Independent investigation into the care and treatment of Mr Y

The trust to develop a stable, cohesive, well-led and nurturing multi-disciplinary team within Lambeth Community Forensic Team, addressing three areas: Staffing profile Performance and Cultural Ethos

Actions to achieve recommendation:
- Staffing ProfileRecruit Band 7 Advanced Practitioner (Aim: improve service systems, structures, staff supervision, support, caseload management). Evidence of Completion: The Lambeth Community Forensic Team Band 7 Advanced Practitioner has been in post from 1/8/22. The service has seen an improvement in the quality and number of supervision sessions with a 100% compliance of team supervision in June 2022. The Advanced Practitoner also facilitates complex caseload discussion with clinical audits. In addition the Advanced Practitoner has oversight of the induction of new starters in the team.
- Staffing ProfileRecruit two Band 6 Registered Mental Heath Nurses as Care Coordinators (Aim: Increase care coordinators within the team, reduce caseloads and support the duty management rota). Evidence of Completion: Whilst substantive posts are being recruited into, two additional locum staff are now in post to reduce caseload numbers. The caseload review aim is to achieve a reduction case load of 20 per clinician to enable face to face contact. Audits of zoning and face to face contact (in accordance to the Teams protocols) are completed by the Advanced Practitioner. Robust systems are in place to ensure continuity of care coordination led by morning planning meetings, daily review of zoning and allocation of daily duty tasks.
- Staffing ProfileNational challenges to nursing recruitment documented in the Directorates risk register with mitigations including; Trust Volume recruitment, allocated Human Resources support and monitoring of vacancies and evaluation of reasons for leaving. Evidence of Completion: Recruitment into substantive posts. All recruitment options discussed with Human Resources which include, secondment opportunities, Band 5 nurse development and staff rotation. Ongoing review of Care Coordinators case load sizes with the aim of a reduction to 20 service users.
- Staffing Profile Monthly reflective practice facilitated by psychologist (Aim: all members of the MDT to have documented reflective practice including discussion of complex clinical presentations). Evidence of Completion: Documentation and monitoring of monthly multi disciplinary team reflective group attendance. This dedicated space focuses on the discussion of complex cases, treatment reviews and mutual support. All escalations are to be immediately escalated to senior managers for support and resolution.
- Staffing Profile Ensure Team members receive 1:1 supervision and annual appraisal (Aim to ensure that all staff from the MDT have monthly supervision and have timely support for complex clinical presentations). Evidence of Completion: Trust appraisal and supervision data recorded on Trust system (LEAP) The team has been at 100% compliance for supervision since June 2022 with all staff having had an appraisal monitored by the new General Manager position. Staff supervision providing a dedicated space for the early identification of risk as well as being a supportive space to problem solve and escalate when necessary.
- Staff Profile Mobilisation of transformation plan (Review of MDT establishment to include Psychiatry Medics, Psychology, Occupational Therapy and Support Time & Recovery Worker). Evidence of Completion: Recruitment to additional MDT positions post establishment review to reflect Community Transformation aims. Appropriately resourced team will improve patient safety, quality of care, staff satisfaction/wellbeing, improving patient outcomes, recruitment and retention.
- Staffing ProfileUndertake skills mix audit of staff (Aim: to ensure that the MDT has the right staff/skills to provide clinical care to complex forensic patients). Evidence of Completion: Completed gap analysis and action plan, included in Community Transformation programme to reflect staffing requirements for the service.
- Staffing Profile Tailored team training developed from training needs analysis (Aim to ensure that all staff in the MDT team has the skills in line with their job description). Evidence of Completion: Completion of training action plan and staff professional development plan. Training and development needs discussed in appraisal and monitored in supervision . Desired outcome of training plan measured by key Patient Safety outcomes such as complaints, incidents, patient satisfaction and staff recruitment and retention. August Mandatory training compliance within the Lambeth Community Forensic Team for August was 89.34% with the Trust target of 85% factoring in staff sickness and long term leave.
- Performance Monitoring of KPI compliance in Care Plans, Risk Assessments, SLT/General CPAs, 1;1 contact with patient, Zoning (clinical system where a caseload of patients is assessed is assessed into zones according to levels of support they need) and Conditional Discharge reports, (Aim to ensure that the team is compliant with Key Performance Indicators). Evidence of Completion: Compliance monitored by Team and Directorate Improvement and Quality and Performance Meetings. General Manager in post to ensure compliance and assurance.
- Performance Monitoring of HCR20 risk assessment compliance (Aim to ensure that ongoing risk events are documented with risk formulations in place). Evidence of Completion: Quarterly audit of HCR20 and risk events completion with additional training provided should there be any gaps in quality.
- Performance Reduce Care Coordinator caseloads to 20 (Aim to ensure that all Care Coordinators have a caseload allocation that enables staff to safely manage the care and treatment required for each patient). Evidence of Completion: Reduction of Care Coordinator case load size to 20. Case load audits including assurance of face to face appointments as per patient zoning requirements. Increased supervision and complex case discussion to safely manage patient care and treatment.
- Performance Daily planning/zoning meetings (Aim: To ensure patients receiving the correct interventions and discussion and planning of complex clinical presentations). Evidence of Completion: Daily team meeting to plan and discuss complex patients and zoning and staff concerns and a debrief meeting at the end of the day. Team meeting minutes. Example of zoning documented on LEAP (Trust supervision system) and Tendable (previously known as Perfect Ward) action plan reviews discussed and
- Cultural Ethos Team Development Day (Aim To ensure that MDT staff are supported to achieve Key Performance Indicators and aims of the service and to implement Community Transformation plans with staff involvement). Evidence of Completion: Advanced Practitioner to provide induction for new staff, including Key Performance Indicators. Team Development Day to include discussion of Key Performance Indicators.
- Cultural Ethos Complete Tenable audits (previously know as Perfect Ward audits) for Clinical Safety, Staff experience, Patient experience, Physical Health and Environment (Aim to ensure that the team are compliant with the schedule of audits and quality oversight of action plans). Evidence of Completion: Compliance in completing Tendable audits, evidence of action plans and quality oversight by matron.
- Cultural Ethos Relocation of Team from Lambeth Hospital to Marina House in the Maudsley Hospital Site (Aim to ensure that staff have offices that are fit for purpose and staff are located in a modern offices with enough space to meet the teams needs, this will have a positive effect on staff well being and recruitment and retention). Evidence of Completion: Team relocation planned for 2023 and staff satisfaction to be monitored in staff supervision. Staff retention rates and staff survey responses to evidence improvements following relocation.
- Evaluation External review of action plan undertaken by Oxleas NHS Foundation Trust (Aim to review, monitor and evaluate team progress against the action plan). Evidence of Completion: Oxleas NHS Foundation Trust to review action plan compliance and assurance including staff engagement and feedback in relation to action plan assurance.