Oxleas NHS Foundation Trust

Agency Report to the Bromley Health & Social Care Partnership Board, 13th of

February 2012

What services do we provide?Until 2010 we were a specialist mental health and learning disability provider

We are now a combined mental health, community and learning disability provider

2100 staff5 Directorates75 sites10 professions290k patient contacts

3250 staff7 Directorates125 sites20 professions500k patient contacts

How we are organised

Patients Families and Carers

Multi-professional teams

Adult

Mental Health

Acute & Crisis

OXLEAS

Corporate directorates

IT, HR, Finance, Estates, Communications etc

Forensic

&

Prison Services

Adult

Mental Health

Complex Needs

& Recovery

Older Peoples

Mental Health

Bexley

Community

Health Services

Greenwich

Community

Health Services

Child & Adolescent

Mental Health & Learning

Disability Services

Service Delivery Strategy (SDS)

Priority

Outcomes in 2012/13

1 Quality is the highest priority

• Meet Quality Board targets• Review our use of inpatient beds

2 Organisational change and development

• Develop integrated care pathways and bring together community health & mental health services

3 Improve data quality • Benefit from new business information system• Ensure all community health service are using RiO• Implement mental health ‘clustering’

4 Use of technology • Technology strategy to improve care and productivity• Expand tele-health in services for people with long term conditions• Replace the trust’s clinical records system (RiO)

Oxleas Annual Plan Priorities 2012/13

Oxleas Annual Plan Priorities 2012/13SDS Priority Outcomes in 2012/13

5 Market development & financial stability

• Develop a Marketing strategy• Promote Oxleas services• Implement ‘Choose & Book’

6 Develop new ways of delivering care

• Redesign care pathways for long term conditions• Support plans to redesign older people's services

7 Support GPs & clinical commissioning groups (CCGs)

• Establish good links with local clinical commissioning groups• Inform GPs about our services and the quality

8 Enhance stakeholder engagement

• Keep good links with LINKs• Keep good links with third sector• Keep working with Health & Wellbeing Boards

Adult Mental Health• On-going partnership work with London Borough of Bromley to reduce

reliance on residential placements by effectively reviewing service user’s needs and developing flexible packages of support to enable people to live as independently as possible within the community.

• Continued focus on efficiently managing acute bed usage by delivering crisis resolution and home treatment as an alternative to admission.

• Expansion in 2011 of the Early Intervention in Psychosis Team enabling us to re-engineer the clinical pathway for individuals with a first episode of psychosis.

• In 2010 a working group was established with GP colleagues from Bromley LMC/ CCG focussing particularly on referral and transfer pathways to improve service user and GP satisfaction.

Older Adults Mental Health• Further Improvements to inpatient service for Older Adults MH

currently underway, including: • The creation of a centre of excellence for dementia at QMS with

environmental improvements scheduled to be completed by the end of April. Similar improvements planned for Green Parks House where older people with other mental illnesses may receive treatment,

• Staffing levels, skill mix and training needs have all been reviewed and improved.

• A volunteer transport scheme is now operational for Bromley carers unable to easily travel to visit relatives/ friends at QMS

Older Adults Mental Health (cont.)• Data from POPPI/ PANSI and DoH suggests that in Bromley

there are around 4,030 people of all ages with dementia, but only about 1,500 on QoF registers ie only around 37% of people with dementia have been diagnosed and are receiving  targeted support and help.

• This figure is expected to grow to 4,790 by 2020. • The National Dementia Strategy sets a target of 100% of people

being referred to memory clinics. Currently developing a business case to increase capacity within the service in order to meet demand.

Older Adults Mental Health (cont.)• Since 2011 we have been undertaking a project working with care

homes. This involves MH staff working with care home staff to explore ways of working with signs of distress (challenging behaviour) without recourse to  anti psychotic prescribing or hospital admission. The Minister for Social Care , Paul Burstow visited Oatleigh Care Centre last week to look at the work we are doing.

• We are planning, (with the support of the CCG) a pilot scheme to look at the effectiveness of working with people with dementia in A&E and on the wards at the PRUH to explore alternatives to hospital admission and early supported discharge.

• We have met with and plan to develop closer relationships with Bromley Healthcare to work towards providing a more joined up approach to our mutual work with local people with dementia .

Adult Learning Disability• A Learning Disability liaison group is meeting regularly with SLHT and

this is producing some good outcomes. Funding from NHS London has been agreed for a joint project with them aim of improving admission and discharge experiences of people with LD at the PRUH.

• The mental health in learning disability team in Bromley have established nurse-led clinics and presented their work as a model of good practice at a national conference last November

• Funding for the Directed Enhanced service for LD continues for another year and clinicians are working hard to engage GPs and increase the number of annual health checks completed. Bromley are also considering a LES to provide this service to individuals who cannot access it from their own surgery.

• An ALD carers handbook has now been produced and is being disseminated across the borough.

Child & Adolescent Mental Health• Following the transfer of  the Tier 2 CAMHS service to Oxleas in 2010,

work has been completed on developing a new integrated service model which will be implemented over the next few months.  This new arrangement will be more multi-disciplinary and will deliver more joined up support.

• A new Obsessive Compulsive Disorder (OCD) service has been developed

• Access to the Oxleas Non-Violent Resistance (NVR) programme for parents with violent children has been extended to Bromley.

• The service has recently been benchmarked against 70 other CAMHS services nationally through the independent Clinical Outcomes Research Consortia (CORC) and has found to be clinically effective and better than most other services when rated for patient satisfaction.

Forensic Mental Health Services• The Bracton Centre continues to provide medium secure forensic

services for Bromley and have contributed to work ensuring that very few Bromley residents are held in the private sector. 

• A dedicated women's challenging behaviour ward has been created, partly in response to an identified need within Bromley for additional women's beds for this client group.

• From February 2012, the Forensic community services are now going into Bromley Police Station each day to support the Police in identifying and better supporting people with mental health issues that have been arrested.

• Oxleas now provides mental health in-reach services to all Kent Prisons plus primary care in the West Kent Prisons.