Cambridgeshire and Peterborough NHS Foundation Trust
Building recovery and resilience – supporting self-management
and wellbeing
A strategy for the next five years to 2020
Forward from Jo Lucas, Non Executive Director and Recovery Champion
I am proud to be presenting this Strategy for the next five years to 2020. Many
people have put a lot of thought into this piece of work, building on the original
pioneering work of the Trust to promote Recovery ethos and practice within mental
health. The Trust now provides a full range of community services across all age
groups and this strategy seeks to widen our approach. This document is about
enabling people to develop the skills to become more resilient and to promote their
own well being. This converges with the ethos within the Care Act 2014 and as a
provider of social work services on behalf of our two local Councils, this Strategy
endeavours to highlight the read across to the Councils’ own Strategies.
Building recovery and resilience is an active process that involves all staff and
people who use our services in working together to find good solutions, as it states in
the current strategy; “We will adopt the principle, in all our services, of empowering
patients to achieve independence and the best possible life chances, removing
dependence and giving them and their families (in the case of children) control over
their care”.
Finally this Strategy can be seen as the glue within the Trust’s organisational
strategy: bringing together ideas around spirituality, volunteering, community
involvement, and social capital, in a way that enables everyone involved in CPFT to
bring the idea to life and to ensure the services that are offered meet these
aspirations. Above all building recovery and resilience requires us to work
collaboratively: staff with patients, people who use our services and their carers,
CPFT with other organisations in the NHS, and with the local authorities and the third
sector. While some of the language of recovery and resilience may differ between
these sectors the underpinning principles and the will to promote health and well
being across the area is common to all.
.
We are not looking to make a better caterpillar but to
develop a strong and beautiful butterfly, to transform
the services we offer people in the community
Recovery, Resilience and Self-Management Strategy December 2015
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Introduction
1. This document is presented at a time of great change within the Trust. Five
years ago the Trust was a pioneer of Recovery and one of the first NHS
organisations to establish peer support workers. The challenge today is not only
to update the old, but to extend the Strategy to encompass the new services, the
physical health services, that became part of the Trust in April 2015 by
harnessing the concepts of “resilience” “self-management” (Appendix 2) and
“wellbeing” as an adjunct to “recovery”.
2. Other changes reflected in this Strategy are a coming of age of the Recovery
College: the need to put this onto a sustainable footing, the role of Carers,
pathways to volunteering and employment, and wellbeing.
3. The Trust is a partnership organisation providing services on behalf of our two
Councils under section 75 agreements. The language may be different, but the
underlying concepts are the same and the read across into the strategies and
ways of working of our Partners can be seen from the diagram below.
4. All of this means that this Strategy could be described as a “hub” with spokes that
connect to other strategies of the Board including: Carers (in development),
Employment (to be developed with Commissioners), Working with the Third
Sector (a CQUIN) Volunteering Strategy, and Spirituality. The Spirituality
Recovery, Resilience and Self-Management Strategy December 2015
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Strategy was approved by the Board in 2014 and this promotes the importance of
the often overlooked subject of Spirituality and “Being Human Together.”
5. This Strategy is also timely as the Government is about to launch its new 5 year
plan for mental health. Key features of this strategy are “prevention, access,
quality and integration.”
6. Finally Recovery has been one of the most powerful “culture carriers” within the
Trust over the last 5 years (Appendix 3) and this Strategy has the potential to be
the culture carrier for the newly expanded mental and physical health, and inpatient and community services organisation. In recognition of this, the current
work on renewing the Trust’s Vision and Values includes consideration of the
issues raised here.
Background
The Trust Strategic Plans
7. The Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) mission is
‘to offer people the best help to do the best for themselves’ (CPFT 2 and 5 year
Strategic Plan Nov 2014). This means that we strive to ensure that people can
stay in the driving seat of their lives whilst receiving our services. We also aim to
exceed peoples’ expectations by making every interaction with us count. We
value and trust our staff and support them in their development. We aim to
inspire people who receive our services, their loved ones and staff and be
inspired by them and to provide excellence in everything that we do.
8. We aim to give those people who receive our services the best possible chance
to live a full and happy life, and aim to support them to thrive beyond any
limitations ensuing from condition or circumstance. Central to achieving this
ambition are the concepts of Recovery, Resilience, Self-Management and
Integration, which are also enshrined in the Trust strategic plan:
‘We will adopt the principle, in all our services, of empowering patients to achieve
independence and the best possible life chances, removing dependence and
giving them and their families (in the case of children) control over their care.
9. We will work closely with providers, along pathways, to deliver integrated, person
centred care and support to local people, close to their homes, principally in noninstitutional settings (hospitals, care homes etc). We will integrate with key
partners to improve efficiency and effectiveness and simplify access’. (CPFT 2
and 5 year Strategic Plan Nov 2014).
10. This Strategy seeks to add the ideas of “resilience,” “self-management” and
“Wellbeing”.
Recovery, Resilience and Self-Management Strategy December 2015
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Integrated Services
11. From 1st April 2015, Community Services for Older People and Adults with Long
Term Conditions transferred into the Trust in partnership with Cambridge
University Hospitals Trust. These services expand the Trust’s portfolio from being
a provider of predominantly (but not exclusively) Mental Health Services. These
services provide assessment, diagnosis, and treatment and also support to
individuals living with a range of debilitating lifelong mental and physical
conditions.
12. As the Trust becomes a provider of a broad range of community services, careful
consideration will be given to the concepts of Recovery, Resilience and SelfManagement and their application more broadly than within a mental health
context. In terms of mental health, Recovery is taken to broadly be concerned
with the development of services based on hope, a sense of control, choice,
autonomy and personal growth for people in receipt of those services. It is clear
that these concepts equally apply to other areas of health. In these broader
health contexts Recovery is articulated as building resilience and wellbeing, and
emphasis on self-management and the notion of the Expert Patient. This also fits
within the overarching context of the Care Act with its emphasis on building
community resilience, prevention and re-ablement.
13. This strategy builds on previous work which was, rightly at the time, based solely
on the notion of “recovery.” It is important now that the concepts this strategy
aims to convey can resonate and gain the same purchase within all of the
integrated services as it has within mental health. The challenge therefore is not
to lose or dilute the recovery ethos but to expand or add to it to envelope the new
services. For this reason the Strategy is entitled “Building Recovery and
Resilience - Supporting Self-Management and Wellbeing”.
Recovery, Resilience and Self-Management – a mixture of the old and the new
Recovery
14. The term “recovery has become almost a trade name embedded within mental
health and within much recent UK mental health policy. It builds on older
concepts of rehabilitation and promoting independence
15. The literature is rich with definitions of Recovery. The CPFT website says that
“Recovery is being able to live a meaningful and satisfying life, as defined by
each person, in the presence or absence of symptoms (Scottish Recovery
Network 2009). Recovery is not about ‘getting rid of problems. It is about seeing
people beyond their problems”. (Julie Repper and Rachel Perkins 2002)
Recovery, Resilience and Self-Management Strategy December 2015
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“Recovery is remembering
who you are and using all
your strengths to be all you
were meant to be”
“What does recovery mean to
me? It means being able to
make my own decisions, having
my voice heard, accessing the
support I feel I need, when I
need it and believing that I can
live a life that I feel proud of”
(RCE Student)
“Recovery to me is being able to
do the things I used to be able to
do, to get out of bed, to get to
work, to enjoy my hobbies and
interests and to love and be
loved in return”
16. The above are quotes from attendees at the Recovery College. Below are some
thoughts from the literature:
“Historically people with mental illness were often not expected to recover…Services
of the future will talk as much about recovery as they do about symptoms and
illness.” (Dept. of Health 2001: p24)
“What’s needed most of all is a change of attitude in each Trust from the community
nurse to the Chief Executive… It is perfectly possible to live a fulfilling life after a
diagnosis [of severe mental illness] [and other illnesses/disabilities]. We have no
doubt that this is achievable.” (Murray 2012: p5)
Reablement and Wellbeing
17. A more recent term used in local authorities is “Reablement” whereby targeted
services are provided with the express purpose of helping people to recover from
a specific illness or event ( typically a fall) and then the service is withdrawn when
the individual is deemed to have sufficiently recovered. Often there is a standard
time attached to how long a Reablement service can be provided for. This
comes with a notion of “throughput” (Peter Beresford 2015)1 which some
commentators up to now have not seen as appropriate within the field of mental
health.
