Emdc 6 Month Review 2009 Pdf Ver

East Midlands

East Midlands Development Centre

6 Month review 2009

Children, Mental Health and Offender Health Care are important policy areas for the Strategic Health Authority (SHA). As the Executive lead for all three I have been keen to ensure that the role of the East Midlands Development Centre (EMDC) to support these key client groups is well profiled in the region and within the SHA. The decision that the EMDC should be located within Patient Care ensured that we combined policy leadership with improvement support to Primary Care Trusts (PCTs) and the delivery system. It allows us to support the Quality, Innovation, Productivity and Prevention (QIPP) agenda for these important client groups and integrate the work with the aims of the directorate and other SHA functions. With an increasing NHS focus on Children’s services, the Bradley report on offender health care and the future publication of New Horizons, a vision for both MH service development and mental health promotion, I am keen that we continue to support these policy areas. Professor Dame Catherine Elcoat DBA Director of Patient Care

Evaluation Spread and adoption Harvesting knowledge and learning Using mixed media for diffusion

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Contents The Report

About us

I am pleased to bring you our first report on the work of the EMDC. 2009/10 is an important year for us as it is our first full business year as an integral part of the SHA. If last year was about transitions, significant change for staff and letting go (Care Services Improvement Partnership (CSIP) and National Institute for Mental Health in England (NIMHE) were closed down), this year had to be about delivery. This is the story so far.

Who are we?..........................................6

We have tried to keep it short but illuminating, so you get a feel of the breadth of the work and our style of working. People still ask us what we do and so we hope this will express that in a way that people can understand better what we do and where it has added value.

Children and Families - CAMHS............12

The report is designed to engage and inform but not overwhelm, there is a lot more to be told about the programmes and our work. Some of this can be found by following the web links or contacting the team and finding out more in person. We are always keen to explain our work but importantly to find out what is on the agenda of people working in the delivery system. We are also eager to hear what is good, success stories of change and how we might do more to support your goals. Please let us know what you think of the report and I do hope you find it a useful read. Dean Repper Director East Midlands Development Centre

Our Approach and Skills..........................6

Our Programmes Children and Families............................10 Offender Health....................................14 Mental Health..................................16-17 Supporting Care Pathway development.........................................17 IAPT......................................................18 Dementia..............................................20 DRE......................................................22 Suicide Prevention.................................24

Our Performance Stakeholder Survey...............................26

Problem/issue definition Focusing and clarifying Capacity and strengths Identification Assessing system maturity Sense-making

Core skill set: Relationship management Advanced interpersonal skills Working with complexity Networking and connecting Building capacity in others Analytical and interpretative Horizon scanning and critical oversight

Goal and objective setting Negotiation Shaping Change methods Policy interpretation Assembling resources

Improvement methods Eg. Lean, process mapping, appreciative inquiry, process consultancy Working with task and process Benchmarking/data analysis/systems modelling Coaching/mentoring Goal review and monitoring

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Who are we?

Our Approach and Skills

The EMDC is an integral part of the SHA Patient Care Directorate. We offer support to the Quality, Innovation, Productivity and Prevention (QIPP) agenda across Children, Mental Health and Offender Healthcare. We work closely with the relevant Next Stage Review (NSR) work streams for those client groups.

We know that health and social care environments are complex systems. They are open to continuous change and to emerging possibilities. They are also ‘human systems’, full of passion, energy, opinions and the potential to be contested and conflicted. Doing the right thing at the right time in the right place can be differently interpreted. When these environments are mature they are naturally innovative and goal orientated.

The team has a role to facilitate policy implementation, service improvement and build partnership working across the multiple agencies that are involved in the delivery system for the above client groups. We work closely with the Regional Department of Health (DH) Social Care Team and run joint improvement collaboratives with them. The core team consists of 9 field workers, 5 of whom have a locality responsibility in mental health and all carry a regional portfolio. The team has policy specific knowledge and expertise in addition to significant skills in change management.

Unique contribution The combination of policy expertise, change management and that we all have either a health or social care background makes our support offer unique. Added together we have 400 years of experience. We care about the same things that you care about and we know the depth of skills that exist in healthcare delivery. We approach our work as partners with you, build on strengths and support local decision making.

