Acute Integrated Services

Acute in-patient workforce

The National Acute Programme and the NIMHE National Workforce Programme have collaborated to identify and address joint priorities relating to acute in-patient workforce issues. One of the major priorities has been the need to provide guidance on the composition, skills, type and numbers of staff and competences needed to achieve an effective and competent acute in-patient workforce.

Two key pieces of joint work were identified:

• to identify and explore different and innovative approaches to staffing levels, skill mix and ward team composition, capability and capacity within acute in-patient care, which can be translated into practical guidance. It was agreed to utilise the CCTA as much as possible; and
• to review and report on current and developing models of NWW for the role of consultant psychiatrists and lead consultants in acute in-patient settings.

Considerable progress has been made towards the production of a guidance document. The following has taken place.

• A literature review and analysis of staffing levels and skill mix.
• A seminar to present and discuss current skill-mix initiatives, identify key issues and themes to inform the guidance, and look at possible options for pilot work. Those attending agreed to act as a reference group during the consultation process. The key points from the skill-mix seminar, together with the findings of the literature review, have been pulled together to form the basis of the draft guidance framework.
• A workshop, held in November 2006, to identify the key issues regarding multidisciplinary ward team composition and the competences required to meet service user needs. The key findings have been summarised and again will inform the guidance.
• Discussions with three Trusts to implement the CCTA within acute in-patient/ services sites. Implementation began in March/April 2007, and the Trusts will share any early learning. The launch of the CCTA project will take place in April. Facilitator training will be made available to Trusts, with CSIP regional development centres providing a resource to Trusts to review acute ward in-patient workforce competences, skills and composition.
• A scoping exercise, which aims to review the role and working relationships of consultant psychiatrists and the impact this has on ward care and management. It aims to link into the 10 Healthcare Commission sites that are piloting the assessment framework that will underpin the Healthcare Commission acute inpatient service review. Interviews will be carried out at the individual psychiatrist, ward, unit and Trust level and will also include focus-group meetings with service users. It is hoped that additional useful information will be gathered to add to the recent NWW survey. The first stage of this work has already begun in Mansfield, with the piloting of the questionnaire and focus group by a researcher from the Centre for Clinical and Academic Workforce Innovation.

Workforce planning & development good practice workbook is available now: More than Just Staffing Numbers. This is a companion document to Laying the Foundations (published May 08). Laying the foundations for better acute mental healthcare (Gateway reference number: 9676) A service redesign and capital investment workbook - This workbook assists those involved in the review, planning and re-design of their adult acute mental health services and informs any related capital development proposals. Action: This has particular relevance for chief executives of all providers and commissioners of adult acute mental health services in light of the current Healthcare Commission's inpatient service review. For more information, contact Barry Foley (at This email address is being protected from spam bots, you need Javascript enabled to view it ) or Yvonne Stoddart (at This email address is being protected from spam bots, you need Javascript enabled to view it ).

East Lancashire Supporting Change Project

This project commenced in East Lancashire in March 2006 with the aim of supporting implementation of NWW, improving the functioning of multidisciplinary teams (MDTs), providing greater accountability to service users, carers and professionals, and developing specialist skills and specialist team skills.

The new model of ‘in-patient/community split’ for consultant psychiatrists is now fully established, having initially been implemented in Burnley in spring 2006 and in Blackburn in autumn 2006. The CPA and case review booking systems have been implemented within in-patient wards in Blackburn and Burnley, and traditional ward rounds have been replaced with user/carer-friendly time. This all operates using a clear MDT approach.

Governance arrangements have been established within in-patient services and are operating well, with a Community Governance Group also being set up recently across East Lancashire to replicate the operational governance arrangements of in-patient services. Strategic accountability to users and carers is provided through the Acute Care Forums and the recently established Community Care Forum, while individual accountability now operates through the in-patient CPA and its booking system.

For each community team practice, service and whole-system development is being reviewed and implemented based on evidence gathered from the caseload audit of community teams. This took place in summer 2006. Community services are utilising this evidence to draft Service Development Plans that will be implemented through to autumn 2007. A re-audit is planned after this, in order to measure successful change.

The services have moved from being heavily dependent on line managers for making decisions to being focused on providing a solution at the level of the service and the locality. The governance structures in particular have reinforced and encouraged this approach. The next six months will see further bedding down of the structures and processes that have been established to ensure that they continue after the end of the project in autumn 2007. Contact: Paul Greenwood at This email address is being protected from spam bots, you need Javascript enabled to view it

NWW in in-patient services

East Suffolk mental health services have been redesigned to have specialised inpatient consultants. There is now evidence of improved patient experience of the service, clarity of the role of the consultant, focused medical time and expertise, improved multidisciplinary team working, improved skill mixes in teams, and greater dissemination of clinical skills. The model also provides a high degree of transparency in addressing working practices. It has brought a major cultural shift by moving away from a service that fostered dependency to one that focuses on recovery. The number of extra-contractual referrals has dropped to zero. Future plans include ongoing evaluation, development of age-inclusive services, a trust-wide Psychiatric Intensive Care Unit (PICU), an early intervention service, refined pathways both between teams and with primary care, a move to keep all stakeholders involved, provision of trust guidance for consultants, and initiation of a team effectiveness and leadership programme as part of a strategy to build capable teams – an essential component of NWW.
Contacts: Albert Caracciolo at This email address is being protected from spam bots, you need Javascript enabled to view it and Kamal Mohammed at This email address is being protected from spam bots, you need Javascript enabled to view it