Report for Resolution - Manchester...Report for Resolution Report to: Health and Wellbeing Overview and Scrutiny Committee – 21 July 2011 ... Mainway building would cease from the

Manchester City Council Item 7 Health and Wellbeing Overview and Scrutiny Committee 21 July 2011

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Manchester City Council Report for Resolution

Report to: Health and Wellbeing Overview and Scrutiny Committee – 21

July 2011 Subject: Provision of Day Service - Modernisation Update

Manchester Mental Health Social Care Trust (MMHSCT) Report of: Stuart Hatton, Chief Operating Officer, MMHSCT Summary Trust Board approved the commencement of the modernisation of day services Engagement with service users and carers On the 11 May a feature was run by BBC Radio Manchester regarding the

modernisation of day services The implementation of the modernisation of day services commenced on the 1

April 2011 with a 3 month transition period Ongoing engagement work is underway that involves service users, carers and

staff in the local development of services, via Service Development Groups The potential of the Benchmark service being established as a Social Firm is

being explored Recommendations That members: Note the ongoing engagement work and service development taking place Note the intention to establish Benchmark as a social firm Consider the next steps Wards Affected: All Contact Officers: Name: Stuart Hatton Position: Chief Operating Officer MMHSCT Telephone: 0161 882 1062 Name: Cath Gormally Position: Associate Director Social Care & Inclusion MMHSCT Telephone: 0161 720 2358


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Name: Zeph Curwen Position: Service Manager Occupational Activities & Employment MMHSCT Telephone: 0161 720 4809 Background documents (available for public inspection): No


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1. Purpose

1.1 To provide Overview and Scrutiny Committee with an update on the

modernisation of day services. 1.2 To appraise the Overview and Scrutiny Committee of ongoing engagement

work taking place with service users and carers. 1.3 To appraise Overview and Scrutiny Committee of the next steps. 2. Background 2.1 On the 23 November 2010, Trust Management Board discussed and

supported the proposal to modernise day services. Approval was also given for wider stakeholder engagement to commence regarding the proposal.

2.2 The proposal suggested that the Trusts current day service provision be

developed, from its present building based approach, to a service that creates mainstream opportunities and provides support to enable people to recover and promotes mental well being. Whilst we have examples of innovative developments in our present day services linking to mainstream opportunities and supporting the social inclusion of our service users, a lot of activity is still provided within building focussed mental health services which fail to achieve social or vocational outcomes adequately.

2.3 The envisaged benefits of the proposed service development over the current

service provision are:

A new, evidence based service model, in line with Trust objectives and local and national policy expectations

A clear purpose for meaningful occupation and vocation within the Trust’s care pathway based service offer

An increased number of people supported to be active citizens and connect with their local communities with improved outcomes

More local and timely access to services An increased number of service users receiving support to move into

employment and mainstream services Development of volunteering opportunities Improved governance arrangements and systems to monitor and evidence

the service impact and outcomes achieved 2.4 The main criteria for this modernisation are that services need to:

Be of high quality, equitable, accessible, responsive and timely Deliver outcomes for individual service users, as defined by them and that

support personalisation and choice Be in line with the direction of local and national policy drivers


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Use resources in the most effective and efficient way possible ensuring value for money

2.5 A key driving force for change is personalisation, with individualised budgets

and direct payments an important aspect of any future service. As service users are offered more choice our services need to be attractive so we can be the provider of choice and attract income through individualised budgets.

2.6 On the 31st March 2011, Trust Board approved the commencement of the

modernisation of day services. 3. Ongoing Engagement with Stakeholders 3.1 We have continued to engage with the service users and carers of the

Mainway service and Manchester Users Network and are having an ongoing dialogue with them to manage resistance to change and address a small number of concerns and complaints that have been raised (see attached engagement plan App. 1).

