A digital place for people who access services, carers, staff and partner agencies, to share ideas around care co-ordination & care planning in mental health

Posts tagged ‘Planning Care’

Hats off to the care coordinators!

Earlier this year, a chance on-line conversation led to Leeds and York Partnership NHS Foundation Trust becoming involved in the EQUIP study: Enhancing the quality of user involved care planning in mental health services. This presents an opportunity for people who use the service and their carers, and for care coordinators to be  involved in a national research study – you can read more about our involvement with the EQUIP study here. Ultimately this is about increasing people’s involvement in planning their care, an idea that has been around for a lot of years but that remains a challenge to mental health services in delivering consistently.  The good people at EQUIP have published a paper that brings together the current evidence base and identifies barriers and enablers to bringing this level of involvement to practice. It reads well and is available on open access here.

The theme of involvement continues as being ‘involved’ in a national research project brings its own challenges. Theoretically, it is the right thing to do: contributing to the body of evidence; potentially improving people’s experience of mental health services; improving outcomes through collaborative working; challenging stigma and power; developing care coordinator skills…… the benefits go on. Then there is the reality of practice – research activity not always making it to the top of the list of ‘things to do’; perhaps being seen as extra to practice and not part of practice; competing with service user visits/contact. That said, care coordinators have responded positively to the clinical studies officers requests; despite being super busy with clinical work, they screened their caseload in super quick time (hats off  and a big thank you to them!). This bodes well for the next hurdle –  releasing a community team for 2 days of training. Looking forward to experiencing the training and seeing how this can influence practice – and ultimately how people can be actively involved in planning their care. This is where the big win lies in being involved in the EQUIP study.

Oh – and do have chance conversations with people, you never know where it will lead……..

Are you involved in planning your care? Does it make a difference?

Care coordinators – what are the main issues with involving people in planning their care?

Planning Care Checklist

Planning Care Checklist

Join the conversation here.

Exit comfort zone stage left…….

That is how it felt when the plan for CPA – making a difference  got the green light and was signed off. CPA - making a differenceThe plan focuses on listening. Listening to what people say about Planning Care – from people’s personal experience of accessing care, support and treatment across LYPFT services  to hearing how people would like services designed and delivered. Listening to what staff say about what they need to provide the best care, support and treatment and listening to what our partner agencies, statutory and third sector, say about what its like being alongside LYPFT.

Listening is a key element of communication, the listening part is key to understanding different viewpoints and identifying people’s priorities; and it is around here that I start to leave my comfort zone. The tension emerges when there are differences between what people want – from differences between individuals to differences between different groups or ‘stakeholders’.  Difference is good, it would be rather dull if everyone wanted the same thing but how to reach consensus fairly? The end result will be some folk are delighted, some are dismayed. My challenge is to remain neutral enough to ensure that people can freely express their views but to provide enough information for people to consider their views upon.  At times there can be different priorities between people who access our services, the professionals delivering the service and the organisation itself; final decisions are often made at quite a distance from where the original discussions took place, it takes courage to shout up for other people’s views and it requires committment and believe  to progress what can initially appear as disparate agendas (though they often are not).

So why am I sharing this? Well, hearing people’s views and making shared decisions is what we all do.  Discussions with staff across the organisation be it face to face, via email or social media constantly reminds me that we are all working in a similar way. I wanted to acknowledge this and share a bit about how this shift has changed the way I work and some of the challenges this has brought along the way.

If you are still reading, then you will be aware that I didn’t manage to squeeze in competence and compassion – oh look, I have now! So what’s all this about? 6CsWell, it’s about building Compassion in Practice;  you can read more about this, along with examples of how this is working locally here,  you can also read here about how Towngate House Rehabilitation and Recovery Team are building a culture of compassion.  So how are you building compassion in  your practice?  If  you access services or are a carer, how do you experience compassion in care – is this something that can be felt/experienced? How does it make a difference?

