Better Care Together

Better Care logoThe way that care is planned and delivered at South West London and St George’s Mental Health NHS Trust is changing to ensure everyone receives the same flexible, responsive and personalised approach.

Like all mental health trusts across the country, we have been using the Care Programme Approach (CPA) to plan and deliver care for almost 30 years. Service users on CPA receive a care plan, including a crisis plan, and a care co-ordinator to organise their care.

Between 2024-2025, we will start moving away from CPA in line with guidance from NHS England and the national Community Mental Health Framework which has been coproduced with service users, carers and professionals.

The aim is to ensure that everyone receives the same level of care, including a named key worker, no matter if they have or have not been on CPA in the past.

Our Trust's new approach is called Better Care Together.

The new approach is based on the following principles set out by NHS England:

  • A shift from generic care co-ordination to meaningful interventions which are identified at an early appointmentand planned between the service user and their care team.

  • A named key worker for all service users but with a multidisciplinary team approach, meaning the right people will be able to provide the right care based on the individual’s needs at the right time.

  • High-quality co-produced, holistic, personalised care and support planning, with service users actively co-producing and regularly reviewing their care plan with staff (see information about DIALOG+ below).

  • Better support for and involvement of carers to provide safer and more effective care. This includes proactively seeking the contribution of carers and family members.

  • A more accessible, responsive and flexible system with personalised and highly responsive crisis planning and safety planning in which approaches are tailored to the health, care and life needs, and circumstances of an individual, their carer(s) and family members.

Phase one - Rolling out DIALOG+

Our move away from CPA is starting with the roll-out of the DIALOG+ tool over 2024. DIALOG is a simple set of 11 questions that service users will do before, or during, their appointments. People are asked to rate their satisfaction and needs for care across different parts of their life and treatment. It helps to guide a structured conversation between a health professional and service user that is patient centred with a focus on key areas the patient would like to improve.

The output of the DIALOG assessment is a DIALOG+ care plan that the service user and health professional create together. It is specific to the service user and is easy to understand. The care plan will be digital, easy to change and updated regularly as agreed with the service user.

DIALOG+ is the first approach that has been specifically developed to make routine patient-clinician meetings therapeutically effective. Research studies in different mental health services and multiple countries have shown that using DIALOG+ can improve patients’ quality of life.

Watch this short animation to see how DIALOG+ works: 

Get involved

This page will be updated with information as we progress the move away from CPA in stages over 2024 and 2025. If you are a service user or carer and have any questions about how the changes impact you, please speak to your local team or named worker.

If you would like to become more involved as we go through this change, please email our involvement team on involvement@swlstg.nhs.uk

Glossary

A

A&UC: Acute & Urgent Care

C

CAMHS: Child and Adolescent Mental Health Services

Care Co-ordinator: A social or healthcare worker that reviews patients’ needs and oversees their treatment plan under Care Programme Approach (CPA) [Cf. ‘Keyworker’ who helps co-produce a care plan under DIALOG+]

Carer: A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support.

CMHA: Cognition and Mental Health in Ageing

CMHT: Community Mental Health Team

COG: Clinical Oversight Group (supports operational delivery of the clinical aspects of the project)

Community: Services relating to those living at home or in community settings while under treatment.

Confidentiality: protecting personal information.

Consent: A person must give permission before they receive any treatment, test, or examination. “Informed consent” clarifies that this permission must be given on the basis of an explanation by a clinician, if necessary.

Contingency plan:  A service(s)-focussed plan, preparing what should be done and by whom in the case of a crisis, or when an individual’s crisis plan has failed to prevent deterioration of their condition and elevation of risk.

Coproduction: An approach in which people (citizens) and organisations (professionals) share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities. (New Economics Foundation)

CPA (Care Programme Approach): Involves assessing, planning, reviewing, and coordinating the range of treatment, care, and support for people with complex care needs.

Crisis plan:  A service-user focussed plan, identifying details of self-management and support to be used in case of crisis. Aims to reduce likelihood of relapse, deterioration of condition, and increase in associated risks.

CTR: Care and Treatment Review

Culture: Includes the shared attitudes, behaviours, beliefs, language, and values of a group or organisation.

