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A set of eLearning modules designed to educate and update clinicians on the importance of involving families wherever possible during mental health crises to improve patient care, avoid harm and reduce deaths. They were developed as a partnership between Oxford Health NHS Foundation Trust and Making Families Count, with funding from NHS England South East Region (HEE legacy funds).   The resources have been co-produced by people with lived experience as patients, family carers and clinicians, supported by an Advisory Group drawn from a wide range of expertise, tested in eleven NHS Trusts and independently evaluated.   The resources can be downloaded by NHS Trust Learning and Development teams to support a Trust-wide approach to essential learning and training.   Through short film and audio scenarios and case studies, Life Beyond the Cubicle shows why it is so important to involve family and friends, helps clinicians reflect on why they don’t do so routinely, and how they can overcome these barriers. The resources are engaging and interactive. The modules are: Introduction (includes guidance on how to use this resource) Module 1: Why do families and friends matter? Module 2: Assumptions and expertise Module 3: Feelings and fears Module 4: Confidentiality and Information Sharing Module 5: Safety planning Resources for family and friends They are free to the health and social care workforce. Further reading on the hub: Safer outcomes for people with psychosis Patient Safety Spotlight interview with Rosi Reed, Development and Training Coordinator at Making Families Count The future has been around for too long—when will the NHS learn from their mistakes?

A casually centred proposal identifying how Fire and Rescue Services can improve pre-hospital care and quality of life outcomes for burn survivors.  David Wales and Kristina Stiles have released this report looking at the burn survivor experience in the pre-hospital environment. The work makes ten operational recommendations and also two 'lessons learned' recommendations exploring strategic partnership working and the resulting fragmented services.

Patients and service users ask us to be clear when we give them information about their health. They also want us to show care and compassion when we talk and write to them. When we explain things clearly and with care and compassion, people have more confidence and trust in us and are more likely to take our advice, and follow medical guidance. They are happy to ask us questions about our advice so that they can take better care of their health. The Health Service Executive gives tips on how we can communicate clearly with patients and service users.

Serenity Integrated Mentoring (SIM) is a new program being introduced in London aimed at improving coping mechanisms and reducing emergency service use in High Intensity Service Users (HISUs). In this feasibility study, Anokhina et al. an evaluation of SIM effectiveness was assessed using demographic data. Three SIM boroughs (Greenwich, Camden and Islington) were compared with a non-SIM borough (Enfield) on emergency service use and costs in the 12 months prior to SIM and 9 months after. Qualitative interviews were conducted with SIM practitioners and service users. They found hat service users did attend A&E less, and were being arrested less, but this was true for both SIM and non-SIM participants. The economic analysis also showed that, at this stage, we cannot see any cost savings to service use yet. These results are something we expected because of the small scale of the study. However, we found that the quality of the data that is recorded by emergency services would allow us to carry out a full-scale study which would give us clearer answers

StopSIM is a coalition of mental health service users and allies who have grave concerns about the rapid, widespread rollout of the High Intensity Network’s ‘Serenity Integrated Mentoring’ (SIM) intervention across NHS England. The intervention is designed for people who have not committed a crime, but are in contact with mental health services, are frequently at high risk of suicide and self harm and are deemed “high intensity users” of emergency services. Key intervention components include a co-ordinated withholding of potentially life saving treatment by multiple agencies (A&E, mental health, ambulance and police services) and, using SIM’s own words, the “coercive” approach of a police officer as an interventionist.   StopSIM calls on NHS England to: Halt the rollout and delivery of SIM with immediate effect, as well as interventions operating under a different name, which are associated with the High Intensity Network (HIN).Conduct an independent review and evaluation of SIM in regards to its evidence base, safety, legality, ethics, governance and acceptability to service users.Respond to this statement within 7 days to communicate the actions taken by NHS England.

