1. Welcome to Celebrating Positive Practice in County Durham and Darlington 19 September 2013 Mrs. Jo Turnbull, Chairman

2. PATIENT & CARER INVOLVEMENT Lucy Prowse – Patient & Carer Involvement Support Officer Anthea Motson - Patient & Carer Involvement Officer Pam Elliot - Carer Paul Wait – Ward Manager, Farnham Ward, Lanchester Road Hospital

3. What is involvement? Involvement partnership Our relationship Work together to help shape and improve our services and help with people’s recovery

4. Types of involvement activity Meetings and consultations Task and finish groups - reviewing services and providing feedback Service improvement workshops Hospital inspections (PLACE visits) Ward visits (validation visits) Recruitment and selection Staff training and induction Recovery stories – sharing your experience Trust conferences and events Readers’ panel – reviewing our leaflets and information

5. How to get involved Do you have experience of our services and are interested in being involved? Details held on our database Involvement opportunities sent via email or post

6. What our service users & carers have said about involvement: “My involvement with the Trust has enhanced my recovery since my discharge and I feel the best I’ve been in my life” from a service user. “I have found absolute salvation being involved with various carers groups and being involved helped put my mind at rest from personal problems” from a carer.

7. Recruitment & Selection ANTHEA MOTSON Patient & Carer Involvement Officer

8. Recruitment & Selection Background: Historically staff involved service users and carers in recruitment and selection by inviting them to sit on interview panels. Partnership working with HR was undertaken to promote involvement in their documentation and Trust Induction.

9. Recruitment & Selection Currently: The Medical Education department hold their own database & train service users and carers in recruitment & selection. Work is ongoing obtaining 360 degree feedback on the current interview process. The trust is hoping to arrange a Values Focus Group to involve service users and carers in recruitment of staff on the basis of the Trust Values. A focus group was set up to look at job descriptions to see if they are sufficiently service user / carer focused.

10. Recruitment & Selection PAM ELLIOT Carer

11. Training for Carers PAUL WAIT Ward Manager, Farnham Ward Lanchester Road Hospital

12. ANY QUESTIONS

13. Crisis Teams The Future

14. What Does A Crisis Team Do?

15. Core Provision Rapid assessment following referral. A viable alternative to hospital admission. Intensive home treatment. Facilitated early discharge from hospital where admission has been unavoidable. Prevent relapse

16. Facts 24 hour service/7 days a week Referrals for crisis assessment average around 160/month Geographical area covered is from Consett to Seaham We aim to see people within 4 hours of referral Able to work intensively in people’s homes Home Treatment case load is often between 20-30 people.

17. What’s next Change perception service users/professionals Be more flexible Creative crisis care planning Bespoke home treatment-build around individual needs Integration with other services User friendly/stop repetition Accessible Listen to feedback/constantly evolve.

18. Benefits Care can be delivered at home. Service user has greater individual input into their episode of care. Increased carer involvement. Integrated working. Supporting community teams. Build on existing coping mechanisms and social networks.

19. Developments

20. The Shildon Crisis and Recovery House

21. Purpose built Intensive home treatment in our home Help stabilise mental health Step up Step down Can assist in early discharge Seeing it from the service users perspective. Benefits

22. Why Give people greater choice –an alternative Provide supportive care – relapse prevention Step in earlier to prevent escalation of crisis Facilitate resolution in crisis situations particularly for those with limited support or felt to be vulnerable Focus on recovery

23. Conclusion Crisis Teams have been established for several years within mental health services. The development of the new Crisis and Recovery House is the next step. It will enable people to have more choice with regards to their treatment and care, and allow services to intervene earlier, which ultimately improves outcomes and aids recovery.

24. A different way of doing things!!!

25. HOW SERVICE USERS WITH A DRUG PROBLEM ARE SUPPORTED IN SUBSTANCE MISUSE SERVICES JUDITH DURKIN - CLINICAL COORDINATOR. ANGELA SCULLY-SERVICE USER, SMART RECOVERY FACILITATOR.

