CLINICAL STRATEGY 2021 -2023 Draft (version 8)

 
CLINICAL STRATEGY 2021 -2023 Draft (version 8)
CLINICAL STRATEGY
   2021 -2023
 Draft (version 8)
CLINICAL STRATEGY 2021 -2023 Draft (version 8)
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Table of Contents

Executive summary........................................................................................................................................ 3
Introduction .................................................................................................................................................. 5
The national context ...................................................................................................................................... 6
Priory Healthcare operating context .............................................................................................................. 8

Safety for all .................................................................................................................................................. 9
Least restrictive care .................................................................................................................................... 12
Co-production ............................................................................................................................................. 14
Evidenced-based care and treatment........................................................................................................... 15
Prevention ................................................................................................................................................... 16
Recovery orientated practice ....................................................................................................................... 18
Reducing suicide and self-harm ................................................................................................................... 19
Equality and diversity................................................................................................................................... 20
Physical healthcare ...................................................................................................................................... 21
Partnership working .................................................................................................................................... 23
Clinical audit ................................................................................................................................................ 25
Continuous quality improvement................................................................................................................. 26
Our service networks ................................................................................................................................... 28
Acute network ............................................................................................................................................. 28
Addictions network...................................................................................................................................... 30
Brain injuries network.................................................................................................................................. 31
Child and adolescent mental health network ............................................................................................... 32
Eating disorders network ............................................................................................................................. 34
Secure network ........................................................................................................................................... 36
Developmental disorders network ............................................................................................................... 37
Personality disorders network ..................................................................................................................... 38
Rehabilitation and recovery network ........................................................................................................... 39
Priory Private Healthcare ............................................................................................................................. 41
How we will assure clinical quality ............................................................................................................... 42
What we will need from our Workforce Strategy ......................................................................................... 43
What we will need from our Estates Strategy .............................................................................................. 44
What we will need from our Digital Strategy ................................................................................................ 44

                                                                      Page 2 of 45
CLINICAL STRATEGY 2021 -2023 Draft (version 8)
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Executive summary

We are delighted to present the three-year Clinical Strategy for Priory Group, taking us to 2023. The
strategy has been developed around the Priory Values, focusing on purpose and behaviour – striving
for excellence, being positive, putting people first, acting with integrity and being supportive. The
strategy focuses on developing our relationships with our core partnerships and delivering consistent,
high quality, service user-focused care. The strategy gives voice to the service user at the centre of
their care, which is informed by the principles of representation, co-production, least restrictive
practice and meaningful recovery. Diversity and equality are central to the care we provide, as are
the staff who deliver it. Supporting this strategy will be our ongoing commitment to developing robust
audit and compliance monitoring, informing governance, and quality improvement initiatives.

We aim to be first choice for the delivery of behavioural health care across the wide range of service
lines that represent Priory. Each service line will ensure consistent delivery of the strategy through
their service network, informed and guided by the wide expertise of the Clinical and Specialist
Directors and supported by development of accurate and informative dashboards. Across the service
lines, we are also investing and integrating a significant upgrade to our electronic service user records,
which will assist the growth of accurate metrics and outcome measures across the networks.

We will continue to grow as a learning organisation, encouraging a psychologically safe environment
focused on transparency, reflection, openness, candour and a sharing of experience across the
divisions. Ongoing awareness and development of Ward-to-Board and Board-to-Ward processes
remain an important focus of the strategy.

The Group Physical Healthcare Strategy focuses on mitigating the inequalities of healthcare long
experienced by our service users and delivering parity of esteem, with each service network
developing individual physical health priorities tailored to their service user groups. Particular focus is
on smoking cessation and obesity as the greatest preventable causes of death in the UK. In addition,
we have strategies for reducing suicide and self-harm and ensuring sexual safety, both of which
significantly impact on the physical and mental wellbeing of service users.

There will be ongoing investment, and development of the environment in which we deliver our
services, with a focus on creating a healthy and productive environment to facilitate the best recovery
outcomes for our service users, and promote the wellbeing of staff. Maximising value from our
commitment to apprenticeship training schemes and our career pathways initiative, epitomises our
commitment to the development of all our colleagues over this three-year period.

                                              Page 3 of 45
CLINICAL STRATEGY 2021 -2023 Draft (version 8)
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

    Page 4 of 45
CLINICAL STRATEGY 2021 -2023 Draft (version 8)
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Introduction

Priory Group and the Healthcare division is dedicated to helping people improve their mental health
and wellbeing and in making a real and lasting difference to every one we support. We focus on every
service user’s specific needs, and strive to deliver excellent clinical outcomes through individually
tailored treatment plans.

This Clinical Strategy builds on our service line model and aims to provide safe, consistent and high
quality services. The diagram below sets out the key components of the strategy, which are delivered
through our clinical networks, wellbeing centres and network of private practice locations.

We have agreed 10 overarching themes and principles that will shape and underpin this strategy.

                                           Page 5 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

The national context

On 7 January 2019, the NHS Long-Term Plan1 was published, setting out key ambitions for the service
over the next 10 years. The plan builds on the policy platform laid out in the NHS Five-Year Forward
View2, which articulates the need to integrate care to meet the needs of a changing population. This
was followed by a number of subsidiary strategies, including primary care, urgent and emergency
care, and mental health3, together with a focus on integrating care locally through Sustainability and
Transformation Partnerships (STPs), Accountable Care Systems (ACSs), and Provider Collaboratives
(formerly New Care Models).