3.2 The Associate Director for User and Carer Involvement and Head of

Communications have been meeting with a small group of Mainway service users to explore the production of a user newsletter. The service users have come up with lots of ideas ranging from promoting existing services to making service users more aware of other sources of support available in the North Manchester area, e.g. those within the voluntary sector. It has also been suggested that the newsletter and an accompanying webpage be used to promote community engagement and user/carer involvement activities and include a calendar of key upcoming events , e.g. FT days, Governor elections, AGM and user carer conferences. The different users and carers are offering different types of skills ranging from designing the newsletter and building the web page. The plan is to roll this out as an opportunity for other users and carers in the different part of the city.

3.3 A meeting was held between Manchester Users Network on the 28th March

and Jackie Daniel, where the concerns of users and carers were discussed and an assurance was given that no service users would lose a service and that we would commit to arranging meetings to assess the needs of all the current Mainway service users to establish what service response will meet identified needs. A follow up meeting took place on the 23rd May 2011 with Craig Harris, Associate Director Joint Commissioning, in attendance. It was clearly communicated at this meeting that the current activities on offer in the Mainway building would cease from the 1st July 2011 and that this decision is fully supported by the JCT and Trust Board.

3.4 Manchester Users Network invited a BBC Radio Manchester Reporter to a

meeting in the Mainway building, where she interviewed service users and carers. Cath Gormally, Associate Director for Social Care and Inclusion, Zeph Curwen, Service Manager Occupational Activity and Employment Services and Judith King, Head of Communications met with the reporter on the 3rd May


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to give a pre-recorded interview to clarify the position and the rationale for the modernisation of day services.

3.5 The item was featured on the 11 May as a news headline and feature piece

throughout the breakfast and drive time shows. We are looking to adopt a more proactive approach to working with the media and have invited the reporter back to cover good news stories and come back to visit services in the future to see how the changes have improved the service.

3.6 The National Development Team for Inclusion led a workshop on the 18 May

aimed at engaging service users and carers to increase their understanding of social inclusion and recovery and help to raise their expectations in terms of life choices and help them to cope with changes to services. This workshop focussed on the service users and carers from the Mainway and Horticulture services. Feedback from the session was mixed with some service users finding this helpful for them to consider alternatives to current activities on offer, some service users didn’t engage in the workshop and remained resistant to change.

3.7 A name for the service has been developed ‘Recovery Pathways: wellbeing

through art, people and places’. 3.8 Correspondence has been ongoing with wider stakeholders such as Graham

Stringer, MP in response to concerns being raised by MUN. 3.9 A service development group has been established and met for the first time

on the 20 June. This involved staff, service users and carers of the ‘North’ service patch. 11 service users and carers attended the meeting and discussions included the activity programme, ideas for new activities, communication and building issues. This was overall an immensely positive meeting and it is clear that engagement has started to take place and resistance to change significantly reduced.

4. Transitional Period 4.1 A small number of users accessing day services at Mainway and Horticulture

on the North Manchester Hospital site were not in support of the service changes and representations have been made to Trust Board and the PCT Board on this issue. Full account has been taken of the expressed concern in the style and method that the implementation of change has occurred and as a result we have worked through a three month transitional period.

4.2 A commitment was given by Jackie Daniel, Chief Executive, to the users and

carers of Mainway that all current service users would have their needs assessed in relation to day services. This process has been led by three Occupational Therapists. From a total of 91 potential service users, 68 Mainway and Horticulture service users have had a needs assessment/review meeting and a follow up meeting and have now been allocated new key workers within the modernised service or allocated to new activities. We are not aware of any service users having disengaged from services as a result of


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the change process. The 23 discharges that have taken place have either been due to non attendance in services prior to the change process, cessation of payment of therapeutic earnings or natural discharges due to needs being met in other ways.

