Report evidence summary
Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 19
NHS Leicester, Leicestershire and Rutland Integrated Care Board Engage potential provider organisations to resolve local female PICU capacity and placement options.
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NHS Leicester, Leicestershire and Rutland Integrated Care Board Develop a local support-network model for patients diagnosed with personality disorder.
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NHS Leicester, Leicestershire and Rutland Integrated Care Board Submit the local personality-disorder support-network model for consideration.
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NHS Leicester, Leicestershire and Rutland Integrated Care Board Work with regional commissioning colleagues to provide a wider range of female PICU placement options.
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Leicestershire Partnership NHS Trust Continue negotiating commissioner contracts for provision of the proposed personality-disorder services.
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Leicestershire Partnership NHS Trust Develop an integrated clinical pathway and care model for people with personality disorders, including a proposed bespoke enhanced community service.
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Leicestershire Partnership NHS Trust Ensure team staff understand the process for allocating a community worker after assessment, including through new-starter induction.
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Leicestershire Partnership NHS Trust Appoint a Band 7 nurse to lead implementation of guidance on reducing restrictive interventions across inpatient areas.
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Leicestershire Partnership NHS Trust Recruit additional psychologists to strengthen psychologically minded inpatient care.
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Leicestershire Partnership NHS Trust Develop a Standard Operating Procedure clarifying CPA roles, care-coordinator allocation, transfers, community allocation and required reviews.
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Leicestershire Partnership NHS Trust Complete a formal twice-yearly CPA audit across adult mental health inpatient and community services and develop resulting action plans.
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Leicestershire Partnership NHS Trust Tailor and structure psychological support and reflective sessions for ward staff managing patients with personality disorder.
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Department of Health and Social Care Make up to £15 million of additional funding available to develop more health-based places of safety.
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Department of Health and Social Care Reduce significantly delayed transfers of care so people can move from hospital to community care.
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Department of Health and Social Care Provide £400 million of additional investment through 2020/21 to improve community mental health provision.
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Department of Health and Social Care Implement comprehensive community-based mental health pathways so people access care at the right time and place.
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Department of Health and Social Care Provide a full response to the acute inpatient psychiatric care review by the end of 2016/17.
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Department of Health and Social Care Eliminate unnecessary out-of-area placements for adult acute mental health care by 2020/21.
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Department of Health and Social Care Publish a revised Mental Health Act Code of Practice strengthening patient rights and involvement of families, carers and friends.
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× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to identify the roles and responsibilities of involved health and social care professionals
Wider context from the report “4) The care programme approach (CPA) was not adhered to and NICE guidelines were not followed, specifically in ensuring there was a review after 2 admissions within 6 months, and to ensure the roles and responsibilities of all health and social care professionals involved were identified .
” Is this part of a recurring concern? No recurring-concern membership is currently published.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of a local community support network for patients diagnosed with personality disorder
Wider context from the report “5) There is no local network for the community support of patients diagnosed with personality disorder , although evidence suggested such networks were effective when adopted elsewhere.
” Is this part of a recurring concern? No recurring-concern membership is currently published.
Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to review patients after 2 admissions within 6 months
Wider context from the report “4) The care programme approach (CPA) was not adhered to and NICE guidelines were not followed, specifically in ensuring there was a review after 2 admissions within 6 months , and to ensure the roles and responsibilities of all health and social care professionals involved were identified.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of local psychiatric intensive care unit beds for female patients
Wider context from the report “1) There are currently no local psychiatric intensive care unit beds for female patients and this means all female patients can only be placed out of area, potentially many miles away from home and local support.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Lack of effective community psychiatric nurse involvement
Wider context from the report “2) There was no, or no effective, community psychiatric nurse involvement and this was a missed opportunity to monitor and assist Victoria when she was in the community.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Failure to adhere to the care programme approach
Wider context from the report “4) The care programme approach (CPA) was not adhered to and NICE guidelines were not followed, specifically in ensuring there was a review after 2 admissions within 6 months, and to ensure the roles and responsibilities of all health and social care professionals involved were identified.
” Open source report × Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Unavailability of community support for patients with challenging presentations
Wider context from the report “3) The “community support” referred to by the in-patient clinicians does not exist in reality for patients with this challenging presentation , leaving discharged patients and their families without adequate support.
” Open source report
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Engage potential provider organisations to resolve local female PICU capacity and placement options.
Verbatim wording from the response “East Leicestershire and Rutland CCG, as the lead commissioners for mental health in LLR would prefer, if possible, for this service to be provided within the LLR border. However, we need to take account of demand, patient quality, cost and provider availability. With this in mind, we are unable, at present, to commission a local service that meets all of these requirements.” Source location Response from East Leicestershire and Rutland Clinical Commissioning Group
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a local support-network model for patients diagnosed with personality disorder.
