A member of a Norfolk Crisis Resolution & Home Treatment (CRHT) team at Norfolk & Suffolk NHS Foundation Trust (NSFT) writes:
“One of our senior managers was heard the other day asking: “How come a crisis team worker can only do five visits in a day?”
Let’s look at the facts:
We cover an area from Wells in the far north to Diss in the far south and NSFT is too tight to give us parking permits for visits in Norwich, making us spend ages finding parking spaces.
Many of our Home Treatment visits involve regular risk reviews. So how long does it take to carry out a good risk assessment? What makes a good risk assessment? Certainly it is not just completing a tick-box form on a computer.
Firstly, it involves talking and listening to the patient: spending time to address some difficult issues. It helps if you know the patient and have a relationship based on trust.
Secondly, talking to relatives: almost every inquiry into tragic events highlights the fact that the views of relatives are ignored.
Thirdly, talking to other agencies who may be involved in someone’s care and talking to colleagues in your ‘multi-disciplinary’ team.
Fourthly, gathering information from past and current notes. If you’ve ever had access to psychiatric notes, you will know how difficult it is to find relevant information. No chronology is kept of serious incidents, life events, treatments, histories, crisis plans, etc. It is also rare to find detailed accounts of serious incidents. Completing the risk assessment involves writing this all up on a computer system, finding a quiet space in the office – not that easy in the days of hot-desking.
Finally, it would help if we all worked from the same IT system.
When staff levels are cut, the standard of risk assessments inevitably falls; however, when something goes wrong, who is held to account?”