Clinical Effectiveness

to the Trust’s Quality and Safety Programme Board in Autumn 2020. The Trust is actively participating in the NCL Suicide Prevention Steering Group. A range of new NCL services, including a referral and support options and a Bereavement After Suicide Service will be launched in the later part of 2020

Next steps and timelines:

• Resumption of the Task and Finish Group

September

• Identification of Training Development

Project Role via Health Education England

Continuous Professional Development

Planner

• Sign off draft Suicide Prevention Plan

October 2020 • Review and Development of Electronic

Patient Record Risk Management

Documentation November 2020

• Development of virtual training December 2020

The review and development of the Trust’s clinical governance structure will include enhanced lessons-learnt processes and a dedicated steering group to review, support and learn from suicide deaths is recommended by the Task and Finish Group.

Priority 3: Clinical Strategy

The Trust has largely achieved many of the goals in the previous Clinical Strategy, including putting expert mental health teams into GP practices and developing specialist services for people with specific illnesses in order to strengthen the offer of evidence-based interventions. It is therefore a good time to refresh and evolve the strategy.

The two main priorities that we will focus on over the next few years are:

• Developing a model of integrated core community mental health services

• Improving patient flow and experience

We undertook a large exercise to hear the views of our service users, carers, staff and partner organisations to co-produce our revised strategy that addresses the ambitions of the NHS Long Term Plan and the Community Mental Health Framework for Adults and Older Adults. We reviewed the needs of our population and compared our services to national benchmarking data in order to understand where to focus our attention and investment.

At the peak of what we want to achieve are four broad outcomes:

• Good clinical outcomes for our service users and carers

• A satisfied workforce

• Being a centre of excellence in equality and diversity

• Financial sustainability

Our approach to clinical care will be:

• A recovery approach which means a strong emphasis on co-production of care with our service users and carers

• A trauma-informed approach that recognises the impact of traumatic events in the lives of people

• Offering evidence-based interventions

• Addressing drug and alcohol problems

We will expect all our teams to pay special attention to equality, diversity and inclusion. They will also prioritise co-production of their services with service users and carers. Our two main vehicles for improving and innovating will be through using Quality Improvement methodology and research.

Our proposed model requires investment to grow our teams in primary care to create core community mental health teams that are aligned to Primary Care Network populations.

A detailed analysis of each Primary Care Network population will enable us to tailor services so that they are right for that population. Everyone who works with people with mental health problems in a Primary Care Network population will function as a member of a multi-agency, multidisciplinary team or network.

Mental, physical and social support and interventions will be holistic and joined-up. We will use a strengths-based approach that will require detailed knowledge of community resources that people can be linked into. Evidence-based mental health interventions will be protected by having clinicians that specialise in interventions for people with particular conditions. The model also includes boroughwide intensive teams to work with people with very complex needs. There needs to be strong co-operation and easy flow between the intensive and core teams with an emphasis on population-based healthcare. The model requires newly designed community services operating longer hours and a stronger focus on prevention and recovery which will deliver more out-ofhospital care.

Our services will operate at three population levels; Primary Care Networks, borough-wide and cross-borough or wider. The main entry points will be through the core community mental health teams, the community acute and hospital liaison services, and directly into some teams who offer a service to well defined groups. The bulk of our work will happen in the community teams.

We aim to change the way our organisation is structured so that we naturally facilitate population-based healthcare.

Priority 4: Improving Physical Health

Physical Health & Infection Control

Focus for 2020 – Governance, Prevention and Management of COVID-19 with enhanced physical healthcare for all our services users across divisions to reduce risk and prevent complications.

Key components /Drivers

• Staff access to information and resources

• Training across Divisions, including upskilling staff for potential redeployment and potentially having to stand up services for the challenges of increased physical healthcare

• Delivery of Health Checks

• Staff Safety and Wellbeing

Activities

Capacity Physical Health and Infection Prevention and Control.

• Recruitment to Head of Nursing for Physical

Health & Infection Control with the addition of two band 7s, anticipated to be in post

for January 2021. In the meantime, the Trust has been committed to supporting teams and ensuring patient safety, with experienced interim staff.

• There has also been a commitment to buddy up with other MH Trusts in NCL towards standardisation and for patient safety.

• Infection Prevention and Control including the Flu Vaccination Programme Planning

• A continued priority for the Trust is to continue to respond to the challenges of Infection Prevention and Control and

COVID-19. Substantial investment has been made to developing the IPC Team, with recruitment of three additional posts, Head of Nursing for Physical Health and Infection

Control and two Band 7 posts.

• Alignment with DIPC Network and NCL

IPC critical Friend Network, and Consultant

Microbiologist to monitor, audit and develop IPC

• BAF COVID-19 – supported with one pager guidance and relevant links for timely, relevant, evidence-based practice e.g. when to test, how to test, results, cohorting patients and the development of designated areas, risk assessment, wearing of masks and access to personal protective equipment and discharging patients.

Development of a service for symptomatic staff testing, aligned to the Gov.UK testing.

As capacity increases, consideration will be given to testing of staff in designated

“hot areas” and potentially rolled out to all clinical patient facing staff. • Development of an Inpatient Management

Pathway of COVID-19 patients

• Development of a Coronavirus Library – useful resources and guidance

• Set up of fast-tracking service for medical equipment

• Early Flu Planning 2020/21 Campaign – network participation to improve uptake in NCL London, aligned to National

Programme Staff will be presented with a choice of clinics to attend, including access for staff not directly employed with the Trust e.g. ISS, agency, NHSP etc. Also includes service users and inpatients

• Increased number of peer vaccinators this year, more than double on last year.

