Huntercombe Hospital Norwich Annual Plan 2016/17
OUR JOURNEY We are an evolving and developing service for children and adolescents with mental health difficulties, (referred to as a CAMHS service). Originally the hospital provided care for adults with mental health difficulties, and was owned by a different healthcare provider. In March 2014, Huntercombe Hospital Norwich became a CAMHS service, offering low secure and psychiatric intensive care services for young people aged 12-18 years. The Huntercombe Group provide a range of services across the country and specialise in three main areas CAMHS, adult mental health and learning disability and brain injury rehabilitation and neurological care services. Huntercombe Hospital Norwich is a Tier 4 CAMHS service commissioned on a national basis by NHS England Specialist Commissioning. All of our patients are NHS patients, and our contract is with NHS West Midlands. Our hospital is regulated by the Care Quality Commission (CQC) and our school is regulated by Ofsted. Huntercombe Hospital Norwich is the only Tier 4 low secure service in the Eastern region, and the only low secure CAMHS service provided by The Huntercombe Group. The young people in our care have a recognised mental illness and are all detained under the Mental Health Act 1983 (2007). We provide very specialist care, support, therapeutic interventions, education and treatment to some of the most complex, unwell and vulnerable young people in the country in a safe environment. For more information, visit: www.huntercombe.com/norwich/
OUR ASPIRATION Huntercombe Hospital Norwich Facilitating hope and positive change for young people with mental health difficulties in a safe environment. 3
For our young people In 2016 we treated 109 young people from across the country and we: Created #pizzachat encouraging young people to suggest improvements to the hospital, contribute thoughts and innovative ideas and work with us collaboratively to achieve our on-going developments Introduced the safe use of mobile phones to aid communication with families Created a visiting lounge on Coast ward to ensure visits can be less formal Facilitated young people s Panels as part of the interview process for senior clinical staff Invited young people to participate in Compassionate Mind and Acceptance and Commitment Therapy groups Had fantastic musical version of Little Red Riding Hood, showcasing inspirational acting, singing and comedy talents of our young people Watched a brilliant fireworks display and made Guys Were scared with costumes on Halloween Organised a Summer Masquerade Ball where every young person was awarded an individual certificate of achievement, and watched a fantastic performance from Essex singer songwriter, and ex patient, Gabriel Cerva (find his new album on itunes and Spotify) Enjoyed Harry Potter week where young people earned housepoints, made butter beer, handled owls from a local Owl sanctuary and a visit by Professor Dumbledore
In 2017, we will: Actively include, involve and be guided by our young people in the running of their wards through Ward Community Meetings Focus on encouraging and maximising school attendance Explore what, how and when we offer activities, using direct feedback from our young people Explore how our days and weeks are structured, focusing on school attendance as a core part of individual recovery Change our approach to meetings so that discussions are with the young people not about them Launch our individual Recovery Journals for the use of young people which includes a fully revised welcome section Increase the multi disciplinary focus of our formal discussions with young people Link more with local groups and activities to maximise young peoples recovery, focus on their skills, strengths and likes Invite to participate in Compassionate Mind groups, Acceptance and Commitment Therapy groups, Dialetic Behavioural Therapy groups and Yalom Experiential groups Explore how we can support young people to safely use social media and Skype whilst they are with us Create visiting lounges on Sky and Rainforest wards in response to feedback from young people and their families Our aspiration is to nurture the world, one person at a time.
