Ocean View and Moorland View are acute inpatient wards in North Devon, part of Devon Partnership Trust. We pride ourselves on delivering a high level of service and support in a light and welcoming environment and atmosphere, to adults who require an acute inpatient admission during times of crisis in their mental health, when they are unable to be supported at home by our Home Treatment team. We have worked with our admitting Crisis Resolution & Home Treatment Team to ensure that there are clear and purposeful goals to admission so that we can begin to support people as soon as they arrive on the ward.
Highly Commended in Crisis & Acute Care Category #MHAwards18
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Ocean View and Moorland View are acute inpatient wards in North Devon, part of Devon Partnership Trust. We pride ourselves on delivering a high level of service and support in a light and welcoming environment and atmosphere, to adults who require an acute inpatient admission during times of crisis in their mental health, when they are unable to be supported at home by our Home Treatment team. We have worked with our admitting Crisis Resolution & Home Treatment Team to ensure that there are clear and purposeful goals to admission so that we can begin to support people as soon as they arrive on the ward. The ward staff then engage meaningfully with the service user and their families to develop shared care plans that are focused on their recovery. We ensure that discharge planning commences on admission and Discharge Facilitators work with individuals and their families to ensure that all actions are clearly planned and communicated and accommodation and finances are appropriately optimised. We have a mean length of stay of 24 days across our two inpatient wards.
What makes your service stand out from others? Please provide an example of this.
The physical environment on our units makes maximum use of natural light with high ceilings and sky-lights. Service user artwork is displayed throughout the units and communal corridors. The garden areas on both units have recently been improved. We have a longstanding gardening group run by our Occupational Therapy team and volunteer who is a previous user of our service. Their hard work has ensured that there is constant colour in the garden throughout the year and this is an inviting and relaxing area to spend time in. We try our best to enable people admitted to our units to have as many home comforts as possible, for example, allowing people to customise their bedrooms. At Christmas and Easter we ensure there is a plentiful supply of goodies for everyone and a wrapped Christmas present or Easter egg. Staff ensure that there are activities in place seven days a week and the staff who deliver activities at the weekend when the full OT programme is not available find this really rewarding. For example, they run breakfast and baking groups, rugby, decoupage, walking groups and coffee groups. Whilst we have a full and engaging OT programme, we recognise that it can be hard to appeal to the tastes of everyone and aim to enhance what we have by working with other organisations such as Devon Recovery Learning Community who are supporting us to design and deliver a programme of recovery based opportunities within Urgent and Inpatient Care, which may encourage people to engage with community based recovery courses upon discharge.
Each course is co-facilitated by someone with lived experience of mental health. For example, ‘What is Recovery’, ‘WRAP for managing emotions’ and a ‘We are Family – Understanding Psychosis for parents’. We are developing links with our local college of further education – Petroc – to provide work experience opportunities for their Sports, health and fitness students who in turn will support our OT team to deliver fitness and exercise opportunities for people using our service. We now have access to our own new inpatient gym space, road bicycles, and opportunities to engage with 5 a side football. Through a National Lottery bid we were awarded finance to engage with local arts company Wolf and Water who provide activities such as music, dance, yoga, print making and model making on the wards during times the OT programme is not available such as weekends and Friday evenings. This manages to engage people at all stages of recovery on a significant scale. Even those who do not actively engage derive enjoyment through observation.
Examples of patient feedback “just wanted to say a big thank you to everyone who has supported me in the recovery and the start of my journey to a better life, you are all lovely people and should be proud of the work you do” “a huge thank you for all the listening ears, wise words and non-stop support which has restored my faith in human kind. You have made me realise I may have a promising future ahead of me, and I appreciate massively all the hard work you have done to prevent me from failing.” “…. I have to mention Ray for giving me confidence and Roz for all the priceless CBT…” “you have helped me out of a deep and dark hole that I couldn’t have climbed out of alone”
How do you ensure an effective, safe, compassionate and sustainable workforce?
