CLINICAL STRATEGY...“Our clinical strategy is a way of describing how we will provide the best possible mental health care for those who use our services. The aim is to make sure

CLINICALSTRATEGYTHE NEXT STEPS IN OUR JOURNEY 2017-2020

NOVEMBER 2017 - VERSION 2 - FINAL

“Our clinical strategy is a way of describing how we will provide the best possible mental health care for those who use our services. The aim is to make sure we keep our focus on improving patient care whilst supporting our staff to deliver this care at the right time and right place” Dr Rick Fraser, Chief Medical Officer

“I want to know what’s happened to me rather than what’s wrong with me – and we need to work on developing this understanding together so that we can work out how I can move on and live my life more fully” Service user

CONTENTS

CLINICAL STRATEGY 2017-2020

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EXECUTIVE SUMMARY04 Executive Summary

INTRODUCTION06 The context

07 Our Values

08-12 The last three years

13-16 Challenges and opportunities

17-19 Defining our outcomes

20 Core principles

21 Our top three priorities

PART 1: OUR OFFER: THE NEWSERVICE MODEL23 Working with communities

24-25 24/7 crisis care

26-27 Access to care

28 Primary care mental health and tier 2 pathfinder services

29-30 Secondary care community and youth services

31-32 Wellbeing, recovery & discovery college

33-34 Acute inpatient services

35 Rehabilitation

36-37 Children and young people: CAMHS,

EIP and perinatal mental health services

38 Specialist services for people with learning disabilities and autistic spectrum conditions

39 Services for older people and people with dementia

40 Forensic healthcare services

41 Carehome Plus

42 Dual diagnosis

PART 2: NEW PARTNERSHIPS AND NEW WAYS OF WORKING44 Suicide Prevention

45-46 Integrated physical & mental health services

47 People participation

48-49 Workforce and new roles

PART 3: ENABLING HIGH QUALITY CARE51-52 Staff wellbeing53 Medicines optimisation54 Improving teams55 Measuring outcomes56-57 Pathways of care58 Using data and technology to improve care59 Digital by design60 Heads On

CONCLUSION61 Conclusion

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OUR TRUSTSussex Partnership NHS Foundation Trust is a large NHS organisation that offers clinical and social care services to children, young people, adults and older adults, who have emotional and mental health problems or learning disabilities.

We support people with conditions such as psychosis, depression, anxiety disorders, eating disorders, dementia and personality disorder. We also provide community and inpatient care for people with complex health needs that can’t be met elsewhere (through our learning disability, neurobehavioural, forensic healthcare and Carehome Plus services).

As a partnership organisation, we offer integrated social care services across many parts of Sussex that enable people with mental health problems to access the social care and community support they need (Care Act, 2015), as well as give people protection through the implementation of Child and Adult Safeguarding, Mental Health Act (2007), Mental Capacity Act (2005), and Deprivation of Liberty Safeguards(DOLS).

We employ approximately 5,000 staff across services based in Sussex and Hampshire.

OUR CLINICAL STRATEGYOur overarching strategy ‘Our 2020 Vision’ sets out how we will provide outstanding care and treatment you can be confident in.

Our clinical strategy aims to help us achieve this vision. It outlines the type and range of clinical services we want to offer by 2020 to deliver the best care we can for service users, carers and their families within the resources we have available. It also describes the type of partnerships we want to form, the key changes in services and clinical practice we want to see, and the support we will put in place to make these changes happen.

The clinical strategy has been developed in partnership with patients, carers, staff, commissioners and other key stakeholders. It aims to directly address the concerns and ambitions of each stakeholder group.

EXECUTIVE SUMMARY

OUTSTANDING CARE AND TREATMENT YOU CAN BE

CONFIDENT IN

OUR ETHOSOur clinical strategy is underpinned by an approach to health and wellbeing that considers the impact that physical, psychological, financial, social, housing and environmental factors have on our mental health and wellbeing. Our recovery focused services will aim to:

l help people to understand how they have got to where they are

l support people to make informed choices about treatment and the broader social care support they need to help them to reach their full potential

We will also commit to work within the communities that we and our service users belong to, to help people access the full range of support available.

DELIVERYThe delivery of the strategy is all of our business. It is as much about the planning and implementation of local ideas, initiatives or developments that align with the strategy, as it is about the design and implementation of large scale change programmes. To that extent, this must been seen as OUR clinical strategy as every service user and carer lead, staff member, commissioner and partner organisation has a responsibility to see through its implementation.

Delivery of the strategy will also be underpinned by the adoption of a new set of trust-wide Quality Improvement (QI) tools and methodologies that will ensure all change programmes are patient centred, measurable and effective in producing the changes we want to see. This will also help ensure that the implementation of the clinical strategy remains a live and on-going endeavour that continues to develop in response to changing circumstances and feedback.

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THIS DOCUMENTThe introduction to this document outlines what the clinical strategyis, the context in which it hasemerged, and the opportunitiesand challenges we face. Havingthen outlined what we have achieved over the last three years, the document will detail the keyoutcomes we want to achieve fromthe perspective of our service usersand carers, staff, and commissionersand other partners, as we move ourplans on to the next stage. The top10 core principles that will underpinthe strategy, and our three priority change programmes, are described. Part 1 describes the changes that we will make in our core service offer and the type and range of services we will be providing Part 2 describes the new partnerships and new ways of working we will be developing Part 3 describes how we will enable our staff to offer the highest quality of care to patients

INTRODUCTION

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INTRODUCTION

THE CONTEXT

OUR 2020 VISIONIn order to achieve ’Our 2020 Vision’ (our overall strategy to improve patient care) we have set ourselves five core goals. The key elements of the clinical strategy which will support the achievement of our five goals are outlined below.

Objective What this means Key sections of the clinical strategy

OUR 2020 VISION AND STRATEGY

Safe, effective, quality patient care

We will treat everyone as an individual, focusing on their strengths and helping them with their recovery and wellbeing in a safety focused culture

Primary care mental health and tier 2 pathfinder services (p28)Secondary care community and youth services (p29)24/7 crisis care (p24)Acute inpatient services (p33)Rehabilitation (p35)Services for older people and people with dementia (p39)

Local, joined up patient care

We want to understand the needs of the communities we serve, working with service users, carers and partners to consistently provide good quality services

Access to care (p26)Working with our communities (p23)Integrated physical & mental healthcare (p45)Wellbeing, recovery and discovery college (p31)Pathways of care (p56)

Putting research, innovation and learning into practice

We will learn from our research and our innovative practice and ensure that this learning is embedded across the Trust

Digital by design (p59)Pathways of care (p56)Using data and technology to improve care (p58)

Being the provider, employer and partner of choice

We want to be the provider that people choose to work with and to seek services from

People participation (p47)Staff wellbeing (p51)Improving teams (p54)

Living within our means Living within our means involves being responsible with public money, using our resources wisely, and demonstrating value for money in what we offer

All service areas (p22-42)Workforce and new roles (p48)Using data and technology to improve care (p58)


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OUR VALUES

People firstPeople are at the heart of everything we do.

Future focusedWe are optimistic, we learn and we always try to improve.

Embracing changeWe are bold, innovative and disciplined about making use of our resources to continuously improve.

Working togetherWe provide services in partnership with patients, families and others.

Everyone countsWe value, appreciate and respect each other.

WHAT WE HAVE ACHIEVED OVER THE LAST THREE YEARS‘Our 2020 Vision’ has shaped the development of our clinical services over the last three years. We have introduced a number of initiatives which have developed and, in some cases, fundamentally reshaped how we deliver services. The key change has been the introduction of Care Delivery Services. This has strengthened local leadership and clinical engagement. It has also helped us develop new types of partnerships with local commissioners and partner agencies (see box below).

We have sought to change the way our organisation works to develop a culture that promotes positive staff, service user and carer experience. We have developed a set of values which guide the way we want to work with each other with the people who use our services and the people who work with us. Our most recent staff survey feedback shows we are heading in the right direction, though we have more to do.

OUR CARE DELIVERY SERVICES

We have seven Care Delivery Services (CDSs). Each CDS is tasked with providing overarching leadership for a particular care group and / or geographical area. Overall leadership of each CDS is provided by a service director and a clinical director, with a multi-disciplinary leadership team (including different clinical professions and business, finance, HR, IT and estates and facilities support staff) providing additional leadership and governance oversight.

The move towards a CDS structure has helped us:

l move away from central ‘command and control’ to more devolved leadership

l provide services that can flex to local needs

l improve clinical leadership

l encourage clinical engagement within services

l promote more local accountability

l develop new partnerships with local third sector organisations

l make more decisions taken closer to where patients are treated

l promote more local accountability.

The CDS model has helped us continue to improve services for patients and carers. However, the intention was never to create completely independent services where decisions about service offer and standards could be developed in isolation. After all, as an organisation we are only as good as our weakest service. Providing consistently high quality services means:

l working together in partnership with each other, the people who use our services and other organisations

l pooling our expertise, experience and resources

l embedding the learning from what we do well, and where we need to improve, across all our services

l defining a commonly agreed set of strategic, clinical priorities.

Our clinical strategy sets out to help us achieve all of the above.

INTRODUCTION

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Forensic Healthcare

Service DirectorClinical Director

Carehome Plus

Operations Director

ChYPS


Learning Disability


Primary Care &Wellbeing


West Sussex


Brighton & Hove


East Sussex


OUR CARE DELIVERY SERVICES

INTRODUCTION

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OVER THE LAST THREE YEARS ACROSS THE TRUST WE HAVE ALSO:l introduced new Clinical Academic Groups (CAGS) for Psychosis, Mood and

Anxiety Disorders, Complex emotional difficulties (personality disorders), Later Life and Dementia, Children and Young People, Learning Disabilities and Neurobehavioural Disorders, and Forensic Health (CAGS – see clinical pathways section)

l introduced new and more robust systems and processes for learning from serious incidents

l secured greater staff engagement and involvement in services and service redesign as evidenced by the significant improvements in our recent staff survey

IN ADULT SERVICES WE HAVE:l developed new pathways of care, and new services, for people with

personality disorders

l developed new third sector partnerships with jointly delivered pathways of care

l delivered on the Crisis Care Concordat (2014) including street triage and family liaison

l developed new care pathways for urgent and priority referrals

l embedded clinical leadership structures throughout our services

l developed new clinically led systems for managing demand into our inpatient services, helping us reduce out of area placements (where people are transferred out of the local area for hospital treatment)

l in some CDSs, achieved significant reductions in the numbers of inpatient admissions due to improved quality of care in community services

l developed new services for people with dementia (for example the Golden Ticket services in East Sussex)

IN OUR PRIMARY CARE AND WELLBEING SERVICES WE HAVE:l developed new primary care and wellbeing services, including winning two

new tenders for Increasing Access to Psychological Therapy (IAPT) services

l developed new pain management services, a new Medically Unexplained Symptoms (MUS) service, and a new service for veterans


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IN CHILDREN AND YOUNG PEOPLE’S SERVICES WE HAVE:l worked collaboratively across all settings that children, young people and

families access to provide care as close to home as possible

l developed services with partners to support young people when they are in crisis

l developed new services in Hampshire

l set up Family Eating Disorder Services to support community treatment for young people who have an eating disorder

l through engaging with children, young people, and their families and friends, we have created a strong participation ethos in our services with young people and families being involved in service design, research and recruitment

l established a Trustwide Clinical Academic Group (CAG) to evaluate and inform our evidence based practice

l worked to understand how young people and families want to access information and support

l set up i-rock, a youth service, with other agency partners to allow young people to drop in and discuss whatever is on their mind and gain information/support from housing to anxiety

l co-produced a shared care plan on a single page that young people and families led

