Report to QNFMHS on Service User Involvement JLees Presentation.pdf · •Provide specification of...

Report to QNFMHS on Service User Involvement

Janine Lees

Remit

• Review the purpose and role of service user experts in the context of the Quality Network.

• Review, and propose more robust, job descriptions for service user experts.

• Review, and propose a more rigorous, recruitment procedure for service user experts.

Remit continued

• Review, and propose more robust, contingency planning policies and procedures for service user experts, including more formalised relationships, with clear roles and responsibilities, with the service user experts’ clinical teams.

• Provide specification of the training needs of the project team, including how to manage visits with overnight stays.

Remit continued

• Develop a proposal for role specification and job description of a service user expert co-ordinator.

• Provide recommendations in the form of a written report.

Methods for this reportSemi-structured interviews were carried out in person with:

• the Project Team Manager and her Line Manager;

• the Project Workers;

• the Chair of the Advisory Group;

• the Former Clinical Advisor,

• National Personality Development Programme,

• Department of Health;

• the Senior Commissioning Manager,

• Therapeutic Environments,

• Personality Disorder Team,

• NOMS Commissioning Team;

• a Project Worker and Service User from another CCQI Quality Network, Community of Communities.

Methods for this report

• Attendance at the quarterly QNFMHS Advisory Group, and the Service User Expert Peer Support Meeting, to canvas opinions from staff and service users.

• Key relevant documents were reviewed for background and information.

• Key relevant literature was reviewed for background and information.

• Draft of final report discussed with QNFMHS Project Manager.

Observation

Although I found plenty of literature dealing with service user involvement generally, there was a lack of detail in the literature about the specific issues presented by forensic services.

The literature often recognised that forensic service users needed to be dealt with differently, but didn’t provide suggestions as to how to do this.

Recommendations

The report contains:

• 4 recommendations to CCQI

• 21 recommendations to QNFMHS

CCQI Recommendation 1

CCQI need to implement in full the recommendations of Lisa Haywood’s 2010 Review of Service User Involvement in the Work of the CCQI.


Particularly, CCQI should employ two part-time service user co-ordinators for CCQI – one professional and one ex-service user, to provide an overview, and work with staff at all levels to ensure that the necessary changes are made and maintained, to support the successful delivery of service user involvement activities. Also, they should co-ordinate all service user involvement across all the CCQI projects.


Service users should be included at all levels of CCQI work, from the Director downwards.


CCQI needs systematic methods across CCQI to provide an evidence base for the effectiveness of service user involvement in all CCQI projects, through the collection of service user feedback, and monitoring and evaluation service user involvement in CCQI projects e.g. through pre- and post-questionnaires, annual questionnaires, and annual reports and dissemination of results.

QNFMHS Recommendation 1

QNFMHS needs a clear written statement of its philosophy and principles of service user involvement.

QNFMHS Recommendation 1continued

QNFMHS needs a clear statement of the limits and constraints to the overarching principles of service user involvement when working with QNFMHS service users.

QNFMHS need a clear written policy and procedure or strategy for how service user involvement will be facilitated.


QNFMHS needs a clear statement about the basis on which service users are employed, and needs to make a conscious choice about which route is takes (employment or honorary contracts), and why.

QNFMHS needs to state clearly what CCQI’s and QNFMHS’s responsibilities are, and the limits to these.


It is increasingly likely that the Project Team will receive MAPPA disclosures – indeed this has already happened.

QNFMHS needs a clear policy, and procedures, about how to handle MAPPA disclosures.


I recommend that such disclosures should be made in confidence to the Project Team Lead, who should then make decisions about whether further risk management measures need to be put in place and what these should be, depending on the gravity of the index offence.


QNFMHS need to re-instate overnight stays for service users.

It needs to be made explicit that the Project Team do not have clinical expertise and, therefore, do not, and should not, have clinical responsibility for service users on peer reviews, nor is the relationship between staff and service users a therapeutic one. This needs to be made clear in writing to, or as part of a contract with, the service users and the service users’ clinical teams.