4.3 The themes emerging related to needs and aims for attending services are:

Learning new things Socialising and meeting others Managing change and stress Maintaining mental health Identified goal areas emerging are: Volunteering opportunities in gardening/ charity shop Developing skills and knowledge learning plant names and growing

vegetables Developing a supporting role within gardening service Developing a supporting role within service – creative activity Developing skills and interests in creative activity and design Learning how creative activity can maintain and protect well being Exploring interests and trying new things Building a healthy routine that maintains and protects wellbeing

4.4 A new activity programme has been developed for the North patch of the City

that includes activities such as digital photography, textiles, green wellbeing, IT drop in, Out and About group amongst many others, some of which are being delivered from the Mainway building. One new development is the bite veg bag scheme. Working in partnership with Harp, the bite veg bag project launched on the 22nd June at the NMGH Green Wellbeing base. This activity is currently available every Wednesday with a view to increasing this once orders increase and systems and processes are refined. This activity has been well attended in its first two weeks by the users and carers from Mainway and Horticulture. This project will provide a range of opportunities for service users to get involved from driving, to quality control, weighing, bagging, distribution and customer service. Initial feedback from users and carers has been very positive.

"The positive thing is that people will be learning new skills and looking to the future," “These new activities will hopefully get people inspired and help them to find new creative abilities. The group was really positive about it and really gave it a go." Simon Jones, Recovery Pathways Creative Wellbeing Tutor.

4.5 The service will continue to have the same eligibility criteria as is currently in

place, which is for those adults with severe and enduring mental health problems who are subject to the Care Programme Approach (CPA) or entitled to a service under Fair Access to Care Services (FACS) operated by Manchester City Council.


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4.6 Social care, unlike health care, is not free to everyone. Local councils have a limited amount of money and can only provide services for people who meet the Government's Fair Access to Care Services criteria. There are four levels of risk set out in the FACS guidance. These are:

Low, when there is little risk to your independence Moderate, where there is some risk to your independence either now or in

the near future Substantial, where there are significant risks to your safety and

independence Critical, where there are immediate risks to your safety and independence

4.7 Manchester City Council currently funds support for people with a substantial

or critical risk to their safety, independence or wellbeing through Individual Budgets.

4.8 Where needs match the level set by the council, a financial assessment will be

carried out in line with the City Council’s Fairer Charging Policy. Depending on income, savings or assets, service users may have to pay for some or all of their support. There are also government guidelines on how much you can have in savings or assets before being asked to pay for your care.

4.9 Work is ongoing with the Local Authority regarding eligibility for social care

services and application of the Fairer Charging Policy. We have established a baseline of existing service user’s eligibility and funding in relation to individual budgets. We will continue discussions with the Local Authority regarding the assessment of individuals to establish whether or not those without an IB are eligible for a social care service and regarding those service users who are currently being charged for services.

4.10 Discussions have taken place with the Local Authority in relation to the service

pathway and the potential to develop a community reablement/recovery service within the Social Care and Inclusion Care Group. This is at a very early developmental stage but would involve the service offering intensive rehabilitation, reablement and support for individual service users to maximise their social recovery and opportunities to reach their full potential and independence. This work is being progressed through the 3D project in collaboration with other care groups. We are working to ensure that the modernised service supports personalisation and choice and that no system or process acts as a barrier to accessing services for eligible service users. Discussions are underway with our Commissioners regarding how we continue to deliver a service that meets health and social care needs and to gain absolute clarity regarding which elements of the modernised service are eligible for charges.

4.11 The service systems and processes are in development to ensure that all

service users receive an equitable service that is goal focussed supports their recovery and social inclusion and is based on aspirations. Work is underway to develop a bespoke key working tool based on the recovery star and OT tools.


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4.12 The current service caseload across the city is approximately 564. We expect this to fluctuate as a result of the work that is underway within Harpurhey, Victoria Park and Hall Lane in relation to those service users currently accessing the service who do not meet eligibility criteria.

4.13 Part of the modernised service includes the substantiating of three

Employment Specialists. Since the 1st of April, this service has supported 6 service users into open employment (see attached case study App.2)

4.14 Work has commenced to establish the viability of Benchmark becoming a

Social Firm. We are working through a process of due diligence to provide an assurance that this is in the best interests of all concerned.

