Welcome to Mersey Care

Welcome to

Mersey Care WHO WE ARE. WHAT WE DO. THE AMBITION WE ARE DRIVEN BY.

WHO WE ARE Here at Mersey Care promoting mental and physical health and wellbeing is our core business.

We serve more than 11 million people, offering specialist inpatient and community services that support mental health, learning disabilities, addictions, brain injuries and physical health in the community, and we are one of only three trusts in the UK that offer high secure mental health facilities.

Since summer 2016 we have successfully become a foundation trust. We acquired specialist learning disability services provider Calderstones Partnerships NHS Foundation Trust in 2015 and more recently became a provider of local community physical health services in Liverpool and Sefton and mental health services in HMP Liverpool.

At the heart of all we do is our commitment to ‘perfect care’ – care that is safe, effective, positively experienced, timely, equitable and efficient.

We support our staff to do the best job they can and work alongside service users and carers to design and develop future services together. We’re currently delivering a programme of organisational and service transformation to significantly improve the quality of the services we provide and safely reduce cost as we do so.

We call this continuous improvement in quality and cost, ‘striving for perfect care’.

Our aim is to play a full part in the health and social care economies we serve, by promoting and driving greater integration between mental and physical health and social care.

In 2017 the CQC rated us as ‘good’ overall.

We have also won the National Patient Safety Awards prize for Changing Culture.

It’s an exciting time to be part of Mersey Care.

2

OVERVIEW OF MERSEY CARE PERFECT CARE • • • •

Mersey Care’s ambition is to strive for perfect care for the people we serve.

We have set ambitious goals in pursuit of this:

Adopt a ‘No Force First’ approach (avoid physical restraint, including medication led restraint) Zero suicide for those in our care Improve physical health for our service users Implement a Just and Learning Culture.

CIRCA

8K STAFF £ 2018/19

Serve a population of

in North West England and beyond

Working in Partnership to integrate physical and mental health

TURNOVER

£370M

1 OF 3

providers of high secure services

Largest provider of learning disability forensic secure care

100 STUDIES

Thriving research and development programme from drug trials, bibliotherapy, app development to genomics

FOR OUR LOCAL SERVICES

97% of all contacts are in the community

CQC OVERALL ‘GOOD’ Only high secure hospital to receive ‘good’ for safety

3

Nicky Taylor cares for her mum Maud, who has dementia and her dad Ted, who has physical health issues. The family is supported by the local community health team and a mental health liaison nurse.

“The team is incredible; they do a fantastic job and always go that extra mile. They’ve been there from the

4

outset, looking after both mum and dad and helping me to understand mum’s awful illness. To have a team of professionals who help when you’re out of your depth is so reassuring, to be able to pick up the phone and know they’ll be there. They understand…they make a difference.”

INTEGRATING PHYSICAL AND MENTAL HEALTH We work with primary care to join up physical and mental health care. We have mental health liaison nurses in A&E and we are finding ways to support people on our mental health wards who have a physical health problem. But there’s still scope to increase the access and the experience of receiving care for people with both mental health and physical health issues.

This different way of thinking includes recruiting physician associates with a ‘mixed’ skill set who take a holistic approach, caring for the physical wellbeing of patients while they are on mental health wards.

We want to take opportunities to work with primary care and to join up physical and mental health care.

“Every contact counts and this is the type of contact everyone should have.”

Consultant Psychiatrist Dr Arun Chidambaram

5

STRIVING FOR PERFECT CARE

Our ambition is to deliver Perfect Care. This means setting our own standards and goals for improvements in care rather than aiming to meet minimum standards set by other organisations.

On a day to day basis, this means getting the basics of care right consistently, repeatedly and predictably, for example when a service user receives information about their appointment, when medication is dispensed, when care plans are produced.

“They are using the notion of pursuing perfection to transform the way they provide healthcare.

To change from a ‘business as usual’ type of model to a totally different way of working.”

Ed Coffey, Professor of Psychiatry and Neurology, Wayne State University School of Medicine, USA

6

OUR PERFECT CARE GOALS

ADOPT A

NO

FORCE FIRST APPROACH

ZERO

SUICIDE FOR THOSE IN OUR CARE

(AVOID PHYSICAL RESTRAINT, INCLUDING MEDICATION-LED RESTRAINT)

IMPLEMENT A

JUST LEARNING

CULTURE

0

IMPROVE

PHYSICAL HEALTH

We have established a Centre for Perfect Care and Wellbeing, whose mission is to help our staff continuously improve the services we provide today, whilst addressing the mental health and wellbeing challenges of the future. Visit the website at: centreforperfectcare.com

NO FORCE FIRST Our award winning ‘No Force First’ initiative to eliminate the need for seclusion and restraint on people who are mentally ill is bringing about efficiencies through lower

unplanned care costs and fewer staff absences. We now have one of the lowest rates of restrictive and face down restraint in our region.

