Triangle of Care is Good to Go!

by Rachel Murnaghan Carer, Involvement Volunteer & Service User


At the end of April  I spent a fantastic day at The Nottingham Involvement Centre with staff and carers across the Trust. It was an interesting collaboration and the purpose was to look at the self assessments forms which give a snapshot of where we are at the moment in our  work across the Trust and how our teams are involving carers, families and friends. The Triangle of Care approach was developed by carers and staff to improve carer involvement in inpatient and home treatment services as well as  giving examples of good practice. It recommends better partnership working between service users and their carers, and organisations.

There are six standards to achieve.

1) Carers are identified at first contact or as soon as possible.

2) Staff are ‘carer aware’ and trained in carer engagement strategies.

3) Policy and protocols re: confidentiality and sharing information, are in place.

4) Defined post(s) responsible for carers are in place.

5) A carer introduction to the service and staff is available, with a range of information across the care pathway.

6) A range of carer support services is available.

I really enjoyed the sharing of best practice and the good work done by our Trust teams to date. This boost for staff morale should encourage them into their future work with carers.

During the day I  heard about how teams such as the Crisis Team for CAMHS (Child & Adolescent Mental Health Services) and the gender clinic  are working with carers and their families.

We looked at some of the familiar themes coming up in the self assessments. Issues carers want to improve include support and communication with carers, lack of training for staff and how we need to share the news that we have Trust  Staff Carer Champions who are leading on how we work with carers.

More work is still needed on guidance around policies and what information staff  can share with carers. There is a new guide coming out soon about this. Sometimes it seems there is little support and compassion for carers and suitable signposting to other services.

Some carers like to use websites and they are a great idea to keep the information up to date but don’t forget those who can’t use technology. There are still issues for  our Trust staff knowing about who provides carers assessments and their information isn’t always up to date.

I just wanted to share a short part of what was a very busy day.  We have carers involved in the decision making processes and I felt really positive at the end. We have made a good start to  including carers, families and friends across the Trust


Rosewood Involvement Centre Friday Meetings

by Sheila & Stephen – Involvement Volunteers (Aka Q)

The Rosewood Involvement Centre holds a centre meeting every Friday afternoon, in Ollerton in North Nottinghamshire. This meeting is for Involvement volunteers with guest speakers and staff sharing their experiences and information together. Sometime we receive training at the meeting to help us with our volunteering activities. The meeting usually kicks off with a sandwich lunch prepared by our volunteers which is a good way to get to know staff and new volunteers too.

Discussions are wide and varied such as the Executive Leadership Council (ELC).

The Executive Leadership Council (ELC) is made up of 150 senior members of the Trust. They meet on a monthly basis to share and discuss the leadership and direction of the organisation.

New volunteers joined the council in September 2015. Volunteers are expected to feedback to the Rosewood Friday meeting about ELC so that Involvement Volunteers have some awareness of what happens in our Trust at senior level. It helps us to understand how the Trust is thinking and moving forward.

We are encouraged to feedback about our involvement work in the meeting. Paul R, Involvement Volunteer, shared his experience at one meeting about The Kings Fund Conference in London. The subject was “Improving access to Mental Health” through digital means. Involvement is really varied and finding out what is going on in other parts of the country can be really useful to help us in Involvement.

Updates from other Involvement meetings are shared in the Friday meeting such as the ‘Routes to Employment’ meeting held at Duncan McMillian House Nottingham which is open to anyone with an interest in getting back to employment for people who have been experienced  mental ill health by raising awareness of the barriers in returning to work after being unwell.

Upcoming weekly events are shared such as ‘Bassetlaw Live’ Hospital Open Day, the Monday Communications Group, Carers Groups and Mental Health Awareness Weeks events.

Patient-led assessments of the care environment (PLACE) Audit Training is just one of the many opportunities held at Rosewood .The meeting encourages us to suggest things that may help in our roles as volunteers. E.g. A dance group was suggested to give volunteers some self-confidence, fun and help fitness.

