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have been pulled together to form the basis of the draft
guidance framework.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
mbarryfoley@aol.com)
or Yvonne Stoddart (at ylstoddart@yahoo.co.uk).
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 paul.greenwood@northwest.csip.org.uk
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 albert.caracciolo@smhp.nhs.uk and
Kamal Mohammed at kamal.mohammed@smhp.nhs.uk,
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