Integrated Acute Care Pathway – Navigo. (ARCHIVED)

The Harrison House in-patient facility brings to life our vision for a total overhaul of the way mental health services are provided, moving away from hospital, creating a specifically designed environment. Harrison House seeks not to disempower people, or make them passive recipients of treatment.

Co-Production

  • From start: Yes
  • During process: Yes
  • In evaluation: Yes

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

What We Did

NAViGO continues and always will continue to push the boundaries of how mental health services are delivered and how staff are involved in the delivery of those services. This attitude is not simply held at the head of the organisation but is embedded within the very fabric of our organisational culture. Each and every employee working for NAViGO is proud of the organisation and what it stands for in some way. Our staff survey results evidence that over 78% of our workforce would recommend NAViGO as a place to work and 81% would recommend the service to family and friends. By ensuring integration, choice, support, fairness, equity, validation and inclusion for our staff teams we will continue to reduce stress in the workplace.

The Harrison House in-patient facility brings to life our vision for a total overhaul of the way mental health services are provided, moving away from hospital, creating a specifically designed environment. Harrison House seeks not to disempower people, or make them passive recipients of treatment. In 2008 we recognised nationally that specialist teams had drained the acute wards of experienced staff and we integrated the crisis home treatment team into the acute wards. Having one staff team allowed for a seamless journey for people who use our service and all staff work together to deliver this model. Accommodation is provided in 2 small community treatment units (‘Lodges’) with a maximum of 10 beds each, together with a 5 bedded flexible enhanced care unit, specifically designed to promote well-being, using innovative thinking to address traditional problems.

• Our own service user employment scheme (Tukes) running all ancillary functions on the site (catering, cleaning, concierge, estates maintenance etc), giving both skills training/work to people with mental health problems and also providing very high quality Facilities services in tandem
• Clinical spaces separate from ‘sanctuary’ environments ensuring appropriate atmosphere for all functions.
• Subtle attention to detail such as individual medicine cabinets in peoples rooms to ensure one-to-one care, negating institutional queuing behaviours
• A ‘quiet’ enhanced care Lodge to de-escalate behaviour , removing the need for a traditional-style seclusion room, thus helping to preserve dignity
• Office/admin/reception/café/associated non clinical areas in a separate main block open to the public with associated sports facilities
• Service user-issued swipe cards to own rooms ensuring safety/privacy (can only be overridden by staff or same sex/person in charge)
• Staff working in-reach/outreach, meaning the same staff work flexibly to meet all acute need, staffing the units, doing assertive home treatment and crisis functions, simply following the people who use the service wherever the care is needed ensuring continuity. This flexibility of staff, has also allowed smaller more therapeutic (10 and 5 bed) units to be affordable in tandem.
• Consultants attending MDT handover 8 am daily on every service user
• Access 5 days per week to clinical reviews (Clinical Lead on each unit – 60% of time is spent on clinical work)
• On-call SHO 24/7, Consultant 24/7, AMPHS 24/7 – AMPHS based on acute site/on-call Dr is on in-patient lodge
• Concierges
• All-inclusive (same staff) crisis/in-patient/home treatment
• Social Work Lead based on acute site in the Therapeutic Community which we opened in 2015 to address the shortfall in services for people with a diagnosis of Personality Disorder.
• Enhanced care unit rather than PICU
• IAPT services offer appointments on site following crisis assessments.
• Dual Diagnosis team are based on site.

 

Wider Active Support

We feel it is fair to say that NAViGO is a well-respected provider locally and as such, not only seeks, but is sought out to work with a whole host of other organisations in a variety of settings. We feel, as an organisation, both physical and mental wellbeing go hand in hand and as such have fostered relationships with providers who are able to address our ‘whole person’ approach to maintaining excellent mental wellbeing. Examples of our networking/partnerships working (but not exhaustively) would be:-

Care Plus (learning/physical disabilities, employment, drug intervention); CERTS Training; ISIS training; Community Learning Service; CAT ZERO; Best Training; St. Andrew’s Hospice; St Hugh’s Hospital; NLAG (Northern Lincolnshire & Goole Hospital Trust); Children’s Centres; Open Door; Care4All; Carlton Education & Enterprise; Health and Wellbeing Collaborative; Employability; GP Practices; Job Centre Plus; In-Training; Lincs Inspire sports centres; Shoreline Housing Partnership; Longhurst & Havelock Housing; Humber YMCA; Salvation Army; Community Services; PCSO’s; Magistrates/Crown Courts (we provide a Liaison and Diversion service both in North East Lincolnshire and more recently have been asked to duplicate this in North Lincs); VANEL (we hold a Supporting Volunteers Award Level 2 evidencing we operate within correct procedures for working with volunteers and can provide excellent facilities); Hull and Grimsby Chamber of Commerce; Women’s Refuge; The Freemen of Grimsby; North East Lincolnshire Council; West Lindsey District Council; Hill Holt Wood; Friends of the Park; Park Ward Action Group.

