2.1 Report to: Board of Directors Date of meeting: 24 November 2016 Section: Patient Experience & Quality Report title: Community Mental Health Patient Survey Report written by: Ian Jerams and Suzanne Chapman Job title: Director of Operations / Compliance Manager Lead officer: Ian Jerams / Jane Marshall, Director of Strategy Board action required: For information For assurance (Yes or No): Yes Purpose of the Report To inform the Board of the outcomes of the 2016 Community Mental Health Patient Survey and the planned actions to address areas for improvement. Key Issues, Options and Risks The Care Quality Commission (CQC) published on 15 November 2016 the results of the 2016 community mental health survey, based on the views of people accessing adult and older adult community mental health services across England. The detailed results are provided at Appendix 1. During March to June this year, 33 per cent of the 850 patients selected at random from the Trust s community and crisis services responded to the survey, this represents an increase of four per cent from last year. Whilst many of the Trust s scores have improved from the 2015 and 2014 surveys, some by significant margins, other trusts have improved accordingly, meaning that LPFT s final scores remain within the lower 20 per cent of all trusts surveyed. Of the questionnaires returned, approximately sixty per cent were returned from adult mental health service users and the remaining forty per cent from those in receipt of older adult community mental health services. The adult community mental health teams were subject to significant efficiency savings during 2015, resulting in a period of destabilisation, high turnover and some increased sickness absence for the teams. In late 2015, work commenced on a transformational change programme, to redesign the services in order for them to be able to meet future demand on the services. In the meantime, work is being undertaken to ensure that safe and sustainable services are available to meet current demands. This period of change has inevitably impacted on the ability to achieve significant improvements in the community mental health survey outcomes during 2016. There has also been an increase in demand for crisis services, with some levels of need being displaced from the community mental health teams over this period. It is likely that the reduction in satisfaction for the crisis services in the 2016 survey is related to the additional pressures and unmet service user expectations associated with this increase in demand. Some of the areas of improvement in the report include that 78% of patients feel involved in agreeing what kind of care they will receive, with 79% of the opinion that it also takes their personal circumstances into account. There are however, particular areas where the Trust would wish to improve the experience for our service users/patients, these themes include: 1
Crisis care whether patients get the help they needed when contacting services Changes in who people see and the impact this has on their care LPFT scoring worse than other trusts in this domain Support and wellbeing whether someone from mental health services supported a patient to take part in local activities LPFT scoring worse than other trusts in this domain There are a number of ongoing pieces of work that the Trust is involved in which will help to address these issues including our older adult teams now providing all service users with a care plan folder, including key contacts and information specific to their needs. They have also moved to more patient-centred correspondence, with all letters now addressed directly to patients and copied to their GP, rather than the other way round. In addition, the establishment of our Peer Support Worker Reference Group has allowed our adult community mental health teams to recruit peer support workers to work and help service users in the community, along with a number of new service user and carer groups being set up across the county. Service users are also now allocated a Care Coordinator within seven days of discharge from an inpatient stay. The College Centre for Quality Improvement of the Royal College of Psychiatrists published, in September 2016, the document Accreditation for Community Mental Health Services (ACOMHS), establishing Standards for Adult Community Mental Health Services. The Trust has previously made good use of the equivalent AIMS standards for its inpatient units, so will be exploring how the use of ACOMHS can contribute to this area of improvement work in the CMHTs. The standards cover thirty-one areas which include the care pathway through services, collaborative and inclusive practice, service user and carer participation, staffing, team working, training and supervision, and audit and service evaluation. The standards endeavour to reflect exemplary practice in mental health care by drawing on new policy and recent insights into best practice such as; promoting physical health, working within a recovery ethos, and providing psychological and psychosocial therapies. Executive Analysis Patient experience is critically important, not only as a measure of the quality of the Trust s services in its own right, but due to the direct relationship between patient experience and the effectiveness of the service delivered. In other words, notably within mental health services, patients will achieve better outcomes if they have positive experiences of the services provided. The adult community mental health services of the Trust have undergone a period of destabilisation during the past 18 months and continue to work through a programme of transformational redesign. The implementation of clear quality standards should support improvements in service quality across the adult community mental health services, if integrated into this service redesign. Such standards will also be of benefit to older adult and other specialist community services. Recommendation (action required, by whom, by when) The Board is asked to receive the report and note the planned actions to address areas for improvement. 2
Regulation, legislation and compliance CQC Impact on key lines of Safe, Effective, Caring, Responsive, Well-led enquiry: Financial Implications: Cost of ACOMHS accreditation is 5.4k plus VAT over 3 years Equality Analysis: Supports equality of service delivery Compliance Impact: Considered by NHSI and CQC as measure of the quality of the Trust s services. Risk Appetite Risk assessment Not applicable Risk Level Avoid Minimal Cautious Open Seek Mature Key Elements Financial / VFM: Compliance/Regulatory: Innovation/Quality: Reputation: APPETITE NONE LOW MODERATE HIGH SIGNIFICANT Explanation of variance from general (G) risk appetite The level of risk against each element should be indicated. Where more than one option is available the level of risk of each option against each element should be indicated by numbering each option and showing numbers in the boxes. The content of this report is the property of Lincolnshire Partnership NHS Foundation Trust Document Control Version 4 November 2016 3
