Appendix B Leeds Mental Health Teaching NHS Trust Briefing Paper - - PDF document

Appendix B June 2006 Leeds Mental Health Teaching NHS Trust Briefing Paper for Scrutiny Board (Health and Adult Social Care) 19 June 2006

• 1. Introduction

This paper describes the role of the Trust, its key challenges and ambition for the future. Not the least of these is our current pursuit of Foundation Trust

• status. Through Foundation status the Trust will benefit from wider

engagement and involvement with its stakeholders, not only in terms of services it will deliver but also in the ongoing development of the

• rganisation`s strategic direction.

The Trust has worked hard at moving from a position of financial dependence in the past to one of actively supporting the local health economy in the

• present. The Trust is now able to focus solely on moving forward in terms of

service quality improvement, linked to value for money, without the burden of short-term financial handling strategies. This has provided tremendous motivation for those involved in delivering services within the Trust. Key to the Trust`s success will be its continuing engagement with service users and carers, the wider community and our partner organisations, both statutory and non-statutory, and these themes are addressed further in this paper. Our future direction is encapsulated in our ambition statement that: “In 2011people choose our Foundation Trust because we always deliver the best mental health and learning disability care”

• 2. Background

Leeds Mental Health Teaching NHS Trust is a provider of specialist mental health and learning disability services. The Trust provides services to over 715,000 people within the metropolitan boundaries of Leeds. Specialist services accept referrals from across the UK. We operate from over 70 sites and provide help to over 2,000 people every day. Our current service user population who are registered as involved in the Care Programme Approach is in excess of 16,000. The Trust is also a centre for teaching, research and development. Service provision is currently divided into five areas which are:

• Working Age Adults
• Older People
• City wide
• Learning Disabilities
• Addiction

Appendix B June 2006

• 3. Overall Vision for Mental Health Services in Leeds

The overall vision of Leeds Mental Health Strategy is to improve the health and well being of people with mental health problems and their carers in ways that are determined by them; and to promote mental well being of the population as a whole. The following guiding principles are intended to act as a foundation for the future and become part of the way the partnership does things and how it should be judged for what it delivers.

• Services adopting a positive and hopeful recovery perspective
• Prevention of mental health problems and promotion of mental health
• Services being guided by transparency of purpose
• Linking with and influencing broader services and strategies
• Services that ensure no harm is done
• Services that offer the lowest level of intervention possible
• Services assessing risk with the person concerned
• Acknowledging that mental health problems may be complex and

multifaceted

• Aligning success criteria
• The service users for individual care plans should determine success

criteria

• Joint approaches to planning and delivery
• Service evaluation
• Links to other strategies and work streams

This strategy is set within the context of other key strategies in the city notably the Strategic Services Plan (Making Leeds Better), Vision for Leeds 2, Leeds Housing Strategy, local implementation of strategies for older people, NSF for

• lder people, CAMHS strategy, Valuing People Strategy, Black and Minority

Ethnic (communities) Mental Health Strategy, Women’s Mental Health Strategy, Supporting People Strategy and the Drugs Treatment Plan.

• 4. Service Development Plans

In 2006/07, work is or will be taking place as follows: 4.1 Working Age Adults

• A key element of service redesign has been the implementation of a

single management structure to support the functional model of service

• delivery. To support this approach and to ensure the whole system of

mental health care can support this process, comprehensive service specifications detailing service roles and access criteria will be produced and agreed with commissioners

• Restructuring of acute community day services (ACDS) was completed

in 2005. There are 5 acute community day treatment centres across

Appendix B June 2006 the city offering locally accessible acute care, either by preventing admission at the point of crisis assessment or by facilitating early discharge from an acute inpatient bed. The south Leeds ACDS was successfully relocated to suitable premises in Beeston in March 2006. There are plans to relocate the East Leeds service (which is inappropriately located on an inpatient unit) to a site in Seacroft subject to full planning permission and the requisite capital funding.