Verbatim wording from the response “With regard to a local network for the support of patients diagnosed with a personality disorder, this was recently discussed at the Mental Health Clinical Forum which is led by CCG GP and LPT Clinical” Source location Response from East Leicestershire and Rutland Clinical Commissioning Group
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Submit the local personality-disorder support-network model for consideration.
Verbatim wording from the response “Leads. A suggested model is currently being developed by Clinicians and will be submitted for consideration during the early part of 2017.” Source location Response from East Leicestershire and Rutland Clinical Commissioning Group
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with regional commissioning colleagues to provide a wider range of female PICU placement options.
Verbatim wording from the response “In line with the national picture, there is recognition that the availability of general acute mental health and PICU beds is under pressure. This continues to be the case despite extensive efforts to minimise out of area placements. Since April 2016, there have been 10 female out of area placements made with an average length of stay of 45 days.” Source location Response from East Leicestershire and Rutland Clinical Commissioning Group
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue negotiating commissioner contracts for provision of the proposed personality-disorder services.
Verbatim wording from the response “Further to our response to concern 3, LPT is not commissioned to provide an “enhanced service” to provide support and treatment for people with a severe and complex personality disorder (SCPD) in the community. A group of our senior clinical and operational leaders, with support from Commissioners, are working together to develop an integrated clinical pathway and model for care for people with Personality Disorders. As part of this proposal a dedicated team to provide this enhanced service is proposed, the purpose of which is to provide an intensive community based treatment support for both patients in treatment, and in crisis. The aim is to link the pathway together with supporting services in primary care, social care, and Police. We continue to work with our commissioners to negotiate our 2017/2018 contracts for provision of services, of which this remains an ambition to provide.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop an integrated clinical pathway and care model for people with personality disorders, including a proposed bespoke enhanced community service.
Verbatim wording from the response “However the community support as mentioned by the inpatient consultants refers to an “enhanced service” for people with severe and complex personality disorder (SCPD) who are difficult to maintain in the community with existing standards services and they inadvertently access acute services (inpatient and crisis services). LPT is currently not commissioned to provide this “enhanced service”. Some Trusts have adopted innovative practice which is commissioned to address this gap and LPT is doing the same with our Commissioners in proposing testing a bespoke service for people with SCPD as part of a wider Personality Disorder service development.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Ensure team staff understand the process for allocating a community worker after assessment, including through new-starter induction.
Verbatim wording from the response “In this case, the lack of effective CPN input during the time Victoria was a community patient was an isolated incident, with the assessing CPN failing to follow the standard operating team process, whereby the assessing worker accepts the person onto their case load if they have capacity. If they don’t have capacity the assessing worker should present the outcome of the assessment at the next Multi-Disciplinary team (MDT) meeting in order to allocate to a Community Worker/CPN within the Team.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Appoint a Band 7 nurse to lead implementation of guidance on reducing restrictive interventions across inpatient areas.
Verbatim wording from the response “We have also appointed a Band 7 nurse to lead on the implementation of the “Positive and Proactive Care: Reducing the Need for Restrictive Interventions” guidance across all inpatient areas of the Trust. This is anticipated to reduce the need for higher environmental restrictions (in Victoria’s case, referral to PICU) and better management in acute ward settings.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit additional psychologists to strengthen psychologically minded inpatient care.
Verbatim wording from the response “We have since tailored and structured psychological support and reflective sessions for ward staff who manage patients with personality disorder and are in the process of recruiting more psychologists to strengthen the psychologically minded approach to care. This will ensure that NICE clinical guidance 78 is followed for inpatient stays.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop a Standard Operating Procedure clarifying CPA roles, care-coordinator allocation, transfers, community allocation and required reviews.
Verbatim wording from the response “In order to ensure roles and responsibilities of health and social care professionals involved in the CPA process are clear, understood and adhered to, a Standard Operating Procedure (SOP) is under development. Included in this SOP it will confirm and clarify the process to identify a Care Co-ordinator for patients in in-patient services, and will confirm and clarify the transfer and allocation process for the identification of the Care Co-ordinator in the community team, and associated reviews required.” Source location Response from Leicestershire Partnership NHS Trust
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Complete a formal twice-yearly CPA audit across adult mental health inpatient and community services and develop resulting action plans.
Verbatim wording from the response “A formal bi-annual CPA audit across AMH in-patient and community services has recently been completed and action plans developed. There are specific questions within the audit in relation to the CPA Care Plan, showing a clear description of needs and there being a description of the action to be taken and by whom. The audit completed in 2014 showed good compliance in these areas.” Source location Response from Leicestershire Partnership NHS Trust
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Tailor and structure psychological support and reflective sessions for ward staff managing patients with personality disorder.