So whats the link between The 6Cs, Planning Care and exiting comfort zone stage left? Well if we apply the culture of compassionate care to the way that we work with people in planning care then the benefits to people who access our services and their carers should be evident. I came across The 6C’s on Twitter. Yes Twitter. Something very new to me and a steep learning curve in many respects. I had not underestimated the value of twitter in relation to connecting with people professionally, with the public and people in other organisations, fact is I had not estimated it at all. But that’s a whole other subject…….

Thanks for reading – Donna Kemp

What’s happening in LYPFT about Planning Care?

LeedsYork%20new%20logo

Take a look through this presentation – CPA- Making a Difference to get a feel for what we want to achieve and to see what is in the Leeds and York Partnership NHS Trust Planning Care Workplan.

wordle feb pcwig

The Planning Care Workplan Implementation Group (PCWIG) are a group of people representing: service users; carers/supporters; staff; adult social care; and managers,  who meet together to monitor the progress of the actions in the Planning Care Workplan.

Here is the summary of the meeting held on 6th August 2015:-

  1. Work to pull together ‘what’s going on where’ in relation to service user groups and fora is underway. This is being led by the Head of Service Improvement.
  2. Service User Network – chair of the group concerned that the issues within the SUN minutes where not being consistently responded to by the Trust; the group discussed how this could be improved and made suggested for actions between LYPFT and Sun. SUN meetings will be held at a new venue from September: Leeds Media Centre
  3. Project aimed at improving occurrence and experience of Care Programme Approach Reviews is underway, baseline data is collected and interventions are planned. Currently includes Recovery and Rehab at Acomb and Ward 6 at Bootham Park Hospital.
  4. The York quality and improvement work around crisis plans – co-production and accessibility is progressing, the report for July has been finalised.
  5. A group have met to review the Procedure for the management of Adult Service Users with Diagnosis of both Mental Health and Learning Disabilities. Updates will be made to the title and the content will incorporate the changing national priorities for people with learning disabilities or autism. First draft is expected in October.
  6. Care group actions plans to address the findings in the Care Programme Approach Audit are due by early September.
  7. Paper published by Penny Bee et al. was discussed ‘The systematic synthesis of barriers and facilitators to service user led care planning’. Recognisable issues were presented. This links in with the EQUIP study, Trust keen to learn from this.
  8. Service User experience Media Clip – This piece of work has been agreed, a number of service users to provide their views and experience of CPA, anticipated that there will be mixed experiences. Group recommends that this is extended to carers. Aim is to be able to bring people’s voices and experiences to training sessions; also available to others in the Trust. The recording is scheduled for October.

If you have any comments or suggestions to make to the Planning Care Workplan Implementation Group, then please either leave a comment here or email planningcarelypft@nhs.net

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

Here are the key points from the 2nd April 2015 meeting, held at Trust HQ, Leeds:-

  1. The service user experience of review final report is now available to staff; service users and carers – here.
  2. The Trust has signed up for involvement in the EQUIP trial; 6 community teams will paired and randomised to control and intervention groups. The intervention involves 2 days of training aimed at enhancing the quality of service user involvement in planning care. The group will be updated on progress.
  3. Improving CPA reviews on the inpatient areas in York has been identified as part of the Trusts Recovery Programme; starting initially on 2 of the wards. The group will be updated on progress.
  4. New work plan for 2015/16 was agreed; to be presented to Effective Care Group. Work plan to focus upon 5 areas: engagement, research and development, providing information, policy & national initiatives and shared learning.
  5. An update on Integrated Care Pathways was provided
  6. Work is underway in developing guidance for staff in Choice of Worker – this includes allocation, communication and a procedure for responding to a request to change worker. This will be brought to the next meeting.
  7. New care plans for CPA and Standard Care Plan are anticipated in May; currently in final stage of development.
  8. Minutes from York and Leeds Service User Networks were presented.

