East Midlands

East Midlands
Development Centre
6 Month review 2009
 Children, Mental Health and Offender Health Care are important policy areas for the
Strategic Health Authority (SHA). As the Executive lead for all three I have been keen
to ensure that the role of the East Midlands Development Centre (EMDC) to support
these key client groups is well profiled in the region and within the SHA.

The decision that the EMDC should be located within Patient Care ensured that we
combined policy leadership with improvement support to Primary Care Trusts (PCTs)
and the delivery system. It allows us to support the Quality, Innovation, Productivity
and Prevention (QIPP) agenda for these important client groups and integrate the
work with the aims of the directorate and other SHA functions.

With an increasing NHS focus on Children’s services, the Bradley report on offender
health care and the future publication of New Horizons, a vision for both MH service
development and mental health promotion, I am keen that we continue to support
these policy areas.

Professor Dame Catherine Elcoat DBA

Director of Patient Care

Evaluation
Spread and adoption
Harvesting knowledge and
learning
Using mixed media for
diffusion

2

The Report
I am pleased to bring you our first report on the work of the EMDC. 2009/10
is an important year for us as it is our first full business year as an integral part
of the SHA. If last year was about transitions, significant change for staff and
letting go (Care Services Improvement Partnership (CSIP) and National Institute
for Mental Health in England (NIMHE) were closed down), this year had to be
about delivery. This is the story so far.
We have tried to keep it short but illuminating, so you get a feel of the breadth
of the work and our style of working. People still ask us what we do and so we
hope this will express that in a way that people can understand better what we
do and where it has added value.
The report is designed to engage and inform but not overwhelm, there is a
lot more to be told about the programmes and our work. Some of this can be
found by following the web links or contacting the team and finding out more
in person. We are always keen to explain our work but importantly to find out
what is on the agenda of people working in the delivery system. We are also
eager to hear what is good, success stories of change and how we might do
more to support your goals.
Contents
About us
Who are we?..........................................6
Our Approach and Skills..........................6
Our Programmes
Children and Families............................10
Children and Families - CAMHS............12
Offender Health....................................14
Mental Health..................................16-17
Supporting Care Pathway
development.........................................17
IAPT......................................................18
Dementia..............................................20
DRE......................................................22
Suicide Prevention.................................24

Please let us know what you think of the report and I do hope you find it a
useful read. Our Performance
Stakeholder Survey...............................26
Dean Repper
Director East Midlands Development Centre

Problem/issue definition
Focusing and clarifying
Capacity and strengths
Identification
Assessing system maturity
Sense-making

Core skill set:

Relationship management
Advanced interpersonal skills
Working with complexity
Networking and connecting
Building capacity in others
Analytical and interpretative
Horizon scanning and critical
oversight
Goal and objective setting
Negotiation
Shaping Change methods
Policy interpretation
Assembling resources

Improvement methods
Eg. Lean, process mapping,
appreciative inquiry, process
consultancy
Working with task and process
Benchmarking/data
analysis/systems modelling

3
Coaching/mentoring
Goal review and
monitoring
4
5
Who are we?
The EMDC is an integral part of the SHA Patient Care Directorate.
We offer support to the Quality, Innovation, Productivity and
Prevention (QIPP) agenda across Children, Mental Health and
Offender Healthcare. We work closely with the relevant Next Stage
Review (NSR) work streams for those client groups.
The team has a role to facilitate policy implementation, service
improvement and build partnership working across the multiple
agencies that are involved in the delivery system for the above client
groups.
We work closely with the Regional Department of Health (DH)
Social Care Team and run joint improvement collaboratives with
them.
The core team consists of 9 field workers, 5 of whom have a locality
responsibility in mental health and all carry a regional portfolio. The
team has policy specific knowledge and expertise in addition to
significant skills in change management.
Unique contribution
The combination of policy expertise, change management and
that we all have either a health or social care background makes
our support offer unique. Added together we have 400 years of
experience.
We care about the same things that you care about and we know
the depth of skills that exist in healthcare delivery. We approach
our work as partners with you, build on strengths and support local
decision making.
To find out more, visit our website at the link: www.eastmids.org.uk/about
6
Our Approach and Skills
We know that health and social care environments are complex
systems. They are open to continuous change and to emerging
possibilities. They are also ‘human systems’, full of passion, energy,
opinions and the potential to be contested and conflicted. Doing
the right thing at the right time in the right place can be differently
interpreted. When these environments are mature they are naturally
innovative and goal orientated.
As a team we work with this understanding, harnessing strengths
and supporting teams to overcome barriers but to also deal with the
ambiguity that frequently arises in rich and diverse systems.
We match our systems knowledge and thinking with skills that have
direct practical application. We have a core and complimentary
set of skills that support key stages of programme design and
consultancy work.
While a cornerstone of the team is accessibility and providing hands
on support we also fund projects that are designed to release local
capacity and leadership in priority policy areas.
These projects also bring together delivery experts to work on
common problems, share solutions and shape strategic change
locally.
We will sometimes combine this approach of hands on support with
funding strategic programmes (see sparks of connectivity, page 8).
Underpinning our approach is the continuous gathering of learning
from those we work with and the results of projects. We use this
to develop a growing local knowledge base of positive practice,
what works, change successes, specialist know how that can be
passed onto others. This is supplemented with knowledge from
our national networks and connections to a broad spectrum of
practitioner expertise.
 Problem/issue definition
Focusing and clarifying
Capacity and strengths
Identification
Assessing system maturity
Sense-making

