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The Royal College of Psychiatrists Improving the lives of people with mental illness

Northern Ireland monthly update

 

May 2018

Chair’s monthly report

Artwork

 

 

 

 

 

 

 

 

 

 

Artwork at the Dementia Transforming the Journey Conference

 

External affairs

16 May: Dr Gerry Lynch hosted one of his regular meetings with the Trust Medical Managers to discuss the College’s agenda where specifically relevant to the work of the Trusts. Among those in attendance was newly appointed Southern Trust Medical Manager Dr Pat McMahon, who has taken over from Dr Neta Chada. Dr Lynch congratulated Dr McMahon on his appointment and wished him all the best in the role. Dr Lynch also thanked Dr Chada for all her helpful input into these meetings in his time as Chair.

 

23 May: An important Strategy meeting at Clifton House was called by Chair Dr Gerry Lynch and was supported by the attendance of College Director of Strategic Communications Kim Catcheside, Head of Policy and Campaigns George Roycroft and Policy and Campaigns Administrator Thomas Rutherfoord who assisted with how to translate various Faculty asks into an overall strategic campaign. As an outcome, it is hoped to focus on the Commissioning model for mental health services going forward.

 

NI Assembly and DoH matters

4 May: RCPsych in NI Chair Dr Gerry Lynch forwarded the recently launched RCPsych in NI Report CR212 on "Alcohol-Related Brain Damage in Northern Ireland - Treatment, Not Just Care" to the Chief Executives and the Medical Directors of the 5 Health and Social Care Trusts, with a request that they give consideration to this Report in their service planning.

 

9 May: The Department of Health released details of a series of important initiatives being funded under the £100m Health and Social Care transformation fund.

“The planned package of investments for 2018/19 includes £15m for enhancing primary care – care which is largely provided from GP practices. This will include some £5m for the roll-out of Multi-Disciplinary Teams (MDTs) at GP practices. These involve the establishment of practice-based physiotherapists, mental health specialists and social workers - working alongside doctors and nurses to better meet the needs of the local population. The roll-out of MDTs this year will cover two areas initially, each serving in the region of 100,000 people. Developing Multi-Disciplinary Teams (MDTs) at GP clinics represents health and social care transformation in action, helping provide more care closer to people’s homes. This will have the added benefit of easing demand pressures on hospitals. It is hoped that success across the MDT pilot areas will lead to the initiative being extended to GP practices across the province in the years ahead.

Further projected investments under the £100m transformation funding also include:

  • £15m for workforce development in the Health and Social Care sector. This funding will support a key transformation goal of developing new and innovative ways of working together across health and social care.
  • Up to £30m for reforming community and hospital services, including mental health and pharmacy. This funding will help implement new strategies for key services including: cancer services; stroke services; paediatric services; medicines optimisation; and diabetes care and prevention. It will also support the reconfiguration agenda, by investing in plans for Elective Care Centres - stand-alone day surgery units that will make a major contribution to tackling hospital waiting times.
  • £5m will be invested in a range of interventions which will enable transformation. This will include a range of targeted actions aimed at strengthening the voice of those who use and those who deliver HSC services, so that they play a key role in developing and implementing new ways of working. Further areas of investment will build capacity for quality improvement across the system, as well as investment in technology and supporting innovation.
  • £5m on building capacity in communities and prevention, including significant investment in children’s social services to fund a new approach to working with parents and families and to provide a different offer to children in care to better meet their needs.

It was recently announced that £30m of the £100m funding for 2018/19 will be targeted at reducing hospital waiting times. This is in line with the Bengoa and Delivering Together reports on transformation, which cited the need to address waiting times as a stabilisation measure. This funding will allow up to a further 24,000 outpatient assessments and approximately 7,400 treatments to be carried out; along with 19,000 diagnostics to reduce the number of people presently waiting longer than 26 weeks. In addition, an estimated 24,000 Allied Health Professional assessments can be provided to reduce the current backlog of patients waiting longer than 13 weeks, mainly for physiotherapy and occupational therapy.”

 

14 May: The Department of Health launched its “Health and Social Care Workforce Strategy 2026: Delivering for Our People and alongside were details of an initial allocation of £15m in workforce development, from the £100m transformation fund for 2018/19.

“The aim of the Strategy is that by 2026, we meet our workforce needs – and the needs of our workforce.