As a team we work with this understanding, harnessing strengths and supporting teams to overcome barriers but to also deal with the ambiguity that frequently arises in rich and diverse systems. We match our systems knowledge and thinking with skills that have direct practical application. We have a core and complimentary set of skills that support key stages of programme design and consultancy work. While a cornerstone of the team is accessibility and providing hands on support we also fund projects that are designed to release local capacity and leadership in priority policy areas. These projects also bring together delivery experts to work on common problems, share solutions and shape strategic change locally. We will sometimes combine this approach of hands on support with funding strategic programmes (see sparks of connectivity, page 8). Underpinning our approach is the continuous gathering of learning from those we work with and the results of projects. We use this to develop a growing local knowledge base of positive practice, what works, change successes, specialist know how that can be passed onto others. This is supplemented with knowledge from our national networks and connections to a broad spectrum of practitioner expertise.

To find out more, visit our website at the link: www.eastmids.org.uk/about 6

Problem/issue definition Focusing and clarifying Capacity and strengths Identification Assessing system maturity Sense-making

Core skill set: Evaluation Spread and adoption Harvesting knowledge and learning Using mixed media for diffusion

Issue Learning

Relationship management Advanced interpersonal skills Working with complexity Networking and connecting Building capacity in others Analytical and interpretative Horizon scanning and critical oversight

Goal and objective setting Negotiation Shaping Change methods Policy interpretation Assembling resources

Improvement methods

Scope

Eg. Lean, process mapping, appreciative inquiry, process consultancy Working with task and process

Results

Formualtion

Benchmarking/data analysis/systems modelling Coaching/mentoring

Intervention

Goal review and monitoring

Director – Private sector 7

About Us Sparks of connectivity Knowing how to pick the right lead for the right plug point to create that spark of connectivity is a specialist skill within the centre. By adding capacity within the system and translating ideas into action, the EMDC has played a pivotal role in Northamptonshire’s implementation of its Flourishing Communities Programme. Guided by existing commitments to commissioning for wellbeing, a team member has provided leadership while building local capacity and connecting the system together. Our work has already delivered accelerated advancements in programme design and partnership developments. Notably, the New Economics Foundation (NEF) in partnership with the University of East London, has been awarded a contract (funded through the IAPT economic downturn plan) to work with Northamptonshire stakeholders to deliver an innovative study and enhance local understanding on issues of wellbeing. Opportunities have also been created for exchanges with national experts on mental health promotion. By being available to support this innovative process, we are ensuring evidence and partnership engagement necessary to deliver commissioning priorities and strengthen the alignment between physical and mental health agendas for wellbeing.

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Children and Families The Children’s programme is an excellent example of our Partnership and multi-agency working both externally but also internally (see case example). So far this year we have delivered support and a number of improvement projects in the following priorities: • Children with a disability • Commissioning • Transition • Vulnerable groups • Safeguarding • Partnerships The Children’s Programme works in partnership with the Children’s policy leads in order to enable a coordinated approach to priority setting and to ensure outcomes are maximised. An example of matrix working across a range of SHA directorates can be illustrated by the approach to the implementation of “Maternity Matters” within the East Midlands. The maternity agenda is both a national and regional priority and focussed work has been ongoing in the region for over 18months. This work began with a scoping exercise involving interviews with all areas undertaken jointly by the SHA Maternity Lead (Patient Care Directorate) and the Regional Change Agent. The exercise produced a clear picture of progress and developmental needs across the East Midlands and assisted in determining future developmental activity. A part time post to assist in the implementation of the Maternity

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Matters guarantee’s (to be delivered by December 2009) was jointly funded by the RDC and the System Reform Directorate and this post has been instrumental in progress towards meeting the deadline (East Midlands are currently on target to meet the guarantee’s across the region). A regional Board has also been established to monitor developments and progress towards the targets and the board has involvement from the EMDC, Patient Care, System Reform, Planning and Performance and Workforce directorates. The System Reform Directorate has commissioned a piece of work, undertaken by the EMDC, to review the role and impact of the Maternity Support Worker post across the East Midlands. This has involved an extensive project including semi structured interviews with Heads of Midwifery, Midwives, Maternity Support Workers and parents in a range of settings across the region. The review has considered models of delivery, impact and effectiveness of role, training and potential impacts on targets. Recommendations from the review will be implemented via a joint approach across the previously mentioned directorates with particular involvement from workforce due to the nature of the recommendations. Maternity remains a high priority for the forthcoming year and work plans are currently being formulated to continue the work and enable further progress and development. To find out more, visit our website at the link below: www.eastmids.org.uk/children-families