If you have any comments or suggestions to make to the Planning Care Workplan Implementation Group, then please either leave a comment here or email planningcarelypft@nhs.net

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

Here are the key points from the 5th February 2015 meeting, held at Bootham Park Hospital, York:-

  1. Many York services have now moved onto PARIS (electronic patient record); people will record care plans and reviews on PARIS as the next review is due. New referrals will have their care plans recorded on PARIS.
  2. The Patient Experience Team are compiling a report detailing Trustwide service user and carer feedback from a number of sources, including the national service user survey. Workshops will be held to explore the feedback and agree responses from the Care Groups. The report will come to this group.
  3. Friends and Family Test results should be available to the group for next meeting.
  4. The WorkPlan for 2015/16 is near completion; likely sign off at next meeting.
  5. The service user experience of review final report was accepted; this is to be available to staff; service users and carers.
  6. A researcher focusing on evidence based improvement, is working alongside the group to focus upon increasing service -user involvement in care planning. She is currently scoping the project.
  7. There is work in progress in developing guidance for staff in ‘Choice of Worker’; aimed at supporting a consistent approach to responding to people requesting a change of worker.
  8. An overview of Self Directed Support was presented; changes in light of the Health and Social Care Act to be presented in a blog.
  9. Minutes from Leeds and York Service User Networks were presented.

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

 

Here are the key points from the 4th December 2014 meeting, held at Trust HQ, Colton:-

  1. The York Service User Network is up and running as of September. This is for people accessing mental health services across York, Selby and Tadcaster. Terms of reference will be shared with the group once agreed.
  2. A researcher, seconded to the Trust to work on Evidence Based Improvement, presented her work around Care Programme Approach and asked the group of their view on what area of CPA should be prioritised. The group reported that service user involvement in developing the care plan along with ensuring the person gets a copy of their care plan were their priority recommendations.
  3. A paper was presented: a Review of CQC MHA monitoring visits. the group were asked to incorporate the findings in next years work-plan.
  4. Advocacy reports from A4MH and Cloverleaf were received; they are to go to the relevant Care Groups Clinical Governance Councils for consideration and response.
  5. The York CPA booklet is now printed and available for service users and carers.
  6. The follow-up CPA audit has actions identified from York Care Group but awaits final actions from other Care Groups before the final report can be circulated. Next CPA audit is due for data collection March 2015.
  7. Planning Care Awareness Sessions are due to commence in December; this is open to staff, partner agencies, people accessing LYPFT services and carers.

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

Here are the key points from the 7th August 2014 meeting, held at Trust HQ, Colton:-

  1. One member of the group had undertaken some research about CPA as part of  a masters programme; to be invited to share this with the group.
  2. Advance Statements – work continues to raise staff and service user/carer awareness of advance statements. Uptake is being monitored. Discussion about how this could be promoted more widely.
  3. There have been some early discussions about developing a self-help recovery tool; this is being led outside the Trust.
  4. Report due soon about the CPA review questionnaire. Donna Kemp to share this through the Planning Care Network.
  5. The external website has now been updated in relation to Planning Care.
  6. York CPA booklet is in final draft and awaiting sign off.
  7. York CPA Workstream – currently working on CPA Review packs, to improve consistency and promote collaborative working. Pack to be shared with the group as this approach could be used more widely.
  8. CPA Audit – Care Groups are currently developing action plans, to be brought to the next meeting. Head of Audit provided information about the Well Led Framework and how this relates to quality. Next CPA audit is due for data collection early 2015.
  9. Planning Care Checklist – This received positive feedback, it was suggested that it is produced in A3 and displayed in team offices.
  10. CPA training to be half day awareness sessions starting in September 2014. This will be supplemented with a team based development approach – currently underway at South South-East Hub in Leeds.
  11. Themes from Service User Network were presented – attitudes towards people with diagnosis of personality disorder and changing care coordinator upon request.