• A multi agency group established between the Trust, PCTs, the Police

and Social Services has been meeting to provide a fast and efficient procedure for assessing those individuals who have been arrested under Section 136 of the Mental Health Act. A further development will see the in-reach service provided by the Crisis Resolution Team extended to provide full 7 day cover over 24 hours. Furthermore, a capital bid has been made to the Department of Health to enable a place of safety to be provided on Trust premises in line with latest policy

• The Trust and the commissioners have been in discussions about

improving continuing treatment and recovery services in Leeds and

• bviating the need for patients to be sent out of area. A significant

assessment of individual patients was concluded in 2005/06 and this is informing the work now being undertaken to produce a service model and subsequently a robust business case

• Improved access to psychological therapies is an increasing priority

and the Trust has been working closely with the PCTs to develop a whole system approach to delivering a “stepped care model”. Throughout 2006/07 the Trust and PCTs will continue working in partnership in developing and implementing new models of service delivery for psychological therapy services 4.2 Older People

• Older people`s mental health services in Leeds have received long

awaited recognition in the past year and the main focus in 2006/07 will be to implement the successful Partnerships for Older People`s Projects (POPPs) programme. However, this work cannot stand in isolation and needs to be part of a fully redesigned service built around a rehabilitation and recovery model, incorporating local and national strategies and guidance. This model includes the provision of care as near to the service user as possible and the transfer of services into the community

• Liaison Psychiatry – This team operates like a community mental

health tem but within the general hospital. The POPPs project will see this service extended city wide and it will also develop a presence in A&E departments, working closely with other liaison services

Appendix B June 2006

• Rapid Response - crisis situations can often be managed without a

person going into acute care by the provision of a rapid response

• service. Rehabilitative and therapeutic services can be provided within

the older person`s own environment. In addition, the service will enable earlier discharge from hospital by providing the option of rehabilitative care within the community. Within POPPs, mental health intermediate care teams will work in partnership with, and where possible, be co- located with the existing intermediate care teams

• Service Redesign – In order to release further investment for

community development, the Trust is consulting on the transfer of services from one of its community units since a significant number of patients have been assessed as no longer requiring NHS inpatient care but are awaiting placement in appropriate residential or nursing homes. The overall investment in services for older people will not be decreased but will be targeted more effectively to better meet people`s needs within the community 4.3 City Wide

• To enable a step down from our low secure facilities, provide

throughput capacity and improve rehabilitation services, the Trust will be reopening the Beeches to provide a rehabilitation facility for 8 male

• patients. Building work has just commenced and the service is likely to

be operational at the end of September

• In 2005/06 the Eating Disorders service was moved from inadequate

accommodation at Seacroft Hospital to a vacant ward within the Newsam Centre. That enabled an increase in beds to be made to meet regional demand and the service has proved very successful. In 2006/07 consideration will be given to the potential for further increasing the bed base as well as developing the centre`s research and consultancy role 4.4 Learning Disabilities

• The service has just completed a strategy for NHS Learning Disability

services for consideration and agreement within the Trust and with our commissioners and partner organisations. The aim is to set a clear direction for the development and improvement of services and create the capacity to bring suitable clients back to Leeds

• The Trust will work in partnership with the joint commissioning service

to develop plans that ensure community services are able to meet the changing demographic needs of the learning disability population. The focus will be particularly on prevention and meeting complex needs such as autism and early onset dementia.

Appendix B June 2006

• The Trust will be taking a leading role in raising the profile of learning

disability within primary and secondary health care. This will include the organisation of a workshop to highlight health issues for people with learning disabilities 4.5 Addictions

• Both alcohol and drug treatment services are going through a period of

intense change with much of the drug misuse agenda being delivered through the Safer Leeds Partnership`s pooled treatment budget. It is expected that the specialist clinical function of the service will be to assist people toward stopping the use of illicit drugs or achieve safe use of licit substances, notably alcohol. The achievement of intermediate and harm reduction goals will often be a realistic end point

• f treatment
• Discussions are taking place with commissioners regarding the

development of an inpatient detoxification unit to meet a nationally perceived shortage of facilities. A business case is being developed but no funding is yet identified

• A number of other areas for improving or developing services are being

considered including: extending the remit of the parenting and pregnancy service; improving support for women working as prostitutes; improving support to LTHT`s Liver unit; and improving the A&E/Addictions liaison service

• The Trust will be working particularly with commissioners to improve

alcohol services and develop associated harm reduction/health promotion strategies

• 5. Estates

The Trust is continuing to review its estate to ensure the most cost effective alignment of service requirements and building utilisation. A recent in-depth survey of the Trust estate has been undertaken and this will inform future decisions. In addition, the Trust will need to make best use of its PFI accommodation and work continues with our partners, particularly Accent, to ensure that buildings and facilities are provided to a high standard.

