*Independent investigation into the care and treatment of Patient C: November 2013

1. A formulation based Policy and Procedure approach to clinical management of patients should Trust Care Co-ordination and CPA Policy NTW(C)20 ratified in November 2010. Completed be adopted. Formulation should be informed by The development of the core assessment document that is used by all services and multidisciplinary evaluations clinicians in the Trust supports and enables holistic assessment as it encompasses health and be regularly reviewed. and social care needs and consequently biopsychosocial formulation. The core assessment has a formulation section which once validated cannot be changed. 2. Decisions regarding patient However when the created new facility of the electronic record is used the previous care should not be taken on the formulation pulls through, so is readily available to view by clinical staff. It is required to be basis of single presentations amended or added to at significant points of transition e.g. admission to an inpatient ward, without regard to case referral to another service either for transfer or to facilitate joint working. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 1 formulation. The electronic record also clearly identifies how many assessments have been entered. 3. At each point of transition in This enables clinical staff to easily view assessments and associated formulations over the the care of a patient there must time period of the record. All clinicians involved in a patient’s care and treatment must be a concise summary readily keep accurate and contemporaneous records and it is the responsibility of the Care Co- available to the receiving ordination/Lead Professional to make sure that all clinical information is up-to-date on the service that accurately sets out electronic patient record (RiO) at any point of transition of care. This would be in addition the patient’s formulation; which to a face-to-face or verbal handover, or discussion as part of the review process. The includes diagnosis, treatment recently developed transition protocol reinforces the need to do this. plan, risk factors and follow up requirements. In addition to this, clinicians have caseload management with their clinical supervisors on a regular basis, which includes a records check of a number of open cases to look at the quality, not just completion, of the record. A safety message from the Executive Medical Director was circulated to all staff in the September Chief Executive’s Bulletin in September 2012 to reinforce the importance of the formulation 2012 and evaluation of risk. (Copy saved on database). Progress since the incident will be further strengthened by the design of new community Ongoing pathways which is part of a two year transformation programme. The new pathways will work minimise transitions for service users and enhance communication and joint working where planned transitions are necessary. The clinical record has been redesigned to include a standardised framework for formulation which will be prominently displayed along with the risk assessment. Standard work has been developed for reviews which greatly enhances multidisciplinary input.

