The HSC Safety Forum Northern Ireland has a remit to provide leadership for the development of Quality Improvement across the Northern Ireland.  It currently supports the work of Q and has been integral to growth of the local Q community.   As part of the Regional strategy to engage the 5 local Trusts with Quality Improvement work, Regional Collaboratives were established across a range of themes including Mental Health.  These Collaboratives  provide an opportunity for local Trusts to work together developing Quality improvement projects around agreed themes. This has contributed to standardisation of practice across the province and created a culture of sharing and learning.

The Mental Health Collaborative is in its fourth year and has consolidated its position as a resource and a support to frontline staff doing Quality Improvement work.  The focus this year has been proactive recruitment of service users and their families into the group. It was clear that there was under representation within the Collaborative. 

Northern Ireland has committed to the Implementing Recovery through Organisational Change (IMROC) program which was launched to drive forward the Recovery model of care.  Recovery Colleges were developed in each Trust.  These Colleges are exemplars in application of the co-design and co-production principles both in the design of the structures of the College and in the development of educational programs.  Service users have been involved every step of the process.   The Collaborative has drawn on and learned from this experience which has been generously shared.  Local Patient and Public Involvement (PPI) experts have been equally supportive.  They have a wealth of expertise from working within and alongside Trusts and have actively engaged and supported the Collaborative efforts to increase service users and carers representation in their meetings.  Working together positive strides have been made and  representation of service users continues to rise;  at a meeting in  January 2018 service user and carer representation was 6% , in May 2018 it was 30%

The next step is to consolidate this “new” Regional team which combines lived experience with professional skills.  This team has the potential to deliver meaningful improvement for those who use Mental health services and those who work in Mental Health services.   The Quality Improvement Model is an enabler for the Team both in guiding the work and demonstrating benefit but only if we train and skill everyone.   There is a growing body of evidence that skilling service users and their families in quality improvement science levels the playing field.  It allows full and confident participation by service users and carers facilitating a true co design co production model working model.   The East London Foundation Trust and London and South Maudsley Trust are two examples leading the way on this nationally.  It is also clear that the framework in which service users and carers engage to influence is changing.   Coproduction provides the framework which facilitates and supports full participation for service users and carers.  Co-production is a very different way of working for professionals.  It is a cultural change which requires change to habitual ways of communicating and behaving.  It takes time and staffs need training to help them make the change.

Two training needs have been identified.

Staff will require training in Co-production to build confidence in their ability to work effectively and respectfully within this framework.  This is in keeping with the work of Hanley et al who highlighted that staff required training to shift them towards collaborative working styles.

Service users and carers require training to become confident in use of the language and in applying the principles of Quality Improvement Science.  This will enhance their confidence in becoming full participants in the work.  Coaching and support are also key elements.

Developing a regional approach to training is challenging. It is clear that Trusts are at different stages in relation to these two areas.   There is wide variation in the development of service user and carer engagement.   This variation is mirrored in professional experience of co-production.  However all Trusts have in common Recovery Colleges which link regionally.  The focus of the Colleges is delivering training, through co-produced modules and they are the ideal vehicle  to progress the aspiration of a level playing field for regional mental health improvement work.

The PPI impact and evaluation framework will form the basis for evaluation.  This moves beyond mere figures for attendance including quality of experience measures and evidence of empowerment.  It will allow both the trainings and the process through which the trainings have been developed to be reviewed.

Benefits

• Skilling up Service Users and their carers to influence and fully participate in Regional quality improvement Work.

• Skilling up staff in the coproduction model so they are confident in using this framework ensuring service user and carer involvement in quality improvement work
• Strengthening of the Regional Team.  Training together to make services better
• Building supportive relationships with Recovery Colleges and PPI aligning effort for effectiveness and efficiency.
• Spreading skills to support QI work at Trust level
• Spread this model to other regional collaborative specialties
• Increase service user and carer representation in Northern Ireland Q Community