Core skill set:

Relationship management
Evaluation Advanced interpersonal skills Goal and objective setting
Spread and adoption Negotiation
Working with complexity
Harvesting knowledge and Shaping Change methods
Networking and connecting
learning
Building capacity in others Policy interpretation
Using mixed media for
diffusion Analytical and interpretative Assembling resources
Horizon scanning and critical
oversight

Issue
Improvement methods
Eg. Lean, process mapping,
Learning Scope appreciative inquiry, process
consultancy
Working with task and process
Benchmarking/data
Results Formualtion analysis/systems modelling
Coaching/mentoring
Goal review and
Intervention monitoring

Director – Private sector

7
About Us
Sparks of connectivity
Knowing how to pick the right lead for the right plug point to
create that spark of connectivity is a specialist skill within the centre.
By adding capacity within the system and translating ideas into
action, the EMDC has played a pivotal role in Northamptonshire’s
implementation of its Flourishing Communities Programme. Guided
by existing commitments to commissioning for wellbeing, a team
member has provided leadership while building local capacity and
connecting the system together. Our work has already delivered
accelerated advancements in programme design and partnership
developments. Notably, the New Economics Foundation (NEF) in
partnership with the University of East London, has been awarded
a contract (funded through the IAPT economic downturn plan) to
work with Northamptonshire stakeholders to deliver an innovative
study and enhance local understanding on issues of wellbeing.
Opportunities have also been created for exchanges with national
experts on mental health promotion. By being available to support
this innovative process, we are ensuring evidence and partnership
engagement necessary to deliver commissioning priorities and
strengthen the alignment between physical and mental health
agendas for wellbeing.

