This is the second in a quarterly series that will share news, progress and information relating to PROSPECT

PROSPECT LPC are the commissioners of Cheshire and Merseyside adult secure mental health and learning disability services.

We aim to use resources effectively to meet the needs of patients to ensure they are placed in the least restrictive and most appropriate placement, as close to home as possible, whilst managing the demand and overseeing the quality for the services we commission.

In the tabs below you can learn about our event coming up on 7 May in Warrington as well as meet members of the team and read details of service developments.

Reflection event - 7 May

Prospect event.jpg

We held an event on 7 May at the Peace Centre in Warrington where people across the Partnership and wider system came together to reflect on the progress of the Lead Provider Collaborative. PROSPECT Chair and Mersey Care CEO, Professor Joe Rafferty spoke about progress so far and the importance of our work.

Service User Engagement

We have continued to progress with pre-employment checks for our expert by experience Project Support Worker roles. Induction plans are being developed pending confirmed start dates.

Single Point of Access Portal

Key aims of PROSPECT LPC include the reduction of delay and duplication in processes, so introducing a system which supports one referral being made into the Partnership’s secure services rather than referrals needing to be made to each individual unit has been a long-term ambition.

A system has now been developed and is currently being tested across the Partnership. We aim to have the new referral system live from Quarter 1 of 2024/25 with a phased implementation being planned. Once fully rolled out all new referrals into our services will be submitted via the portal.

North West Learning Disability and/or Autism Services Commissioning Plan

With changing trends of diagnosis for Learning Disability and/or Autism, and an increasing need for bespoke placements or packages of care for patients who have an Autism-only diagnosis we have identified the need to review the current North West service provision to make sure we’re meeting our population’s needs.

A programme of work has been developed for 2024/25. We have approval to start the scoping work so that we fully understand what the data is telling us, and what service models are working well outside of the North West. Once complete, we will start a schedule of engagement sessions across the Partnership and wider system. This will help us to understand what works well with our current provision and where we can look to improve our offer.  

Women’s Pathway Transformation Programme

NHS England National Team have launched a transformation programme for women’s services. The programme considers the full range of services in the women’s secure pathway and has an initial focus on Women’s Enhanced Medium Secure Services (WEMSS). There will be a focus on the North West co-ordinated by regional NHSE Specialised Commissioning colleagues. We’ll update you on the programme timetable in future bulletins.

Cheshire and Merseyside Specialist Community Forensic Team

We are delighted to announce the launch of the new Specialist Community Forensic Team dedicated to serving individuals with Learning Disabilities and/or Autism across the Cheshire and Merseyside region.

This initiative is a joint commission by Cheshire and Merseyside ICB and Prospect Partnership, aligned with the Transforming Care programme and NHS Long Term Plan.

The Specialist Community Forensic Team’s purpose is to work alongside existing services to enhance the support provide to people with Learning Disabilities and/or Autism where there are also significant forensic concerns. This includes people leaving prison, secure hospital placements and people based in the community where there is a risk of reoffending or readmission.

Throughout May and June 2024, we will actively engage with services, families, carers and colleagues across the region to develop clinical pathways and enhance the lives of individuals with learning disabilities and/or autism.

For further information please reach out to us on 01925 644 004 or cmscftlda@merseycare.nhs.uk

The Prison Pathway Team is a new service development that has been developed by PROSPECT and North West Health and Justice Commissioners. The commissioning teams have jointly funded a two year pilot which will implement a new team to support staff and prisoners being referred to secure mental health services, as well as service users being remitted from secure mental health services to prison.

Background

PROSPECT carried out extensive engagement with prisoners, prison staff, clinicians and medics to understand what works well currently in the pathway between prisons and health services, as well as highlighting the areas of challenge.

We were told that there is a gap between the prison and health systems, to the extent that we may not truly understand how big the gap is. Even between prisons there can be different processes, limited standardisation of approach and different methods of communication. This is more apparent between prison and secure services and makes it difficult to share accurate, timely information. This is vital to informing clinical decision making and effectively supporting service users to progress in their pathway.

Objectives of the Prison Pathway Team

At a high level, the new service will be the link between health and prison systems to make sure there is a better understanding of each system and its functions. It will also support the flow of intelligence needed to inform decision making.

The team will make sure that the most clinically appropriate service users are within the health system. They will directly support prisoners with their admission into secure services. Also, they will support clinicians with the remission of service users back to prison when this is appropriate.

Implementation and Access

We are expecting the team to be operational from April 2024. The team is currently being recruited to. Clinical Services Manager Debbie Brennand is now in post to oversee the remaining recruitment and implementation of the team. Recruitment has also been recently completed for senior clinical roles. 

For the pilot, the team will sit as part of the Offender Health and Community Service Line within Mersey Care’s secure division.

The Prison Pathway Team will be an integrated team within the prisons and health systems. They will work directly with the In Reach Mental Health Teams in HMP Altcourse and HMP Liverpool, seeking referrals as an escalation point within the prisons. They will also be integrated into clinical decision-making forums for health services to enhance the flow of clinical information, as well as working closely with the Multi-Disciplinary Teams for patients who have a pathway back to prison.

Further updates about the team’s development will be provided on the PROSPECT LPC webpages.

Patient Safety Incident Response Framework (PSIRF)

The Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents. Its purpose is to enhance learning and improving patient safety and experience.  It replaces the Serious Incident Framework (SIF) and is used across NHS and Independent Sector services.

Fundamentally, PSIRF is a substantial change in how incidents are responded to. It favours a systemic and qualitative investigative methodology over the more linear approach used under the SIF. It recognises the need to establish a culture of psychological safety and promotion of a Just and Learning Culture to support reporting through openness and transparency when patient safety events occur.

