Independent Review of Adult Mental Health Services

19 November 2021

​Health and Community Services (HCS) have shared the summary and recommendations of an independent review of Adult Mental Health Services.

HCS have accepted and acted on all of the recommendations in the review, which they commissioned.

Minister for Health and Social Services, Deputy Richard Renouf, said: "We are taking the decision to publish the executive summary and recommendations of this report because we believe we have a duty to be open and transparent about our services and because I and my team are acutely aware of the interest islanders have in our Adult Mental Health Services.

"They are a much-used and much-valued service which we are committed to improving and the colleagues who work in them in a huge variety of roles do all they can for the islanders in their care. But we want to improve the way they are run even further.

"The report was commissioned to provide an important external set of "fresh eyes" as an overview of Adult Mental Health Services.

"Importantly, the findings of the report, which identified both positive findings and some areas for improvement are not about culpability or blame; it is about learning and transparency and part of a journey of change; it is good practice which we support and I commend our staff for engaging with the review so openly and honestly, that engagement is how we ensure we deliver safe care and make improvements in the way our services are run."

The key issues found by the reviewers were:

• a lack of senior management leadership and direction
• a lack of a system of multi-disciplinary team (MDT) working such as the Care Programme Approach (CPA) or an equivalent
• within Adult Mental Health, inadequate systems to learn from serious incidents
• silo working professionally and within teams
• lack of a system to ratify, manage and implement policies and procedures
• poor management supervision structures
• within Adult Mental Health the reviewers spoke with many professional staff who had a real motivation to develop and improve the service and have the potential to achieve positive change. Inpatient services have made some recent improvements, but further work is required
  

The authors of the report made a number of recommendations, all of which have been accepted by the Executive Team at HCS, and some of which have been put into place immediately, with all others being progressed.

All of the recommendations focus on the key issues facing mental health services.

There were ten recommendations in the report:

1. the senior management structure within Mental Health Services should be reviewed to ensure it is fit for purpose
2. Mental Health Services must introduce a system of Care Programme Approach (CPA)
3. the importance of the development of Adult Mental Health Services must be considered within the context of the Jersey Care Model
4. management roles in Adult Mental Health Services should be reviewed to ensure that they receive regular supervision, have clear objectives, and understand their role as part of a whole system
   
5. there must be a clear process for developing and agreeing policies within the MH care group, and where there are delays, there must be an escalation process
6. the Community Mental Health Team (CMHT) staff should work across clear catchments areas 
   
7. consultant job plans should be reviewed to ensure they facilitate multi-disciplinary team working
8. the model of care for in-patient wards should be reviewed to ensure effective MDT working, continuity of care between inpatient and CMHT services, and to ensure there is a clear emphasis on safety and therapeutic interventions
9. consideration should be given to joining the Royal College of Psychiatrists (RCP) networks across a range of specialities in mental health, working towards accreditation in each area, and using the networks to maintain best practice and share learning
   
10. there needs to be a clear communication process that informs and allows all Adult Mental Health Services staff to feel involved in the development of services

 

The actions taken as a result are:

• reviewing existing Adult Mental Health Management team and supporting the service with a team with delegated executive authority led by the Deputy Medical Director
• ceasing the integration of Adult Mental Health and Social Care services
• updating and ratifying policies
• initiating a weekly executive oversight meeting chaired by Director General
• agreeing the Nurse Consultant 'line of sight' to Chief Nurse office
• recruiting an experienced Director of Mental Health

 

The report was written by Professor Peter Lepping and Simon Pyke, a mental health nurse. Professor Lepping is a clinical psychiatrist in the UK, and Simon Pyke has experience of working for the Care Quality Commission (CQC) as a specialist advisor.

 The review can be found here.