Liaison Mental Health Network 27 September 2017 Dr Katie Martin, - - PowerPoint PPT Presentation

www.england.nhs.uk

• Dr Katie Martin, Network Clinical Advisor & Consultant Liaison Psychiatrist, TEWV MHFT
• Rebecca Campbell, Quality Improvement Manager
• Charlotte Whale, Quality Improvement Manager
• Sarah Boul, Quality Improvement Lead
• Twitter: @YHSCN_MHDN #yhmentalhealth
• September 2017

Yorkshire and the Humber Mental Health Network

Liaison Mental Health Network 27 September 2017

www.england.nhs.uk

@YHSCN_MHDN #yhmentalhealth

Housekeeping:

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Welcome & Introductions

Dr Katie Martin, LMH Clinical Advisor, Yorkshire and the Humber Clinical Networks and Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS FT

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• Update on national guidance UEC pathways
• Aims & Actions from previous LMH network meetings – where are we

now?

• Workforce: Good Practice
• Developing a LMH Practitioners Forum Y&H – all
• Break (15 mins)
• Transformation Bid Updates Waves 1, 2 and ‘wave 3’
• Small group discussions – what’s worked, what hasn’t and what do we

do next?

• Next steps and closing remarks

Overview

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Update: Urgent & Emergency LMH services and upcoming national guidance on UEC Pathways Aims and actions from the last meetings – where are we now?

Dr Katie Martin, LMH Clinical Advisor, Yorkshire and the Humber Clinical Networks and Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS FT

www.england.nhs.uk

• FYFV for MH - independent MH Taskforce report
• Implementing EBTP for UE LMH services for Adults

& Older Adults – Guidance on establishing, developing and maintaining LMH services

• Upcoming national guidance on Urgent & Emergency Mental Health

Care Pathways for all ages

• Support local implementation of EB acute & crisis care
• Examples of what good looks like around the country
• Contain clear set of access and quality benchmarks
• Quality Assessment & Improvement Scheme
• Identify current levels of service provision & support local improvement
• MHSDS will also provide increased transparency of activity across

crisis and acute MHS – will aid assurance of data quality (CCG/ provider/ STPs)

• CCGIAF – will include transformation indicators for U&E MH

Policy Headlines

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What should the whole system of urgent and emergency mental health care look like?

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Recommendation 18:

• By 2020/21, no acute hospital is without all-age mental health

liaison services in emergency departments and inpatient wards

• At least 50% acute hospitals meet ‘core 24’ service standard

as a minimum by 2020/21 (currently 10%, up from 7% last year) Spending Review 2015/6

• By 2020, there should be 24-hour access to mental health crisis

care, 7 days a week, 365 days a year – a ‘7 Day NHS for people’s mental health’

• Transformation funding to aid development of LMH services

in every hospital emergency department (over 4 years from 2017/18) – Wave 1 £30m, Wave 2 £90m

Background to LMH TF

www.england.nhs.uk

Application for and acceptance of the one-year transformation pump prime funding constituted a local commitment to the following:

• recurrent funding of the newly-expanded service in future years

beyond the year of receipt of the transformation funding

• provision of a 24/7, on-site, distinct service to an acute hospital with a

24/7 Emergency Department within one year of receipt of the transformation funding

• provision of a 1 hour response to emergency referrals and 24 hour

response to urgent ward referrals within one year of receipt of the transformation funding

• staffing of the liaison service at or close to the recommended levels for

core 24 as per bid

Transformation Fund – Wave 1 2017/8, Wave 2 2019-2021

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• Clear, unambiguous CCG sign up to recurrent funding
• Consultation/ direct input from liaison clinicians
• Explicit statements about aims/ plans for additional funding
• Data evidencing current/ projected savings from LMH
• Commitment to collect EB outcome measures
• Robust timelines and plans for next 24 months
• Reasonable balance between current investment & requested £
• Rationale for any differences explained clearly
• e.g. developing advance practitioner/ nurse consultant roles
• Highlighting strengths of current model
• e.g. incorporating existing D&A services/ expanding links with

primary care/ integration with IAPT for MUS

Summary of key elements of successful bids – local services

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Features of strong UEC LMH Core24 Transformation Funding bids (NHSE)

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Aims and Actions from the Last Meeting

Dr Katie Martin, LMH Clinical Advisor, Yorkshire and the Humber Clinical Networks and Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS FT

www.england.nhs.uk

• Understand Y&H geography baseline of liaison services meeting the Core 24

minimum standard, including concerns, risks and good practice

• Ensure clinical expertise in liaison, both adult and child & adolescent, drives the

programme of work and adds appropriate local narrative to data

• Using a regional (North) liaison mental assurance framework which includes

appropriate links to the UEC, Primary Care and wider Crisis Care programmes, develop this into a bespoke framework for Y&H for local STP use

• Troubleshoot problems and provide Y&H support and feedback to North region

– disseminate guidance and information from national team

• Provide an expert liaison mental health clinical and advisory voice to Y&H area,