QNFMHS needs a clear statement of the relationship between the Project Team, service users and their clinical teams.


It needs to be made explicit that the Project Team do not have clinical expertise and, therefore, do not, and should not, have clinical responsibility for service users on peer reviews, nor is the relationship between staff and service users a therapeutic one. This needs to be made clear in writing to, or as part of a contract with, the service users and the service users’ clinical teams.


QNFMHS needs a Code of Conduct for service users, and may need to update the CCQI’s Code of Conduct for Project Team staff – this could be the same document, and needs to be very explicit. If CCQI develop an overall Code of Conduct for service users, QNFMHS may not need to do this.


• QNFMHS needs a clear specification of each involvement opportunity for service users.

• This would need to include what is expected of service users, so service users can make a fully informed choice.


It would be helpful for service users to be asked to specify, on application, their relevant knowledge, skills, competencies and experience; and any relevant practical information e.g. willingness to travel, availability at different time of the day, any special needs; and an outline of the types of services they have experiences of and when.


It would be helpful for QNFMHS to undertake a full knowledge and skills review, including the needs of the project, and the knowledge and skills available in the service user team, as well as the staff team, particularly in relation to working with service users.


This would help QNFMHS identify gaps, and develop roles and job descriptions which address these gaps. This needs to be a written review, which is updated annually, to ensure a skills mix, and job fit, between project and service users.


• Because of increasing restrictions on current service users, QNFMHS may need to draw up at least three job descriptions:

1. for in-patient service users who can do work mostly by post, email and telephone e.g. SU telephone conversations, and head up peer review meetings, and attend meetings with an escort – which would help give them experience until they can leave the unit and develop their service user role.


2. For ex-service users in the community, who can attend one-day peer reviews, and meetings.

3. For ex-service users in the community, who can attend one-day peer reviews, and meetings, and for peer reviews requiring overnight stays.


• QNFMHS need to recruit more, and more diverse, service users to the project.

• QNFMHS may need to offer regular information or induction sessions/workshops, offering informal briefings for interested individuals. This can be done for ex-service users, but needs not to be arranged just in London, and also for current service users. These (road shows) are something that could be done by the two part-time Service User Consultants.


• QNFMHS should ensure the project-specific Induction Pack, and Service User Involvement Handbook includes information about e.g. CCQI’s and QNFMHS’s involvement philosophy and procedures, all relevant policies, support mechanisms.


QNFMHS may want to consider a two stage recruitment process for service users.

QNFMHS Recommendation 13 continued

• Service users would attend initial interview and then be accepted on to the induction training programme. They would then undertake induction training programme, including role plays, and then would be re-interviewed at the end of the training programme. This would give the service users and QNFMHS additional information on which to make decisions about whether the project work is suitable for the service users and vice versa.


• QNFMHS would need individual specific contracts that state the nature of each service user’s involvement.

• QNFMHS may want to consider fixed term contracts e.g. for one year at a time, with explicit rationales – e.g. part of recovery, offering training and development, need to move on. The needs of the project or service user may change over time.


QNFMHS may also want to have more formalised annual personal development plans and appraisals for service users, related to the individual’s role description and job specifications.


• QNFMHS need to rethink their policy about not using service users who need escorts, as this excludes many current service users from involvement in the project outside of their units.

• QNFMHS will need to develop appropriate policies and protocols for this.


QNFMHS may want to review its policy about telephone support for service users, and make sure telephone support is adequately implemented, such as phoning service users the day before reviews, to check they are still able to attend and to offer any necessary support – many guidelines suggest this is particularly helpful and inclusive.


• If QNFMHS recruits enough service users, they could have an on-call or back-up rota for reviews, whereby other service users could step in at the last minute, if the scheduled service user cannot attend a particular review for any reason.


• QNFMHS may want to consider offering separate service user briefings before peer review visits and debriefing after, as a matter of course.

• QNFMHS could also consider setting up a formal buddy system, so service users can be offered peer support before and after visits, and where necessary otherwise.


