Creating a blueprint for mental health partnerships | Latest updates

An innovative approach to improving services at St Andrew’s Healthcare has been delivered by the East Midlands Alliance for Mental Heath and Learning Disabilities. 

Together the Alliance took a collective approach to give quality improvement focused support to St Andrew’s, as the provider has embarked on a journey of change and quality improvement, in partnership with the five Trusts.

The improvement programme began in Autumn 2021 and focused on best practice initiatives to support the needs of patients and staff, helping St Andrew’s to focus on key areas raised by the CQC in relation to some of their services and governance.

What has been happening? 

The support programme has been led by the alliance of partners and co-ordinated through a ‘buddy’ Trust, which has involved sharing ideas, listening and learning to drive forward positive change to benefit patients across the region.

The various elements of the programme are led by different members of the Alliance, and each workstream has an NHS lead and a St Andrew’s lead. Together they meet regularly to drive actions forward, to help St Andrew’s focus on the areas they need to make changes to.

This work has been carefully planned to manage capacity and focuses on best practice initiatives to support the needs of patients and staff.

One of the key benefits of the Alliance is that the region becomes responsible for the patient, so all involved partners play an important role in providing quality of care and appropriate specialised treatment.

Alliance workstreams

The support programme was broken down into eight workstreams, each with an NHS lead and a St Andrew's lead, with the aim of sharing ideas, listening, and learning to drive positive change forward. 

The workstreams were led as follows:

• Workforce safeguards – Northamptonshire
• Fundamentals of care – Derbyshire
• Patient safety strategy – Northamptonshire
• Appropriate use of Enhanced Observations – Derbyshire
• Embedding lessons learnt into practice – Lincolnshire
• Communications as an enabler – Northamptonshire & Leicestershire
• Quality Improvement as an enabler – Nottinghamshire
• ‘Culture of patients’ safety and high-quality care – Leicestershire

 

A 'buddy' relationship

The role that the ‘buddy trust’ (Northamptonshire Healthcare NHS Foundation Trust) played has been very important in the process.

This included a range of activities and arrangements to help deliver quality improvement and targeted support.

Key staff were supported to focus time on the development and delivery of the programme, and mentoring and supporting St Andrews staff.

This included Julie Shepherd, Northamptonshire Healthcare NHS Foundation Trust Chief Nurse, taking the role of Improvement Director. Julie supported the project management of the relationship and enhancing a ‘Ward to Board’ framework to help ensure changes were being effectively implemented at all levels.

Key improvements 

Through the work of the Alliance, St Andrew’s has seen lots of productive and tangible changes:

• CQC improvements – Women’s and Men’s Service

Following a re-inspection from the Care Quality Commission of its Women’s Service in April and May 2022, St Andrew’s ratings improved from Inadequate to Requires Improvement. The service has also been rated as ‘Good’ in the caring and responsive categories, as detailed in the chart below.

A re-inspection of St Andrew’s Men’s Service by the Care Quality Commission took place in June 2022. While the overall rating remained at Requires Improvement, the service has also been rated as ‘Good’ in the caring and responsive categories, an improvement from its previous inspection. 

• e-Observations roll-out

St Andrew’s is rolling out e-Observations, which can be used on mobile devices, such as a tablets and smartphones. This investment directly supports the Charity’s strategic objective to improve the quality of care and patient outcomes by enabling clinical teams to respond swiftly; ensuring observation data is always up to date; providing up-to-date patient information at the point of care; reducing costs and ensuring staff time is better spent, to name but a few.

• Appropriate language

St Andrew’s has made significant improvements in the way staff talk and write about their patients. The organisation has developed a New Language Guidance document, co-designed with patients to ensure language gives hope and drives recovery.

• MHOST staffing model

A new patient staffing model called MHOST – Mental Health Optimum Staffing Tool – has been introduced. The model bases staffing levels on patient numbers, and considers each patient’s needs at specific times of the day. MHOST allows the organisation to make sure they have more staff on shift when they’re needed, and fewer staff at quiet times of the day.

• Review of Blanket Restrictions

St Andrew’s has reviewed blanket restrictions in their LD/ASD, Medium Secure and Locked and Specialist Rehabilitation wards. Each ward ran a session with its patients to explore the rules that are currently in place. Following this, many wards successfully reduced and removed unnecessary blanket restrictions. Importantly, these co-produced sessions mean that patients now understand the purpose of rules and what needs to change for them to be removed.

• Sustainability

A core focus of the alliance from the outset is maintaining a focus on ensuring the lasting impact of the buddy and quality improvement journey. This is achieved through accountability conversations, effective impact analysis and the development of a robust exit criteria.

• Improvement in ward environments

The organisation has delivered improvements to wards, working closely with patients, who have been integral to the design process.

Engagement through regular community meetings ensured that patient choice was at the forefront of decision making, and ward improvements include wall art, sensory rooms and new furniture.

• Change Leaders

There are also now over 90 members of staff registered as Change Leaders in St Andrew’s ‘Lead the Change’ programme, which focuses on their culture and listening to staff. It means that they have been able to find ways to empower staff and improve their well-being, which in turn means they will deliver better care to patients.

• Supporting shared learning

All colleagues have had a strong focus on sharing best practice and are empowered to take learnings back into their own organisations.

What does this mean for future collaboration opportunities in mental health?

For those in the Alliance this is a pioneering step that focuses on the delivery of high-quality care and the best interests of service users. It is not about organisational boundaries, so St Andrew’s has been a partner in it from the outset.

No Trust or provider is an island, and as the national care model changes, it’s important now more than ever, that we work collaboratively to ensure the best quality of care for people living with complex mental health conditions. This programme is a shining example of that.

The Alliance’s work to support mental health service users across the East Midlands is an important signifier of the role and commitment of healthcare providers in driving positive change across regional footprints and providing care closer to home. 

The model also allows providers to get on the front foot to improve service delivery standards and could help lay the foundations as a blueprint for further collaborations in mental health in the NHS.