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Issue 1



June 09

Walkabout abouttfocus The bulletin for the East Midlands Development Centre NHS East Midlands

Introduction Welcome to our first edition of Walkabout, a planned regular bulletin on the work of the East Midlands Development Centre (EMDC), a service improvement and development team at NHS East Midlands dedicated to Mental health, Offender healthcare and Children. While this performs the function of a regional update on our programs, we want it to convey something more. As a team we work actively with and on behalf of the delivery system, we are out and about in the region working closely with commissioners and providers most of the time. A critical function for us is to facilitate and act as a catalyst for positive change. Our programs draw on a vast base of experience from users/carers, voluntary sector, offender health services and professionals. While we see the challenges that staff deal with, we are always struck by just how hard people strive to deliver the best, the opportunities and innovation that they create to overcome obstacles and the excellence services and care they provide. We want Walkabout to convey the experience of delivering high quality care and positive change. So we hope that those who read this will work with us to share and spread what is happening in the East Midlands. Walkabout aspires to be about the lived experiences of change in the East Midlands and about the endless possibilities for continuous self-sustaining improvement and innovation. As this is an E-bulletin further content can be access via the “Read more” hyperlinks at the end of each article. This link will take you to our regional website where further information can be found. www.eastmids.org.uk

Who are we? A dedicated improvement and development team that is deployed by NHS East Midlands to support Mental Health, Offender Healthcare and Children & Families. We are funded by the National Health Service (NHS) and Department of Health (DH). To enable the most effective impact, the team works with all aspects of the delivery system, this means in practice that we are out and about across the region, not based in an office. Some refer to this type of role as a ‘fieldworker’. The role we occupy draws on a consultancy model and the team have a range of skills from improvement methods, organisational development, change management techniques and project management. We also have team members who have specific policy based knowledge and experience of care delivery. This provides a unique combination of skills and knowledge to support improvement. There are five posts that hold locality responsibilities and have been put in place to provide an individual and personal contact point at the sub-regional level and support local projects. The resources we have access to are used to fund our team and distributed to programmes and through these processes, the delivery system to enable local and regional projects to be undertaken in line with agreed priorities for change and improvement. We maximise the release of staff to 1


undertake projects, build temporary capacity until the system embeds change, and allow stakeholders to take control of the skills they need to deliver the desired improvements. This combination of a core team and funded projects has provided flexible and adaptive approach while maintaining a continuous with a speed of response that is at times required. The following link shows some case examples: http://www.eastmids.org.uk/about/case-examples/ We also believe as a dedicated improvement resource, embedded in the Strategic Health Authortiy (SHA) we bring a number of advantages over other options for Primary Care Trusts (PCTs) and providers to seek assistance and expertise on change management approaches;     

Intimate understanding of the workings of health, social care and offender healthcare systems of the East Midlands environment as our team comes from the environment you work in Access to a broad and informed knowledge base and extensive networks in and outside the region Expertise and familiarisation with a range of improvement methods, organisational development and user/carer/professional engagement skills As part of the SHA, commitment to the values of NHS East Midlands and consistent with the vision and strategy for the NHS, your interests and values are ours too Appreciation of the policies relevant to healthcare and ability to support with implementation

We are focused on 3 critical work streams   

Children and maternity, including mental health Offender Healthcare Mental health, with joint funded programs with social care for dementia and personal budgets

Each work stream will have a number of priority programmes, in line with the needs of the NHS. They are agreed with key senior stakeholders and continuously reviewed so that we can take account of the changing needs and new priorities that emerge throughout the year. More information on the work streams can be found below or on our website: www.eastmids.org.uk To find out more about the team follow this link: http://www.eastmids.org.uk/about/our-team/

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Directors Update Dean Repper Director – East Midlands Development Centre Dean.repper@eastmidlands.nhs.uk

