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Improving Mental Health Services in Bristol

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Presentation on theme: "Improving Mental Health Services in Bristol"— Presentation transcript:

1 Improving Mental Health Services in Bristol
Andy Sylvester – Executive Director of Operations 1

2 Welcome and introductions
Housekeeping Format of the day Presentations Questions and answers Information stalls: find out more and meet our staff What happens next

3 Bristol context NHS Bristol tender Relationships
AWP want provide strong, local, responsive services Striving to improve local confidence Service changes demonstrate how we can meet expectations

4 The need for change Bed numbers Old service models
Variations in service user experience and outcomes Value for money, improved quality and outcomes

5 AWP’s vision for Bristol
Strong service users and carer engagement Improved accessibility through your GPs Locally managed, responsive services Greater choice of community support Operate above nationally recognised standards

6 Benefits: service users and carers
Improved care co-ordination through regular review, taking account of individual needs Equal access to services Easier access to the right services, with the right specialist staff at the right time Recovery focused services

7 Presentations Liaison and later life services – Roger Bullock, Clinical Director Community services – Justine Faulkner, Clinical Director for adult acute community services & colleagues Rehabilitation Services – Carol Bowes, Acting Service Director for specialised & secure services Adult inpatient services – Andy Johnston, Clinical Director and Mark Bunker, Consultant Nurse, for adult acute inpatient services

8 Liaison and later life services in Bristol
Roger Bullock – Clinical Director 8

9 Liaison and later life Liaison Front door for specialist services
Helping other providers of care perform their work (particularly primary care, acute hospitals and care homes). No health without mental health Promoting mental health – no thresholds Working in a preventative way alongside social care Signposting and direction Achieving independence Front door for specialist services

10 Liaison and later life..2 Later life
Age-appropriate specialist psychiatric and psychological therapies Dementia services Memory clinics Community based complex intervention teams Inpatient

11 Who and where All services are based from Callington Road Hospital
Liaison Led by Alyce Chappell Team comprises 16 nurses and Dr Andrew Brindley with admin support Runs 8.00 am to 8.00 pm Monday-Friday and Saturday morning Later Life Community services led by Gina Lang (9.00 am to 5.00 pm) Inpatient services (Aspen and Laurel wards) led by Mandy Taylor Memory services led by Claire Morley (9.00 am to 5.00 pm)

12 Aims of Bristol’s liaison & later life services
Flexibility Early assessment at GP surgery, local clinic, at home, in hospital or in a care setting Local emphasis, integrated with family care – no thresholds or bureaucracy Problem solving approach rather than diagnosis based Speed Rapid response to requests for advice and quick access to specialist community based complex intervention team for ongoing care and support where needed

13 Aims of Bristol’s liaison & later life services
Expertise Provision of specialist therapeutic support and treatment from occupational therapists, physiotherapists, psychologists, psychiatric nurses, consultant psychiatrists and other staff. Access to specialist inpatient care at Callington Road Hospital Collaboration Mental health is not an isolated issue Specialist mental health support and advice to GPs, Bristol Community Health and social care staff and any other staff caring for older people with frailty, mental health and cognitive disorders Clear pathways, with delegated roles and responsibilities to ensure people do not get ‘bounced around’

14 Current issues Historically too many inpatient beds provided in Bristol Need for more community based staff to meet the demands of an ageing population Need an integrated approach with older people’s services and social care – including using personalised care to full advantage

15 Current issues..2 Need to manage the increasing numbers of people requiring a memory assessment Need to be part of a comprehensive multi-agency dementia pathway Need to increase confidence and capacity in primary care to meet some of the needs of older people in the surgery rather than specialist settings

16 Planned changes No longer providing inpatient beds for older people at Southmead Hospital will release existing resource to further invest in our plans for improving services in Bristol More comprehensive and therapeutic community-based services will be delivered including expanded memory, liaison and support to people in care homes Consolidation of high quality, specialised inpatient services in one location in Bristol (Callington Road Hospital) also means on-site access to the full range of community and therapeutic support services

17 Planned changes..2 Increased partnership with GPs and Bristol Community Health to look after people with a variety of mental health and cognitive problems in the primary care setting and only using secondary specialist mental health services when needed Fully exploit the advantages of primary care liaison alongside Bristol Council to help promote mental wellbeing in the city

18 Benefits Preventative approach Early intervention and diagnosis
GPs, social care and other staff looking after people with dementia and mental health difficulties will get better support from specialist nurses and doctors to allow people to get the help they need more quickly Early intervention and diagnosis Will enable people to be aware and understand their problems at an earlier stage of their illness, allowing more choice and control over what happens in their treatment journey

