Clinical Strategy 2014-2018
Contents About the clinical strategy Page 2 About our Trust Page 3 What we stand for Page 6 Our clinical services Page 9 Supporting our staff Page 12 The five year plan Page 13 Avon & Wiltshire Mental Health Partnership NHS Trust Page 1 of 17
About the clinical strategy This strategy sets the direction for the clinical and care delivery services provided by Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) for 2014-2019. Our clinical strategy summarises how we plan to do this, how this work relates to our strategic priorities and how we will develop clinical services over the next five years. It describes our vision, values and objectives, how we maintain clinical quality and accountability and gives an overview of our plans for service development. In this healthcare environment, we aim to continue to provide excellent services for all the communities we serve locally and to be a leading provider of secure and specialist mental healthcare services throughout the South West. We aim to keep our position as a core provider of local, regional and specialist mental health services by: maintaining high standards of care delivery continuously improving our services responding to changes in service user and commissioner requirements. We will focus on the provision of specialist mental health care for people of all ages, across the full spectrum of care, including the provision of specialist mental health care for people with learning disabilities and the provision of secure mental health services. All our services will be accessible and culturally sensitive. Hayley Richards Medical Director Our purpose is to provide high quality mental healthcare that promotes recovery and hope. This strategy will guide our clinical priorities for the next five years to ensure that we continue to achieve this purpose and make our services right for each individual. This strategy is for all the communities we serve and for our staff. We expect the detail to be of particular interested to: our PCT and Clinical Commissioning Groups (CCGs) NHS England our local authority and other partners. Most importantly, this strategy outlines for our service users, those developments in clinical services which will facilitate their personal recovery. Avon & Wiltshire Mental Health Partnership NHS Trust Page 2 of 17
About our Trust Services Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) is a significant provider of mental health services across the South West. We deliver a wide range of locally focused mental health services across Bristol, North Somerset, South Gloucestershire, BANES (Bath & North East Somerset), Wiltshire and Swindon to a total population of 1.8 million people. We also provide specialised and secure services across the South West to a population of 5.3 million individuals. These include services to meet the needs of people who experience mental illness relating to pregnancy and childbirth, eating disorder, substance misuse, autistic spectrum disorder or learning disability, as well as people who need secure care, criminal justice liaison or treatment of mental disorder while in prison. We pride ourselves on offering care and support to all, including people who present with the most pressing and challenging needs. This includes caring for people whose needs for safe and secure care cannot be met by other providers. Our services cover all parts of the acute care pathway, from crisis care, liaison and inpatient care, through to longer term care and rehabilitation, both in the community and on the ward. They also span a wide age range, from early intervention in psychosis to the assessment and care of all older adults, including dedicated dementia services. Localities Our six local delivery units operate from over 100 community and inpatient sites, including sites where we deliver services in partnership with other organisations. These geographical localities include diverse populations, rural and inner city locations and some areas of high deprivation and groups with specialist health needs, including traveller communities and military families. Avon & Wiltshire Mental Health Partnership NHS Trust Page 3 of 17
Activity In 2013/14, the Trust s community services saw 32,170 individuals from just under 33,000 referrals, and had more than 338,000 contacts with service users (telephone or face to face). In addition, 2,513 people were admitted to our inpatient units for more intensive treatment. Partnerships We recognise that we cannot deliver high quality mental health care alone. We are a partnership Trust and have strategic alliances with wide range of commissioners, including CCGs, NHS England, Local Authorities, prisons and probation services. We work closely with GPs, primary care teams, acute Trusts (liaison), care homes, police, ambulance services and other community and voluntary organisations. We have relationships with regulatory and statutory bodies including the CQC Monitor and the Trust Development Authority. We expect these relationships to continue to develop as we work towards becoming a Foundation Trust. We share information on public protection through Multi- Agency Public Protection arrangements (MAPPA) and work closely with the criminal justice system to provide integrated services for patients using our forensic services. Income We employ over 3400 staff. In 2013/14, we had an income of 195.3 million. Of this, we receive 73% directly from CCGs, 14% from NHS England, with the remaining 13% from other sources. Our main commissioners are defined below. Table 1: Commissioners Estimated Population Size 2014/15 % Trusts Income Avon & Wiltshire Mental Health Partnership NHS Trust Page 4 of 17
