COCAPP-A full report published

COCAPP-A front pageThe full and final report from COCAPP-A has been published, and can be downloaded here. Led by Alan Simpson, this cross-national comparative case study investigated inpatient mental health care planning and coordination and their relationships to recovery and personalised care in six NHS organisations in England and Wales. COCAPP-A is the partner project to COCAPP, which asked similar questions about community mental health care in the same six sites.

The full COCAPP-A report is a substantial document, but also comes with summaries. Here’s the plain English one to give people a flavour:

Care planning processes in mental health wards should be personalised, conducted in collaboration with service users and focused on recovery.

We conducted a study on 19 wards in six NHS mental health hospitals in England and Wales. Over 330 service users, 320 staff and some carers completed questionnaires and took part in interviews. We also reviewed care plans and care review meetings.

We aimed to identify factors that helped staff in, or prevented staff from, providing care that was discussed with service users and that supported recovery.

When the ward seemed more recovery focused, service users rated the quality of care and the quality of therapeutic relationships highly. Staff rated the quality of relationships with service users better than did service users.

Staff spoke of the importance of involving service users in care planning, but from both interviews and care plan reviews it appeared that, often, this did not happen. Staff were trying to work with people to help their recovery, but they were sometimes unsure how to achieve this when service users were very distressed or had been detained under the law. Service users and carers often said that care was good and provided in an individualised way. Keeping people safe was important to staff, and service users were aware of measures taken to keep them safe, although these were not always discussed with them.

Our results suggest that there is widespread commitment to safe, respectful, compassionate care. The results also support the need for research to investigate how staff can increase their time with service users and carers, and how they can involve people more in discussions about their own care and safety.

There’s plenty of work ahead with journal articles to be produced, derived from the larger document. As the COCAPP and COCAPP-A teams now have community and hospital data relating to the same organisations we also have the opportunity to draw conclusions from both studies. This work has already commenced: Michael Coffey and Sally Barlow have taken a paper titled, ‘Barriers to, and facilitators of, recovery-focused care planning and coordination in UK mental health services: findings from COCAPP and COCAPPA’ to this year’s #MHNR2017, Refocus on Recovery and ENMESH conferences.

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#MHNR2017 recap

Cardiff welcomed delegates to the 23rd International Mental Health Nursing Research Conference (#MHNR2017), which took place at City Hall on September 14th and 15th 2017. This was the conference’s first visit to Wales, with the theme for the year being Imagination, Invention and Inquiry. Papers were welcomed emphasising the need for new ideas, new research and new ways of providing services. As a curtain-raiser, with the involvement of André Tomlin (aka The Mental Elf), keynote speakers took part in a pre-conference streamed webinar which can still be viewed here.

#MHNR2017 (which, as readers of this blog will know, was until last year known as the Network for Psychiatric Nursing Research Conference), was again organised jointly by Mental Health Nurse Academics UK (MHNAUK) and the Royal College of Nursing. It remains the UK’s leading annual event of its kind. I was pleased to serve as chair of the conference steering committee for this year, and got to open proceedings with a short welcome address.

Across the two days keynote speakers (all of whom were live streamed: see below) were Professor Joy Duxbury, who drew on her programme of research into reducing restrictive practices; Dr Phil Cooper, Danny Sculthorpe and Jimmy Gittins who gave inspirational talks drawing on the personal experience of mental distress and their work with State of Mind; Dr Jay Watts, who challenged delegates to embrace the idea of trauma-informed care; Dr Michael Coffey, who spoke as one of two inaugural MHNAUK Lecturers about the problem of assessing risk; Professor Paul French, also an inaugural MHNAUK Lecturer, who talked about his programme of research into psychosis; and Professor Gary O’Reilly who introduced his research into the use of computer games as a vehicle for the provision of psychological therapies for young people with mental health difficulties.

Here are the saved live streams from our excellent keynotes for those who are interested. Eventually we’re hoping to upload higher quality recordings to our conference YouTube account:

#MHNR2017 also provided an opportunity for Cardiff academics to showcase their research and engagement activities. Dr Nicola Evans talked of her work with colleagues in Canada and Australia on benchmarking competencies for mental health nurses working in child and adolescent mental health services, and Alicia Stringfellow and Gemma Stacey-Emile talked of their work promoting mental health and wellbeing in Grangetown through the Community Gateway project. John Hyde presented his research into the boundaries between community mental health teams and crisis resolution and home treatment services. On behalf of the team led by Professor Jon Bisson I introduced the ongoing 3MDR for treatment resistant post-traumatic stress disorder study. I also presented a new (and in-progress) analysis from COCAPP of the practice and processes of care coordination, and introduced a paper uniting theory, design and research methods for the study of complex mental health systems. 