Verbatim wording from the response “We have since tailored and structured psychological support and reflective sessions for ward staff who manage patients with personality disorder and are in the process of recruiting more psychologists to strengthen the psychologically minded approach to care. This will ensure that NICE clinical guidance 78 is followed for inpatient stays.” Source location Response from Leicestershire Partnership NHS Trust
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Make up to £15 million of additional funding available to develop more health-based places of safety.
Verbatim wording from the response “You may also be aware that the Government made available £15m to develop more health based places of safety as appropriate places for people with mental health problems who are detained by the police. The Prime Minister announced this month that we will make further additional funding available, up to £15m, to build on this successful work.” Source location 2016-0370-Response-by-Department-of-Health
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Reduce significantly delayed transfers of care so people can move from hospital to community care.
Verbatim wording from the response “We want to eliminate unnecessary out of area placements for adult acute mental health care by 2020/21 and reduce significantly delayed transfers of care so that people can move from hospital to care in the community, ensuring that beds are available for those most in need. We appreciate that this will not happen overnight but we are committed to delivering change. Also, through the Five Year Forward View, we will implement a comprehensive set of community-based mental health pathways of care so that people have access to care at the right time in the right place.” Source location 2016-0370-Response-by-Department-of-Health
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide £400 million of additional investment through 2020/21 to improve community mental health provision.
Verbatim wording from the response “The Government announced an additional £400m investment up to 2020/21 to improve the quality of community mental health provision as an effective and safe alternative to hospital admission. This builds on the successful National Mental Health Crisis Care Concordat which has seen every local area develop a crisis care action plan to ensure that no-one in crisis is turned away.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement comprehensive community-based mental health pathways so people access care at the right time and place.
Verbatim wording from the response “We want to eliminate unnecessary out of area placements for adult acute mental health care by 2020/21 and reduce significantly delayed transfers of care so that people can move from hospital to care in the community, ensuring that beds are available for those most in need. We appreciate that this will not happen overnight but we are committed to delivering change. Also, through the Five Year Forward View, we will implement a comprehensive set of community-based mental health pathways of care so that people have access to care at the right time in the right place.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide a full response to the acute inpatient psychiatric care review by the end of 2016/17.
Verbatim wording from the response “You may be aware that the Commission to review the provision of acute inpatient psychiatric care for adults, led by Lord Crisp, published its review in 2015. The review found that access to mental health beds nationally was not so much an issue of bed capacity but an issue of discharge policies and alternatives to hospital admission in the community. We are committed to providing a full response to the review by the end of 2016/17.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Eliminate unnecessary out-of-area placements for adult acute mental health care by 2020/21.
Verbatim wording from the response “We want to eliminate unnecessary out of area placements for adult acute mental health care by 2020/21 and reduce significantly delayed transfers of care so that people can move from hospital to care in the community, ensuring that beds are available for those most in need. We appreciate that this will not happen overnight but we are committed to delivering change. Also, through the Five Year Forward View, we will implement a comprehensive set of community-based mental health pathways of care so that people have access to care at the right time in the right place.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Publish a revised Mental Health Act Code of Practice strengthening patient rights and involvement of families, carers and friends.
Verbatim wording from the response “You have raised concerns about the quality of care planning in Victoria Halliday’s case. We published a revised Mental Health Act 1983 Code of Practice in 2015 which strengthened the guiding principles of the Code. This included strengthening the rights of patients and better involvement of patients’ family, carers and friend in their care so that they can provide the much needed support for patients to manage their condition and support recovery and independent living in the community.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation A local PICU service cannot currently be commissioned because demand, quality, cost and provider availability cannot all be met.
Verbatim wording from the response “East Leicestershire and Rutland CCG, as the lead commissioners for mental health in LLR would prefer, if possible, for this service to be provided within the LLR border. However, we need to take account of demand, patient quality, cost and provider availability. With this in mind, we are unable, at present, to commission a local service that meets all of these requirements.” Source location Response from East Leicestershire and Rutland Clinical Commissioning Group
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Direct provision of local female psychiatric intensive care beds is outside the Trust’s commissioning remit.
Verbatim wording from the response “Service Response
LPT is not currently commissioned to directly provide Female Psychiatric Intensive care beds (PICU). Our commissioners are in the process of procuring a local, medium to long term solution, for female Psychiatric Intensive Care Unit (PICU) placements in Leicester, Leicestershire and Rutland. The procurement process is unlikely to be resolved until 2017/18. For patients who are placed out of area, through our Adult Mental Health (AMH) Bed Management Team, we keep in touch on a weekly basis with the placement providers to ensure that length of stay out of area is for an agreed period of time, and that repatriation back to local services is facilitated at the earliest opportunity. In Victoria’s case, referrals to PICU were made from the Bradgate inpatient area due to her challenging presentation and its impact on staff.” Source location Response from Leicestershire Partnership NHS Trust
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Providing an enhanced community service for people with severe and complex personality disorder is outside the Trust’s current commissioning remit.