1
Article “From Recovery to reclaiming madness” in Clinical Psychology Forum Special Issue
Recovery April 2015
Recovery, Resilience and Self-Management Strategy December 2015
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18. However with new duties under the Care Act 2014 to promote wellbeing (see
below), this is leading to a renewed interest in the concept of reablement in
mental health and our two local authority partners have asked the Trust to
develop mental health reablement services. In Peterborough this is to develop a
dedicated Reablement Team. The approach in Cambridgeshire is different,
based on introducing Reablement practices into two of the existing teams on a
pilot basis (Huntingdon and Fens initially).
19. This fits well with recent new funding from the CCG for “recovery coaches” who
will be able to support reablement approaches and support individuals out of
services and provide quick re-access if required.
20. The concept of reablement within physical health is long established and
reablement services were in the past in Cambridgeshire County Council areas
run as an integrated service with health teams. Although this is no longer the
case the working interface and relationships remain close. Reablement within
Peterborough is delivered by the Council.
Definition of Wellbeing
Wellbeing” is a broad concept, and it is described as relating to the following areas in
particular:
•
personal dignity (including treatment of the individual with respect);
•
physical and mental health and emotional wellbeing;
•
protection from abuse and neglect;
•
control by the individual over day-to-day life (including over care and support
provided and the way it is provided);
•
participation in work, education, training or recreation;
•
social and economic wellbeing;
•
domestic, family and personal relationships;
•
suitability of living accommodation;
•
the individual’s contribution to society.
The individual aspects of wellbeing or outcomes above are those which are set out in
the Care Act, and are most relevant to people with care and support needs and
carers. There is no hierarchy, and all should be considered of equal importance when
considering “wellbeing” in the round
Official Care ACT 2014 Guidance, DoH 2015)
Recovery, Resilience and Self-Management Strategy December 2015
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Resilience – a partner to Recovery
21. Google resilience, or resilience and mental health, or resilience and wellbeing,
and thousands of websites come back: the literature on resilience is large.
Factors that contribute to resilience include:
Close relationships with family and friends
A positive view of yourself and confidence in your strengths and abilities
The ability to manage strong feelings and impulses
Good problem-solving and communication skills
Feeling in control
Seeking help and resources
Seeing yourself as resilient (rather than as a victim)
Coping with stress in healthy ways and avoiding harmful coping strategies, such as
substance abuse
Helping others
Finding positive meaning in your life despite difficult or traumatic events
http://www.pbs.org/thisemotionallife/topic/resilience/what-resilience
22. Key points to note are:
• The use of “resilience” and “self-management” across all ages i.e. across the
life course which matches our portfolio of activity;
• The read across to mental health;
• The commonality underlying the principles of recovery and the list of factors
that contribute to resilience; and
• Resilience can be applied at different levels: individual, community and
economic resilience. This reads across to the plans below to strengthen
pathways to employment, and to the Wellbeing Services that were being
developed under the banner of UCP that are based on harnessing social
capital within local communities. This work has now passed to the CCG to
continue.
• The importance of developing “personal resilience” within our staff – for
example around the concepts of home/ work life balance.
23. Self-Management comprises a portfolio of tools and techniques to support
people to manage their own physical and mental health. It requires a fundamental
transformation of the ‘patient’ / ‘care giver’ relationship towards a collaborative
partnership. In this way it has considerable resonance with the concept of
Recovery in Mental Health.
Recovery, Resilience and Self-Management Strategy December 2015
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The Story So Far
Achievements
24. This builds on the strong progress that has already been made by CPFT in the
pursuance of a Recovery orientation across its services. This progress is evident
across a number of service streams and departments and includes:
•
•
•
•
•
•
•
•
development of Peer Support Worker roles
delivery of cohorts of training towards this Nationally and UK accredited
qualification
inception of Recovery College East
PROMISE project which involve a number of initiatives which have
o significantly improved the experience of people in adult inpatient
services
o empowered staff to make small but significant changes to their own
practice.
Training, delivered by HR colleagues through the Recovery College, for
people with a lived experience to sit on interview panels in CPFT
Feedback from people with a lived experience using a variety of methods
including IPad based surveys, focus groups
Development of Daisy Change and Rising Roses Women’s Institutes which
provide an opportunity for women with a lived experience to re-frame
themselves as women first and members second and take part in everyday
activities and educational opportunities. This also enables them to move away
from illness saturated environments and which provides a link to local WIs in
the area
Board Recovery and Resilience Champion appointed (see appendix 2)
25. It is impossible to represent here the entire breadth and wealth of the
developments towards Recovery that are going on across the Trust. There is
more detail in the recently published biennial report for the period Jan 2013 to
Jan 2015 for the Recovery College East.
Challenges and Opportunities
This strategy seeks to address the following challenges within an ongoing wider
environment of austerity and reduced funding generally.
Our challenges include:
•
Embedding recovery and resilience within our organisational DNA and as
referred to above, we are now an organisation that provides mental and
physical health services. This supports the opportunity to use this Strategy as
the “glue” within the organisational development strategy.
Recovery, Resilience and Self-Management Strategy December 2015
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•
•
•
•
•
•
•
Identifying, supporting and embedding the initiatives that have come across
with the community health services (for example health coaches and the
“Breathe Easy” service within COPD)
Taking the Recovery College East to the next stage – should the College be
at arms length from the Trust, and if so what governance positions it best to
attract funding from sources other than health and social care
Developing the capacity within and the offer of Recovery College East to meet
a greater and widening demand – for instance from Carers
Bringing the Recovery College East to more of the rural geographies and
service localities – consider a base in Wisbech or a peripatetic service offer
within this part of the County where travel without a car is very difficult
Growing and making the most of our relationships with the vibrant
independent sector within Cambridgeshire and Peterborough, especially the
rich culture of volunteering.
Opening up generic jobs within the Trust to peer workers when they become
vacant.
Encouraging all CPFT staff to engage more with the Recovery College.
Five Year Strategy
26. Our objectives fall under the following headings:
• Embedding the culture of Recovery and Resilience throughout the organisation
• Walking our own walk – CPFT as an exemplary employer
• Improving people’s life chances – health, employment, education
• Changing the way we approach risk and supporting staff to work differently
• Financial sustainability of Recovery College East
Embedding the culture of Recovery, Resilience and Self-Management
throughout the organisation
27. Over the life of the previous strategy considerable progress has been made in a
number of areas in relation to the development of a culture of Recovery across
the Trust but like all such initiatives the drive to embed this has to be a
continuous rather than continuing process if Recovery, Resilience and SelfManagement are to become everybody’s business and firmly established
throughout the organisational DNA. This must span the entire organisation from
the Board to the direct care staff, staff enacting administrative functions and
across all services, teams and departments. Recovery, Resilience and SelfManagement orientated practices will need to be explained and articulated in a
way that is appropriate for individual teams and departments and to ensure that
everyone understands how Recovery applies to their service or department and
what is demanded of their own practice.
Recovery, Resilience and Self-Management Strategy December 2015
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28. This also requires different approaches for different services which means that
one overarching plan will no longer, if it ever did, fit the wide range of services
provided by the Trust. For example, there are a number of the community health
staff moving into CPFT who are trained as health coaches and this is an example
of a service that might be grown and embedded into mental health services.
29. We need to consider how we understand and map over the recovery orientated
practice into our integrated older person’s services, learning disability and
specialist services.