8
9
Children and Families
The Children’s programme is an excellent example of our
Partnership and multi-agency working both externally but also
internally (see case example).
So far this year we have delivered support and a number of
improvement projects in the following priorities:
• Children with a disability
• Commissioning
• Transition
• Vulnerable groups
• Safeguarding
• Partnerships
The Children’s Programme works in partnership with the Children’s
policy leads in order to enable a coordinated approach to priority
setting and to ensure outcomes are maximised. An example of
matrix working across a range of SHA directorates can be illustrated
by the approach to the implementation of “Maternity Matters”
within the East Midlands.
The maternity agenda is both a national and regional priority and
focussed work has been ongoing in the region for over 18months.
This work began with a scoping exercise involving interviews with
all areas undertaken jointly by the SHA Maternity Lead (Patient Care
Directorate) and the Regional Change Agent. The exercise produced
a clear picture of progress and developmental needs across the East
Midlands and assisted in determining future developmental activity.
A part time post to assist in the implementation of the Maternity
10
Matters guarantee’s (to be delivered by December 2009) was jointly
funded by the RDC and the System Reform Directorate and this post
has been instrumental in progress towards meeting the deadline
(East Midlands are currently on target to meet the guarantee’s
across the region).
A regional Board has also been established to monitor
developments and progress towards the targets and the board has
involvement from the EMDC, Patient Care, System Reform, Planning
and Performance and Workforce directorates.
The System Reform Directorate has commissioned a piece of work,
undertaken by the EMDC, to review the role and impact of the
Maternity Support Worker post across the East Midlands. This has
involved an extensive project including semi structured interviews
with Heads of Midwifery, Midwives, Maternity Support Workers
and parents in a range of settings across the region. The review
has considered models of delivery, impact and effectiveness of role,
training and potential impacts on targets. Recommendations from
the review will be implemented via a joint approach across the
previously mentioned directorates with particular involvement from
workforce due to the nature of the recommendations.
Maternity remains a high priority for the forthcoming year and work
plans are currently being formulated to continue the work and
enable further progress and development.
To find out more, visit our website at the link below:
www.eastmids.org.uk/children-families
Around the region local leads identified
the need to support Health Visiting
and School Nursing services as they
entered a period of change. There is a
requirement to deliver both core and
targeted services in the most efficient
and effective way. It was decided that
training a range of managers in the
“Lean approach” would help develop
skills within the service that would then
be able to contribute to this challenge.
A number of training events were held
across the region with over 40 managers
trained in the approach. Bassetlaw PCT
is now piloting two lean projects within
children’s community services. One
project is considering administrative
support and processes whilst the other
is considering breastfeeding targets
and the services involved in provision of
breastfeeding support. It is anticipated
that clear measurable improvements
will be gained from the projects and if
successful the aim will be to share the
work across the region and to develop
further projects.
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Children and Families - CAMHS
The CAMHS element of our Children and Families programme is sponsored by the Department
of Health (DH) and the Department for Children, Schools and Families (DCSF) and is part of a
network of improvement practitioners supported by a national programme.
The CAMHS (Child and Adolescent Mental Health Services)
programme is delivered in close partnership with the SHA policy
lead and Local Authority partners. Working this way ensures that
we deliver targeted support, challenge and service improvement in
a coordinated way.
Key projects delivered or in progress this year include:
Cultural competence in CAMHS
We have used the Cultural Competency tool in Lincolnshire to
determine training needs and promote Cultural Competency
practice. A report has been produced.
CAMHS Tier 4 service standards development
Set of regional protocols and procedures agreed by Tier 4 providers
group and disseminated.
Workforce
All localities offered detailed structured support to develop
workforce plans and a thematic analysis. Results from this have
been shared across the region.
Learning Disability and CAMHS
A training course for CAMHS staff to develop capacity to work
with Learning Disabilities, has been developed and delivered to
Derbyshire and Lincolnshire.
12
Transition from CAMHS to Adult Mental Health (AMH)
Services
A Project to map transition processes and protocols across the
region has taken place and a report will be delivered in December.
The Mental health of Young Offenders
A Project to map mental health input into youth offending teams
and secure units and scope models of best practice has taken place.
The report will be delivered in December.
Development of Children, Young People and Family
Participation within CAMHS
A project to map CAMHS participation projects across the region
has taken place and a report will be delivered in December.
Support Service Improvement in early Intervention,
promotion and prevention
A multi-agency clinical network has been developed. Study days
and newsletters are delivered three times a year.
Support and Challenge to Targeted Mental Health in
Schools programme.
This has led to successful Phase 1 pathfinders and is now supporting
those coming on-stream in phase 2 and 3.
Follow this link for the detailed reports mentioned here:
www.eastmids.org.uk/children-families/camhs
Unexpected Outcomes
The East Midlands CAMHS Programme
Team run a Regional Forum for
Commissioners, Providers and other key
stakeholders which has been widely
welcomed and well attended.
At one of these forums a commissioner
wanted to get local agreement on how to
invest some new money she had received
for early intervention within a short
timescale.
The CAHMS team using their knowledge
and networks supported the commissioner
in planning, preparing, and delivering
a stakeholder event using a style which
was designed to engage all partners. The
team also ran the event as independent
facilitators, providing on the spot
assimilation, summary and feedback
about what the issues were. This enabled
comparison with other areas, new ideas and
objectivity.
What became clear at the event is that local
providers were not aware of what other
services existed, sharing and hearing this
was really powerful. The aim of the session
was to find the best way to spend new
money, the group actually found ways to
change their practices and work together
differently without spending money. A
working group is now implementing the
changes.
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Offender Health
We want to create safer, stronger, more inclusive communities in the East Midlands, by reducing
offending and re-offending. We want to improve health and reducing the social-economic
inequalities and exclusion that affect offenders, ex-offenders, their families, their victims and
the communities in which they live.
By developing health services for people whilst in custody we aim
to reduce health inequalities by working with a group who have
traditionally been difficult to reach. Also Increasingly diversion away
from the Criminal Justice System (CJS) into treatment at point of
contact such as Police custody or court diversions schemes are
becoming more the norm.
We have had a major emphasis on building up the quality agenda
through a series of partnership based projects.
Quality Indicators
The East Midlands is the first region to have achieved a collaborative
approach in reviewing Prison Health Performance Indicators (PHPIs)
with prison and SHA teams on a quarterly basis. In addition we have
established that each prison partnership board also have these as
standing item.
Working closely with PCT’s (Primary Care Trusts) we are now moving
to implement QOF (Quality Outcomes Framework) across the
prisons. During this year we have seen a continual improvement in
self assessment compliance with the PHPIs.
Safety and Quality
A regional forum has been established that brings together PCTs,
the prison service and Probation Prison Ombudsman to review all
deaths in custody and to review and monitor recommendation form
all reports pertaining to Death in Custody (DIC). This is the first such
group in any region in England.
Training has been provided to clinicians in each PCT to become
clinical assessors in order to undertake reviews on behalf of PCTs for
Prison Probation Ombudsman.
14
PCTs and prisons are now working more collaboratively on actions
plans arising from DIC leading to changes in clinical procedures.
Quality care for older people in prison
We have facilitated a review of health and social care services
available to Older prisoners.
Richard Bradshaw National Director for Offender Health attended
a stakeholder event on the report findings and gave positive feed
back that the region was tackling the needs of older prisons in a
positive and innovative way.
The report has made a number of recommendations and supports
commissioners in devising new provider specifications.
Supporting commissioning capacity
We produced a regional review of service provision and the
commissioning process. A number of recommendations have
been made and will be supporting commissioners in devising new
provider specifications.
Cross programme work
We have worked closely across two of our programmes to
• Review mental health services in secure units for children
• Bring together stakeholders who have expertise with working
with children who are accommodated in secure provision.
To find out more, visit our website at the link below:
www.eastmids.org.uk/offender-health
15
Mental Health : Locally Focused
The mental health programme strives to ensure practical solutions
can be delivered at a local level. As well as leading on regional
programmes, team members work within specific areas of the East
Midlands to provide a local focus on service development. This
is a core aspect of the Strategic Relationship Manager posts. We
work with individuals and organisations enabling local solutions to
national policy aims.
We have also actively lead on consultations for New Horizons,
DH vision for Mental Health, engaging with Clinicians, Users and
Carers and BME communities. We prepared two reports for the
consultation. In other key policy areas we have supported regional
workshops on learning from implementation e.g. Mental Health Act
– one year on. To find out more, visit our website at:
www.eastmids.org.uk/mental-health