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

Here are the key points from the 5th June 2014 meeting, held at Bootham Park Hospital, York:-

  1. Service User Network (SUN) expanding with the development of a further SUN in Lovell Park. SUN or similar needed in York, plans not confirmed as yet.
  2. People who have had a Care Programme Approach (CPA) review continue to be posted out a questionnaire that asks about their experience (more about this here). Some people have been on contact to say they have received a questionnaire when they have not had a review. Updating the care plan on the electronic record triggers the questionnaire being sent.
  3. Wording about Planning Care has been drafted as a starting point for the external website; this is currently being consulted on.
  4. The CPA information booklets for Leeds are now printed and available. It was agreed in the group that care coordinators should distribute these to people either following assessment or at review rather than be sent out centrally. The booklet for York needs slight revision and checks to ensure the correct contact numbers are in place.
  5. The CPA audit  is a follow-up to the full audit that took place in 2012. The results were presented as a whole and also as care group specific. Each care group to agree their actions in response to the recommendations.
  6. Work continues to promote Advance Statements; this is intended to include York; this supports wellbeing and recovery. The recovery model to be rolled out again soon, ideally to include GP’s.
  7. Service User and Carer conversation event planned for people accessing services from Aire Court
  8. Training – the full day care coordination training will be reviewed and a team based approach will be introduced, starting with South South-East Hub.

Donna Kemp (on behalf of the Planning Care Workplan Implementation Group)

Here are the key points from the first meeting on 6th February 2014 meeting, held at Bootham Park Hospital, York:-

  1. Planning Care Network is up and running; all welcome to join/follow. Anyone wanting to post an article/discussion can contact donna.kemp@nhs.net to arrange access. Post cards to be created to promote the Network.
  2. CPA Care Plan name – 273 votes were counted; top results:- CPA Care Plan – leave it as it is = 38%. My Wellbeing & Recovery Plan = 25%.  Interpretation options 1) first past the post would mean that CPA Care Plan is chosen 2) 38% want to keep it the same, 62% want a change (of which Wellbeing & Recovery Plan was favourite).  It was agreed that the voting told us that people do want to change the name of the CPA Care Plan but that another vote should take place to determine which name this should be – click here to vote now.
  3. New model for involvement and engagement proposed/being developed; this includes drop in/café style ‘gathering’ aligned to each community team. To link in to Leeds and York ‘Service User Networks’, reporting to the Council of Governors.
  4. Ventures proposed to have their Obesity and Lifestyle Integrated Care Pathway agreed as a standard care plan. This was agreed as it meets the agreed standards and is person centred.
  5. Responses to the CPA Review questionnaire are coming in – click here for more info.
  6. Programme of sessions aimed at supporting staff in working with people/communities that are hard to reach is being developed.
  7. A workshop is being planned to explore the data that we have in relation to Planning Care; this is to help inform understanding of the National Service User Survey results and consider what this means for us. The workshop will include people who use the service, carers/supporters, frontline staff, operational managers as well as colleagues with DATA expertise. Further details coming soon.
  8. CPA posters and leaflets are being distributed to clinical and waiting areas across York and Leeds; the leaflet has been translated into Polish, Czech, Farsi, and Urdu as the most popular language requests.
  9. CPA audit is imminent with data collection planned from 24th February.
  10. Involving service users in care coordination/ CPA training is being explored, looking at 2 approaches to this 1. Co-facilitation, 2. Using media to capture York/Leeds service user views/experience. Click here for more information; people interested in getting involved should contact donna.kemp@nhs.net.
  11. Team based learning/development discussed; this is focused on quality and is done in collaboration with the team; to commence with the community teams.

Donna Kemp (on behalf of the Planning care Workplan Implementation Group)

Feedback from York Conversation Event

 wordle York conversation

18 people met last week for our first Conversation Event in York. This was in response  to a number of people wanting to get more involved in developing services in York and North Yorkshire.

Using a relaxed café style we held three facilitated conversations:

1)      Should we attempt to establish a service user/carer drop-in meeting in Y&NY and should we host a more formal Service User Network? Are people aware of the peer-led service user forum hosted by the Retreat and York Mind?

2)      Do people know about CPA and would they like to be involved in the CPA network?

