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ED clinicians and CMHT clinicians trained in different therapies to each other, and some patients would be better cared for in CMHT

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Staffing:
H&W - Nurses are a struggle and no medic in the team so nurse led. Waiting list has increased by 200%.

H&W - funding is limited and therefore behind on transformation.

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Staffing is a challenge with lots of vacancies in Black Country leaving us thin on ground, adult children and outreach

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- Staffind shortfalls, in particular staff with ED experience.
Niche environments- find staffin invested in ED.

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With staffing levels not optimal it's impacting on MDT approach. Staff are stretched with new expectations across CMHT

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recruitment is extremely difficult
Black Country - staffing is also hard. we do have the funding but can't find the appropriate individuals to fill those roles. Have introduced developmental roles to encourage engagement.

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Community - big investment £1m plus into community into Cov and Warks, but big challenge re recruitment. Adding equity for mild to moderate pathway for Coventry and balancing across Warks. Barriers to access for patients with comorbidities.

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Difficulties for transitions between CAMHS and adult services. Black Country all age team sits under CAMHS directorate which creates its own challenges

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would benefit from day care facilities. gap for symptom interruption patients. Aspen Centre used to operate this but pts have to wait for this and the enviornment is sustainable

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- there is a place for peer support in ED and value from lived experience.
- difficulty in finding balance between valued input and support for patients, peer support worker being a valued member of MDT.
- difficulty in ensuring that this does not become entrenching and overwhelming especially in times of acuity and complex needs

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Population of students - managing comm o/p across the geography. End up relying on primary care and no agreed pathway.

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Referrals rate gone up by 100% in Cov and Warks

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need individuals to support students to move forward in their student palcement roles.

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Discussion around acuity and the need to NG patients.
Talked about previously being able to build relationships and when the AED-PC went live, to some extent lost this rapport with patients which mean could not fall back on this in order move forward with patients.

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- place in ED for physiotherapy.
-low BMIs- long time in medical beds, immobile, muscle wastage. Patients with BMI < 10.
- Frailty fractures
- complex needs
- older admissions

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Burn out of staffing due to the need for constant observations and NG feeding (restraint).

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Birmingham - student - big challenge - working with local practices. Discharged from CAMHS go to Uni and then relapse. Differences in perspective in relation to professionals re medical /pharmalogical students - fitness to practice and fitness to study. 5/6 times a year we have this as an issue. we need to be present in Universities and that people are protected

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employing people with live experience into non-clinical roles

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Complexity of patients - Those who need constant observations and NG Interventions.

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supporting individuals with a digital offer - i.e. when on a waiting list; for assessment and treatment

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In inpatients also have the challenge re University students. Anxiety inducing for staff. Medical and nursing - locally is 17.5

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In inpatients similar issues regarding disparity across geography and wider West Mids and staffing challenges

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ASD patients obtaining the right diagnosis and support them with interventions out side of hospital as this can often cause more distress.

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Lack of
- additional room space
-therapeutic spaces/ sensory (ASD/ND)
- space for feeding (therapy)

-HDU spaces for
LTS
Restraint NG
high obs/ dependency
inappropriately placed (after bed identified)

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-additional training
- specialist input

-CeTR processes

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for all students to have the same oppourtunities

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Getting to know University leads and student leads. For regular check ins. To share information in a safe space and learning from examples. At Uni of Bham 2 GPs that meet with students - local Bham team meet with the team to see if trends, if students going home offer dietetic session and CPA to make sure psychoeducation at home and support. Putting in place safety nets

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Training/ management.

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Recruitment!

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gap in day treatment - black country especially

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Offer training to professionals but building relationships is key with Universities and local GPs within

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- not all units use the same outcome measures
- lack of definitions for metrics (are we able to compare).

- Different providers use different systems and processes
- Clouds the reporting picture

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Also meeting with Chancellor, Heads of Service to make sure there is understanding and engagement of fitness to practice and study policy. Coventry policy - hitting at a strategic level. Need wider Collaborative to set some of the direction/approach to this. What is the risk to the individual and what are the medical risks. Knowing who the links are for when we need clear governance

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Management of patients with EUPD and improving outcomes for these groups of patients.
More training for staff on the EUPD diagnosis.

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Clear protocols for when pts go home, what can be expected, links with GPs, can be difficult esp for overseas students

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PEACE pathway (ASD Diagnosis) - One service taking the lead on this so we have a designated unit to offer to patients for ASD.
Autism liaison role.

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could we look at the data - how many pts are in our services in local Universities and how many are local residents?  Could James support a piece of work around this to establish what this looks like

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Workshop to discuss University students and approach to this.

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offering a blended model of day-care with half on site and half digital

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EUPD - don't have agreed treatment programmes. Programme at Northampton but out of area (DBT). Major challenge and need to work as a Collaborative to address this. could we have EUPD programme? Does lead to high staff turnover

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Day care providers - Looking at alternative to admissions.

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Community support.

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challenges retaining consultants and medic cover

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Look at data re EUPD across the Collab- have pts come from a CAMHS background? (Diagnosing early and establishing model of care within CAMHS). Separate ward with longer length of stay to address trauma

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Retention of staffing.

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- Set standard of metrics
- Actioning from Data reviews
- Utilising scrutiny groups to standardise and implement suggestions

- capturing leave

- including metrics into referral management system and use this for reporting
- optimise auto generated reporting
- set points for data inputting- ie: BMI @ admission and discharges inputted by wards

-using SSQD for supervision record
- OR get rid of SSQD... submit in a different way- using exports
- make reporting easier
- buy in from inpatient units

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Particularly with transformation, concerns about finding qualified staff. Thinking about progression of nursing careers within inpatient services. Considering ACPs, ANPs, nurse consultants. Thinking about own professional boundaries and challenging why certain professions have to do particular tasks

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Provision of day care across Cov and Warks and wider areas. Day provision for low weight and emotional regulation can be better alternative. Taking responsibility for eating and making changes in behaviours. Do admit pts unnecessarily with some pts being better off in a day therapy service

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Rotation of staff from inpatients and community etc. to share across the service.
Improves areas for learning and development.

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Developmental role.

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Trying to implement FREED but can't due to not being able to recruit

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Maintaining staff wellbeing.

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Addressing limited provision for step down to address social factors for young people in transition if home is not the right place for discharge. In core MH - safe houses etc - but nothing there for ED. Work with housing associations /housing navigators to get support for these individuals

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rather than having one post - having two part time roles to provide support for one another i.e. peers support works