IN FORENSIC HEALTHCARE SERVICES WE HAVE:l maintained a high quality inpatient secure service, rated outstanding for

effectiveness by the Care Quality Commission

l developed a pathway which includes ‘high dependency rehabilitation’ for Sussex residents moving through secure care

l developed professional service user roles to enhance engagement and co-production within services

l directly employed GPs into our inpatient services in order to improve the physical health of these patients

l developed a responsive community outreach service providing case management, liaison and consultancy services

l maintained and developed services into the two local prisons which primarily cater for Sussex residents

IN LEARNING DISABILITY AND NEUROBEHAVIOURAL SERVICES WE HAVE:l been working with our commissioners and local authority partners to

reduce unnecessary inpatient admissions and prevent crises occurring as part of our commitment to the Transforming Care agenda

l begun to describe and embed clinical pathways in mental health, challenging behaviour, autistic spectrum conditions and complex physical health across Sussex

INTRODUCTION

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l continued to develop our specialist Partnership and Domiciliary Care Agency which supports Sussex people with a learning disability in their own flats who present with very high levels of complexity and risk to themselves and others

l continued to provide a specialist inpatient service and community services for people with a learning disability and complex health needs which the CQC described as good across the board

l developed our neurobehavioural services to comprehensively assess, understand and diagnose, where appropriate, people referred who may have autistic spectrum disorders, ADHD or other tic disorders

IN OUR CAREHOME PLUS SERVICES WE HAVE:l commissioned, piloted and developed the first NHS Foundation Trust care

home service to meet the needs of people with increasingly complex health and dementia presentations and co-morbidities

l worked with social care, third sector and social enterprise partners to embody holistic, cross sector working

l established relationships with academic groups to enable a research led, best practice approach to care delivery

l aligned care strategies to the NHS England framework – ‘New Care Models – Framework for enhanced health in care homes’

l focused within our annual operating plan on enhancing our Care Partners and Wellbeing strategies with our key stakeholders

Our clinical strategy aims to build on the progress described and to continue to deliver against ‘Our 2020 Vision’. However, it also has to take into account the rapidly changing context of healthcare, as well as a number of new opportunities and new challenges we are yet to fully address.


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CHALLENGES AND OPPORTUNITIES

ADAPTING TO A CHANGING HEALTH AND SOCIAL CARE SYSYEMWe cannot continue to offer services in the way we do now. The NHS is grappling with a number of interrelated challenges: increasing demand, changing health and social care needs, financial pressure and staff recruitment and retention problems.

In order to continue providing the best possible care to the patients and local communities we serve we need to think and work differently. Across the whole NHS and social care system, we need to focus more on health promotion and early intervention, on addressing social care needs (Care Act, 2015), treating people in the community rather than in hospital, and working much more effectively across agencies to share resources across commonly agreed care pathways. Our clinical strategy describes the key service changes we will be making both within Sussex Partnership NHS Foundation Trust and in partnership with others through our local sustainability and transformation plans (STPs). It will require us to:

l focus on mental health promotion and prevention

l support greater resilience in the community in partnership with public health

l in partnership with local authorities, address needs as early as possible so that fewer people need our more intensive hospital services

l work in partnership with others to deliver care, in a way that avoids people feeling being ‘bounced’ around the system between different organisations

It is also likely that some NHS providers across Sussex will increasingly take a lead role in coordinating both the commissioning and provision of care for specific patient groups through the development of new accountable care systems. These will take a lead role in managing all aspects of a person’s care, ensuring better coordination of resources and services across the healthcare system, and supporting a focus on prevention and early intervention to avoid hospital admission wherever possible. The recent STP commissioned review of mental health provision across Sussex and East Surrey has recommended the creation of an accountable care system for people with severe and enduring mental illness. Sussex Partnership NHS Foundation Trust is likely to play an important role in this new system. It will require us to develop our role as a potential joint commissioner, as well as a provider, of services.

ENSURING CAPACITY MATCHES DEMANDAs in other parts of the NHS, we have had to manage increasing demand with no significant additional investment in services. Many staff now report feeling stressed and overwhelmed by the demands being placed on them. We cannot continue to run services in the way we do now. The clinical strategy outlines the changes we are going to make to our services to better match capacity with demand, including the choices we will make in how we will prioritise our resources in jointly delivered care pathways developed with partner organisations.

INTRODUCTION

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DOING MORE IN PARTNERSHIPWe recognise there are many organisations and services out in the community who can work with us to develop more integrated pathways of care that ensure better and more effective use of resources. We believe other organisations may be able to provide some aspects of care more effectively and / or more efficiently, enabling us to focus our resources on people who are most at need. Our clinical strategy will describe how we will develop these new pathways, and the new types of workforce roles that will support them. We also recognise there are opportunities to work more effectively with the support systems that are already available to a person in their community, including their carers, family, community support and workplace. We will work hard to ensure that these groups are properly supported.

PROVIDING CONSISTENT HIGH QUALITY CAREWe have many examples of excellent, high quality services. However, we know there is more to do to improve consistency of the care and treatment we provide. We also need to build on the work of our Care Delivery Services, our Research Department, our Education and Training Department, and our Clinical Academic Groups to:

l improve the systems and processes which support clinical services

l better understand variation in service quality

l learn from best practice elsewhere

Our clinical strategy outlines how we will do this.

CLINICAL CARE INTELLIGENCEWe don’t currently record everything we do accurately. This can make it difficult to compare outcomes across services, fully account for how we are currently using our resources and make decisions on what we should be prioritising. Our clinical strategy will describe how we will work to obtain the type of clinical care intelligence information that we need. Improving the way we collect and use clinical information also means we will be better placed to make the case for extra investment for mental health and learning disability services where this is needed.

NATIONAL AND LOCAL PRIORITIESThe Government has produced several documents in recent years that describe the key areas of unmet need that NHS mental health services are expected to address. These include

FIVE YEAR FORWARD VIEW FOR MENTAL HEALTH

CRISIS All areas will provide crisis resolution and home treatment teams (CRHTTs) delivering a 24/7 service

ACUTE All acute hospitals will have all-age mental health liaison teams in place, and at least 50% of these

will meet the ‘Core 24’ service standard as a minimum

IAPT 75% of people are able to access treatment within six weeks, 95% within 18 weeks, and at least 50% achieve recovery across the adult age group, with a focus on people living with long-term physical health conditions

25% of people with common mental health conditions are able to access psychological therapies

EIP At least 60% of people with first episode psychosis will start treatment with a NICE-recommended package of care with a specialist early intervention in psychosis (EIP) service within two weeks of

referral

PRIMARY New mental health therapists will be co-located in primary careCARE

INTEGRATION More people with a severe mental illness will receive a full annual physical health check. People with long term conditions will receive mental health support

IPS Twice as many people will have access to individual placement and support (IPS), enabling SMI patients to find and retain employment

ECRs Out of area placements will be eliminated for acute mental health care

SUICIDE Suicide rates will be reduced by 10%, supported by local multi-agency suicide prevention plans

Source: Mental Health Five Year Forward View, Carnall Farrar analysis


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For people with learning disabilities and people with autism, guidance from Transforming Care (2012), Building the Right Support (2016) and the Confidential Inquiry into the Premature Deaths of People with Learning Disabilities (2013) require us to:

For children and young people, Future in Mind (2016) requires us to:

LEARNING DISABILITY STRATEGIES

Make sure our own services are fully inclusive

Work with families and carers as partners in the circle of support around

people referred to us

Facilitate access and support of mainstream health services using our understanding of where people are most at risk of dying prematurely

Work with partners in social care and housing to ensure people are living with the right support to meet and understand their health needs

Re- focus and prioritise our work on crisis prevention and support

Work with partners to minimise unnecessary inpatient admissions and bring people back to their local communities in the least restrictive provision available

FUTURE IN MIND

Promote resilience, prevention and early intervention for children and young people

Improve access to effective support – a system without tiers

Care for the most vulnerable

Provide increased accountability and transparency

Develop our workforce – including increasing the number of psychological therapists through the IAPT developments in children and young people’s service

INTRODUCTION

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ENABLING OUR TEAMSMost of our staff work as part of a team, harnessing different skills and perspectives to achieve an agreed set of goals. The multi-disciplinary team – where professionals from different backgrounds and training work together - is also a cornerstone of how we deliver integrated biopsychosocial care. And yet, we too often give insufficient thought to how we might enable these teams to be as effective as they can be. Indeed, the King’s Fund argues that a great number of NHS teams only function as pseudo teams – not gaining the true benefits that teams should provide (West, 2017).

We will put our teams at the heart of our clinical strategy in the belief that strong teams and good teamwork are essential components of high quality and effective clinical care.

RESPONDING TO FEEDBACK FROM SERVICE USERS AND CARERSWe have obtained consistent feedback from service users and carers about what they would like from our services. We also engaged with a specific group of service users and carers and asked them to define what the outcome of the clinical strategy should be from their perspective. This resulted in a series of ‘I will experience’ statements that have been used to underpin all of our work. We expect the clinical strategy to deliver against these expectations and to help improve our annual patient experience survey.

SUPPORTING OUR STAFFOur staff provide care and treatment with skill and compassion. Their work is highly stressful and demanding. Our clinical strategy therefore focuses on how we can ensure that our staff are supported to do the best job they can. We will continue to work on improving our annual staff survey feedback.

In addition to the above, our local Sustainability and Transformation (STP) plans have also developed 12 workstreams, and four enabling workstreams, to address priorities for mental healthcare in Sussex and East Surrey. These priority workstreams are:

OPPORTUNITIES ENABLERS

1. Primary prevention and resilience

2. Suicide prevention

3. Early identification

4. Proactive care coordination, planning and support

5. Access to whole pathway psychological therapy

6. Single point of access

7. Integrated physical and mental health care

8. Crisis support with improved out of hours access

9. Housing and employment

10. Recovery care model

11. Eliminate out of area acute placements

12. Reduce out of area specialist placements

Workforce

Information and digital

Accountable care delivery models

Strategic commissioning

Source: Carnall Farrar analysis

DEFINING OUR OUTCOMES In developing the clinical strategy we sought the views of service users and carers, staff, commissioners and other partners in a series of specific engagement events as well as through their contributions to the 20 clinical strategy workstreams.