Our Quality In 2016, we Satisfied the Care Quality Commission (CQC) about the improvements in care which led to 3 warning notices being removed Received a positive Quality Network for Inpatient CAMHS (QNIC) peer review on Rainforest ward Had positive feedback from a CQC Mental Health Act unannounced inspection October 2016 (Sky Ward) Focused hard on preventing incidents and de-escalating situations Dramatically improved our reporting internally and externally in relation to incidents Improved our overall governance and assurance systems Improved our reporting of and management of safeguarding Reduced restrictive practices overall Reduced the number of physical interventions we used with young people when they were a risk to themselves or others In March 2016 we received a "GOOD" CQC rating from a planned inspection. Reduced the number of overall incidents and serious incidents on average over the year, despite increased occupancy and acuity towards the end of the year Reduced the number and length of seclusions, that are needed sometimes when young people are unsafe Improved our response rates to formal complaints Started to record compliments Shared our information and learning much more across the site Improved the provision for monitoring the physical health needs of young people 6
Incidents The overall frequency of incidents has seen a marked reduction as would be expected in line with downward fluctuations in occupancy. However, as occupancy has increased, the total rate of incidents has not returned to that previously recorded. The majority of incidents continue to be categorised as no harm or injury, with the number of minor injuries requiring intervention reduced. 7
Physical Interventions The total number of physical interventions has also seen a reduction against occupancy rates which reflects the increased focus on less restrictive practice and the positive involvement of young people in managing situations during times of distress. There continue to be fluctuations that are attributable to individual cases where ensuring the safety of young people has been paramount. 8
Safeguarding An increased awareness of safeguarding practice has been encouraged across the staff team supported by additional training and supervision. There is increased confidence in reporting safeguarding concerns and the recognised high level of caution is reflected by the number of referrals that are acted upon externally. 9
Complaints The overall number of complaints received can be seen to have increased during the course of 2016. This has been welcomed as an indication that the complaints process has become more effective and responsive with the feedback of our young people being utilised to inform continued improvements in practice. The consistency of the rate at which complaints are managed has also increased and our goal is to achieve 100% completion within 25 days. 10
Serious Incidents The rate of incidents that are categorised as serious has decreased overall and is now in line with occupancy and the nature of our patient population. Confidence has increased in relation to the appropriate notification of serious incidents and the quality of reporting has been a specific focus within our service improvement plan. 11
In 2017, we will: Aspire to achieve an outstanding rating with the CQC Aim to have more compliments than complaints every month Continue to reduce the number of incidents that require external notification and maintain the quality of any such notifications Continue to reduce the incidence of physical interventions Train our staff in Positive Behavioural Support as part of a company wide programme of work Identify never events and aspire to a zero incidence Reduce the incidences of police interventions and referrals Increase visibility of senior managers on the wards via regular visits Focus more on internal audits as part of our overall assurance framework Focus on nurse leadership and be a pilot site for the corporate preceptorship programme Consider further QNIC peer review and aspire to achieve accreditation Continue to engage in positive quality reviews with our commissioners NHS England Improve our overall approach to medication management with a reduction in any recorded errors Engage in external and internal peer review programmes Barry, our therapy dog
Achieved an overall rating of "GOOD" and "outstanding" for Personal Development, Behaviour and Welfare Our School In 2016 we: Increased our teaching team to seven, covering the full curriculum with specialist teachers and doing more besides Ran our second collaborative drama project with our local university, University of East Anglia. Students worked together to devise an examined performance piece, performed in school to parents, guardians, friends, family and hospital staff. The performance was then showcased in the UEA drama studio. Had two students who sat GCSE exams. One achieved a C in maths and the other achieved 5 A* to C grades in English language, English literature, maths, physics, chemistry and biology. Our headteacher as Bellatrix Developed our assessment and feedback systems, creating a learning dialogue in all student folders and linking individual Education Plans to each student folder Had a careers day with independent advice from our local careers team Appointed a substantive Head Teacher Appointed a Deputy Head Teacher and Head of Sixth Form Supported students to interview and appoint candidates for two teaching posts and gained two excellent teachers for art and science Extended our PSHE and personal development learning through collapsed curriculum days on British values, substance misuse, sex and relationship education, health and fitness, discrimination and diversity Developed our assessment and feedback systems, creating a learning dialogue in all student folders and linking Individual Education Plans to each student folder We marked our first full year as an Ofsted registered school 13
