Rosewood Mother and Baby Unit (MBU) - KMPT NHS Trust

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.

In January 2016, the Government announced that £290 million will be made available over the five years to 2020/21 to invest in perinatal mental health services (PNMH). This resulted in the procurement of 4 specialist inpatient Mother and Baby units across North West, South West, East Anglia and South East Coast. In December 2016 we received the invitation to tender for the procurement of a Mother and Baby Unit (MBU) for the South East of England covering Kent, Surrey and Sussex and were successful in our bid to deliver the service from an existing ward in Dartford. The Rosewood Mother and Baby Unit (MBU) is an integral part of perinatal mental health community teams, ensuring that there is timely access to specialist care and support without a mother being unnecessarily separated from her baby. The MBU is an 8 bedded unit which provides treatment and support to women with significant perinatal mental ill health across Kent, Surrey and Sussex, within a safe environment, whilst ensuring a developing relationship with the baby and its physical and emotional wellbeing. The service supports the mother in developing a relationship with her baby in order to reduce the impact of the mother’s illness on the child.

The treatment programme is holistic, and encourages the involvement of fathers, partners or other family members in the process. The procurement also includes a perinatal outreach service working across Kent, Surrey and Sussex. Perinatal Outreach workers work as part of local community perinatal mental health teams in these areas and provide assessment and care of women in pregnancy and the postpartum year. We have two mums who have experienced perinatal mental ill health following the birth of their babies. As distressing as this experience was for them and their families, they received specialist care from Kent and Medway’s Partnership Trusts’ (KMPT) Mother and Infant Mental Health Service (MIMHS) and fully recovered, going on to be fantastic mums to their beautiful children – now aged 4 and 7 respectively. They were so grateful for the specialist care that they received, they had both made it known to their clinicians that they would be keen, in the future, to contribute in any way they could to the perinatal mental health service; wanting to give something back to the service that helped them so much and to help other mums and their families in similar situations to keep hope alive, when all hope seem to have been lost.

Once we were awarded the MBU tender; with such a daunting task ahead we were given the names of these mums from one of our MIMHS clinicians. We met with them and explained our situation. They were delighted to be able to help and support us. The mums joined our MBU Project Board and were key members. Their dedication and commitment was unwavering and this included support from their partners and families who often did the “school run” to allow them to attend our project meetings. They were actively involved and contributed to all aspects of the MBU’s development and led on the MBU’s layout and design, interior décor, colour schemes, furnishings, equipment, uniforms, information booklets for mums and their families. They researched local “mother and baby” groups and created a resource pack. They were part of all our interview panels for our multi-professional MBU team.

What makes your service stand out from others?

There are two aspects that make Rosewood MBU stand out, and they are: the co-production in the development of the MBU, and Peer Support Workers in the ongoing support and delivery of the service, and also the multi-professional team employed on the MBU which includes: Health Visitor, Midwife, Social Worker, Occupational Therapist, Psychologist, Registered General Nurse, Registered Mental Health Nurses, Psychiatrists, Nursery Nurses, Healthcare Workers, Peer Support Workers, Housekeepers, Dietician, Pharmacist, Administrators.

How do you ensure an effective, safe, compassionate and sustainable workforce?

Prior to the MBU opening, our MBU Matron devised a five week bespoke specialist perinatal mental health training package for the whole team. This included training sessions on perinatal mental health, physical health, mental health, care of babies, recognising early signs of common infant illnesses, training sessions from a Health Visitor and from the Midwife, bespoke Prevention and Management of Violence and Aggression (PMVA), shadowing staff on other Mother and Baby Units, shadowing staff within the community perinatal mental health service, International Training School for Infancy and Early Years (ITSIEY) on an introduction into perinatal mental health. This was all in addition to the Trust’s mandatory and statutory training that staff are required to undertake. Since the initial training package, staff are encouraged during their appraisal to identify other pertinent training opportunities. As part of their continued professional continued development, and we have supported them in these applications. In addition to this, we have facilitated internal rotation to other acute units for staff to increase their knowledge and confidence.

