Independent investigation: Valerie Thomas, Cardiff (2005)

The Welsh Assembly Government should ensure that commissioners and providers of mental health services in Wales examine the current provisions for the care and treatment of those suffering from a personality disorder and that commissioners put in place relevant services where there are currently none provided (Related Healthcare Standard3 2).

Cardiff and Vale NHS Trust and Cardiff County Council Social Services and Housing Departments should ensure that integrated and co-ordinated services are provided for those experiencing mental health problems of whatever severity or duration, including for homeless people experiencing such problems. In particular:
(a) the matter of management arrangements for effective joint working within CMHTs should be addressed,
(b) pathways for patients/clients need to be established which will provide seamless services irrespective of the point of entry to the services (those pathways should identify how people may access services, the arrangements to ensure comprehensive assessment, the treatment and care to be mobilised, arrangements for smooth transfer from one service to another, the way in which exit from the system will be managed and provisional arrangements should return to care and treatment become necessary) (Related Healthcare Standard 12).

Cardiff and Vale NHS Trust and Cardiff County Council Social Services Department should ensure that:
(a) patient/client records are available at short notice to professionals who need them to inform assessments,
(b) that required standards of recording are explicit and that staff are trained to complete records to those standards,
(c) the adequacy of records and their availability are monitored,
(d) staff are fully trained in the assessment of risk, understand the need for more detailed risk management plans and are able to utilise specialist tools in making assessments in those cases displaying severe and complex needs (related Healthcare Standard 25, 26, 27).

Cardiff and Vale NHS Trust and Cardiff County Council Social Services and Housing Departments should ensure that the Care Programme Approach and the related Unified Assessment Process is properly used:
(a) in respect of all those for whom it is prescribed within the Welsh Assembly Government Guidelines,
(b) through full assessments of patients/clients and addressing matters of co-ordination of all services to which the patient should have access in respect of the needs they present, and
(c) the Welsh Assembly Government should encourage the negotiating bodies in respect of GP contracts to reach an early agreement for the contribution of GPs to the full assessment process (related Healthcare Standard 2, 7, 8, 12, 22, 24).

Cardiff and Vale NHS Trust and Cardiff County Council should:
(a) develop structures, systems and procedures which will require, encourage and support active engagement of those health and social care services with patients/clients who may have difficulties in complying with rigid, formal arrangements for contact, including people who are homeless,
(b) encourage and support an organisational culture in which health and social care staff take responsibility for engaging appropriately with people who need services but may be unable or unwilling to do so without help to recognise a service’s relevance or value to them
(related Healthcare Standard 1, 2, 4, 5, 6, 7, 8, 12).

A review of the staffing made available to the CMHTs within Cardiff and Vale NHS Trust should be undertaken. In particular the number of medical, nursing and social work staff and the provision of a broader range of support staff and services should be considered. The guidelines referred to in Annex E may be helpful in taking this forward (related Healthcare Standard 22).