The Leeds Managed Clinical Network

1. 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. 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 The Network Model

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

7. CRISIS RESPONSE EMERGING CARE PATHWAY FOR PERSONALITY DISORDER SERVICES, LEEDS PATHWAY DEVELOPMENT SERVICE 5 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

8. 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

11. Cost analysis – NHS savings per service after PDCN care coordination

12. Average scores Journey 1, 2 and 3

16. 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 can’t fix everything, I am able to tolerate my feelings instead of ‘becoming’ them” “I‘m glad I came…I didn’t want to…” “I like attending and feel like I’m 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 it’s there to look at when I need/want to”

17. 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 I’m in prison and you guys come and visit me • The DBT groups are extremely helpful as the skills related to all the problems that I’ve 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.

18. What is not going well or could be improved? • I miss having a Care Co-ordinator now I’ve been discharged. I have difficulty getting out to join groups etc. now I’ve been discharged as I can’t afford taxis and can’t 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 don’t feel part of this group. • More information about other areas and how to access them.

19. 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