Transforming Care Where are we now? Dr Hannah Toogood FIND Team April 2018

Outline Who is in hospital currently? Who is getting admitted? What works (and what doesn’t)?

Who is in secure hospitals currently?

People by CCG 55 Plus 4 awaiting beds. High Medium Low Total Gender M F B&NES - 1 Bristol 8 6 16 Glos 3 9 2 15 North Somerset 5 Somerset 4 South Glos Swindon Wiltshire 22 24 55 Plus 4 awaiting beds.

Where are they? 8 specialist beds in Bristol 5 in mainstream services within region

High levels of institutionalisation 10 have been in secure hospitals for 5-10 years. 4 for more than 10 years. 9 have never lived in the community as adults.

Highly complex needs Majority have at least two different major diagnoses. 56% have LD, of those: 29% also have ASD 35% also have a personality disorder 29% also have a serious mental illness 29% have a combination of two of these and LD Plus ADHD

Diagnoses

History of trauma 62% have documented histories of severe trauma. 40% were ‘looked after children’.

82% sent to hospital by the Courts or via prison transfer. Offending behaviour Fire Violence Sex 2 of these All 3 29% 87% 36% 33% 11% 82% sent to hospital by the Courts or via prison transfer.

Discharge planning 40% are currently involved in active transition work/discharge planning.

Who is getting admitted currently?

Admissions during financial year (2017-2018) 4 from the Courts/prison: Murder Violence with weapons Multiple child sex offences. 3 from other hospital settings: 2 failed step-downs to ‘locked’ rehab 1 from open acute ward with charges pending.

Discharges during financial year (2017-2018) 7 to the community (4 direct from medium secure care). 1 to prison 2 to ‘locked rehab’ (both from medium secure care).

What works (and what doesn’t?)

Gatekeeping and alternatives to admission Effective, high quality care Discharge planning

Avoiding inappropriate admissions Specialist multidisciplinary gatekeeping of all referrals. Effective use of ‘Blue Light’ meetings and CTRs. Offering alternatives to admission. Close working relationships.

Effective, high quality inpatient care

Effective, high quality inpatient care Personalised. Start prior to admission. Based on a detailed understanding of needs. Collaborative – service users and families/carers. With clear direction and markers of progress. Overseen by specialists. Strategic use of mainstream services.

Cartoons by www.pixton.com

Co-created therapeutic programmes Cartoons by www.pixton.com

Effective, high quality inpatient care Active MDT working with high levels of involvement from consistent skilled community professionals. Work on independence skills. Building hope for the future. Identifying and addressing blocks to progress: Difficulties with engagement External review when things feel ‘stuck’.

Working with ‘out of area’ hospitals Knowing our service users well. Building relationships and ensuring good communication. Asking lots of questions. Clear expectations.

The future: Low secure specialist beds within region. Assessment beds: Focused 3 month MDT assessments. Is hospital necessary? Are there any safe and appropriate alternatives? Transition beds: Designed specifically to provide a base for transition back to the community for people from out of area hospitals.

Facilitating discharge Always thinking about discharge planning. Working closely with other agencies, service users, families and carers. Addressing barriers early. Can this treatment be provided safely in the community? CTRs and life planning.

Facilitating discharge Highly skilled community providers. Instilling hope and self-belief. Building relationships. Working collaboratively, trying things out and learning together.

Sustaining discharge On-going high quality care: Care provider Community health team Community social care Work with families Communication Effective and responsive crisis and contingency planning: Police Liaison and Diversion Services Intensive and Inpatient mental health services Forensic services ‘Blue light’ and MAPPA meetings.

Thoughts?