Patient Quality Forum

The Patient Quality Forum (PQF) was launched in December 2015 to provide us with a cross-section of views about quality and the experience of our services from the people who use them.

Members of the PQF live in the five boroughs we cover, and meet monthly to consider quality and patient experience. They consider the same reports on quality used in our internal governance, receive reports in person from various teams, and provide feedback on recent and current issues affecting patients.

We ran a training programme to give forum members the skills to take part in challenging discussions and presentations, which was recognised at the annual Health Innovation Network and Health Education South London Innovation Grants and Recognition Awards.

Not only did the project win an Innovation and Educational Excellence Award in the Learning from Patient Experience and Involvement category, securing one of 10 innovation grants awarded on the night to further support the project but it also won one of two Chairman's Choice awards.

The Carers Friends and Families Reference group (CFFRG)

This long-standing group meets bi-monthly to consider quality and patient and carer experience. Individual members of the CFFRG live in the five boroughs we cover and has representation from organisations that support carers within the Boroughs including the five Carers Centres. They consider the same reports on quality used in our internal governance, receive reports in person from various teams, and provide feedback on recent and current issues affecting people who have contact with our services. To find out more about how to become involved please contact involvement@swlstg.nhs.uk

Mental health care pathways

Our services deal with a variety of mental health conditions ranging from depression and anxiety to bipolar and schizophrenia. They also deal with specialised conditions such as eating disorders, PTSD and OCD.

This means our services have to cater for a diverse range of people and conditions. How you access a service depends on your individual circumstances, and you may follow any one of a number of different care pathways. You can find out more about these pathways here.

Overview - services we provide

Community services

• perinatal services

• services for deaf people

Adult services

• assessment teams

• community mental health teams/Recovery support teams

• early intervention for psychosis teams

• recovery and rehabilitation

• eating disorders teams

• crisis home treatment teams

• community forensic teams

• community drug and alcohol teams

Older people's services

• community mental health team for older adults

• memory services for dementia assessment and care

Liaison psychiatry teams

• Liaison Psychiatry Teams in Acute Hospitals

Children and young people's services

• child and adolescent mental health teams

• eating disorders team specifically for young people

Learning disability service

• learning disability services for adults

• learning disability services for young people

Hospital services

• acute wards

• psychiatric intensive care units

• open and intensive rehabilitation units

• inpatient eating disorder units

• inpatient deaf services

• inpatient OCD/BDD services

• other specialist mental health services for adults

• specialist mental health services for children and young people

• forensic wards

What are psychological therapies?

The Improving Access to Psychological Therapies (IAPT) programme aims to put more trained therapists into GP surgeries. This should provide easier access to talking treatments on the NHS. The service is already available in some parts of England. The therapy offered will usually be a course with a fixed number of sessions of a particular type of therapy. Psychological therapies involve a person talking to a wellbeing practitioner or therapist, either one-to-one, in a group or with family and friends. Types of psychological therapy that are approved for use within the NHS include:

• cognitive behavioural therapy (CBT)
• interpersonal psychotherapy (IPT)
• brief dynamic interpersonal therapy (DIT)
• eye movement desensitisation and reprocessing therapy (EMDR)
• couples therapy for depression
• counselling for depression
• behavioural family therapy and cognitive behavioural family interventions
• intensive placement employment support

What are assessment teams?

These are teams dedicated to seeing people quickly, assessing their needs and agreeing how these would be best met e.g. advising referrer on change in treatment, signposting to community resources or referring them on to other services, such as community mental health teams or early intervention teams. They work closely with primary care services such as GPs and pharmacists, as well as more specialist mental health services.

What are community mental health teams (CMHT)/Recovery Support Teams (RSTs)

Community mental health teams (CMHTs) or Recovery Support teams (RSTs) are multidisciplinary, multi-agency teams offering specialist assessment, treatment and care to adults with mental health problems, both in their own homes and in the community. They work with people often described as having complex needs – for example, in relation to housing and homelessness, benefits, unemployment, use of drugs or alcohol, or those who have had contact with the criminal justice system. They aim to provide the day-to-day support needed that allows a person to live in the community. Teams may provide a whole range of community-based services themselves, or be complemented by one or more teams providing specialist functions.

What are early intervention for psychosis teams (EIPTs)?

