Inpatient and Community Mental Health Patient Surveys Report written by:

2.2 Report to: Board of Directors Date of Meeting: 30 September 2014 Section: Patient Experience and Quality Report title: Inpatient and Community Mental Health Patient Surveys Report written by: Jane Marshall Job title: Director of Strategy and Performance Lead officer: Jon Tomlinson, Interim Director of Operations Board Action Required: To receive For Assurance (Yes or No): Yes Purpose of the Report To report the results from the Inpatient Mental Health Survey and the Community Mental Health survey. The detailed results of both surveys will be presented to the Operations Governance Meeting and Quality Committee to focus on assurance that the plans in place to address areas of decline are sufficient to ensure improvement. There are plans in place to address both the Inpatient and Community Survey results where these are not as good as expected along with work to test out in more depth any underlying issues relating to performance. The results of the Community Mental Health Survey showed some significant declines and the results for Lincolnshire Partnership NHS Foundation Trust s (LPFT) services. As a result this was identified as being of some concern to the Care Quality Commission, who published the results of the Community Survey on 18 th September. This paper specifically records some of the actions already underway to address the community service issues as well as future plans to secure improvement. Key Issues, Options and Risks The Community Mental Health Survey results are disappointing and far below the standards aspired to by the Trust. Whilst this is the first time LPFT has been identified as performing in the lowest quintile in England, historical performance has been relatively weak compared to the benchmark for other Trusts. The Care Quality Commission (CQC) published the results of the Community Mental Health Survey on 18 September 2014. The Press Release listed Trusts identified by the CQC with high numbers of questions where their performance is 'worse than expected': Norfolk and Suffolk NHS Foundation Trust Lincolnshire Partnership NHS Foundation Trust The Isle of Wight NHS Trust Kent and Medway NHS and Social Care Partnership Trust Birmingham and Solihull Mental Health NHS Foundation Trust The CQC Deputy Chief Inspector of Hospitals (lead for mental health) has indicated that poor performance on the (community) survey could result in an early inspection and that failure to act on the findings of the survey could affect ratings from October. This survey highlights the need for sustained and sustainable improvements some of which were already in hand but others which now need to be put in place. A summary of current and new actions is set out below. 1

The Trust Executive will receive regular reports from the Interim Director of Operations about progress and a full report prepared for discussion at the November Board meeting. 1. Inpatient Survey Executive Analysis This section provides a summary of the findings of the National 2014 Mental Health Inpatient Survey. This is a voluntary survey, which was conducted by Quality Health on behalf of the Trust. Comparative data referred to in this report is against other mental health trusts that ran their survey with Quality Health. As the survey was run on a purely voluntary basis, benchmark reports will not be produced by the coordination centre. In comparison to the 2013 survey results the Trust has improved in 14 areas. In comparison to the 2013 survey results, the questions below have seen a decline in patient satisfaction: Never able to get the specific diet that was required from the hospital Did not find talking therapy helpful Not given enough notice of discharge from hospital Discharge was delayed There will be more in depth analysis and presentation of the results and action will be taken to ensure that there is improvement where areas of concern are highlighted. These issues will also be considered as part of the CQC mock inspection visits being run by the Trust. 2. Community Mental Health Survey This section provides a summary of the findings of the National 2014 Community Mental Health Survey, commissioned by the CQC and published on 18 th September 2014. The 2014 survey of people who use community mental health services involved 57 NHS Trusts in England (including combined mental health and social care trust, Foundation Trusts and community healthcare social enterprises that provide mental health services). Nationally the response rate to the survey was 29%. The Trust s response rate to the survey was 33% (compared to 29% in 2013). People aged 18 and over were eligible for the survey if they were receiving specialist care or treatment for a mental health condition and were seen by the Trust between 1st September and 30th November 2013. The survey included people in NHS mental health services, including those who received care under the Care Programme Approach (CPA). Similar surveys were carried out in 2010, 2011, 2012 and 2013. However the 2014 survey questionnaire was substantially re-developed and updated in order to reflect changes in policy, best practice and patterns of service. This means the results from the 2014 survey are not comparable with the results from the 2010-2013 surveys. 2

