Clinical Strategy

As people working in the Trust, we all want to provide the best care, with the best outcomes possible and the best value for the money. At the same time, we want the experience of working in the Trust to be something that enriches our lives. We also want our organisation to be valued by our communities and partners. In our Trust Strategy we set out our ambition to provide great care. Our Clinical Strategy describes how we will do this and the changes that we will need to make to the ways we deliver care.

National and local guidelines describe a need to evolve and develop the way healthcare is delivered in England. There are 3 clear underpinning changes have been proposed for health services:

• Analogue to digital.
• Hospital to community.
• Treatment to prevention.

This is a huge opportunity for the Trust as the services we provide, in mental health, children's and adult community, are central to that national vision. Our Clinical Strategy will show the way in which we will respond to these national priorities, in the knowledge that if we are not prepared to change, we cannot get better.

The population of Cornwall is also changing. We are growing older as a county and we need to be prepared for the health needs that come with this. We also have groups of people in our communities who are disadvantaged in their access to our services and their experiences of care. As a result, their health outcomes are worse. Our Clinical Strategy will describe how we will respond to changes in our population, support an approach to prevention and tackle health inequalities.

We have made a number of commitments as an organisation; to the wellbeing of our staff, to the preservation of our environment and to harnessing the healthy power of nature and creativity. We have committed to use new digital technology wisely and with ambition. We commit to developing a culture of learning and continuous improvement. We will prioritise co-production with the people that use our services, to making the co-creation of new and innovative approaches to care a core part of how we offer treatment. Our Clinical Strategy, alongside the other strategic delivery plans in our Trust Strategy will be our guide to achieving these commitments.

This Clinical Strategy is the picture we paint and the narrative we share of how we will deliver our care in the next 5 years. It is a commitment that we make to each other, captured in a document that we can refine and develop together over time. And when we have it right, we will all be able to see the part that we play in it and to tell our part of the story.

My name is Elaine, I am 82 years old. For many years I have had COPD, caused by smoking when I was younger. It has limited me a lot more in recent years and I have had 5 hospital admissions. Hospital frustrates me, I feel powerless and could do so much more for myself if I were at home. 2 years ago, I needed hospital treatment and instead I was offered the virtual ward. I had all the same treatment and monitoring, but at home. At first, I was frightened to be alone, just with my husband Colin overnight. I came to realise that knowing I would have a phone call first thing in the morning made it OK. I once had an admission to a community assessment treatment unit (CATU), but they linked me back into the virtual ward and I was home again in 2 days.

Colin has been very tense lately. He could see how much worse I was and how much it unsettled me to be admitted and to lose control. My community nurse noticed this and said that she could help. The next time she came, she brought a colleague from the mental health team with her and we had a very different conversation. They asked if I was happy to talk about dying and I was relieved to say yes. He showed me an advanced care plan and I realised that what I wanted most was to be able to see Abby, my 16 year old granddaughter finish high school, if I can do that, I can face whatever comes next. Colin was surprised but calmed by hearing me talk like this.

The mental health worker suggested he join a Men in Sheds group at the local green space for health where I used to attend my breathing group. He goes once a week and seems much happier for it. He keeps in touch with the people he has met there.

We completed Colin's advanced care plan last week and gave them both to Dr Kumar our GP. We can now see it on our health records every time we log on. I feel that I am in safe hands. I have been so poorly these last months and wondered if I would make it. Now it is Abby's prom in 2 weeks. I have bought something special for her, I will be here to give it to her and that is what matters to me most.

I am Kadim, I work in the Children and Adolescent Mental Health Service (CAMHS) providing support to young people with mental health problems. I have children of my own and I know how important it is that they have someone consistent in their lives. I started as a volunteer and the support worker, then I moved to Cornwall when I heard about the approach the Trust were taking to incorporate nature-based approaches, community development and sustainability in their services.

Shortly after I started, I was trained in nature-based approaches to health. I care about this and easily hit my target of having half of my appointments outdoors, I spend most of my time at the community green space and see most of the young people on my caseload there. Connecting young people to their place in nature can make such a big difference. They become more grounded, and some develop a passion that they never imagined before. Engaging people in assessing the impact our services have on biodiversity has given me some great opportunities and a research project that I was part of is about to be published in a journal. I am so proud of that.

Last year I was very stressed at work. My manager was supportive about flexible working to enable me to do my share of childcare at home. I also saw some people doing Tai Chi at the green space and got talking to them. Twice a week, I now spend the first half hour of my working day doing a class with staff and patients. I am in a much better place because of it and have taken up an apprenticeship to be a social worker.

There are some big IT changes planned in the service. The young people are now so digitally connected to the range of community resources for adolescents, that the transition into adult services when it is needed is so much easier. Some of them have really taken to the avatar based online therapy, that can make such a difference for people with conditions like anxiety, trauma experiences and people with autism. The goal-based outcome measures we report with people help us to see each month just what a difference we are making. Next week I begin training in ambient dictation. If I work with the technology, it will pick what the young people and I talk about in our appointments and automatically create a draft record. This cuts down so much on my admin time and gives me more time to spend on the clinical work I value most.

I am Sally, a GP. So much has changed in community and mental health services these past few years. Whether people are employed by our practice, by a VCSE organisation or by the Trust, we all feel like we are working for the same purpose. The shared care record helps, because we can all see what each other is doing and communicate with one another, but it is more than that. The hub meetings and development of local community-based services dedicated to our population has changed how we work together. Shared care actually feels shared.

I had been concerned about Connor a man in his 30s with severe mental illness. He looked distracted when I saw him for his annual physical health check, and we had a message from his individual placement and support worker who is helping him into work, at the mental health hub meeting. The community mental health team are better staffed now, but they also work so differently. It is not about thresholds and appropriate referrals anymore. When I said I was worried about Connor the community psychiatric nurse just agreed to get in touch with him. She and the support worker saw him a bit more often for a while and ironed out some problems he was having getting to his work placement. I was happy to briefly increase his medication because I knew it would be reviewed by the consultant and we would bring it down again. Connor used the care record system to book his own follow up appointment with me last week. He has not done that before, and I know I can reach out to the team if he needs more support in the future.

I have an interest in end-of-life care and work closely with the local Palliative Care Team. Across our patch we have focussed so much on advanced care plans. I have such different conversations with people now and their care seems so much more led by them. Knowing I can quickly get the medications and support needed for people at the end of life makes such a difference. We host a locality learning from deaths meeting with the Trust's community teams every quarter. We use it to focus together on continuous improvement and the performance and outcome data shows we are getting better all the time.