26. KEY THEMES INDEPENDENT/SUPPLEMENTARY NON MEDICAL PRESCRIBING WITHIN SUBSTANCE MISUSE SERVICES THE DISTRIBUTION OF NALOXONE TO SERVICE USERS/PARENTS/ CARERS AND OTHERS. WORKING AND SUPPORTING PREGNANT SERVICE USERS. ROAD TO RECOVERY - ANGELA SCULLY.

27. LEGISLATION AND GUIDANCE WHICH HAS SUPPORTED THE DEVELOPMENT OF NON MEDICAL PRESCRIBING - NEIGHBOURHOOD NURSING A FOCUS FOR CARE 1986, FIRST CROWN REPORT 1989. CHANGING PROFESSIONAL BOUNDARIES. SUPPORTING THE ETHOS OF THE NHS. RENEGOTIATION IN HEALTH CARE LABOUR. INTRODUCTION OF NURSE - LED CLINICS. INDEPENDENT/SUPPLEMENTARY NON MEDICAL PRESCRIBING

28. THE FIRST NURSES IN THE SUBSTANCE MISUSE SERVICES COMPLETED THEIR TRAINING IN 2005. AT PRESENT THERE ARE 17 NURSES IN COUNTY DURHAM, A MINIMUM OF 2 WORKING IN EACH CENTRE WHO ARE QUALIFIED AS NON MEDICAL PRESCRIBERS.

29. BENEFITS OF NON MEDICAL PRESCRIBING TO SERVICE DELIVERY AND CLIENT CARE TIMELY ACCESS TO SUBSTITUTE PRESCRIBING. IT IS AN APPROPRIATE, EFFECTIVE AND COST EFFECTIVE INTERVENTION. IT IS STRUCTURED AROUND CLIENT NEED. GIVES PATIENT CHOICE AND CONVENIENCE. AND GIVES CONSIDERATION TO BEST PRACTICE BASED ON EVIDENCE. LEADING TO CONSISTENCY OF CARE DELIVERY FOR CLIENTS.

30. NON MEDICAL PRESCRIBING PROVISION WITHIN THE SUBSTANCE MISUSE DIVISION COMMUNITY SUBSTANCE MISUSE SERVICES – SUBSTITUTE PRESCRIBING, DETOXIFICATION, SYMPTOMATIC RELIEF,OPIATE BLOCKERS. HARM MINIMISATION SERVICES – ANTIBIOTICS, VACCINATIONS RECOVERY INJECTABLE OPIOID SERVICE – SUPPORTING THE SMOOTH TRANSITION BETWEEN SERVICES.

31. RECOVERY ACADEMY – SUBSTITUTE PRESCRIBING AND SYMPTOMATIC RELIEF DURING DETOXIFICATION TO SUPPORT RECOVERY. COMMUNITY ALCOHOL SERVICES – ALCOHOL DETOXIFICATION TREATMENT REGIMES, PRESCRIBING TO PROMOTE PHYSICAL HEALTH.

32. FUTURE DEVELOPMENTS NON MEDICAL PRESCRIBING PROVISION INCREASED TO 75% ACROSS COUNTY DURHAM. INCREASE ACCESS TO NURSE LED CLINCS. DEVELOP THE ROLE OF THE INDEPENDENT NURSE PRESCRIBER AND THE PRESCRIBING OF CONTROLLED DRUGS.

33. NALOXONE DISTRIBUTION IN 2011 – THERE WAS A TOTAL OF 1,772 MALE AND 880 FEMALE DRUG POISONING DEATHS INVOLVING BOTH LEGAL AND ILLEGAL DRUGS. HEROIN/MORPHINE DEATHS HAD DECREASED BY 25% TO 596 IN 2011 BUT WAS STILL 596 DEATHS TO MANY. THE HIGHEST MORTALITY RATE WAS IN THE AGE GROUP 30-39.

34. OPIOID DEPENDENCY INCLUDING HEROIN AND OTHER OPIOID DERIVITIVES HAS A HIGH MORTALITY RATE DUE TO ACCIDENTAL OVERDOSE. EVIDENCE SHOWS THAT THESE NUMBERS CAN BE REDUCED IF NALOXONE IS GIVEN TO SERVICE USERS, CARERS AND OTHERS.