The priorities in the NHS Long-Term Plan include cancer, cardiovascular disease, maternity and
neonatal health, stroke, diabetes and respiratory care. There is also a strong focus on children and
young people’s health.

Mental health priorities and funding 4

With regards to mental health, national leaders have used the
Long-Term Plan to reassert their commitment to improving mental
health services, both for adults and for children and young people.
This begins with funding - the plan reaffirms that mental health
funding, provided through a ring-fenced investment fund, will
outstrip total NHS spending growth in each year between 2019/20
and 2023/24 so that by the end of the period, mental health
investment will be at least £2.3 billion higher in real terms.

In adult services, the plan signals an extension of commitments in the Five-Year Forward View for
mental health beyond 2020/21 to 2023/24. It aims to create a more comprehensive service system,
particularly for those seeking help in crisis, with a single point of access for adults and children and
24/7 support with appropriate responses across NHS 111, ambulance and A&E services. It also
highlights the need for capital investment, as identified by a recent review of the Mental Health Act,
to ensure suitable therapeutic environments for inpatients.

Similarly, the plan commits to a significant expansion of services for children and young people in line
with the proposals outlined in the Green Paper on young people’s mental health, for example, the
creation of ‘mental health support teams’ in schools. To support these changes, the plan mandates
that investment in children and young people’s mental health provision will grow faster than the
overall NHS budget and total mental health spending.

1
    The   NHS Long-Term Plan (2019)
2
    The   NHS Five-Year Forward View (2014)
3
    The   Mental Health Taskforce Report (2016)
4
    The   Kings Fund – The Long-Term Plan explained

                                                Page 6 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Provider Collaboratives (formerly New Care Models)

A key vehicle for integrated care in the LTP is the national roll out of Provider Collaboratives (PCs)
across England. PCs build on the successful New Care Model pilots and devolve responsibility from
central NHS England (NHSE) to a lead NHS Trust in a specified region. Each lead provider will take
on traditional NHSE roles and responsibilities for commissioning and quality, assuring specialised
commissioned services (secure, eating disorders and CAMHS). The key focus of each Collaborative is
to reduce inappropriate out–of-area placements and where possible the need for inpatient care
through investment in community alternatives. NHS leaders are keen to build on this ICS model within
mental health in the future, to other services such as personality disorders and rehabilitation and
recovery (R&R), etc. if this programme is viewed as successful.

Learning disabilities and autism

There is also a strong focus on improving care for people with learning disabilities (LD) and autism.
Commitments include increasing access to support for children and young people with an autism
diagnosis, developing new models to provide care closer to home, and investing in intensive, crisis
and forensic community support. The aim is that, by 2023/24, inpatient provision for people with
learning disabilities or autism will have reduced to less than half of the 2015 level. This work is driven
by local Transforming Care Partnerships (TCPs); please note that TCPs will be absorbed into Provider
Collaboratives in due course.

Reform of the Mental Health Legislation

In December 2018, the Government announced that it would introduce a new Mental Health Bill
following publication of the final report from the independent review of the Mental Health Act 19835.
The recommendations focus on treating service users as individuals, ensuring their views and choices
are respected, carrying out least restrictive practice, and promoting therapeutic benefit. In 2018 the
Mental Health Units (Use of Force) Act was passed and in 2019 the Mental Capacity Act was amended
to introduce Liberty Protection Safeguards. Both of these pieces of legislation await codification. The
Group’s Mental Health Law Group will advise on implementation.

Mental Health Strategies for Scotland and Wales

As a provider of healthcare services in Scotland and Wales, it’s important to consider the priorities of
respective Mental Health Strategies in the development of this strategy. The Scotland Mental Health
Strategy6 was published in March 2017. This focuses on a series of actions to achieve:

         Prevention and early intervention
         Accessible services
         Physical well-being of people with mental health problems
         Rights, information use and planning
         Data and measurement

5
    Modernising the Mental Health Act – final report from the independent review (December 2018)
6
    The Scottish Government’s approach to mental health from 2017-2027 – a 10 year vision (2017)

                                                Page 7 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

With regards to Wales, there has been a big drive to promote integrated and effective care for mental
health service users. In 2010, the Mental Health Measure was passed, which placed legal duties
surrounding the treatment of mental health problems, on Health Boards. In 2012, the Welsh
government also introduced Together for Mental Health7– a 10-year cross-governmental strategy for
mental health and wellbeing that builds on the legal requirements of the Mental Health Measure.
Together for Mental Health, amongst many other things, stated a desire for equality of access to
services across Wales and for interventions offered to be based on the best available evidence.

Priory Healthcare operating context

Priory has the largest network of independent mental healthcare hospitals and clinics in the UK. We
have over 7,000 inpatient beds across more than 95 sites, supporting the needs of some of the most
vulnerable people in the UK. Priory currently treats more than 70 different conditions through a
nationwide network of over 300 facilities that support service users’ health, care, education and
specialised needs.

Working in partnership with service users and their families, Priory specialises in addictions
treatment and rehabilitation, as well as treatment for acute mental health, child and adolescent
mental health (CAMHS) secure services, adult and young people’s eating disorders, brain injuries,
personality disorders and intellectual disabilities.