In 2017, we will: Aspire to achieve an OUTSTANDING rating with Ofsted Start the year with a new focus on education for 16 to 18 year olds Expand our teaching team to offer a wider range of subjects on the curriculum Expand our timetable to introduce lessons on employment skills and careers Collaborate again with UEA drama students on another outreach project Invite our local MP to visit so that students can learn about government, ask questions about mental health services and request his support in our aim of initiating our own actions to respond to and contribute to services Introduce the nationally recognised Asdan qualification, which offers imaginative ways of accrediting young people's activities across a vast spectrum of levels and abilities and subject matter including vocational subjects Develop opportunities to incorporate more vocational training and accreditation to the curriculum Enter more students for GCSE exams Further develop and increase our programme of PSHE through more collapsed curriculum learning days and events, working closely with our social care team, the hospital team and people and organisations in our local community Invent, create and devise more ways to help our students attend and achieve in school Hold more performances, productions, workshops and events Welcome more visitors from different sectors of the local community Work hard, take part and love learning with our students Consider extending our school provision for local children with special educational needs
15 In 2016, we: Reached the end of the year in a financially sustainable position building confidence to drive appropriate occupancy, sensibly managing costs and continuing to invest in teams and staff Managed our staffing costs, overall expenses and facilities costs well within budget Implemented clearer structures, formal meetings and processes Did not keep young people in hospital any longer than they needed to and had a good average length of stay compared to other low secure CAMHS services nationally In 2017, we will: Ensure we utilise all available beds for young people who really need our help and support Ensure our length of stay is appropriate and reduce wherever possible Our Business Fully engage with the national consultation on Tier 4 CAMHS Service Specifications, working with commissioners to adapt to new service models as needed Prioritise our provision for local young people to ensure that care is as close to home as possible Continue to work with young people from across the country where there is no local suitable specialist provision Consider developing step-down and/or crisis provision with our local Clinical Commissioning Groups and providers
Our Relationships In 2016 we: Developed relationships with NHS England (East), our local specialist commissioners and NHS West Midlands, our contract holders Worked hard to build up confidence and trust with commissioners after historical challenges Built up good working relationships with our local CQC Inspector Established links and regular forums with our local Safeguarding teams Developed the existing open and honest approach with all of our external stakeholders Commenced our Internal Care Coordinator role to coordinate communication with families and external teams Developed a weekly update system with NHS case managers across the country Started a more proactive approach to transition and discharge planning with young people and their local teams Started to engage with our local Healthwatch representative Talked to our local Magistrates courts and Youth Offending Teams In 2017, we will: Develop a Carers and Family Forum with a focus on different themes such as how to help young people with self-harm, and how to be involved in a young person s treatment Improve our communication with families by continuing to develop the internal care coordinator role and using our ward clerks as a central point of contact for communication Continue to develop our proactive stance on early discharge planning and liaison with community teams Develop more relationships with our local Clinical Commissioning Groups, our local mental health Trust (Norfolk and Suffolk NHS Foundation Trust), the county council (Norfolk County Council) and the voluntary and independent sector Continue to operate in a collaborative and transparent way with all of our external stakeholders Winning Carer of the Year award
In 2016 we: Employed a team of substantive 120 whole time equivalent staff at any one time, including Psychiatrists, Psychologists, Nurses, Teachers, Occupational Therapists, Support Workers, Housekeepers, Maintenance, Administrators, Catering Improved our staff to patient ratio and ensured we were comparatively well staffed in comparison with other similar units cross the country Valued our regular agency nurses as a core member of our team, ensuring they received the same training and supervision as our substantive nurses Managed our use of agency staff in line with the national recruitment challenges, ensuring we were positively comparable with other services across the country Focused on nursing and support worker recruitment and retention, given the national and regional challenges Appointed a number of substantive leadership positions including Marie Garside, Head of Quality and Nursing following the appointment of Pauline Goffin, Hospital Director in November 2015 Expanded our Occupational Therapy Team to include two additional OT assistants and another OT in addition to a Lead OT, OT and OT Assistant Expanded our Social Work Team adding two Assistant Practitioners to support our Senior Social Worker Introduced the Huntercombe Heroes initiative in February 2016 to highlight the fantastic work our team do 24/7, to date receiving 98 nominations to the committee, with 27 awards to individuals Our Clinical Team