People with psychosis can experience changes in thinking and perception severe enough to significantly alter their experience of reality. An episode of psychosis is usually caused by an underlying mental health condition such as schizophrenia or bipolar disorder, and may be complicated or caused by drug or alcohol misuse. Early intervention for psychosis teams (EIPTs) work with people between the ages of 18 and 35 who may be experiencing their first episode of psychosis. In some areas, they work with people who are younger than 18. They may then work with them for two or three years after they first presented with psychotic symptoms. Sometimes these symptoms may go back many years, or they can come on very abruptly. EIPTs focus on the early detection and assessment of psychotic symptoms, and provide support and treatment to treat the underlying causes and prevent relapse. Early intervention is crucial because the condition causes such distress and disability both to the person and their carers, but treatment can be very effective. During the first few years, people with psychotic symptoms are at greatest risk of harm to both themselves and others, and the earlier a severe mental condition is treated, the better the long-term outcomes tend to be.

What are eating disorder services?

Eating disorder services are there to help adults and children who have moderate to severe eating disorders. They are multidisciplinary teams of psychiatrists, psychologists, psychotherapists, nurse specialists, dietitians, support workers and administrative staff. Based in the community, they offer services such as assessment, treatment and counselling for individuals and their families and carers. Eating disorder clinics often provide a combination of occupational and talking therapies, as well as feeding for patients with serious malnutrition. Staff in clinics include doctors, dietitians, psychotherapists, occupational therapists, social workers, family and relationship therapists, and specialist nurses. Common types of eating disorder are anorexia nervosa and bulimia nervosa. But there are also atypical eating disorders, sometimes referred to as EDNOS (eating disorder not otherwise specified). These include binge eating, atypical anorexia nervosa and atypical bulimia nervosa.

What are forensic mental health services?

Forensic mental health services work with people who have mental health conditions and have committed a serious criminal offence, or are thought to be at high risk of committing an offence. Forensic mental health services may care for people in secure hospitals or prisons. Most of the people who are in need of such services are thought to be a risk to both themselves and others. Community forensic mental health services can also care for people out in the community following discharge from a secure hospital or prison. These community services may also be asked to review patients who are known to other mental health services, where there is a concern that someone may be at high risk of committing a criminal offence. An important goal of forensic mental health is to treat any mental health problems that may have contributed to a pattern of criminal behaviour, and discharge a person back into the community with the right level of support when it is thought safe to do so.

What are liaison psychiatry teams?

Liaison psychiatry teams are multidisciplinary teams that provide mental health assessments in hospitals, A&E and clinics for patients experiencing distress during their stay. They function as a liaison between mental and physical health teams. The co-occurrence of mental and physical health problems is common among patients, often leading to poorer health outcomes, delayed discharges and the increased use of resources. Teams are able to assess and treat a range of mental health problems, including dementia. Some problems that may be referred to liaison psychiatry teams include:

• psychological reactions to physical illness
• self-harm
• medically unexplained symptoms
• organic mental disorders such as delirium and dementia
• alcohol and substance misuse
• mental illness related to childbirth
• diagnostic difficulties
• abnormal illness behaviour
• behavioural disturbance
• medicolegal decisions
• assessment of capacity to refuse medical treatment

What are memory assessment services?

Memory assessment services are specialist teams that assess memory problems or similar cognitive impairments. They advise on the support patients and their carers may need from their GP or older people's mental health services.

What are perinatal mental health services?

Perinatal mental health teams provide specialist services for women with mental health problems. They also provide care for women who are at the risk of developing problems during pregnancy and the first year post pregnancy, as well as those considering becoming pregnant. Promoting emotional and physical wellbeing and development of the infant is central to perinatal mental health services. Specialist multidisciplinary perinatal teams exist in many, but not all, local areas. They provide direct services, consultation and advice to maternity services, other mental health services and community services. They can give specialist expert advice on the risks and benefits of using medications such as antidepressants and antipsychotics during pregnancy and breastfeeding.

Our strategy

After a year of external and internal engagement work we have we have launched our 5 year Trust Strategy (September 2018).

We have engaged externally with: service users, carers and families; members of the public, commissioners; voluntary sector and community groups; MPs and councillors; the South West London Health and Care Partnership.

Our new strategy includes four strategic ambitions:

• Increasing quality years
• Reducing inequalities
• Making the Trust a great place to work
• Ensuring sustainability

These ambitions move us to focus on outcomes, not processes and are held together by our mission – Making Life Better Together – which is at the centre of our work.

We have a core set of programmes (quality, co-production and service user and carer involvement, collaboration and partnership working, the Estates Modernisation Programme, and transformation), enabling strategies and service line specific initiatives that will ensure delivery of an exciting new phase in the Trust.

The Trust agrees an annual set of corporate objectives that have quarterly milestones per year working towards delivery of these overarching strategic objectives.  There are also a suite of Board approved enabling strategies that help support delivery of these strategic objectives.  These are all reviewed on an annual basis, and implementation plans updated annually. The enabling strategies are:

• Quality
• Workforce and Organisational Development
• Estates
• Research and Development
• Digital
• Co-production/Service User Experience
• Communications and Engagement