3 STP Programme Offices, Y&H Mental Health & Dementia Programme Group & any associated sub-groups / T&F groups which may be established

Y&H LMH Network: Aims

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• Work collaboratively across the Y&H localities to support CCGs and Providers to prepare

for the release of funding from 17/18 onwards to expand/improve/develop liaison services to meet national standards

• Collate and share a range of good practice models in liaison including national pilots and

work with STPs ensuring learning and models are shared across the patch

• Develop tools and guidance as necessary to support local understanding of the

requirements, preparing for delivery, assessing baseline and gap analysis and understanding demand

• Develop a process to undertake economic evaluations and evidence of a range of

liaison services which includes patient and public review of effectiveness

• Unite individuals and partners across Yorkshire and the Humber in a common purpose
• Promote common understanding, joint working and prevent duplication
• Work collaboratively to build capacity and capability for quality improvement in services.

LMH Network: Purpose

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• National direction – does it lack vision? Too focussed on UEC pathway?
• Acute trust colleagues – relationships, expectations, understanding roles
• STPs – collaborative working difficult with each area’s differing needs
• Workforce shortage – skill mix, staffing resource, development
• Impact of UEC pathway – still pending…
• TF Wave 2 – lessons learned, how to prepare, what does good look like?
• CQUIN – A&E coding, information sharing/ IG issues
• Smaller services – whatever do we do next?
• Outcomes – what to measure and how?
• Proposed actions:
• Work collaboratively with acute trust colleagues – invited here today!
• Online liaison practitioners’ forum
• Region-wide training for liaison practitioners – develop LMH competencies

and skills – draw on considerable expertise and local experience

• Share experience of TF bids – process, bids, challenges
• CQUIN – further guidance on tables, peer support
• Continue to link in with UEC/ crisis care concordat groups

Key concerns and proposed actions – feedback from LMH network meetings

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Where are we now as a region?

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London

Areas that have successfully bid in Wave 1 to meet core 24 liaison services by the end of 2017/18* Areas that currently have access to core 24 liaison services’ Areas that have successfully bid in Wave 1 to meet core 24 liaison services by the end of 2018/19* Areas with liaison services that are not yet at core 24 service level *at the time of publication, funding awards are provisional

Wave 1 bidding process now complete:

• 17 hospitals already at Core

24 (10%)

• £30m funding to 74 acute

hospital sites to achieve ‘Core 24’ from 2017-2019

• By 2019 – 81 aim to have

achieved Core 24 standard

Wave 1 transformation funding for Core 24 U&E MH Liaison

19

Humber, Coast & Vale (HCV) STP Area

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of Beds in

Acute Hospital York Teaching Hospital NHS Foundation Trust Scarborough General Hospital Tees, Esk & Wear Valleys NHS FT Scarborough Acute Hospital Liaison Team 300 The York Hospital Tees, Esk & Wear Valleys NHS FT MHALT York LMHT 750 Hull And East Yorkshire Hospitals NHS Trust Hull Royal Infirmary Humber NHS FT (Department of Psychological Medicine) Department of Psychological Medicine 1400 Northern Lincolnshire And Goole NHS Foundation Trust Scunthorpe General Hospital Rotherham Doncaster and South Humber NHS Foundation Trust. N Lincolnshire Access service N Lincolnshire Acute Liaison Team 406 Diana, Princess of Wales Hospital Grimsby NAVIGO Not Known 439

20

Core 24 minimum functions Staffing gap to core 24 Trust Name

Hospital Name

Core 24 staff 24/7 Targets 1h/ 24h Extra Cons Extra LMHN Stratification at Trust level

Notes

York Teaching Hospital NHS FT York Hospital N Y Y 0.6 0.18 2 *FUNDING 17/18 Scarborough General Hospital N N Y 1.9 8 5 Hull & East Yorkshire Hospitals NHS Trust Hull Royal Infirmary Y Y N 3 *FUNDING 18/19 ?potentially be classed as core 24 - committed to setting response time standard Northern Lincolnshire And Goole NHS FT Diana, Princess of Wales Hospital N N N 2 13 5 Scunthorpe General Hospital N N Y 1.8 9.8 5

Stratification of HCV STP Liaison Services (from National data mid-2016)

Strata description: 1 = Trust operates at Core 24/ 2 = Trust awarded transformation funding in 2017/18/ 3 = Trust awarded transformation funding in 2018/19/ 4 = Close to Core 24 <1 consultant AND < 6.5 nurses needed for Core 24/ 5 = > 1 consultant OR >6.5 nurses needed for Core 24

21

Humber, Coast & Vale

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of Beds

in Acute Hospital 1. On-site, distinct 24/7 Liaison Service in Acute Hospital 2. In line /close to recommended staffing levels for Core 24 3. 1 hour response to A&E 4. 24 hour response to inpatient wards 5. Commitment to local recurrent funding

• 6. Transformation

Funding York Teaching Hospital NHS Foundation Trust Scarborough General Hospital TEWV NHS FT Scarborough Acute Hospital Liaison Team 300 No No Yes Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2 The York Hospital TEWV NHS FT York LMHT (adults) MHALT (Older adults) 750 Yes Yes Yes Yes No Successful Wave 1 (2017- 18) Hull & East Yorkshire Hospitals Hull Royal