The table below shows examples of our locality work.

Locality Activity Benefit
Northamptonshire • Increasing the levels of individual budgets for people • A partnership infrastructure for Self Directed Support with
accessing mental health services senior level backing.
• Lead collaboration between statutory and voluntary • Increasing awareness amongst partners of existing and
sector enabling the Flourishing Communities Reference emerging programmes strengthening the mental health
Group component
Leicestershire • Learning and Improving In Partnership – programme • Course to educate and develop staff/Users/Carers across
developed with Leicestershire Partnerships Trust and mental health delivery agencies in the East Midlands
De-Montford University • Provides change enablers within services with transferable skills
• Direct Link to work/patient focused projects
• Supporting Leicester City PCT Commissioners in • Informed and current submission
refreshing their MH Commissioning and Investment • Document reflects current national drivers
Strategy • Reflection of regional initiatives into local programmes
Derbyshire • Acute Inpatient Review with Derbyshire Mental Health • Assurance on progress against Care Quality Commission
Services Trust assessment
• Report to Executive and Senior Nurses for future service
development
• Derbyshire County PCT Train the Trainers coaching • Enabling senior managers to develop a coaching leadership
programme approach
Lincolnshire • Lincolnshire Partnership Foundation NHS Trust supported • Improvements in service model for dementia care
in Dementia Care • Increase in new types of roles to support people with dementia
• Monitoring Programme • Application of outcome measures based on successful
results in CAMHS services, leading to more rapid service
improvements
Nottinghamshire • Supporting Bassetlaw Commissioners with service • Configuration and modelling of current Psychological
modelling Therapies.
• Improved specification for competitive tendering process
• External input to Nottinghamshire Healthcare Training • Provide external input into review
Review • Access to impartial comment and assurance on strategy
development