“No Force First helped me towards a no force future.”

Ashley Power, former patient at Ashworth Hospital (you can see Ashley’s film on Mersey Care’s YouTube channel).

7

ZERO SUICIDE

“If zero isn’t the right number then what is?”

We are the first mental health trust in the UK to publicly commit and develop a policy to have zero suicides among people in our care by 2020. At Mersey Care: • Every patient who has had a history of intent or self-harm now receives a personalised “safety plan” and a specialised team continually monitors those at highest risk • we aim to complete post-suicide reviews within two weeks • patients who have self-harm injuries receive therapies on the spot at A&E and follow up when they go home • we’re developing a suicide prevention mobile phone app with Stanford University, which would provide roundthe-clock support. Staff, including non clinical staff, have undertaken suicide awareness training. We launched the Zero Suicide Alliance backed by leading businesses and politicians from all parties in November 2017 (see page 10).

8

We teamed up with McLaren Construction to help address the alarming suicide figures for men who work in the construction industry.

Our inspiration is the Henry Ford Health System in Detroit which screens every patient for risk of suicide, not just those who have mental health issues.

Improved staff training, increased contact with patients and better education for families of people deemed to be at risk saw the suicide rate among its patient population fall by 75 percent within four years. Seven years after it began they had eliminated all suicides among patients in their care.

“Let me go home when I’m ready, not when the system’s ready.”

IMPROVING PHYSICAL HEALTH Our Safer initiative, which helps people leave hospital when it’s right for the patient rather than the system, has been held up as a national example of good practice in Parliament.

be discharged, we’ve already liaised with our community teams to create a robust plan for the person to continue their recovery at home.

If someone’s medically ready for discharge but for some reason stays longer, they can actually become less well.

Integrating services means that when someone is ready to

We have recruited physician associates with a ‘mixed’ skill set who take an holistic approach, caring for the physical wellbeing of patients while they are on mental health wards.

A JUST AND LEARNING CULTURE

We’ve learned from academics and experts and applied it to our work so we can deliver friendly and accountable care.

Mersey Care is developing a reputation for its work creating “a just and learning culture”. For us, this is an environment where we put equal emphasis on accountability and learning. It’s a culture that instinctively asks in the case of an adverse event: ‘what was responsible’, not ‘who is responsible’. It’s not finger pointing and it’s not blame seeking. That said, a just and learning culture is not the same as an uncritically tolerant culture where anything goes - that would be as inexcusable as a blame culture.

We’ve seen a massive drop in disciplinaries and an increase in innovation as the process of changing the organisational culture for the benefit of staff and service users.

9

ZERO SUICIDE ALLIANCE

17 people kill themselves every day in the UK. Three quarters are men.

The impact on family, friends, workplaces, schools and communities can be devastating; it carries a huge financial burden for the local economy and contributes to worsening inequalities.

END THE SILENCE END SUICIDE

We are part of the Zero Suicide Alliance (ZSA) a coalition of like minded partners determined to work together and share best practice to help rid the UK of suicide.

Partners include mental health organisations, emergency services, local government, charitable enterprises, major employers and community groups. zerosuicidealliance.com Source: Samaritans suicide statistics report 2017.

SAVE A LIFE TAKE THE TRAINING Because ONE life lost is ONE too many

10

We’ve developed a 20 minute online suicide awareness package with the Zero Suicide Alliance to equip people to have a real conversation and help to prevent the heartbreak of suicide for people in this country.

BIG BREW OUR CAMPAIGN TO TACKLE STIGMA No-one likes to talk about suicide. But that’s why people who are in need of help don’t ask. The Big Brew is a national campaign aimed at shattering stigma by getting more people talking about suicide, sharing thoughts and offering support.

Coping can start with a cuppa. It’s only a tea bag but it can be a lifeline. A small display of kindness, like the offer of a brew and the conversation that follows, could be the first step to helping someone.

Everyone can get involved.

1

ACCEPT OUR #BREWFIE CHALLENGE

2

TAKE A ‘MUG-SHOT PICTURE’ WITH YOUR BREW

3

4

UPLOAD THE IMAGE TO SOCIAL MEDIA USING #BREWFIE

Help us break the stigma around speaking out about mental health and suicide, by spreading the word!