Elsewhere I heard some outstanding presentations from colleagues elsewhere in the UK and around the world, and was particularly heartened to listen to and to meet student nurses. Thanks for coming, everyone. 

Planning for #MHNR2018 will begin shortly, with updates available via the conference twitter account which can be found here.

 

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Nominal group technique

Time this morning for a quick post drawing attention to this new paper published in Research Involvement and Engagement reporting on our use of the nominal group technique in the now-completed RiSC study.

In this project we were interested in risk, broadly defined, for young people in inpatient mental health settings. We used a two-stage evidence synthesis, convening a stakeholder group midway through to guide us in our focus. This new article gives the detail on the process we used when the group met.

As it happens, the stakeholder meeting was a pivotal event in the life of this study, during which we were directed to find evidence on a whole range of risks which are very rarely considered in mental health services. Examples include the risks of losing contact with education, family and friends. The next step in this programme of research is a KESS2 PhD studentship which will bring to the surface all the things that child and adolescent mental health practitioners do to help young people in hospital to keep in touch. In the meantime, anyone wanting to know more about the RiSC study (should their appetite have been whetted following a read of this new article) might want to follow this link for our main findings paper and this link for our accessible summary.

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Recruiting to mental health nursing degrees

Huge congratulations to all who, earlier this month, secured the necessary qualifications to begin their mental health nurse education in the coming academic year. Welcome to the profession, and to the start of a rewarding career.

Following the publication of A level results on August 17th, as John Baker was first to point out, over 50 UK higher education institutions (HEIs) went to clearing to recruit new mental health nursing students:

That, as John suggested, seemed a large number by any measure: worth noting is that Mental Health Nurse Academics UK counts representatives from just over 60 HEIs. Also worth noting is that this is the first year of recruitment to nursing degrees to follow bursary reform in England: a policy the Department of Health explicitly linked to an expansion in student places. So have universities been to clearing to recruit increased numbers of students – assuming they wanted, and were able, to accept more? Shaun Lintern from the Health Service Journal has been tweeting extracts from the Universities and Colleges Admissions Service (UCAS) data analysis service, comparing the numbers of students placed with previous years. Here’s an example from three days ago:

Between now and September 1st 2017 UCAS is publishing daily updates, and as it happens is paying particular attention to nursing: these are in the separate files marked as ‘B7 reporting’. The most recent report, published on August 24th, still shows a fall in the number of people placed on nursing courses compared to 2016:

This is important, but what UCAS is not displaying is data on the numbers of applicants placed to nursing degrees broken down by field (mental health, learning disability, child and adult). Data on the age of placed applicants is available, and as Steven Pryjmachuk points out shows a reduction (compared to 2016) amongst mature students:

Mental health nursing courses attract older applicants, and so may have experienced a disproportionate reduction in the number of new students compared to other fields. But we can’t know for sure, in the absence of having the data. What we do know, though, is that the evidence so far on overall placements to nursing degrees commencing in the 2017-18 academic year suggests that recruitment will be doing little to plug the hole in nursing vacancies.

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Educating nurses

The Nursing and Midwifery Council is consulting on its programme of change for education. Information can be found here, and there’s a lot of it. Mental Health Nurse Academics UK (MHNAUK) will be submitting a response, with Anne Felton from Nottingham University (who leads MHNAUK’s Education Standing Group) coordinating this work.

On July 11th, with mental health nurse academic colleagues in the School of Healthcare Sciences in Cardiff I spent part of our annual summer away day formulating a team response to the NMC’s proposals. Once we’re happy with the content we’ll be forwarding it to Anne, and simultaneously submitting directly to the NMC.

Individually and collectively, other mental health nurses will be formulating responses too. For now, the NMC confirms that the four nursing fields (mental health, adult, child and learning disability) will remain. For an explanation of the importance of preserving mental health nursing as a pre-registration speciality, follow this link for MHNAUK’s relevant position paper. But, as MHNAUK Chair Steven Pryjmachuk pointed out last month in this piece (£) for the Nursing Times, the list of nursing procedures contained in the NMC’s draft standards of proficiency is heavily skewed towards the adult field. This is the Cardiff University mental health team’s concern too, and we’ll be saying so (with specific examples) in our response. Another place for this (and any other) view to be given is at this forthcoming WeMHNurses chat:

Meanwhile, last week ended with two days of professional doctorate teaching. With Nicola Evans I lead a module which addresses working in, and examining, complex systems of health and social care. We’ve run this module before, and as always the student group was a lively and engaged one. Amongst the things we discussed together are the connections running within and between systems of different scale, and the sometimes unforeseen consequences of introducing change. These are matters about which both Nic and I have written (see here, here, here and here). 

