Claire Holmes Programme Lead Dr Katina Anagnostakis Clinical Lead IMPACT EAST MIDLANDS REDESIGN OF ADULT SECURE SERVICES Co-Production Workshop (3) Discharge & Effective Support in the Community 24th April 2019 Claire Holmes Programme Lead Dr Katina Anagnostakis Clinical Lead

Overall Aim:- Provide better support in the community, less reliance on secure beds to achieve improved outcomes for service users and their families How we will achieve this:- Shorter lengths of stay, reduced admissions, improved community infrastructure

New Care Models: National Progress There are 8 wave 1/2 sites for adult secure All have identified savings through less use of inpatient beds by providers working together They have each reinvested into community services including step down, intensive community support and adult mental health services such as crisis. They have introduced new ways of working such as: Streamlined assessment systems for example through Trusted Assessor SPA into secure services for a region Introduced new care pathways

Redesign of Services: National Update NHSE aim to delegate its specialised commissioning functions and budgets for all adult secure services across England by April 2020 (CAMHs & adult ED April 2021) They are in the process of developing guidance and proposals as to how this will happen during 2019 “Provider Collaboratives” are working together to identify what a new model will look like in their regions. Within this a Lead has to be agreed to take this work forward with NHSE; for the EMs it is Nottingham Healthcare NHS FT A high level business case will be submitted to NHSE in June that outlines a new clinical model; new partnership for the EMs; financial arrangements and how all of this will be monitored in terms of quality and success. New contracts will be awarded by December with sites live across some of England 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  

What do we want to achieve through the Programme? Better quality of life and experience for service users and families More people being effectively supported within community settings 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 streamlined assessment processes on a regional basis. Less time spent in an inpatient unit ie only when needed Less people having to go out of area due to lack of availability of secure beds in the EMs Reinvestment into new and different community services which can be achieved through less use of beds.

February Workshop 62 people attended from across the EMs including a number of service users. Cygnet Derby service user group and NHCFT did a presentation about the work they have done around values and what is important to them around this service redesign. The improved admission T&F group did a presentation on the work so far which was discussed in small table groups. The afternoon focused on peer support developments in forensic services. In terms of learning/ issues people took away from this session, the overwhelming response was around peer support ie taking this back into respective organisations and developing the role. A lot of people said they felt enthused around doing more work around service user involvement.

You Said…. We Did… Approved assessment process Decision Tree Referral form Performance management process & audit Assertive transitions team Peer support workers – Blended Pilot Transitions task & finish group Fewer assessments to step down security levels/ discharge Women’s Blended Pilot Service directory Regional bed management panel Too many assessments Not enough choice Not enough support before and after discharge Need for peer support You Said: There are too many assessments to get into secure services Individual choice as to where people are placed is often not taken into account. We did: We are introducing a single “approved assessment” process that negates the current practice of multiple assessments We have developed a “decision tree” ie a set of principles that are applied by all clinicians when people are placed in a secure bed or move between levels of security. Service user and family choice will be central . This will be introduced when the new referral form starts being used from 1 June. Decisions around bed allocation will be audited to ensure choice is consistently applied. There should be more support available to help people well before discharge from secure services and after discharge Peer support and support workers are needed in forensic services to provide practical advice and assistance including emotional support. We are developing a new service that will provide support to people up to a year before discharge and help transition in the community; a large part of the staff will be peer support and support workers. People are often “stuck” in secure services; they don’t know when their discharge date is or what is happening. We have set up a new task & finish group to look specifically at transitions and a system whereby there will be much more oversight of people when in secure care including a “single point of exit”. This group is also looking at how we can end repeated assessments when people move between levels of security. The Women’s blended pilot at St Andrew’s should reduce the times people transition; if successful this can be rolled out across other services. ‘Stuck’ in secure services Not enough information

IMPACT Values HOPE PEOPLE FIRST & WORKING TOGETHER OPENNESS & HONESTY Safety: shared responsibility; public protection Least restrictive: closest to home; positive risk taking Autonomy: control of our own lives; choice; no decision about me without me Empowerment: passion; pride; best practice; innovation Opportunity: encouraging resilience; recovery opportunities Inclusivity: respecting diversity including families, carers, staff Honest Transparent Clear Mutual Expectations: clear pathways and expectations; not setting people up to fail; not ‘sugar coating’ things Trust Accountability Person Centered: people first; not them & us; one team; respect Working Together: collaboration; co-production Genuinely Responsive: real; genuine; listening PEOPLE FIRST & WORKING TOGETHER OPENNESS & HONESTY SAFE & LEAST RESTRICTIVE EMPOWERMENT & OPPORTUNITY HOPE

Our Proposed Name for the East Midlands New Care Model IMPACT Improving Mental Health Pathways and Community Teams Having a positive IMPACT on our future.

Documents Exploring the lived experience of women in secure care services 2018 Carer support & involvement in secure mental health services: a toolkit (NHSE) https://www.england.nhs.uk/wp-content/uploads/2018/05/secure-carers-toolkit-v2.pdf

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