Appendix 3 Briefing Note Supporting Staff in Positive Working Arrangements 1 Introduction The need for this briefing note came out of discussions between the services following a number of Serious Untoward Incidents (SUIs). Whilst on most occasions there are good joint working relationships / arrangements, where these breakdown it is often about poor communication or very set ideas or assumptions about what services do or role responsibilities. At two SUI reviews it was apparent that the perceived stance “you have to have a care co-coordinator in planned care before we can get involved” was detrimental to assessment, engagement and the service users’ care and treatment At another it was apparent that the planned care staff involved had a review and decided to discharge the service user without any involvement of the addictions staff. This was also without working with the service users, and no subsequent communication resulting in addictions staff thinking that care and treatment in relation to mental health needs was still being provided. It should be noted that care packages agreed with service users through the Multi- Disciplinary Team (MDT) process should only be changed following agreement with the service user and all other colleagues involved in the package of care. It is the responsibility of all clinicians involved in the care package to ensure good communication of any proposed changes using the full range of means of communication available, e.g. meetings, telephone, electronic patient records (RIO). 2. Planned Care and Addictions There is sometimes an assumption the service user whose assessment identifies issues with alcohol use automatically equates to a referral to the Northumberland Tyne and Wear (NTW) addictions services. NTW only offers addictions service North of Tyne. Additionally there are a range of services that can provide appropriate interventions for addictions. Information about these is attached as Appendix 1. NTW addictions services are very willing to provide advice regarding services, and indeed about whether they are the appropriate service to assist with care planning prior to any referral. However, this advice needs to be informed by a recently completed AUDIT tool within the assessment. Northumberland, Tyne and Wear NHS Foundation Trust 1 Appendix 3 – Briefing Note – Supporting Staff in Positive Working Arrangements – Issue 1 – Mar 14 Part of NTW(O)69 - Northumberland Recovery Partnership Policy Project ANSWER is an NTW addictions service for North Tyneside that currently (September 2013) are NOT Rio users. For service users who come into contact with North Tyneside Planned care services that have any indications of substance misuse contact with project answer is recommended to ascertain: Is this person currently in treatment with Project ANSWER OR Could they benefit from treatment with Project ANSWER For service users who come into contact with other locality planned care services who have previously lived in North Tyneside and have any indications of substance misuse contact with project answer is recommended to ascertain if they have previously had treatment with Project ANSWER Psychiatric staff, nurses and doctors and other professionals should also be aware and cognisant of the assessment for alcohol abuse and dependence, use the AUDIT tool, and deliver brief interventions and or other interventions appropriate if the person is already in service. The use of motivational interviewing is always part of assessment and engagement (National Institute for Health and Care Excellence (NICE) 2012). If the person remains in treatment with Community Mental Health Teams (CHMT), the psychiatric team should be able to support community detoxifications if appropriate both with the GP and in shared care with alcohol services There is sometimes the assumption that addictions staff will not take on the role of care coordinator or lead professional. This assumption is correct in relation to the role of care coordinator, as the very fact that a service user has enhanced needs means they have complex mental health issues, and it is entirely appropriate that a professional from mental health service takes on that role. However this does not mean that the care coordinator is then solely responsible for completing the service users record, i.e. care plans risk assessment review. Where a service users mental health needs are such that they are not enhanced then addictions staff are very wiling to be lead professionals. Of course this will be a joint decision on a case by case basis which is dependent on the service user, their needs and who is best placed to undertake the role. Again this does not mean that the lead professional is then solely responsible for completing the service user’s record, i.e. care plans, risk assessment, review etc. Where there is joint work shared assessment of risk is critical and this can be facilitated by an agreement as to how this is best recorded, i.e. where FACE is being used, which of the FACE risk profiles is most appropriate to record the assessment of risk, e.g. Adult or Addictions. Once the decision is made then it is important that the risk profile not being used references where the assessment of risk is recorded. Northumberland, Tyne and Wear NHS Foundation Trust 2 Appendix 3 – Briefing Note – Supporting Staff in Positive Working Arrangements – Issue 1 – Mar 14 Part of NTW(O)69 - Northumberland Recovery Partnership Policy 3 Planned Care and Community Forensic Personality Disorder Team (CFPDT) The Community Forensic Personality Disorder Team is a regional service that offers a service to: Males age 18 or over Primary diagnosis of personality disorder or psychopathy IQ over 70 (those with an IQ between 70-79 will be considered on an individual basis) Permanent resident of the Adult Forensic Service catchment area History of violent or sexual offending or significant concern about the risk of future violent or sexual offending Within NTW, Cumbria, South Cumbria, Tees and Durham. A formal referral for the specialist assessment offered by CFPDT requires that the individual is supported within local secondary care services. This is usually by a care co-ordinator or maybe a lead professional. Where post assessment the CFPDT provide intervention, the usually complex needs of those with personality disorder who also present risk of harm to others means it is usual that all patients accepted for assessment have a care co-ordinator within their locality. As the team covers a wide geographical distance this ensures that patients’ needs can be met and responded to in a timely way. However, there may be rare exceptions to this situation which should be negotiated between the teams on a case by case basis, and the CFPDT recognise that there may be rare occasions where it is appropriate that a CFPD clinician to take on the role of lead professional. This does not mean that CFPDT cannot be involved pre a formal referral for assessment, or indeed where there is no plan for a referral. Members of the team will offer advice / consultation to secondary services at any stage of care and treatment with secondary services. Advice and consultation does not require that the individual has an allocated care co- ordinator / lead professional. 4. Planned Care and Richardson Eating Disorder Service (REDS) In urgent cases joint work can begin post referral if the information provided by the referrer (which may be supported by previous records held by the Trust) is indicative of the need for the involvement of the Richardson Eating Disorder Service (REDS). It is good practice to have early contact with REDS who can provide advice / support (if needed) as to areas of enquiry to include in the assessment that will clarify the appropriateness of a formal referral to REDS or may agree a joint assessment process. Northumberland, Tyne and Wear NHS Foundation Trust 3 Appendix 3 – Briefing Note – Supporting Staff in Positive Working Arrangements – Issue 1 – Mar 14 Part of NTW(O)69 - Northumberland Recovery Partnership Policy If the initial assessment concludes that the service users has needs that require input from REDS, then an initial plan needs to be agreed jointly including (if needed) support whilst waiting or any further assessment. The outcome of the assessment processes should enable the identification of the service user’s needs, and care planning to meet those needs; including who is best placed to be the care co-ordinator / lead professional dependant on the level and nature of their needs. For service users who are on Enhanced Care Co-Ordination, who have severe mental health issues with clinically complex needs including those relating to an eating disorder, it will be most likely that the care co-ordinator will be a planned care clinician. For service users who require a Lead Professional and for whom the eating disorder is their only significant presenting difficulty, and where this is stable and low risk, it is likely that the Lead Professional will be from REDS. When the outcome of the assessment is that the service user’s needs are not enhanced, the role of lead professional should be undertaken by the professional best placed to do so, based on the service users needs. The principles that inform allocation of a care co- ordinator should be used as guidance. There may be occasions where the assessment process identifies that the service user’s needs are such that they require input from either planned care or REDS only, in which case the care co-ordinator / lead professional will be identified from that service. It is recognised that a referral to a CMHT may not identify the need for involvement from REDS but that the assessment process may do so. As soon as possible there should be contact with REDS to agree additional assessment. The outcome of the overall assessment process will inform allocation of care co-ordinator / lead professional as previously described.