London s Crisis Care Coordination Function

London s Crisis Care Coordination Function Programme Updates March 2016

Scope of the report The London crisis care coordination function was established in December 2015 to increase transparency and strategic alignment across London s crisis care system. Spanning initiatives at a local, London and national level, this function aims to maximise the effectiveness of pan- London transformation programmes and ensure local activity led by the local concordat implementation groups and Urgent and Emergency Care (UEC) Networks is properly informed and supported by broader transformational work and vice versa. The function also aims to promote cohesion, the recognition of interdependencies and opportunities for collaboration within London s crisis care system going forward. The programmes and governance groups in the coordination function are listed below: NHS England Mental Health Crisis Care Programme Urgent and Emergency Care Programme (including NHS 111) Children and Young People Programme Mental Health Programme London s five Urgent and Emergency Care Networks London s Crisis Concordat Implementation Groups London s Mental Health Partnership Board London s Mental Health Chief Operating Officers Forum Health and Justice Strategic Clinical Network (London) Mental Health Transport Delivery Group NHS England (London) Commissioning Operations See the crisis coordination function scope and reporting structure in Appendix 1. This bi-monthly update is a key aspect of the coordination function, the following information provides a high level update for each of the listed work programmes and governance groups and where available upcoming plans for 2016 are identified. If you have any queries about the coordination function or the information included, please contact england.mentalhealthcrisis@nhs.net. 2

Programme Updates NHS England Mental Health Crisis Care Programme NHS England is designing a five year national crisis and acute mental health programme, setting out the action required to achieve the recommendations outlined in the Crisp Commission report and Mental Health Five Year Forward View, which cover crisis response in both the community and acute settings. In 2016/17, the programme will be focussed on undertaking preparatory national work to identify the national levers and incentives that can support local delivery in anticipation of new money which will be made available for mental health services over the next few years. This will include: Developing access and quality standards for crisis and acute care; Establishing changes to national datasets; Developing the CCG Improvement and Assessment Framework (designed to fit with the forthcoming Sustainability and Transformation Plans, crisis care and out of area transfers measures are included); The development of new payment models for mental health and UEC. Work is already underway towards developing an access and quality standards package for urgent and emergency mental health care. This process is being led by an expert reference group and includes identifying referral to treatment pathways with clinically informed access and quality standards including waiting times. In the view of achieving parity of esteem it has been decided that a four hour timeframe should be implemented to ensure that mental health emergencies are treated with the same urgency and seriousness as physical health emergencies. The ability of services to meet this standard will be monitored in 2017 and refined for implementation from 2018-19. The development of further waiting time standards, including access to liaison mental health services are also in progress. Key contact: Sarah Khan, Deputy Head of Mental Health at NHS England - sarah.khan@nhs.net Urgent and Emergency Care Programme Working with and on behalf of London CCGs, the Urgent and Emergency Care programme is supporting the development of the UEC element of Sustainability and Transformation (STP) plans. London s UEC Networks have submitted their UEC network plan for a plan to the National UEC programme, the London programme collated these and identified commonalities looking at what could be done once for London rather than individually in CCGs or UEC network level. One focus is the development of pan-london clinical pathways and the ambulance pathway has been proposed as an area to scope further. The programme has coordinated and facilitated meetings with relevant groups to progress this work. The programme has also collated and shared information to the UEC networks to help inform the UEC element of Sustainability and Transformation Plans. This information included data from a recent Mental Health Trust bed audit, the self-assessed Emergency Department audit (focussed on the ED specific Mental Health Crisis Commissioning Standards), data outlining 3