14. Guidance on the North of Tyne Services management of patients whose cases are complicated by Community Mental Health Teams can access specialist clinical advice and support from Completed misuse of drugs or alcohol Trust Addiction services. should be followed. Any such misuse should be noted as a In addition there is 1 full-time Dual Diagnosis Clinician embedded into North risk factor and marked in any Northumberland Community Mental Health Team and 1 further specialist part – time care plan as an issue for alcohol clinician based within West Northumberland Community Mental Health Team. ongoing care. South of Tyne Dual Diagnosis Services Within Trust South of Tyne Planned Care services there are 7 full-time “Dual Diagnosis” Therapists. All Dual Diagnosis Therapists are highly experienced clinicians in their own right, having now had several years’ clinical experience of working with complex substance misuse issues and co-occurring mental health concerns. These clinicians provide expert clinical advice and support across Trust care teams in South of Tyne and are embedded into existing Community Treatment Teams to promote and augment Team clinical skills and expertise whilst working with substance misuse issues and to mitigate clinical risk. All Dual Diagnosis therapists referred to above in both North and South of Tyne Services are in receipt of monthly 1 to 1 clinical supervision from the Planned Care Dual Diagnosis Nurse Lead. Training The need for additional staff training in dual diagnosis has been a central theme identified in a range of National documents since publication of the Department of Health Dual Diagnosis Practice Implementation Guide (2002). In addition the core competencies required to deliver effective care for people with combined mental health and substance use problems were identified in DH paper, Closing the Gap (2006). In keeping with national dual diagnosis guidance a tiered approach to training has been implemented which has now been formally adopted since 2010: to address both essential and specialist training needs by way of a measured and evidence based process. Essential Dual Diagnosis Training Since June 2010 essential awareness NTW dual diagnosis instructor led training has been rolled out for all NTW clinical staff. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 11 With Dual Diagnosis Therapists now in post and all contributing to the instructor led training: dual diagnosis essential awareness staff training completion target rates are: Staff training completion rates in August 2013 Service Line > Directorate staff Numerator Denominator Percent PLANNED CARE Total 1,452 1,638 89% COMMUNITY Total 1,103 1,229 90% STEPPED CARE Total 349 409 85% URGENT CARE Total 801 863 93% ADULT MENTAL HEALTH Total 600 655 92% OLDER PEOPLES FUNCTIONAL & LEARNING Total 201 208 97% DISABILITY SPECIALIST CARE Total 1,207 1,459 83% CHILDREN & YOUNG PEOPLE Total 411 480 86% SPECIALIST ADULT Total 796 979 81% Total Total 3,460 3,960 87% Specialist Dual Diagnosis Clinical Training 1. Motivational Interviewing training has been commissioned and hosted in South of Tyne during 2011, 2012 and 2013. 2. For all South of Tyne Trust clinicians there are also now a range of regular “open training events” facilitated by the Dual Diagnosis Therapists in each South of Tyne locality area: e.g. Substance Misuse and Mental Health. Future Direction Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 12 A Dual Diagnosis Training Plan for Planned Care services has been developed and submitted to Planned Care Clinical Director for further consideration and potential roll out under the Trust Quality Priority Training plans associated with Transforming Services and Skills Programme. Summary of training plan given below: Training Plan Name of Course: Dual Diagnosis Training Lead: Dual Diagnosis Lead and / or nominated deputies Course Format and How Delivered: Course consists of 4 modules delivered over 2 whole days or as individual half day modules. Following attendance there will be opportunities for practice development and consolidation of learning through advanced workshops / master classes. Training delivery will be via Power-point, handouts, discussion, links, references and further reading. Supervision Arrangements: Specialist dual diagnosis clinical supervision will be provided following training. This will include small group supervision plus some opportunities to co-work with a supervisor, and an information / advice Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 13 service. Course Content:  Substances of Misuse and Managing Risk  Treatment Approaches and Dual Diagnosis  Alcohol Clinical Management  MI and Cycle of Change NICE Guidance Recommended: Participants will gain awareness of the following NICE Clinical Guidance’s and their contexts:  Service user experience in adult mental health CG136  Psychosis with co-existing substance misuse CG120  Schizophrenia (update) CG82  Bi-polar Disorder CG38  Medicines adherence CG76  Alcohol dependence and harmful alcohol misuse CG115  Alcohol Use Disorders CG100  Drug misuse - psychosocial interventions CG51  Drug-misuse – opioid detoxification CG100  Self-Harm CG16  Self-harm (longer-term management) CG133 Skills/Knowledge Developed:  A clinically informed, evidence based view of the constantly changing field of substance misuse and its relationship with mental disorder, risk, mental health Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 14 treatment and recovery.  Knowledge of Substances of Misuse and Associated Disorders  Awareness of principles of Motivational Interviewing  Working knowledge of Harm Reduction and Health Education clinical approaches  Dual Diagnosis and Recommended Therapies  Awareness of Service User and Carer issues in Dual Diagnosis care.

11. An effective system should be implemented to ensure that all records, including patient administration records, are appropriately made and maintained in accordance with policy and statutory requirements. Dashboards also are the monitoring tool that provides data to managers re the completeness administration requirements e.g service users with first name ; surname address phone number and allergies completed; waiting times