The Strategy has three objectives:

  • By 2026, the reconfigured health and social care system has the optimum number of people in place to deliver treatment and care, and promote health and wellbeing to everyone in Northern Ireland, with the best possible combination of skills and expertise
  • By 2021, health and social care is a fulfilling and rewarding place to work and train, and our people feel valued and supported
  • By 2019, the Department and health and social care providers are able to monitor workforce trends and issues effectively, and be able to take proactive action to address these before problems become acute.

The Strategy has three consecutive action plan periods, designed to take account of changes and improvements to health and social care over the life of the Strategy to 2026.  The first action plan period runs to 31 December 2020, and contains 24 actions.  Detailed action plans on each will be co-produced between the Department, health and social care service employers and trade unions, and other interest groups.

Around a third of the £15m will be directed towards the nursing, midwifery and Allied Health Professional workforce. This will include funding for 74 additional pre-registration nursing places, and 25 additional midwifery places, meaning a total of 1000 nursing and midwifery training places are being commissioned from universities in 2018/19 – an all-time high in Northern Ireland. The transformation funding will also support other training investment in nursing, midwifery, nursing assistants, physiotherapy, radiography, paramedics and medical specialties. The investment will boost a key transformation goal of developing new ways of working across health and social care.

Key actions outlined in the Workforce Strategy include:

Develop and, by 2026, sustainably fund, an optimum workforce model for reconfigured health and social care services

  • Take account of and plan for the workforce implications arising from the UK’s exit from the EU and the subsequent implications for the EU/EEA and non-EU/EEA workforce
  • Explore and establish non-salary incentive programmes as a means of recruiting and/or retaining people and/or dealing with pressures in less popular specialties and locations
  • Set up and roll out a regional health and social care careers service targeted at the existing workforce, young people from the age of 14, and possible returners to service
  • Develop and integrate new ways of working and jobs across health and social care, and fund sustainable training and development programmes that meet service needs
  • Adopt and roll out new regional staff health and wellbeing policy and invest more in occupational health services
  • Co-produce a regional work-life balance policy for health and social care workers
  • Simplify employment arrangements, including examining whether a single employer for all HSC staff is feasible and will produce benefits for staff/patients/ clients”

The Department also published alongside this document: 

 

15 May: Drs Gerry Lynch and Michael Doherty met at Clifton House to draft our response to the DoH Consultation on its Revised Service Framework for Mental Health and Wellbeing 2018-2021. Comments had been received from Drs Paddy Moynihan, Deirdre Shields, Rowan McClean, Arun Subramanian and Colin Gorman, all of which were considered and incorporated as far as possible in the overall drafting process.

 

17 May: Vice Chair of Child and Adolescent Faculty Dr Mark Rodgers represented the College at a meeting organised by the Department of Education  with Community Paediatricians to discuss future pathways for the Education Authority to get input for Special Educational Needs (SEN) statements for pupils with physical and mental disorders. Dr Ian McMaster had flagged this opportunity. Afterwards Dr Rodgers commented that:

“I was delighted to attend this meeting where the Department of Education had brought together key stakeholders to devise a more effective SEN framework aiming for inclusion, early identification, assessment and intervention. A new list of SEN categories and medical categories have been devised that focus on these aims. Implementation will be in Autumn 2018. This is good news for those children with physical health conditions, mental health conditions or complex healthcare needs wherein a more inclusive SEN framework can improve and assist access to the curriculum. It is also a positive step in terms of parity of esteem between physical health conditions and mental health conditions.”

 

24 May: We submitted our response to the DoH Consultation on its Revised Service Framework for Mental Health and Wellbeing 2018 – 2021, in advance of the 31 May deadline.

 

Legislation

An article by Dr Phil Campbell and Professor Keith Rix, Honorary Consultant Forensic Psychiatrist (Norfolk and Suffolk NHS Foundation Trust) and Visiting Professor of Medical Jurisprudence (Institute of Medicine, University of Chester) has been published in this month’s BJ Psych Advances (Volume 24, Issue 3) at pages 195-203 entitled “Fusion legislation and Forensic Psychiatry: the Criminal Justice provisions of the Mental Capacity Act (Northern Ireland) 2016.”

(Note: The College now provides free online access to all BJPsych journals for members (access changed from 1st May 2018). Signing in is required to access this and other articles. Non-members with academic access can also access the article.)