4.15 The modernisation of day services and provision of socially inclusive services

is the responsibility of the Social Care & Inclusion Care Group. The work to deliver these changes is extensive and requires appropriate planning and oversight. As a contributory part of the Trust’s work on its Service Strategy it was suggested that a multi-disciplinary Implementation Oversight Group be created on behalf of Trust Management Board to support the Care Group with this work and in particular respond to any need for specific clinical input into revised services. This group has met and provided feedback on the process so far and ideas and suggestions for continued engagement of service users.

5. Workforce Impact 5.1 The majority of staff have moved into the new posts in the structure a few

posts remain vacant and are in the process of being recruited to. 5.2 TUPE staff have been maintained on their existing Terms and Conditions.

Ongoing discussions will take place with these staff to ensure that this arrangement does not impact negatively on any staff.

6. Next steps 6.1 The Social Care & Inclusion Care Group will continue to implement the revised

service model. Key steps are:

Ongoing discussions with commissioners regarding the pathway through the modernised service in relation to health and social care and personalisation

Working with service users, carers and staff via Service Development Groups to co-produce services locally

Fully implementing the new staffing structure Establishing service systems and process Support the Benchmark service to establish as a Social Firm

6.2 Discussions with Commissioners

It is important that agreement is reached with social care commissioners about how the redesigned service relates to the City Council’s charging policy. The historical funding position has created a lack of clarity and inequity.


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Clarification and agreement is being sought from social care commissioners to enable a clear position to be implemented as soon as possible.

6.3 Working with service users, carers and staff The first of the Service Development Groups has met and we will continue with these to provide a forum for staff, service users and carers to work together to co-produce services. These groups will work together underpinned by the principles of recovery, social inclusion and personalisation and within the limits of the staffing structure and budgets. These groups will establish which current activities can be developed, which are to cease and which new activities be developed.

6.4 A range of goal focussed and recovery focussed activities that are themed around wellbeing are now on offer in the Mainway space and will continue to be developed.

6.5 A key working tool is being developed that will ensure a recovery focussed

approach is adopted across the whole service and outcomes monitored.

7. Summary 7.1 OSC is asked to:

Note the ongoing engagement work and service development taking place Note the intention to establish Benchmark as a social firm Consider the next steps

Manchester City Council Appendix 1 – Item 7 Health and Wellbeing Overview and Scrutiny Committee 21 July 2011

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Appendix 1 - Day Service Modernisation Proposal Stakeholder Engagement Plan

Engagement Objectives Group Communication & Engagement Activities Timescales Individual

responsible Service Users and Carers

A series of engagement meetings will take place to present the proposal to service users and answer any questions they have, in each service area affected by the proposal;

(w/c 13th Dec 2010 – 14th January 2011) Revised dates - 17th Jan to 11th March 2011

Zeph Curwen, Patrick Cahoon

Horticulture Engagement meeting 31st Jan 11am

Mainway Engagement meeting 31st Jan 9.30am

Studio One Engagement meeting 9th Feb 2pm

Start Engagement meeting 10th March

Victoria Park Engagement meeting 7th Feb

Hall Lane Engagement meeting 1st Feb

Benchmark Engagement meeting

21st Feb 10.30am

Harpurhey Centre Engagement meeting

31st Jan 2011 Zeph Curwen

Open Engagement meeting Harpurhey 2nd Feb 2011 Zeph Curwen & John Butler

Open Engagement meeting Victoria Park 7th Feb 2011 Zeph Curwen & John Butler

To inform the process of engagement with service users and carers in the development of a modernised day service. To strengthen the understanding of service users regarding the engagement process and the drivers behind the proposal. To ensure that local service users and carers, including those who have needs which require support to be able to engage, are able to access reliable and accurate information regarding the proposal, and have an option to engage directly with the Trust to address any Open Engagement meeting Hall Lane 1st Feb 2011 Zeph Curwen & John