15. There should be full Policy and Procedure compliance with policies dealing with non-attendance The Trust has a comprehensive Non Attendance policy NTW(C)06 which was ratified in Completed and in particular, that any March 2010. It also has a policy called Promoting Engagement with Service Users, referrer is consulted in order to NTW(C) 07, which clearly articulates the expectation that staff will assertively try to engage re-assess the situation and with patients. If a service user does not engage or attend or if a carer raises a concern formulate an appropriate action about a service user then the care coordinator or lead professional should actively seek to plan. reengage and manage any concerns raised. At no point should an individual or team discharge a patient who has disengaged or where concerns are raised without a full discussion with the team and referrer about ongoing risks, needs and how to re refer if necessary. The CPA process embedded in Care Coordination Policy NTW (C) 20 would be the framework to ensure this happened. It was recognised that a standard approach in this area was required and when the policy was reviewed, practices such as opt in / opt out letters and automatic discharge after three missed appointments were removed. The policy Clinical Supervision NTW (C) 31 would also support safe practice as the supervisor would be ensuring all actions had being taken to ensure safe decision making. Care Co-ordinators can a use clinical supervision sessions to discuss patients who are difficult to engage. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 15 The Trust has a Managing Complex Cases process with a decision tree to support staff in its use. The tiered approach it outlines is based on the detailed guidance for staff within the Trust’s Promoting Engagement with Service Users Policy and adds the option of a Complex Case Panel where the presenting risks and nature of the problem is a sufficiently serious nature, and cannot be resolved through :-  the care co-ordination process, with the option of the Lead Professional / Care Coordinator arranging a review meeting incorporating consultation with an appropriate clinician or managers who may have the necessary knowledge, skills or experience to help the team resolve the complex case issue(s).  seeking specialist case specific consultation advice from appropriate sources outside of the Lead Professionals / Care Coordinator’s immediate service area e.g. ‘expert clinician’ from a specialist area, MAPPA, Safeguarding Leads, Trust Clinical Risk Manager or escalating to the directorate triumvirate. A strategy meeting consisting of appropriate staff in an attempt to resolve the complex case issues should be used. Training and Implementation Training has occurred as part of the rolling Care Co-ordination training programme.

8. An assurance system Policy and Procedure should be put in place to ensure CPA policy is complied Care Co-ordination policy NTW(C)20. Completed with and any shortcomings in individual cases are identified Audit and Outcomes at the earliest opportunity in order for remedial action to be Clinical audit to ensure appropriate implementation of Care Co-ordination is undertaken taken. e.g. the annual Trust-wide Quality Monitoring audit programme The Trust Quality Monitoring audit programme is undertaken by ward / team managers / clinical leads on a regular basis. This ensured that there was a process for audit of records both in terms of completeness, compliance with key policies including Care co-ordination (CPA) and quality and provided excellent evidence for the Trust NHSLA assessment In 2012 the Clinical Audit department and other colleagues undertook a significant review of the Quality Monitoring tool, removing content no longer required due to other audits in place, identifying the elements that Rio can report on and developing these into a clinical audit dashboard. This allows the clinical audit process by ward / team managers / clinical leads to be much smaller and focus on quality elements of the records , compliance with key policies including Care co-ordination (CPA) The Quality Monitoring Audit results are reported via the Operational Groups Quality and Performance assurance structures. The identified Operational Groups Quality and Performance group is also responsible for monitoring the action plans produced by service. i.e. Specialist Group Q&P sub group Safety Planned care Q&P sub group Quality and Management. Urgent Care Quality and Performance Group The current build of the electronic patient records system (RiO) has incorporated a navigation page that identifies if the key components of Care Co-ordination have been Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 7 completed; including reviews, again this is available for managers to use in clinical supervision. Within the CQ Essential Standards of quality & safety there is a requirement under Outcome 14 for Trusts to ensure that staff receive among other things regular supervision to ensure that appropriate levels of care and treatment are provided and Policy and Procedure are being observed. Every month this requirement is reviewed by all Trust Service Managers via the utilisation of the CQC Essential Standards pre-visit questionnaire. Dashboards also are the monitoring tool that provides data to managers re the completeness of administration requirements. Reflection on a patient’s care and treatment following a serious incident , identifying Deputy remedial action and sharing lessons learnt. Director of Quality and Safety December 2013

10. An effective system should be implemented to ensure adherence to professional standards of contemporaneous record keeping. This must include all discussions and events relevant to the patient’s care. In addition to this, clinicians have caseload management with their clinical supervisors on a regular basis, which includes a records check of three random open cases.

