OPERATIONAL PLANS MENTAL HEALTH AND LEARNING DISABILITY

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					Annex 4

                                   OPERATIONAL PLANS MENTAL HEALTH AND LEARNING DISABILITY
                                                        February 2008


REQUIREMENTS PLANS TO BE ACHIEVED                                 PLANS IN PLACE                            COMMENTS
Tier 1
Cleanliness and           C4 within Standards for Better Health   The quality schedule attached to the      Statements of assurance will be collected
healthcare                – Risk of HCAIs is reduced and all      2008/08 contract requires the provider    as evidence against compliance.
associated                risks associated with medical devises   to provide assurances during HCC
infections                are minimised and medicines are         declarations by sharing information and   The PCT is currently reviewing all
                          handled safely                          evidence with Commissioner.               contract monitoring systems to ensure the
                                                                                                            delivery of meaningful and robust contract
Improving patient         New AHC target for 2008/09              Included as a requirement within the      information. A set of business rules has
experience, staff                                                 Performance Framework attached to         been agreed alongside revised terms of
satisfaction and                                                  the contract. Patient Experience 5        reference for contract performance
engagement                                                        Domains to be monitored.                  monitoring meetings. This includes the
                                                                                                            development of robust financial
                          Performance Measures Human              Model employer requirements are           monitoring linked to activity schedules for
                          Resources (Excellent Employer           included within the performance           each service and team.
                          requirements)                           framework attached to the quality
                                                                  schedule. Monitors turnover, sickness,
                                                                  and staff in post, vacancy and sickness
                                                                  rates, ethnicity recording, staff
                                                                  supervision PDP and appraisal.
                                                                  Staff surveys response rate and
                                                                  achievement against targets.




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REQUIREMENTS PLANS TO BE ACHIEVED                                  PLANS IN PLACE                             COMMENTS
Tier 2
Mixed – Sex               Review Current situation across all      The main in patient facility (Weller       Service Reviews are currently taking
Accommodation             Trusts                                   Wing) currently at Bedford Hospital is     place in keeping with the SHA reporting
including learning                                                 compliant with single sex                  framework. The PCT with report to the
disability and            Monitoring processes                     accommodation. The PCT is currently        SHA on the 18th April.
mental health                                                      working in partnership with our main
                                                                   provider (BLPT) to re provide Mental
                                                                   Health In-Patient beds into the Bedford    The PCT led review of specialist LD
                                                                   Health Village site. All current nursing   services will incorporate compliance
                                                                   and residential home placements are        requirements in relation to single sex.
                                                                   accommodated in single sex rooms.

                          Ensure that by 2010 no 16 – 17 yr        (See CAMHs section below)
                          olds are treated on adult psychiatric
                          wards unless in accordance with their
                          needs.
                          NAO recommendation that 95% of           Data requested to verify such referrals    To be included within the revised data
                          each admission is gate kept.             have been made, numbers of referrals       activity schedule monitored by the
                                                                   completed, assessing impact on length      Business Unit. This will be included within
                                                                   of stay of in-patient and bed usage.       the contract monitoring mechanisms of
                                                                                                              8/09 contract in accordance to
                                                                   To agree gate keeping policies and         Commissioning Guidance.
                                                                   procedures and monitoring
                                                                   mechanisms with the Trust
                          Trusts to re-engineer sufficient         An integral part of the CRHT
                          resources to make fully staffed 24/7     development and implementation
                          CRHTs and integral part of the           process.
                          mental health care pathway.
                          CRHTs – Impact assessment. To            To undertake a comparison of
                          monitor an expected fall by 30% of in-   admissions as CRHTs develop against
                          patient admissions                       previous years
                          24 hour service – to have a nurse        Plans will need to be developed to
                          based on the in-patient unit during      respond to this requirement.
                          the night paid for from the CRHTT
                          budget to do A&E assessments that
                          do not leave the hospital campus.



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REQUIREMENTS PLANS TO BE ACHIEVED                                   PLANS IN PLACE                              COMMENTS
Learning                  In partnership with local stakeholders    Through Person Centred planning             Redefined strategic commissioning plan
Disabilities              and through the Learning Disability       approaches a wide range of service,         for specialist NHS services by June 2008
                          Partnership Board the PCT is actively     vocational, recreational and educational    which sets out the scope and specific
                          pursuing the implementation and           initiatives are being taken forward which   requirements      of     modern      and
                          delivery of the Valuing People            will have a positive impact on the lives    contemporary community based care.
                          requirements.                             of adults with a learning Disability.
                                                                                                           Successful delivery of closure programme
                                                                    The strategic review of specialist NHS by 2010
                                                                    services is nearing completion and the
                                                                    PCT will be formulating its future Involve service users and carers in this
                                                                    commissioning plans and strategies process
                                                                    based on the recommendations.

                                                                    Local delivery plan being developed
                                                                    through learning disability leadership
                                                                    group.
                          The PCT is leading on the                 Detailed response and action plan Involve service users and carers in this
                          development of a local response to        delivering the Death by Indifference process
                          the recent Death by Indifference          requirements by August 2008
                          report and will engage with a broad
                          range of service users and carers in
                          its implementation.
                          Following the transfer of                 Formal transfer of commissioning            Develop detailed service specification
                          commissioning responsibility for          responsibility to BCC took effect on
                          social care to Bedfordshire County        1/03/08.Governance arrangements and         Conduct market testing of services
                          Council the PCT has commissioned a        safeguards have been built into the
                          strategic review of specialist NHS        section 256 agreement and the PCT           Develop robust procurement processes
                          provided services and this will cover     continue to have involvement in             and timeframe
                          meeting the Mental Health needs of        performance management and quality
                          adults with a Learning Disability.        monitoring of the transferred services.     Involve service users and carers in this
                                                                                                                process
                          Prepare for the transfer of learning      Plans are being developed in
                          disability funding to local authorities   partnership with the acute hospital
                          as set out in ‘Valuing People’.           sector and primary care sector to meet
                                                                    the needs of individuals with Learning
                                                                    Disabilities




