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Vicky Hall CEO
Cascade Care Ltd |
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The election is over. But the waiting goes on. Across England and Wales PCTs and Trusts are in a state of limbo as they await anticipated cuts to their budgets from the Government’s forthcoming Spending Review. That much is understandable. What is less understandable is why so many PCTs and Trusts are deferring front line operational decisions to improve community based mental healthcare, when the Government has repeatedly stated that healthcare, in general, will be ring fenced from future cuts.
Regrettable as it may sound, the only explanation for this inertia appears to be that top heavy administrations in the NHS have as much of an eye on job preservation, as on getting the job done.
If nothing else, the spending review will force the pace of change, where leaner administrations will be empowered to start taking faster decisions. As a leading private sector mental healthcare provider, dedicated to working in partnership with the public sector, we will welcome this change.
Cascade is also changing. Over the past month we have introduced two new care products within our residential care portfolio. Already we are receiving referrals for our short term ‘Respite’ care package that provides a highly cost effective solution to Commissioners for service users in the community who are prone to relapse. Our other new care product, providing short term adjustment and rehabilitation for more able service users on step down from psychiatric units or prison is also proving popular.
I am pleased, too, to announce this month two new appointments that will strengthen our management team, being those of Cashain David and Alma-Katrina Francis in the roles of Operations Manager and Referrals & Admissions Manager respectively. Many of you will already have had contact with Alma, who is being promoted internally. Many of you will also know Cashain, who has worked in mental healthcare in both the public and private sectors for over 20 years. Profiles of both are included in this newsletter, together with a case study on one of our service users that demonstrates the value of the care Cascade provides. |
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Case Study
Feedback on what we print in Cascade News shows that Care Coordinators find it helpful to learn how Cascade has worked with different service users. This month’s case study on ‘Tom’ (not his real name) tells a story all of its own.
Tom came to Cascade in April 2008 diagnosed with Post Traumatic Stress Disorder, Borderline Personality Disorder, Mild Retardation, and Emotionally Unstable Personality. Before Cascade Tom had been admitted into various Mental Health hospitals experiencing a lot of negative care.
When he arrived at Cascade Tom had very low self esteem, lacking both confidence and motivation. He found it hard to communicate with staff and avoided social contact in the Home. If he had been permitted to do so, Tom’s preference was to spend most of the time slumped in front of the television, staring blankly at the screen, hearing the inner voices who talked to him.
The idea of a Care Plan, for which he had to take ownership and responsibility, was foreign to Tom. At one level, it meant unwelcome intrusion. At another, and puzzingly at first, it signalled that he was no longer fighting his battles alone.
It took Tom time to get used to this idea. Three weeks of good mood would be followed by one week of low mood. When he was in his low moods he would rarely eat. The staff worked very closely with Tom when he was in his low moods, providing a 24/7 safety net, building up his trust and confidence. Slowly, gradually, the low moods evaporated, and went away. Before long, when the inner voices started again, Tom would approach the staff and sit and discuss what they were saying to him.
During his low moods, Tom would never have ventured out. It was the team’s decision that Tom should start going out into the local town on his own irrespective of his moods. Another new challenge for Tom. At first the staff would shadow Tom and then give him feedback on his return to the Home. Tom started to realise he could cope on his own.
Over the course of the next few months Tom’s confidence grew and grew. He went on social leave, managing the journey by himself. He visited the local cinema by himself. Inside the Home he made friends with other service users.
The low moods rarely, if ever, returned.
As in all our Homes, the staff had communicated with Tom’s social worker on a weekly basis. By now both the social worker and Tom’s mother had noted the difference in his behaviour. How soon, they wondered, before Tom would be ready to leave Cascade?
It was the decsion of his CMHT team that Tom now needed lower supported accommodation. Tom went and viewed his new accommodation and a discharge date was set for him to move on from Cascade in December 2009. But on the day he was due to move out he refused. Simply, Tom found it too hard to cope with this new change, and so the decision for him to leave Cascade was put on hold.
The staff and his key worker now had to work to make the transition from Cascade to his new accommodation less stressful on Tom. Agreement was reached. Tom would start by making short day visits, accompanied by a member of staff. These would gradually build to spending the whole day there - now without support of his key worker. The transition was nearly in place.
Stuart Allen, Manager of Cascade’s Home in Romford says “By the time Tom left Cascade he had been with us for 14 months. He was in a very fragile state when he first arrived. He was a different person when he left. We were very touched when Tom’s mum thanked the staff for all the hard work they had put in with Tom. Yes, it was a team effort, and all the staff had worked very hard. But the real catalyst for change was Tom himself. He should feel very proud of what he has achieved”. |
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