3)      What levels and format of information are people keen to receive? Can we do away with some of our old fashioned leaflets or do we need to re-design?

The atmosphere was very good and many views were freely expressed.

Here’s some feedback:-

A group for York and North York?

The outcome of the network meetings was overwhelmingly in favour of establishing a group, and this of course we shall do. Probably alternating between a meeting in an afternoon and one in the early evening so that people who work are able to attend.

There will be future meetings of the Conversation Place, happening in York, so watch out for more information.

Care Programme Approach & LYPFT Planning Care Network

These were discussed as general topics; some folk had heard of Care Programme Approach (CPA) but not all, no one was aware of the Planning Care Network (PCN = this blog).

Care Programme Approach

The feedback told us that people were not always aware of the ways that care, support and treatment is organised within Leeds & York Partnership NHS Foundation trust (LYPFT) through either CPA or Standard Care Plan.   Information about CPA and what should be happening was not readily available and people did not know how to access the information.  There was concern that information was Leeds focused  and that people in York were not getting the information they needed.

People said that they were not always sure if they were on CPA or not; that there was inconsistency in reviews, they did not always happen and were not always conducted in a person centred way.

People were concerned that there should be ‘quality checks’ of CPA; to make sure that staff were doing as they should and that people were receiving the right support.

LYPFT Planning Care Network

The feedback told us that some people are concerned that the Planning Care Network (PCN) excludes some people as not everyone has access to the internet; and that their preference is for face to face contact and the benefits that it brings in engaging with people. There was concern expressed that the PCN was targeting the younger generation as they are more able to get involved with online.

Some people said that there was a benefit to PCN – it was a good way of connecting professionals, service users and carers – but that it should be remembered that it’s for service users benefit and should keep that focus.

People were concerned that there was not a Service User Network for York.  People highlighted that they did not know about PCN and thought that it was focused on Leeds; they felt that they should have been told about PCN before now.

Information: What information about mental health services would you find helpful?

 Here are some of the points that people made:

 1. The right information, at the right time, in the right place

  • Listening, information and support early on, or when waiting for an appointment, can lessen the distress and worry – problems may not then escalate; a stitch in time saves nine
  • Information needs to be where people are in the community not in MH service eg GP surgeries, schools, cafes, church etc. and shouldn’t be diagnosis focussed. Should also include support and information for carers/parents (including young carers)
  • Need better knowledge in schools – about mental health, able to pick up the signs, information in schools eg posters. Links to websites about mental health problems designed for teenagers , information about how to access services,
  • Better response from Social services when young people are struggling; GP’s need to have good mental health knowledge and not wait until a crisis
  • People need information about what they have a right to ask for and expect from services, and what to do if not getting this eg advocacy
  • Information that helps people have some understanding of what might be going on without having a diagnosis; diagnosis not always needed

 2. Information and help on websites

  • Set up single directory for York in a way that when people search for mental health information this will be one of first to pop up ie when people search using plain English questions – website would need to be kept up to date (York MH and Learning Disability Partnership board are making progress with this).
  • People able to “shop for support”, clear the people have choices eg access to personal budgets, promote recovery
  • Information on service websites needs to be well designed, up to date, answer the questions people are likely to ask (what does service do, how to access etc). Have links to other useful information – eg LYPFT website has very little about York services
  • Information needs to be joined up not just each service having its own or lots of different directories; to include NHS/statutory and voluntary/3rd sector services
  • Help service users to set up groups (eg Yahoo) to connect with each other – currently using  or after discharge from services
  • Websites  can’t be the only solution not everyone uses the internet to look for help – needed printed directories and information about where to get help to navigate all the different information out there.

