Revesby is classed as supported living and slow stream rehabilitation. The service users all have a tenancy within the property which also means that should the staffing level be required to change we have the flexibility to do that without the service users having to move from their home, or should they no longer need rehabilitation and instead a domiciliary care service be appropriate we have the option to 'pull out' springboard and 'put in' another provider. Its flexible, innovative, person centred and in my view that makes it stand out as a service all of us within Springboard and Navigo are proud of.
Highly Commended - Mental Health rehabilitation category - #MHAwards18
Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.
Revesby Court was an innovative project created in collaboration with the local CCG in 2016/17. We identified a need in the local area for a slower stream rehabilitation service, for service users being managed out of area that until that time we had been unable to manage locally. We identified 4 service users who had been in locked rehabilitation placements out of area for a number of years (10 years in one case). These service users are all adults, all diagnosed with a severe and enduring mental illness and were all under section 3 of the Mental Health Act. It was identified they needed 24 hour care and had significant risks identified- risk to others when unwell through assault, risk of self-neglect not eating or managing personal hygiene, risk of non-concordance with medication, risk of non-engagement with services and risks related to substance misuse (and the direct impact of this on their mental health).
Each of the 4 service users were incredibly vulnerable and had been through residential care, supported living, numerous locked rehabilitation placements and made little to no progress. They were feeling helpless away from home and family life; ‘stuck’ in a hospital with little choices or time out enjoying life- they could see no future. We wanted to bring these service users back in area, keep them and others safe and improve their overall quality of life. Alongside this our hope was to work with them in a way as to not de-skill but up-skill them, in a person centred way- at their pace and in a way that met their needs. We put our heads together as a service alongside the CCG, care coordinators and service users and their families and came up with the innovative service that became ‘Revesby Court’. We worked with a local social landlord and developer who purchased a property that met our requirements and adapted- creating a wet room for one service user, adding in patio doors and creating a homely environment inside and out.
Safety was paramount and so specialist locks were installed to allow privacy in rooms but allow staff to be able to enter as needed, window restrictors and sturdy fencing. The service users were involved in choosing items for their rooms and had and still have a huge amount of choice and input in the service delivery and design. We have utilised the Mental Capacity Act and the Mental Health Act working with colleagues around CTO’s, DOLS, in order to support the service users and keep them safe. Allowing us to restrict individuals to the property and escort on leaving has reduced a number of risks such as the access to illegal substances with would have a detrimental effect on their mental health, but is still far less restrictive than being within a hospital environment.
This project has been running for 15 months now and in that time we have seen the service users flourish. There has been no admissions into Acute Mental Health Wards, engagement and skill set have steadily improved, engagement with their families is much improved and we have also seen a saving in £200,000 on the cost of the placements vs the cost of the staffing of Revesby. Due to the success of this service we have begun designs on the next, and we have 4 males with dual diagnosis of mental health and learning difficulty due to move from low secure care into a new property with a support team in coming months. The service as with the last will be set up with the service users and we are all extremely excited about this new development and the potential impact this will have on these gentlemen’s (and their families) lives.
What makes your service stand out from others? Please provide an example of this.
The innovative nature and personalisation of the service. Utilising the MCA and MHA to work with service users and keep them and others safe, whilst also encouraging them to have an improved quality of life and most importantly giving choice- choice in their room colour, what they eat, supporting them to access the community daily, shopping, building relationships with families and living a ‘normal’ life. One service user is attending a gig at Manchester arena supported by staff next month- a lifelong dream to see a band she never thought she would get too. The service was designed for these service users- where the building is, how its decorated, the support and activity plans, the meals are all designed for and with the service users- and in doing so we have seen great improvement in their motivation and skill set- washing up/hoovering, reduction in PRN medication, reduction in hospital admissions.
Revesby is classed as supported living and slow stream rehabilitation. The service users all have a tenancy within the property which also means that should the staffing level be required to change we have the flexibility to do that without the service users having to move from their home, or should they no longer need rehabilitation and instead a domiciliary care service be appropriate we have the option to ‘pull out’ springboard and ‘put in’ another provider. Its flexible, innovative, person centred and in my view that makes it stand out as a service all of us within Springboard and Navigo are proud of.
How do you ensure an effective, safe, compassionate and sustainable workforce?
