Re-designing Adult Mental Health Community Services

July - September 2015

Background

What we want to improveLong waiting times

Adult Mental Health Community Services have different waiting time targets.

Duplication of assessments and having to tell your story more than once

The feedback from service users is that they do not want to have to retell their story to every staff member they are introduced to.

Increasing clinical capacity

GPs (and other referrers) have asked for timely access to LPT consultants to enable a clinical conversation about some of their patients.

There is also the principle that those with the greatest skill should work with those people with the most complex needs.

Areas of inefficiency in the service

Demand is increasing and we are not able to manage this as we are currently organised.

The services involved

• Assertive Outreach• Homeless Mental Health Service• Clinical Psychology• Community Mental Health Teams (CMHTs) including Outpatient

elements• Specialist Psychological Therapies

Cognitive Behavioural Therapy

Dynamic Psychotherapy

Therapy Service for People with a Personality Disorder• Referral Management Service (RMS) for City• Psychosis Intervention Early Recovery (PIER)

Re-design methodology

• Fortnightly meetings of representatives of all services affected

• Desk research

• Site visits

• Modelling day involving staff, service users and carers

• Shortlisting

• Briefing of service users and carers

Current model

Leicestershire West CCG Leicester City CCG Leicestershire East CCG

Referral Management ServiceFor City CMHTs

PIERCluster 10

Specialist Psychological TherapiesClusters 4 to 8

Assertive OutreachCluster 13, 14, 16 and 17

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

CMHT4-8, 11-

13

Clusters 4 to 8 and 11 to 13Clinical PsychologyCluster 14, 16 and 17

Future vision

Proposed changes common to both models

Assessment service

• All referrals for all services• Multi-disciplinary team with senior clinicians,

including medics, clinical psychologists, occupational therapists and nurses. Staff from specialist psychological therapies to conduct assessments

• Daily review of all referrals by smaller group (screening meeting)

• Assessment allocated to worker from most appropriate specialism

• Mix of staff on rotation and permanent (nurses)

Teams

• City• County 1Hinckley & Bosworth, North West Leicestershire

and Charnwood (Coalville and Loughborough)• County 2Melton, Rutland, Harborough, Oadby & Wigston

Other improvements

• Introduce a service to support transfer of care

• Transfer stable patients to primary care

• Ensure the right people are in the right service (review the criteria)

• Identify the appropriate length of time for different treatments

• Improve the support offered to staff treating people with the most complex conditions

Option A

Option A

• Integrates Community Mental Health Teams (including outpatients) and Assertive Outreach (AO) into three community teams (one in city and two in county) with specialist sub-teams (psychosis / non-psychosis in the first instance then Cluster groups beneath).

• Clinical Psychology would be integrated into each of the teams but retain their current management arrangements.

• For Specialist Psychological Therapies there would be no change. They will be retained as distinct services across Leicester, Leicestershire and Rutland.

• Create two assessment services in the county providing a single access / assessment route for the new community teams. Expand the Referral Management Service in the City to include assessments.

Clinical PsychologyClinical Psychology Clinical Psychology

County Team 1 Leicester City County Team 2

Non-Psychosisteam

Assessment ServiceFor Community Team

Community TeamSplit into N-Psyc. and Psyc. Services

Specialist Psychological Therapies

Psychosis team

Non-Psychosisteam

Assessment ServiceFor Community Team

Community TeamSplit into N-Psyc. and Psyc. Services

Psychosisteam

Non-Psychosisteam

Assessment ServiceFor Community Team

Community TeamSplit into N-Psyc. and Psyc. Services

Psychosisteam

Psychosis Intervention Early Recovery

Option B

Option B

•Reduce number of Community Mental Health Teams from eight to three, one in city and two in county.

•Split Community Mental Health Teams into non-psychosis / psychosis teams to develop specialisms with targeted training / support

•All other services are maintained in form and function.

•Create two assessment services in the county providing a single access / assessment route for their respective Community Mental Health Teams. Expand the Referral Management Service in the City to include assessments.

Leicestershire West CCG Leicester City CCG Leicestershire East CCG

CMHTClusters 4 to 8 and 11 to 13

CMHTClusters 4 to 8 and 11 to 13

CMHTClusters 4 to 8 and 11 to 13

Non-PsychosisClusters 4 to 8

PsychosisClusters 11 to 13

Non-PsychosisClusters 4 to 8

PsychosisClusters 11 to 13

Non-PsychosisClusters 4 to 8

PsychosisClusters 11 to 13

Specialist Psychological TherapiesClusters 4 to 8

Psychosis Intervention Early RecoveryCluster 10

Assessment ServiceFor City CMHT

Assessment ServiceFor County West CMHT

Assessment ServiceFor County East CMHT

Assertive OutreachCluster 13, 14, 16 and 17

Clinical PsychologyClusters 4 to 8 and 11 to 17

Clinical PsychologyClusters 4 to 8 and 11 to 17

Clinical PsychologyClusters 4 to 8 and 11 to 17

How the models address the areas we want to improve

Objective Intended outcome

Reduce waiting times

The assessment service is expected to reduce the waiting times.

The introduction of the referral management system in the city reduced waiting times.

Reduce duplication of assessments

The assessment service will be a multi-disciplinary team comprising senior clinicians

Objective Intended outcome

Increase clinical capacity

The integration of Community Mental Health Teams and Outpatients will create capacity for consultations to support referrers

Improve areas of inefficiency in the service

Freeing up clinical time from unnecessary administration.

Doing more with less.

Implementation timetable

Implementation timetable• Response to engagement: October

• Make decision on preferred model: October

• Transitional arrangements will start: Autumn 2015

• Implementation planning: November to March

• Implementation complete: April 2016

Areas to consider

The models

What are your views on the assessment service?

What are the characteristics of an effective team?

What is good about each model?

What would improve either model?

Which model do you prefer? And why?

What do you think about the psychosis/non-psychosis split?

Questions

If Leicestershire Partnership NHS Trust introduced a single point of access that conducted all the assessments following a referral it would mean that the person treating you will be different from the person assessing you. Does this matter?

Once Leicestershire Partnership NHS Trust has treated you and you are stable, we would like to transfer your care to your family doctor (GP). This will make more appointments available for new patients. Tell us how you would feel about this

Not all services can be provided locally. For some specialist services this may mean you have to travel to a central base or clinic. Which services do you think should be available close to your home?

Currently our outpatient clinics are staffed only by consultants and trainees. How would you feel about being seen by a nurse or therapist in outpatients?

Which services would you be willing to travel for?

Are you willing to see your worker in a clinic rather than your own home?

Questions

We would like to support our patients towards making as quick a recovery as possible. This may mean that treatments are shorter than they are at present but they will be more focused on your condition. Tell us how you would feel about this.We will make sure that once you have been treated by us you will be able to come back to us quickly, if necessary.

How would you feel about receiving some of your care from a voluntary or community organisation?

How would you feel about someone other than a doctor prescribing medication for you? This may be a nurse or a therapist? They will be specially trained and supervised.

Would you be willing to use new technology as part of your monitoring and treatment? Eg Skype and text messaging