11 Improve access to inpatient units by developing Clinical Decision Unit CDU beds for male admissions by ay5aByO


									APPENDIX B


   October 2007 (13 AFinal)

                                                                Southwark Primary Care Trust

                                                                 Lambeth Primary Care Trust

                                                South London and Maudsley NHS Trust

                                      King’s College Hospital NHS Foundation Trust

                                        Guy’s and St Thomas’ NHS Foundation Trust

      Lambeth and Southwark crisis review implementation plan                              1
The cross agency implementation plan describes a series of actions
to ensure the following occur:

    Creation of further clinical decision beds at the Maudsley site
    Extend the specialist mental health support provided within the A&E
     department of King’s College Hospital
    Enable relevant community teams to respond to the needs of mental
     health users in crisis on a 24/7 basis
    Close the Emergency Clinic (EC) to walk in services.

An implementation team drawn from clinical and managerial roles
from the following agencies oversees this work:

    Southwark Primary Care Trust
    Lambeth Primary Care Trust
    South London and Maudsley NHS Foundation Trust
    King’s College Hospital NHS Foundation Trust
    Guy’s and St Thomas’ NHS Foundation Trust
    service users representatives (from Southwark MIND and Lambeth
     mental Health partnership Board)

The implementation team meet every two weeks.

The implementation plan comprises:

    A high level description of the work to alter services prior to the
     closure of the Emergency Clinic
    A more detailed actions, with timescales and those leading the
    A glossary of terms and abbreviations used in this document.

Lambeth and Southwark crisis review implementation plan                    2
AIM                                         ACTION                                        Lead person and Progress                 Completion date
1. To strengthen (medical) mental              Consultation with junior medical staff    Dr. Eleanor Cole Consultation has        Completed May
   health response to Kings A&E                Identification of over night room at      (SlaM)           taken place.            2007
   during office hours and out of               King’s                                                     Room agreed.
   hours. Delivery of more                     SHO move from EC to be based at                            Relevant medical
   integrated service by ensuring               Kings A&E                                                  staffing rotas
   ready availability of medical staff         SHOs attend handover with PLN team                         organised and
   at all times and closer working of           and make contact with duty A&E Co-                         agreed.
   medical staff with PLN team.                 ordinator
                                               Confirm cover arrangements for                               Consultant
                                                Wednesdays when junior medical                               supervisor agreed
                                                staff attending academic day                                 for SHO
3. Move 136 suite from EC to ES1               New improved 136 suite built as           Ann Carrington     Complete              Completed June
                                                annexe to ES1in place                     (SlaM)                                   2006
                                               Operational Policy in place
                                               Training provided to ES1 staff
                                               Unit opened 16th June

4. Review and amend crisis plans (1)           Identify all Southwark and Lambeth        Joanne Grant /     Complete              Completed
                                                patients known to services who            Cha Power
                                                attended the clinic over the last year.   (SlaM)
                                               Produce lists for all community

5. Review and amend crisis plans (2)           Review crisis plans of all patients       Locality           SLaM clinical audit   Completed
                                                identified above.                         Managers, Jo       team completed        May/June 2007
                                                                                          Kent               audit of care plans
                                                                                          Sam Antwi-Marful   to review content.
                                                                                          & Lou Hellard

6. Review and amend crisis plans (3)        New crisis plans in place specifying:         Locality           Completed and         Completed
                                             Contacting CMHT in times of crisis,         Managers           audited – as (5)      May/June 2007
                                             Interventions to be implemented,            Care Co-           above

Lambeth and Southwark crisis review implementation plan                                                                                             3
AIM                                         ACTION                                      Lead person and Progress                 Completion date
                                            Role of CREST & Home Treatment              (SlaM)
                                            Teams to support CMHTs out of hours in
                                            deteriorating situation,

7. Enhance Crisis Response of                  Pilot CREST post to work with North     Simon Rayner       Complete              March 2006
   Southwark ABT Teams.                         Southwark ABT teams and North           Cha Power
                                                Southwark GPs                           Vanessa Smith
   Develop two additional CREST                Review CREST Operational Policy to
   posts to support Southwark ABT               include crisis support to GPs and       Cha Power and                            July 2006
   teams one in the North CREST                 CMHTs (new presentations)               Tamsin Hooton
   and one in South CREST.                     Implement new CREST worker in
                                                South CREST                             (SlaM and          Southwark Home        August 2006
   Teams to assess new patients                Promote new service and way of          Southwark PCT)     treatment team to
   presenting in crisis at GP                   working to GPs                                             take self referrals   Sept / Oct 2006
   practices and at the CMHTs                                                                              from April 16th

8. To promote the existing rapid               Locality Team Leaders to meet with      Team Leaders &     Complete              Completed
   response function of Assessment              sector GPs                              Clinical Co-                             October 2006
   & Treatment Teams to GPs within             To promote via the Lambeth Clinical     ordinators
   Lambeth                                      Forum
                                               Review Home Treatment Operational       Sam Antwi-Marful   Lambeth home          Completed
   Lambeth Home Treatment Team                  Policy                                  & Denis            treatment to take     April 07
   to assess new patients presenting                                                    O’Rourke/Sue       self referrals from
   to GP practices out of hours                                                         Field              clients known to
                                                                                        (Lambeth PCT)      services.

