Onwards and Upwards PALS report by runout


									                  TRUST BOARD OF DIRECTORS – SUMMARY REPORT

          Date of Board meeting: 27th November 2007

                   Name of Report: PALS

                            Author: Graeme Kerr-

                     Approved by:
                                    Hilary McCallion
          (name of Exec Member)

                     Presented by: Graeme Kerr

Purpose of the report:
Provide an update for the Board on developments within PALS and future options

Action required:


Recommendations to the Board:

To approve

Relationship with the Assurance Framework (Risks, Controls and Assurance):

Summary of Financial and Legal Implications:


Equality & Diversity and Public & Patient Involvement Implications:

PALS is fairly central to PPI
Onwards and Upwards
  PALS Board Report
     November 2007

        Graeme Kerr
       Head of PALS
PALS: The Basics

  Patient Advice and Liaison Services within health services in England are a product
  of the NHS National Plan of 2000, which promoted them – along with the Patient and
  Public Involvement Forums (PPIFs) and Independent Complaints Advocacy Services
  (ICAS) – as a replacement for the previous Community Health Councils. PALS in
  particular were tasked with:
     Providing information to service users and their family and friends about services
      available to them and relevant policies and procedures
     Gathering information from the above groups to identify problem areas within the
     Acting to resolve conflicts and difficulties between clients and the staff working
      with them.
  In addition to the above, PALS was intended to be “highly visible”, “a catalyst for
  change” and to “allow [service users and carers] to influence the development of all
  aspects of the Trust‟s services”.
  Note that despite the acronym PALS was always intended to work with families and
  friends as well as service users themselves.
  PALS at SLaM commenced operations in February 2004 and has retained a stable
  staff team since then. They are:
  Kieron McNulty, Senior Adviser (full time)
  Angela Christie, Adviser (4 days per week)
  Epsie-May Payne, Co-ordinator (3 days per week)
                                                                    PALS Report November 2007
                                                                   Introduction: About this report
This report described the work of the Trust‟s PALS (Patient Advice and Liaison
Service) to the end of October 2007. As shown in Figure 1, the service has
experienced a continuing growth in take up figures, with the team dealing with 1728
new contacts in the past six months (May to October 2007) as against 294 in the first
six months of operation (February to July 2004). That the service has been able to
absorb an approximately six fold increase in workload with static resources says
much for the dedication – and ever increasing competence – of the individuals
Overall, SLaM‟s PALS have recorded more than six thousand discrete contacts and it
has been a source of continuing difficulty to find a means of presenting this work
qualitatively, such is the diversity of the issues presented. As a result, most of the
statistics presented here are based on an analysis of the last thousand recorded
cases (shown in crimson on the graph below), which equates to the period 16 th July
to 31st October 2007. These are further analysed below.

       Au 4

       Au 5

       Au 6





       Fe 5

       Fe 4

       Fe 6




       D 4

       D 5

       D 6






































                                    Previous data   Data in this report
                                                               Figure one: New contacts per month

                                                                Geographical origin of casework
Of the 1000 most recent cases, 768 (77%) were attributable to a particular area,
including 132 which were identified as non-Trust issues. Some of the latter relate to
international enquiries originating from the Institute of Psychiatry but others concern
enquires about health care in this (or other) localities or to aspects of physical health
care. The remaining 23% of overall contacts – labelled as “non-attributable” for these
purposes – included a large number of enquiries about mental health services,
mental health policy or practice or about mental health issues generally. It is probable
that the majority of these originated from SLaM clients (including both service users
and carers) but we cannot be absolutely sure.
A breakdown of the figures for main trust areas is at Table 1, while full figures are
included at Appendix One.

                                                                                         Page 1
  PALS Report November 2007
  Of the contacts relating to identified Trust services (636 or 64% of the total), 441
  originated with the four “central” Boroughs (83% of Trust contacts). Unusually,
  Croydon was the largest single contributor to these figures, with a surprisingly low
  level of take up from Lewisham. These and other apparent anomalies are further
  explored below, but for the moment it should be noted that the “corporate” contacts
  detailed below are mostly enquiries coming through PALS from people wanting to
  contact Complaints, HR or other central departments rather than from people with
  issues with any of these areas.