D

DACT: Deaf Adult Community Team

DIALOG: A psychometric scale based on 11 questions through which service users rate their satisfaction with eight life domains and three treatment aspects on a 7-point scale, providing a score for subjective quality of life and a score for treatment satisfaction.

DIALOG+: “Afull therapeutic intervention”: a new care planning approach based on the DIALOG scale, making it much easier to co-produce a personalised care and support plan. It is the first approach that has been specifically developed to make routine patient-clinician meetings therapeutically effective (ELFT.nhs.uk).

Directorate: See ‘Service Line’

DOG (Digital Oversight Group): Supports operational delivery of the digital aspects of the project (inc. ICT integration, such as use of computers, mobile technologies, electronic patient records, and other software tools).

E

ELFT: East London NHS Foundation Trust. The Trust was involved in the development and delivery of DIALOG+, alongside the Unit for Social and Community Psychiatry, part of Queen Mary University of London (QMUL).

F

FSN: Forensic, Specialist and National Services

G

Governance: The framework of decision-making and accountability processes involved in managing an organisation. Clinical governance describes activities that help sustain and improve high standards of patient care. There are Trust-wide governance meetings and service line governance meetings.

H

HCP (Healthcare Professional): A provider of health care treatment and advice based on formal training and experience.

I

ICT (Information and Communications Technology): Encompasses information technology (computer systems) and communications technology (inc. telecommunications: networks and wireless systems), so covering use of computers, mobile phones, internet, email, voice calls, video conferencing, etc.

Inpatient: A service user living in hospital while under treatment, or services relating to them.

Intervention: Any activity undertaken to maintain or improve the health of a person.

Involvement: “[…] is also often called 'participation', and is the active inclusion of the perspectives of service users collectively in the design, commissioning, delivery and evaluation of services, as well as in policy development”. (Together / NSUN Service User Involvement in the delivery of mental health services – May 2014)

IRH: Integrated Recovery Hubs

K

Key worker: A named professional helping co-produce a service user’s personalised care and support plan under DIALOG+.     [Cf. ‘Care co-ordinator’ who reviews a patient’s needs and oversees their treatment plan under Care Programme Approach (CPA)]

L

LD: Learning Disability

Lived Experience Network member: A person with lived experience of accessing or caring for someone who has accessed SWLSTG's services in the past 5 years, and has registered with the Involvement Team.

O

Outpatient: A service user attending hospital for treatment without staying there overnight, or services relating to them.

P

Peer Support Worker: In this context, a person who has lived experience of accessing or caring for someone who has accessed mental health services and uses their lived experience within their employed role at SWLSTG.

 

PROMIS (Patient-Reported Outcomes Measurement Information System): A set of person-centred measures that evaluates and monitors physical, mental, and social health.

Q

QSG (Quality Governance Group): Oversees the values, behaviours, structures, and processes needed to enable the Trust to discharge its responsibilities for quality and quality improvement.

R

RiO: the electronic patient records (EPR) system used by the Trust.

 Risk Assessment: A service user focused review of psychological and social factors to assess their care needs and their risk of harm to themselves or other people.

S

Safety: the absence of interpersonal fear.
AND/OR
“avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of healthcare”. (Vincent C. Patient safety. 2006)

Service line:  A group of services governed together due to shared specialism. The Trust adopted a service line management model in 2017 and has four clinical service lines: community, acute and urgent care, specialist, and CAMHS and eating disorders, as well as corporate services. They were previously referred to as directorates.

Service user: Anyone accessing health or social care services. May also be referred to as ‘clients’ (particularly in the private sector) or ‘patients’ (particularly in medical settings).

SOP: Standard Operating Procedures): A guide compiled to describe the steps involved in routine operations to help workers carry them out efficiently, uniformly, and in compliance with standards and/or regulations.

SRO ( Senior Responsible Owner): the individual responsible for ensuring that a programme or project meets its objectives and delivers the projected benefits.

Steering group: The group overseeing a project (e.g. “Moving on from CPA” steering group).

T

Task-and-finish group: A time-limited group set-up to deliver on a specific project objective and to report back to a steering group.

TOR (Terms of Reference): A document defining the purpose and structures of a project, committee, meeting, or similar working groups.

Z

Zoning: A case management system which helps staff to adjust level of resources and intensity of input, depending on the changing risk and complexities presented by patients. It involves categorising patients into red amber or green by risk.

Rating