Members event recording

Members' Event - Clinical Quality Priorities-20240227_110350-Meeting Recording

February 27, 2024, 11:03AM

54m 50s

Marcel Berenblut   0:05
Well, good morning, everybody. And as you just heard, this meeting is being recorded.
So I hope that is OK for all attendees. We have a slim attendance in the meeting today, but this meeting will then be posted on our website. So we hope that more people will be able to benefit from watching it at a time that is convenient to them.
Really excited that this is our first members event of 2024.
The schedule for members event for the year.
Has been published in the latest edition of partnership people, which was sent out to members a few weeks ago. I will put a link in the chat now.
To help people find the latest newsletter on the website. But if you are looking for it and you're not in the meeting, then you're watching this on the recording. If you go to our website and go to the Members area and look for the members newsletter, it is in the most recent members newsletter, which is in a new, very easily accessible format.
On Page Six of the newsletter. So let's talk about this particular event and I'm really excited about the topic for today. This was a topic that was originally considered for covering at Member's Day last autumn, but we felt that there was too much to talk about for a quick slot at Member's Day. So.
We thought we'd put it on today, so before I go into the topic, I just want to do the little housekeeping notes piece. Could people keep microphones and cameras off unless they are actually speaking?
So that we keep things as smooth for all the participants as possible. A quick overview on this topic. So each year sorry and borders establishes 10 clinical quality priorities and these are the things that we decide that we will concentrate our efforts on to drive improvements and and now that we have one to support the delivery of our strategy, this event is going to give an overview of the progress against this year's clinical quality priorities and an opportunity to discuss and influence.
What next year's priority areas should be, and I'm now going to hand over to our speaker, Helen Potter, who'll be able to put me right on anything that I've said wrong there about the clinical quality priorities, but to introduce herself properly and to begin the presentation over to you, Helen.

Helen Potter   2:30
Thank you very much, Marcel. So as you said, I'm Helen Potter. I'm the director of quality management and the chief nurse in Information Officer. And that last bit, the cnio means I'm the digital lead for nurses and allied health professionals in the organisation. But today we're talking about quality. I can see some familiar faces on the call and I know you've seen some of these slides last week saying thank you for for coming back to hear it again and apologies for any, any repetition. I'm just going to search, share some slides.
Let me just pop those into presentation mode. Bear with me.
So I'm also joined on the call by Lisa Musselwhite, who's our associate director of Quality and Assurance. I'll let Lisa introduce herself when when she comes on to screen. So in terms of what we're covering today, so we're just going to give a very quick background to clinical quality priorities, what they are and where they sit, the progress against this year's priority areas, the planning process for next year's, as well as the proposed priority areas. And at the moment, we've got 15 proposed priority areas.
And we need to reduce those to 10. So that's really what we're looking for your support here today is to help influence what are the 10 areas within those 15 identified that we should be focusing on there be an opportunity for questions and answers, but please do ask questions as we go through because there's quite a lot to cover. And then there's a survey which we will share in the chat at the end for you to share your views and you can fill that in after the session. There's no pressure to do that within the time.
It's of this of this meeting, so I'm going to hand over to Lisa first to talk us through the background.

Lisa Musselwhite   4:20
Thanks, Helen. Hi, everybody. For those of you that don't know me, I'm Lisa muss whites and I'm the associate director for quality and assurance. And as Helen said, I'm just going to give a very brief background of where the quality indicators actually sits within the organisation. So every year we have to produce a very, very large document called our quality accounts and the quality accounts.
Is basically an account of of the of our priorities priorities over the last year.
But it doesn't just include the priorities for the clinical quality priorities which Helen's going to go into in a minute. It includes lots and lots of different information and there's information there that is set. So we have to report on and there's other information that we choose to share. 'cause we're proud of or we want to share things that we've been working on. So the quality account, it starts off with a review from our Chief executive and they take a look over the previous year to see things that we've achieved and things that we've been working on and a kind of a forward.
Position as well, things that we want to look at in the following year.
We then reviewed the last year's clinical quality priorities and we give a we look for the whole year and get and some just give a summary of where we are and what we've achieved during that time. We then identified the next clinical quality priorities and this is really important and this is a piece of work that Helen's doing now and this is lots of stakeholders are involved in creating these and we have lots of different focus each year. So we can really.
Bottom out. What is it that we want to focus on for the coming year?
As I've already said, we then have lots of other information in it as well. So it's really important that although we have these 10 clinical quality priorities, we do have lots of other priorities as well and we do include those within the report.
There's also statements of assurance from the board as well, so this is the set information that we have to produce. So these would be things like from research from clinical audits.
And it'll be kind of specific data that's required for us as an organisation. And then finally, we get lots of feedback from stakeholders. So as part of the quality accounts process, we have to gather feedback from our Commissioners. We have to gather feedback from our Council of Governors and for a variety of other areas as well, which we include verbatim within the within the documents. So as I said, it's a really, really big document. It's a really important one and it's.
Really nice to see each year.
Where we are and where we're going with our quality agenda. Thank you. Hand it back to Helen.