Verbatim wording from the response “However the community support as mentioned by the inpatient consultants refers to an “enhanced service” for people with severe and complex personality disorder (SCPD) who are difficult to maintain in the community with existing standards services and they inadvertently access acute services (inpatient and crisis services). LPT is currently not commissioned to provide this “enhanced service”. Some Trusts have adopted innovative practice which is commissioned to address this gap and LPT is doing the same with our Commissioners in proposing testing a bespoke service for people with SCPD as part of a wider Personality Disorder service development.” Source location Response from Leicestershire Partnership NHS Trust
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commissioners are responsible for developing and commissioning the proposed enhanced severe and complex personality disorder community service.
Verbatim wording from the response “However the community support as mentioned by the inpatient consultants refers to an “enhanced service” for people with severe and complex personality disorder (SCPD) who are difficult to maintain in the community with existing standards services and they inadvertently access acute services (inpatient and crisis services). LPT is currently not commissioned to provide this “enhanced service”. Some Trusts have adopted innovative practice which is commissioned to address this gap and LPT is doing the same with our Commissioners in proposing testing a bespoke service for people with SCPD as part of a wider Personality Disorder service development.” Source location Response from Leicestershire Partnership NHS Trust
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Commissioners are responsible for procuring a local medium- to long-term solution for female psychiatric intensive care placements.
Verbatim wording from the response “Service Response
LPT is not currently commissioned to directly provide Female Psychiatric Intensive care beds (PICU). Our commissioners are in the process of procuring a local, medium to long term solution, for female Psychiatric Intensive Care Unit (PICU) placements in Leicester, Leicestershire and Rutland. The procurement process is unlikely to be resolved until 2017/18. For patients who are placed out of area, through our Adult Mental Health (AMH) Bed Management Team, we keep in touch on a weekly basis with the placement providers to ensure that length of stay out of area is for an agreed period of time, and that repatriation back to local services is facilitated at the earliest opportunity. In Victoria’s case, referrals to PICU were made from the Bradgate inpatient area due to her challenging presentation and its impact on staff.” Source location Response from Leicestershire Partnership NHS Trust
Open published response
×
Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation The lack of effective community psychiatric nurse input was an isolated incident, not evidence that community support generally did not exist.
Verbatim wording from the response “A standard community service exists within LPT for people with personality disorder in the form of community mental health team (CMHT), Crisis Resolution Team (CRT) and Specialist Personality Disorder Service (FDL). Victoria was accessing all these services during the course of her contact with LPT. An identified Community Psychiatric Nurse (CPN) from the CMHT, CRT was present during professional and CPA meetings whilst Victoria was an inpatient. Due to the nature of Victoria’s presentation of presenting in different areas of the country in a crisis covering CPNs and CRT professionals tried to ensure continuity as much as possible.” Source location Response from Leicestershire Partnership NHS Trust
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation National access to mental health beds is characterised primarily as a discharge and community-alternatives issue rather than a bed-capacity issue.
Verbatim wording from the response “You may be aware that the Commission to review the provision of acute inpatient psychiatric care for adults, led by Lord Crisp, published its review in 2015. The review found that access to mental health beds nationally was not so much an issue of bed capacity but an issue of discharge policies and alternatives to hospital admission in the community. We are committed to providing a full response to the review by the end of 2016/17.” Source location 2016-0370-Response-by-Department-of-Health
Open published response
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Local clinical commissioning groups are responsible for commissioning psychiatric intensive care beds because they assess and meet local community needs.
Verbatim wording from the response “You have raised concerns about the availability of psychiatric intensive care beds locally for women. Psychiatric intensive care beds are commissioned locally by clinical commissioning groups (CCGs) as they are best placed to assess and meet the needs of their local communities.” Source location 2016-0370-Response-by-Department-of-Health
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Source evidence
How this respondent position was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Local mental health commissioners and providers are responsible for taking necessary action when care-planning shortfalls are identified.
Verbatim wording from the response “You have raised concerns about the quality of care planning in Victoria Halliday’s case. We published a revised Mental Health Act 1983 Code of Practice in 2015 which strengthened the guiding principles of the Code. This included strengthening the rights of patients and better involvement of patients’ family, carers and friend in their care so that they can provide the much needed support for patients to manage their condition and support recovery and independent living in the community.” Source location 2016-0370-Response-by-Department-of-Health
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