in Bexley
Mind in Bexley
QUALITY ACCOUNTS
2014 - 2015
Chief Executives Statement
A foreword from the Chief Executive
I am pleased to present our annual Quality Account which demonstrates our continued commitment to delivering high quality care for those residents of Bexley who
access our services. We continually strive to improve the quality and practice of our
services, to deliver high standards of care and to safeguard our clients/service users. This report assures our clients and those who commission our services, that our
services are safe, appropriate and effective, but additionally highlights the excellent
quality improvement initiatives undertaken by staff which are monitored through
Clinical Audits and monthly Key Performance Indicators (KPIs)
Clinical Audit is a process to improve client care through training, clinical supervision
and the regular review of care against clear standards and the implementation of
change. Monthly Key Performance Indicators (KPIs) are undertaken to review / monitor clinical quality indicators, and all staff are involved in collecting evidence, such
as, time taken to access services, clinical incidents, pressure areas, complaints and
compliments.
The provision of high quality patient care is and will always be the highest priority
for Mind in Bexley. Of course our team of clinical and non-clinical staff and are very
much at the forefront of achieving this but there is also very much an organisation
wide commitment to ensure that we continue to improve our outcomes throughout
the year. Quality is central to the services that we provide. Our approach is forward
thinking, flexible and responsive to the local health care environment and we continue to build upon a well-established quality assured framework. I am committed to
promoting and developing an environment of openness, honesty and transparency
to ensure we fulfil our duty of candour. Our new 3 year strategy plan will support us
to fulfil our goal of delivering high quality service provision. In collaboration with a
number of stakeholders and partner agencies, we have developed new exciting initiatives to implement our new strategy which focuses in particular on supporting and
providing more co-produced therapeutic and recovery based services with the local
community.
During the year we have developed staff straining and revised our suite of mandatory training to ensure that our teams have the skills they need to continue providing
safe and effective services. In addition to feedback mechanisms, we have undertaken
research with cares and with those who access our green spaces services so that they
can tell us about their experience of accessing these services and how effective these
services are in making a difference to their well-being. We will next year be working
with academic partners to review our IAPT and Recovery services. We have revised
our policies and training on Safeguarding and maintained Level 2 of the NHS Quality
Assurance framework. We aim to achieve Level 3 by March 2016.
I remain very proud of the commitment of all staff and volunteers at Mind in providing the best possible service provision to residents of Bexley and we will work
together to further explore the user experience so that we provide service which are
effective, quality assured and safe for all those who use our services.
Strategic Objectives
1 - Development
We will develop new services and funding streams, where appropriate in partnership
including exploring working in new demographic areas, to ensure the sustainability
and growth of Bexley Mind and to meet changing individual, internal and external
needs
2 - Customer/Client Care
We will ensure everyone’s experience of Mind in Bexley is of a consistent high quality,
tailored to their individual needs
3 – Promotion
We will promote Mind in Bexley to attract more people to choose our services and
support the organisation
4- Staff, including Volunteers
We will improve the way we motivate, support and recognise the achievements of
our staff
5 – Engagement
We will listen to, communicate with and engage people in improving, promoting and
delivering Mind in Bexley’s services
6 – Value for Money
We will make best use of our resources to provide affordable services that prove their
effectiveness through positive outcomes
Priorities for improvement
Achieve Information Governance Level 3
Mind in Bexley have maintained Level 2 in the NHS Connecting for Health Information
Governance Statement of Compliance (IGSoC) process in the year 2014-2015 and were
approved for a NHS N3 connection.
Mind in Bexley are working towards achieving Level 3 in 2015-2016.
This will involve a continuous process of assessments, audits, reviews and improvement in information security and internal processes.
Customer/user Care
Identify the key characteristics of a ‘quality customer/user experience’ in Mind in Bexley
Equip all staff and volunteers to deliver this experience consistently
Review provision of advice, information and day service provision and identify ways to
develop this work within the context of co-production
Adapt current service models in response to customer/user demand
Monitor customer/user experience through feedback and internal and external qualitative
research and make improvements as required
Context
The expectations of people using our services will continue to rise, and an increasing number will exercise greater choice as a result of the development of personalisation in social
care services and the Any Approved Provider model.