The 2014 results are broken down into 9 section scores with the LPFT patient response score shown along with the position relative to other Mental Health Trusts: - 1. Your Health and Social Care Workers 7.6/10 (Average) 2. Organising your care 8.3/10 (Average) 3. Planning your care 6.8/10 (Average) 4. Reviewing your care 7.1/10 (Average) 5. Changes in who you see 5.6/10 (Average) 6. Crisis Care 5.4/10 (Below average) 7. Treatments 6.7/10 (Average) 8. Other areas of life 4.00/10 (Below average) 9. Overall 6.8/10 (Average) LPFT services fall into the category of worse than average versus other Trusts for: - Crisis Care and other areas of life. The remaining categories fall within the about the same as other trusts but LPFT scored towards the lower end of this scale in the following questions: Have you been told who is in charge of organising your care and services? Were you involved as much as you wanted to be in agreeing what care you will receive? Does this agreement on what care you will receive take your personal circumstances into account? Were you involved as much as you wanted to be in discussing how your care is working? Did you feel that decisions were made together by you and the person you saw during this discussion? Did you know who was in charge of organising your care while this change was taking place? Were you involved as much as you wanted to be in decisions about which medicines you receive? In the last 12 months, has an NHS mental health worker checked with you about how you are getting on with your medicines? Were you involved as much as you wanted to be in deciding what treatments or therapies to use? In the last 12 months, do you feel you have seen NHS mental health services often enough for your needs? 3

Context for Community Services There have been significant changes to the community services over the past 12 months which may have impacted adversely on the perception and experience of the services provided. The data from complaints does not highlight any significant change over the year so it is particularly important that the services ensure closer links with groups such as Healthwatch and promote feedback at all opportunities to ensure that we are getting an accurate picture of all areas requiring improvement throughout the year. Service specific information Integrated Teams In 2013 the integrated teams were formed from a number of other teams including staff from Recovery, Early Intervention (EI) and Assertive Outreach (AO). There were variations in working practices and the overall change caused upheaval for both staff and service users as the new teams formed and developed their ways of working. Of particular note was the change of role of the social workers whose remit was refocused to ensure a clear social care position where they had previously been in a more general role including care coordination. This caused a lot of change for service users. The teams are now quite established but it is acknowledged that there remains significant work to do. Actions to date: 1. Following on from this and more recently there have been a number of leadership changes to the teams. This has been done to ensure only the most effective leaders remain in post. The service now has a full time Head of Service dedicated to the teams which was previously not the case. 2. The teams now have psychology input (currently 1 day per week in each team) and the consultant psychiatrists are aligned to all areas and in most areas are moving to work directly with the teams from October 2014. This will improve multi-disciplinary team working and communication. Psychology waits however remain a concern that impacts adversely and is subject to review. 3. The service now has monthly performance meetings with all of the team coordinators where all areas of performance are discussed and teams are held to account for service provision. This includes feedback on care plan audits, complaints and learning the lessons from incidents. In addition there is a monthly community development day where existing services are discussed in the context of future improvements required. These are very outcome focussed and are supporting consistent service improvements in all areas. 4. Complaints are managed directly by the team coordinators and the Head of Service now meets face to face with any complaints relating to service delivery. 5. To ensure EI does not lose focus within the teams more staff are being trained in EI interventions and an EI steering group will be in place by in November 2014. All the team psychologists have also had EI specific training. 6. The Head of Service and team leader recently arranged and led a meeting between the team coordinators and consultant psychologists in order to discuss improving 4

working practices. This proved a positive forum which is going to continue to promote effective MDT working. 7. There is a Transforming Social Work Programme is underway and a nursing forum that is attended by integrated team staff. Further involvement will be supported for this with the social work remit directly emphasising the community involvement aspect of their role with stronger links to the managed care network. New Actions: 1. The survey results are being cascaded to all teams for direct consideration of improvements required at local level relating specifically to the areas identified of concern throughout the survey. 2. The service has developed a dashboard for each team s performance and are awaiting IT implementation. 3. The community development days will be broadened out to ensure MDT inclusion. 4. The service is in the process of arranging 2 development days (1 North and 1 South) to ensure all staff have a clear and consistent understanding of service needs and quality improvements required. The focus will now be on the survey results and improvement requirements. 5. All staff have appraisal dates with a clear remit from managers about performance requirements. 6. The roll and use of the new risk assessment tool is being implemented. 7. Quarterly quality reviews are to be carried out by General Manager and Head of Service. Crisis teams As with the Integrated Teams there has been a lot of change in the crisis service over the last year. It was acknowledged in early 2013 that the service needed significant improvement and change. Since that time all the team coordinators and also the team leader have changed and work is underway to ensure consistent standards are achieved. The crisis service is significantly over utilised with the original remit of the service being for 1000 new referrals per year. The service is currently receiving this per month a further increase from 2013 when the service achieved 6 times its required activity. The commissioners have agreed to a review of the service specification however there are no dates for this. This has further been exacerbated by the closure of HIPS for example crisis team received 136 referrals from A&E in August which they would not previously have seen. With this in mind the service has a full day planned next week to review all of the capacity and demand data and model out what we can achieve given this position. Actions so far: 1. The new leadership team held MDT development days earlier this year with external facilitators focussing on service improvement and team working. Part of this was the development of a protocol for the service. This is due to be ratified shortly and 5

