Access to Mental Health Care Assessment and Treatment - General. Document author Assured by Review cycle. Quality and Safety Committee

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1 Bard library reference Dcument authr Assured by Review cycle P114 Acting Directr f Operatins Quality and Safety Cmmittee 3 years This dcument is versin cntrlled. The master cpy is n Ourspace. Once printed, this dcument culd becme ut f date. Check Ourspace fr the latest versin. Cntents 1. Intrductin Plicy statement and service standards Service prcesses: unpacking the standards Referrals Bking appintments Nn-attendance utcmes Assessment Internal Service Transfer Planned Treatment End/Onward Referral Implementatin: Rles and Respnsibilities Mnitring References and Related Plicies...5 Expiry date 20/05/2019 Versin N:3.0 Page 1 f 6

2 1. Intrductin This AWP dcument sets ut service standards fr service users referred int the Trust, ensuring reasnableness and fair management fr all. This general access plicy is supprted by mre detailed Standard Operating Prcedures (SOPs) fr each cmpnent f ur services which prvide an access pint t secndary care. These bring tgether and align with CPA plicy, service specificatin and were develped in cnsultatin with service users, carers and PCT/GP cmmissiners. 2. Plicy statement and service standards The AWP Plicy Statement is that we will prvide a range f services that are delivered in the right place, at the right time, are persnalised t the needs f the individual and prmte the greatest pssible ease f access fr first time service users and thse wh are re-referred. The Trust is cmmitted t ensuring equality f access t ur services and will endeavur t ensure that arrangements are made t supprt thse individuals wh have a cmmunicatin r supprt need fr example fr thse wh cmmunicate thrugh British Sign Language r fr where English is nt their first language. We recgnise that we may need t make reasnable adjustments fr thse wh have a disability in rder that they are able t access the services we prvide. In pursuit f this, AWP has agreed with the Cmmissiners f its services a series f access standards. In mst cases, the standards are applicable acrss all six Cmmissining areas within the Trust, where this is nt the case, lcal variatin is referenced belw. Referral t assessment (RTA); - Emergency assessments t cmmence within 4 hurs (delivered by Intensive teams, via 24/7 services) - Urgent / rutine assessments by Primary Care Liaisn teams t be priritised using clinical triage, with a maximum wait between referral and assessment f 28 days (i.e. 4 weeks). Variatin in Swindn lcality, where the Primary Care Liaisn Service ffer assessment within 24 hurs (fr thse service users that wish t be seen that quickly) - Urgent / rutine assessments by Memry teams t be priritised using clinical triage, with a maximum wait between referral and assessment f 28 days (i.e. 4 weeks). Referral t treatment (RTT); - IAPT services: Natinal target t achieve 75% f treatment starts within 6 weeks Natinal target t achieve 95% f treatment starts within 18 weeks - Early Interventin fr peple with suspected first episde psychsis: Natinal target t achieve 50% f treatment starts within 2 weeks, where treatment is defined as a NICE cmpliant interventin - Secndary Mental Health services: Lcal target t achieve 95% f treatment starts within 18 weeks f referral 3. Service prcesses: unpacking the standards 3.1 Referrals Receipt f any valid referrals (frm any care prfessinal r service permitted by an English NHS Cmmissiner (e.g. CCG, GP, Lcal Authrity, ther Healthcare prvider, r assigned third Expiry date 20/05/2019 Versin N:3.0 Page 2 f 6