17. There should be an Policy and Procedure operational policy for each team that is kept updated and There is a service specification for CMHTs which is underpinned by policies and Completed observed. frameworks which promote best practice. A copy of the service specification for Northumberland CMHTs 2013-14 is on database. A task and finish group will be formed to look to set a standardised format for operational Service policies for each community team. The first meeting of this group will be held on 21/10/13. Manager, The group will then oversee the rollout of format for each team and ensure all operational North of policies are updated as a result. Operational policies will then be reviewed as required but Tyne as a minimum on an annual basis. Any amendments to operational policies must be Planned agreed through Clinical Management team meetings. Care December 2013

12. Secondary mental health Policy and Procedure services should establish with Completed primary care services the The Trust Care Co-ordination policy NTW(C)20 ratified in November 2010 makes explicit circumstances and procedures the standards expected with regards to communicating with primary care. The Trust has by which changes in risk are standardised letters to GPs on RiO which includes standardised information, including effectively communicated to current risk assessment. In addition if there is an escalation of risk and the patient each other. becomes subject to the Mental Health Act or has contact with crisis services, there is a clear system in place to inform the GP about the escalation and provision of information regarding the patient’s management plan. The Trust has a CQUIN target agreed with commissioners to implement an improvement plan undertaken during 2012/13 regarding agreed standards of communication with GPs for three milestones on a service user pathway for agreed teams in three localities:  Completion of assessment (to be signified by point of clustering)  Medication change  Inpatient discharge Work is currently underway to further standardise information that is communicated to primary care and refine the electronic discharge summary. This will enable discharge information to be more easily recorded and retrieved which should result in significant improvement in performance across the Trust by the end of the year. This will include a new interim discharge form being introduced (based on headings agreed by the Royal College of Psychiatrists). GP’s have been heavily involved in the design of the new Principal Community Pathways Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 9 and have contributed to the design of the new formulation document and risk assessment. Standards for communication specify the required timeliness of communication to the GP as well as the key content that should be included. The Trust will continue to look to make communication more timely and effective through evolving IT systems.

4. There should be consultant Policy and Procedure psychiatric input in cases in which there is diagnostic Trust Care Co-ordination and CPA Policy NTW(C)20 ratified in November 2010. Completed complexity or uncertainty, medication related issues or Following implementation of New Ways of Working for Psychiatrists (October 2005), the significant risk. consultant psychiatrists are increasingly embedded into multi disciplinary teams. This enables rapid access to all members of the team when additional advice or guidance is required to meet service users’ needs. Within the community teams the team manager is responsible for ensuring that resources are allocated safely and that team members Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 2 including consultant psychiatrists prioritise tasks based on clinical needs. This will be further strengthened by the design of new community pathways which is part of a two year transformation programme.

