The Phoenix Centre is an adolescent inpatient eating disorder unit provided by CPFT. Approximately one year ago a decision was made to pause service provision on the ward due to high vacancy rates and both the clinical and physical environment on the ward being in need of refreshing. This was an incredibly difficult decision to make at the time, however having reopened approximately 6 months ago it is now possible to see the huge benefits that this decision has facilitated: A new clinical service model has been developed and implemented alongside a complementary bespoke Phoenix patient workbook; patient and family satisfaction and staff morale levels are high; vacancy rates are low and the environment has been updated and modernised and now includes a high dependency area.
Highly Commended - National CYPMH Awards 2019
Co-Production
From start: No
During process: Yes
In evaluation: Yes
Evaluation
Peer: Yes
Academic: No
PP Collaborative: Yes
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Michelle Espley - Interim Deputy General Manager - Cambridgeshire and Peterborough NHS Foundation Trust
The Phoenix Centre is an adolescent inpatient eating disorder unit provided by CPFT. Approximately one year ago a decision was made to pause service provision on the ward due to high vacancy rates and both the clinical and physical environment on the ward being in need of refreshing. This was an incredibly difficult decision to make at the time, however having reopened approximately 6 months ago it is now possible to see the huge benefits that this decision has facilitated: A new clinical service model has been developed and implemented alongside a complementary bespoke Phoenix patient workbook; patient and family satisfaction and staff morale levels are high; vacancy rates are low and the environment has been updated and modernised and now includes a high dependency area.
The Phoenix Centre provides 12 inpatient beds, day-patient and outreach specialist treatment for young people aged between 13-18 years old with complex eating disorders. Young people will be supported in their treatment by a multi-disciplinary team consisting of clinical psychiatrists, nurses, healthcare assistants, clinical psychologists, a family therapist, a dietitian, the head of patient involvement, a research assistant, admin team and teachers. Generally speaking there are three strands of treatment: 1. Weight restoration and dealing with behaviours related to this 2. Help with recognising and countering anorexic thoughts and feelings 3. Return to aspects of normal life Treatment varies according to each young person’s individual needs but typically would include: – Support with eating – Individual and family psychological treatment – Weekly appointments with the consultant psychiatrist and a nurse – Appointments with a range of ward based allied health professional as appropriate – Education in the Phoenix Centre school – Monthly review meetings with members of the Phoenix Centre team, the young person and their family, and referrers from the young person’s local Child and Adolescent Mental Health Service (CAMHS)
When a young person leaves the Phoenix Centre, they will return to the care of their local Child and Adolescent Mental Health Service (CAMHS). Our outreach worker helps with planning discharges and setting up appointments. He may also see the young person and their family for a while after discharge to provide support during this time of change. The unit makes a significant difference in the lives of the young people accessing services and their families as demonstrated in the young peoples own words in the “outcomes” section below. Both the physical and psychological health of each young person is significantly improved by the point of discharge back to the community; their weight is improved; they have far fewer physical co-morbidities and their risk of physical health complications is substantially lower. In addition to this, many young people leave the ward feeling more confident, have a higher self esteem, improved body image and a range of skills to manage distressing emotions and feelings. Through engagement with the newly developed clinical service model and completion of their own individual workbook, many young people leave the ward physically and psychologically ready to engage with their family, friends, further outpatient treatment, education and hobbies and continue to make good progress towards recovery.
Wider Active Support
The Phoenix Centre, along with the two other tier 4 inpatient units within CPFT are heavily involved in the local quality network “QNIC” that facilitates sharing of good practice, learning, guidance and support. This method of working effectively with other organisations, in conjunction with robustly embedded clinical governance processes on the ward, enables the delivery of high quality continually improving care and treatment. Other important partners, instrumental in continuing to drive the service forward are patient and family focus groups, community adolescent mental health teams, the national eating disorders charity “BEAT”, similar adolescent inpatient eating disorder units nationally and NHS England. These partnerships enable learning from research and ensure that treatment always reflects the current “gold standard”
Co-Production
Co-production has been pivotal to the implementation of a new clinical service model and the physical redesign on Phoenix ward. Throughout the process of pausing and redeveloping services on the ward a number of previous patients and their families were involved through consultations, focus groups and other formal and informal collaboration and feedback mechanisms. This was a key component of reviewing and developing the service model and accompanying workbook; the architect redesign and decoration of the ward; recruitment, and a number of other elements crucial to the development and implementation of a range of improvements. Staff at every level were also heavily involved in every aspect of the project and worked hard to develop a team charter, learn new skills and cultivate a productive, collaborative and caring team ethos.
Looking Back/Challenges Faced
Throughout the implementation of a new clinical service model, redevelopment of the ward and the recruitment of a large number of new staff it is now possible to reflect back on the positives we achieved and also identified what would have enabled the process to have been even better. The positives included: • The successful team work and skill mix of the project group, including co-production, project management and involvement of staff at all levels on the ward and leadership team. Everyone worked well together in a positive and constructive manner. • The recruitment plan went extremely well given the recruitment issues currently facing a large number of NHS services. The Phoenix Centre (at the time of writing) is now fully staffed. • In house infrastructure project management support and engagement received was of a high standard. • Bringing the team together to inspire a shared vision and common purpose went extremely well; spending time together as a whole team on a weekly basis was important for the development of close working relationships. • The team developed huge energy and enthusiasm for change. • The new clinical service model and workbook may have implications for the future treatment of adolescent eating disorders. • The opportunity to embed new care models (NCM) into a research format. The reflections on the following issues, in hindsight, could provide learning for any similar future projects: •
The temporary pausing of the provision of services ran over time, due to the lack of bed available for a young person on the ward at the time of the initial decision to pause provision. This meant ward staff could not start their redeployment and the commencement of the transformation project was delayed. In the future it would be prudent, if possible, to plan for delays within the project time frame and expenditure. • Staff initially felt a burden and sense of pressure to perform well in their new temporary redeployed roles, in addition to their involvement in the project implementation and development of a new service model, inducting new colleagues and the uncertainty that inevitably accompanied this period of change. • Further communication regarding the role of NHSE in process and leverage to address some of issues raised in terms of commissioning suitable care provision for young people, not just at this time for the Phoenix Centre, but more widely, needs to take place. Overall however, the project has been incredibly successful and the first cohort of patients treated using the newly implemented clinical service model are now in preparation for, or have been discharged.
