1. PbR : Ideas from local implementataion Dr Pratima Singh Strategic Clinical Leadership fellow NHSL& Oxleas FT

2. Background Clinical lead for PbR in Oxleas NHSFT London Fellow in Strategic clinical leadership NHSL Deputy to Dr Strathdee, AMD NHSL and London SHA lead National input Regional Local Joint working with Devon, Avon, Solent healthcare, CNWL

3. PbR projects undertaken MHCT trainer and PbR Lead for Care Package Development Audit of Current care PbR clusters (n=126)* Poster Deep dive into understanding variation in lower clusters 1-3 (n=600+) and 11-17 ( n=1000+) Evidence based care package development for 1-21 based on above with clinical group*

5. 7 Cardinal Basics of Every NICE Guideline The appropriate team provides care Crisis plans and advance directives including choice of medication is negotiated between patient and clinician Occupational assessments are undertaken Psychological Therapies as appropriate are provided Physical health monitoring: Appropriate monitoring of health based on condition and treatment given Medication : Patient is offered a choice of medication and given information on it with side effects monitored Information: the patient should be given information on the condition

6. Diagnoses: Risk : Course: Expected Needs QUALITY AND OUTCOMES GOALS ENTRY TO OXLEAS SERVICES Common referral sources: Assessment: DISCHARGE CRITERIA (eg) Case Contingent Elements of Care: Collaborative Working with agencies to meet CLUSTER xyz CARE PACKAGE ELEMENTS IN OXLEAS NHS FOUNDATION TRUST Core Elements of Care: CRISIS MANAGEMENT CARE COORDINATION MONITORING OF PHYSICAL AND MENTAL HEALTH Indicative episode of care: Cluster reviews at least every: Step up criteria: Step down: C luster Description:

7. Key findings Variation of patient profiles wide within each cluster ? Variation between cluster allocation by clinician and MHCT booklet Clusters 1-3: Upto 57%,Clusters 11-17: Upto 55% * Importance of getting this first basic step right. Overlaps and exclusions Inconsistency of recording clinical information and lack of feedback of information to clinicians Gaps between actual and proposed care packages- very wide even between clinicians, teams, boroughs

8. Way Forward Quality of cluster allocation and Link with a care package Use existing NICE core interventions as frame work of Care packages that can be audited Developing common language of beds, interventions to understand care packages Link MH MDS data to outcomes I- ICD10, accommodation, crisis/acute/rehab/HTT beds Commission a 1in 10 audit sample to check Cluster appropriation and Care Packages that follow* tool

9. Thank you