MC2018.29 (FINAL)

MERSEYCARE NHS FOUNDATION TRUST

LOCAL SERVICES DIVISION

Post and specialty: Consultant in Old Age Psychiatry (replacement post)

Base: Hospital, Park Avenue, , L18 8BU

Contract: Full-time (10 PAs)

Dr Andrew Sedgwick, Associate Medical Director, on Accountable professionally to: behalf of the Medical Director.

Accountable operationally to: Dr Anna Richman, Lead for Complex Care

Line Manager : Dr Anna Richman Team Lead : Andrew Garrity Clinical Director : Dr Simon Tavernor Key working relationships and lines Responsible Officer : Dr Noir Thomas of responsibility: Chief Operating Officer : Mrs Donna Robinson Medical Director : Dr David Fearnley Chief Executive : Mr Joe Rafferty

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INTRODUCTION AND TRUST DETAILS

Liverpool has benefited from a tradition of innovation over the past 15 years. A new mental health inpatient unit for North Liverpool and Sefton patients was opened in March 2015. A new inpatient unit is being built in Southport and a further new inpatient unit is planned for Liverpool (for and South Liverpool patients) in the next few years.

The following services are available:

• Acute Services (including 8 x Acute In-Patient Wards, Crisis Stepped up Care Teams, Mental Health Liaison Teams) • Criminal Justice Liaison Service (operated within Courts, Police Stations and Prisons) • Eating Disorder Service • A&E Assessment Teams on 3 acute hospital sites • Acquired Brain Injury Service • Rehabilitation Unit (low secure rehabilitation) • Psychotherapy Services • Early Intervention Teams • Learning Disability services • Addiction services • Older peoples Mental health services including Acute Hospital Liaison Services at the 3 acute hospitals . Child and Adolescent Psychiatric Services are provided by Alder Hey Children’s NHS Foundation Trust.

Where practicable, trust services are organised within the boundaries of the Clinical Commissioning Groups.

FACTS AND FIGURES

During 2016/17, Mersey Care:

- provided care, treatment and support to 20,621 service users from May 2016 to March 2017 (20,387 in local services and 240 in secure services) - was dispersed across over 36 sites both of its own and premises rented from others - had 760 inpatient beds as at 31 March 2017 - had 351,306 outpatient attendances and contacts from May to March 2016/17.

(Statistics based on audited figures for 2016/17)

The Trust is made up of 2 Divisions, namely Secure Services division incorporating high, medium, MC2018.29 (FINAL) low secure services and learning disability and Local Services Division incorporating adult, older adults, addiction, acquired brain injury, psychotherapy, eating disorder and rehabilitation services. Service lines are in place within the Local Services Division and the current post is part of the Complex Care service line. Other service lines are Assessment and Immediate Care; Community, and Drugs and Alcohol. In 2016 the trust completed the acquisition of Calderstones Partnership NHS Foundation Trust, to establish a centre of excellence for learning disabilities

The trust has also recently acquired Liverpool Community Health NHS Trust, enabling the trust to work towards a fully integrated service providing physical and mental health care.

The trust has established a Centre for Perfect Care, whose mission is to help staff continuously improve the services we provide today, whilst addressing the physical, mental health, addiction, learning disability care and wellbeing challenges of the future.

A central component of NHS England’s Driving Digital Maturity programme is to create global digital exemplars.Mersey Care is also a Global Digital Exemplar. A global digital exemplar is an internationally recognised NHS care provider delivering exceptional care, efficiently, through the world-class use of digital technology and information flows, both within and beyond their organisation boundary. It will also be a reference site to other care providers. In 2017 Mersey Care successfully attracted £5m of central NHS funding to accelerate our ambition to digitally transform our services. Being a Global Digital Exemplar -

• means we will use technology and digital systems in all aspects of the services we offer • means we will design systems and apps with the insight and co-production of our service users and staff

Suicide Prevention is also a commitment we have made as a Trust, and which is the first of its kind in the country, to bring the suicide rate amongst our patients down to zero.