1. A formulation based Policy and Procedure approach to clinical management of patients should Trust Care Co-ordination and CPA Policy NTW(C)20 ratified in November 2010. Completed be adopted. Formulation should be informed by The development of the core assessment document that is used by all services and multidisciplinary evaluations clinicians in the Trust supports and enables holistic assessment as it encompasses health and be regularly reviewed. and social care needs and consequently biopsychosocial formulation. The core assessment has a formulation section which once validated cannot be changed. 2. Decisions regarding patient However when the created new facility of the electronic record is used the previous care should not be taken on the formulation pulls through, so is readily available to view by clinical staff. It is required to be basis of single presentations amended or added to at significant points of transition e.g. admission to an inpatient ward, without regard to case referral to another service either for transfer or to facilitate joint working. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 1 formulation. The electronic record also clearly identifies how many assessments have been entered. 3. At each point of transition in This enables clinical staff to easily view assessments and associated formulations over the the care of a patient there must time period of the record. All clinicians involved in a patient’s care and treatment must be a concise summary readily keep accurate and contemporaneous records and it is the responsibility of the Care Co- available to the receiving ordination/Lead Professional to make sure that all clinical information is up-to-date on the service that accurately sets out electronic patient record (RiO) at any point of transition of care. This would be in addition the patient’s formulation; which to a face-to-face or verbal handover, or discussion as part of the review process. The recently developed transition protocol reinforces the need to do this. plan, risk factors and follow up requirements. In addition to this, clinicians have caseload management with their clinical supervisors on a regular basis, which includes a records check of a number of open cases to look at the quality, not just completion, of the record. A safety message from the Executive Medical Director was circulated to all staff in the September Chief Executive’s Bulletin in September 2012 to reinforce the importance of the formulation 2012 and evaluation of risk. (Copy saved on database). Progress since the incident will be further strengthened by the design of new community Ongoing pathways which is part of a two year transformation programme. The new pathways will work minimise transitions for service users and enhance communication and joint working where planned transitions are necessary. The clinical record has been redesigned to include a standardised framework for formulation which will be prominently displayed along with the risk assessment. Standard work has been developed for reviews which greatly enhances multidisciplinary input.

5. In cases where issues of Policy and Procedure non compliance with medication arise, this ought to This is covered by the Care Co-ordination policy NTW(C)20 in relation to care planning of a Completed be noted specifically as part of patient’s individual needs which includes risk assessment and contingency planning. the risk management plan. This plan should specify to all The policy Promoting Engagement with Service Users NTW(C) 07 clearly articulates the concerned how future expectation that staff will assertively try to engage with patients. If a service user does not instances of non-compliance engage or attend or if a carer raises a concern about a service user then the care are to be notified, as well as coordinator or lead professional should actively seek to reengage and manage any interventions required to concerns raised. At no point should an individual or team discharge a patient who has develop concordance. disengaged or where concerns are raised without a full discussion with the team and referrer about ongoing risks, needs and how to re refer if necessary. The CPA process embedded in Care Coordination Policy NTW (C) 20 would be the framework to ensure this happened. The policy Clinical Supervision NTW (C) 31 would also support safe practice as the supervisor would be ensuring all actions had been taken to ensure safe decision making. The Trust has a Managing Complex Cases process with a decision tree to support staff in its use. The tiered approach it outlines is based on the detailed guidance for staff within the Trust’s Promoting Engagement with Service Users Policy and adds the option of a Complex Case Panel where the presenting risks and nature of the problem is a sufficiently serious nature, and cannot be resolved through :-  the care co-ordination process, with the option of the Lead Professional / Care Coordinator arranging a review meeting incorporating consultation with an appropriate clinician or managers who may have the necessary knowledge, skills or experience to help the team resolve the complex case issue(s).  seeking specialist case specific consultation advice from appropriate sources outside of the Lead Professionals / Care Coordinator’s immediate service area e.g. ‘expert Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 3 clinician’ from a specialist area, MAPPA, Safeguarding Leads, Trust Clinical Risk Manager or escalating to the directorate triumvirate. A strategy meeting consisting of appropriate staff in an attempt to resolve the complex case issues should be used. Training and Implementation Training has occurred as part of the rolling Care Co-ordination training programme. Further training has been developed as part of a medication concordance programme, to help staff understand the issues associated with medication non-adherence and enhance skills in identifying and managing non-adherence. The Trust is currently recruiting some trainers and will continue with workshops for all clinical staff at the end of October. The aim is to train all clinical staff over the next two years and to evaluate the training in terms of what has changed as a result. Programme documentation on database.

