The Leeds Managed Clinical Network

Report
The Leeds Managed
Clinical Network
Developing confidence whilst
living with uncertainty
The Clinical Network
One of 11 DH funded national pilot sites
2004 – community services
 National Evaluation by Imperial College –
“Learning the Lessons”.
 Local Evaluation by University of Chester
 Six-monthly DH Monitoring including
service user commissioners
 Service and User generated measures
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The Clinical Network Model
Staff from a range of agencies and disciplines,
funded from a single source to achieve common
aims which no single agency could achieve.
 BUT …
 Great effort needed to make partnerships, multiagency work and care pathways feasible or
satisfactory.
 Added complexity when attempting to capture
outcomes.
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The Network Model
Leeds Partnerships NHS
Foundation Trust
 Community Links
 Touchstone
 Leeds Mental Health
Advocacy Group
 Leeds Survivor Led Crisis
Service
 Leeds Adult Social Care
 PD institute
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Shared aims and
principles
 Shared commitment
 Individual
agency/discipline
roles and
responsibilities
 Service User
Involvement and
Collaboration
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Resources
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24.8 WTE
Clinical Service Manager
Clinical Lead
Clinical Team Manager
Practice Development Lead
Care Co-ordinators
Health Care Support Workers
Occupational Therapists/Technical Instructor
Psychological Therapists
Service User Consultants/Involvement Lead
Pharmacist
Accommodation Support
Voluntary Sector Support and Inclusion
Services
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Assessment and Formulation – 8 weeks
Care co-ordination – 100 weeks
Case consultation – sessional
Diverse Pathways – 24 months
Journey Day Programme – 24 weeks
Dialectical Behaviour Therapy Skills Groups –
modular
Pear Tree Partnership
Training/Facilitated Learning
EMERGING CARE PATHWAY FOR PERSONALITY DISORDER SERVICES, LEEDS
PATHWAY DEVELOPMENT SERVICE
CRISIS RESPONSE
ALTERNATIVE TO
ADMISSION
5
IN-PATIENT
SERVICES
4
CARE COORDINATION
ACCOMMODATION
SUPPORT
OCCUPATIONAL
THERAPY AND OASIS
3
INDIVIDUAL
THERAPY
DBT SKILLS
GROUP
2
DIVERSE
PATHWAYS
JOURNEY
1
INFORMATION
AND ADVICE
2 DAY TRAINING
PROGRAMME
CONSULTATION
Activity
7000 face to face contacts per year
 Any given week – 82 places available for
direct work
 12 in assessment/formulation
 28 in care co-ordination
 16 in Diverse Pathways
 10 in Journey
 16 in DBT skills
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Involvement?
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Involvement lead and two user consultant posts
Service User group and newsletter
Volunteers at Pear Tree Partnership
Delivering training and conference workshops
Survivor led crisis post
Satisfaction survey
Evaluation of services
Outcomes …
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Service use pre-Network and one year later
Medication review 2007/audit 2009
Journey evaluation and focus groups
DBT CORE outcomes
Day TCs national review
Service User involvement initiatives, satisfaction survey
Acute in-patient audits 2007 and 2008
NFA Review 2008
Regional Training Programme – 600 staff
Award winning allotment – Pear Tree Partnership
Cost analysis – NHS savings per service after PDCN care coordination
Service Area /Intervention
Annual use 1
year prior to
PDCN (total)
Annual use 1
year during
PDCN (total)
A&E admissions
20
16
-20%
PICU admissions
1
0
-100%
PICU nights
54
0
-100%
Acute Ward admissions
23
9
-60.87%
Acute Ward nights
675
294
-56.44%
Day Hospital admissions
0
6
+ infinity
-
Day Hospital days
0
76
+ infinity
£59 x 76
Crisis Resolution Direct
contacts
28
19
-32.14%
[£364 x 28] [£364 x 19]
Crisis Resolution Indirect
contacts
33
93
+181.81%
Total NHS Savings
Reduction/Rise
in use of
Service/
Intervention
Calculation
based upon
PSSRU Unit
Costs in Health
and Social Care
2006
Cost Savings to
NHS
Based on 22
clients
[£101 x 20] [£101 x 16]
-
£528 x 54
[£201 x 675] [£201 x 294]
-
£404
-
£28,512
£76,581
-
-£4,484
£3,276
£104,289
Average scores Journey 1, 2 and 3
OSA average scores- Journey 1,2,and 3
100
90
80
Average score
70
60
before
50
after
40
30
20
10
0
competence
values
Competence and values
WHOQOL average scores- Journey 1,2, and 3
100
90
Average score (1-100)
80
70
60
before
50
after
40
30
20
10
0
physical
psychological
social
WHOQOL domains
environment
DBT: Group Levels of Psychological Distress
Pre Mean
Post Mean
4
CORE-OM Mean Score
3.5
3
2.5
2.16
2.65
2.45
2.58
2.22
1.84
2.44
2
2.09
1.5
1
0.5
0
IE
(Jan - Mar 08)
ER
(May - Jun 08)
CM
(Jul - Aug 08)
DT
(Oct - Nov 08)
DBT: Group Levels of Risk
Pre Mean
Post Mean
4
CORE-OM Mean Score
3.5
3
2.5
2
1.5
1
1.69
1.27
1.54
1.54
1.29
1.45
1.29
1.06
0.5
0
IE
(Jan - Mar 08)
ER
(May - Jun 08)
CM
(Jul - Aug 08)
DT
(Oct - Nov 08)
SERVICE USER FEEDBACK
“The group was helpful in offering possible solutions”
“The group has been helpful in gaining control of myself and realising that I
can’t fix everything, I am able to tolerate my feelings instead of ‘becoming’
them”
“I‘m glad I came…I didn’t want to…”
“I like attending and feel like I’m treated like a ‘human being’”
“I find the skills really useful. I keep my skills folder next to my chair where I sit
at home so it’s there to look at when I need/want to”
Service User Satisfaction Survey -2009
What is good about the service you receive?
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Meets my individual needs with flexibility
Very defined, kept to time, feel safe
There are other service users just like myself
DBT – great staff, small group. Has changed my life over the last two
years. More aware accepting of my illness. Diverse Pathways – more
challenging in a positive way.
Very clear about how and when groups run
The fact that I’m in prison and you guys come and visit me
The DBT groups are extremely helpful as the skills related to all the
problems that I’ve encountered in my life. It is beneficial to be able to
listen and talk to the other group members who have the same problems
as me. Also being able to repeat modules if is thought that it will help is
good.
What is not going well or could be
improved?
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I miss having a Care Co-ordinator now I’ve been discharged. I
have difficulty getting out to join groups etc. now I’ve been
discharged as I can’t afford taxis and can’t use public transport.
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I would have liked to have been told about other services within
the Network instead of picking up bits here and there from other
group members.
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Everything is put down to being Personality Disorder rather than
me being seen as an individual. I don’t feel part of this group.
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More information about other areas and how to access them.
New Developments 2009/10
Understanding of PD and responsiveness across Primary
Care Mental Health Teams
 NSPCC Project
 Younger People and developing personalities
 Short term occupational interventions on acute in-patient
areas
 Social Inclusion initiatives
 Creative Personalities Project
 Partnership with PDi
 Implementation of NICE Guidance across Leeds
 KUF Training Programme
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