The original plan and a brief summary of progress and the most common implementation issues raised.

Issues Arising from the Healthcare Commissions Review of Acute In-patient Services

Between June and August 2007 the Healthcare Commission reviewed Acute inpatient wards for adults aged 18-64 including, psychiatric intensive care wards, high dependency units/areas and the links between crisis resolution home treatment teams and acute in-patient wards as provided by 69 Trust in England.
The key purpose was to ensure: "Admissions to acute inpatient mental health services are appropriate, purposeful, therapeutic and safe". The review used 58 data grouped under 4 criteria

1. Effective care pathway that ensures admission is appropriate and discharge is timely
   
2. Provide individualised whole person care that promotes recovery and inclusion
3. Service users and carers are involved in, care planning, how the ward is run, operational and strategic planning, evaluation and development
4. Systems in place to ensure the safety of service users, staff and visitors

National data showed that:

• No trust was scored excellent on all four of the key criteria, suggesting there is room for improvement for all service providers.
• Almost two-fifths of trusts (39%) were scored weak on involving service users and carers - this was the area with the highest proportion of weak scores.
• Around one in every nine trusts was scored weak on the whole person care and safety criteria.
• No trust was scored excellent for the effectiveness of the acute care pathway, although fewer trusts were scored weak here compared with the other three criteria.
• No Trust scored more than 1 for "ward staff managing people with dual diagnoses (substance misuse)" and there is a widespread need for improving staff awareness of sexual safety.

West Midlands data raised the following points:

• Trusts with capable Acute Care Fora may have had a higher likelihood of achieving higher score, though some Acute Care Fora have difficulties moving from "planning" through to "action".
• Many service user and carers were not receiving copies of their care plans, and many did not know who their care co-ordinator was, or had a telephone number for accessing support during a crisis.
  
• There were potential efficiency improvements around the maximizing use of clinical capacity e.g. more efficient ward rounds, handovers and ensuring adequate administrative staff.
  
• There were shared difficulties in ensuring the "gate keeping" function of all Crisis Resolution / Home Treatment teams were being adhered to
  
• Care Co-ordination was variable through the whole systems, often highly dependent upon individual practitioners working methods rather than operational standards.
  
• Many operational standards were not developed from a "systemic" approach which establishes standards across a set of functional teams, for example around care co-ordination of the acute care pathway.
• Better use of existing data (such as service demands, unmet needs, delayed discharges, lengths of leave, referral and discharge pathways, etc.) would have supported improvements in management of Acute Services and the integration of acute in-patient care with other functional teams, workforce planning. The development of integrated information systems across all acute services (in-patient, CRHT and Acute Day Care) may improve this but must be addressed on a local basis due to the varying service configurations.

West Midlands Regional Development Centre (Former CSIP West Midlands) Acute Development Plan: Aims and Objectives

1. To provide participating Trusts with service development support to help them achieve a score of three or higher when re-audited against the original criteria.
   
2. To further strengthen the capability of Acute Care Fora as "sponsors" of improved acute care service standards within the context of local systems of care rather than service users acute care being managed in isolation.
   
3. To improve the use of and compliance with operational standards to promote consistency of care AND to inform standards based commissioning.
   
4. To provide an audit tool based on the HCC criteria and scoring framework to enable a consistent approach to re-auditing.
   Identify any additional problems or needs of Trusts requiring support.

Development Support through local consultancy

• Setting Standards for Acute Pathways
  
• Standards for Acute Care planning
  
• Improving use of data for management of Acute Services
  
• Ensuring the standards for the Ward Environment
  
• Capable Acute Care Forum
  
• Maximising Capacity and Addressing Training needs
• Service users and carer outcomes in service evaluations

West Midlands Regional Networking

Three specifically themed Seminars about:

• Sexual Safety and Women issues in Acute Mental Health Care.
  
• Dual diagnosis / Substance Misuse issues in Acute Inpatient Care
  
• Equality and Diversity in Acute Inpatient Care

If you have any questions on any of the above, please email nick.adams@wmrdc.org.uk or call on 07747 793748

Links:

Acute Inpatient Care (webpage with links to all Acute Inpatient pages)
WMRDC Acute Care Development Plan (PDF Document)
WMRDC Acute Care Development Overview (PDF Presentation)
Care Quality Commission (Website)
Healthcare Commission Review National Report (PDF Document)
Road to Recovery (PDF Document)