REDESIGN OF ADULT SECURE SERVICES TRANSITIONS CO-PRODUCTION WORKSHOP 4 13th June 2019 Claire Holmes - Programme Lead Dr Katina Anagnostakis - Clinical Lead REDESIGN OF ADULT SECURE SERVICES TRANSITIONS

Aims for today… Ensure all stakeholder views included in ongoing progress New Care Models & IMPACT programme update and context Focus on Transitions: Highlight new developments & good practice Review Task and finish group work Work on how this progresses Organisational buy in

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: 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:

PEOPLE FIRST & WORKING TOGETHER EMPOWERMENT & OPPORTUNITY IMPACT Values 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

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.

April Co-production event: Community Infrastructure

You Said…. We Did…April 2019 Discussions with third sector organisations Built into the bid for new Assertive Transitions service Now built into the bid for new Assertive Senior leadership panel convened today More Peer support & community navigation within new service developments Work with Carer’s and families 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. Organisational buy in for service changes

Thank You Thank you for listening We hope you enjoy the workshop! ncmadmin@nottshc.nhs.uk

Summary & next steps… Themes and actions from all four events summarised into business case