In common with the rest of the NHS, we are trying to find ways of delivering better care that meets the needs of service users and carers and makes the most of research and clinical developments, when resources are pressured and we face a challenging economic climate.
We are committed to working collaboratively with commissioners and other partners in north west London to continue redesigning our services and increasing efficiency, while exploring new options for better care suggested by the Dalton Review and Five Year Forward Plan.
We are working as part of Like Minded, an initiative in North West London in which NHS, local authority and voluntary sector leaders have committed to partner together and with patients, carers and services users to jointly transform mental health and wellbeing services.
Through conversations with service users, carers, GPs and others we work with, we know that what really matters to people with mental health problems is:
- Getting help urgently day or night using a single point of access
- Personalised care, focussed on recovery
- Support to remain at home
- Prevention of illness/self-management
- Support for carers
- Better integration of physical and mental health care.
We have launched a range of schemes to deliver these radical changes, the two high priority ones are:
- Transforming planned and primary mental health care
- Access and urgent care.
Find out more about our plans and progress in the latest Transformation News and the over-arching narrative.
Planned and primary mental health care
Our proposals are to redesign secondary care and further develop primary care mental health services.
The evidence so far from our programme, Shifting Settings of Care, which we introduced in 2013, are that service users benefit from discharge into the community, their feedback is positive, and physical and mental health care are more integrated as a result of GPs’ involvement in delivering the primary care-based service.
So far we have discharged 1,049 service users back into primary care.
The plan is that more people will be discharged into primary care and fewer people will be treated in secondary care, mostly people with significant personality difficulties and psychotic disorders. Community services will be delivered by three recovery teams, one in each borough, and there will be closer links to an enhanced primary mental health service staffed by specialists from our services.
We will further develop GP-based services to handle more complex cases, promote recovery and prevent crisis escalation. We will also create new primary care based roles for a wider range of staff, and increase access to IAPT (improving access to psychological therapy) services. There will be closer working with liaison teams on integrating care for long-term conditions.
Access and urgent care
Alongside this and in response to calls nationally for better access to urgent mental health care we propose a single point of access to services, with the crisis resolution and home treatment teams working together with the service user telephone lines that will operate on a 24/7 basis.
The programme builds on the north-west London mental health strategy, which aims to:
- Reduce reliance on inpatient beds and promote recovery
- Provide care closer to home, where people want it, and focus on primary care
- Improve quality by joining up mental and physical health care
- Make the most of limited money.
We are working in partnership with Central and North West London NHS Foundation Trust, Brent, Ealing, Harrow and Hillingdon clinical commissioning groups (CCGs) and Central London, West London, Hammersmith and Fulham and Hounslow CCGs on this programme.
We are also working with third sector organisations such as Rethink Mental Illness and our local authority colleagues to introduce recovery houses that will enable us to discharge service users from inpatient care earlier or prevent inpatient admissions.
Our first recovery house – Amadeus House in central Ealing is due to open shortly. We are discussing plans for a recovery house in Hounslow with our partner organisations and exploring possible options for Hammersmith & Fulham.
We propose having two admissions wards in Hammersmith & Fulham that will focus on rapid assessment and treatment, in the way that triage services operate in some trusts, with a view to reducing average length of stay on an admissions ward to seven days. We will continue to admit service users to an available bed in any of the boroughs, but they will remain supported by their local care coordinators.
This model of working provides continuity of treatment plans, with minimal disruption to individual service users’ care plans. It has also helped us improve quality by working together as one service with the same standards of care and practice underpinned by a single management structure.
What the changes will mean for patients, carers and staff?
Far more service users will be cared for in the enhanced primary care service than are currently looked after there. Fewer service users will be admitted or cared for in secondary care, and notably far fewer people will spend time on inpatient wards.
For staff, there will be significant changes. Community based teams will become smaller but there will be new roles in primary care services for mental health care workers, peer support workers, consultant psychiatrists and clinical psychologists.
The scale and pace of service transformation is challenging – especially for staff who have been through a great deal of change in recent years. But we know that our staff are dedicated to providing the best possible service and that they understand that we don’t have the luxury of making these changes slowly. We are committed to working with staff in a genuine partnership that empowers staff as we go through this process of change.
These changes will help deliver more recovery-oriented care by providing more alternative services in the community that reflect individual needs. They will help ensure people have better access to physical health care alongside mental health services and there will be clearer pathways of care with better join up of physical and mental health care as well as social care and less duplication of services.
Planned and primary mental health care will create:
- Improved pathways and ways of working
- Better step up and step down care
- Focus on recovery and personalisation
- Links to enabling services
- Better join up between mental and physical healthcare
- Staff linked to GP networks
- A wider range of primary care workforce – mental health workers, peer support workers, consultant psychiatrists and psychologists.
The access and urgent care programme will bring:
- Improved response times for people who need emergency care
- Better access to expert urgent assessment and care to drive up quality
- Improved patient, carer and referrer experience
- Improved localised response at home 24/7
- 24/7 telephone support
- Equality of access to mental health services.
These transformation programmes require inclusive discussion and engagement with a broad range of stakeholders:
- Staff, service users and carers: detailed models of care and skill mixes for services will need to be co-produced with service users, carers, stakeholders and staff needs will be taken into account
- Local authority overview of plans
- Clinical commissioning groups and GP colleagues
- Charity sector partners on development of the recovery houses and roles in delivering services