New volunteers are welcome at Rosewood. Tel: 0115 993 4567 for more information

E-mail: Twitter: @InvolveT1

Doubleplusgood By Kevin Thompson


I was ‘tasked’ to do something recently.

‘Tasked’?  …I took it to mean ‘asked’ only I had to do it, whatever it was.  So I guess I was being told to do it then.   But tasked somehow sounds sexier…

Jargon is a temptation that is hard to resist.  It arrives one day in the neighbourhood, shiny and immaculate as a new car, and people have an urge to test it.  They want to be proactive in this respect.

After all why say ‘talk’ when you can say ‘dialogue’? The latter makes you sound so much more profound.

But the trend for NHS jargon has been officially exposed.  In 2014 NICE, the National Institute for Care and Excellence, released guidance on how to write more effectively, or put it another way, how to communicate more effectively.

I make this point because that’s what writing is – communication.  Thinking about writing as communication stops me parroting out jargon.  Or so I thought.

NICE compiled a list of jargon to avoid whenever possible – some of which are listed below.

Back-filling   Deliver (when you mean abstract concepts such as improvements)

Dialogue       Drivers (for change)           Facilitate (use ‘enable’ or similar)

Going forward         Impact (used as a verb)      Incentivise/disincentivise            Issue 

Key (try ‘important’)  Progress (when used as a verb)

Robust          Signposting Streamline

Oh dear. Hands up.   I have used some of those words…quite often.  But it is a relief to know that I am one of many sinners in this regard in my NHS Trust; how often do you see the word ‘robust’ used these days in reports and the like?  It has become the writer’s equivalent of salt, to be sprinkled over everything to make things more palatable.  In fact I can’t remember the last time I saw a plan that wasn’t ‘robust’.  Before the word ‘robust’ became a first team fixture for ‘official’ reporting, did it mean that every plan fell apart when exposed to gentle winds?   I like cake.  But I don’t ask for a slice of ‘robust’ cake in a cafe, yet a piece of Victoria Sponge that disintegrates on impact is no use to anyone.  I think that it’s probably common sense that means you don’t have to ask for robust cake.  People just know it. You don’t need to say it.

But often when I have my manager’s hat on, I can forget common sense in my efforts to sound the part, to sound suitably ‘authoritative’.  So you dress up sentences like a Christmas turkey, forgetting that you should be communicating.  It’s not good to forget that you are talking to real people; having imaginary conversations with an audience entirely composed of versions of yourself won’t help.

I offer up an analogy.   I had a friend called Claire.  She used to give me lifts to work.  Claire was a pleasant, chatty person; but I used to dread the lift – when she got behind the wheel, she became a public menace.  When I asked Claire about her habit of commonly using the horn as a means to tell (slower) people to get out of her way, she talked about driving as if it was a dog eat dog world where she had to bark loudest.  I was baffled; when we walked to the shops to get a sandwich at lunch she didn’t push people out of the way, so why did ownership of a Fiesta XR2i (in red) turn her into a monster?

My point is that Claire projected a daft idea of driving which affected and prevented her real, thoughtful self from taking control.  I think many of us do something similar in our working lives; this feeds into our communication – we allow this projection of what ‘official writing’ is to circumvent our natural impulse to communicate clearly.  So I end up facilitating rather than doing, auditing rather than checking…etc.

And jargon isn’t just fancy words when plain ones will do.  If we want to be truly open in the NHS we have to recognise that the public doesn’t necessarily understand the implications of words such as ‘diversity’ or ‘engagement’ – NHS insiders use such terms with distinct, internally understood set of meanings that may not be available to the person on the street.  Such words in normal life have a different, set of meanings – ‘engagement’ is something that happens before marriage, and ‘diversity’ may reflect the plant life in your garden.  Openness cannot happen when we load up our communication with a particular set of internal codified meanings that effectively ‘fence off’ non NHS and NHS people.

