Previously the Trust had two inpatient CAMHS units, The Platform located in Preston and The Junction located in Lancaster. However, the small and isolated nature of both services, the increase in acuity and risk of the young people being admitted and the increased demand all contributed to the units becoming unsustainable both from a financial and a safety perspective. In order to improve both patient and staff experience, it was decided to co-locate both units and move on to one single site, The Cove in Lancaster. The move to one site now means that young people aged between 13-18 are able to access to Tier 4 beds in a recently re-furbished, modern and safe environment which has been tailored to suit their needs.
What We Did
Previously the Trust had two inpatient CAMHS units, The Platform located in Preston and The Junction located in Lancaster. However, the small and isolated nature of both services, the increase in acuity and risk of the young people being admitted and the increased demand all contributed to the units becoming unsustainable both from a financial and a safety perspective. In order to improve both patient and staff experience, it was decided to co-locate both units and move on to one single site, The Cove in Lancaster. The move to one site now means that young people aged between 13-18 are able to access to Tier 4 beds in a recently re-furbished, modern and safe environment which has been tailored to suit their needs. A number of improvements were made to the physical environment of the site including re-decorating, new furniture and a new catering system was also put in place. These improvements have now supported the young people in our care to be more comfortable in their environment, increase independence in order to support their recovery. Staff are also benefitting from being located on a single site by having increased access to the Multi-Disciplinary Team (MDT) and are able to support more effective MDT working to benefit the people in their care.
Wider Active Support
The Trust has been working together with a number of partners in order to drive The Cove forward and improve the pathway for young people in distress including Acute providers, CAMHS providers and the Police. The Trust has held stakeholder events to share practice, celebrate transformation success and build partnerships with external agencies. This included the development of a new information pack to provide stakeholders with useful information about The Cove. The Cove’s Access Team have also been visiting services that refer young people to The Cove to build relationships and increase knowledge and understanding regarding the access process. The Cove have also held meetings with local residents in order to ensure that the new site fitted in to the new community and gave an opportunity for both the Trust and residents to raise and queries or concerns. By doing this the Trust has been able to build on the relationship with the local community to benefit the people at The Cove.
The Cove has a Lancashire Wide, service user group called ‘The Crew’ for young people who have previously used inpatient mental health services and their families/carers. The Crew have been involved in all aspects of development of The Cove including decoration, catering, patient information materials right through to the recruitment of staff and the interviewing process. The Cove have recently appointed a specialist Participation Consultant that supports the facilitation of meaningful and effective young people and carer engagement and involvement from those who currently or have previously accessed CAMHS Tier 4 services. The role is based at The Cove and supports involvement activities that inform service planning and delivery and champion best practice.
The Participation Consultant provides specialist experiential input into the service teams and as part of a peer support and mentoring role they will co-ordinate responses from a young person and carer perspective to contribute to the development of the services. The Cove holds weekly Participation meetings which is facilitated by our Participation Consultant; this meeting is key to ensuring that young people (inpatients) have a voice and the chance to help develop and improve The Cove. It talks about all the positive and helpful things that are happening on the ward, as well as some of the things that might need improving.
Looking Back/Challenges Faced
The Trust undertook a Quality Impact Assessment (QIA) prior to move to understand the potential impact that the move would have. However some of the impact was underestimated, this included the turnover of staff that the move may cause, the recruitment of new staff as a result of this. The merging of two teams, and the integration of large numbers of new staff with different ways of working and difficulty with team cohesiveness. We also faced some challenges in the new environment for young people. The Trust has put in place a Quality Improvement plan in place to address issues impacting on the quality of the service provided at The Cove. This further incorporated actions required to address issues identified by the CQC inspection, QNIC peer view and NHSE quality visits. The progress of this plan has been supported by the Trust’s Transformation Advisory Service, the Quality Improvement Team and AQUA and has been monitored during a weekly meeting involving Network senior leadership, staff at the Cove and representatives from the Estates and Facilities team. There has been close liaison with NHSE throughout the process.
We have put a number of measures in place to ensure a positive service at The Cove continues including; a robust recruitment process, training programmes for staff, and a tailored Governance structure for the site which fits in to the overall Governance of the Children and Young People’s network and of the Trust. We also have the Friends and Family Test (FFT) and other Key Performance Indicators (KPIs) in place to ensure that we are listening to feedback and working towards the key areas. We also have a number of regular meetings in place externally including; the estate team, stakeholder events and resident meetings in order to strengthen relationships to provide a high quality service.
Evaluation (Peer or Academic)
We have had both an internal Quality Assurance visit completed by the Trust in October 2018 and two Peer Reviews completed over the last two years by the Quality Network for inpatient CAMHS. The Quality Network external review noted excellent transformation and a significant improvement at The Cove including changes to the environment, safety, morale within the team, in house training provided to staff and the responsiveness to estate issues.
Young people at their families/carers at The Cove were involved in the Quality Network Review in January 2019 and will continue to be involved in the annual review going forward. The feedback received will inform the action plan in order to inform the areas of need. The number of incidents, use of restraint and use of seclusion/ECA has reduced since the implementation of the Quality Improvement Plan. All young people now have a care plan that specifically addresses how identified risks specific to the individual are managed. New guidance / procedures have been developed and disseminated to staff concerning action to take following a clinical incident and the escalation of incidents. A recent re-audit of debriefs following incidents of restraint or seclusion demonstrated an improvement whereby debrief occurred more frequently and all involved both a staff member and young person. We have received positive feedback from young people, their families and their carers including the transformation of the service, the improvement in the overall environment, the morale of staff and how well the service has been adapted to meet the needs of the young people staying at The Cove. The Children and Young People Network has improved its Friends and Family Test (FFT) to be much more children and young person friendly in order to improve access and enrich the feedback received.
As mentioned above, we have been working together with a number of partners in order to drive The Cove forward and improve the pathway for young people in distress including Acute providers, CAMHS providers and the Police. We have also been working closely with other CAMHS Tier 4 providers across the North Wesr to share best practice and build relationships.
Is there any other information you would like to add?
Over the past two years The Cove has faced a number of challenges in relation to the initial move, staffing and the increase in the level of acuity in young people coming to The Cove. We have conducted a number of Quality Improvement initiatives in order to improve the experience of patients in our care and overcome the challenges we have faced along the way. We now believe that the service at The Cove has been transformed and we hope to aim for Accreditation in the future!
Can you please tell us who your service is commissioned by and provided by?
Commissioned by NHS England and provided by Lancashire Care NHS Foundation Trust