We are mindful to the national nursing recruitment issues and regrettably this is no different locally. Being so far from Plymouth University, we are not a natural option for many graduating nurses looking for employment. Therefore, we have invested in our own staff and are ‘growing our own’ nurses and leaders. We have had seven nursing assistants embark on the band 4 Assistant Practitioner programme; one of those on successful completion has already gone on to continue towards their registered nurse training and this year another one has applied to do so. We currently have three support workers who have undergone training via the Open University and will qualify this September, following in the footsteps of other staff who have previously taken this or similar ‘in house’ routes. We have a great retention record for staff, some of whom have been here for their entire careers, beginning as healthcare assistants and continuing as staff nurses after their training. We are aiming to provide exciting opportunities to attract newly qualified nurses by the creation of a rotational preceptorship programme across our different inpatient wards (inc OPMH) and the community. Professional development opportunities are available and many staff have completed or are currently are enrolled on individual modules with Plymouth University (such as CBT or Bateman model) as well as being supported to complete Masters degrees and non-medical prescribing. We develop our nurses to become leaders, through opportunities such as the Mary Seacole Programme, Clinical Leadership Course and the NHS South West Leadership Academy.
We welcome staff with lived experience and Devon Partnership Trust has its own service ‘Workways’ which supports staff with lived experience to remain at work. We have previous patients from both of our wards now working in paid and non-paid volunteer roles and we are developing a peer support worker programme. The positive attitude and high standards within our teams are embedded at induction and reinforced through supervision, team meetings and positive feedback led by the Ward Managers and Senior Nurse Manager. All staff take pride in the services that they provide and this culture is passed on through positive practice and ensures the sustainability of high standards. Alongside a robust 4-6 weekly supervision and annual appraisal system, staff have the opportunity to engage in group supervision or in 1:1 clinical supervision with the inpatient psychologist. We value our staff as they are our greatest resource and working in an inpatient setting is demanding. We hold fortnightly tea and cakes sessions as an opportunity to get together, take a break, eat cake and talk about anything. Additionally, the Ward Managers and Senior Nurse Manager have an ‘open door ‘ policy and encourage feedback, reflection and offer support whenever required.
Who is in your team?
We have an outstanding staff team. Each of our wards has a team of: 1 Consultant Psychiatrist 1 Junior Doctor 1 Band 7 Ward Manager 2 Band 6 Charge Nurses 8.5 Band 5 RMNs 14.5 Band 3 Support Workers / Trainee Assistant Practitioners / Band 4 Assistant Practitioners 1 Band 5 Discharge Facilitator 1 Medical Secretary 1 Ward Administrator. Additionally we have a shared resource of: 1 Band 8a Senior Nurse Manager 3 Band 7 Night Nurse Practitioners (who support the wards at night and perform the assessment and gatekeeping role for mental health presentations in the Emergency Department) 0.6 WTE Clinical Psychologist 1 Band 6 Occupational Therapist 2 Band 5 Occupational Therapists 3 Band 3 Occupational Therapy Assistants 1 Clinical Pharmacist and Pharmacy Technicians 2 Volunteers Some of our staff have worked on the units for over 30 years, this experience supports the provision of a containing and calming influence; alongside newly qualified nurses who bring in fresh ideas and keep us on our toes.
How do you work with the wider system?
We work alongside our colleagues in the acute trust – North Devon Healthcare – to provide for the physical health needs of people on our wards. Through Service Level Agreements and close working, healthcare professionals in both Trusts ensure that there is parity of esteem and people receive the care that they need in a professional and responsive manner. A recent example of good practice is both services working together to provide ECT locally, in the acute Trust operating theatre, to ensure treatment could be provided to someone who was too physically frail to travel to the Devon Partnership Trust ECT suite, despite this being outside of normal practice or SLA. We score highly on infections control and cleaning audits working closely with hotel services – Sodexho – who work as part of our team. We ensure all feedback from people who use our services is shared with the Sodexho team and their managers so they can appreciate the impact of their hard work. We have a strong working relationship with our local drug and alcohol services, Together, who respond promptly to referrals and engage early with patients whilst in our inpatient environments and ensure appropriate support is available on discharge They are also supporting our inpatient staff with training to deliver co-facilitated groups on substance misuse. As previously mentioned, we have employed local arts organisation Wolf and Water on our wards to provide activities, additionally Flying Fish Artists, a local art charity, have been attending Ocean View ward in the evenings to complete a seaside ‘Ocean View’ mural which engaged many patients and produced a fantastic piece of work which we are looking forward to be officially unveiled by our local MP.
