MINUTES WEDFAN STEERING GROUP – 17TH DECEMBER 2018 Present: Anna Sussex, National Programme Manager, Frequent Attenders USC (AS) Rachel Skippon, Clinical Psychologist, BCUHB (RS) Rio Talbot, ED Consultant, YG, BCUHB (RT) Victoria Goodwin, ED Sister, FA Lead, RGH, ABUHB (VG) Chris Nelson, ED Charge Nurse, FA Lead, YGC, BCUHB (CN) Bridget Cavanna, ED Specialty Dr, FA Lead, Bronglais, HDUHB (BC) Katrina Rees, ED Sister, FA Lead, Morriston, ABM UHB (KR) Apologies: Jo Ramesseur Williams, Detective Superintendent, PRID, ACEs (JRW) Matt Wyatt, Improvement Advisor, PHW (MW) Emilie Richards, Site Manager, HDUHB (ER) Robin Petterson, Frequent Caller Lead, Welsh Ambulance Service NHS Trust (RP) Sarah Evans, ED Registrar, FA Lead, PCH, CTUHB (SE) Ken Morris, ED SN, FA Lead, PCH, CTUHB (KM) Zoe Evans, ED FA Lead, CAVUHB (ZE) National Update Red Cross · Winter Funding from WG has enabled the Red Cross to work in 7 EDs around Wales supporting staff and patients – Royal Gwent; Withybush; POW; YGC; UHW; Glangwili and Wrexham Maelor. Should the Red Cross staff come across Frequent Attenders, they will link in with the FA Case Load Manager in that ED to update any pertinent information CALL helpline · January – starting a pilot supporting national 24/7 mental health helpline... they have approached us for some support/information sharing re their frequent callers. They have approx 10 callers nationally who hit our definition and they feel they have explored all available avenues of support within their current network. We met to go through some options and discussed a 3 month pilot whereby they would fill in a referral form and send it to the corresponding health board lead, who would then share any info/plans with them. The helpline is hosted within Betsi health board and all the emails are internal. They will audit the work and we'll assess it at the next steering group in March unless early reports show concerns Training · National Programme putting together some training sessions – localised to each ED needs · MDT workshops – roles and responsibilities, how to manage difficult stories – staff care “unexpected death” · Panel pack – all the team coming together to pull the pack together, creating team cohesiveness Audit · Second audit of local Frequent Attenders Services being undertaken currently. This will be analysed against the first one that was done last Dec/Jan 18 and the report will make up part of the National Report. This will be disseminated via the National Unscheduled Care Board to each LHB and involved partner agencies, so it is imperative that each Frequent Attender Service fills in the audit so there is adequate representation of the work and effort being put in by local teams. The 2 EDs who are not currently engaging in the programme are encouraged to also fill in the audit so their views are captured Future Generations Commissioner/WLGA · AS met recently with both the Future Generations Commissioners Office and the Chief Exec of the Welsh Local Government Association to update them on the work with frequent attenders · They have agreed to put FAs on the agenda for regional service boards – this will aid us in securing partnership working with range of agencies across different sectors Patient engagement work · There is a need going forward to engage with users of all our services to understand the following things: o What led them, in their opinion, to becoming FAs o What one thing could’ve taken them off this pathway (ie if a service/person/support system/initiative had been in place in their past, would they still have become a FA?) o How does it feel to be a FA? o What can/does our service offer to make a difference to them? · AS met with a Professor of Story Telling in USW who works with persons/staff/organisations to tell stories in order to influence change and empower the person telling/sharing their stories. They are currently working with groups like Woman’s Aid to help the woman share their journeys. We are scoping out ways that this may work with our various patient cohorts · Also contacting CHC to explore the requirements for patient engagement Primary Care pilot · Undertaking a couple of primary care projects to try and match/analyse the FA data to see what the cross over is between primary care and the ED/WAST/OOHs/police patients · Starting with 2 practices in Cardiff and Vale due to length of Cardiff data · Supporting social prescribing research project West Wales – trying to understand whether social prescribing helps GP FAs – WEDFAN sitting on their expert reference group Mortality review update · 1000 Lives Data Analyst Team undertook