7
    Together for mental health – a strategy for mental health and wellbeing in Wales (2012)

                                                 Page 8 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

    1. Safety for all
       The safety and wellbeing of those who use our services and of our colleagues, is paramount.
       This aligns with the renewed focus of the Care Quality Commission (CQC) to reduce avoidable
       harm, as set out in their publication Opening the Door to Change8. Here at Priory we aspire
       to be open, to effectively report, investigate and learn from any incidents and near misses,
       with the intention of offering speedy resolution and putting in place improvements. We
       recognise that we have an opportunity to learn from incidents, near misses, complaints and
       claims.

       Around two million incidents are reported and managed within healthcare providers every
       year, with most reporting across acute mental health and community care [1]. In 2019, there
       were 68,643 incidents reported in the Healthcare Division. Of these, 1372 (2%) were
       categorised as serious incidents. Serious violence accounted for 0.3% (425 incidents) and
       serious self-harm 0.7% (163 incidents).

       What we have done

       The recommendations and actions for improvement arising from the findings of any internal
       or external review or investigation are made clear and easy to audit. They are integrated into
       an action plan and the recommendations can be aimed at a local level, which are monitored
       and incorporated into the local governance meetings. Where recommendations are made for
       the division or indeed more widely, then these are publicised in colleague briefings and via
       the ‘Your Weekly Brief’ weekly newsletter. Training is updated and webinars on specific
       subjects are delivered.

       Any longer term risks are placed on the local risk register as a means of ensuring frequent
       review and enhanced actions for mitigation are considered and introduced. Similarly but less
       frequently, where risks are identified which impact on the wider Priory Group, these will be
       placed on the corporate risk register as a means of ensuring wider action.

       The improvement agenda is highlighted via monthly Safety First briefings, which is an initiative
       to which the Priory Group CEO has lent his full support. Previous briefings have included the
       importance of good service user observation, the importance of colleague induction, and fire
       safety.

       All of our colleagues are subject to an effective induction, which covers key aspects of health
       and safety such as security arrangements and the response to a fire.

       All of our colleagues are required to undertake mandatory training to ensure they are
       competent in their duties. The Priory Academy includes a range of mandatory training
       modules that colleagues must complete, for example Safeguarding for Adults, Children and
       Young People, Moving and Handling, Clinical Risk Assessment and the Identification of Sepsis.

       Other opportunities for improvement include:

8
 Opening the door to change – NHS safety culture and the need for transformation, CQC (Dec 2018)
[1]
  Developing a service user safety strategy for the NHS - Proposals for consultation, NHS Improvement (Dec
2018)

                                              Page 9 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

      Learning from external organisations, for example our regulators, the NHS, and social
       care organisations. We routinely respond to alerts from NHS organisations, reviewing
       new guidance, integrating this into our current policies, procedures and training
       programmes. This includes the work undertaken in respect of IDDSI and allergens
      Learning from experience, for example we know that the risk of choking increases at
       Christmas due to dietary changes
      Taking practical steps in response to lessons learned – dashboard stickers were
       circulated to remind staff to lock the vehicle doors; keyrings were distributed to
       measure tyre tread; LifeVac anti-choking devices were rolled out
      Using staff survey systems to understand risk assessments and obtain feedback on
       where improvements could be made
      Involving Priory stakeholders, for example we purchase tried and tested items and
       aim for consistency. This could include suction machines and ECGs

We check and evidence that lessons are being learnt by:
    Ensuring that our Directors of Clinical Services, located at each hospital, are monitoring
      individual service user safety and have oversight of any local incident themes and
      trends
    Making sure our Quality Improvement Leads check on the content standard and
      outcomes of governance meetings and have in place a feedback loop where staff can
      be reassured that action has been taken in response to incidents they may have been
      involved in or witnessed
    Ensuring our Quality Improvement Leads are present at sites and check the standards
      of service user care, for example clinical documentation, leave and hospital discharge
      arrangements. Scrutinising and spot-checking, recommendation tables and ensuring
      that actions are being taken to implement those recommendations
    Undertaking routine audits, for example our Health and Safety and Internal
      Compliance teams undertake structured audits which act as a checklist of activity

What we will focus on

      We will continue to build a culture of service user safety and be open, honest and
       transparent with incidents and complaints, ensuring that lessons are learnt and shared
      A Mortality Group has been established to ensure learning from deaths
      We will adopt a ‘zero suicide’ approach, underpinned by the development of a new
       Suicide Prevention Strategy
      DATIX has been rolled out across the Group and was introduced to the Healthcare
       division in the summer of 2019. It has been embraced by staff and already we are
       finding that it gives us a rich source of incident related data
      In 2020 we rolled out the DATIX complaints modules and we anticipate this will also
       provide us with improved complaint related data
      We aim to harness technology – Care Protect and the development of e-observations
       as a means of ensuring an enhanced level of service user and staff safety
      We will enhance our staff safety management of violence and aggression training and
       ensure that the most up to date course content is being delivered to our staff and in
       accordance with national standards
      We will continue to work towards year-on-year reductions in RIDDOR related incidents
       – our view is that the enhanced management of violence and aggression training will
       help us to achieve this

                                     Page 10 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

   We will distribute LifeVac anti-choking devices to all of our hospitals in response to
    the serious risk of service user choking incidents
   We will continue to embed the use of NEWS2 across the Healthcare division in
    response to the overwhelming evidence that this will help to save lives
   We will work towards ensuring that all of our staff understand the risk posed by sepsis.
    We will do this by putting in place a training programme to all staff

                                 Page 11 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

    2. Least restrictive care
       In 2015, the Mental Health Act Code of Practice 9 set an expectation for mental health services
       to commit to reducing restrictive interventions and put blanket bans on restricting a person’s
       liberty. These interventions include the use of restraint, seclusion and rapid tranquilisation.

