Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH)

What does RDaSH do?

We are a mental health and community trust who provide services across a large area stretching from Grimsby on the east coast, through North Lincolnshire, Doncaster and Rotherham. We provide inpatient and community mental health services as well as IAPT services in partnership with our local GPs.

We are proud to have been rated overall as ‘good’ within our CQC inspection, with our crisis and urgent mental health services rated as outstanding. This rating demonstrates we provide a valuable service for our patients that meets their needs throughout their contact with our acute and community care pathways.

We have provided these services for a number of years at RDaSH and feel that our rating has been gained due to:

• enhancements we have made to our pathways
• meeting our commissioning guidance
• partnership arrangements with others involved in these pathways including our acute providers, our colleagues from the police and also our local authority providers.

What is it about how you work that makes it good?

We were rated outstanding for a number of reasons, firstly due to the caring and compassionate core work that our crisis and home based treatment teams provide each day. But the additional work we conduct was also a factor. Here are some examples:

• Using formulation based approaches to the delivery of diagnostic and treatment information with the people who access our services in our North Lincolnshire services.
• Our specific focus upon criminal justice liaison and diversion in our Doncaster and Rotherham services.
• Our overall positive approach to timely supervision for our staff, so that each day the multi-professional team can link in to discuss any issues that have arisen for our patients and to think together about the most supportive plan of care that we can provide to help resolve the crisis. This may mean increasing contact to three of four times per day to support someone to remain in their home.
• Our project work in terms of constantly striving for service improvement – at the time of the CQC review this involved using the ‘Perfect Week’ methodology to work with all partners in the acute care journey, including patients and carers, to examine where pressure points caused difficulty or didn’t work as smoothly as they may.

Since the CQC inspection our service improvement work has not stopped. We have hosted a series of ‘Big Conversations’ involving our staff, patients and carers to explore what works well and what further improvements can we make. Out of this over the past few months we have focused on:

• providing different crisis and transitional support for the young people we have who are transitioning to adult services
• providing enhanced physical health assessment and monitoring for people accessing our crisis service who may be at heightened risk of physical ill health
• improving communication with our deaf community in Doncaster.

What impact is your work having?

At RDaSH we are very focussed upon patient and carer engagement in evaluating the services we provide, celebrating what goes well and problem solving.

Acute and crisis treatment is a difficult set of services to evaluate because of how unwell people are when they access the services. However we do get feedback after each encounter and also at review and on discharge from our services.

This feedback provides us with information about where our teams are providing positive care and also where we may need to change interventions or approaches in order to improve the experience for people who access our services in the future.

Do you have any learning to share?

Being in a mental health crisis, which requires either an inpatient admission or intensive home treatment, can be frightening and mean that the person and their family have changing needs.

In order for support to be of highest standard there need to be positive relationships within the whole care pathway, not just within a single provider. It is therefore essential to have a constant dialogue with the partner agencies who provide this care, with regular reviews concerning the whole pathway and its parts.

Finally – see change and coproduction as your core business! Constantly listen to your community of patients and carers, as what you will learn in these individual and collective encounters will support you to improving your services as a part of your ongoing journey, not one with a start and end point.

From PALS (Patient advice and Liaison) feedback forms

“I would like to sincerely thank the doctors, nurses and support workers for their amazing support – I truly can say that if I had not had the daily visits from the team I know I would not be here today as I genuinely had lost the will to live. The support I received was absolutely fantastic – please pass on my sincere thanks to all the staff who visited me.”

“How the staff member managed to get my brother to talk openly and honestly was a huge breakthrough and the start to him finally getting better – she managed to get him the help he so desperately needed – I can’t thank her enough.” Carer

“What an excellent service – the workers put the patient at ease so he could talk about his issues – they were excellent.”

“I found the lady who came to see me really easy to talk to – non-judgemental – gave me hope and a lot of information on services that I wasn’t aware of. She gave me the impression that she cared and that there is help out there.”