Through this work we identified the most important outcomes for service users and carers, staff, and commissioners and partners, so that these would serve as key targets. The key outcomes were:

PRIORITIES FOR SERVICE USERS, CARERS AND FAMILIES

OUTCOMES

I will be treated with care and compassion I will have support that addresses all of my needs, including the psychological and social components of my difficulties where appropriate

I will be at the centre of my care and services will seek to understand my needs from my perspective

Our carers and families will be involved as full partners

It will be much easier to access the services I need and to navigate between different services

Where appropriate, I will have an opportunity to work with a peer worker who has been through what I am going through so I can benefit from their learning, knowledge and experience

It will be clear what’s on offer and I will be supported to make fully informed choices about my care

My care will be joined up and consistent, and staff who help me will stay with me throughout my journey in services

Me and my carers will be fully involved in designing and delivering services

I will be receiving up to date evidence based care that is likely to help me with my recovery journey


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PRIORITIES FOR STAFF

OUTCOMES

We will be treated with care and compassion and experience a work environment that enables us to do our jobs effectively

We won’t experience bullying and we will all be holding all staff to account for the values and behaviours we aspire to hold

We will have our hard work acknowledged and valued

We will get the supervision and management support that we need

We will have jobs that are more manageable, and we will have ways to address excessive workload without putting patients at risk

We will feel involved in key decisions affecting our work

We will have more time to do all that we need to do – including more time in face to face contact with patients. We will also be able to take time out for training and to be a better team

We will fully understand the strategic plans impacting on our work and these will be enacted in a thoughtful and thorough way

Our key systems and processes will help us with our jobs, not hinder them

PRIORITIES FOR COMMISSIONERS AND OTHER PARTNERS

OUTCOMES

You help us deliver our service development and service improvement targets as set out in the Five Year Forward View for Mental Health (2015)

You work with us, using your specialist knowledge and expertise, to jointly deliver the strategy set out for mental health within the Sussex and East Surrey, and Hampshire, STP work-plans

You can evidence what you do across services so that we can hold you to account for the care that you provide

You are measuring outcomes in ways that are meaningful for service users, including those that focus on recovery and supporting people who live well

You are offering consistent high quality care across all services but in ways that take into account local need

Service users and carers are being placed at the heart of your service redesign and development plans and co-production with a fuller range of partners will be business as usual

You will have formed new partnerships or be proposing new partnerships with the third sector with a clear description of how your partnerships will improve care for patients

You are making the best use of the specialist skills and expertise of your staff by ensuring they work with people when they most need it and with the people who can most benefit from it

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INTRODUCTION

QUALITY OBJECTIVESOur clinical strategy will also be important in enabling us to achieve our quality objectives. Key objectives include:

OBJECTIVE IN THE CLINICAL STRATEGY WILL BE ACHIEVED THROUGH:

To deliver against our four quality priorities: care plans, suicide prevention, physical health and staff health / wellbeing

All workstreams

Services must be responsive, recognising a service user’s changing needs, with access to flexible 24/7 crisis care support

Access to care (p26)Secondary care community and youth services (p29)24/7 crisis care (p24)Acute inpatient services (p33)

Services must be easy to access for everyone irrespective of age, disability, gender and ethnicity

Access to care (p26)Digital by design (p59)

Care pathways should be understandable, joined up and provide integrated care and treatment across seamless provision of services

Pathways of care (p56)

Outcomes must be clear, achievable and be the ones that service users want

Measuring outcomes (p55)

Physical and mental health components of a person’s difficulty should be addressed together

Integrated physical and mental health services (p45)

We should be making use of more digital innovation Digital by design (p59) Using data and technology to improve care (p58)

Co-production should be business as usual and we will fully adopt the ‘Triangle of Care’ programme that promotes effective carer involvement

People participation (p47)

We will make sure that all staff and teams have the right tools and skills to deliver the best quality care. This will mean that people and teams will have time to learn, seek support and reflect

Staff wellbeing (p51) Improving teams (p54) Workforce and new roles (p48)People participation (p47)

“The clinical strategy will be the means by which we achieve safe, consistent care of the highest quality across all of our services whilst still ensuring that delivery is sensitive to the specific needs of local populations” Simone Button, Chief Operating Officer


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1 . Provide service users and carers with effective, high quality and

compassionate care. We will do this by committing to provide the right environment, resource and support to staff and teams to enable them to do their jobs well.

2. Put teams at the heart of our strategy. We will help them function effectively and efficiently, grow and develop, and learn from best practice elsewhere.

3. Provide care based on clear goals. We will define and explain the outcomes we expect people to experience from using our services.

4. Promote partnership with the people who use our services. We will ensure the people who use our services and their carers will be supported to help design, develop and lead our services in partnership with our staff

5 . Intervene early. Our aim will be to provide people with help at the earliest possible opportunity, before their problems become more complex and difficult to treat. We will advocate strongly for the needs of children and young people with mental health problems, and the needs of their families, within the wider system as we know that 70% of mental health difficulties begin before the age of 17.

6. Deliver truly recovery-orientated services. We will build on our experience of providing recovery colleges which deliver the outcomes that service users want.

7. Offer more integrated services with other partners. We will work effectively with other organisations to provide care so that people don’t feel they are being ‘bounced’ around the system between different organisations.

8. Continue to challenge discrimination and inequality in mental and physical healthcare, and make reasonable adjustments to ensure that people with disabilities get the care that they need.

9. Provide care based on reliable, up to date research evidence. We will close the gap between research knowledge and implementing improvements to patient care.

10. Demonstrate the value and outcome of every penny spent on our clinical care services. We will use our clinical information to ensure that services can respond flexibly to ongoing financial pressures and changing clinical demands.

CORE PRINCIPLESOur clinical strategy is based on a set of 10 core principles which are to:

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CLINICAL STRATEGY 2017-2020INTRODUCTION

SUPPORTING BEST PRACTICETo offer more effective and consistent care across services we will:

Support our teams to be as effective as they can be through a new focus on team development, team outcomes and the introduction of 2 away days a year for every team in the Trust.

Use data and our new care pathways to make services better. We will use our clinical care intelligence data and our new care pathways to ensure that all teams and staff are able to learn from best practice and to constantly improve what they are doing.

Improve our use of digital technology. Our Digital by Design strategy will ensure that we make much more effective use of digital and online resources in enabling people to access services and deliver high quality clinical care.

Implement QI methodology, training and improvement networks to support the delivery of the clinical strategy workstreams

NEW PARTNERSHIPS AND NEW WAYS OF WORKINGTo create new partnerships and introduce new ways of working we will:

To implement a new ‘towards zero’ suicide prevention approach to suicide in partnership with local authorities.

Develop services that meet people’s mental health and physical health care needs in more integrated ways

Create new roles to address difficulties with recruitment and retention but to also offer the best care that we can within the resources we have available.

OUR THREE PRIORITY CHANGE PROGRAMMES


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2

3

OUR OFFER - OUR NEW SERVICE MODEL To develop and implement our new service model we will:

Focus on communities, working with local authority partners and community organisations to support the development of emotional resilience and help prevent or intervene early in someone’s mental health journey.

Create a single point of Access for mental health services that run alongside access to social care and third sector services, and provide clearer information on what services we offer.

Secure funding for and provide 24/7 crisis care services so that fewer people need to attend A&E or be admitted to hospital.

Build on the success of our recovery and discovery colleges, embedding them into existing care pathways with increased in-reach from these colleges into community, crisis and acute settings.

Expand on the Tier 2 Pathfinder partnerships in West Sussex to create a new service offer, delivered in partnership with a coalition of third sector partners, and that sit between primary and secondary care. These partnership services will help intervene earlier in someone’s mental health journey. They will also help people transition back from secondary care by enabling them to make full use of resourcesavailable to them in the community.

Develop seamless services led by our community mental health teams. Community services will take a greater leadership role in managing the care pathways across community, crisis and acute services. Staff will follow the patient across traditional care and team boundaries, with the creation of a more seamless service from the perspective of service users, carers and families. As part of this, we will also provide better mental health care for 14-25 year olds through implementing our youth services strategy across the Trust.

1

“I don’t know which services you provide and I don’t know how to contact them. It would be good if you could also tell me what to expect once I have started using a service and I don’t want to have to repeat telling you the same information again”

Service user

OUR OFFER:

OUR NEW SERVICE MODEL

PART 1: OUR OFFER: OUR NEW SERVICE MODEL

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1

As individual practitioners we will:

l Agree how our initial contact with people referred invites an initial conversation about the person and their support network as a starting point to our work with them

l Enable a shift in culture from ‘treatment’ done by ‘experts’ towards an enabling approach based on the principles of Live, Love, Do - where and how we live, what we do with our lives, who we love and who loves us

WHAT WE WILL DO

l Work with each Care Delivery Service to make sure that we know of, and are in contact with, community organisations, both those who work to support people and those who exist as part of local communities such as sports clubs and faith groups

l Ensure staff have the confidence and skill to engage with family members and carers and work with them

l Co-produce resources to help and support community organisations, including schools and colleges and offer consultation to these groups where appropriate

CONTEXTPeople do not exist in isolation, but in relationships. We are born into families and live as part of wider social networks.

Our clinical strategy needs to engage with the wider social network and communities we serve. Without this we will continue to operate in silos, failing to draw on the support and expertise available in our wider community.

OUR AMBITION

l Use our influence and connection to support community groups and networks

l Help embed the recovery and discovery colleges as a community resource

As teams we will:

l Learn from expertise elsewhere about community resilience and compassionate communities

l Know our local resources and belong to them so we become part of our shared community assets

WORKING WITH OUR COMMUNITIES

LIVELOVE

DO

COMMUNITY

CO

MM

UN

ITY

COMMUNITY

CO

MM

UN

ITY

Allpeople

Our familiescarers &friends

Oureducation

& work

Our clubs& groups

Ourhomes

OurTrust &

partners


l Ensure that emotional wellbeing for all is driven by a focus on young people and their families with increased access to books on prescription, social prescribing and co-produced on-line multi-media resources

l In Forensic Healthcare services, support mental health promotion and the promotion of emotionally resilient communities within the Criminal Justice System (CJS) and those at risk of coming into contact with the CJS

l Work directly with commissioners to agree ways in which this activity becomes a recognised and costed part of our work objectives

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CONTEXTWe know the way we respond to people in crisis, and the resources which are available, varies between services across the Trust. This includes how we work with service users and carers.

Our clinical strategy will describe service models that will be accessible, responsive and effective for people in crisis 24/7. These models will incorporate the national standards described in the Five Year Forward for Mental Health and Crisis Concordat. The urgent and crisis services will work across the ‘whole system’ to ensure that we can achieve ‘right patient, right time, right place’.

We will develop pathways that demonstrate collaboration and joint working with patients, carers and partner organisations.

“Ensure that all ways into crisis care are focused on providing accessible and available help, care and support for all those who require it at the time they need it”

The CQC recommended local Crisis Care Concordat groups

24/7 CRISIS CARE


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“We will co-design first contacts with referrers, patients and carers to set relationships off on a pathway that recognises carer contributions”

“To ensure that information can be shared quickly and easily between services so that patients don’t have to repeat themselves. Includes referral information from GPs and when patients are transferred between services”

Action commitments from the Hackathon

OUR AMBITIONOur ambition is to provide effective and accessible urgent and crisis pathways that:

l Include new crisis home treatment services, offering intensive support and care around the clock

l Are easily accessible through new improved access points and processes

l Have staff available 24/7 who will be skilled and able to assess the needs of the caller and effectively meet the immediate needs, manage onward referral and risk

l Are provided as part of a seamless continuum of care with community and acute services, with community services taking a leading role in planning continuity of care

Our ambition is to also provide crisis services that:

l Share information with partner organisations to improve the flow of clinical information

l Provide patients in acute hospitals with access to mental health clinicians 24/7

l Reduce demand on acute services and reduce out of area hospital placements

WHAT WE WILL DO

l Describe the clinical model for crisis home treatment, mental health liaison and 24/7 crisis care

l Work to secure the additional resources we require to deliver the full Five Year Forward View implementation

l Develop a new clinical model that breaks down barriers between community, crisis and acute services

l Review pathways so that specialist crisis staff provide additional support to community teams rather than operating as separate teams with separate caseloads

l Enhance the use of information technology and e-resources to improve access and the quality of care provision in crisis services

l Identify opportunities for peer workers to support service users in their transition between services

l In CAMHS we will continue the role out of crisis services as specified in Future in Mind. We will also continue to deliver the New Care Models in Sussex to reduce the number of young people who present at A&E without a shared crisis plan

l In learning disability services we will work to link together intelligence about crisis cases and crisis response and foster a better linkup of existing crisis resources by knowing who is at risk of admission via our dynamic risk registers

l In forensic healthcare services, we will develop the relationships between police and court liaison and diversion services (PCLDS), and crisis and urgent care pathways, in order that this service can provide a direct link into CRHT as required. We will also develop crisis provision within prison healthcare services in order that an equitable service is provided in an ‘in cell’ model of acute care provision


CONTEXTIn our new service model people will know how to access our services, will know what’s on offer and the choices available dependent on their needs. People will be better able to access the care they need as quickly and easily as possible (Five Year Forward View for Mental Health, 2015).

