Lead CAMHS Nurse
4 days ago
Etwall
Young Crisis Hub Nurse-Led Service Delivery Model Referral, Clinical Leadership, Quality Assurance and Growth Purpose Young Crisis Hub supports young people with complex and challenging needs. As we grow the number of homes and packages we take on, I want a clear structure behind how we do that, one that keeps quality consistent, gives clinical leadership a proper place in how packages are run, and gives us a way to grow without losing control of standards. None of this is starting from nothing. We already know nurses working within our packages are capable of taking real ownership, sorting the practical setup, building relationships, dealing with whatever comes up. What's missing is structure around that, so it can be repeated properly across homes rather than depending on who happens to be involved each time. Being nurse-led is central to what we offer. Between us we've got senior clinical leadership with real experience running mental health services, and the plan is to use that to develop and empower the nurses working directly in our packages, not to parachute a senior-grade nurse into every home, but to give capable nurses the authority and support to lead, with proper oversight around them. 1. Referral to Package Three stages. Stage 1 — Referral comes in. Jordan, as Business Manager, builds the Local Authority relationships and brings referrals in. Where one comes through, Jordan, myself and Ella get involved in the initial discussion understanding the young person's needs, the risks, what the package would need to look like, staffing, what the LA expects, and whether we can actually meet the need safely. Stage 2 — Agreement to proceed. Once the LA and we are both satisfied, the referral moves into setup. This is the formal handover point. Jordan stays responsible for new business and moves on to the next opportunity. I become the main contact for the ongoing setup and delivery, alongside Ella this is communicated to the local authority.. This is deliberate, it stops the Business Manager getting tied into operational management of every package, and it gives the LA a clear point of contact once things move from “will we take this” to “how do we deliver it.” Stage 3 — Package setup. Once the home is identified, a Lead Nurse is allocated and brought into the setup discussions. They don't replace me or Ella in making commercial or organisational decisions, their job is clinical and operational leadership, understanding the package from day one. That means they're across the young person's needs, the LA's expectations, the environment, the risks, the staffing, and what has to be in place before we go live. It also means they can start contributing to staffing decisions and care documentation before the package starts, not after. 2. The Lead Nurse The Lead Nurse is the clinical link between the organisation and the staff team on the ground. The expectation is they take real ownership of the package, not just work their shifts. That includes: ● contributing to staffing decisions and helping identify the right fit for the young person and the team ● supporting the setup of the home ● building relationships with the young person and the professionals around them ● developing the support/care plan ● identifying what's needed clinically and practically from day one ● making sure staff actually understand the plan ● spotting risks and emerging concerns early ● keeping an eye on how the package is progressing overall ● contributing to audits and improvement ● giving regular updates to me and the wider clinical leadership ● identifying training needs ● escalating when they need more support The point is the Lead Nurse should have a view of the whole package, not just their own shifts. We're giving them a genuine leadership role, but making sure they're properly supported to do it. First week of onboarding: once the young person arrives at the property, we want the Lead Nurse on-site for their shifts for that first week. It gives space to build the relationship early and troubleshoot whatever comes up before it becomes a bigger problem. 3. Staffing the Package The Lead Nurse gets involved in building the team once they're allocated. Staffing still takes account of availability, experience and suitability at an organisational level, but the Lead Nurse adds the clinical view, they know the young person and they'll be working alongside whoever's picked. Over time, this should build teams who work well together, rather than assembling something new from scratch every time. Groups with shared experience, developed ways of working, that can be deployed where their experience actually fits. That's the aim, established nurse-led teams we can move into new packages as they come up. We're also building a tiered agency staffing panel as emergency backup, so a gap in our own staffing never becomes a reason a package can't run. The aim is 4 to 5 agencies we know and trust, available at short notice, rather than one or two options we're relying on. 4. How the Service Runs Young Crisis Hub is nurse-led. The clinical leadership behind it is built on mental health nursing experience, including senior clinical leadership and real experience working with children and young people. That needs to show up in how we actually operate day to day. Nurses working in packages need clear access to clinical leadership, and need to know exactly who to go to when something's difficult or outside their experience. To make that real: Monday and Wednesday — 15-minute Lead Nurse check-ins. Current position, immediate priorities, staffing, emerging risks, anything they need support with, actions for the day or week. Short and useful, not another formal meeting. Friday — Team meeting. The wider weekly review — young person updates, incidents, safeguarding, staffing, package developments, audit findings, outstanding actions, training, learning across packages. This is mandatory. If the Lead Nurse can't attend, it's the placement team's responsibility to send a representative — non-attendance isn't an option, this is part of how the organisation communicates and escalates, not just a meeting for nurses. 5. Supervision and Development More responsibility for Lead Nurses has to come with more support behind them. Lead Nurses get regular clinical supervision. I'll be providing this initially, alongside Richard once he's on board. (?) Lead Nurses are, in turn, expected to provide supervision to the support workers in their homes. Supervision isn't just something that happens to Lead Nurses, it cascades down through the structure. Supervision should cover clinical practice, leadership, risk, difficult situations, team relationships, quality, and where the nurse wants to develop next. We also want to build in space for nurses to contribute to how the service develops, not just be supervised, but have a genuine say. The aim is to develop nurses, not just roster them onto shifts. 