• Infirmary. Castle

Hill Hospital Humber NHS FT Hospital Mental Health Team 1400 Yes Yes Yes Yes Yes Successful Wave 1 (2018- 19) Northern Lincolnshire And Goole NHS Foundation Trust Diana, Princess

• f Wales

Hospital, Grimsby NAVIGO Part of the Access Team - Liaison element 439 No No Yes Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2 Scunthorpe General Hospital Rotherham Doncaster and South Humber NHS FT N Lincolnshire Access service N Lincolnshire Acute Liaison Team 406 No No No Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2

22

South Yorkshire & Bassetlaw (SYB) STP Area

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of Beds

in Acute Hospital Barnsley Hospital NHS Foundation Trust Barnsley Hospital South West Yorkshire Partnership Barnsley Mental Health Liaison Team 350 Doncaster And Bassetlaw Hospitals NHS Foundation Trust Bassetlaw District General Hospital Nottinghamshire Healthcare NHS Trust Bassetlaw MH Liaison 305 Doncaster Royal Infirmary Rotherham Doncaster and South Humber NHS Foundation Trust. Access Team Older People’s MH Liaison 850 Rotherham NHS Foundation Trust Rotherham Hospital Rotherham Doncaster and South Humber NHS Foundation Trust. Rotherham Hospital Mental Health Liaison Service 500 Sheffield Teaching Hospitals NHS Foundation Trust Northern General Hospital Sheffield Health & Social Care NHS FT Not Known 1100

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Stratification of SYB STP Liaison Services (from National data mid-2016)

Core 24 minimum functions Staffing gap to core 24 Trust Name Hospital Name Core 24 staff 24/7 Targets 1h/ 24h Extra Cons Extra LMHN Stratification at Trust level Notes Barnsley Hospital NHS FT Barnsley Hospital N Y N 1.8 4 5 Doncaster & Bassetlaw Hospitals NHS FT Bassetlaw District Hospital N Y Y 2 5.5 5 Doncaster Royal Infirmary N N N 1.9 5 Rotherham NHS Foundation Trust Rotherham Hospital N N N 0.8 4 3 *FUNDING 18/19 Sheffield Teaching Hospitals NHS FT Northern General Hospital Y N Y 2 ?enough staff to

• perate

24/7 rota. TF means service committed to 24/7

Strata description: 1 = Trust operates at Core 24/ 2 = Trust awarded transformation funding in 2017/18/ 3 = Trust awarded transformation funding in 2018/19/ 4 = Close to Core 24 <1 consultant AND < 6.5 nurses needed for Core 24/ 5 = > 1 consultant OR >6.5 nurses needed for Core 24

24

South Yorkshire & Bassetlaw

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of

Beds in Acute Hospital 1. On-site, distinct 24/7 Liaison Service in Acute Hospital 2. In line /close to recommended staffing levels for Core 24 3. 1 hour response to A&E 4. 24 hour response to inpatient wards 5. Commitment to local recurrent funding 6. Transformation Funding Barnsley Hospital NHS FT Barnsley Hospital SWYPFT Barnsley Mental Health Liaison Team 350 Yes No No Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2 Doncaster And Bassetlaw Hospitals NHS FT Bassetlaw District General Hospital Nottinghams hire Healthcare NHS Trust Bassetlaw Mental Health Liaison Service 305 Yes No Yes Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2 Doncaster Royal Infirmary RDASH NHS FT Doncaster Acute Hospital Liaison Team 800 including Mexboroug h Yes Yes No Yes No Unsuccessful Wave 1. Plan to apply for Wave 2 Rotherham NHS FT Rotherham Hospital RDASH NHS FT Rotherham Hospital Mental Health Liaison Service 500 No Yes Yes Yes Yes Successful Wave 1 (2018- 19) Sheffield Teaching Hospitals NHS FT Northern General Hospital Sheffield Health & Social Care NHS FT Mental Health Liaison Team 1100 No Yes Yes Yes Yes Successful Wave 1 (2017- 18)

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West Yorkshire (WY) STP Area

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of Beds in

Acute Hospital Airedale NHS Foundation Trust Airedale General Hospital Bradford District Care Trust Bradford A&E Liaison/ Hospital Liaison Team 395 900 Bradford Teaching Hospitals NHS Foundation Trust Bradford Royal Infirmary Calderdale And Huddersfield NHS Foundation Trust Calderdale Royal Hospital South West Yorkshire Partnership Mental Health Liaison Team 800 Huddersfield Royal Infirmary Harrogate And District NHS Foundation Trust Harrogate District Hospital Tees, Esk & Wear Valleys NHS FT Acute Hospital Liaison Team 384 Leeds Teaching Hospitals NHS Trust St James' University Hospital Leeds & York Partnership NHS FT ALPS/ LPIOS/ Old Age Liaison Team 1113 Leeds General Infirmary 590 Mid Yorkshire Hospitals NHS Trust Pontefract Hospital South West Yorkshire Partnership Psychiatric Liaison Team 1116 Dewsbury and District Hospital Pinderfields Hospital