The Serenity Integrated Mentoring (SIM) model is described as "an innovative mental health workforce transformation model that brings together the police and community mental health services, in order to better support 'high intensity users' of Section 136 of the Mental Health Act (MHA) and public services." The SIM model is part of a 'High Intensity Network' (HIN) approach, which is now live in all south London boroughs. In this hub post, Steve Turner highlights the benefits and risks of this approach and seek your views on it. Background In 2018, SIM was selected for national scaling and spread across the Academic Health Science Networks (AHSNs). The High Intensity Network (HIN) has been working with the three south London Secondary Mental Health Trusts: The South London and Maudsley NHS Foundation Trust, Oxleas NHS Foundation Trust and South West London and St George’s Mental Health NHS Trust, and the Metropolitan Police, London Ambulance Service, A&E, CCG commissioners, and the innovator and Network Director of the High Intensity Network. The model can be summarised as: A more integrated, informed, calm approach in the way we respond to individuals that have unique needs during a crisis and A better form of multi-skilled, personalised support after the crisis event is over. So in July 2013 the Serenity Integrated Mentoring (SIM) model of care was proposed. This is how it works: SIM brings together all the key urgent care agencies involved in responding to high-intensity crisis service users around the table, once a month. This multi-agency panel selects each individual based on demand/risk data and professional referrals. They use a national 5-point assessment process to ensure that the right clients are chosen and in a way where we can ensure a delicate balance between their rights as an individual but our need to safeguard. Selected individuals are then allocated to a SIM intervention team. The SIM team is led principally by a mental health professional (who leads clinically) and a police officer (who leads on behaviour, community safety, risk and impact). The team supports each patient, to better understand their crises and to identify healthier and safer ways to cope. In the most intensive, harmful or impactive cases, the team also does everything it can to prevent the need for criminal justice intervention. Together, the mental health clinician, the police officer and the service user together create a safer crisis plan that 999 responders can find and use 24 hours day. The crisis plan is then disseminated across the emergency services. The SIM team reinforces these plans by training, briefing and advising front line responders in how to use the plans and how to make confident, consistent, higher quality decisions. What are the benefits and risks of this approach? Benefits: It is claimed that this is a more integrated, calm and informed approach to responding to individuals in crisis and the HIN provides "better multi-skilled, personalised support after a crisis event was over". The HIN website states: "Across the UK, emergency and healthcare services respond every minute to people in mental health crisis and calls of this nature are increasing each year. But did you know that as much as 70% of this demand is caused by a small number of ‘high-intensity users’ who struggle with complex trauma and behavioural disorders? These disorders often expose the patient to higher levels of risk and harm and can simultaneously cause intensive demand on police, ambulance, A&E departments, and mental health crisis teams." Risks: This approach has been subject to strong criticism from some users of mental health services, mental health clinicians and mental health support organisations. Concerns have been raised about whether the HIN/SIM approach is safe, effective or appropriate. I believe we need an open and inclusive discussion about High Intensity Networks, with users of mental services leading the debate. As a former mental health nurse in an Assertive Outreach team I'm keen to learn: How users of services were involved in the initial development of the model? What are the similarities and differences between High Intensity Networks and an Assertive Outreach model? How this approach compares with approaches in other countries? How users of services are involved in evaluating and adapting the model? What the specific benefits are for users of services and are there any risks to this approach? Does this lead to a long term improvements for users of services? I hope people will feel able to contribute openly to this discussion, so we can learn together. #HighIntensityNetwork #mentalhealth

The shift towards a digital-first healthcare system has accelerated during the COVID-19 pandemic, demonstrating that, given the opportunity for better access, people will engage in new ways with their health and wellbeing services. However, while many individuals have developed a greater awareness of their health and taken meaningful steps to improve it, the pandemic has exposed, and potentially increased inequalities in health outcomes due, in part, to inequalities in access to the technologies, connectivity, and digital and/or health literacy needed to improve outcomes equitably. The move to Integrated Care Systems (ICS) provides an opportunity to give greater priority to patient engagement and to integrate services around a 360 degree view of patient’s needs, focusing on how people experience their lives and health conditions, rather than on specific treatment/disease areas or pathways. This blog from Catherine Skilton, Deloitte, discusses what ICSs can do to realise the long-held vision of a person-centric health and care system.

This whitepaper takes a deeper look at the impact the COVID-19 pandemic has had on mental health services, outlining some immediate actions taken as a result of increased needs to meet mental health demands. These are further broken down according to distinct stakeholders across the spectrum of mental healthcare. Importantly, the research that backs SilverCloud’s digital mental health solution is presented, as providing an evidence-backed solution is key to offering and implementing treatments. Further, this whitepaper explains some of the key considerations that are essential for integrating internet-delivered Cognitive Behavioural Therapy (iCBT) within a wider delivery of mental health support in the future. A series of recommendations is made for reshaping the delivery of digital mental health therapy to create technology-enabled mental health services and processes, addressing current inequalities, and with built-in flexibility to withstand those challenges.

A framework has been developed by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives and the Society and College of Radiographers, in partnership with NHS England and NHS Improvement, to support maternity services with the local reintroduction of hospital visitors and individuals accompanying women to appointments. This framework has been designed to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. It applies to inpatient and outpatient settings. Reintroducing visits is challenging during a pandemic, and the priority must be the safety of all service users (including pregnant women), staff and visitors. 

