Www.england.nhs.uk How do we integrate Urgent Care Services to support patients with mental health needs?

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How do we integrate Urgent Care Services to support patients with mental health needs?

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• Established to define, enable and support the delivery of a future integrated NHS 111 service

• With feedback from service providers and people accessing the service, established a Mental Health Programme

• Works closely with other initiatives; such as the Crisis Care Concordat

• Ensure systematic improvements for those using the NHS 111 service with Mental Health needs

The NHS 111 Futures programme

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• Developing a user led training package

• Establishing a service user board

• Improved visible access to patient information

• Improved triage / assessment

• Improved awareness of the NHS 111 service

• Improved DoS profiling

In addition to undertaking a series of listening events, our programme of work includes

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• Often left out of the discussion of integration is the joining up of physical and mental health services.

• People with long term conditions, especially those with more

than one, often suffer from depression that goes untreated.

• Conversely, the physical health needs of people with enduring mental health conditions are rarely considered by mental health services

• There may be no, or limited assessment of the interaction between physical and mental conditions.

Physical / Mental Health Integration

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• People want co-ordination. Co-ordination is key to joining things up for service users.

• People want care. Where it comes from is secondary.

• People want information flows that actually work.

• People have told us that the presence of all of the above correlate most closely with good patient experience.

Integrated care: what do patients, service users and carers tell us that they really want?

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• They want organisations not to argue between themselves or send conflicting messages.

• They expect professionals to work together as a ‘team around the patient’, and they want services to work together likewise: that is, to come together at the point they are needed, and to meet people’s needs in the round.

• Divisions into ‘primary’, ‘secondary’, ‘community’ and ‘social’ care are relatively meaningless.

Patients have little interest in organisational/institutional priorities or mergers.

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• knowledge of the patient/service user/carer as a person, including their home circumstances, lifestyle, views and preferences, confidence to care for themselves and manage their condition(s), as well as their health status and symptoms

 • knowledge of the relevant condition(s) and all options

to treat, manage and minimise them, including knowledge of all available support services

Integration is most relevant for those with long term conditions, and who consistently say that they are looking for the ‘system’ to combine two things in one place:

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• People know they may need a variety of professionals and support services, but within this they want a single trusted point of liaison, to which they can have recourse as necessary, where the above knowledge is held.

• They expect this person/service to advise them on how to take next steps and, ideally, to co-ordinate their care or to help the patient/carer to co-ordinate it.

• People do not want to fall through gaps, to be forgotten about, to have to explain themselves anew to every professional or service they encounter

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• For people with enduring mental health conditions; these are most often fluctuating conditions where individuals’ needs can escalate and decline at different times.

• This can be sudden and unexpected.

• Even where it is predictable, people tell us they frequently still need to be reassessed to access services. This delays timely and effective care

• Fluctuation means some people have many assessments in any given year to access the different services they need for their condition.

People with enduring mental health conditions

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• Social care• Preventable hospital admissions• Crisis resolution

Integration needs to provide preventive approaches:

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• For mental health services to have the same strategic focus as cancer and diabetes, for example

• Access to a range of mental health clinical expertise / services; either directly from within NHS111 call centres, or accessed by direct (warm) transfer to a ‘clinical hub’.

• To mirror the Crisis Concordat principles and by including access to crises care support

• Competent call handlers who are appropriately trained in mental health care, and who are supervised and supported by qualified clinicians; also appropriately trained in mental health care.

Commissioning Standards

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• Access to relevant aspects of patients’ medical and care information, where the patient has consented to this being available.

• For the Directory of Services to hold accurate information across all acute, primary care and community services, be expanded to include health based places of safety, NHS commissioned services, (third sector / independent) social care and services for homeless people

Commissioning Standards

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• For services to be profiled with regards to their capacity status to enable faster access to services, reduce the risk of suicide / adverse events,

• CDSS system that is capable of safely aiding the assessment of callers in need of mental health care.

Commissioning Standards