26

Core 24 minimum functions Staffing gap to core 24 Trust Name

Hospital Name

Core 24 staff 24/7 Targets 1h/ 24h Extra Cons Extra LMHN Stratification at Trust level

Notes

Airedale NHS FT (Airedale General Hospital) Airedale General Hospital

N N N 2 10.4 5

Bradford Teaching Hospitals NHS FT (Bradford RI) Bradford Royal Infirmary

N N N 2 9.2 5

Calderdale & Huddersfield NHS FT Calderdale Royal

N Y Y 0.5 3 3 *FUNDING 18/19

Huddersfield Royal

N Y Y 0.5 3.2 3

Harrogate And District NHS FT (Harrogate DH) Harrogate District Hospital

N N Y 1.3 7.76 5

Leeds Teaching Hospitals NHS Trust LGI

N Y N 1.8 3.2 3 *FUNDING 18/19

St James’s

N Y N 1.1 4 5

Mid Yorkshire Hospitals NHS Trust Dewsbury & District Hospital

N Y Y 1.7 6.6 2 *FUNDING 17/18

Pinderfields

N Y Y 1.4 1.4 2

Pontefract Hospital

N Y Y 1.9 12 2

Stratification of WY STP Liaison Services (from National data mid-2016)

Strata description: 1 = Trust operates at Core 24/ 2 = Trust awarded transformation funding in 2017/18/ 3 = Trust awarded transformation funding in 2018/19/ 4 = Close to Core 24 <1 consultant AND < 6.5 nurses needed for Core 24/ 5 = > 1 consultant OR >6.5 nurses needed for Core 24

27

West Yorkshire & Harrogate

Acute Trust Hospital Name Liaison Provider Name of Liaison Service

• No. of

Beds in Acute Hospital 1. On-site, distinct 24/7 Liaison Service in Acute Hospital 2. In line /close to recommended staffing levels for Core 24 3. 1 hour response to A&E 4. 24 hour response to inpatient wards 5. Commitment to local recurrent funding 6. Transformation Funding Bradford Teaching Hospitals NHS FT Bradford Royal Infirmary (BRI) and Airedale General Hospital (AGH) Bradford District Care NHS Foundation Trust A and E Psychiatric Liaison Team 1475 Yes Yes No Yes No Unsuccessful Wave 1. Calderdale and Huddersfield NHS FT Calderdale Royal Hospital Huddersfield Royal Infirmary South West Yorkshire Partnership Mental Health Liaison Team 800 Yes Yes Yes Yes Yes Successful Wave 1 (2018- 19) Harrogate And District NHS FT Harrogate District Hospital Tees, Esk & Wear Valleys NHS FT Acute Hospital Liaison Service (Harrogate and Rural District) 384 No No No Yes No Application not made for Wave

• 1. Plan to apply

for Wave 2 Leeds Teaching Hospital NHS FT St James' University Hospital and LGI Leeds and York Partnership NHS FT Leeds Liaison Psychiatry Service 2000 Yes Yes No No No Successful Wave 1 (2018- 19) Mid Yorkshire Hospitals NHS Trust Pontefract Hospital South West Yorkshire Partnership Psychiatric Liaison Team 1116 Yes Yes Yes Yes No Successful Wave 1 (2017- 18) Dewsbury and District Hospital Pinderfields Hospital

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• Following several requests from providers and commissioners, it

was agreed a condensed version of LMH survey (May 2016) was undertaken by Yorkshire and Humber Clinical Network Aug 2017

• The aim was to enable a comparison with 2016, to assist those

wishing to apply for Wave 2 funding and allow those services who had been successful to map their progress half-way through the year

