Operational Standards to Support the Delivery of Acute Services consistent with the HCC Criteria

A set of operational standards were developed which, when implemeted, would promote the practices that would satisfy the standards underpinning the original HCC criteria.

These are the terminology used in the operational satndards, explained so that a common language can be used by all of the teams that these standards relate to.

"Acute Services" includes any:

• Acute Inpatient Service including Acute inpatient wards, Psychiatric Intensive Care Unit, Acute Day Care Facility, Crisis House
  
• Crisis Resolution and Home Treatment Team
  
• Acute Therapeutic Programme

 

"Community Service" includes any:

• Community Mental Health Teams (including Primary Care Mental Health and Liaison Service)
  
• Assertive Outreach Teams
  
• Community Rehab and Recovery Teams
  
• Early Intervention in Psychosis Teams
  
• Community Substance Misuse Teams
  
• Psychiatric Outpatients Clinics
  
• Psychology Services
  
• Psychiatric Liaison Services
  
• Arrest Diversion Service / Court Diversion Services
  
• Parent and Baby services

"Inpatient non acute / specialist services" include:

• Neuropsychiatry
  
• Rehabilitation wards
  
• Mental Health Resource Centres with beds

An "Acute "Keyworker" or "Named Nurse" is a member of an acute team whose responsibilities include liaison with their Service Users respective Care Co-ordinators and any other health professionals involved in their care.

A "Care Co-ordinator" should provide or co-ordinate continuity of service, therefore they should be the person that the Service User sees from start to finish throughout their care OR they should ensure proper transfer of care co-ordination to another person. 
...usually a qualified person who is best placed to oversee care management and identification of Service User's needs (that indicate resource allocation) and can be of any discipline depending on capability and capacity. The care co-ordinator should have the authority to coordinate the delivery of the care plan and ensure that this is respected by all those involved in delivering it, regardless of the agency of origin. It is important that they are able to support people with multiple needs to access the services they need. However, it is not the intention that the care coordinator necessarily is the person that delivers the majority of care. There will be times when this is appropriate, but other times when the actual therapeutic input may be provided by a number of others, particularly where more specialist interventions are required. This approach supports the principles of New Ways of Working, which aims to use the skills of all in the most appropriate, effective and efficient manner...

A Service User is a person who is receiving a service from any team or member of staff of the MH Trust and or Local Authority Service that manages the services listed above. Service Users who are receiving a service from any of the above AND are receiving service form any other organisation are still "Service Users" for the purposes of these standards.

Who these standards apply to:

These standards underpin ALL services which are provided to ALL Service Users. They therefore apply to ALL staff, of all professions - including Social Care Staff, who are involved in delivering services.

Rationale for standards:

1. To provide a predictable and continuous presence of the Care Co-ordinator for the service User/carer as they move along the care pathway.
2. To improve the quality of care for people using services by providing a consistent approach across all teams where these standards are shared by all teams rather than being confined specifically to any specialist functional team. The is particularly intended to help bring about a "smooth" transition of services from one team, or type of service, to another as this is intensely worrying to carers and service Users. Note: Audits of service provision should involve people who use the services to ensure that their perspective as recipients of the service is included in all audits of outcomes. This is important because recent audits (including the Healthcare Commission Inpatient Review 2007) show that whilst a Trusts records may show that all of their Service Users have an allocated care co-ordinator, a significant number of service Users ARE NOT aware of being allocated a care co-ordinator
3. To provide a measurable and auditable set of standards. Measurable standards can be a basis for teams' operational policies, individuals practice, clear service management actions and auditable activity. 
   
4. To monitor consistency between teams and confidence that these standards through the audit process are being implemented.
   
5. To promote performance management approaches that are based on measurable service standards which underpin the quality of care delivered rather than purely quantitative targets.
   In any instance where these standards cannot be applied then all practitioners and managers involved MUST exercise their professional judgment in the best interest of the Service Users and make defensible decisions and actions. ALL instances where these standards are not met MUST be recorded in Service User's notes, explaining the reason for the exception and the actions taken and brought to the attention of the relevant service manager and service forums (e.g. Acute Care Forum)
6. Exceptions will be collated at a service level and brought to the attention of Senior Managers on a regular basis. This is to ensure that any monitoring of the implementation of standards is not dependent upon exception reporting. (A sole dependence upon exception reporting places the standards in practice at risk of not being monitored).
   Note: There will be a need to develop a description of the local exception reporting process and standards for senior management responses to exceptions
   Note: Audits of service provision should involve people who use the services to ensure that their perspective as recipients of the service is included in all audits of outcomes. This is important because recent audits (including the Healthcare Commission Inpatient Review 2007) show that whilst a Trusts records may show that all of their Service Users have an allocated care co-ordinator, a significant number of service Users ARE NOT aware of being allocated a care co-ordinator

Operational Standards

This Explanation of terms should be read and implemented in combination with:

• Standards for Ensuring Effective Acute Care Pathways in Mental Health Services (webpage) (PDF Document)
  
• Standards for Care Planning and Delivery for Acute Mental Health (webpage) (PDF Document)
• Standards for the Ward Environment (webpage) (PDF Document)
  
• Standards for Staff Training and Supervision(webpage) (PDF Document)
• Matrix for local exception reporting for Operational Standards:Audit database and forms (PDF Document)

Other related documents and information in support of these operational standards include:

• Acute Workload Calculator CSIP West Midlands (webpage) (Excel Application 7MB)
  
• Local Service Data

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 Overview (PDF Presentation)
Care Quality Commission (Website)
Pathway to Recovery -  Healthcare Commission Review National Report (PDF Document)

WMRDC would like to thank the following for their contributions to these standards:

Coventry and Warwick Partnership NHS Trust
Dudley and Walsall Partnership MH Trust
Walsall SUE
Wolverhampton PCT
Sandwell Mental Health Foundation Trust
South Staffordshire and Shropshire Foundation Trust
North Staffordshire Combined Healthcare NHS Trust