Market position Overall The Trust profile is comprehensive, both in terms of the geographical area we serve and services provided. Overall, our service portfolio has an estimated average 70% market share of adult mental health services across the six localities, with some areas having as much as 85%. Over the next five years, we plan to grow and develop our business to provide a seamless care pathway, which optimises both quality and efficiency. Bristol Bristol clinical commissioning group s decision to tender a range of mental health services was the driving force for our Trust developing new, clinically led, innovative approaches to service delivery in the city. Clinicians in Bristol, who were keen to deliver more responsive and effective services, were brought together to help shape the new model. The result was an approach which brings together NHS health trusts and voluntary and community sector (VCS) organisations to work in partnership to deliver mental health services in the city. By working with the voluntary sector, staffing in the new model will increase with the focus of ensuring that qualified specialist clinical staff undertake the work they are trained to do and not work which others can effectively undertake. This approach resulted in our being appointed to deliver with our partners a significant part of the tendered contract and to provide the system leadership role for the new services which will be phased in from October 2014 under the banner of Bristol Mental Health. Avon & Wiltshire Mental Health Partnership NHS Trust Page 5 of 17
What we stand for Our purpose In 2013, the Trust set out its overarching purpose to provide the highest quality mental healthcare to support recovery and hope. Our values To help us deliver this, we have a set of core values that underpin everything we do. These are: Our motto When providing clinical care, the views of service users, carers, staff, GPs, commissioners and third sector groups all matter to us. We care about how we listen and respond to all groups and individuals with whom we work. This is embedded in our motto: Passion Respect Integrity Diversity Excellence Doing our best all of the time Listening and understanding what you tell us Being honest, open, straightforward and reliable Relating to everyone as an individual Striving to provide the highest quality support Strategic priorities We have five strategic priorities for the care and treatment of our service users and their families, for our staff and for the wider development of our services. 1. To deliver the best care 2. To support and develop our staff 3. To continuously improve what we do 4. To use our resources wisely 5. To be future focused The clinical strategy is our primary strategy and both drives and is supported by our enabling strategies. Avon & Wiltshire Mental Health Partnership NHS Trust Page 6 of 17
Strategic aims The clinical strategy aligns itself to our strategic priorities, focusing on key elements, as shown in blue text below. Avon & Wiltshire Mental Health Partnership NHS Trust Page 7 of 17
Our services span a range of settings and interventions but are all underpinned by the same principles. Recovery focus The recovery approach means working within a culture of optimism and hope. Our approach to care is based on facilitating recovery and helping people retain control wherever possible and to lead a productive life despite the impacts of mental illness. Our growing peer mentor programme will support this by showing patients that recovery is possible. Patients at the centre This means we will: treat people with compassion, dignity and respect at all times have information available when and how services users and carers need it share decisions and jointly agree treatment goals and care plans recognise that service users are experts in their own condition listen and respond in an appropriate way be open and honest about all aspects of care and treatment treat people equally and respect responding to their different needs use the least restrictive intervention possible, which is compatible with safe care. seek to maximise recovery and to achieve outcomes which are meaningful to that person s situation help with social care needs when we can or facilitate referral to other agencies when necessary. involve carers and families, according to the Carers Trust Triangle of Care and as pledged in our local Carers Charter. Involving and engaging We have a wide network of involvement workers, who work with service