       In November 2018, a new Act of Parliament was announced - the Mental Health Units (Use
       of Force) Act 201810 and in 2019 new provisions were introduced in regards to the oversight
       and management of the appropriate use of force in relation to people in mental health units.

       In December 2018, the Royal College of Psychiatrists published a report relating to restrictive
       interventions in service user intellectual disability services11 and was concerned with the
       monitoring and regulating of restrictive interventions involving people with intellectual
       disabilities, mental health and/or challenging behaviours, within in service user services.

       Also in December 2018, the CQC announced that they had been commissioned to review and
       make recommendations about the use of restrictive interventions in settings that provide
       inpatient and residential care for people with mental health problems, a learning disability
       and/or autism. This review commenced in January 2019 with an interim report in summer
       2019. A full report was published in March 2020.

       What we have done

       To date, our work has focused on the standards set out in the Code of Practice. There is an
       established steering group that oversees this programme of work and to date we have
       developed and refreshed our strategy on reducing restrictive practice.

       We have focused on implementing the Safewards model on a number of wards across
       Healthcare, and in 2019 we provided enhanced support to three sites, to help embed the
       model.

       We also introduced a new incident recording system (DATIX) to ensure improved data capture
       and consistency across Healthcare sites and reviewed our Group RRP terms of reference and
       membership, with greater focus.

9
  Mental Health Act 1983: Code of Practice
10
   Mental Health Units (Use of Force) Act 2018
11
   Restrictive interventions in in-service user intellectual disability services (December 2018)

                                                 Page 12 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

What we will focus on

     Continuing to monitor and support sites to reduce levels of restraint and restrictive
      practices
     Continuing to embed Safewards interventions at all sites
     Ensuring that all PMVA training complies with the Reducing Restraint Network
      Standards and is BILD – Act accredited, with a full transition plan in place for this to
      be achieved safely by April 2021
     Implementing in full the recommendations from the CQC report on restrictive
      interventions

                                   Page 13 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

 3. Co-production
         Co-production is about the inclusion of people who live with or have experiences of mental illness.
         This includes the individual as well as their partners, family and friends (who are all ’Experts by
         Experience‘). This is in regards to the commissioning, planning and delivery of services, with these
         individuals being equal partners along with our service providers and professionals.12

         What we have done

                Developed a new care planning system which supports co-production
                Ensured all sites have forums for engagement, from community meetings to representation
                 at hospital groups/committees
                Encouraged service user involvement in recruitment, staff training and service developments
                Employed experts with ‘lived experience’ to support achievement of CQUIN indicators in
                 secure services
                Conducted satisfaction surveys of service users and carers and implemented suggested
                 service improvements at sites
                Co-produced a new Participation and Engagement Strategy for 2020/22, which is currently
                 being implemented

         What we will focus on

         Implementing in full the new Priory Group Participation and Engagement Strategy:
              Each division identified a P&E Lead
              Each divisional committee will have a 12 month plan of P&E initiatives/activities by April 1st
               2021
              P&E Steering Group to be established with 2 reps from each division by 1st January 2021
              P&E Steering Group to conduct NHSI Service user Experience Audit by February 1st 2021
              Working group for ’Always Events Project‘ set up
              DoQ agreed the process for ’service user story‘ at each Board Meeting, which commenced
               from a January 2020 meeting

12
     Rethink Mental Illness definition

                                             Page 14 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

4. Evidenced-based care and treatment
   We provide evidence-based, bespoke mental health treatment for all of our service users and we are
   dedicated to developing personalised treatment journeys, instead of taking a ‘one size fits all’
   approach. Our tailored treatment programmes address the unique difficulties faced by our service
   users and evaluate mental health challenges in a person-centred way, allowing underlying causes and
   individual triggers to be identified. This enables our specialists to deliver high quality mental health
   support for every individual who uses our services.

   Our specialist teams of nurses, psychiatrists, psychologists, therapists and other healthcare
   professionals consist of renowned thought leaders in their field who are committed to remaining up
   to date with current research, in order to ensure that their practice adheres to the National Institute
   for Health and Care Excellence (NICE) guidelines, and is guided by the very latest thinking. As such,
   we are extremely well-placed to provide exceptional treatment for a wide range of mental health
   challenges, ensuring the best possible outcomes for each and every one of our service users.

   What we have done

   We have developed and embedded a Clinical Network system to ensure that each network can
   monitor, review and implement changes to NICE guidance with relevance to the service user group
   they treat. These clinical networks are supported by the Drug and Therapeutic Committee, along with
   the Physical Health Committee, to ensure guidance is evidence based and follows best practice
   principles.

   What we will focus on

         Our workforce strategy will address the skills, attributes and capabilities of our colleagues so
          that they are equipped to deliver evidenced-based interventions
         Our clinical networks will identify the skills they require in their workforce to deliver all the
          NICE approved interventions relevant to them and then ensure staff have the relevant training
         Clinical networks will measure whether they are delivering evidence-based interventions and
          how effective they are in delivering them
         Every contact that clinicians have with service users will count, by ensuring they are helping
          service users move forward in achieving their recovery goals
         Our pharmacists will provide medicine information, to ensure our formulary is evidence based,
          and new NICE guidance on medication is disseminated and incorporated into our policies
         We will implement training on medicines and provide competency assessments for colleagues

                                        Page 15 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

 5. Prevention

         The Department of Health and Social Care (DHSC) published a new vision Prevention is better than
         cure13 in November 2018. This document sets out a vision for putting prevention at the heart of the
         nation's health. Its mission is to improve healthy life expectancy so that, by 2035, we are enjoying at
         least five extra years of healthy, independent life, whilst closing the gap between the richest and
         poorest.

