Welcome to
Celebrating Positive Practice
in County Durham and
Darlington
19 September 2013
Mrs. Jo Turnbull, Chairman
PATIENT & CARER INVOLVEMENT
Lucy Prowse – Patient & Carer Involvement Support Officer
Anthea Motson - Patient & Carer Involvement Officer
Pam Elliot - Carer
Paul Wait – Ward Manager, Farnham Ward,
Lanchester Road Hospital
What is involvement?
Involvement partnership
Our relationship
Work together to help shape and improve our
services and help with people’s recovery
Types of involvement activity
 Meetings and consultations
 Task and finish groups - reviewing services and providing
feedback
 Service improvement workshops
 Hospital inspections (PLACE visits)
 Ward visits (validation visits)
 Recruitment and selection
 Staff training and induction
 Recovery stories – sharing your experience
 Trust conferences and events
 Readers’ panel – reviewing our leaflets and information
How to get involved
Do you have experience of our services and are
interested in being involved?
Details held on our database
Involvement opportunities sent via email or post
What our service users & carers have said about
involvement:
“My involvement with the Trust has enhanced my recovery
since my discharge and I feel the best I’ve been in my life”
from a service user.
“I have found absolute salvation being involved with various
carers groups and being involved helped put my mind at
rest from personal problems” from a carer.
Recruitment & Selection
ANTHEA MOTSON
Patient & Carer Involvement Officer
Recruitment & Selection
Background:
Historically staff involved service users and carers in
recruitment and selection by inviting them to sit on interview
panels.
Partnership working with HR was undertaken to promote
involvement in their documentation and Trust Induction.
Recruitment & Selection
Currently:
 The Medical Education department hold their own database &
train service users and carers in recruitment & selection.
 Work is ongoing obtaining 360 degree feedback on the
current interview process.
 The trust is hoping to arrange a Values Focus Group to
involve service users and carers in recruitment of staff on the
basis of the Trust Values.
 A focus group was set up to look at job descriptions to see if
they are sufficiently service user / carer focused.
Recruitment & Selection
PAM ELLIOT
Carer
Training for Carers
PAUL WAIT
Ward Manager, Farnham Ward
Lanchester Road Hospital
ANY QUESTIONS
Crisis Teams
The Future
What Does A Crisis Team Do?
Core Provision
 Rapid assessment following referral.
 A viable alternative to hospital admission.
 Intensive home treatment.
 Facilitated early discharge from hospital where
admission has been unavoidable.
 Prevent relapse
Facts
 24 hour service/7 days a week
 Referrals for crisis assessment average around
160/month
 Geographical area covered is from Consett to Seaham
 We aim to see people within 4 hours of referral
 Able to work intensively in people’s homes
 Home Treatment case load is often between 20-30
people .
What’s next
 Change perception service users/professionals
 Be more flexible
 Creative crisis care planning
 Bespoke home treatment-build around individual needs
 Integration with other services
 User friendly/stop repetition
 Accessible
 Listen to feedback/constantly evolve.
Benefits
 Care can be delivered at home.
 Service user has greater individual input into their
episode of care.
 Increased carer involvement.
 Integrated working.
 Supporting community teams.
 Build on existing coping mechanisms and social
networks.
Developments
The Shildon Crisis and Recovery House
Benefits
 Purpose built
 Intensive home treatment in our home
 Help stabilise mental health
 Step up
 Step down
 Can assist in early discharge
Why
 Give people greater choice –an alternative
 Provide supportive care – relapse prevention
 Step in earlier to prevent escalation of crisis
 Facilitate resolution in crisis situations particularly for
those with limited support or felt to be vulnerable
 Focus on recovery
Conclusion
Crisis Teams have been established for several years
within mental health services. The development of the
new Crisis and Recovery House is the next step. It will
enable people to have more choice with regards to
their treatment and care, and allow services to
intervene earlier, which ultimately improves outcomes
and aids recovery.
A different way of doing things!!!
HOW SERVICE USERS WITH A DRUG
PROBLEM ARE SUPPORTED IN
SUBSTANCE MISUSE SERVICES
JUDITH DURKIN - CLINICAL
COORDINATOR.
ANGELA SCULLY-SERVICE USER, SMART
RECOVERY FACILITATOR.