• The original questions were modified to match the scoring

criteria for recent Wave 1 funding applications

• You should all have now received Liaison Mental Health

Summary report 2017

Latest results from LMH Scoping for Y&H August 2017

www.england.nhs.uk

Y&H Summary – Core 24

STP Acute Trust / MH Trust Position relating to Core 24 HCV Hull & East Yorkshire Hospitals / Humber NHS FT Close to CORE 24. With additional work would achieve the requirements of a comprehensive service. NLAG - Diana Princess of Wales / NAVIGO Would not meet the requirements of CORE 24. This is unchanged from 2016. NLAG – Scunthorpe / Rotherham Doncaster and South Humber NHS FT (RDASH) Would not meet the requirements of CORE 24. This is unchanged from 2016. York Teaching Hospital – Scarborough / Tees, Esk & Wear Valleys NHS FT (TEWV) Would not meet the requirements of CORE 24. This is unchanged from 2016. York Teaching Hospital – York / Tees, Esk & Wear Valleys NHS FT (TEWV) Close to CORE 24. This is a change from 2016 when the service would not meet the requirements of CORE 24. SYB Barnsley Hospital / South West Yorkshire Partnership FT (SWYPFT) Would not meet the requirements of CORE 24. This is unchanged from 2016. DBH – Bassetlaw General/ Nottinghamshire Health Trust Would not meet the requirements of CORE 24. This is unchanged from 2016. DBH – Doncaster Royal Infirmary / Rotherham Doncaster and South Humber NHS FT (RDASH) Would not meet the requirements of CORE 24. This is unchanged from 2016. Rotherham General/ Rotherham Doncaster and South Humber NHS FT (RDASH) Would not meet the requirements of CORE 24. This is unchanged from 2016. Sheffield Teaching Hospitals / Sheffield Health & Social Care NHS FT (SHSC) Close to CORE 24 WY H Bradford Teaching Hospitals – Bradford & Airedale / Bradford District Care FT (BDCT) Would not meet the requirements of CORE 24. Unchanged from 2016. Leeds Teaching Hospital NHS Foundation Trust / Leeds and York Partnership NHS FT Very close to meeting the requirements of CORE 24 and with additional work would meet the requirements of a comprehensive service. This is a slight change from 2016 when the service was close to meeting the requirements of CORE 24. Calderdale & Huddersfield NHS FT / South West Yorkshire Partnership FT (SWYPFT) Very close to CORE 24. This is unchanged from 2016. Mid Yorkshire Hospitals NHS Trust/ South West Yorkshire Partnership FT (SWYPFT) Close to meeting the requirements of CORE 24. This is unchanged from 2016. Harrogate And District NHS Foundation Trust / Would not meet the requirements of CORE 24. This is unchanged from 2016.

Y&H Summary – Workforce Totals

10 20 30 40 50 60 70 80

Total of All WTE members of the LMH Service, per Provider, comparison of 2016/17 and Core 24

Overall total of all members of the liaison mental health service (WTE Basis) 2016 Overall total of all members of the liaison mental health service (WTE Basis) 2017 Core 24 Note:

• Humber: The workforce return has been amended from 2016 to reflect CORE24, last year Consultants from General liaison were also added on, however they

are an outpatient service and do not routinely see patients on the ward.

• Navigo: The 2016 return included staffing for all adult acute mental health (mental health inpatient, crisis, home treatment) and the significant reduction in

staff simply reflects a more accurately completed document this year.

• Sheffield: A service was in place in 2016 however a procurement process was underway and therefore the Survey was not completed.

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Workforce: Good Practice

Kate Chartres Nurse Consultant, Sunderland Liaison Team/ Network Clinical Lead, NHS England

Workforce Development in

Liaison Psychiatry

Kate Chartres, Nurse Consultant

What are ‘CORE’ services?

3 main areas of work:

 Direct patient care (assessment, diagnosis and provision of mental healthcare for patients referred to the team).  Support and training to general hospital staff relating to mental health needs.  Interfacing with other parts of the health and social care system.

WHAT DO LIAISON TEAMS NEED TO DO?

• Behavioural management?
• Education, advice, positive behaviour support,
• Nurse led clinics.
• Risk assessment? Intuition, gut feeling.
• Formulation? Holistic assessment of needs.
• Diagnosis?
• Engagement/ presence and individual creative way’s that guide
• thers back to themselves. In whatever way works for them.
• Liaise and advocate.

Continued…

• Urgent and Emergency Care?.
• With long term conditions?
• With unexplained symptoms?
• Psychology
• Low intensity workers…
• Support workers
• Peer support

‘Growing your own Liaison nurses’

The concept and outcomes

Using the competency framework

Competency Framework for LMHN PLAN education/ training assessment and consultation Conducting MH assessment (18.1), person-centred care planning (18.2), Use of therapeutic approaches in assessment (18.2) assessment of risk including self-harm Awareness of risk (17.2), Conducting MH assessment (18.1), Assessing & managing risk (18.1), Understanding self-harm & suicide (18.1), Suicide awareness (18.1), Use of therapeutic approaches in assessment (18.2) nursing assessment and patient’s capacity Conducting MH assessment (18.1), Use of legal frameworks (18.1), Use of therapeutic approaches in assessment (18.2) identifying and considering ethical issues providing nursing advice on legal issues Use of legal frameworks (18.1) interventions used in LMHN MH & stigma (17.5), awareness of LMHT response to major incident (18.2) admission and discharge of patients maintaining accurate records, documentation and report writing Information sharing & confidentiality (17.3) advice on the management and care of patients with complex psychosocial and/or challenging presentations Detecting & Managing Acute disturbance (18.1) nursing advice on medication working with people with specific physical illnesses Understanding the interface of complex physical & psychological problems (18.2), Adjustment to illness (18.2) working with older adults Ageism & stigma (17.6), working with older people (18.1), Detecting & Managing Acute disturbance (18.1), Protection of vulnerable adults & children (18.1), Suicide awareness (18.1) working with people with a substance misuse problem Detecting the misuse of drugs & signposting (18.1) working with people with specific psychosomatic disorders Recognising & managing medically unexplained symptoms (18.2) working with people with learning disabilities Protection of vulnerable adults & children (18.1), needs of people with learning disabilities (18.2) working with mothers and babies Protection of vulnerable adults & children (18.1) working with children & young people Working with 16-18 (18.1), Protection of vulnerable adults & children (18.1), Suicide awareness (18.1) education, training, and supervision evaluating LMHN provision Diversity and equality issues (17.4 /18.2), Recognising special needs (17.6) , Emotional responses to trauma (18.2) Organic disorders (18.2) Nutrition and diet (18.2), Eating disorders (18.2), Pain

• management. (18.2)

38

Training skills star for liaison

• Developed based on review of the band 6

workforce.

