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: Discussion Recommendations to the Board: To approve Relationship with the Assurance Framework (Risks, Controls and Assurance): Summary of Financial and Legal Implications: None 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 organisation 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 involved. 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. 350 325 300 275 250 225 200 175 150 125 100 75 50 25 0 Au 4 Au 5 Au 6 07 04 04 05 05 Fe 5 06 06 Fe 4 Fe 6 07 07 4 5 6 7 D 4 D 5 D 6 7 0 0 0 r-0 -0 r-0 -0 r-0 -0 r-0 -0 -0 -0 -0 n- n- n- n- b- g- b- g- b- g- b- g- ec ec ec ct ct ct ct Ap Ap Ap Ap Ju Ju Ju Ju Fe Au O O O O 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 categories: “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 required “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 considerations. 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 itself. 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 1.5 1 0.5 0 m n k s S l th A te le t na us ar n o H O b ha be ra tio yd io ta Tr w AM H po is m th ic at ro M bu on w La d or C u N C tri Le Ad So N C At -0.5 on N -1 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.
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