We received over 100,000 referrals in 2016 and want to make sure the decisions we make about these referrals are as safe, effective and timely as possible. We will offer maximum choice and flexibility over where, how and when people will be seen.

ACCESS TO CARE

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“I find it difficult to work out how to access Sussex Partnership Trust services and get help, especially in a crisis. Often I am told that you can’t help me and I should try calling somewhere else”

Carer


OUR AMBITION

l Provide a single access point to ensure that people in crisis can access our services 24 hours a day

l Provide multi-agency single points of access for mental health alongside local authority, physical healthcare, third sector and community support

l For children and young people with mental health problems, provide co-designed multi agency access across schools, colleges, health settings, local authority settings and other community settings

l A no ‘wrong front door’ approach so people are never turned away without being supported to access the care and support that they need

l Flexibility to reach more people in different ways through the increased use of technology including social media to publicise options, online booking, assessments and interventions

l A service that reaches out to communities that aren’t able to easily access our services and may need more support to do so

l A front door staffed by peer workers, care navigators, carers, voluntary sector staff and mental health clinicians who have time to talk to you and who between them can offer quick access to an extensive range of services and support in both voluntary services and health services

l A front door that is responsive to families’ and carers’ needs and involves them from the start

l New administrative systems, processes, technology and telephony that enable us to operate as safely, quickly and efficiently as possible and offer the widest choice over who will see you, where and at what time without unnecessary delays

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“It was difficult after seeing my GP not knowing what I’ve been referred for and what will happen next. Knowing the steps will make me feel better. Not knowing adds anxiety”

Service user

WHAT WE WILL DO

l Develop new access points that bring health, social care and third sector resources together so that people can access what they

need from one front door

l Provide accessible information about what’s on offer through up to date leaflets, new website content and enabling people to have conversations with staff before referral

l Co-design the core elements of the referral process that are patient focused, safe and effective

l Enable services to offer better access to services who can support people with debt, housing, employment and other social issues

l Develop new peer worker and care navigator roles

l Make best use of technology, and develop new standardised approaches to triage, e-referrals, appointments, administrative processing and triage assessments

l Implement new information and data systems that enable CDSs to match capacity to demand

l Ensure access points take into account communication and / or cognitive needs

l Make reasonable adjustments for people right from the start

l Ensure services are created and delivered in partnership with peer workers with lived experience of mental health issues

WHAT WE WILL DOl Ensure our step two therapists are

working directly with community groups to assist with mental health promotion and to increase early access to psychological support for those that need it

l Build on the success of recent tenders to develop more comprehensive support services for people with mild to moderate mental health problems who are struggling to find work or stay in work

l Make our services more accessible, offering more treatment out of hours and further developing our range of on-line/ digital treatments

CONTEXTIn our service model, people experiencing anxiety, depression and other common mental health issues will be able to access a wide range of effective treatments to support them and help them manage their difficulties. They should be able to access these services quickly, in a range of settings, at a time that suits them.

OUR AMBITIONBuild on the success of the Tier 2 pathfinder services in West Sussex and to work with commissioners to support a further roll out of this model of care across all parts of Sussex

l Work very closely with the newly developing GP cluster groups to articulate a joint vision and new models for the delivery of primary care based mental health through these clusters

l Offer new ways of addressing the needs of people with comorbid physical health and mental health issues

l Better support people to stay in work or obtain work after experiencing a mental health problem

l Make more effective use of digital technology

PRIMARY CARE MENTAL HEALTH AND TIER 2 PATHFINDER SERVICES

“I was recently suffering from severe anxiety and depression. My doctor referred me to Health in Mind …. (my therapist) has been absolutely fantastic in helping me to get through this difficult time. She has given me the tools to help me cope with and change my outlook on life.”

Service user

CLINICAL STRATEGY 2017-2020PART 1: OUR OFFER: OUR NEW SERVICE MODEL

l Develop a wider range of group treatments that are jointly delivered with trained peer support workers

l Seek to increase psychological therapy provision for people with long term physical conditions and medically unexplained symptoms

l In children’s services, continue to develop our on-line provision of services and the use of multi-media resources to help promote support and engagement

l Work with colleagues to make sure people with disabilities (including learning disabilities and autism) have good access and that reasonable adjustments are routinely made.

l Further develop our primary care mental health services in HMP Ford and HMP Lewes.

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CONTEXTOur community services, both for adults and children and young people, have the potential to transform the care we offer. So it is here the most significant changes to service provision are needed.

OUR AMBITION

l Pilot new models where community teams remain with the patient throughout their mental health care even if they go into hospital or other crisis care

l Reduce barriers between teams (and to review current structures such as the separation between

“We want our community services to keep the service user at the centre of everything we do, with specialist care brought in to support the individual as needed, minimising duplication of information gathering, maintaining continuity of staffing wherever possible, providing treatment as close to home as possible and ensuring a collaborative care plan provides a clear road map for the recovery journey”

Dr Rick Fraser, Chief Medical Officer, March 2017

SECONDARY CARE COMMUNITY AND YOUTH SERVICES

SERVICE USERFAMILY/CARER

Recoveryorientated

Crisismanagement

Careplanning

Risk management


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our community and assertive outreach teams) so that service users have a care team that stays with them throughout their recovery journey

l Pilot different ways of wrapping crisis care around community services

l Develop bespoke youth services for 14-25 year olds

l Fully meet the needs of people in our community services regardless of disability

l Work with recovery colleges to build support for people coming out of secondary care into community services

l Do more of our work in the wider community to see people in places that are comfortable, safe and non-stigmatising

l Identify and develop closer links to community based resources to help people in their recovery

l In specialist CAMHS community services, to make further use of complex case planning and the ‘Team around the Child’ approach to reduce barriers between services

l In forensic healthcare services, to ensure that community forensic outreach services are increasingly ‘integrated’ with other community services and support transitions between services

WHAT WE WILL DO

l Focus the skills of our most experienced staff on those who are most unwell

l Pilot new roles such as peer support workers, associate physicians, and non-medical prescribers

l Offer more integrated support around people’s housing, employment, debt and other social care issues

l Work alongside substance misuse and alcohol services for those with dual diagnosis

l Find better ways of enabling adults with mild to moderate mental health problems (clusters 1-4), and children requiring primary care based tier two care, to get the care they need

l Match the service we offer to the demand with better use of data and technology

l Offer more evidenced based treatments – as indicated by NICE guidelines

l Work more effectively with other community based organisations on jointly delivered pathways of care and access

l Make better use of technology and e-resources to provide better, more accessible care


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l Provide better information about services so people can make informed choices about their treatment

l Record clinical outcomes that are meaningful to patients

l Meet the needs of people aged 14 – 25 more effectively

l Make sure moving from one service to another is better for the patient through joint working or through combining teams where appropriate

l Build on existing links between learning disability, adult and CAMHS community teams - and further develop best practice in joint working - to actively support mental health services to work with people with autism who are experiencing mental illnesses

CONTEXTRecovery College provides educational courses for people with mental health challenges and their families, together with staff. Each course is co-produced by a peer trainer with expertise though personal experience of mental health challenges alongside a trainer with expertise through professional training. People who attend our courses become students, alongside carers and staff, fundamentally changing the traditional dynamics of services.

Recovery College course completion is associated with significant improvements in wellbeing and achievement of personal recovery goals, and reduces pressure on other services. The strongest track record of excellence for this approach is for people with serious mental health challenges (Recovery College), but pilots have also successfully applied an adapted model for common mental health problems (Wellbeing College) and for children and young people (Discovery College).

Courses are often run in partnership with third sector or community organisations. Recovery College use is associated with a significant reduction in the use of traditional community, crisis and acute mental

WELLBEING, RECOVERY & DISCOVERY COLLEGE

“The best thing I have ever experienced in mental health, it gave me hope”Recovery College student


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health services worth approximately £1,200 per registered student.

OUR AMBITION

l Launch an expanded Wellbeing, Recovery and Discovery College, offering courses aimed at people of all ages and all types of mental health challenges

l Expand the colleges to offer more courses to more students, within specific service specifications with appropriate support and funding

l Seek partnerships to create a Wellbeing College network, delivering an educational offer for people with common mental health problems, faithful to Recovery College principles

l Deliver Discovery College courses for young people across Sussex and Hampshire, building on the successful pilot in East Sussex

l Develop Recovery College in-reach into acute, rehabilitation and forensic services

l Extend the role of the expanded Wellbeing and Recovery College to drive new ways of working in health services, for example by:

l Training an expanded peer workforce through the college

l Offering mental health awareness training across the health economy from the college

l Supporting the development of other peer-led approaches in services through training and consultancy


WHAT WE WILL DO

l Develop clear and sustainable funding plans attached to clinical contracts for the college to expand to deliver more courses reaching people of all ages and across a wider range of difficulties

l Create a network of substantive peer trainer posts to support the expansion, within a structure of professional peer leadership and governance

l Develop additional revenue streams for the college where it extends beyond traditional NHS practice, including training contracts, direct donations, advertising and sponsorship

l Expand to deliver more places on courses to NHS staff, to support culture change and break down stigma and the sense of ‘them and us’ in mental health care

l Provide consultancy from the college to help drive the wider roll out of peer led approaches (for example, peer support)

l Work specifically with people with learning disabilities and carer organisations to increase the number of recovery courses that reflect the needs of people with learning disabilities and autism

“I have lived with depression for many years, the course has given me different ways to look at and hopefully try to manage it better”Recovery college student


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CONTEXTThe Commission on Acute Adult Psychiatric Care in England (2016) recommended that patients with mental health problems should have the same rapid access to high quality care as patients with physical health problems. The Commission emphasised the importance of seeing inpatient services as part of the whole system of mental healthcare.

Admissions should be purposeful, integrated with other services, as open and transparent as possible and as local and as short as possible.

Our clinical strategy needs to ensure inpatient services offer the best possible patient experience by delivering treatment as part of an extended community intervention. This will ensure inpatient care is fully aligned with a person’s community treatment plan, with community clinicians playing a key role in the inpatient admission and in supporting discharge.

