- Set up urgent mental health care hub in 11 days
- Worked closely with system partners
- Helped more patients stay in the community
Leicestershire Partnership NHS Trust is a mental health and community services integrated trust, which covers the whole of Leicestershire and Rutland, employing around 6,800 staff.
At the start of the coronavirus pandemic, mental health trusts across the country received a letter from Claire Murdoch, NHS England and Improvement national director for mental health, asking if they could divert as many patients as possible from A&E in order to increase capacity.
"We sort of took that and made it our own really", says Saskya Falope, mental health urgent care hub team manager. The trust set up an urgent mental health care hub in around 11 days in the hope that they could divert patients from A&E, but it soon became much more than that.
Setting up the hub
Staffing the project was the first hurdle the trust faced, but they were able to put together a multidisciplinary team of staff to support the service. "We borrowed and begged staff from our crisis teams, liaison teams that were already working in mental health, staff from our acute inpatient wards and junior doctors from other services," explains Saskya, "it was really a mixed model."
The new team hadn't worked together before, so they took some time to consider their shared objective for the hub. They wanted to not only divert patients from A&E, but also to see if they could care for patients who would ordinarily have needed treatment from A&E staff, such as those who might have self-harmed or taken minor overdoses.
"We wanted to care for those patients in a sort of bespoke environment. We started collecting patient feedback and ideas from very early on", Saskya says, "we asked patients what do you like or not like about A&E? How can we do it differently?" The hub was based on the trust's acute mental health hospital site, where the space was freed up as a result of virtual outpatient appointments. Many patients made comments about the bright A&E lighting which some in mental health crisis can find distressing, and the trust was able to make changes to the hub environment in order to ensure it was as safe and comfortable as possible for its patients.
A system-working approach
The team worked closely with partners in the ambulance service, A&E, and at the acute trust to set up an idea of what they wanted it to look like. It's an all-age hub, so they worked closely with Child and Adolescent Mental Health Services (CAHMS) colleagues too. They then went about creating a standard operating procedure around how it would work.
"It's just blossomed really into something that I don't think we would have envisioned at the start. The team have really taken on a can-do approach and little hurdles that we come across we haven’t let them set us back, we've pushed forward." Saskya explains. Most of the referrals to the hub come from the ambulance service, so it's no longer just a diversion service as patients aren’t having to go to A&E first. This has greatly increased capacity and the A&E department has been able to make structural changes to the space as a result to meet infection control requirements during COVID-19.
The urgent care hub gave the trust the opportunity to take a more holistic approach, keeping patients somewhere safe while they spoke to the social care services and arranged temporary accommodation, things that A&E colleagues did not have the time or resources to sort.
"It has allowed us to think differently about how we use our resources and has allowed partnerships to really come together, using everybody's expertise rather than working in silos." says Saskya. "Working with colleagues in social care, housing and acute trusts, gets patients the right care that they need rather than the fallback always being A&E in an acute hospital."
Better outcomes for people
The pandemic has seen an increased number of people seeking support for their mental health, many for the first time. Angela explains that many people seeking help are very acutely unwell: "in early intervention psychosis services we have seen a doubling of need." Saskya adds that more people than expected have been admitted under the Mental Health Act. This has underscored the need for a person-centred approach to meeting people’s needs.
Chief executive Angela Hillery offers her reflection on the opportunity they have had to take a new approach, "The COVID experience has given us the acceleration around local systems because in the past we would have waited to be commissioned to provide it, whereas this has actually provided us with the power to act. It's not just that it's a response to COVID, it’s actually about improving opportunities to signpost and get patients to the right place."
This new approach has helped more patients stay in the community. Saskya explains: "If you look nationally, people who present in acute crises to A&E, 20% of those will need acute mental health beds. Ours is at about 2%. The hospital environment is a last resort. Some people need that little bit of time and someone to talk to, so that they feel supported and there’s a plan for them."
The approach has also helped them reduce their out of area placements to zero, and that helps ensure more money can be spent on investing in local services.
And certainly, the response to the hub speaks volumes for its future. "The patient feedback for me has been the biggest win. We ask around 85% of our patients to give feedback, and they've all been positive about their experience, not just in comparison to A&E, but just in general." says Saskya.
The future of the hub
As the NHS faces the winter months, Angela is keen for the hub to continue its work. "We want to support our acute colleagues, to be able to manage winter as well," she explains, "This hub represents a huge opportunity not only for winter but also for future mental health models." The economic climate also means they are expecting an increase in the level of need: "we know that the recession in 2008 increased the suicide rate. So we're expecting an increase and we will do some work around capacity. Mental health is not easy to predict".
But strong leadership has helped them take a new approach, and plan to develop the service further. Saskya reflects on the importance of senior support for the work: "the biggest thing [that helps] is to listen to your frontline clinicians and patients". Angela agrees, saying "absolutely, empower young leaders. But also be ambitious, for your patients and your population".