Summary of results: Key: Appendix 1 2016 Community Mental Health NHS Survey Better: the trust is better for that particular question compared to most other trusts that took part in the survey. About the same: the trust is performing about the same for that particular question as most other trusts that took part in the survey. Worse: the trust did not perform as well for that particular question compared to most other trusts that took part in the survey. Patient survey section heading Patient Compared with response other trusts Health and social care workers: 7.5/10 About the same Listening - 8.0/10 About the same For the person or people seen most recently listening carefully to them Time - 7.5/10 About the same For being given enough time to discuss their needs and treatment Understanding - 6.9/10 About the same For the person seen most recently understanding how their mental health needs affect other areas of their life Organising care: 8.2/10 About the same Being informed - 6.9/10 About the same for having been told who is in charge of organising their care and services Contact - 9.6/10 About the same for those told who is in charge of organising their care, being able to contact this person if concerned about their care Organisation - 8.1/10 About the same for those told who is in charge of organising their care, that this person organises the care and services they need well Planning care: 7.1/10 About the same Agreeing care - 5/6/10 About the same For having agreed with someone from NHS mental health services what care and services they will receive Involvement in planning care - 7.8/10 About the same For those who have agreed what care and services they will receive, being involved as much as they would like in agreeing this Personal circumstances For those who have agreed what care and services they will receive, that this agreement takes into account their personal circumstances 7.9/10 About the same 4
Patient survey section heading Patient Compared with response other trusts Reviewing care: 7.4/10 About the same Care review - 7.2/10 About the same For having had a formal meeting with someone from NHS mental health services to discuss how their care is working in the last 12 months Involvement in care review - 7.5/10 About the same For those who had had a formal meeting to discuss how their care is working, being involved as much as they wanted to be in this discussion Shared decisions - 7.5/10 About the same For those who had had a formal meeting to discuss how their care is working, feeling that decisions were made together by them and the person seen Changes in who people see: 5.1/10 Worse Explanations - 5.8/10 About the same For those for whom the people they see for their care changed in the last 12 months, that the reason for this change was explained to them at the time Continuity of care - 5.5/10 Worse For those for whom the people they see for their care changed in the last 12 months, that their care stayed the same or got better Information - 4.0/10 Worse For those for whom the people they see for their care changed in the last 12 months, knowing who was in charge of their care during this time Crisis care: 5.8/10 About the same Contact - 6.8/10 About the same For knowing who to contact out of office hours if they have a crisis Support during a crisis - 4.8/10 About the same For those who had contacted this person or team, receiving the help they needed Treatments: 7.2/10 About the same Involvement in decisions - 6.9/10 About the same For those receiving medicines, being involved as much as they wanted in decisions about medicines received Understandable information - 7.1/10 About the same For those prescribed new medicines, being given information about it in a way that they could understand Medicine review - 7.6/10 About the same For those receiving medicines for 12 months or longer, that a mental health worker checked how they are getting on with their medicines Explanations - 7.8/10 About the same For those who received treatments or therapies other than medicine, that the treatments or therapies were explained to them in a way they could understand Involvement in deciding other treatment or therapies - for those who received treatments or therapies other than medicine, being involved as much as they wanted in deciding what treatments or therapies to use 6.7/10 About the same 5
Patient survey section heading Patient Compared with response other trusts Support and wellbeing: 4.6/10 About the same Help finding support for physical health needs - 4.2/10 Worse For those with physical health needs receiving help or advice with finding support for this, if they needed this Help finding support for financial advice or benefits - 4.0/10 About the same For receiving help or advice with finding support for financial advice or benefits, if they needed this Help finding support for finding or keeping work - 3.8/10 About the same For receiving help or advice with finding support for finding or keeping work, if they needed this Local activities - 3.3/10 Worse For someone from NHS mental health services supporting them in taking part in a local activity, if they wanted this Involving family or friends - 6.7/10 About the same For NHS mental health services involving family or someone else close to them as much as they would like Information on support from others - 4.1/10 About the same For being given information about getting support from others with experiences of the same mental health needs, if they wanted this Support - 6.2/10 About the same For the people seen through NHS mental health services helping them achieve what is important to them Overview of care and services: 6.9/10 About the same Contact with services - 5.7/10 About the same For feeling that they have seen NHS mental health services often enough for their needs in the last 12 months Respect and dignity 8.1/10 About the same For feeling that they were treated with respect and dignity by NHS mental health services Overall experience: 6.7/10 About the same Overall view of mental health services For feeling that overall they had a good experience 6.7/10 About the same The results are published on the CQC website: http://www.cqc.org.uk/provider/rp7/survey/6#undefined 6