To link the two parts of this post together: the NMC is a big player, and for better or worse its programme of education reform will trigger significant disruption. A systems thinking perspective encourages us to consider the possible impact of the NMC’s proposals alongside other sources of change. These include the introduction of fees for student nurses in England, the arrival of nursing associates and reductions in the size of the UK’s registered nurse workforce. As cumulative shifts take place I’m hoping mental health nursing as a distinct profession emerges intact, with its current and future practitioners able to fulfil their places in a system which continues to very much need them. 

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Nurses needed

Yesterday the Nursing and Midwifery Council issued a press release reporting on a continued decline in the number of EU-qualified nurses and midwives joining the register, and a simultaneous increase in the number of EU-qualified nurses and midwives leaving. Behind the press release is a longer report, from which I have extracted two tables:

EU trained nurses and midwives joining the NMC register for the first time. Extracted from: https://www.nmc.org.uk/globalassets/sitedocuments/special-reports/nmc-eu-report-june-2017.pdf

EU trained nurses and midwives leaving the NMC register. Extracted from: https://www.nmc.org.uk/globalassets/sitedocuments/special-reports/nmc-eu-report-june-2017.pdf

 Judged on these figures the number of EU nurses coming to the UK looks to have slowed to a trickle. Elsewhere, in its report In short supply: pay policy and nurse numbers The Health Foundation points out that in 2015 NHS England had 22,000 too few nurses specialising in the care of adult patients. The mental health field, The Health Foundation adds, is one where (for the present) tools to calculate safe staffing are virtually non-existent.

Meanwhile, UCAS (the Universities and Colleges Admissions Service) reports that applications for higher education programmes commencing in the 2017-18 academic year have declined across the board, but that it is nursing courses which have seen the sharpest fall. Applicants from England making at least one choice to study nursing dropped by 23% (to 33,810) in 2017.

The RCN, amongst others, has long been campaigning against persistent low pay for NHS nurses, arguing that a career which is so obviously poorly remunerated is no incentive to potential new recruits. Nor, for that matter, does it help efforts to retain existing staff. Previous reports from the RCN tell us that the UK’s nursing workforce is an ageing one

Taken together, the loss of European nurses in the context of last year’s EU referendum, chronically poor workforce planning, a nursing profession which is getting older (and will therefore lose members to retirement), the loss of bursaries in England and continued low pay make for a toxic combination. But things can be done. Agreeing the future security of EU citizens in the UK would be a start, along with removing the NHS pay cap. Reintroducing bursaries might help rekindle UCAS applications. Better planning of future NHS staffing needs is long overdue. Nursing, of course, remains a mightily fulfilling career and I would hate to think that this (admittedly rather negative) post puts off anyone contemplating a move in this direction. But it also serves to highlight some of the serious challenges which lie ahead.

 
 

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Skellern Award and MHNAUK meet-up

My general election postal vote cast, June 8th began with a PhD examination at City University London moving as the day progressed to London South Bank University for this year’s Eileen Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award.

As Skellern Lecturer Mary Chambers gave a fine, interactive, presentation emphasising the importance of making visible the invisible work of mental health nurses. Here’s Mary with Ben Thomas and Isaac Marks, no less. Amongst other things Mary talked about her work developing the Therapeutic Engagement Questionnaire, a tool designed to establish the value of mental health nursing.

Len Bowers was recipient of the Lifetime Achievement Award. He gave a deeply personal, altogether humorous, account of his career in mental health nursing, highlighting in particular the curious accidents which helped propel him to the forefront of the profession. Len’s Safewards programme, of course, was no accident and his contribution to improving mental health nursing practice through research of this type continues to be sorely missed in the months following his retirement. Here he is receiving his award from Alan Simpson.

Friday was a meeting of Mental Health Nurse Academics UK, hosted by Sally Hardy at London South Bank University. Detailed notes from the meeting will appear in due course on the group’s website. In the morning Katie Evans from the Money and Mental Health Policy Institute talked about the associations between mental health problems and money difficulties, making the point that debt advice (which is a regulated activity) needs to be incorporated into care pathways where necessary.

MHNAUK is in the process of setting up permanent standing groups, covering the areas of: research; education; policy and practice; and communication. Each group now has a lead person, and each group has plenty to do. The education group, led by Anne Felton, will be coordinating MHNAUK’s response to the NMC’s consultation on proposed new standards for pre-registration nurses. At this last week’s meeting, under the education group agenda item, members heard about plans for this autumn’s #FutureMHN conference. The research group, led by Mary Chambers, will be coordinating MHNAUK’s work in the context of the future Research Excellence Framework. On Friday, as part of the research group update I gave a progress review for this year’s #MHNR2017 conference. The policy and practice group is led by John Baker, and members (John included) have been working on (amongst other things) safe staffing. The final group is communications, led by Steven Pryjmachuk and me.

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