19 Benefits..2 Meeting need through building capacity
Development of expanded and comprehensive community services will help more older people to continue to live at home by providing the care that is needed with high quality therapeutic, practical and intensive support Offering help in the right place Shifts the emphasis from hospital and institutional forms of care to the provision of services that meet the needs of service users and carers in their own homes or in an environment that optimises their abilities to live independent and fulfilling lives

20 Modernising mental health services in Bristol
Five themed objectives: Have a locally accountable Bristol structure Ensure greater partnership and interface working Provide clearer routes into and services that are easier to access Provide dementia as a distinct care pathway Have prevention and early intervention as the default position

21 Improving Mental Health Services in Bristol

22 We heard what people were telling us and….
Restructured our teams Talking therapies available as a matter of routine Re-selected 600 staff Set up new training pathways to ensure all are highly skilled Made sure that all teams have drugs and alcohol expertise

23 Our teams Primary care liaison service - the front door Intensive team
Recovery teams Early intervention team Psychological therapies service Vocational service

24 The Bristol intensive team
Formerly known as crisis resolution and home treatment teams (CRHT) Multidisciplinary team of more than 35 staff Drs Sarah Oke and Susanne Wille – consultants Holly Starkey, Tony Bohanna +2 (Senior pracs/managers) Based at Colston Fort Operate 24/7, 365 days a year Contact us on

25 The Bristol intensive team - what we do
Home treatment: two to three times a day visits as an alternative to admission for very unwell and high risk service users Diagnose, prescribe, dispense and supervise medication Interventions – counselling, CBT, practical support, psycho-education, carer support etc Also provide: All four hourly crisis assessments Gatekeeping all admissions Bed management and early discharge from hospital

26 The Bristol intensive team - out of hours service
24 hour home treatment visiting at night in patients’ homes 24 hour crisis assessments in places of safety, police stations, service users’ homes and in A&Es (BRI and Frenchay) Cover other teams (primary care liaison(PCL), recovery, early intervention etc and out of hours PCL). Crisis service only. Support night shift junior doctors

27 The Bristol recovery teams
Three teams in Bristol North Gloucester House, Southmead Hospital Contact: Central Brookland Hall, St Werburghs Contact: South Petherton Resource Centre, Hengrove Contact: The teams will operate flexibly between 8.00 am and 8.00 pm Monday to Friday

28 The Bristol recovery teams - what we do
Provide ongoing assessment and multidisciplinary specialist interventions Service will be offered to any one who has been assessed by primary care liaison service or the intensive service as requiring ongoing treatment from specialist mental health services

29 The Bristol early intervention in psychosis team
City wide service based at Colston Fort, Kingsdown The multidisciplinary team includes: Team manager, psychologist, consultant psychiatrist, clinical development lead, care coordinators (including CPNs, occupational therapists, social worker), non-medical prescribers, support workers, sports worker as well as administrative support

30 The Bristol early intervention in psychosis team
What we do Team works directly with people aged 16 – 35. For young people aged 14 – 16 we work in partnership with child and adolescent mental health services Referrals can be from any source, although most come from GPs Assess anyone meeting the age criteria who has symptoms of psychosis (hearing voices, paranoia, disordered thinking) or where there are concerns that this may be developing

31 The Bristol psychological therapies service
The Bristol psychological therapies service (PTS) is one overall team serving the whole area. Head: Shane Matthews, consultant clinical psychologist Staff background: clinical and counselling psychologists, nursing, art psychotherapy, medicine. Our hours of operation will be where possible 8.00 am to 8.00 pm in Gloucester, Brookland Hall, Petherton and Callington. Contact us at Petherton Resource Centre

32 The Bristol psychological therapies service
What we do Support the new teams by offering consultations to help with assessment and treatment decisions and the supervision of psychological interventions which the teams carry out Directly provide where appropriate psychological interventions for complex cases such as clinical psychology formulation and intervention, CBT, brief psychotherapy, family work, etc

33 Questions and answers 33

34 Improving specialist services Carol Bowes – Service Director
Rehabilitation services Eating disorder inpatient services Eating disorder primary care services Specialist learning disability inpatient service for people suffering from a mental illness

35 Rehabilitation services
Rehabilitation services provided in Bristol are for: Hospital based resettlement services, bringing people back from out of area placements Hospital based rehabilitation Community based rehabilitation In December 2011, the temporary closure of one of the community based units, Lodge Causeway, resulted in bed numbers falling from 41 to 30

36 Why change? Rehabilitation beds were underutilised - across all the units, bed occupancy averaged 60% Occupancy in community units was 10% lower (50%) Pooling resources into a single community based ward meant we could improve the interventions made available to people using the service

37 Why Lodge Causeway? The other community based unit, Blaise View, had better safety infrastructure, such as an alarm system Blaise View was more compliant than Lodge Causeway with the Disability Discrimination Act Lodge Causeway did not meet the single sex accommodation requirements to the same standard as Blaise View Although Blaise View is a community based service, support is immediately available during office hours from another AWP building next door Lodge Causeway provided respite accommodation, which was not formally requested by the PCT, and could be maintained within other units

