NTW Review of the Urgent Mental Health Pathway:
About the report, and our response to it.
The review of the urgent mental health pathway was commissioned by the Healthier Lancashire and South Cumbria Integrated Care System in October 2018 following a significant increase in waiting times for urgent mental health services across Lancashire and South Cumbria. The increase has led to people waiting too long for admission to hospital and has also had an impact on the ambulance service and police.
The results of the review, which was carried out independently by Northumberland, Tyne and Wear NHS Foundation Trust, are now available and the full report can be accessed here.
There is a firm commitment to take action from Lancashire Care and the Healthier Lancashire and South Cumbria Integrated Care System, which is a partnership of NHS, police, local authority, public sector and community and charitable organisations.
Lancashire Care’s new Chief Executive, Caroline Donovan said in response to the report: “We welcome this report and its recommendations even though it makes for very difficult reading for all of us involved in the delivery of mental health care. We are so sorry that our services have, in many instances, fallen way short of what we aspire to, and that our patients and families deserve.
“We offer a heartfelt thanks to the service users and carers and our own, and other staff, who have participated in this review and given their valuable feedback with such candour – it is a great help in telling us where we have gone wrong have what we need to do. The vast majority of our staff are dedicated, professional and compassionate. They are the life blood of Lancashire Care Foundation Trust and we will work with them, listen to them and support them so that they can deliver our vision, ‘high quality care in the right place, at the right time, every time’. The CQC found them to be caring, right across the acute care pathway.”
“I am recently appointed to this position and I understand and respect the responsibility attached to it. I am personally committed to making Lancashire Care Foundation Trust an outstanding provider of integrated care. This is a long term goal and it will take time, effort and the extra investment we will receive as part of the national strategy for mental health. This will support the improvement we must see.”
Below, you can find details of the urgent actions that the Trust will be taking in response to the recommendations of the report. Updates will be provided about how these programmes of work are progressing.
Improvement Partnership with Northumberland Tyne and Wear
The Trust will continue to work closely with NTW to transform its services and drive up quality standards with the involvement of people that use services, commissioners and wider partners. This will serve to ensure that our mental health services are working as effectively and efficiently as possible and providing the highest standards of care that is evidence based. It will also identify any gaps in services in order to produce plans to address these gaps. A key programme of work that is already on-going with AQuA is to improve the care and treatment for people with a diagnosis of personality disorder and this will continue as part of the wider transformation programme.
Involvement and Co-Production
We are committed to involving the people that use our services in how they are delivered and want to ensure that this is co-produced. We will be involving people that use services in improving how services are accessed and also enhancing how people are involved in developing their own care plans.
Our staff will also play a key role in supporting the Trust’s quality improvement and transformation programmes and will be fully involved in designing and delivering the required improvements. From June, we will be using Listening Into Action as new way of engaging all employees in a meaningful way to co-produce and deliver positive changes together.
People with mental health problems need a range of support and the input of partners is key to ensuring that this in place. We will work collectively with the Integrated Care System to ensure that there is a plan in place to better support people with mental health problems in Lancashire and South Cumbria. This will include:
- Working with police colleagues to explore the role of police liaison officer
- Increasing relationships with the voluntary sector
- Building on the partnerships that we have with local authority teams including Associate Mental Health Practitioners and social workers
- Working with CCGs to put new developments in place such as street triage and support for people that frequently experience mental health crisis and present at A&E.
- Collaborating with acute sector colleagues to provide training for A&E staff to support people with mental illness. We will also ensure that we have appropriate environments for A&E employees and mental health liaison employees where they can work together to support people who have presented in A&E due to mental illness
Keeping People Safe and Managing Risk
We will be adopting a home first approach, whereby as far as possible people are cared for in their own homes with the input of specialist teams. Within our services we will aim to ensure that we are not putting unnecessary restrictions place and getting the balance right in terms of keeping people safe and empowering them to take the steps needed towards recovery. For some people in inpatient settings, this will mean supporting them to plan leave from the wards in readiness for discharge. We already do this but we are going to look at how we can do this more effectively.
These specialist teams work alongside teams in A&E to provide assessment for people who present at A&E in mental health crisis. Money from the mental health investment standard will be used to increase staffing in these teams and ensure that there is enough capacity to meet demand patterns. We are also re-locating some of these teams so that they are based nearer to A&E departments to ensure that they can respond quickly when people are in mental health crisis.