9. Improve responsiveness of                   Review role of duty staff               Jo Kent and ABT    Complete              October 2006
   Southwark ABT duty rota                     Ensure improved telecommunications      Team Manages
                                                in place                                (SlaM)
                                               Review ABT operational policies with
                                                ABT managers

10. Ensure availability of doctors at          Check junior and senior medical cover   Dr Eleanor Cole    Complete              Completed
    CMHTs                                       in all CMHTS                            (SlaM)                                   April 07

Lambeth and Southwark crisis review implementation plan                                                                                            4
AIM                                         ACTION                                      Lead person and Progress                   Completion date

11 Improve access to inpatient units           Convert two existing acute male beds    Cha Power, Dr       Complete               Completed
    by developing Clinical Decision             to CDU beds                             Eleanor Cole and                           November 2006
    Unit (CDU) beds for male                   Review CDU Operational Policy and       Scott Kerr
    admissions.                                 revise for ES2                          (SlaM)
                                               Agree additional nursing support for
                                                CDU beds

12. Open two additional CDU beds on             Review the need for extra beds         Keep under          Beds completed         Complete and on
    ES2                                          following EC closure by monitoring     review after EC     review of use on       Going
                                                 bed activity                           closes              going.
                                                Review the need for further female     (SlaM and
                                                 CDU beds                               Southwark PCT)      CDUs are reviewed
                                                                                                            daily and monitored
                                                                                                            weekly. Option for
                                                                                                            opening additional
                                                                                                            beds is available if
                                                                                                            needed – to date
                                                                                                            this has not been
                                                Create 4 female CDU beds across        Paul Calaminus      Complete               April 16th 2007
                                                 Lambeth and Southwark on ES3           Patrick Gillespie
13. Ensure weekday medical                      Agree medical support for CDU beds     Dr Eleanor Cole     Complete               Completed March
   decision making to clear CDU                                                         (SlaM)                                     2007
   beds every day.

14. Introduce 7 day a week senior              Appoint SpRs to support this function   Dr Eleanor Cole     6 month pilot to       March 2007
    decision making                            Agree funding                           (SlaM)              begin in March 2007

15. Implement a 24/7 information line.         Strengthen arrangements for planning    Cha Power and                              Completed May
    Develop a one number                        to include communications and IT.       Sam Antwi-          Further publicity to   2007
    information line for Southwark             Develop Operational Policy for the      Marful              be agreed.
    and Lambeth for GPs, service                information line.                       (SlaM)              Other elements

Lambeth and Southwark crisis review implementation plan                                                                                              5
AIM                                         ACTION                                       Lead person and Progress               Completion date
   users, carers and other agencies            Develop protocol to access service                       complete
   to signpost access to appropriate            information from SLaM intranet
   services. (To be included in crisis         Develop protocol for recording calls.
   plans)                                      JD for staff member 9.00 to 5.00.
                                               Lambeth to pilot out of hours cover
                                                with Home Treatment Team.
                                               Clarify arrangements for out of hours
                                               Set up freephone number.
                                               Arrange appropriate publicity.
                                               Arrange appropriate training

16. Extend the hours of drop-in                To develop a service specification for   Southwark PCT   Contract awarded       July 2007
    support in Southwark & Lambeth              extended drop-in support                 Lambeth PCT
    to provide additional social               To agree process to award this                           Steering group         August/September
    support out of hours                        contract to a local provider                             including service      2007
                                               Steering group including service users                   users set up to
                                                to review and agree timetable                            oversee progress of
                                                                                                         the service.

                                                                                                         Service operating      October 2007
                                                                                                         from fixed location.

17. To improve information relating to  Develop leaflets and information packs          Cha Power and   Completed              June 2007
    access to services for GPs,           to be distributes electronically and by        (SlaM)
    Service Users, Carers and other      post
    agencies                            Put in place a communications plan              Southwark PCT   Completed              May 2007

                                               Leaflets to be drafted to go to user     SLaM            Completed              May 2007
                                                councils for comments

Lambeth and Southwark crisis review implementation plan                                                                                        6
AIM                                         ACTION                                       Lead person and Progress              Completion date

18. Alterations to the A&E                  Phase one:
    environment in King’s                                                                                 Ongoing review
                                             Users involved in advising during the
3 phases of work                              implementation of the changes
                                             Alter the arrangements for being able      Briony Sloper    Completed 10 April   April 16th 2007
                                               to leave the A&E department onto          (King’s)         ‘07
                                               Denmark Hill (using buzzer system
                                               and access codes to leave) Police
                                               and security supportive
                                             Interview room – alter to make a quiet
                                               environment for mental health users
                                               to the specification of users
                                             Other rooms available in majors that
                                               are enclosed
                                             Waiting room - triage desk does not
                                               give much privacy - create privacy
                                             Some have asked for a separate
                                               waiting areas (some competing
                                               views)– viability to be established
                                               once initial changes have been made
                                               (possibly into the sisters office)
                                            Phase two:
                                                                                                          On going review
                                                   2 month programme with MH staff      Briony Sloper                         May 2007
                                                    and A&E sisters to improve initial   (Kings)
                                                    assessments and the
                                                    pathway/patient journey
                                                   Improve the access to electronic     Paul Calaminus                        May 2007
                                                    records for enhance CPA and          (SlaM)
                                                    crisis plan in A&E in order to
                                                    transfer a patient to the care of
                                                    their relevant community team