Mind in Bexley has a strong culture of delivering person centred support based on the
principles of co-production and we seek to build on this, as part of our commitment to
consistency and Continuous improvement, by increasing the customer/user focus of each
part of the organisation.
Who will be involved and How ?
Staff including volunteers will take a lead in developing this approach and in ensuring it is
delivered consistently
People who use our services and Carers will be involved in the delivery of induction and
training for our staff and will also deliver training as part of the recovery college model.
How Mind in Bexley will Measure Success
Undertaking research and evaluating feedback from people who use our services and
Carers, including from:
Satisfaction questionnaires
Individual interviews and Focus groups
Compliments, comments and complaints
Monitoring of people choosing Mind in Bexley services
Organisational and Service evaluations and quality assessments
Forensic IMHA service providing Advocacy to
120 patients across two sites
Contact
The IMHA service is not an emergency service therefore it is expected that an
advocate will see the patient within 5 working days after the patient contacts
the service. Mind in Bexley Advocacy Service is the provider of the IMHA service
and has aimed to see the patient within 1 working day, this has been achieved
and at no time has there been any occasion for a waiting list.
We have ensured we have spoken to all patients, including new patients who
have arrived over the last 12 months.
With over 1,100 contacts over the last 12 months, it shows that a proactive advocacy service has benefitted the patient on the Bracton Centre and the Memorial
Low Secure wards.
Patients have commented how they like having one service for all the patients
as before it was difficult to find out who the advocate was and to contact them,
they have also commented that they like that we attend the wards regularly.
Weekly surgeries
Surgeries are carried out on a weekly basis to ensure that even when there is
no request from any patient to see an Advocate we still have a presence on the
ward as some people may find it difficult to request an advocate. It has also been
commented on many times by patients that this time allows them to build confidence in the Advocate.
Bracton User forum
We have a presence at the user led ‘Bracton User Forum’ where the members
regular ask for comments from the Advocate on issues that are raised at this
meeting and also for the Advocacy Service to take issues forward on their behalf.
No Incidents
The Mind in Bexley Advocacy team is an experienced group of advocates well qualified in the role of IMHA, this has meant that any possible volatile clients that the advocates are working with are dealt with in an empathic manner, this has been evident
in a number of cases when the patient was upset and asked to see the advocate and
by us being independent and using our skill have assisted the client to look at the situation again and make an informed choice, which in all cases led to a better outcome.
Comments
“Nicki sorted my isssues out quickly”
“Thank You for all your help”
“Thanks for supporting me in my ward rounds , keep up the
good work”
Improving Access to Psychological Therapies
(IAPT)
“I don’t worry now. An anxious thought used to stay there and manifest, get bigger
and bigger….Now, that negative thought might come in and is there for a few seconds before I can use a strategy. I’ve learned to think how realistic is this?”
We are very pleased to say that we have had another very successful year as an Improving
Access to Psychological Therapies (IAPT) service with over 2000 residents accessing the
service. The IAPT service offers evidence based psychological therapies as recommended
by the National Institute for Health and Clinical Excellence (NICE) to residents registered
with a Bexley GP. It delivers these treatments through a stepped- care model. ‘Stepped
care’ means that clients are offered the type of intervention that is best suited to their
needs: which could range from guided self help or psycho-educational workshops to intensive one to one therapy depending on the nature and severity of their problem.
The focus of the service is to provide both high standards of talking therapy, helping clients to recover from their anxiety and depression, and high levels of access to this therapy
– increasing the numbers entering the service and working consistently to remove barriers to access. With regard to quality of therapy, we continued to achieve above national
average recovery rates of over 50%. A satisfaction rate of between 95-100% on questionnaires at the end of therapy represents that even those clients who do not enter ‘recovery’
are benefiting from our service by an improvement in their mental health.
During the year we fully integrated the local counselling service into IAPT and now offer
appointments in selected local GP surgeries throughout the borough as well as our central Bexleyheath Hub. The extension of the service into GP surgeries has led to further
improvement in access, particularly for those who find it difficult to travel due to physical
health problems. We have also further extended the range of therapies we offer. We continue to offer Cognitive Behaviour Therapy, in the treatment of depression and a range
of anxiety problems. We also offer counselling (recommended by NICE for depression),
mindfulness, Rational Emotive Behaviour Therapy acceptance and commitment therapy
and Eye Movement Desensitization and Reprocessing (EMDR). Group therapy plays a vital role in increasing access and during the year the service has expanded the range of
groups on offer to include Depression, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD) whilst also undertaking groups for mothers with young children. In partnership with SLaM, we continued to offer specialised interventions for those
coping with long term physical health conditions, including both guided self-help and
one to one therapy.