KEY THEMES
 INDEPENDENT/SUPPLEMENTARY NON MEDICAL
PRESCRIBING WITHIN SUBSTANCE MISUSE
SERVICES
 THE DISTRIBUTION OF NALOXONE TO SERVICE
USERS/PARENTS/ CARERS AND OTHERS.
 WORKING AND SUPPORTING PREGNANT
SERVICE USERS.
 ROAD TO RECOVERY - ANGELA SCULLY.
INDEPENDENT/SUPPLEMENTARY NON MEDICAL
PRESCRIBING
 LEGISLATION AND GUIDANCE WHICH HAS
SUPPORTED THE DEVELOPMENT OF NON
MEDICAL PRESCRIBING - NEIGHBOURHOOD
NURSING A FOCUS FOR CARE 1986, FIRST
CROWN REPORT 1989.
 CHANGING PROFESSIONAL BOUNDARIES.
 SUPPORTING THE ETHOS OF THE NHS.
 RENEGOTIATION IN HEALTH CARE LABOUR.
 INTRODUCTION OF NURSE - LED CLINICS.
 THE FIRST NURSES IN THE SUBSTANCE MISUSE
SERVICES COMPLETED THEIR TRAINING IN 2005.
 AT PRESENT THERE ARE 17 NURSES IN COUNTY
DURHAM, A MINIMUM OF 2 WORKING IN EACH
CENTRE WHO ARE QUALIFIED AS NON MEDICAL
PRESCRIBERS.
BENEFITS OF NON MEDICAL PRESCRIBING TO
SERVICE DELIVERY AND CLIENT CARE
 TIMELY ACCESS TO SUBSTITUTE PRESCRIBING.
 IT IS AN APPROPRIATE, EFFECTIVE AND COST
EFFECTIVE INTERVENTION .
 IT IS STRUCTURED AROUND CLIENT NEED.
 GIVES PATIENT CHOICE AND CONVENIENCE.
 AND GIVES CONSIDERATION TO BEST PRACTICE
BASED ON EVIDENCE .
 LEADING TO CONSISTENCY OF CARE DELIVERY
FOR CLIENTS.
NON MEDICAL PRESCRIBING PROVISION WITHIN
THE SUBSTANCE MISUSE DIVISION
 COMMUNITY SUBSTANCE MISUSE SERVICES –
SUBSTITUTE PRESCRIBING, DETOXIFICATION,
SYMPTOMATIC RELIEF,OPIATE BLOCKERS.
 HARM MINIMISATION SERVICES – ANTIBIOTICS,
VACCINATIONS
 RECOVERY INJECTABLE OPIOID SERVICE –
SUPPORTING THE SMOOTH TRANSITION
BETWEEN SERVICES.
 RECOVERY ACADEMY – SUBSTITUTE
PRESCRIBING AND SYMPTOMATIC RELIEF
DURING DETOXIFICATION TO SUPPORT
RECOVERY.
 COMMUNITY ALCOHOL SERVICES – ALCOHOL
DETOXIFICATION TREATMENT REGIMES,
PRESCRIBING TO PROMOTE PHYSICAL HEALTH.
FUTURE DEVELOPMENTS
 NON MEDICAL PRESCRIBING PROVISION
INCREASED TO 75% ACROSS COUNTY DURHAM.
 INCREASE ACCESS TO NURSE LED CLINCS.
 DEVELOP THE ROLE OF THE INDEPENDENT
NURSE PRESCRIBER AND THE PRESCRIBING OF
CONTROLLED DRUGS.
NALOXONE DISTRIBUTION
 IN 2011 – THERE WAS A TOTAL OF 1,772 MALE
AND 880 FEMALE DRUG POISONING DEATHS
INVOLVING BOTH LEGAL AND ILLEGAL DRUGS.
 HEROIN/MORPHINE DEATHS HAD DECREASED BY
25% TO 596 IN 2011 BUT WAS STILL 596 DEATHS
TO MANY.
 THE HIGHEST MORTALITY RATE WAS IN THE AGE
GROUP 30-39.
 OPIOID DEPENDENCY INCLUDING HEROIN AND
OTHER OPIOID DERIVITIVES HAS A HIGH
MORTALITY RATE DUE TO ACCIDENTAL
OVERDOSE.
 EVIDENCE SHOWS THAT THESE NUMBERS CAN
BE REDUCED IF NALOXONE IS GIVEN TO SERVICE
USERS, CARERS AND OTHERS .