The University of Leeds have developed and tested the first mechanism for gathering real-time feedback from patients in acute mental health settings, about how safe they feel, and explored how this might be used to manage ward safety.

Time to Talk Mental Health UK is a fully private and confidential Facebook Community. The community is highly interactive and fully moderated. They provide a safe place for people to talk about their mental health in confidence with others who understand. In addition, they provide events, regular clubs and a library of resources.  The community enables consistent support, which may otherwise be lacking in the mental health care package.

Venous thromboembolism (VTE) is responsible for over 25,000 deaths a year in the UK, including 10% of hospital inpatient deaths. A House of Commons report in 2005 led to the development of guidance by the National Patient Safety Agency (NPSA), the National Institute for Health and Clinical Excellence (NICE) and the Chief Medical Officer, for the safe use of anticoagulants and other measures to prevent VTE (deep vein thrombosis and pulmonary embolism). VTE prevention is a patient safety priority for the National Health Service (NHS). The NICE 2010 guidance (CG92) requires that all adult hospital inpatients undergo a VTE risk assessment (RA) using a standardised national VTE RA template – upon admission, again 48 hours later, and whenever the patient’s clinical condition changes. Based on the national template, clinicians at Colchester Hospital University NHS Foundation Trust (CHUFT) pioneered an electronic VTE RA tool that enables the assessment to be completed in 30 seconds. This tool has the added benefits of calculating the risk of VTE and recommending appropriate prophylaxis using a pharmacological and/or mechanical agent. This decision support tool is web-based and is now available to any organisation across the globe. The tool and the VTE prevention programme at Colchester Hospital won the 2010 NHS Innovation Award for Patient Safety.

Technology is often viewed as either positive or negative. On one hand weight loss apps are usually seen as a positive influence on users. From the sociocultural perspective, on the other hand, media and technology can negatively impact body satisfaction and contribute to eating disorders; however, these studies fail to include weight loss apps. While these apps can be beneficial to users, they can also have negative effects on users with eating disorder behaviours. Yet few research studies have looked at weight loss apps in relation to eating disorders. In order to fill this gap,these researchers conducted interviews with 16 women with a history of eating disorders who use(d) weight loss apps. While findings suggest these apps can contribute to and exacerbate eating disorder behaviours, they also reveal a more complex picture of app usage. Women’s use and perceptions of weight loss apps shift as they experience life and move to and from stages of change. This research troubles the binary view of technology and emphasises the importance of looking at technology use as a dynamic process. This study contributes to the understanding of weight loss app design.

This is part 1 of a series of blogs on end of life care planning and people with learning disabilities. This is a tricky subject as there seems to be confusion on the language. What's the difference between an end of life plan and a funeral plan? Should these plans be for young and old - well and unwell? What does the CQC say? This blog, by Irene Tuffrey-Wijne, Professor of Intellectual Disability and Palliative Care at St Georges NHS Foundation Trust, should give you some of these answers.

This article, published by the University of Hertfordshire, addresses the need for reasonable adjustments, and other issues, by using examples of: a hospital passport assessing the mental capacity of a person how to improve care provided how to reduce clinical risks for people with intellectual disability.

Having surgery can be a daunting experience for most people. Staff at the Princess of Wales Hospital in Bridgend, Wales, have recognised this, especially in their patients with complex needs. The reasonable adjustments that they have put in place to ensure their patients receive a bespoke, calming, safe experience won them an NHS Wales Award in 2016 in the Citizens at the Centre of Service Redesign and Delivery category. This short video, by Abertawe Bro Morgannwg University Health Board, demonstrates the Soothing Patient Anxiety (SPA), a unique approach to co-production in meeting the needs of complex patients requiring a surgical intervention.

Action against Medical Accidents (AvMA) provides a list of patients/family members with lived experience of patient safety issues who can speak at events, help with training, or provide consultancy.

The language we use in healthcare can have a huge impact on our patients and families. What we say and how we say it could have a negative or a positive impact. As clinicians we need to be mindful in how we say things and relay information. This short blog illustrates this.

Internationally, safety of care in child and adolescent mental health has received limited attention. Attempts to understand this area have mainly focused on issues of safety in relation to safeguarding on the one hand, or lack of access to services on the other. There is a call for clinicians, service developers and researchers to consider harm and safety more generally in child and adolescent mental health service (CAMHS). America and other countries have begun to initiate discussions on the possibility of harm caused by psychotherapy, however, the lack of shared definitions as to what constitutes safety and harm present ongoing challenges. To start to rise to these challenges this paper, published in Current Treatment Options in Pediatrics, outlines a possible framework for considering harm in relation to child and adolescent mental health provision.

