Over the last two years OAMH have worked with commissioners and other providers to deliver services in a way that keeps the persons needs at the heart of their offer. They refuse to see organisations, directorates, authorities, regions as barriers to care delivery - rather truly live the value of Right Place, Right Time, Every Time.
What We Did
Older Adult Mental Health Services work into two Vanguard sites (and border with a third in Airedale – where some of their service users attend for emergency care), 8 CCG areas, 5 Acute Trusts and 3 Local Authorities. They have learnt to build their services around people not systems.
Over the last two years they have worked relentlessly with commissioners and other providers to deliver services in a way that keeps the persons needs at the heart of their offer. They refuse to see organisations, directorates, authorities, regions as barriers to care delivery – rather truly live the value of Right Place, Right Time, Every Time.
Specific examples of work include aligning our clinical service in Lancaster so our mental health care home services locate with physical care home services to offer more joined up thinking: Supporting the Wyre and Fylde Vanguard Extensive team to grow in confidence and competence in working with psychological distress: Collaborating with the Better Care Together Vanguard to understand mental health and physical health co-dependencies: Piloting mental health nurses in district nursing services in Central Lancs: Progressing mental health nurses in community nursing in East Lancs.
The lived experience of these examples leads to examples such as a district nurse and a psychiatrist supporting each other in a best interest assessment relating to someone’s dangerous lack of adherence to an insulin regime through to Support workers in community services being MECC trained and offering thorough advice to service users on how to keep well and stay out of secondary care services. Innovation has even seen our Lancaster team develop an award winning ‘safer wandering scheme’ with the police. In terms of working in the service, we have good recruitment and retention, a ‘Peoples Plan’ and a clinically led, operationally enabled passionate, stable leadership team.
Wider Active Support
People by experience, Third Sector Partners, communities (the trust are registered as a Dementia Action Alliance and are active in numerous dementia friendly communities across the county), NWAS, Police, acute hospitals, primary care, care homes, local MPs, supermarkets, dementia cafes – are all partners to the service.
Although the service is commissioned as a secondary care specialist mental health service, its ethos is one of creating sustainable resilient communities that know how to care for themselves for as long as possible – and then know where to turn to when they need help.
The Vanguards and other community services responding to the financial challenges within the NHS can find themselves looking inwards rather than outwards for solutions. At times of unprecedented demand we have found that service redesigns can sometimes concentrate on acute models of ill-health unconsciously forgetting the impact of psychological and social factors that sustain well-being and prevent ill- being. The older adult mental health services have been ambassadors for encouraging whole person thinking when considering system redesign, serving as a source of knowledge and experts in psychological science in support of partner organisations looking to deliver new models of collaborative health and social care.
Our organisation has been actively using the Friends and Family Test for over 18 months – with 4 added questions to help us understand more. The data is reported team by team including qualitative feedback so we can respond very quickly to both fix and applaud issues/compliments raised. We also hold Our Time meetings on our inpatient wards to have some focused opportunities for people currently staying with us to share their experiences. Feedback from FFT, Our Time and other ad hoc surveys and questionnaires are then used to promote action – and feedback to those who use services in the future in the form of ‘you said – we did’ posters across the organisation. One example of this is a recent request for more classical music choice on the inpatient units at the Harbour. The poster confirmed the request and the new purchases!
The two Vanguards in the North are currently acting as ‘test beds’ piloting a range of technology, and we have actively ‘recruited’ a people by experience advisory group to test out ideas/evaluation materials – and be a sounding board for the clinicians/ technicians and academics throughout the duration. ‘No decision without us’ is again a reality, not a phrase in LCFT Older Adult Mental Health Services.
Looking Back/Challenges Faced
We knew promoting whole person health across services usually contracted to provide physical OR mental health services would be challenging – but were clear that Kings Fund, Five Year Forward View and other national policy clearly supports this – not to mention the clinical gains to the person! We have worked hard to provide both a clinical, financial and practical rationale to commissioners, fellow clinicians and people, carers and communities alike to continue to progress a ‘bio-psycho-social’ whole person health approach to service delivery.
The most powerful tool we have had have been service users stories of how the approach has benefited them – or GPs stories of how MDT conversations have helped them make better decisions about people with multiple needs. Maybe mobilising these stories – and capturing more of these could have helped progress things quicker and with more success?
Funding – of course has been a challenge! In some areas, commissioners have legitimately recognised that the older adult mental health service is stretching its capacity beyond itself and have funded further nurses to support their and our ambitions for further mental health input into physical health services. In other areas and teams it has been around more creative approaches to the way we work together. How many people on their caseload are on our caseload? If its 20% then we will do x – if its 90% then of course we need to co-locate and consider a single assessment process.
Overcoming the funding issues and/or any perceived organisational/ccg barriers have very much centred on the fact that as long as you keep the person at the heart of your decision making, then you cannot go wrong… Strong leadership – clinical leadership has been central to these positive conversations.
When presenting to our executive team last week – it was clear there were at least 5 leaders in the room involved across Lancashire in driving forward collaborative models of care on a whole person health agenda – and that was but a few of those passionate about the ambition. This isn’t a project – its a philosophy – and its not the ideas of one person who might move on. Thus it has real sustainability – not least because it is wholly supported by our executive team as a principle, its just been quickly and warmly adopted by the older adult mental health directorate.
The pilot in Central Lancs was evaluated and feedback to numerous stakeholders. The Vanguards are being evaluated through more rigorous independent review processes – though we might need to encourage the evaluation to consider the extent to which they are evaluating whole person health as well as the new models of care. Developing East Lancs whole person health models includes evaluation in the agreed specification.
In Central Lancs. – we wrote up the project and delivered this back to commissioners. The report was rich with stories written by people who had experienced the whole person health service. We discussed our collaborative working with the Vanguards with the National Deputy Director of Public Health (Dr Charles Alessi) last year and with our Executive team only last week.