Around the region local leads identified the need to support Health Visiting and School Nursing services as they entered a period of change. There is a requirement to deliver both core and targeted services in the most efficient and effective way. It was decided that training a range of managers in the “Lean approach” would help develop

skills within the service that would then be able to contribute to this challenge. A number of training events were held across the region with over 40 managers trained in the approach. Bassetlaw PCT is now piloting two lean projects within children’s community services. One project is considering administrative support and processes whilst the other

is considering breastfeeding targets and the services involved in provision of breastfeeding support. It is anticipated that clear measurable improvements will be gained from the projects and if successful the aim will be to share the work across the region and to develop further projects. 11

Children and Families - CAMHS The CAMHS element of our Children and Families programme is sponsored by the Department of Health (DH) and the Department for Children, Schools and Families (DCSF) and is part of a network of improvement practitioners supported by a national programme. The CAMHS (Child and Adolescent Mental Health Services) programme is delivered in close partnership with the SHA policy lead and Local Authority partners. Working this way ensures that we deliver targeted support, challenge and service improvement in a coordinated way. Key projects delivered or in progress this year include: Cultural competence in CAMHS We have used the Cultural Competency tool in Lincolnshire to determine training needs and promote Cultural Competency practice. A report has been produced. CAMHS Tier 4 service standards development Set of regional protocols and procedures agreed by Tier 4 providers group and disseminated. Workforce All localities offered detailed structured support to develop workforce plans and a thematic analysis. Results from this have been shared across the region. Learning Disability and CAMHS A training course for CAMHS staff to develop capacity to work with Learning Disabilities, has been developed and delivered to Derbyshire and Lincolnshire.

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Transition from CAMHS to Adult Mental Health (AMH) Services A Project to map transition processes and protocols across the region has taken place and a report will be delivered in December. The Mental health of Young Offenders A Project to map mental health input into youth offending teams and secure units and scope models of best practice has taken place. The report will be delivered in December. Development of Children, Young People and Family Participation within CAMHS A project to map CAMHS participation projects across the region has taken place and a report will be delivered in December. Support Service Improvement in early Intervention, promotion and prevention A multi-agency clinical network has been developed. Study days and newsletters are delivered three times a year. Support and Challenge to Targeted Mental Health in Schools programme. This has led to successful Phase 1 pathfinders and is now supporting those coming on-stream in phase 2 and 3. Follow this link for the detailed reports mentioned here: www.eastmids.org.uk/children-families/camhs

Unexpected Outcomes The East Midlands CAMHS Programme Team run a Regional Forum for Commissioners, Providers and other key stakeholders which has been widely welcomed and well attended. At one of these forums a commissioner wanted to get local agreement on how to invest some new money she had received for early intervention within a short timescale.

The CAHMS team using their knowledge and networks supported the commissioner in planning, preparing, and delivering a stakeholder event using a style which was designed to engage all partners. The team also ran the event as independent facilitators, providing on the spot assimilation, summary and feedback about what the issues were. This enabled comparison with other areas, new ideas and objectivity.

What became clear at the event is that local providers were not aware of what other services existed, sharing and hearing this was really powerful. The aim of the session was to find the best way to spend new money, the group actually found ways to change their practices and work together differently without spending money. A working group is now implementing the changes.

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Offender Health We want to create safer, stronger, more inclusive communities in the East Midlands, by reducing offending and re-offending. We want to improve health and reducing the social-economic inequalities and exclusion that affect offenders, ex-offenders, their families, their victims and the communities in which they live. By developing health services for people whilst in custody we aim to reduce health inequalities by working with a group who have traditionally been difficult to reach. Also Increasingly diversion away from the Criminal Justice System (CJS) into treatment at point of contact such as Police custody or court diversions schemes are becoming more the norm.