         Prevention is about helping people stay healthy, happy and independent for as long as possible. This
         means reducing the chances of problems from arising in the first place and, when they do, supporting
         people to manage them as effectively as possible.

         Whilst within the Healthcare division we are not able to affect the wider political, economic and
         environmental issues that can impact on health and wellbeing, we can ’do our bit‘ to help, by
         supporting our service users to make healthy life choices and providing them with the resources to
         do this.

         What we have done

         Our work on creating ’smoke-free‘ sites continues apace and all of our hospitals are now able to
         provide service users with guided information and support on how to stop smoking. This includes the
         availability of prescribed nicotine replacement products or having access to commercially purchased
         alternatives to smoking.

         All sites have in-house catering services and so we have a greater ability to be responsive to the
         individual dietary needs of our service users. This also means that all sites are also able to offer a
         greater array of healthy options at all meal times, as well as access to healthy snacks and fruit
         between meals.

         Exercise is key to a healthy lifestyle, this can sometimes be challenging to achieve whilst someone is
         in hospital, in particular when there may be some legal limitations on access to public spaces.
         However, at many sites we have created fitness suites that are accessible to all service users under
         the guidance of our staff. In many of our sites, we also have employed specific activity co-ordinators
         who will work with service users to help develop exercise plans and keep motivating them to achieve
         those goals.

         What we will focus on

         We will continue our work on reducing smoking across all of our sites with the ambition of being
         entirely ’smoke-free‘ within the lifetime of this strategy. This will involve continued work on addressing
         the culture of smoking within inpatient environments, supporting staff to act as positive role models
         and providing timely and appropriate alternatives to smoking.

13
     Prevention is better than cure: Our vision to help you live longer (Nov 2018)

                                                  Page 16 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

We are partnered with a charitably funded external group whose aim is to close the health gap and
reduced life expectancy experienced by those with mental disorders, more than half of which is
attributable to smoking, the biggest cause of avoidable death for our service users and the UK
population. This will be delivered through consultancy work, engagement and innovative training.

We will work to improve links with Public Health England’s local Health Promotion teams who can
provide access to a wide array of community and hospital-based services, to help improve access to
diet and exercise advice. This links into our work within the Physical Health Strategy, which will be
working to ensure that individualised and realistic goals are set for those that wish to make changes
to their lifestyle. This will include a systematic approach to providing information and guidance, to
help inform positive choices. This is something that our whole site teams can get involved with, from
catering staff, activity co-ordinators and clinical colleagues.

                                    Page 17 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

6. Recovery orientated practice
   Recovery means different things to different people. We use ‘recovery’ to mean service users working
   towards their goals, having opportunities and control to fulfil their goals and having hope for the
   future. Not everyone will stop having symptoms during their recovery, but a goal can be to stop them
   from affecting their life as much. Medical treatment is one way towards recovery. It helps a lot of
   people, but it is not the only way to recover. Recovery is something you achieve for yourself. It is not
   something that someone else does for you, but others may be able to help if you want them to.

   What we have done

   The key driver to recovery-orientated practice is co-production and fostering an environment of care
   where service users are involved, have choices and can express their views. To achieve this, we have
   introduced several initiatives which support these principles:

              Person-centred care planning, focused on Keeping Safe, Keeping Well, Keeping Healthy and
               Keeping Connected
              Use of Behavioural Support Plans
              Use of Advanced Statements or Wishes
              Community meetings and joint planning meeting
              Full involvement in multidisciplinary teams (MDT) and care programme approach (CPA)
               reviews of care and treatment
              Involvement in Recovery Colleges
              Joint statements on ’mutual expectations’
              Peer Support Groups
              Engagement in community activities for education, work opportunities, vocational
               rehabilitation and leisure pursuits

   What we will focus on

             Continuing to ensure co-production in all aspects of service user care
             Developing Peer Support Workers across all longer stay services
             Implementing the Participation and Engagement Strategy
             Ensuring a recovery focused, strengths-based model of care in all services
             Increasing the involvement of experts with ‘lived experience’ and relatives/carers in service
              users care and service developments
             Continuing to promote use of Safewards interventions
             Create links with Recovery Colleges and Support Groups in the communities where our services
              are located

                                           Page 18 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

7. Reducing suicide and self-harm
   Priory Group recognises the importance of a suicide and self-harm plan and this has been developed
   and guided by the national context. In preparing this strategy, a Review Group was formed in 2019
   with input from clinicians and carers. It was informed by the Royal College of Psychiatry document
   CR226 - ’self-harm and suicide in adults - final report of the Patient Safety Group’, February 2020 and
   the most recent ‘National Confidential Inquiry into Suicide and Safety in Mental Health’, 2019.

