Clinical Service Strategy

Making Life Better Together

Sutton 1 in 4 Network’s response to the consultation on the Clinical Services Strategy of the South West London and St Georges Mental Health NHS Trust

1. Do you think that early assessment will improve the quality and speed of access to mental health services?

This question asks about a proposed change in responsibility for assessing the needs of people referred to community teams. Instead of each assessment being carried out by an interdisciplinary team the assessment will be made by a consultant clinician.

  • We feel that in almost all cases it is important that holistic assessments are carried out. That any assessments do not just focus on a medical model but take account of the social, economic, spiritual, and physical needs of individuals.
  • Assessments should not be used as a way to ‘blackmail’ patients into a particular course of action.
  • Will one Consultant have the relevant skills, expertise and experience to ensure a holistic assessment takes place?
  • If a holistic assessment is carried out at an early stage then we feel there could be a wide range of benefits for the individual.
  • It is essential that real value is given to the views and experiences of those who are given an assessment.
  • Psychiatrists should not always be the ones that carry out assessments. However, those that carry out this process need to have clear guidelines and a code of practice that ensures a holistic approach
  • It is important that there is a consistent approach to assessment. That those who carry out them out are given supervision that works. There should be systems put in place to measure their performance
  • There needs to be a clear rationale about why assessments are carried out and what actions, resources and pathways they trigger

2. If you have had contact with our services what changes would you like to see?

There have been a wide range of comments and issues raised by our members Therefore we have decided just summarise them into core themes

  • Improvements to the way that complaints are handled and dealt with.
  • Have clear statement on the Philosophy of Care for each service the Trust provides
  • Proactive work to inform patients of their rights and responsibilities
  • Strengthen the role of the SURG.
  • Support the development of a Patient Council on each ward and develop a forum bringing together patient representatives from each ward to meet with senior management.
  • One to One allocated time with primary nurse, care co-ordinator, psychiatrist
  • Have access to banking and internet facilities on site
  • Have lockers and secure storage of patients’ valuables and clothes.
  • Develop a Patient/Service User Information Strategy
  • Widen the scope of the Recovery College to those who are not currently in touch with Trust services.
  • Ensure that all those working in the Trust have a clear understanding of the recovery approach and that this is reflected in their practice.
  • Ensure that all staff meet the 10 Essential Shared Capabilities,
  • Have meaningful activities on wards, not just in the day but out of hour times as well, evenings and weekends.
  • Make sure people are given enough notice when discharges are being planned and that their home situation is fully assessed before it takes place
  • Ensure that patients are safeguarded from abuse 24/7 whilst on the ward. Have a day and night ward manager
  • Ward Manager should focus on the clinical and care/treatment provided on the ward
  • There should be House Managers that take responsibility for all non clinical matters
  • Community Teams to ensure that individuals are supported on day of discharge and for at least the next 28 days after discharge.
  • Provide clarity about what service users, their carers and the public can expect from those employed by the Trust.
  • Provide clarity about the roles of peer support workers in the Trust and how this role is different from those who provide intentional peer support
  • Consider developing an agreement on joint working with mental health and social care voluntary sector providers in each of the Trust catchment areas.
  • Encourage and support the development and implementation of User Led Quality Standards.
  • Provide information on the range of Care Pathways.
  • Have distinct wards for those patients who are voluntary and those who are detained under the Mental Health Act.
  • Consistency in the management and standards of wards and teams. Identify the wards and teams that do not improve and take action

3. We are aiming to engage individuals far more in decisions and choices around care and treatment. We will encourage an “easy in, easy out” approach to services and not keep people unnecessarily linked to long-term care as has sometimes happened in the past. This means working very closely with primary care to ensure that we respond quickly and minimise the period of anxiety and disruption associated with the onset of mental ill health. What is your view on this?

  • “Easy in, easy out” is an unfortunate phrase it seems that it is based purely around the economic and financial needs of the Trust and the shift to Payment by Results rather than patient care pathways and treatment outcomes.
  • Admission to hospital is often a traumatic experience and a lack of patient involvement in decision-making and planning leads to mistrust and fear.
  • There needs to be a major overhaul of the CPA process within the Trust. Patients need to be involved and engaged in the development of their care plans. Advance Directives should be made available to all service users of the Trust.
  • Whilst we agree that the Trust needs to work very closely with primary care it also needs to have an effective relationship with the local authority and other community agencies providing social care. It should take proactive steps to ensure that patients are checked to see if they meet the fair access to care criteria and be supported towards direct payments and personal budgets
  • It is important that individuals have access to independent advocacy and intentional peer support.
  • Community teams are also under pressure and sometimes do not respond as swiftly as patients and their carers have a right to expect.

4. What are the best ways of engaging with our partners and local communities?

  • Build partnership by joint working.
  • Recognise the skills, experience and world-view of others.
  • Giving proper recognition and value to the input of others outside the Trust in the shaping of services and models of care.
  • By sharing information openly.
  • Allowing the agenda to be shaped by people who are affected, listening to their views and involving them in making decisions.
  • Sutton 1 in 4 Network and other User Organisations have an important part to play in this.
  • Decision-making behind closed doors should be replaced by an open and communicative approach.
  • Establish Listening and Learning Forums in each borough
  • The Trust should be willing to be an partner not taking over control of other people ideas and ways of working.
  • Understand the cultural needs of local communities.