35. NALOXONE IS AN ANTIDOTE THAT RAPIDLY BUT TEMPORARILY REVERSES THE EFFECTS OF HEROIN AND OTHER OPIOIDS. IT IS REQUIRED TO BE ADMINISTERED VIA INJECTION TO THE OVERDOSE VICTIM. IN 2005 THE LAW WAS AMENDED TO PERMIT EMERGENCY ADMINISTARTION OF NALOXONE BY TRAINED MEMBERS OF THE PUBLIC.

36. KAIZAN EVENT KEY THEMES INCREASE AWARENESS OF OVERDOSE PREVENTION AND THE USE OF NALOXONE DEVELOP AN OVERDOSE PREVENTION TRAINING PACKAGE – TO INCLUDE, BASIC LIFE SUPPORT AND ADMINISTRATION OF NALOXONE TRAIN STAFF TO DELIVER THE PACKAGE

37. OUTCOMES OF KAIZAN PATIENT GROUP DIRECTION. TRAINING PACKAGE. PROCEDURE. STANDARD WORK. LEAFLETS. QUESTIONNAIRES. POSTER.

38. EVALUATION OVER 50 TRAINING EPISODES COMPLETED. A KEY PRIORITY FOR SERVICES. THREE NALOXONE USED IN OVERDOSE SITUATIONS WHICH ARE 3 LIVES SAVED.

39. SUPPORTING PREGNANT SERVICE USERS MULTI AGENCY GROUP ESTABLISHED TO EXPLORE THE DELIVERY OF A ROBUST SERVICE MODEL REVISITED AND UPDATED IN 2012, LEADING TO - STANDARDISED WORKING ACROSS COUNTY DURHAM. THE PROMOTION OF PARTNERSHIP WORKING WITH THE WIDER CARE TEAM ENSURING CONSISTENT SAFE PROACTIVE PRACTICES.

40. SERVICE USER INVOLVEMENT SUPPORTING THE DEVELOPMENT OF THE PREGNANCY PATHWAY. DEVELOPMENT OF SERVICE USER LEAFLETS. DEVELOPMENT OF THE PREGNANCY CARE PLAN.

41. 2012 SERVICE USER AUDIT. IDENTIFIED - GOOD PRACTICE IN SAFEGUARDING THE NEEDS OF THE CHILD APPROPRIATE REFERRALS TO THE LOCAL AUTHORITY WHEN CONCERNS WERE IDENTIFIED POSITIVE CLIENT ENGAGEMENT WITH SUBSTANCE MISUSE SERVICES POSTNATALY

42. ROAD TO RECOVERY ANGELA’S STORY.

43. Hospital Liaison Service Update Chris Binns, Operational Service Manager

44. Hospital Liaison Service Psychiatric liaison services provide mental health care to people being treated for physical health conditions in general hospitals. Mental health disorders such as depression, anxiety, alcohol and memory problems are very common in general hospital. Research has shown that they are often not recognised or treated Untreated mental health issues can lead to longer hospital admission and poorer physical health overall in hospital inpatients and increased health care costs. An effective liaison psychiatry service offers the prospect of saving money as well as improving health.

45. What did will be different? Extend location of services and visibility Better Support to hospital staff Increased hours of working Improved Multi disciplinary approach Post discharge support Service for High Intensity Users of Hospital Services

46. Patient stories

47. Whats next... Improving follow up for people who self harm Working with Specialities within the Hospital Development of MUPS service Service Evaluation And hopefully long term funding....

48. Questions?

49. Refreshment Break Refreshments served on the mezzanine level and market place

50. Patient and Carer Feedback How the Trust obtains and acts on feedback from patients and carers, what it tells us and what we do about it. Corinne Aspel Lead Senior Nurse Patient Experience

51. Trust Values and Associated Behaviours Commitment to quality Respect Involvement Wellbeing Teamwork

52. Benefits in collecting and using patient feedback.... helps to improve communication between patients and staff helps to build trust and confidence in the NHS locally and nationally informs planning and service improvement helps the organisation to provide accessible and responsive services based on people’s identified needs and wants helps patients to shape the services that they use.

