2012 Service Model

Inpatient Workstream

Workstream Structure

2012 Project Board

2012 Project Co-Ordination Group

2012 Inpatient Workstream

Workstream Core Group

Workstream RepresentationThe Workstream consisted of representation from:

• Consultants

• Service Directors

• Management Team

• Clinicians and Practitioners

• Local Authorities

• Primary Care Trusts

• Service User Representatives

• Carers

• Voluntary Sector

• Estates

• Finance

• Human Resources

Service Mapping

Mapping of current services was undertaken. This was a lengthy process commencing with the extraction of measurable standards from a large number of documents.

The purpose of this exercise was to measure where services are at present and to guide what needs to be done to develop quality services in line with these standards.

One of the critical areas for mapping was the service user experience. A number of areas within this category were highlighted as areas of concern. These are summarised as follows:

Service User Experience

(Areas of Concern)

• Inpatient wards should be a sanctuary and provide a non-threatening environment

• Reception and admission arrangements must ensure that service users are made welcome, properly informed, orientated to the inpatient unit/ward environment, and have any immediate needs and concerns dealt with

• Privacy and dignity should be respected

• There should be family visiting areas and activity areas

• Specific attention must be placed on ensuring the physical and psychological safety of women. There should be women only day areas and toilet/washing facilities

• Users should have single rooms and single sex environments as far as is possible

• A ward of no more than 15 beds shall be aimed for

• A broad range of social, group and physical activities should be available

• Staff time to enable such activities should be properly resourced

• These activities should be part of the inpatient care plan

• Some activities will be off the ward and may involve other health teams or non-health agencies

• More creative responses to service users needs for therapeutic, social and recreational activities during inpatient care need to be developed and need to be supported by inreach from multidisciplinary teams and other community support services, including voluntary and non-statutory services

• Activities should be available in the evenings and at weekends

• The physical space for a range of activities should be available

• Input needs to be planed, consistent and reliable and not dependant on the interest or enthusiasm of individual practitioners

• Clinical leadership should be clear across the Trust. Each ward should have a dedicated lead consultant psychiatrist

• Staff should have the opportunity to jointly reflect on the impact of the day to day work with users and their families in order to feel informed and empowered to make the most effective interventions

• Physical assessment of inpatients should take place and needs should be provided for

Shared Ideas and Agreed Outcomes

• There should be centralisation of acute care on a single site, most likely at the Glenfield (Bradgate) site. Dementia assessment would also benefit from being on a single site (most likely at the Leicester General (Evington) site). Older or frail elderly acute care should also be on one site

• There are no proposals to alter the current bed arrangements for the specialities of treatment and recovery, drug and alcohol and mother and baby admissions, in the short to medium term

• The general liaison beds should be subsumed within generic acute care

• There should be separate beds for the PIER service

• Wards should be 20 bedded unless there is an extra ring-fenced and recurrent investment to increase the number of wards

• Centralising acute care on the Bradgate site will require new building and increased staffing resource

• There should be a target maximum occupancy of a ward (including leave)

• There needs to be a clear decision about whether a female only ward is mandatory or not

• The preferred method for defining the function of wards is by service

• There is no proposal to alter the current functioning of Belvoir PICU

• There is no proposal to alter the current development plans for a place of safety site at the Bradgate Unit

• Users with mild to moderate learning disability will be managed within generic services

• The child and adolescent unit should move to the acute site in the longer term if feasible

Generic Care Pathway

Decision to Admit

Admission Procedure

Initial Care Plan

Multidisciplinary Review Within 72 Hours

Formal CPA Review

Psychological and Occupational Interventions

Weekly Review

Second Opinions

Discharge Plan

Early Discharge

Governance

Implementation Issues and Priorities

• Areas of work that could not be finished within the timescale of the initial stage of the project

• Care pathway interface issues

• Review of systems relating to documentation

• Opportunities for improving the ward environment

• Impact of changes to medical staffing and service change