverig the more geeral demeaour/ambiece of the uit which is felt to be extremely coducive ad beeficial to the treatmet of patiets. Plas for the layout of the uit were available over the luch period for people to look at ad make commet. A geeral questioaire was completed by those attedig ad which suggested topics/subject areas for discussio as follows: 1. What activities would you like to see available i the uit e.g. board games, computer games, arts ad crafts, yoga etc? 2. What do you thik would make the uit a icer place to stay i/visit e.g. fresh flowers, pictures o walls etc? 3. If Iteret access was available for patiets what would you use it for? 4. Do you thik it would be a good idea to have access to your ow mobile phoe please give reasos for your aswer? 5. Visitig if we had access to videocoferecig facilities i.e. face to face visitig via computerised equipmet do you thik you/your relatives would use it? Please give reasos for your aswer. 6. Do you thik commuity meetigs would be a good idea please give reasos for your aswer? 7. If there was access to outside visits what would you like to do e.g. equie therapy, clothes shoppig sessios, supervised swimmig etc? 8. If you are takig i persoal possessios from home what would you brig e.g. ipods, laptops, persoal photographs etc. 9. How importat do you thik it is to have some free time o the uit i.e. ot takig part i therapy sessios or activities? Please give a idicatio of how much time per day you would feel reasoable? 10. Do you thik therapy sessios/activity sessios should be available at the weekeds? The topics/subject areas above were iteded to geerate ideas/discussio areas which worked extremely well. 26 27
I this report I have ot listed all the aswers give but have give examples (below) of the mai outcomes/poits from these discussios. Iteret Access Most patiets said they would use the iteret but that this should be a privilege rather tha a right. It would require to be policed well as it may be used for detrimetal purposes e.g. accessig pro-aa websites, checkig calorific values of food etc. People said they would use it to keep i cotact with frieds via email ad social etworkig sites. Mobile Phoe Access The majority idicated that they felt they would like access to mobile phoes but safeguards would eed to be i place. It was agreed that there should be strict regulatios regardig the use of phoes i.e. ot durig therapy work, mealtimes etc. It was geerally felt that perhaps, agai, access to mobiles should be a privilege rather tha a right due to the fact that they could be abused i the same way that access to the iteret could i.e. accessig the iteret via the phoe, raisig body image issue by usig the phoe aspect available o mobile phoes. Although oce agai there were issues with mobile phoes it came across that everyoe would use their phoe to keep i cotact with relatives/frieds. Other Issues Mealtimes It was strogly felt that staff should eat with patiets at mealtimes ad eat the same food. The tables i the diig room should be roud ad ot rectagular to create a iclusive atmosphere. The quality of the food should be really good. Portio sizes. Everyoe should eat together icludig tub fed patiets. Rules surroudig mealtimes should be clear, easily uderstood ad adhered to by all. Iformatio Discussio took place surroudig iformatio booklets for both patiets ad carers. It was agreed that this would be a extremely good idea ad some ex-patiets preset agreed to become ivolved i developig these booklets. It was felt that testimoials/some motivatioal statemets from recovered patiets could be helpful to ew admissios (although they may ot realise this immediately). Iformatio leaflets for patiets/carers, available withi the uit, was thought to be very importat. Patiets suggestios for activities/facilities for the uit: Wash-had basis i sigle rooms it was raised that these could be potetially problematic for patiets with OCD type symptoms ad that patiets felt these should be removed from the sigle bedrooms. What patiets take ito hospital it was felt that this should be policed so that ay harmful objects/substaces be cofiscated. What visitors take ito hospital agai it was felt that this should be policed so that ay harmful objects/substaces (which visitors may uwittigly take i) ca be stopped before reachig the patiet. Radom room searches debate took place over this with the majority statig that they should occur. Film club. Therapets. Arts & Crafts e.g. card makig, jewellery makig. Books. DVD s/cd s. Getle cotrolled exercise (for patiets i active recovery) e.g. yoga. Musical istrumets. Massage. Jigsaws. Board games. Ski Checks agai this would be ecessary for severely ill patiets. Computer games. Visitig times it was geerally felt that ope visitig at the weekeds was a good idea so log as it did ot iterfere with mealtimes/sack times. Bigo. Televisio/radio. Carers should be made to feel icluded. Staff should be appropriately traied to work i a eatig disorders uit. Patiets should be afforded some choices i their treatmet. Idividual/tailored treatmet plas were importat. Structure of the day/week was importat. Free time was importat but i geeral it was felt that some activities should be available at weeked for patiets who would ot have visitors. O outigs Clothes shoppig. Visit to beach. Ciema/theatre. Local park. Equie therapy. Supervised swimmig. 28 29