Co-Production

Service Users/Carers are completely integral to everything we do. It is their views/opinions that shaped the service even before Harrison House was built or NAViGO existed. The building design for Harrison House came about following consultation with service users/carers, together with North East Lincolnshire Service User/Carers Independent Forum, to establish what they felt would make a difference to their experience of mental health services and what they would/would not like in a care setting.

NAViGO is ‘owned’ by its membership, which consists of staff and community members (service users/carers/members of general public with special interest), all with equal voting rights. This means we:

• Vote on changes to services/plans for additional services/staff conditions etc.
• Consult membership heavily on numerous occasions, including voting on how surplus is allocated through large/ small internal grants.
• Eight elected staff/community representatives sitting on our membership/CIC Boards.
• Membership have real powers as above and including areas such as Senior positions such as the chief executive/chairman being periodically reapproved (or not) by the membership.
• Tukes, (training and employment arm), has its own Membership Board with service users, volunteers and staff representatives sitting alongside Board directors. Representatives are nominated by peers and voted on to the Board on an annual basis by Tukes Service Users, ensuring a fair and equitable process.
• People who use services and carers on interview panels, present at new inductions and involved in teaching of staff

NAViGO is governed by the NAViGO CIC Board which has service users, carers and staff stakeholders sitting alongside NAViGO Executive and non-Executive Directors, ensuring consultation takes place at all levels. Community and staff representatives attend both the CIC and NAViGO Membership Board meetings ensuring information is cascaded down through the organisation in an open and transparent way. The CIC and Membership Boards meet bi-monthly and monthly respectively. One of each staff and community representatives are also adopted as full non-executive directors, along with an elected chair, elected councillor and a GP rep.

Looking Back/Challenges Faced

Moving away from Public Services to become an employee led mutual has been a great challenge in itself. On the whole there are very little changes we would make to how we did this and what we have achieved since we made the move bears testament to the multiple benefits – we truly feel blessed with having had the ability to make this decision. However, if we had to pinpoint one thing we would do differently it would be to not underestimate the length of time it would take us to change the staff culture and the levels of stress and anxiety this would cause due to resistance to change.
Having moved directly out of NHS services it was a huge challenge to change staff mentality away from being part of a Public Service. When you are a social enterprise everything you do has a consequence that can be felt throughout the organisation – it IS important that we pay attention to our spending and what we spend money on, it IS important that we do not allow sickness to impact on service delivery etc etc. We have had to instill that change throughout the organisation both in terms of attitude and operational objectives. If we had to do the move all over again we would tackle this issue much earlier and much more stringently to avoid problems later down the line.
Other than this one issue there is nothing we would change.

*Changing the view of the local community in terms of mental health and stigma – This has been done in numerous ways. Broadly speaking many of the activities offering wider community benefits, making facilities more open, designing the organisation to be a locally owned one, getting involved in wider non-specific community projects, running community cafes etc. showing people with MH problems in positive ways, offering openness and media campaigns discussing issues around mental health.

*Gaining planning permission and getting an appropriate site(s) – Many of the above activities. Running some council facilities, showing social value, getting community groups on side, large community consultations and working closely with councillors including engaging them in non-paid roles in services.

* Funding – presenting facts, offering solutions to wider problems, trying to benchmark services. Before being a social enterprise we moved into the NHS PCT to help facilitate change for a period.

* Moving to a community owned organisation – A lengthy process of showing staff and the local community services that were more community facetted and seen as useful to all. A vote was taken at the end of consultation to agree movement in social enterprise and despite considerable resistance and propaganda from some national staff side organisations 74% of staff voted for and 98.4% of service users/carers

* Designing an organisation that represented all, but was still decisive and quick to act. A process of considerable consultation and discussions with service users, carers and staff and all represented on design groups

* Changing staff attitudes and practice – Lengthy process of suggesting and showing better ways of working. Giving service users more rights and powers and exposing staff to service users views in courses, daily interactions and seminars. Also involving service users in all mechanisms to run the services. Clear philosophical statements and messages. nb – No staff member questioned or challenged the article giving service users equal voting rights at any point in the final process, yet this was widely discussed!