Valued staff development by investing over 50,000 in staff training, offering an extensive training programme to all staff Continually reviewed and improved our two week induction programme using direct feedback and ideas from new staff Supported 5 Support Workers and an additional 5 Support Services staff to start vocational courses via the Huntercombe Academy Supported two Support Workers with the Grow Your Own Nurses programme and in partnership with Huntercombe Academy and the Open University Supported three nurses to complete their Royal College of Nursing Leadership Course Involved and included staff more in everything we do, improving communication Introduced Safeguarding Champions on each ward Won the Carer of the Year award with Radio Norwich Developed a different ethos and leadership approach across the hospital Commissioned some Leadership and Development sessions for our Senior Management Team Launched a new Benefits package for staff giving them choices regarding additional pay, annual leave and private healthcare insurance In 2017, we will: Support two additional Support Workers on the Grow Your Own Nurses programme in February 2017, and encourage more in future cohorts Continue to support staff in a variety of training and development from the Huntercombe Academy Continue to improve communication between managers and frontline staff, operating an open invitation to senior meetings Increase the quality of appraisals, ensuring all staff have clear personal development plans linked to training needs Increase our focus on staff wellbeing and support, and explore how we can better support staff who are injured at work Focus on recognising the skills and talent of our staff, encouraging career development and progression Formalise our Allied Health Professionals networks and develop our Social Work, Psychology, OT and Teachers (SPOTT) group Explore formal leadership training and development for our middle managers Ensure we are represented at company events and meetings, sharing best practice and influencing the direction of travel Continue to focus on nursing and support worker recruitment and retention, and substantive recruitment into key clinical posts
CATERING In 2016 we: Prepared and served 20,440 meals to our young people Installed a new combi oven Joined the events committee and catered at a number of BBQ s and themed events Supported a young person with work experience in the kitchen Hosted charity events in the dining room Maintained a 5 star environmental health standard Improved the CCTV coverage to further safeguard our young people In 2017 we: Are hoping to introduce local suppliers for fresh fruit and veg, also increasing positive links with the local community Will listen to young peoples feedback about food choices and re-establish food group meetings on each ward to involve them in improving the menu Will continue CATERING to be an integral part of the events committee Will encourage more work experience ADMINISTRATION In 2016 we: Consulted, implemented and completed a full review of processes Restructured roles and responsibilities to move to a team approach Our Support Team Created an Administration Team Leader role Improved our data quality Increased the remit of Ward Clerks, giving them more reporting responsibilities Introduced Support Service Team Meetings Recruited a new Human Resources Officer Responded to staff feedback by improving our induction programme In 2017 we will: Recruit an additional Ward Clerk, helping with improved communication to families and external teams Continue to align tasks with the right roles Continue to review responsibilities of the team Continue to improve our recruitment and selection processes Continue to review our induction programme and improve retention Monitor and improve our data quality and processes Improve how we manage sickness absence and support staff wellbeing
19 In 2016 we: Created a beauty room for young people to have their hair and nails done, have camouflage makeup for scars if desired and to complement our pamper sessions Redecorated Sky, Rainforest and Coast Wards Bought 10,000 of new furniture to create a brighter, friendlier environment Created Sensory Rooms on all the wards Installed TVs into all the bedrooms Cleared and landscaped the School/Therapies garden ready to be planted Installed an Outdoor gym Used our family flats every weekend Spent 42,000 on our grounds and buildings that our maintenance team support Our Environment In 2017, we will: Look at how we can further support families and staff to get to our rural location Continue with our redecoration programme across the site Refurbish our reception to be more welcoming Purchase more replacement furniture Install cinema screens and projectors into the link areas of all wards Install bird nest swings into the courtyards Purchase games tables for each ward Install a wet play area Have a therapy hut in each courtyard Trial tarmac in the car park Display some new local area art work around the site Huntercombe Hospital Norwich Buxton Road Norwich NR10 5RH T: 01603 277100 E: norwich@huntercombe.com