London s liaison psychiatry provision (collated by the national programme) and the crisis care I statements. This information will be shared with this coordination function update. Rapid design workshops where pan-london programmes (e.g. workforce programme or crisis care) attend UEC Network meetings are also being scoped. The meetings would allow the individual UEC Networks / STP areas to draw on ongoing and planned pan-london work to inform their direction and vice versa to ensure any pan-london developments support local delivery. Following the development of the London UEC facilities specifications (which include the London mental health crisis commissioning standards) each UEC network will lead on and be responsible for the designation of UEC facilities within their region based on these specifications. To support consistency across London, designation guidance has been developed and endorsed by a number of groups however they remain in draft form until a nationally agreed approach to principles and implementation has been agreed. Key contact: Patrice Donnelly, Programme Lead for Urgent and Emergency Care - patrice.donnelly1@nhs.net Integrated Urgent Care Programme The programme is continually working to improve crisis care support offered by NHS 111. Currently, this includes working with the Mental Health Trusts to reach a position where 111 callhandlers can warm transfer callers to the local Trusts crisis line ensuring callers are directly transferred to someone who is trained to provide further support. An increasing number of mental health services now have their details available on the 111 Directory of Services (DoS) to support referrals between services, the information is also available using a mobile platform and search tool, MiDoS. The tool has been rolled out across a number of London ED s, LAS, Urgent Care Centres (UCCs), GP Out of Hours (GPOOHs) and 111 providers and services are increasingly making use of this new resource. The programme is also preparing to provide capacity information on acute mental health beds across London including Psychiatric Intensive Care Units (PICU). Using the MiDoS tool capacity can be updated in real time and made visible to health care professionals and other agencies as appropriate. Funding was approved in March and mobilisation has commenced to initially trial this approach across the three South London Trusts (SLaM, SWLSTG, Oxleas) to ascertain proof of concept. If the concept is found to be successful there is potential for adopting the same approach to support the capacity management of London s Health Based Places of Safety. The programme is focussed on enabling crisis plans to be accessible across Integrated Urgent and Emergency Care services. Through a Patient Relationship Manager (PRM), innovative cloud technology is being used to retrieve crisis plan information so it can be viewed by 111 clinicians in real-time. The programme is working with a number of crisis plan providers to achieve data integration and the next step is to extract crisis plans and other pertinent data summaries from Mental Health providers to then share with urgent care providers, including GP OOH providers, 111 clinicians and LAS paramedics. Conversations are underway with all of London s Mental Health Trusts, with a particular focus on understanding the technical requirements. 4

A pilot has also been established in North Central and inner North West London to improve the 111 experience for people with suicidal ideation. Mobilisation is underway and an academic evaluation partner is reviewing the service model prior to implementation. Key contact: Eileen Sutton, Programme Lead for Integrated Urgent Care - eileensutton@nhs.net Mental Health Crisis Care Programme Service user engagement With support from Mind and YoungMinds charities, has undertaken an engagement process to understand the experiences and expectations of London service users when faced with a mental health crisis. An online survey and a series of focus groups provided the opportunity for service users to voice their recent experiences of crisis care, including those in emergency departments and health based places of safety. This helped develop a series of I statements for both adults and young people outlining what Londoners expect from the services and agencies involved in their care. The I statements were launched at the crisis care summit and are available to support the crisis care system, ensuring the service user needs and expectations are at the core of any new models of care. Further engagement is planned through a series of co-production workshops to ensure the Health Based Place of Safety specification and s136 pathway (see below) respond to service user expectations. London s Mental Health Crisis Care Summit The crisis care summit was held on 25th February and over 200 stakeholders from across the crisis care system attended including over 20 service users. The summit included a plenary session where updates were provided on national, London and local crisis care work programmes, good practice and innovative models across the crisis care pathway were then shared and discussed in a series of workshops and poster display. The summit also provided delegates with the opportunity to discuss the crisis care vision in each UEC network region and the actions and support required to achieve this. An event report summarising the different presentations and good practice models has been shared and used to support local and pan-london transformational change. The event report, speaker and workshop presentations and feedback from the UEC network discussions are available on the crisis care website and have been shared with UEC networks and crisis concordat group leads. Health Based Place of Safety specification and s136 care pathway The mental health crisis care subgroup continues to lead the development of an all age Health Based Place of Safety (HBPoS) specification and wider section 136 care pathway; both documents outline a minimum standard of care to support a more consistent approach across London. An initial draft of the specification and care pathway has been developed from current guidance, literature and focused discussions with representatives from Acute and Mental Health Trusts and key partners such as the Police, Local Authority and London Ambulance Service. Clinical champions from different London Mental Health Trusts have also supported the development of early drafts to ensure current issues are addressed and frontline staff are bought into the work programme, which will support implementation going forward. 5

The programme team have also engaged with the national crisis care programme and Royal College of Psychiatry to understand the wider context and ensure alignment with national work programmes. The programme team are working with South London and Maudsley (SLaM) Mental Health Trust as they build an integrated section136 suite. SLaM have agreed to pilot the HBPoS specification and evaluation methods are in development to ensure the impact of the specification is well understood. The programme is now entering a period of extensive engagement over the next three months ensuring all relevant stakeholders are involved in the development of both the specification and care pathway, it is anticipated final versions will be available from July. Key contact: Patrice Donnelly, Programme Lead for Urgent and Emergency Care - patrice.donnelly1@nhs.net Children and Young People Programme Children and Young People Crisis Care Programme The out of hours children and young people crisis pathway has been finalised and launched at the crisis care summit (refer to the presentation slides here). The pathway has a key focus on multiagency access to a safety and coping plan agreed and developed by and for the young person. It also calls on providers to have clearly defined protocols and systems in place to respond to mental and physical health care needs as locally as possible. Broader guidance will be developed over the next couple of months to include the out of hours pathway, CYP crisis standards (in line with London s mental health crisis commissioning standards) and the all age Health Based Place of Safety specification, engagement with London s CAMHS transformation groups will help shape this work. Late last year the programme developed recommendations for transforming CYP mental health crisis services; this report was shared with commissioners, partners and clinicians to support the development of CAMHS transformation plans. The report continues to be refined with support from the CYP Mental Health Clinical Leadership Group and the finalised version will be shared across the CYP crisis care system to support local transformation initiatives. See the draft report here. The s Children and Young Person Implementation Board is being re-established and first meeting will occur in March. The scope of the work programme still needs to be defined however an initial focus on London s CAMHS Tier 4 provision has been proposed. Key contact: Steve Ryan, Strategic Lead for CAMHS Transformation - steve.ryan2@nhs.net 6