    A.    Strategy aims

                 To ensure we set up an organisational framework to collect, interpret and apply data
                  on self-harm and suicide to drive quality improvement across the Priory Group
                 Creation of a leadership-driven, safety orientated culture committed to reducing
                  suicide amongst people under our care
                 Training needs to develop a competent, confident and caring workforce
                 Systematically identify and assess suicide risk in our service user population
                 Ensure every service user has a pathway to care that is both timely and adequate to
                  meet their needs
                 Introduce and establish collaborative safety planning
                 Use of effective evidence-based treatments that directly target suicidal and self-harm
                  thoughts and behaviours
                 Ensure continuous contact and support during transition periods with clear
                  collaborative safety planning with service users and co-ordination with community-
                  based services
                 Improving our after-suicide support for family and friends, service users and staff

    B.    Key areas for strategy in 2021

                 To ensure the strategy meets the needs of each division within Priory
                 To set up the suicide and self-harm steering group with representation form each
                  division and ideally with service user input
                 Design and embed a collaborative safety planning document for care notes
                 Develop training for staff in collaborative safety planning
                 Circulate the documents from the Royal College and other organisations supporting
                  staff, family and carers who are affected by suicide

                                        Page 19 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

8. Equality and diversity
   Priory Healthcare is committed to delivering high quality services and recognising that each individual
   has differing needs that may influence their healthcare requirements. As a major national employer,
   we recognise and accept our duty to eliminate discrimination, advance equality and foster equality of
   opportunity, and we will not tolerate discrimination against any individual employee, service user, or
   carer.

   Priory Group has a set of strong values which are designed to promote high standards in our service,
   and we expect every employee to practice these values in all that they do, from the delivery of services
   to how they behave towards their work colleagues.

   What we have done

   We established an Equality and Diversity Group in 2018, which was launched following an initial equality
   and diversity workshop. A representative group membership was sought via an expression of interest
   communique. This resulted in a large response and a wide and varied group membership was
   established. The group meets quarterly and has focused on developing a new Equality and Diversity
   Strategy and work plan.

   What we will focus on

         How our leaders champion diversity and embed ‘Thriving at Priory’, our Diversity and Inclusion
          Strategy
         Establishing our Divisional Champions and specialist networks
         Capturing data about diversity and inclusion for a baseline to use in 2021 and future years
         Achieving the objectives year on year, that we co-produce

                                        Page 20 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

 9.        Physical healthcare
           The physical health of people with severe mental illness (SMI) is known to be significantly
           worse than that of the general population. Publications ‘Schizophrenia Commission Report’
           (2012)14 and ‘Death by Indifference’ (MENCAP, 2012) 15 highlighted the disparity between the
           life expectancy of the general population and those adults who live with SMI and LD. In
           summary, people with a SMI:

                                                          Diagram 2: Public Health England16
                  Have a life
                   expectancy that is
                   shortened by 10–
                   20 years
                  Have higher rates
                   of physical ill-
                   health than the
                   general
                   population
                  Have higher rates
                   of health-risk
                   behaviours,
                   including obesity
                   and tobacco smoking (approximately twice as high than the general population)
                  Are likely to have a long-term physical condition

           Diagram 3: Public Health England17

                                                                                 This increased burden of
                                                                                 physical health problems
                                                                                 affects all ages. Recent
                                                                                 analysis by PHE found that
                                                                                 younger adults with SMI
                                                                                 are five times more likely
                                                                                 to have three or more
                                                                                 physical health conditions
                                                                                 compared to younger
                                                                                 adults overall.

14
     The Abandoned Illness - Schizophrenia Commission Report
15
     Death by indifference
16
     Health Matters: Reducing health inequalities in mental illness (Dec 2018)
17
     Health Matters: Reducing health inequalities in mental illness (Dec 2018)

                                                 Page 21 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

What we have done

During 2018, we focused on the development of a Physical Healthcare Strategy, which was
launched in December 2018. This sets out eight key areas that we will focus on in the three
years of its lifetime. They are:

      Support to quit smoking
      Tackling obesity
      Improving physical activity levels
      Reducing alcohol and substance use
      Sexual and reproductive health
      Medicine optimisation
      Dental and oral health
      Reducing falls

We have instigated an over-arching Physical Healthcare Group, which has the responsibility
for the co-ordination and oversight of the implementation of this strategy.

What we will focus on

      Our strategy will include skills training in physical health care
      Implementing the 3-year priority objectives and areas for action against the 8 core
       areas identified in the strategy
      Monitoring the impact of our strategy on the physical health of our service users

                                  Page 22 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

10. Partnership working
    Priory is the largest and leading independent provider of mental health services in the UK
    with c. 8,800 beds. We offer a comprehensive service to local communities through our
    nationwide network of services.

    Priory has a dedicated business development and strategy division. Principally for our
    partnership work, this is led by the Service Development team, responsible for working
    closely with clinical colleagues to define and deliver our market strategy, engaging
    commissioners and referrers, and leading all business development activity to meet our
    occupancy and growth targets. The team manages referral pipelines across all divisions and
    is responsible for the development of appropriate services to meet the needs of our NHS,
    local authority and private referrers. Service development work across the business
    development division is supported by the Bids, External Communications and Marketing
    teams.

    As discussed earlier in this document, a key aspect of the Long-Term Plan is the movement
    towards integrated and more local care. Provider Collaboratives (formally New Care Models)
    are a key aspect of this. Priory is involved in 30 of the 48 across the country, covering all of
    our CAMHS, eating disorder and secure inpatient services. Priory is involved where it has
    beds in the Provider Collaborative footprint or provides beds to that footprint. Priory will
    work with its contract lead at NHSE during the transition to local Lead Provider NHS Trust
    commissioning.

