Claire Holmes Programme Lead Dr Katina Anagnostakis Clinical Lead EAST MIDLANDS REDESIGN OF FORENSIC MENTAL HEALTH SERVICES Co-Production Workshop (2) February 2019 Claire Holmes Programme Lead Dr Katina Anagnostakis Clinical Lead

New Care Models: Recap The overall aim of the national NCM programme is to reduce usage of inpatient beds within the forensic mental health system by preventing avoidable admission, reducing lengths of stay. This can be done by providing better pathways of care and joined up processes through groups of providers working together. This also includes fewer people going out of area into placements often many miles away. Through less use of beds the idea is that money freed up is used by groups of providers to provide improved services and support in the community including use of non-NHS services for example third and voluntary sector. This is a national programme whereby NHS England will pass their specialist budgets to groups of providers by April 2020.

New Care Models: East Midlands We are using this as an opportunity to completely redesign adult secure mental health services in the East Midlands hence we are holding these events to ensure as many people as possible can be involved and provide their views. The organisations involved are: NHS Trusts Independent Sector Derbyshire Healthcare Leicestershire Partnership Lincoln Partnership Northamptonshire Healthcare Nottinghamshire Healthcare Cygnet Healthcare Elysium Healthcare Priory Group St Andrew’s Healthcare  

Proposed Benefits of the Programme Better quality of life and experience for service users and families More people being effectively supported within community settings (and not readmitted into either forensic inpatients or adult acute services) with access to educational and employment opportunities Avoidance of people entering into forensic mental health services without a negative associated impact on other services such as adult mental health Faster admission into a secure unit if required without any unnecessary delays through improved gatekeeping and assessment processes on a regional basis. Reduction in time spent in an inpatient unit People being repatriated from placements out of area and a reduction in people going into inappropriate placements Reinvestment into new community services.

January Session: What Did We Cover? We provided information as to what is happening nationally and locally in the East Midlands around the new care model programme The role of co-production in service redesign Guiding principles NHS England provided information about secure mental health services, including demand, to help inform our thinking about a new model Challenges for people using forensic services at present; solutions and opportunities

January Session: Guiding Values/ Principles Around 40 people attended the workshop from across the region; this is what people said as values & principles for any new model: Patient, carer, significant other and support network experience Personal goal focused Supporting reduction of stigma Knowing what opportunities are out there Creating an environment where people want to work, including educating the community about the risks / benefits of working in forensic services Supporting places to employ ex-offenders Community centred approaches, resulting in capable, confident communities

January Session: Challenges & Solutions There was a lot of discussion around this. Some of the general themes were: Need for a more rapid single assessment process as opposed to long waits and multiple assessments: action “approved assessor” Lack of service user choice where placed People are often “stuck” in secure services; lack of consistency with monitoring people for their whole journey “Single point of exit” seen as a solution to this ie closer oversight of people when in inpatient services Do we need levels of security? Move away from this? Need to target support very early on when an inpatient to support discharge Extended period of support needed on discharge Need to be much more community focused and use community resources- access to meaningful employment & education Consistent theme around use of peer support and support workers both in inpatient and in community teams; use of care navigators Access to mental health care when in prison- can this be done differently? Tensions between NHSE and CCG funding.

What have we done following the workshop? (1) We are developing a single access point for referrals into secure services across the East Midlands We are streamlining assessments using an “approved assessor” process We are planning on managing beds on a regional basis Developing a new process (“decision tree”) for bed allocation ensuring principles such as closer to home and choice are followed We have set up a new working group to look specifically at transitions through services; not conducting access assessments at every security move; developing a “clinical hub” for the region with multi-professional and organisational oversight of all people in secure services. Set up a learning disability & autism working group. There is a new funding opportunity from NHSE to develop community forensic services due very soon; issues from the workshop will be part of the proposed model including:

What have we done following the workshop? (2) Working with people in inpatient services up to a year before discharge; more intensively closer to discharge Providing intensive support post discharge, including out with usual hours, for a number of months over and above existing service support We want this new service to include third sector input, peer support and more support workers generally to help provide practical and emotional support to people as well as link in with employment, educational and other opportunities in the community. We want to ensure these aspects are built into our new model.

Thank you for listening We hope you enjoy the workshop Questions..