 

22 May: Dr Gerry Lynch and Professor Roy McClelland met Sean Holland, Chris Matthews and Taryn McKeen from DoH at Castle Buildings, Stormont, Belfast to discuss progress with the implementation of the Mental Capacity Act (NI) 2016. Work continues on drawing up the Code of Practice and Regulations, but it seems that the formal consultation process cannot begin without Ministerial approval. Dr Gerry Lynch afterwards stated: “We discussed the importance of working on the Forensic parts of the Code of Practice, of the need for a clear awareness raising and training strategy across all of Health and Social Care and of beginning to address the issue of children under 16, who are not included in the new Act’s provisions.”

 

24 May: Forensic Faculty Chair Dr Adrian East met with officials from the Department of Justice in relation to their work on the Criminal Justice aspects of the Code of Practice for the Mental Capacity Act (NI) 2016. This task is commencing shortly and it was agreed that further meetings would be held as the work progresses.

 

Trainees

1 May: Core Psychiatry Trainee Dr Kathryn Mitchell and Informatics Committee Chair Dr Stephen Moore posted a blog in the "Mental Elf" entitled “Nobody knows the trouble I’ve seen: Depression and Bipolar Disorder in People with Intellectual Disabilities”. The authors say that their paper highlights the importance of identifying and treating mental illness thoroughly in people with intellectual disabilities, with new information given on the factors that predict an incident depressive episode in an ID population which will be helpful for awareness in clinical practice – accompanied by a plea for more services to research affective disorders in this population to gather further robust evidence to support these results.

 

Media coverage

24 May: Latest Insight magazine on page 2 featured Dr Gerry Lynch and his lobbying trip to Westminster to campaign for release of funds for mental health services in Northern Ireland.

 

30 May: Dr Gerry Lynch was quoted in the Lancet Psychiatry 2018 Editorial published online today, entitled “The Mental Health Act Review: Getting out of the twilight zone” - in relation to his view of the Mental Capacity Act (NI) 2016. Also referenced was the article on said Act published in the December 2017 edition of BJ Psych and penned by Drs Gerry Lynch, Catherine Taggart and Phil Campbell.

 

Faculty and Committee business

1 May: Members of the Perinatal Faculty met as a follow up to their highly successful Conference in mid April.

18 May: SAS and Affiliates Faculty met in Clifton House with Vice Chair Dr Adele Swindles assuming the Chair due to Chair Dr Liz Dawson being unavailable. Consideration was given to expansion of the role of the SAS doctor such as through CESR application, locally as OSCE/ DMH examiner or indeed College Assessor. Training opportunities in Medical Education and Mentoring were discussed, as was the usefulness of Multidisciplinary SASG groups within each Trust. 

21 May: Intellectual Disability Faculty met in Clifton House with their Chair Dr Arun Subramanian. Issues discussed included Epilepsy, Rapid Tranquillisation Protocol, STOMP Pledge, Dr Bawa Garba case implications and Recruitment,. A survey was completed on restrictive practice (organised by Dr Edel O’Neill). Finally, presentations on Health Facilitation and ADEPT experience were given by Drs Brea Crothers, Lorna Brown and Judy Curran.

22 May: Child and Adolescent Faculty Chair and Vice Chair Drs Richard Wilson and Mark Rodgers attended the Central Child and Adolescent Faculty Executive meeting in London.

Afterwards, Dr Wilson reflected:
“The packed agenda contained many issues relevant to Northern Ireland. We do not currently experience the dire recruitment/retention issues either in the CAP Consultant complement or in our Specialist Registrar Training Programme that seem to be endemic in many other areas of the Country....I tend to think this is due to a combination of our excellent training program (Dr Boyd and all trainers take a bow!) and perhaps to the generally good working conditions and relationships in Northern Ireland....long may this continue!

You may know that CR182 (“Building and sustaining specialist CAMHS to improve outcomes for children and young people” -ie Consultant workforce planning guidance)- is being revised; by no means an easy revision and hopefully improved, more evidence based guidance will be available for the Regional Representatives upon completion.

The Mental Capacity Act (NI) 2016 continues to generate great interest across the water. England again has drawn back from adopting a pure fusional approach so Northern Ireland continues to ride the first wave of this radical reform alone. We have had excellent advice and support freely given by our UK colleagues regarding the under 16 exclusion from the Act conundrum and we will continue in the local Faculty to develop our own view of a potential bespoke solution.