    These Provider Collaboratives present a new opportunity for Priory to engage with a variety
    of partners to support local pathways. Its cross divisional offering ensures it is well-placed
    to offer new and innovative models of care, in addition to protecting its core bed base.

    What we have done

          Full demand analysis on future services and market position
          Engagement of key referrers and commissioners including Provider Collaboratives
          Delivery of referral pipelines
          Management of media issues
          Marketing support, including website management
          Support with service frameworks and tenders
          24/7 enquiry and referral management
          Establishment of a new Provider Collaborative partnerships team to support our
           national engagement.

    What we will focus on

    To be the provider of choice for behavioural healthcare across domestic and key international
    markets, providing our clients with access to the highest quality of service in the way that
    best suits their needs.

                                        Page 23 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

We will harness the opportunities presented by commissioning reforms to deliver innovative
services and maximise the provision of end-to-end treatment pathways encompassing
Healthcare, Adult Care and Education & Children’s Services.

This includes:
     Remaining the partner of choice for the NHS
     Understanding future demand and service requirements
     Provider Collaborative engagement and protection of services
     Cross divisional pathways including exploring the opportunities for new services that
        step-down from traditional mental health pathways

                                  Page 24 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

11. Clinical audit

    Priory Group recognises that clinical audit is an effective quality improvement process that
    seeks to improve service user care and outcomes through systematic reviews of current care
    and the implementation of change where necessary. We are committed to seeking ways of
    using clinical audit as a method of improving care, and actively encourage all clinical
    colleagues to be involved in undertaking audit and sharing the learning from completed audit
    projects.

    What we have done

    We have developed a clinical audit framework document to set out the rationale for clinical
    audit and provide a framework for such activity, including standards, guidance and
    procedures, as well as details of the central support available:
          For registering and approving clinical audit project proposals
          For developing and designing clinical audit projects

    This framework aims to support a culture of best practice in the management and delivery
    of clinical audit, and to clarify the roles and responsibilities of all colleagues involved.

    What we will focus on

    We will launch the new clinical audit framework document and focus on embedding the
    culture of clinical audit further at sites and in the service networks. We will further seek to
    build our capacity and capability to support this work across the Group.

                                        Page 25 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

12. Continuous quality improvement
    Continuous quality improvement in healthcare is a structured organisational process that
    involves our frontline planning and implementing ongoing pro-active improvements in
    processes of care to provide quality healthcare outcomes. Each year we publish our
    annual Quality Account, which sets out our quality objectives. For 2019/20 we had four key
    objectives. These were:

          Reducing incidents of AWOL by 10%
          Roll out of Safewards
          Reducing incidents relating to observation and engagement
          Reducing restraint and restrictive practices

    The objectives above were led by our Clinical and Quality Leads, and Specialist Directors.

    What we have done

    In our Quality Account last year, we successfully achieved two of our key objectives:

          Zero tolerance reduction in assaults (met)
          Safewards implementation (partially met)

    We will expect the work relating to our strategies to continue at pace and in line with their
    three-year shelf life. Progress on these include:

    Therapies and activities

    We are currently developing therapy pathways for service users within the clinical networks.
    We have mapped out the therapist provision, therapy input and therapy pathways in
    Education and Children’s Services. Recruitment and retention work is ongoing, with positive
    outcomes. (Therapist retention has improved.) Business development and growth
    encouraged and developed in different areas.

    Digital Strategy

    The Digital Strategy includes the implementation of the ‘Doctify’ review system which has
    led to over 1700 service user reviews across private sites with scores ranging from 4.5 – 5
    (out of 5).

    The recent launch of ‘Priory Connect’ enables service users to choose their therapist and
    book appointments at their convenience. This service is new and in the trial phase but has
    achieved some success. We are developing this to improve the digital offering to service
    users wishing to receive therapy online. ‘Thrive’, the alumni App for private clients has been
    downloaded by over 175 people to date and has provided valuable aftercare support.

    Suicide and Self-harm Strategy

                                       Page 26 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

The Suicide Prevention Strategy is in draft and a working group has been set up to develop
the key actions from the strategy, which include training, toolkits, risk management
strategies and support for staff.

Service user involvement and engagement

The new Group Participation Strategy was approved by the Board in January 2020. This
strategy is essential in respect of a caring and well-led organisation, and how this transcends
throughout the organisation.

Clinical Strategy

This strategy has been written and is due for Group Operating Board in November 2020,
having been approved by the Healthcare Executive Group. This strategy is key for ensuring
the delivery of excellent services, and the clinical and operational management needed to
achieve this.

Physical health

This work is progressing well and is a three-year programme. Work streams are in place
looking at physical health monitoring, access to primary care, dentistry and specialist
services, access to screening programmes and liaison with acute services. There is also a
particular focus on the needs of people with a learning disability, and this is an area for
further development in 2021.

What we will focus on

We will undertake a project to choose and implement a quality improvement methodology.

                                    Page 27 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Our service networks

Across the Group, there are several clinical networks that are responsible for service improvement
and development, enhancing and unifying existing individual services across the country, and
ensuring consistent quality and outcomes. The service networks interface with the Healthcare division,
Wellbeing Centres and the Adult Care division. Led by a Clinical Director and a Specialist Director,
each network has a key role in supporting and monitoring the implementation of this strategy. We
have recently joined the NHS benchmarking group, to increase the use of external data in measuring
ourselves, and learning and developing our practice.