SHORT TERMINPATIENT CARE

24/7 CRISIS CARE

COMMUNITY CARE

“Often, and for too long, we have struggled to manage beds locally and offer the best possible experience and treatment to our patients”

Dr Adil Jawad, Acute Workstream Lead

ACUTE INPATIENT SERVICES


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OUR AMBITIONOur ambition is to offer safe and high quality inpatient care to our service users, carers and families with:

l community services being fully involved in planning and delivering inpatient admissions, and supporting discharge

l an environment where people feel safe and empowered to begin their recovery journey

l the right digital technology being used to support effective care and allow patients to keep in contact with families and communities

l highly skilled and engaged staff teams and new roles including peer support workers, nursing associates, non- medical prescribers, non-medical responsible clinicians, and graduate mental health workers

l excellent inpatient treatment and care where people are only admitted to hospital when there are no alternatives for safe care. There will be a clear purpose for admission with personalised care and meaningful treatment plans, discharge planning from the day of admission, and agreed length of treatment (inpatient stay) with community teams

l a wide range of effective interventions which are available to meet each patient’s needs with time for 1:1 meetings daily. Therapeutic activities will be available right through the day, seven days a week

- acute, crisis and community services work in a more integrated way

- staff are able to move with the patient through current team or service boundaries

- community services have shared responsibility for planning periods of inpatient admission, supported by specialist inpatient staff

l Review current ward rounds to deliver a more service user focused model of care and one that more effectively involves community staff

l Implement clear pathways of care, with new responsibilities placed on community services, to ensure that average length of stay is reduced to 28 days

l Work with community services, recovery colleges, social care, housing, and other third sector organisations to agree joint working and dedicated input/access for acute services and to ensure delayed transfers of care remain below 5%

l Implement and assess the impact of new roles in inpatient services

l Introduce new therapeutic interventions to improve the therapeutic environment of inpatient settings

l In CAMHS services, work to improve inpatient transitions and develop the ‘follow through’ model of care

l In learning disabilities services we will form closer links between Selden and other inpatient services

l In forensic healthcare services, ensure that the model of acute inpatient care provided in HMP Lewes is based on the model of care provided elsewhere in the Trust

l clinicians and peer workers from community services and recovery colleges supporting people to begin their recovery journey into the community whilst in hospital

l care plans being reviewed with community services by senior clinicians on the day of admission

l closer partnership working established with partner organisations, including housing providers, to avoid unnecessary delays to discharge

l Create a place of safety for young people in Sussex

l Utilise the New Care Models and Local Transformation Plans to explore further inpatient/day service opportunities provided from Chalkhill

l Provide inclusive provision for LD and autism as part of Transforming Care and Greenlight work

WHAT WE WILL DO

l Agree and implement systems and structures to ensure:


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l Ensure that wherever possible the person’s rehabilitation needs are met close to home, whilst retaining access to specialist provision for those who need it

l Ensure consistency across all of the Care Delivery Services in the delivery of specialist interventions in the rehabilitation pathway

WHAT WE WILL DO

l Develop a single leadership team who will manage the specialist inpatient rehabilitation provision across the Trust, whilst retaining strong working relationships with local leadership teams and commissioners

l Ensure robust 24 hour, seven day a week community support and effective interventions for people to reduce the need for inpatient care and to reduce length of stay in all parts of the pathway

l Require all Care Delivery Services to report regularly on interventions available within community services, to ensure equitable access for those with rehabilitation needs

l Identify a lead to work with housing providers to explore the feasibility of more structured collaborative work to increase accommodation options, and reduce the risk of homelessness

l Identify a lead to work on improving the interface between health and social care - ensuring both closer working and sharing of resource

l Ensure all specialist out of area placements are reviewed by a single team, who will have strong links with local services. They will identify and resolve difficulties in bringing people back to be cared for closer to home

REHABILITATION

“Investing in local rehabilitation…enables effective care and treatment to be provided closer to home, and reduces the use of costly, out of area placements”

JCPMH (2013) Guidance for commissioners of rehabilitation services for people with complex mental health needs

CONTEXTAlthough a third of people with a diagnosis of schizophrenia will recover completely, about 10% of people having a first episode of psychosis will require rehabilitation.

A rehabilitation pathway should include evidence based interventions that can be delivered in the community by a range of partners including housing providers. As a specialist mental health provider, we have a key role in working collaboratively with partners in the community to ensure specialist community based interventions are available close to where people live. A smaller number of people will also require higher intensity rehabilitation, offered in specialist placements where care is available 24 hours a day, seven days a week. A care pathway that ensures high quality and local effective interventions will minimise the need for people being placed out of area.

OUR AMBITION

l Provide local, safe, effective, quality care and support by working with and supporting the expertise of different organisations in our communities


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CHILDREN AND YOUNG PEOPLE: CAMHS, EIP AND PERINATAL MENTAL HEALTH SERVICES


“By its very nature children’s mental health services need to be delivered in a different way to those for adults but are inextricably linked through parents, families, growing up and transition”Service user

CONTEXTIn Child and Adolescent MentalHealth Services (CAMHS) we work inpartnership with other organisations/communities to support youngpeople who are experiencingdifficulties with their mental healthand their families and networks.

The Early Intervention in Psychosis (EIP) service works with peoplefrom the age of 14 up to 65. Itoffers assessment and treatmentfor people who have experienceda first episode of psychosis as wellas for people identified as havinghad an ‘at risk mental state’ (ARMS).

The Specialist Perinatal MentalHealth Community services fundwas launched in August 2016 toincrease the availability of highquality perinatal mental health carefor women, their families and babies,at risk of severe perinatal mentalhealth problems.

OUR AMBITIONIn children and young people’s services our ambition is to:

l Place children, young people and their families at the centre of decisions about their care

l Develop a strong participation ethos in our services, with children, young people and families actively engaged in service development, research and staff recruitment, with service decisions being actively informed by the people who use them

l Work with our communities to support emotional health and wellbeing, and reduce mental health stigma

l Promote better and faster access to care through stronger partnerships with schools, colleges, and other agencies working with children, young people, adults and families

l Provide more information for carers and service users on the availability of services and how to access them

l Ensure a smooth transition between children’s and adult services

l Develop Discovery Colleges across the region

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WHAT WE WILL DO

CAMHS

We will:

l Continue to develop and improve the single points of access for CAMHS

l Develop better and more robust services for 14-25 year olds based on the i-Rock model and other initiatives

l Further develop services with partners to support young people and families in crisis

l Further develop the role of the Trust-wide Clinical Academic Group (CAG) for children and young people to evaluate and inform our evidence based practice

l Continue to transform services locally guided by the Five Year Forward View, Future in Mind, ‘Delivering With, Delivering Well (formerly CYP IAPT)’, iThrive and Local Transformation Plans

l Continue to develop our specialist CAMHS-LD services in line with the Transforming Care agenda

l Continue to work with partners in the design and delivery of our digital offer

EARLY INTERVENTION IN PSYCHOSIS (EIP)We will:

l Continue to expand the age range of people offered a service from 14-35 to 14-65

l Continue to improve access to screening and assessment for people who are suspected of experiencing a first episode of psychosis

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l Increase involvement and participation from service users and family members, with a focus on increasing the numbers of peer support workers in the service and piloting a peer family worker post

l Increase the number of people receiving NICE recommended treatments including cognitive behaviour therapy for psychosis, family interventions, vocational support, medication and physical health assessment and support

l Use new and innovative approaches to support the physical and mental health needs for people experiencing their first episode of psychosis

PERINATAL SERVICESWe will:

l Continue to develop a single clinical pathway for perinatal mental health

l Improve access to perinatal mental health services

l Focus on workforce development to build capacity and competency

l Promote better and faster access to care via knowledge sharing partnerships and practice links with partners in the wider perinatal pathway

l Increase the numbers of community based clinics across the STP, including jointly delivered psychiatric/obstetric antenatal clinics and trial early intervention triage in universal maternity ‘birth options’ clinics

l Increase the number of women, their families and babies receiving NICE compliant treatments, including highly specialised parent-infant mental health interventions

l Implement a digital pilot of cognitive behavioural therapy in line with the Five Year Forward View

l Continue to offer the women, families and babies who use our services opportunities for meaningful involvement and co- design

SPECIALIST SERVICES FOR PEOPLE WITH LEARNING DISABILITIES AND PEOPLE WITH AUTISTIC SPECTRUM CONDITIONS

CONTEXT For people with a Learning Disability (LD) and those with an Autistic Spectrum Condition (ASC) our strategic priorities are focused on delivering Transforming Care – particularly ‘Building the Right Support’ (October 2015) -which sits well in the context of the broader Trust clinical strategy.

Equally important is our role within the wider health system in helping to prevent premature deaths (see the Confidential Inquiry into Premature Deaths of People with Learning Disabilities and the Autustica paper ‘Personal tragedies, public crisis – the urgent need for a national response to early death in autism’).

OUR AMBITIONl Implement new care pathways for people with LDs or ASCs relating to: -challenging behaviour -mental health -complex physical health -ASC diagnosis and formulation

l Implement the Trust pledge to the STOMP-LD agenda (Stopping Over Medication of People with a Learning Disability).

WHAT WE WILL DOl Introduce the following outcome measures across all our services: -HONOS-LD -Mini MANS-LD -Goal based outcomes

l Continue to develop our Specialist Clinical Assessment service and Neuro-behavioural clinic for people with ASC and work with social care, mental health and physical health providers to develop effective care packages post assessment

l Work closely with colleagues in CAMHS LD to introduce lifelong pathways for people with learning disabilities

l Work with colleagues in Forensic Healthcare to establish more integrated pathways for people with a learning disability with offending behaviours

l Build on existing work to make all of our Adult and Children’s Services more inclusive and understanding of LD and ASC

l Further develop our Domiciliary Care Agency (PDCA) which provides home care support to 14 people with a learning disability with complex and high risk behaviour

l Continue to develop our inpatient service at the Selden Centre to minimise our lengths of stay, and improve our provision for people in crisis

PART 1: OUR OFFER: THE NEW SERVICE MODEL

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SERVICES FOR OLDER PEOPLE AND PEOPLE WITH DEMENTIA

CONTEXT Currently our older people’s mental health services sit as part of our broader adult mental health services, with specialist community and inpatient services available for people with dementia, as well as their families and carers.

In 2017 we launched a review of our older people mental health and dementia services. This is about looking at how we can build on our existing strengths in this area, at the same time as being clearer and more consistent about the specialist care and treatment we offer. The outcome of the review, which has involved over 100 people, will be reviewed by our Board of Directors in early 2018. It will then become incorporated within the delivery of our clinical strategy.

We do already know that the further development of services for people with dementia is a priority for the health system within Sussex. We have a prevalence rate that is 25% above the national average, and the costs of providing care has been estimated to increase by £33.7 million per year in Sussex alone.

OUR AMBITIONl To deliver all aspects of the Trust’s clinical strategy relevant to our older people and dementia services

l To complete our comprehensive review of older people mental health and dementia services and implement the recommendations

l To ensure that services are truly needs led and not age led

l To work alongside and in partnership with the STP place based plans to ensure co-delivery of high quality dementia care services for service users, families and carers.

WHAT WE WILL DOl Continue to support earlier diagnosis and intervention for people living with dementia

l Ensure older people’s mental health and dementia services provide access to expert advice and support to other specialties across the health and social care economy, including learning disability services, substance misuse services, neurology and services for people with an acquired brain injury.

l Ensure access to appropriate training for all staff relating to dementia awareness, age related conditions and the management of challenging behaviour

l Work to further develop integrated health and social care services for this patient group

l Develop clarity over the service model required for mental health liaison services for people with dementia

l Develop shared care wards with acute trusts

l Improve end of life care for people with dementia across all health and social care partners

l Improve crisis support for older people with a functional illness and those with dementia

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FORENSIC HEALTHCARE SERVICES

CONTEXT Forensic healthcare services are a branch of general adult mental health services and provide care for those, who due to their mental disorder, pose a risk to others.

Sussex has a comprehensive in-patient and community forensic mental health services for those aged over 18. In addition, the service provides mental health and primary care services within HMP Lewes and HMP Ford, the only prisons within Sussex.

The services also provide liaison services to probation and assessments for those detained within police custody units and magistrates courts This provides a service from the point of arrest for a cohort of people who will require ongoing forensic mental health care.

OUR AMBITIONl To deliver all aspects of the Trust’s clinical strategy relevant to our forensic healthcare services

l To develop additional specialist community services to facilitate the safe discharge of patients into the community and prevent patients being unnecessarily admitted into secure in-patient facilities

WHAT WE WILL DOl As part of NHS England’s New Care Models strategy,develop new regional specialist secure and forensic services in partnership with other providers

l Establish better local connections between specialist services and local communities to support a more streamlined return to local communities.

l Develop facilities to enable more people to be treated closer to home

l Develop new pathways for those who have both learning disabilities and autistic spectrum disorders and for whom there is no specific secure provision in Sussex

“We aim to respond quickly to those people who need our services, identifying need as early as possible in order that we can provide specialist and comprehensive treatment with the intention of enabling people to return to their lives safely as soon as possible whilst managing risk effectively” Dr Richard Noon, Clinical Director,

Forensic Healthcare Services


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CAREHOME PLUS


CONTEXTLindridge care home in Hove is unique within the NHS as a commercial venture.

