Recommendation
The CMHT should ensure that where there is significant forensic history, including claims of a serious criminal nature of patients who come into contact with mental health services when a patient is known to MAPPA, there should be clear evidence …
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The CMHT should ensure that where there is significant forensic history, including claims of a serious criminal nature of patients who come into contact with mental health services when a patient is known to MAPPA, there should be clear evidence of liaison by mental health services within this body.
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View response
Information received from Multi-Agency Public Protection Arrangement (MAPPA), relevant to current service users will be discussed at daily zoning meetings within the services. Recent developments in two borough of a SIM project, a project which is a joint team of MH nurses and dedicated Police officers has commenced in two boroughs. This has ensured that any significant forensic history or offending behaviour, including potential risks not yet acted upon are shared and managed locally between Multi-Agency Public Protection Arrangement (MAPPA) and mental health services. The service is currently being monitored and audited with a view to roll out across the other three boroughs .
Recommendation
The CMHT should ensure that patient discharge information is sent to all relevant professional teams and services.
View response
Communication reminding staff of the need to ensure that the patient discharge communication is sent to all relevant professionals, teams and services will be sent to all staff. Discharge communication is sent using and MH5 form. An audit will take place to ensure that all relevant parties have been copied into this.
Recommendation
The CMHT should ensure that the practice of making clinical entries and sending written communication regarding outcomes of clinical reviews should be completed.
View response
Communication reminding staff or the need to ensure that the practice of making clinical entries and sending written communication regarding outcomes of clinical reviews should be completed and sent to all staff. A randomised audit will take place specifically looking at the timeliness of entries.
Recommendation
The Hillingdon mental health services should ensure that all staff are made aware of that access criteria to their respective teams.
View response
To ensure access criteria is included in the operational policy The Trust is currently in the midst of a major community mental health transformation programme which will ensure standardisation of operational procedures. New Standard Operating Procedure (SOP) is in the process of being developed and this will include the duty system and implementation plan.
Recommendation
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during …
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Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during local safeguarding induction and training and should also incorporate information regarding key agencies and forums which support management of this risk.
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View response
Hillingdon mental health services will collate information from all domestic violence agencies in the borough and distribute to all teams Training to include greater emphasis on assessing risk and indicators of domestic abuse including how staff can ask the difficult questions. Staff awareness to be further enhanced through displays of standardised domestic violence public information in staff and public areas of the community bases. Evidence of completeness Named Professionals for Safeguarding Children and Safeguarding Adult/Mental Capacity Act Specialist to plan with each service/borough safeguarding lead to complete an audit of all teams to gain assurance they have the relevant information in a domestic abuse folder and have a display of relevant information available in public areas. A review of safeguarding training materials, content, and checking of learning will be standardised trust wide to ensure a greater understanding of domestic abuse.
Recommendation
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during …
Read more
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during local safeguarding induction and training and should also incorporate information regarding key agencies and forums which support management of this risk.
Show less
View response
Hillingdon mental health services will collate information from all domestic violence agencies in the borough and distribute to all teams Training to include greater emphasis on assessing risk and indicators of domestic abuse including how staff can ask the difficult questions. Staff awareness to be further enhanced through displays of standardised domestic violence public information in staff and public areas of the community bases. Evidence of completeness Named Professionals for Safeguarding Children and Safeguarding Adult/Mental Capacity Act Specialist to plan with each service/borough safeguarding lead to complete an audit of all teams to gain assurance they have the relevant information in a domestic abuse folder and have a display of relevant information available in public areas. A review of safeguarding training materials, content, and checking of learning will be standardised trust wide to ensure a greater understanding of domestic abuse.
Recommendation
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during …
Read more
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during local safeguarding induction and training and should also incorporate information regarding key agencies and forums which support management of this risk.
Show less
View response
Hillingdon mental health services will collate information from all domestic violence agencies in the borough and distribute to all teams Training to include greater emphasis on assessing risk and indicators of domestic abuse including how staff can ask the difficult questions. Staff awareness to be further enhanced through displays of standardised domestic violence public information in staff and public areas of the community bases. Evidence of completeness Named Professionals for Safeguarding Children and Safeguarding Adult/Mental Capacity Act Specialist to plan with each service/borough safeguarding lead to complete an audit of all teams to gain assurance they have the relevant information in a domestic abuse folder and have a display of relevant information available in public areas. A review of safeguarding training materials, content, and checking of learning will be standardised trust wide to ensure a greater understanding of domestic abuse.
Recommendation
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during …
Read more
Hillingdon mental health services need to ensure that awareness of the risk of domestic abuse and the available local resources is increased and embedded into practice. This should include greater emphasis on assessing risk and indicators of domestic abuse during local safeguarding induction and training and should also incorporate information regarding key agencies and forums which support management of this risk.