53. What it says to those who access our services : we need and value your views on how we are doing we are actively looking at how we are doing, and striving to do better we look at your comments regularly and give a quick response to your opinions we are open and honest, showing you how we have responded to your feedback we will keep you informed about how other patients experienced care here

54. What it says to staff.... we believe that your satisfaction with your work is key to giving patients and service users a positive experience of care we will involve you in designing systems to gather and respond to feedback we will support you to improve services, building our reputation as a high-quality service provider.

55. Current Patient Experience System Electronic touch screen devices in use to collect feedback ( anonymous ) A wide range of services are covered Reports monthly to participating teams pie charts and written feedback Acting on feedback

56. Results for Durham and Darlington – July 2013 92 patients completed discharge surveys from inpatient areas. 16 carers gave us feedback 49 patients completed surveys in 3 community teams in July. 13 carers gave us feedback

57. Adult services Maple ( WPH) scores Farnham (LRH) – scores above 78% for all questions Elm (WPH) 100% felt staff were friendly and approachable but poor scores for feeling valued and understood similar picture for Tunstall (LRH)

58. Adult services Cedar (WPH) 58% felt safe during their stay All areas excellent scores for friendly and approachable staff and being made to feel welcome by staff

59. Adult Community Two teams surveyed Darlington Affective team and South Durham Affective team Overall feedback very good but poor scores for being given a copy of care plans in the Darlington team

60. Older peoples services Oak (WPH) overall scores excellent lowest scores for purpose and side effect of medication being explained 60 and 50% Roseberry (BLU) again overall scores excellent 2 of 3 patients did not always feel listened to or have side effects of medication explained

61. Community Sedgefield CMHT – excellent scores for majority of questions except side effects of medication explained 50%) and being given a copy of their care plan but this had increased from 35% in June to 56% in July

62. Carer feedback Numbers of carers giving us feedback are small and this is an areas we would like to improve. No themes are evident from feedback to date but each area are asked to action any questions which score poor.

63. Developments Friends and Family Test question introduced in July - early indications are that we will get more valuable typed feedback ( see display for examples of the feedback received from this question in July 48 positive comments received and 3 negative) Activity questions added to the inpatient survey to understand the range of activities available and the times they are available, and if they were helpful in the persons recovery Staff experience Learning Disability and Children's surveys introduced

64. Lanchester Road Hospital Adult Learning Disability Service

65. Getting Feedback from the people who use our learning disability service. A Service User from the Trusts Reference Group visit patients once they have been discharged. They get feedback about the persons stay while in hospital.

66. The Reference Group

67. What the people who use our service say…

68. I was involved in my care, I had choices and options, I could ask questions. I didn’t want to be involved in the CPA but staff helped me understand and I understood it. I liked the staff, they handled situations well when I got upset.

69. I was sick of stopping in, you had to smoke outside. I used to go to the shops and café with the staff. I was fed up, liked to spend more time outside. Nothing to do sitting bored – chose to watch the TV

70. Hard Mattress – making my back hurt! Sometimes I didn’t really like the food 50% of people did not like the food!

71. What we did!

72. We have ordered some new Mattresses! We have changed the way food is cooked.

73. We bought a new Computer Touch Screen for everyone to use

74. We have developed a good timetable of activities!

75. Jackie - 0191 441 5800

76. Learning Disability Service What support and treatment is available for those patients who may have a Dementia? Shirley Hall, Occupational Therapist

77. Children and Young People’s Services Dr Lynne Howey

78. CYP-IAPT Model (Duncan Law) On-going feedback promotes quality of service On-going reflective practice supervision based on feedback Clinical staff to deliver the best evidence based interventions Service delivery models that are evidence based and shaped by service users. Leadership Role. Effective services Evidence based interventions Service User feedback and outcomes monitoring Supervision

79. Question Time??

80. Summary of Morning Mrs Jo Turnbull, Chairman

81. Lunch available on the mezzanine level Market place stands Networking opportunities with your Governors, staff and other members Expense payments – registration desk Please take the time to complete your evaluation form and if you have a specific question you have not been able to ask – write it down and leave it with us.