5. Does it help to know more about an illness when you are living with it?

  • Accurate and accessible information, which can properly be made available to, and understood by, the patients and their carers is to be welcomed.
  • Promote the Experts by Experience approach
  • Those in need of treatment should be given information on the choices and options available to them, the benefits or risk associated with them and the impact it may have on their quality of life
  • More effort need to be made at the earliest point possible, to help people gain skills and insights to manage their illnesses/ conditions
  • Much more focus should be given in enabling people to maintain their wellbeing.

6. Are clinics in community settings such as GP surgeries the best way of providing a speedy response for people with mental health problems?

  • Provided that the service offered is staffed by people with appropriate skills and experience, offering services close to home and at a place convenient to the patient is a good idea.
  • Whilst GP surgeries are an obvious setting it may be worth exploring with service users if they can identify other venues that they would feel safe and comfortable in.
  • Where people need specialist help, we recognise that it may not always be possible to provide this locally.
  • We believe that further efforts to bridge the gap between primary and secondary care would be desirable.
  • There needs to be some measures to strengthen and maintain the competence of GPs in relation to their skills knowledge and expertise around mental illness.

7. Do you have any views or comments about the recovery approach?

  • The clinical services strategy make a lot of references to recovery as it main driver however we feel that the Trust needs to undertake a fundamental culture change to ensure that its is embedded in the whole culture of the organisation. And that this is evidenced in the day to day practice of those it employs and those who are responsible for managing service delivery from the board of trustees, senior management staff, and clinical and support staff.
  • A recovery-focused organisation will face a wide range of challenges and there will be a need to have a firm commitment from all stakeholders to overcome them.
  • This needs to be a priority otherwise recovery will become just window dressing.
  • It will be important to look where current practice, ways of working, and relationships are counter to the principles of recovery and to take action to change this.
  • Feedback from people who use the Trust’s services suggest that the principles which underlie it are not well understood by many Trust staff and that more needs to be done to ensure that people are treated with respect, provided with the information they need and enabled to voice their own views on what is important to their recovery.
  • It is not enough to have a Recovery College – the whole organisation must behave in a way that promotes and supports recovery.
  • As for the Recovery College itself, there should be an independent evaluation of its operation to assess its impact.

8. Would it be better to have all older people’s wards together?

  • The consultation document explains that it is to the provider’s advantage to concentrate provision for older people in one place.
  • Service Users and Carers want to be looked after in their own community, within easy reach of their friends and family.
  • Being uprooted from one’s surroundings at a time of crisis only adds to the trauma and undermines the community links, which are often the key to recovery.

9. Would it be better to have all adult acute wards together?

  • It seems that the Trust has already decided this course of action.
  • We are concerned that the move towards the centralisation of services is a backward step to the return to the asylum.
  • The key driver of this is not about improved quality of care or treatments but the reduction of costs.
  • There needs to be honesty about the drivers and pressures that have made the Trust want to create a centralised estate
  • If it could be demonstrated that short, focussed in patient stays with a high therapeutic input could lead to a successful outcome, this might become more acceptable.
  • For many their experiences of-patient stays are neither focussed nor therapeutic – patients complain that they lack purpose, that the environment is not conducive to recovery and that they receive little attention from staff.
  • Individuals report the transition from hospital to community is problematic and community teams seem to lack the resources to provide prompt attention during the critical period immediately following discharge.

10. Would you be willing to travel further to be treated in a centre of excellence?

  • We believe that most people prefer local treatment and that if they must travel to receive specialist care they should have a choice of provider.
  • However under present arrangements, choice is rarely if ever available.
  • We would like to have a clear definition of what a centre of excellence is so that we make an informed choic

11. What are your views about a dedicated intensive care service for women?

  • It is not unusual for women to feel threatened in a mixed environment. Provision for care in a single sex environment is essential for people who are at their most vulnerable.

12. What are your views about the role of rehabilitation in mental health services and how should mental health rehabilitation be provided?

  • We believe that the Trust should examine in consultation with local people how best to provide rehabilitation services in a community context.
  • How many individuals does the Trust estimate need such a service , borough by borough.
  • What would such a service provide that makes it distinct from other provision.
  • It would be important to describe the eligibility criteria used to enable people to access such service
  • Consultation should take place before proposals are put forward.

13. Are clinics in community settings, such as GP surgeries, the best way of providing a speedy response if you have complicated mental health problems?

  • In a model such as that proposed by the Trust, in which specialist services are concentrated at a location, which is distant from many of the people that are served, it makes good sense to bring the services to the people. There may also be synergies in dealing with physical and mental health conditions in the same location. 
  • However, where this is done, recognition should be given to the needs of people who may need support in accessing services.

Sutton 1 in 4 Network
May 2011