Items patiets may wish to take ito uit with them: ipod. Laptop. DVD player. Games cosole e.g. Nitedo DS. Books/writig equipmet. Persoal photographs. Duvets. Throws/cushios. Cuddly toys. Posters. Geeral ambiece of uit Workshop 3 The outpatiet jourey Workshop 3 took the form of a geeral discussio over the jourey of care received as a outpatiet. It was clearly felt that GP s required more educatio with regards to eatig disorders i geeral. Carers felt that GP s did ot kow eough ad therefore could ot advise them where to seek help. There appeared to be discrepacies betwee primary ad secodary care they did appear to work together. A suggestio was made for more commuity ivolvemet? district urses. Ofte difficult to get ito the care/hospital system at what poit did GP s refer to specialist eatig disorder services. People were asked what they thought would make the uit a icer place to be/visit: Artwork o the walls. Fresh flowers. A place which looks as homely/comfortable as possible. Cushios/beabags/throws i sittig areas. Coffee/tea for visitors. Friedly staff. Waitig times for treatmet were too log ad uacceptable it was suggested that these waitig times could make the patiet much more ill before treatmet was actually commeced ad that early itervetio could perhaps prevet the illess from takig such a strog hold. (It was oted that Metal Health was curretly excluded from the 18 week waitig time rule). There was a eed to bridge the gap betwee outpatiet ad ipatiet treatmet. A commuity lik with the GP was required whe people are beig discharged from hospital. Curretly there appeared to be a lack of commuicatio betwee services. There was a keeess for patiets to have access to a wide variety of people e.g. Occupatioal Therapy, Art Therapy etc. Liaiso betwee departmets was importat. A patiet who had bee o the ANNITT programme (Aorexia Nervosa Itesive Treatmet Team) said that this programme did ot take accout of people who were workig e.g. appoitmet times were usuitable. Suggestios from those preset to overcome these issues Set up support groups to prepare people to eter health services. Provide more educatio for GP s. Issues curretly beig addressed The MCN have already started work i providig educatio for GP s ad would cotiue to make progress i this area. A atioal educatio ad traiig programme is curretly beig developed. Iitially this will be aimed at geeric metal health workers ad GP s. The ew uit are hopig to provide a day service which may help bridge the gap betwee ipatiet/outpatiet services (access to which may be depedet o geographical locatio of patiets home). Cotiuity of care - referrig outpatiet service will be aware of patiet s progress durig ipatiet stays via MDT meetigs doe via videocoferecig. 30 31
Feedback from the day Where do we go from here? A very simple feedback form was provided ad icluded the followig questios: 1. What do you thik worked well today. 2. What did t go so well today. 3. Ay other commets about the day. The feedback was extremely good ad below are a selectio of commets from those submitted. What worked well Discussio ad exchage of ideas o a equal level betwee patiets, carers ad professioals. Everyoe ivolved i ope discussio ad took o board commets people had a passio to get voices heard. The professioals are really kee to get the best possible service up ad ruig for ED patiets ad listeed to both carers ad patiets. The hadouts ad slides were good. Workshop sessios seemed very effective ad comprehesive. Related experieced appeared to be very iformed. Beig able to see the plas for the uit opeed more doors for discussio o facilities. The whole set up of the workshops was professioal ad o-patroisig (very importat). I felt ackowledged ad the whole group s ideas were heard ad oted. Very much a two way coversatio betwee staff, carers ad ex-patiets. Mutual respect ad geuie care for all attedees. What did t go so well today Work is still ogoig developig the plas ad the cliical programme for the ew Eatig Disorders Ipatiet Uit which is due to ope i Aberdee i late 2008/early 2009. Feedback/commets ad suggestios from the day have already bee take o board ad some of the