* Overcoming chronic recruitment difficulties – Creating an organisation where staff are involved and making clear all things can be changed and redesigned to work better. Setting aspirations for people to engage with and trying to make people proud of their services. We now have very few recruitment difficulties in any staff group, coming from a position of real difficulties.

*Having staff skilled and flexible enough to work in this mode. Nurturing, training, involving, clarifying standards, not tolerating anything beneath those.

* External pressures against moving to a not for profit social enterprise. As above getting the local community on board and increasing their sense of ownership. Making the MH services useful to the community and being very open about issues.

Sustainability

Pushing the Boundaries – Ownership – NAViGO continues and always will continue to push the boundaries of how mental health services are delivered and how staff are involved in the delivery of those services. This attitude is not simply held at the head of the organisation but is embedded within the very fabric of our organisational culture. Each and every employee working for NAViGO is proud of the organisation and what it stands for in some way. Our staff survey results evidence that over 78% of our workforce would recommend NAViGO as a place to work and 81% would recommend the service to family and friends. By ensuring integration, choice, support, fairness, equity, validation and inclusion for our staff teams we will continue to reduce stress in the workplace.

Prevention – We actively promote prevention techniques around all manner of health related issues including alternative stress release methods. Traditionally, Grimsby and the local area has a culture of high levels of drinking and smoking, linked to the high levels of deprivation; Especially bearing in mind NAViGO’s practice to recruit local people wherever possible, we continue to challenge this by innovative ways of tackling traditional issues – Reiki training is a good example of building up resilience.

Culture – Health and wellbeing are extremely high on NAViGO’s agenda and are embedded in the organisational culture. NAViGO regards staff and service user wellbeing as being fundamental to having a happy, positive and productive workforce.

We have various programmes/procedures in place to ensure sustainability such as:

Emerging Leaders programme – each year candidates are nominated by managers (from all banding levels) to work on a 6 month leadership talent programme. They are taken through a host of various training, development and information sessions around leadership and management, eventually culminating in them designing and delivering their own project.

Medipex Innovation Champions – we have two employees who are trained as Innovation Champions and who support colleagues in bringing forward/developing their innovations. By being inclusive to all employees, we ensure the workforce is motivated around future-proofing NAViGO. We are soon to bring in an annual Innovation Award where all projects developed throughout the year will be considered for this prize/reward scheme.

Business Plan – There is a business plan in place to ensure the organisation moves in the right direction – this is backed up by a fully comprehensive risk register which is scrutinised on a quarterly basis through our Clinical Governance Committee

Objective Setting – annually we consult with the Membership (staff, service users, carers and local community) to determine the main organisational priorities for the year ahead – this ensures a comprehensive buy-in to the shape of the NAViGO going forward. The same objectives are fed into staff Personal Development Reviews.

Environmental sustainability – we have a whole host of environmental practices including, for example:- LED low energy lighting throughout; Water saving options on urinals/toilets/showers; Fair trade on food and use of Fairshare ethical food distributor; Buildings eco-friendly including solar, PV panels, meeting BREEAM standards; Recycling including cardboard, paper, waste oil, WEEE, Toner cartridges, batteries etc.