 NALOXONE IS AN ANTIDOTE THAT RAPIDLY BUT
TEMPORARILY REVERSES THE EFFECTS OF
HEROIN AND OTHER OPIOIDS. IT IS REQUIRED TO
BE ADMINISTERED VIA INJECTION TO THE
OVERDOSE VICTIM.
 IN 2005 THE LAW WAS AMENDED TO PERMIT
EMERGENCY ADMINISTARTION OF NALOXONE BY
TRAINED MEMBERS OF THE PUBLIC.
KAIZAN EVENT KEY THEMES
 INCREASE AWARENESS OF OVERDOSE
PREVENTION AND THE USE OF NALOXONE
 DEVELOP AN OVERDOSE PREVENTION TRAINING
PACKAGE – TO INCLUDE, BASIC LIFE SUPPORT
AND ADMINISTRATION OF NALOXONE
 TRAIN STAFF TO DELIVER THE PACKAGE
OUTCOMES OF KAIZAN
 PATIENT GROUP DIRECTION.
 TRAINING PACKAGE.
 PROCEDURE.
 STANDARD WORK.
 LEAFLETS.
 QUESTIONNAIRES.
 POSTER.
EVALUATION
 OVER 50 TRAINING EPISODES COMPLETED.
 A KEY PRIORITY FOR SERVICES.
 THREE NALOXONE USED IN OVERDOSE
SITUATIONS WHICH ARE 3 LIVES SAVED.
SUPPORTING PREGNANT SERVICE USERS
 MULTI AGENCY GROUP ESTABLISHED TO
EXPLORE THE DELIVERY OF A ROBUST SERVICE
MODEL
 REVISITED AND UPDATED IN 2012, LEADING TO  STANDARDISED WORKING ACROSS COUNTY
DURHAM.
 THE PROMOTION OF PARTNERSHIP WORKING
WITH THE WIDER CARE TEAM ENSURING
CONSISTENT SAFE PROACTIVE PRACTICES.
SERVICE USER INVOLVEMENT
 SUPPORTING THE DEVELOPMENT OF THE
PREGNANCY PATHWAY.
 DEVELOPMENT OF SERVICE USER LEAFLETS.
 DEVELOPMENT OF THE PREGNANCY CARE PLAN.
2012 SERVICE USER AUDIT.
IDENTIFIED -
 GOOD PRACTICE IN SAFEGUARDING THE NEEDS
OF THE CHILD
 APPROPRIATE REFERRALS TO THE LOCAL
AUTHORITY WHEN CONCERNS WERE IDENTIFIED
 POSITIVE CLIENT ENGAGEMENT WITH
SUBSTANCE MISUSE SERVICES POSTNATALY
ROAD TO RECOVERY
ANGELA’S
STORY.
Hospital Liaison Service Update
Chris Binns, Operational Service Manager
Hospital Liaison Service
 Psychiatric liaison services provide mental health care to people being
treated for physical health conditions in general hospitals.
 Mental health disorders such as depression, anxiety, alcohol and memory
problems are very common in general hospital. Research has shown that
they are often not recognised or treated
 Untreated mental health issues can lead to longer hospital admission and
poorer physical health overall in hospital inpatients and increased health
care costs.
 An effective liaison psychiatry service offers the prospect of saving money
as well as improving health
What did will be different?
 Extend location of services and visibility
 Better Support to hospital staff
 Increased hours of working
 Improved Multi disciplinary approach
 Post discharge support
 Service for High Intensity Users of Hospital Services
Patient stories
Whats next...
 Improving follow up for people who self harm
 Working with Specialities within the Hospital
 Development of MUPS service
 Service Evaluation
And hopefully long term funding....
Questions?
Refreshment Break
 Refreshments served on the mezzanine level and
market place
Patient and Carer Feedback
How the Trust obtains and acts on
feedback from patients and carers, what
it tells us and what we do about it.
Corinne Aspel
Lead Senior Nurse Patient Experience
Trust Values and Associated
Behaviours
 Commitment to quality
 Respect
 Involvement
 Wellbeing
 Teamwork
Benefits in collecting and using patient
feedback....
 helps to improve communication between patients and
staff
 helps to build trust and confidence in the NHS locally
and nationally
 informs planning and service improvement
 helps the organisation to provide accessible and
responsive services based on people’s identified needs
and wants
 helps patients to shape the services that they use.