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 Personality Disorder – no longer a
diagnosis of seclusion.
Gainsborough
Louth Launching our PD pathways project
Dronfield Retford
Worksop That is no doubt that care and
Buxton Chesterfield
Bolsover Lincoln
treatment for Personality Disorder has
Skegness
Matlock
Mansfield been a vexing problem for many. We
Newark-on-Trent held a regional workshop back in May
Hucknall
Ripley
Heanor Boston with input from local clinical leaders,
Ilkeston Nottingham commissioner representatives, user and
Beeston Grantham
Derby West carer input and national leads from the
Bridgford
Sleaford Department of Health.
Swadlincote
Melton
Loughborough Mowbray We worked through what was known
Stamford
about current service delivery, peoples
Leicester experience of it and of the challenges
Hinckley Market of delivering quality care. We had
Corby
Harborough excellent input from experts on the
Kettering
subject as well as presentations on care
pathway design.
Daventry Wellingborough
Northampton Clinical teams were invited to put
forward proposals to take forward local
pathway projects and we worked with
them to refine these over the summer.
We now have three projects that will
start this autumn.

Supporting Care Pathway development

Engaging with a range of service providers EMDC has taken forward a number
of initiatives which are underpinning how services can create more effective care
outcomes through designing user focused care pathways or as some prefer care maps
or menus.

Personality Disorder (PD)

Through providing programme support and finance we are working with PCTs and
providers to develop PD care pathways that will inform Commissioning Strategies.

Payment by Results (PbR) for Mental Health Trusts

Working with the 5 Mental Health Trusts funding has been made available across
the East Midlands to enable them to identify clinical leads and project leads who can
work with EMDC to expand and implement organisational change as well as sharing
learning across the delivery system. We have begun to identify with Trusts a number
of pathway priorities that they see as critical ones to be developed in the context of a
emerging PbR policy.

17
IAPT
Anxiety and depression are common mental disorders that affect over 400,000 people aged 16
to 74 in the East Midlands region, nearly 14% of that population.

The Commissioning community has risen to the challenge of the IAPT programme and made a
major investment that provided services across 90% of the population by October 2009. This is
significantly head of many areas of the country.
The IAPT (Improving Access to Psychological Therapies) investment We have invested in leadership development running two
will give us 300 more staff trained in NICE (National Institute for development programmes for primary care and clinical leaders . We
Health and Clinical Excellence) compliant therapies. We are leading will follow this up with a clinical network in the new year as part of
the way in access to training for part time staff and for training in our future sustainability of IAPT. With a set of comprehensive KPIs
IPT (inter-personal therapy) giving choices to staff and patients. We (Key Performance Indicators) we will routinely collect outcome data
have also facilitated 100 staff already trained in the evidence base to plan further improvements in treatment and service models.
with top up master classes.
The IAPT programme has a major focus on employment both
Supporting commissioners with policy interpretation and advice in terms of work retention and also return to work. A major
on modelling need and treatment numbers, we have ensured that pilot has been funded in Lincolnshire but in addition funds have
service specifications have been dynamic and evidenced based. been directed to every IAPT service to link and co-ordinate with
employment support locally. We have supported the delivery system
Activity Results with a dedicated specialist employment advisor.

Quality Application of Evidence Improved outcomes More recently we launched support for PCT communication leads
base and performance and Patient experience with colleagues from the SHA communications department. This
indicators will focus on marketing of IAPT services. In addition we have
Innovation New workforce roles, Critical mass of the supported providers to devise training awareness for universal
large scale application workforce applying services to increase step 1 support and improved identification of
of NICE guidelines new practices need.
Productivity Increased treatment Improved access rates
The EMDC is proud of its work in this area and to have been able to
numbers over existing and lower population
work with a remarkable group of commissioners, provider mangers
service models with morbidity
and clinicians in what has been at times challenging timelines.
stepped care
Prevention Alignment with Increased access for To find out more, visit our website at:
wellbeing interventions general population www.eastmids.org.uk/mental-health/iapt
in the community and to support in non-
engagement of BME treatment settings
communities