NAViGO policies and procedures are updated regularly and staff wellbeing is a high priority within NAViGO and within the Springboard Service. Healthy and happy staff members are more effective, improving recruitment and retention and preventing burnout and compassion fatigue. Within the service there is a great focus on upskilling of staff. We have an ‘area of expertise’ that forms a large part of this- with each member of the team having areas they ‘specialise’ in, this could be infection control, Reiki, cooking…. There are many of them. Staff members would then be encouraged to seek training, shadow other professionals inside and outside of NAViGO, attend conferences, develop information leaflets/posters where appropriate for service users and pass information on to colleagues and service users. They would be involved in organising and facilitating groups. It’s an initiative we started 4 years ago and continue to review with staff adding new areas to the list as new members of the team arrive.
Our hope is by staff focusing on areas they are interested in this enthusiasm will come across to others and allow them to develop as well. Here at NAViGO we pride ourselves on being pro-active towards the health and wellbeing of our staff – we like to be responsive to need yet innovative/proactive towards improving our employee’s health in any way we can. A healthy workforce is a happier one and whatever we can do to reinforce this we will go the extra mile. We have an extended team of Wellbeing Champions in each team who are supported by other employees who are engaged in the delivery of health promotion.
We hold monthly Wellbeing Meetings to develop and initiate new strategies for health promotion for our staff. Within Springboard staff members have initiated a staff cycling group, and will often be seen socialising with others outside of the workplace. Staff members attend individual supervision bi-monthly (more as needed) where wellbeing, training and development as well as reflection on practice are encouraged. Within this staff members have annual Performance and Development Reviews which focusses on their development over the coming year and also reviewing goal from the previous year to ensure that this is a fluid and evolving process. Alongside this we have weekly team meetings and fortnightly group supervision with our team Psychologist- allowing staff the time and space to talk about how they are feeling and the impact of their role on their mental health and ways to deal with this. We are a very close team, filled with team members who have such a great relationship that there is a real culture of openness, honesty and support.
We have a varied team in relation to roles and experience, with Nurses, OT’s, Social workers with back grounds in childcare, support workers having joined us with experience from the police force, Learning disability. We recently had an apprentice support worker join the team which has offered an exciting new approach and is encouraging the team to consider different ideas and really think about why we work the way we do- as we pass on that knowledge. We also have a number of support workers who have had or do currently have mental health issues themselves. One member of staff started their career as a STR worker within the recovery service, having a severe and enduring mental illness them self- they are now a valued assistant practitioner within the team offering a unique perspective both from a lived experience perspective as well as their experiences and skills learnt within the team over the last 6 years.
If staff members go off sick, sickness monitoring is used as a supportive tool to keep people in work, occupational health is utilised in this respect to enable solutions to allow people to return. Return to work interviews are then completed in a supportive and informal manner, if the cause is work related than solutions are found to ensure improvement. As a team we have had a number of staff members come to work with us as part of a return to work plan- from their primary role in other areas. The nature of the service and support in the team is such that staff members have found this a fantastic environment to support the return to work and allow them to transition back into their primary role. Because of the team culture and environment recruitment and retention in the team has been excellent with minimal staff turnover, this has helped keep consistent relationships for staff and service users alike and to ensure we have a high level of experience and expertise within the team. The team has been growing consistently over recent years as new projects occur- with the development of Revesby Court last year and the new project this will increase the overall team size to around 50 people.
The team often describe themselves as a work family, they may fall out or disagree but this is done so in an environment where they feel safe to be honest and open about their opinions and trust that colleagues will respect and value these contributions. The team has an amazing warmth too it, with the friendships and support, and the ‘we have your back’ attitude being prevalent across the service areas. If staff members go off sick, sickness monitoring is used as a supportive tool to keep people in work, occupational health is utilised in this respect to enable solutions to allow people to return. Return to work interviews are then completed in a supportive and informal manner, if the cause is work related than solutions are found to ensure improvement.
Training is essential and alongside a thorough mandatory training programme offered within NAViGO staff will also attend numerous courses or conferences outside of Navigo that will help to develop their roles within the team, improve their confidence but also improve their motivation. Staff have said that by encouraging them to attend other courses they have felt valued, knowing that the team support their development and can see the ‘worth’ in what they are able to bring to the team. Because of the team culture and environment recruitment and retention in the team has been excellent with minimal staff turnover, this has helped keep consistent relationships for staff and service users alike. The aim of this is to ensure that the team has a warm, friendly, supportive and nurturing environment in which they can thrive both personally and professionally.
