Independent investigation: Simran Sidhu (5)Aman Raj (23 mths), Southall Station (2005)

The Cultural Competencies Toolkit needs a separate section to address the cultural issues that are clearly significant to experiences in South Asian culture. Reference needs to be made to honour codes and ‘izzat’ both of which are fundamental to the experiences of South Asian communities. In highlighting these experiences examples can be given about help-seeking behaviour, births, practices, customs and other areas that are relevant to the communities being addressedincluding sources ofhelp.

Learning from thecultural issues raised in this report need to be incorporated into the clinical leadership programmes offered by theTrusts.

All service users must be offered the opportunity to be interviewed on their own. When there are specific cultural or gender issues where this is not appropriate a chaperone should be considered. When there are known instances of abuse or coercion the service user must not be seen with the perpetrator.

The Independent Investigation Team recognise that the Mental Health Trust has taken action to address the medical capacity within the CMHT and would like to support the Trust further by recommending that the Trust works with the Commissioners in Primary Care to develop a protocol to transfer those patients who are welland stable within their “mentalillness” to primary care services and thereby more effectively use specialist mental health services to treatandmonitor thosewhoareunstable or unwell.

The Nurse Lead Practitioner plays an integral and important role in the day to day running of a CMHT and greater efforts must be made to ensure the post is covered whether this is through enabling a suitable team member to act up or offering the post as a development opportunity to the wider Trust. Consideration also needs to be given to how this post is professionally supported to reduceattrition rates.

The Trust needs to review the CMHT Operational Policy to ensure that all the contributory factors noted in this report have been addressed, in particular the role and function of duty workers and the interface between the OPAand dutysystems.

Priority needs to be given to the development of the CMHT practitioners to ensure that the operational policy and the changes therein are implemented. Further, practitioners must be given the opportunity to develop as advanced practitioners through non medical prescribing, Adult Mental Health Practitioners, coaching, and mentoring etc to ensure their full development to meetpatientneedsand thechallenges ofthe future.

The Trust needs to introduce and develop the concept of case formulation to underpin and promote robust clinical practice and to embed policywithin practice.

The CPA policy was reviewed in 2008. The Trust should undertake a full audit to ensure that the revised policy had been implemented effectivelyandthatpractitioners are operating appropriately.

Consideration needs to be given to the development of core competencies for duty workers, team leaders and managers that are in keeping with the Knowledge and Skills Framework and the National Occupational Standards to support the implementation of the Operational Policy. Core competencies should be completed with Care Coordinators as part of their annual appraisal process.

The Trust needs to revisit the supervision policy with a view to enhancing integrated practiceand notlimiting this to uni professionalgroups.

Whilst some of the record keeping issues have been negated through the introduction of the electronic record system (RiO) i.e. dates and names, clinical files should be scrutinised as a matter of course during supervision to ensure they are up to date and that Trust policy is being followed especially in relation to the CPA process. Managerial supervision notes should be recorded in theclinical file.

Clinical files should be scrutinised as a matter of course during supervision not only for accuracy but also quality and appropriateness of mentalhealth interventions.

The PCT should actively take responsibility for developing reflective practitioners and where there are staff who fail to engage with this or show no evidence of continuous learning, their capability for the job should be reviewed in thecontextofperformanceappraisal.

Ealing Primary Care Trust should require both GPs and Health Visiting staff to consider whether inappropriate anxiety in a parent as exhibited by one who takes the children too frequently to the doctor, hospital or health visitor clinic may be pathological and share that information with the CMHT ifitis involved.

Whereit is known that a parent is in receipt of mental health services the assessment of the children must incorporate the views of the care coordinator or theclinician working withthe serviceuser.

The RiO system will assist in supporting local management to ensure that policies are adhered to in a timely manner however it will not ensure the quality ofwhatis recorded. It is thereforerecommended thata protocol be developed through the clinical governance system in conjunction with the commissioners’ to ensure that core assessments, risk assessment, crisis and contingency plans andcareplansarecompleted to anacceptable standard.

Where it has been identified that there is a gap in the skill or knowledge base of a practitioner this must be immediately incorporated into their Continuing Professional Development Plan and form part of their annual appraisal.