In Blackpool, Fylde and Wyre the Trust is working with the police and ambulance service to provide a team that responds to people in crisis. The Psynergy team works seven days a week from 4pm until midnight (identified as key time of day when people are requesting support due to mental health.) The pilot has been extended having proved to be very effective in supporting people in crisis and avoiding the need for attendance at A&E or s136 where possible.
Since the project launched in December 2018, 570 incidents have been attended with only 20 section 136 detentions arising from these contacts. 195 cases were given advice only at point of contact instead of a transfer to A&E or a section 136 (as at April 2019.)
We are going to evaluate this pilot with partners and develop a plan to roll out street triage across Lancashire.
Section 136/place of safety
A new staffing model will be put in place to ensure that there is enough resource to respond to the increase in people being brought to a place of safety by the police and ambulance. We are also going to work with the police to ensure that we have the right processes in place to make sure that detentions are appropriate and that people are being supported in the right place.
There is a group of patients that regularly present at A&E departments in crisis. We have worked with our partners to develop shared care plans with a named lead professional. We are now going to establish a frequent attenders clinical team to provide dedicated support for this group of patients.
We will introduce a new tool which will enable us to manage our beds more effectively by providing a live overview of bed availability across the Trust. We are going to review the process for admissions to our beds and are also undertaking work to ensure that discharge is planned early from the point of admission. We are also putting extra steps in place to prevent delayed discharges.
The Trust has 2 assessment wards across Lancashire that provide a safe space in an inpatient setting where people are assessed and supported during a short stay. We are going to strengthen the clinical leadership on these wards and review how long patients are staying in these wards for. This will ensure that people don’t stay longer than required which will support their recovery and long term outcomes whist freeing up space for people that need to come in to be assessed.
Integrated discharge teams are in place and are increasingly working with social care and wider partners to ensure that arrangements are in place for funding, support and placements that may be required upon discharge so that people can go home as soon as they are ready. This is better for the patient in terms of ensuring their recovery and better outcomes. Discharging people in a timely way will also increase the availability of beds for people that need to come into hospital. This will serve to reduce 12 hour breaches; we absolutely do not want our patients to have to wait an unacceptable amount of time for admission to a bed. By ensuring that people can be discharged as soon as they are ready this will free beds for people that need to come in.
At present there are no short term rehabilitation beds or learning disability beds, therefore people with these needs are currently cared for on the Trust’s acute wards. Going forward we are discussing with commissioners the potential for these specialist beds to be provided which will result in better care for these groups of patients. It will also free up beds on our acute wards so that there is availability for people needing an admission.
Community Mental Health Teams
We are going to invest in increasing the staffing in these teams to increase the support that is available to people in the community.
Home Treatment Teams
We have already extended the operating hours of our home treatment teams to 24/7 so that people can be supported in their own homes. We are also going to review and strengthen how these teams work so that they operate more effectively.
Acute Mental Health
Mental Health Decision Units
The Trust has mental health decision units across the county, these facilities provide a safe place where people in mental health crisis can be assessed and supported. For some people this may mean admission to a bed, for others it would be a package of care provided by their local community team.
These facilities will not be part of our long term solution, however in the short term we will make the best use of this resource. We are going to review how the MHDUs currently work so that over the next 12 months they are able to support a broader range of people and operate more efficiently. Staffing will also be enhanced in those units where there are high levels of demand, for example in Blackpool.
Mapping of existing services is going to be undertaken by the Integrated Care System so that gaps in provision can be identified and addressed.
Mental Health Investment Standard
The Trust has worked with commissioners to increase investment in mental health, in line with national guidance, to improve frontline mental health services in Lancashire and South Cumbria. The investment will go into A&E liaison, mental health decision units, crisis/home treatment and community mental health teams.
We are going to enhance the leadership across our inpatient wards to ensure that they are working as effectively and efficiently as possible. We are going to review the number of beds that we have for each locality to ensure that it is appropriate in terms of the need for that area as this varies across the county. We will continue to work with partners to ensure that in the long term there is the provision of specialist beds including rehabilitation, learning disability, assessment and treatment beds that are not currently commissioned.