Driving quality implementation in the context of the Francis report

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to individual autonomy. This is even more important when there are potential risks to others, when psychiatrists support decision-making processes across multi-agency teams to decide on the optimum way forward, protecting both the public and the patient in a thoughtful, considered and professional way. College action 1 The College will continue to support and develop best practice, and publish educational materials to support patient-centred professionalism and care. 2 The College will revise its report Good Psychiatric Practice to incorporate the necessary lessons from the Francis report. 3 The College recognises that it is crucial to recruit doctors with person-centred skills and values, and we will explore how our recruitment methods might become more values based. 4 The College will continue to influence the development and implementation of patient-centred mental health policy and legislation. 5 We will work in partnership with patients and carers to develop all of the above. Patient Safety Expert Advisory Group The Group is currently updating two major College reports which asserted the need for compassionate care and collaboration with patients and carers – Rethinking Risk to Others in Mental Health Services (Royal College of Psychiatrists, 2008), due in 2014, with reference to the findings and recommendations of the Francis report, and Self- Harm, Suicide and Risk: Helping People who Self-Harm (Royal College of Psychiatrists, 2010), which will be reviewed at a later date. Faculty of the Psychiatry of Old Age The Francis report is particularly poignant and relevant for old age psychiatry. Many of the vulnerable people who formed the basis of the report were elderly. There is no complacency in old age psychiatry regarding the issues raised by the report. Francis states that caring approaches are applicable to all, but makes particular mention of elderly people. All staff need to understand life-cycle changes and dependency issues in old age. The Faculty has established a working party to consider the implications of the Francis report for psychiatric care for the elderly. Faculty of General Adult Psychiatry We recognise the profound importance of the Francis report and its core recommendation that patients must be at the heart of everything we do. We must bear in our minds the need to treat patients not only with technical expertise, but also understanding and compassion. To this end, the Faculty has established a ‘compassion in care’ workstream which aims to make sure that the right values are instilled in psychiatrists from their training onwards, are maintained in the clinical workplace, and that psychiatrists model these values for others. Compassion and competence are themes of the Faculty’s residential conference in 2014. Faculty of Medical Psychotherapy Consultant psychiatrists in medical psychotherapy are increasingly active in developing, leading and delivering flexible integrated services for people with a diagnosis of severe and complex personality disorder. These services are delivered across clinical pathways through primary care, secondary mental healthcare, local authority and criminal justice provisions, and specialist treatment services provided locally within borough/county and nationally in specially commissioned tier 4 in-patient personality disorder treatment services. Not uncommonly, this patient group has faced cumulative adversities and can become fixed in their response pattern to adversity – a response that is frequently replicated in the services set up to manage their extreme difficulties in caring for themselves safely and in relating to others. A Faculty member has recently taken on leadership of a tier 4 in-patient service that was rigid and fixed in its approach to challenge and change. He, the multidisciplinary team and the patients have decided to encourage patients to be present and 10 Occasional Paper OP92
active in all discussions about their care in ward rounds, in care programme approach meetings and in mental health tribunal reviews. In addition, the multidisciplinary team has reintroduced a monthly carers’ forum. The consultant is involving all families in meetings with their family member in treatment to build towards recovery and discovery of a new way of living safely and with purpose. Patients and their families, as well as staff, referrers and commissioners, have responded very positively to this approach and have welcomed the opportunities to engage openly and transparently. Principle one: always put patients first 11
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Driving quality implementation in the context of the Francis report

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