Show less
View response
Hillingdon mental health services will collate information from all domestic violence agencies in the borough and distribute to all teams Training to include greater emphasis on assessing risk and indicators of domestic abuse including how staff can ask the difficult questions. Staff awareness to be further enhanced through displays of standardised domestic violence public information in staff and public areas of the community bases. Evidence of completeness Named Professionals for Safeguarding Children and Safeguarding Adult/Mental Capacity Act Specialist to plan with each service/borough safeguarding lead to complete an audit of all teams to gain assurance they have the relevant information in a domestic abuse folder and have a display of relevant information available in public areas. A review of safeguarding training materials, content, and checking of learning will be standardised trust wide to ensure a greater understanding of domestic abuse.
Recommendation
The CMHT, which now incorporates the assessment and brief intervention team, need to ensure that where it is known that patients under the care of that team are in a relationship that this is discussed in clinical reviews. Systems need …
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The CMHT, which now incorporates the assessment and brief intervention team, need to ensure that where it is known that patients under the care of that team are in a relationship that this is discussed in clinical reviews. Systems need to be put in place to identify and manage the potential risks when individual patients are thought to be in a potentially abusive relationship with another patient, this should include links with partner agencies.
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View response
Discussion at local quality meeting and senior management team, reminding staff to record this in the relationship status part of the clinical record. Potential risks and links with external agencies to be placed on the alert management system of JADE (clinical record system) Evidence of completeness and embeddedness Trustwide quality assurance workshops with the aim of establishing levels of awareness and embeddedness of best clinical practice will be commenced. The methodology will be to identify and rag rate specific risk reducing indicators and initiate focussed work on areas of concern and then evaluate the results. Trustwide quality assurance workshops will be coordinated
Recommendation
The CMHT should use the adults mental health initial assessment tool to collate information obtained from the patients, carers, family and other agencies at the point of referral to the service. Clinicians should use the tool as the basis for …
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The CMHT should use the adults mental health initial assessment tool to collate information obtained from the patients, carers, family and other agencies at the point of referral to the service. Clinicians should use the tool as the basis for decision making and care planning.
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View response
Following service redesign the adult mental health initial assessment tool is now used as standard. Operational Policy will be updated to make this explicit. The Trust is currently in the midst of a major community mental health transformation programme which will ensure standardisation of operational procedures. A revised Standard Operating Procedure (SOP) is in the process of being developed. An amendment to the current Standard Operating Procedure (SOP) will be in put in place whilst the system wide policy is in the process of development.
Recommendation
The CMHT should develop robust systems of communication with children and families social services wherever children are potentially at risk, in consultation with children and families social services.
View response
No specific action plan response found in the detailed table. The Trust's general statement indicates it 'will fulfil all of the recommendations'.
Recommendation
Where risk is evident, the CMHT seniors or consultants must set out a formulation with a statement of what responsibility lies with the clinical team and what responsibility lies with the patient. These actions should be clearly documented in the …
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Where risk is evident, the CMHT seniors or consultants must set out a formulation with a statement of what responsibility lies with the clinical team and what responsibility lies with the patient. These actions should be clearly documented in the patients care plan and disseminated to all involved including the patients care plan.
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View response
Discuss and remind at care quality meeting that the statement of responsibility must be clear in the ‘NB’ section of records and also documented in clinic letters and care plans. Evidence of completeness and embeddedness The CNWL current Care Programme Approach (CPA) policy is in the process of revision along with the CPA policy. Updated Risk Assessment QRG The risk assessment process will be incorporated into this to include DIALOG which is an outcomes measure to support structured concersations between patients and clinician focussing on the patients views. Revised Standard Operating Procedure (SOP) Revised training package Clinical Message of the Week
Recommendation
The CMHT must develop a system to ensure that clinical risk assessments are completed to the expected standard as per Policy for all patients.
View response
A monthly peer review across all mental health teams with regard to the quality of risk assessments will commence Evidence of completeness and embeddedness The CNWL current Care Programme Approach (CPA) policy is in the process of revision along with the CPA policy. Updated Risk Assessment QRG The risk assessment process will be incorporated into this to include DIALOG which is an outcomes measure to support structured concersations between patients and clinician focussing on the patients views. Revised Standard Operating Procedure (SOP) Revised training package Clinical Message of the Week
Recommendation
A CMHT need to ensure that there is an effective system in place whereby patients who no longer require input from the team are closed on the patient electronic information system.
View response
Administrative managers within teams will run monthly reports to establish activity within a four month period. This will identify closed cases on a monthly basis and the administrative manager along with the team manager will ensure these are closed from systems. Results from first run of the new system to be shared at senior management team. Evidence of completeness and embeddedness CNWL London based mental health services are monitored via Central Performance and Finance Information Group (Performance and Financial Governance). Local contract meetings divisional boards - Monthly Updating partners occurs at these meetings across the five London boroughs. A Trustwide electronic performance monitoring system ( Tableau) is now in place and monitored by performance analysist who in turn report to Divisional Boards. Each borough also attends a local monthly contract meeting with commissioners and partners where this case information is monitored.
Recommendation
The CMHT needs to review the role and responsibilities of the duty worker rota system to ensure that actions are always followed through, that updates are obtained and documented accurately.
