Category: Services

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.

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.

 
 

Mental health awareness week

Mental Health Awareness Week 2017 has the theme of ‘surviving or thriving’, this also being the title of a new report from the Mental Health Foundation. Included in this document is a summary of research completed by NatCen, on behalf of the Mental Health Foundation, into the prevalence of mental health problems across the population and into the activities that people do to manage these.

Here’s a snip from the report, summarising the self-reported difficulties experienced by the 2,290 people who took part:

MHF thriving
Extracted from Surviving or thriving

Using their NatCen data the Mental Health Foundation goes on to highlight major health inequalities. Almost three quarters of those on the lowest household income report experience of mental health difficulties, compared to six in ten of the wealthiest. A large majority of unemployed people responding reported experience of mental health problems, with women and younger people also particularly affected.

These findings are broadly in line with those reported in the most recent Mental Health and Wellbeing in England Adult Psychiatric Morbidity Survey, the data for which was collected in 2014. This is the latest in a series of studies dating back to 1993, involving (in the 2014 iteration) a sample of some 7,500 people. In the case of Surviving or thriving, the new (to me, at any rate) detail is the reporting of what actions people take to help themselves with their difficulties. Here’s another snip:

Surviving 2
Extracted from Surviving or thriving

Family and friends, outdoor physical activity and hobbies look to be the three most-used strategies. I can’t say I’m surprised by this, and am reminded of the value placed in relationships with others by people taking part in COCAPP.

Elsewhere during Mental Health Awareness Week, The Guardian has published a number of pieces including this one on the shortage of mental health nurses and this one on Hafal‘s Gellinudd Recovery Centre (about which I previously blogged here). Coincidentally, this is also the month that the full and final report from COCAPP-A has been accepted for publication: well done Alan Simpson for leading this work. This mighty tome, reporting from our cross-national study into care planning and coordination in acute mental health inpatient settings, has now proceeded to the production arm of the NIHR and is scheduled to appear in gold open access form towards the end of the year. In the meantime, work is progressing to produce papers for journals. More on these to follow in due course.

PhD opportunity

KESS2With Nicola Evans and Rebecca Playle I’m on the look-out for someone to begin a full-time PhD in the autumn, investigating the interventions and processes that promote young people’s connection to their education, friends and families during inpatient mental health care. This is a Knowledge Economy Skills Scholarship (KESS2), which is part funded by the Welsh Government’s European Social Fund (ESF) West Wales and the Valleys programme. It has also been developed in collaboration with Cwm Taf University Health Board which is making a contribution to the award.

For those interested, the studentship has been explicitly designed to build on our RiSC evidence synthesis, about which I have previously written here, here and here. We found significant knowledge gaps in this previous project, which we’re now anticipating this PhD will begin to fill.

Safe staffing (again)

safe staffingJust over a year ago I posted a short piece on this site on safe staffing, particularly noting the work of Shaun Lintern and John Baker in alerting people to the importance of this in the mental health nursing context. Since then, the Nurse Staffing Levels (Wales) Act 2016 has passed into law, and the Welsh Government has opened this consultation on its draft statutory guidance for Local Health Boards and NHS Trusts. My colleague Aled Jones is coordinating a School of Healthcare Sciences response.

Here in Wales, the duty to calculate nurse staffing levels is currently limited to adult acute medical and surgical inpatient wards. In each NHS organisation with responsibilities in these fields, the Government’s draft document refers to the appointment of a ‘designated person’ with the job of calculating nurse staffing levels using three elements:

  • professional judgement;
  • use of an evidence-based workforce planning tool; and
  • a consideration of the extent to which patients’ wellbeing is sensitive to nursing care.

Making these calculations, I can only imagine, will be a mighty challenging task requiring in-depth understanding of individual wards, the characteristics of patients admitted, and use of a tool which has (so far as I understand it) yet to be finalised.

Meanwhile, via John Baker I learn today of this new publication by NHS Improvement on safe, sustainable and productive staffing in mental health services. This is not about safe nursing staffing, but is about interprofessional staffing in specialist mental health services. Here I read of expectations around right staff, right skills and right place, right time and also spot a rapid review of the relevant literature. This begins with the understated observation that, ‘the issue of safe and sustainable staffing in mental health is complex and research is lacking’. I should say so. The time is ripe, I think, for some serious independent studies in this area.

 

Abstract top tips

img_6122As I mentioned in this earlier post, last month I made the trip to the RCN’s headquarters in London for a first planning meeting for this coming September’s 23rd International Mental Health Nursing Research Conference. Handily for me, we’re meeting in Cardiff: and the call for abstracts will be published soon (very soon). This will include information on the themes for #MHNR2017, and guidance on the preparation and submission of abstracts. Further down the line, sometime in May, the scientific committee will convene to deliberate over which abstracts to accept.

