Orientation

After a hectic week in Birmingham I returned to Oxleas on Monday to continue with my orientation period. I spent Monday at the ‘Bracton', a medium secure forensic mental health centre. Tuesday was spent in the acute in-patient wards and Wednesday I have been shadowing people who work in occupational therapy.

Monday
I was very much looking forward to my visit to the Bracton centre as I have worked in prisons before and was very interested to see how a medium secure mental health facility would compare. I immediately noticed how much nicer the physical environment was but also the atmosphere although potentially difficult was on the whole a lot calmer. I had a tour of the centre and its facilities which I thought were impressive, especially ‘the cottage' which was a small house designed for patients to move into prior to their release where they were given more independence to prepare them to enter the community. I thought this was a great way of helping people to make that transition as it can be very difficult to leave an institution directly into a community setting.

The nature of the Bracton meant there were many logistical issues that staff had to work around such as movements or which ‘section' the patient was under could also determine their care. Staff seemed to manage these issues well with the interest of the patient in mind but without ever compromising safety for staff or patients. Despite the environment being a difficult one to work in, staff engaged patients and it seemed would often put in extra hours where needed. The culture in the Bracton was definitely patient centred and friendly and that was a result of having staff who genuinely cared.

At the end of the day I attended a ‘modern matrons' meeting where there was a strong emphasis on the effective use of data and seeking feedback. It was acknowledged though that whilst data is always useful it is important the data provided is collected using valid, reliable methodology and that only relevant and valuable data is sent to individuals. I think these are important issues as people need to be confident the data they are using is reliable in order to act upon it with confidence but also that people are not ‘bogged' down with data and can clearly see information that is relevant and useful to their role to not lose sight of the bigger picture.

Tuesday
My day spent in the acute mental health wards was equally interesting. I think the most valuable thing I saw on this day was how targets, objectives and government incentives actually translate in practice and some of the problems that can arise from the sheer volume of government based targets. In fact often many of the prescribed targets were already being completed in practice but just required recording. The sheer volume of data that required recording was resource intensive and often some targets or initiatives would overlap with each other. It seemed as though data was being utilised well in order to identify and address issues and I realised the importance in useful data that can provide intelligence upon which to make improvements.

I thought there may be scope for a project to streamline the recording processes used by nurses to ensure everything being recorded is necessary and is utilised but also to ensure similar information is not recorded twice. This day really highlighted to me the valuable support that managers can provide when it comes to enabling front line staff to be able to record what is necessary but to allow their main focus to be in delivering care.

Wednesday
Wednesday I shadowed various occupational therapy leads. I found the day useful toward understanding the complex but vital role of an OT. I observed three meetings throughout the day, all of which seemed to have a strong focus on delivering initiatives to make efficiency savings whilst improving patient care.

For example ensuring timetables and shifts are run in the most effective manner, considering the appropriateness of certain tasks to which bands to ensure efficient working, ensuring patient goals are identified so that care is relevant and outcomes can be measured and the possibility of using volunteers from the V2W (volunteer to work) scheme to aid the running of some sessions. I found this day really showed me how important an OT's role is, both in terms of patient experience but also in eventually making savings as if falls or other problems can be prevented when a patient is at home that may in turn lead to less hospital admissions as a long term outcome.

The final meeting I attended today was regarding the roll out of ‘personalisation' in mental health - a government initiative to hand choices regarding patient care over to the patient themselves whilst professionals can assess and guide the patient, the patient makes the ultimate decision over what care pathways they think would be most beneficial to them. This involves Oxleas working alongside other local authorities to implement the system effectively which was an interesting relationship to observe. Additionally I witnessed some of the inevitable teething issues during a transition between the way services are run for example what service can be provided to patients during the interim period? And will there be exceptions that cannot fit the new system?

Once again, thank you everyone who hosted me this week. It has been such an insightful and valuable experience for me so your help is much appreciated.