NAViGO Health and Social Care Community Interest Company run integrated acute mental health services for a population of about 160,000 people in North East Lincolnshire. The inpatient, crisis and home treatment aspects of acute mental health care are combined to ensure continuity of care for people who use the services. Staff can follow people from their presentation in crisis, through treatment and onto discharge. Additionally, the crisis and home treatment workers are based in the inpatient areas and support the junior staff over the 24-hour period. This ensures that a staff member who knows the person best can deliver care to them at home.
NAViGO Health and Social Care Community Interest Company run integrated acute mental health services a population of about 160,000 people in North East Lincolnshire. The inpatient, crisis and home treatment aspects of acute mental health care are combined to ensure continuity of care for people who use the services. Staff can follow people from their presentation in crisis, through treatment and onto discharge. Additionally, the crisis and home treatment workers are based in the inpatient areas and support the junior staff over the 24-hour period. This ensures that a staff member who knows the person best can deliver care to them at home.
The acute mental health services at NAViGO meet the pathway standard in the following ways:
All people who require acute mental health care have an initial assessment conducted within 48 hours, or sooner if clinically indicated. At this point, physical health is checked and addressed, and social care issues are identified. The integrated nature of the acute mental health services means that a person only needs to tell their story once, instead of undergoing several assessments.
Care plans are created with the person on admission and are audited for quality and content each night.
NAViGO reduced the target time for follow-up after discharge in December 2016 following the recommendations in the 2016 National Suicide Enquiry Report. The target is now within 2 to 3 days.
NAViGO always has an acute bed available within the locality for those who need it and have not had to send someone out of area, other than for reasons of clinical need, in 20 years.
Inpatient activities are offered every day during the morning, afternoon and evenings. The activities are offered and agreed with people in the coffee morning meeting every day and then discussed weekly at the communication meeting. Activities include exercise, one-to-one bespoke activities, arts and crafts, relaxation, smoking cessation, massage and beauty therapy. Some of these can also include gender-specific groups. There is also a partnership with the local college whose small animal department brings animals onto the inpatient wards.
Regular access to advocacy for both informal and formal admissions.
Various psychological and psychosocial interventions are offered throughout the acute mental health services, alongside pharmacological interventions. This includes a carers’ group, which a pharmacist will also attend, and inpatient staff also run weekly wellbeing clinics.
Table 4: Staff breakdown of the acute care services at NAViGO (March 2017)
Staff type
WTE
Consultant psychiatrists
2
Middle grade doctors
2
F1 and F2 doctors
On rotation
Medical students
Assistant director
1
Band 7 nurses
4
Band 6 nurses (crisis, home treatment and inpatient)
17.4
Band 6 nurses (liaison in emergency departments)
2.7
Band 5 nurses
11
Band 3 practitioners
23
Band 2 practitioners
7.4
Psychologists
0.8
Admin manager
1
Administrators
12
Pharmacist
1
Occupational therapist
0.4
Note. WTE = whole time equivalent
NAViGO aims to collect outcomes via tablet devices linked to electronic patient records, laptops where documents can be uploaded to patient records and voice recognition to dictate directly into the patient record. Online survey platforms are also used to collect experience and feedback measures. Data can be presented to the individuals, teams and managers, such as live electronic patient record bed state and summary level clinical information.
The service also has its own recovery units in partnership with the local housing association. Springboard at Hope Court is a 24-hour staffed rehabilitation unit with 13 beds with five ‘hub and spoke’ homes in the community. The unit offers intensive rehabilitation and recovery, rather than long-term accommodation. See the Springboard webpage for more information. There is also a 4-bedroom bungalow in the community for people who need high levels of care.
NAViGO has also developed a therapeutic community to address the needs of people with borderline personality disorder and emotionally unstable personality disorder. The Sequoia Personality Disorder Team can provide consistency and containment of problematic presentations and reduce readmission to acute services. The Sequoia team has been recognised by the CCQI Community of Communities accreditation programme as a service that has shown improvement. See the Sequoia Personality Disorder Service webpage for more information.
Over 2016-17 the whole-system acute mental health care services has managed to stop readmissions, prevent a number of admissions, potentially saving 584 bed days at a cost of £233,600, and managed to bring 95% of people from out-of-area locked rehabilitation placements back to the local area. NAViGO has received excellent feedback from those who use the services. In quarter 3 of 2016-17, out of 115 adults who answered The Friends and Family Test, 101 (87.8%) answered that they would be ‘extremely likely’ or ‘likely’ to recommend the service to a friend or family member.