As I write I have completed just over a year of working in the East Midlands. They say time flies when you are enjoying yourself. And yes, I have enjoyed many aspects of the past year but also been filled with some trepidation as we prepared and implemented changes to the improvement model for East Midlands and established a fresh approach to working with the delivery system. This has included strengthening partnerships across the region and at the county level and responding to the local agenda. Releasing resources to support change as well as providing change expertise through our core staff group. Championing the needs of key vulnerable groups through improved strategic relationships and working inside the system as an integral part of it. Want to know more about Dean? http://www.eastmids.org.uk/about/our-team/dean-repper/ Within the last year we have seen the Care Services Improvement Partnership (CSIP) and the National Institute for Mental Health in England (NIMHE), previous improvement organisations working in the region, wound up both regionally and nationally. They both made a fantastic contribution to our appreciation of change and its intricacies in health and social care and they have left a valuable legacy of knowledge in the important areas of mental health, learning disability, social care and children. There were a number of reasons for that change both at the national level and locally. A key driver was the devolution of resources from the centre to the regions to support regional and local improvements and to move key parts of DH(located in regional government offices) into the regions so it is closer to service delivery. In the East Midlands we made an early move to make changes to the model we had while conserving what worked well. Along the way we had to ask some hard questions of ourselves. In the early months when I went out and about I realised we had a tough job on our hands to meet the challenges that the emerging health and social care landscape presents. As an improvement team we have to be able to articulate our value added, we have to be relevant and visible. I hope you find our first of regular updates interesting and helpful but as ever it will get better with your feedback. Tell us what you think: jonathon.king@eastmidlands.nhs.uk

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Team Information Dorsey Precht Job Title: Strategic Relationships & Programme Manager Program Responsibility: Delivering Race Equality (DRE) Region: Northamptonshire Email: dorsey.precht@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/dorsey-precht/

Dena Adamson Job Title: Strategic Relationships & Programme Manager Program Responsibility: Improving Access to Psychological Therapies (IAPT) and Organisational Development (OD) Region: Derbyshire Email: dena.adamson@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/dena-adamson/

Jill Guild Job Title: Strategic Relationships & Programme Manager Program Responsibility: Mental Health in Later Life Region: Nottinghamshire Email: jill.guild@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/jill-guild/

John Gibbon Job Title: Strategic Relationships & Programme Manager Program Responsibility: Policy related to Service Quality Region: Leicestershire Email: john.gibbon@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/john-gibbon/

Alan Riggot Job Title: Programme Manager Program Responsibility: Personality Disorder and IAPT Region: Cross Regional Email: Alan.Riggott@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/alan-riggott/

Carl Finch Job Title: Programme Manager Program Responsibility: Offender Healthcare Region: Cross Regional Email: carl.finch@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/carl-finch/

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Team Information Heather Sahman Job Title: Programme Manager Program Responsibility: Childrens and Families Region: Cross Regional Email: heather.sahman@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/heather-sahman/

Fiona Warner-Gale Job Title: Programme Manager Program Responsibility: Child and Adolescent Mental Health Services (CAMHS) Region: Cross Regional Email: fiona.gale@eastmidlands.nhs.uk

Asha Day Job Title: Programme Manager Program Responsibility: Service Improvement Region: Cross Regional Email: asha.day@eastmidlands.nhs.uk Read more: http://www.eastmids.org.uk/about/our-team/asha-day/

Business Support

Jonathon King Knowledge Management

Sylvia Sverdloff Senior PA/Office Manager

Kay Morgan PA/Finance Officer

Pam Swift PA/Administrator

Helena Atkin PA/Administrator

jonathon.king @eastmidlands.nhs.uk

sylvia.sverdloff @eastmidlands.nhs.uk

kay.morgan @eastmidlands.nhs.uk

pam.swift @eastmidlands.nhs.uk

helena.atkin @eastmidlands.nhs.uk

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Programme News Children The Children’s and families programme is comprehensive, responsive to current strategy, works with regional partners and assists individual organisations and partnerships at a locality level. The priorities for 2009/10 have been identified as follows:         

Children with a disability Transition Commissioning Vulnerable groups Maternity Safeguarding Partnerships Leadership and capacity building CAMHS (child & adolescent mental health services)

The programme supports both national policy frameworks and local strategic objectives. All work programmes and approaches are developed jointly with policy leads in the SHA and work programmes are delivered in partnership. Read more: http://www.eastmids.org.uk/children-families/

