While we are very proud of the quality improvement we have achieved to date, in the spirit of continuous improvement and striving for perfect care, we recognise there is always room for more.
Our understanding of what it means to ‘strive for perfect care’ is changing. It no longer means just striving for perfection in an episode of care, but also means becoming more preventative and integrated in our approach, seeing people in the context of their families, their communities and their neighbourhoods, not as problems to be solved, but as assets to be invested in.
We characterise the next phase of our improvement journey as being about embedding quality improvement techniques and results, including in our newly acquired services, so that we move from having some great examples of outstanding care to more systematic quality improvement that is everywhere in our organisation.
To reflect this quality improvement in the mainstream of our services, we continue to aim to have an overall CQC ‘Outstanding’ rating for our services by 2024.
We use a zero-based approach to deliver significant safety improvements in places that have historically been in the ‘too difficult box’. By framing our ambitions in this way, we can unlock the talent we have. This culture of continuous improvement will be critical in ensuring recovery from the Covid-19 pandemic for service users, staff and our services.
Mersey Care adopted this goal in 2020 because, as a Trust, we remain true to our values that we respect people for what they do and not what they are. Despite racism being rightly regarded as offensive and an offence in law, the issue hasn't gone away.
We know equality is still not in place, so we’re committed to lowering the conversational water line.
We want to recognise and call out inequalities so they’re seen as clearly unacceptable and we aim to do that by supporting our staff in the following ways:
- 100 per cent of new starters to receive Respect and Civility awareness on induction
- Develop Respect and Civility tools to be used as part of team-based working interventions to improve patient and staff safety
- Create psychological safety at team level by embedding evidenced-based team working through Mersey Care team accreditation and culture of care improvement plans
- Increase the number of our workforce attending Just and Learning training (which includes four-step process and Respect and Civility)
- Promote Mersey Care Just and Learning journey, achievements, and developments in relation to our people and clinical practices to share our learning widely in the NHS and beyond
To achieve this, we have set the following objectives:
- Create a workforce representative of the communities we serve through positive action in recruitment
- To improve understanding of 'what is racism and allyship'
- Improve BAME colleague experience of working within the Trust in line with Restorative Just and Learning Culture approaches
- Reduce the differential between BAME and white staff in their experience of bullying, harassment and abuse
- Identify protected groups disproportionately affected by restricted practice
- Coproduce a standard operating procedure for patients and colleagues on how to report discrimination
- Improve BAME patient/service user advocacy representation
We strive for a Restorative Just Culture. This is an environment where we put an equal emphasis on accountability and learning. It’s a culture that instinctively asks, in the case of an adverse event “what was responsible, not who is responsible”.
Of course, it’s not the same as an uncritically tolerant culture in which anything goes – that would be as inexcusable as a blame culture.
We’ve learnt from established academic works and studied other industries and systems where there's always an element of risk.
Zero tolerance of disrespectful behaviours and racism are now set out in our Trust’s goals.
We’ve created special tools for staff to support civility and manage inappropriate behaviours. This approach has seen a significant reduction in disciplinary cases.
No Force First
No Force First is our initiative aiming to reduce restrictive practice in our care. All the work we’re doing is part of our long-term goal to achieve Perfect Care. At the heart of that is trying to reach the highest possible standards in everything we do, not just in clinical care but also how we deliver our messages to the outside world.
External organisations have taken such an interest in our journey to No Force First, but there are senior figures in other organisations (and still a few in our own) who still believe suicide is inevitable and No Force First is unachievable. It’s when we are confronted with attitudes like those that we need to show our courage on a number of levels:
- Organisational – the Board must have the serious ambition to make change and turn ideas into reality despite opposition or conflicting views from peers.
- Professional – clinicians and GPs must confront their own practices and practices of others, a difficult challenge to change day-to-day methods and gently change the system without confrontation.
- Experts by experience – they have given so much to help coproduce practice, having the courage to tell their stories and, in some cases, having the courage to stand up and address and influence large groups of people.
- Staff and patients – have shown great courage in accepting No Force First and making Mersey Care a better caring environment. Our belief that people who use our services are at the centre of everything we do and are, to use our own Perfect Care terminology, ‘the people we serve’ helps to strengthen our incredible emotional commitment to positive change – whatever the obstacles we may encounter.
If you would like any more information about the No Force First initiative, contact the project lead for No Force First on 0151 472 4550.
We were the first NHS mental health trust to commit to achieving zero suicides among our service users in 2015.
Mersey Care is a founder member of the Zero Suicide Alliance (ZSA), a collaboration of organisations committed to preventing suicide, and has developed training to give people the skills and confidence to identify, support and signpost someone presenting with suicidal thoughts or behaviour.
You can access the ZSA training here.
Find out more about our Trust’s suicide prevention work.
Mersey Care believes strongly in setting the highest of healthcare standards across everything we do. This includes zero tolerance of harm from medication, which we aim to achieve through the following steps:
- 100 per cent drug error reporting to include classification of harm
- Zero moderate or severe harm from drug errors
- 100 per cent of medication doses administered and administered on time in EPMA areas
- Reduce errors relating to medicines given by injections to zero, with a focus on dental services and agency staff in 2020/21
- Develop a plan to roll out refresher training to other Trust staff over the next few years
- Implement safety register for high dose antipsychotic polypharmacy
- 100 per cent antimicrobial prescribing reviewed within 72 hours
- 100 per cent of medication administration by restrictive method with the risk of psychological harm will be subject to a multidisciplinary review within 48 hours
Mersey Care is committed to reducing the number of falls and has introduced new practices to ensure that. These include:
- 100 per cent of inpatients have a falls screening within 24 hours of admission and those at risk of falls have a multi-factorial risk assessment and management plan in place
- 20 per cent reduction in harm related to falls in inpatient areas, taking account of the previous 24-month rolling baseline - by September 2021
- Standardised falls risk assessment process across community settings to be introduced - by September 2021
- Develop a clear pathway for access to support services for those identified as at risk of falling in the community by September 2021 - supported by our integrated care teams
Find out more about our falls prevention work.