North of Scotland Planning Group TIER 4 Child and Adolescent Mental Health Services Pre-Visit Information Pack and Questionnaire NORTH OF SCOTLAND PLANNING GROUP This pack is designed to be used to prepare for an organisational site visit. It gives those involved in the organisation hosting the visit some general information about the North of Scotland Planning Group (NoSPG), some specific information regarding the Tier 4 Child and Adolescent Mental Health project and some details of the information that could be useful to prepare prior to the visit taking place. If you have any questions regarding the visit or this questionnaire please contact Neil Strachan 01382 527874 or 07769 672630 (neil.strachan@nhs.net) 1
Background Information 1. North of Scotland Planning Group The North of Scotland Planning Group (NoSPG) is a collaboration of the six north of Scotland NHS Boards; NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles. The Chair of NoSPG is Mr Richard Carey, who is also Chief Executive of NHS Grampian. Dr Annie Ingram is Director of Regional Planning and Workforce Development. NoSPG promotes and fosters a regional approach to service, workforce and financial planning and commissioning, where regional working has been deemed to add value. The Group provides strategic direction and support to enhance the work of the north of Scotland NHS Boards. 2. Tier 4 Child and Adolescent Service Project In October 2004, the Inpatient Working Group of the Child Health Support Group published Psychiatric Services for Children and Young People in Scotland: A Way Forward which recommended a phased expansion of the psychiatric inpatient provision for children and young people in Scotland. In order to translate policy into practice, a Project Board, with representation from each of the mainland Boards, was established under the auspices of the North of Scotland Planning Group, to develop an Initial Agreement outlining the proposed approach to Tier 4 service provision for adolescents with severe and complex mental health disorders. This Initial Agreement was endorsed by the Scottish Government in July 2009. Key proposals submitted to and subsequently approved by the Boards included the development of a regional, Tier 4 inpatient facility and the establishment of a regional Adolescent Tier 4 Mental Health Network. The Board also approved the establishment of a Service Modelling and Workforce Planning Group to develop the regional network plans, plan and commission the new unit, develop appropriate models and pathways of care and create a workforce plan to provide a sustainable staffing model. 2
The Project Board, with input from the SMWP Group, is now responsible for the successful development of an Outline Business Case for submission to NoSPG and the Scottish Government in early summer 2010. 3. Tier 4 Child and Adolescent Service Project The visiting team has been selected to reflect the skills and experience required from each of the key stakeholder groups in the project. Each team member is responsible for gathering information relevant to their own specialty, and in the context of the proposed network model. The team members are as follows: XXXXXXXXXXXXXXXXXXXXXXXXXXXX Team members would like to meet with their respective peers for discussion and will use the questionnaire items as a basis for this. The team hope to take every opportunity to learn from the experience of other clinicians, managers and services and to consider how this may be applied in the North of Scotland context to benefit young people. We would be especially interested to hear of patients and families views about how any service is provided. A short tour of the facility and possibly a chance to meet some of the young people if this would not be disruptive - would be welcomed. The majority of data and information will be captured in writing but, where appropriate, team members may wish to use recording devices and/or digital cameras to supplement their notes. Permission will always be sought BEFORE such devices are used; they will never be used without the full knowledge and approval of all those concerned and no images of patients, carers or families will be captured. 3
4. Criteria used to choose services to visit Criteria for Service Visits Criteria Rationale 1. Proximity and Scottish Context It is sensible to coordinate visits to relevant local services, where possible, due to reduced time and travel costs. This is particularly apt given recently developed services e.g. in Glasgow, and in view of the inter-relations between Scottish services and implications of changes in policy in any area. 2. Commissioning arrangements Services that are nationally or regionally commissioned, or working with many commissioning bodies. 3. Service quality and satisfaction Demonstration of good clinical outcomes and high levels of use of routine outcomes measures, patient satisfaction, positive QNIC inspections (for in-pt services) 4. Geographical challenges Though it may be difficult to replicate the extent of the NoS challenges in this respect, examples of services operating in remote and rural settings should be identified. 5. Population Services providing interventions for similar population numbers should be sought 6. Physical building Services where good design has led to safe clinical and working environments 7. Innovation Services that are innovative in terms of design, structure, ways of working, adoption of technology, clinical intervention, 8. Integrated care pathways Services with agreed multi-agency care pathways in place 9. Networking Services already operating in a network context 10. Links with Local Authorities Those services with well established links with LA s where effective working is facilitated and can be demonstrated NB. Criteria not in ranked order of importance 4