Sustainability
Ongoing retention of staff through team development, staff morale is high and training/support is ongoing for all ward staff. • Embedding the new clinical service model into the fabric of the working ward. • Use of the ‘high dependency area’ which is an enhancement and has been developed to support the ward and meet the NHSE service specification requirements. • Continual upskilling of staff which will allow them to have more confidence in undertaking new challenges, and deputising in the event of the departure of their manager.
Evaluation (Peer or Academic)
Peer evaluation of the newly implemented clinical service model took place over several months. It is anticipated that in the future academic research and further peer reviews will be conducted on the data that is currently being gathered and that this exciting project may well inform future developments in the treatment of adolescent eating disorders, particularly in terms of the implementation of new care models (NCM).
Outcomes
In addition to the positive physical and psychological health outcomes experienced by young people engaged with treatment on the ward (as detailed above) there are a number of other positive outcomes that are best described in their own words. The following messages of hope written by a young people previously treated at the Phoenix Centre, to all new prospective patients demonstrates the progress and outcomes experienced by young people during their time on the ward: “If you are reading this you are probably in need of some support. I have been in your position and have come out the other side a much stronger person. Being admitted to The Phoenix was probably the scariest thing I have ever done, but I am so glad that I did it. During my time here I have had some of the best times and some of the worst times I will probably ever have but I have learnt from each and every one. For a long time I thought that recovery was impossible and everything seemed far too terrifying to even contemplate, I never thought that I would leave and I certainly never imagined myself as happy as I am today – but I was wrong! It isn’t easy but it is possible ; if you are willing to work, things will get better and you will be okay. My time has taught me to ask for help instead of burying my head in the sand. My biggest piece of advice to you is to talk, use the staff because they are there to help – they don’t want to hurt you but unless you let them in they can’t help. Once you start opening up they will practically throw support at you! If you are a wise owl you can leave here prepared for anything the future might bring – work hard and co operate now and your future will be BRILLIANT! Whatever you do, do not give up. Life is far too much fun to throw it away over an eating disorder. I have often felt like giving up but I know now that it is not worth it. Life might be scary but anything is better than anorexia. I am finally moving forwards onto better things. You can too if you keep going – it will be worth it in the end. I wish you the best of luck in your journey – come and join me in the big wide world, its fun! Many thanks to all xxxxx” “Never give up. I know it’s tough but the nurses and staff are the best – I could not have done it without them. Talk to people and share your thoughts and feelings – it helps. You have your whole life ahead of you and you don’t need this illness to still be yourself. You’re so brave and you have taken the first step by admitting you have a problem. Believe me it gets easier, and you CAN do this, however hard it may seem. Best wishes and all my love.” “I am writing this having come to the end of my journey at the Phoenix and I wish above anything else I could tell you it has been easy, but it hasn’t.
When I was admitted, I felt things were completely hopeless; I had been trying to manage for months and I had still ended up in hospital so how were things ever going to change? What I hadn’t realised was that I wasn’t going to have to do it alone. The people here, staff and patients alike, understand everything you’re going through and their help has been invaluable. I don’t think I can put into words how grateful I am to them. If there’s one piece of advice I would give you, it would be to make the most of every minute here – you’ll need all the tools you can get so that you’re ready to cope in the outside world. So don’t be afraid to tell someone if things go wrong. The longer you leave it, the harder it will be and the more time you will waste. Because, in the end, the only solution is to learn to manage. There will be good days and bad days, and times when you feel you’re not moving forward. But gradually, as each week goes by, you will move closer and closer to the edge of the cliff, ready to take the leap and take responsibility for your illness. It won’t happen overnight and you may not feel ready. At times you’ll feel like running back as far away as possible so you don’t have to face your fears. But no one can do it for you – you have to decide that you want it more than you are afraid of it. I’ve made the decision, I’m going to take the leap, and boy, does the view look good! All my love and all the luck in the world” “Everyone deserves a life, and mine was taken away by this horrible illness – I never thought there was a way out until I came to the Phoenix. I saw that there was an amazing life out there waiting for me with open arms, and what’s more I could enjoy that life too. The only thing stopping me was myself. You have to learn to live one day ahead and not worry yourself too much about the future or the past. Two phrases that helped me were : “Don’t open your umbrella until it rains” and “Life is not measured by the height you have grown, but by the depth you have climbed.” Stay strong and achieve your dreams!”
Sharing
All progress and findings are shared through quality networks and it is anticipated that future peer and academic research based on the newly implemented clinical service model and workbook will be shared via appropriate journals and similar media.
Is there any other information you would like to add?
We would like to recognise the dedication of the Team under exceptionally difficult circumstances, when faced with the uncertainty of ‘pausing’ service delivery on the ward. The team continued to remain committed to their role, providing support to the other Tier 4 units and Community ED team; to the young people who required ongoing care, as a result of the temporary closure, whilst also demonstrating a continued passion for the future of the Phoenix Centre. We would like to applaud the team for remaining focused and loyal throughout this process and supporting new members of staff as they have joined.
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