Mersey Care NHS Trust

Dr Simon Tavernor – Consultant Psychiatrist / Associate Medical DirectorJoanne Scoltock - Modern Matron (Physical Health)

Mersey Care NHS Trust

Mersey Care NHS Trust

• Specialist Inpatient and Community Mental Health, Learning Disability and Addiction Services.

• Secure Mental Health services for NW England, Wales and West Midlands.

• 30 sites = 641 Inpatient Beds• 4000 staff serving a population of 11 million• 2014/15 – provided care, treatment and support

to more than 36,000 people

In context – Acute Adult Inpatients

• Above average beds and admissions per 100,000 weighted population.

• Above average occupancy and upper quartile for average length of stay.

• Above average delayed discharges and upper quartile for duration of delays.

• Above average percentage of people detained under the Mental Health Act.

• Lower quartile for consultants per 100 beds, above average for total nursing per 100 beds but in lower quartile for qualified nurses.

Ref – NHS Benchmarking 2014/15

Objective 1:We will ensure the people we care for live longer

Strategic Target 1. Preventable Premature DeathsBy June 2013 each division will have in place a strategy, identify key performance indicators and produce an implementation plan approved by the Executive Committee to ensure that preventable premature deaths are in the bottom Quartile for England by March 2019.Population will be Service users on CPA, Inpatients and people with learning disabilities.

NHS IQ Project

• Embed Lester Tool in a 24 bedded acute male inpatient unit

• Staff training • Changes to Clinical Information System• Care pathway development – cardiac• Service User Survey

Physical Health Care Pathway - ePEX

• Joint Inpatient Medical and Nursing Assessment – including VTE

• Clinical Observations – including Nutritional Screening

• Investigations• Other – Waterlow, FRAT, Influenza, IPC

Hospital Transfer

Getting the balance right

• Clinical v Performance – understanding of agendas/requirements

• Joint working across departments – Information, Performance and Business

Screening Audit – Aug,Oct,Dec

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LOCAL PILOT AUDIT AUG 2015 (n=18) LOCAL PILOT AUDIT OCT 2015 (n=27) LOCAL DEC 2015 (n=74)

Whole systems approach• Governance structure• Recognising deteriorating patient - MEWS• AQuA Mortality Collaborative - Reducing Avoidable Deaths• Education and Training – Skills Passport, Video Vignettes• Nutrition and Hydration• Performance – KPI’s /CQUIN• ‘Community of Practice’

Measures and DataRecorded Co-Morbidities in Physical Health Related Deaths

MEWS implementation: Increased staff confidence. 96% of staff said “improved my nursing skills”. Staff also reported that it helped them to “speak the same language” as acute trusts and ambulance staff.

Recognising the deteriorating patient• Have all observations (including appropriate

recording of Absent (A) or Refused (R)) been completed at the prescribed frequency?

• Have all scores for individual parameters been calculated correctly?

• Has the overall score been calculated correctly each time all observations have been completed?

• If any single parameter score was 3 or the overall score was 4 or higher, did escalation occur in accordance with the MEWS pathway?

MUST Screening

MUST SCREENING Oct 2013 to Dec 2013

MUST SCREENING Oct 2015 to Dec 2015

Moving forward

• Community Physical Health Standards• Care pathways – acute and specialist • Confident and Competent Workforce• Hospital Food Standards• ‘Dr Feelwell’

‘So never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.’ Florence Nightingale

Questions and

Discussion