Who is in your team?
Springboard as a team consists of a Team Manager, Clinical Lead OT, Social Workers (x2), RNMH x3, OT assistant, Assistant Practitioners (X 3), Support workers x 20, Fitness instructor/support worker and an Apprentice support worker. (All full time) Within Revesby Court there are 2 members of staff there 24 hours per day and an additional member of staff 10-6pm. We have a Consultant Psychiatrist that holds 1 session per week at Springboard that ensures each service users has a review on a Monthly basis. We also have a Psychologist who attends each Monday offering assessments with service users, 1:1 sessions, runs groups and also offers group and individual supervision with staff members.
How do you work with the wider system?
Springboard are part of the overall NAViGO family and we work incredibly closely with colleagues within NAViGO. As mangers of Acute services we meet fortnightly and these relationships between managers have helped develop the relationships between the team. This has allowed some unique options for staff, taking time to shadow other areas, to assist in covering when staff shortages are an issue. Staff have moved from Acute over to Springboard for periods of time when they have physically been unable to manage the physical interventions of Respect and required a period of healing- but otherwise have been able to manage the day to day role. Or even staff who have felt they were becoming a little ‘burnt out’ within the acute environment- they have been able to move and take some time out within another environment before returning. Staff have moved from Springboard for 6 months to Acute in order to develop their knowledge base and experience. This is the benefit of a small organisation and something that I think makes NAViGO amazing- that staff all feel valued and part of a wider organisation that cares about them.
Springboard Rehabilitation (And Revesby Court) have a large focus on physical health, and work extensively with our WHISe well-being service. The aim of WHISe is to tackle the comorbid pandemic in SMI and reduce the 20-30 year mortality gap by improving holistic care and outcomes. WHISe provides direct access for physical health and wellbeing checks for Patients currently within secondary mental health services experiencing severe mental illness (SMI). WHISe provides physical health checks including, blood pressure, pulse, BMI, urinalysis and routine blood tests. It also offers lifestyle advice and general health promotion. The clinics are run by dedicated practitioners with experience in both mental health and physical health practice. We also provide full body composition analysis and ECG’s when felt necessary. All results are documented on a health improvement profile which is shared with GP and other health professionals. As a team Springboard work with this information and guidance to formulate individual plans of care for each service user to tackle the areas needed most whether this is dietary advice, cooking lessons to help with a healthy diet, getting more active with our gym instructor or assisting in stopping smoking.
An example of this would be -We have one service user within Revesby Court who is currently prescribed Clozapine and physically was incredibly unwell. They were vomiting on a regular basis; we saw a decrease in their weight and noticed deterioration in mental health. Following a referral to the WHISe team requesting a full assessment of their physical health several issues were identified and a referral for further investigations at the local hospital was made. We worked together closely with the general hospital who performed a number of examinations to look at the cause of the sickness, the GP to look at prescribing anti-sickness medication, the WHISe clinic to continue to monitor the overall well-being, clozapine clinic to look at having regular tests to monitor the plasma assay level of medication and worked alongside the consultant considering other options such as liquid clozapine in the hopes that this would be absorbed at a fast rate and as such when sick would limit the amount of medication ‘lost’.
We worked with a dietician to look at foods and approached to eating ie smaller meals more regularly to look at overall maintaining and increasing their weight. The team worked tirelessly managing the decline in mental health monitoring and promoting good physical health this hard work managed to avoid admission to either a general hospital or acute mental health ward. The service user is now feeling much better and issues are under control. Springboard and Revesby Court work a lot with outside agencies. Through Hope Court and the Hub and spoke properties we work with Shoreline the local authority housing provider.
Revesby Court is owned and managed by Inclusion Housing so we work with them extensively in relation to the upkeep of the property and the grounds, any maintenance issues, tenancy related issues. We work with The Court of protection around the DOLS and link in with local authority teams to support in the applications for these. We work with Corporate appointees for 2 service users who lack capacity to manage their finances and so we work closely with their appointees to manage their day to day finances ensuring bills are paid and also that they are able to have trips out and purchase items they may need- new clothes for example. We work extensively with the CCG around the ongoing progress of Revesby Court but also in the development of new projects.
