1. Rapid Process Improvement Workshop (RPIW) Acute Mental Health Multi-Agency Discharge Final Report Out 11th October 2019

2. Agenda Purpose of the RPIW Current State Overview
Ideas and key themes for Improvement
Proposed Future State
Outline implementation plan
Lessons learnt

3. What’s the problem we’re trying to solve?
Individuals are staying too long in acute mental health settings, which is negatively impacting on their recovery time & journey due to unnecessary delays in the assessment and discharge
When a patient is admitted to a mental health unit, good practice suggests that discharge planning should begin at the point of admission.
Currently it is reported that the process to progress additional and ongoing support for patients where this need has been identified is complicated and protracted and often causes delay for the patient in accessing their recovery support.
Through a collaborative, system-wide approach to working, solutions will include:
- Improving the patient, carer and staff experience
- Reducing waste and improving efficiency
freeing up acute mental health beds, improving flow and
sending less people to private providers out of Hampshire
Pathway:
Concerns:
Impact:

4. Current State Overview
There are potentially 77 steps in the process from admission to transfer to destination on recovery journey

5. Current State Overview
A real patient journey took 8 months
from admission to onward care setting

6. Staff, Service User & Carer Feedback
“Feels like we are trying to spend their own money.”
“Less Detention,
More Prevention”
“Ask me what I want, not what you think I want”
“Not always clear about what is expected in an application and sometimes the goalposts seem to change.”
“Urgent out of panel decisions are useful.”
“Take the money out, not good for patients”

7. Generating ideas for Improvement
Over 60 ideas for improvement …
… grouped into 7 themes

8. Themes 1. Opportunities on Admission 2. ‘Supporting’ Processes
3. Rehabilitation
4. ‘Funding’ Panel
5. Planned Admission Bed
6. Planned Coordination through CPA
7. Ward Based Social Worker
EUPD Pathway = already work going

9. Idea #1 Opportunities on Admission
Ideas & Key Themes for Improvement
Idea #1 Opportunities on Admission
Repairing the Yellow Brick Road and not getting stranded on the way……..

10. Opportunities on Admission
Admission Flow
Information Packs
Informal 1:1 meetings
Phone App
One point of information gathering!
Trusted Assessor
History of Mental Health Act Status – 117 eligible or at risk?
Embedded SW/CCG/ Housing Advice
Crisis Services
HCC
Housing
Health/ CCG
Advocacy/ Other
Crisis & Contingency Plan/ WRAP/ Personal Profile/ Wellbeing Check
Keeping home life ticking over – not adding stress
Triggers for next step
Longer Term Residential
Maintain outside life
Prep for going home
Enhanced support at home
Short Term – Step down/ Rehab
Opportunities on Admission
Clear identification of 117 needs
Ongoing prevention/ planning e.g. CMHT
Guides and flow charts – Keep it simple, accurate, available to all and stick to it!

11. Opportunities on Admission
Family
Consent to share – keep asking!
Carers Assessment
Support Groups
Advocacy
“There’s no place like home”
Why am I not there now?
Accommodation
Ask the question.
Referral response – 48 hours.
Home status & how long.
Going back?
Barriers.
Housing drop in to ward
Opportunities on Admission
Benefits & Finances
Adults Health and Care
Safeguarding
Is there a need?
Benefits drop in to ward
Known/ Have a SW?
Eligible for SC? – Dummies Guide
117 or 3 – Automatic referral to Social Worker & notify CCG
Apply 3 part test.
Use NHS Safeguarding App.
Waiting for everyone for a CPA delays things – Invite agencies to Ward Round and get moving!