implemented in December 2014 and will help to clearly establish what the service should be aiming to achieve. 2. Development of the triage car which supports a rapid response for people in crisis and should begin to support the teams to meet home treatment requirements although this has currently been taken up by the extra work from the closure of HIPs. 3. The service has monthly performance meetings where they focus on each area with improvements identified. Examples include improved uptake of appraisals and supervision. In addition all lessons learned from incidents are discussed and areas for improved practice identified. 4. Capacity issues have been highlighted to the commissioners and an internal planning event is taking place to aim at making best use of resources. In addition the absence of a helpline has been identified as a concern as crisis receive a high volume of calls that do not meet the need for a crisis service but would for a helpline. New Actions: 1. Sharing of community survey results to all teams for local action plans to be developed relating specifically to the areas identified of concern throughout the survey. 2. Launch of protocol with follow up away days to support implementation. 3. Continue to highlight capacity concerns and the need for a fit for purpose service specification. 4. Roll-out the use of the new risk assessment tool. 5. Quarterly quality reviews by General Manager and Head of Service. Specialist services Community Mental Health provision in Specialist Services primarily sits with Eating Disorders and Older Adults, with the highest number of referrals coming through older adult services. There has been pressure on older adult community teams in recent years due to an ageing population with an increase in referral rate up to a third, and no increase in commissioning of service capacity. In order to manage this gap between capacity and demand a complete review of service provision is underway this involves a number of individual projects to improve patient care: 1. Nurse led clinics in GP practices; - this involves close working with GPs to enable better communication and enable nurses to explain more about the care and medication. It frees up capacity to enable the teams to see more patients. Furthermore it frees up consultants to see the more complex comorbid patients. 2. Cognitive Behavioural Therapy - CBT groups have been rolled out across older adult services in West and South West CCG areas to enable more patients to receive therapeutic interventions. These have been well received with excellent feedback from service users and carers. It is planned for these to be extended across the county 6

3. Shared Care- OA CPN s have had high caseloads due to the number of cases held for medication monitoring and review. Much work has been undertaken to get a shared care protocol agreement which has now been signed off by PACEF. A letter of communication to the GPs is now in draft and when this is implemented it will reduce pressure on the teams to enable better interaction with service users. 4. Eating disorders services have extended the group work and day care sessions to reach more service users within the limited capacity. Recommendation (action required, by whom, by when) To consider the results of the surveys To note the improvements, declines and changes since the 2013 survey To consider the further report to Board of Directors on the Community Mental Health Survey and the specifics of actions already in place and those planned To note the potential for early inspection visits from the Care Quality Commission. CQC Standards Impacted: Financial Implications: Equality Analysis: Compliance Impact: All CQC Standards To be notified Not applicable Significant The content of this report is the property of Lincolnshire Partnership NHS Foundation Trust Document Control - Version 1 1 October 2011 7

Appendix A Summary of the 2014 Mental Health Inpatient Survey 1. Introduction This paper is presented to the Executive Team and provides a summary of the findings of the National 2014 Mental Health In-patient Survey. This is a voluntary survey, which was conducted by Quality Health on behalf of the Trust. Comparative data referred to in this report is against other mental health trusts that ran their survey with Quality Health. As the survey was run on a purely voluntary basis, benchmark reports will not be produced by the coordination centre. 2. Response Rate 57 completed surveys were returned from the Trust s sample of 229; a group of 27 service users were excluded from the sample as they had either moved or were not known at the address. The final response rate for the Trust was 27%, compared to a 28% response rate in 2013. 3. Characteristics of Respondents 48% of service users responding were women; 52% were men. The gender of 3 service users is not identifiable from the survey. 22% of respondents were aged between 16 and 34 and 78% aged between 35 and 64. 87% of the service users were White British; 2% of the respondents were from Asian backgrounds. 74% of the service users said they were not currently in paid work; 12% said they were in paid work and a further 2% said they were on sick leave; 5% were retired. Service users were also asked whether they had any long standing health conditions other than their mental health condition. 60% said they did not have a long standing condition; 29% said they had a long standing physical condition; and 9% said they had a long standing illness such as cancer or heart disease. 8