• Using competency framework
• Gap analysis based on what we think we need,

still being developed.

• We know who needs what training, reviewed

annually.

• Currently developing this for support staff and

wider team.

SKILLS TRAINING STAR LIAISON PSYCHIATRY

Recovery Training WRAP/Belief in recovery Behavioural family work Communication skills Difficult situations

Assessment/ formulation and recovery care planning

Dementia Awareness and managing challenging behaviour

DBT Skills Dual Diagnosis – awareness Understanding and Intervention session Medication legal issues

Specialist level training i.e. 1 of or more CBT/Family intervention/ Dual diagnosis/ structured clinical management/solution focused therapy/ acupuncture and/ NLP/ EMDR Physical health training Foundation Intermediate Advanced

• 1. Not Stated
• 2. In Training
• 3. Completed Standard

1 2 3

Training and induction…

• New starters come in to a weeks

induction.

• The trust wide induction is a weeks course

trained by our experts within Liaison Services and our wider trust colleagues for specific areas.

• Enhanced by simulation and PLAN

suggested areas of training.

The induction week is enhanced by

• Working half time across each part of the service.
• Emergency and Liaison.
• Initial Assessments are completed jointly, initially
• bserved, then as skill is developed.
• Brief psychological intervention’s are developed
• ver time and with training available in house and

externally for Liaison Visits.

Build in work with other specialist nurses where possible

• Stroke nurses
• COPD/ respiratory nurses
• Cardiac speciality/ Diabetes and Renal as

we develop.

• Use the competency framework in

supervision and review annually.

Expansion and future development

• Outpatient Clinics
• Developing a team response to LTC’s and

MUPS/ Persistent physical symptoms.

What is the function on the Liaison leadership forum within the Clinical Network.

Liaison leaders hip forum Commissi

• ners

Support and informati

• n

sharing STP Clinical resource

Providers Sharing best practice and concerns

NHS England Conduit for intelligenc e to and from providers.

What is the function on the Liaison Practitioner forum within the Clinical Network.

Liaison Practitio ner forum

Share training packages/ innovatio ns Support with better ways of collecting data to enhance

evidence

base.

Sharing best practice and concerns

Act as a support group/ reflective practice forum

Current work

• Two meetings, next 14th September,

bimonthly meetings.

• Presentations of good practice, COPD,

Frequent Attendee’s, Older Persons post discharge team etc.

• Clinical case discussion.
• Interface with CRHT
• Documentation standards including safety

planning.

Current work continued

• FROM-LP uptake and support in terms of

delivering

• Peer support across the network

(particularly for lone working night staff)

• Liaison psychology
• Developing support workers
• Team and Acute Trust training strategies
• National and Regional updates

www.england.nhs.uk

Developing a Liaison Practitioners Forum

All

www.england.nhs.uk

Go to the Yorkshire and the Humber Clinical Network website here: www.yhscn.nhs.uk Click the orange ‘forum’ tab at the top right of the page Fill in the form on the right side of the page In the interested network section, select “Adult Mental Health” from the drop down box and then in the categories section select “Liaison Mental Health Network Forum” Create a password Once registered, in approx. 1-2 working days you will receive an email to let you know you have access to the forum Log on to the forum and you should be able to see the heading ‘Liaison Mental Health Network Forum’ and all posts for this group

Liaison Mental Health Online Network Forum – how to register:

www.england.nhs.uk

Time for a break?

15 minutes only please!

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Wave 1 Updates

Psychiatric Liaison Wave 1 - Mid Yorkshire

James Waplington, SWYPFT Alix Jeavons, Wakefield CCG

The Bid

• Two Advanced Nurse Practitioners to support people with

complex physical and mental health conditions

• A nurse with a special interest in substance misuse and mental

health to provide education and support to the team

• Project support to develop pathways and protocols

The challenges

• “Localising” national guidance – be clear on what you’re

trying to achieve and for what purpose

• Recruitment

– Agenda for Change – Cross organisation prescribing

• Data
• Existing culture
• Governance

LIAISON CORE 24

Sheffield Health Community

Sheffield Health & Social Care NHS Foundation Trust

∗ Current Position ∗ PLAN ACCREDITATED

∗ Project structure in place ∗ Staff recruited to implement Core 24 (Induction phase) ∗ Consultation under way for existing staff ∗ Medical recruitment – exploring options for provision ∗ Supported Discharge - service extended ∗ Extended IAPT offer – implementation phase ∗ Training packages under development ∗ Data requirements and coding quality under review