PCTs and prisons are now working more collaboratively on actions plans arising from DIC leading to changes in clinical procedures.

We have had a major emphasis on building up the quality agenda through a series of partnership based projects.

Richard Bradshaw National Director for Offender Health attended a stakeholder event on the report findings and gave positive feed back that the region was tackling the needs of older prisons in a positive and innovative way.

Quality Indicators The East Midlands is the first region to have achieved a collaborative approach in reviewing Prison Health Performance Indicators (PHPIs) with prison and SHA teams on a quarterly basis. In addition we have established that each prison partnership board also have these as standing item. Working closely with PCT’s (Primary Care Trusts) we are now moving to implement QOF (Quality Outcomes Framework) across the prisons. During this year we have seen a continual improvement in self assessment compliance with the PHPIs. Safety and Quality A regional forum has been established that brings together PCTs, the prison service and Probation Prison Ombudsman to review all deaths in custody and to review and monitor recommendation form all reports pertaining to Death in Custody (DIC). This is the first such group in any region in England. Training has been provided to clinicians in each PCT to become clinical assessors in order to undertake reviews on behalf of PCTs for Prison Probation Ombudsman. 14

Quality care for older people in prison We have facilitated a review of health and social care services available to Older prisoners.

The report has made a number of recommendations and supports commissioners in devising new provider specifications. Supporting commissioning capacity We produced a regional review of service provision and the commissioning process. A number of recommendations have been made and will be supporting commissioners in devising new provider specifications. Cross programme work We have worked closely across two of our programmes to • Review mental health services in secure units for children • Bring together stakeholders who have expertise with working with children who are accommodated in secure provision. To find out more, visit our website at the link below: www.eastmids.org.uk/offender-health

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Mental Health : Locally Focused The mental health programme strives to ensure practical solutions can be delivered at a local level. As well as leading on regional programmes, team members work within specific areas of the East Midlands to provide a local focus on service development. This is a core aspect of the Strategic Relationship Manager posts. We work with individuals and organisations enabling local solutions to national policy aims.

We have also actively lead on consultations for New Horizons, DH vision for Mental Health, engaging with Clinicians, Users and Carers and BME communities. We prepared two reports for the consultation. In other key policy areas we have supported regional workshops on learning from implementation e.g. Mental Health Act – one year on. To find out more, visit our website at: www.eastmids.org.uk/mental-health

The table below shows examples of our locality work. Locality Northamptonshire

Leicestershire

Derbyshire

Lincolnshire

Nottinghamshire

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Activity • Increasing the levels of individual budgets for people accessing mental health services • Lead collaboration between statutory and voluntary sector enabling the Flourishing Communities Reference Group • Learning and Improving In Partnership – programme developed with Leicestershire Partnerships Trust and De-Montford University

Benefit • A partnership infrastructure for Self Directed Support with senior level backing. • Increasing awareness amongst partners of existing and emerging programmes strengthening the mental health component • Course to educate and develop staff/Users/Carers across mental health delivery agencies in the East Midlands • Provides change enablers within services with transferable skills • Direct Link to work/patient focused projects • Supporting Leicester City PCT Commissioners in • Informed and current submission refreshing their MH Commissioning and Investment • Document reflects current national drivers Strategy • Reflection of regional initiatives into local programmes • Acute Inpatient Review with Derbyshire Mental Health • Assurance on progress against Care Quality Commission Services Trust assessment • Report to Executive and Senior Nurses for future service development • Derbyshire County PCT Train the Trainers coaching • Enabling senior managers to develop a coaching leadership programme approach • Lincolnshire Partnership Foundation NHS Trust supported • Improvements in service model for dementia care in Dementia Care • Increase in new types of roles to support people with dementia • Monitoring Programme • Application of outcome measures based on successful results in CAMHS services, leading to more rapid service improvements • Supporting Bassetlaw Commissioners with service • Configuration and modelling of current Psychological modelling Therapies. • Improved specification for competitive tendering process • External input to Nottinghamshire Healthcare Training • Provide external input into review Review • Access to impartial comment and assurance on strategy development