Helen Potter   7:09
Hey, Lisa. So in terms of the clinical quality priority areas for 2324, I've just listed them there. Those are the 10. I'm not going to read those out because we're actually going to go through each one in the in the subsequent slides. So jumping straight into strengthen carers support, so you can see there's a little sort of tagline as to what we're looking to achieve. So we're looking to say that carers will always be identified and will be offered support.
Now that in itself perhaps might sound quite basic, but we're really looking at getting those brilliant basic set in line with our strategy. So we can then build upon that to say how do we start to embed the carers views and voice, how do we improve consent and ensure that their integral in care planning. So this really is the foundations we need to identify those carers and they need to be offered support so you can see some of the data here that shows the progress actually more than just the last year's. So this goes back to August.
22.
So within the last financial year, so 2324, we have seen a 10% increase in carers being identified and we're identified being offered support.
We've still got a significant way to go that leaves us at around 31% as it stands at the moment.
Of of all of our open referrals being asked the question around carers so clearly whilst there's been a significant improvement, there is more work to do. There has been the development of carers training for staff and that's just over the last couple of months, so we've started to roll that out and there's been significant work on embedding the triangle of care into care into all services.
We've made some improvements on the electronic health record and so you'll see back in August 22. That's when we first launched our carers templates to really allow us to start recording, reporting and monitoring carer related data within the record and that's why you can see us going from nought percent up to where we are today. But we're actually in the process of making further improvements to that so we can incorporate the carers views we're looking at embedding that template in other templates in the pathways.
Somebody does an initial assessment. There's a link right there to be asking about carers, and we're looking to do the same with care planning and all those different steps in the hope that we can really make it an integral part of all of our pathways. And we developed a carers dashboard, so this graph is actually taken from the dashboard. So we now have visibility of where we are, not just at a trust level, but there is a philtre that can be applied on that dashboard. So people can drill right down to a service level level and really see.
Their progress. So there's been a lot of development work.
Around carers with a 10% increase in carers being identified and supported. But as I say, still still more work to do in that area.
The next priority in the current year is improve the way we receive feedback from people. So this is a commitment that people, their families and carers will always feel that their voices are heard. Now this has been a priority for a number of years and sadly there hasn't been much movement in the data in relation to this. We've tried different things we've, you know, put QR codes, we've put posters up, we're really encouraging to get that feedback. But you know, we must be honest. It's not giving us the the results that we would like to see so.
There's more work underway at the moment to explore completely refreshing the surveys to actually separate out the family and friends test, which should be completed after every contact.
From the more detailed feedback measure, which is what we actually report on here, so you know, we would still want that more detailed feedback, but perhaps that could be completed as a minimum of once per episode of care rather than every contact and then really focus on that family and friends test on on an every contact basis. So we're exploring that at the moment and we're also looking at new ways of sharing the links with people. So can we automate and you know, text messaging once an appointment has taken place.
So there's a lot more work going because we're not seeing the results that we want to see in this area.
So improving the flow through our inpatient services. So our commitment is that people will experience an effective inpatient pathway in the least restrictive environment that supports their recovery. And there's been a significant programme of work around our inpatient and flow at the moment. So there's been redesigning of our admission gateway processes, optimising the bed flow processes, identifying the most common admission pathways and mapping the most.

AMANDA EDIRIWEERA   11:48
OK.