Butler


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Service Users and Carers

The Project Director will be contactable via email or phone to answer any questions that service users have and to receive feedback on the proposal. Email set up – [email protected] 10th Jan

Ongoing from 13th Dec 2010

Zeph Curwen

Service Users Meetings will be held with service user representative groups to share the proposal and engagement plan;

3rd Jan 2011 onwards


Manchester Users Network TBA South Manchester User Group – shared

engagement plan 12th Jan 2011

Engagement plan presented to: Manchester LINk 9th December 2010 NHS Manchester w/c 10th Jan 2011 Proposal and Engagement plan presented to;

Manchester Carers Centre 9th March 2011

Zeph Curwen & Patrick Cahoon

Adult Social Care - Meet with James Williams

Sent 12th Jan 2011 10th Feb – cancelled TBA

Health & Wellbeing overview & scrutiny committee

tbc

Service Users & Carers

Proposal presented to: Zeph Curwen, Patrick Cahoon

Manchester LINk Sent w/c 17th Jan 2011 Meeting to update LINk arranged for 2nd March but LINk dna

Zeph Curwen & Patrick Cahoon

Adult Social Care Sent 12th Jan 2011 (team to team meet Dec cancelled)

issues or areas for concern To ensure service users, carers and other stakeholders contribute to the proposal in a meaningful way To demonstrate that views of service users, carers and others are considered and taken on board To inform the process of engagement, proposal being considered and the choice made in a timely manner.

NHS Manchester Discussed with Cara Ciliento, emails to Craig Harris, discussed with Nick Gomm

Sent w/c 10th Jan 2011


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A service user proposal engagement document will be produced, uploaded to the intranet and given to all existing users of day services.

17th Jan 2011 on internet and sent out to Team Managers for dissemination

Zeph Curwen, Judith King

Service Users Questionnaire sent out to all existing users of day services to gather feedback on current service satisfaction and any gaps in service offer.

11th Nov 2010 Zeph Curwen

Service Users The day service modernisation booklet produced by the National Social Inclusion Programme will be made available for all existing users of day services.

17th Jan 2011 Zeph Curwen, Judith King


The Social Inclusion Care Group Trust web page will hold any updates

17th Jan 2011 Judith King


Trusts User and Carer Forum presented the proposal and engagement plan.

4th March 2011 Patrick Cahoon

Carers Manchester Carers forum to hold a meeting for carers where proposal and engagement plan will be presented

9th March 2011 Zeph Curwen, Patrick Cahoon


Inform Care Co-ordinators of proposal and engagement plan via email Trust update so they can advise service users.

w/c 17th Jan 2011 Zeph Curwen


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Briefing prepared and sent to a range of local groups and communities of interest in order to ensure that they have access to up to date reliable information on the proposal, and included feedback questionnaire. Groups included:

- George House Trust - Harp – - Mood Swings Network - St Lukes - Body Positive North West - Black Health Agency (including

Manchester LINk) - Manchester People First - Manchester Race and Health

Forum - Adult Social Care – Carers Forum - Manchester Council for

Community Relations - SEVA - Faith Communities Network - Breakthrough UK - Manchester Deaf Centre - Manchester Drug and Alcohol

Strategy Team (DAST) - Manchester Carers Centre –

meeting 3rd March - Manchester Carers Forum - Caring in Confidence - Manchester Expert Patient

Programme

- Yasp

- 42nd Street

Ongoing from 17th Jan 2011

Zeph Curwen, Judith King


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All staff of affected services will be sent a copy of the service modernisation proposal including an explanation of the consultation process.