Hello My Name is Kevin

Kevin Thompson – Corporate Performance Team.

Duncan Macmillan House

Nottinghamshire Healthcare NHS Foundation Trust

Who Takes Care of the Caretakers Daughter? By Michael Osborne

Michael Osborne

In this blog I want to discuss the role of the mental health patient, their carer and any staff of Nottinghamshire Healthcare Foundation Trust.

They will be called:

The patient. The carer. The clinician.

Please note that the term clinician may be a different person each time. The patient is taken care of at various times and places by the carer and the clinician.

Who should the patient care for?
They should take care of themselves as the first option. Often of course, they do not take care of themselves. It would solve many problems if they did especially for the carer and also the clinician and of course for themselves.

The patient should also take care of the carer.

This is part of the very emotional relationship between carer and patient. The carer/patient relationship can be challenging and this situation would be described and understood better by a patient and their carer.  However I will have a try!

The patient is often dependent on the carer but sometimes finds that very irksome and restrictive. The patient also can feel guilty about the physical and emotional strain they put on the carer. They do not want to be a burden. The patient is often more distressed by making the carer suffer.

Whilst the carer though loving the patient can feel anger at having their lives taken up by caring, this gives guilty feelings too. Often carers are angry with the illness and also with the clinicians for failing to find a cure.

Question: Should the patient help the clinician? (Discuss). I feel they should. When someone offers help either in friendship, physical care, advice or medication they should be helped and respected. However, the patient does not always want to be helped and may believe the treatment they are being offered is unhelpful. This can create conflict and distress to both.

But what happens when the carer joins this pairing?  Do they side with patient or the clinician?

The Carer frequently lacks information from either person to decide.  They end up with a double conflict of duty to the patient or their faith in the skills of the clinician.

All parties end up distressed and frustrated.

My proposal to improve the problems discussed in this blog is to increase communication and to encourage more of it; actually lots of it!

Communication between patient and carer I see as being very important with the same emphasis on carer and clinician whilst balancing this with the vital communication between patient and clinician.

The clinician may believe that the carer knows how to treat and take care of the patient. The clinician may believe that the patient knows how to treat and take care of the carer.

This is often not the case.

I believe a clinician should help and advise the carer in how to care for the patient.

I also believe a clinician should offer support and advise the patient how to care for the carer. (Discuss)

So often, the patient and carer don’t know whether to have faith in the clinician. Sometimes they get different perspectives from different clinicians.

Friendly, informal meetings should be the norm between patient, carer and clinician. They should all agree to discuss how to treat each other, how to care for each other and of course discuss the medical care together. Friendly communication can resolve a lot of problems.

Do not underestimate the power of the spoken word. Use it frequently and well.

Michael Osborne is a service user and volunteer with years of experience as a well respected member and champion of involvement within our NHS Trust.  Michael is generous with his time and always listens to others who may need support, often putting others needs before his own.

Michael is a passionate and keen advocate of open dialogue and invites you to a discussion. Please share and comment on his blog article.

Social media (Julie Grant, Head of comms, Nottinghamshire Healthcare Foundation NHS Trust)

This guest post from our head of comms, Julie Grant, is a response to a piece on our blog here.

As Head of Communications for the Trust I share some of the responsibility for the public relations and reputation management talked about here. I am also a firm champion of engagement and involvement – but in fact the two can live together. We have been engaging with social media for a couple of years and as with other online tools we started quietly and waited to see how it developed. When we first started using Patient Opinion I was worried that it was a very public way to hear about complaints and gripes about our services. In fact – although we do have some of those – I now realise that the vast majority of postings are positive in tone. When we get things wrong, as we sometimes do, then a public response to that is a really strong message about how much we value the feedback of our service users and patients (and an opportunity to make things right).

We have had real conversations on social media, with people in crisis or who just need signposting to the correct service. We try and be responsive, helpful and make a difference for someone. We can’t be online 24 hours a day but it is a measure of our commitment to this area that we have recently created and recruited to a New Media Specialist post. Nina is helping us make better use of social media in a meaningful way.