Helen Potter   12:03
Effective interventions for them so we can bring some consistency and really embed the learning and good practise across those pathways.
Aligning operational processes to support the discharge pathway, so really making sure that we're working together, strengthening the system, partnership working. So they've actually started a new meeting which I think started around three months ago where we have sort of social services representation from the different areas of the system to come together and discuss some of those more complex cases to ensure that we're removing those barriers to discharge. And we have seen a reduction in the number.
Of people with length of stay over 60 days as a result of that partnership working.
So we are seeing some good results there and we've also got a digital programme of work underway at the moment to optimise those digital opportunities to really put the right information in the right place for people and to automate where possible and just try and join up and give a a really clearview of where someone is in their pathway and preempt the next step. So a lot of work has been going on in that area.
Improving the quality of our care planning so people will have improved outcomes through high quality, accessible.
Co Produce care plans that supports the needs of the person. So with this we actually didn't have a care plan in policy in its own right. We had ACPA policy and it's referenced in many policies, but that wasn't pulled together for one really clear set of guidance for our workforce. So we have Co designed six care planning principles. These have been developed into a new policy which was published in July and there's currently engagement work.
On a divisional level, to really look at the procedures to provide.
The the sort of standards and the how to implement those principles into all of our care planning. There's also work you may have heard of going on around dialogue plus. So there are some sort of more specific things around care planning, but this is that generic quality of care planning across all of our services that we're looking at here.
Reducing restrictive practise in inpatient services so people in inpatient services will be cared for in the least restrictive way will experience a reduction in restrictive practises across all of our inpatient services, and there was a quality improvement piece of work on Rowan Ward and the Deacon unit which saw some really good results and that's now been shared across all services and you can see I think it was actually shared in September and we've seen a significant reduction.
In restrictive practise.
With with the sharing of the learning that's taken place from that quality improvement work. So we have got data that sort of drills down on a on a ward by ward level. But this is looking at all of our inpatient services grouped together and we can see back in April that was 123 in the month and last month it was 51. So that's reduced by over half, which is excellent.
Reduce in sexual harm in inpatient services, so our commitment is that people will feel safe from sexual harm whilst being supported in visiting or working in our inpatient services. So again there has been quality improvement work in this area. There's been the development of a sexual safety policy which is still in development, but that's nearing approval. But there's been a lot of work that's gone into that sexual safety policy. We're looking at a process flow for addressing concerns. So this is active work that's on at the moment.
But with a gap analysis on the sexual safety standards and a plan for assurance cheques around that, there's a big piece of work still underway to really understand, you know, where the gaps are.
And and to ensure that we've got the right assurance cheques in place, we are also focusing on addressing concerns about incidents that are not being reported to the police and the investigation process as well because we know that you know the the ones that we're reporting on aren't necessarily all of the concerns that are going on in those areas. So we're conducting a survey across all inpatients for their feelings about sexual safety on the ward, to really try and get more insight as to.
Where we are at the moment in the areas that we really need to be focusing on.
Improve risk assessments so people will experience a new risk formulation process which will provide a greater understanding of what influences their mental health and well-being. So we always used a risk stratification process. So that was your sort of high, medium and low risk and there was a change in the Nice guidance last year actually year before last now.
The set you know, recommended a shift to a more dynamic risk formulation. So we have introduced a.
Broader formulation of risk with a simplified version of the five PS. For those that don't know the five PS it is a recognised model that looks at really 5 PS. So what are the precipitating protective and I'm not going to try and list them all because I'm going to forget them, but there are five PS that really kind of break down what we're looking for in relation to risk. So that was Co designed, built and piloted last October and then rolled out to all services in January.
So literally just last month with that roll out has come bespoke training. So we had. So this is by the end of December, the data I've got at the moment. So we were nearing half of the workforce that required that training having completed it by December and were on track to have everybody trained by the end of this financial year. The survey attached to that training showed that there was an increase in staff's confidence.
Following the training, so from this was on a scale of 1 to 10 and confidence levels increased from 6.8 to 8.4 following training. So that was very positive and initial indications are that it's been very well received by staff, but we need to really be able to assess how that's being received by people who use our services and their carers and being sinew. We don't have the data to share that and that's the ongoing work that's happening as we speak.
Improved physical health cheques so people will experience a reduction in health inequalities through improved physical health monitoring. So there was a lot of work that went into the development of a new physical health template which went live last October and that replaced a vast array of templates that were being used across our services with some inconsistencies across those templates as well. So we've consolidated all of that into this one, hopefully easy to access.
Template that's being used by all services and what it does is not only brings all of that physical health information, I should say from Surrey and borders, not across the system, it's all of the physical health information across the different services within Surrey and borders into one place. It provides a really clear visual aid for the clinicians to know what cheques have been completed, the date they were last completed, what might be due and there's graphs in there to really start to shame the trends and support.
Decision making.
And we've also, we're working on a dashboard at the moment, so we can really start to drill down into what areas of people's physical health are we identifying and addressing and perhaps where do we need some more targeted work. So there's a lot going on to really now drill down into this data to give us the insights that we need to to really improve quality and practise in this area.

Jane Margaret Owens   20:29
I'll.