Lambeth and Southwark crisis review implementation plan                                                                                          7
AIM                                         ACTION                                       Lead person and Progress                Completion date

                                            Phase 3:

                                            Development of the whole of A&E to           Briony Sloper      In progress in       Complete
                                            create a primary care front door, and        (King’s)           consultation with    2 years
                                            more space:                                  Southwark PCT      service users

                                             A Business plan is being developed to:                         Pre consultation     Sept 2007
                                                    Primary care front door                                document prepared
                                                    Improve the A&E environment                            and out for
                                                     to include better consultation                         consultation
                                                     space for MH users
                                                    Quieter waiting area
                                                    Development of up to a 15
                                                     bedded acute care CDU in
                                                     better environment (base the
                                                     PLN’s and ASW in this area)
                                                 Optional appraisal
                                                 Link to commissioning options
                                                 Build and alter environment

19. Home Treatment Team Staff to be            Recruit staff to post                    Sam Antwi-Marful   Complete             April 16th 2007
    based in A&E overnight.                    CREST based at Kings A&E                 & Cha Power
                                               Lambeth HTT based at Lambeth             (SlaM)
21. Review risk assessment                     Review risks to patients after changes   SlaM and           Ongoing. In          June-September
                                                have been made                           Southwark PCT      progress. Standing   2007
                                                                                                            agenda item of

                                                                                                            Performance          Sept/October
                                                                                                            monitoring plan      2007

Lambeth and Southwark crisis review implementation plan                                                                                            8
AIM                                         ACTION                                        Lead person and Progress               Completion date
22. Service user inclusion in the                  User involvement in the design of     Kings           Ongoing. In            Ongoing
    implementation plans                            A&E                                                   progress
                                                   User representation input through     Southwark PCT
                                                    representative structures with the    and SlaM
                                                    implementation group in their work                    Structures in place    Sept/Oct 2007
                                                   Public information produced to        Southwark PCT   to allow for ongoing
                                                    regularly update local residents of                   involvement.
                                                    the changes to their services                         Measurement of
                                                                                                          such included in
                                                                                                          monitoring plan.

[Areas in blocked in yellow                          are already completed]

Lambeth and Southwark crisis review implementation plan                                                                                          9
Glossary of terms and abbreviations

SlaM                    South London and Maudsley NHS Foundation Trust
King’s                  Kings College Hospital NHS Foundation Trust
GSTT                    Guys and St Thomas ’NHS Foundation Trust
PCT                     Primary Care Trust
A&E                     Accident and Emergency Department
SHO                     Senior House officer
SpRs                    Specialist Registrars
PLN                     Psychiatric Liaison Nurse
EC                      Emergency Clinic
ES1                     A Ward at the Maudsley Hospital
ES2                     A ward at the Maudsley Hospital
136 Suite               Assessment area where service users are taken by
                        the Police under Police powers with the mental
                        Health Act
CREST                   24 Hour crisis resolution service for new or known
                        mental health service users and home treatment
                        team in Southwark
Home treatment          Teams designed to treat people in the acute phase
teams                   of mental illness in their homes, who would
                        otherwise need a hospital admission.
CMHT                    Community mental Health Team
GPs                     General Practitioners
ABT                     Assessment Brief Treatment – team working with
                        users referred by their GP for up to 6 months
CDU                     Clinical decision unit (short term bed care to decide
                        what treatment an individual may need)
CPA                     Care Programme Approach – A framework for care
                        co-ordination, aimed at ensuring all patients – and
                        carers where relevant -receive comprehensive, well
                        co-ordinated health and social care, which is
                        sensitive to their individual needs. Currently two
                        are two CPA levels – Standard, for people requiring
                        minimal intervention and support and enhanced for
                        people requiring a more frequent intensive service
Care Plan               A plan denoting how a person’s needs will be meet
                        and who will meet them.
Crisis Plans            Included as part of a Care Plan for people on
                        enhanced CPA denoting action to be taken should a
                        person’s mental health deteriorate rapidly.

Lambeth and Southwark crisis review implementation plan                         10
         Author:              Sarah Ives
         Version no:          9
         Date:                1t October 07
                                              Aim 12 clarification as to how this
                                               would happen included
                                              Aim 16 updated
                                              Aim 18 progress updated
                                              Aim 21 progress updated
                                              Aim 22 progress updated
                              30th October 07
                                            Glossary amended to include, Cpa,
                                              Care Plan, Crisis Plan and update of
         Document Owner:      Rod Craig
         Copy No:             N/A
         File Name:           Lambeth and Southwark crisis review implementation
         Doc Ref:             N/A

Lambeth and Southwark crisis review implementation plan                              11

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