NOMINATE THREE FRIENDS TO DO THE #BREWFIE CHALLENGE

11

GLOBAL RECOGNITION Mersey Care is a Global Digital Exemplar (GDE). These are internationally recognised NHS care providers which deliver exceptional care, efficiently, through the world class use of digital technology and information flows, both within and beyond their organisation’s boundary. In 2017 we successfully attracted £5m of central NHS funding to accelerate our ambition to digitally transform our services.

As a GDE we have pledged to use technology and digital systems in all aspects of our services and we are designing systems and apps with the insight and co-production of our service users and staff. We are developing tools for clinicians, apps to engage with service users and standardising clinical pathways to reduce risk and variation where appropriate.

The GDE programme is led by Dr David Fearnley, Mersey Care’s Medical Director, who is also the Chief Clinical Information Officer for the Trust. We are working alongside other local NHSE global digital exemplars Royal Liverpool and Broadgreen University Hospital Trust and Salford Royal NHS FT.

12

In 2017 we successfully attracted £5m of central NHS funding to accelerate our ambition to digitally transform our services.

WE’RE ALL ABOUT RECOVERY

We have adopted the principles of recovery in all parts of the organisation including, in a ground breaking initiative, to our most difficult and dangerous patients, in high secure services.

Experiences of mental illness really can provide opportunities for change, reflection and discovery of new values, skills and interests that help people build their future. Our Recovery College is not a college in the traditional sense, but a place where courses, learning programmes and activities are designed to recognise, develop and make the most of people’s skills and achieve what they want in their lives.

Because we aim to reduce the stigma of mental health in communities, courses are run in community venues (see Life Rooms page 14). The college has also been adapted for people while they are inpatients at our hospitals.

13

LIFE ROOMS Life Rooms former Walton Library

The Life Rooms model was developed to raise our ambitions. Rather than simply stabilise health conditions, to give people the hope, control and opportunity that leads them to a meaningful life of their own.

Each Life Rooms reflects its unique community; we’ve listened to established groups who know the landscape and the people.

The Life Rooms hosts a range of services including: • An employment and enterprise hub to help Mersey Care service users and people in the local community get back to work through employment support, volunteering opportunities and further education • An advice area offering information and support about physical and mental wellbeing, advice on money, housing and community services, including sessions for Liverpool City Council and other agencies • A library for health and wellbeing, learning, literature and poetry operated by volunteers who are service users • A children’s library area for schools and children’s centre use • Meeting spaces for community groups • A free IT suite for everyone to use.

Our first Life Rooms was established at Walton Library (earmarked for closure by the local authority) as a centre for recovery and social inclusion and was sensitively refurbished and re-opened in 2016. Our second is in Southport, a seaside community with a large elderly and Eastern European population. The third Life Rooms in Bootle, is a collaborative project with further education provider Hugh Baird.

14

A NEW GENERATION OF MENTAL HEALTH HOSPITALS

Clock View Hospital

MSU exterior We are leading in the development of a new generation of mental health hospitals that are designed to improve recovery, wellbeing and reduce lengths of stay.

Our ÂŁ25 million Clock View Hospital, opened in March 2015, which exemplifies our commitment and ability to provide therapeutic environments and approaches to care. New hospitals are to be built for our communities in Southport and in Liverpool and work has begun on our new medium secure unit at Maghull health park.

Our addictions service inpatient detoxification facility has been extensively refurbished and renamed.

MSU bedroom

Brain Injury Unit

15

OUR SERVICES

ADULT MENTAL HEALTH SERVICES We provide adult assessment and immediate care, acute mental health inpatient services and rehabilitation services. We work closely with GPs and other referrers in order to signpost to the most appropriate care setting.

ADDICTION SERVICES We provide specialist community and inpatient drug and alcohol services.

Our community assessment, advice and information and community detoxification programmes combine with a recovery focused approach to care planning and delivery. Our inpatient service offers medically assisted detoxification programmes for people 16

with complex problems and those who are unable to detoxify from alcohol and drugs within the community and need 24 hour care to enable them to do so.

BRAIN INJURY AND TRAUMA REHABILITATION

We offer assessment, treatment and care for people with an acquired brain injury, including cognitive and ATTENTION DEFICIT psychological/behavioural rehabilitation.

HYPERACTIVITY We have unrivalled expertise in this DISORDER AND field and our brain injury rehabilitation ASPERGER SERVICES centre has approved provider status by Diagnosis and support is offered to Headway, the national brain injury people living with Asperger’s Syndrome, association.