Helen Potter   20:30
And sort of really identifying where things are going. Well in our inpatient services, sharing that learning across and bringing a consistent approach and positive outcomes noted. We've had more accurate documentation, reduced duplication, improved patient experiences, particularly at night is the feedback that we're getting. So the data has showed higher scores that we're seeing and you can see we've improved our audit by 20.
Two. Well, I'm going to call it 23% by December end. So we're seeing some really positive outcomes from.
The focused work and the shared learning around supportive observations.
This is the last one, so bear with me. Improved outcomes and we're referring to dialogue, which is an outcome measure and goal based outcomes goal based outcomes is currently used in our in our children's adolescent services. So our under eighteens and dialogue is what we're using for our adults. They're not exclusively used, but that's how we're using them in the trust. So our commitment is that people will have an improved quality of life by receiving solution focused therapeutic interventions.
Through the implementation of dialogue and depending on the age goal based outcomes. So in our under 18. So with our goal based outcomes, a solution has been developed and rolled out to SIP services and you can see that that was actually rolled out in October. So we've gone from you know very little data to increasing quite significantly month on month where we were up to 27% having at least one pair down.
And by the end of December, but what's really positive here is when we look at those paired outcomes, we were consistently from day one exceeding the target of 70% improvement. So more than 70% of children with a paired outcome showed that they were improving following the interventions being offered. And I think it was actually around sort of 80%. So we were exceeding that target quite significantly in terms of dialogue, there's been a lot of design work underway for solutions around how do we send the dialogue forms out, how do we.
That remote completion and pull that back into our system to be able to use it to inform those therapeutic interventions and there's developments of sort of dashboards for reviewing that. But that hasn't gone live across services yet. So we don't have the data to share with you on that part. But we are, we're getting close, we're getting close with that one. So I'm going to pause there because that is the feedback on our progress against this year. So I'll pause for any questions.
And then I'll take us on to the planning and the proposed priorities for the coming year.

Jane Margaret Owens   23:26
It's my pleasure.
But it's my.

Helen Potter   23:30
Do we have any questions at all? I can't see hands and I can't see people, so please do shout if there is anything.

Jane Margaret Owens   23:37
Be lots of bloody things, but I don't what it is.

Helen Potter   23:43
OK.

Hayley Brewis   23:43
Really. I will get. Janice has her hand up. She has a question.

Helen Potter   23:48
Oh, please do Janice jump in.

Janice Clark   23:51
Thank you. In terms of the measuring quality improvements, as you know, there's new statutory guidance around discharge from inpatient mental health inpatient care. And I wonder if that shouldn't, is another indicator that we should be added to the list of performance improvements that we should be looking at?

Helen Potter   24:12
Yeah. So behind all of these are a host of measures that we are monitoring. I think 'cause, we're just given a very brief overview here. I know certainly for this year's, we're keen to to really nail down what the different sort of ambitions are under each of the priorities, which again I haven't been able to go into detail here. And then what are the measures to ensure that we're achieving those ambitions? So we can really measure ourselves and our progress against that. But no, that that's great. We'll certainly make certainly make sure that's embedded.

Janice Clark   24:20
Yeah.
Hmm.

Helen Potter   24:44
Janice, thank you.

Janice Clark   24:45
And and just the and the second bit to my question is, is there some work going on around adapt? Which is the common language for based developing a common language? But I've had some difficulty in requesting that it embraces all the carer data as well. So do you have a view about how carers data actually features within the ADAPT programme?

Helen Potter   25:12
Can I just do you mean dialogue? Plus when you're saying adapt because adapt is the digital, OK, so adapt is our digital, it's our yeah, OK, because people often do combine the two. So we actually have a service user reference group that's meeting that I know.

Janice Clark   25:16
No, I mean, I mean adapt.
Yeah, I mean adapt.
Yeah.
Yeah, I I sit on it. I sit on it, Helen.

Helen Potter   25:34
Oh, you're you're on. OK, fantastic. So.

Janice Clark   25:36
I've had. I've had difficulty in them understanding.
Importance that carers are seen also as a discreet group.
And I just.

Helen Potter   25:48
To be to be separate from people who use our services. You're saying that it's sort of grouped together in adapt, is that?
Sorry, Janice, I can't hear.
I'm. I'm just going to respond to what I think you're asking.

Lisa Musselwhite   26:04
I think I think Janice is frozen.

Helen Potter   26:07
OK, sorry. I'll respond to what I I believe Janice is saying. So we do have a user reference group and that does combine people who use our services as well as carers as well as any interested members of the community. It is open to anybody to attend to really influence the transformation of our electronic health record under the ADAPT programme. The insights from that forum feed into our clinical design authority and our clinical design authority is made-up of.
Multidisciplinary team that represents all divisions.
And they come together. There is the the chair of the of the service user Reference Group sits in the Clinical Design Authority. They also sit on our programme board so that that's kind of how it's anticipated that the voice of carers is is embedded and integral as well as the voice of the clinician people who use our services to really drive the digital prioritisation, the digital design work solutions and and the roll out of of all of those changes.

Raj (Guest)   26:48
Wow.