30. The concept of building resilience in Children’s Services is well established and
learning might be taken from these services across the rest of the Trust.
Principles from Person-centred Dementia Care (Tom Kitwood) have been
mapped against the principles underpinning Recovery. The diagram below is the
famous Kitwood2 “dementia flower” used now over the last 25 years within
dementia care services.
2
T Kitwood (1997) Dementia Reconsidered
Recovery, Resilience and Self-Management Strategy December 2015
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Comparable Principles in Recovery-orientated practice and person-centred care
Recovery
(CSIP, RCPsych & SCIE, 2007;
Sainsbury Centre for Mental Health, 2008)
Person-Centred Care
(Kitwood, 1997, McCormack, 2004; Brooker,
2007)
Recovery is fundamentally about a set of
values related to human living applied to
the pursuit of health and wellness
A value base that asserts the absolute
value of all human lives regardless of age
or cognitive ability
The helping relationship between clinicians
and patients moves away from being
expert/patient to being ‘coaches’ or
‘partners’ on a journey of discovery
The need to move beyond a focus on
technical competence and to engage in
authentic humanistic caring practices that
embrace all forms of knowing and acting, in
order to promote choice and partnership in
care decision-making
Recovery is closely associated with social
inclusion and being able to take on
meaningful and satisfying roles in society
People with dementia need an enriched
environment which both compensates for
their impairment and fosters opportunities
for personal growth
People do not recover in isolation. Family
and other supporters are often crucial to
Recovery and should be included as
partners wherever possible
Recognises that all human life, including
that of people with dementia, is grounded in
relationships
Recovery approaches give positive value to
cultural, religious, sexual and other forms of
diversity as resources and supports for
wellbeing and identity
An individualised approach – valuing
uniqueness.
Accepting differences in
culture, gender, temperament, lifestyle,
outlook, beliefs, values, commitments, taste
and interests
Walking our own walk – CPFT as an exemplary employer
31. Building on the more generic section above regarding improving peoples’ life
chances, as a large NHS employer CPFT is ideally placed to lead by example as
an exemplary employer. There are a number of frameworks we can use to help
us achieve this: such as further developing the Mindful Employer initiatives or
adopting another framework such as the “Wearing 2 Hats” initiative, ensuring we
are an organisation that actively seeks to employ people with lived experience
and life impacting conditions.
32. The following is recommended:
• To continue to host ‘Time to Change’ initiatives ensuring we are challenging
the stigma of mental health within the wider community.
Recovery, Resilience and Self-Management Strategy December 2015
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•
To proactively support staff in the organisation who are also experiencing
mental and physical health challenges.
33. There is a clear need to also ensure that the mental and physical health needs of
staff are met appropriately including:
•
•
•
•
•
•
To treat staff with compassion in order for them to also treat people with
compassion:
To address the need for education and training in new ways of working
Assurance that staff concerns will be listened to and acted upon:
Support for staff to be open about their own lived experience and life
impacting conditions:
Improved Occupational Health and HR processes:
For staff to be appropriately and sensitively supported by mental health
services when they need to be
Improving people’s life chances – wellbeing, employment, education
34. Central to the concept of Recovery is the challenge to service providers to
maximise opportunities for people to build lives beyond illness. This involves
ensuring that service providers contribute positively to peoples’ sense of identity
as citizens and focus on them in the context of their whole lives, not defining
people by illness or deficit. This means mental health services being ‘on tap not
on top’ in people’s lives (Repper and Perkins 2003).
35. The Recovery College is key in delivering the aspiration of “improving people’s
life chances”. The Recovery College would like to widen its curriculum to
incorporate expert patient self management courses, and to increase the focus
on building resilience and wellbeing.
36. This is also about situating the Recovery College within a pathway towards
employment that makes it easier for service users. This may include both
volunteering and employment opportunities acknowledging the rich network of
employers and volunteering support organisations across Cambridgeshire and
Peterborough with whom the Trust is developing closer working relationships.
37. But volunteering is not just about pathways to employment. For an older person,
no longer in paid employment, it may be about social engagement and activity
that builds their resilience and supports their wellbeing.
Changing the way we approach risk and supporting staff to work differently
38. A recovery orientation and the building of individual resilience within the context
of service provision, is largely agreed to be concerned with the development of
Recovery, Resilience and Self-Management Strategy December 2015
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delivery based on hope, a sense of control, choice, autonomy and personal
growth for people receiving services.
39. It is also agreed that, in order for staff to work within this framework,
organisational commitment to supporting them in their efforts to do so is also key.
Traditional risk management is usually concerned with danger avoidance,
restrictions, containment, protection and control. Our challenge is to reconcile
these tensions and to find a way to support people appropriately in their recovery
journeys and to support staff in their attempts to do so (Boardman and Roberts
2014).
40. There are two main strands to this challenging goal. The Trust-wide articulation of
a recovery and resilience orientated attitude towards risk and the policy
framework to underpin this and some subject specific initiatives including the No
Force First project.
41. This is acknowledged to be difficult. The implementation of personalisation under
the Putting People First Concordat (2007) has led local authorities to develop
positive risk taking policies and procedures so that they can step back and
relinquish control over the lives of people with life long conditions and disabilities.
Examples include the choices of individuals who may not wish to settle in one
place, choices about food, and about the way that people choose to live.
42. There is also a read across to the new adult safeguarding provisions of the Care
Act 2014 which lower the threshold for safeguarding. It might be thought that a
widening of safeguarding would increase risk-averse behaviour. However,
paradoxically, knowing that this framework is in place might actually assist
clinicians to feel more confident in their approach to risk.
Financial sustainability of Recovery College East
43. CPFT is rightly very proud of this innovative and ground-breaking work carried
out at Recovery College East since its inception.
44. However, a victim of its own success, the College has out grown its funding base,
and the College is at a watershed in terms of its future direction. A vital strand of
the Recovery and Resilience Strategy therefore needs to focus on ensuring that
the Recovery College is sustainable into the future and can continue to thrive and
develop in more diverse areas.
45. We are proud of the reputation of our Recovery College and the developments
around our partnership working. We have recently secured funding from the
Skills Agency to pilot courses around transition and change in partnership with
the City College in Peterborough. Additionally, the CCG have asked the
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Recovery College to host a number of recovery coach posts to support people
who are struggling with being discharged from mental health services.
46. This Strategy is an opportunity to take stock of progress made so far in all the key
areas and to consider the strategic direction and priorities over the five coming
years. This has been co-produced with a number of stakeholders including
people with a lived experience, carers, staff, Governors and Board members.
This is summarised in the tables in Appendix I below.
Next Steps
47. The next steps for the Recovery, Resilience and Self-Management Strategy will
include:
• The production of a detailed action plan to include dates and lead
responsibilities
• Ensure that the action plans are built into the annual CPFT Business planning
cycle
• Develop and implement an internal and external communication plan
• Formulate a process of outcome measures and evaluation to measure
progress as an organisation, team or individual. This should include an audit
of recovery and resilience work across the Trust by peers and other workers.
Recovery, Resilience and Self-Management Strategy December 2015
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APPENDIX 1
Role of Recovery Champion – Jo Lucas
1.
To champion the ethos of Recovery in Mental Health
• as a way of thinking about and framing services within the Board and with staff
and partners in the role of NED
• promotion of the Recovery College to the Board and external partners, attending
their events etc
• To work with the Board in extending and adapting this concept to the other
services that will be in the Trust from 1st April 2015
Actions:
• to host a workshop on recovery later on in the year to embed more into the
Board
• visit other RCs eg the Harrow campus of CNWL's RC which is in partnership
with Westminster University
2. Promotion of the values of social care and developments
• giving visibility to social care at the Board
• prompting the inclusion of social care in the relevant papers that come through
the Board (workforce plans, business planning etc)
• Be visible to social care staff eg through the Social Care Forums – as an
emissary from the Trust Board
3. Carers
• to be Trust Board lead on this area of work (Strategy to be refreshed and
updated in 15-16)
• To work with Governors in this area of work (a key priority for Governors)
• To develop the linkages between Recovery for service users and support for
Carers
1. Social Enterprise
• To support the development of social enterprise initiatives including the
possibility of a café, as one way of promoting employment and social capital
and providing services to CPFT users.