• Investment in IT software, to monitor flu vaccine uptake, stock and build a trajectory towards success of 90% uptake.

Advanced Physical Health Training

The Trust is committed to education and upskilling of staff, recognising it’s crucial to sustainability and provision of physical health services.

In 2020, 20 staff were funded to attend formal training courses for the Physical Assessment in Mental Health (11) and Physical Health Assessment and Management (9) modules at North Middlesex University. These courses are a requirement towards being able to undertake the non-medical prescribing.

Additionally, Venepuncture and ECG training has been provided, the latter in byte size sessions in clinical areas. Staff feedback has been positive and demand for these sessions continues to increase, example of the phlebotomy training is attached together with the competency

framework for sign-off; risk assessments support face-to-face training both internally and externally. The Practice Development Nurses and Consultant Nurse for Physical Health and Infection Control have also provided a framework of bespoke training to clinical areas e.g. Topaz programme attached and are proactive in upskilling staff Trust wide.

• Working on Deteriorating Patient – Resus

Equipment Training and Audit, new policy due to be published.

• Escalating concerns SBAR

• Health Promotion / Management of Long-

Term Conditions (Physical Health Policy /

Lester Tool) this is built into the Physical

Health Screening Tool; this data informs the

Dashboard.

• Sexual Health / Safety QI Project on Ruby ward (PICU). 8th Annual White Ribbon

Event 6 November 2020, via MS Teams. Key topics included C&I’s road to becoming a trauma-informed organisation, FGM and

Mental Health Care, and Dowry Payments and Domestic Servitude.

• The Smoking Cessation Policy has been refreshed and embeds evidence-based practice, launched for Stoptober.

• Falls Prevention and Harm Reduction work continues to be effective.

• Pressure Ulcers – safeguarding input

• Development of Medical Management for

C19 Inpatients

• Patient Safety/Staff Safety – World Patient

Safety Day

• Phlebotomy now part of the Newly

Qualified Nurses Development Programme

Physical Health Screening focus on the six cardiometabolic parameters of the Lester Tool. The National Screening Programme is also incorporated.

Collection of the screening data supports care planning, onward clinical referral and long-term condition management

Contingency plans have included being able to step up and provide physical healthcare provision in a mental healthcare setting, e.g. oxygen therapy, NEWS2 monitoring and SBAR for escalation (all transfers out to acute services for “ill-health are reported on Datix, and have been well-managed and appropriately).

We explored the limits of physical health management possible in a mental health setting with an awareness that our acute hospital colleagues, LAS and other health resources will be stretched to an extraordinary degree. We aim to provide the best possible care on-site to deteriorating and seriously physically ill patients until transfer out to an appropriate setting is possible.

Clinical Pathways (as above)

With expert advice and support provided by colleagues in the acute sector we have developed Clinical Guidance/Medical Management for inpatients. This includes considering their, respiratory conditions, infectious diseases, Microbiology and End of Life Care.

Practice Development Topaz Ward Every Wednesday 2pm-3pm for 1 hour

Subject Date Topics being covered Further information

Deteriorating 17th June • NEWS2 (dot and plot) Patient • Why our patients become medically unwell e.g. diabetes/COVID-19/ physical health problems • “Talk to me in SBAR” NEWS2 24th June • Wards scenarios for collapsed/ unwell patient, management and escalation • 999 Calls

ECG

1st July • Revision Anatomy/Physiology

Diabetes 8th July • Type 1 & Type 2 • Management of Hyper/Hypo • Referral – Diabetic Team • Care of feet, teeth and eyes – onward referral

Depot administration and Medicines Management

Clinical Governance

Smoking Cessation

15th July • CDS – Ordering, recording, checking, destroying • Prescribing • Administration • Responsibility, accountability, Law • Incidents With input from pharmacy colleagues

22nd July • Shift management (coordinators competencies) • QI • Audit • Research • Patient Safety/Learning from incidents

29th July • Physical Health Screening Tool • Level 1 Very Brief Advice • CQUINS • NRT/E-Cigs • Level 2 Training Prep for the session - Goggle CQUINS 20/21

https://elearning.ncsct. co.uk/england

Physical health driver diagram V1.2

Aim Key drivers

Enhanced physical healthcare for all of our service users across all divisions to reduce their risk factors for complications from COVID-19 Staff access to information

Training across all divisions

Delivery of routine physical health checks

Other areas of note: Phlebotomy – training model under development Single resuscitation bag procurement underway No-smoking policy requires refresh Pharmacy proposal to bring on call in house Sustainability of twice a week Clozapine Clinic Capacity of physical health/infection control resource Proposal to step down IPU meetings

Activities

• Update physical health dashboard to include shielding and at risk group filters for targeting service users (Sep-Oct) • Promote use of dashboard (I) Health information exchange (I) Refinement of SLAs of what services are available and how to access (PF) Map out all roles responsible for physical health and what their connections are

Advanced physical health training – who to do and how to use once trained

Long term condition management (first get date about transfers due to LTCs) Wave 2 upskilling – incl. review of who has already been trained (Sep)

Address gaps in medication monitoring as a result of COVID-19 (I) Review of physical health tool (I) Supporting service users to access community physical health (inpatient and community) (I) Supporting service users to access national screening programmes and sexual health (inpatient and community) (I & PF) Flu vaccinations – staff and service users (F) (Sep-Mar)

* = COVID wave 2 preparation priorities I = Integration; PF = Patient Flow; F = Flu