I agree completely that you can’t control social media – it is definitely the people’s voice. I’d welcome any ideas to improve what we do or how we engage – we are delivering your services and we want to know from you as to how we can do things better. I also think we are being more open and honest with the way we use it. There was a recent tweet about the lack of funding for CAMHS services, something about which I feel strongly. However I was worried that I was engaging the Trust in a political argument. I took the views of the team and we decided that most mental health trusts would agree with this view and so I retweeted – with more people retweeting after that. So we’re open to challenge and we’re trying our best – but we know we can do better and we’ll look to continually develop new media in an innovative and creative way, whilst not abandoning more traditional communications tools. Anyone for Periscope?!

Engagement in the digital age (Paul Radin)

Today we have two guest posts, from different sides of the desk, one from an Involvement Volunteer (Paul Radin) and one from the Trust’s head of comms (Julie Grant). To see Julie’s response please go here.

Social Media is a massive opportunity for the NHS. An opportunity to engage with Patients and Public on a scale and to a depth never before possible. It’s easily the best engagement tool to arrive since the printing press. So isn’t it time we started making good use of it?

Generally, in NHS organisations, the initial responsibility for ‘coping with’ Social Media falls to the communications department. The approach taken is usually defensive: all about Reputation Management and Public Relations. The communication is one-way. It’s about telling people what you want them to think.

What a waste! When the obvious potential lies in the opportunity to have conversations with Patients, Members and Communities.

In my opinion, the way to get digital strategies right is for them to be led by someone who understands and believes in the concepts of Involvement and Engagement. Traditional communications should step aside. The curtain is coming down… it’s time to get off the stage.

“Valuable conversations take place at the borderline of what we understand, with people who are different to ourselves.” Theodore Zeldin

Brands like ours can no longer be sustained by old style one-way communications. Spin does more reputational harm than good. Brands now depend upon what consumers are saying to each other.

Conversations about healthcare will happen, whether we like it or not, with or without input from the NHS. These conversations have always existed, even before the internet age, but now Social Media gives us the opportunity to be part of those discussions, to respond quickly to urgent concerns, and always know what our patients think about services.

… and before we get all the usual, feeble excuses, 21st century digital engagement doesn’t have to be labour intensive, if you let people talk to each other instead of thinking that you need to ‘control’ everything, then the response ratio could be 1 to 30 perhaps, not 1 to 1. The secret, if there is one, is to take part, not take over.

The Five Year Forward View challenges us to “raise the game on health technology – radically improving patients’ experience of interacting with the NHS”. Now is the time to take that leap forward. To boldly go where no Trust has gone before.

In keeping with the spirit of Engagement, this short piece is intended to be a conversation starter. Therefore I would very much welcome comments. Whether you agree with the points I have raised or not, please chip in.
Any argument needs opposition, to test, to challenge, to probe for weaknesses. The resulting proposition is stronger for it, and in the end all sides win.

Paul Radin, Notts FT Involvement Volunteer. Twitter: @paul_radin

THE STORY SHOP by JULES – Involvement Volunteer

The Story Shop in Action

It was a lovely Summers Day when we did a Story Shop at Retford Post 16 College on 17th June 2015.  A Story Shop is when you sit with a person or small group and talk about your own personal lived experience of mental health. The aim was to help the students understand about mental health and to combat stigma.

When I tell my story, I feel different emotions and feelings which can help heal me inside.  Telling my story often makes me feel very high but in a positive way.  When I look at the students faces they can looked puzzled and very often don’t know what to say or ask you.  I try to be open and honest and whilst telling my story, encourage them to ask questions to help them understand my diagnosis and what I have been through.

Once I have finished talking, the students sometimes say how very brave I am to tell my story about my lived experience.

I feel that my life has changed for the better. I am looking forward to the future.