1. A formulation based Policy and Procedure approach to clinical management of patients should Trust Care Co-ordination and CPA Policy NTW(C)20 ratified in November 2010. Completed be adopted. Formulation should be informed by The development of the core assessment document that is used by all services and multidisciplinary evaluations clinicians in the Trust supports and enables holistic assessment as it encompasses health and be regularly reviewed. and social care needs and consequently biopsychosocial formulation. The core assessment has a formulation section which once validated cannot be changed. 2. Decisions regarding patient However when the created new facility of the electronic record is used the previous care should not be taken on the formulation pulls through, so is readily available to view by clinical staff. It is required to be basis of single presentations amended or added to at significant points of transition e.g. admission to an inpatient ward, without regard to case referral to another service either for transfer or to facilitate joint working. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 1 formulation. The electronic record also clearly identifies how many assessments have been entered. 3. At each point of transition in This enables clinical staff to easily view assessments and associated formulations over the the care of a patient there must time period of the record. All clinicians involved in a patient’s care and treatment must be a concise summary readily keep accurate and contemporaneous records and it is the responsibility of the Care Co- available to the receiving ordination/Lead Professional to make sure that all clinical information is up-to-date on the service that accurately sets out electronic patient record (RiO) at any point of transition of care. This would be in addition to a face-to-face or verbal handover, or discussion as part of the review process. The recently developed transition protocol reinforces the need to do this. plan, risk factors and follow up requirements. In addition to this, clinicians have caseload management with their clinical supervisors on a regular basis, which includes a records check of a number of open cases to look at the quality, not just completion, of the record. A safety message from the Executive Medical Director was circulated to all staff in the September Chief Executive’s Bulletin in September 2012 to reinforce the importance of the formulation 2012 and evaluation of risk. (Copy saved on database). Progress since the incident will be further strengthened by the design of new community Ongoing pathways which is part of a two year transformation programme. The new pathways will work minimise transitions for service users and enhance communication and joint working where planned transitions are necessary. The clinical record has been redesigned to include a standardised framework for formulation which will be prominently displayed along with the risk assessment. Standard work has been developed for reviews which greatly enhances multidisciplinary input.

6. All members of integrated Policy and Procedure teams should have access to all of the relevant clinical The Trust’s electronic health record (RiO) is the unified health record which is used by all Completed information. NTW staff involved in the patient’s care. The NTW Care co-ordination policy NTW (c)20 and associated PGNs and Record Keeping Standards PGN-02 (Part of NTW(O)09 Management of Records) set out the expectation in relation to the sharing of key clinical documents’ with partners (LA: GP: Cares; Service User and other members of the care team) who do not have access to the Trust’s electronic patient record ( RIO). These polices / PGNs also guide staff as to how to integrate Local Authority documentation in the Trust electronic care record (RiO) This is further enhanced by information sharing protocols and associated arrangements with two local authorities in respect of an automated electronic exchange of information between their electronic care records and Rio and mutual read only access to each organisation’s electronic records. In one locality of the Trust where the community teams remain integrated, RiO is the shared record.