Offender Health The main focus for our Offender Health programme is on supporting positive changes in the well-being of people with health and social care needs in all areas of the criminal justice system. The Offender Health and Well-being Partnership builds on the work of the Department of Health (DH), the Home Office (HO) and more recently Ministry of Justice (MoJ) to modernise and mainstream prison health care into the wider NHS and the developments highlighted in the consultation on ’Improving Health, Supporting Justice’. As changes in structures within the MoJ and DH regional presence proceed, we will continue to work in partnership to improve health, address health inequalities and reduce crime by maximising the opportunities provided by better integration of health, social care and criminal justice systems. Read more: http://www.eastmids.org.uk/offender-health/

Mental Health The mental health programme responds to joint commissioning and provider agendas across health and social care. It builds in where appropriate and agreed locally a number of national policy objectives.

Dementia February 2009 the Department of Health has launched its first National Dementia Strategy called Living Well with Dementia. This is the first of its kind in the UK and will provide a framework within which local services can deliver quality improvements to dementia services and address health equalities relating to dementia. What does that mean for us in this region? The region will be lead by the collaboration of the Department of Health and the Strategic Health Authority. Programs of improvement will be delivered through the East Midlands Joint Improvement Partnership (JIP) the Prevention and Early Intervention programme board. This is chaired by David Pearson from Nottingham County Council and the board recently set up an East Midlands Dementia Strategy Improvement group where Brenda Howard Director of Strategy, Nottingham County Teaching Primary Care Trust has agreed to be the sponsor for the Improvement Group.

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On the improvement group are representatives from both Health and Social Care across the East Midlands region. Commissioners and providers and people who use the service and their carers are all members. We are delighted to have the Alzheimer’s Society chairing this group. The group aims to meet quarterly and to over see the support for implementation of the strategy and co-ordinate the development activity. Leadership for the support programme for the Dementia Strategy will come from: jill.guild@eastmidlands.nhs.uk (SHA) + annette.lumb@eastmidlands.nhs.uk (DH regional team) Read more: http://www.eastmids.org.uk/mental-health/later-life/

Improving Access to Psychological Therapies (IAPT) We know that in the short-term psychological therapies are as effective as medication in treating anxiety and depression and can be more effective at preventing relapse in the long term. Improving access to psychological therapies (IAPT) was identified in the Government’s white paper, Our Health, our care our say, as one of its key mental health programmes that will contribute to improving the health and wellbeing of the population. To meet this aim the IAPT programme is concerned with increasing the recognition of depression and anxiety and raising the standards of treatment for people suffering from those disorders. Last year we had two new services set up by PCTs as part of the wave one IAPT roll out. This year we have a significant growth as all bar one PCT will set up new IAPT services. In addition to services from Nottingham City(provider arm of PCT) and Lincolnshire NHS Foundation Trust, this year we will have services in; Derby City (Trent CBT-independent provider), Derby County (Lincolnshire Foundation Trust/Mental health Mattersvoluntary sector & Derby Mental health service/Turning Point-voluntary sector, Nottingham county (Nottinghamshire healthcare Trust/Rethink-voluntary sector), Leicester county& Rutland (Leicester Partnership Trust/Rethink/Assuria), Leicester City (transition project with Leicester Partnership Trust and City Voluntary Sector), Nothamptonshire (Changing Minds- PCT provider arm). Supported by the SHA Service Improvement Team and the workforce deanery the IAPT providers are beginning to recruit their trainees in readiness to join the new high and low intensity therapy courses starting this autumn. Existing trainees are getting close to finishing their courses, preparing for exams and putting together professional portfolios in readiness to take up permanent posts in IAPT services in Nottingham and Lincolnshire. Drop out from the courses has been relatively low and trainee feedback has been positive overall. It really is going to be an exciting year as East Midlands progresses an ambitious and visionary programme of access to ‘talking therapies’. Nationally IAPT has focused on CBT for depression and anxiety. It is important to make this evidence base available and to deal with what is one of the commonest forms of mental health disorder. However, we are keen to promote all evidenced based ‘Talking therapies’ for a range of problems. We are supporting Interpersonal therapy for depression and also NICE guidelines for Personality Disorder. We will have more updates on that in our next Walkabout. Read more: http://www.eastmids.org.uk/mental-health/iapt/