Personality Disorder – no longer a diagnosis of seclusion. Gainsborough

Launching our PD pathways project

Louth Retford Worksop

Dronfield Buxton

Chesterfield Bolsover Matlock Ripley Heanor Ilkeston

Derby

Lincoln Skegness

Mansfield Newark-on-Trent

Hucknall

Boston

Nottingham Beeston West Bridgford

Swadlincote Loughborough

Grantham Sleaford

Melton Mowbray

Stamford

Leicester Hinckley

Market Harborough

Corby Kettering

Daventry

Wellingborough Northampton

That is no doubt that care and treatment for Personality Disorder has been a vexing problem for many. We held a regional workshop back in May with input from local clinical leaders, commissioner representatives, user and carer input and national leads from the Department of Health. We worked through what was known about current service delivery, peoples experience of it and of the challenges of delivering quality care. We had excellent input from experts on the subject as well as presentations on care pathway design. Clinical teams were invited to put forward proposals to take forward local pathway projects and we worked with them to refine these over the summer. We now have three projects that will start this autumn.

Supporting Care Pathway development

Engaging with a range of service providers EMDC has taken forward a number of initiatives which are underpinning how services can create more effective care outcomes through designing user focused care pathways or as some prefer care maps or menus. Personality Disorder (PD) Through providing programme support and finance we are working with PCTs and providers to develop PD care pathways that will inform Commissioning Strategies. Payment by Results (PbR) for Mental Health Trusts Working with the 5 Mental Health Trusts funding has been made available across the East Midlands to enable them to identify clinical leads and project leads who can work with EMDC to expand and implement organisational change as well as sharing learning across the delivery system. We have begun to identify with Trusts a number of pathway priorities that they see as critical ones to be developed in the context of a emerging PbR policy. 17

IAPT Anxiety and depression are common mental disorders that affect over 400,000 people aged 16 to 74 in the East Midlands region, nearly 14% of that population. The Commissioning community has risen to the challenge of the IAPT programme and made a major investment that provided services across 90% of the population by October 2009. This is significantly head of many areas of the country. The IAPT (Improving Access to Psychological Therapies) investment will give us 300 more staff trained in NICE (National Institute for Health and Clinical Excellence) compliant therapies. We are leading the way in access to training for part time staff and for training in IPT (inter-personal therapy) giving choices to staff and patients. We have also facilitated 100 staff already trained in the evidence base with top up master classes. Supporting commissioners with policy interpretation and advice on modelling need and treatment numbers, we have ensured that service specifications have been dynamic and evidenced based. Activity

Results

Quality

Application of Evidence base and performance indicators

Improved outcomes and Patient experience

Innovation

New workforce roles, large scale application of NICE guidelines

Critical mass of the workforce applying new practices

Productivity

Increased treatment numbers over existing service models with stepped care

Improved access rates and lower population morbidity

Prevention

Alignment with wellbeing interventions in the community and engagement of BME communities

Increased access for general population to support in nontreatment settings

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We have invested in leadership development running two development programmes for primary care and clinical leaders . We will follow this up with a clinical network in the new year as part of our future sustainability of IAPT. With a set of comprehensive KPIs (Key Performance Indicators) we will routinely collect outcome data to plan further improvements in treatment and service models. The IAPT programme has a major focus on employment both in terms of work retention and also return to work. A major pilot has been funded in Lincolnshire but in addition funds have been directed to every IAPT service to link and co-ordinate with employment support locally. We have supported the delivery system with a dedicated specialist employment advisor. More recently we launched support for PCT communication leads with colleagues from the SHA communications department. This will focus on marketing of IAPT services. In addition we have supported providers to devise training awareness for universal services to increase step 1 support and improved identification of need. The EMDC is proud of its work in this area and to have been able to work with a remarkable group of commissioners, provider mangers and clinicians in what has been at times challenging timelines. To find out more, visit our website at: www.eastmids.org.uk/mental-health/iapt

Psychological Wellbeing Practitioners Conference – positive practice in Step 2 brief interventions. The massive interest and enthusiasm for the IAPT change initiative culmulated in a very successful evidence base diffusion conference on 9th July 2009. 600 people attended our local event, with many coming from across the country. You can see the outputs on our website at: www.eastmids.org.uk/mental-health/iapt/li-conference We now have planned a further event in January focusing on depression that will be designed by a CLARC diffusion fellow. 19

