The primary aims of NTW's Initial Response Team (IRT) were to offer an efficient and clinically effective 24/7 response, through a single point of access, to urgent telephone requests for help from people of all ages and conditions, and to offer triage & routing or signposting to appropriate services within and without NTW. Further still, the implementation was to reduce clinician administration burden in the existing crisis response & home treatment teams, and Community treatment teams freeing time to care for service users with the greatest need, while also improving personal and clinical outcomes for people in crisis with mental ill health by reducing harm and premature mortality, improving safety and patient experience. Urgent referrals are triaged within Hours of initial referral and all planned care referrals are triaged within 5 days and seen within 4 weeks of initial referral.
Co-Production
From start: No
During process: Yes
In evaluation: No
Evaluation
Peer: Yes
Academic: No
PP Collaborative: No
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Andrea Malton-Earl - Clinical Lead IRS
What We Did
Northumberland, Tyne and Wear NHS Foundation Trust (NTW) is one of the largest Mental health and disability Trusts in England serving a population of approx 1.4 million and providing services across an area totalling 2,200 square miles.
The primary aims of NTW’s Initial Response Team (IRT) were to offer an efficient and clinically effective 24/7 response, through a single point of access, to urgent telephone requests for help from people of all ages and conditions, and to offer triage & routing or signposting to appropriate services within and without NTW.
Further still, the implementation was to reduce clinician administration burden in the existing crisis response & home treatment teams, and Community treatment teams; freeing time to care for service users with the greatest need, while also improving personal and clinical outcomes for people in crisis with mental ill health by reducing harm and premature mortality, improving safety and patient experience. Urgent referrals are triaged within Hours of initial referral and all planned care referrals are triaged within 5 days and seen within 4 weeks of initial referral.
Wider Support
From April 2013 Sunderland CCG & South Tyneside CCG have continued the collaborative support for this development and secured on-going funding for the service transformation to further evaluate its relationship to 111, the impact on other community pathways and further development of the call centre technology. Neighbouring CCGs are now also in discussion about commissioning the IRT. Northumberland is currently rolling out the model to include non urgent with support and guidance from the Sunderland team.
Co-Production
We have worked closely with local services and through receiving carer feedback need to improve access to mental health services where there was an urgent request for help became clear through extensive engagement with service users, families and referrers across Sunderland, South Tyneside & Gateshead through 2010/12. This work was the result of a whole system engagement & service transformation about mental health care, led by the Commissioners, which provided the means to develop a wide range of improvements, one of which is the Initial Response Team.
Working collaboratively with Commissioners and other partners the transformation of access to NTW for urgent referrals was implemented and tested as a pilot in Sunderland, developing telephone triage and a rapid response function as a first point of access for the public, service users, carers and referrers, supported in its first year through the imaginative use of a CQUIN attached to the contract. The support (and ultimately funding) from Commissioners facilitated the roll out of the system to cover the whole of the South of Tyne services for NTW. Through the development of this model there has been a full health economy benefit (Qualitative and Financial) and thus commissioners fully supported the roll out.
Looking Back/Challenges Faced
Greater engagement and collaboration with local G.P’S became paramount in moving this project further. Access to services in a prompt and timely manner is paramount within urgent and planned care services and through scoping work it became a priority to engage GP’S and other interested parties fully.
Collection of data around referrals and output of the service has become a vital element of service.By regularly monitoring the service we are able to meet demands of the service by utilising the resources available to provide a whole service approach.
Sustainability
Improved response times (average 30 minutes from call to door)
Improve telephone access (average 9 second pick-up)
Equality of access to urgent mental health services
Improved service user, carer and referrer experiences
Reduced avoidable harm – no “bounced referrals” (these are now routed to the
most appropriate service)
Reduced assistance required from emergency services
Positive staff feedback
All of the above provide sound evidence for the continued support of the service to ensure both service users and carers provide the best possible service that is not only responsive but accessible.
Evaluation
As the service is still in its infancy we continue to evaluate on a regular basis to share good practise and areas of continued challlenges.Stats are collected on a daily basis and regularly monitored to improve service outcome. All with the expectation of best practise to commissioners service users and there carers.
Sharing
As part of ongoing evaluation and discussion with partners we regularly meet up with other services both locally and across the trust in order to improve and expand upon the service we offer. Northumberland is about to embark on a similar service and we have worked closely with them to share experiences and provide useful feedback. I continue to be happy to share experiences with others in terms of best practise.