suggestios made have bee acted upo. Some examples of these are:- Wash-had basis i the sigle rooms have bee removed. The cliical programme will be tailored to meet idividuals eeds i terms of therapy. Whe orderig items such a soft furishigs commets re cushios, throws etc will be take ito accout. The issue of policig iteret access withi the uit is beig addressed. A budget for rehabilitatio requiremets e.g. Trips/outigs etc has bee costed. DVD players will be available i all sigle rooms/sittig room ad 4 bedded area. A music system will be purchased for the uit. Iformatio booklets will be developed for patiets/carers. GP teachig sessios have bee set up i Tayside for September this year (followig o from the oes held i Grampia prior to the evet). A umber of the attedees have bee i touch sice the evet took place to give other ideas/suggestios they had ot thought of o the day. All the resposes received are, wherever possible, beig take ito accout whe plaig the ew uit. Although some may ot be able to be implemeted due to costraits placed upo us e.g. fiacial we are extremely grateful to all who took part. Nothig really ay digressio was ipped i the bud i a effective maer. Gettig sidetracked by additioal issues did become a problem but was addressed. I took o egatives from the day. The afteroo sessio was excellet, very good iteractio from patiets. Commuicatio about the day seemed to have got cofused with some people ot realisig it was a full day format. Everyoe who atteded the evet ad those who could ot make it alog o the day will be issued with a copy of this report ad we would like to take this opportuity to thak them for takig the time to become ivolved ad to give our thaks to Mrs Paulie Mile, Nurse Therapist, Grampia ED Service ad Dr Phil Crockett, Cosultat Psychiatrist, Grampia ED Service for comig alog o the day to help us out. We would also like to thak the Scottish Health Coucil for givig us the grat to make the day possible. Ay other commets about the day Brilliat that patiet s views are recogised. It was really well orgaised ad really well structured. Thak you. Opiios were seemigly take o, ad of geuie value to the process. Remember other eatig disorders e.g. bulimia, bige eatig. Lida Keea MCN Maager MCN for Eatig Disorders North Scotlad Dr Harry Millar Cosultat Psychiatrist/Lead Cliicia MCN for Eatig Disorders North Scotlad 32 34 33
Appedix B Appedix C Questioaire o Treatmet Compoet Results Patiet Resposes 0 1 2 3 4 5 6 Supervised exercise sessios Social skill sessios Self-awareess sessios Review/plaig sessios Relaxatio sessios Problem solvig exercises Patiet support group sessios Mealtimes Meal supervisio Meal preparatio idividual sessios Meal preparatio group sessios Maiteace sessios Logbook sessios Locked bathroom doors Key-worker sessios Iformal visits Hour-after supervisio Ex-patiet support group sessios Drama therapy sessios Dietic educatio idividual sessios Dietic educatio group sessios Creative writig sessios Cousellig idividual sessios Cosultat cotact Commuity meetigs Cogitive-behavioural therapy Clothes shoppig sessios Cliical psychology sessios Body image sessios Assertiveess sessios Art therapy sessios Axiety maagemet sessios Not applicable Markedly helpful Moderately helpful Slightly helpful Not at all helpful Eatig Disorders Cosultatio Meetig for Users ad Carers 07 Jue 2008 Thak you very much for agreeig to atted our cosultatio meetig. We thik it is extremely importat whe plaig services for people with eatig disorders to have the views of those with persoal experiece either as sufferers or carers. The North of Scotlad Maaged Cliical Network for Eatig Disorders was set up at the ed of 2005. There are a umber of aims icludig helpig to pla ad co-ordiate services for patiets across the North of Scotlad. I the past 2 years there has bee a great deal of discussio about settig up a ipatiet uit which led to a decisio i February 2008 by the mai health boards, Grampia, Tayside ad Highlad, to fud a dedicated specialist 10 bed ipatiet uit i Royal Corhill Hospital, Aberdee. This is primarily for patiets aged 18 ad over although it will be possible to take some patiets aged 16-18. Detailed plaig, staffig of the uit ad refurbishmet of the ward is uderway ad tederig for the buildig works has bee completed. This meas that the mai structural features of the uit are decided i that it will have 6 sigle rooms ad 4 beds i a 4 bed bay for more severely ill patiets. It would primarily be desiged for people with very severe aorexia ervosa ad the aim will be to keep hospital admissio as brief as possible. This meas that it will be essetial to have the closest possible itegratio with outpatiet ad day patiet treatmets before ad after hospital admissio. Although the basic structure of the uit is decided details of décor, facilities ad operatioal policies of the uit still have to be worked out. A variety of differet types of therapies will be provided but the fial balace of differet treatmet approaches has yet to be decided. There will be three mai themes to the cosultatio day: 1. Discussio of the therapeutic programme. It is realised that sometimes patiets ad carers have a differet perspective o treatmet ad there will be separate discussio groups for patiets ad carers. 