3 r private sectr agent) and any self-referral where there is a lcal agreement fr such arrangements is the pint at which the waiting time starts. All referrals will be lgged nt apprpriate electrnic recrd system (e.g. RiO, IAPTUS) n the day f receipt. If a referral is nt accepted as legitimate the cnsidered view f the team and the reasns fr it shuld be ntified t the referrer during the telephne screening, and shuld be fllwed up with cnfirmatin in writing within 48 hurs (by r letter as per agreed peratinal practice with GPs). 3.2 Bking appintments It is gd practice that appintments shuld, wherever pssible, be arranged in persn with individuals. In additin, a minimum ffer f 2 appintments n different days, with at least 3 weeks ntice, shuld be prvided. Hwever, clinical needs may dictate that such a ntice perid may nt be apprpriate even fr rutine referrals, with assessments cmmenced within days f referral, nt weeks. The three week rule and ffer f appintment chices are tests f reasnableness t avid situatins where individuals feel they have been ffered an appintment that is t sn, r difficult t attend due t existing cmmitments. While these specific tests may nt always be achievable, it is fr all staff and managers t ensure that this spirit f fairness is bserved in hw appintments are ffered and bked. 4. Nn-attendance utcmes If an individual des nt attend (DNA) an agreed assessment r subsequent appintment, all effrts shuld be made t find suitable alternatives using the principles in 3.2. If there is further nn-attendance, effrts shuld be made t bk a new and attended appintment. As a minimum this will be ne attempt fr rutine/lw risk referrals, but mre fr higher risk grups such as thse referred t Crisis Services. It is expected that in all but very exceptinal circumstances any persn accepted fr a crisis r urgent assessment will be seen befre clsing the referral. Individual SOPs set ut requirements fr different services. Did nt attend (DNA), is defined as where a client fails t attend an appintment and prvides n ntice that they will nt be able t attend. (ref 1) Where an individual DNAs 2 successive appintments and where there has been n cntact between the events (frm the time f the first DNA, t the end f the 48 ur windw after the secnd DNA) a letter must be sent t the GP ntifying them f the DNAs within 48 hurs f the secnd DNA. This letter shuld be imprted nt RIO within 48 hurs f the secnd DNA. The definitin f a cntact in these circumstances is where there has been cntact with the service user f significant value as per RiO clinical manual guidance fr recrding cntacts and telephne calls. Telephne cntacts fr the purpse f arranging appintments d nt cunt as a cntact in these circumstances. It is a clinical decisin, based n a clinical risk assessment using all available infrmatin, t clse a referral. Hwever, if there is still failure t attend fairly scheduled and apprpriately cmmunicated appintments the referral shuld be clsed, and the referrer and individual infrmed, unless there are cmpelling clinical r access t service reasns fr further attempts t engage. In all cases, the principle shuld als be t discuss with the referrer, prir t the decisin, where this is pssible. A letter clsing the referral shuld be sent in all cases, t the individual and referrer, setting ut the prcess undertaken t date t secure an appintment, any relevant clinical/assessment infrmatin gathered, alternative surces f supprt, prcess fr re-referral and setting ut the reasns fr the discharge. This letter shuld be imprted nt RiO within 48 hurs f the decisin t discharge and befre the referral is clsed. Where an individual cancels and re-schedules appintments the principles abve d nt apply. Expiry date 20/05/2019 Versin N:3.0 Page 3 f 6

4 Where the Trust cancels appintments, due t unfreseen circumstances, the principles in ref 1 must be applied. 5. Assessment Mental Health Liaisn Services (based in Primary Care, Acute Trusts, Emergency Departments and Care Hmes) will cmmence initial face t face assessment. This will establish whether the individual will be accepted fr shrt-term interventins by the liaisn teams r whether a mre specialist assessment is required fr secndary, lnger-term treatment. This latter stage f assessment will be in the secndary team and t develp an apprpriate individual care plan frm a range f evidence-based interventins. Practitiners at bth the initial and subsequent care planning assessments will brker all elements f assessment and care packages, as part f a single integrated assessment prcess. This includes wrking acrss strategic business units (e.g. where the individual presents with c-mrbidities). Where, fllwing initial assessment, an individual is nt indicated fr services (either Liaisn r Secndary Care) the case must be clsed within 2 weeks f assessment. N CPA status r care cluster shuld be applied. The referral shuld either be transferred t a mre apprpriate service r returned t the referrer. A letter clsing the referral and summarising the utcme f the assessment, tgether with any frmulatin, advice and signpsting shuld be sent t the GP and service user. It is best practice that this be written t the individual and cpied t the GP. A shrt summary f this needs t be sent within 48 hurs f the discharge date with any fuller clinical reprts sent n later than 2 weeks. This referral shuld then be clsed n RiO. 6. Internal Service Transfer Peridically, service users mve between gegraphic areas r between service specialties (e.g. where the balance f care indicates care crdinatin wuld be mre effectively managed by an alternative service). Once indicated fr transfer, this will take place within 2 weeks unless agreed therwise fr specific clinical r service user cnsideratins. Where this is the case, transfer will be planned and managed in a sensitive way taking in t accunt individual service user needs. The existing service care crdinatr will be respnsible fr management f the transfer and ensuring all cmmunicatin is clear t the user, referrer and receiving service. As per CPA plicy, care will remain with the riginating team, until it has been fficially transferred thrugh a CPA review r a cmprehensive handver meeting. 7. Planned Treatment End/Onward Referral All pen cases shuld be reviewed systematically and regularly in line with the Trust s CPA and Risk Plicies, accrding t need and as part f the team s case management prcesses. Where treatment is cnsidered t have been cmpleted and a discharge is planned, this shuld be dne in partnership with the service user (carer, where apprpriate) and referrer. A full discharge plan will be negtiated with the service user in advance, and the planned discharge date will give adequate time t prepare the service user, carer and any receiving service (where apprpriate) fr this transitin. A full discharge letter will be issued t the referrer and service user within 48 hurs f the actual discharge date and imprted t RiO. 8. Implementatin: Rles and Respnsibilities Within the parameters defined in this Plicy, SBUs have develped Standard Operating Prcedures that set ut hw the General Plicy fr Access will be adhered t. They cntextualise it t the specific service type including any service-specific service standards (e.g. Expiry date 20/05/2019 Versin N:3.0 Page 4 f 6