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REQUIREMENTS PLANS TO BE ACHIEVED                                 PLANS IN PLACE                               COMMENTS
                          The PCT is working closely with the     There are three clients who continue to      Detailed campus closure plans have been
                          Local Authority to deliver the campus   reside     inappropriately     in     NHS    submitted to EoE in line with national
                          closure programme                       accommodation and whose needs do             requirements which stipulate both capital
                                                                  not require the inputs of a specialist       and revenue requirements .
                                                                  NHS facility. These clients also feature
                                                                  in the campus closure initiative and         Involve service users and carers in this
                                                                  agreement has now been reached with          process
                                                                  Bedfordshire County Council on move
                                                                  on plans for each client which will result
                                                                  in more appropriate residential type
                                                                  care      whilst    awaiting      eventual
                                                                  reprovision .Given the complex nature
                                                                  of these clients it is expected that the
                                                                  transition process will take up to three
                                                                  months to be completed.
Improving Access          The IAPT programme and                  A development plan and proposed
to Psychological          implementation of the stepped care      implementation with procurement
Therapies                 model                                   options has been developed. This is
                                                                  being finalised and agreed with PBC’s /
                                                                  PEC and PCT commissioners.
                                                                  The plan includes new ways of working,
                                                                  JDs for new roles linking to the
                                                                  requirements of Workforce and service
                                                                  modernisation. The JDs have been
                                                                  developed against the KSF framework
                                                                  to ensure that the roles are skills and
                                                                  competency based.




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REQUIREMENTS PLANS TO BE ACHIEVED                                PLANS IN PLACE                             COMMENTS
Older people with         Develop local services that ensure     A joint commissioning strategy has
Dementia                  early intervention of cases of         been ratified within the PCT which
                          dementia                               includes the need to provide people
                                                                 with dementia and their carers the best
                                                                 life possible. The developments will be
                                                                 prioritised in accordance with local
                                                                 priorities for implementation and
                                                                 available resources.

Early intervention in     PCTs must ensure that this potential   Early intervention teams are being
Psychosis                 is realised and EIP is fully           established across Bedfordshire and
                          implemented                            Luton. Year end activity targets are
                                                                 being monitored monthly.

Workforce                 Graduate Primary Care Workers          The Implementation Plan for IAPT
                                                                 describes new emerging roles and
                          Gateway / Link workers                 contains job descriptions for Primary
                                                                 Care Mental Health Development/
                          Community Development Workers          Improvement Managers and
                                                                 Primary Care Mental Health Link
                          Support Time and Recovery              Workers (Gateway Worker).
                          Workers                                A set of identified skills and
                                                                 competencies contained in the Job
                          New ways of working with existing      Descriptions will be used to assess all
                          practitioners                          existing or new practitioners against as
                                                                 services change to meet revised
                          Development of skill mix               models of service delivery. The
                                                                 implementation plan describes plans for
                                                                 the procurement of new roles.
CMHT Re- Design           To use the CBT competency              A major service review and service re-     The PCT is anticipating a resource shift
                          framework to underpin service re-      design process has been undertaken by      over time from secondary care into
                          design and the development of new      BLPT. The results of the review will       Primary Care, the PCT will be securing an
                          educational and training programmes    reshape the role of CMHTs in line with     increased capacity within Primary Care
                                                                 the implementation of IAPT and service     and a future reduction and diversification
                                                                 modernisation.                             in CMHTs.




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REQUIREMENTS                                  Key Actions                                                                             Timescales
CAMH

   National Indicator 50:                    Development of multi-agency approach to alternatives to inpatient beds. E.g.            July 2008
    Emotional health of children. PSA         Trained Foster Carers, with wrap around service team
    12
                                              Development of young person’s psychiatric ‘pod’ for crisis use for psychotic
   Promote Health and Wellbeing for All      young people under 16 years old and those aged 16 and 17 years old.
    PSA 18
                                              Benefits
   National Indicator 51: Improving          Young people receive the psychiatric care they require in the most appropriate
    CAMHS. Effectiveness of CAMHS             setting and closer to home, family and friends.
    DCSF DSO
                                              Reduction in inappropriate admissions to acute mental health beds and
   Develop effective CAMHS for 16 – 25       paediatric Acute Hospital beds – more cost effective.
    year olds, including transitions Mental
    Health Act – no under 16year olds in      Respite care is provided with appropriate multi-agency support.
    adult mental health beds. 16 & 17 year
    olds in age appropriate environments      Young people are not placed in expensive private sector CAMHS beds out of
                                              county.

                                              Young people are not removed from the local environment, school, college,
                                              friends and family.
Prison Mental Health

   Use of Section 117                        Mental Health needs assessment completed.                                               January 2008
   Use of Care Programme Approach
   Assessment of risk of suicide and self-   Development of a comprehensive model for mental health services within HMP              April 2008
    harm                                      Bedford. A community within a community approach.
   Access to Specialist Mental Health
    Services                                  Development of detailed service specification for mental health service provision.      May 2008
   Access to Primary Mental Health
    Services                                  Commission components of comprehensive mental health services including:
   Transfer time for prisoners with acute
    mental illness                               Primary mental health services
                                                 Care programme approach
                                                 Access to specialist mental health services including services for those with a
                                                  dual diagnosis.


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