                                       Distribution of casework
                           Overall            Central Boroughs                   Other SLaM
                          n = 1000                       n = 441                        n = 195
              Unknown     232      23%     Croydon       175       40%   Addictions      30       15%
              Non trust   132      13%     Lambeth       113       26%     National      70       36%
       "Four Boroughs"    441      44% Lewisham           39        9%      MHOA         26       13%
           Other SLaM     195      20% Southwark         114       26%     CAMHS         11        6%
                                                                         Corporate       58       30%

                                                                          Table 1: Casework by origin

Further analysis: The nature of the contact

  The nature of the work involved in dealing with these enquiries is difficult to quantify
  but the following is based on categorising contacts on two axes, the nature of the
  response required and the “theme” of the contact. The former divides work into four
       “simple information” requests, which are largely those capable of being
        responded to rapidly from the team‟s own knowledge or commonly accessed,
        trusted information resources
       more “complex information” enquiries where the information required is complex
        or obscure or where significant exploration is required to elicit the information
       “casework”, which involves an active intervention on the part of the team to
        negotiate or otherwise liaise with clinical teams or others and
       “data protection” work – a relatively recent aspect of PALS work, which involved
        dealing with “missing persons” requests or initial approaches for access to clinical
        records. This was previously handled by the Data Protection Office directly.
  Table 2 gives a breakdown of PALS activities by these categories against the
  “geographical” categories set out above.

  Page 2
                                                           PALS Report November 2007

                        All    Croydon Lambeth Lewisham Southwark National

           "Simple"     321      85       14       5           33        22

         "Complex"      292      19       17       10          26        31

         "Casework"     160      43       23       16          22        10

               DPA      225      28       59       8           33         7

                n=      998      175     113       39         114        70

                        All    Croydon Lambeth Lewisham Southwark National

           "Simple"     32%     49%      12%      13%         29%       31%

         "Complex"      29%     11%      15%      26%         23%       44%

         "Casework"     16%     25%      20%      41%         19%       14%

               DPA      23%     16%      52%      21%         29%       10%

                      Addictions CAMHS   MHOA   Non trust Corporate Non attrib

           "Simple"      15       3       9        27          46        62

         "Complex"       5        4       8        87          11        74

         "Casework"      9        4       4        10          1         18

               DPA       2        0       5        8           0         75

                n=       31      11       26      132          58        229

                      Addictions CAMHS   MHOA   Non trust Corporate Non attrib

           "Simple"     48%     27%      35%      20%         79%       27%

         "Complex"      16%     36%      31%      66%         19%       32%

         "Casework"     29%     36%      15%      8%          2%         8%

               DPA      6%       0%      19%      6%          0%        33%

                                                        Table 2: Contacts by type and origin

                                          “Simple requests”and Data Protection work
A third of all the contacts made to PALS are categorised as “simple” requests, most
frequently from clients asking for „phone numbers of Trust services or to be put
through to named workers. For some reason, a high proportion of these are from
Croydon clients, with 49% of all calls logged from the Borough being in this category.
It is possible that this reflects recent phone number changes or perhaps genuine
difficulties in getting through to some Croydon teams at busy times, but it is also the
case that this “excess” of simple requests largely explains the apparent over-
                                                                                  Page 3
  PALS Report November 2007
  representation of the Borough in the overall figures. Similarly, Lewisham appears
  relatively under-represented in this area (less than 1% of “simple requests came from
  Lewisham) possibly because there are relatively robust local information systems in
  place locally, at least in in-patient services.
  In addition to contact information, simple requests would include enquiries as to how
  to access a GP or get an onward referral to secondary care, details of how to get to a
  particular site or basic rights / systems requests such as methods of getting a second
  opinion or providing information around the mental health act. This is further explored
  under “Themes” below.
  Data Protection work involves dealing with agencies or individuals who believe
  someone is in our care. Almost a quarter of the team‟s work involves dealing with
  these enquiries, roughly two thirds of which come from criminal justice or social care
  agencies with the remainder coming from friends or relatives of the individuals
  concerned. These contacts require sensitive handling as the Data Protection Act
  does not allow us (in most cases) to confirm or deny the presence of named
  individuals within our wards without their consent but these are generally relatively
  simple to deal with. Exceptions include examples where an out-of-area service is
  trying to locate someone who they merely believe to be mentally unwell and “in
  London” or where there are other complicating factors.
  It is unclear why a relatively high proportion of Lambeth contacts relate to Data
  Protection queries, but it may be that local police and probation services have simply
  become more aware of the service, or that the number of sites on which in-patient
  wards operate – and recent reorganisations – have led to some confusion.
Complex information and casework