We are planning to launch a new Anger and Weight Management group and Mindfulness
drop-in group specifically designed for those with long term physical health difficulties in late
2014. Our Introductory CBT and Counselling workshops were well attended and clients have
reported benefit from the information offered. As a result we have added two disorder specific workshops (OCD and Trauma) due to start next year, as well as an Emotional Wellbeing
Group commencing in December 2014.
Another achievement this year was to extend out of hours appointments to provide early
morning and evening appointments and a full Saturday service. This is a much needed service
for Bexley residents, many of whom commute into London and find it difficult to attend week
day appointments. We also expanded our outreach service and are now based in a number of
children’s centres in the borough, providing workshops in libraries and have plans to extend
our outreach to Age UK and BME community groups next year. There was a further expansion
of service, with three high intensity trainees and two low intensity trainees joining the team.
The service has been performing strongly and it is our hope that over the coming years with
the developments highlighted above, that we will be able to make a significant contribution
to the wellbeing of many residents in Bexley, while at the same time producing cost savings
for GPs and the NHS as a whole.
IAPT KPI’s
4,614 referrals received
63% of these referrals had at least 1 appointment
Average Recovery Rate of 49.58%
t
Within the reporting period 3,091 clients received a minimum of 2 sessions.
IAPT KPI’s
Demographics of clients completing therapy within the reporting period
27% were male aged 18-64
67% were female aged 18-64
4% were female aged 65-74
The average client DNA Rate within the reporting period was 11%
The average client cancellation rate within the reporting period was 13%
95% of triages were completed within 14 days of client engaging (opting in)
Treatment PEQ responses Oct-Dec 2014
Did staff listen to you and treat your concerns seriously?
At all times
Most of the time
Sometimes
Rarely
Do you feel that the service has helped you to better understand
and address your difficulties?
At all times
Most of the time
Sometimes
Rarely
Never
Did you feel involved in making choices about your treatment and
care?
At all times
Most of the time
Sometimes
Rarely
Never
On reflection, did you get the help that mattered to you?
At all times
Most of the time
Sometimes
Rarely
Never
Did you have confidence in your therapist and his / her skills and
techniques?
At all times
Most of the time
Sometimes
Rarely
Never
Quotes from IAPT users
“All the help and advice I have had from Mind this year has
helped me make a big mind-shift.”
Excellent! Probably saved my life!”
“I found it helpful to reflect on my past and how I behave
to situations, as it will help me to try and look at situations
more positively.”
“I found it very helpful and good, I’m proud that I have
changed and can do better. ”
“I have found it very useful to be able to speak to someone
that would listen to me and felt comfortable talking and felt
safe that I could say anything I wanted to.”
“My sessions have helped me gain confidence and learn to
control situations that cause me stress. They have definitely
helped my well being. Thank you! ”
The Board of Trustees Commitment to Quality
The Board of Trustees have a robust approach to the monitoring of the quality and
safety of all Mind in Bexley’s services provided to those who access us and their
families. Their role is to ensure that Mind continues to provide a comprehensive
range of high quality, cost effective services, and innovative services that offers significant return on investment and benefit to the Bexkey local community.
Mind in Bexley has developed a strong, professional and clinical governance framework and has a culture of continuous quality monitoring, in which any shortfalls are
identified and acted upon quickly. This ensures that we continue to challenge ourselves by considering how we can offer the best quality service to those residents
we work with and recognising the need for service adaptation.
The Trustees achieve this through their active involvement in the quality of care review processes. Quarterly board reports are presented to the Trustees by the Chief
Executive and senior managers and these are appraised at the meetings. Additionally there are monthly meetings, held by the External Advisor to the Board and the
Chief Executive, to review any current clinical and governance issues.
These strategies ensure that the Board of Trustees have a good understanding of
the quality of the care provided to those residents who access our services. This enables them to be confident that quality is integral to all of Mind in Bexley’s internal
governance arrangements.