• 6. Involving People

The Trust is committed to involving people who receive our services, their carers and the public. We are currently reviewing and updating our Involving People Strategy and developing an Involving People policy that sets out our statutory obligations under sections 11 and 7 of Health and Social Care Act (2001). We have a Public Involvement Department that provides leadership for involvement and service user and carer involvement workers in each of the service directorates. The Patient

Appendix B June 2006 Advice and Liaison Service (PALS) provides information, advice and support to people receiving our services if they have a query or want help to resolve a concern. We also have an excellent working relationship with

• ur Patient and Public Involvement Forum which has undertaken a

number of inspections of our services and participated in consultations. Vocational Services The Trust is currently in the process of developing a model and strategy for vocational services. This includes help to structure time and activity, such as finding or staying in paid employment, volunteering and/or learning, education and training. Our voluntary services team currently has 250 volunteers working a wide variety of roles throughout the

• rganisation

Creativity and Arts The Trust has recently approved a three year Capturing Arts and Minds strategy for developing the role of the arts in health and social care. The Arts and Minds network is a multi-sector partnership involving service users and carers and which is led by the Trust. The network has a regular newsletter and email updates and is holding a series of events throughout the year. A website is under development and funding secured to set up a multi-media equipment resource that can be loaned to service users, carers and staff. A charitable fund has been established to provide grants for individuals and groups to participate in creative activity. Supporting carers We recognise the important role that partners, relatives and friends often play for people who receive our services. We have a Carers Team that

• ffers information, advice and training as well as individual and group

support for carers. The team is currently undertaking a review, involving carers, to improve the service further. Diversity The Trust has developed a strategic approach for Diversity, which is promoted under the banner of ‘Respect’. Key achievements have included;

• Consultation and agreement of a Respect Strategy and Action Plan,

Respect Recruitment & Retention Strategy, Respect Training Plan, Diversity & Race Equality Scheme and Harassment in Clinical Settings Framework.

• Secured funding from the West Yorkshire Workforce Development

Confederation for the delivery of 3 personal development programmes under the title of Talented People; Navigator for men, Springboard for women and service users.

Appendix B June 2006

• Established 7 funded staff support networks; Women, Parent and

carer, People with disabilities, Over 50’s, Lesbian, gay, bisexual & transgender, BME and Experts by experience.

• Introduced a First Contact Supporter Scheme to help staff deal with a

range of difficult situations in the workplace, especially bullying and harassment.

• Rolled out Diversity Foundation training to all staff within the Trust and

new staff will participate as they join the Trust.

• Provided over 80 prayer mats throughout the Trust for use by staff and

visitors along with 10 copies of the Koran.

• Developed translation services to ease communication.
• Undertaken a range of recruitment sessions at a variety of community
• events. We also offer placements to a number of BME training
• rganisations in an attempt to encourage Members of minority

communities to work with the Trust.

• 7. Forthcoming legislative changes

7.1 The Mental Capacity Act 2005 The Mental Capacity Act 2005 comes into force from April 2007. This will apply to all people who lack capacity irrespective of whether they are in hospital or the wider community. The Act will apply to informal patients who lack capacity to make decisions for themselves. Patients who lack capacity and are detained will have their rights safeguarded under the Mental Health

• Act. There will be a new Lasting Power of Attorney, an Office of Public

Guardian, a new Court of Protection and the introduction of Independent Mental Capacity Advocates (IMCAs). The Trust will need to ensure that clinical practice guidelines, policies and procedures comply with this new legislation. Staff will need to be trained and made aware of the Act and its implications for their practice. Service users and carers will also need information about how the Act applies to them. There will be financial implications of preparing the Trust to incorporate the Act into its' work in terms of training the workforce, administrating elements of the Act and in utilising information technology to support new processes that develop to satisfy the requirements of the Act. This will need underpinned with partnership working with other organisations, an effective communications strategy, and once the Act is enacted, monitoring and review

• f practice and policies to ensure the Trust is addressing its obligations under

the Act. A working group, which is a sub-committee of the Mental Health Act Clinical Governance Council, is already working on these areas and co-opting appropriate personnel as required to prepare the Trust for this legislation.

Appendix B June 2006 7.2 The Mental Health Bill The government is planning to introduce a shorter, streamlined Mental Health Bill that amends the existing 1983 Act. It is anticipated that the new Act will become law in April 2007 and enacted in April 2008. The new Act will change the definition of mental disorder; revise the nearest relative provision to align it to Human Rights legislation; introduce Community Treatment Orders; amend the "treatability" test and introduce safeguards by amending the Mental Capacity Act for people who are deprived of their liberty and do not receive mental health legislation safeguards. The Trust will need to prepare meticulously for the introduction of this legislation to ensure there is a smooth transition between the existing and new legislation.