We are currently arranging team building days 6 monthly, and we have our third planned for 4th July. This includes not only team building activities, but also guest speakers in the field of perinatal mental health. Reflective Practice sessions take place monthly for all staff, facilitated by the Clinical Psychologist. Monthly team business meetings and monthly lunchtime learning sessions also take place. Six weekly supervision also takes place for every member of staff. We also have Trust-wide staff MOT days. Staff are encouraged to attend to receive their health check. Our MBU Matron is also a ‘Freedom to Speak Up’ Ambassador should staff wish to raise any concerns / issues confidentially, and she promotes a culture of openness and transparency. Our Matron also undertakes a Lead Nurse role, offering flu vaccines to all our staff and we achieved 90% compliance. Following the successful co-production of developing the MBU our service users by experience gained employment as peer support workers (PSW) on the unit. They are afforded all of the same training and support as other members of the team. Additionally, they receive clinical supervision from our Lead PSW for the Trust. They also receive support from the PSW leads Trust-wide.

Who is in your team?

1 Band 8a Matron 1 Band 7 Ward Manager 2 Band 6 Deputy Ward Managers (Physical Health Nurse) 1 Band 6 Occupational Therapist 10 Band 5 Staff Nurses 7.8 Band 4 Nursery Nurses 2 Part Time Band 3 Peer Support Workers 1 Consultant Psychiatrist 1 Speciality Grade Psychiatrist 2 Band 3 Senior Healthcare Workers 2 Band 2 Healthcare Workers 1 Band 6 Social Worker 1 Band 3 Administrator 1 Band 2 Administrator 2.8 Band 2 Housekeepers 1 0.4 Band 6 Midwife 1 0.4 Band 6 Health Visitor 1 Band 8a Psychologist 0.2 Band 7 Pharmacist 0.2 Band 5 Pharmacist Technician Weekly dietetic input

How do you work with the wider system?

We work closely with the Community Mother and Infant Mental Health Service (MIMHS). The MBU is part of the clinical pathway. All mothers discharged from the unit are supported by specialist perinatal mental health community teams in their specific localities. Our Midwife and Health Visitor liaise with their counterparts in the community when a mum is being discharged re delivery plan etc. Our Health Visitor and Midwife are employed by a Service Level Agreement with Primary Care. The unit is supported by our local GPs in Primary Care. Our Consultant Psychiatrist has created a paediatric clinical pathway with the paediatrician at our local district hospital. We work closely with Social Services around safeguarding for our mothers and babies, with our Social Worker liaising with Social Services in other areas. The MBU is supported by a local charity called ‘Deeds not Words’ which campaigns to raise awareness in perinatal mental health, and gifts us children’s toys, toiletries, clothes and other very welcomed items.

Do you use co-production approaches?

We have two mums who have experienced perinatal mental ill health following the birth of their babies. As distressing as this experience was for them and their families, they received specialist care from Kent and Medway’s Partnership Trusts’ (KMPT) Mother and Infant Mental Health Service (MIMHS) and fully recovered, going on to be fantastic mums to their beautiful children – now aged 4 and 7 respectively. They were so grateful for the specialist care that they received, they had both made it known to their clinicians that they would be keen, in the future, to contribute in any way they could to the perinatal mental health service; wanting to give something back to the service that helped them so much and to help other mums and their families in similar situations to keep hope alive, when all hope seem to have been lost. Once we were awarded the MBU tender; with such a daunting task ahead we were given the names of these mums from one of our MIMHS clinicians. We met with them and explained our situation. They were delighted to be able to help and support us. The mums joined our MBU Project Board and were key members. Their dedication and commitment was unwavering and this included support from their partners and families who often did the “school run” to allow them to attend our project meetings. They were actively involved and contributed to all aspects of the MBU’s development and led on the MBU’s layout and design, interior décor, colour schemes, furnishings, equipment, uniforms, information booklets for mums and their families. They researched local “mother and baby” groups and created a resource pack. They were part of all our interview panels for our multi-professional MBU team.