The new property that will open this year will be again a piece of work closely between us and commissioners at the CCG, identifying suitable properties, looking at the service users moving back and also in considering the commissioning and finance arrangements in funding the packages of support. We work with Advocacy, having drop in clinics at times at Springboard but also in making referrals and the 1:1 services offered to all service users- this was essential in setting up Revesby and with the new service. Many of the service users lacked capacity and were subject other MCA and MHA so it was essential that they had additional support and someone to talk to. For service users at Hope Court moving onto independence is essential so we work closely with the employment specialists, Tukes (who support service users in training and returning to work) and other organisations such as Green futures, supporting the service users in gaining confidence and skills within training and voluntary work before moving to paid employment in the future.
Do you use co-production approaches?
Co-production is essential to any service and this is something NAViGO as a whole focus greatly on. Whether this is having community members- service users, carers on the NAViGO Board, as community representatives, within surveys and questionnaires, we have a service user forum ‘your voice’ where they are able to find out more information and give ideas, service users support on interview panels and we also have a number of staff members within the services who have been (or are) service users within the services themselves NAViGO have numerous ways to get the involvement of those most important. Service users and carers are included within the make-up of NAViGO- it’s something that has been incredibly important too is and thus incorporated at every level since day 1, the thought being why develop a service FOR someone when you can develop a service WITH someone– the service is for them after all. Within Springboard we really value the input of the service users, their carer’s and families.
Within the development of Revesby the initial stage was actually way before Revesby coming about- we spent time talking with the service users, carers and families about what it was they wanted- that focused on being close to home, being out of hospital and being safe. We then used this information to start designs of the service and asked at each stage for further imput- even down to what colour towels in the bathroom. For us the result is clear- they are now 15 months into living in their ‘home’ not a house, a service, a hospital or even a building but a ‘home’ and when you haven’t had one for 10 years I don’t think you can really appreciate the impact that has had. The best example of this for me was with one service user who for the years in placement he refused to unpack his bag and never once slept on his bed- when asked he stated he didn’t feel safe and he was waiting to go home. Staff spoke with him and tried many approaches but this (even after 2 years) didn’t change. Within 1 week of being in the new property he had his bedroom ready, bedding on, tv on the wall, clothes in the wardrobe and he was snuggled up in bed each night sleeping peacefully- this was his home and he felt safe.
I truly believe part of this was because he was involved and invested in this home and room. When asked what he felt about Revesby Court by our CEO a few months after moving he stated ‘It’s great, best place I have ever been, its home. You get the best of both worlds my own room if I want to be on my own or I can come out and see people, I love it’.
Do you share your work with others?
Attendance at Conferences, through the PPiMH Family, twitter and we are in process of writing it up for publication. Also in discussion with other areas and services, we have had a number of people visit and look around at the services provided and discussions around how it was developed.
What outcome measures are collected, how do you use them and how do they demonstrate improvement?
The main outcome for us has been more qualitative- so seeing how much happier the service users are. The improvement in their engagement has been observed through monitoring of the number of activities they have been doing, improvement in the amount of time spent with families. We have had zero admission into hospital which is massive- given all 4 individuals had been inpatients for a number of years previously. Service users when asked had reported feeling happy in the home and supported. There has also been a financial implication with a saving of £200,000 being made in the first year.
Has your service been evaluated (by peer or academic review)?
Revesby Court were awarded the ‘CEO-Innovation Award’ at the staff awards ceremony held earlier in the year. Revesby Court has been open for 15 months and as yet has had many external visitors who have commented on the unique and innovative idea but has had no external evaluation. Navigo as an organisation has been evaluated by the CQC getting a rating of ‘good’- which looked at the training and overall wellbeing of staff within NAViGO.
How will you ensure that your service continues to deliver good mental health care?
We already work with the CCG and commissioners on a regular basis and this will continue not only in ensuring the sustainability of this project but also with looking at the development of new projects. We have a clear policy and protocol in place for Revesby and an amazing team of staff who are incredibly invested in the service. The service will continue to change and evolve as the needs of the service users evolve- for me it’s the service user involvement that will help to ensure the service continues and it continues to meet their needs- because they were involved in the start-up and invested in it continuing I am sure they would continue to voice their opinions no matter who was managing the service. Navigo’s aim is to deliver ‘services we would be happy for our families to use’ and so because of this there are incredibly high expectations on staff to ensure that we provide not only ‘ok’ care but exceptional care. AS this is ingrained into Navigo as a whole this is also ingrained into Revesby court and so I know that the amazing care they deliver now will go on well into the future.