We are aiming to improve the physical activity opportunities for people in our service by engaging with local college Petroc to support with health and fitness programmes and activities. We have close working relationships with Devon and Cornwall Police and come together in bi-monthly liaison meetings to improve and support the relationships between both organisations. We host placements for new police officers to allow them an insight into the workings of an acute inpatient unit and dispel myths around mental health and the use of leave from the wards. We host learning opportunities for other students from our acute Trust Northern Devon Healthcare (NDHCT) such as nursing associate and radiography students and Physician Assistants, to allow them to develop an insight and understanding of mental health issues, aspiring to achieve parity of esteem for people who use any health services. The hosting of Physician Assistant students has generated a modest income which has been put aside to offer training awards for the learning and development of all staff working for DPT within the North Devon locality. The chaplaincy service from NDHCT visits the wards regularly and as well as spiritual support they host services and singing. Other regular visitors to our wards include ‘Oscar’ the PAT dog. We have developed a working relationship with the local Samaritans charity who offer our patients a pioneering service whereby the Samaritans will proactively call people, who may otherwise struggle to make initial contact, and will continue to proactively call them for a number of times until they feel comfortable to initiate a call to the Samaritans themselves when required.
Do you use co-production approaches?
We are committed to working together with people who use our services and their families in everything that we do. We engage users in their care planning and hold weekly community meetings on the wards to gain feedback on their experience of any aspect of their admission. We are fortunate to have people with lived experience volunteering on our wards participating in groups such as ‘preparing for my ward round’ and WRAP and the afore mentioned gardening group. We endeavour to collect feedback through an enhanced Friends and Family survey called the ‘Acute Care Survey’ and we examine this feedback locally and in our Learning from Experience group meetings in order to improve our services. We also use the ‘Letter of Hope’ which was written by people with lived experience to provide hope in darker moments; this is given to appropriate people prior to their discharge from inpatient services. We welcome innovative ideas and provide opportunities for staff to engage with service development. We encourage feedback through formal methods such as the staff survey, supervision and team meetings.
However, the Urgent and Inpatient care management team have an open door ethos and staff will readily approach with ideas or concerns. One of our longest running staff initiatives is the SAFTI programme (Self Accessed Flexible Treatment Intervention) which allows identified individuals with a EUPD diagnosis to access short (3 night) respite admissions to the units in a planned way to promote self-management and avoid escalation of self-harming behaviours which had previously led to long admissions with little change in their longitudinal risk. This has been running for over 10 years and has proved successful and is being rolled out elsewhere in the Trust with support from North Devon staff to support its implementation. Staff are encouraged to utilise existing skills and to develop new skills in areas of interest. For example staff who have pre-existing fitness instructor qualifications are assisting in the development of the new inpatient gym, inductions and exercise regimes. We even have our own table tennis instructor. Staff who are keen to develop new skills include a healthcare assistant developing a healthy eating group on the wards having spent time with dieticians and the Trust physical healthcare lead.
Do you share your work with others?
Internally we share via Locality meetings and the Trust’s Directorate Governance Meetings and newsletter. The Trust also hosts peer observations of care visits where our managers will visit other wards to observe and share experiences and learning. We engage in inpatient workshops quarterly where our adult inpatient ward managers share good practice and plan service developments.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
All of the Devon Partnership Trust inpatient wards have engaged in the quality improvement programme ‘Four Steps to Safety’, which aims to increase patient and staff wellbeing whilst reducing violence and aggression on inpatient wards through the use of a toolkit of interventions that work in an integrated way to improve four key areas. This has been very successful and our Medical Director was recently able to share with the Secretary of State for Health, Jeremy Hunt, the work that our fantastic inpatient teams have been doing to reduce violence. In particular, data which sustained reductions of up to 78% in violence and aggression in some of our units, including our North Devon wards. As well as informal feedback, compliments and complaints, we endeavour to collect feedback through the Acute Care Survey, an enhanced Friends & Family Test developed within Devon Partnership Trust for feedback from people in the Acute Care Pathway. In order to improve the response rate from this we have recently introduced iPads onto the wards for the completion of this anonymous survey prior to discharge. Feedback is then considered in our local quality meetings and the locality Learning from Experience group, to examine trends, learn from feedback and improve services.
An example of patient feedback: “without you all and these services I’m pretty sure my situation would have ended a very different way. So not only am I grateful for helping me get through the hardest time of my life, but essentially saving my life when I really needed it”. We strive to create an encouraging and engaging learning environment and both wards have continuously achieved positive feedback from nursing students and have been rated as ‘Outstanding’ placement providers by Plymouth University, receiving feedback such as “Great team environment, inspiring nurses and great manager”. “The whole team were amazing, on shifts when I wasn’t with a mentor all staff made me feel involved and aided me in learning opportunities. My mentor came in on days off to assist me with things if needed, for example if the ward had been too busy to complete paperwork as planned”
Has your service been evaluated (by peer or academic review)?