The mums contributed to the MBU Development Project in a way that Karen and I were unable to; from a mum and baby point of view. Both were clear; having a baby was still a celebration and the environment needed to reflect that whilst being somewhere that mums would feel safe, supported, cared for and welcomed, more like a hotel than a hospital. As peer support workers they continue to develop and grow, offering mums admitted to the unit and their families hope for their recovery journeys, sharing their own recovery stories and empathy which comes from lived experience. Their input, support, knowledge, dedication and commitment to the development of the Rosewood Mother and Baby Unit has been invaluable. We have absolutely no doubt that the outstanding success that we have achieved in terms of the end result of our MBU project has been because of the input and support from them. Feedback so far from mums admitted to the Unit and their friends/families, colleagues, Commissioners, the Perinatal National Team and other stakeholders has been overwhelmingly positive. One GP from East Kent, following her visit, said she was “blown away by the Unit” going on to say it was “beautiful in it’s design and décor and that it was obvious a lot of thought had gone into it”. Our Unit’s strapline is “built by mums for mums” and that is exactly how it was developed.

The PSW are engaged in all Occupational Therapy Groups. They have devised a Parent and Partner Advisory and Support Group (PAPAS) which runs on a Saturday morning marking it accessible for partners to attend and provides not just support and advice but also a bacon sandwich and a cup of tea. They also assist in the Walk and Talk Group, Infant Sensory, Cookery Group including baby weaning and nutrition sessions. They were instrumental in the design of the sensory room with the Occupational Therapist. Having them on the unit provides hope of a full recovery, particularly to mums with no previous experience of mental ill health. Partners and Dads have also commented on the value of speaking to somebody with lived experience, who is able to offer ideas and suggestions as to how partners and dads can help. The co-production of the unit resulted in the MBU feeling more like a hotel than a hospital. Following a visit from a local GP, who is the perinatal mental health lead for Kent, she commented: ‘’Absolutely blown away by Rosewood MBU. What an amazing job the team have done to create such an amazing space. Also, the service users who were key decision makers – it shows.’’ Some key compliments: ‘’I just want to say thank you to you all for your support, compassion and patience. I have learnt so much in my time here and I think I will be a better mother than I would have been had I not come here. I was full of fear and you have all made me feel safe and now confident and capable. I will never forget you all and the wonderful care you have given my son as well as me. People at home comment on how happy he is and I know that is because of all the hard work and commitment you have to every mother and baby here. My son will miss you all making him smile and giggle and he’ll miss your cuddles. I will miss you all too Once again, thank you, I am so very grateful. ‘’ ‘’Thank you from the bottom of my heart for your patience, kindness and compassion. Thank you for helping me to believe in myself and for helping me to build this bond with my daughter, something not too long ago I never thought possible. Even the very biggest thank you I could find is not enough! Each and every one of you is amazing and will be remembered by myself and my family forever.’’

Do you share your work with others? If so, please tell us how.

Learning is shared via the Care Group Quality Newsletter (monthly) and the weekly Peak of the Week, shared with the whole Trust. Additionally, we staff from the MBU have presented at local and national events, showcasing the development of and service delivery within the MBU. We also attended NHS England MBU Learning Events, and shared ‘lessons learned’ in setting up the MBU. Our Health Visitor has recently had published within the Institute of Health Visiting Journal, an article regarding her role within the unit as the Link Health Visitor. Also published within Kent Community Health Foundation Trust (KCHFT) journal is a recovery story of one of our former mums. The MBU opening was also featured in the KMPT publication: ‘i-connect.’ We share our good news stories and updated via social media, including Facebook and Twitter.

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

We collect a wide range of feedback by asking our patients to complete the Trust-wide PREM (which has the FFT questions within it), the MBU Patient Satisfaction Survey, and the PROM and CROM, which focuses on the outcomes of the service. Clinicians also use the ‘CORE-10’ outcome measure. Patients are asked on discharge to complete these measures, and are supported by the PSW in the undertaking of these. The Care Group Quality Team support the MBU to analyse the data and present it in clinical reports with action plans for improvement. You Said, We Did posters are also displayed, to show our patients the changes we have made as a result of their feedback. Community meetings take place weekly, providing an opportunity for patients to put their views across and receive updates from staff. A member of the Quality Team also chairs a food evaluation meeting, taking feedback from our patients to the catering providers, so they are aware of how the food is being received and can make changes as necessary.

