The CSH and RCPsych sustainability scholars

CSH  and RCPsych have four sustainability scholars who are advanced Trainees in psychiatry. They are using their special interest day to work with their local CCG to improve the sustainability of commissioning. They are now half way through their scholarship. They have each started working in their own ways to embed sustainability principles into the redesign of mental health services commissioned by their respective CCGs. Mike Pearce at Oxfordshire CCG has undertaken a sustainability appraisal of a 'Young Person with Dementia' service, evaluating the service from an environmental, financial and social perspective. Arif Ahmed is developing sustainable outcomes for a MH liaison service in Liverpool. Oliver Bashford's work is on redesigning of City and Hackney CCG's crisis pathway and Suhana Ahmed's is working on a new mental health homeless service with Brighton and Hove CCG. Please see below for their half term reports.

Dr Daniel Maughan

Suhana Ahmed

Half term report: RCPsych scholarship and Brighton and Hove CCG

Nearly midway through the RCpsych Sustainability Scholarship, I’ve been thinking about the last 6 months and where I am at the moment. Having been paired with Brighton and Hove CCG, the first few months were getting to meet the relevant people and gain some understanding about the sustainable aspects of the CCG by reading through their sustainability plan and the progress they had made so far. It was clear from early on that they were keen for me to be involved and highlighted a new service being commissioned and piloted called ‘Mental Health Hostels Link’. The aim of the pilot was to gain a greater understanding of the mental health needs of the homeless within hostel settings and to identify barriers to mental health treatment and support.

Whilst significant progress has been made to improve health outcomes of the population as a whole, inequalities remain for many socially excluded group, one of which is the homeless population, with evidence of lower life expectancy and poorer health outcomes. In March 2014, services estimated that 132 people were rough sleeping in one night in Brighton. In addition, there are approximately 400 people in emergency accommodation and the city has 288 hostel places, with a current waiting list of 125 people.

The first few months of the scholarship involved me carving a role for myself in this project, with the 4 principles of sustainability being key in this. Various possibilities were discussed including patient related outcome measures (PROM) and focussing on the restoration of social capital, leaner, more effective pathways and training and empowering hostel staff with training.

In the last few months, after some very informative and useful meetings with individuals at the CCG, we identified an area of focus for the project which would have a sustainable basis and also be helpful in developing the service. To research the evidence around mental health intervention from the 1st stage (every contact counts) and how ‘treatment’ could be incorporated into the engagement process which can be time consuming in this complex population. How does this link into sustainability I hear you say? Improving value – by ‘treating’ from the very first contact, we are delivering interventions that provide the maximum benefit for the least cost (in theory reducing the time spent in the service by ‘treating’ and engaging side by side rather than one after the other). Prioritising prevention – aiming to prevent this population from becoming homeless again by equipping them with skills to build resilience (there is well known ‘revolving door’ phenomenon in the homeless). Empowering individuals and communities – promoting self-management and independent living.

And there you have it, the first 6 months of my scholarship. Let the final 6 months proceed…

Oliver Bashford

Half term report: Sustainability in crisis pathways and the RCPsych scholarship

The first half of the RCPsych sustainability scholarship has brought fascinating insights into the workings of a CCG, and the steps involved in the commissioning of services. I was involved in a GP members engagement event in which priorities for commissioning were discussed and ideas invited from participants. I was part of a session on waste reduction in which we spoke with local GPs to generate ideas about how local services could be improved and waste reduced. I have also been involved with a review and redesign of the crisis pathway in the local area. I looked into best practice from elsewhere around the country to identify efficient models of organising services, which led to a recommendation that a Single Point of Access could be developed in alignment with a new service in another part of London. The work with the redesign of crisis pathways has led to the current project which involves analysing data about the users of crisis services in order to inform decisions about how resources should be most effectively focussed. If we find that particular demographic groups are over-represented in the use of crisis services in this locality, this may allow for focussed intervention to support these groups. Related to this we will be looking at social sustainability in relation to crisis care, including a review of models of services such as street triage, crisis cafe and a peer-supported 'open dialogue' approach currently being implemented in other parts of the world...