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APPENDIX 2
What is resilience?
Resilience is the capacity to withstand stress and catastrophe. Psychologists have
long recognized the capabilities of humans to adapt and overcome risk and
adversity. Individuals and communities are able to rebuild their lives even after
devastating tragedies.
Being resilient doesn’t mean going through life without experiencing stress and pain.
People feel grief, sadness, and a range of other emotions after adversity and loss.
The road to resilience lies in working through the emotions and effects of stress and
painful events.
Resilience is also not something that you’re either born with or not. Resilience
develops as people grow up and gain better thinking and self-management skills and
more knowledge. Resilience also comes from supportive relationships with parents,
peers and others, as well as cultural beliefs and traditions that help people cope with
the inevitable bumps in life. Resilience is found in a variety of behaviours, thoughts,
and actions that can be learned and developed across the life span.
•
•
•
•
•
•
•
•
•
•
Factors that contribute to resilience include:
Close relationships with family and friends
A positive view of yourself and confidence in your strengths and abilities
The ability to manage strong feelings and impulses
Good problem-solving and communication skills
Feeling in control
Seeking help and resources
Seeing yourself as resilient (rather than as a victim)
Coping with stress in healthy ways and avoiding harmful coping strategies, such as
substance abuse
Helping others
Finding positive meaning in your life despite difficult or traumatic events
http://www.pbs.org/thisemotionallife/topic/resilience/what-resilience
Recovery, Resilience and Self-Management Strategy December 2015
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Arch Project
What is resilience?
Resilience is a key factor in protecting and promoting good mental health. It is the quality of
being able to deal with the ups and downs of life, and is based on self esteem.
We look into many different factors that affect resilience:
• secure early attachments
• confidence of being loved and valued by one’s family and friends
• clear sense of self-identity (personal, cultural and spiritual)
• sense of self-efficacy (being able to make decisions and act independently)
• confidence to set goals and attempt to achieve them.
Based on these, the project uses 6 domains to work with to try and build people’s resilience:
(Brigid Daniel & Sally Wassell – Assessing & Promoting Resilience in Vulnerable Children)
http://www.barnardos.org.uk/arch/arch_what_is_resilience.htm
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Recovery, Resilience and Self-Management Strategy December 2015
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Appendix 3
Recovery, Resilience and Self-Management Strategy December 2015
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Recovery, Resilience and Self-Management Strategy December 2015
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Building Recovery and Resilience – Supporting Self-Management
and Wellbeing Strategy
Discussion Period Feedback Report
Introduction
The formal Recovery, Resilience and Self-Management Strategy discussion period ran from
September 14th to October 31st 2015. Additionally, the Strategy was sent via formal and
informal networks to people with a lived experience of receiving services and their loved
ones, Trust staff, partner organisations and other third sector services and groups including
the Service User Network and Anglia Ruskin University. Additionally it was available on the
Trust website and staff at various meetings and events, including Trust induction sessions
during the period, were alerted to it.
The majority of responses were received via the Survey Monkey on line system but
additionally people took opportunities to feedback via email, via the planned drop-in sessions
at the Recovery College East sites and at other events and meetings.
The responses have been very helpful and often detailed and made with a great deal of
consideration.
Due to the many ways people could choose to respond and the choices that were largely
open as to what people chose to answer and what they chose to omit, there are quite large
variations in the numbers of people responding to different questions. Some people chose to
feed back broad themes and others chose to answer each and every question and fill each
comment box.
The total number of responses was encouraging and the level of detail in some of the
comments was both useful and appreciated. A total of 40 responses were received; 30 of
these responded to the Survey Monkey questions and 10 gave more general comment. 23
people responded as individuals and 1 as an organisation. Of those who identified
themselves, 20 respondents categorised themselves as CPFT staff, 3 as members of
partner organisations and 6 as Experts by Experience (n=29). Many people identified the
service they came from but aggregating this has proven impossible due to differences in
language, terminology and abbreviations. There was, however a broad spread across
service areas.
Many respondents, from a variety of backgrounds spoke openly about their appreciation of
being involved in the process.
This data has been collated and analysed and the results are shown in Appendix A. The
revised Strategy is shown in Appendix B. General discussion about the results and their
impact is below.
Recovery, Resilience and Self-Management Strategy December 2015
21
Discussion
The overwhelming tenor of the discussion period feedback was positive and supportive with
many comments helpfully qualifying that support or giving useful suggestions in terms of
application and initiatives.
“The idea that a patient can come through the service provided by CPFT, to aid their
recovery to a point in which they can self manage their lifestyles is a brilliant concept.
If CPFT can work to provide after care in the way of peer support and community
programmes I feel this will be a great foundation step in preventing recurring
admissions”
There was also considerable energy expressed by many for adopting the changes in their
own practice and teams and taking responsibility for ‘walking our own walk;’ being
courageous in our own practice and challenging others and the system when necessary.
Much of the detailed feedback will be very informative during the implementation of the
Strategy and the development and roll out of the action plan. However, the main feedback
that directly impacts on the Strategy itself is the need for it to be widened to be fully
inclusive of all care groups, professional groups, services and localities. This is in line
with the development of the Strategy and a clear intention within it. However, to achieve this
comprehensively and effectively it will take longer than the time available before the launch.
This is discussed further under heading 4 below – Inclusivity.
Where appropriate, amendments have been made to the Strategy as a result of the
feedback and these are presented (Appendix B) to the Trust Board as the final version of the
Strategy which will be subject to the changes to be made over the forthcoming year, under
heading 4 below - Inclusivity.
Generally, feedback falls into 4 main themes:
2.
3.
4.
5.
Caution about the size of challenge and the need for systemic change,
Vision for the future - outcomes and evaluation,
Staff support and consideration and
Inclusivity.
(Full data and thematic analysis is attached at Appendix A)
1. Caution about the size of the challenge and the need for systemic change
Many comments related to the need for Trust-wide, or beyond, systemic changes that
respondents felt were necessary for the successful implementation of the Strategy. This
included comprehensive use of appropriate language, consistency of approach, adequate
funding and resource provision as well as building and communicating a strong reputation.
Recovery, Resilience and Self-Management Strategy December 2015
22
There was an acknowledgement of the enormity of this task and the size of the challenge in
terms of organisational development and culture change. In the main these will require
strong leadership and impetus from the Board, Executive and Senior Management teams.
One respondent summed it up:
“Leadership and change in culture and working practices. The challenge seems huge”
A main focus, post launch, will be the need to design an action plan which has coverage
from Board to the front line, with clear means of evaluation and which does not shy away
from addressing the tensions between the existing systems and processes and those which
would reflect a Recovery, Resilience and Self-Management orientation:
“Recovery focussed care pans”
“Clarity around competing pulls towards disorder-specific core services focused on
delivery of time-limited interventions and throughput and supporting the recovery
journey of the individual; moving at their own pace where treatment for a disorder
might not be a priority”
2. Vision for the Future - Outcomes and Evaluation
Questions 2 and 3 asked respondents to name what they expected to have changed over a
two and five year period. This elicited much useful data which will be very helpful in
considering how to measure outcomes and evaluate progress in individual, team and
organisational practice. Suggestions ranged from broad categories like “Principles fully
embedded” to specific measures including:
•
•
•
•
•
•
•
•
Regular ‘temperature taking’ of staff and service recovery orientation using
recovery outcome measures and tools like TRIP
Reduction and eventual elimination of restraint and physical interventions
Reduced staff stress/absence and improved reporting of wellbeing in relation
to work
Better data quality for recovery outcomes including employment and
education
Increased patient and carer/family satisfaction
Fewer people accessing crisis services
Fewer people returning to mental health services
New ways of considering positive risk taking within the Trust
Finding appropriate ways to measure outcomes and evaluate progress is a huge challenge
and may also require the tensions between the existing systems and processes for
measuring outcomes and evaluating progress and those which would reflect a Recovery,
Resilience and Self-Management orientation to be addressed:
“Changes to the way that care coordination and key working are carried out in (adult
mental health) community services. Currently there is an emphasis an allocation of a
care coordinator or key worker to a service user (or vice-versa) as if being on a
Recovery, Resilience and Self-Management Strategy December 2015
23
caseload somehow in itself meets a service user's needs and manages their safety.