A suggestion box is also on display on the ward at all times. A further Quality Improvement Project is also in place: a ‘referral’ survey, for those referring patients to the service to let us know how they experienced the process of referral, and suggest improvements. A PAPAS (Parent and Partners Group) is also in place, so the loved ones of our patients have an opportunity to learn more about the service, and ask questions if they have them. This group was created following the request from a previous user of the service, who felt her husband would have benefitted from further support. We use all of the feedback received to learn about how our service is received, and to make service developments as necessary. Recent qualitative feedback as follows: • I was given time and space when I first arrived to recover. I was given support, praise, encouragement and advice. People shared their experiences and were there when I felt ready to talk. I was reassured by people who were experts. • Facilities new and well designed, number of staff excellent, very caring staff. • So helpful with getting me back to my usual self, staff were always there to listen, comfort me, when sad, it has felt like a second home. • Staff kindness patience and compassion, environment, physical and atmosphere. • The staff, the calmness, the facilities. • Hearing peer support workers experiences and seeing they have come out the other side, sessions, always having someone around for myself and baby, people understanding. • It made me feel safe and supported to be on the MBU.

The quality of care is superb. I think it is mostly down to the fantastic team of people who work here. • Support services and homely environment. As a result of feedback to date, the following improvements have been made at the MBU: You Said: Please can we have a hairdryer / straighteners. We Did: Purchased. You Said: Please can we have a laundry basket in every room. We Did: Purchased. You Said: A better breast pump please. We Did: We purchased an electric one with accessories. You Said: We would prefer if visitors would not take pictures with our children in the background. We Did: A poster was put up to remind visitors to resect this wish. You Said: Our families need to be given information regarding the unit. We Did: We made more copies of our brochure more readily available.

Has your service been evaluated (by peer or academic review)?

As a new unit, we are registering with NHS England for CCQI accreditation, however we have been successful in our first CCQI compliance audit and are awaiting the second. The CQC have also undertaken a MHA compliance visit, which highlighted many areas of positive practice. The Care Group Quality Team undertakes Clinical Audit (CLIQ) checks every two months, looking at the quality of care plans and clinical record entries, as well as medication recording and keeping.

How will you ensure that your service continues to deliver good mental health care?

We were awarded the contract to deliver the mother and baby unit. The contract is for 5 years, however there is an expectation that this will be extended for a further 2 years. We meet with NHSE specialist commissioners on a quarterly basis to review the contract and give updates on progress and any challenges that we experience. The Quality and Performance Assistant puts together quarterly Quality Reports which include feedback from our patients and referrers, training figures for the team and performance updates, we well as service developments such as the MBU sensory room, the Howden’s kitchen, and the usability of the garden area. The unit is fully staffed, which allows for succession planning, should any posts become vacant.

What aspects of your service would you share with people who want to learn from you?

Managers and PSW of the unit have attended the 6 monthly MBU development feedback and learning events, organised by NHS England. As Rosewood MBU was the first 8 bedded unit to open, we were able to feedback many areas of learning including the importance of working closely with architects and builders, the importance of having people with lived experience on each of the interview panels, the importance of having people with lived experience involved from the very beginning of the MBU development, and asking them to lead on aspects such as design, layout, furnishings and décor of the unit. We also shared the importance of interface working with other mental health services, i.e. acute and community and we also shared the importance of having a midwife and health visitor as substantive members of the MBU team. In terms of challenges, we have had to train and develop a completely brand new team. We put together a bespoke induction and training programme. The team were employed for 5 weeks before the unit officially opened, to give them time to bond as a team, as well as develop their skills in perinatal mental health. 6 monthly team building days were also put in place for our staff.

Additional Questions

The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.

Access

Complete only if applicable to your service or team.

How many people do you see?

Since opening in August 2018, we have had 35 mothers within our MBU.

How do people access the service?

Generally, referrals are received from the perinatal community teams in each locality. There is a national standardised referral form for MBUs via the ‘web bed’ website which is updated daily by all MBUs in the country. We publicise this via our Trust website. Other referrers include: GPs, community mental health teams, specialist mental health midwives, the Trust crisis teams, psychiatric liaison services at A&E.

