Monday, 15 January 2018

Back to the Floor: Katie Blackburn, Powys Community Health Council at Newtown Community Mental Health Team

Katie Blackburn (top left) with Newtown Community Mental Health team
In August last year I observed Superintendent Jon Cummins go Back to the Floor at the mental health inpatient unit in Powys, Felindre Ward, and wrote about the idea behind the activity and Jon’s experience on this blog. Put simply the concept is that Chief Officers, Service Directors and other high-level staff have the opportunity to experience a day in the life of a member of staff at the operational end of a service. This gives them the opportunity to find out what is really happening on the ground, and what consequences strategic decision-making can have on people who are in receipt of a service.

In late 2017 I was pleased to observe Katie Blackburn, the Chief Officer of Powys Community Health Council, go Back to the Floor at Newtown’s Community Mental Health Team. The county CHC is the “Healthcare Watchdog for Powys - an independent statutory organisation that represents the interests of patients and the public in the National Health Service in Powys”. Katie has been in post since January 2017.

Lauraine Hamer, Senior Practitioner AMHP (Approved Mental Health Professional) at the CMHT, met us at the start of the morning with details of what she had planned for Katie’s visit. This included chance to find out more about her work and that of her colleagues, plus an opportunity to join a Multi-Disciplinary Team meeting and also to accompany a Community Psychiatric Nurse on a visit to a client. In the event we had to stay flexible as circumstances changed throughout the morning… but such is life at a busy mental health service.

Before the visit: Katie’s view

I had no idea about the work of this particular CMHT in Newtown before my visit. From my previous life, I have an understanding of the roles of CPNs and social workers. I was CEO of a drug and alcohol charity and mental health is an issue there. To a lesser extent with The Prince’s Trust, I was working with vulnerable young people in the care system.

I was very keen to shadow and meet the team and listen. I felt that perhaps I could ask questions that other people were perhaps uncomfortable asking.

The key barrier I am aware of – which I know of from my domestic abuse background – is that whilst aspiring to put individual people at the heart in reality individuals are often bounced from pillar to post. For example, they might have to continually provide their national insurance number, or relate details of stressful events to different people. The journey should be (and could be) much smoother and easier. Sometimes we need to make a decision there and then, which might not fit in with governance and procedure. For example, the question of who pays to get people from A to B often comes up. If there is an individual who needs to be transferred from Brecon to Nottingham……who pays? Agencies can become tied up in which budget is paying for this journey and can lose sight of the individual’s needs.

When it comes to strategic issues, I am not aware of any recent changes within the CMHT, but, I am aware of, and have been involved with the development of the Health & Care Strategy and the intention to align health and social care in Powys. It will be nice to see the operational impact of that.

I am conscious that services are very stretched because of pressures on staff and budgets, and that things can sometimes become more complex and complicated than they need to be.

I hope that Powys’ Health & Social Care Strategy will bring change – whilst recognising that not everyone likes change; there is a risk of unsettling an already stretched workforce.

There will undoubtedly be a growing use of digitisation going forward – however, it’s about putting the individual first. With regard to a future workforce we need to identify what skills Powys needs.

Lauraine Hamer and Katie Blackburn
Back to the Floor exercise

Lauraine is an extremely experienced and knowledgeable Senior Practitioner, and was able to give Katie a very thorough grounding in the work of the team at Newtown CMHT. At the MDT meeting we met CPNs, members of the North Powys Crisis Resolution Home Treatment Team, Admin staff, a trainee AMHP, Social Workers, and a Support, Time and Recovery (STR) worker. Later we learnt more about the Accredited Accommodation Scheme* from the Co-ordinator Wendy Laws, and Katie spoke to Dr Fran Foster, a Consultant Psychiatrist.

Unfortunately, we were unable to shadow CPN Kelle Hall on a home visit to a client. This was due to a last minute change in the person’s circumstances.

After the visit: Katie’s view

When deciding whether my understanding of what the services does is correct, I think “no” is the simple answer. There were elements of it that I knew, however, other elements were new to me. Staff in the MDT meeting worked co-operatively very well together. Particularly when sharing information - the team focussed on the needs of the individual rather than their specific jobs.

The “seeing is believing” approach is very important. It would have been nice to sit in on a visit with an individual using services, but I understand the issues around confidentiality and the vulnerable lives people lead.

My main observation is that the people in this team are doing the best they can in the circumstances. There is clearly an issue around staff capacity. Other obvious issues include – cross-border, cross-boundary provision and the lack of in-county beds for people. In the MDT meeting, the real focus was on the discussion of high-end/vulnerable situations and not on the preventative side of the service. I wonder if there is an opportunity for reflection and discussion on what might have prevented a specific situation and what changes could be made in the future (if any)?

Staff are very much dealing in the here and now. They are not looking at people’s pasts or where they might be in five years’ time. I wonder - is there an opportunity to look at where resources should be channelled?

This experience will definitely mean I’m able to contribute more effectively at times when strategic decisions about services are made. I am a big believer in real-life examples. There are also pressures on recruitment for the CMHT. There appears to be an element of disjoint between strategic and operational. The staff clearly work well as a team, and there are a number of opportunities to build on (and share) existing good practise across Powys. In addition, their working environment is extremely poor, despite this, it strikes me that they are a dedicated, professional team doing their best in the circumstances.

Going forward, I am keen to do something in my role at the CHC around listening to vulnerable voices. There is definitely an opportunity to start with this service - certain groups do not access our service or receive support including young people and young carers. Listening to Vulnerable Voices will be a priority for Powys CHC in 2018-2019.

* Wendy Laws co-ordinates the Accredited Accommodation scheme in Powys, which is the only one of its kind in Wales. People supported by secondary mental health services are entitled to access day visits or overnight stays with registered accommodation providers who have their own lived experience of mental health distress. People accompany their hosts on shopping trips or days out to the seaside, for example, and enjoy a caring and nurturing environment. This service prevents hospital admission and people have described the incredible benefits of feeling part of an extended family.

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