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Progress to date
The aim of Rights, Relationships and Recovery is to enhance and develop mental health nursing in Scotland and produce continual improvements in the experiences and outcomes of care of service users, their families and carers. To that end, a detailed Delivery Action Plan has been drawn up listing 24 specific actions that require to be completed between now and 2010. This requires input from the Scottish Executive, NHS Education for Scotland ( NES), NHS Quality Improvement Scotland ( QIS), NHS Board Nurse Directors, Higher Education Institutions ( HEIs), and mental health nurses themselves.
Progress against these actions is to be measured twice yearly from returns submitted by the various stakeholders. This report is based on the information that we received from the stakeholders after the first six months of activity. It therefore only provides us with an initial 'sense' of where developments have taken place but it is nonetheless a useful baseline to work from. This is, therefore, the first of a series of annual reports that will summarise the position each year between now and 2010.
Cultures and values
Mental health nursing is focused on developing and maintaining helpful relationships with service users, their families and carers. Practice needs to be based solidly on values and principles. Care and intervention should focus on recovery, particularly in supporting people with long standing mental health problems.
Actions that will promote this work include:
- ensuring all nurses have access to values-based training;
- using recovery audit tools to review service delivery;
- developing training in recovery based practice;
- developing models of care that build strong therapeutic relationships; between nurses and service users.
A positive start has been made in providing the tools that can be used locally to support these objectives. NES has developed learning materials for use in Scotland to provide values-based training. These are based on the 10 Essential Shared Capabilities that have already been extensively piloted and positively evaluated in England. Issues covered include: values based practice; the meaningful involvement of service users and carers; socially inclusive practice; and equality and diversity issues. The materials are available to download from http://www.nes.scot.nhs.uk/mentalhealth/work/#values. NES will also be supporting roll out of these materials via a training for trainers initiative that will act as the building blocks for higher level training in recovery focused practice.
The Scottish Executive's Mental Health Delivery and Services Unit and the Scottish Recovery Network is working on producing an audit tool (Scottish Recovery Indicator) that will be used to assess the degree to which organisations and programmes meet expectations with regard to equality, social inclusion, recovery and rights. The tool will be piloted this year and a working group has been established to review this work. With this change in emphasis and timing it is important to note that the actions within the mental health nursing review in respect of timescale will now follow that of Delivering for Mental Health and therefore a timescale of delivery of 2010 should be worked towards.
Progress is also being made in developing a national framework for training in relation to recovery. This work is being taken forward by the Scottish Recovery Network and NES and has involved user groups being asked what they think nurses need to learn to embrace recovery-related practice. Staff are already receiving recovery-based training in some parts of Scotland and lessons learned from these approaches will be used to develop the framework.
It is encouraging to see that NHS Greater Glasgow and Clyde have already implemented recovery-based models in some of their services and others, including NHS Borders, Forth Valley, Fife, Lothian and Lanarkshire, are redesigning services to support a recovery based approach.
There are few values-based training programmes in place although some areas have developed training packages and others have established working groups to take this forward. Many NHS Boards reported that they are waiting for the learning materials and audit tools before proceeding with training. However, Boards are starting to make plans and there is an attempt to take this forward in a collaborative way and we understand that some Boards are discussing joint training opportunities..
Values-based training is now available to nursing staff in a number of areas and some are also considering using the Wellness Recovery Action Plan ( WRAP) system in the future. WRAP is a self-management and recovery system developed by a group of people with experiences of mental health problems. It is a structured system to monitor uncomfortable and distressing symptoms and can help to reduce, modify or eliminate those symptoms by using planned responses.
Practice and services
There is a need to support and develop roles that mental health nurses perform in number of areas including acute inpatient care; crisis care and intensive home treatment services. Other priorities include supporting people with long term and complex mental health problems, improving the care of older people, and providing early intervention to people at risk of developing mental health problems. There is a further need to develop "talking therapies" such as psychosocial interventions and psychological therapies. Nurse prescribing also requires further thought in terms of benefits to users and the wider service delivery agenda..
Actions that will promote this work include
- developing progressive competency based frameworks and education that will enhance the role of mental health nurses in acute care and older peoples mental health;
- developing models of care based on the recovery approach;
- supporting nurses in delivering psychosocial and psychological interventions;
- creating nurse consultant posts to lead the development of services.
NES has made progress on a number of fronts to support the development of the mental health nursing workforce. It organised a national conference in 2006 to explore the type of network that is needed to support staff working in acute care. This has led to an options appraisal document being prepared for consideration and the network will be established this year in the light of the responses received.