Staff consultation doc sent 6th Jan 2011

Zeph Curwen, Emma Cain

All staff of affected services will be invited to a consultation meeting in their service area to provide feedback to inform and contribute to the development of the proposal.

w/c 10th Jan 2011 Zeph Curwen, Ric Wilkinson, Felicity Grey

Start team 17th Jan

Studio One team 17th Jan

Benchmark 11th Jan

Harpurhey Centre 12th Jan

Victoria Park Centre 11th Jan

Hall Lane Centre 12th Jan

Mainway 17th Jan

Horticulture 17th Jan

OTs 17th Jan (BM) & 11th Jan (MC)

Employment Specialists and Admin staff 17th Jan (SS)

Any staff member will be able to post questions to Zeph Curwen by e-mail or use an online feedback form to post comments and will be responded to..

Ongoing from 10th Jan 2011

Zeph Curwen

The Trust’s senior managers receive an update about the progress of the consultation/engagement process at Care Group Management meetings and OMT

24th Jan OMT 25th Jan TMB

Zeph Curwen, Judith King, Patrick Cahoon


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Meeting with John Butler from MaCC to inform of proposal and share engagement plan

30th Nov 2010 Zeph Curwen

Proposal shared with;

Operational Management Team (OMT)

Exec Team

Trust Management Board

1st Nov 2010 3rd Nov 2010 23rd Nov 2010

Zeph Curwen, Ilsa Finnigan, Stuart Hatton

Meeting to be held with Staffside to share proposal

Mid consultation point meeting

23rd Dec 2010 15th Feb 2011

Zeph Curwen, Emma Cain

Specific briefings prepared for Councillors, MP’s and MEP’s.

Sent 7th Feb 2011 Zeph Curwen, Judith King

Briefing to be sent to Lead GP, Practice Managers and PBC Hub Chairs.

31st Jan 2011 Zeph Curwen, Judith King, Nick Gomm

SUs and carers plus representative groups including Manchester Local Involvement Network (LINk) and Manchester Carers’ Forum invited to attend engagement workshops.

w/c 17th Jan – 11th March 2011


Present proposal and engagement plan to Voluntary Sector Mental Health Forum

18th Jan & 22nd Feb 2011

Patrick Cahoon; Zeph Curwen

www.ewin.northwest.nhs.uk/

GOOD PRACTICECASE STUDY

This pilot Individual Placement andSupport (IPS) service is being run byManchester Mental Health and SocialCare Trust for service users who are onthe Care Programme Approach. Its aimis to support people with severe andenduring mental health problems,obtain competitive paid employment.Funding was made available fromCentral Government via the NHS NorthWest for the 2 year project, based onresearch evidence that having a jobimproves mental wellbeing. As theyapproach the end of their first yearthey already have 7 people who havefound employment and a number whothey are supporting to stay in work.

This case study looks at how thescheme was set up and runs, the outcomes and challenges, and keylearning points. It focuses onthe change of culture that wasneeded within communitymental health teams to make employment supporta key aspect of servicesoffered to people, recognising the significant health benefits of having apaid job.

• IPS is now offered to people withsevere and enduring mental healthissues in Manchester through ateam of employment specialistsworking alongside health andsocial care professionals. It providesindividually tailored support toindividuals to support them intoemployment

• Manchester Mental Health andSocial Care Trust Board fully support the pilot and funding hasnow been agreed to continue thescheme beyond the initial 2 yearpilot

• Last year 101 people were referredto the service. In February 20113.85% of service users currently onCPA against a full year target of4.5%, were in competitive paidemployment

SUMMARY KEY OUTCOMES

MANCHESTER MENTAL HEALTH AND SOCIAL CARE TRUST

MANCHESTER IPS PILOT GETS PEOPLE WITH SEVERE

MENTAL HEALTHPROBLEMS INTO JOBS

Manchester City Council Health and Wellbeing Overview and Scrutiny Committee______________________________________________________________________________

Appendix 2 - Item 7 21 July 2011

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• A 2006 report for DWP ‘Is work goodfor your health and wellbeing?’highlights the positive impacts ofwork on both the mental and thephysical health of individuals. Theevidence suggests employment can:

- promote recovery

- support better health and wellbeing

- reduce long term sickness

-improve quality of life and

- reduce social exclusion

This project using the IPS approachaims to support individuals with severemental health problems into paidemployment.