Dementia We aim to support world class commissioning across the East Midlands by listening to people with dementia, putting them in control and helping them with compassion. We have worked with the Regional DH team to run a Dementia Improvement collaborative. This will support the system to implement the National Dementia Strategy. Since the launch of the strategy in Feb 2009 the regional support team have been identifying and meeting with internal and external stakeholders who have an interest and responsibility for making dementia their business. Together with key stakeholders they have been planning and scoping the project. One of the first tasks was to produce data packs of information on what we already know about dementia. Primary data was sourced by the East Midlands Public Health Observatory and collated together to form a profile for each city and county within the 5 sub-regions within the East Midlands. As well as data directly concerning dementia, other information regarding general and elderly population was included in order to help understand the socio-demographic characteristics and health status of the elderly population as a whole. The second task was to devise a diagnostic screening tool. This tool has enabled commissioners and providers to map their current activity against the 17 key objectives outlined in the National Dementia Strategy. This has work has already started to show where current resources are focused and where gaps of activity are emerging. This activity shows a lot of services across the East Midlands being delivered for people living with dementia.

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During the summer months a process of discovery was underway. The regional team engaged regularly with people and their carers who live with dementia discovering what it means to live well with dementia. These stories started to inform us of what services and support systems would need to look and feel like. We asked these individuals to help us plan a regional summit for the autumn and their ideas formed the structure of the day’s event. We used a film company to capture what people were telling us for future training and awareness raising. In October people from across the East Midlands came to the regional summit. They created a regional vision, they built on the discovery work and at the summit they inquired into what it means to live well and better with dementia. Participants worked together, telling and listening to powerful, inspiring stories of times when people felt most valued, connected and supported. A report has been drafted and will be shared with colleagues and friends at the end of November 2009. We have supported the delivery system with direct hands on support, the addition of specialist expertise on pathway redesign and the provision of funding to support local improvement posts working across health and social care commissioning. To find out more, visit our website at: www.eastmids.org.uk/mental-health/later-life

Following the regional summit event the regional team are working with commissioners together with their key stakeholders through a process which will help them create an integrated care pathway. Across the region there will be over 25 collaborative workshops with each sub region having five workshops. Three workshops have already taken place. The main objectives of the workshops are to: • Have people living with dementia at the heart of these workshops as equal partners • Local providers and community partners working in collaboration • Identify and analyse what is happening already and where and what the needs are of the local population • Prioritise investment – balancing prevention of harm with intervention as well as improving health outcomes with efficiency and sustainability • Promote improvement and innovation – services specifications to be created which specify outcomes and improvements that they expect from providers • Secure procurement skills – services are developed through procurement and contracting skills within partnerships • Make sound financial investments – commissioners will be able to show that dementia services tie investments to progress against local dementia specific health and social care priorities, as well as national ambitions

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DRE The Delivering Race Equality (DRE) Programme was established to improve access, outcomes and experiences for people with mental health needs. It is designed to tackle mental health inequalities for all people of Black and Minority Ethnic origin, including people of Irish or Mediterranean origin and East European migrants. Leading the ‘Delivering Race Equality’ (DRE) agenda has highlighted the passions and challenges for local stakeholders. Many have found it difficult to harness the momentum and shared understanding needed to drive the agenda forward. Key actions by the EMDC have greased the proverbial cogs in the DRE wheel to help support the regional agenda and promote good practice. Action

Benefit

We reassessed the function, purpose and quality of regional groups supporting DRE and reconstituted a DRE Regional Leads Forum.

Active engagement of commissioners and providers who are now relating more closely, sharing best practice and assuming a leadership role for DRE regionally and locally.

We devolved regional planning and resource allocation for designing and delivering innovative development work to the Regional Leads Forum.

Awarded 4 localities a total of £130K to deliver DRE development projects inviting local leadership and initiative, offering high impact value and region spread.

We worked with Community Development Workers to help interpret and improve understanding and articulation of the CDW role including merits and productivity within the mental health economy.