Helen Potter   27:12
So I know that's our structure. I'm I think what I'm hearing from Janice is there's a concern that carers aren't seen as a as a separate group on their own, and I'm certainly happy to pick that up with you outside of this, Janice, to have a conversation around how we may want to address that. But I know certainly the voice of, you know, the the community, including people who use our services and carers is very strong and influential throughout the ADAPT programme. But I hear what you're saying about perhaps that needs to be separated down further. So I'll pick up with you outside, Janice, if that's if that's OK.
I'm gonna move us on. I don't know if Janice has come back, but do jump back in if there's more we want to to mention in relation to that.
So I'm going to take us on to the clinical quality and priority planning for 2425 and just I'm not going to go into this in great detail. We could almost have a whole session on this alone. So if you give me while I give a bit of a whistle stop tour, but we have identified a new quality management system and what this really does is ensure that we're looking.
But you know quality, well, main how we maintain quality, the quality improvement, the quality planning, wrapping, wrapping, the quality assurance around as well as focusing on relationships, Co design, Co production. But at the centre of all of that is the learning how are we taking all of the learning from all of these things to really drive forward quality in the organisation. So we've adopted this model which has the four main domains of quality, quality, our quality management. So I've just kind of really run through those there.
Ensuring that all of those quality domains are working together. So for the purpose of this, we're in the quality planning stage and this really means that we want to, you know, understand the evidence base. We want to understand the needs of the the population. We need to obviously decide on what the priority areas are, and we need to design the sort of structures and processes to enable those needs to be met. This is something we generally do on an annual basis.
But it can be done at any time when there's a, when it's clear that there's an unmet need in the population, but generally speaking, it's on an annual basis and that's the phase that we're in at the moment, that sort of annual planning for what are the priorities for next year. So how do we come up with the 15? So these have been informed through numerous insights gathered from clinical audits and data analysis. We've also looked at our progress against the current years priorities and sort of pulled those forward.

Jane Margaret Owens   29:47
Oh.

Helen Potter   29:52
Where there's further work to be done.
Themes identified in Psif and Psef is our sort of incident management framework where we look at the themes in the learning out of anything that hasn't gone so well within the organisation, any incidents, those are sort of grouped into themes and we've taken those into the planning for these priorities, themes from complaints as well as compliments as well. But we've focused obviously on the themes that come in through where there's that dissatisfaction and perhaps things we need to be improving on.
As well as insights from staff people who use our services, family and carers as well, and we've taken a slightly different approach to the insights from people who use our services, family and carers this year, because I know previously we have hosted an event but they've not been particularly well attended and yet we have a whole suite of engagement forums that run throughout the year with, you know with, with Healthwatch, with focus, with the Care Action Group. We have all of these great.
Management opportunities where we're hearing so much useful information and we've actually taken the themes across all of those forums across the year to bring that, you know, a more robust voice of that cohort into these priorities. We also take the themes from your views matter as well, which is the feedback survey I was referencing earlier. So we've pulled all of that together. We've aligned it to our strategy, so.
So in that, you know what we're proposing is really delivering against our our ambitions and we have come up with 15. So again, I'm not going to go into a huge amount of detail. I will take sort of questions at the end, but it's these 15 that we need to drill down into 10 and we've got a survey that I'm going to share at the end, which is an opportunity for you to sort of rate how important or relevant each of these are to you.
You don't need to rate all 15, you might just say do you know what I really wanna just say that these three are particularly important or these three are are really not important and that won't skew the results because we take an average of the rating against each one where there's been a score. So don't feel you have to score all of them, but any insights would be gratefully received. So improving risk assessment. So you've heard about the work that's gone on in the current year about introducing that five piece model.
And we would like to take this further really just to to monitor the quality of the completion of that new risk assessment to further engage with people who use our services to get the feedback and sort of just make any tweaks as needed throughout the year because we've had the development this year and we're proposing that this carries forward to next year to really kind of monitor track and and sort of refine that approach.
Improve the flow through our inpatient services. So again, we've heard that this is a priority in the current year and we've just heard from Janice that perhaps we need to be looking at some of the different measures there. This is always a priority area and I think the demand is so high and it's so important that we, you know, we're really keen to get this right and make it as streamlined as possible. And there is more work we could do to bring improvement in this area despite the significant steps that have been made. So this is going to have a very similar feel.
The current priority, it's really just continuing that work.
Improving the quality of our care planning. So again you'll have I've already covered that this was in the current year where we've now identified those principles, but there's further work to really embed those principles into practise, really give the guidance on the how, see if we can bring some consistency. What we're finding at the moment is there is a lot of different ways or or tools that people are using around care planning and we need a mechanism to really understand what all of those are.
Identify where it's working well and kind of share that learning.
Across the organisation so there is more work here. This also comes up in in some of our complaints in our feedback around people, you know, not experience and not experiencing high quality when it comes to care planning.
And again this I've already covered this one, so this is just continuing the work that's underway this year. I should have said actually the box at the bottom is the alignment to the strategic ambitions. So I'm not covering that, but it's just to kind of show where it would be delivering against our strategy against each of these.
Communication. So this is a new one and this has been identified through that incident management framework that I spoke about and it was also the highest theme from our complaints in 2324 to date.
He accounted for 26% of our complaints and 20% of our concerns raised through pals and and this is both internal and external communication. But we're seeing this coming up in both dissatisfaction but also in our incidents as well. So we're proposing that as a priority area.
Physical health cheques. Again, we mentioned that this, this one in in the current year, but it has been a theme through the incident management and from feedback. So this was from some of the your views matter I think it's come up as a theme through Healthwatch as well. So we're still hearing that there's a lot more work to do in relation to improving physical health cheques. The proposed change here from the current year is that we want to have perhaps a specific focus on Community services at the moment. It's across all services.
And we believe we need to to drill down into Community services to really get that right. It's where the highest volume of people who use our services are. But also I think we're actually doing this reasonably well in the inpatient setting. So we want to be able to focus on the Community areas in this financial year.
Access to service. Oh, access to services. So this has been again identified through and the incident management and through feedback being able to know what services we have and how to access them and to to get that access as and when it's needed. And there appears to be some blocks for people there at the moment. We'd like a focused attention on this.
Transition between services. This again came through instant management, so this is when somebody are transitioning from one service to another. We typically think of children reaching 18 and transitioning from children's services to adults, but it can be transitioned across any services from inpatient to community, from primary care to secondary care. You know from, you know, in and out of specialist services that we may run. So this is all of those transitions between services that we're looking at here.
Reducing restrictive practise, so this is one that we've got in the current year, but this actually came up in two of our clinical audits as an area for improvement. So the the specific areas in the clinical audits would sort of adjust the measures and the focus of this, but it would sit under that same overarching priority.

