Officers from NELFT will update the Sub-Committee on the following issues:
· Mental health support in the community
· Intermediate care
· The Acorns Centre
Minutes:
Mental Health Liaison Service
Officers from NELFT explained that, while acute hospitals had always had some mental health liaison services, this was generally patchy and people with mental health issues often fared badly in acute settings, leading to longer lengths of stay etc.
NELFT favoured a model based on rapid access, intervention and discharge (RAID). This was very expensive and funding had been allocated for an enhanced service available 24:7 on site in A & E for over 18s. This had allowed the introduction of parallel assessment whereby BHRUT and NELFT mental health liaison staff assessed patients together. Staff also went into A&E seeking to identify cases with a mental health element.
The target of seeing all patients referred in 60 minutes was met by mental health liaison staff on 94% of occasions. On-ward targets were being met at 100% and the service could have up to 120 referrals per week. Patient satisfaction with the service was high with comments indicating the team was caring and engaged with family members.
Work was also in progress regarding high intensity users – those who attended A & E more than 10 times per year. NELFT wished to reduce this by setting up complex care plans in order that these patients could be better supported in the community.
The new service also sought to ensure people with dementia received appropriate care in hospital. Delirium could often be misdiagnosed as dementia and mental health liaison staff trained A & E colleagues in how to identify this. This had led to fewer breaches of targets at BHRUT. Other training offered to BHRUT staff included case discussions and more specific courses such as working with people with dementia.
Future initiatives planned included a street triage service to reduce the need for the Police to pick up people from the street under s. 136 powers. An under 18 service could also be introduced into A & E, albeit this would involve fewer patients and better IT systems would allow mental health records to be fully accessed from the A & E department.
It was emphasised that the mental health team worked closely with partners such as the Police and London Ambulance Service although more work needed to be undertaken with the Police. If the project was supported going forwards then work on mental health issues could also potentially be undertaken with Police Community Support Officers.
It was confirmed that there were now two s. 136 suites at Goodmayes Hospital which reduced the need for people with mental health issues to be held in police cells. Officers felt there should be parity in A & E between responses for physical and mental health issues.
Patients with mental health issues would still attend the main triage in A & E but mental health liaison service staff would seek to proactively identify these patients and try to offer other community-based routes of crisis support where appropriate.
The Police were able to notify NELFT and the Council of people they had dealt with who had exhibited mental health issues and information sharing was included within this framework. Patients who refused treatment would be proactively contacted by staff but officers confirmed that nobody could be forced to accept treatment unless they were considered a danger to themselves or others.
Intermediate Care
Officers explained that changes to intermediate care were being implemented across Barking & Dagenham, Havering and Redbridge and that most Havering patients requiring intermediate care already accessed Foxglove ward at King George Hospital. The intermediate care beds at Grays Court in Dagenham were due to move to Japonica ward at King George by the end of March 2016.
NELFT officers would respond in due course to feedback from a recent enter and view visit that Healthwatch Havering had carried out to Japonica ward. General patient feedback on the new locations had been positive and any lack of space on the ward was being addressed.
There were a total of 51 intermediate care beds available at King George that could be increased to 57-61 beds if required. It was confirmed that the wards were currently full and that some additional beds were being used for intermediate care at present.
Officers confirmed that the referral of the intermediate care plans by Redbridge health scrutiny to the Secretary of State had not been upheld and implementation would proceed as scheduled.
It was AGREED that the Sub-Committee should undertake a site visit to Foxglove and Japonica wards at King George Hospital in late April or early May.
Acorn Centre
The Acorn had begun operating in February 2015 and opened officially in summer 2015. Child and adolescent mental health services (CAMHS) were in the process of being relocated from Raphael House in Romford and it was hoped to complete this by September 2016.
Officers accepted that parking was a problem at the centre and were now looking for new staff parking areas. The installation of new pay and display bays near the centre had helped the situation slightly.
Staff at the centre used hot-desking which was working well overall. Clinicians no longer had dedicated office space in order to make the best use of the facility. A virtual tour of the Acorn Centre was available on the NELFT website and offices would send a link to this.
The Sub-Committee NOTED the updates.