It follows that there needs to be some hard thought put in to streamlining the role of
care coordinators and key workers to allow time and thinking space for the emphasis
on intervention”
It is proposed that this is a main focus for the coming months and that processes for
measuring outcomes and evaluating progress is developed and implemented at individual,
team and Trust-wide levels.
3. Staff support and consideration
A major theme of the feedback was the impact of all of the changes on staff and the need for
staff support during the process and into the future. This covered many aspects including the
need:
•
To treat staff with compassion in order for them to also treat people with compassion:
“Managers at all levels, to feel confident in supporting the staff's emotional
wellbeing”
“We must care about each other in the workplace if we are to really embed the
idea of recovery and resilience”
•
The need for education and training:
“Adequate funding to train and empower staff at all levels to feel able to respond
to people's distress in a compassionate way”
•
For assurance that staff concerns will be listened to and acted upon:
“Effective management and support, and confidence that concerns will be
listened to/acted upon”
•
For support for staff to be open about their own lived experience:
“Staff's lived experience will be able to be tapped into as a resource because
they will not be afraid to be real about it”
•
For improved Occupational Health and HR processes:
“More thought needs to be given to the support that with people with lived
experience receive in employment. Anecdotally people who have been open
about their lived experience … have then fallen foul of Trust policies around
sickness absence”
This section has been strengthened in the Strategy and will be incorporated into the Action
planning process and implementation.
4. Inclusivity
As mentioned above, the main feedback that directly impacts on the Strategy itself is the
need for it to be widened to be fully inclusive of all care groups, professions, services and
Recovery, Resilience and Self-Management Strategy December 2015
24
localities. This is in line with the development of the Strategy and a clear intention within it.
However, to achieve this comprehensively and effectively it will take longer than the time
available before the launch. It is noted that, given the history of the Trust and the previous
focus on mental health and Recovery, this Strategy is work in progress in its journey towards
comprehensive inclusivity. This was also reflected in the feedback received:
“Physical health needs to be built up a bit more in the main body”
“It’s not quite strong enough in relation to children and young people”
“I think it should mention working collaboratively with people as this was a thrust of
work in the 7 Cs of care planning and should be a key part of the way we work, as
this is a big component of recovery”
“Nowhere does spirituality or chaplaincy actively carving socially intelligent activities,
spaces and places that chaplaincy– equally valuable, viable and needed – get a
mention.”
In addition, the structure and content of the Strategy and activity around the ImROC
framework (which is mental health focussed) will need to reconsidered in the light of the
Inclusivity work.
It is therefore proposed that the current Strategy be subject to the minor amendments prior
to sign off and that a further tranche of work be launched, for completion within one year, to
address the inclusivity issue. This work will involve all professions and non-mental health
groups and services. This will be acknowledged in the Foreword and the revised, fully
inclusive Strategy will be prepared for re-launch in January 2017.
Further discussion, which has taken place subsequent to the formal period, has involved the
title of the strategy. The following title is now proposed:
“Recovery and Resilience (Supporting Self-Management and Wellbeing)”
Conclusion and Recommendations
The overwhelming tenor of the feedback has been positive and the Strategy has been
amended in the light of the feedback (Appendix B). It is now proposed that the Strategy is
launched under the new title as proposed, with an understanding that further work needs to
be done over the coming year. A foreword from the Recovery Champion will explain the
work to be done over the coming year, including:
•
•
•
developing the detail around inclusivity,
developing a Board to Front Line Action Plan and
the development of outcome measures and evaluation processes for
individuals, teams and the organisation as a whole.
Recovery, Resilience and Self-Management Strategy December 2015
25
Appendix A
Data and Thematic Analysis
Question 1
Do the concepts of Recovery, Resilience and Self Management speak to you and the
services you are involved in? Or if you are from a partner organisation or are a carer,
does this resonate with the way you think CPFT should aspire to work?
7 people strongly agreed, 19 agreed, 1 didn’t know and 1 disagreed. 0 strongly disagreed
(n=28). This means that the total number of people to agree was 26, to disagree was 1 and
there was 1 person who expressed ambivalence.
Chart 1 - Question 1 quantitative analysis
30
25
20
15
10
5
0
Strongly Agree
Agree
Don't Know
Disagree
Strongly
Disagree
Total
Chart 2 – Question 1 aggregated data analysis
30
25
20
15
10
5
0
Total in Agreement
Total Ambivalent
Total to Disagree
Recovery, Resilience and Self-Management Strategy December 2015
Total
26
A total of 20 people provided comments to question 1.
The majority of responses suggest that there is agreement, in the main, for these concepts
and the principles behind them. Many comments supported the respondent’s agreement. For
example:
“The idea that a patient can come through the service provided by CPFT, to aid their
recovery to a point in which they can self manage their lifestyles is a brilliant concept.
If CPFT can work to provide after care in the way of peer support and community
programs I feel this will be a great foundation step in preventing recurring
admissions”
“As a partner organisation, we absolutely agree in these concepts, and have
designed and run all of our services according to these principles for the last few
years”
“These words should shape practice”
“Our services are about the long game, so these concepts are very relevant”
“In general, facilitating resilience and self-management allows people to maximise
their independence and minimise their dependence upon services”
“The important thing is to educate yourself to:
• help yourself
• have coping mechanisms.”
2 respondents suggested additional words as having resonance for other care groups
including people with learning disabilities and physical health:
• Discovery
• Rehabilitation
• Independence
One person suggested that the term Recovery might not have ‘fit’ for long-term conditions or
end of life care and one other person wanted to return to Recovery only.
A stronger theme from the responses was a call for caution in terms of the application of
these principles in practice. There were also requests to give consideration about how this
applies to the different care groups and within a system that is not always amenable. For
example:
“I think there is a lack of consideration of how these principles work in practice for
people with significant cognitive impairment”
“I think we still have some way to go in reconciling contradictions in our services. For
Recovery, Resilience and Self-Management Strategy December 2015
27
example, we have core services organised on concepts of diagnosis/disorder-specific
care pathway - with emphasis on the delivery of time-limited, evidence-based
interventions and throughput with limited choice. This makes it difficult to adopt a
pure recovery model as part of our DNA and current recovery initiatives, like the
Recovery College and the proposed Recovery Champions feel something like 'addons' rather than central aspects of our services”
“This will require behaviour change and shorter-term interventions (new contract with CCG)”
Question 2
What would you hope would have changed by the end of the first two years as a result
of this strategy? Please write your answer below with as much detail as possible
A total of 26 people responded to this question.
Answers fell into eight broad categories; Systemic Change, Initiatives, Consistency,
Language, Person-Centred, Outcomes, Staff Support and Education. Some answers fell into
more than one category and this is reflected below. This data will be used to inform the
process of evaluation that will be designed following the launch of the Strategy.
1. Systemic Change – which relates to Trust-wide, or beyond, systemic changes that
respondents wanted to see as a result of the Strategy. In the main these will require strong
leadership and impetus from the Board, Executive and Senior Management teams. Details
are listed below:
•
•
•
•
•
•
•
•
•
Reduced use of restraint and physical interventions
Improved links between mental health and physical health services both conceptually
and practically (e.g. health coaching)
Recovery-focussed care plans.
