Healthwatch Portsmouth Board meeting 10 September 2019 Solent

Healthwatch Portsmouth Board meeting 10 September 2019

Solent NHS Trust - Mental Health Rehabilitation Transformation proposal

Solent Mental Health Rehabilitation Service Redesign

The case for change Effective Responsive Recovery focused Own home Remain engaged community Reduce stigma Psychology Remain part of your care team O/T

Staff and patient Engagement • • Frontline staff (including Oakdene and community MH staff) developed the model in a number of workshops. Oakdene staff formally consulted SHFT captured patient feedback and seeking views of secondary care users HOSP approved NHS England Assurance process Shared QIA / EIA / PIA responsibilities being met via Solent’s Governance Processes. Service users in process of deciding the services name.

The proposed model • • • The new Community Rehabilitation Team will deliver intensive rehabilitation to patients in their own homes. If home rehab is not possible, or not appropriate, the service will in-reach into a new offer of rehab supported living accommodation. Rehabilitation will be available following admission to an acute MH hospital, but also now as a step-up function from the community to prevent the need for admission. MDT Staffing including psychology, occupational therapy, nursing, social worker, peer worker and support workers. Medical input will be pulled from existing community psychiatry. Providing intensive, time-limited outreach rehabilitation in home environment

How the Team will work • • • Caseload of up to 18 patients across the team Sit alongside Community Recovery Teams, Crisis Teams and ICM function. Ability to scale support up or down considering mental state, risks, ability , rehabilitation goals and recovery capital. Build or improve ability to manage ADLs such as Self Care, Shopping, cooking; laundry Building confidence, Community / Social Integration. Medication administration and Concordance Understanding of illness and illness management. Relapse prevention. Improvement of mental and physical condition. Maintain safety and manage risk. Opportunity to look beyond survival but build hope

How the Team will work • • • Psychological Interventions such as Anxiety Management, Distress Tolerance; Motivational Interviewing ; Behavioural Activation ; CBT etc. Structured activities to encourage lasting community engagement. Link with Social and leisure groups , recovery focussed psychosocial groups. Confidence building and promoting hope, often we hold the hope until Patient is able to gain enough self-belief to garner their own hope and identify their strengths. Support in managing harmful habits such as harmful alcohol use and illicit drug. Good quality, safe housing with right level of support. Support and recovery plan to include, family, carers, partners, friends. (Open Dialog) Tenancy support with finances, rent, bills, benefits. Involvement with peer recovery groups. Opportunity to learn new skills , regain lost skills, to stay in job , maintain job.

How the Team will work • • • Rehab plans developed with patients and carers using Dialog model and delivered across the ream Active rehab - if patients are deemed to have no rehab potential or fail to engage during this period they will be discharged from the service back to community teams and encouraged to come back under specific circumstances. No limit on how long the service is provided for or how intensive it is whilst patients are being rehabilitated - can be multiple visits a day, or in contact with service for 1 year +. Regular reviews of progress against rehab plans Discharge from service when rehab goals are met or no continued progress is being made/no further rehab potential is identified. MDT decision with patient and carer involvement.

Solent Staffing structure for community Rehab Job Role Grade WTE In Post Recruitmen t Psychologist Social Worker Clinical Manager Senior Nurse Occupational Therapist Occupational therapy Aid Senior support worker Admin 8 a 1 0 At Advert 6 1 0 Appointed 7 1 In post 6 1. 5 In post 1 WTE Appointed 6 1. 6 In post 5 1 Not recruiting for 1 year 3 2 In post. Appointed 3 3. 5 In post 2 WTE Appointed 3 1 Peer Recovery worker Non Solent 1 Not recruited to as yet

Referral Sources • • Step up element – linking with Intensive Case Management to review whether service users receiving intensive support over a period of time have rehab potential. Discharge from acute – the service can in-reach into acute wards to begin to develop rehab plans, or following referral from HTT 3 day follow up visits. Acceptance criteria: Adults aged 18 + with a diagnosis of severe and enduring mental illness who are registered with a Portsmouth GP and able to identify rehabilitation goals and are willing to engage with the support on offer. Exclusion criteria: Forensic cases that are not ready to return to the community or require more specialised service, e. g. those high risk to others.

Specialist rehab provision linked to bed closure: • • A small number of rehab beds are still needed, where home treatment would not be clinically appropriate, or where individuals have lost tenancies prior to an acute admission. A new partnership arrangement with Two Saints will provide xx supported living beds with a specific focus on rehab. Housing benefit will cover accommodation costs, and Two Saints support staff will supplement the work of the community rehab team by implementing rehabilitation plans in a suitable rehab environment. The community rehab team will develop rehab plans and provide in-reach support to the accommodation, and follow the individual in to the community as required. In cases where patients need more specialist rehab interventions or more intensive medical interventions, a budget to cover spot purchased provision has been set aside. In the longer term these patients would be included within the PSEH shared base model

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