Independent investigation: Jane WheatleyGary Gardiner, Sheffield (2007)

The Trust should ensure that when urgent requests are made for initial appointments these are dealt with in line with the acute care pathway and this should be the subject of audit on a regular basis.

Staff should develop a more co-ordinated approach to avoid multiple versions of basic case history information being taken.

Risk assessments should be improved by seeing service users in as many contexts as possible, and include inputs from carers and others in close contact with the service user whenever this is possible.

The Trust should develop robust methods of reviewing its information sharing policies (both internal and external) to assess their effectiveness and to implement changes as required. Reviews should include investigations of the timeliness of responses from other agencies.

The Trust should carry out regular audits of activities such as record creation ensuring that Trust policies are being carried out in a timely manner and staff supervision should be used to check that notes are made contemporaneously with appointments (i.e. within 24 hours) and that any subsequent formal record accurately reflects the nature of the discussion to ensure their trustworthiness.

When new relevant policy initiatives are announced they should be discussed at the next Trust Board meeting and a process should be put in place to ensure that the Board is kept informed of developments through to implementation including ensuring a review of the internal policy. The Board should consider obtaining external assurances on the quality of major new policies.

The Trust should produce a policy on the provision of Cognitive Analytical Therapy (CAT) within the Trust and the policy should include clear criteria as to who is qualified to provide CAT and how staff providing CAT are to be trained and supervised. A centralised waiting list should also be organised. The Trust should aim to make the provision of CAT more systematic and prevent localised fragmented provision.