Clarity around competing pulls towards disorder-specific core services focused on
delivery of time-limited interventions and throughput and supporting the recovery
journey of the individual; moving at their own pace where treatment for a disorder
might not be a priority
Changes to the way that care coordination and key working are carried out in (adult
mental health) community services. Currently there is an emphasis an allocation of a
care coordinator or key worker to a service user (or vice-versa) as if being on a
caseload somehow in itself meets a service user's needs and manages their safety.
It follows that there needs to be some hard thought put in to streamlining the role of
care coordinators and key workers to allow time and thinking space for the emphasis
on intervention
Much greater emphasis on and investment in the delivery of evidence-based, timelimited and active intervention(s) - because this is what actually meets service users'
needs - and openness about when there is no appropriate intervention available
New ways of considering positive risk taking within the Trust
Increase the number of peer workers
Continued improved partnership working and information sharing with partnership
Recovery, Resilience and Self-Management Strategy December 2015
28
•
•
agencies
Share outcomes from Recovery College with wider audience outside the trust to
promote positive working
A pooled budget (s75) between LA and NHS that supports the development of
Recovery and Resilience and for this to capture all investment in Mental Health for
the third sector
2. Initiatives - respondents made a number of suggestions which fell into the category of
specific new initiatives or building on existing examples. The list of initiatives is below:
•
•
•
•
•
•
•
More teams using TRIP as a multi agency evaluation tool as well as a change tool.
Regular ‘temperature taking’ of staff and service recovery orientation using recovery
outcome measures and tools like TRIP
Publication of Trust work around Recovery (eg transformation work in arts therapies)
Improved focus on children and young people and physical health
Sustainability of the Recovery college
Investing in trained therapists to deliver psychologically informed therapy with those
people who require more intensive 1:1 therapy sessions to support them in
understanding and building their resilience and self-management skills
More peer support and community based programs to aid people leaving the service
3. Consistency – A major theme in the feedback was a call for consistency in the application
of these principles.
Detailed responses are below:
•
•
•
•
•
•
•
•
All CPFT staff to have a good understanding of the concepts
Embedding this in daily practice
Embed this in the culture of the organisation
Ideas for self-management discussed throughout treatment and built into discharge
planning for every person to maintain recovery and resilience
Everyone working more efficiently
Emotional wellbeing is seen as an important aspect of people's lives which should be
attended to; all staff within the system should be aware of people's emotional needs
and how best to respond to these
Better communication throughout the Trust so that everywhere you go you hear
about what’s available to support recovery
Widening participation in recovery practice i.e. a growth across all services by
directorate-led projects and initiatives
4. Language – Linked to consistency, language was a theme in the feedback which seemed
important to note:
•
•
•
•
Consistent use of recovery focused language spoken and written
That we are all using the language and this becomes habitual
Services having a cultural shift and embedding these words firmly into practice
Better understanding of the vocabulary involved and that stigma around mental
Recovery, Resilience and Self-Management Strategy December 2015
29
health issues is lifted
5. Person centred – Linked to systemic change theme, there was a strong sense that
authentic person-centred approaches needed to be strengthened and developed, including:
• People to choose who is involved in their care.
• People would know where to go for help with their health need, people would know
the plan for the management of their health need and will be happy with this plan
because it is their plan, people will get the help they need at the time they want
• Working collaboratively with people to give them real choices and a real say in their
care.
• Clients will be aware of the concept and how it relates to their journey within this
service
• Health delivery truly driven by the people who use services and not the vocal few
who do not always represent the views of the majority
• Co-produced care plans
5. Outcomes – This was a theme mentioned by a number of respondents. This endorses the
Strategy in its intention to develop outcome measures and evaluate performance in terms of
Recovery:
• Increased numbers of people using services in employment or education
• Starting to collect performance data about quality of interactions
• People will get better more quickly
6. Staff support – A central theme was the need to ensure a balance between what a
Recovery, Resilience and Self-Management orientated system demands of staff and how it
should also be experienced by staff in terms of the support they receive and the nature and
culture of the organisation:
• OT input into Occupational Health processes leading to better staff support
• Managers at all levels, to feel confident in supporting the staff's emotional wellbeing
• Effective management and support, and confidence that concerns will be listened
to/acted upon
• Staff resilience
• Better quality Occupational Health
• More flexible HR services
• Staff beginning to feel supported to care
• Staff's lived experience will be able to be tapped into as a resource because they will
not be afraid to be real about it
7. Education – Underpinning all themes seems to be the need to provide the appropriate
education to enable and provide a framework for sustainable change:
• Increase in self-management courses.
• Staff trained in behaviour change, motivation and in patient-centred approaches
• Education of all staff to embed this in the culture of the organisation
• Adequate funding to train and empower staff at all levels to feel able to respond to
people's distress in a compassionate way
• Training available in positive risk taking
Recovery, Resilience and Self-Management Strategy December 2015
30
•
Training for peer workers to work in other parts of the trust e.g. children’s services,
integrated care
One respondent also suggested reducing the emphasis and reliance on ImROC for the
development of these principles.
Question 3
What would you hope would have changed over the next 3 to 5 years as a result of
this strategy? Please write your answer below with as much detail as possible
A total of 23 people responded to question 3.
Answers to this question fell into three broad categories: Practical outcomes (this was the
main theme about which comments were received), Funding and Reaching Out.
1. Practical Outcomes - Measures relating to people using services and staff were
suggested and these suggestions will be used to inform the process of evaluation that will be
designed following the launch of the Strategy.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Principles fully embedded
That all teams are engaged in the process can show evidence of how recovery
focused they are
Service redesign is influenced by a variety of stakeholders
Reduced staff stress/absence and improved reporting of wellbeing in relation to work
Better data quality for recovery outcomes including employment and education
Elimination of restraint and restrictive practice
Leadership over the efficient use of limited Trust resources to achieve clearly stated
aims
Clients/ patients doing more self care. Understanding that they are best placed to do
this
Staff dealing only with more complex patients
Increased patient and carer/family satisfaction
Staff employed within the organisation genuinely feel cared for with compassion by
the organisation
People in receipt of services across the organisation feeling genuinely cared for with
compassion and from this base of secure care they could then feel empowered to
make their own choices and take control to make the most of their lives
Fewer people needing to access crisis services
Clients are experts in the management of their own illness
Expectations shifting from being managed to self-management
Incorporating recovery as central from the start of the journey of people using our
services rather than as an add-on to be considered at the point of discharge
Patient outcomes measured
Recovery, Resilience and Self-Management Strategy December 2015
31
•
•
•
•
•
•
•
More peer workers;
More involvement throughout the Trust of peers
More alternative therapies
Fewer people returning to mental health services more people maintaining their
recovery in the community.
More places available for people to drop in or continue their personal development in
the community
Meeting the needs of those identified as currently subject to inequality in care
Staff morale improved
2. Funding - this was a secondary theme within this answer:
• A commitment from commissioners and social care to fund the level of service in the
community required to support people who would previously have been placed out of
area even if this involves single person service solutions.
• Housing to be part of S75 agreement that supports as many people as possible to be
cared for and supported to live independently in their own homes.
• More money spent on community based services (eg crisis Centres) than on
traditional services (Day Centres/Wards)
• A clear separation of health and social care resources
3. Reaching out – refers to a final theme which refers to building a strong reputation beyond
the Trust and the NHS.
• The Trust is well known for adopting the approach well in to practice.
• Recovery College needs to be thought about in terms of links with non NHS
education
• Beginning to reach out beyond our organisation so that employees of other
employers will benefit
Question 4
What can you or your organisation contribute to making the aspirations in this
strategy happen?
A total of 18 people responded to this question
The numbers of respondents and detail of the answers suggests that there is considerable
energy for delivering on this agenda and some really positive feedback in terms of what
people are willing to commit to. Answers have been divided into three main themes; Walking
Our Own Walk, Sharing good practice and Speaking Up.