Michael Pearce

The first half of the year has been a busy one so far in my role as a psychiatry sustainability scholar… As-well as collaborating and learning with the other enthusiastic scholars, attending and presenting at conferences and engaging with NHS colleagues in the ideas of sustainable healthcare, I have been undertaking 2 main projects: I have been working with Oxfordshire Clinical Commissioning Group to try to apply the principles of sustainable commissioning to the reviewing and commissioning of older adult mental health services. This involves working with the CCG team to review whether current services are sustainable, and to feed sustainability principles into the redesign to ensure all aspects are considered. Examples have included highlighting guidance on early identification of patients, generating guidance on specific risk factors and prevention strategies for functional illness in older age, helping to map which services or innovations/pilots might be best placed to tackle the risks, and others in the works. I have also been undertaking a sustainability appraisal (possibly the first of its kind!) of a young person with dementia service. This service is an innovative charity which uses sustainable methods such as group activities in natural settings, to provide respite to carers/relatives of the sufferers. The project has involved evaluating the service from an environmental, financial, and social perspective (the triple bottom line). I hope to use this as a template for other services to be able to follow… I hope to be able to provide further updates as my work progresses, and I’m looking forward to more collaborative work with the other scholars.

Arif Ahmed

The main focus of my scholarship to date has been involvement with Liverpool Clinical Commissioning Group (CCG) on their liaison service redevelopment. This has given me an insight into commissioning, business cases and the importance of networking. I have been able to attend important meetings at the CCG about the project and introduce them to the  four principles of sustainability.

I have visited a local liaison service in Liverpool which has given some useful insights into the current setup. I am helping Liverpool CCG on the outcomes section of their business case, introducing ‘sustainable liaison outcomes’. The latter has been put together as an abstract and submitted to the liaison faculty for a potential poster and stand at the conference in Birmingham in May 2016. This has involved some joined up working with my fellow scholar Oliver and expert support from Phil and Frances.

You might be thinking what benefits there are to thinking sustainably in liaison psychiatry. Actually, by looking at a service’s structure and outcomes through a lens of the 4 sustainability principles, one might expect improvements such as these:

• Improved patient and family satisfaction with services
• Greater patient resilience through education and linking up with community services
• Improved access to local psychiatric inpatient beds, meaning less travel and more convenience for family
• Better outcomes for vulnerable groups such as the homeless and asylum seekers
• Reduction in unnecessary investigations

These are just a handful of the potential positive outcomes – keep an eye out on the Psych Susnet blog over the coming months for a more detailed report.

As well as engaging colleagues at the CCG in Liverpool, I have also given talks on sustainability in Cumbria (where I work) to the frail elderly pathway Vanguard group and at a dementia steering group meeting (given via teleconference!). I plan to further this with potential talks to trainees and medical students at educational sessions. There will hopefully be an opportunity to lead a session to my fellow higher trainees in psychiatry, which could increase awareness in sustainability and encourage others to take up future scholarships.

If time permits I would like to do a quality improvement project with Liverpool CCG on a selection of the sustainable outcomes. Another potential project is to measure the carbon footprint of the liaison service as a case study, possibly as a joint project with my fellow scholars. I am soon to work with Frances on the ‘improving value’ section of a mental health service review template.

At almost midpoint through this scholarship, I can genuinely say that I have been fortunate to have had this opportunity and enjoyed the journey so far. It has enhanced my training in psychiatry by opening my eyes to sustainability, commissioning and the impact one can have on the services we work in as psychiatrists. I look forward to the second half of the scholarship, collaborating with supportive colleagues and hopefully gaining further tools to be of greater benefit to my patients. For those doctors in training who wish to broaden their experiences and perspectives, I would recommend they consider a special interest in sustainability.