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Design in Mental Health 2016 Keynotes


From ‘institutional’ to welcomingandtherapeutic


In the opening keynote at May’s Design in Mental Health 2016 conference, Tom Cahill, CEO of the Hertfordshire Partnership University NHS Foundation Trust (HPFT), explained how, over the past 3-5 years, the Trust had put an ever-stronger focus on the quality of its buildings – wherever possible ‘de-institutionalising’ them – to improve the care and recovery environment, and centralised its services into fewer, purpose- designed facilities. The Network’s editor, Jonathan Baillie, reports.


Introducing Tom Cahill, DIMHN chair, Jenny Gill, explained that he began his career as a mental health nurse, later holding a number of increasingly senior positions in the field before being appointed chief executive of Hertfordshire Partnership University NHS Foundation Trust (HPFT) in 2009. In the chief executive role, he had overseen a number of capital developments, including the award- winning £42 million adult acute inpatient mental health unit, Kingfisher Court, built by Medicinq Osborne at Kingsley Green near Radlett (The Network – January 2015). Tom Cahill said he would give the audience a CEO’s view of the impact of good (and bad) buildings on service-users and staff, in a presentation entitled ‘Building for better care’. In opening, Tom Cahill said he had been asked to talk about the Trust’s work in ‘transforming’ its services. While his presentation would thus naturally focus on buildings, the ‘transformation’ was also ‘about culture, dignity and respect, the way we think, and the way we behave’. He would thus also cover ‘the journey’ the Trust had been through


in this respect, which was ‘all about our service- users and their carers’. Beginning, however, with some facts


and figures, he explained that the £200 m turnover mental healthcare provider, based predominantly in Hertfordshire, also delivers services into North Essex and Norfolk. The Trust employs around 3,000 staff, has some 37,000 service-users, about 3,000-4,000 of them ‘seriously unwell’, and a thriving IAPT service across North Essex and Hertfordshire which, Tom Cahill said, ‘really increases the level of contact we have with service-users’. He added: “Most of our work is in the community.”


‘We also had a poor staff survey, and poor patient experience, and at the time had to say: Stop, we have to do something; these premises are not fit for 1990, let alone for 2020 healthcare’


KEY VALUES’ IMPORTANCE HPFT provides services including adult mental health, learning disability, CAMHS, older people’s, forensic, and medium (LD) and low secure services, plus eating disorder and mother and baby services. Tom Cahill said the Trust’s key values were central to everything it did. The values – to be ‘welcoming, kind, positive, respectful, and professional’ – had been chosen by service-users and staff, ‘with no management speak, or Board directors talking about effectiveness or efficiency’. He told delegates: They are vital to us, because they underpin who we are and how we work, including the way we interact with each other – whether as service-users, carers, or staff. The values have underpinned a lot of our work over the past three years.”


Moving to look at where the Trust, as it is


today, had ‘come from’, he explained: “About five years ago – in my early stages as CEO – we had a conversation with our board of governors, our service-users, and the public, about the ‘state’ of our services.” He next showed slides of a typical inpatient unit from the period, in which he explained that service-users were housed on the second and third floors, and, to, for example, have a cigarette, would have had to descend 2-3 floors and wait for a member of staff. Doors in wards were often locked, or ‘meant to be locked’, resulting in many ligature risks. He said: “We also had a poor staff survey, and poor patient experience, and at the time had to say: ‘Stop, we have to do something; these premises are not fit for 1990, let alone for 2020 healthcare.’”


One of the HPFT’s older ‘typical’ inpatient units, in which Tom Cahill explained service-users were housed on the second and third floors, and, to, for example, have a cigarette, would have had to descend 2-3 floors. Doors in wards in some of the Trust’s older units were often locked, or ‘meant to be locked’, resulting in many ligature risks.


10 THE NETWORK OCTOBER 2016


AN ‘HONEST CONVERSATION’ This led to ‘an honest conversation’ with service- users to ask then about what they wanted. Tom Cahill said: “They talked about improving access, more consistent care, about a better experience, and about the need to feel valued and trusted, but they also wanted better care environments.” Staff felt ‘much the same’. Following the consultation, the Trust developed a ‘transformation plan’ agreed on by both service-users and the public, and used its Foundation Trust powers to borrow to help it invest; around a £90 m investment, which the speaker acknowledged was ‘a significant risk’ for the Trust. “However,” he added, “it was either take that route or leave the services as they were, which wouldn’t have been right.” In developing and progressing the ‘transformation plan’, the Trust began by looking at academic studies and best practice, as Tom Cahill put it,


©Hertfordshire Partnership University NHS Foundation Trust


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