Dr David Foreman and others are currently developing a CAP Outcomes strategy and we will both contribute to this and hopefully benefit when we come to create our own NI Regional Outcomes approach in partnership with the HSCB Leads.

A Youth Mental Health Special Interest Group is being established with special emphasis on Transition areas, notably Student Mental Health which presents unique challenges to effective service delivery. Our local Vice Chair, Dr Michael Doherty has been instrumental in the genesis of this important group and we will give every support from the CAP Faculty to this and other Transition projects.

CAP Faculty Scientific Conference 2019 is looking good and venues are being considered....we did wonder about an overall theme around Transgenerational Trauma & Neurobiology being appropriate and relevant.

Finally, myself and Dr Amani Hassan (CAP Faculty Wales) have been asked to take over an advisory role with Save the Children to help develop educational input for mental health workers delivering services in the Middle Eastern war zone.”

23 May: The Executive met in Clifton House chaired by Dr Lynch and heard from various Faculties and Committees. 

 

Sharing best practice and Quality Improvement ideas

 

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UPS

Pictured left to right are Dr Richard Wilson, Michael Owen and Dr Shilpa Shah
Pictured left to right are Martin Donnelly, Drs Richard Wilson and Elaine Lockhart

 

2 May: The 8th Joint Annual Meeting of RCPsych in NI Child and Adolescent Faculty with the Ulster Paediatric Society (UPS) entitled “Adolescent Psychiatry – Bridge over Troubled Water” was held in Riddel Hall, Stranmillis, Belfast and attracted over 70 delegates. After introductions from Faculty Chair Dr Richard Wilson and Honorary Secretary of UPS Dr Shilpa Shah, the morning session heard from Chair of the Royal College of Paediatrics and Child Health in NI Dr Karl McKeever on Paediatric and Child Health Managed Networks NI, from Public Health Agency Regional Alcohol and Drugs Lead Michael Owen on Substance Misuse Services for Children and Young People, from our own member Dr Kate Latimer on Development in Adolescent Psychiatry and finally from keynote speakers (both working in Glasgow) Consultant in Paediatric Liaison Psychiatry Dr Elaine Lockhart and Clinical Nurse Specialist, Martin Donnelly on Paediatric Liaison Services for Young People. The latter received the national RCPsych Team of the Year Award in 2017 for their multidisciplinary team providing a bespoke liaison psychiatry service supporting local, regional and Scottish national paediatric services.

The afternoon session heard from Northern Trust Crisis Team Lead Caroline Brown on their new Crisis Resolution and Home Team Service, from Northern Trust Team Lead for Eating Disorder Service Sinead Hutchinson and her Team on harnessing the lived experience of Mentors in Eating Disorder Practice and concluded with our own member Dr Hannah Browne, along with Fiona Paterson from the NI Knowing Our Identity Service – who both addressed Knowing Our Identity: Swimming in Troubled Waters. Afterwards Dr Richard Wilson commented:
“It felt like a good day and an excellent turn out, with a balanced representation from Child Psychiatry & Paediatrics”.

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Pictured left to right are Drs Hannah Browne, Kate Latimer and Richard Wilson with Caroline Brown...also a local cat which networked with delegates throughout the day!

 

4 May: Bernadette Hamilton attended Clifton House to continue work on an update of the GAIN (Guidelines & Audit Implementation Network) guidance to the Mental Health (NI) Order 1986, being done at the request of the Regulation and Quality Improvement Authority. 

 

9 May: Staff attended a further planning meeting in relation to the forthcoming Dementia Conference taking place on 17 May.

9 May: Masterclass led by University of Ulster’s Professor Gerry Leavey and Dr Annette Thampi was held in Clifton House to discuss the results of a study on “Improving Mental Health Pathways and Care for Adolescents in Transition to Adult Services in NI (IMPACT)” which was undertaken by the University of Ulster and funded by the Public Health Agency.  Our members, Drs Lisheen Cassidy, Stephen Moore, Ciaran Mulholland, Annette Thampi and Gail Walker had been among the principal investigators involved in this in each of the 5 Trusts. A large number of our Trainees assisted with the pilot and/or the case note data collection. The Masterclass was very timely in seeking to ensure that young people do not “fall through the net” as they transition from CAMHS to Adult Services.