  These types of call overlap to some extent as provision of very complex information
  (or responding to very confused or inchoate enquiries) can be more demanding than
  some forms of active intervention. The latter can range from simply contacting a team
  with a client‟s concerns through to long term work with an individual to resolve a
  variety of concerns or to contribute to building trust between them and people
  working with them. Similarly, complex information can involve significant research
  and exploration to establish the nature of the information required as well as verifying
  the accuracy of the results. This is particularly the case as these enquiries may fall
  outside the strict remit of mental health services, and include questions about
  housing, welfare benefits and community support or opportunities in general.
  Broadly, about half of the service‟s work comes into these categories. Lewisham has
  a relatively high proportion of “casework” contacts but this may be an artefact of
  relatively low take up as well as a number of long standing, involved cases with
  which PALS has been involved. Against that, “Non Trust” enquiries clearly do involve
  a greater degree of complexity as they will usually involve out of area or international
                                             Casework themes: The content of enquiries
  Although the above gives a degree of insight into PALS workload, it is limited in its
  ability to illustrate the nature of the work as aside from its complexity. To this end, we
  have attempted a further analysis of the dataset based on the information we were
  being asked to provide or the issue in question. These divide the more complex
  areas of work into six separate strands:

  Page 4
                                                          PALS Report November 2007
   Health issues – including information about mental health problems, positive
    mental health and treatment options [Health]
   System issues, including NHS and Trust procedures and policies [System]
   Resource issues, including access to particular services or care options, including
    secondary and tertiary mental health services [Resource]
   Engagement issues, including volunteering or membership requests but als o
    including requests for employment or student placement (the last always sub
    categorised as “corporate” [Engagement]
   Issues relating to current, active or planned mental health care services, delivered
    or organised by SLaM and with which the client is unhappy [In Service] and
   Issues relating to a current perceived mental health crisis on the part of the
    individual contacting PALS or someone known to them. These may include
    aspects of all of the above, but have an additional urgency. [Crisis]
Additionally, we have further separated out the very simplest calls, as
   “Switchboard” enquiries relating to providing a phone number of contact details or
    cancelling or rearranging a Trust appointment [Switchboard].
Data Protection work remains a category on it own for these purposes, which
explains its omission from Table 3, which
                                                             Simple Complex Casework
cross tabulates the two systems of
categorisation. Note that even                 Switchboard      195       3        2
“Switchboard” requests can sometimes
produce significant amounts of work.                System       29      53       18