The service launched in response to an identified local need for a specialist care home offering long and short term stays for complex physical healthcare packages, dementia care and end of life care. It takes both private and healthcare referrals.

In 2018 it will relaunch as a care community, which is more reflective of the work we do and the people we support.

OUR AMBITIONl To become a local leader in complex physical care and palliative care packages, whilst working closely with other local services to share skills and expertise, and manage the needs of the local population

l Offer a specialist dementia beds service and work closely with Sussex Partnership’s dementia services to deliver the Trust’s dementia strategy

l To play an active role in the local community and help residents maintain a sense of ‘society’

l Expand the service by branching out into home care and personal healthcare budget options, for people transitioning from acute to community care

l Develop the Carehome Plus/ Lindridge model across the Trust

WHAT WE WILL DOl Put service users, carers and families at the centre of everything we do by working with third sector, social enterprise and industry experts to develop our inclusion and engagement strategy for the next two years

l Work in partnership with others, building on existing links with other trusts, care home Vanguards and academic groups to share learning and run pilot projects

l Give even greater focus to supporting the local community, Continuing with established projects, which to date have included knitting hats for the local homeless project, organising joint activities with the local school and celebrating young carers

l Think differently about how we provide services, developing new roles and networks to meet the changing needs of our staff and people who use our service

l Support staff to provide the best possible care, growing their skills and knowledge and providing more opportunities to progress their careers through personal development plans

41

DUAL DIAGNOSIS

CONTEXTPeople with a dual diagnosis almost always have multiple needs, often struggling with physical health and social care issues as well as their dual mental health and substance misuse problem. They may be unemployed or struggling to hold onto a job. They may be in debt, homeless or poorly housed. They could even be in an abusive relationship.

To add to their difficulties, they are also more likely to be stereotyped and stigmatised and as a group be seen as unreliable, difficult to engage, aggressive or abusive.

As a consequence, they tend to get passed around the various services they need support from with no-one wanting to take responsibility for their care. This can all too easily lead to a downward spiral and sooner or later a crisis, perhaps forcing them into A&E, or onto the streets. They may even find themselves in the magistrate’s court.

OUR AMBITIONl Work collaboratively and in partnership with other providers to create more integrated services that better meet the mental health, physical health, social support and social care needs of this patient group (see NICE guidance “Coexisting severe mental illness and substance misuse: community health and social care services”).

l Do further training and support work to ensure that all staff take a non-judgmental and empathetic approach to the care of people with a dual diagnosis that builds mutual respect and trust.

l Ensure staff are trained to identify co-morbid substance misuse issues, have skills in motivational interviewing to work with a patient’s possible ambivalence to change, and a good knowledge of the role that other providers can take (including substance

misuse services) to help a person with their difficulties.

l Ensure clear cross agency care pathways are in place to help staff manage care effectively for people with a dual diagnosis

WHAT WE WILL DOl A review of all our mental health services to benchmark them against the new NICE guidance for people with a dual diagnosis.

l Engage with key commissioners, primary care and third sector providers to scope out an improvement plan to meet the requirements of NICE.

l A review of existing contractual and partnership relationships with local substance misuse providers to ensure that services are effectively meeting the needs of people with a dual diagnosis.

l Ensure that people with a dual diagnosis of severe mental illness and substance misuse have dedicated care co-ordination in line with NICE guidance.

‘I was pushed around from pillar to post…the drug and alcohol team staff said I had a mental illness and the mental health worker said I had a drink problem. Neither of them did much to help.’ Service user

PART 1: NEW PARTNERSHIPS AND NEW WAYS OF WORKING

42

NEW PARTNERSHIPS

AND NEW WAYS OF WORKING


2

43

CONTEXTApproximately 1 million people across the world die by suicide every year. Of these, over 6000 live in the UK, leaving behind thousands of loved ones and friends who may never recover from their loss. About 1/3 of people who die in the UK are under the care of secondary mental health teams at the time of their death.

Preventing suicide is complex and challenging but there are a number of effective solutions that can address or mitigate the variety of factors which collectively contribute to suicide. Sussex Partnership holds the view that the suicide of those in our care should always be seen as having been potentially preventable at some point in a person’s mental

SUICIDE PREVENTIONhealth journey. We have therefore adopted a ‘Towards Zero’ suicide approach, which will constantly strive to eliminate suicide for all people in our care. A ‘Towards Zero’ approach does not mean that we won’t engage in positive risk taking and in providing care that aims to empower people to take control over their lives. Indeed, this is a key element in helping to reduce risk and suicide over the medium to longer term. Rather, it views all suicide as having been potentially preventable if something was done differently in a person’s life journey and therefore seeks to strive to learn from events, and improve care and practice, in a constant attempt to reduce the number of suicides of people in our care to zero. It may not mean that we will ever eliminate suicide completely, but we will continually strive to do so.

OUR AMBITIONl Adopt a ‘Towards Zero’ suicide approach and to support the implementation of this strategy across agencies and partnerships

l Build on the collaboration with Public Health and our community partners to address suicide prevention together

l Continue to improve the safety of our environments through reducing access to means

l Make more use of digital technology particularly embedding the use of the ‘StayAlive’ app

l Develop a suite of recovery based suicide prevention training packages co-developed and co- produced in partnership with those with lived experience.

WHAT WE WILL DOl Establish a ‘Towards Zero’ Suicide Programme Board to oversee the implementation of a revised Suicide Prevention Strategy with Service User and Carer involvement as well as linking with other agencies and the community. This will be chaired by the Chief Medical Officer

l Agree areas of priority for action including reducing access to means, training and development of staff, access to interventions in a crisis, and patient/family collaboration in safety planning, together with measurable outcomes that can be monitored and evaluated. The approach will be underpinned by a consistent QI methodology.

l Undertake a detailed analysis of local moderate/severe self-harm, near miss and suicide data to better inform the updated strategy

l Review findings from Thematic Review of Serious Incidents for areas of learning

l Review evaluation findings from the SAFE program in Hampshire

‘Suicide is never inevitable if we intervene at the right time and in the right place in a person’s mental health jour-ney. However, prevention of suicide requires a collective community, public health and mental health coordinated approach to care that draws on the best evidence we have available’.

44


CONTEXTPhysical health care for people with mental illness or learning disabilities

l Within Sussex and East Surrey, people with a serious mental health problem or learning disability will on average die between 15 and 20 years earlier than other people

l 17% of A&E admissions are for people with mental health problems although they only represent 7% of the population

l People with serious mental health problems are three times more likely to smoke but are less likely to be offered support to stop. The cost of smoking among people with mental health problems was estimated at £2.34 billion in 2009/10.

l Poor diet, less exercise, increased rates of alcohol and substance misuse and weight gain are all side effects of antipsychotics and contribute to diabetes and cardiovascular disease

INTEGRATED PHYSICAL & MENTAL HEALTH SERVICES

45


Psychological care for those with physical health problems including long term conditions

l 15 million people in England have long term conditions (LTC) such as diabetes, arthritis, asthma, cardiovascular diseases, chronic obstructive pulmonary disease and musculoskeletal disorders

l Having a mental health problem as well as a LTC can almost double the cost of care; an extra £8 - £13 billion spent each year in England

Integrated care for medically unexplained symptoms

l £3 billion is spent each year on people who have physical symptoms with no obvious physical cause. This can have a dramatic effect on people’s lives leading to frequent costly, and often unhelpful, investigations

OUR AMBITION

l Everyone we work with will have an integrated care plan where physical, psychological and social needs are fully addressed

l Physical healthcare and mental healthcare services will be brought together to work seamlessly around the person’s needs

l We will be the leading provider of, or partner in, the delivery of integrated healthcare services

l We will give people with learning disabilities and mental health problems support to live healthy lives and stop smoking by helping them access prevention services, education and information

“If I go to see someone about my eyes, my eyes are what I am and the rest of me doesn’t matter. It’s the same with mental health. If I go to see someone for amental health problem, I am a mental health problem”

Focus group participant

WHAT WE WILL DO

l Communicate a clear vision for what good integrated care should look like

l Support physical health services, including the new GP care clusters, to better meet the psychological and mental health needs of patients by providing training, advice and guidance

l Expand our perinatal and liaison psychiatry services

l Expand our Improving Access to Psychological Therapies (IAPT) services to meet the needs of people with long term conditions and medically unexplained symptoms

l Introduce peer support workers (health buddies) to help people access community resources and improve wellbeing

l Ensure all people with a serious mental illness or a learning disability are offered lifestyle screening and physical health care plans in secondary care

l Develop new pop up physical health clinics for people with severe and enduring mental health problems who find it difficult to access traditional primary care

l Work with partners in primary care and paediatrics to ensure young people and families can access physical and emotional care alongside each other

l Participate fully in shared care planning with physical health, substance misuse and those in social care to promote consistent support for young people and families across all settings

l Make sure that people with complex communication needs can access services and represent their needs clearly - addressing diagnostic overshadowing issues

l Ensure that people are supported to fully access primary and secondary physical health services… and to engage in activity to promote health and wellbeing


46

CONTEXTWe know the best way to develop and maintain services that meet the needs of those using them is to place those service users and their carers at the heart of our organisation.

OUR AMBITION

l Ensure that service users and carers are central to our thinking and part of everything we do

l Embed full participation and partnership into our daily work with patient participation leads working in all Care Delivery Services

l Create new opportunities for service users and carers to meaningfully influence how services are developed and to review how our services are performing

l Develop and establish the Youth Council for the CAMHS service, which will engage with young people and provide them with opportunities to design and further shape services

l Develop new Quality and Safety Reviews, with service users, carers and Governors taking a leading role in identifying concerns and gathering feedback

l Develop and maintain a database of service users and carers who want to be involved with the Trust and actively seek to engage people from age groups, backgrounds and cultures that are not well represented at the moment

l Develop training to support service users and carers to sit on interview panels and to take part in service improvement work

l Develop and implement a peer strategy for the organisation to support the goal of having a peer worker in every team

l Work with colleagues to ensure we are able to offer service users, carers and peer workers greater opportunities to access further education and employment opportunities

PEOPLE PARTICIPATION

“If this is going to be successful, we all need to be involved and be equal”

Participants at our Clinical Strategy Consultation Event March 2017

l Ensure all parties are supported to work effectively with each other, in full partnership, using the standards set out by the National Survivors User Network

l Support the further development and integration of peer workers - people who have experiences of using mental health services

l Give people the opportunity to be involved in a way that suits them and provides opportunities for further training and routes into employment

WHAT WE WILL DO

l Establish local service user and carer forums in all localities to focus on service improvement. The groups will identify good practice as well as areas of concern and will work with local staff teams to plan appropriate responses to this feedback

l Establish a Trust-wide Central Working Together Group. This group will seek to resolve issues that can’t be addressed locally and will be a place to share best practice and new initiatives

l Implement the Triangle of Care way of working, a scheme run by the Carers Trust, a charity for carers to help our services work closely with carers

47


“My son does not appear to get CBT… he is only given drugs. The single challenge…to give people strategies to cope”

“For the first time when I heard the peer support worker speak I felt such joy, because they had been where I was, it gave me hope”

Service users

WORKFORCE AND NEW ROLES CONTEXT

We need the right people, with the right skills in the right place at the right time to make it easier for our patients to access high quality care, and to support and deliver the services outlined in our clinical strategy.