Here, then, are some top tips for people sharpening their pencils in anticipation of the call appearing. When the conference scientific committee meets to pool our individual abstract assessments and to make decisions we’ll be looking, generally put, for well-presented submissions which follow our published guidelines. This may sound obvious, but experience suggests that not everyone submitting abstracts pays close attention to the information provided. We’ll be looking for evidence of relevance to mental health nursing, and commitments to rigour. We will also pay considerable attention to the categorisation of abstracts. Workshops need to involve work; proposals for these should therefore promise interaction and participant activity. Suggestions for symposia should offer to bring a number of people together to present papers on a shared theme, and be presented as a package. Proposals for concurrent sessions should present work completed or well underway; offers to present findings from studies in which data have yet to be generated are unlikely to be accepted. In these cases, submitting poster abstracts might be a better option. And, whilst our conference themes are important, they are not intended to serve as straightjackets: so abstracts relevant to the field but which do not fit perfectly are still worth submitting.

I’ll post more on the conference and its call for papers as things unfold. In the meantime, dig that keyboard out and prepare to get writing.

Reflections on #AfterWhitchurch

Further to my last post looking ahead to #AfterWhitchurch, here now are my reflections on the event as it happened as also recorded on the Cardiff University mental health blog. I’ve selected some photos, too.

The closure of Whitchurch Hospital to inpatients in spring 2016 provided the backdrop for #AfterWhitchurch, a collaborative Economic and Social Research Council (ESRC)/Cardiff University Festival of Social Science event focusing on the changing system of mental health care hosted at Cardiff’s Chapter Arts on November 10th 2016.

2016-11-10-17-42-30

Whitchurch Hospital opened as the Cardiff City Mental Hospital in 1908, the image below being the first entry on the first page of the hospital’s visitors book.

2016-11-10-21-40-00

Members of the hospital’s Historical Society were on hand with objects, documents and photographs from their archive. Artist and director Elaine Paton presented and talked about her work with Moment(o)s of Leaving, a multimedia performance produced to mark the occasion of the hospital’s closure. Audiorecorded interviews, created for Momento(s) of Leaving by artist/curator and researcher Julia Thomas, recounted staff members’ reflections on leaving Whitchurch and their thoughts for the future.

Chaired by Norman Young from Cardiff and Vale University Health Board, School of Healthcare Sciences and service user researchers discussed how mental health care has shifted from hospital to the community, and shared reflections from research into the organisation of services, the work and experiences of service users and staff and the provision and evaluation of novel psychological interventions.

2016-11-10-21-47-35

Ben Hannigan talked about using in-depth case methods to understand mental health services at different levels of organisation, and Nicola Evans discussed her research into the mental health of children and young people. Dean Whybrow drew on 18 years of experience in the Royal Navy to describe how mental health support and interventions is provided in the military. Alan Meudell shared his reflections on being a service user researcher, and Bethan Edwards spoke of her dual identity as an occupational therapy researcher investigating care for older people with dementia and as a service user researcher. Stimulating and informed questions from the floor challenged the panel to think about stigma, the impact of research on changing practice and services offering respite and asylum.

Programme for #AfterWhitchurch

Tomorrow evening at Chapter Arts I’ll be joining friends for #AfterWhitchurch, an Economic and Social Research Council/Cardiff University Festival of Social Science event on the changing system of mental health care. Here is our programme, for those interested:

And here is a link to Elaine Paton’s Moment(o)s of Leaving video, which Elaine herself will be introducing:

As I type this post we have a handful of (free) tickets which have just become available, returned by people no longer able to be there. Follow this link to book in: and look forward to seeing people there.

COCAPP Knowledge Transfer

Last week I joined the rest of the COCAPP team at an all-day event at City University London, designed to help NHS staff, service users and carers make use of what we found. I was pleased to meet Donna Kemp, who has since written about her experiences of the day. I thought it would be a nice idea to reblog this.

donnajkemp

Last week I was fortunate enough to be invited to the COCAPP Knowledge Transfer event held at City University London on 21st July 2016. You can read more about this here.

It was great to meet people face to face, beyond Twitter – particularly Alan Simpson (PI) Ben Hannigan, and Michael Coffey who are leading this important NIHR funded research, #COCAPPimpact.

Whats really good about this piece of research is that it is within my area of interest and that the method used aimed to address care planning on 3 levels – macro (national), meso (organisation) and micro (care delivery, face to face). To achieve this they used a mixed methods approach . The fabulousness of this is that it answered the research question on the 3 levels, perhaps anticipating that tackling one level in isolation would give rise to questions in the other levels. Adding to the credibility is…

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