Improved communication with commissioners and more robust performance management for demonstrating the value of the role.

We have been acknowledging gaps in the workforce’s cultural competency and capitalising on opportunities for community empowerment by funding a series of training programmes held in services and community settings.

Evaluation of WRAP training and train the trainer cohorts for RECC and RECAP will support commissioners contract requirements and training opportunities that promote wellness, recovery and cultural sensitivity.

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Fundamental questions continue to be asked regarding culture change, access points and experiences of BME communities in contact with services. The desire is there to improve confidence in services and reduce stigma around mental illness but the mechanisms for making it happen weren’t always clear. In an effort to resist creating dependency on the centre and empowering local leaders to grapple with the issues as a collective, the centre formed a Regional Leads Forum where influential

Enabling regional leadership and local ownership of DRE agenda

commissioner and provider organisations have come together in 2009. This group has seized this opportunity to share best practice, improve support and contract management for the Community Development Worker role. Most recently development projects have been agreed for local partnership to implement delivering high impact and potential spread across the region. To find out more, visit our website at: www.eastmids.org.uk/mental-health/delivering-race-equality

Count Me In regional picture, community voice

Encouraging use of data by commissioners, clinicians and managers, BME service user engagement, measuring wellbeing

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Suicide Prevention Promotion of suicide prevention strategies are important in preventing deaths. Conveying the message that we can make a difference is essential in raising awareness and challenging myths and prejudice. Having a regional focus keeps suicide prevention on the health and social care agendas. A multi-agency and community approach is needed as many are not in contact with mental health services at the time of their death. EMDC has supported the regional programme to underpin the types of activity needed to make this process happen. Frequent contact is made with statutory agencies in both health and the social care as well as ensuring close involvement with non-statutory agencies. As a central part of the way we work, Service User involvement and engagement with young people enables the programme to focus what it wants to achieve on the guidance of those who really understand. As a result there is now a central resource for tools on support around suicide, suicide reduction and support in dealing with self harm. Key to promoting positive attitudes and meeting targets for

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suicide prevention, is the training and working with clinical areas especially Accident and Emergency which is part of the programme. We have also conducted a region wide survey of A&E departments that will be reported at a the regional conference on 2nd December 2009. Working in this way at risk groups can be identified and support of local strategy groups can be undertaken. This realises earlier intervention and connects local and national strategies, allowing transfer of best practice. Benefits for the region include an expert knowledge resource and associated network of contacts. All this can also be linked to informing national strategy and access to national experts, allowing tracking of trends and data. To find out more, visit our website at: www.eastmids.org.uk/mental-health/suicide-prevention

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Stakeholder Survey The East Midlands Development Centre as part of the Patient Care Directorate were keen to establish the following: • Engage with our critical stakeholders in a proactive way • Determine what they think of the services the EMDC provides • Improvements that could be made • Impact our work has for our Stakeholders • Future innovations for the business planning cycle A semi-structured interview schedule was designed. We identified 63 Stakeholders and telephone interviews were conducted with 57 over a three week period during September. Stakeholders The survey established that of those interviewed the NHS makes up 74%, Social care/local Government made up 10%. Other organisations represented 9%. These included academia, research, regulatory/inspections bodies and consultants, 5% stakeholders came from the 3rd sector/not for profit.

Stakeholders level of responsibility within their own organisations The following pie chart represents the level of responsibility our stakeholders hold within their own organisations. Senior Managers were the largest group, 53%, followed by Managers at 28%, Directors made up 10%, Chief Executives have up a further 2% and there were 7% not stated.

Not Stated Manager Senior Manager Director Chief Executives

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Area of current work agenda Commissioners make up the largest group in this section, 30%. Stakeholders who had a key responsibility for developing services made up 22%, and those who delivered services accounted for 15%. Those stakeholders who reported that they managed services/organisations made up 9% of this data set. Stakeholders who reported ‘Other’ as their category described work agenda(s) as: Research, Performance management, Strategic planning and Regulation.

Current activity stakeholders are engaged with at the EMDC Mental Health makes up the key area of activity which is represented by 38%. Children, young people and families make up 23%, commissioning 20% and learning disability 7%. The categories of social care, older people, health and social care in the criminal justice system and other make up 3% each. Interviewees made it clear that if they had not selected mental health as an overall activity, each area selected was within the mental health ‘umbrella’.