Involving and Listening to Service Users and
Volunteers
We believe that effective and genuine service user involvement is key to the success of
Mind in Bexley. We have a number of Board members who are experts by experience who
help govern the charity and service users are supported to have an active role in the day
to day running of services and activities. We work hard to make communication between
users and staff as open as possible. Our Mind quality standards highlighted the open door
policy of the Chief Executive and several staff are involved in outreach activities in order to
listen to service users’ views and give information. Much of our work depends on volunteers and the descriptions of our services in this report highlight the very valuable input
from volunteers in our IAPT, Recovery, Carers and Peer Mentoring services. We also benefit
from volunteers who contribute to the general administration of the charity.
During the year Mind in Bexley continued to undertake academic research in order to
demonstrate outcomes and actively translate, disseminate and share information to key
stakeholders to provide timely and relevant advice and information to complement our
traditional therapeutic and recovery based activities. Over the last the year we continued
to engage with our users in order to develop and reshape our services. We showcased our
innovative oral history project with carers which explored the impact of the caring role on
well-being. The exhibition, which was held at Bexleyheath Library for national carers week,
helped raise awareness wilst also highlighting the heavy responsibilities of caring for those
experiencing mental health and the impact of the caring role on the wellbeing of carers.
Users attending our green space initiatives contributed to a very interesting narrative study
which explored the impact of accessing green spaces on mental well-being. Qualitative interviews generated rich data, which were examined in the light of concepts drawn from the
literature on ecotherapy, green spaces, therapeutic horticulture and social networking. The
study concludes that there are particular qualities of the plant/growing -person relationship
that promote people’s interaction with their environment and hence their health, functional level and subjective well-being. The project findings were exhibited in the Thames Innovation Centre. We are currently writing up an academic paper on the project and are also
working with Christchurch University with a view to holding a conference in early 2015 on
the theme of ecotherapy and well-being.
During last year we also stated on a study which aims to explore the impact of intergeneration experiences within the South Asian community in Bexley. We undertook a comprehensive literature review and developed a culturally appropriate guide with users from the
South Asian community who access Mind services. We will be undertaking interviews in the
New Year and aim to exhibit our finding during 2015. This project will enable us to engage
better with diverse communities and provide service, which are culturally appropriate.
We are also working closely with colleagues from Healtwatch on a project which aims to
find out the views of people who receive care at home (or domiciliary care as it also called)
and the impact of this service on their quality of life. We hope that the project will provide
new information on the quality of Home Care services and will help to improve service provision in the Borough. At the end of the project, the research team will report the findings
to the Health and Wellbeing Board and Commissioners to consider ways of improving the
existing provision.
Recovery Services
“I didn’t want to go out; I didn’t want to see anyone. And most of my friends didn’t
really understand and it just means that some days I just found it hard to get out
of bed. So going to MIND and doing activities and getting out and about has really
helped me”
The Mind in Bexley recovery service, which is based on a personalised and co-production model of health, aims to deliver services which are based on the principles of peer
support, and focuses on training and employment outcome-based interventions. Our
dedicated staff work closely with experts by experience in order to provide an array of
interventions to support residents of Bexley to access, maintain or return to employment or education. Services are provided in partnership with voluntary and secondary
agencies and operate from a variety of settings including Erith Town Hall, allotment
sites, Crook Log swimming pool, libraries, church halls and the Bexleyheath cinema.
During the year in excess of 200 individuals engaged with the service.
During the year we continued with music therapy provided in partnership with the Joy
of Sound, expanded our dance therapy and complementary therapies initiatives, redesigned our art therapies and writing groups so that they because user led, expanded
our green spaces initiatives and provided a range of workshops and courses in order to
improve confidence to access opportunities in the market place. The team continued
to consult with users to find areas that we could develop further. Using these techniques we developed groups and activities such as Photography; Men’s Well-being
Group; Walking Groups; Food, Nutrition and Well-being workshops; Mindfulness for
Carers and expanded our Allotment initiatives. We also developed our courses to include – Managing your tenancy; Debt management; I Can Do; and Developing Skills
to be Job Ready. We also expanded our peer support mentoring model to support
those suffering from dual diagnosis. Our mentoring brings many types of benefit and
is an integral part of our service. During the year 30 new mentors were trained with 26
going on to provide individual support to 26 mentees.
Mind in Bexley Basic Organisation Chart