1. Walking our Own Walk – this involved people committing to a variety of aspects of
Recovery, Resilience and Self-Management orientated practice from including it in their
management team agendas to the development of local Recovery tools and outcome
measures. This showed considerable energy for the challenge and a strong sense of people
taking the initiative and not waiting to be told or for a new policy to be issued. The full list is
Recovery, Resilience and Self-Management Strategy December 2015
32
extensive but some key examples are below:
• “Dietetics is really well placed to be able to help patients develop self care and
manage Long Term Conditions e.g diabetes through programmes of education,
support for self help groups”
• “Ensure the strategy is embedded into practice and use the terminology on a daily
basis”
• “We will continue to prioritise recovery within our leadership agendas and workforce
development”
• “We will continue to develop our use of recovery tools and outcome measures”
• “Any service change will be thought about and informed by recovery values and
aspirations - and evidence”
• “We will support self-management for people who have a long history of using
services by refining and developing our goal setting and transitions work in OT and
Arts Therapies”
• “We will work as a leadership team to find ways to cross the traditional boundaries
between mental and physical health and work inclusively around recovery - and most
importantly - promote this within the wider workforce”
• “We are a partner organisation and will be delivering post-discharge support”
• “Fundamentally show care and compassion to those we work with (both colleagues
and service users)”
• “Promotion of the concepts to the clients and their carers and how to achieve these in
their own journey”
• “Implement training that encompassed these values”
2. Sharing good practice? – some people were keen to share with others their own progress,
learning or knowledge:
• “Share results of TRIP and how it is being implemented”
• “Share recovery stories”
• “Seeking to publish and promote innovative work and outcomes to support both the
Trust and the wider recovery agenda nationally”
• “Show that recovery orientated arts therapies can be beneficial and to grow the
evidence base around this (and our positive reputation)”
• “Have recovery events which are opened up to individuals who do not work with the
trust do they are aware of what recovery means”
• “We are fully committed to working in partnership with the Trust to share good
practice and information, and to highlight issues as they arise in a constructive way”
3. Speaking up – this third theme expressed the courage that is needed when one has to
stand up for what is right in the face of competing pressures and priorities. Fewer
respondents mentioned this but it felt worthy of note. Examples are:
• “I will feedback concerns from patients and staff and take joint and personal
responsibility for own and team's wellbeing and practice”
• “I can contribute by living the values in my area and speaking up where appropriate”
Recovery, Resilience and Self-Management Strategy December 2015
33
Question 5
Do you need any support to contribute?
11 people did not feel they needed any support to contribute whilst 12 people did feel that
they needed support (n=23).
Chart 3 – Question 5 quantitative analysis
25
20
15
10
5
0
Yes
No
Total
A total of 13 people commented on question 5:
Comments to question 5 fell into four main themes; those who felt they were already being
adequately supported, Leadership, Communication and Understanding.
1. People who felt adequately supported – examples included:
• “We are receiving support to run our second TRIP day”
• “The support is in situ and we are grateful for the close links that the AHPLG and key
recovery champions have - these must continue”
• “The Trust AHP Lead already sits on the Recovery and Inclusion Board”
2. Leadership – many respondents suggested that strong leadership was key to their ability
to contribute. For example:
• “By having a little longer consultation times and a little more resource for structured
education programmes”
• “Specific guidelines”
• “In the development of Health Coaching within strategic plans”
Recovery, Resilience and Self-Management Strategy December 2015
34
•
•
•
“Leadership and change in culture and working practices. The challenge seems
huge”
“Recovery and Inclusion Board needs more Integrated Care representation”
“The vision and strategy has to adopted by all working within the services”
3. Communication – this recurrent theme throughout the feedback featured in what people
felt was needed in their contribution towards the implementation of the strategy.
• Just ongoing communication between the Trust and ourselves (partner org)
• Regular update meetings with colleagues from different areas to discuss
progress/issues arising/share good practice/advice
4. Understanding – this recurrent theme throughout the feedback again featured in what
people felt they needed in order to contribute. For Example:
• “Support of others”
• “Working currently through such uncertain times is a challenge. Hopefully support
through this process, and then clear, compassionate leadership within the Integrated
Care Team to enable compassion to flourish”
Recovery, Resilience and Self-Management Strategy December 2015
35
Question 6
Do you agree with 'Embedding the culture of Recovery and Resilience throughout the
organisation'?
21 people answered ‘yes’ to this question and 2 answered ‘no’ (n=23)
Chart 4 - Question 6 quantitative analysis
25
20
15
10
5
0
Yes
No
Total
A total of 7 people commented on question 6:
Three main themes emanated from the responses to question 6; supporting for the answer
‘yes’, Evaluation, Suggestions and the Size of the Challenge.
1. Supporting the ‘yes’ included:
• “We need to do this in order to be a flagship - if we can't get it right internally, as the
'experts' in mental health there is no hope for external organisations”
• “To build on CPFTs recovery focused approach with programs in the recovery
college and peer support would be fantastic”
2. Evaluation Suggestions – These suggestions involved ways to evaluate progress towards
embedding Recovery, Resilience and Self-Management within practice including:
• “The TRIP as an evaluative tool”
• “Trust dashboard”
• “Team appraisals where the team show how they are engaging in a recovery focused
way”
Recovery, Resilience and Self-Management Strategy December 2015
36
3. The size of the challenge – two respondents noted the enormity of this initiative:
• “The scale of culture change and OD development should not be underestimated”
• “This will be the most challenging area and will need a robust strategy in place”
Question 7
Do you agree with 'Walking our own walk – CPFT as an exemplary employer'?
21 people answered ‘yes’ to this question and 1 answered ‘no’ (n=22). The person who
responded ‘no’ stated a “lack of understanding of the concept”.
Chart 5 - Question 7 quantitative analysis
25
20
15
10
5
0
Yes
No
Total
A total of 8 people commented on question 7 including the comment noted above:
Three themes came through the feedback; Supporting the ‘yes’ answer, Culture and
Concerns.
1. Supporting the ‘yes’ answer - included:
• “Having people with lived experience as part of the nursing team builds an invaluable
knowledge base”
• “This is fundamental”
2. Culture – this theme involved many aspects of the organisational culture including staff
Recovery, Resilience and Self-Management Strategy December 2015
37
and their attitude to their own psychological wellbeing, the need for action and not just words
and embedding it in all teams:
• “This needs to be embedded in the culture of the organisation”
• “Actively encouraging staff to think about what keeps themselves well”
• “This is crucial, and must be about more than words”
• “The actions of those in leadership roles across the organisation must really take
account of the fundamental finding that a secure base is crucial to people flourishing”
• “We must care about each other in the workplace if we are to really embed the idea
of recovery and resilience”
• “Translating them into action by the employees of the organisation will require that
those employed at all levels can feel it in action on a daily basis in how they are
treated at work”
3. Concerns – these were raised by a number of respondents and will be taken into account
in the rolling out of the Strategy:
• “I am concerned about professional boundaries”
• “I would not want to receive mental health care from people I work with or know
personally”
• “More thought needs to be given to the support with people with lived experience
receive in employment. Anecdotally people who have been open about their lived
experience of mental health challenges have had higher-than-average sickness
absence records - but they have then fallen foul of Trust policies around sickness
absence”
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Question 8
Do you agree with 'Improving people’s life chances – health, employment, education'?
21 people answered ‘yes’ to question 8 and 1 person answered ‘no’ (n=22).
Chart 6 - Question 8 quantitative analysis
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20
15
10
5
0
Yes
No
Total
A total of 8 people commented on question 8:
All comments endorsed or reinforced this point. For example:
• “Everyone is entitled to a good life which has purpose and is inclusive”
• “These three areas are so interdependent and can provide a spiral either upwards or
downwards, depending on how well they are managed”
• “Expanding services which are helping by developing and empowering people to
achieve realistic goals once they leave mental health services is paramount in
improving peoples lifestyles”
One respondent called for strengthened links to other sectors:
• “Better links in with employment and voluntary sector would be brilliant”
Two respondents sounded a note of caution:
• “I think we need a strategy for people who need long term support - we cannot simply
assume that episodic care will work for everyone”
• “Volunteering isn't always a pathway to employment, but can also be about social
engagement”
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Question 9
Do you agree with ‘Changing the way we approach risk and supporting staff to work
differently'?