                                                    Resource        24        47         5
Chart Two, below, gives an overview of
PALS activity by the above “themes”. This           In-service      5        28         54
is notable in that it shows that actually
                                                       Health      40       107         15
relatively little (9%) of contacts relate to
resolving difficulties between Trust clients            Crisis      5        49         65
and teams directly (although these cases
do take up a disproportionate amount of           Engagement       20         3          0
time) while 12% of contacts involve a                            Table 3: Cross tabulation
current or imminent crisis, at least in the
opinion of the caller. Overall, 21% of contacts involve “problem solving” and 37%
more general advice and information, in addition to 20% of “switchboard and 22%
DPO work. This is interesting as it demonstrates that PALS within SLaM had
developed a role which is quite distinct from the original concept as envisaged by the
Department of Health.
We have also looked at the demands on the service, in terms of these “themes”,
against geographical / service origin. These are set out in Table 4 below, again
grouping together Resource, System, Health and Engagement issues as advice and
information and In-Service and Crisis issues as Problem Solving. Note that in a
significant number of contacts the team have been able to offer problem solving
interventions to individuals about issues directly – or uncertainly – related to the Trust

                                                                                     Page 5
PALS Report November 2007

            Switchboard   System   Resource   In Service   Health   Crisis   Engagement   DPO

                                                                              Chart 2: Contacts by theme

                  ALL           Croydon Lambeth Lewisham Southwark Addictions
   Switchboard            200          80      8        2      16          15
  Problem Solv            207          39     23       19      37           7
Advice and Info           366          27     22       10      28           7
           n=             773        146      53       31      81          29

                  ALL         Croydon Lambeth Lewisham Southwark Addictions
   Switchboard            26%      55%    15%       6%      20%        52%
  Problem Solv            27%      27%    43%      61%      46%        24%
Advice and Info           47%      18%    42%      32%      35%        24%

                  National CAMHS MHOA    Corporate Non Trust Non Attrib
   Switchboard            14     2     6        27         9         21
  Problem Solv            10     3     3         2        20         44
Advice and Info           39     6    12        29        97         89
           n=            63     11    21        58      126       154

                National CAMHS MHOA    Corporate Non Trust Non Attrib
   Switchboard        22%    18%   29%      47%        7%       14%
  Problem Solv        16%    27%   14%       3%       16%       29%
Advice and Info       62%    55%   57%      50%       77%       58%
                                                                      Table 4: Contact Themes by Area

Page 6
                                                         PALS Report November 2007
Note also the relatively high proportion of advice and information requests within the
National, “non Trust” and “non-attributable” categories. These will often involve
providing information and assistance about Trust services, perhaps as an alternative
to what are perceived to be unsatisfactory local arrangements. (Contacts are logged
as National if the caller directly asks about a specific service, as “non-Trust” if the
reason for contacting us is simply to explore alternatives generally.) This is an aspect
of PALS work that could be expanded.
                                                               Conclusion and overview
The above represents an analysis of PALS current activities covering, in detail, the
past three and a half months. This work has, however, been the result of an organic
process of development, which has seen PALS evolve into a useful and well used
resource across the Trust and beyond. The basic ethos and practice of the team –
attempting to always respond positively to enquiries, however unusual or strictly
outwith their remit– and the service‟s proven ability to respond effectively and
promptly to a wide range of circumstances and situations makes it an effective public
face of the Trust.
We believe that this should continue to be developed and will be looking at ways of
developing PALS – and Trust information and support capacities more generally – in
ways that continue to meet the needs of both our local and national clients, the wider
public and the organisation itself.

                                                                                 Page 7
                                                                   Appendix one
                                           All                      4 Boroughs
                          All    Attributable Trust contacts           contacts

       Croydon     175   18%            23%            28%                 40%
       Lambeth     113   11%            15%            18%                 26%
     Lewisham       39   4%              5%             6%                  9%
     Southwark     114   11%            15%            18%                 26%

     Addictions     30   3%              4%             5%
       National     70   7%              9%            11%
         MHOA       26   3%              3%             4%
        CAMHS       11   1%              1%             2%
      Corporate     58   6%              8%             9%
      Non Trust    132   13%            17%
Non Attributable   232   23%
                                Total number of contacts by origin and proportion
                                                                                                                                   Appendix two



































                                 Switchboard             Problem Solving    Information and Advice           DPO
        Chart shows proportion of work per category against proportion of total PALS contacts for each service area. Columns above one
                                                                    indicate a higher proportion of contact in that area than the average.

To top