Evaluation

NAViGO as an organisation is continually monitored for its compliance with CQC standards as a matter of course. However, we take evaluation of our services very seriously indeed as we view this as a way of evidencing that our methods REALLY work. With this in mind we engage in the evaluation methods shown below. Although some of the evaluation methodology relates to patient experience rather than staff mental wellbeing, we feel the two go hand in hand and you cannot have a quality service without a well-motivated and happy workforce hence we have included these in our answer:-
• Friends and Family Tests – evidence that our service users and their Carers’ are happy with the services received
• Staff Surveys – we engage in an annual staff survey (conducted by an external body) to evaluate the morale of our workforce. Our results to date have been well above the national average in almost all categories and have resulted in NAViGO being identified at one of the ‘Top 10 Organisations to work for’ by Health Service Journal
• Best Companies – In 2016 NAViGO registered to take part in the Best Companies accreditation. This entailed a separate external questionnaire aimed at our staff, our working practices and our leadership. Upon assessment we are happy to say we appeared in the Sunday Times 100 Best Companies Award this year
• ISO9001 – NAViGO has started the process towards gaining ISO9001 accreditation. We see this as being essential towards evidencing our quality nationally/internationally and being an excellent tool with which to streamline operations, offering consistency/higher morale for our staff
• MSNAP – Memory accreditation shows we are almost 100% compliant with MSNAP and AIMS– we shared 1st place for response times and for Dementia diagnostic referrals nationally
• PREMS/PROMS – Patient Reported Experience Measures (PREMS) and Patient Reported Outcome Measures (PROMS) feedback is positive, borne out by testimonials received.
• Star Wards – this is a service user-led quality evaluation tool for which we are accredited as excellent in both of our in-patient areas (Acute & Older People’s)
• Quality Reviews – conducted by our in-house Performance Team who analyse statistics, service user information, complaints, compliments etc to evidence our performance levels, producing comprehensive Quality Accounts annually that map progress
• Annual Reviews – Carried out by our Communications Team, our Annual Reviews offer a round-up of the previous year and highlight areas of excellence
• PDR’s/Supervisions – NAViGO firmly believes in staff supervision and an annual Performance Development Review for each and every staff member. Objectives for the year are set by our Membership and feed in to both team and personal objectives set in order to ensure the Memberships views/needs are seriously addressed
• In-patient discharge questionnaires – these are a mandatory survey completed by each service user on discharge from one of our in-patient units. Ensuring questionnaires are completed and reviewed also keeps us in touch with how our service users feel about the care they receive and gives us the ability to make changes when necessary. The results are compared to 26 Mental Health trusts (40% of the total number of trusts in the UK) and NAViGO performed excellently.
• Positive About Disabled People – this is annually reviewed and re-accredited
• Mindful Employer – this is annually reviewed and re-accredited
• Awards – we have 13 national awards under our belt for best practice in a variety of our service areas

Sharing

We are very proud of our methods of service delivery and in the fact that we know the changes we have made in traditional mental health service delivery really work in terms of increasing staff morale, improving patient outcomes and on cost savings.

We are only too happy to share our experiences with others and positively welcome the chance to host a pro-active all-systems learning event around developing a pro-active approach to the management of workforce mental wellbeing. We hope to bring about a step-change in the way mental health staff are consulted and treated worldwide and see this as ‘hand in glove’ towards improving not only staff wellbeing but also patient safety/experience.

Examples of what we have done already along these lines promoting our working methods as a whole are:-

• We have had over 150 organisations visit us in the last three years.
• Consultation events with a host of Health Trusts Nationally around our methods of service delivery/staff engagement.
• Consultation events on setting up employment and support services similar to ‘Tukes.’
• We have recently attended and spoken at a Conference in Canada around our WHISe Project (combining physical and mental health evaluation for Schizophrenia service users, tackling the huge inequality in longevity (up to 20 years) between those with Schizophrenia and those without). This is something our staff are very passionate about and it is their innovation that has brought about this new service any improvement we can make on statistics will have a positive effect on job satisfaction.
• Working internationally with Demir Kapji, a mental health hospital in Macedonia, assisting in staff training to improve service delivery and their mental wellbeing
• Working internationally with mental health organisations in both Antigua and Barbuda around adoption of our RESPECT training solution in dealing with challenging and difficult behaviour. Learning RESPECT techniques within an organisation can reduce levels of violence and aggression as service users are less stressed, ultimately staff suffer less trauma as a result.
• We are presently in discussion with Councils outside our region who want to work with Tukes/NAViGO on setting up a host of different community projects
• We are working additionally with three general hospital trusts around avoiding admitting older people to hospital and issues regarding the Francis inquiry and general hospitals and different models of care (Home from Home facility came from this work)
• We also have contacts and projects with several universities, internal research into non-invasive treatments and contacts and projects with numerous other not for profit organisations nationally.
• We host monthly management development days the content of which is disseminated through supervisions etc to keep staff involved at all levels
• We host annual Health and Wellbeing events – another example of sharing good practice around wellbeing

• We continue to try to reach as many organisations as possible and being successful in securing a Positive Practice in Mental Health Award would mean the ability to promote our innovation, bringing about positive changes in treatment on a much wider basis. Several large MH trusts and councils for example already are mentored/supervised by us for Respect training and this continues to grow nationally, especially bearing in mind the Government agenda around abolishing prone holding techniques.

We are very proud of our methods of service delivery and in the fact that we know the changes we have made in traditional mental health service delivery really work in terms of increasing staff morale, improving patient outcomes and on cost savings – for example, the reduction in sickness benefit costs mentioned earlier.
 

 

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