Attention Deficit Hyperactivity Disorder and other neuro developmental conditions. Our person centred care uses creative interventions which help with the social and communication difficulties faced by people with Asperger’s and ADHD, their families and carers.

COMMUNITY MENTAL HEALTH Our community mental health teams work with people with severe and enduring mental health issues as well as those with less severe illness who have not responded to interventions from primary care services. They offer flexible, responsive and proactive integrated services to individuals with severe and complex mental and behavioural disorders.

COMMUNITY NURSING Our community nursing services include bowel and bladder nurses, community DEMENTIA AND MEMORY matrons, district nurses, palliative care SERVICES nurses, infection control nurses and Our community and hospital based intravenous therapy nurses. services offer specialist assessment, medication, post diagnostic support, peer support groups and courses for RESPIRATORY SERVICE carers. Our treatments are recommended This specialist rapid access service by the National Institute for Health helps people with a diagnosed and Care Excellence and our memory respiratory condition to manage their services are accredited by the Royal condition and prevent exacerbation College of Psychiatrists. We are a of their symptoms. partner in the Innovate Dementia project, which produced a human rights based assessment and care planning tool for people with dementia.

DIETETICS AND NUTRITION SUPPORT We offer evidence based assessment, advice and individualised treatment for people with clinical conditions and allergies.

DIABETES SERVICE Specialist diabetes team works with other community health care professionals, such as district nurses and community matrons, to provide the right support for people to manage their diabetes.

DENTAL HEALTH Our dental service supports people who have difficulty getting treatment in high street dental practices, or require treatment not available in a general dental care setting.

“Our biggest strength is the pioneering attitude of our leaders, the sheer quality, across the board, of our diverse range of services�

Joe Rafferty Chief Executive Mersey Care NHS Foundation Trust.

17

OUR SERVICES

(CONT)

EARLY INTERVENTION IN PSYCHOSIS We support young people between 14 and 35 who are thought to be experiencing their first episode of psychosis, or appear to be at increased risk of developing psychosis. Our teams include mental health practitioners who are from a mental health nursing, social work or occupational therapy background, consultant psychiatrists, psychologists and pharmacists.

EATING DISORDERS We offer specialist assessment, psychological education and outpatient therapy to men and women aged 16 and over who have psychological difficulties associated with eating including anorexia nervosa, bulimia nervosa, binge eating disorder and a typical eating disorder.

FAMILY SUPPORT Our services to support and safeguard families include health visitors, school nurses and link nurses for children not in school.

18

HEART FAILURE SERVICE

INTERMEDIATE CARE

A specialist service provides patients in heart failure with support, care and understanding of their condition to optimise anti-heart failure therapies, reduce hospital admissions and improve quality of life.

Multi-disciplinary teams support people and their carers when they are in transition between hospital and home, or have entered some kind of health and/or social care crisis at home.

HOMELESSNESS SERVICES The Homelessness Outreach Team reaches out to homeless people in Liverpool with mental health problems, working with them on their mental health and linking them into support services.

HOSPITAL MENTAL HEALTH LIAISON 24 hour support is offered to people who are identified at A&E departments as having a mental health issue as well as a physical health problem, and frail older people who need mental health support as part of their discharge plan.

IMPROVING YOUNG PEOPLE’S MENTAL HEALTH We are leading a partnership to build links, improve knowledge and understanding and design a youth mental health service model with planned whole service redesign to ensure young people receive the right interventions, by the right staff at the right time to promote recovery.

INTENSIVE COMMUNITY CARE

LIAISON AND DIVERSION SERVICES

Our liaison and diversion services Intensive care is offered at home to assess and support adults and children people who would likely otherwise be aged ten years and upwards, who admitted to hospital, or those ready to come into contact with youth and be discharged. criminal justice systems, where their mental health problems, learning disability, substance misuse problems LEARNING DISABILITIES and other vulnerabilities are identified Highly specialised inpatient and as factors in their offending behaviour. community services are offered to people with learning disabilities and complex needs, (including forensic NEUROPSYCHIATRY AND needs). Human rights based services NEUROPSYCHOLOGY are uniquely designed to enable We provide neuropsychiatric and people to be supported in their own neuropsychology assessments and community, preventing the need and treatments to patients affected by expense of out of area packages. We trauma that result in complex mental care for adults who require care in health problems such as depression, conditions of medium and low security anxiety, psychosis, or adjustment including offenders detained under the reactions.

Mental Health Act who present a risk to themselves or others.

OCCUPATIONAL THERAPY The service supports people to maintain or increase their level of independence and ability to carry out daily living tasks, and to manage long term and life threatening health conditions at home to avoid hospital admission.

