The Leeds Managed Clinical Network

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The Leeds Managed Clinical Network

• Developing confidence whilst living with
  uncertainty

2
The Clinical Network

• One of 11 DH funded national pilot sites 2004
  community services
• National Evaluation by Imperial College
  Learning the Lessons.
• Local Evaluation by University of Chester
• Six-monthly DH Monitoring including service user
  commissioners
• Service and User generated measures

3
The Clinical Network Model

• Staff from a range of agencies and disciplines,
  funded from a single source to achieve common
  aims which no single agency could achieve.
• BUT
• Great effort needed to make partnerships,
  multi-agency work and care pathways feasible or
  satisfactory.
• Added complexity when attempting to capture
  outcomes.

4
The Network Model

• Leeds Partnerships NHS Foundation Trust
• Community Links
• Touchstone
• Leeds Mental Health Advocacy Group
• Leeds Survivor Led Crisis Service
• Leeds Adult Social Care
• PD institute

• Shared aims and principles
• Shared commitment
• Individual agency/discipline roles and
  responsibilities
• Service User Involvement and Collaboration

5
Resources

• 24.8 WTE
• Clinical Service Manager
• Clinical Lead
• Clinical Team Manager
• Practice Development Lead
• Care Co-ordinators
• Health Care Support Workers
• Occupational Therapists/Technical Instructor
• Psychological Therapists
• Service User Consultants/Involvement Lead
• Pharmacist
• Accommodation Support
• Voluntary Sector Support and Inclusion

6
Services

• Assessment and Formulation 8 weeks
• Care co-ordination 100 weeks
• Case consultation sessional
• Diverse Pathways 24 months
• Journey Day Programme 24 weeks
• Dialectical Behaviour Therapy Skills Groups
  modular
• Pear Tree Partnership
• Training/Facilitated Learning

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EMERGING CARE PATHWAY FOR PERSONALITY DISORDER
SERVICES, LEEDS
PATHWAY DEVELOPMENT SERVICE
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IN-PATIENT SERVICES
ALTERNATIVE TO ADMISSION
4
CARE CO-
ORDINATION
3
ACCOMMODATION SUPPORT
OCCUPATIONAL THERAPY AND OASIS
INDIVIDUAL THERAPY

DBT SKILLS
GROUP
2

DIVERSE PATHWAYS
JOURNEY

1
2 DAY TRAINING PROGRAMME
INFORMATION AND ADVICE
CONSULTATION
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Activity

• 7000 face to face contacts per year
• Any given week 82 places available for direct
  work
• 12 in assessment/formulation
• 28 in care co-ordination
• 16 in Diverse Pathways
• 10 in Journey
• 16 in DBT skills

9
Involvement?

• Involvement lead and two user consultant posts
• Service User group and newsletter
• Volunteers at Pear Tree Partnership
• Delivering training and conference workshops
• Survivor led crisis post
• Satisfaction survey
• Evaluation of services

10
Outcomes

• Service use pre-Network and one year later
• Medication review 2007/audit 2009
• Journey evaluation and focus groups
• DBT CORE outcomes
• Day TCs national review
• Service User involvement initiatives,
  satisfaction survey
• Acute in-patient audits 2007 and 2008
• NFA Review 2008
• Regional Training Programme 600 staff
• Award winning allotment Pear Tree Partnership

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Cost analysis NHS savings per service after
PDCN care coordination
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Average scores Journey 1, 2 and 3
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SERVICE USER FEEDBACK The group was helpful in
offering possible solutions The group has been
helpful in gaining control of myself and
realising that I cant fix everything, I am able
to tolerate my feelings instead of becoming
them Im glad I cameI didnt want to I
like attending and feel like Im treated like a
human being I find the skills really useful.
I keep my skills folder next to my chair where I
sit at home so its there to look at when I
need/want to
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Service User Satisfaction Survey -2009

• What is good about the service you receive?
• Meets my individual needs with flexibility
• Very defined, kept to time, feel safe
• There are other service users just like myself
• DBT great staff, small group. Has changed my
  life over the last two years. More aware
  accepting of my illness. Diverse Pathways more
  challenging in a positive way.
• Very clear about how and when groups run
• The fact that Im in prison and you guys come and
  visit me
• The DBT groups are extremely helpful as the
  skills related to all the problems that Ive
  encountered in my life. It is beneficial to be
  able to listen and talk to the other group
  members who have the same problems as me. Also
  being able to repeat modules if is thought that
  it will help is good.

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What is not going well or could be improved?

• I miss having a Care Co-ordinator now Ive been
  discharged. I have difficulty getting out to join
  groups etc. now Ive been discharged as I cant
  afford taxis and cant use public transport.
• I would have liked to have been told about other
  services within the Network instead of picking up
  bits here and there from other group members.
• Everything is put down to being Personality
  Disorder rather than me being seen as an
  individual. I dont feel part of this group.
• More information about other areas and how to
  access them.

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New Developments 2009/10

• Understanding of PD and responsiveness across
  Primary Care Mental Health Teams
• NSPCC Project
• Younger People and developing personalities
• Short term occupational interventions on acute
  in-patient areas
• Social Inclusion initiatives
• Creative Personalities Project
• Partnership with PDi
• Implementation of NICE Guidance across Leeds
• KUF Training Programme