All 21 respondents to question 9 answered ‘yes’ and 0 answered ‘no’ (n=21).
Chart 7 - Question 9 quantitative analysis
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20
15
10
5
0
Yes
No
Total
A total of 7 people commented on question 9:
Respondents overwhelmingly supported this question. Comments fell broadly into two
categories; supporting the ‘yes’ answer’ and Practical Application.
1. Supporting the ‘yes’ answer included:
• “Embracing risk in a positive ways is a good thing as we all have the right to make
unwise decisions”
• “I think we can be overly concerned about risk at times; for some people talking
about suicide is a way of releasing their mental pressure and when we all jump into
panic mode it can have the effect of shutting them down”
• “Changing the way in which we view recovery to see it as a possibility, and not just a
result of medication, to aid in building a knowledge base of tools which a person can
use in their home life to maintain their well being should be paramount in aiding
recovery, by doing this we allow people the chance to take a risk in their own
wellbeing to take a chance in returning to living a fulfilled life”
2. Practical Application – involved question or comments about how this will work in practice,
including:
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•
•
•
•
“I would welcome clarity on safeguarding thresholds - as it appears difficult to predict
what will be investigated and what won't be at this time”
“I would be very interested to see how this translates to actual practice, and once
again may be about leading by example”
“There needs to be less of a blame culture within the organisation and shared
responsibility for risk management”
“This will require significant culture change and re-skilling of front-line workers”
Question 10
Do you agree with 'Financial sustainability of Recovery College East'?
19 people answered ‘yes’ to question 10. 4 answered ‘no’ (n= 23).
2 people who said ‘no’ did not give any further comment or reason.
One person who answered ‘no’ said that they feared that if the college was made
independent of health commissioners and became third sector or a social enterprise, that
would make it vulnerable to future funding cuts.
One person who said ‘no’ commented that they questioned the Recovery College’s
contribution to the “patient's journey within services” (rather seeing the college as 'adding
another layer of service') arguing that the College and the concept of recovery should be
“amalgamated into the teams”.
Chart 8 - Question 10 quantitative analysis
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20
15
10
5
0
Yes
No
Total
A total of 11 respondents provided comments to question 10
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Many comments commended the work of the College, its staff and volunteers, and noted the
limited resources provided previously. Many also wanted to see additional resources within
the College but not at the expense of other services.
“Staff in the REC have worked very hard with very little and we must now ensure that
the REC has the solid foundation to develop an grow without putting pressure on the
existing staff group”
“The work the recovery college has done up to now in providing a service for people
who are living in the community is fantastic, to continue to provide funding and to
increase funding to aid the expansion of this service to encompass a greater area
including rural area is unquestionably a wise step”
Two comments implored equity for different care groups (physical health) and localities
(Fenland).
Question 11
Do you agree with ‘Implementing Recovery Through Organisational Change (ImROC)
– applying the 10 key organisational challenges identified by ImROC as fundamentals
for change?
18 people answered ‘yes’ to question 11 and 2 people answered ‘no’ (n=20). Of the 2
respondents answering ‘no’ one said they didn’t know what it was and the other commented
that their preferred answer would have been ‘maybe’ and advised caution in being overly
attached to ImROC as an organisation rather than commenting specifically on the 10 key
challenges.
Chart 9 - Question 11 quantitative analysis
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25
20
15
10
5
0
Yes
No
Total
A total of 7 people commented on question 11 including those noted above:
Whilst in the main there was support for the ten key changes, a note of caution was sounded
in regard to the degree to which the Trust is ‘wedded’ to ImROC into the future and how
such initiatives are led in the organisation:
“As is clear from the discussion around strategy, there needs to be central leadership
on ImROC rather than leaving this to individual services”
“I do think that we need to be a bit cautious about being quite so wedded to IMROC,
whilst it has been a brilliant support to date, there is a risk that we will not reflect our
integrated services”
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Question 12
Which of the Implementing Recovery through Organisational Change (IMROC) 10 key
organisational challenges should we focus on?
A total of 23 people responded to question 12.
Chart 10 - Question 12 quantitative analysis
0
5
10
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20
25
Changing the nature of day to day interactions
Establishing a Recovery Education Centre to drive the
programme forward
Delivering comprehensive user-led education and
training
Ensuring organisational commitment, creating the
culture. The importance of leadership
Increasing personalisation and choice
Changing the way we approach risk assessment and
management
Co-production as a founding principal
Transforming the workforce
Supporting staff in their recovery journey
Increasing opportunities for building a life beyond
illness
There was a good response to question 11 and a broad spread of priorities. Some
respondents explained that their preferences had focussed on new areas of focus and not
on those areas they currently felt had sufficient focus.
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Question 13
Do you have any other comments about any of the 10 IMROC organisational
challenges?
A total of 6 people responded to question 13.
Most responses were broadly positive:
“They are all well thought out aims that we can aspire to and steeped in evidence”
“This should be the bedrock of any public sector service”
Some respondents reinforced previous points:
“The majority of clients are involved in the community teams, therefore these
concepts should be made possible through development within the teams, not as
separate entities”
Some sounded notes of caution:
“I am not convinced it is realistic or achievable in the current political and economic
climate; it risks becoming an excuse to withdraw services over time”
Question 14
Is there anything else you would like to add in relation to the strategy?
A total of 7 people responded to question 14.
The feedback to question 14 fell into four broad categories; Backing, Inclusivity, Resources
and Embedding in Practice.
1. Backing – many people reiterated support for the strategy and its approach although
some found it very long and suggested removing the action plan from the main Strategy:
“This is a really well written and well thought out piece of work and I do hope that you
choose to continue to take an inclusive approach to recovery going forwards”
“It’s also very inclusive of all professional groups and their contributions which is
much appreciated”
“So positive to think of moving forwards with such fantastic ideas that will
undoubtedly improve service user experiences”
“It has to be the way forward in a world of shrinking resources”
Although one person said it read too much like propaganda and not objectively enough and
we were reminded that:
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“You speak about the recovery College report as the evidence for Trusts
achievements - but this is not the sum of the Trust’s work”
“Its hard to record all the great work in one action plan”
2. Inclusivity – some people felt it was not yet inclusive enough of certain groups or
concepts, or too Mental Health focussed:
“Nowhere does spirituality or chaplaincy actively carving socially intelligent activities,
spaces and places that chaplaincy– equally valuable, viable and needed – get a
mention. Fulbourn chapel offers an hour of gentleness and loving kindness 52 weeks
of the year without fail, and at least 1000 people from our community share that time,
that space - staff, patients, visitors and guests, being human together”
“Physical health needs to be built up a bit more in the main body”
“It’s not quite strong enough in relation to children and young people”
“I think it should mention working collaboratively with people as this was a thrust of
work in the 7 Cs of care planning and should be a key part of the way we work, as
this is a big component of recovery”
3. Resources – a recurrent theme within the feedback has been the question of using
dwindling resources appropriately.
“It will require resources used in different ways and probably more resources”
4. Embedding in Practice and evaluating – another theme throughout the feedback again
featured in question 14:
“This would imply radical organisational change and commitment in a world/wider
culture that is very risk adverse and blaming”
“It sounds good, it just need to be embedded within the teams that are already
working with clients, not be sitting in a place by itself where it is not reaching the
client population”
“These principles are only going to valuable if they are embedded into practice”
“My concern is how we then use this as the 'glue' within our organisational
development strategy if staff can't picture the status. And I think this is essential for a
variety of reasons; patient care, holistic approach, achieving the walk the walk
for CPFT”
“How do we evaluate and benchmark progress?”
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