Mental Health Programme Mental Health Commissioning Programme An event was held in January to establish the mental health commissioner s network and bring together London s mental health commissioners and members of the senior mental health commissioning group to share good practice and learning. Going forward quarterly events and study clubs for each Strategic Planning Group area have been proposed to focus on specific areas within mental health e.g. contracting models and crisis care. A suite of Mental Health dashboards to support strategic commissioning are under development and a contract has been awarded to the NHS Benchmarking Network to develop this work. Drawing on a range of data sources the dashboards will provide regular reports to commissioners and providers on key deliverables focused on particular clinical groups or strategic areas. They will enable greater transparency around data and allow provision and performance comparisons to be made across London s system. Initial discussions suggest the dashboard domains cover areas such as psychosis, CAMHS and Urgent and Emergency Care (which will include measures that are specifically related to crisis care). The specific measures will not be finalised until engagement workshops with stakeholders to design the dashboards have taken place, however it is intended that the measures will align with the existing priorities across HLP s Mental Health and UEC programmes. A review of the approaches to capacity and demand modelling across London is taking place to help co-ordinate and develop mental health demand and capacity models across SPGs. SPGs are sharing both the methodologies used and the results (when received) of the capacity and demand modelling across London. The results may highlight further work and support that is required at a London level. Key contact: Claire Ruiz, Strategic Clinical Networks Senior Project Manager - c.ruiz@nhs.net Urgent and Emergency Care (UEC) Networks: London s UEC Networks are continuing to develop the urgent and emergency care element of Sustainability and Transformation Plans (STPs) due at the end of June. The UEC Networks have responsibility for ensuring mental health crisis care is addressed in the STPs to ensure the provision of mental health crisis care improves and London s mental health crisis commissioning standards are implemented. Initial discussions with UEC networks have shown a drive to understand both the current provision of crisis care services in each region and the new models of care that are required. Key contacts (Network Chairs): North Central London: Mo Abedi Mo.Abedi@enfieldccg.nhs.uk North West London: Mark Spencer mark.spencer@nhs.net North East London: Kate Adams kateadams@doctors.org.uk / Jane Milligan jane.milligan@towerhamletsccg.nhs.uk South West London: Agnelo Fernandes agnelo.fernandes@nhs.net South East London: Angela Bhan angela.bhan@nhs.net 7

London s Crisis Concordat Implementation Groups London s Crisis Concordat Implementation Groups have recently been working to refresh their local concordat action plans and produce progress reports regarding their implementation. The concordat groups were well represented at London s Mental Health Crisis Care Summit; this enabled useful discussions to take place and strengthened connections between multi-agency colleagues to support local work. Following the summit, s Urgent and Emergency Care Programme is supporting alignment between the concordat groups and Urgent and Emergency Care Networks, these connections should prove useful as local plans to improve mental health crisis care progress. Mental Health Partnership Board (MHPB) The Mental Health Partnership Board last met in mid-january, the meeting provided members with an opportunity to hear updates from other London work programmes and review recent performance monitoring information that is collected bi-monthly from Mental Health Trusts and key partners. The data presented in January outlined the reduction of police transport for s136 detainees, the progress LAS are making in responding to s136 transport requests in less than 30 minutes and the downward trend of the use of police custody for a health based place of safety. The Board was also presented with data that showed the increase in the number of incidents involving the police being called to assist hospitals with patient management (however it was discussed that this could be a consequence of raised awareness and more reliable reporting) and a slight increase in the use of s136 across the capital. The next meeting is scheduled for April 13th. Key contact: David Monk, Mental Health Partnership Board Secretariat - david.monk@symmetricpartnership.co.uk Chief Operating Officers (COO) Forum A Mental Health Trust Chief Operating Officers (COO) forum has recently been established to focus on understanding and improving the urgent and crisis care pathway across London. The first meeting took place in early March and concentrated on defining the scope of the work programme going forward, this included an initial proposal to develop a standard operating model for urgent mental healthcare across London. This work is still in the scoping phase whilst further discussions occur with other London work programmes, a more detailed update will be provided in the May crisis coordination function update. Key contacts: Dawn Chamberlain, Chair of London s Chief Operating Officers (COO) Forum - Dawn.Chamberlain@swlstg-tr.nhs.uk / David Monk, Chief Operating Officers (COO) Forum Secretariat - david.monk@symmetricpartnership.co.uk 8