7. Appropriate weight should Policy and Procedure be given to all reported concerns of carers and other Care Co-ordination policy NTW(C)20 includes section 13 – “involving carers”. This section Completed key figures in patients’ lives; of the policy outlines the Care Co-ordinator’s responsibility for ensuring carers are not only particularly when past reporting offered an assessment of their needs but also highlights the importance of carer input. It has proved to be reliable. states that concerns from carers should be taken very seriously and should lead to the Whilst such policy guidance Care Co-ordinator considering the need to initiate a review. may form part of training, it is Engagement with Carers is also promoted though Common sense confidentiality ( part of essential to achieve a Confidentiality policy ) the introduction of which was supported by a programme of training demonstrable change in the for staff. approach taken by Embedding and Evidence of Improved Outcomes professionals in such instances. The Trust Quality Monitoring tool for records audit demonstrated that in 2013 Planned care 74% of care plans had been developed with the involvement of SU and their family/carer Urgent care 83% of care plans had been developed with the involvement of SU and their family/carer Specialist service 75% of care plans had been developed with the involvement of SU and their family/carer The Trust Quality Monitoring tool for records audit is augmented by a clinical audit dashboard available to all managers. Figures for the percentage of carers involved in a patient’s risk assessment are available on request. At the time of the incident, while there was wide acknowledgement of the importance of the support to carers and appropriate policies were in place, implementation of these assessments were not well embedded, and systems to monitor completion were also not well developed. The Trust has undertaken significant work over the past few years to engage and support Carers. A carer’s charter has been developed in partnership with carers and carer organisations that clearly outlines expectations and standards for carers and Trust staff in relation to involvement and information. Common Sense Confidentiality guidance for carers Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 5 and staff is part of the Trusts information sharing policy and training has taken place to raise awareness of the importance of this with all staff. A high quality ‘Carers’ Pack’ has been developed which until April 2013 focused mainly on in-patient services. Following positive evaluation from our annual carer’s survey this is now being rolled out across community services as a CQUIN scheme for 2013/14. The pack is comprehensive and includes:  Getting to Know You process (which supports a ‘think family’ philosophy)   Carers Charter  Useful contacts for Carers  A Carers checklist  A guide for Carers, family and friends relating to ‘Common Sense Confidentiality”  Carers resource Information  Carers Pocket Pack Both the ‘Getting to Know’ you guide and the ‘Carers Checklist’ provide a framework for staff to share information and listen to carers. Additionally the RIO system will record if the information has been given to carers and whether it is accepted or declined in supporting monitoring of the CQUIN scheme. A large number of community teams from the Trusts localities have received carer’s awareness training in line with the GTKY process and CQUIN scheme Training and Implementation Training has occurred as part of the rolling Care Co-ordination training programme. 20.11.13 Information received from Performance Management The CQUIN is actually about the roll out of the “Getting to know you Process” for carers and roll out of Carers packs. Community teams have been included in the CQUIN from this year, last year the Carers CQUIN related to In Patient Units. There has been a slight delay on the roll out of the carers packs due to printing issues. Post Independent Investigation Action Plan Patient C – version 10 26.11.13 – published 6 The timescales for the CQUIN Sunderland & South Tyneside GTKY Training Q1 Roll out Q2 Carers Packs Roll Out Q2 Gateshead & Newcastle GTKY Training Q2 Roll out Q3 Carers Packs Roll Out Q3 Northumberland & North Tyneside GTKY Training Q3 Roll out Q4 Carers Packs Roll Out q4

9. Professionals who counter Policy and Procedure sign any clinical document should be aware that they are Highlighted in Management of Records policy NTW(O)09, ratified in October 2012, which is Completed accountable for it and must NHSLA compliant. This includes a Practice Guidance note on record keeping standards take steps to check its for clinicians, which was ratified in December 2012. Northumberland Tyne and Wear NHS accuracy. Foundation Trust is the only trust which has implemented a standard for time in relation to contemporaneous recording.

13. When professionals have Effective Care Co-ordination in Mental Health Services – Modernising the Care Completed dual roles, the responsibilities Programme Approach (Department of Health guidance 2000), set out that The CPA will be and functions of each must be integrated with Care Management in all areas to form a single care coordination approach clearly set out and fully for adults of working age with mental health problems. This requirement has underpinned discharged. Trust policy from that date onwards. Although the role of Care coordinator and Care manager (attached document) are congruent in most aspects of clinical activity the significant differential, dependent on partnership arrangements, is the arrangement to access social care budgets. However the review and development in partnership arrangements with Northumberland Social Service (SW staff are now within Service called CSBU) recognised the need to clarify roles and responsibilities between Health and Social care staff including identifying when care management is the only framework of care. This has resulted in a clear model of integrated working agreed by both organisations and recorded in a document that sets out the integrated model of working with an number of appendices that address specific issues / circumstances - 2 of which are attached as examples 131112 Care 24 04 2013 - Costed Operational Management in PracticCea.dreo cPackages NorthuSmtabnedlaanrdd. vd7o c-Northumberland.doc