What it says to those who access our
services :
 we need and value your views on how we are doing
 we are actively looking at how we are doing, and
striving to do better
 we look at your comments regularly and give a quick
response to your opinions
 we are open and honest, showing you how we have
responded to your feedback
 we will keep you informed about how other patients
experienced care here
What it says to staff....
 we believe that your satisfaction with your work is key
to giving patients and service users a positive
experience of care
 we will involve you in designing systems to gather and
respond to feedback
 we will support you to improve services, building our
reputation as a high-quality service provider.
Current Patient Experience System
Electronic touch screen devices in use to
collect feedback ( anonymous )
A wide range of services are covered
Reports monthly to participating teams pie
charts and written feedback
Acting on feedback
Results for Durham and Darlington –
July 2013
 92 patients completed discharge surveys from inpatient
areas. 16 carers gave us feedback
 49 patients completed surveys in 3 community teams
in July. 13 carers gave us feedback
Adult services
 Maple ( WPH) scores Farnham (LRH) – scores above
78% for all questions
 Elm (WPH) 100% felt staff were friendly and
approachable but poor scores for feeling valued and
understood similar picture for Tunstall (LRH)
Adult services
 Cedar (WPH) 58% felt safe during their stay
 All areas excellent scores for friendly and
approachable staff and being made to feel welcome by
staff
Adult Community
 Two teams surveyed Darlington Affective team and
South Durham Affective team
 Overall feedback very good but poor scores for being
given a copy of care plans in the Darlington team
Older peoples services
 Oak (WPH) overall scores excellent lowest scores for
purpose and side effect of medication being explained
60 and 50%
 Roseberry (BLU) again overall scores excellent 2 of 3
patients did not always feel listened to or have side
effects of medication explained
Community
 Sedgefield CMHT – excellent scores for majority of
questions except side effects of medication explained
50%) and being given a copy of their care plan but this
had increased from 35% in June to 56% in July
Carer feedback
 Numbers of carers giving us feedback are small and
this is an areas we would like to improve.
 No themes are evident from feedback to date but each
area are asked to action any questions which score
poor.
Developments
 Friends and Family Test question introduced in July - early
indications are that we will get more valuable typed feedback ( see
display for examples of the feedback received from this question
in July 48 positive comments received and 3 negative)
 Activity questions added to the inpatient survey to understand the
range of activities available and the times they are available, and if
they were helpful in the persons recovery
 Staff experience
 Learning Disability and Children's surveys introduced
Lanchester Road Hospital
Adult Learning Disability Service
Getting Feedback from the people who use
our learning disability service.
A Service User from the Trusts
Reference Group visit patients
once they have been
discharged.
They get feedback about the
persons stay while in hospital.
The Reference Group
What the people who use our service
say…
I didn’t want to be involved
in the CPA but staff helped
me understand and I
understood it.
I liked the staff, they
handled situations well
when I got upset.
I was involved in my
care, I had choices
and options, I could
ask questions.
I was sick of stopping in, you
had to smoke outside. I used
to go to the shops and café
with the staff. I was fed up,
liked to spend more time
outside.
Nothing to do sitting bored
– chose to watch the TV
Hard Mattress – making my
back hurt!
Sometimes I didn’t
really like the food
50% of people
did not like the
food!
What we did!
We have ordered some new
Mattresses!
We have changed the
way food is cooked.
We bought a new Computer
Touch Screen for everyone to
use
We have developed
a good timetable
of activities!
Jackie -
0191 441 5800
Learning Disability Service
 What support and treatment is available for those
patients who may have a Dementia?
 Shirley Hall, Occupational Therapist
Children and Young People’s Services
 Dr Lynne Howey
CYP-IAPT Model (Duncan Law)
• Clinical staff to
deliver the best
evidence based
interventions
• Service delivery
models that are
evidence based and
shaped by service
users. Leadership
Role.
• On-going reflective
practice supervision
based on feedback
Effective
services
Evidence
based
interventions
Supervision
Service User
feedback
and
outcomes
monitoring
• On-going feedback
promotes quality of
service
Question Time??
Summary of Morning
 Mrs Jo Turnbull, Chairman
 Lunch available on the mezzanine level
 Market place stands
 Networking opportunities with your Governors, staff
and other members
 Expense payments – registration desk
 Please take the time to complete your evaluation form
and if you have a specific question you have not been
able to ask – write it down and leave it with us.