A capability framework in acute and crisis care is being developed and has been issued for wide consultation this month. A similar process has led to the development of another capability framework for older peoples mental health. Both of these cover the entire spectrum of nursing experience from initial registration to consultant level practice.
Planning is continuing in a number of areas to develop models of care based on recovery. There is interest from NHS Lothian and NHS Grampian in using the TIDAL model which is already in use in NHS Greater Glasgow and Clyde and NHS Fife. The TIDAL Model builds upon the nursing profession's core concepts of caring about people and is based on collaborative working that promotes peoples strengths and attributes to bring about change in their own lives. The values of the model link well to the principles of the Mental Heath (Care and Treatment) (Scotland) Act 2003. Focused individual and group work promotes recovery-centred working.
Nurse consultant posts have been agreed in NHS Greater Glasgow and Clyde (eating disorders), NHS Ayrshire and Arran (psychosocial/psychological interventions with discussion underway on a post in older people's services), NHS Forth Valley (older people) and funding has been identified in NHS Lanarkshire for one post (psychosocial interventions) and for two posts in NHS Lothian (crisis home intervention and psychosocial interventions). However, progress has been slow in developing this role in some areas and we need to review this within the context of delivering services.
Similarly, access to training in psychosocial and psychological therapies is extremely variable. Staff are being trained in NHS Borders and NHS Forth Valley and training is being planned in NHS Dumfries and Galloway. NHS Greater Glasgow and Clyde has developed a strategy on psychosocial interventions which is not yet implemented. Disappointingly, a number of areas reported little or no progress. Therefore, we need to make sure that there is connection at Board level. Each Board now has a psychological therapies plan and colleagues at NES have published a 'Phase 1' paper highlighting the additional support that they will offer in supporting access to the CBT courses and supervision, as well as funding additional part-time posts in each Board for supervision.
The same is true for nurse prescribing. There are good examples of progress such as prescribing in the crisis and addictions service in NHS Borders and the development of a local nurse prescribing strategy. NHS Highland also have a local protocol for mental health nurse prescribing. At the same time we are being informed that there are a lot of barriers that are put in front of nurses once they have trained to become prescribers. We need to address these issues locally and nationally in order to progress this agenda.
Education and development
It is important that the right people are attracted into mental health nursing and they are prepared in the right way. That includes maximising opportunities to help nurses learn and develop. A more robust learning environment needs to be created to allow innovations and solutions to be developed and shared. Strong and effective leadership is vital to realising the potential of mental health nursing in Scotland.
Actions that will promote this work include
- redesigning programmes that prepare people to be mental health nurses;
- developing the role of support workers;
- supporting newly qualified mental health nurses;
- strengthening and enhancing leadership;
- ensuring regular opportunities are provided for clinical supervision.
NES is facilitating the development of a new national framework for pre-registration mental health nursing programmes working with representatives of HEIs and other stakeholders. A draft framework is being prepared which will be shared at events with student nurses and service users and carers, among others.
NES is also working on an education and training framework for mental health support workers. Meanwhile, some boards such as NHS Lanarkshire and NHS Forth Valley already have education programmes in place but a number of other areas are still at the planning stage. NHS Lanarkshire intends to assist all support workers to gain an SVQ qualification and to continue on to HNC study, as appropriate. At the moment, 18% of support workers have been trained to SVQ2 level and 10% to SVQ3 in Lanarkshire and we know that other Boards such as Highland, Ayrshire and Arran and Lothian are also doing work in relation to progressing the support worker role.
The national education programme 'Flying Start' was launched in 2005 to support newly qualified nurses as they enter the NHS workforce. It is a web-based programme and the learning units cover topics such as clinical skills, teamwork, safe practice, communication and research. Participation levels vary across Scotland however NHS Lothian, NHS Tayside and the State Hospital report that all newly qualified nurses are engaged in the programme while participation is encouraged in other Board areas. We would like to see all Boards ensuring that newly qualified nurses take up the 'flying start' programme.
Good leadership is essential to help mental health nursing meet the challenges of the future. A number of NHS Boards already provide access to leadership courses although these are often confined to senior staff and charge nurses and do not extend to staff nurses.
The quality of clinical supervision and access to it is acknowledged by many NHS Boards to be inconsistent and variable within their services. A more structured approach is recognised as being required and a number of Boards are reviewing current provision as the first step towards making improvements.
Links have been developed between a number of services and Scottish universities to help foster learning and research. NHS Borders is going further by encouraging all nurses to participate in research. It is also planning a number of events to highlight the importance of this aspect of mental health nursing.
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