Delivering Race Equality (DRE) See www.mentalhealththequalities.org.uk for more on this important initiative The East Midlands benefits from 40 Community Development Workers (CDWs) who are a driving force responding to the DRE agenda. Community development workers take a holistic approach to mental health which focuses on the interrelationship between health, culture and social economic factors that affect a service user and their carers. CDWs work in partnership with mental health staff and community groups/organisations to support ethnic minorities across a range of issues that affect a person's mental wellbeing and recovery. CDW'S link these community services with the work of mental health services. This promotes greater understanding by professionals and improved access to mental health services for people from BME communities. This agenda is supported by a multi-agency DRE Leads Forum represented by

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leaders who can provide the scaffolding of support not just for CDWs but for the working systems and processes that DRE requires to take it beyond 2010. Read more: http://www.eastmids.org.uk/mental-health/delivering-race-equality/

Personalisation and Mental Health How much choice and control do you have over what happens to you? For those who access public services, they want a lot more choice and control. Since 2007, there has been an drive to see that health and social care must begin to put people first through a fundamental transformation of public services. Central to this is enabling people to exercise choice and control over the way they live their lives, reassured that the services they receive are of high quality, safe and meet their individual needs for independence, well-being and dignity. The Putting People First Concordat (2007) reflected this message and prompted a commitment to create a personalised Adult Social Care system. “Ensuring older people, people with chronic conditions, disabled people and people with mental health problems have the best possible quality of life.” This requires system wide transformation, aided by a 3 year programme started in April 2008 which is meant to show significant progress by 2011. It is naturally linked to a national performance indicator – NI130 which stipulates that 30% of people accessing mental health or learning disability services in receipt of personal budget must be using a direct payment. One way this is being reflected regionally is through a joint exercise between the DH Social Care Team and the EMDC to work with partners in sub localities to promote not only meeting but exceeding the 30% target. By injecting additional resources within an existing pool of investment we are matching enthusiasm within the system to make person-centred approaches central to how we do business. We will be working with test sites like Northamptonshire, where leaders and staff within the County Council, Northamptonshire Healthcare Foundation Trust and the PCT are exploring the big questions about resource allocation, eligibility criteria and culture change; sending a strong message of commitment followed by action in order to take the agenda forward across health and social care. Read more: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081118

Suicide Prevention This project is a key part of the support we are providing to the Mental Health Next stage review, which in the east midlands identified suicide prevention a priority. The national suicide prevention strategy identifies that those who have self harmed are a significant high risk group. Many who self harm will attend an A&E department following their act. The National Clinical Practice Guideline Number 16 relates to the initial management of self harm and contains guidance on assessment. In the East Midlands we are reviewing, (based on the nice guidance and ‘Better Services for People Who Self-Harm Quality Standards for Healthcare Professionals’ the psychosocial assessment availability and delivery across the large A&E and the acute hospitals sites to help inform how care is delivered and learn from the approaches being taken. Read more: http://www.eastmids.org.uk/mental-health/suicide-prevention/

Legislation While this programme has now come to an end there are a number of projects that we would like to keep you informed about in 2009. The Amended 1983 Mental Health Act (2007) came into place on November 3rd 2008. We have been supporting local areas with the implementation of the Act. In so doing we have seen the enormous commitment and enthusiasm by local services to bring this Act in and to prepare their staff for the various changes. In addition we have been supporting carer and service user engagement as core to the work being undertaken. Ongoing work remains with the implementation of the Independent Mental Health Advocacy Services, age appropriate services

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(children and young people) and the new roles that can be undertaken by mental health professionals. So if you want to find out more about this new legislation and the acronyms of AC, RC, AMHP, IMHA, CTO etc we have a range of literature, booklets and publicity materials that provide easy ways to understand the Act and the changes that have been made. Read more: http://www.eastmids.org.uk/mental-health/mental-health-legislation/

Regional News In this section we want to encourage you to share what is going on in your area, we hope it will be a mix of innovation in care examples, improvement stories, ward winners, personal successes etc Click on the county hyperlink to read more.