In addition to a ‘Good’ rating by the CQC, Ocean View and Moorland View wards have been accredited with the Royal College of psychiatrists AIMS (Accreditation for Inpatient Mental health Services) process for the past six years. The purpose of AIMS is to improve the standard of care provided by inpatient mental health services in the United Kingdom and Ireland. To achieve the required standards the wards underwent a rigorous process of self-review and a peer review visit by an external team which formed the basis for the accreditation decision.
Areas of achievement noted included the following: • The wards are spacious and clean • There is a large staff room • The professional and relaxed nature of the ward was reflected by positive responses received from patients on the day of the review • Ocean view has good garden area • There is a robust supervision and appraisal structure • There is good staff retention and morale • A Pharmacist is visible on the ward • Patients fed back that the wards are “lovely” and they were very happy with the wards • Patients also praised the staff highly • Patients reported that the food was great • There is a learning disability link. • There is a full-time ward based consultant. • Morale was high amongst the team and staff are supportive of each other • There is evidence of a good understanding of the health record system and they have a care notes • The health records were comprehensive and easy to navigate • Good use of former patients to provide the gardening group and to support patients with planning for MDTs • A carer felt that staff did everything possible to help and involve them in their relative’s care • The patients spoken to on the day said they would recommend the wards to an unwell friend or relative
Plymouth University have rated our wards as ‘Outstanding’ learning environments for student nurses and the deanery (post graduate training authority) feedback regarding the training opportunities on ocean view and the staff support is excellent: “Very supportive team, great to work with, lots of opportunity for learning, trusted with a good deal of responsibility”
How will you ensure that your service continues to deliver good mental health care?
The Executive team within Devon Partnership Trust continuously work with commissioners to raise the profile of our services and ensure funding in core mental health services is maintained or increased. During the current economic climate however, we recognise the pressures on all services and therefore respond creatively by working with partner agencies, local charities and organisations to ensure there is a breadth to the opportunities and activities that can be provided (as already described our work with college Petroc, arts charities, Devon Recovery Learning Community). We develop our nurses to become leaders, through opportunities such as the Mary Seacole Programme, Clinical Leadership Course and the NHS South West Leadership Academy. The positive attitude and high standards within our teams are embedded at induction and reinforced through supervision, team meetings and positive feedback led by the Ward Managers and Senior Nurse Manager. All staff take pride in the services that they provide and this culture is passed on through positive practice and ensures the sustainability of high standards. Therefore, if management changes the services are stable and sustainable and the high standards will continue, as these run through the core of our multi-disciplinary team.
What aspects of your service would you share with people who want to learn from you?
In terms of challenges we have faced, we would have welcomed opportunities to be more involved in the design of the unit in order to avoid some of the challenges with the estate that we have encountered. However we do strive to address any issues that our environment poses. Recently, the practicalities of becoming ‘smoke-free’ wards did not really hit home until the initiative was in place, resulting in us having to hastily consider how to manage this locally. We have worked hard with our staff teams and considered how to overcome this challenge within our Urgent & Inpatient Care managers Quality meeting and now have a locally agreed protocol and improved information for people on our wards. Any challenges that have been encountered have been overcome by a calm and reflective team approach. We recognise that we are greater than the sum of our parts, as together we have many years of experience from many different fields – many staff members having careers prior to healthcare – that can help to identify fresh ideas, providing solutions.
How many people do you see?
16 patients on each ward. Average length of stay was 24 days over the past year
How do people access the service?
All admissions are gate kept by our Crisis Resolution & Home Treatment Team or Mental Health Act Assessment, with the exception of patients under the SAFTI programme who can self-refer for brief time limited inpatient stays.
Hours the service operates *
Brief description of population (e.g. urban, age, socioeconomic status):
Urban and Rural communities of North & Mid Devon, adults ages 18-65 (upper age may be lower or higher dependent on presentation, need and physical health
Size of population and localities covered:
North & Mid Devon
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
Provided by (e.g. name of NHS trust) or your organisation: *
Devon Partnership NHS Trust
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