Marcel Berenblut   37:26
Helen, would you consider taking a question from Katie? I'm sorry to interrupt you. Go ahead, Katie.

Helen Potter   37:29
Yes, of course, yes.

Katharine Nurse   37:32
Thank you. Hi, good morning. Just going back to communication.
With.
Say with speech and language therapists, they don't have the equipment they need to go and do proper assessments. They don't even have iPads.
Let alone the the software.
What are we going to do about that? Because we've got speech and language therapist wanting to leave because of it.

Helen Potter   38:03
I mean, again, something that perhaps we can I can reach out to you after this session to understand that a little bit more. I think if communication were to be one of the sort of top ten, the very next thing we need to do is really drill down and understand what are we going to be delivering and perhaps you know we'll be taking all of this these insights not just what's included on the surveys, but all of these comments. So you know we can put that forward. Do we need to have an understanding of of what equipment and.
You know, perhaps it might include staff training equipment.
If the tools needed in order to support positive and effective communication, so that may well be something that we want to have in the sort of layer that sits under communication. So I think if that's an insight that you obviously you're sharing with us here, we will, we will take that forward and I'll be interested to know more about that.

Katharine Nurse   38:56
Because it also goes across transitions as well.
Transition.

Helen Potter   39:01
I think.

Katharine Nurse   39:02
From from school to adult services, if you haven't got the communication, people are losing their communication because we don't have.
The support.

Helen Potter   39:15
Yeah. And I think what you're picking up there in the overlap between two of these priorities is feedback that we've that we've had or just last week in fact on a lot of these have interdependences between them and it's almost like, well, if you don't do that, how effective is that going to be? And if we, you know is, is that not quite similar to this? And I think you know, once we once we get all of the feedback, we'll be looking at how maybe some of these need to sort of group together or really work to complement each other as well. And I think that overlap is is absolutely there.
And like you say, communication within transition is.
Is essential as well.

Katharine Nurse   39:51
Thank you.

Helen Potter   39:53
Thank you.
I'm just gonna take us back to. We just got to strengthen in and carer's support again. I think I covered that in this year's one, so I won't go into too much detail. There's been a lot of work, not just in the current year but in the previous several years and it's about how do we take that further and build upon that work to to really get us to where we need to be in supporting our carers.
Improving the way we receive feedback, again, you could see this is one that we've had as a priority for a number of years, but we're just not.
Getting the feedback that we need, I think we've done a lot on a lot of work on ensuring that we weave that feedback into decision making and we take the learning. So there's been some really great work about what we're doing with the feedback in the insights, but it's the volume, it's the volume of the feedback that's still lacking and that's what we really want to focus on.
In in this coming year.
People waiting for services. So this is people on waiting lists for perhaps beds or for assessments. It's really just waiting for for any intervention. How do we support those people whilst they are waiting? This is something that has come up in our incident management framework, but also it's our second highest theme in our complaints and our concerns raised through Powell. So we've added this as a as a potential focus area.

Lisa Musselwhite   41:26
Hi, Helen. We just got another hand up.