18
Psychological Wellbeing Practitioners Conference –
positive practice in Step 2 brief interventions.
The massive interest and enthusiasm for the IAPT change initiative
culmulated in a very successful evidence base diffusion conference on
9th July 2009. 600 people attended our local event, with many coming
from across the country. You can see the outputs on our website at:
www.eastmids.org.uk/mental-health/iapt/li-conference
We now have planned a further event in January focusing on
depression that will be designed by a CLARC diffusion fellow.
19
Dementia
We aim to support world class commissioning across the East Midlands by listening to people
with dementia, putting them in control and helping them with compassion.
We have worked with the Regional DH team to run a Dementia
Improvement collaborative. This will support the system to
implement the National Dementia Strategy.
Since the launch of the strategy in Feb 2009 the regional support
team have been identifying and meeting with internal and external
stakeholders who have an interest and responsibility for making
dementia their business. Together with key stakeholders they have
been planning and scoping the project.
One of the first tasks was to produce data packs of information
on what we already know about dementia. Primary data was
sourced by the East Midlands Public Health Observatory and
collated together to form a profile for each city and county within
the 5 sub-regions within the East Midlands. As well as data directly
concerning dementia, other information regarding general and
elderly population was included in order to help understand the
socio-demographic characteristics and health status of the elderly
population as a whole.
The second task was to devise a diagnostic screening tool. This
tool has enabled commissioners and providers to map their current
activity against the 17 key objectives outlined in the National
Dementia Strategy.
This has work has already started to show where current resources
are focused and where gaps of activity are emerging. This activity
shows a lot of services across the East Midlands being delivered for
people living with dementia.
20
During the summer months a process of discovery was underway.
The regional team engaged regularly with people and their carers
who live with dementia discovering what it means to live well with
dementia. These stories started to inform us of what services and
support systems would need to look and feel like. We asked these
individuals to help us plan a regional summit for the autumn and
their ideas formed the structure of the day’s event. We used a film
company to capture what people were telling us for future training
and awareness raising.
In October people from across the East Midlands came to the
regional summit. They created a regional vision, they built on the
discovery work and at the summit they inquired into what it means
to live well and better with dementia. Participants worked together,
telling and listening to powerful, inspiring stories of times when
people felt most valued, connected and supported. A report has
been drafted and will be shared with colleagues and friends at the
end of November 2009.
We have supported the delivery system with direct hands on
support, the addition of specialist expertise on pathway redesign
and the provision of funding to support local improvement posts
working across health and social care commissioning.
To find out more, visit our website at:
www.eastmids.org.uk/mental-health/later-life
Following the regional summit event
the regional team are working with
commissioners together with their key
stakeholders through a process which
will help them create an integrated care
pathway. Across the region there will be
over 25 collaborative workshops with each
sub region having five workshops. Three
workshops have already taken place.

The main objectives of the

workshops are to:

• Have people living with dementia at

the heart of these workshops as equal
partners

• Local providers and community partners

working in collaboration

• Identify and analyse what is happening

already and where and what the needs
are of the local population

• Prioritise investment – balancing

prevention of harm with intervention as
well as improving health outcomes with
efficiency and sustainability

• Promote improvement and innovation –

services specifications to be created which
specify outcomes and improvements that
they expect from providers

• Secure procurement skills – services are

developed through procurement and
contracting skills within partnerships

• Make sound financial investments –

commissioners will be able to show that
dementia services tie investments to
progress against local dementia specific
health and social care priorities, as well as
national ambitions

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DRE
The Delivering Race Equality (DRE) Programme was established to improve access, outcomes
and experiences for people with mental health needs. It is designed to tackle mental health
inequalities for all people of Black and Minority Ethnic origin, including people of Irish or
Mediterranean origin and East European migrants.
Leading the ‘Delivering Race Equality’ (DRE) agenda has highlighted the passions and challenges for local stakeholders. Many have found it
difficult to harness the momentum and shared understanding needed to drive the agenda forward. Key actions by the EMDC have greased
the proverbial cogs in the DRE wheel to help support the regional agenda and promote good practice.

Action Benefit

We reassessed the function, purpose and quality of regional Active engagement of commissioners and providers who are
groups supporting DRE and reconstituted a DRE Regional Leads now relating more closely, sharing best practice and assuming a
Forum. leadership role for DRE regionally and locally.

We devolved regional planning and resource allocation for Awarded 4 localities a total of £130K to deliver DRE development
designing and delivering innovative development work to the projects inviting local leadership and initiative, offering high impact
Regional Leads Forum. value and region spread.

We worked with Community Development Workers to help Improved communication with commissioners and more robust
interpret and improve understanding and articulation of the CDW performance management for demonstrating the value of the role.
role including merits and productivity within the mental health
economy.

