New Ways of Working Pilot Including an update on the inpatient project and the development of the in

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New Ways of Working PilotIncluding an update on
the inpatient project and the development of the
integrated care pathwayClair Carson Alison
Kendall
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Inpatient project January 2006 August 2006 The
original inpatient project ran from January 2006
August 2006 This project and its findings were
presented to Trust Board on 13 December 2006 To
recap Project Brief To apply the principles of
modernisation to a working age acute inpatient
unit/ward within a mental health service To
develop a new approach to service delivery based
on skills and competencies To develop a new
workforce model for Adult Inpatient services
Phase 1 Baseline mapping of two inpatient
services Oldham Bury Phase 2 To use that
information / findings to develop a new model of
care / integrated care pathway for inpatients
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• Integrated Care Pathway Development
• Development of a generic care pathway for
  inpatients
• Identify the functions and tasks required and the
  timescales in which they should be delivered /
  completed
• Identify the appropriate competency level for the
  task
• Does it require
• Basic A level competency Bands 1 3
• Basic B level competency Band 4
• Intermediate level competency Bands 5 6
• Advanced level competency Bands 7 - 8
• Identify the appropriate supporting National
  Occupational Standards / competencies mapped to
  KSF
• Consider the options for the delivery
• Identification of required skill mix for the ward

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Process development of the care pathway
competencies
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Care Pathway Documentation

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The care pathway had been designed on the basis
that the inpatient unit concerned would have a
ward-based Consultant thus making implementation
difficult.. However in 2007. Towards the end of
2006 /beginning of 2007 the Consultant Psychiatry
body in Oldham led by Dr Alistair Stewart
developed a proposal to develop and pilot a New
Ways of Working in Psychiatry pilot in Oldham to
develop inpatient and community
consultants. Project Group Consequently in June
2007 the New Ways of Working sub-group was
established in Oldham, supported and reporting to
the Acute Care Strategy Group The group is
chaired by Bev Worthington and includes
Consultant Psychiatrists, Locality Manager, Acute
Services Manager, Community Services Manager,
Service Improvement Manager and Performance
Information Manager (North Division). The group
meets every other Monday and is supporting the
implementation of both the New Ways of Working
project, including the implementation of the
integrated care pathway.
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New Ways of Working in Psychiatry National
Drivers Recent debates have discussed a move away
from the traditional model due the current
pressures on consultant psychiatry encompasses
debates around becoming more truly consultative
or specialising either as a team, such as
dividing responsibilities for inpatient and
community care, or within teams by moving away
from generic responsibilities to more
specifically identified medical
responsibilities Too many of our inpatient
wards have multiple consultant psychiatrists
involved without any of them having a specific
responsibility for how the inpatient ward /
service as a whole operates. Each inpatient
ward/service must have its own dedicated lead
consultant psychiatrist who can provide expert
input into key matters of inpatient service
delivery, staff support and supervision, and
overall acute care service co-ordination. Mental
Health Policy Implementation Guide - Adult Acute
Inpatient Care Provision. Department of Health,
p. 19 One thing is certain, we cannot continue
with the model of consultant psychiatry that we
have had in recent years. General psychiatrists
in particular see the demands on them increasing,
their responsibility spread thinly across too
many parts of their local service..the solution
lies in re-defining the role of psychiatrists to
reflect their specialist skills. In general, it
should mean that we no longer do a bit of
everything but become specialists in our part of
the service. New Roles for Psychiatrists, Issues
by BMA, February 2004
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• Project Plan
• A project plan has been developed to support the
  pilot and key milestones include the following
• Medical milestones
• Full caseload review by all Consultant
  Psychiatrists of their current caseloads
  utilising review criteria potential for
  identifying those service users who could return
  to Primary Care
• Decision making amongst the consultants to
  determine who will work across inpatients and who
  will work across community services
• Work to clarify changes in job descriptions
• Work to develop job plans and clarify work
  patterns for Consultants specific to inpatient or
  community services
• Work to clarify arrangements for junior medical
  staff e.g. rotations and medical supervision

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• Community milestones
• The Community Services Manager, together with the
  Community Mental Health Team (CMHT) team managers
  have undertaken a large piece of work to ensure
  that the CMHTs are configured as per Department
  of Health guidance e.g. needs led rather than
  diagnostic split
• This reconfiguration of the teams has included
• Work to re-look at the appropriateness of the
  localities geography, populations, deprivation,
  Mini indices of the three sector teams
• Caseload reviews utilising the CSIP caseload
  profiling tool to ensure appropriateness of
  caseloads identifying those service users
  appropriate for review recovery team or primary
  care
• Developing the role of the Care Co-ordinator as a
  key member of the ward reviews as the key to
  supporting continuity in care
• Inpatient milestones
• Re-visit the integrated care pathway to take
  account of Crisis resolution developments
• Training with staff to support the implementation
  of the care pathway
• Piloting the Creating Capable teams approach with
  inpatient staff to commence April 2008.

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• Consultation
• The project group has developed a robust
  communication plan with service users and carers
  in Oldham. This has included the opportunity for
  them to respond with any questions or concerns
  regarding the project.
• A service user and carer briefing has been
  developed and distributed via the following
  means
• Care Co-ordinators of current service users
• Via outpatient clinics at Cherrywood and Glodwick
  clinics
• Via the F/T membership for Oldham (approx 350
  Oldham residents)
• Responses have been received and these are
  currently being collated.
• Service User and Carer Focus Group will be held
  in January 2008 to respond to the questions and
  comments made via the consultation.

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Evaluation The project group is also working to
develop a robust evaluation plan to include the
following Service User Carer satisfaction
survey The group is currently looking at
different questionnaires (including the Verona
model) that could be utilised to measure service
user carer satisfaction. These discussions have
included the Trusts Audit department. Enquiries
are also being made amongst other Trusts who have
implemented this model to see how they have
evaluated. Given that the Royal College has also
advocated this approach, contact has been to see
what recommendations they would make regarding
service user satisfaction Staff satisfaction
survey The staff satisfaction survey developed as
part of the inpatient project in 2006 has been
amended and adapted to measure inpatient,
community and medical staff satisfaction with the
new way of working. A baseline will be taken in
Dec / Jan prior to implementation, and then
again, 6 months post implementation.  
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• Evaluation continued
• Outcome performance measures
• The project group has identified a number of
  baseline measures (list is not exhaustive) which
  it expects the pilot to impact on
• Bed occupancy levels
• Reduction in number of admissions
• Reduced bed occupancy levels
• Reduction in delayed discharges
• increase provision of ward based therapeutic
  activity
• Improved access to medical staff
• Reduction in waiting time for allocation of a
  Care Co-ordinator (CMHT)
• Reduction in complaints
• Reduction in adverse incidents
• The Performance Information Manager for the North
  Division is currently populating an evaluation
  framework with a baseline of these measures. This
  will be repeated 6 months post implementation and
  the impact assessed.
•  

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Implementation of the pilot is planned for
February 2008 (to coincide with the next junior
doctor rotation) We will keep you informed on
progress.. For more information please
contact Dr. Alistair Stewart, Lead Consultant
Psychiatrist, Oldham Email alistair.stewart_at_nhs.n
et Clair Carson, Acute Services Manager,
Oldham Email clair.carson_at_nhs.net Alison
Kendall, Service Improvement Manager Email
alison.kendall_at_penninecare.nhs.uk