There are some key drivers that need to be addressed in reshaping our workforce:

l Many of our staff feel under pressure in their jobs, and stress is one of the main causes of sickness absence. High levels of stress and burnout reduce the quality of the care and treatment we can offer

l It is difficult to recruit and retain workers in more traditional roles across registered professional groups in sufficient numbers

l There is a significant cost and quality impact of using agency staff to fill gaps in our teams as they are currently constituted

l We need to place greater emphasis on delivering effective interventions at the same time, we need to further refine and develop the role of our highly experienced and skilled care co-ordinators and determine their role in supervising and training others

l We need to increase our capacity to provide evidence based interventions to deliver on treatment that we know works


48

OUR AMBITION

l Support the health and wellbeing of our staff, and develop them so they have the right skills for their job, can maintain their compassion, and deliver safe and effective care (see the Enabling our Staff section)

l Recruit and retain registered staff across nursing, psychiatry and therapies, and support these staff in occupying core positions in our teams, supported by strong professional leadership

l Train staff and protect their time so that they are able to deliver more evidence based interventions as described by the Clinical Academic Groups

l Ask our highly qualified staff to support effective assessment and formulation, to supervise others and to provide clinical leadership, and focus less on routine follow-up

l Develop an expanded workforce of non-registered staff in the following new roles:

l Peer support workers – trained to deliver support and signposting to help people navigate through the mental health service

l Nursing associates, trained to take on roles in inpatient services, and physician associates to support psychiatrists

l Graduate mental health workers – trained to deliver psychologically informed interventions for children and adults and work as lead practitioners in adult community services

l Train non-registered community staff to coordinate care safely under the supervisor of our more experienced staff

l Implement apprenticeships into the workforce at scale

“My team feels like a family, they are fun, supportive and caring. To us it’s personal”

Staff member

WHAT WE WILL DO

l Develop early implementer teams within acute services to safely incorporate nursing associates to fill vacancies, improve continuity of care and reduce agency use

l Develop early implementer teams within community services to use some vacancies to expand

substantive peer support worker posts, and introduce graduate mental health workers who will deliver psychologically informed interventions and become lead practitioners

l Invest in a new career path for nursing, to support recruitment and retention - enabling development of healthcare assistants through nursing associate roles into registered mental health nurses and beyond

l Increase the number of roles which can reduce use of agency doctors including non-medical prescribing, Physician associates and non-medical responsible clinicians

l Develop our apprenticeship programmes at scale for developing existing staff and training new staff

l Deliver values-based recruitment and include service users and carers in our recruitment processes

l Improve workplace wellbeing by enabling local teams to make changes to address stress and burnout as well as access to specific staff wellbeing interventions (see the Staff

wellbeing section)

l Benchmark our workforce breakdown against that of other progressive mental health trusts to see what new learning can be gained from these organisations

l To support the professional and career development of the increasing number of registered social workers who are employed directly by the Trust

l Further refine and devlop the role of the expert care co-ordinator

l Establish a trust-wide safeguarding team to ensure staff get the training, supervision and support they need to undertake safeguarding effectively


49


SUPPORTING BEST

PRACTICE


3

PART 3: SUPPORTING BEST PRACTICE

50

CONTEXTOur staff deliver care and treatment with skill and compassion. However, it can be highly stressful and demanding work. We want to ensure we support our staff to do the best job that they can.

Research shows the factors with the biggest positive effect on staff health and wellbeing are positive team culture, a supportive manager, making a positive contribution, being able to participate and being kept informed.

Key sources of stress and burnout include excessive job demands, staff feeling they have little control, a perception of high effort for little reward, having a lack of clarity over their task or role, a poor work environment, bullying, and lack of social support in the workplace (Harvey et al, 2017).

“I can often feel overwhelmed by all that I have to do and I then worry that I am letting people down”

Member of staff – clinical strategy engagement event, February 2017

STAFF WELLBEING


51

WHAT WE WILL DO

l Develop a sustainably funded staff wellbeing programme and define the range of evidence-based interventions that will be offered

l Introduce a new self-referral system where staff can anonymously refer themselves to talking therapy services outside their work area” with “services, outside their work area if they wish

l Provide clear information for staff about how confidentiality and dignity will be protected if they need to use our specialist mental health services

l Ensure staff are well informed on how and where to gain access to mentoring and coaching

l Promote the use of our internal Bullying and Harassment Advisors Service

l Ensure all staff have clear job plans with clear and realistic expectations set around task and workload

l Ensure more consistency in job plans within particular grades and professions

l Make sure all teams are using our new clinical intelligence data to develop systems and processes that more effectively match demand to capacity

l Ensure all staff receive regular supervision where workload and wellbeing can be regularly reviewed. This will be backed by wellbeing, mentorship and continuing professional development training or support programmes.

l Ensure all teams conduct a workplace environment review to identify solutions to improve the working environment for staff (for example, the introduction of a quiet room for mindfulness)

OUR AMBITION

l Reduce staff stress and burnout and improve staff wellbeing, as evidenced in our annual staff survey

l Reduce excessive pressures on staff by developing new care pathways in partnership with other organisations so some of what we do now is shared with other able partners

l Develop more effective information and management systems to better match capacity to demand

l Continue to extend the role of staff wellbeing champions

l Increase the availability of coaching and mentoring support

l Promote a culture that encourages staff to raise concerns

l Help teams develop robust and supportive ways to deal with discrimination and abuse towards staff at work

l Be explicit in assessing and supporting the development of our values by using them in our recruitment and appraisal processes

l Make giving feedback on how we support each other a routine part of what we do

“It’s our job to look after and help people but we are not al-ways good at helping each other”

Member of staff – clinical strategy engagement event, February 2017

CLINICAL STRATEGY 2017-2020PART 3: SUPPORTING BEST PRACTICE

52

We need to recognise this and not only make sure we are supporting our service users in choosing the right medicine but also that we are closely monitoring them for treatment failures and side effects so that adjustments to treatment can be made early. If we do this service users will have more confidence in the potential benefits of their medication so will use it in the best way to support their care.

OUR AMBITIONWe will only prescribe medication when:

l There is good evidence to support its use

l The benefits outweigh the risks

Whenever possible:

l After the service user has had a chance to express their beliefs, experiences and hopes around medication use

l After the service user has been given a choice of medicines, based on good, easily understood information

l When there is a plan in place to monitor both the benefits and side effects, ideally agreed with the service user

l When carers and relatives have been involved in decisions, if appropriate

We will minimise the risks of medication by:

l Closely monitoring for side effects in line with national and Trust guidance

l Closely monitoring for treatment failure and adjusting treatment at the earliest appropriate time

l Providing good and accurate communication when transferring responsibility for prescribing and monitoring between prescribers. This will include if appropriate guidance on when to consider stopping a medication and how to stop it

l Providing additional support when service users with greater risks of non-adherence or greater potential for side effects are identified

l Monitoring prescribing against agreed guidelines and challenging prescribing that is outside the norm

WHAT WE WILL DO

l The pharmacy team will offer training in how to have meaningful conversations about medicines with patients and carers to all clinicians involved in medication

l Invest in an electronic prescribing and administration system to reduce risks and improve monitoring

l Assess the benefits of the recent investment in community-based mental health pharmacists

l Develop electronic transfer of care summaries.

l Improve how Carenotes handles medication-related documents and records, to improve access to all medication-related information

l Really put patients at the centre of decisions about their medication.

l Upskill all clinical staff so they fully appreciate the benefits and the limitations of medication across different diagnoses

MEDICINESOPTIMISATION

“We want to put service users and if appropriate carers at the centre of decisions on medicines to optimise their use. This can be done by really listening to people’s experiences of medicines, their beliefs around medication and finding out what they hope any medicine will do for them”

Ray Lyon, Chief Pharmacist

CONTEXTPsychotropic medication is being taken by more than 90% of our service users and for many it can form the bedrock on which other interventions are provided. Unfortunately medication has the potential to do harm as well as good and some service users will fail to get any benefit from it.


53

l Promote a positive, supportive, appreciative culture

l Have regular meetings to reflect on work and improve it

l Introduce agreed measures of team wellbeing and team functioning with this data being available to all teams

l Enable all managers, clinical and professional leads to develop specific plans for improving team functioning, drawing on the support of our 25 organisational development practitioners

l Give all teams time out to consider the way they work together and work with other teams, and to think of ways this could be improved

l Ensure that this time out is used in an effective way using evidence- based approaches to improve team functioning and wellbeing

CONTEXTWe will put our teams at the heart of our clinical strategy in the belief that good teamwork is an essential component of high quality and effective clinical care.

OUR AMBITION

l Define the team task in a patient-centred way that gives inspiration

l Recruit the right people with the right skills to achieve the task

l Ensure everyone knows who their team is and with the right numbers of people to deliver the team objectives

l Provide clarity about who does what

l Set five to six challenging measurable team objectives per year

l Set an objective for every team to work better with other teams

WHAT WE WILL DO

l Ensure all teams have a small number of clearly defined and shared goals

l Ensure that everyone’s role in achieving their team’s goals is clearly spelt out in their own job plans

l Introduce a common measure of team wellbeing and team functioning across all teams

l Enable all teams to hold two team development days per year to work on improving their effectiveness

l Highlight examples where teams are working well together and identify key components of this best practice to be shared more widely

l Offer top up management training on working with teams and improving the functioning of teams

l Embed the role of the organisational development practitioners in supporting team development

“If our teams are working well our organisation will be working well”

Chief Operating Officer, March 2017


IMPROVING TEAMS

“Teams that are given time out to improve are 25% more effective than those that aren’t”

West, 2016

54

OUR AMBITION

l We accurately record clinical outcomes across all of the Trust

l Outcomes are meaningful to the people who use our services

l Clinical outcome measures are used as an integral part of any clinical work with a patient

l Outcomes recorded enable meaningful comparisons to be made in the effectiveness of services across CDSs and pathways. The outcomes chosen will be agreed across our services, based on CAG recommendations

l Individual clinicians are able to review outcomes to make decisions about a person’s ongoing care

l Individual clinicians have an opportunity to reflect and learn from the outcomes they are achieving in their work

WHAT WE WILL DOBy the end of 2017, every service user, in partnership with their clinician, will have a clear target for:

l Symptom reduction in the

area considered the priority for treatment

l The achievement of mutually agreed goals that should promote autonomy, independence and recovery (the REQOL measure)

l Their experience of care

Every staff member will have clear targets for:

l The number of people they see and the number of sessions they offer

l The clinical outcomes they achieve (as defined above)

l The quality of their record keeping and risk management processes

These targets will be reviewed regularly in supervision so that any learning needs can be reflected upon and where necessary addressed

Every team will have:

l A clearly specified set of criteria for whom they should be treating and what they should be offering

l Targets for symptom reduction, achievement of service user goals, and service user experience of services

l Clear targets around other important quality matrices

l Measures of team functioning and staff wellbeing that should be used by the whole team in helping to improve wellbeing and team effectiveness

l In learning disability services, we will work to ensure outcome measures reflect all aspects of a person’s care, including physical health and social care outcomes

The data will be available to the team in a way that is easy to use and to understand.

MEASURING OUTCOMES

“It’s only by accurately recording outcomes that we can assess the effectiveness of different interventions across different conditions and pathways”

MaCAG Chair, October 2016

“I want to record outcomes that are meaningful for me and which accurately reflect my goals”

Service user


55

CONTEXTPatients and families have a right to expect clear information about what treatment options are available, what they involve and their likely effectiveness.