Each network has an overarching steering group that meets quarterly. Each has developed a Service
Network Operating Framework (SNOF) that sets out the key evidence-based interventions and
treatment provided, key performance indicators and outcomes, how they will engage and co-produce
with service users and carers, and their key areas of focus and quality improvements for the three
years ahead.

Each service network is accountable to the Group Service Network Committee that reports to the
Group Professional Development, Service Improvement Group and to the Board, through the Group’s
Director of Nursing, Professional Development and Service Improvement. Each work with the
divisions, and their Regional Operational Management teams, to ensure the work of the network is
aligned from a clinical effectiveness and commercial perspective.

 Acute network

 What we do

 The acute clinical network covers acute and intensive care wards for adults, across 17 sites. The
 overarching purpose of the network is to continuously improve the quality of the care provided to service
 users and to ensure consistency of care across the multiple sites.

 Our teams specialise in the safe management and treatment of service users presenting with acute mental
 health disorders. We accept emergency referrals 24/7 and service users can be informal or detained under
 the Mental Health Act. We provide safe, caring and evidence-based care.

 We accept service users with a wide range of diagnoses, including psychosis, affective disorders,
 neurodevelopmental disorders and personality disorders as well as service users with dual diagnosis.
 Service users are assessed by skilled nursing and medical staff within an hour of arrival and detailed care
 plans are discussed and quickly implemented. As far as possible, service users are fully involved in deciding
 on the aims of their admission and their treatment. Care plans are regularly reviewed by consultant-led
 multidisciplinary teams.

                                            Page 28 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Acute services have some specific challenges. Service users are usually admitted as an emergency, often
out of hours and with limited information, and will often have a complex mixture of mental, physical and
social needs. Assessments are completed quickly so that care plans and treatment can be implemented
without delay. Admissions are usually focused and short, with high turnover rates, with many discharges
needing to be arranged at short notice. Colleagues work in a high pressure and demanding environment.

Network meetings are focused on sharing good practice and learning. Service developments, serious
incidents, complaints and internal and external inspections are all seen as learning opportunities. Training
priorities are then agreed. The implications of new or revised internal policies are discussed and we
consider the implications of new national clinical guidance. Senior staff in nursing, medical and other
professional groups attend meetings, so that differing perspectives can be considered.

Our aims and vision

Our vision is to deliver safe and effective care which is tailored to individual’s needs. We aim to help our
service users recover as quickly and as safely as possible and we believe that to do this we need to:

       Provide a safe physical environment
       Involve service users as much as possible in decisions about their care
       Be caring and responsive during all interactions with service users
       Provide evidence-based treatments
       Ensure that service users’ physical health needs are assessed and met
       Involve families and carers as much as our service users want us to

Key areas of focus and quality improvements

Acute and psychiatric intensive care units (PICU)
    Implementation of meaningful therapeutic activities (7 day programme)
    Ensuring that Physical Health Standards listed in Section 4 are achieved consistently
    Development of ’first 72 hour‘ guidance
    Management of physical health needs audit, focusing on improving physical activity levels and
      medicine optimisation

Acute
    Develop and deliver a bespoke acute training package
    Reduction of AWOLs

PICU
       Development of a PICU outcome dashboard
       Development and implementation of the PICU care pathway
       Pilot of service user dynamic mapping
       Audit of implementation of zero tolerance

Outcome measures

       Safe – analysis of incidents and reduction of those that are preventable, including a reduction in
        medication errors
       Effective – length of stay, Health of the National Outcomes Scales (HoNOS)
       Service user experience - satisfaction reports

                                          Page 29 of 45
Priory Healthcare Draft Clinical Strategy – 2021 - 2023

Addictions network

What we do

Our addiction programmes offer expert assessment and treatment of chemical and behavioural
addictive disorders. We accept referrals from providers as well as directly from individuals, and the
assessment process is conducted by clinicians, doctors, nurses and therapists with accredited
expertise in the treatment of addiction, that ultimately leads to a holistic treatment plan. This is
particularly important given the prevalence of co-morbid physical and psychological problems.

The treatment offered is based on best-evidence, and compliant with national guidance, e.g. NICE.
The treating team collaborates in a multidisciplinary approach, and always with the central
involvement of the service user. This results in a recovery plan for each service user, with aftercare
support included.

The addictions network meets monthly and brings together the skills and expertise of a wide range
of specialists across all of Priory’s addictions services. This provides an opportunity to share learning
and best practice, review progress against agreed network priorities and consider latest national
guidelines.

Our aims and vision

Our aims and vision include:
    The provision of a safe environment of a high standard
    Treatment delivered by responsive and caring staff, in an effective manner
    All clinicians having expertise and experience in the treatment of addiction
    Treatment based on the best available evidence, and compliant with national standards
    Physical health assessment, and intervention where required
    Active involvement of the service user, and family support, where required

Key areas of focus and quality improvements

      Provide education and training for medically assisted withdrawal and addictions across our
       addiction treatment programme (ATP) and non-ATP specific services
      Ensure consistent use of assessment, care and discharge planning and outcome tools across
       all addictions services
      Reduce incidence of medication-related errors

Outcome measures

      Completion of safe detoxification
      Completion of planned treatment programme
      At discharge, 3, 6 and 12 month contact (with consent); PARQ & PHQ-9

                                         Page 30 of 45
You can also read