4. LPFT Results In comparison to the 2013 survey results the Trust has improved in the following areas: On arrival on the ward staff made patients feel very welcome On arrival on the ward staff knew about patients previous care received On arrival on the ward, patients were informed about the daily routine, including meal and visiting times The toilets and bathrooms were very clean The hospital helped patients keep in touch with family and friends Received help needed from hospital staff with organising the home situation Felt as though the psychiatrist listened Had confidence and trust in the psychiatrist The psychiatrist treated patients with respect and dignity The nurse listened carefully When sectioned rights were explained in a way that could be understood Have been contacted by a member of the mental health team since left hospital 9% increase in rating the overall care received as very good Enough activities available to do during evenings/weekends In comparison to the 2013 survey results, the questions below have seen a decline in patient satisfaction: Never able to get the specific diet that was required from the hospital Did not find talking therapy helpful Not given enough notice of discharge from hospital Discharge was delayed This paper will be presented to the Operations Governance and Quality Group to focus on developing an improvement plan. 9

Appendix B Summary of 2014 National Community Mental Health Service User Survey 1. Introduction This paper is presented to the Executive Team and provides a summary of the findings of the National 2014 Community Mental Health Survey, commissioned the by Care Quality Commission. The Care Quality Commission will publish all Mental Health Trusts results on the 18 th September 2014. The Trust s response rate to the survey was 33% (compared to 29% in 2013). The 2014 survey of people who use community mental health services involved 57 NHS trusts England (including combined mental health and social care trust, Foundation Trusts and community healthcare social enterprises that provide mental health services). Nationally the response rate to the survey was 29%; people aged 18 and over were eligible for the survey if they were receiving specialist care or treatment for a mental health condition and had been seen by the Trust between 1st September 2013 and 30th November 2013. The survey included people in contact with local NHS mental health services, including those who received care under the Care Programme Approach (CPA). Similar surveys of community mental health services were carried out in 2010, 2011, 2012 and 2013. However, please note that the 2014 survey questionnaire was substantially re-developed and updated in order to reflect changes in policy, best practice and patterns of service. This means that the results from the 2014 survey are not comparable with the results from the 2010-2013 surveys. 2. LPFT Results Interpreting the results The report shows how the Trust scored for each evaluative question in the survey, compared to other trusts; identifying whether the Trust has performed Above (Better), Below (worse) or Average (about the same) as the majority of other trusts for each question. Responses to the questions have been converted into scores on a scale of 1 to 10. A score of 10 represents the best possible response, therefore the higher the score for each question, the better the trust is performing. The graphs contained throughout the report demonstrate the Trust s position nationally together with the range of scores achieved by all trusts. The black diamond represents LPFT score. 10

The results are broken down into 9 section scores: 1. Your Health and Social Care Workers 2. Organising your care 3. Planning your care 4. Reviewing your care 5. Changes in who you see 6. Crisis Care 7. Treatments 8. Other areas of life 9. Overall Section Scores As detailed in the table below, LPFT fall into the category of worse than most other trusts for: Crisis Care Other areas of life 11

The tables below detail the results to the questions for both crisis care and other areas of life. The remaining categories fall within the about the same as other trusts but the LPFT scored towards the lower end of this scale in the following questions: Have you been told who is in charge of organising your care and services Were you involved as much as you wanted to be in agreeing what care you will receive Does this agreement on what care you will receive take your personal circumstances into account Were you involved as much as you wanted to be in discussing how your care is working 12

Did you feel that decisions were made together by you and the person you saw during this discussion Did you know who was in charge of organising your care while this change was taking place Were you involved as much as you wanted to be in decisions about which medicines you receive In the last 12 months, has an NHS mental health worker checked with you about how you are getting on with your medicines Were you involved as much as you wanted to be in deciding what treatments or therapies to use In the last 12 months, do you feel you have seen NHS mental health services often enough for your needs The results of the survey will be presented to the Operations Governance and Quality Group to focus on developing an improvement plan. The results will also be presented to the Board of Directors. 13