Liaison Core 24

∗ Future Plan

∗ 24/7 A&E cover from December 1st ∗ Twilight cover on admissions units and wards ∗ Extended medical provision in place ∗ Pathway development linked to

∗ IAPT investment ∗ Crisis Hub development

∗ Training packages to be available to STH ∗ Accurate coding ∗ Data collection to evidence system wide savings linked to Liaison development

Liaison Core 24

∗ Successes: Recruitment of 6 Liaison Practitioners Recruitment of 2 Support Workers Effective and motivated workforce Access targets achieved Across the age range working Education and training to support the whole range service working

LIAISON CORE 24

∗ Challenges: ∗ The recruitment process (Internal and external) ∗ Data collection across two systems to evidence savings ∗ A&E CQUIN ∗ Release of A&E staff for training ∗ Logistics of increased service offer

LIAISON CORE 24

no Risk Mitigation 1

Failure to recruit nursing staff

• Well established respected service. PLAN accreditation already

sought.

• Comprehensive induction in place.
• Ongoing peer support and mentoring arrangements established.
• Robust CPD schedule in place.
• Supervision scheduled on a routine basis with debriefs undertaken

weekly or as required.

• Student nurse placements supported and a band 5 rotation system

established to support the development of junior staff.

• Strong nurse/medic leadership arrangements.
• Collaborative team approach fostered.
• Established training plan with Acute Trust already in place.

Liaison Core 24

no Risk Mitigation 2 Failure to recruit medical staff

• Well established respected service.
• Supported and supervised by consultant posts.
• Training grades currently within the service.
• Comprehensive training and development supported.
• Well established links with medical staffing in related teams.
• Post will offer a variety of experiences in acute mental health across

the age range 3 Failure to achieve the response times specified

• Recruitment to required staffing levels.
• Robust referral triage system in place.
• Pathways established and embedded to ensure appropriate

response.

• Access to crisis care outside of A&E (ie home treatment teams, out
• f hours team)to prevent avoidable A&E attendances.

4 Failure to collect required data to evidence achievement of targets and system savings

• Dashboard already established.
• Electronic records embedded.
• Response times collected

Liaison Core 24

Transformation Bid Development & Service Implementation Process LMHT ‘Core 24’ Service Development

Background

 Service development throughout TEWV contract

 Identified under developed & under resourced service @ Commencement (based on funding, performance & demand data)  ‘Pump Priming’ monies (bid team ‘genesis’)  Costed Business Case developed for enhanced service  Ongoing communication throughout interim period

 Consensus across all stakeholders (TEWV/CCG/LYPFT)

• f need for service development (however tensions about

how!)

Bid Development Process – Key Points (1)

 Existing momentum – early start  Clinically/Service led process throughout  ‘Broad Based’ bid team (but small) – full corporate support  Evidence based process:

 Clinically – build on existing, aligned with national & regional

• bjectives i.e. STP, A&E Improvement Plans

 Supporting infrastructure – governance, recruitment, finance  Identified Savings – realistic & realisable

 Not developed in isolation – engaged with CCG & acute trust throughout

Bid Development Process – Key Points (2)

 Understanding & honesty about existing service & resource  Be realistic about level of award & funding available  Robust Challenge process throughout:

 Limited word count – need to be ruthless!  Used MuSCoW approach  All aspects challenged by all team i.e. clinical, finance, governance…

 ‘Golden Thread’ approach:

 Ties bid together  Recognises scoring approach

Post Bid Implementation Process (1)

 ‘Seamless’:

 Activity & communications not stopped after bid  Implementation aims & objectives reflect bid commitments – ‘REALISTIC’  Define relationships & responsibilities

 Performance measures:

 Clear, concise, practical & baselinable  Reflects bid commitments i.e. relevant  Do not create an industry

 Implementation Steering Group

 Includes bid team development members  Expand to include key stakeholders  Acute Trust i.e. ED Service Managers, Operations/Performance Manager  CCG  Liaison team Consultants & Managers (inc. in-ward staff)  Defined ToR

Post Bid Implementation Process (2)

Summary

 Difficult, if not impossible, to develop successful bid if significant work not already done  Bid MUST be led by the service  Engagement with stakeholders is key - THROUGHGOUT  Maintain momentum post-bid

 Retain Core bid team within implementation process  Recruitment timescales critical

 Sustainability - performance metrics/measures key

www.england.nhs.uk

Wave 2 Updates

Y & H Network Liaison Mental Health Core 24 Wave Two Bid

Simon Robinson Nurse Consultant Acute MH Care Barnsley

Core 24 Wave Two Bid

• Current Position in Barnsley
• Demand and Capacity

– Demand – Staffing Provision

• Impact of the ED CQUIN
• What Next
• Conclusion/ Bottom line

www.england.nhs.uk

Wave 3: Guidance for non-Core 24 sites

LMH Clinical Lead for Y&H MH Clinical Network, and Liaison Psychiatrist, TEWV

www.england.nhs.uk

• MH Task Force Report Recommendation 18 –
• By 2020/21, no acute hospital is without an all-age MH liaison service in

ED and inpatient wards AND at least 50% of acute hospitals are meeting Core 24 service standards as a minimum

• Idealistic view - 24/7 ED requires 24/7 dedicated MH service – evidence

and rationale understood & outlined in NICE guidance BUT…

• Unrealistic in current economic climate with ongoing liaison workforce

constraints - perhaps not all can/ should ultimately achieve Core 24

• NHSE will not be issuing further guidance/ service specification for

smaller services - maintain that all acute trusts should have Core 24 or at the very least, provide a 24/7 responsive service

• So what are the problems for these services?
• Are there possible solutions/alternatives/ suggestions to aid their case?