We have been acknowledging gaps in the workforce’s cultural Evaluation of WRAP training and train the trainer cohorts for RECC
competency and capitalising on opportunities for community and RECAP will support commissioners contract requirements and
empowerment by funding a series of training programmes held in training opportunities that promote wellness, recovery and cultural
services and community settings. sensitivity.

22
Fundamental questions continue to be asked regarding culture
change, access points and experiences of BME communities in
contact with services. The desire is there to improve confidence
in services and reduce stigma around mental illness but the
mechanisms for making it happen weren’t always clear.
In an effort to resist creating dependency on the centre and
empowering local leaders to grapple with the issues as a collective,
the centre formed a Regional Leads Forum where influential
commissioner and provider organisations have come together in
2009. This group has seized this opportunity to share best practice,
improve support and contract management for the Community
Development Worker role. Most recently development projects have
been agreed for local partnership to implement delivering high
impact and potential spread across the region.
To find out more, visit our website at:
www.eastmids.org.uk/mental-health/delivering-race-equality

Enabling Encouraging use of

regional data by commissioners,
leadership and clinicians and
local ownership managers, BME service
of DRE agenda user engagement,
Count Me In measuring wellbeing
regional picture,
community
voice

23
Suicide Prevention
Promotion of suicide prevention strategies are important in preventing deaths. Conveying the
message that we can make a difference is essential in raising awareness and challenging myths
and prejudice.
Having a regional focus keeps suicide prevention on the health and
social care agendas. A multi-agency and community approach is
needed as many are not in contact with mental health services at
the time of their death.
EMDC has supported the regional programme to underpin the types
of activity needed to make this process happen. Frequent contact is
made with statutory agencies in both health and the social care as
well as ensuring close involvement with non-statutory agencies.
As a central part of the way we work, Service User involvement
and engagement with young people enables the programme to
focus what it wants to achieve on the guidance of those who really
understand.
As a result there is now a central resource for tools on support
around suicide, suicide reduction and support in dealing with self
harm. Key to promoting positive attitudes and meeting targets for
24
suicide prevention, is the training and working with clinical areas
especially Accident and Emergency which is part of the programme.
We have also conducted a region wide survey of A&E departments
that will be reported at a the regional conference on 2nd December
2009.
Working in this way at risk groups can be identified and support
of local strategy groups can be undertaken. This realises earlier
intervention and connects local and national strategies, allowing
transfer of best practice.
Benefits for the region include an expert knowledge resource
and associated network of contacts. All this can also be linked to
informing national strategy and access to national experts, allowing
tracking of trends and data.
To find out more, visit our website at:
www.eastmids.org.uk/mental-health/suicide-prevention
25
Stakeholder Survey Stakeholders level of responsibility within their own
organisations
The East Midlands Development Centre as part of the Patient Care The following pie chart represents the level of responsibility our
Directorate were keen to establish the following: stakeholders hold within their own organisations.

• Engage with our critical stakeholders in a proactive way
• Determine what they think of the services the EMDC provides
• Improvements that could be made
• Impact our work has for our Stakeholders
• Future innovations for the business planning cycle
Senior Managers were the largest group, 53%, followed by
Managers at 28%, Directors made up 10%, Chief Executives have
up a further 2% and there were 7% not stated.

A semi-structured interview schedule was designed. We identified

63 Stakeholders and telephone interviews were conducted with 57
over a three week period during September.
Not Stated
Stakeholders
Manager
The survey established that of those interviewed the NHS makes
up 74%, Social care/local Government made up 10%. Other
Senior Manager
organisations represented 9%. These included academia, research,
regulatory/inspections bodies and consultants, 5% stakeholders
Director
came from the 3rd sector/not for profit.
Chief Executives

26
Area of current work agenda
Commissioners make up the largest group in this section, 30%.
Stakeholders who had a key responsibility for developing services
made up 22%, and those who delivered services accounted
for 15%. Those stakeholders who reported that they managed
services/organisations made up 9% of this data set. Stakeholders
who reported ‘Other’ as their category described work agenda(s)
as: Research, Performance management, Strategic planning and
Regulation.
Current activity stakeholders are engaged with
at the EMDC
Mental Health makes up the key area of activity which is
represented by 38%. Children, young people and families make
up 23%, commissioning 20% and learning disability 7%. The
categories of social care, older people, health and social care in the
criminal justice system and other make up 3% each. Interviewees
made it clear that if they had not selected mental health as an
overall activity, each area selected was within the mental health
‘umbrella’.