• It set out initially to get 4.5% ofservice users in Manchester intoemployment

• It aimed to seek out and build relationships with local employersrather than relying on job adverts

• It recognised the need to gainBoard-level support to maintain thescheme beyond the initial two-yearpilot by providing evidence of success, positive outcomes andensuring stakeholder engagement

Bauer Il Palazzo



Manchester Mental Health and Social Care Trust wasformed in April 2002 as one of only five mentalhealth and social care NHS organisations in thecountry.

• It delivers social care and health services inManchester for people with severe and enduringmental health problems in both community andhospital settings.

• It employs around 1600 staff

• It has three main locations, the Rawnsley andEdale buildings at Manchester Royal Infirmary,Park House at North Manchester General Hospitaland Laureate House at Wythenshawe Hospital

There are clear links between work and health. It iscommonly accepted and well evidenced that work isgood for health, and unemployment is bad for mental and physical health and wellbeing. Worklessindividuals are generally 2-3 times more at risk ofpoor mental health. Individuals with mental healthissues are more likely to experience poverty, incomeinequality and exclusion.

The Centre for Mental Health is leading the way interms of Individual Placement and Support and hasa programme of local Centres of Excellence in ninelocalities across England. Individual Placement andSupport (IPS) was initially piloted in the USA andidentified as an effective model for people withmental health issues. It adopts a “place and train”approach which involves assessing individuals’ skillsand vocational abilities and interests relativelyquickly, matching these with appropriate employment opportunities and providing intensivesupport.

Taking an individual’s desire to work as its startingpoint, the priority is to respond to this quickly bybeginning the search for competitive employment,then ensuring that training and in-work support areprovided as needed.

In Manchester, the mental health and social careTrust previously ran an employment service support-ed by ESF monies and had retained one EmploymentOfficer. After hearing about funding for IPS pilots,Zeph Curwen, Occupational Activity andEmployment Service Manager led on an expressionof interest to NHS North West to deliver an IPS pilot.A team of three employment specialists now workwithin the community mental health teams acrossthe city.

BACKGROUND

PURPOSE



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• A bid was successfully made to the

NHS North West to fund a two year

IPS pilot

• Staff were recruited to two

additional employment specialist

posts (making a team of three plus

the manager). Key elements of the

job required people who were able

to work with three groups of people:

- Service users

- Local employers

- Mental health teams

• A steering group was set up including

CMHT managers plus the lead for

Occupational Therapy community

services

• Briefing sessions were held to

inform health and social care

professionals about IPS to improve

their understanding and gain their

support for the approach

• Referral protocols were developed

and agreed

• Key performance indicators were put

in place as part of Board reporting

(NHS and Local Authority) to

monitor outcomes against target

• The Employment Specialists are

co-located with a CMHT in the

North, Central and South areas of

the City and work closely with the

other CMHTs in their ‘patch’

A CHANGE IN CULTURE

The Trust strives to provide a recovery

focussed service that supports service

users with their aspirations in relation

to employment. In 2010, for the

first time, the Trust had a Key

Performance Indicator in relation to

the employment rate of service users.

This helped to raise the profile of

employment support for service users

and its importance.

Through the IPS pilot, the CMHTs now

have a member of the team who can

help to provide the expertise required

in relation to employment as part of a

service users care package.

Additionally the Employment Specialists

are able to increase the knowledge

and confidence of the CMHT staff in

relation to employment issues. Many

service users now expect support with

employment to be part of the service

they receive where in the past it may

have been an aspiration that someone

with severe and enduring mental health

issues would not have considered.