5. Organisational Visit Questionnaire Service Description: name of service / unit 1. Total number of places in the service 2. Number by type i.e. inpatient, day care, intensive treatment, other 3. Average % utilisation of each place type 4. Average length of waiting lists 5
5. Average length of stay / contact 6. Level of delayed discharges (and reasons for) 7. Client group (age, gender, condition etc) 8. Describe the formal and informal links with other agencies i.e. Local Authority Education, Social Work, Voluntary Sector, Police etc. 9. Does your catchment service(s) operate intensive treatment (current or future) or outreach teams? 10. Describe the formal and informal links with these teams 6
11. Do in/day patient services provide outreach to pre or post-discharge patients? (how is this done?). 12. Are there formal criteria around this? If so Please describe (and provide) 13. Describe the use of the Mental Health Act e.g. average number of patients detained, use of CTO s 7
and their impact on length of stay, is the MHO part of the team, RMO input to those detained etc. The Patient Journey 1. Describe the referral criteria used for each part of the service (and any exclusions) 2. Describe the discharge planning process for the service (and provide) 3. Describe the clinical procedures i.e. assessments, treatments, reviews and multi-agency involvement 8
4. Describe the patient pathway, including any proposed developments and how young people are involved in the process(and provide) 5. Describe any other networks that impact on the patient pathway. 6. Describe any operational policies and procedures that exist for your services. (and provide) 9
7. Describe how young people are informed, consulted and involved in the designing of programmes and the planning of services 8. Describe the role of other stakeholder group In the above process. 9. Describe the use of video conferencing / telemedicine within the service(s), in relation to effectiveness, access, purposes, evaluation 10
Staffing 1 Current staffing complement including: Consultants, nursing, Psychology, AHP and other. Provide workforce planning data. 2 Describe the workforce planning process. 11
3 Describe your safe (optimum) staffing complement 4 General information on levels of recruitment and retention of staff 5 General information on staff training and development programmes 6 Is the service part of any inspection and/or quality assurance network. (If so please 12
provide details) 7 What was identified as good / less good in recent reviews? Buildings and Infrastructure 1 Total footprint of building; space shortages; spare capacity; space restrictions; waste (please include outdoor space and security of such) 2 General look and feel; natural light and ventilation; decoration; floor/wall coverings; light fittings 13
3 First impressions on entering; special design features; use of art work 4 Ease of maintenance and repair (please describe any problems and level of damage/vandalism 5 Room adjacencies and access to outdoor areas (including patients private space and storage) 6 Opportunities for future development 7 Ease of access and levels of Disability 14
Discrimination Act (DDA) compliance. 8 Describe facilities for friends/families and visitors (including transport links) 9 Describe facilities for staff (including students) Finance and Project Dynamics 1 Duration of project from Initial Agreement to commissioning 2 Methods of Capital and Revenue funding 15
3 Cost per m 2 and total cost of project 4 Level of optimism bias used (and why) 5 Items of specialist equipment purchased (including for leisure use) 6 Details of project structure(s) 7 Please provide copies of the IA, OBC and FBC 8 Please provide copies of gateway review documents 16
9 Please provide copies of project evaluation documents 10 Please provide copies of Project Risk Logs 11 Please provide copies of any other documentation you would consider relevant. Do s and Don ts 1 What were / are the best 5 things about the project / facility / service 17
2 What were / are the worst 5 things? General 1 What causes staff most difficulties? e.g. inappropriate admissions, working with other agencies, delayed discharges etc. 18
2. What causes managers most difficulties? e.g. Skill mix, staffing levels, sickness, training etc. 3. If you were to start the project again now what would you do differently? 19
4. Describe elements of the project that were innovative, thought leading or developmental. 20