"Crisis resolution service"

About: Highbury Hospital

(as a staff member posting for a carer/relative),

The Highbury Carers group would like to raise various issues with regard to the new Crisis resolution service.

Their issues are as follows:

There is a need to monitor response times. What happens if there are no staff available to give support to s/users and their family members/friends. Will people be advised to ring 999.

Will there be continuity of care/ How can this be achieved with the various shift changes etc?

Will there be specific carer support workers? Will they have sufficient expertise and experience to meet the carers needs and ensure the carers strategy is implemented.

Will Carer support workers be released to participate in carer forums such as the Highbury Carers Forum/Carers Community of Interest etc.

Is there likely to be high staff sickness levels when working within crisis resolution/ how can this be avoided?

How will the service respond to lone working issues /Will the team visit in pairs? How will this impact on the family dynamic?

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Response from Debbie Dolan, Clinical Project Lead, Adult Mental Health, Nottinghamshire Healthcare NHS Trust

Dear All

Please accept my sincere apologies for the delay in providing a response to your questions this was an oversight on our part. I will respond to your questions point by point

1) As part of the monitoring process by the Clinical Commissioning Groups we have been asked to measure our response times to any referrals to the Enhanced CRHT service. This measurement will cover how many referrals are offered an initial appointment within 4 hours and also how many Service users take up the appointment offered. The service will have a qualified duty worker available 24 hour hours a day and seven days a week who will be accessible to offer advice and support and to make decisions alongside the service user and carers around the response required and the urgency of the same. If a more urgent response is required then the enhanced crht would look to meet this need wherever possible. The enhanced crht would not advise service users or carers to access services Via 999 routinely, this would be suggested in cases of an immediate risk being posed to self or others when a 999 response would be the only appropriate option partcularly if a service users physical wellbeing was at immediate risk or that of other people.

2) In order to maintain continuity of care a full hand over of all patients will be conducted on a twice daily basis by the enahnced crht as a minimum with further hand overs occuring as required. Wherever possible visits will be allocated to staff members who have previously been involved in the service users care to minimise the impact of inconsistency. Any new staff member will have access to all relevent clincal information for the service user via the electronic patient record. If a service user is already involved with a longer term community team then the CRHT would aim to support the usual community team to meet the care needs allowing consistency and continuity of care to be maintained.

3) As the new enhanced CRHT model is developed we are aiming to have individual staff members who speciailise in specific roles. One of the key roles we believe is that of a specific carer support worker and we will prioritise the development of this role within the teams. The project team have developed a training and development plan for the enhanced CRHT teams, part of this plan focuses on the need for all team members to receive brief family interventions training, we also are keen to work with carers to develop carer led training for CRHT which could be offered regualarly to all staff. We would be keen to support an staff memeber with a specific focus on carer support to develop and acquire knowledge, skills and experience to effectively manage this role.

4) We would be keen to realised carer support staff to participate and engage in all appropriate groups and forums on a regualr basis

5) Our CRHT teams historically have recorded low levels of sickness. We recognise this is a diverse and challenging role and will ensure staff are regularly and appropriately supported to maintain high quality service provision and to maintain thier own physical and emotional wellbeing. Regualar managerial and clinical supervision for all saff is one key to achieving this goal as is the visibility and accessibility of senior experienced colleagues in order to access advice, support and guidance whenn required. With this in mind we have increased the focused clinical leadership offered to the enhanced teams in order to provide this level of expertise and support.

6) All initial appointments with CRHT will be carried out by 2 staff members in order to effectively assess and manage risks. Following this initial appointment an inclusive discussion will be had about future contacts. In the majority of cases these will be carried out by an individual staff member, 2 person visits or appointments on the hospital site would only be suggested when any potential risk relating to lone working had been identified. This would be reviewed at every contact and changes would be made according to to clinical need and risks identified. Often a joint appointment can allow dedicated time to be offered to both the service user and carer before joining together to outline the plan of care moving forward and can facilitate improved communication between service users, carers and professionals.

I hope this information is helpful if you do have further questiosn please don't hesitate to make contact with me Via Trust email Debbie.dolan@nottshc.nhs.uk and I will be happy to respond or to arrange a meeting as appropriate

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Response from Nottinghamshire Healthcare NHS Trust

Many thanks for your detailed response to the concerns raised by the Highbury Carers group. The group have considered your comments and still have outstanding issues to discuss with you. They are particularly concerned that the service is monitored effectivly to ensure that it responds to the needs of service users and carers. Members of the group have had recent personal experience of the service and would like to feedback their experience and propose that they could function as mystery shoppers.

Our next Highbury Carer meeting is on Wed 26th November at 2pm at Highbury Hospital. We would be very grateful if you could attend

Many thanks

Highbury Carers Group

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