user and carer groups in localities, delivery units and across the Trust. Using these networks we will regularly seek to: capture and listen to service user and carer experience involve patients and carers in reviewing, planning or designing new services. use recognised methodologies, such as Experience Based Design when planning any changes to services work with our service users to determine what choice means in mental health services improve our response to feedback through PALs and complaints. We will involve services users in training, recruiting of staff and in the quality assurance of aspects of our work such as doctors appraisals and mock quality inspections. We are proud to have been the first Mental Health NHS Trust to adopt the Friends and Family Test, which has been running in AWP since April 2013. Avon & Wiltshire Mental Health Partnership NHS Trust Page 8 of 17
Our clinical services Spectrum of care We believe we can produce the best outcomes by continuing to provide services across the full spectrum of mental healthcare. Management structure To support our strategic aim to provide clinically led local services, services in each locality or delivery unit are led by a clinical director, supported by a managing director and a head of profession and practice. This means the full range of mental health problems, from moderate to severe, within a variety of settings, including individuals own homes and highly specialist inpatient wards. By working in this way, we will support individuals effectively at every stage of their recovery journey. Our services will increasingly be designed for flexibility and accessibility to meet the needs of individual service users and so that they can be commissioned to meet the needs of the local community, GPs, commissioners and delivery partners. Locality management teams are responsible and accountable for ensuring quality and driving change in local services, with support and information from central support teams. Advice & education Recovery College Medicines Advice BEST Primary Care Psychology Liaison in acute & primary care Primary Care Emergency Department Acute Care Care Home Community teams Early Intervention Support & Recovery Rehabilitation Inpatient care PICU Acute Care Frail Elderly Rehabilitation Highly Specialised Perinatal Eating Disorder Drug & Alcohol Learning disability Autistic Spectrum Prison in reach CJIT Secure Services Low secure Medium Secure Community teams Pathfinder Avon & Wiltshire Mental Health Partnership NHS Trust Page 9 of 17
Support for delivery of clinical services Progress is monitored through local and Trust-wide governance structures and reported against the Integrated Quality Plan. We also use mock regulatory inspections, and peer review of services between delivery units to monitor care and service. Key aspects of quality and safeguarding are monitored and analysed through the Critical Incident Overview group. This group also monitors actions taken in response to serious incidents, ensuring that lessons are learned and shared. Our complaints and investigations policies and procedures reflect learning from the Berwick and Clywd reports, and have been developed in collaboration with service users and carers. We will continue to meet the risk management standards set by the NHS Litigation Authority. Several Trust management groups oversee and manage areas of clinical practice such as Mental Health Act Legislation & Safeguarding, Medicines optimisation, Infection control and Physical healthcare. Supporting the continual improvement of our clinical service quality also comes through the work of other departments. Pharmacy Pharmacy staff are leading on the multidisciplinary medicines optimisation actions, to improve medicines management, information and safety. Quality Academy Set up in 2013, the Quality Academy defines organisational standards for care, monitors standards of delivery at team, locality and Trust level and ensures that best practice and clinical improvement are shared. Trust Active Life Projects offer a variety of activity sessions across all our localities, providing physical activity, exercise and sport for people with serious and enduring mental illness, to improve and maintain physical and mental wellbeing. These projects delivered in partnership with numerous local organisations have had a positive impact on all aspects of physical health including weight management, reducing the risk of diabetes and coronary heart disease, whilst promoting social inclusion through healthy lifestyles. Physical health groups have successfully challenged stigma, improved confidence, self-esteem and provided the opportunity to learn new skills. Information for quality (IQ) Performance is monitored via the Information for Quality System (IQ); a real-time display against seven key indicators. This system is visible to all staff and is shared with commissioners and regulators. We also use service and national benchmarking to measure and improve performance over time. Avon & Wiltshire Mental Health Partnership NHS Trust Page 10 of 17
