Independent investigation: Kenneth Auger, Merthyr Tydfil (2008)

Re-evaluate the systems and processes it has in place for ensuring that patient history-taking is fit for purpose. Clear written guidance and training should be put in place to aid front line staff in compiling a complete patient history, using all available sources. History taking is an invaluable part of basic risk assessment and all staff need to be aware of how to take a history and of its importance in assessing risk. The guidance should also include information about how to deal with issues relating to confidentiality

Audit the use of carer’s assessments, in conjunction with Merthyr Tydfil Social Services, to ensure that a full picture of the client’s family arrangements are clear at an early stage during the care and treatment of the individual, whether they are subject to standard or enhanced CPA.

Review the approach taken in respect of conducting collaborative assessments between health and social services, with particular focus given to ensuring that an effective system of noting relapse indicators and contingency planning is implemented and audited.

Encourage carers, especially young carers, to engage and make contact with services including in transition planning when young people themselves become adults and move out of contact with children’s services. This process needs to be audited and reviewed to ensure its efficiency.

Review the arrangements currently in place for accessing patient records across their respective organisations with the aim of developing a single information sharing system across health and social services. In particular, work needs to be done urgently to ensure uniformity of access to electronic records across the whole of the health board area, as well as with the local authority.

Examine the possibility of implementing new IT systems that will support the ability to electronically scan documentation and also to provide the necessary support and training for any new IT system that is introduced.

Audit and review the CPA process currently in place and take steps to improve the implementation of CPA, having regard to the guidance issued by WAG in 20038 and the recommendations contained in NLIAH’s review of CPA in Wales in 20099.

Ensure that all relevant staff are trained and have the appropriate skills required to improve the care delivered within the framework of CPA.

Produce clear guidance, in line with WAG policy, concerning the criteria for enhanced CPA and ensure that staff have a clear understanding of when enhanced CPA should be used.

Ensure that all relevant staff are adequately trained in risk assessment, with risk management being well integrated into the CPA process. This training should be audited to assess its impact.

Audit the discharge planning element of CPA, ensuring all decisions are documented accurately whether the patient is subject to standard, or enhanced level CPA.

Review and audit the information sharing processes and arrangements in place between services within the organisation, with particular attention given to the interface between CMHTs, CRHTs, and with Primary Care Services, to ensure that patients are clear over which service they are under the care of.

Audit the arrangements for the MDT process within the CMHTs.

Ensure that medical support arrangements are put in place in relation to the CRHT.

Review the function and model of its CRHT, ensuring that the Home Treatment and Crisis Team staff are not split in their function.

Support more assertive engagement with patients around alcohol problems, utilising processes such as motivational interviewing training or standardised alcohol assessments. The Health Board should also remind staff to access and read patient notes before any new assessment.

Implement specific guidance and training to CRHT staff relating to conducting mental health state assessments.

Review and audit the processes in place for medication monitoring in primary care, in particular the processes used for the purposes of monitoring Lithium levels in mental health service users in line with National Patient Safety Agency (NPSA) guidelines10.