Helen Potter   41:26
And.
Yeah, go ahead.

Lisa Musselwhite   41:29
It's so Raj.

Raj (Guest)   41:33
Basically I'm more in contact with older adults through the Alzheimer's Cafe, and one of the concern of the carers or relative was.
The the information changes in in how you are dealing with because they said they are only just given a telephone number to contact if there is any issue.
I think there is a cultural change from when I was the memory clinic nurse where, you know, we we used to support the carers.
By opening the channel communication now the just given telephone and most of the carers are in their 70s and I have brought it in in issue with Joe Lynch and she is going to talk with.
The Camberley Alzheimer's Cafe lady so that she can come and talk to the carers. I think it's important the communication in all areas but older adults there, there are under lot of stress.
As a Canada, you know and there need to be some form of.
Governance on on communicating with carers.
This issue came about during COVID, so I hope things have improved now that that the family was waiting for for the prescription and things and to to be seen by the psychiatrist and they went private all the way to Southampton from Frimley and I I I feel embarrassed about it, but that was COBD and I hope things are improving.
And I hope to be involved with the memory clinic in this area so that I can take the message back. Thank you.

Helen Potter   43:17
And it's good to hear that that feedback obviously has been shared with Joe who, who no doubt will be in touch with that service. But I think in terms of carers who are older, we actually have now with the new carers templates have a way of identifying both young carers and older carers as well. So what that would allow is the foundations there in our electronic health record to really build, do we need to have any kind of different pathways, any different methods of communication, any different levels of support.
So the fact that when we're identifying carers, we are identifying both the younger and the older cohorts. Again, this year has been a lot about laying down the foundations and getting those brilliant basics so that we can start to build upon that and say what do we need to do differently here. So that's really good feedback. Thank you.
Just gonna take us back. Where did I get to? I think I was at supportive observations and and again I've spoken about this one. This is a current priority and really, the proposal is about continuing with those improvements and making it consistent. You know, getting the the same level across all of our inpatient services.
And again, this is one in the current year. So you can see there's been some great steps in relation to goal based outcomes, but that was only rolled out in October. So there's still that kind of embedding monitoring assurance piece that we need in relation to that. And how are we using that data to really drive the interventions, the care planning and so on. So there's a lot more work to do around goal based outcomes and dialogue is, yeah, still in that development phase. So the.
The proposal is that this would continue.
Into the next financial year.

Lisa Musselwhite   45:12
There's another hand up.

Helen Potter   45:14
Yeah, go ahead.

Janice Clark   45:18
Hi. I'm sorry it was in relation to what Raj was saying, really. I'm sorry it's you've moved on a bit since then but.

Helen Potter   45:24
No, no. Can't bring us back. That's fine.

Janice Clark   45:27
Yeah. Well, on Thursday, I think it is, yeah, Thursday.
The there's going to be the launch of no, no, wrong doors, which is the national memorandum of understanding for young carers and within it there is guidance for mental health services as well. So we'll have something more formal to to work to in terms of pathways for young people.
So I thought that would be quite helpful.
And I've I've also then, because my Internet went down, I have sent you an e-mail around adapt because I've got a meeting tomorrow and I wanted an answer really to take to the meeting to meeting. So I'll send you an e-mail. Thank you.

Helen Potter   46:05
Will.
I will certainly look at it today and I'll respond to you by the end of the day. Thank you, Janice.

Janice Clark   46:15
Thank you.

Helen Potter   46:17
So let me just bring us back. We are nearly at the end, so bear with me. So improved physical health monitoring post rapid tranquilisation. So where we said with the physical health cheques that we wanted to have a focus on community what we wanted in our inpatient services was really a focus on that physical health monitoring where there has been rapid tranquilization. And this I believe came up in one of our our quality absolutely clinical audits.
As an area that required improvement. So again from the insights from the clinical audits, we've added that as a proposal here for a focused piece of work in the coming year. So that is the 15.
I'm going to pause. I'll. I'll leave this on just for a moment. If anyone wants to grab the QR code, but I'll ask Hayley just to share the link in the chat as well. Both the QR code and the link will take you to a survey which allows you to specify how important or relevant.
Each of those 15 priorities are for you, and it is about you and you personally. There's no right or wrong answer. We're keen to get the insights of as many people as possible. And as I said, you don't need to fill in all 15. There might be a couple that you particularly want to flag or have strong feelings on, or you may want to share your sort of initial thoughts in relation to all of those, and we will welcome any feedback that you have. But this is also an opportunity for any any questions, yeah.
General discussion.
I'm gonna stop sharing my screen. Hopefully this is gonna come back into the room so I can see you all. There we go. So is there any? Oh, we do have some questions. I can see some hands up there. Oh, they've disappeared. When I clicked on the list. No hands up. Sorry.
Did anybody have any questions they wanted to ask?

