Independent investigation: Bethany Rae Fields, Huddersfield (2019)

To organise and facilitate an Oxford Model learning event to ensure that the widest reflection and learning is achieved across adult services from this case. Key points to be drawn out are: management of complex service users with personality disorder(s), including psychosis, outside of the CPA framework; domestic abuse; multi-agency communication, information exchange and engagement; carer engagement and support.

The trust must determine the extent to which there is a gap in service provision for those service users meeting Care Programme Approach criteria, to ensure that it is aware of its risk management position in relation to this gap, and to have a clear plan for mitigating its impact. For all service users identified as meeting Care Programme Approach criteria, the trust must ensure that there is an auditable and defendable approach to determining which of them are accepted onto the Care Programme Approach as a matter of priority once capacity is released. The trust has implemented a complex case forum, and other initiatives, for service users who may meet the threshold for enhanced care but cannot be accommodated on the enhanced care pathway, as well as service users who are presenting as more complex than the Core team can accommodate. The trust must audit the usage and effectiveness of the safety nets provided and provide assurance that the avenues to achieve a more enhanced and intensive package of support are being used as intended and to identify those service users for whom an enhanced care package must be achieved. Where it is identified clinically that enhanced care must be delivered to a service user and the range of safety nets is not sufficient to deliver an effective or safe package of care, there must be tangible and measurable steps in the care pathway design to enable this to be escalated via the trust’s risk/patient safety committees and brought to the attention of the commissioners. The trust board should receive quarterly reports detailing the number of adult service users who meet the threshold for the Care Programme Approach but are not receiving this intensity of care package and explaining why not. Assurance regarding the delivery of safe and effective care will also be required.

The revised FIRM model must facilitate the consistent capture and consideration of information relating to the spectrum of domestic abuse (emotional, psychological, financial, physical). This must encompass risk posed by the service user to others, not only risks to the service user. Reasonable expectations are that assessed risk will include known episodes of police and/or probation involvement in relation to such behaviours. A reasonable expectation is that the risk assessment process will triangulate what a service user reveals with these agencies where it is clear that the service user has had contact/involvement with them. Information captured via FIRM that highlights safeguarding concerns for vulnerable adults, such as domestic abuse, should trigger a force-field alert for the assessing professional to consider whether a referral to adult safeguarding, or a domestic abuse agency, is necessary. If it is determined that no action is required, the system must require the professional to record their rationale for this.

A situation must be achieved where working/informal carers providing emotional, physical, or day-to-day living support to a service user are routinely offered a carer’s assessment and are provided with a carer’s passport, in line with the trust’s Family, Friends and Carers Commitment.