12. Getting on our Ruby Slippers and making it happen
30 Days
Housing and Benefits drop in - Melbury Lodge commencing Wednesday 16th Oct 10am
‘Start and Stop’ group for a joint triage document that is owned by and follows the patient.
Crisis and Contingency/ Wellbeing Assessment/ Passport/ WRAP.
Robust flowchart of the main process
Simple Guides with embedded documents for ward staff.
Adding Apps to patient information packs.
60 Days
Housing and Benefits drop in – Elmleigh
Test the new assessment document.
90 Days
Housing and Benefits drop in – Parklands.
Roll out the new assessment document.
ASK: A portal is produced for all members of the public to input
their own crisis/action plan with all the relevant inf0.
Opportunities on Admission

13. Dear Wizard (Sponsors) we have one wish
CHIE – Can we make this work for us all?
The system pulls data from all 3 agencies’ IT systems.
Can we make this work better?
Automatically completing onward referral forms.
Benefits
Greater accuracy
Faster
Easier to track
Less staff time and shorter hospital stays
Opportunities on Admission

14. Opportunities on Admission
So remember –
Use your brain
Have courage
Keep heart
Opportunities on Admission
And if all else fails release the flying monkeys!

15. Ideas & Key Themes for Improvement
Idea #2 ‘Supporting’ Processes
Non-value added activity during twice weekly flow calls* and weekly Stranded Patient Teleconference**
- * 80 minutes per person per week wasted with repetitive information
- ** 30 minutes per person per week wasted with information that is readily available elsewhere
- (Excluding preparation time)

16. ‘Supporting’ Processes
Cease twice-weekly call and replace with commitment by MDT to maintain information on RiO Patient Flow Record
Focussed, planned discussion on the weekly teleconference that uses time more effectively to address blockages to progress
Sending advanced agenda information, requiring actions, out earlier to prepare and undertake ready for call.

17. Ideas & Key Themes for Improvement
Rehabilitation Pathway Within Acute Care – South West. Referring from inpatient to rehabilitation
Idea #3 –
Problem Definition:
Process for staff, carers and service users feels confused currently due to misinformation regarding processes to access rehabilitation and the timeframe for this. This can cause frustration and significant delays within the patient journey.
Definition of Rehabilitation:
“A whole systems approach to recovery from mental illness that maximises an individual’s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future and leads to successful community living through appropriate support.” (Joint Commissioning Panel for Mental Health).

18. Rehabilitation Pathway OUR AIM:
To clarify the most effective processes and to correct incorrect information within the service in order to provide a clear and streamlined rehabilitation pathway at Melbury Lodge.
#rightplacerightpace

19. Rehabilitation Pathway

20. Rehabilitation Pathway ACTION PLANNING
Quick Wins
Already set up links to HCC to provide drop-ins at Melbury re: housing and benefits- awaiting start date.
Relationship built and agreement to explore links with CCG /HCC and Advocacy
Clarify/outline and disseminate the process for discussing complex cases with CCG/HCC.
30 Day Plan
Visit rehab units in trust- obtain criteria for referral, outline beds available to specific areas/current SOP?
Obtain referral forms for supported housing providers.
Change MDT report templates for funding to add in; - outcomes for the person, markers for change and indicative (baseline) timing- Anna, Bernie and Nat to lead.
Present Rehab Pathway to Senior Leadership Team at Melbury- 5th November 2019.
Anna to liaise with in trust rehab re: referral forms for intrust Rehab- prior to review of their SOP. Recommendation for Anna to be involved.

21. Rehabilitation Pathway ACTION PLANNING
60 Day Plan
Team Leads from all areas within Acute Care Pathway South West to disseminate the Rehab pathway at team meetings.
Pilot the rehab pathway at Melbury Lodge- Anna and Nat o lead- taken to each Flow meeting and ward rounds and professionals meetings.
Pilot of the MDT report templates to be completed.
Nat and Anna to review the process for liaising with HCC/CCG regarding complex cases.
90 Day Plan
Anna to clarify changes to rehab intrust SOP and how this impacts on rehab pathway.
Review the rehab pathway and makes changes- Anna and Nat in consultation with MDT- discussion at leadership on 7th January 2020.
Review of the MDT report templates and make changes- Anna, Nat and Bernie.