Hayley Brewis   48:14
Hi, Helen. It's Haley. I just wanted to jump in quickly and say I think that the questions that were on the chat and the hands have already been acknowledged. I have put that form the link to the form in the chat for you as well.

Helen Potter   48:31
Thank you. And equally, if you wanted to to share that information and ask for other people's feedback, if there's a forum you go to that you think this would be useful to to get more feedback, please do let us know. We are looking at doing this within the next couple of weeks. So you know, inviting me in April probably wouldn't be beneficial in terms of influence in that year's priorities, but we're always happy to engage and and sort of share the insights, the processes, the you know.

Hayley Brewis   48:32
Thank you.

Helen Potter   49:03
Getting any information that people have that can help influence that process, so yeah, please do reach out.
Amanda, do you want to come in?

AMANDA EDIRIWEERA   49:15
Oh.
Hi, can you hear me?

Helen Potter   49:18
Yes, I can, yeah.

AMANDA EDIRIWEERA   49:19
OK, wait. Yeah. I'm a retired staff member of the Trust.
I retired about four years ago, just before the pandemic, and I was just wondering, I mean, I'm really pleased to see that the trust is considering one of the priorities being people waiting for services.
Because when I was working, the neurodevelopmental service was something that had been a long standing issue about waiting times and I think.
You know, if that can be got on top of.
It has a really strong knock on effect on men.
To help set you know on the services that are provided.
But I was just wondering about clinical improvement and how it relates to staff well-being. I wondered whether there were sort of separate quality measures for staff support and well-being.
Whether the trust?
Anything, because a lot of the clinical improvements obviously do rely on good quality staff who are not feeling burnt out or stressed, and that was something, you know that I think when I was working a lot of the staff you know were very sort of positive about new developments. But the on the negative side was, Oh my gosh, how am I going to find the time to do this recording of monitoring as well? And I wondered whether you get feedback from staff of when you introduce these sort of new?
Tools.

Helen Potter   50:48
Yeah. So I mean, we do what? We'll be, what we will be looking to do is when we've got the sort of 10 priority areas, we'll be working with our quality improvement team to to sort of look at a line in their road map if you'd like for the next year to support the delivery of these ten quality priority areas that will then ensure that we've got that additional resource to really go into services, understand what's needed, what's the best approach, but also assess the readiness as well. And we do look at readiness.

AMANDA EDIRIWEERA   50:48
How it's received?
Hey.

Helen Potter   51:37
We're going out and understanding what's happening in the services there. You know, a high absence at the moment, we might want to wait until the staff in them. So we do factor all of that in. That's easier when we've got our quality improvement team really engaged because they obviously go in with that specific focus. But we are always very mindful of the service readiness for for any changes coming back to that overall staff well-being. We do have the staff survey, I'm sure we had that when when you worked with us, Amanda, and we do look at the sort of the where we are in the themes and trends around you know what what our staff.
What our workforce are telling us in that survey and we also the questionnaire that I've shared in the in the chat here.
It's also been shared trust wide as well for people to have an opportunity to sort of feedback from a staff perspective, what's relevant to them and an opportunity to comment against any of those as well. So we are, we are looking at factoring that in, but when we're actually doing the improvement work really, it's that readiness that we're that we're looking at to say, is this going to be workable. We also really try and make sure that we're not just adding things on to the staff in duties that whatever we're introducing brings efficiencies.
So really making sure that we're, you know, taking away something that they're currently doing and replacing it with something better rather than adding on. So we're we're mindful of that looking at the kind of efficiencies that the changes are bringing. So it's a balancing act, but it's getting all of those things lined up.

AMANDA EDIRIWEERA   53:14
Right. Great. Oh, thank you. That's good to hear. Thank you.

Helen Potter   53:19
I can't see any other. Oh, was that another thing that was Amanda again? No, I can't see any other hands going up.

AMANDA EDIRIWEERA   53:24
OK.

Helen Potter   53:29
Marcel or Hayley? Shall I pass back to you? To to close the session?

Marcel Berenblut   53:37
Thank you very much. So thank you so much for that presentation this morning. It was really helpful enlightening and I hope people take advantage of the form to give their thoughts and feedback to help us improve the process.
Our next Members event is in June on the 27th of June at Chertsey Hall from 11 till one, so that is in person, which is very exciting. The topic is emotional based school, non attendance.
And the school based needs team will also be at that event. I hope to see many more people at that event than we had today.
And if you enjoy this event, please do tell other people about our programme of events and how they can find it in partnership people and direct them to our website to find that. I'd like to really thank the organisers, particularly Haley and the presenters, Helen especially.
Thank you all very much for coming along today.
See you in June.​​​​​​​

Raj (Guest)   54:46
Thank you.

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