How long do people wait to start receiving care?

All referrals are screened and prioritised based on risk. If a bed is available then the client will be admitted immediately.

How do you ensure you provide timely access?

The referral is screened at the point it’s received. We ensure we are in receipt of any risk information before making a decision regarding admission. This is facilitated as soon as possible.

What is your service doing to identify mental health inequalities that exist in your local area?

As part of the minimum data set, we are mandated to collect information relating to gender and ethnicity, which is analysed by our Business Intelligence team. This highlights which groups are accessing our service. Eligibility for admission to the unit is based solely on need.

What is your service doing to address and advance equality?

We know that approximately 20% of women will experience perinatal mental ill health during pregnancy or following birth of their child, of which between 3% and 5% will experience moderate to severe mental ill health and are likely to require admission to a Mother and Baby Unit. In the last 3 years, perinatal mental health has been highlighted as a key priority by NHS England, hence 4 additional 8 bedded MBUs have been commissioned across England. This has meant that more women can access specialist services locally, reducing the need to travel for miles to receive specialist care and treatment. Perinatal Mental Health has been highlighted via media campaigns and through education of primary and secondary care clinicians. Campaigns such as ‘Beds Together’, founded by the Princes William and Harry has helped to reduce the stigma of mental health.

How do you identify the needs of a person using the service ?

Referrals to our MBU are made using the universal referral form available via the MBU website which details current risk, presence of mental illness, reason for referral and current mental state.

How do you meet the needs of people using the service and how could you improve on this?

We meet the needs of our mums by providing a range of specialist interventions by a range of multi-professionals such as CBT, Occupational Therapy Groups (OT), Baby Massage, Sensory Groups, Relaxation, Psycho-education, Mentalisation, Nutritional / Weaning Groups, Dietetic support and Health Visitor & Midwifery Groups. The Psychosocial interventions that we are offer are in adherence to NICE guidance. Following admission, each mother has a person centred care plan created with input from the mum and their family. This includes a specific care plan relating to the care of their baby. The view from the mum is incorporated as much as possible in the care plan, reflecting a collaborative approach to care and treatment. Care Plans are reviewed with the mum and the MDT at least weekly, but more often (on a daily basis) if required.

What support do you offer families and carers? (where family/carers are not the service users)

The MBU information booklet, created for mums and their families was written by people with lived experience and our Trust’s Communication Team. It includes what to expect when coming to our MBU, our staffing, our support for partners / dads and their families, useful resources, i.e. online help and groups. A PAPAS (Parent and Partners Group) is also in place, so the loved ones of our patients have an opportunity to learn more about the service, and ask questions if they have them. This group was created following the request from a previous user of the service, who felt her husband would have benefitted from further support.

Further information

Is there anything else you want to share about what makes you an example of positive practice?

The success of the MBU development has been due to the co-production of this project. From the very beginning we enlisted the help of women with lived experience to give their views and opinions on how a mother and baby unit should be. They are an integral part of the design team and as a result of this the MBU has a wonderful non-clinical, caring, relaxed and therapeutic feel about it. Feedback so far from women admitted to the unit, their families, staff, referrers, commissioners and others has been overwhelmingly positive and a credit to our service users who have contributed to its development.

Population details

Brief description of population (e.g. urban, age, socioeconomic status): The Rosewood Mother and Baby Unit is predominately for women from the counties of Kent, Surrey and Sussex, however this is an NHS England Commissioned resource and as such, will take women from anywhere in the country. Being that we take admissions from such a vast geography, the socioeconomic status is equally diverse.

Size of population and localities covered: The live births of Kent is 21.5K per year on average (1.5 million population figure). Surrey is 13.5K per year (1.1 million population) and Sussex is 14,130 (1.6 million population).

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England): NHS England

Provided by (e.g. name of NHS trust) or your organisation: Kent and Medway NHS and Social Care Partnership Trust (KMPT)

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Rosewood Mother and Baby Unit (MBU) – KMPT NHS Trust

Co-Production

Evaluation

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