a mortality review on all FAs across Wales who died within 60 days of triggering as a FA · 30% approx. of all deaths within this cohort were palliative care or oncology · Macmillan and Velindre approached – task force set up to analyse the potential work streams · Other work streams also highlighted including the predictable and preventable deaths · Report will be written on the review and set to USC Board for sign off before dissemination to LHBs Tri Service Intelligence Hub · WEDFAN invited to sit on the working group for the South Wales Tri Service Intelligence Hub between WAST, Police and Fire & Rescue, sharing intelligence on joint demand. Frequent callers are top priority for all 3 services Conference update · 13th June 2019 – building on the previous 2 national events, this event will be a practical day based around successful MDT working and care planning · In Swansea – details will be sent out in the New Year Liaison Psychiatry national steering group · WEDFAN sitting on above steering group Cardiff University · funding bid for research “interested in the relationship between FAs across ED, police and ambulance services. Are they the same people? Are there any notable changes in their lives that caused the emergence of this behaviour? There is also a substantial literature in this area. Interestingly, little research considers cross partner FAs” · Professor Simon Moore - Director, Alcohol and Violence Research Group Theme Lead, Applied Clinical Research and Public Health School of Dentistry College of Biomedical and Life Sciences and Co-Director, Crime and Security Research Institute WAST CCC · AS and RP met with the Clinical lead for the Clinical Contact Centre, WAST, recently to discuss the management plans held for FAs. There have been some concerns raised that the plans were not being followed, and frontline staff were not aware that there were plans in place for some of our FAs. · Feedback from the CCC is that the plans are not consistently on the same template, which makes it difficult for staff to find pertinent information, there’s not enough NOK contact details, or enough information for referral pathways. They would like to see the NHS number added to the demographics, and some information around what to do if they can’t make contact with the pt on returning the call. There often isn’t a patient contact number on the plan, or staff contact numbers, and they would like to have information about “identified others” e.g. elderly parents living with FA · For the time being, it has been agreed to send all plans via RP, until we are sure processes are robust enough that all local plans are being collated and sent on by local Frequent Caller Leads – this will ensure the plans enter the WAST governance structure · Information Sheets – need to be clear that these are for the purpose of acknowledging the status of a new FA, for info sharing and gathering – need to have contact boxes for staff feedback · Risk Alerts – need to be sent to RP. Be aware that WAST risk alerts are shared with police for a police response when responding on scene so need to be explicit on what the risk is and what the response should be · Discussions held around the ability to flag/put warnings on WASTs CAD system – at the moment it is not possible to upload plans onto the crews computers on the ambulance so they do not know the contents of a management plan when arriving at a FA address. This leads to difficulties in care planning and ongoing referrals, and ultimately FAs attending EDs when a plan is already in place for alternate care Chief Medical Officers presentation · The work of WEDFAN was presented to the CMO in November 2018 – presentation to be shared. Issues highlighted around executive support, time and resources not being allocated to the service but also the hard work of frontline staff committed to doing this, often in their own time or over and above any allocated hours M.O.U launch · Launch of the Obligatory Responses to Violence in Health Care Settings in November 2018. Attended by AS – summary given of the amount of risk sharing WEDFAN does across all statutory partners via our panels and management plans Service Updates Bangor – Community Hub – based in all 3 EDs, like a crisis café, can do social prescribing and referrals on, can do the initial Frequent Attender assessments. Struggling with in hours GP interaction due to lack of time and resources. Management plans going on Welsh Clinical Portal (Karen – MD). Some issues with sign off from WAST on plans. Monthly meetings going well – 20 odd people attending, including 3rd Sector, plus GP OOHs – dedicated GP from OOHS has time given, really helpful, specifically for those needing care plans. Admin support going well. 2 band 7s have approached Rio to offer support, will attend meeting tomorrow. IT remains an issue. Invited into the Q&S meetings monthly Actions: AS to raise WAST issues at monthly meeting with RP YGC – HIT score for DV. Couple of patient based meetings, CN in place but has 2 management days a month which also includes other duties, admin has potentially been promised at 8-10 hours a week but only to pull files. No dedicated time for anyone, no meetings regularly, some very complex cases. Unable to flag patients who are at risk, nowhere to put plans Actions: AS to spend time with CN to start a service planning Rachel – 2 vacant posts – 1 new staff – including service user experience work. Recent Tri-site meeting. Governance overview – where do they fit. Mel Maxwell supporting. FAs in the 90 day plan – feeling from execs that it can be ticked off but no resource input – can highlight things but can’t action it. Strong feeling that reports need to go in – but not sure of content Actions: AS to send statement on reportables for governance All to consider Governance reporting structure and content Bronglais – palliative care attending panel. Still no dedicated time for BC – meeting in the new year to discuss. Logging hours spent on FA work – RT will send her what we did. Work well known within the health board but concerns re: engaging with senior management – gave presentation to nurses, had interest from junior staff. Monthly panel going well, Red Cross attending from Pembs, frailty nurses – keen to have early referrals, community nurses very active. Clinical psychologist attending and supporting long term chronic health problems… link into health board pain team. Gorwellian mental health work – getting onto FACE. Pulling together multi-agency plans. Pembs need admin support. Send update report to Bridget Action: AS to send Update Report to BC to support business case RT to send breakdown of Hours Log to BC Wrexham – palliative care attending panel. Monthly meetings going ahead, agencies turning up, really good admin support, but that will change soon due to staff reallocation. Clinical psychologist leaving in Feb, she does most of the background assessment work. Safeguarding lead attending panel Morriston – no sign off on plans from WAST, still having monthly meetings, putting in bids to finance – exec level, Winter money for KR to be 25 hrs a week, SWJ to have 7.5, primary care has been given some money – requested a day’s admin time too. Staffing levels down in ED. 3 months money. Met with finance lead – monthly data sending. Patient stories – have the biggest impact. Need to go through all the plans – 5 lever arch files. Some issues with the ICF – difficulty in asking some of the questions. MH attending panels, really useful information coming out, can refer into secondary mental health. Some issues with WAST – ?no time to engage fully outside of panel meetings. OOHs attending, clinical desk, housing – attending. Police attending – only cover NPT area, not Swansea – Chief Constable to find out who covers that area… EPP attending from January… KR receives the monthly report for Morriston, NPT, Singleton and POW – none of the others attend the meeting. Need support agencies involved – 3rd Sector. Actions: AS to discuss WAST issues and support with scoping 3rd Sector Aneurin Bevan – 1yr funded post in ED, 3 months OOHs, plus one other post, attending CASAM meetings with the police, looking at reducing attendances from Custody – can link into the Frequent attender work. JD gone for matching AOB Prison pathway With some of our vexatious FAs having recently received custodial sentences, it will be necessary to agree a standardised format for managing cases like this. A Task & Finish group to be set up to work on this, liaising with the prisons, police, probation, housing, 3rd Sector, Welsh Health Legal Services and other expert partners Altcourse Wrexham - Berwin Parc Swansea Knox Eastwood Parc Usk Prison Prescoed Explanation of various orders - Police A variety of orders (Criminal Behaviour Orders etc) are in place across the different FAS in Wales – need to understand what there is and what they mean for our patients – AS to liaise with JRM National Risk Register Need for a Risk Register that will impact on the ability of FAS to provide service e.g. closing the PD beds in Wrexham; alcohol detox/managing those who abscond due to needing a fix but need significant treatment. To be discussed further Date of Next Meeting: 14th March 2019