• QNFMHS needs an explicit project-specific exit strategy for dealing with service users who are not performing their roles adequately.


The expectations of service users need to be outlined clearly in writing, together with the sanctions for failing to meet these e.g. review, warnings, retraining, reassessment, re-interview, dismissal.


• QNFMHS could consider setting a 5 year limit to renewal of contracts, so that service users are encouraged and helped to move on. To do this, QNFMHS would need to recruit more service user experts.

• QNFMHS could also develop work placements that are designed for SUs – e.g. fixed term 6 months jobs on NHS Band 1.


• QNFMHS need to include skills in working with service users in Project Team job descriptions.

• Staff members work with service users should be discussed during supervision and appraisals, and any further support or training needed should be identified.


QNFMHS need to undertake a review of the training needs of Project Team staff and service users.


• For example:

• The Project Team may benefit from regular training about the philosophy, values, practice and standards of service user involvement.

• The Project Team staff may benefit from basic training about mental health issues, and offending behaviour, while continuing to make it clear the team do not have clinical responsibility for service users.


• The Project Team may benefit from training on the therapeutic management of risk and aggression. I do not feel that training, such as self-defence, is appropriate for the Project Team, nor do I think it is particularly helpful.

• The project staff, and service users, may benefit from training on how to deal with difficult situations confidently and assertively, and on how to manage overnight stays.


• Service users have said they would like more training on running SUTCs; on the peer review role; on chairing SU meetings on peer reviews; on interviewing front line and especially senior staff; on managing overnight stays; and training on the whole standards book, especially as new standards are coming out.


QNFMHS need to provide an evidence base for the effectiveness of service user involvement, through feedback, and annual monitoring and evaluation, and reports and dissemination.


QNFMHS should consider appointing two part-time service user consultants - one a senior clinician, known and respected in the field, and one a service user expert, to work collaboratively.


• Their roles would be:

1. To actively recruit new service users for the project, and revise recruitment procedures.

2. To liaise with, including visiting, staff and service users in all the units in both the medium and low secure projects.


3. To run information and induction workshops both in London but also in the regions, and possibly in larger units.

4. To devise and deliver the training requirements of the project team staff and service users.

5. To lead research and evaluation projects related to service user involvement in the project, and provide any necessary related training.


6. To provide back-up cover and support for peer review visits.

7. To devise protocols for dealing with MAPPA disclosures.

8. To update risk management strategies for the team.


9. To explore further the usefulness, or not, of using DBS checks.

10. To co-ordinate and supervise the supervision and support provided by the project team, including annual performance reviews and the renewal of contracts.


The service user consultants’ jobs would involve:


1. in consultation with the project team, drawing up, and revising annually, all necessary documents, protocols, handbooks, information leaflets, terms of reference, guidance, good practice guidelines for reviews, committees, advisory groups, etc; glossaries; service user checklists, etc.


• This would also include reviewing and updating all existing documentation, such as contracts, role descriptions and job specifications, contingency plans; and devising a QNFMHS specific guidance on the management of mental health, and forensic, issues.


2. delivering training.

3. liaising with, including regular support visits to, and collating feedback from, service-providers and current service users.

4. carrying out recruitment drives, devising advertisements, doing recruitment ‘roadshows’ etc.


5. Being available on the phone if necessary, especially for staff and service users on peer review visits.

6. Developing methods for identifying, sharing and disseminating knowledge and learning on a regular basis.

7. Continuing to develop the sharing of best practice through workshops, taking this out to regions, as well as offering it centrally.


8. Developing monitoring and evaluation tools for measuring the impact of service user involvement, and helping develop and deliver small-scale research/service evaluation projects, which are service user led.


• Initially, these two consultants may need to be employed for a day a week (the clinician could be seconded from their current employment), but if their work is effective, the amount of time for which they need to be employed may reduce over time.


• QNFMHS would need to devise job descriptions and specifications for both these posts, which should include the tasks listed above.

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