        

10 May: Staff participated in a mandatory Lunch and Learn session via Skype with Central College, given by Kathryn Campling, who is an Information Governance Consultant employed by Central College - in relation to the forthcoming introduction of the General Data Protection Regulation which becomes enforceable from 25 May.

10 May: Dr Michael Doherty in his capacity as General Adult Faculty executive representative on the Universities’ UK Task Group on Student Mental Health, was in London for the launch of a Report entitled “Minding our future: starting a conversation on student mental health”. Dr Doherty stated that:
“this report addresses the interface between University student support services and the NHS mental health services. It is an easy to read report with key information directed at Senior Managers in the Universities and Health services and anyone interested in student mental health services.”

 

11 May: SAS and Affiliate Chair, Dr Liz Dawson, attended College Assessor training at the Centre for Life in Newcastle Upon Tyne. Afterwards, Dr Dawson explained:
“This role has only recently been opened to Staff, Specialty and Associate Specialist (SASG) Doctors within the College. Subsequently, the College plan to train and develop a pool of Assessors who will be able to provide input into SASG recruitment panels throughout the UK. The College Assessor has the important role of ensuring that Trust SASG recruitment panels have an independent and external influence. They also help to monitor compliance with College approved job descriptions. In addition, the Assessor can advise Trusts on identifying an appropriate Mentor for new appointees, which is essential for successful transition into a new role. Currently 75% of job descriptions submitted for College approval are in the specialities of General Adult, Old Age and Child and Adolescent psychiatry.  Approximately 15% of these submissions relate to SASG posts. College Assessors can attend panels covering any psychiatric sub-specialty, providing the Assessor has some previous experience or understanding of the role. The Assessor cannot sit on panels within their employing Trust to prevent the development of a conflict of interest. With regards to time commitment, the Assessors are asked to attend 2-3 Advisory Appointment Committee sessions a year. This can be facilitated via professional leave in agreement with the Assessor’s employing Trust. There is flexibility with regards to geographical area covered by the Assessor. The College Assessor role is certainly a dynamic and empowering role for SASG doctors which I look forward to embracing over the coming years. I would also encourage my senior SASG colleagues to consider this role. Further information regarding the application process and training opportunities is made available by the College.”

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Pictured left to right are Drs Gerry Lynch and Tony Stevens, Richard Pengelly, Bob McCann, Dr Petra Corr, Dr Liz Simpson and Oscar Donnelly

 

Dementia

17 May: The College, in collaboration with the Northern Health and Social Care Trust, the NI British Psychological Society (BPS) and Ulster University, held a Conference on “Dementia: Transforming the Journey”. This was the largest Conference in many years on this topic, attracting over 270 delegates, 18 speakers for 6 parallel sessions, over 30 posters and was opened by Richard Pengelly, the DoH Permanent Secretary. Keynote Speakers were drawn from Psychiatry and Psychology and included Professors Gill Livingston (University College London) and Mary McCarron (Trinity College Dublin), Dr Afifa Qazi (Mid and South Essex & NE London Foundation Trust), with Professor Bob Woods and Dr Frances Duffy representing BPS. RCPsych in NI Chair, Dr Gerry Lynch chaired the Parallel Sessions on both Innovation and Prevention and one of our Old Age Liaison Psychiatrists Dr Ronan Kehoe (who was on the organising Committee) chaired the Parallel session on Intervention. Dr Joe Kane presented and members submitted posters. (Guiding principles worth remembering from the day for this area of clinical work are: Mental Stimulation, new ideas thoughts and associations, using orientation both sensitively and implicitly, opinions rather than facts, key reminiscences add to the here-and-now, providing triggers to aid recall, continuity and consistency between sessions, implicit (and not explicit) learning, stimulating language, stimulating executive functioning, person-centredness, respect, involvement, inclusion, choice, fun, maximising potential, building/strengthening relationships.)

 

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Richard Pengelly DoH Permanent Secretary addressing the Conference (left)

 

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Dr Ronan Kehoe as Parallel Session Chair (right)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sarah Travers shared a personal perspective after lunch (below)

 

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Dr Gerry Lynch

Dr Gerry Lynch, Chair RCPsychNI

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