Employment specialists are based with

the community MH teams across

Manchester. Referrals are made directly

from the team when a service user has

a desire to gain employment. The

employment specialists then work with

the individual to build up their trust

and confidence, find out what skills

they may have and determine together

the kind of employment that would be

most suitable. They also discuss possible

barriers that might need to be taken

into account.

Rapid job search then takes place and

help is provided with applications and

interview preparations based on the

amount of support agreed with the

individual. Often negotiations with

employers are carried out by the

employment specialist to proactively

identify opportunities and discuss job

requirements/adjustments. Support is

ongoing for as long as the individual

and employer require it.

• Funding for the two year pilot has

been provided by the NHS North

West

• The Trust supports the pilot by

contributing the funding for a full

time Employment Specialist, putting

in place line management

arrangements and accommodation

• Changing the cultureIPS is now a key part of the serviceoffered by the Trust. However, itwas necessary to influence theCMHTs and their culture for themto take on board the importantrole they needed to play in its success. It is now an accepted mainstream activity and embeddedsufficiently to allow much closerworking with the employment specialists leading to key capacitybuilding within the team

• Changing mindsetsThe CMHT professionals are soimportant in helping service usersto understand that jobs are not badfor your mental health, and willhelp contribute to their recovery.They are also able to address anyconcerns from service users aboutloss of benefits etc

• Keeping an eye on the ballPromoting and explaining thescheme and its benefits for healthand wellbeing are continuallyrequired to keep up the momentum.Leadership of the team is essentialif performance targets are to bemet as the team will require support and guidance as they workremotely

• Finding jobsConsiderable effort is needed, particularly during difficult economictimes, to find paid jobs – the role ofthe employment specialists is centralin engaging with employers andsearching out vacancies

• Investing in employment specialists’developmentThe role of employment specialistrequires a range of skills and experience as the role can be verydemanding and support is neces-sary to develop them to ensuremaximum performance. Plans arein place to continually review theirperformance and work with themon clear objectives and personaldevelopment

Bauer Il Palazzo



KEY STAGES OF SET-UP

HOW IT WORKS

RESOURCES

KEY CHALLENGES



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• Support for service users variesfrom individual to individual, but itcan be really labour intensive at thestart of the process to ensure that people secure the rightemployment and are able to retainit Support for employers is vital aswell to ensure that a good relationship is built with the service, to help educate employersregarding mental health issues andto intervene early when problemsarise.

• Leadership is essential for theemployment team to ensure optimum performance and schemepromotion

• Partnership with health and socialcare professionals who are keystakeholders in the IPS scheme isessential

• Change of culture for the CMHTs isneeded to mainstream IPS andachieve KPIs

• Employer engagement and education is an important factor inthe scheme’s success

• The support for the employee inthe first few weeks/months.

• Employment specialists are nowlocated in the CMHTs acrossManchester and referrals are beingmade from the health and socialcare professionals

• Service users with severe andenduring mental health problemsare securing competitive paidemployment

• The Trust has agreed to support thecost of the scheme beyond the pilotphase

• The management of the employment officers will be transferring to the mental healthteam managers which reflects themainstreaming of this activity

• A letter from the Chief Executive,Jackie Daniel shows her support forthe scheme and its value to serviceusers

NEXT STEPS• Use of the Fidelity scale to assess

the level of implementation

• Increased focus on employerengagement and establishingobjectives for the employment specialists

• Client Case Study

http://www.centreformentalhealth.org.uk/

Bauer Il Palazzo



KEY LEARNING

SUSTAINABILITY

FURTHER LINKS

SUPPORTING MATERIAL

©N

HS

No

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CONTACT FOR FURTHER INFORMATION

• Zeph Curwen Service ManagerOccupational Activity andEmployment Services

Email: [email protected]

Telephone: 0161 720 4809



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Documents

Report for Resolution - Manchester...Report for Resolution Report to: Health and Wellbeing Overview and Scrutiny Committee – 21 July 2011 ... Mainway building would cease from the