Actively promoting Suicide Prevention is important because we want to develop a culture within our organisation that does not pride itself on meeting objectives set down by regulatory bodies or commissioners. Instead, as a Trust we strongly believe that we should aim higher and set more exacting standards that resonate with staff, patients and carers alike. Especially when it comes to talking about peoples lives, we refuse to believe that it’s acceptable to say that anything less than zero deaths by suicide amongst our patients (each year), is a respectable ‘target’. Suicide Prevention is about creating the best environment to eliminate suicide for all those in our care. It’s an initiative that was inspired by a health centre in Detroit, Michigan, which has reported not losing a single patient to suicide in two-and-a-half years. In 2015, the centre saw 74,000 patients. MC2018.29 (FINAL)

As a standard we have specialised teams who continually monitor the highest risk people. But we now also offer patients who have self-harm injuries therapies on the spot at A&E and follow up with them when they go home. We are also developing a suicide prevention mobile phone app with Stanford University. In addition to the above measures, we now aim to complete post-suicide reviews within two weeks, so we can learn from the circumstances surrounding a death quickly so that we can (if necessary) instigate change to better ourselves and the way in which we work as a Trust.

LOCAL SERVICES DIVISION

The Chief Operating Officer of the Local Services Division is Donna Robinson and the Associate Medical Director is Dr Andrew Sedgwick. There are two Deputy Chief Operating Officers, one for Liverpool (Lynn Hughes) and the other for Sefton and Kirkby (Andy Williams). The Clinical Director for Liverpool is Dr Simon Tavernor, and for Sefton and Kirkby is Dr Kuben Naidoo. The Lead for Complex Care in Liverpool is Dr Anna Richman and in Sefton is Dr Lisa Williams.

OLDER PEOPLES’ SERVICE IN THE LOCAL SERVICES DIVISION

Older Peoples’ services are provided from Mossley Hill Hospital in Liverpool; Hub, South Sefton Hub in Waterloo and Southport General Infirmary. Norris Green and South Sefton sites cater to the population of North Liverpool, South Sefton and Kirkby with a population of approx. 70000 people over the age of 65 years. Southport site caters to the population of North Sefton with a population of approximately 30,000 older people.

At Norris Green and Waterloo sites, there are currently 4 WTE consultants. Three of the WTE community consultants now manage their own patch dementia inpatients (and those of the other Consultant at Norris Green) on Irwell Ward at Clock View, Walton Hospital site. This is an inpatient building for adult and older adults (dementia only). The functional inpatients from Norris Green Hub are admitted to Oak ward at Mossley Hill hospital and are managed by one of the Norris Green Consultants.

There are well established and fully staffed community mental health teams for older people in the trust across the division. Memory services are also well established. There are also well resourced general hospital liaison services at the three acute trusts (2 in Liverpool and 1 in Southport)

COMPLEX CARE IN LIVERPOOL

Older Peoples’ services are provided from the Mossley Hill Hospital site. The site caters to the population of Liverpool with a population of approximately 70 000 people over the age of 65 years.

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There are currently 5 WTE consultants at Mossley Hill. This WTE post is a replacement post to provide community mental health services for older patients living in Liverpool – predominantly central Liverpool, as well as in-patient care of his/her own patients at Mossley Hill Hospital and his/her own patients at Paisley Court (A 60 bedded residential unit for and Liverpool patients with dementia and challenging behaviour) and Heys Court (A 16 bedded Mersey Care owned residential unit for older people in Liverpool with enduring functional mental illnesses).

Acorn ward is a specialist 15 bedded dementia inpatient assessment unit at Mossley Hill and Oak ward is a specialist 20 bedded functional inpatient assessment unit. All the Mossley Hill old age consultants have admitting rights to both wards and manage their own patients on the wards. Outliers are occasionally admitted from other parts of the Trust or from out of area and are managed on a rota system by the 5 Consultants

There are well established and fully staffed community mental health teams for older people in the trust. There is no discrete memory service at Mossley Hill, and patients referred with memory problems are seen in the outpatient or community clinics along with all other patients. There are no non-medical prescribers in the team, but once a patient is stabilised on a Cholinesterase Inhibitor, there is a shared care agreement in place with the CCG whereby the GP will take over the prescription and patients can be discharged from the service. There is an established mental health liaison team at the Royal Liverpool University Hospital and no liaison work is involved in this post, apart from urgent liaison cover for the Consultant’s own patients when the Consultant in Liaison Psychiatry is on leave.