• 8. Foundation Trust Status

The Trust is currently pursuing Foundation Trust status with the aim of achieving this by April 2007. FT status fits well with the ethos common to many mental health trusts; that is – maximising the engagement of the public, service users, carers and stakeholders in developing strategy and improving

• rganisational performance. It will also create new opportunities for the Trust

to demonstrate its accountability to the communities it serves for delivering a consistent, high quality service and the removal of inefficiencies. Benefits for service users and carers

• Social ownership and local accountability
• The strategic aspirations of the FT being aligned with local communities,

through mutuality and social ownership

• Local people being in the majority on the board of Governors
• Specific to service users and carers, direct involvement in governing the

Trust as Members and Governors

• Opportunities to influence the day to day operation of services
• Opportunities to influence commissioning decisions
• Excellent information about services in a format that suits the person
• Informed choice of clinically effective options, including psychological

therapy

• Clear and coherent care pathways with a range of choices built in
• Choice of treatment times and location
• Choice of service ie alternative to hospital admission (where clinically

appropriate) Benefits for staff

• Greater empowerment – the five year integrated business plan requires

support from staff, involvement and participation in its ongoing development

Appendix B June 2006

• Being Members and Governors
• Expected to deliver excellence and be rewarded for doing so
• Being part of a learning organisation with development opportunities and

effective leadership

• Enjoying the best standards of employment practice

Benefits for our commissioners

• Collaborative approach to health improvement
• Legal contracts providing purchaser and supplier stability alongside quality

services, with constructive dialogue and challenge

• Tight specifications that ensure delivery with the financial resources to

make things happen

• Payment regimes that secure the best value for money
• Clarity on where the money is going and what it is being used for
• PCTs represented as stakeholders as Governors within the structure

Benefits for the organisation

• Improved and integrated governance process accountable to local people

and stakeholders through the roles of Members and Governors

• The rigour of the application process, and the successful transition to FT

will provide a better, more streamlined, efficient, focused and integrated services for the communities the Trust serves

• Better physical and mental health through innovation from greater
• rganisational flexibilities which will benefit the local economy
• Financial flexibilities – to borrow, to generate and re-invest surpluses and

use to benefit local people

• Optimise the benefits of being a public benefit corporation in the context of

a contestable market Consultation Consultation on our plans for FT status is now beginning and there will be a series of events towards the end of June. The official launch will take place

• n 26 June. There will be extensive publicity through the local media and we

have identified over 80 meetings that senior managers will attend to promote and discuss the consultation with trust stakeholders and partners. We are arranging to hold events at public venues during the 3 month consultation period. Membership We have set targets to grow membership and involvement over three years. We believe that we should favour a high-engagement policy for members. This means that we will look to attract a higher percentage of members who will be actively involved in creating a vibrant and active membership base. The overall breakdown for the range of membership numbers during the first three years;

Appendix B June 2006

• Year 1 : 5,000 – 7,500
• Year 2 : 10,000 - 15,000
• Year 3 : 15,000 - 20,000

The Membership Council The membership council is made up of representatives of the members and also key local partner organisations. They will ensure that the existing Board

• f Directors, who will maintain responsibility for the day to day running of the

trust, is accountable to the community. The members of the council will also

• versee the activities of the trust, hold the Directors to account and help

shape the future strategy of the trust. The Membership Council will be chaired by the Trust Chairman. We are proposing that the Membership Council will be made up of 36

• members. This will include;
• 8 Public members
• 12 Service User and Carer members
• 6 Staff members.

The membership council will be elected by the members. All elections will be by secret ballot and an independent organisation will be used to run and validate the elections. Members of the council will usually be appointed for a term of three years however some initial appointments will be for less than

• this. This will mean that there are regular elections to the Membership Council

ensuring the Council runs smoothly in its early years of development providing local people with the opportunity to elect new members to the council or re- elect existing ones. There will also be 10 stakeholder non-elected members who will be representing the following key partner organisations;

• Leeds Teaching Hospital Trust
• Leeds Metropolitan University
• University of Leeds
• Accent Care Partnerships
• Volition
• West Yorkshire Police
• Chair – Health Scrutiny Committee – Leeds City Council
• Leeds Social Services (Provider representative)
• Leeds Social Services (Commissioner representative)
• Leeds Primary Care Trust