Nottinghamshire http://www.eastmids.org.uk/a bout/our-team/jillianguild/nottinghamshire/

Derbyshire http://www.eastmids.org.uk /about/our-team/denaadamson/derbyshire/  Derbyshire Mental Health Services, HCC review

 Nottingham Health Care Trust - ‘Positive about Education and Training’ project  Shaping health and social care over the next five years

Lincolnshire http://www.eastmids.org.uk /about/our-team/deanrepper/lincolnshire/  IAPT advancements  Employment Service Pilot  MOD Contract

Leicestershire and Rutland http://www.eastmids.org.uk/about/ourteam/john-gibbon/leicestershire-andrutland/  Service Improvement Course De Montford University  Ward Managers Development Course – Leicestershire Partnership Trust

Northamptonshire http://www.eastmids.org.uk/about /our-team/dorseyprecht/northamptonshire/  Northamptonshire Healthcare Trust – Foundation Trust  Joint Mental Health Commissioning Strategy

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Thought Piece This months thought piece, presented by Dean Repper, Director East Midlands Development centre “The therapist or the therapy” http://www.eastmids.org.uk/about/thought-piece/ If you would like to submit a thought piece please email jonathon.king@eastmidlands.nhs.uk

Notice Board Latest news, resources and products you may find useful.



A multi-lingual leaflet on patient’s rights is released for the first time ever Patients’ rights will no longer be lost in translation as an NHS leaflet is released in more than 25 different languages for the first time ever. This multi-lingual leaflet is the idea of the Mental Health Act Administration Team at Northamptonshire Healthcare NHS Foundation Trust and focuses on a patient’s rights when detained under the Mental Health Act. The team recognised the difficulties of many patients from different ethnic communities in understanding their rights and when to use them. With the support of NHS teams in the East Midlands and nationally, who work on safeguarding patient rights in mental health, money was raised to cover costs. The Northamptonshire team began the ambitious task of producing the different documents, which will now be launched on 8th June at a dedicated event in Northampton. Read more: http://www.eastmids.org.uk/2009/06/05/nhs-leaflet-released-in-more-than-25-different-languages/



New Horizons On 22 May, service users and carers gathered at the Park Inn, Northampton to participate in a regional Listening Event with Louis Appleby, National Director for Mental Health in England. Participants’ views will help shape the policy developments for, “New Horizons which is a new strategy that will promote good mental health and well-being, whilst improving services for people who have mental health problems. It will build on the National Service Framework for mental health.” http://nds.coi.gov.uk/content/detail.asp?NewsAreaID=2&ReleaseID=398462



Coaching and Mentoring Did you know that we have a qualified coach and mentor in the centre? I am registered on the T.I.N. (The Improvement Network) coach list, where you can read my area of interest and support. I particularly enjoy working with staff working in change and organisational development so if you are interested in taking up a coaching or mentoring opportunity please call or email me on dena.adamson@eastmidlands.nhs.uk or 01623 812941.



IAPT – Leadership and Influence Course We have successfully filled the first cohort of the IAPT Leadership course which is fantastic news and the team (Dena Adamson, Dr Les Ashton and Mark Houghton) are now busy preparing the action learning orientated course to start in mid June. In addition we are also looking at how we might create some training opportunities for Primary Care staff in mental wellness and signposting for help and support. So many people who are starting to suffer from anxiety and depression could be helped from progressing into a more severe condition if they were supported effectively in the early stages of their problems. We are presently looking as to how we can support staff to intervene appropriately by providing training and information sessionsPP. Watch this space.

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Psychological Mindedness for Employees Did you know that 1 in 10 employees in any one year will be affected by Mental Health conditions? The economic downturn is forecasted to cause a 26% rise in Mental Health problems affecting more than 1.5 million people in the UK. Dena Adamson has been working with Marie Chellingworth, Low Intensity Course Leader from Nottingham University as well as with one of the major clothing retailers in the East Midlands to look at how HR Managers might deal with and recognise Mental Health issues within their employees and start to act as sign-posters and to help further services. We hope that we might be able to transfer this model to other large employers in our region in the near future.

East Midlands Development Centre NHS East Midlands www.eastmids.org.uk Pleasley Vale Business Park Mill 3, Floor 3 Outgang Lane Mansfield Nottinghamshire NG19 8RL T: 01623 812930 F: 01623 812940 E: jonathon.king@eastmidlands.nhs.uk

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Walkabout - EMDC Bulletin - June 2009 - Issue 1