22. Rehabilitation Pathway OUR RECOMMENDATIONS
We have 1 referral process/form for all trust rehab units- which utilises RIO and sends off an nhs.net to appropriate team
We have someone to coordinate the funding applications within the CMHT who can link with those leading the rehab pathway
Kingsley (possibly OT Team Manager) should be involved in the review of Hollybank and other intrust rehab units SOP

23. First draft blue sky thinking
Ideas & Key Themes for Improvement
Idea #3 ‘Funding’ Panel #not
Panel Process
First draft blue sky thinking

24. Purpose of panel Governance around decisions that are made.
CCG/HCC are accountable and responsible for all packages of care they agree – assurance that safe and appropriate care is being agreed and public money is being allocated in the right way.
Ensure that the least restrictive options are being sought.
Guarantee the reviewing of placements/packages of care and following the person after they are discharged from hospital to ensure recovery goals are being achieved.
Social care, Southern Health and the CCG are working together which fosters relationships and benefits the person needing support.
Sharing of possible safeguarding alerts and issues so high quality suitable services are offered to individuals.

25. Disband Panels!!
Took a day to debate the pros and cons with mixed feelings and emotions!
Trust
Frustration
Fear
Building relationships

26. Improving Flow through Panel Process

27. No decision about me without me

28. All agencies working with me in collaboration to support me
What are we trying to achieve?
How will we do it?
When?
Who is responsible?
What will success look like?

29. Improved forms Process will not delay my discharge when I am ready!
Multi agency meeting planned for 21st October 2019 to redesign the form
Consult via steering group and widely: report back on 30 day catch-up workshop
Responsibility: CK
Success:
Stakeholder Feedback
Application decision made at first presentation to panel
Process will not delay my discharge when I am ready!

30. Help to get home hub
Fortnightly Multi-agency in-reach to ward including:
CCG commissioning assessor
HCC representatives
CAB
Advocacy
Wellbeing Centre Advisor
Responsibility:
CK, NH, CA, JG and DP
Success:
Attendance from organisations trialled over 90 days. Evaluation of experience from patients, carers and staff.
Develop form to monitor topics requested.
Shared Knowledge and collaborative working to help me move on from hospital

31. Proposed Future State Improved patient, carer and staff experience
Reduced staff time on non-value added activity
Streamlined process and collaborative working across organisations
Value adding current processes that puts the patient at the centre with early identification of need, timely access to required support and recovery journey
Improved access to in-patient care close to home and reduction in private acute bed usage

32. Measuring Impact Potential reduction in:
Staff time spent in non-value added activity time
Time wasted on repetitive information sharing
with no additional benefit
- Delayed Transfers of Care (DTOCs)
Number of patients accessing high levels of
support
Length of time away from home/right place to
continue recovery journey (length of stay)
Improvement in service user and carer experience and feedback
Improved morale, wellbeing and satisfaction of staff

33. Car Park Community Provision
Prevention and proactive action is better/more effective than crisis response and can also help people leave hospital
Overarching I.T. provision
Senior Management calls/meetings – Why?
More support from Advocacy
Standardised Consent to Share
MHA
Tribunals are archaic and not person centred

34. Lessons Learned INSERT PHOTO Don’t underestimate what we can do
Consider all the information/knowledge but don’t get caught up in it
Keep it simple
All organisations have contributed to the complexities of the current process and therefore all organisations are part of the solution
Positive outcomes are maximised when we work together rather than in isolation
A focussed week together fosters and improves relationships both internally and across organisations
INSERT PHOTO

35. Thank you to:
Our service users, carers and Experts by Experience for their feedback, openness and honesty
Our Colleagues who have kept the services running whilst this week has taken place
Our attendees who have made the time and put in so much effort during the RPIW
Our Facilitators for their time, and particularly to Paul for his endless supply of sweet treats!

37. And Finally…
A word from our Sponsor…