6. Referral Decision-Making Explore. All referrals come through Jordan first, who establishes with the LA whether it's potentially suitable, needs, risks, placement requirement, staffing needs, current care/risk information, LA expectations. Where relevant, Jordan, myself and Ella are in that initial conversation. At this stage we're not committing to anything, just working out whether it should go further. Assess. Once there's enough information, we look at four things: can we clinically meet the need safely; can we operationally set the package up properly; can we staff it, including nursing capacity; and is the proposed home/environment actually right for this young person and their risks. We think about what's needed now and what's needed to sustain it, not just to start it. Decide. Jordan, myself and Ella assess the referral and agree a recommendation. The final decision to accept or decline sits with Mike, as CEO. He can decline or pause a referral the operational team has recommended proceeding with, where he judges it's a distraction or not in the group's best interests as a whole. GREEN — ACCEPT We proceed. Confirm with the LA, confirm the home, identify the staffing model, allocate a Lead Nurse, begin setup, agree mobilisation. Responsibility shifts from Jordan's business development into package delivery. AMBER — CLARIFY The referral might be right, but something's missing, more clinical information, staffing not confirmed, the home needs changes, more discussion needed with the LA. Home readiness shouldn't be something we discover at this point, homes are audited proactively ahead of referrals so generic gaps are already closed, and a tiered agency staffing panel is in place as backup where our own staffing can't be confirmed straight away. It stays open, not accepted. Every open item gets an owner and a deadline, and it comes back to the decision point once resolved. RED — DECLINE Case by case, but there are firmer no's, this covers where the need is outside what we can safely deliver, the risks can't be managed in the proposed setting, or the LA's requirements genuinely can't be met. This gets recorded clearly. 7. Package Goes Live Once ready, the Lead Nurse and their team start delivering. The Lead Nurse is the day-to-day clinical leadership point. Myself, Ella and the wider clinical leadership stay involved, for escalation, complex risk decisions, professional support, supervision, quality oversight, governance. The Lead Nurse leads the package. They don't carry it alone. 8. Initial Governance Baseline Every new home gets a baseline audit within the first week of placement, to identify any areas of need early and give us an action plan to work from rather than finding gaps months in. Two audits, which complement each other, one tells us whether the systems and environment are right, the other tells us whether the practice and relationships are right. Alongside the new-placement baseline, we're also auditing every existing home proactively, not waiting for the next referral to find out something isn't ready. Health, Care & Environment (see Appendix A) Health and safety, medication, infection control, safeguarding, documentation, staffing, training, care planning, environment, records, governance. Mapped against relevant CQC/Ofsted expectations. Communication & Therapeutic Practice (see Appendix B) Quality of staff interaction, therapeutic communication, consistency, relational practice, recording of interactions, whether care plans actually show up in day-to-day practice. Mapped against relevant CAMHS/clinical standards. Both audits already exist and ready to be rolled out, they're not something we still need to build, they're attached as appendices to this document. 9. From Baseline to Action Plan The audits produce an action plan for each home: what's working, what's missing, what needs to improve, who owns it, by when, and what evidence shows it's done. This baseline then informs staff training, supervision, care planning, future audits, and decisions about where more support is needed. Routine audits continue at agreed intervals so we've got a consistent way of checking whether standards are being kept up and whether things are actually improving, not just checked off once. 10. Ongoing Governance Once live, the package moves into the normal governance cycle: Lead Nurse, team, senior clinical support, governance, improvement, review. That means weekly Lead Nurse updates, the Monday/Wednesday check-ins, the Friday meeting, supervision, care plan and risk review, training, routine audits, escalation where needed, and review of actions from previous audits. How much oversight a package needs can flex up or down depending on risk and stability, this isn't one fixed level of scrutiny regardless of how settled things are. 11. Standing Nurse-Led Teams Longer term, the aim is established teams around experienced Lead Nurses — people who've worked together, know how each other operates, and have built experience with particular kinds of presentation. These teams should get more self-sufficient over time while staying connected to the wider clinical structure. That means we're not starting from scratch every time a new package comes in — we can draw on teams who already know how to work together. In time, this could mean an experienced nurse taking oversight across more than one package in the same area, backed by staff within each individual home. As the service develops, it may also open up wider leadership routes — Senior/Area Clinical Lead, potentially Registered Manager responsibility. That's what makes the Band 6/7 point work properly, we're not trying to have senior-grade nurses in every home. We're building a structure where capable nurses get developed and empowered to operate at a higher level, with senior clinical leadership around them. 12. Growth and Capacity Growth follows quality. A new package only gets accepted where we can show: the young person's needs are understood, the environment's suitable, it can be safely staffed, a Lead Nurse can be identified, the care arrangements can be set up, governance is in place, and we've got the capacity to actually oversee it properly. The cycle: good package, good care, good outcomes, good reputation, stronger referrals, sustainable growth. We're not there in terms of hitting any kind of capacity ceiling yet — this is a short-to-medium term structure, and we'll look at capacity limits properly if and when we're actually close to them. The standard we're setting is standardised: what we expect in terms of CQC and Ofsted compliance in the environment and our overall approach is consistent across every home. What flexes is the therapeutic offer — the interventions, the communication approach — because that has to be adaptive and person-centred by nature. Consistent standards, individual care. 13. Derby — First Live Implementation Derby is our first live test of this model. What that means in practice: the formal structure isn't fully in place yet. The Monday/Wednesday/Friday meeting structure goes live from next week. But myself and the Lead Nurse are already working collaboratively to develop and support the package, and supervision is already being arranged. Derby is where the model gets tested and adapted in real time. The lessons from it — including the value of having the Lead Nurse on-site for that first week — feed directly back into this document. Once this is properly bedded in on Derby, the same approach applies to future packages. Immediate Priorities ● Agree the model with Mike and the wider leadership team ● Confirm the referral handover process and responsibilities ● Confirm the Lead Nurse role ● Roll out the Monday/Wednesday check-ins and Friday meeting from next week ● Continue booking in supervision with Lead Nurses as they come on board ● Attach the baseline audits (Appendix A and B) to every new package ● Continue monitoring Derby and feed the learning back into this model ● Apply the model to the next
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