Core 24 – to be or not to be…?

www.england.nhs.uk

• Proven clinical benefits: NICE-recommended care, expert, compassionate

response, better patient experience, care planning and links to community mental health services, identify and treat (many) underlying mental health needs of physical health presentations in acute hospitals

• Proven financial / productivity benefits: reduced LoS, reduced admissions,

reduced re-attendance rates

• 5% of attendances for MH as primary reason for attendance, many more with underlying MH

needs - 75% of most frequent attenders have secondary MH needs

• Repeated evidence to show that there is high demand ‘out of hours’
• most MH ED attendances between 5pm and midnight (Royal College of EM)
• Most mental health admissions via EDs are between 10pm and 7am (CQC)
• MH Liaison is more than UE response – it is about working alongside physical health

pathways – ‘inreach’ from crisis/ CMHT is not the same

• On-site services help build relationships – breaks down stigma, aids training
• Impact on KPIs – need to be close to achieve target response times, have an impact on

breaches, avoid ‘backlogs’

• Shared data sets and IT systems
• Shared goals e.g. CQUIN, Treat As One
• Many testimonies about benefits of becoming 24/7 once it has happened – recently

Northumbria HCFT credited decision to move to 24/7 as one of key factors in outstanding CQC rating for hospital

Evidence for Core24 services

www.england.nhs.uk

• There is still the expectation that each service will improve beyond the baseline,

both in investment, workforce/ skill mix & functionality

• How this is done, depends on: EVIDENCE

1. What is local demand & how does this measure against capacity? 2. Can the service evidence the short-fall and how do they ensure this is accurate? 3. What is their current/ projected future investment?

• Possible suggestions

1. Consider alternatives e.g. CORE as minimum standard with 1 LMHN overnight 2. An extended hours service with CRHT cover out of hours if there is minimal demand for dedicated 24/7 liaison cover – may fit in with CRHT/ local plans 3. Bespoke service which suits local needs e.g. Bradford’s 1st Response Service

• Challenges

1. Unclear how this will fit with Wave 2 TF 2. Need to ensure acute/ mental health trust/ CCG/ public are confident proposed local model will meet demand & provide a quality service 3. 2-tier services/ ‘postcode lottery’

But back to reality – suggestions for smaller services…

78

Reminder Core vs. Core 24 workforce

Core Core 24 Example Number of Beds c 500 c 500 Consultants 2 2 Other Medical 0.6 2 Nurses 2 Band 7 6 Band 6 6 Band 7 7 Band 6 Other Therapists 4 Team Manager Band 7 1 1 Clinical Service manager Band 8 0.2 0.2 - 0.4 Admin Band 2, 3 and 4 2.6 2 Business support (band 5) 1 Total Whole Time Equivalent 14.4 25.2 - 25.4 Hours of Service 9-5 24/7 Age 16+ 16+ Older Person Yes Yes Drug and Alcohol No Yes Out Patient No No Specialities No No

• Approx. Costs

£0.7M £1.1M

www.england.nhs.uk

• Link smaller services to areas of excellence, ‘hub and spoke’ model
• Encourage shared learning and transfer of skills
• Encourage/ reward innovation & collaboration – CCGs and acute/ MH trusts
• Upskilling non-MH staff e.g. MH First Aiders
• Use of technology e.g. telemed/ video links for rural services
• Further research/ economic analysis – ?apply locally & avoid repetition
• Sharing data/ information – ask questions, share ideas & best practice
• Upcoming national guidance for Urgent and Emergency Mental Health Care

Pathways – likely impact on LMH services, especially smaller services - need to work closely in coming months with Crisis Care colleagues

• Further discussion at Liaison Faculty meeting & strategy day Nov 17
• LPSE-4 possibly commencing later this year – will provide national picture
• Any more suggestions from today’s audience?

Further suggestions – recent LMH workshop for smaller services

www.england.nhs.uk

Discussion Waves 1-3

What’s worked What hasn’t Links to STPs Debunk myths

www.england.nhs.uk

Next Steps and Closing Remarks

Dr Katie Martin, LMH Clinical Advisor, Yorkshire and the Humber Clinical Networks and Consultant Liaison Psychiatrist, Tees, Esk and Wear Valley NHS FT

www.england.nhs.uk

Yorkshire and the Humber Liaison Mental Health Network

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