Clinical audit Multidisciplinary, Trust-wide and external benchmarking audits are prioritised and are supported by our clinical audit team. Over the next five years, we will seek to involve more service users and carers in clinical audit activities. Research and development The Register is for people with memory problems and their carers, who want to be informed about memory research taking place across the South West. We host over 90 research studies per year. Funding comes from the Department of Health, via funding schemes such as Research for Patient Benefit and from non-commercial, charitable or commercial research funding organisations. Quality of research is ensured by registration of all projects with the R&D team, the application of research governance policies and procedures, peer review of project proposals, and ethical approval. Julian Walker Director of R&D We also work closely with the Quality Academy to ensure evidence-based practice and innovation. AWP is a teaching, learning and research active Trust. We are committed to contributing to national mental health research and making research opportunities available to all our service users, carers AWP has a strong and exciting research culture with excellent links to our three local universities in Bristol and Bath, universities across the country and other research partners. Our R&D department currently hosts SW DeNDRoN and the MHRN West Hub. We also host the Memory Research Register in collaboration with the West of England Academic Health Science Network. We have recently introduced the Everyone Included initiative in the Trust. This is our way of making sure that everyone who uses our services is given the chance to find out about research opportunities and to decide for themselves whether they wish to take part. Avon & Wiltshire Mental Health Partnership NHS Trust Page 11 of 17
Supporting our staff Our staff are our most valuable resource and our aspiration is to become the best mental health employer in the country. We will recruit clinical staff, who share and demonstrate our values and who seek to provide expert care with compassion and creativity. Staff development We recognise that staff development is key to the delivery of high quality care and expert specialised services. We will achieve this by: a clear and thoughtful induction programme followed by regular update training ensuring that supervision, appraisal, education and learning and development are at the centre of clinical developments ensuring that the Trust priorities for compassionate high quality, evidence based care are embedded in staff education, development and appraisal. ensuring that there is appropriate recognition of the key role of non-registered staff developing clinical leaders throughout the organisation talent spotting and succession planning Staff support All AWP staff have access to a Health and Wellbeing manager, trauma support service and a range of occupational health services. BEST in MH (Best Evidence Summaries of Topics in Mental Health) is a clinical question answering service hosted by Avon and Wiltshire Mental Health Partnership NHS Trust. The range of questions that we need to answer as health care professionals never seems to end, and with increasing pressures upon time, it can be difficult to consult the evidence surrounding a topic, even when we know that we need to. This service was developed with the aim of overcoming some of these barriers. BEST in MH can help clinicians formulate a question to be researched via best quality evidence, and to summarise the findings clearly succinctly. Staff engagement We value the ideas and feedback our staff bring. We maintain an active dialogue with our staff through staff meetings, the annual NHS staff survey and the Staff Friends and Family Test We listen to our staff when conducting Quality Improvement visits and we engage in formal consultations with staff about any changes in services. further developing our partnerships with academic institutions. Avon & Wiltshire Mental Health Partnership NHS Trust Page 12 of 17
The five year plan Clinical aspirations To support the delivery of the Clinical Strategy and Trust s strategic priorities, we have defined the following clinical aspirations, which we will develop and deliver from 2014-2018/19. Avon & Wiltshire Mental Health Partnership NHS Trust Page 13 of 17
