Following a process of co-production, NWL has now launched 24/7/365 Single Point of Access (SPA) services (by email & telephone) covering the entire population who may need support in a crisis. The service is accessed by patients, carers, family, GPs, health and social care professionals, housing associations and the police.
North West London (NWL) has worked collaboratively on transforming mental health services since 2012 – this means addressing poor mental health outcomes and transforming mental health services for a population of 2.2million in Brent, Harrow, Hillingdon, Westminster, Kensington & Chelsea, Hammersmith & Fulham, Ealing and Hounslow. The commitment of partners across health, social care, police and the voluntary sector is evident through our Crisis Care Concordat plan – which was the first in London to be signed by 25 organisations.
Following a process of co-production, NWL has now launched 24/7/365 Single Point of Access (SPA) services (by email & telephone) covering the entire population who may need support in a crisis. The service is accessed by patients, carers, family, GPs, health and social care professionals, housing associations and the police. We heard praise recently from a shopkeeper who used the telephone line to access support when concerned about a shopper who comes in daily and whose behaviour was increasingly erratic. Previously, the shopkeeper would have called the police however through the SPA telephone line he received advice and was able to connect the shopper back to his own mental health support team.
The approach is a consultant psychiatrist-led first point of contact service for adult mental health services providing access to routine, urgent and emergency mental health referrals 24 hours a day, 7 days a week, 365 days a year, through one central urgent advice line replacing all previous referral points. In addition to the phone line (also accessible by email), there is support for rapid response and home treatment in times of crisis, also now available 24 hours and 365 days of the year. A system which focuses on supporting people outside of hospital is what our service users tell us matters to them – and what enables recovery to commence sooner. As a by-product of the introduction of the new service we are also pleased that:
– We can better monitor access to services and understand demand and need which differs across our communities;
– We are moving quickly to a paper free system – where communication is no longer faxed.
Alongside the SPA for adults, we have a corresponding “out of hours” service for children and young people providing evening and weekend access to specialist children’s mental health nurses – in children’s homes, in A&E and providing phone advice to other staff. Thankfully the numbers requiring this service are small, but early data since January is showing a real need for services targeted at older teenage girls and on self-harm. In April alone the SPA received over 8,000 calls which result in 1,500 referrals to the services. Of these a small number (5%) are classed as emergencies; these are calls which would have resulted in an A&E visit or ambulance call out – or worse. 25% of calls are managed solely by providing advice or signposting to other services – this approach supports de- escalating potential crisis situations before needs exacerbate.
During our extensive co-production process we have worked with service users and carers and a wide range of teams across North West London. During the implementation process both local Mental Health Trusts – Central and North West London NHS Foundation Trust (CNWL) and West London Mental Health Trust (WLMHT) have continued to engage collaboratively with their users, staff and wider stakeholders. Since the launch, targeted communications campaigns have supported the service ensuring that partners in London Ambulance Service, Metropolitan Police, GPs and other teams are aware of the service and the benefits. One GP commented that ‘the Single Point of Access is the best anti-anxiety drug for GPs – meaning they can confidently manage their patients in the community with rapid access to expert support and advice if needed’.
Service Users and carers from across all of our 8 boroughs were active participants from the inception of the idea for developing this new service and approach. Likewise, staff have been formally and informally consulted during the planning, implementation and evaluation phases. Some of the ways in which we have done this include: Through membership of the expert reference group; Through events – such as a full day ’24 hour in Urgent Care’ simulation event; Service Users on recruitment panels for staff; Review of communications materials and involvement in planning communications; Membership of evaluation groups.
Throughout the process we benefited from strong collaborative clinical leadership – from primary care and from the mental health Trusts. A joint focus on changing the system within services, and before people even access services, was influential in defining how services will work.
From the initial idea to develop services through to seeing the positive impact for service users, carers and primary care has taken more time than we would have liked. Maintaining momentum throughout the process has been important whilst managing related matters such as personnel changes, evolving financial positions for our commissioning organisations and multiple conflicting and emerging priorities for all parties. In commencing the services, we have ended up phasing in the introduction of 24 hour teams (following the launch of the telephone line). Whilst not planned, it became clear that this approach was both safer as well as reflecting the real challenges of recruiting to a large number of posts, whilst supporting existing staff to change working patterns. The ability to be flexible on agreed plans and to strive for collaborative working across the 8 boroughs has helped to ensure we created a fantastic service.
There is an expectation that change can happen quickly and that benefits and impact can be tracked over a very short timeframe. For both service users and wider stakeholders who are impatient for change, the time lag from agreeing an ambitious model to actually starting service delivery feels lengthy. Likewise, changing how people access services will start from day 1 but benefits will only be track-able in a meaningful way over a much longer time period. We believe the benefits within the mental health system are already apparent, but the real benefit will be when we see a reduction over time of people in crisis accessing mental health support via A&E, 999 and through contact with the police. The data and methodology to assess this impact will take time to deliver but we are working with colleagues to collect data and make national comparisons.
North West London as a health and social care sector is hugely proud of the service we now have, and the impact it will have for individuals. Whilst the development is owned across the whole system the actual delivery is very local, with teams based in local boroughs and working with the other local services. Providers of the service produce detailed dashboards describing activity, and ahead of formal evaluation (see below) this supports a clear picture of the way in which the services are filling an obvious need in the system. The approach is now embedded in local pathways and referenced as a clear example of 7 day services, and an enabler of wider mental health service redesign within the North West London Sustainability and Transformation Plan (STP).
Across North West London we review activity data which describes the urgency of the contact and the service provided in response for all callers/referrals. We are now planning a wider evaluation which will be qualitative, quantitative and comparative. We want the evaluation to help us address a number of questions arising from what the data tells us, but also what users, staff and referrers say: How are the Single Point of Access (SPA) and rapid response service working?; Are there any pressure points for SPA?; Is there a smooth transition between SPA/referrers/other services?; What is the impact on A&E attendances, on functioning and the role of Liaison Psychiatry Services, on numbers of hospital admissions and length of stay?; What are the current risks and mitigating factors?; What are the views and experiences of service users, carers, staff and referrers? We are working with other areas across England – in particular Northumberland, Tyne and Wear – to share learning and benchmark our services without providers.
In addition to sharing learning from the development and delivery of the service across North West London, we are keen to learn from other health economies which have delivered similarly innovative approaches at large scale. We are part of the London-wide Crisis Care Concordat network and through events and working groups we share our emerging learning. We are also working through a number of networks promoting the service model; recently NHS Improvement published guidance on examples of 7 day working using the Single Point of Access as their first exemplar: http://www.nhsiq.nhs.uk/ media/2416738/every_day_counts.pdf
Wide publicity of the service has made a difference in directing users to their local SPA line. Please see below for links to key communication channels used to promote these services: Press release: https://www.healthiernorthwestlondon.nhs.uk/news/2016/02/24/great- minds-think-alike Central and North West London Single Point of Access: http://www.cnwl.nhs.uk/service/ single-point-of-access-north-west-london-adult-community-mental-health-services/\ West London Mental Health Single Point of Access: http://www.wlmht.nhs.uk/about-wlmht/ redevelopment/transforming-local-services/access-urgent-care/