OFFENDER HEALTH Assessment, intervention services and group and individual therapy programmes are delivered by a team of highly specialised clinical and forensic psychologists with expertise in assessing and reducing risk of offending.

We offer specialist mental health services within the health centre at HMP Liverpool.

19

OUR SERVICES

(CONT) PHYSIOTHERAPY Our services improve quality of life for people with physical problems caused by accidents, ageing, disease or disability.

PODIATRY This service manages complications related to diabetes and other disorders that may affect the feet, arthritic conditions and those that affect circulation, nervous and musculoskeletal systems.

PSYCHIATRIC INTENSIVE CARE Patients who are suffering an acute episode of mental ill health receive intensive one to one care and support that may be needed to aid recovery.

PSYCHOLOGICAL THERAPY SERVICE – TALK LIVERPOOL We use a stepped care model to provide assessment and treatment for common mental health problems such as depression, generalised anxiety disorder, panic disorder, social phobia, obsessive compulsive disorder and other diagnosable mental health disorders.

20

PALLIATIVE CARE

PERINATAL

An holistic approach encompassing physical, social, psychological and spiritual wellbeing supports people with a palliative diagnosis and their families and carers.

This specialist service supports women who have serious mental health problems during pregnancy and in the first year after birth. The patient has access to evidence based treatments and frontline staff caring for local women to ensure consistent, high quality care.

“We know we have the right people. They’re a great team...”

Noreen Clarke perinatal mental health service lead.

PSYCHOTHERAPY AND PERSONALITY DISORDER SERVICE The service offers a more therapeutic alternative to inpatient services.

Skills based on reflective/exploratory psychotherapies are tailored to issues the service user wishes to work on or what they feel they need to change. A dedicated service for people diagnosed with a personality disorder includes a therapeutic day programme, crisis support and a transition group. Our specialist PD nurses support people whose personality disorder is more complex, so they don’t have to go further afield for treatment.

SECURE AND FORENSIC SERVICES We provide 24 hour specialised assessment, treatment, inpatient care, rehabilitation and after care for people who are mentally ill and within the criminal justice system. Consultant led multidisciplinary teams use a care planning approach in conditions of varying levels of security. A streamlined assessment for admission and discharge means patients experience responsive yet efficient care. In one year the average stay at Ashworth Hospital has fallen from over seven years to around five and a half years.

A similar situation exists in our medium secure services.

“I have the same life issues but since I got help I deal with them in a different way...”

Tammy psychotherapy service user.

21

OUR SERVICES

(CONT)

SEXUAL HEALTH SERVICES

TRIAGE CAR SERVICE

SUPPORTED LIVING

Our services offer confidential support, information and counselling including dedicated support for lesbian, gay, bisexual and trans (LGBT) communities and street based sex workers.

Up to a fifth of all calls to the police in Liverpool are related to mental health issues. Our triage car service involves a police officer and psychiatric nurse providing on the spot assessment and advice. This will increase specialist mental health support to help people in crisis. Patients detained on Section 136 of the Mental Health Act have reduced by over 40 percent since the introduction of triage cars.

People who have experienced severe and enduring mental illness, who have been in hospitals for long periods of time, have had repeated admissions to acute wards for treatment, have struggled to live in the community, receive intensive support to develop the skills to become more independent.

SPEECH AND LANGUAGE THERAPY People who are experiencing communication and/or swallowing difficulties are supported by experienced therapists.

The impact of triage car service...

22

VETERAN SERVICES

WALK IN CENTRES

Services from talking therapies to help with addictions are delivered with understanding, sensitivity and support by experienced and highly trained staff, many trained in veteran awareness or veterans themselves.

A Trust wide veterans’ advisory group of staff and service user veterans contributes to service developments, training, and information. We have a dedicated veteran lead who champions veteran issues across the Trust and we collaborate with local and national veteran charities.

Liverpool walk in centres provide consultations, advice and treatment for minor injuries and illnesses, as well as x-rays, emergency contraception and advice, and chlamydia screening for people under 25.

“Recovery can only happen if they get help to express their emotions…”

Mark Beddows veteran service nurse.

23

“We are a partner in the £5.4 million Innovate Dementia project that has been developed with eight partners from the Netherlands, Belgium, Germany and the UK.”

Mersey Care NHS Foundation Trust, V7 Building,

Contact Details Contact us at the following address.

Kings Business Park, Prescot, Merseyside L34 1PJ. Telephone: +44 (0)151 473 0303 Email: communications@merseycare.nhs.uk

MerseyCareNHSFoundationTrust