Social Services are neither co-located nor integrated with the services at Mossley Hill Hospital, and all referrals to social services (urgent or routine) have to be made directly to Liverpool Social Services by phone call or letter. There are strong links with Charities and Voluntary Groups in the Community, especially for patients with dementia and their carers.

THE POST

The trust wishes to appoint one full time Consultant in Old Age Psychiatry at Mossley Hill Hospital to provide community and in-patient services for older patients as detailed. This is a replacement post. The post covers older adults living predominantly in central and South Liverpool (City centre, , Dingle and ), some of these areas of Liverpool have very high levels of deprivation, above the NHS Liverpool CCG average. Patients with a Liverpool GP living in Halton and Knowsley are also referred to Mossley Hill Hospital. The catchment population for the post is approximately 12500 people over the age of 65. There were approximately 355 new referrals in the last year (April 2017 – April 2018) from this patch. The current caseload is 358. Consultants work on a sector based model, receiving referrals from set GP practices. Most new referrals are seen initially by the Consultant or the trainee. Liverpool Young Onset Dementia Referrals are shared between Dr Barnes and Dr Upton (allocation is based on referring GP). The post holder will not be expected to see any young onset dementia referrals.

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There were 8 admissions to Oak ward for this post last year (3 patients detained – 2 requiring tribunals) and 10 admissions to Acorn ward (10 patients detained - 3 tribunals). At present the post holder sees patients at Paisley Court within a routine community clinic and the patients at Heys Court (5 at present) are seen monthly by the Consultant.

The post holder will be supported by a Core Trainee. The post holder will have a dedicated office at Mossley Hill Hospital and will be supported by a shared Band 4 secretary (shared with one of the other Consultants) and 0.5 WTE Band 3 transcriptionist.

DUTIES

The post holder is expected to provide a community and inpatient mental health service for older adults in his/her patch. He/she will see new patients and follow up existing ones, either in the community or in an out-patient clinic at Mossley Hill Hospital. He/she will be supported in this by a Core Trainee. On an average, 1-2 new patients and 2-4 follow up patients are seen by each Consultant in a clinic session. He/she will work closely with the older adults CMHT and will hold weekly MDT meetings with the team. The post holder will be expected to work in a consultative manner to the CMHT. Liverpool has a Dementia Strategy whereby patients diagnosed with dementia by Geriatricians and Neurologists can be referred directly to the post-diagnostic support group (run by nursing staff, OTs and a psychologist) at Mossley Hill Hospital, without the need for another medical review by a Consultant at Mossley Hill Hospital, thereby reducing the Consultants’ workloads. The post will be as described in the new Consultant Contract and based on 10 programmed activities. Other than the academic meeting at Ashworth Hospital and occasional meetings at other sites, all activity is at the base hospital other than community clinics. A sample time-table is shown below. Changes to job plan and time-table will be made in discussion between the consultant and the Lead for Complex Care (Liverpool).

AM PM MONDAY Team meeting Mossley Hill Community clinic and admin (DCC) and CT supervision (DCC) TUESDAY Academic Meeting/ CPD (SPA) Out patient clinic once a month at Mossley Hill Hospital and community clinic otherwise (DCC) WEDNESDAY Admin (DCC) and CPD (SPA) Community clinic/ Heys court reviews (monthly) and admin (DCC) THURSDAY Ward rounds Oak and Acorn Admin/ Urgent home visits/ MHA and (DCC) tribunal work (DCC) MC2018.29 (FINAL)

FRIDAY CPD/ Audit (SPA) Urgent home visits and admin (DCC)

INTERIM JOB PLAN REVIEW

In accordance with the Department of Health document, ‘Job Planning – Standards of Best Practice,’ there may need to be an interim job plan review where duties, responsibilities, or objectives have changed or need to change significantly within the year. A complete review of the Complex Care service line across the Trust is being planned over the next year, and job plans may need reviewing after the outcomes from this are known. Any job plan reviews will be undertaken by the Consultant and the Lead for Complex Care (Liverpool).