Commissioning
Services Mental Health

Developing Services Social care

Delivering Services Older People

Managing Services/ Learning

Organisations Disability
Children, young
Other people and
families
No Responce
Health and
Social care
in Criminal
Justice
Commissioning

Other

27
Role of the East Midlands Development Centre
Stakeholders were asked what they felt was the role of Other
the EMDC. Almost equal responses were recorded in all
the categories offered: To advise on policy, to share good To offer service improvement advice
practice, to promote multi-agency-partnership working
and offer service improvement advice. To promote multi-agency/partnership working

To share good working practice

To advise on policy

0 5 10 15 20 25 30

Attending Events
Communication
How our stakeholders found out about activity and the
Walkabout' e-bulletin
work of the EMDC.
Website -
The most successful communication method was word eastmids.org.uk
of mouth and working with our Strategic Relationship Word of mouth -
Managers and attending workshops Working with one
of the Strategic
Partnership Managers

Publications

Working with
regional Strategic
Partnership Manager

NHS East Midlands

Other

28
How well the EMDC keeps its stakeholders Transforming promising pracice into best practice
informed about its work
46% of our interviewed stakeholders reported that the Adding value
EMDC kept them ‘fairly well informed’. 23% reported
that they were ’very well informed’. 2% reported that Accelerated learning/sharing best practice
they were ‘not at all well informed’.
Better partnership working
All respondents who did not receive Walkabout
(our e-bulletin) requested that they be added to the Service Improvement
circulation list.
Enabling you to achieve your target/s (PSA KPIs)

0 5 10 15 20 25 30

Supporting Positive Outcomes

83% of our stakeholders agreed that the EMDC
supported positive outcomes in health and social care
across the east midlands. 15% did not respond to this Very well
question. A comment that had been made to support
Fairly well
the non response included: ‘I Have not been in present
post long so can’t comment’ and ‘have only just started Don't know
to work with EMDC’
Not very well
Stakeholders reported that as a result of working with
the EMDC they were able to: Not at all well
Improve Service 22%, accelerated learning/sharing
No response
best practice 19%, better partnership working 18%,
adding value 15%, transforming promising practice to
best practice 13% and enabling them to achieve their
target/s (PSA, KPIs).

29
What they Identified
Examples sited by our stakeholders to achieve their outcomes
include work in the following area/agenda(s): Maternity
Matters, training in LEAN approach s, leading Flourishing
Communities, Dementia – Discovery Meetings, New Horizons
– ‘taking it forward’, Action Learning Sets and Increasing
Access to Psychological Therapies.
Comments about other areas that were covered included:
Project planning; good networking; financial resources;
facilitation; link to DH; system modelling; mentorship; high
level of leadership; supervision and advocacy role.
Our Stakeholders also wanted more information about the
team, its skills, areas of responsibility and what more could be
offered.
Some of our stakeholders also made very strong requests that
the EMDC does not lose the valuable work it has undertaken
in the service user/carer agenda.
30
Visioning for the Future
Our stakeholders were given the opportunity to express views about
future EMDC objectives. The following themes emerged;
• Continued support with the service improvement agenda
• Continued support with sharing best practice and
accelerated learning
• Transforming promising practice into best practice
• In addition to Adding Value it was strongly suggested that we
also support ‘value for money’ – but stakeholders asked the
question ‘how do we do it?’
• Further support with the commissioning agenda: specifically
with cost benefit analysis
• Support with interpretation and implementation of strategy
and policy. Regionally and locally
• Personalisation agenda
• Critical friend
• Information/data analysis
31
 East Midlands

For further copies of this report, or to provide

feedback, please contact:
East Midlands Development Centre
NHS East Midlands
Octavia House
Interchange Business Park
Bostock’s Lane
Sandiacre
Nottingham
NG10 5QG

Tel: 01623 812930

Fax: 01623 812940
www.eastmids.org.uk

Acknowledgements
The artwork within this report has been reproduced with the kind permission of the following artists:
Adam Pick, Kathleen Hill, Ian Morris, Kath Hardy, Kaye Kidd, Paul Dexter, Wendy Olsen, Julie Burrows
and Reflections Magazine, a national publication dedicated to showcasing the creative talents of people
with mental health problems.
Both the artists and Reflections can be contacted via breakthrough@mentalhealth.freeserve.co.uk