Hertfordshire Partnership NHS Foundation Trust Hertfordshire Partnership University NHS Foundation Trust Community Services Transformation - Achieving structural, cultural and workforce change 1

Hertfordshire Partnership NHS Foundation Trust 2 EPMHS

Hertfordshire Partnership NHS Foundation Trust 3 Specialist service is full I need more support at the moment I need help with preparing for work I need help with my housing I want to be seen by people who know my needs I don’t need any help at the moment

Hertfordshire Partnership NHS Foundation Trust How new model was designed Step One - Identify the optimal model for Service Users = Recovery Step Two – Create a staff profile that enables the provision of interventions to promote the optimal model of care = skill mix Step Three - Form teams that have range of skills and expertise to efficiently cater for the needs of the local population = PBR cluster teams Step Four – Implement an operational policy that ensures the Goal is met = Pathways 4 Step Four Operationalise (Pathways) Step Three Organise staff in efficient teams (Pathway Teams) Step Two Create a workforce that enables step one (Skill Mix) Step One Deliver the optimal model of service for Service Users (Recovery)

Hertfordshire Partnership NHS Foundation Trust Simplified New Structure 5 Team 1 Team 2 Team 3 THE NEW STRUCTURE - 3 LOCAL TEAMS THE WELL BEING TEAM Common Mental Health conditions – Mild to Severe THE SUPPORT AND TREATMENT TEAM Very severe, High Risk, Complex conditions with no psychosis – PROMOTING RECOVERY AND RESILIANCE THE TARGETED TREATMENT TEAM Early Intervention in First Episode of Psychosis, on-going recurrent psychosis including crisis & severe engagement challenges - PROMOTING RECOVERY AND REHABILITATION

Hertfordshire Partnership NHS Foundation Trust Underlying Processes The following processes now underpin the model: – High quality single trusted assessment – Implementation of the Recovery Care Pathways – Timelines for regular review and the use of predicted date of discharge – Fast track via SPA to enable re-entry to services for people known to service – Use of Flexible Assertive Community Treatment (FACT) for intensive support when required 6

Hertfordshire Partnership NHS Foundation Trust Flexible Assertive Community Treatment 7 High RiskHigh Need Medium RiskMedium Need Low RiskLow Need Level of service intervention and support provided

Hertfordshire Partnership NHS Foundation Trust BENEFITS OF NEW MODEL Making improvements to access times What support and treatment and how long Increased access to DBT and PIP Less transfers between teams with service users being able to access short term increases in the level of support provided when needed Service users receiving services from staff with specialist knowledge of the appropriate care pathway Better access to staff working in recovery orientated roles Better links with CCG areas 8

Hertfordshire Partnership NHS Foundation Trust Lessons Learned Worked well Operational ownership Steering group structure HR department expertise in change management OD and skills development work was effective but we needed more Transformation engagement events with stakeholders Not so well Size and complexity - to much change to handle well all at once The trial in one area did not reflect the actual proposed model Managing competitive interview process - stressful for staff and more damaging in the long run Huge challenges to recruit to vacancies Better planning needed to deliver FACT 9

Hertfordshire Partnership NHS Foundation Trust In Summary In Summary the model IS MAKING: the process of access to treatment…. faster, the amount of duplication of assessments… fewer, the care provided… more managed, the interventions used… more evidence based, The use of costly interventions which add little value … reduced, and the balance of clinical staff - more aligned with the needs of the service provided, and the cultural attitude… more recovery focused 10

Hertfordshire Partnership NHS Foundation Trust ? Any Questions? 11