5 fr specialty teams under the NSF), any exclusins r deviatins, within the clinical r peratinal ratinale. An audit prgramme, arranged by the Directr f Nursing Cmpliance and Quality spnsred by the Deputy Directr f Operatins, will give assurance that the principals and spirit f this Plicy are being implemented acrss all teams. The Deputy Directr f Operatins will ensure that perfrmance data is available at team, SBU, area and PCT level t supprt teams t mnitr their delivery f the range f indicatrs cntained in this Plicy. This will be in the frm f ReprtZne Perfrmance Reprts (t all teams and DUs), mnthly balanced screcards and quarterly activity reprts, available thrugh Ourspace. The Bard and its Executive Management Team has a duty t satisfy itself that this Plicy is being implemented in full. Screcard and dashbard indicatrs directly relate t these, which frms a systematic and n-ging surveillance apprach. They may als require bespke reprts frm the Directr f Operatins and independent assurance reprts frm the Directr f Nursing and Quality and the Deputy Directr f Operatins. The Directr f Operatins is accuntable fr ensuring that all Delivery Unit staff (frm Directr t frntline wrker) are aware f this plicy, key targets and have rbust plans in place that ensure delivery. Critically, this plicy must be understd and peratinalised; and evidenced in the audit prgramme as well as in delivery f key indicatrs f service quality. 9. Mnitring The Trust has in place mnitring reprts that allw managers t view in real time their cmpliance with the varius standards utlined in sectin 2 abve. This infrmatin is reprted mnthly t bth the AWP Trust Bard and Cmmissiners. 10. References and Related Plicies NICE Clinical Guideline 178, (2014). Psychsis and schizphrenia in adults: preventin and management: Care Prgramme Apprach and Risk Plicy: Trust Servies Standard Operating Prcedures fr Access: Expiry date 20/05/2019 Versin N:3.0 Page 5 f 6

6 Versin Histry Versin Date Revisin descriptin Editr Status May 2010 Final apprved versin after discussin at Quality Health Gvernance Cmmittee Oct 2011 Apprved by Quality and Effectiveness Management Grup fr minr amendments and inclusin f standards fr serial DNA GP letters. RTT guidance als updated Nv 2011 Revisins fllwing discussin and agreement at the Perfrmance Slutins Grup Plicy Review Sub- Grup, Feb 2012 Final revisins fllwing discussin and agreement at the Perfrmance Slutins Grup Plicy Review Sub- Grup, May 2012 Including amendments as apprved by Quality & Effectiveness Management Grup July 2012 Final apprved versin including agreed amendments as apprved at Quality and Healthcare Gvernance Cmmittee ART ATw GM GM Atw Apprved Apprved. Apprved. Apprved. Apprved. Apprved May 2016 Apprved Quality and Standards Cmmittee Acting Directr f Operatins Apprved Expiry date 20/05/2019 Versin N:3.0 Page 6 f 6