PSIRF encourages a more qualitative, systemic perspective towards patient safety incidents. Investigations are seen as opportunities for learning and insights into the system, exploring how work unfolds and considering all the elements, from human to technical factors, in a complex, layered and multifactorial system.

The PSIRF approach recognises that a day when an incident occurs may be the same as any other day: the processes and procedures may remain the same, however an incident occurred on one day and not on the other. The incident is regarded as a unique disruption in the usual course of events, which may have been influenced by multiple variables that are broad, deep and far reaching.

PROSPECT has embraced PSIRF. All partners in the provider collaborative have successfully implemented their PSIRF plan and policies.  The initial feedback across the partnership is that providers are evolving into these new ways of working. They remain committed to the PSIRF principles, and the positive influence upon the quality of care, patient safety and patient experience in their service areas.

Name: Dr Alex Cookson

PROSPECT role: Learning Disability and/or Autism Clinical Advisor

Start date: September 2023

What is your clinical background?

Acookson.pngI have worked with people with learning disabilities since I was around 13 years old, and as far as I remember I have always wanted to work in learning disability services.

As part of my Doctorate, one of my placements was cancelled which meant I was able to undertake a 12 month placement at Whalley and my second placement was also 12 months working in children learning disability services. Given that I knew that learning disability services was the specialist pathway I wanted to work in, this was ideal for me!

I started my career in Mersey Care in 2007 working in learning disability community services, and I have remained part of Mersey Care ever since. My experience as a Clinical Psychologist has been wide ranging working across the community learning disability service, as well as spending time working into what was the Liverpool Aspergers team on a sessional basis and providing training and consultation across the Trust.

Currently I work into the learning disability service as a consultant clinical psychologist and work privately, offering specialist assessment and interventions to people who are Autistic and/or have a learning disability.

I am also the Associate Director for Learning Disabilities and Autism for the Trust, with a key role in developing and delivering the trust strategic intentions and priorities for autistic people and people with a learning disability.

What is your role with PROSPECT Provider Collaborative?

The Learning Disability and/or Autism (LDA) Clinical Advisor role is new to PROSPECT and will be delivered on a rotational basis across the Partnership.

My remit is to provide subject matter expertise, consultation and advice around patient’s care and treatment, as well as the wider system in which we’re working. I see the role as being a critical friend to partners in the collaborative to help identify where there may be blocks or barriers and support the identification of ways to overcome them. I also offer quality assurance from clinical perspective, both within the PROSPECT commissioning team and across the wider partnership.

What have been your priorities for the first few months in post?

As it’s a new role, one of the key priorities has been thinking about where the role fits and is best placed, and to start providing an immediate supportive role to the PROSPECT team and wider collaborative.

I’ve also been able to start providing a second clinical opinion for complex patients, supporting the wider system with regards to formulation of need and clinical pathways.

What are the challenges in your new role?

I think one of the biggest challenges relates to the amount of change within all parts of the system currently which can make the landscape difficult to navigate. This can present challenges in understanding how we can shape and influence decision making at both a local and regional level system, as well as understanding who the key people are and how we can achieve connectivity with other Clinical Advisors.

We also know that there are gaps in the current provision across the system, for example there is a lack of a clearly defined secure pathway for adults who are autistic only; some patients with an autism only diagnosis will be able to well supported in mainstream services with reasonable adjustments, but for some patients we know that the environment does not meet their needs and a specialist service may be needed. There’s a big piece of system work needed to understand what that specific model of care needs to look like.

What do you hope to achieve in your role?

I want to provide a good understanding of what the role of Clinical Advisor should be and how best to utilise this role moving forward. I am aiming to use my time in role to help shape and influence new and emerging pathways, as well as supporting the system to have made progress around a service model for autistic adults.

What’s one thing that people may not know about you?

I don’t think that too many people know that I am a purple belt in Brazilian ju-jitsu. I love the outlet that training gives me and really enjoy it!

Start date: September 2023

REMMY.jpgRemmy is the newest member of the PROSPECT Commissioning Team and is undertaking an Internship role which aims to give a local young person with lived experience of the care system experience of the NHS and an opportunity to develop work-based skills.

We spoke to Remmy about his role and what parts of the opportunity interested him most.

What is your role with PROSPECT Provider Collaborative?

I started my Internship in mid-September and since then I have been completing induction learning, and supporting the team with the development of a newsletter and updating data sets such as tracking the discharge trajectories of patients.

The role will be varied so I have the chance to see different parts of working in the NHS and Mersey Care.

Why did you apply for the Intern position?

I applied for this role to get hands on experience of working in a role in the NHS and to learn more about the NHS generally. I want to help people so I thought it was a good chance to get an overview of different services and roles which will help me to decide what I’d like to do for my future career. Earning a salary whilst gaining this experience has also really boosted my confidence.  

What have you been enjoying about your new role?

I have really enjoyed lots of elements of my new role. I love the flexibility of working from different bases, and have liked getting to know my new colleagues, seeing where I can help and learning new skills. It has been good to challenge myself and get used to a new routine.

What are the challenges in your new role?

It has been a huge learning experience coming into a new role. English is my second language so there has been a language gap, but my understanding and confidence is growing all of the time. Getting used to terminology and understanding the services was the biggest challenge over the first few weeks.

What do you hope to achieve in your new role?

My main aim is to develop my skills, experience and confidence. I am looking forward to supporting the service user engagement work that the team is setting up. I also really want to see how I can help and inspire other young people with lived experience like mine.  

What’s one thing that people may not know about you?

Outside of work I like to play football. I am a huge Manchester United and Saint George FC fan. I started supporting United when I was 7 after my Uncle gave me a United shirt as a present and I have loved them ever since.

In the next update, we’ll introduce the new Prison Pathway Team and meet other members of the PROSPECT team.