Health and Justice Strategic Clinical Network (HJSCN) Health Needs Assessment (HNA) Data Exercise An HNA is being commissioned in response to the requirement for a clearer understanding of the current activity and services across London s mental health crisis system, including an explicit focus on s136 detentions. This work is being undertaken with the Healthy London Partnership Urgent and Emergency Care programme. The focus areas covered by the HNA include current and projected activity, current service provision of London s HBPoS sites, detailed analysis of the s136 and mental health crisis pathway (this includes transport processes, access to services, management in ED, MHA assessments and inter-agency/inter-organisational working), the interface between services and service-user and staff experiences across the crisis care and s136 pathways. The HNA will include both qualitative and quantitative data. A submitted bid to undertake this work is currently being considered. If approved, this work will commence in April 2016 and is predicted to take 6 months to complete. Street Triage Evaluation NHS England commissioned an evaluation of the nine Street Triage pilots funded by the Department of Health. The London HJSCN team led the evaluation process, commissioning UCL to produce a report which was published this month (March 2016). The report makes several key recommendations including key features to consider when developing or extending Street Triage schemes. Specialist mental health service to support Counter Terrorism Command (SO15) HJSCN are working in partnership with the MET Police s Counter Terrorism Command (SO15) and Barnet Enfield and Haringey (BEH) Mental Health Trust to develop and commission a specialist mental health service diverting those with mental health problems who are at risk of radicalisation or being drawn into terrorist activity towards specialist clinical help. This work is still in early planning stages but it is hoped that it will be operational before the end of the year. Suicide Prevention HJSCN are continuing to work in partnership with the British Transport Police (BTP) and BEH Mental Health Trust to provide a mental health liaison service to BTP officers and those at risk of suicide who present on the rail and underground network. The service will be expanded from April 2016 with additional funding from Network Rail, which will enable mental health staff to accompany police officers when attending hotspot suicide areas. Key contacts: Hong Tan, Head of Health in the Justice System, NHS England (London Region) - hong.tan1@nhs.net / Sinead Dervin, Senior Mental Health Commissioning Manager, Health in the Justice System, NHS England (London Region) - s.dervin@nhs.net 9

Mental Health Transport Programme NHS England and Brent CCG s recent review of the transport pathway for people subject to assessment under the Mental Health Act has now been concluded and a new transport pathway agreed. A stakeholder event was held on 12th February to launch the proposed changes to the current pathway. It has been agreed that from April 2016 LAS will provide a Non-Emergency Transport Service (NETS) for those subject to the MHA. The service will be bookable in advance to reduce current inappropriate time frames when transporting individuals from their homes to hospital. There will be a phased roll out across London between from April to March 2017. A delivery group comprising NHSE (London), Brent CCG and LAS has been established to oversee the roll out and delivery of the transition arrangements for MH Trusts across London. Camden & Islington will be the first boroughs to move to the new provision; the order for the rest of the roll out across London is currently being decided. Key contact: Sinead Dervin, Senior Mental Health Commissioning Manager, Health in the Justice System, NHS England (London Region) - s.dervin@nhs.net NHS England (London) Commissioning Operations Team Since mid-2015 the Commissioning Operations team have held regular Mental Health Stocktake meetings between mental health commissioners and their providers. The discussions at these meetings have focussed on the delivery of new and existing mental health standards, the preparedness of the CCGs and providers to produce operational plans for 2016/17 and the development of Sustainability and Transformation Plans, ensuring mental health remains a priority. The Commissioning Operations team has also been responsible for assuring the CAMHS transformation plans, along with assuring the local delivery of the new early intervention in psychosis access and waiting time standard which comes into effect 1st April. Key contact: Katie Horrell, Commissioning Operations Team, NHS England (London Region) katie.horrell1@nhs.net Conclusion We want to ensure this document provides a useful resource to stakeholders across London s crisis care system. If you have any feedback or comments on the contents and its usefulness, please contact england.mentalhealthcrisis@nhs.net 10

Appendix 1: Crisis Coordination Function Scope and Reporting Structure