A Statement from Wiltshire and Avon Health Branch Unison
The exciting promise…
We are fast approaching one year since the transition to the New Model of Working associated with the Bristol Mental Health partnership.
This model, involving notable reductions in the numbers of registered staff in each of the Recovery teams, was sold by AWP management as offering a more dynamic and advanced approach whereby an influx of Recovery Navigators would open up opportunities for more recovery-focused working whilst also enabling the caseloads of registered staff to be markedly reduced (to 15-18) in order to free up time for providing supervision to RNs and to provide more effective, psychologically informed, therapeutic interventions.
Likewise, the change in the team bases was presented as driven not by financial savings but because it brought various advantages, such as less stigmatising settings, and greater integration into the community via the ‘liberating’ potential of greater mobile working.
…and the dangerous reality
Meanwhile things continue to get worse, not better. Caseloads for most registered staff are not coming down (although in response to the on-going joint-Union Collective Grievance process some exceptionally large caseloads in the high 30s have come down). Serious understaffing, including in the Bristol Crisis Service (BCS) which is continually working below its minimum numbers and hence only providing a skeletal service, means huge strain on nurses and high sickness rates.
The resulting significant safety concerns and increased likelihood of preventable fatalities is made worse by the completely inadequate work spaces. We’re aware here of a number of letters from a large group of AWP consultants protesting serious safety issues, including how more hit-and-miss opportunities for inter-professional communication works against ensuring responsible risk management strategies. The crude daily scramble and unpredictability of trying to find a desk top computer eats further into practitioners’ work time.
Recent Root Cause Analysis (RCA) meetings (triggered by the death of a service user) have highlighted the chronic under-resourcing. Senior Practitioners talk about the impossibility of providing quality service. In the light of shortage of assessors North Bristol Recovery was last week considering going into ‘emergency mode’ where the team will ‘only react and only carry out assessments’. Due to the general atmosphere of chaos mistakes are more likely to be made.
Yet it is individual stressed-out staff, who routinely go above and beyond, who are being targeted for blame. A major symptom of the problems and safety issues is the high numbers of staff leaving their jobs in Bristol services or actively seeking alternative employment. Just in Central Recovery for example 7 RNs have already departed or are about to since the new model was introduced. Across all teams many experienced registered staff have either moved on or are seriously seeking alternative employment. RNs feel unsupported, burdened down with work which originally had been defined (in terms of complexity and risk) as needing care co-ordination by more highly paid registered staff. Meanwhile hundreds of unallocated patients float around with no care or support, such that further catastrophe looms. What remains is an even more basic, medically-driven service, further minimising opportunities for therapeutic person-centred care.This corresponds to the cutting of the AWP training budget (from which RNs have been excluded) and the effective de-skilling of staff, with negative consequences for job satisfaction and service quality.
Despite these problems there is a continuing management refusal of accountability. Hence their reluctance to provide any milestones for the original promised improvements (which now more clearly appear as mere sweeteners to help crowbar in the New Model). There is simply the repeated mantra that we first have to demonstrate to the commissioners that we have had a good go at making the New Model work, even whilst management unburdens itself of any responsibility to provide a deadline by which improvements have to be evident.
In an earlier management document from last Autumn entitled somewhat laughably ‘modernising Mental Health in Bristol’, and claiming to be an agreed statement between Bristol management and the Joint Union Committee (JUC), there was reference to ‘a need to look at a trend line of data (starting from an unacceptable status quo) which will only begin to be clear after about 4 to 5 months’. The previous ‘status quo’ remains a distant dream compared to the present and we’re way beyond 4-5 months, yet management’s instinct for face-saving trumps honest reflection, sticking to promises and putting patients first.
A Collective Grievance procedure related to the above problems was initiated by union reps in March. Although key union concerns were ‘partially upheld’ at a hearing on 27th March, no concrete improvements are visible on the ground for most staff. We have stated that we expect change by the time of the review on 17th June but staff understandably worry that we are once again simply being strung along.
UNISON will be holding meetings to listen to staff views and for staff to consider their options. It is simply unacceptable for this reckless gamble with patient safety (as AWP trade unions described it during last summer’s consultation) be allowed to continue in its current form.
We cannot sit back wondering how many more life-threatening incidents have to happen, not to mention staff break downs, until the Trust finally communicates to the Clinical Commissioning Group (CCG) that the new model is not working.