3. Crisis Information

  • Information about what to do when there is not services/in crisis (eg late at night) – ways of not ending up going to A&E in desperation; information should be given to people early on
  • Information for carers about how to get help – especially when the person they care for is not wanting help or wanting their involvement
  • Information about support and help for young carers – picking them up early on eg through schools or adult MH services
  • Support after discharge – information, links to post groups/support forums

4. Ask service users

  • To design information
  • Advice on language – dropping the jargon, don’t overwhelm with info/details
  • Invite service users directly to be involved (eg letter at discharge)
  • Advise services on how and where people try to access information – so we put it where people look

Here are some useful links that were mentioned during the conversations:-

Healthwatch York  – this is the new way to influence local health and social care services;  Healthwatch York will help you and your family get the best out of your local health and social care services. You can be involved in shaping these services according to what your community wants or needs. We want to put you at the heart of health and social care services in York. http://www.healthwatchyork.co.uk/

CPA in Yorkclick here to see an information booklet about CPA in York

Independent Service User Forum – this group meets monthly in Library Square, York; contact nigelayre@yorkmind.org.uk @SUVoiceNYN for more information

York Carers Forum is a user-led group of unpaid Carers & Former Carers who live, work or care for someone who lives in the York area. Visit the website www.yorkcarersforum.org , email yorkcarersforum@tiscali.co.uk or call 01904 422437 for more information.

York Mind – York Mind is an independent provider of high quality mental health services in York and its surrounding area  http://www.yorkmind.org.uk/

Do these comments represent your views on what’s happening in York and North Yorks? Feel free to join in the conversation too – you can respond by leaving a comment below.

How the meetings went…….

Well it was good to meet with people who are interested in Planning Care.  There were 2 meetings held on Wednesday 20th November – York in the morning and Leeds in the afternoon.

The idea of the meetings was to gather informally to present the concept of the Planning Care Network, to talk about how it might work  and to explore any issues that arose.  The Network is for people to share their views and ideas about Planning Care; it is everyones Network.

LYPFT’s Planning Care standing support group (awaiting a name change) has an annual work plan to progress quality and engagement in Planning Care, covering CPA, Standard Care Plan, Self Directed Support  as well as local and national initiatives. The idea is that the Network feeds into the Planning Care standing support group, letting the group know about what’s important to people that use the service, carers, supporters, staff and partner agencies, and that the Network members contribute to solutions and get involved in work groups to progress agreed work. A summary of the Planning Care standing support groups minutes and the work plan will be posted on the Network;  a couple of representatives for the Network are requested to attend the meeting – held bi-monthly.

People that use the service, carers and supporters sharing their experiences and ideas is a positive way of getting an understanding of what is important. Sharing service or team experiences of Planning Care is welcomed; it may be what is working well, or what could work better.  Sharing examples of good practice is a way of helping other teams to make changes.

Some very interesting points were raised by the people at the meeting,  such as:

How do we reach the people that don’t use social media?

How about people who don’t use English as their first language?

What if people post comments that they later regret?

The questions prompted discussion in the groups; the Planning Care Network is one of a number of ways that we are trying to engage with people.  Ideas around producing a postcard to promote the Network were discussed; this could be a way of staff offering the people that they are working with the opportunity to participate in the Network; postcards could be made available in public places such as libraries, where people would have access to computers.  There are also plans to introduce computer access to service users in parts of the Trust. It would be great to hear more about this on the blog……….

It was suggested that help line numbers be available on the blog so that people can access them if needed; a link to the external website would address this as it has a number of useful numbers listed including the Single Point of Access number – I will add an About LYPFT page this week.  Any other suggestions or comments about this are welcomed – just blog.

Comments posted on the blog are published as you hit return; there is no filtering or censoring of the comments before they are published.  This will be reviewed over time but it was felt that people should not have to wait to see their contribution go live and that people should feel free to contribute their views.   If you make a comment that you later regret then you can either post another comment saying as much, or contact me and I can remove it for you as administrator (there may be other options but I am still learning about blogging!).  Feel free to comment on this, it would be great to hear your views.

For those of you that couldn’t make the meetings, this is the power point presentation Planning Care Network ppt.

That’s all for now; thank you for reading, please consider the questions and post your views.  Also, if you are interested in representing the Network at the Planning Care standing support group then please express your interest via email donna.kemp@nhs.net

Donna

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