2. There will be a discussio about the possible facilities, services ad other o-cliical aspects of the ruig of the uit. 3. There will be a sessio discussig the outpatiet jourey i the lead up to possible hospital admissio ad followig discharge. It is iteded that the discussios will be as iformal ad uthreateig as possible. Dress will be casual ad we will break the meetig up ito smaller groups where appropriate to help make it as easy as possible to egage i discussio. There will also be opportuities to provide writte thoughts ad commets ad we will be very happy to hear from idividuals if they have aythig to add that they were uable to raise at the time o the cosultatio day. We are very much lookig forward to what we expect to be a very iterestig ad iformative day. 0 1 2 3 4 5 6 No. of Patiets 34 35
Appedix D Appedix 4 Questioaire o Treatmet Compoets This is a questioaire that has bee used i the Priory Hospital to ascertai the views of patiets. Please try to rate how useful you would expect the compoets of the treatmet programme to be. Please idicate if you are a patiet/ex-patiet/carer... Do you have ay experiece of beig i/havig had a relative i a Ipatiet Uit? YES/NO Please place a umber o each lie to rate how helpful you fid the differet compoets of the treatmet programme: 1. Not at all helpful. 2. Slightly helpful. 3. Moderately helpful. 4. Markedly helpful. 5. Not applicable. Axiety maagemet sessios... Art therapy sessios... Assertiveess sessios... Body image sessios... Cliical psychology group sessios... Clothes shoppig sessios... Cogitive-behavioural therapy sessios... Commuity meetigs... Cosultat cotact... Cousellig idividual sessios... Creative writig sessios... Dietetic educatio group sessios... Dietetic educatio idividual sessios... Drama therapy sessios... Ex-patiet support group sessios... Hour-after supervisio... Iformal visits... Key-worker sessios... Locked bathroom doors... Logbook sessios... Maiteace sessios... Meal preparatio group sessios... Meal preparatio idividual sessios... Meal supervisio... Mealtimes... Patiet support group sessios... Problem solvig sessios... Relaxatio sessios... Review/Plaig sessios... Self-awareess sessios... Social skills sessios... Supervised exercise sessios (swimmig, walkig, yoga)... Other (please specify)... Patiet & Carer Cosultatio Day Name (Optioal):... Topics/Subject Areas for Discussio 1. What activities would you like to see available i the uit eg. Board games, computer games, arts & crafts, yoga etc. 2. What do you thik would make the uit a icer place to stay i/visit e.g. fresh flowers, pictures o the wall etc. 3. If iteret access was available for patiets what would you use it for? 4. Do you thik it would be a good idea to have access to your ow mobile phoe please give reasos for your aswer? 5. Visitig if we had access to videocoferecig facilities i.e. face to face visitig via computerised equipmet do you thik you/your relatives would use it? Please give reasos for your aswer. 6. Do you thik commuity meetigs would be a good idea please give reasos for your aswer? 7. If there was access to outside visits what would you like to do e.g. Equie therapy, clothes shoppig sessios, supervised swimmig etc. 8. If you takig i persoal possessios from home what would you brig e.g. ipods, laptops, persoal photographs etc. 9. How importat do you thik it is to have some free time o the uit i.e. ot takig part i therapy sessios or activities? Please give a idicatio of how much time per day you feel would be reasoable. 10. Do you thik therapy sessios/activity sessios should be available at the weekeds? 11. If you have ay experiece of beig a i-patiet are there ay tricks/scams that patiets get up to that you thik staff should look out for oce the uit opes? Thak you for takig the time to complete this questioaire. Name: (Optioal)... 12. Have we missed aythig? Ca you thik of aythig else that we should take ito accout whe thikig about how the uit is ru/or what it might provide for patiets/carers. 36 37
Appedix E Appedix F Eatig Disorders Ipatiet Uit Patiets & Carers Cosultatio Day Evaluatio Questioaire Q1. What do you thik worked well today? Q2. What did t go so well today? Ay other commets about the day Thak you, your commets will help us to pla future evets. 38 39