What aspects of your service would you share with people who want to learn from you?
Initially I would want to share that it’s ok to be different, it’s ok to think outside the box and to think creatively. Just because something hasn’t been done before doesn’t mean we shouldn’t try something new this time. Our focus was all about being person centred and developing a bespoke service- something we are incredibly privileged to have been allowed to do and also incredibly pleased it has gone so well when we have. I think the biggest challenge was with the staff team- whilst they were incredibly enthusiastic and eager for the project they struggled with the new concept at times and the change of thinking from a ‘hospital’ to a person living in their ‘home’.
In simple terms this was meaning not having a staff room, not having staff areas, not having the posters on the walls or copies of documents on notice boards. Working with the staff through training, team away days, regular team meetings and supervision this culture shift changed and we are now in a better position for the next time as we know these are some of the things we need to address with the staff initially so they know what to expect. It was also difficult for service users, their carer’s and families and staff to envisage what this service would be like as it was so different- we have the benefit this time around that they have the option of visiting Revesby Court and considering that the new service will be a similar replica of this.
Webpage for service :
www.navigocare.co.uk
Hours the service operates *
24 hour per day 365 days per year
Population details
Brief description of population (e.g. urban, age, socioeconomic status):
North East Lincolnshire is a small unitary authority covering an area of 192km2 with a population of around 159,000. The majority of the resident population (around 94.2%) live in the urban towns of Grimsby and Cleethorpes with the remainder living in the smaller town of Immingham, or in surrounding rural villages. On the Northern border, the Humber estuary has been designated as a Site of Special Scientific Interest and to the south, the Lincolnshire Wolds are recognised as an Area of Outstanding Natural Beauty. Cleethorpes gained 4 national Seaside Awards in 2015. North East Lincolnshire has a distinctive economy, built on expertise in manufacturing, engineering, ports and logistics, and food processing. The local area has some significant advantages stemming from its location, labour force, and transport infrastructure that position it for growth in renewables, chemicals, advanced manufacturing and the food and drink sector. Taken together, Grimsby and Immingham constitute the UK’s largest port by tonnage shipped. Whilst the general direction of travel for the locality is around improving the environment and perception of the area, N E Lincolnshire does have pockets of high deprivation, ranking high on the IMDO (Index of Multiple Deprivation) which measures the following 7 deprivation indicators:- • Income • Barriers to housing and services • Employment • Living Environment • Health/Disability • Crime • Education/Training An example, East and West Marsh, two Wards within the North East Lincolnshire Council area, now rank in the top 1% deprived sub-areas nationally. As a result of the deprivation there are long standing health inequalities with those in the more deprived areas dying on average 8 – 10 years before those in the most affluent. According to the National Office of Statistics, around 18.46% of the population have some sort of emotional disorder. Other key points to note:- • The boundary of North East Lincolnshire is comprised of 106 Lower Super Output Areas (LSOAs); these LSOAs which contain a minimum population of 1,000 and a mean average of 1,500 are distributed amongst the fifteen electoral wards. • Overall, North East Lincolnshire is ranked as the 31st most deprived local authority in England, out of 326. (increased from 46th in the ID 2010.). • 32,567 residents, which is approximately 20% of the population are classed as income deprived with 25% of LSOAs being in the 10% most deprived for income nationally. • 15,140 residents are classed as employment deprived. • 20.1% of the working age (16 to 64) population of North East Lincolnshire have a known disability • 95.4% of the resident population of NEL are White British. • The January 2015 School Census shows 23,541 children on roll, 2981 ( 12.5%) of school pupils were identified as having Special education needs • Presently 28.5% (8,500) local children are thought to live below the poverty line.
Size of population and localities covered:
Population c159,000 – NAViGO covers the area of N E Lincolnshire
Commissioner and providers
Commissioned by (e.g. name of local authority, CCG, NHS England): *
NELCCG and NHS England
Provided by (e.g. name of NHS trust) or your organisation: *