STAFF IN CMHT AT MOSSLEY HILL HOSPITAL

1 WTE Band 8A CMHT Manager 1 WTE Band 8A Dementia Lead 1 WTE Band 8A Clinical Psychologist 2 WTE Band 7 Deputy CMHT managers 1 WTE Band 7 Physiotherapist (covers wards also) 1 WTE Band 5 Physiotherapist (covers wards also) 0.6 WTE Band 7 Speech and language therapist (covers wards also) 15.2 WTE Band 6 Staff Nurses (one exclusively supporting YOD service users) 4.6 WTE Band 5 Nurses 3.5 WTE Band 6 Occupational Therapists 1 WTE Band 5 Occupational Therapist 3 WTE Band 4 Care Navigators 1 WTE Band 4 Psychology Assistant 10.2 WTE Band 3 Support Workers 1 WTE Band 4 Personal Assistant There are no non-medical prescribers in the CMHT

STAFF ON ACORN WARD

1 WTE Band 7 Ward Manager 1 WTE Advanced Practice OT 2 WTE Band 6 Deputy Ward Managers 8 WTE Band 5 Staff Nurses 1 WTE Band 4 Assistant Practitioner 9.7 WTE Band 3 Nursing Assistants 3 WTE Band 2 Health Care Assistants 2.0 WTE Band 1 Apprentices 1 WTE Ward Clerk

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Physiotherapy and SALT input from CMHT staff to both wards

STAFF ON OAK WARD

1 WTE Band 7 Ward Manager 2 WTE Band 6 Deputy Ward Managers 8 WTE Band 5 Staff Nurses 1 WTE Band 5 OT 2 WTE Band 4 Assistant Practitioners 11 WTE Band 3 Nursing Assistants 4 WTE Band 2 Health Care Assistants 2 WTE Band 1 Apprentices 1 WTE Ward Clerk

The trust has also now appointed a Physician Associate who works on both wards and at Heys Court.

OTHER MEDICAL COLLEAGUES IN OLDER PEOPLES’ SERVICE AT MOSSLEY HILL HOSPITAL

Dr R Barnes, Consultant in Old Age Psychiatry Dr A Chatfield, Consultant in Old Age Psychiatry Dr S Kodali, Locum Consultant in Old Age Psychiatry Dr I Upton, Consultant in Old Age Psychiatry

Dr A Richman works in the Mental Health Liaison Team at the Royal Liverpool University Hospital.

Travel

The post-holder will be expected to travel to undertake home visits. This can be by private car, lease hire car or public transport with costs being reclaimed on-line. (Full details of rates are available in the Trust policy available on the Mersey Care Trust Website)

Office Accommodation

The consultant will have individual office accommodation at Mossley Hill Hospital. There is a PC with internet access. The trust will provide a mobile telephone and laptop as well. The trust is paper light with a view to becoming completely paper free in the near future. The post holder will be provided with a digital Dictaphone. The trust is working towards numerous remote working solutions and the post holder would be provided with appropriate training and instruments to implement these.

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There are close links with Liverpool University including under-graduate training.

There is 1 ST4-6 trainee, 1 FY1 trainee, 1 FY2 trainee and 3 Core trainees at Mossley Hill Hospital. There is a comprehensive induction course for all junior doctors.

There is a Local Academic Programme on a weekly basis that the post holder is required to attend. These are lively sessions where both trainees and consultants take an active part and the post holder is expected to contribute to the sessions. Medical student teaching is on an individual student attachment basis.

The post holder will provide hourly supervision to their Core Trainee.

Dr I Vinjamuri is the DME of the trust.

Dr D Hyland is the Clinical Audit Coordinator. The Clinical Audit Department provides administrative support. The post holder will be expected to attend Audit meetings, to take part in these meetings and to lead or complete an audit task each year.

There is no requirement in the training of non-medical clinical staff, although Consultants play a significant role in showing clinical leadership to the team he/she works with.

The Trust provides standard levels of professional and study leave, funding appropriate courses. The post holder will be expected to take part in CPD and remain in good standing with the Royal College of Psychiatrists for CPD.

The trust has an active online Knowledge and Library Service which publishes an up-to-date, evidence-based information service for all needs. It brings together clinical and health information to save valuable time. All of the quality web-based resources are searched and the service provides doctors with an easy to use, labour saving essential tool. There is a postgraduate library at the Ashworth site of the Trust.

The trust supports Consultants in their links with the local University; the Royal College of Psychiatrists; the GMC; the CQC and other statutory bodies.