Commissioning Services

Mental Health

Developing Services

Social care

Delivering Services

Older People

Managing Services/ Organisations

Learning Disability

Other

Children, young people and families

No Responce

Health and Social care in Criminal Justice Commissioning Other

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Role of the East Midlands Development Centre Stakeholders were asked what they felt was the role of the EMDC. Almost equal responses were recorded in all the categories offered: To advise on policy, to share good practice, to promote multi-agency-partnership working and offer service improvement advice.

Other To offer service improvement advice To promote multi-agency/partnership working To share good working practice To advise on policy 0

Communication How our stakeholders found out about activity and the work of the EMDC. The most successful communication method was word of mouth and working with our Strategic Relationship Managers and attending workshops

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10

15

20

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Attending Events Walkabout' e-bulletin Website eastmids.org.uk Word of mouth Working with one of the Strategic Partnership Managers Publications Working with regional Strategic Partnership Manager NHS East Midlands Other

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How well the EMDC keeps its stakeholders informed about its work 46% of our interviewed stakeholders reported that the EMDC kept them ‘fairly well informed’. 23% reported that they were ’very well informed’. 2% reported that they were ‘not at all well informed’. All respondents who did not receive Walkabout (our e-bulletin) requested that they be added to the circulation list.

Transforming promising pracice into best practice Adding value Accelerated learning/sharing best practice Better partnership working Service Improvement Enabling you to achieve your target/s (PSA KPIs) 0

Supporting Positive Outcomes 83% of our stakeholders agreed that the EMDC supported positive outcomes in health and social care across the east midlands. 15% did not respond to this question. A comment that had been made to support the non response included: ‘I Have not been in present post long so can’t comment’ and ‘have only just started to work with EMDC’ Stakeholders reported that as a result of working with the EMDC they were able to: Improve Service 22%, accelerated learning/sharing best practice 19%, better partnership working 18%, adding value 15%, transforming promising practice to best practice 13% and enabling them to achieve their target/s (PSA, KPIs).

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10

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Very well Fairly well Don't know Not very well Not at all well No response

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What they Identified Examples sited by our stakeholders to achieve their outcomes include work in the following area/agenda(s): Maternity Matters, training in LEAN approach s, leading Flourishing Communities, Dementia – Discovery Meetings, New Horizons – ‘taking it forward’, Action Learning Sets and Increasing Access to Psychological Therapies. Comments about other areas that were covered included: Project planning; good networking; financial resources; facilitation; link to DH; system modelling; mentorship; high level of leadership; supervision and advocacy role. Our Stakeholders also wanted more information about the team, its skills, areas of responsibility and what more could be offered. Some of our stakeholders also made very strong requests that the EMDC does not lose the valuable work it has undertaken in the service user/carer agenda.

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Visioning for the Future Our stakeholders were given the opportunity to express views about future EMDC objectives. The following themes emerged; • Continued support with the service improvement agenda • Continued support with sharing best practice and accelerated learning • Transforming promising practice into best practice • In addition to Adding Value it was strongly suggested that we also support ‘value for money’ – but stakeholders asked the question ‘how do we do it?’ • Further support with the commissioning agenda: specifically with cost benefit analysis • Support with interpretation and implementation of strategy and policy. Regionally and locally • Personalisation agenda • Critical friend • Information/data analysis

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East Midlands

For further copies of this report, or to provide feedback, please contact: East Midlands Development Centre NHS East Midlands Octavia House Interchange Business Park Bostock’s Lane Sandiacre Nottingham NG10 5QG Tel: 01623 812930 Fax: 01623 812940 www.eastmids.org.uk

Acknowledgements The artwork within this report has been reproduced with the kind permission of the following artists: Adam Pick, Kathleen Hill, Ian Morris, Kath Hardy, Kaye Kidd, Paul Dexter, Wendy Olsen, Julie Burrows and Reflections Magazine, a national publication dedicated to showcasing the creative talents of people with mental health problems. Both the artists and Reflections can be contacted via [email protected]