38 What next? As the temporary closure of Lodge Causeway has not prevented anyone from receiving rehabilitation care when needed, we believe this closure can be made permanent Care coordinators and NHS Bristol are working together to understand how best to provide respite care that meets individual needs. A single type of provision, such as a bed within a community rehabilitation unit, cannot meet all needs

39 Eating disorder inpatient services
Background Inpatient eating disorder services in Bristol were provided in an annex of an acute ward at Southmead Hospital This provided six beds for use by people in Bristol, B&NES, North Somerset and South Gloucestershire People were regularly sent out of area as these six beds were not sufficient to meet the needs of these areas In autumn 2011 we were told that inpatient eating disorder beds would be commissioned through the NHS Commissioning Board and would need to comply with a national specification

40 Eating disorder inpatient services
Proposal The national specification was not met by the annex service we were providing We already knew that six beds were not sufficient to meet the needs of the PCT areas What we did Identified space on the Southmead site where we could operate a 10 bedded specialist eating disorder inpatient service Worked to get this specialist service operational from April 2012 Opened the NEW service in April 2012, providing care that meets the national specification for up to 10 people at any one time

41 Eating disorder primary care services
In 2011 we started a pilot project for a primary care eating disorder service for Bristol University This service has been very well received and we are now working with NHS Bristol on how it can be expanded across the city This would mean the service working from three primary care bases within Bristol opening up access to the service to the whole Bristol population

42 Specialist learning disability inpatient service
The Lansdowne assessment and treatment unit admits people with learning disabilities and mental health problems whose needs cannot be met within mainstream mental health services This service is used primarily but not exclusively by people from the Bristol area

43 Specialist learning disability inpatient service
This service is currently provided in a 12 bedded unit based on the Blackberry Hill site The current environment does not meet the best practice guidance for this type of service, nor is it fully compliant with CQC standards Proposal To relocate the service to an environment that fully meets best practice guidance and is fully compliant with CQC standards To achieve this through redesigning an empty ward on the Southmead site and relocating the service

44 Review of inpatient service redesign and impact assessment
Mark Bunker - Consultant Nurse Andy Johnston - Clinical Director 44

45 What have local people told us?
Focus on people’s recovery and strengths Service user and carer involvement in planning Be socially inclusive and help people stay in touch with home, family, work - a meaningful life Provide better information Integrated, prompt assessments and where possible, through a single point of access Equitable, fair, person-centred and flexible Clear pathways of care into, out of, and in between services

46 Current services – adult inpatients
15 acute beds – Weston Ward, Southmead Hospital 19 acute beds – Lime Ward and Silver Birch Ward, Callington Road Hospital 8 HDU beds – Mason, Southmead Hospital

47 Proposed adult inpatient model of care
52 adult acute inpatient beds 19 Silver Birch Ward, 23 Lime Ward, 10 Weston Ward A reduction of one acute inpatient bed No HDU beds A reduction of eight HDU beds and re-patterning the four HDU beds on Lime Ward into Acute beds through transferring the four acute beds from Weston Ward to Callington Road as part of the Southmead project

48 Quality improvement initiatives
Productive Ward programme National quality Acute Inpatient Accreditation Programme (AIMS) Silver Birch: accredited as ‘Excellent’ Lime: awaiting Royal College of Psychiatrists award Clinical handover initiative developed by Lime Ward Completed ‘Missing Persons’ action plan, complied with AWOL clinical performance targets and improved clinical management Physical healthcare clinics on wards for wellbeing/health promotion Completing improving therapeutic approaches pilot using a solution focused approach Recovery approaches to care and treatment on all wards

49 Quality improvement initiatives..2
Developed and embedded a clinical lead nurse role for safety and compliance to ensure learning from incidents, events and feedback Life cycle environmental improvements completed in some areas and work to improve other environments underway Weekly care pathways meetings assist reviewing service users progress and ensuring the right service is being delivered Performance management framework being used to effect the attitude, motivation and opportunities of our workforce Developing a new ‘welcome and hospitality facilitator’ role for each ward having listened to service user feedback Recovery Star used to promote recovery approach for service users New service user feedback initiative called VOICE

50 Leadership improvement initiatives
Established New nurse consultant and medical lead consultant psychiatrist posts in Bristol Consultation about to begin on new clinically focused roles for modern matrons and ward managers Delivering development programme for all Band 6 team leaders throughout the inpatient services Designed a matrons MasterClass programme Monthly peer supervision programme for matrons Matron development away days to support cross learning Bespoke training pathways for staff across the inpatient services based on core competencies Medical leadership coaching programme

51 Questions and answers 51

52 Improving Mental Health Services in Bristol
Andy Sylvester – Executive Director of Operations 52

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