Research/Special Interest

There are good links with the University of Liverpool. The trust takes part in various national and multi national research projects, some of which are supported by NIHR and DENDRON. It maintains an active database of all research projects which is available to all doctors. The post holder would be encouraged to take an active role in some of the projects or can generate his/her own research ideas. The trust R&D department provides support for such projects. The post holder would be encouraged to take an interest in external duties such as Royal College work, links with academic health science networks and the local university.

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CPD

The individual consultant is responsible for maintaining his/her own CPD identified through appraisal, in line with the Royal College of Psychiatrists requirements and Trust peer groups. This will be undertaken through study leave, in-house teaching and individual study of journals, books and relevant websites in the Programmed Activities/Sessions allocated in the job plan.

Induction and mentoring

Newly recruited Consultants will attend the essential mandatory Trust Induction and be provided with a local induction by their Medical Manager. A mentoring scheme exists for medical staff in the Trust and is available to all doctors, including Consultants, for guidance and support for as long as they feel the need for it. The post holder would join the existing Liverpool old age consultants peer group for peer review, supervision and case based discussions.

Section 12(2) / Approved Clinician

Consultants must be Section 12 (2) approved and have Approved Clinician Status or be eligible to gain approval, ideally before commencing in the post. During the course of their employment, they will renew their approval in good time prior to the date of expiry.

Clinical Governance

The Trust has an established Clinical Governance Support Team responsible to the Medical Director and Chief Executive.

Line Management Arrangements, Appraisal, Revalidation and Job Planning

The current line management structure is via the Lead for Complex Care in Liverpool (Dr A Richman); the Clinical Director (Dr S Tavernor) for operational matters, and Dr A Sedgwick (Associate Medical Director) for professional matters, on behalf of the Medical Director. The post holder will be expected to participate in the Trust’s current and future arrangements for appraisal in line with good medical practice and guidance from the General Medical Council. An appraiser will be allocated to the post holder. Annual job-planning will be undertaken with the post holder by the Lead for Complex Care. The Responsible Officer for Revalidation at Mersey Care NHS Trust (The Designated Body) is one of the Associate Medical Directors – Dr Noir Thomas. The post holder will have a license to practice from the General Medical Council and be legally required to revalidate as per the GMC Guidance “Good Medical Practice”. The proposed job plan will be reviewed in 3 -6 months.

Leave and On-call

Annual, study and professional leave is arranged in agreement with the Lead for Complex Care (Liverpool) and would be in line with national terms and conditions. It is the responsibility MC2018.29 (FINAL) of each Consultant to arrange cover with other Consultants at Mossley Hill Hospital. The post holder will provide 3rd on-call duties with 10 other old age consultants in the trust covering older adults mental health services only in trust footprint (1% band). There is a Core and Higher trainee on-call every night.

Confidentiality

It is the responsibility of all employees to comply with the law in relation to Information Governance which incorporates all areas of processing data. This includes professional codes of practice and common law duties: specifically relating to Confidentiality, Information Security, Data Protection Act 1998, and the Freedom of Information Act 2000

You may, in the course of duty, gain knowledge of confidential matters, which may include personal and/or medical information about patients/staff, or matters related to the business of the Trust. Such information should be regarded in the strictest confidence and as such, must not be discussed or disclosed, except as part of your legitimate duties or professional responsibilities. Unauthorised disclosure may lead to disciplinary action. Your attention is drawn to the Protected Disclosure of Issues of Concern Policy which can be accessed via your line manager, the Trust’s Intranet or the Human Resources Department.

The Trust has in place a range of policies which underpin information governance legislation and your attention is drawn particularly to the Information Governance Policy, the Information Sharing Policy and the Information Lifecycle Management policy. All policies can be found on the Trust Intranet site.

Failure to observe these policies and rules may, in some circumstances leave employees open to prosecution. Any breach of confidentiality or misuse of the Trust’s e-mail, intranet/internet facilities or other information systems will be regarded as serious/gross misconduct and may result in disciplinary action, up to and including dismissal.

Equal Opportunities

To promote the concepts of equality of opportunity and managing diversity Trust wide.

Health and Safety

Employees must be aware of the responsibilities placed upon them under the Health and Safety at Work Act 1974, paying due regard to health and safety in the workplace and management of risk to maintain a safe working environment for patients, visitors and employees.

