Summary of Patient & Carers Reference Group Event –

Mental Health6thMarch 2013

The thirdMental Health Patient & Carers Reference Group Event as part of the Clinical Services Review took place on 6thMarch 2013. This is a summary of the discussion and feedback, and although not specifically capturing all the individual points is intended to convey the general key points and issues covered.

Questions / Comments following Presentations

  1. We speak about more holistic care – but at the same time are proposing care pathways for specific conditions. Is this not contradictory?

A: We are proposing a shift in emphasis from Levels 4 & 5 to concentrating more on the whole patient experience across Levels 1 to 5. Also, the identification of condition pathways allows you to look at patient outcomes more readily.

  1. Moving between Adult and Older People’s services causes transition issues.

A. People should not move services because of age – only because of need. Thereafter, yes we need to manage the transition process

  1. It would be good to see the involvement of carers in the use of CORENet, and across all 5 levels of care – not just at the acute end of the care spectrum.

A. Agreed, if patient consent issues don’t mitigate against this.

Feedback from Workshop Discussions

Responses to Question 1: Are the Model of Care ideas set out understandable?

  • Yes, they make sense, but there are a number of distinct challenges
  • We know the questions, trick is in delivering the solutions
  • Ease of access to services, particularly when there are co-morbidity issues, impacts significantly on the success of specialist services
  • Continuity in mental health services makes a huge difference. Detrimental when Out of Hours services involves you having contact with staff that you don’t know and who don’t know you
  • Transition between services must only be driven by need, and must happen smoothly.
  • Needs to be better communication of the services that are available and less complexity in the services we provide
  • Less paperwork and bureaucracy for medical staff  more reliance on admin staff – BUT, needs to be balanced with appropriate written and verbal communication with patients  INFORMATION, EDUCATION, CHOICE
  • Fairly clear and understandable
  • Broad aims & proposals/principles thought this is what should already be being done.
  • Sample Case studies would aid understanding of models of care.
  • Clearer and quicker access understandable.
  • Clarify role of NHS services in addressing increase in demand.
  • Need to define in more detail aspects of access at all levels for all services.
  • Models need to reflect importance of input from Carers.
  • Can’t all be dependant/left to GP to control access.

Responses to Question 2: Do the models of care set out respond to the issues raised in the Case for Change?

  • Not sufficient emphasis on the role of carers – still feels like a bit of an add-on.
  • Feels like we have moved away from the idea of holistic care – particularly in Mental Health and Dementia
  • Dementia – it’s crucial to involve carers in the year of post-diagnostic support
  • Also require to provide support for carers when they themselves become subject to physical or mental ill-health
  • Access for basic information at early onset of all mental health illness required.
  • Addressing different perspectives of service user & carer and how they fit into & where in model of care.
  • Crisis, at time it feels only option is police.
  • Definition of crisis and when you can access.
  • GP liaison service from Mental Health.
  • Self referral is/can this be an option at some level?
  • Smoother and better processes.
  • Greater Involvement of carers.
  • Do appointment letters invite carer/relative/friend to appointment.
  • Sense of being overwhelmed by demand and increasing age population.

Responses to Question 3: Are there ideas for the emerging models of care that are missing that need to be considered before the next stage of the Clinical Services Review process?

  • Crisis services – there can often be differences of opinion as to whether a person is in crisis  person says yes, NHS staff say no
  • Should we have a service that responds to all instances where a person thinks themselves to be in a crisis? Worse when its OOH, as it will be someone who doesn’t know you, who is assessing you over the phone.
  • Failing to get access to crisis services could result in the individual ending up in a police custody situation  should we have a place of safety arrangement?
  • There needs to be good community support arrangements in place – this is being adversely impacted upon by the personalization agenda
  • Case for Change is all about health – what about the integration agenda? We need to have some sort of shared view that the model of care works for the service user /service user outcomes
  • Need to be continually focused on recovery not treatment. Recovery will be patient specific  maintenance of recovery is highly dependant on the strength of community (NHS & SW) services
  • Early intervention is a key service
  • Access – there are services which people are not aware of
  • There is very little done about pre-diagnosis  often dependant on the individual making contact with services  need for education of family carers in advance of diagnosis
  • Carers outcome measures have not been mentioned – involvement / value of carers is understated. Triangle of Care roll-out would help address this
  • Staff training and development will be key. Timeframes for implementation will be interesting  how quickly are we asking staff to change practices?
  • Service user involvement in student training has proven to be very useful to both students and service users
  • Need to engage with those who don’t want to seek help  early involvement of peer support mechanisms required
  • Improve access/information points within GP surgeries – leaflets, etc on what services are available
  • Need to clarify what is meant by “self-referral” – so that everyone knows how you get into any given service
  • Evaluation aspects not included.
  • Are all models achievable?
  • Ensuring service remains boardwide and does not develop system variation but service user/carer led variations.
  • How to ensure cultural change will be addressed.
  • More on earlier interventions.
  • Addressing self stigma.

Summary:

  • There are a number of good services currently – in general, themes are being picked up
  • There is a consensus that what has been said has been listened to
  • Yes, each of the models makes sense and addresses the bulk of issues raised by the Case for Change

Areas where improvement could be made:

  • Role of carer needs to be strengthened
  • Communication of services needs to be improved – service users and staff need to know what services there are and what the referral process is
  • Staff training and development will be required