We need to support teams to describe and account for the very good work they are doing, including the evidence-based care they are currently providing.

We also need to ensure that our clinical services are putting research, innovation and learning into practice quickly, effectively and systematically. This will help us provide care and treatment to patients based on up to date research evidence.

We also need to be clearer about what teams might need to do less of or what they might do more effectively in partnership with third sector or other health and social care partners.

“I would like to feel more confident that the help being offered to me is based on the best evidence about what works”

Service user

PATHWAYS OF CARE

EVIDENCE-BASED CARE

Clinicalresearch

Clinical experience

Service uservalues and

preferences

WHAT ARE CLINICAL ACADEMIC GROUPS?

Each CAG brings together clinical staff, service users, carers and academic researchers in a particular specialist area. Their role is to support evidence-based care by developing guidance for staff who are delivering care about the interventions and ways of working that are likely to be most effective.

They are also responsible for ensuring that consistent and high quality care is being delivered across the organisation for their care group, providing direct support for the services that require improvement to reach the required standards.


56

WHAT WE WILL DO

l Ensure that each clinical service area can draw on the expert advice and support of our Clinical Academic Groups.

l Develop specific menus of interventions for the main presenting problems in services

“There is a lag between

research and impact of

between 10 and

25 years, with a

mid-point of 17 years”

Health Economics Research Group, Office of Health Economics, RAND Europe. Medical. London: UK Evaluation Forum; 2008

“When people have lots

of complex problems

it’s sometimes hard to

know where to start

– it would be great to

be clearer about what

interventions are most

likely to help”

Staff member

OUR AMBITIONTo provide consistently high quality care and treatment based on reliable, up to date research evidence about what works.

Clear expectations

l Provide clearer information to patients and families about what they can expect from our services

l Ensure staff know the most effective interventions and approaches for people with particular needs

Consistency

l Consistently offer interventions across our services, based on evidence of their effectiveness

l Understand why there are variations in the type and duration of interventions we currently offer, in order to do something about it

Making best use of our resources

l Ensure our resources are used effectively

l Reduce the amount of non-evidence based care we offer which will increase capacity to offer more evidence-based care

l Get better at capturing all the work that we do on our electronic patient information system (Carenotes). This will provide teams with better information about how they compare with other similar services. It will also help us develop common standards, so we can describe more clearly to patients, families and commissioners what they can expect from our services

l Identify where a particular approach or intervention could be provided in a way that makes more sense in terms of quality and/or cost

l Support services to audit the degree to which they currently provide evidence-based care and the extent to which their services differ from ‘standard care’ in the Trust. We will help them assess whether these differences reflect real differences in need given the local context

l Agree a standardised way of capturing a patient’s main presenting problem on Carenotes and will expect this to be recorded consistently for everyone who is under our care. We will also record more clinical outcomes against an agreed set of clinical measures. When taken together, this will enable us to make more effective comparisons of service outcomes across services and service models

l Ensure that there are effective mechanisms for CAGs and clinical services to communicate with, and be accountable to, each other.

l Continue to develop core clinical standards that are common to all our services so that staff, service users and carers can be clear what to expect from us

l Provide each service area with the data reports that they need in order to compare outcomes across services and support them to implement learning from areas of outstanding practice

Encouraging innovation

l Reduce the time it takes for research to be used systematically to improve services. All our research will be geared towards the needs of patients, carers and clinical services

l Expand on the development and roll out of our research clinics

CLINICAL STRATEGY 2017-2020CLINICAL STRATEGY 2017-2020

57

OUR AMBITIONl We will make it easy for teams to

access and use information to deliver quality services

l Everyone will take responsibility for getting our data right

l We will develop a culture that values clinical information so that clinical care intelligence is seen as ‘business as usual’. Dashboards, heat maps and proactive information alerts will all be used as standard to improve patient experience and the quality of care provided

All teams will have access to information on:

l Their patients, service demands and patient outcomes

l Their performance against key quality targets set

l Their own wellbeing and how

their team works

CONTEXTWe need to provide teams with information to help them deliver outstanding care you can be confident in.

We don’t currently capture or evidence all of the work teams do or use this to help us plan how we make best use of resources. Not only can this make it difficult to justify additional investment, it also makes it difficult to match capacity with demand and learn from best practice.

Where teams are using information about their caseloads, by drawing on clear and visually accessible data they can manage demand, improve quality and make changes which improve outcomes.

WHAT WE WILL DO

l Learn from services in the Trust where clinical intelligence is used effectively to improve quality, and ensure that the learning is applied elsewhere

l Consult with staff on what they need for new operational reports and dashboards – including new tools if appropriate

l Introduce a new data presentation tool which staff are trained to use

l Roll out a new demand and capacity monitoring system that will mean we can compare the interventions carried out against the evidence-based recommendations set, and explore variation in the duration and volume of activity delivered

l Develop reports to support teams to measure and demonstrate the clinical outcomes achieved by their services and by individual staff so that this can be used routinely to improve practice and outcomes


USING DATA AND TECHNOLOGY TO IMPROVE CARE

58

l Incorporate physical and mental health into any future digital patient record, drawing information from different health and social care organisations

l Place ‘digital’ at the heart of service design in recognition of the growing dependence on accurate and timely information to treat patients

l Continually develop our systems ensuring integration with partner systems, to support our patients’ care pathways across organisations and services

CONTEXTDigital technology presents new ways of delivering services more efficiently and effectively.

Service users and their families have changing expectations. Increasingly they want to use digital technology to engage with services and staff in different ways.

OUR AMBITION

l Embed digital technology into the way we deliver care

l Use technology to help patients access services, contribute to their clinical record, book appointments, communicate with our staff and give us valuable feedback

l Make sure staff have the right digital tools for their roles and access to the correct training to use them

l Continue to improve Carenotes, our clinical information system, using feedback from our staff

l Use information to plan and transform services to improve the quality of the care we deliver. Staff must have easy access to the information they need

WHAT WE WILL DO

l Deliver the annual Digital Plan and specific projects to assure delivery of our Digital Strategy

l Make best use of the current digital tools available

l Maximise use of Skype to enhance service users access to the Trust, for example, Instant Messaging (IM) and video

l Enable service users and clinicians to make the most of apps and digital tools to improve outcomes. Helping them keep track of medication, symptoms, outcomes and overall health

l Deliver our Digital Adoption Plan to increase our staff’s digital enablement and the Trust’s overall digital maturity.

When we transform our services we should always look to leverage the potential of existing and new digital technologies. Enabling the delivery of these services more efficiently and increasingly via the channels service users will prefer to access them by. All staff should feel empowered to be innovative.

“People working collaboratively with technology are far more effective than either people or technology alone”

(Robert Wachter – Author of The Digital Doctor)

DIGITAL BY DESIGN


59

HEADS ON

“Having the opportunity to

raise money with Heads

On has been fantastic –

the positive impact it has

had extends far beyond

what anyone would have

imagined when it was first

mentioned in our ward team

meeting. The nursing team

have really embraced the

opportunity to strengthen

our community as a ward

and the whole experience

has given us renewed

creativity, vision and bundles

of motivation.”

Charge Nurse, Rowan Ward

CONTEXTHeads On is our official NHS charity, supporting people with mental health problems, learning disabilities or within the criminal justice system. The charity helps people to feel supported, to stay active and to be more involved in their communities.

We achieve this by fundraising for and investing in innovative projects that support people’s recovery, funding cutting edge research that improves support and treatment for people with mental health problems and transforming our patient spaces into warmer, more welcoming environments.

OUR AMBITIONHeads On’s aim is simple; to work for and alongside people who come to Sussex Partnership for help, giving hope when times are tough, by fundraising for bold, innovative and inspiring projects that help to create outstanding mental health care.

WE WILLl Think “charity first” using Heads On to its full potential to support the development of new projects within the Trust.

l Work with Heads On to maximise the funding opportunities we access to improve patient care, embracing the full range of sup port open to us from local community groups to large grant making trusts.

l Collaborate with Heads On to co- fund projects that otherwise could not be delivered solely with NHS monies.

l Build on Heads On’s community and events fundraising programme to encourage staff engagement and wellbeing.

WHAT WE WILL DOl Ensure all projects Heads On fundraises for are developed and delivered in partnership with service users and carers – they know best how Heads On can add value to NHS care.

l Be ambitious in the projects we ask Heads On to fundraise for, and make sure those projects have a clear impact on delivery of the clinical strategy.

l Build links between Heads On and each CDS to make sure we know of and are able to access funding opportunities that will enhance patient care.

l Develop projects with Heads On that are delivered in partnership with third sector colleagues and that complement resources and expertise in other organisations.

l Ensure staff are supported to engage in fundraising for Heads On, both to make a difference to the service they work in and to support staff morale and wellbeing.

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Our clinical strategy outlines the vision we have for services moving forward and describes the work we will be doing to get from where we are now to where we want to be.

Our vision is underpinned by the need to:

l Focus more on prevention and early intervention

l Work more closely with community partners to support the development of more resilient local communities

l Focus on providing joined up integrated care, putting our community services at the heart of all care pathways

If we achieve this, we expect it to result in reduced numbers of people needing hospital admission and more people receiving care closer to home.

The strategy has been developed through a bottom up approach

generated in 20 workstreams where service users, carers, staff, commissioners and other partners have come together to vision the future. Our task now is to realise the benefits of the strategy by taking forward the implementation of the workstreams, using the resources of both the Trust and the wider STP to achieve this. The adoption of a new and more consistent approach to Quality Improvement (QI) will be a key delivery mechanism.

The strategy should not be seen as a fixed product – rather it is an evolving strategy that needs to adapt constantly to the changing environment and new research evidence. It must also be seen as a strategy that belongs to all of us; for only by working together will we be able to achieve the ambitions we have set for ourselves.

“This clinical strategy describes our ambitions for our patients, carers and families, and our staff. We have created these together. We will only achieve the outcomes we want by continuing to work together, challenging the status quo and by putting people at the heart of everything we do. By working together we can achieve this”

Sam Allen, Chief Executive, March 2017

CONCLUSION

A huge thank you must go to all of the service users and carers who have volunteered their time so generously in the clinical strategy work to help us to make our services better. We would also like to thank the staff who have contributed time and effort to the development of the strategy on top of their everyday jobs and responsibilities. Specific thanks needs to go to:

Dr Nick Lake, Michael Mergler, Dave West, Tony Sharp, Jonathan Beder, Rachel Thomas, Hilary Charlton, Dr Jason Read and Dr Adrian Whittington who are providing overall leadership to this programme of work.

Louise Patmore, our clinical strategy patient leader.

Martin Packwood, our clinical strategy commissioner representative.

Andrew Cole, Viki Baker, Ruth Hillman, Claire Newman, Juliet Couche, Dr Angela Busuttil, Bryan Lynch, Dr Rick Fraser, Dr Brian Solts, Lindsay Towle, Simone Button, Dr Adil Jawad, Dr Sophie Holmes, Rebecca Hills, Sue Esser, Dr Nick Grey, Ray Lyon, Dean Birch, Emma Wadey, Karl Goatley, Rachael Kenny, Sue Turner and John Child , our workstream leads

Dan Charlton, Hannah Clubb, Elsa Marchewka and Courtney May from our communications team, who have worked tirelessly to put the final document together.

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CLINICAL STRATEGY 2017-2020CLINICAL STRATEGY 2017-2020

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Get involvedOur charity, Heads On, supports projects that make a real difference to patient care. Get involved at: www.headsoncharity.org

Documents

CLINICAL STRATEGY...“Our clinical strategy is a way of describing how we will provide the best possible mental health care for those who use our services. The aim is to make sure