View response
Following recent community service redesign the duty system has been changed to reflect the need for continuity. This will be included in the Operational Policy for the teams. The Trust is currently in the midst of a major community mental health transformation programme which will ensure standardisation of operational procedures. New Standard Operating Procedure (SOP) is in the process of being developed and this will include the duty system and implementation plan.
Recommendation
CNWL medicines management group to ensure that all prescribers within the Trust are made aware of the Policy in relation to off-licence prescribing.
View response
CNWL medicines management group will send a memo reminding prescribers of the Policy. Resending of internal medicines management newsletter 'green pen' to remind staff Trustwide of the existing protocol on the use of off license medications. An audit completed on compliance with off licence prescribing. Audit completed on compliance with off license prescribing. Evidence of completeness Chief pharmacist should review 'Unlicensed medicines' and 'off label use' policy
Recommendation
We recommend that in the interim a clinical message of the week is utilised to advise staff accordingly until an amendment to the Policy can be actioned.
Recommendation
Share the investigation findings with the patient (as appropriate) and the patient's family.
Recommendation
Share the investigation findings and action plan with all those involved in the care and treatment of the patient and with other teams/services as applicable for the purposes of learning.
Recommendation
We recommend therefore that the Trust includes a domestic abuse ‘deep dive’ when they review whether their approaches to learning are effective.
Recommendation
We recommend that the Trust seeks formal assurance of the completeness, embeddedness and impact of this action within three months, through auditing the daily zoning meetings notes, and by ratifying the draft MAPPA Policy including monitoring compliance.
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We recommend that the Trust seeks formal assurance of the completeness, embeddedness and impact of this action within three months, through auditing the daily zoning meetings notes, and by ratifying the draft MAPPA Policy including monitoring compliance.
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Recommendation
We recommend that the Trust seek assurance as to the impact of this action through the 2018-2019 North West London (NWL) commissioners quality schedule.
Recommendation
We recommend that the Trust seeks formal assurance of the impact of this action through the Trust Business Intelligence Tool Tableau governance structure.
Recommendation
We recommend that the Trust includes a domestic abuse ‘deep dive’, when they review whether their approaches to learning are effective, to seek formal assurance of the embeddedness and impact of these actions.
Recommendation
We recommend that the Trust seeks formal assurance of the impact of this action through the Quality Improvement (QI) workshops in Community Mental Health Teams (CMHT) to support staff in all areas of clinical practice, covering communication, risk, mental capacity, …
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We recommend that the Trust seeks formal assurance of the impact of this action through the Quality Improvement (QI) workshops in Community Mental Health Teams (CMHT) to support staff in all areas of clinical practice, covering communication, risk, mental capacity, safeguarding and care delivery.
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Recommendation
We recommend that the Trust seeks formal assurance of the embeddedness and impact of this recommendation through the QI project structure to improve the quality of clinical documentation, to ensure the initial assessment tool is being used as the basis …
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We recommend that the Trust seeks formal assurance of the embeddedness and impact of this recommendation through the QI project structure to improve the quality of clinical documentation, to ensure the initial assessment tool is being used as the basis for decision making.
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Recommendation
We recommend that, as a matter of urgency, the Trust assess the risk and develop Trust wide options to address the specific action for the Hillingdon mental health services to keep a register of all service users subject to child …
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We recommend that, as a matter of urgency, the Trust assess the risk and develop Trust wide options to address the specific action for the Hillingdon mental health services to keep a register of all service users subject to child protection procedures and to appoint a children’s and family services mental health champion within the services as the direct point of contact.
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Recommendation
We recommend that the Trust seeks formal assurance of the impact of this action this through the QI workshops in CMHTs to support staff in all areas of clinical practice, covering communication, risk, mental capacity, safeguarding and care delivery.
Recommendation
We recommend that the Trust seeks formal assurance of the impact of this recommendation, through the Trust wide improvements in the application of the Clinical Risk Assessment & Risk Management Policy.
Recommendation
We recommend that the Trust seeks formal assurance of the impact of this recommendation through the regular sharing of the Hillingdon quarterly report with partners, which contains information on open cases, new cases, discharged cases, referrals into service and outcome, …
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We recommend that the Trust seeks formal assurance of the impact of this recommendation through the regular sharing of the Hillingdon quarterly report with partners, which contains information on open cases, new cases, discharged cases, referrals into service and outcome, and percentage of accepted referrals seen within 28 days.
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Recommendation
We recommend that a task group approach is taken to the implementation of the final duty system within a three month timescale, with formal assurance provided of the completeness, embeddedness and impact of this action.
Recommendation
We recommend that the ‘unlicensed medicines’ and ‘off label’ use’ policy specifically with regards to the use of off-licence prescribing in personality disorder is subjected to audit by the Trust to seek formal assurance of the embeddedness and impact of …
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We recommend that the ‘unlicensed medicines’ and ‘off label’ use’ policy specifically with regards to the use of off-licence prescribing in personality disorder is subjected to audit by the Trust to seek formal assurance of the embeddedness and impact of this action.
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