The Young Epilepsy app is a free information and support tool designed primarily for young people with epilepsy, their parents and carers. The app includes a seizure video function, symptom log and diary to help keep track of seizures and aid diagnosis. It also features key emergency and contact details, an information library tailored for either adults or young people, and provides data in both email and chart format that can be easily shared with a school, carer or medical professional. This has not been implemented in a clinical setting. However, parents/ carers have been involved in the initial testing and ongoing development. Feedback is provided either via the helpline, an online survey signposted within the app or the email address [email protected].

What is the Autism Act? The Autism Act 2009 was the result of two years of active campaigning, with thousands of National Autistic Society members and supporters persuading their MPs to back Cheryl Gillan MP’s Private Members Bill. It is the only act dedicated to improving support and services for one disability. The Act did two key things: Put a duty on the Government to produce and regularly review an autism strategy to meet the needs of autistic adults in England. The first ever strategy for autistic people in England, Fulfilling and rewarding lives, was published in 2010 with a commitment to review this strategy three years later. The new strategy, Think Autism, was published in April 2014. Put a duty on the Government to produce statutory guidance for local authorities to implement the strategy locally.

Sepsis can be difficult to spot or articulate. This short video by MiXiT days, a theatre company made up of people with and without learning difficulties, describes the symptoms of sepsis in song format.

When someone you love is hospitalised, it can be scary-even terrifying-for the patient and for family and friends. A hospital may seem like a foreign land. Sounds, smells, and the culture are unfamiliar; even the medical terminology sounds like a different language. Understanding the hospital environment and knowing how to navigate its complicated pathways can make you a strong champion for your loved one. You are as critical to your loved one's recovery as the doctors and nurses. Your role is different, but vital. In some cases, you can make the difference between life and death. Hospital Warrior de-mystifies the process and provides the tools, understanding and insight you need to get the best care for your loved one. Based on the author, Bonnie Friedman's own experiences, Hospital Warrior lays out in direct, simple terms hard-learned and time-tested tactics to help ensure a loved one's medical needs are met. Hospital Warrior also includes checklists and interviews with doctors and other healthcare professionals who provide essential tips and advice for the reader. Bonnie Friedman is passionate about hospital healthcare. Her expertise is hard-won, based on more than 24 years of advocating for her husband through 14 separate hospitalisations – some fairly routine, some quite dramatic and some truly life-and-death experiences.

STOMP stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines. It is a national project involving many different organisations which are helping to stop the over use of these medicines. STOMP is about helping people to stay well and have a good quality of life. Psychotropic medicines affect how the brain works and include medicines for psychosis, depression, anxiety, sleep problems and epilepsy. Sometimes they are also given to people because their behaviour is seen as challenging. People with a learning disability, autism or both are more likely to be given these medicines than other people. These medicines are right for some people. They can help people stay safe and well. Sometimes there are other ways of helping people so they need less medicine or none at all. NHS England has provided a number of resources: An easy-read leaflet that you can download and print to give to your patients, service users, families and carers to inform them about STOMP. Online medication pathway for family carers Film: STOMP STAMP collaboration in Sunderland The recorded sessions of STOMP STAMP webinar day where you can hear personal stories from people with a learning disability and autistic people. Watch Dr Carter Singh, a GP in Nottinghamshire, describe how non-medical interventions can be used to support people with a learning disability. STOMP-STAMP STAMP (Supporting Treatment and Appropriate Medication in Paediatrics). Case studies: Zoe has a happy life in the community thanks to the support she received. Support received helped Graham with his diagnosis, An easy read story about helping Charlie’s communication aids and his reduction in medication. An easy read story about helping Eddie reduce his medication. Make a choice, take a chance and life can change. Peter is living the life he chooses thanks to STOMP. Stopping over-medication: Ricky and Andy’s story. Helping people get the right medicines in Bury. An easy read story about helping Andrew to stop taking the wrong medicine. A blog about why STOMP matters by Anne Webster, clinical lead for the improving health and quality team in the NHS England learning disability programme. Carl Shaw, a learning disability adviser with NHS England, tells his story in a blog about working on the STOMP project. Or you can watch his video.

A 24/7 clinical tele-triage service for care homes in Wirral has resulted in an average 66% decrease in the number of NHS 111 calls and a 10% decrease in ambulance conveyances to A&E for care home residents. The service is delivered by all the area’s health and social care partners with funding support from the Innovation Agency. Care homes have been provided with iPads and secure nhs.net email addresses, and staff have been trained to take basic observations and equipped with blood pressure monitors, thermometers, urine dipsticks and oximeters. This page by the Academic Health Science Network includes a case study and a video demonstrating the triage in action