Safeguarding Children

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The post holder must be aware of the responsibility placed on them under the Children Act 1989 and 2004 which states that the child’s needs are paramount.

Service / Departmental standards

Support the development of performance standards within the Service / Department to ensure the service is responsive to and meeting the needs of its customers.

Code of Conduct

Maintain a consistently high standard of conduct and to provide the highest standard of service in accordance with the Trust Code of Conduct for all employees.

Infection Prevention and Control

Employees must be aware of their responsibilities to protect service users, visitors and employees against the risks of acquiring health care associated infections, in accordance with Trust policy.

Professional standards and performance review

Maintain consistent high professional standards and act in accordance with the relevant Professional Code of Conduct. Employees are expected to participate in the performance review process.

Finance

All Trust staff will comply with financial processes and procedures.

TERMS AND CONDITIONS OF SERVICE

As per Terms and Conditions – Consultants (England) 2003.

Consultants shall be expected in the normal run of their duties to deputise for absent consultant colleagues so far as is practicable. (Schedule 2).

Study & Professional Leave

30 days over three years.

Sick Leave

Entitlement as per Terms and Conditions of Service.

Special Leave

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The Trust Policy on special leave covers areas such as compassionate leave and time off for domestic emergencies etc.

Travel Expenses

These are paid in line with the Terms and Conditions of Service for Hospital Medical and Dental Staff, Doctors in Public Health Medicine and the Community Health Service, Terms and Conditions – Consultants (England) 2003 and the General Whitley Terms and Conditions of Service (England and Wales).

The appointee will be required to live no more than 10 miles by road from the main hospital, unless prior specific approval to a greater distance is given by the Trust.

Annual Leave

Over seven year’s consultant service – 34 days. Under seven year’s consultant service – 32 days.

Cover of Annual and Study Leave

Cover will be provided by the Consultant’s colleagues in old age psychiatry at Mossley Hill Hospital.

Arrangements to Visit the Unit

Applicants or prospective applicants are encouraged to visit the Hospital and to meet prospective colleagues. Arrangements for visiting may be made with:

Dr A Richman Dr D Fearnley Lead for Complex Care Medical Director Mental Health Liaison Team V7, King’s Business Park Royal Liverpool University Hospital Prescot, Merseyside Liverpool L7 8XP L34 1PJ 0151 706 2418 0151 471 2423

Dr A Sedgwick Associate Medical Director – Local Division Local Services Division V7, King’s Business Park Prescot, Merseyside L34 1PJ 0151 527 3433

Travel and subsistence expenses can be reimbursed for such visits only to those candidates selected for interview. Reimbursement is restricted to two visits whether they are made before or after a decision being reached on a shortlist. In the case of candidates travelling from abroad, MC2018.29 (FINAL) travelling expenses are payable in certain circumstances and then only from the point of entry to the United Kingdom.

PERSON SPECIFICATION

Assessed via the application, and if interviewed, at interview also

ESSENTIAL DESIRABLE Qualifications and ▪ Basic medical qualification ▪ Management training or Training ▪ Full GMC registration/eligibility qualifications for full registration ▪ CCST/CCT in old age ▪ Registered as a Specialist on psychiatry GMC Specialist Register or ▪ MRCPsych or equivalent eligible for inclusion within 6 ▪ MSC, DGM months ▪ Section 12(2) Approval + Approved Clinician Status or demonstrated ability to gain approval by the time of commencement in post

Knowledge ▪ Up to date knowledge in the ▪ Special interest in an area field of old age psychiatry relevant to the speciality, ▪ Awareness of current issues in mental health service provision, policy and legislation Experience ▪ Wide clinical experience in old ▪ Experience of multi-agency age psychiatry work especially with user, ▪ Experience of multi-disciplinary carer and voluntary team working organisations

Skills ▪ High level of clinical skill ▪ Record of clinical leadership MC2018.29 (FINAL)

▪ Ability to work constructively in ▪ Established record as clinical and to lead a multi-disciplinary teacher team ▪ Ability to network into ▪ Excellent communication skills. different teams and organisations Personal Attributes ▪ Maturity and openness ▪ Valid driving licence ▪ Commitment to working with users, carers and voluntary organisations ▪ Ability to sustain self and support others ▪ Enthusiasm for work with severely mentally ill people