Local priorities Each delivery unit produces a five year plan describing how it will improve quality, efficiency, meet the needs of service users and carers and how it will respond to the priorities of commissioners. This section presents the clinical priorities for each locality/delivery unit for the next five years. North Somerset Bristol South Gloucester For people who seek advice, signposting or education Develop service user information, choice and engagement. Provide mental health expertise into local business occupational health departments. For people who need psychological support to live well at home Develop local partnerships, including offering psychology services to local business. Integrate LIFT Wellbeing services. Incorporate LIFT into locality management For people with acute mental health needs in any setting Move to seven day service. Increase variety of interventions offered. Work with the clinical commissioning group and service users and carers to help reshape inpatient services in the city. Improve the care pathway between community and ward, including improved transitions of care. Focus on clinical outcome measures and service evaluation. Increase access to Liaison Services. Develop and evaluate S136 suite, including for under 18 s. Provide CAMHS in partnership. Work with commissioners to reduce delayed transfers of are. Increase access to liaison services. For people who are experiencing crisis and who need treatment at home Provide 24/7 Crisis Service with acute partners. Reduce admissions through Street Triage with Police. Provide appropriate, accessible, accommodation for Crisis Teams as alternative to Bybrook Lodge. For people with severe and enduring mental health needs Improve physical health care and health awareness. As part of Mental Health Bristol, support provision of community rehabilitation services. Focus on physical health and wellbeing, including reducing harm from smoking. For people with dementia Develop a PICU for male dementia sufferers who present challenging behaviour to offer care close to home. Provide safe, effective inpatient care for frail elderly, including dementia sufferers. Work with commissioners on Dementia Advisory Service. For people who have highly specialised needs Develop a specialist Personality Disorder unit to treat people close to home. Work with commissioners to provide ADHD services. Avon & Wiltshire Mental Health Partnership NHS Trust Page 14 of 17
Local priorities continued Bath and NE Somerset Swindon Wiltshire For people who seek advice, signposting or education Development of community resources with partners such as the Wellbeing College. For people who need psychological support to live well at home Integration of LIFT Service with Primary Care Liaison to create Primary Care Mental Health Service. Reprofile care pathway in primary care pathways for LIFT and Primary Care Liaison. For people with acute mental health needs in any setting Improve quality of inpatient care through reprovision of Sycamore ward and through EBD. Improve inpatient care and experience of service users. Improve pathways for returning Armed Forces personnel and their families. Provide local S136 suite. Consolidate the acute care pathway around improved Access, Therapy and Recovery Services. Focus on medicines optimisation and shared care protocols with Primary care. Improve acute liaison services. For people who are experiencing crisis and who need treatment at home Consolidate the acute care pathway around improved Access, Therapy and Recovery Services. For people with severe and enduring mental health needs Improved engagement and reporting re safeguarding. Strengthen adult and children s safeguarding pathways. For people with dementia Develop improved dementia care pathway with partners in RUH and others. Work with commissioners to redesign dementia Care pathway. Increase capacity in dementia and memory services. Work with commissioners to develop dementia strategy and to reduce harm from delayed transfers of care. For people who have highly specialised needs Develop evidence based care pathway for people with personality disorder. Develop local specialist services for autism, ADHD and anxiety. Seek to provide CAMHS services. Seek to develop local services for people with ADHD, autism, personality and eating disorders. Seek to provide CAMHS services. Develop tailored, local Services for people with autism and learning disability. Reduce numbers of people cared for away from home. Avon & Wiltshire Mental Health Partnership NHS Trust Page 15 of 17
Local priorities continued Specialised services Secure services For people who seek advice, signposting or education Improve information for service users, carers and staff. Improve access to services through electronic referrals portal. For people with acute mental health needs in any setting Learning difficulties: Develop effective partnerships with Sirona and The Priory. Eating disorders: Increase capacity and geographical span in partnership. Redesign to embed multi-professional team. Working at ward level, enhance clinical accountability and leadership, increase access to meaningful activity. For people who have highly specialised needs Develop mental health, drug and alcohol and personality disorder services into prisons. For people who need care in a secure setting Work in partnership to develop step down facilities for low and medium secure. Expand service to include low secure step down for women. Avon & Wiltshire Mental Health Partnership NHS Trust Page 16 of 17
Contact details For further information about our clinical strategy contact: Avon and Wiltshire Mental Health Partnership NHS Trust Jenner House Chippenham Wiltshire SN15 1GG Tel: 01249 468088 E-mail: awp.communications@nhs.net Website www.awp.nhs.uk Avon & Wiltshire Mental Health Partnership NHS Trust Page 17 of 17